Emerging Cases of Cat-Transmitted Sporotrichosis Driven by Sporothrix brasiliensis in Northeast Brazil.

Cat-transmitted sporotrichosis is caused by the emerging fungal pathogen Sporothrix brasiliensis and constitutes a significant public health issue that affects people living in resource-poor urban centers in Brazil. The lack of knowledge about transmission dynamics makes it difficult to propose public health policies to contain the advance of sporotrichosis. We describe the recent emergence of 1,176 cases of sporotrichosis in cats (2016 to 2021) in the metropolitan region of Recife, Brazil, leading to significant zoonotic transmission and an overwhelming occurrence of S. brasiliensis as the etiological agent. Most cases were from cats in the cities of Olinda (408/1,176; 34.70%), Jaboatão dos Guararapes (332/1,176; 28.23%), and Recife (237/1,176; 20.15%). Molecular typing using amplified fragment length polymorphism (EcoRI-GA/MseI-AG) revealed low polymorphic information content (PIC = 0.2499) and heterozygosity (H = 0.2928), typical of an outbreak scenario. Dendrogram and multivariate cluster analysis revealed that isolates from Pernambuco are closely related to Rio de Janeiro isolates. We report a substantial occurrence of MAT1-2 idiomorphs in the metropolitan region of Recife (0:60 ratio; χ2 = 60.000, P < 0.0001). The limited population differentiation and genetic diversity of the isolates from Pernambuco suggest a recent introduction, possibly via a founder effect, from the parental population in Rio de Janeiro. Our findings emphasize the critical importance of molecular surveillance of S. brasiliensis for outbreak response. A comprehensive one-health strategy is mandatory to control the spread of cat-transmitted sporotrichosis driven by S. brasiliensis, encompassing sanitary barriers, quick diagnosis, and treatment.

First occurrence of feline sporotrichosis in a metropolitan area of Central-West Brazil

ABSTRACT Sporotrichosis is a neglected mycosis that affects human and animal hosts, including domestic cats. In Brazil, its most frequently diagnosed etiological agent is Sporothrix brasiliensis. Zoonotic transmission of S. brasiliensis occurs via direct contact between an infected cat and a susceptible human host. Notification of confirmed cases of feline sporotrichosis is not mandatory in Brazil. The metropolitan area of Goiania city can be considered a silent area for the occurrence of feline sporotrichosis. In this context, voluntary reporting of feline sporotrichosis cases is recommended for all healthcare professionals. This study aimed to report the first occurrence of S. brasiliensis in a cat from the metropolitan area of Goiania city. Cytopathology, mycology, thermal dimorphism and calmodulin gene amplification tests were performed. The mycological and molecular biological diagnoses corresponded to S. brasiliensis. The etiological agent of zoonotic sporotrichosis was detected in the metropolitan area of Goiania city, and therefore there is a risk of the emergence of new cases of cats infected with S. brasiliensis and the occurrence of zoonotic transmission of this fungus.

Subcutaneous mycosis caused by filamentous basidiomycete Megasporoporia setulosa-first report of human infection.

Filamentous basidiomycetes are an emerging cause of human infection in tropical and subtropical regions. We report a case of subcutaneous infection caused by the shelf fungus, Megasporoporia setulosa, in an immunocompetent male. This is also the first report of human infection caused by this filamentous basidiomycete. Identification of the fungus could only be achieved by sequencing the ITS and LSU regions of rDNA. The patient recovered following surgery and treatment with amphotericin B and oral itraconazole. This report underscores the cross-kingdom pathogenicity of plant fungi and the importance of molecular tools for definitive identification of nonsporulating fungal species.

Chromoblastomycosis: A Case Series and Literature Review.

Chromoblastomycosis is a subcutaneous mycosis caused by a variety of dematiaceous fungi. Fonsecaea (F.) pedrosoi is the most common causative agent. Majority of cases have been reported from tropical and subtropical regions with rural and agricultural background. It is a chronic disease with low incidence of complications but is very refractory to therapies. This is a case series of 22 cases of chromoblastomycosis from two health-care facilities in India. Information regarding the history, clinical presentations, diagnostic methods, therapy, and outcome of treatment were retrieved. Preponderance was seen among the males and in the age group of 41-60 years. Manual and agricultural laborers were commonly affected. Lower extremities were the most common sites affected. Morphological patterns like verrucous plaque, psoriasiform plaque, and verrucous nodules were seen. Direct microscopy with potassium hydroxide (KOH) mount was positive in all the cases. Histopathology in all cases displayed suppurative granulomatous inflammation with pigmented fungal cells. Fungal culture was positive in 10 cases with F. pedrosoi being the commonest agent. Antifungal treatment alone was instituted in 10 cases, cryotherapy along with antifungal therapy was given in 9 cases, and surgical excision was done in 3 cases. Complete clinical cure was achieved in seven cases. Chromoblastomycosis is characterized by chronicity, diverse clinical presentations, and therapeutic recalcitrance. Direct KOH mount of the black dots forms an important bedside tool in the diagnosis. Long-term antifungal therapy along with adjuvant cryotherapy may be the best option for the management.

