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.

Multifocal Sporotrichosis Associated with Armadillo Hunting in Midwest Brazil: An In-Depth Case Study and Comprehensive Literature Analysis.

Sporotrichosis is a globally distributed subcutaneous mycosis caused by dimorphic Sporothrix species commonly found in soil, mosses, and decaying plant matter. The lymphocutaneous manifestation, historically associated with occupational activities and sapronotic transmission, has recently been observed to also occur through animal contact, particularly notable in Brazil. We describe a rare case of lymphocutaneous sporotrichosis with simultaneous pulmonary complications resulting from the scratching of a southern three-banded armadillo, Tolypeutes matacus, primarily inhabiting the arid forests of South America's central region. Speciation using multiplex quantitative polymerase chain reaction (qPCR) established the etiological agent as S. schenckii s. str., while amplified fragment length polymorphism (AFLP) analysis unveiled a novel genotype circulating in the Midwest of Brazil. The patient received treatment with itraconazole (200 mg/day) for two months, leading to substantial clinical improvement of cutaneous and pulmonary symptoms. This case highlights the critical role of animal-mediated transmission in sporotrichosis epidemiology, particularly within regions with diverse armadillo species. The unusual epidemiology and genetic characteristics of this case emphasize the need for enhanced awareness and diagnostic vigilance in atypical sporotrichosis presentations.

Sporotrichosis Cluster in Domestic Cats and Veterinary Technician, Kansas, USA, 2022.

We describe a feline sporotrichosis cluster and zoonotic transmission between one of the affected cats and a technician at a veterinary clinic in Kansas, USA. Increased awareness of sporotrichosis and the potential for zoonotic transmission could help veterinary professionals manage feline cases and take precautions to prevent human acquisition.

Primer aislamiento de Sporothrix brasiliensis en un caso humano de esporotricosis en Chile. Un hongo emergente y preocupante / First isolation of Sporothrix brasiliensis in a human case of sporotrichosis in Chile. An emerging and worrisome fungus

Se describe el aislamiento de Sporothrix brasiliensis desde una biopsia de piel de un caso humano de esporotricosis linfocutánea, en la región de Valparaíso, Chile. Esta especie es la más virulenta del género y es de transmisión zoonótica, desde los gatos a los humanos. Hasta ahora, solo se había publicado un brote por esta especie en gatos domésticos y asilvestrados en el extremo sur de Chile, por lo que este aislamiento, en una mujer residente de un sector densamente poblado de la Región de Valparaíso, constituye una preocupación por su eventual diseminación hacia otros gatos y la población general.

The isolation of Sporothrix brasiliensis from a skin biopsy of a human case of lymphocutaneous sporotrichosis in the region of Valparaíso, Chile is described. This species is the most virulent of the genus and is zoonotic in transmission from cats to humans. Until now, only one outbreak of this species has been published in domestic and feral cats in the extreme south of Chile, so this isolation in a woman residing in a densely populated sector of the fifth region is a concern for its eventual spread to other cats and the general population.

The spread of cat-transmitted sporotrichosis due to Sporothrix brasiliensis in Brazil towards the Northeast region.

BACKGROUND: Sporotrichosis is a worldwide subcutaneous mycosis caused by Sporothrix spp. In the past, this infection was associated with armadillo hunting, horticulturists, miners, and gardeners, being considered an implantation mycosis acquired by plant debris injury. Nevertheless, since the late nineties, it has been considered a zoonotic disease in Brazil. Here we report a case series of 121 patients with cat-transmitted sporotrichosis seen in Northeast Brazil. METHODOLOGY/PRINCIPAL FINDINGS: Patient's demographic, clinical data, and length of treatment were recorded. In addition, a mycological examination and further PCR confirmation of species identification were performed. One hundred and twenty two patients were diagnosed with subcutaneous sporotrichosis from October 2016 to December 2019, while PCR revealed that 71 of them were due to S. brasiliensis. The majority of the individuals were female (n = 86; 70.5%). Patient's age ranged from 5 to 87 years old. The clinical forms found were lymphocutaneous (58.2%) and fixed cutaneous (39.4%). Interestingly, 115 patients reported previous contact with cats diagnosed with sporotrichosis. Patients were successfully treated with itraconazole and potassium iodide. CONCLUSIONS/SIGNIFICANCE: Our study adds important contributions for the investigation of the spread of cat-transmitted subcutaneous sporotrichosis in Brazil, specifically towards the Northeast region of a continental-size country. It will also help clinicians to be aware of the existence and importance to accurately diagnose sporotrichosis and treat patients with this infectious disease in the lowest income region of Brazil.

Can cats cause colossal contagious cutaneous carbuncles?

