Tuberculosis cutánea esporotricoide en la Amazonía peruana: reporte de caso / Sporotrichoid cutaneous tuberculosis in the peruvian amazon: case report

RESUMEN La tuberculosis cutánea es una presentación rara de la infección por Mycobacterium tuberculosis. Se presenta el caso de una mujer sin antecedentes médicos de importancia, con un tiempo de enfermedad de año y medio, caracterizado por lesiones tipo esporotricoide, con diseminación linfocutánea en miembro superior derecho, de evolución lentamente progresiva. Se realizó un estudio histopatológico encontrándose células gigantes tipo Langhans y escasa necrosis. El paciente recibió terapia de esquema sensible antituberculoso, con evolución favorable.

ABSTRACT Cutaneous tuberculosis is a rare presentation of Mycobacterium tuberculosis infection. We present the case of a woman without important medical history, with a disease period of one year and a half, characterized by sporotrichoid-like lesions, with lymphocutaneous dissemination in the right upper limb, and with slowly progressive evolution. The histopathological tests revealed Langhans type giant cells and scarce necrosis. The patient received therapy with a sensitive antituberculous scheme, and evolved favorably.

Esporotricosis linfocutánea en un paciente pediátrico, a propósito de un caso / Lymphocutaneous sporotrichosis in a pediatric patient, a case report

Resumen La esporotricosis es una infección fúngica de evolución subagudacrónica causada por hongos dimórficos del Complejo Sporothrix schenckii. Es más frecuente en zonas tropicales. La prevalencia en Argentina se estima entre 0,01 y 0,02%. En la mitad de los pacientes se manifiesta como una esporotricosis linfocutánea, la cual se produce tras la inoculación del hongo en la piel luego de un trauma menor. La lesión inicial es una pápula o nódulo que se sucede con la aparición de una cadena ascendente de nódulos subcutáneos móviles, indoloros y eritematosos. El diagnóstico se realiza a partir del cultivo micológico. El antifúngico de elección es itraconazol y el pronóstico es usualmente favorable. Se presenta el caso de una niña de 4 años, previamente sana, que consultó por adenopatías axilares de evolución subaguda sin respuesta a múltiples esquemas antimicrobianos, confirmándose el diagnóstico de una esporotricosis linfocutánea por el cultivo de una biopsia ganglionar.

Abstract Sporotrichosis is a subacute-chronic fungal infection caused by dimorphic fungi of the Sporothrix schenckii Complex. It is more common in tropical areas. The prevalence in Argentina is estimated between 0.01 and 0.02%. In half of the patients it manifests as lymphocutaneous sporotrichosis, which occurs after inoculation of the fungus into the skin after minor trauma. The initial lesion is a papule or nodule that occurs with the appearance of an ascending chain of mobile, painless and erythematous subcutaneous nodules. The diagnosis is made from mycological culture. The antifungal of choice is itraconazole and the prognosis is usually favorable. We present the case of a healthy 4-year-old girl who consulted for subacute axillary lymphadenopathy without response to multiple antimicrobial regimens, arriving at the diagnosis of lymphocutaneous sporotrichosis from the culture of a lymph node biopsy sample.

Ocular involvement in sporotrichosis: report of two cases in children

Abstract Sporotrichosis is a subcutaneous mycosis that affects humans and animals, with a typically subacute or chronic evolution, caused by Sporothrix spp., a dimorphic fungus. Although the cutaneous form is the most frequent presentation, the ocular involvement has been more frequently diagnosed in endemic areas, affecting mainly children and the elderly. Approximately 80% of affected patients have the lymphocutaneous form, while only 2.3% have conjunctival lesions, with 0.7% showing primary ocular involvement. We describe two cases of sporotrichosis with ocular involvement in children through inoculation by felines, with a good response to antifungal treatment.