Sporothrix brasiliensis: Epidemiology, Therapy, and Recent Developments.

Sporotrichosis caused by Sporothrix brasiliensis is an emergent mycosis that is now a worldwide concern. One important step to sporotrichosis control is its correct treatment. However, limitations abound; thus, new antifungals, mainly focused on S. brasiliensis, are urgently needed. We performed a systematic review (following the PRISMA guideline) focused on (1) the global distribution of human and animal sporotrichosis by S. brasiliensis, especially outside of Brazil; (2) appraising therapies tested against this pathogen. We identified sporotrichosis caused by S. brasiliensis reported in five countries (Paraguay, Chile, Argentina, the United Kingdom, and the United States) in addition to Brazil, occurring on three continents, highlighting the epidemiological scenario in Argentina with an important increase in reported cases in recent years. Regarding the antifungal activity of drugs, 25 articles described the in vitro action of 20 unique chemicals and eight repurposed drugs against S. brasiliensis. Only five studies reported in vivo activity against S. brasiliensis (five drugs) using invertebrate and vertebrate models. Sporotrichosis caused by S. brasiliensis has a global impact and it is no longer specifically a Brazilian problem. We review the need for understanding the disease epidemiology, education of clinicians and of the populace, organization of health care delivery to respond to a spreading epidemic, and research on therapy for sporotrichosis.

Cytopathological study of cutaneous and subcutaneous mycosis presenting as soft-tissue swellings: A 5-year retrospective study from a tertiary care center in South India.

Objectives: Cutaneous and subcutaneous mycosis can mimic skin and soft-tissue neoplasms clinically and pose diagnostic challenge to pathologists on cytology. Since there are a limited number of studies on this topic from South India and etiological agents vary with geographic region, in this paper, we present clinical and cytological features of the same the objective of this study is to review and evaluate clinical and cytological features of subcutaneous and cutaneous mycosis with histopathological correlation wherever available. Materials and Methods: This was an observational and retrospective study of 5-year duration. All cases diagnosed as mycosis on cytology were retrieved from pathology records. Cytology slides along with special stains for fungus were reviewed. Review of histopathology slides and culture correlation was done whenever available. Statistical analysis was done using frequencies and percentages. Results: There were 39 cases during the study period (male - 34 and female - 5). On aspiration, all cases yielded pus; microscopy revealed necrotic debris in 39 cases, inflammatory infiltrate in 39 cases, epithelioid granulomas with multinucleated giant cells in 25 cases, and negative staining hyphal forms in 37 cases. Special stains for fungus showed septate hyphal forms suggestive of Aspergillus species in 34 cases, and yeast and pseudo hyphal forms of candida species in one case. A broad category as fungal infection without subtyping was given in four cases. Culture did not yield growth but fungus was identified on KOH mounts. Histopathology showed fungus in 13 of 14 cases done. Conclusion: Subcutaneous mycosis should be suspected when aspiration yields pus and appropriate special stains must be done. Aspergillus species was the most common etiological agent in our study.

Encapsulated eumycetoma caused by Biatriospora mackinnonii.

Eumycetoma is a chronic infection due to filamentous fungi. Herein, we report a case of eumycetoma presenting as a subcutaneous encapsulated lesion on the right leg with no previous traumatic implantation. From microscopic morphological characteristics and molecular analysis, the pathogenic fungal species were identified as Biatriospora mackinnonii. Surgical excision of the entire lesion was performed to reduce the fungal load and improve antifungal therapy response.

Ocular Sporotrichosis: Different Spectrums of Clinical Manifestations and a Review of the Literature.

We hereby describe two cases of patients with ocular sporotrichosis who presented with different spectrums of clinical manifestations. Both patients had an antecedent history of zoonotic and vegetative contact. The first patient presented with acute granulomatous anterior uveitis, and the second patient presented with granulomatous conjunctivitis. Patients received topical antibiotics, steroids, and cycloplegics. Systemic oral antifungals were added until full recovery was achieved. Both cases were treated without any episodes of relapse or recurrence.

