In vitro susceptibility of Sporothrix spp. to complexes coordinated with Co(II) and cobalt chloride hexahydrate

Abstract Sporothrix spp. are the major dimorphic fungus associated with a type of subcutaneous mycosis, sporotrichosis. The limitation of antifungal availability and the past reports of in vitro resistance of Sporothrix spp. clinical isolates makes it important to search for new compounds with antifungal activities. In this study, we therefore evaluate the in vitro activities of complexes coordinated with Co(II) and cobalt chloride hexahydrate against clinical isolates of Sporothrix spp. Broth microdilution test was performed as per M38-A2 from CLSI (2008) in duplicate for 31 clinical isolates of Sporothrix spp. (27 S. brasiliensis e 04 S. schenckii stricto sensu). The antifungal activities of the complexes coordinated with Co(II) and cobalt chloride hexahydrate were detected at a concentration range of 32-128 µg/mL for all isolates. None of the compounds demonstrated any cytotoxicity (to macrophage cells) at the concentration of 200 µg/mL. The activity against Sporothrix spp. recorded in this study instigate the continuity of experimental studies with Co(II) to search for the mechanisms of antifungal action as well as to evaluate its interaction with the commercial antifungal drugs.

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.

Sporotrichosis refractory to conventional treatment: therapeutic success with potassium iodide

Abstract Sporotrichosis is a subcutaneous mycosis caused by dimorphic fungi of the genus Sporothrix. The authors report a case of fixed cutaneous sporotrichosis with therapeutic failure after 18 months of itraconazole and terbinafine associated with cryosurgery. The patient was cured after the introduction of saturated potassium iodide solution. Sporothrix brasiliensis was the identified species, presenting a susceptibility profile to itraconazole and terbinafine. This fact suggests that therapeutic failure is probably related to the host-fungus interaction rather than drug resistance. It is possible that the immunomodulatory action of the saturated potassium iodide solution may have played an important role in curing this patient.

Therapeutic failure with itraconazole in sporotrichosis due to bariatric surgery

Abstract Sporotrichosis is a deep mycosis of subacute or chronic evolution, caused by the dimorphic fungus of the genus Sporothrix. The treatment is carried out with antifungal orally or intravenously. Therapeutic success can be affected by several factors, such as altered gastrointestinal physiology by surgery. More and more patients are submitted to bariatric surgeries and the literature for the alterations of the absorption of medications in this context is very scarce. We intend to contribute to a better understanding with this case report of cutaneous-lymphatic sporotrichosis in a patient after bariatric surgery without response to itraconazole treatment, even at high doses.

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.

Anti-Sporothrix brasiliensis activity of different pyrazinoic acid prodrugs: a repurposing evaluation

From drug repurposing studies, this work aimed to evaluate the activity of different pyrazinoic acid (POA) derivatives against Sporothrix brasiliensis. The POA esters were prepared and characterized as previously reported by classical esterification reactions, with good to excellent yields. Sporothrix brasiliensis isolates from cats (n=6) and standard strains of S. brasiliensis and S. schenckii were used to assess the antifungal activity of the POA derivatives through broth microdilution assay (CLSI M38-A2). Among the tested compounds, molecules 3 and 4 showed fungistatic and fungicidal activities against all Sporothrix spp. strains, and the obtained MIC and MFC values ranged from 2.12 to 4.24 mg/mL and from 1.29 to 5.15 mg/mL, respectively. Compound 2 and 5 were active as in vitro inhibitors of fungal growth, but showed weak fungicidal activity, while molecules 1 and POA itself were inactive. The results suggest the activity of POA derivatives against Sporothrix spp. may be dependent on the lipophilicity. In addition, the antifungal susceptibility of the isolates to itraconazole was performed, showing that two Sporothrix isolates from cats were itraconazole-resistant. Compounds 3 and 4 were also active against these itraconazole-resistant isolates, indicating a possible alternative route to the standard mode of action of itraconazole.

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.

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.

