Feline sporotrichosis: associations between clinical-epidemiological profiles and phenotypic-genotypic characteristics of the etiological agents in the Rio de Janeiro epizootic area.

BACKGROUND: Sporotrichosis is caused by species of the genus Sporothrix. From 1998 to 2015, 4,703 cats were diagnosed at the Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil. Even after the description of the Sporothrix species, the characterisation of feline isolates is not performed routinely. OBJECTIVES: To characterise the clinical isolates from cats at the species level and correlate them with the clinical and epidemiological characteristics of the cats. METHODS: Forty seven Sporothrix spp. isolates from cats assisted at Fiocruz from 2010 to 2011 were included. Medical records were consulted to obtain the clinical and epidemiological data. The isolates were identified through their morphological and physiological characteristics. T3B polymerase chain reaction (PCR) fingerprinting was used for molecular identification of the species. FINDINGS: In phenotypic tests, 34 isolates were characterised as S. brasiliensis, one as S. schenckii and 12 as Sporothrix spp. PCR identified all isolates as S. brasiliensis. MAIN CONCLUSIONS: S. brasiliensis is the only etiological agent of feline sporotrichosis in Rio de Janeiro to date. None association was found between the isolates and the clinical and epidemiological data. In addition, we strongly recommend the use of molecular techniques for the identification of isolates of Sporothrix spp.

Advances and challenges in the management of feline sporotrichosis.

The domestic cat is the most susceptible host to Sporothrix infection, developing severe clinical forms. Few effective antifungal agents are available for treating feline sporotrichosis, and cases of treatment failure are common. Treatment success depends on cat health status, therapy-related factors, as well as social/economic issues, but it is mainly contingent upon the host-fungus interaction. The owner's adherence is critical and should be reinforced throughout the treatment to increase the chances of a successful outcome. The antifungal agents described for feline sporotrichosis are most often used in monotherapy regimens. Due to cases in which the treatment with itraconazole failed, the use of antifungal agents in combination should be considered to achieve synergy. The combination of itraconazole and potassium iodide represents an important option for the treatment of naïve cats presenting multiple cutaneous lesions, nasal mucosal lesions and/or respiratory signs, as well as for refractory cases. However, the therapeutic options for unsuccessfully treated cases are scarce. Therefore new options are needed, even more taking into account that there are many in vitro potential molecules not available for use in cats yet. More studies are necessary to correlate in vitro antifungal susceptibility tests results and the outcome of cats treated due to sporotrichosis. This review will briefly discuss both the antifungal drugs and treatment protocols used in cats with sporotrichosis, as well as the determinants of treatment failure.

Sporothrix brasiliensis and Feline Sporotrichosis in the Metropolitan Region of Rio de Janeiro, Brazil (1998-2018).

Feline sporotrichosis is enzootic in different regions of Brazil, especially in Rio de Janeiro. This study compared the genotype profiles of Sporothrix sp. isolated from cats in Rio de Janeiro between 1998 and 2018 and evaluated their association with clinical and epidemiological characteristics. One hundred nineteen Sporothrix sp. isolates from a cohort of cats with sporotrichosis seen at INI/Fiocruz were included. Clinical and epidemiological data were obtained from the medical records of the animals. T3B PCR fingerprinting was used for molecular identification of the Sporothrix species. All isolates were characterized as Sporothrix brasiliensis, with the observation of low intraspecific variation in 31 isolates (31.3%). The interval between lesion onset and first medical visit at INI/Fiocruz, as well as treatment duration until clinical cure, was longer in cats from the first decade of the epizootic. In addition, the frequency of the variables "good general status" and "presence of lymphadenomegaly" was higher among cats whose strains did not exhibit intraspecific variation. So far, S. brasiliensis has been the only species identified in feline cases of sporotrichosis since the beginning of the epizootic in Rio de Janeiro at INI/Fiocruz.

