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.

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.

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.

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)

Cytotoxicity and anti-Sporothrix brasiliensis activity of the Origanum majorana Linn. oil

Abstract The study aimed to evaluate the anti-Sporothrix sp. activity of the essential oil of Origanum majorana Linn. (marjoram), its chemical analysis, and its cytotoxic activity. A total of 18 fungal isolates of Sporothrix brasiliensis (n: 17) from humans, dogs and cats, and a standard strain of Sporothrix schenckii (n: 1) were tested using the broth microdilution technique (Clinical and Laboratory Standard Institute - CLSI M27-A3) and the results were expressed in minimal inhibitory concentration (MIC) and minimal fungicidal concentration (MFC). The MIC50 and MIC90 of itraconazole against S. brasiliensis were 2 µg/mL and 8 µg/mL, respectively, and the MFC50 and MFC90 were 2 µg/mL and >16 µg/mL, respectively, with three S. brasiliensis isolates resistant to antifungal. S. schenckii was sensitive at MIC of 1 µg/mL and MFC of 8 µg/mL. For the oil of O. majorana L., all isolates were susceptible to MIC of ≤2.25-9 mg/mL and MFC of ≤2.25-18 mg/mL. The MIC50 and MIC90 were ≤2.25 mg/mL and 4.5 mg/mL, respectively, and the MFC50/90 values were twice more than the MIC. Twenty-two compounds were identified by gas chromatography with a flame ionization detector (CG-FID) and 1,8-cineole and 4-terpineol were the majority. Through the colorimetric (MTT) assay, the toxicity was observed in 70-80% of VERO cells between 0.078 and 5 mg/mL. For the first time, the study demonstrated the satisfactory in vitro anti-Sporothrix sp. activity of marjoram oil and further studies are needed to ensure its safe and effective use.

Virulencia de Sporothrix globosa en modelos murinos / Virulence of Sporothrix globosa in murine models

Introducción: La esporotricosis es una infección causada por especies pertenecientes al complejo Sporothrix schenckii. Dependiendo de la especie, estos organismos pueden tener virulencia y formas clínicas diferentes. Objetivo: Verificar la virulencia de una cepa de Sporothrix globosa en un modelo murino usando 2 concentraciones de inóculo, en aplicación intraperitoneal o subcutánea. Materiales y métodos: Estudio experimental no aleatorizado en murinos inoculados con una cepa de S. globosa (CBS 14.076 M), por vía intraperitoneal y subcutánea, a 0,5 y 4 de concentración McFarland. Se utilizaron 18 roedores CF-1 (ISP, Santiago, Chile). Resultados: La cepa estudiada no provocó enfermedad ni lesiones, todos los animales sobrevivieron, no hubo desarrollo de hongos en el cultivo de tejidos y el análisis histopatológico de órganos no mostró alteraciones sugerentes de infección. Conclusiones: La cepa de S. globosa estudiada no presentó virulencia en modelos murinos y no provocó enfermedad al ser inoculada a concentración McFarland 0,5 y 4, tanto por vía intraperitoneal como subcutánea.

Introduction: The sporothricosis disease is an infection caused by species included in Sporothrix schenkii complex. Objective: Verify the virulence of a strain of S. globosa using two different concentrations of inoculum by intraperitoneally and subcutaneously, into a mouse model. Materials and methods: Nonrandomized pilot study, in murine inoculated with a strain of S. globosa (CBS 14.076 M) by intraperitoneally and subcutaneously with inoculum concentrations of 0.5 and 4 McFarland. For this purpose 18 rodents CF-1 (ISP, Santiago, Chile) were used. Results: The studied strain did not induce illness or injury on animals, they all survived and neither the tissue culture nor the histopathological analysis showed fungal growth or suggestive infection by organ abnormalities. Conclusions: The S. globosa strain did not present any virulence enough to cause disease at 0.5 and 4.0 McFarland concentration inoculum when inoculated in both intraperitoneally and subcutaneously, in murine models.