Fungal infection control by garlic extracts (Allium sativum L) and modulation of peritoneal macrophages activity in murine model of sporotrichosis / Controle da infecção fúngica pelos extratos de alho (Allium sativum L) e modulação da atividade de macrófagos peritoneais em modelo murino de esporotricose

Abstract Garlic (Allium sativum L.) is grown all over the world as seasoning and medicinal vegetable since 3,000 BC. Allicin is the main component of garlic, being attributed to it the most of its biological activities, such as bactericidal, antifungal and antiviral actions. However, other compounds of garlic present antioxidant, hypocholesterolemic, vasodilator activities, protective action against different types of cancer, and immunomodulatory. Fungal infections are important causes of morbidity and mortality in people mainly in immunosuppressed ones. Sporothrix schenckii, the causing agent of Sporotrichosis (most common subcutaneous mycosis in Latin America), is dimorphic fungus, of saprophytic life in soil or plants, infecting people and animals mainly through skin injuries and bruises. The main of this work was to evaluate the influence of garlic consuming on immune modulation of healthy and infected Swiss mice in induced way by S. schenckii, since these animals functioning of peritoneal macrophages as well as the nitric oxide and cytokines' production (IL-1β, IL-10 and IL-12) and to evaluate the antifungal potential of garlic with S. schenckii through minimum inhibitory concentration test and colony-forming units. The results showed that garlic offers antifungal potential with S. schenckii. The oral taking of garlic extracts influences the releasing of cytokines by macrophages, regular consuming shows anti-inflammatory effect, and its acute use may take to an inflammatory response. Mice that consumed garlic responded more effectively to fight against the infection.

Resumo O alho (Allium sativum L.) é cultivado em todo o mundo como hortaliça condimentar e medicinal desde 3.000 a. C. A alicina é o principal componente do alho, sendo atribuída a ela a maior parte das suas atividades biológicas, dentre elas as ações bactericida, antifúngica e antiviral. Porém, outros compostos do alho apresentam atividade antioxidante, hipocolesterolemiante, vasodilatadora, ação protetora contra diversos tipos de câncer e imunomoduladora. As infecções por fungos são causas importantes de morbidade e mortalidade no homem principalmente em indivíduos imunossuprimidos. O Sporothrix schenckii, agente causal da esporotricose (micose subcutânea mais comum na América Latina), é fungo dimórfico, de vida saprofítica no solo ou em vegetais, infectando homens e os animais principalmente através de lesões e arranhões na pele. O objetivo desse trabalho foi avaliar a influência do consumo de alho na imunomodulação de camundongos Swiss saudáveis e infectados de forma induzida por S. schenckii, a partir do estado funcional dos macrófagos peritoneais desses animais quanto à produção de óxido nítrico e das citocinas (IL-1β, IL-10 e IL-12) e avaliar o potencial antifúngico do alho frente ao S. schenckii por meio de teste de concentração inibitória mínima e unidades formadoras de colônia. Os resultados demonstraram que o alho apresenta potencial antifúngico frente S. schenckii. A administração oral de extratos de alho influencia a liberação de citocinas por macrófagos, o consumo regular apresenta efeito anti-inflamatório, e seu uso agudo pode gerar uma resposta inflamatória. Camundongos que consumiram alho responderam de forma mais efetiva no combate da infecção.

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. A propósito de un caso / Sporotrichosis. A propos of a case

La esporotricosis es la micosis subcutánea más frecuente en todo el mundo; se considera una enfermedad ocupacional; las principales fuentes de infección son la materia vegetal y la madera; puede afectar a todos los grupos etarios, pero predomina en la población adulta. El objetivo es diagnosticar y reportar un caso de esporotricosis cutáneo-linfática. Se describe el caso utilizando el método clínico-epidemiológico y el diagnóstico micológico. Se diagnostica una esporotricosis cutáneo-linfática, lo cual corrobora que el cultivo micológico es el estándar de oro en el diagnóstico de esta micosis. En conclusión, la descripción de este caso, constituye una alerta en el diagnóstico de esta entidad poco frecuente en Cuba(AU)

Sporotrichosis is the most common subcutaneous mycosis worldwide. It is considered an occupational disease whose main sources of infection are vegetal material and wood; it may affect all the age groups but predominant in the adult population. The objective is to diagnose on and report a case of cutaneous-lymphatic sporotrichosis. The case is described on the basis of the clinical and epidemiological method and the mycological diagnosis. Cutaneous-lymphatic sporotrichosis was diagnosed, which confirms that the mycological culture is the golden rule in the diagnosis of this mycosis. In conclusions, the description of this case is an alert to the diagnosis of this rare disease in Cuba(AU)

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.

Parinaud's oculoglandular syndrome and possibly causing cortical cataract / Síndrome oculoglandular de Parinaud como possível causa de catarata cortical

According to the World Health Organization, cataract is the leading cause of blindness and visual impairment throughout the world. However, the etiology of cataracts often remains unknown. This report describes the development of cortical cataract in a patient after Parinaud's oculoglandular syndrome caused by the fungus Sporothrix schenckii.

