Report of 73 cases of cutaneous sporotrichosis in Mexico

Abstract: We report 73 cases of cutaneous sporotrichosis from the Community Dermatology program, at the central and mountain areas of the state of Guerrero, Mexico. A similar number of cases was found between children and adults, mostly peasants and school-age children with rural occupations. Upper limbs were the mostly affected and the predominant clinical form was lymphocutaneous (56.16%). All cultures corresponded to Sporothrix schenckii (sl). Treatment was done with potassium iodide in 54 patients, achieving clinical and mycological cure in all cases.

Esporotricosis del pabellón auricular: comunicación de un caso atípico simulando una celulitis bacteriana / Auricular sporotrichosis: atypical case report simulating bacterial cellulitis

Resumen La esporotricosis es la micosis subcutánea o por implantación más frecuente en México. Se comunica el caso de una esporotricosis cutánea-fija preauricular que simuló una celulitis bacteriana atípica, en una paciente anciana sin antecedente de traumatismo. La biopsia mostró un granuloma supurativo con presencia de levaduras escasas. En el cultivo se identificó Sporothrix schenckii que se confirmó por biología molecular. Se trató con itraconazol obteniéndose una curación clínica y micológica. Se presenta el caso de presentación atípica, proveniente de una zona semidesértica con clima extremo.

Sporotrichosis is the most common subcutaneous or implantation mycosis in Mexico. The case of a preauricular cutaneous-fixed sporotrichosis simulating atypical bacterial cellulitis is reported in an elderly patient with no history of trauma. The biopsy showed a suppurative granuloma with scarce yeast. Sporothrix schenckii was identified in the culture and confirmed by molecular biology. She was treated with itraconazole and a clinical and mycological cure was obtained. The case of atypical presentation is presented, coming from a semi-arid zone with extreme weather.

Caracterización epidemiológica, clínica y de laboratorio de esporotricosis en pacientes de un hospital de tercer nivel en Lima-Perú, entre los años 1991 y 2014 / Epidemiological clinical and laboratory characterization of sporotrichosis in patients of a tertiary care hospital in Lima, Peru, from 1991 to 2014

Introducción: La esporotricosis es una afección endémica en numerosos países latinoamericanos y en el resto del mundo. En Perú se concentra en regiones con clima cálido y húmedo, siendo poco conocida en el resto del país. Objetivo: Describir las características epidemiológicas, clínicas y de laboratorio de esporotricosis en pacientes de un hospital de tercer nivel en Lima-Perú, entre los años 1991 y 2014.Método: Estudio descriptivo, retrospectivo, tipo serie de casos. Resultados: Se incluyeron 94 pacientes, la mayoría de los cuales fueron adultos del sexo masculino. Los lugares de adquisición más frecuentes fueron Cajamarca, Apurímac, y Amazonas. Las formas linfo-cutánea y cutánea fija fueron observadas con mayor frecuencia en adultos y, en especial de localización en los miembros superiores. Las localizaciones en la cabeza y el cuello fueron más frecuentes en niños. Co-morbilidades estuvieron presentes en 15% de pacientes, en particular en aquellos con la forma cutánea diseminada. El 78% de los cultivos procedentes de lesiones cutáneas fueron positivos dentro de siete días, y el tiempo de positividad fue mayor en cultivos de biopsia que en las muestras por raspado-aspirado. Conclusiones: Esporotricosis fue adquirida mayoritariamente en zonas del Perú con pobreza extrema. Las características clínicas, epidemiológicas y de laboratorio no difieren de las reportadas en otros estudios. El tiempo de positividad de los cultivos varía según tipo de muestra, lo que deberá ser mejor evaluado en estudios futuros.

Background: Sporothricosis is endemic in numerous Latin American countries and the rest of the world. In Peru is concentrated in regions with warm and humid climate being little known in the rest of the country. Aim: To describe the epidemiological, clinical and laboratory characteristics of patients diagnosed of sporotrichosis in a tertiary-care level hospital in Lima, Peru from 1991 to 2014. Methods: This was a retrospective, case series. Results: Ninety four patients were involved; most of them were male adults. This condition was acquired more frequently in Cajamarca, Apurímac, and Amazonas. Fixed and lymphocutaneous form were the most frequent forms of presentation in adults and were mostly distributed in upper limbs. Lesions located in head and neck were most frequent in children. Comorbidities were present in 15% of patients and were more frequent in those who presented disseminated cutaneous form. Seventy eight percent of cultures from skin lesions were positive within 7 days. The time to positivity of cultures was longer if the sample came from skin biopsies than skin scraping or skin aspiration. Conclusions: Most cases of sporotrichosis were acquired in areas of extreme poverty in Peru. The clinical, epidemiological and laboratory findings were similar to those reported elsewhere. The time to positivity of cultures varies based on the type of skin sample. This finding needs to be further evaluated in studies with an increased number of cases.