Disseminated cutaneous sporotrichosis associated with ocular lesion in an immunocompetent patient

Abstract: A 59-year-old female patient, previously healthy, immunocompetent, presented left bulbar conjunctiva lesions and nodular-ulcerated lesions on the arms and cervical region, besides left cervical and retroauricular lymphadenopathy. She had previous contact with domestic cats that excoriated her face. The diagnosis was conclusive of disseminated sporotrichosis through clinical and epidemiological history and cultures of skin and ocular secretions. It evolved with good response to oral antifungal therapy.

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.

Aislamiento ambiental de Sporothrix globosa en relación a un caso de esporotricosis linfo-cutánea / Sporothrix globosa isolation related to a case of lymphocutaneous sporotrichosis

Introduction: Sporothrix schenckii complex comprises a group of environmental dimorphic fungi that cause sporotrichosis. In Chile, isolated cases have been reported in humans, though no environmental isolates have been described. Objective: To achieve isolation of Sporothrix complex from the soil where a 75 year old patient with lymphocutaneous sporotrichosis performs horticulture work. Materials and Methods: In March and July 2011 soil and plant debris from five sectors where the patient does his work in horticulture was extracted. The soil samples were diluted and inoculated in Sabouraud agar with cycloheximide and chloramphenicol at 26 °C. The plant debris was directly inoculated in the same medium. Colonies suggestive of Sporothrix complex were reseeded in PDA agar at 26 ° C and identified as recommended by Marimon et al. Results: Of the 10 plates from the first sampling, one colony was identified as Sporothrix globosa. In the second sampling, Sporothrix globosa grew in two plates seeded with soil, with a total of 6 colonies. There was no growth of Sporothrix complex in plant debris. The isolate from the patient was also identified as Sporothrix globosa. Conclusion: For the first time in Chile a species of Sporothrix complex was isolated from the environment. Sporothrix globosa was the species identified both in the ground and from the patient with sporotrichosis.

Introducción: Sporothrix schenckii complex comprende un grupo de hongos dimórficos ambientales que provocan esporotricosis. En Chile se han comunicado casos aislados en humanos; sin embargo, no se han descrito aislamientos de este hongo desde el ambiente. Objetivos: Orientados por un caso de esporotricosis linfo-cutánea en una paciente de 75 años, se realizó un estudio ambiental para lograr el aislamiento de S. complex desde el suelo donde la paciente realizaba labores de horticultura. Materiales y Métodos: Se extrajo tierra y restos vegetales de cinco sectores donde la paciente efectuaba sus labores de horticultura. Se realizaron diluciones de tierras y siembra en agar Sabouraud con cicloheximida y cloranfenicol a 26°C. Los restos vegetales fueron sembrados directamente en el mismo medio. Las colonias sugerentes de S. complex se resembraron en agar PDA a 26°C y se identificaron según recomendación de Marimon y cols. Resultados: De las diez placas del primer muestreo, una colonia de la siembra de tierra se identificó como Sporothrix globosa. En el segundo muestreo hubo desarrollo de S. globosa en dos placas sembradas con tierra, con un total de seis colonias. No hubo desarrollo de S. complex en los restos vegetales. La cepa aislada desde la paciente también fue identificada como S. globosa. Conclusión: Por primera vez en Chile se logra el aislamiento del ambiente de una especie de S. complex. Sporothrix globosa fue la especie identificada tanto del suelo como desde la paciente con esporotricosis.

Lesões molusco-símiles em paciente com esporotricose / Molluscum-like lesions in a patient with sporotrichosis

Esporotricose é uma infecção fúngica subcutânea, adquirida por inoculação direta, causada pelo Sporothrix schenckii. Embora a apresentação clássica linfocutânea represente a maioria dos casos, as formas clínicas atípicas e graves têm aumentado em ocorrência. Esporotricose sistêmica e esporotricose cutânea disseminada são variantes raras, usualmente associadas à imunodeficiência celular ou a estados debilitantes. Relatamos o primeiro caso na literatura de lesões molusco-símiles em esporotricose cutaneomucosa múltipla. Os exames micológico direto e histopatológico apresentavam-se ricos em células leveduriformes.