Esporotricosis, una realidad aún presente en Chile: a propósito de un caso / Sporotrichosis, a reality still present in Chile: a case report

OBJETIVO: Reportar un caso de esporotricosis linfocutánea contraída en Chile y realizar una revisión de la literatura con énfasis en los hallazgos dermatoscópicos de las lesiones y en los casos reportados en el país. CASO CLÍNICO: Paciente adulto mayor con lesiones nodulares ulceradas siguiendo trayecto linfático en extremidad superior derecha. RESULTADOS: Estudio micológico confirmó la presencia de Sporothrix schenckii. Se inició tratamiento con antifúngico oral con buena respuesta terapéutica. CONCLUSIONES: Existe un escaso número de reporte de esporotricosis linfocutánea contraída en Chile con confirmación micológica. Este es el único caso chileno con descripción dermatoscópica de las lesiones.

OBJETIVE: To report a case of lymphocutaneous sporotrichosis adquired in Chile and provide a review of the literature with emphasis on dermoscopic findings and previous cases reported in the country. CLINICAL CASE: An elderly patient presented with ulcerated nodular lesions following lymphatic vessels in his right upper limb.RESULTS: Mycological work-up confirmed the presence of Sporothrix schenkii. Oral antifungal treatment was initiated with good therapeutic response. CONCLUSIONS: Few case reports of lymphocutaneous sporotricosis adquired in Chile can be found in literature. Until now this is the only chilean case with dermoscopic description of the lesions.

Immunoreactive cutaneous sporotrichosis

Abstract Sporothrix spp. infection can occur through the inoculation of the organism in the skin through direct contact with the soil (sapronotic infection), through contact with animals, such as infected cats and dogs (zoonotic infection), or less frequently via inhalation. With a subacute or chronic evolution, approximately 80% of patients affected by the disease present with the lymphocutaneous form; episodes associated with a hypersensitivity reaction are rare. The authors report the case of a 12-year-old child with immunoreactive sporotrichosis manifested clinically as erythema nodosum lesions in the lower limbs, associated with an ulcerated lesion in the left arm.

Nota técnica 09 DVE/DVZ/COVISA/2020: vigilância e manejo clínico da esporotricose humana no município de São Paulo / Technical report 09 DVE / DVZ / COVISA / 2020: surveillance and clinical management of human sporotrichosis in the city of São Paulo

A Esporotricose é uma infecção fúngica de implantação, subaguda ou crônica, causada por fungo do complexo Sporothrix schenkii. No Brasil, a espécie mais frequente é S.brasiliensis. No município de São Paulo, em 2011, foram identificados os primeiros casos de esporotricose em felinos e em humanos, na região de Itaquera, na Coordenadoria Regional de Saúde Leste. A partir de 2018, houve um aumento significativo do número de casos em felinos, acompanhado do aumento de casos humanos. Esta Nota técnica, elaborada pela Coordenadoria de Vigilância em Saúde de São Paulo, tem como objetivo orientar a vigilância e o manejo clínico da esporotricose humana no município de São Paulo. O documento aborda a situação epidemiológica da esporotricose no município de São Paulo, o agente etiológico, as formas de transmissão, as manifestações clínicas, os diagnósticos diferenciais, o diagnóstico laboratorial, o tratamento, o prognóstico e as definições de casos suspeito e confirmado, além dos fluxos de atendimento e vigilância epidemiológica de esporotricose humana na cidade e da orientação para coleta e armazenamento de amostras para envio ao laboratório.

Nota técnica 09 - vigilância e manejo clínico da esporotricose humana no município de São Paulo / Technical note 09 - surveillance and clinical management of human sporotrichosis in the city of São Paulo

Nota técnica elaborada para nortear a vigilância e manejo clínico da esporotricose humana no município de São Paulo. O documento aborda a situação da esporotricose no município de São Paulo, agente etiológico, transmissão, manifestações clínicas da esporotricose humana, diagnóstico diferencial, diagnóstico laboratorial, tratamento, prognóstico, unidades de referencia, vigilância epidemiológica e fluxos de atendimento de casos humanos. Apresenta ainda orientações para coleta, armazenamento e ficha de encaminhamento de amostras para diagnóstico laboratorial, ficha para notificação, ficha de encaminhamento de caso suspeito e fluxograma de atendimento de casos humanos.