Current Progress on Epidemiology, Diagnosis, and Treatment of Sporotrichosis and Their Future Trends.

Sporotrichosis, a human and animal disease caused by Sporothrix species, is the most important implantation mycosis worldwide. Sporothrix taxonomy has improved in recent years, allowing important advances in diagnosis, epidemiology, and treatment. Molecular epidemiology reveals that S. brasiliensis remains highly prevalent during the cat-transmitted sporotrichosis outbreaks in South America and that the spread of S. brasiliensis occurs through founder effects. Sporothrix globosa and S. schenckii are cosmopolitan on the move, causing major sapronoses in Asia and the Americas, respectively. In this emerging scenario, one-health approaches are required to develop a creative, effective, and sustainable response to tackle the spread of sporotrichosis. In the 21st century, it has become vital to speciate Sporothrix, and PCR is the main pillar of molecular diagnosis, aiming at the detection of the pathogen DNA from clinical samples through multiplex assays, whose sensitivity reaches remarkably three copies of the target. The treatment of sporotrichosis can be challenging, especially after the emergence of resistance to azoles and polyenes. Alternative drugs arising from discoveries or repositioning have entered the radar of basic research over the last decade and point to several molecules with antifungal potential, especially the hydrazone derivatives with great in vitro and in vivo activities. There are many promising developments for the near future, and in this review, we discuss how these trends can be applied to the Sporothrix-sporotrichosis system to mitigate the advance of an emerging and re-emerging disease.

Tattooing as a gateway to Sporothrix brasiliensis infection.

Recently, sporotrichosis caused by Sporothrix brasiliensis transmitted during tattooing process was described in the epicenter of the Brazilian epidemic sporotrichosis. We report a similar case of this mycosis in a patient recently tattooed, but probably infected by a sick cat instead of via a contaminated procedure. Clinical cure was attained after two months of oral itraconazole. In the hyperendemic S. brasiliensis regions of sporotrichosis, health professionals must be aware of atypical transmissions of this fungus.

A Spotlight on Sporothrix and Sporotrichosis.

Sporothrix (order Ophiostomatales) comprises a genus with 53 species, of which S. brasiliensis, S. schenckii, S. globosa, and S. luriei cause skin infections in humans and other mammals. Remarkably, closely related Sporothrix can follow different strategies in epidemics. For example, during the cat-transmitted sporotrichosis, there is an increased prevalence of the highly virulent S. brasiliensis in South America, whereas S. schenckii and S. globosa are generally associated with a sapronotic route worldwide. Therefore, species-specific types of transmission may require distinct public health strategies to mitigate the advance of sporotrichosis, including early diagnosis, isolation of new animal cases, administration of adequate antifungal therapy, and population education on the main aspects of the disease. Here, we shed light on the system Sporothrix-sporotrichosis covering hot topics in the epidemiology and diagnosis of this important neglected disease.

Intranasal clotrimazole spray 1% associated with oral itraconazole for nasal feline sporotrichosis: a case series.

Feline sporotrichosis is a major clinical problem among cats in Brazil and is also a neglected, but important, public health issue, due to its zoonotic potential. The nasal clinical form of the disease is particularly challenging, having treatment refractoriness and clinical signs relapse as common features. This case series study aimed to preliminarily describe the effects of the azolic antifungal drug, clotrimazole, as a topical 1% solution spray, together with per os itraconazole on inducing disease remission, as well as treatment tolerability and safety. Medical records of the Feline Medicine Service from the Universidade Federal Rural do Rio de Janeiro were reviewed, and 7 feline patients met the inclusion criteria (confirmatory diagnostic reached, available follow-up records, and use of intranasal clotrimazole 1% solution -1 spray per nostril every 24 hours- as adjunctive therapy to itraconazole - 100 mg/cat per os every 24 hours). Among these, 4 had a history of treatment refractoriness done until then. Follow-up records included clinical evaluation, along with complementary tests and owner reports on tolerability and occurrence of adverse reactions. All patients have undergone clinical remission within 60 days. Tolerability were satisfactory, and adverse reactions were only found on complementary tests (hepatic enzyme elevation), without clinical repercussion. The intranasal use of 1% clotrimazole solution has shown as a promising adjunctive therapy to itraconazole for feline nasal sporotrichosis, even in previous refractory cases.