Sporotrichosis is a subcutaneous fungal infection caused by Sporothrix schenckii and acquired by direct inoculation. Although the majority of cases consist of the classic lymphocutaneous presentation, the frequency of atypical and severe clinical forms of the disease has increased progressively. Systemic and disseminated cutaneous sporotrichosis constitute rare variants and such cases are generally associated with cellular immunodeficiency or debilitated states. The present paper describes the first published case of molluscum-like lesions in disseminated mucocutaneous sporotrichosis. Direct mycological examination and histopathology revealed numerous yeast cells.

Ocorrência familiar de esporotricose zoonótica / Familial occurrence of zoonotic sporotrichosis

A esporotricose é micose subaguda ou crônica, causada pelo fungo dimórfico Sporothrix schenckii, endêmica no Brasil e transmitida principalmente através da inoculação traumática de seu agente causal na pele. A transmissão zoonótica, especialmente por gatos infectados, tem sido demonstrada em diversos relatos e séries de casos. Nós descrevemos a ocorrência simultânea da doença em três membros de uma mesma família através da arranhadura por gato doméstico infectado. Dois pacientes desenvolveram a forma cutânea-linfática e apenas um desenvolveu a forma cutânea fixa. Dois pacientes foram tratados com sucesso, com solução saturada de iodeto de potássio; entretanto, o terceiro caso apresentou efeitos colaterais e teve seu tratamento substituído por itraconazol, com resolução de suas lesões.

Sporotrichosis is a subacute or chronic mycosis caused by the dimorphic fungus Sporothrix schenckii which is endemic in Brazil and is transmitted primarily through traumatic inoculation of its causative agent into the skin. The zoonotic transmission, especially from infected cats, has been demonstrated in several reports and case series. We present simultaneous occurrence of the disease in three members of the same family by scratches from an infected domestic cat. Two patients developed the lymphocutaneous form and one only developed the fixed cutaneous form. Two patients were successfully treated with saturated solution of potassium iodide; however, the third case reported side effects and had his therapy substituted for itraconazole, with resolution of his lesions.

Sucesso terapêutico da terbinafina em um caso de esporotricose / Successful treatment of terbinafine in a case of sporotrichosis

A esporotricose é uma infecção subaguda ou crônica, causada por fungos pertencentes ao Complexo Sporothrix. Relato do caso: esporotricose de localização nasal foi tratada com iodeto de potássio e como não se obteve sucesso, reiniciou-se o tratamento com associação de iodeto de potássio e itraconazol. Porém, ocorreu nova recidiva. As culturas dos exames micológicos foram submetidas a ensaios de atividade antifúngica in vitro para auxiliar no tratamento. A terbinafina foi o antifúngico que apresentou melhores resultados, por isso, o tratamento foi reiniciado com este antifúngico e, após dois anos do término do mesmo, não recidivou. Adicionalmente, ambas as culturas foram comparadas por RAPD, obtendo padrões de fragmentos distintos, indicando que os isolados são diferentes ou demonstrando um processo microevolutivo do microrganismo.

Sporotrichosis is a chronic subacute infection caused by fungi belonging to the Sporothrix Complex. In the present clinical case, nasal sporotrichosis was treated with potassium iodide. This was unsuccessful, and the treatment was restarted with a combination of potassium iodide and itraconazole. This however resulted in a further recurrence of the infection. The mycological cultures were tested in vitro for antifungal activity to assist in treatment. Terbinafine, an antifungal drug, produced the best results and was therefore used for the rest of the treatment course, with no recurrence after two years of its completion. In addition, both cultures were compared using RAPD and different fragment patterns were observed. This indicated that the isolates were either different or indicated a microevolutionary process of this microorganism.