Esporotricosis granulomatosa: presentación de dos casos inusuales / Granulomatous sporotrichosis: report of two unusual cases

Sporotrichosis is a subcutaneous mycosis caused by Sporothrix complex, endemic in Abancay, Peru. Is acquired by traumatic inoculation with plant material. Common clinical presentations are lymphatic cutaneous and fixed cutaneous disease. We report 2 cases of fixed cutaneous sporotrichosis with granulomatous appearance. The first case was a patient of 65 years old with no risk factors and the second case was a 67 year old diabetic patient. Subjects underwent mycological culture with Sabouraud agar, with isolation of Sporothrix schenckii and clinical dignosis of fixed cutaneous sporotrichosis with granulomatous appearance. One patient received oral treatment with saturated solution of potassium iodide (SSKI) with a initial dose of 3 drops tid up to a maximum dose of 40 drops tid. Mycological and clinical cure was achieved after 2 months of treatment. We should consider the unusual clinical presentations of fixed cutaneous sporotrichosis with granulomatous appearance that present morphological and clinical features in diabetic and nondiabetic patients older than 60 years from endemic areas and communicate adequate response to treatment with SSKI in one case.

La esporotricosis es una micosis subcutánea ocasionada por el complejo Sporothrix, endémica en Abancay, Perú. Se adquiere por inoculación traumática con material vegetal. Las formas clínicas comúnmente descritas son la cutánea linfática y cutánea fija. Presentamos dos casos de pacientes adultos con una esporotricosis cutánea fija granulomatosa. El primer caso era una paciente de 65 años de edad, sin antecedentes de riesgo y el segundo era una paciente de 67 años, diabética. El diagnóstico se realizó por cultivo micológico aislándose Sporothrix schenckii. Un caso se trató con solución saturada de yoduro de potasio (SSKI), vía oral, alcanzando la cura micológica y clínica tras dos meses de tratamiento. La otra paciente no acudió a tratamiento. Se revisan las presentaciones clínicas inusuales de la esporotricosis cutánea fija y la forma granulomatosa que presenta características morfológicas y clínicas poco habituales en pacientes diabéticos y no diabéticos mayores de 60 años provenientes de zonas endémicas.

Cutaneous sporotrichosis treatment with potassium iodide: a 24 year experience in São Paulo state, Brazil / Tratamento da esporotricose cutânea com sski: experiência de 24 anos no estado de São Paulo, Brasil.

BACKGROUND: Sporotrichosis is a subacute or chronic disease caused by a dimorphic fungus, Sporothrix schenckii. The first and most traditional treatment is potassium iodide in satured solution (SSKI) used by DE BEURMANN in 1907. For its effectiveness, it is still used for cutaneous sporotrichosis. OBJECTIVE: To evaluate the treatment of cutaneous sporotrichosis with SSKI in relation to clinical cure, side effects, length of treatment and reactivation. METHODS: We conducted a retrospective analysis of medical records over a 24-year period (1981-2005). Patients of all ages who were treated in the hospital´s division of dermatology were included in the study providing that they had a positive culture of S. schenckii. Satured solution of potassium iodide (3 to 6g per day) was the treatment prescribed. For children, half of the dose was prescribed. RESULTS: The lymphocutaneous disease was prevalent, the cure rate was 94.7 percent, side effects were described in 5.5 percent of the cases, mean length of treatment was 3.5 months and possible reactivation was observed in 11.1 percent. CONCLUSION: SSKI is an effective drug, with many side effects, but with low frequency. Resolution was for maximum six months of treatment. SSKI has been found to be a very effective drug in this retrospective study of culture-proven cases of cutaneous and lymphocutaneous sporotrichosis. It should be used as first drug of choice especially in resource-limited settings.

FUNDAMENTOS: Esporotricose é doença subaguda ou crônica causada pelo fungo dimórfico Sporothrix schenckii. O primeiro e mais tradicional tratamento é o iodeto de potássio em solução saturada (SSKI) usado por De Beurmann em 1907. Por ser eficaz,ainda é muito utilizada no nosso meio para o tratamento da esporotricose cutânea. OBJETIVOS: Avaliar o tratamento da esporotricose cutânea com SSKI em relação à cura clínica, efeitos colaterais, tempo de tratamento e recidiva. MÉTODOS: A partir da revisão dos resultados de exames do laboratório de Micologia da Clínica de Dermatologia da Santa Casa de SP, durante 1981 a 2005, foram incluídos pacientes de qualquer idade com lesão cutânea sugestiva de esporotricose e cultura positiva para S. schenckii. Em todos pacientes o tratamento prescrito foi SSKI na dose de 3 a 6g/dia para adultos, por um período de até duas semanas após cura clínica. Em crianças foi utilizada a metade da dose. RESULTADOS: Houve predomínio da forma cutânea localizada, taxa de cura de 94,7 por cento, efeitos colaterais em 5,5 por cento, média de tempo de tratamento de 3,5 meses e 11,1 por cento de provável recidiva. CONCLUSÃO: A SSKI é eficaz, com diversos efeitos colaterais, porém de baixa frequência, permanecendo indicada para as formas cutâneas da esporotricose.