A esporotricose felina é um dos principais problemas clínicos entre os gatos no Brasil. É também um problema de saúde pública negligenciado, mas importante, devido ao seu potencial zoonótico. A forma clínica nasal da doença é particularmente desafiadora, sendo a refratariedade ao tratamento e a recidiva dos sinais clínicos características comuns. Este estudo de série de casos teve como objetivo descrever preliminarmente o efeito da infusão intranasal do antifúngico azólicos clotrimazol, na forma de solução "spray" a 1%, com itraconazol dado via oral, na indução da remissão da doença em pacientes felinos, bem como a tolerabilidade e segurança do tratamento. Os registros médicos do Serviço de Medicina Felina da Universidade Federal Rural do Rio de Janeiro foram revisados, e 7 pacientes felinos atenderam aos critérios de inclusão (diagnóstico confirmatório alcançado, prontuários de acompanhamento disponíveis e uso de solução intranasal de clotrimazol 1% ­1 borrifada por narina a cada 24 horas­ como terapia adjuvante ao itraconazol ­100 mg / gato por via oral a cada 24 horas). Destes, 4 tinham história de refratariedade ao tratamento realizado até então. Os registros de acompanhamento incluíram avaliação clínica, realização de testes complementares e relatórios dos responsáveis pelos animais acerca da tolerabilidade e ocorrência de efeitos adversos. Todos os pacientes apresentaram remissão clínica em até 60 dias. A tolerabilidade e a segurança foram satisfatórias, sendo encontrados efeitos adversos apenas em exames complementares (elevação das enzimas hepáticas), sem repercussão clínica. O uso tópico de solução de clotrimazol a 1% mostrou-se uma promissora terapia adjuvante ao itraconazol dado por via oral para o tratamento da esporotricose nasal felina, mesmo em casos previamente refratários.

Subcutaneous phaeohyphomycosis caused by Aureobasidium Pullulans in an immunocompetent carpenter.

Phaeohyphomycosis refers to uncommon infections due to a large group of heterogeneous organisms called "dematiaceous fungi". Here, we report a rare case of subcutaneous phaeohyphomycosis in an immunocompetent carpenter, presenting as multiple verrucous and confluent papulo-nodules of the right leg, and likely due to traumatic inoculation. The pathogenic fungal species was identified as Aureobasidium pullulans, according to macroscopic and microscopic morphological characteristics of the colonies. Surgical excision of the entire lesion and adjunctive antifungal therapy was curative.

Sporotrichosis in Children: Case series and Narrative Review.

Purpose of Review: Pediatric sporotrichosis has not been sufficiently studied; this review aims to evaluate the risk and prognostic factors related to the development of sporotrichosis associated to this age group. Also, we want to evaluate the causes of the increased number of cases of sporotrichosis in the pediatric population such as environmental changes in endemic areas, the biodiversity, and virulence among the pathogenic clade causing sporotrichosis in different areas of the globe, and especially the progression of the zoonotic transmission of infections caused by Sporothrix brasiliensis infections, associated to zoonotic transmission in Brazil and other endemic sporotrichosis countries. Recent Findings: After evaluating a case series of 40 patients, we found that pediatric sporotrichosis in Mexico is mainly caused by Sporothrix schenckii which prevails in rural areas and is mainly sapronotically transmitted. In Brazil, the longest and largest pediatric sporotrichosis outbreak is caused by Sporothrix brasiliensis, etiologically related to sick cats, directly from lesions containing a high yeast cell burden. When affecting children S. schenckii and S. brasiliensis may cause distinct clinical manifestations especially in the onset of the disease and affected anatomical site. In Mexico, most of the patients are successfully treated with potassium iodide, whereas in Brazil, all patients respond to itraconazole. Summary: Sporothrix schenckii is the major etiologic agent in Mexico, being sapronotically transmitted, while in Brazil, Sporothrix brasiliensis is only transmitted by cats. In Mexico, the disease prevails in male patients (60%) from rural areas; in Brazil, the disease is more frequent in females (60%) from an urban region. Due to the zoonotic sporotrichosis outbreak in Brazil, the time of evolution seems to be shorter in Brazilian patients than in Mexican patients. Most Brazilian patients presented with facial lesions, including ocular involvement, while in Mexico, most of the children presented upper limbs involvement. In Mexico, treatment with potassium iodide in children was observed to induce faster remission than itraconazole, but controlled studies are lacking to evaluate this versus itraconazole, due to the low number of cases. A comparative study should be designed to evaluate the best and safest antifungal therapy for pediatric sporotrichosis. Supplementary Information: The online version contains supplementary material available at 10.1007/s12281-022-00429-x.