Esporotricose ocular: manifestações atípicas / Ocular sporotrichosis: atypical manifestations

Resumo A esporotricose humana e animal é uma infecção subaguda a crônica causada pelo fungo dimórfico Sporothrix schenckii. A esporotricose ocular tem ganhado destaque em função da epidemia de esporotricose urbana enfrentada pelo estado do Rio de Janeiro na última década e se apresenta classicamente como conjuntivite granulomatosa, mas formas atípicas podem ocorrer. Este artigo tem por objetivo relatar 2 casos atípicos de esporotricose ocular em pacientes imunocompetentes, ambos apresentando quadro clínico compatível com a síndrome oculoglandular de Parinaud associada à dacriocistite em um caso e presumivelmente à coroidite no outro caso.

Abstract Human and animal sporotrichosis is an infection caused by the dimorphic fungus Sporothrix schenckii, which is classified from subacute to chronic. Ocular sporotrichosis has been highlighted due to the epidemic of urban sporotrichosis faced by the state of Rio de Janeiro in the last decade and presents classically as granulomatous conjunctivitis, but atypical forms may occur. This article aims to report two atypical cases of ocular sporotrichosis in immunocompetent patients, both presenting a clinical picture compatible with Parinaud oculoglandular syndrome associated with dacryocystitis in one case and presumably to choroiditis in the other case.

Esporotricosis. presentación de un caso en Brasil / Esporotricose. apresentação de um caso no Brasil / Sporotrichosis. a case presentation in Brazil

Se presentó un paciente masculino, de 7 años de edad, antecedente de contacto con un gato doméstico, procedente del municipio Gaspar, estado Santa Catarina en Brasil. La madre refirió la presencia de lesiones rojizas y purulentas en la piel del pecho y brazos, que no mejoraron con el tratamiento que se le aplicó. El cultivo micológico de las lesiones demostró la presencia del hongo Sporothrixschenckii, por lo que se hizo el diagnóstico definitivo de esporotricosis. Se trató con itraconazol y evolucionó favorablemente(AU)

A male patient, 7 years old, presented a history of contact with a domestic cat, from the Gaspar municipality, Santa Catarina state in Brazil. The mother reported the presence of reddish and purulent lesions on the skin of the chest and arms, which did not improve with the treatment that was applied. The mycological culture of the lesions demonstrated the presence of the fungus Sporothrixschenckii, so the definitive diagnosis of sporotrichosis was made. It was treated with itraconazole and evolved favorably(AU)

Um paciente do sexo masculino, 7 anos, apresentava histórico de contato com um gato doméstico, do município de Gaspar, estado de Santa Catarina no Brasil. A mãe relatou a presença de lesões avermelhadas e purulentas na pele do tórax e braços, que não melhoraram com o tratamento aplicado. A cultura micológica das lesões demonstrou a presença do fungo Sporothrixschenckii, pelo que foi feito o diagnóstico definitivo de esporotricose. Foi tratado com itraconazol e evoluiu favoravelmente(AU)

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.

Cutaneous atypical mycobacteriosis with sporotrichoid clinical presentation caused by automotive accident

Abstract: Atypical mycobacterial infections are caused by mycobacteria other than those from the M. tuberculosis complex and M. leprae. Its incidence has increased progressively, with considerable increase of scientific publications on the subject. Only 10% of the cases present with cutaneous infections, most of them related to surgical interventions and aesthetic procedures. We present a case of mycobacteriosis due to automotive accident that presented a diagnostic challenge due to its clinical presentation with lesions of sporotrichoid progression in the lymphatic system.