Feline sporotrichosis: associations between clinical-epidemiological profiles and phenotypic-genotypic characteristics of the etiological agents in the Rio de Janeiro epizootic area

BACKGROUND Sporotrichosis is caused by species of the genus Sporothrix. From 1998 to 2015, 4,703 cats were diagnosed at the Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil. Even after the description of the Sporothrix species, the characterisation of feline isolates is not performed routinely. OBJECTIVES To characterise the clinical isolates from cats at the species level and correlate them with the clinical and epidemiological characteristics of the cats. METHODS Forty seven Sporothrix spp. isolates from cats assisted at Fiocruz from 2010 to 2011 were included. Medical records were consulted to obtain the clinical and epidemiological data. The isolates were identified through their morphological and physiological characteristics. T3B polymerase chain reaction (PCR) fingerprinting was used for molecular identification of the species. FINDINGS In phenotypic tests, 34 isolates were characterised as S. brasiliensis, one as S. schenckii and 12 as Sporothrix spp. PCR identified all isolates as S. brasiliensis. MAIN CONCLUSIONS S. brasiliensis is the only etiological agent of feline sporotrichosis in Rio de Janeiro to date. None association was found between the isolates and the clinical and epidemiological data. In addition, we strongly recommend the use of molecular techniques for the identification of isolates of Sporothrix spp.

Furunculose eosinofílica canina / Canine eosinophilic furunculosis

Background: The eosinophilic furunculosis is an uncommon skin disease that affects young dogs aged between two and five years. Sex predilections are not noted. Most reported cases have been in large breeds with abundant access to the outdoors like public gardens and parks. The exact pathogenesis remains unknown but the pattern of lesions development suggests involvement reaction to insect bites and arthropods. The time between contact with the agent and the appearance of lesions is short, often less than 24 h. The skin lesions appear suddenly in the face, usually on the dorsal muzzle and/ or periocular region, pinnae and lips. More rarely on the trunk, chest and legs and it is characterized by predominantly hemorrhagic ulcers with edema. Pustules, nodules and plaques rapidly fistulate and drain serosanguinous exudates. Pruritus is variable, but may be severe. Severely affected dogs may be febrile, lethargic and anoretic. Peripheral blood eosinophilia is seen in the majority of cases. Clinical differential diagnosis include demodicosis, dermatophytosis, nasal deep bacterial folliculitis and furunculosis, pemphigus foliaceus, pemphigus erythematosus and drug reactions. None of these diseases share the fulminant rapid onset of eosinophilic furunculosis. The diagnosis is based on history, clinical signs, cytology and skin biopsies. The treatment involves oral steroids until complete remission of lesions and the antibiotic therapy is indicated in cases of associated bacterial infection. Case: The patient was a 4-year-old, male Pit Bull dog attended in a small animal clinic in Niteroi-Rio de Janeiro, which presented ulcerated, exudative lesions on the dorsal muzzle and right leg. After sedation, clinical examination was performed and an exudate was collected from the ulcerated skin lesion for cytopathological analysis .The slide containing the lesion impression was stained by a quick panoptic method. In order to collect samples, the dog was sedated with a combination of ketamine hydrochloride and acepromazine and a skin fragment was collected from the nasal bridge lesion with a 6 mm punch after local anesthesia with 2% lidocaine hydrochloride. The specimen was fixed in 10% buffered formalin and sent for histopathological analysis. The cytopathological exam revealed a marked eosinophilic inflammation. Histopathological examination revealed ulcerated skin. The epidermis was moderately acanthotic with mild espongiosis and the dermis was characterized by intense eosinophilic folliculocentric inflammations. An extensive folicular rupture, eosinophilic mural foliculitis were presented and PAS staining did not identify fungal structures. Oral prednisone (2 mg/Kg) at 24h intervals was prescribed until complete remission of the lesions. After fifteen days of glucocorticoids therapy, involution of the skin lesions was observed by physical examination and was also reported by the owner. Discussion: The eosinophilic furunculosis is an acute, severe predominantly facial disease of outdoor dogs, which occurrence is rare. The diagnosis and treatment of this disease are frequently neglected because they are not included in the differential diagnosis of diverse cutaneous infections. In view of the scarcity of reports and to alert veterinarians that the disease should be included in the differential diagnosis with other bacterial diseases, this report described a case of canine eosinophilic furunculosis.