Estudo da virulência, adesão e características fenotípicas de isolados do complexo Sporothrix / Study of virulence, adhesion and phenotypic characteristics of isolates of Sporothrix complex

A esporotricose é uma doença micótica, infecciosa e crônica, que envolve o tecido cutâneo e subcutâneo, e que pode afetar seres humanos e animais. Esta micose sempre foi atribuída a um único patógeno, o Sporothrix schenckii, um fundo termodimórfico, que cresce como levedura a 37 oC e como micélio à temperatura ambiente. No entanto, nos últimos anos, foi demonstrado que isolados identificados como S. schenckii apresentavam grande variabilidade genética, sugerindo que esta táxon consiste em um complexo de espécies. Esta doença é causada pela implantação traumática do patógeno fúngico, porém os mecanismos de invasão e disseminação deste microorganismo, bem como as moléculas envolvidas nestes processos, ainda são pouco conhecidos. Com base nessas informações, este trabalho visa identificar moléculas de superfície deste patógeno envolvidas na interação deste fungo com proteínas matriciais, bem como analisar diferenças fenotípicas entre espécies do denominado complexo Sporothrix. Foram utilizados, neste estudo, cinco isolados de Sporothrix spp., sendo três isolados clínicos, um isolado ambiental e um isolado de gato. A virulência de cada isolado foi comparada à capacidade adesiva à proteína matricial fibronectina. Foi observado que os isolados com amior capacidade infectiva eram os que apresentavam maior capacidade adesiva à fibronectina. Verificamos então a expressão de adesinas para fibronectina na superfície de cada isolado, por Western blot, e observamos que os isolados mais virulentos e com maior capacidade adesiva expressavam mais adesinas para fibronectina. Bandas reativas com o anticorpo monoclonal contra adesina gp70 (mAb P6E7) foram reveladas nos extratos de parede celular dos isolados estudados. Análises por microscopia confocal revelaram a colocalização da gp70 com a adesina para fibronectina na superfície dos isolados. Análises filogenéticas demonstraram que os isolados estudados possuíam diferenças genotípicas capazes de agrupá-los em duas espécies...

Sporotrichosis is a chronic and infectious diseases that involves the cutaneous and subcutaneous tissue, which can affect humans and animals. This mycosis has always been attributed to a single pathogen, the Sporothrix schenckii, a dimorphic fungus, that grows as yeast at 37 oC and as mycelia at room temperature. However, in recent years, some isolates identifies as S. schenckii showed considerable genetic variability, sugesting that this taxon consists of a complex of species. This disease is caused by the traumatic inoculation of the fungal pathogen, however, the molecules involved in the invasion and dissemination of this microorganism are still poorly understood. The aim of this study is to identify surface molecules involved in the interaction of this fungus with extracellular matrix proteins and to examine phenotypic differences between species in the Sporothrix complex. Five isolates were used throughout this study, three clinical isolates, an environmental and one cat isolate. The virulence of each isolate was compared to the adhesive capacity to fibronectin. We observed that the most virulent isolates exhibited the higher capacity to interact with fibronectin. The expression of adhesins for fibronectin on the surface of each isolate was verified by Western blot. This analysis showed that the most virulent isolates expressed more fibronectin adhesins than the avirulent ones. Positive bands for the monoclonal antibody raised against gp70 adhesin (mAb P6E7) were revealed in cell wall extracts of the isolates studied. Confocal microscopy confirmed the colocalization of fibronectin and mAb P6E7 on the yeast cell surface. Molecular analysis showed genotypic differences between isolates used in this study, that can cluster than them into two species, S. schenckii and S. brasiliensis. This phylogenetic analysis revealed that the avirulent isolate was S. brasiliensis and not S. schenckii as previously thought. This new data led us o determine whether...

Esporotricosis cutánea: revisión a propósito de un caso contraído en Chile / Cutaneous sporotrichosis: a Chilean case report

La esporotricosis es una infección subaguda a crónica causada por el hongo dimórf¡co Sporothrix schenckii, distribuido por todo el mundo, particularmente en climas templados y tropicales. La enfermedad afecta principalmente la piel y los vasos linfáticos, produciendo distintas formas clínicas, siendo la más frecuente la linfocutánea; sin embargo, puede ocurrir una diseminación a estructuras osteoarticulares y viscerales, especialmente en pacientes inmunosuprimidos. La infección linfocutánea generalmente se origina como consecuencia de traumas durante el trabajo al aire libre y la posterior inoculación del hongo a través de elementos contaminados, como el suelo, heno, espinas, madera y alambre de púas. La mayoría de los pacientes van a requerir tratamiento antimicótico, siendo el itraconazol el fármaco de elección. Además se utiliza ampliamente el yoduro de potasio en países subdesarrollados debido a su efectividad y bajo costo. Se presenta el caso de un paciente trabajador agrícola con esporotricosis cutánea, contraída en Chile, confirmada, que recibió tratamiento con itraconazol, evolucionando favorablemente.