Esporotricose em felinos domésticos (Felis catus domesticus) em Campos dos Goytacazes, RJ / Sporotrichosis in domestic felines (Felis catus domesticus) in Campos dos Goytacazes/RJ, Brazil

A esporotricose é uma micose subcutânea de evolução subaguda a crônica, causada pelo fungo dimórfico e geofílico Sporothrix schenckii. A transmissão zoonótica vem recebendo destaque, tendo os felinos domésticos um importante papel epidemiológico na doença. Este trabalho pesquisa teve como objetivo diagnosticar casos de esporotricose em felinos domésticos atendidos no município de Campos dos Goytacazes/RJ, bem como correlacionar os casos positivos com os sinais clínicos observados nos mesmos, assim como fatores de risco tais quais sexo, animais castrados ou não, dentre outras características. Foram utilizados 100 felinos domésticos, portadores de lesões cutâneas suspeitas de esporotricose, os quais passaram por avaliação clínica minuciosa e preenchimento de fichas individuais. As lesões foram então selecionadas para coleta de material em suabes estéreis e posterior análise laboratorial, através da citologia e cultura fúngica. Dos 100 animais analisados, 66 (66%) foram positivos para Sporothrix spp., sendo 46 (69,6%) machos não castrados, 15 (22,7%) fêmeas não castradas, 4 (6,06%) fêmeas castradas e 1 (1,5%) macho castrado, os quais 89,3% tinham acesso à rua. Quanto à topografia lesional e estado clínico dos animais, 43 (65,2%) apresentavam lesões focais e 23 (34,8%) lesões disseminadas, onde 21 (31,8%) vieram à óbito ou foram submetidos a eutanásia por opção do tutor. Com os resultados dos exames foi possível a adequada prescrição do protocolo terapêutico e acompanhamento de 40 animais (60,6%), e nos casos dos felinos encaminhados (7,5%), foi reportado ao médico veterinário responsável o respectivo diagnóstico para que este escolhesse sua conduta terapêutica.(AU)

Sporotrichosis is a subcutaneous mycosis of subacute to chronic evolution, caused by the dimorphic and geophilic fungus Sporothrix schenckii. The zoonotic transmission has been highlighted, with domestic cats having an important epidemiological role in the disease. This research aimed to diagnose cases of sporotrichosis in domestic cats treated in the city of Campos dos Goytacazes/RJ, as well as to correlate the positive cases with the clinical signs observed in them, as well as risk factors such as sex, castrated animals or not, among other characteristics. One hundred domestic felines were used, with skin lesions suspected of sporotrichosis, which underwent a thorough clinical evaluation and completion of individual files. The lesions were then selected for material collection in sterile swabs and subsequent laboratory analysis, through cytology and fungal culture. Of the 100 animals analyzed, 66 (66%) were positive for Sporothrix spp., Being 46 (69.6%) uncastrated males, 15 (22.7%) uncastrated females, 4 (6.06%) females castrated and 1 (1.5%) castrated male, 89.3% of whom had access to the street. Concerning the lesion topography and clinical status of the animals, 43 (65.2%) had focal lesions and 23 (34.8%) disseminated lesions, where 21 (31.8%) died or were submitted to euthanasia at the option of tutor. With the results of the exams, it was possible to adequately prescribe the therapeutic protocol and follow up of 40 animals (60.6%), and in the cases of the cats referred (7.5%), the respective veterinarian was informed of the respective diagnosis so that this To choose their therapeutic behavior.(AU)

Canine sporotrichosis: report of 15 advanced cases / Esporotricose canina: descrição de 15 casos avançados

Sporotrichosis is a chronic, granulomatous and usually lymphocutaneous infection of animals and humans, caused by a dimorphic fungus, Sporothrix schenckii complex. The disease in dogs is considered rare, however, in the last years a crescent registration of cases was observed in Brazil, especially in the city of Rio de Janeiro. Fifteen dogs with ulcerated cutaneous lesions were seen at the Dermatology Service in the Small Animal's Hospital at Universidade Federal Rural do Rio de Janeiro, between January 2014 and October 2015. Most lesions were located on the head, mainly the nose. Lesions were even seen on the chest, disseminated on the body and on the limbs. Three dogs (20%) exhibited the cutaneous-lymphatic form, with lesions initially on the distal aspect of one leg and ascending via lymphatics up the leg to the trunk and head. It was not ruled out the disseminated form in at least 3 dogs (20%). They had consistent signs of generalized or disseminated disease exhibiting respiratory symptoms (nasal discharge, sneezing, stertorous breathing), anorexia and weight loss. Draining tracts and cellulitis were very common. Some had large areas of skin necrosis with exposure of muscle and bone. Definitive diagnosis was obtained by cytological examination of exudates, histological examination, and/or isolation of S. schenckii complex by fungal culture. Because of the severity of the lesions that mimic other disorders like neoplasms or autoimmune skin diseases, and due to the difficulties of getting an accurate diagnosis, this study describes 15 advanced cases of canine sporotrichosis.(AU)

