A One Health Approach to Combatting Sporothrix brasiliensis: Narrative Review of an Emerging Zoonotic Fungal Pathogen in South America.

Cat-transmitted sporotrichosis caused by Sporothrix brasiliensis has become a major public health concern and presents a distinct divergence from the traditional epidemiology of sporotrichosis. This emerging fungal pathogen spreads readily among cat populations, and human infections occur exclusively via zoonotic transmission. While sporotrichosis is an implantation mycosis that typically manifests as cutaneous lesions in humans and cats, severe extracutaneous manifestations are more common with S. brasiliensis than other Sporothrix species infections. Rapid diagnosis and appropriate treatment regimens are critical for successful clinical resolution of sporotrichosis in both cats and humans. Species-level identification of Sporothrix is possible with molecular diagnostics and necessary for tracking the geographic expansion of S. brasiliensis and better understanding its epidemiology. Combatting cat-transmitted sporotrichosis requires a One Health approach to successfully implement public health control measures.

Injection Drug Use-Associated Candidemia: Incidence, Clinical Features, and Outcomes, East Tennessee, 2014-2018.

BACKGROUND: Injection drug use (IDU) is an established but uncommon risk factor for candidemia. Surveillance for candidemia is conducted in East Tennessee, an area heavily impacted by the opioid crisis and IDU. We evaluated IDU-associated candidemia to characterize the epidemiology and estimate the burden. METHODS: We assessed the proportion of candidemia cases related to IDU during January 1, 2014-September 30, 2018, estimated candidemia incidence in the overall population and among persons who inject drugs (PWID), and reviewed medical records to compare clinical features and outcomes among IDU-associated and non-IDU candidemia cases. RESULTS: The proportion of IDU-associated candidemia cases in East Tennessee increased from 6.1% in 2014 to 14.5% in 2018. Overall candidemia incidence in East Tennessee was 13.5/100 000, and incidence among PWID was 402-1895/100 000. Injection drug use-associated cases were younger (median age, 34.5 vs 60 years) and more frequently had endocarditis (39% vs 3%). All-cause 30-day mortality was 8% among IDU-associated cases versus 25% among non-IDU cases. CONCLUSIONS: A growing proportion of candidemia in East Tennessee is associated with IDU, posing an additional burden from the opioid crisis. The lower mortality among IDU-associated cases likely reflects in part the younger demographic; however, Candida endocarditis seen among approximately 40% underscores the seriousness of the infection and need for prevention.

Haemogregarine infections of three species of aquatic freshwater turtles from two sites in Costa Rica.

Twenty-five black river turtles (Rhinoclemmys funerea) and eight white-lipped mud turtles (Kinosternon leucostomum) from Selva Verde, Costa Rica were examined for haemoparasites. Leeches identified as Placobdella multilineata were detected on individuals from both species. All turtles sampled were positive for intraerythrocytic haemogregarines (Apicomplexa:Adeleorina) and the average parasitemia of black river turtles (0.34% ± 0.07) was significantly higher compared to white-lipped mud turtles (0.05% ± 0.006). No correlation was found between parasitemia and relative body mass of either species or between black river turtles from the two habitats. In addition, one scorpion mud turtle (Kinosternon scorpioides) examined from La Pacifica, Costa Rica, was positive for haemogregarines (0.01% parasitemia). Interestingly, parasites of the scorpion mud turtle were significantly smaller than those from the other two species and did not displace the erythrocyte nucleus, whereas parasites from the other two species consistently displaced host cell nuclei and often distorted size and shape of erythrocytes. This is the first report of haemogregarines in turtles from Central America and of haemogregarines in K. leucostomum, K. scorpioides, and any Rhinoclemmys species. Additional studies are needed to better characterise and understand the ecology of these parasites.