Sporotrichosis is a sub acute to serious infection caused by a dimorphic fungus called Sporothrix schenckii, and disributed throughout the world, particularly in temperate and tropical climates. The disease affects mainly skin and lymph vessels, producing several clinical forms, most frequently lymphocutaneous. However, dissemination to musculoskeletal and visceral structures in immune suppressed patients may occur. Lymphocutaneous infection usually originates as a result of trauma during outdoor work and the subsequent inoculation of the fungus through contaminated objects such as soil, hay, thorns, wood and barbed wire. Most patients will require antifungal treatment; being itraconazole the drug of choice, Potassium iodine is widely used in developing countries due to its effectiveness and low cost we present the case of a farm worker with a confirmed cutaneous sporotrichosis infection contracted in Chile; the patient received itraconazole, with a favorable outcome.

Molecular characterisation of Sporothrix schenckii isolates from humans and cats involved in the sporotrichosis epidemic in Rio de Janeiro, Brazil

An epidemic of sporotrichosis, a subcutaneous mycosis caused by the fungus Sporothrix schenckii, is ongoing in Rio de Janeiro, Brazil, in which cases of human infection are related to exposure to cats. In an attempt to demonstrate the zoonotic character of this epidemic using molecular methodology, we characterised by DNA-based typing methods 19 human and 25 animal S. schenckii isolates from the epidemic, as well as two control strains. To analyse the isolates, the random amplified polymorphic DNA (RAPD) technique was performed using three different primers, together with DNA fingerprinting using the minisatellite derived from the wild-type phage M13 core-sequence. The analyses generated amplicons with considerable polymorphism. Although isolates exhibited high levels of genetic relatedness, they could be clustered into 5-10 genotypes. The RAPD profiles of epidemic S. schenckii isolates could be distinguished from that of the United States isolate, displaying 20 percent similarity to each primer and 60 percent when amplified with the M13 primer. DNA fingerprinting of S. schenckii isolated from the nails (42.8 percent) and the oral cavities (66 percent) of cats were identical to related human samples, suggesting that there is a common infection source for animals and humans in this epidemic. It is clear that cats act as a vehicle for dissemination of S. schenckii.

Esporotricosis cutánea micetomatoide: a propósito de un caso / Micetomatoide cutaneous sporotrichosis: a propos of a case

La esporotricosis es una infección micótica profunda de la piel, causada por un hongo dimorfo, es Sporothrix schenckii, que se encuentra en forma saprófita en la naturaleza. Tiene distribución mundial, predominantemente en regiones tropicales y subtropicales. La infección usualmente se produce por inoculación traumática. Las formas de presentación clínicas se clasifican en : cutáneas y extracutáneas. El diagnóstico definitivo se establece por cultivo. El tratamiento de elección es la solución satura de ioduro de potasio; otras alternativas son los derivados asólicos, la anfotericina B y el uso de terapia térmica. Presentamos el caso de un paciente de sexo masculino, de 30 años de edad, oriundo de Bolivia, trabajador rural, que presenta lesiones vegetantes en pie izquierdo de un año de evolución. En el cultivo micológico fue identificado el Sporothrix schenckii, observándose una excelente respuesta al tratamiento con itraconazol.

Sporotrichosis atypical presentation as a soft tissue tumour

Sporotrichosis is a mycosis caused by a saprophytic dimorphic fungus named Sporothrix schenckii. Infections occur following traumatic inoculation of fungus from plants and infected cat bites and scratches. We report a case of a farmer who presented with a solitary subcutaneous nodule initially diagnosed as a soft tissue tumour. A history of agricultural activity and feline contact should draw the clinician's attention to sporotrichosis, as the diagnosis can be easily missed in atypical cases. The diagnosis, microbiology and management of the case are discussed.