A esporitricose é uma doença infecciosa crônica, granulomatosa e frequentemente linfocutânea, causada por um fungo dimórfico do Complexo Sporothrix schenckii. A doença em cães é considerada rara, no entanto, nos últimos anos, um número crescente de casos foi registrado no Brasil, especialmente no Rio de Janeiro. Quinze cães com lesões cutâneas ulceradas foram atendidos no Setor de Dermatologia do Hospital Veterinário de Pequenos Animais da Universidade Federal Rural do Rio de Janeiro, entre Janeiro de 2014 e Outubro de 2015. Todos os animais foram submetidos ao exame clínico e dermatológico. A maioria das lesões estava localizada na cabeça, principalmente no plano nasal. Havia também lesões no tórax, disseminada pelo corpo e nos membros. Três cães (20%) apresentaram a forma cutâneo-linfática, com lesões inicialmente nos membros e se propagavam via vasos linfáticos para o tronco e a cabeça. Não foi descartada a forma disseminada em pelo menos 3 cães (20%). Estes cães apresentaram sinais consistentes de doença generalizada ou disseminada, exibindo sinais respiratórios (descarga nasal, espirros, estertoração), anorexia e perda de peso. Fístulas e celulite eram muito comuns. Alguns tinham grandes áreas de necrose que desencadearam a exposição de músculo e osso. O diagnóstico definitivo da infecção foi obtido por exame citológico de exsudato e por exame histológico, e/ou apenas isolamento do complexo S. schenckii pela cultura de fungos. Por causa da severidade das lesões que imitam outras enfermidades, principalmente neoplasias e doenças autoimunes, e pela dificuldade de se obter o diagnóstico correto, este estudo descreve 15 casos avançados de esporotricose canina.(AU)

PLECT: enfermedades tropicales de manifestación verrucosa / PLECT: tropical manifestation diseases verrucosa

Cada día es más habitual ver en nuestra consulta médica enfermedades dermatológicas endémicas de zonas tropicales, gracias a los flujos migratorios recientes y aumento del turismo hacia el extranjero. Presentamos un acrónimo muy utilizado en Brasil, PLECT, que reúne a enfermedades infecciosas que deben tenerse en mente en el diferencial de lesiones verrucosas, a saber, Paracoccidiodomicosis, Leishmaniasis Tegumentar, Esporotricosis, Cromomicosis y Tuberculosis Cutánea.

Increasingly, it is more common to see dermatological diseases that are endemic in tropical areas in our medical practice, thanks to recent migratory flows and increased tourism abroad. We present an acronym widely used in Brazil, PLECT, which brings together infectious diseases that should be borne in mind in the differential of verrucous lesions, namely, Paracoccidiodomicosis, Cutaneous Leishmaniasis, Sporotrichosis, Chromomycosis and Cutaneous Tuberculosis.

Disseminated cutaneous sporotrichosis in patient with alcoholism

Abstract Sporotrichosis is the most prevalent subcutaneous mycosis and is characterized by a subacute or chronic development of a cutaneous or subcutaneous nodular lesion. It is caused by the dimorphic fungus Sporothrix spp, which may manifest in different clinical forms. The disseminated cutaneous form is uncommon and is more likely to occur in immunocompromised patients. We report a 47-year-old male patient with multiple cutaneous and subcutaneous nodules. The patient was diagnosed with disseminated cutaneous sporotrichosis based on the isolation and identification of Sporothrix spp. The patient was treated with potassium iodide, which resulted in clinical improvement of the lesions.