Cyphellophora laciniata: A new etiological agent of chromoblastomycosis.

Chromoblastomycosis is a chronic subcutaneous mycosis caused by traumatic inoculation of dematiaceous fungi especially in tropical and subtropical areas. Cyphellophora genus include melanized fungi reported as etiological agents of skin and nail infections. We report a 60-year-old male from the south of Mexico with a 40-year history of chromoblastomycosis caused by Cyphellophora laciniata. The isolated fungus was identified by sequencing of the internal transcribed spacer region of rDNA. The patient was treated with itraconazole and cryosurgery with unsatisfactory results.

CATastrophe: Response to the challenges of zoonotic sporotrichosis in southern Brazil.

BACKGROUND: In Brazil, zoonotic sporotrichosis became a national public health problem, with thousands of cases in the last decade in several regions of the country. In this context, health education activities are critical, especially in promoting early diagnosis and access to proper health care in sporotrichosis hyperendemic areas. Therefore, we report the implementation of a public specialised reference service (SRS) for diagnosis and treatment of sporotrichosis in southern Brazil. We evaluated the impact of the SRS on diagnostic confirmation and speed of diagnosis. METHODS: The SRS was implemented in Rio Grande City. We implemented a public service to promote the correct diagnosis, treatment and follow-up of human sporotrichosis cases. To study the impact of implementing SRS, the annual number of cases and the period between the appearance of lesions until diagnosis were compared, using prior data and that post-implementation. RESULTS: The implementation of the SRS directly benefited almost 50 patients in only four years, with the collaboration of almost 50% of the local health groups, together with an increase of more than 200% in diagnosis confirmation and speed of diagnosis, showing the reach, impact and importance of the SRS. CONCLUSION: The impact on the individual and collective health of the local population highlights the value of this public health approach in facing the epidemiological threat of zoonotic sporotrichosis.

Influence of iron on growth and on susceptibility to itraconazole in Sporothrix spp.

We evaluated the growth and the susceptibility to oxidative stress of Sporothrix spp., exposed to different iron concentrations in culture medium, and the susceptibility of Sporothrix spp. to itraconazole, alone and in combination with to the iron chelator deferasirox. The results showed that the growth of S. brasiliensis isolates was more affected by iron availability in comparison to S. schenckii, but both fungal species conidia became more prone to oxidative stress when iron was added to culture medium. Conversely, the combination of itraconazole and deferasirox only resulted in synergism against a minority of S. schenckii isolates.

Diagnosis and Management of Fungal Neglected Tropical Diseases In Community Settings-Mycetoma and Sporotrichosis.

BACKGROUND: This is a retrospective, analytic observational study where we describe cases of sporotrichosis and mycetoma from Acapulco General Hospital and Community Dermatology Mexico C.A. over 25 years. Analysis of environmental features that favour the development of such diseases has been made, as well as the limitations in the study and treatment of such diseases in resource poor settings. METHODS: We reviewed the information on 76 sporotrichosis and 113 mycetoma patients out of a total of 14,000 consultations at Acapulco General Hospital and from Community Dermatology clinics. We analysed the epidemiological and mycological characteristics and the investigations used for diagnosis such as direct examination, culture, intradermal test reactions, and biopsy. RESULTS: In total 91 confirmed cases of actinomycetoma, 22 of eumycetoma and 76 of sporotrichosis have been identified including diagnostic studies for both diseases and their treatment. DISCUSSION: The results obtained have been analysed and interpreted in patients with mycetoma and sporotrichosis in the state of Guerrero, México, along with limitations in their management in areas with limited economic and logistical resources. The prevalence of mycetoma in our setting is compared with other centres where patients from all over the country are seen. The possible causes for variations in prevalence in specific areas has been looked for, in one of the poorest states of the Mexican Republic.

Exophiala psychrophila: A new agent of chromoblastomycosis.

Chromoblastomycosis is a chronic cutaneous and subcutaneous mycosis, is caused by dematiaceous fungi, the most frequently implicated are Fonsecaea, Phialophora, Cladophialophora, Rhinocladiella and Exophiala. We report a woman who was treated before with mycological cure, but she experience a relapse requiring treatment again. Direct microscopic examination and skin biopsy with culture were necessary to identify a Exophiala psychrophila, and for our knowledge this is the first case reported.