Susceptibilidade a antifúngicos de isolados de Sporothrix brasiliensis provenientes de gatos do Rio de Janeiro

Esporotricose é uma micose subcutânea causada por espécies que constituem o complexo Sporothrix, acometendo seres humanos e animais, principalmente os gatos. Na região metropolitana do Rio de Janeiro vem ocorrendo uma epidemia que até o ano de 2012, acometeu cerca de 4.000 seres humanos, 4.000 gatos e mais de 120 cães, diagnosticados no Instituto Nacional de Infectologia Evandro Chagas (INI)/Fiocruz. A transmissão zoonótica que vem ocorrendo, principalmente através de arranhadura e mordedura de gatos doentes, tem sido relatada na maioria dos casos humanos assistidos na mesma instituição, demonstrando a dimensão do grave problema de saúde pública. No tratamento da esporotricose felina, o itraconazol é o fármaco de eleição. Entretanto, o cetoconazol, os iodetos, a terbinafina e a anfotericina B são outras opções de tratamento. No entanto, em uma parcela considerável de casos felinos provenientes dessa epidemia tratados com itraconazol e cetoconazol, tem sido observada a ocorrência de desfechos desfavoráveis, mas com um pequeno número de isolados analisados. Estudos sobre a susceptibilidade antifúngica de isolados de Sporothrix oriundos de casos humanos do Rio de Janeiro têm sido realizados. Porém, até o momento, apenas dois estudos foram conduzidos utilizando isolados de Sporothrix provenientes de gatos do Rio de Janeiro e os resultados sugeriram susceptibilidade à terbinafina e resistência ao itraconazol. Além disso, ainda não foram realizados estudos que associem a susceptibilidade antifúngica de isolados de gatos provenientes desta região, a apresentação clínica e ao desfecho do caso após tratamento antifúngico O objetivo geral deste estudo foi avaliar os isolados clínicos de Sporothrix brasiliensis provenientes de gatos da região epidêmica do Rio de Janeiro em relação à susceptibilidade antifúngica. Sendo os objetivos específicos: a) descrever e comparar a susceptibilidade in vitro de Sporothrix brasiliensis frente a fármacos antifúngicos e b) descrever a associação entre a susceptibilidade aos antifúngicos, as diferentes apresentações clínicas e o desfecho do caso após tratamento antifúngico com cetoconazol e itraconazol. Foram incluídos no estudo 47 isolados de Sporothrix brasiliensis de gatos provenientes de um ensaio clínico realizado no Laboratório de Pesquisa Clínica em Dermatozoonoses em Animais Domésticos do INI/Fiocruz. O teste de susceptibilidade in vitro para a fase filamentosa foi realizado utilizando o método de microdiluição em meio líquido de acordo com o protocolo M38-A2 do Clinical and Laboratorial Standards Institute. Os agentes antifúngicos testados foram: anfotericina B, cetoconazol, itraconazol e terbinafina. Os valores obtidos do perfil de susceptibilidade mostraram uma alta atividade in vitro da terbinafina, e uma moderada atividade da anfotericina B. Entre os azólicos, o cetoconazol apresentou melhor atividade in vitro que o itraconazol. Não houve associação entre as concentrações inibitórias mínimas encontradas com as diferentes apresentações clínicas e ao desfecho dos casos. Concluimos que, para os isolados felinos oriundos da região epidêmica do Rio de Janeiro, os azólicos apresentam moderada atividade in vitro, assim como a anfotericina B, sendo a terbinafina o antifúngico com a maior atividade in vitro