Avaliação da resposta terapêutica ao iodeto de potássio na esporotricose felina / Evaluation of therapeutic response to potassium iodide in feline sporotrichosi

A esporotricose é uma micose subaguda ou crônica ca usada pelo fungo dimórfico Sporothrix schenckii que infecta o ser humano e uma variedade de animais . O felino doméstico é o animal mais susceptível à doença e desempenha um papel importante na transmissão zoonótica, especialmente no Rio de Janeiro, onde ocorre uma epidemia envolvendo os seres humanos, cães e gatos desde 1998. A efetividade do iodeto de potássio foi avaliada em uma coorte longitudinal constituída por gatos com esporotricose confirmada pelo isolamento de S. schenckii em cultura. Os gatos foram acompanhados no Laboratório de Pesquisa Clínica em Dermatozoonoses em Animais Domésticos, Instituto de Pesquisa Clínica Evandro Chagas, Fiocruz, entre abril de 2010 e julho de 2011 e fora m submetidos à terapia com iodeto de potássio (KI) em cápsulas na dose entre 2,5 mg/kg e 20 mg/kg, a cada 24 horas. A cura clínica foi obtida em 47,9 por cento dos gatos, em 37,5 por cento ocorreu falência terapêutica, 10,4 por cento abandonaram o tratamento e 4,2 por cento foram a óbito. Efeitos adversos clínicos foram observados em 52,1 por cento dos casos. Treze gatos apresentaram leve aumento nos níveis das transaminases hepáticas durante o tratamento, dos quais, seis apresentavam sinais clínicos sugestivos de hepatotoxicidade. Em comparação com estudos prévios realizados com itraconazol e solução saturada de iodeto de potássio, o tratamento com KI em cápsulas é uma alternativa promissora no tratamento da esporotricose felina.

Sporotrichosis is a subacute or chronic mycosis caused by the dimorphic fungus Sporothrixschenckii, which infects man as well as other mammals. The domestic cat is the animal most affected by this mycosis and plays an important role in the zoonotic transmission of this disease especially in Rio de Janeiro, Brazil, with a large number of cases involving man, dogs and cats since 1998. In order to evaluate the effectiveness of potassium iodide treatment, an observational cohort was conducted in 48 cats with sporotrichosis confirmed by isolation of S.schenckii in culture at Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz between April 2010 and July 2011. All cats received potassium iodide capsules,2.5mg/kg to 20mg/kg, once a day. The cure rate was 47.9 percent, treatment failure 37.5 percent,treatment abandonment 10.4 percent and death 4.2 percent. Clinical adverse effects were observed in52.1 percent of the cases. Thirteen cats had a mild increase in hepatic transaminase levels during the treatment, six of them presented clinical signs suggestive of hepatotoxicity. Compared to previous studies with itraconazole and iodide (SSKI), potassium iodide capsules are analternative for feline sporotrichosis treatment.

Esporotricose: a evolução e os desafios de uma epidemia / Sporotrichosis: development and challenges of an epidemic

A ocorrência de esporotricose em animais e sua transmissão ao ser humano têm sido relatadas em diversos países. Contudo, em nenhum lugar a doença assumiu proporções epidêmicas, envolvendo pessoas e gatos, como no Estado do Rio de Janeiro, Brasil. Dados preliminares apontam para aproximadamente 2200 casos humanos diagnosticados até dezembro de 2009. No Laboratório de Pesquisa Clínica em Dermatozoonoses em Animais Domésticos foram atendidos, até essa data, aproximadamente 3244 gatos. A distribuição geográfica mostra concentração de casos na região metropolitana da Cidade do Rio de Janeiro. O grupo mais acometido são as mulheres de baixo nível socioeconômico, com idade de 40 a 59 anos, que realizam atividades domésticas. O itraconazol foi a droga de primeira escolha para o tratamento. Embora a esporotricose normalmente não acometa órgãos além da pele, mucosa e subcutâneo, tem um custo social indireto - pelo absenteísmo ao trabalho, pelo sofrimento durante a doença ativa e pelo aspecto desagradável das lesões cicatriciais. Por sua vez, nos gatos, é comum o acometimento sistêmico, levando a formas graves de difícil tratamento e evolução para o óbito. Considerando que o tempo de tratamento dos animais é maior do que nos seres humanos, tratar gatos com esporotricose tem sido um dos maiores entraves e permanece como o grande desafio para o controle da epidemia.

In the state of Rio de Janeiro, Brazil, sporotrichosis reached epidemic levels, involving humans and cats. Preliminary data indicate that approximately 2200 human cases were diagnosed between 1998 and December of 2009, and 3244 cats were treated. The geographic distribution of cases reveals a concentration in the City of Rio de Janeiro metropolitan area. The disease affects mostly women of a low socioeconomic status, aged 40 to 55 years, who work as housekeepers. Itraconazole has been the drug of choice for treatment. Although sporotrichosis does not usually affect organs other than the skin, mucosa, and subcutaneous tissue, it has an indirect social impact resulting from absenteeism, pain, and discomfort during the active disease stage, and the unpleasant appearance of the scars. In turn, systemic involvement is frequent in cats, leading to serious and difficult- to-treat forms of the disease and death. Considering that treatment time in animals is longer than in human beings, treating cats with sporotrichosis has been the greatest obstacle and the most important challenge for the control of this epidemic infection.