De acordo com a Organização Mundial de Saúde, a catarata é a principal causa de cegueira e deficiência visual em todo o mundo. No entanto, a etiologia das cataratas frequentemente permanece desconhecida. Este relato descreve o desenvolvimento de catarata cortical em um paciente após Síndrome oculoglandular de Parinaud causada pelo fungo Sporothrix schenckii.

Tratamento da esporotricose felina refratária com a associação de iodeto de potássio e itraconazol oral / Treatment of refractory feline sporotrichosis with the association of potassium iodide and oral itraconazole

A esporotricose é uma micose causada por espécies do complexo Sporothrix. Apesar do itraconazol ser o fármaco de escolha devido a sua efetividade e segurança, casos de falência terapêutica em gatos com esta micose têm sido descritos. O iodeto de potássio em cápsulas é uma opção terapêutica nos casos felinos. Adicionalmente, este fármaco é uma alternativa em pacientes humanos não responsivos ao itraconazol. A associação do iodeto de potássio e agentes antifúngicos pode apresentar melhores resultados quando comparada à monoterapia com estes fármacos. Foi realizado um estudo de coorte, o qual teve como objetivo descrever a resposta terapêutica ao iodeto de potássio em cápsulas via oral (5 mg/kg a cada 24 horas) associado ao itraconazol via oral (100 mg/gato a cada 24 horas) em gatos com esporotricose refratária ao itraconazol, assistidos no Laboratório de Pesquisa Clínica em Dermatozoonoses em Animais Domésticos do Instituto de Pesquisa Clínica Evandro Chagas/Fiocruz no período de 2012 a 2013. Foram incluídos no estudo 38 gatos, dos quais foi observado cura clínica em 24, falência terapêutica em cinco e óbito em três gatosEm seis casos houve abandono do tratamento. O tempo mediano de tratamento até a cura clínica foi 20 semanas. Vinte e nove animais apresentaram efeitos adversos clínicos, sendo 26 classificados como grau leve. Emagrecimento, hiporexia e vômitos foram os efeitos adversos clínicos mais observados. Quatro animais apresentaram efeitos adversos laboratoriais, representado pelo aumento dos valores das enzimas hepáticas. A utilização de iodeto de potássio em cápsulas associado ao itraconazol se mostrou um esquema terapêutico efetivo e seguro, sendo uma opção na esporotricose felina refratária ao itraconazol.

Sporotrichosis is a fungal infection caused by Sporothrix species complex.Itraconazol is the drug of choice for the treatment of the disease due to itseffectiveness and safety. However, cases of treatment failure in cats have beenreported. Potassium iodide capsules are an option for the feline cases.Additionally, the drug is an alternative to human patients unresponsive toitraconazole. The association of potassium iodide and antifungal agents mayprovide better results when compared to the mono therapy with these drugs. A cohort study was conducted, which aimed to describe the therapeutic response oforal potassium iodide (5 mg/kg every 24 hours) associated with oral itraconazole(100 mg/cat every 24 hours) in cats with sporotrichosis refractory to itraconazole,followed up at the Laboratório de Pesquisa Clínica em Dermatozoonoses emAnimais Domésticos do Instituto de Pesquisa Clínica Evandro Chagas/Fiocruz between 2012 and 2013. Of the 38 cats included in the study, 24 were cured,treatment failure ocurred in five and death in three cats. In six cases there wasnon-compliance with treatment. The median time from treatment until clinical curewith the combination was 20 weeks. Twenty-nine animals presented clinical adverse effects, which were classified as mild in 26 animals. Weight loss,hiporexia and vomiting were the most frequently observed. Four animals showed laboratory adverse effects represented by an increase in liver enzymes. The useof potassium iodide associated with itraconazole has proved to be an effective andsafe therapeutic regimen and, therefore, represents an option in the treatment offeline sporotrichosis refractory to itraconazol.

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.

Atypical presentation of sporotrichosis: report of three cases

Sporotrichosis occurs after fungal implantation of Sporothrix spp. in the skin, and is the main subcutaneous mycosis in Latin America. Here we describe three atypical cases of the disease. The first case report an extra-cutaneous occurrence of the disease with joint infection; the second one describes a patient with bilateral lymphocutaneous form of sporotrichosis; and the third shows a zoonotic cutaneous case with the development of an erythema nodosum as a hypersensitivity reaction. These cases show the disease importance on the region and the necessity of fungal culture to the diagnosis confirmation.