Sporotrichosis: an update on epidemiology, etiopathogenesis, laboratory and clinical therapeutics

Abstract: In the late 90's there was a change in both the route of transmission and the people at risk for sporotrichosis. This zoonotic cat-man alternative transmission route elicited changes in strategies to control the epidemic. There was a progressive increase in the number of cases involving especially children and the elderly. In addition to becoming hyperendemic, uncommon clinical pictures like immunoreactive clinical presentations or severe systemic cases have emerged. New species were identified and classified through molecular tools using more virulent clinical isolates, like S. brasiliensis, compared to the environmental isolates. Likewise, different species of Sporothrix have been associated with different geographic regions. The serological and molecular techniques are used as an auxiliary tool for the diagnosis and/or for species identification, although the isolation and the identification of Sporothrix spp. in clinical specimen is still the gold standard. Currently sporotrichosis epidemics requires the knowledge of the epidemiological-molecular profile to control the disease and the specific treatment. Itraconazole, potassium iodide, terfinafine, and amphotericin B are the available drugs in Brazil to treat sporotrichosis. The drug of choice, its posology, and treatment duration vary according to the clinical presentation, the Sporothrix species, and host immune status. New treatment choices, including a vaccine, are being developed; nevertheless, more clinical trials are required to confirm its efficacy.

Esporotricosis linfocutánea. A propósito de un caso pediátrico / Lymphatic-cutaneous sporotrichosis. A pediatric case

La esporotricosis es la micosis subcutánea más frecuente en Uruguay. Es producida por hongos del complejo Sporothrix. Su reservorio son los restos vegetales y madera en descomposición. En su hábitat natural las condiciones climáticas, temperatura y humedad son variables, pero es inviable a 40°C. Afecta al hombre y animales. Es una enfermedad ocupacional y recreativa, poco frecuente en la edad pediátrica. En nuestro país el modo habitual de adquirirla es a través de arañazos de armadillos (mulitas). La forma clínica clásica y más frecuente de la esporotricosis se caracteriza por un chancro cutáneo de inoculación acompañado de una linfangitis de carácter nodular y troncular. Su evolución tiene un desarrollo subagudo y crónico. A pesar de su signología típica es muchas veces confundida con otras afecciones dermatológicas lo que retarda el diagnóstico. La presentación visceral u osteoarticular es excepcional. El diagnóstico definitivo requiere el aislamiento del hongo en cultivos a partir del sitio de infección. La resolución espontánea es poco común. El tratamiento recomendado es itraconazol administrado durante 3 a 6 meses. También puede utilizarse de manera alternativa yoduro de potasio y la terbinafina. La termoterapia local preconizada por la escuela micológica uruguaya significa muchas veces una valiosa alternativa terapéutica. El objetivo de esta comunicación es la presentación del caso clínico de un niño que cursó una esporotricosis cutáneo-linfática. La misma fue confirmada por estudio micológico y recibió tratamiento con itraconazol y termoterapia local, con buena respuesta.

Sporotrichosis is the most frequent subcutaneous mycosis in Uruguay. It is caused by fungi from the Sporothrix complex. This fungus lives in decaying plant matter, including wood. Climate, temperature and humidity vary in their natural habitat, although they cannot survive when it is hotter than 40°C. It affects both men and animals. Sporotrichosis is an occupational and recreational disease, rather unusual in children. In our country it is usually acquired through armadillo scratches. The classical and most frequent clinical presentation is characterized by a chancre following inoculation, accompanied by nodular and troncular lymphangitis. Evolution of the condition has a subacute and chronic development. In spite of its typical signs, it is often confused with other skin diseases, what delays diagnosis. Visceral or osteoarticular presentation is exceptional. Final diagnosis requires the fungus to be isolated in cultures from the site of the infection. Spontaneous resolution is rather unusual. Itraconazole during 3 to 6 months is the recommended treatment. Alternatively, potassium iodide and terbinafine may be used. Local thermotherapy, recommended by the Uruguayan mycological school often constitutes a valuable therapeutic alternative. This study aims to present the clinical case of a boy with a lymphatic-cutaneous sporotrichosis. The condition was confirmed by mycological studies and he was treated with itraconazole and local thermotherapy, the response being good.