Sporothrix spp. cause the most common deep fungal skin infections in Brazil and this is related to infected cats. Transmission is traditionally from organic material/plants but can also be zoonotic. Culture of a skin biopsy is the golden standard for determination. Treatment with oral itraconazole approaches up to 95% efficacy in patients with cutaneous sporotrichosis.

Molecular-based assessment of diversity and population structure of Sporothrix spp. clinical isolates from Espírito Santo-Brazil.

BACKGROUND: Sporotrichosis is a subcutaneous mycosis caused by Sporothrix species that affects humans and animals. Little information on the genetic diversity and population structure of the pathogen is available for Brazil, which is needed to design effective strategies to tackle the advance of sporotrichosis in endemic areas. OBJECTIVES: We assessed the genetic diversity and mating-type distribution of Sporothrix isolates recovered from human and feline cases of sporotrichosis in Espírito Santo-Brazil to better understand the population structure, epidemiology and diversification of this pathogen, as well as to explore the possible routes of transmission involved in the ongoing outbreaks. METHODS: In all, 75 Sporothrix isolates were identified with phenotypic characteristics. Then, fungal DNA extraction was performed, and the species-specific PCR technique was applied, using markers directed to the calmodulin gene. The mating-type idiomorph of species was identified by PCR using primers targeting the MAT1-1 and MAT1-2 loci. RESULTS: Among the 75 Sporothrix isolates, 76% were confirmed as S brasiliensis and 24% as S schenckii sensu stricto. S brasiliensis was more prevalent in the metropolitan area and S schenckii s. str. in the mountainous region of the state. In both species, the presence of the two sexual idiomorphs was detected, suggesting that they are heterothallic species. CONCLUSIONS: Our data suggest that sporotrichosis takes on an epidemic-urban character involving S brasiliensis. This species in Espírito Santo is likely to originate from Rio de Janeiro, as most isolates harbour the same MAT 1-2 locus. We confirm that S brasiliensis has significantly broadened its area of occurrence, an essential feature of emerging pathogens.

Sporotrichosis in Brazil: Animals + humans = one health / Esporotricosis en Brasil: animales + humanos = una sola salud

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[Hospitalizations and deaths related to sporotrichosis in Brazil (1992-2015)]. / Hospitalizações e óbitos relacionados à esporotricose no Brasil (1992-2015).

Sporotrichosis is a subcutaneous mycosis with global distribution, and patients generally receive outpatient treatment. Since 1998 there has been an increase in cases in the state of Rio de Janeiro, Brazil, mainly via zoonotic transmission involving cats. Patients coinfected with the human immunodeficiency virus (HIV) often require hospitalization and evolve to death. This study analyzes and describes data from 1992 to 2015 obtained from the database of the Brazilian Unified National Health System (SUS). There were 782 hospitalizations and 65 deaths in Brazil. Six percent of the hospitalizations and 40% of the deaths involved coinfection with HIV. There were 250 hospitalizations and 36 deaths in Rio de Janeiro, with a progressive increase over the course of the period. The states of São Paulo and Goiás also showed high numbers. Men, non-whites, and individuals with low schooling evolved more frequently to death. In conclusion, sporotrichosis is associated with hospitalizations and deaths throughout Brazil, especially in the state of Rio de Janeiro.

A esporotricose é uma micose subcutânea de distribuição global e, em geral, os pacientes são tratados ambulatorialmente. Desde 1998, observa-se aumento dos casos no Estado do Rio de Janeiro, Brasil, especialmente por transmissão zoonótica envolvendo gatos. Os pacientes coinfectados pelo vírus da imunodeficiência humana (HIV), muitas vezes, necessitam de hospitalizações e evoluem a óbito. Este estudo analisa e descreve dados de 1992 a 2015, provenientes de bancos de dados do Sistema Único de Saúde. No Brasil, ocorreram 782 hospitalizações e 65 óbitos. Em 6% das hospitalizações e 40% dos óbitos, havia coinfecção pelo HIV. No Rio de Janeiro, foram 250 hospitalizações e 36 óbitos, com aumento progressivo, ao longo do período. Destacaram-se, ainda, São Paulo e Goiás. Homens, não brancos, com baixa escolaridade evoluíram mais frequentemente a óbito. Conclui-se que a esporotricose está associada a hospitalizações e óbitos em todo o Brasil, com destaque para o Rio de Janeiro.

La esporotricosis es una micosis subcutánea de distribución global y, en general, los pacientes son tratados ambulatoriamente. Desde 1998, se observa un aumento de los casos en el estado de Río de Janeiro, Brasil, principalmente por transmisión zoonótica implicando gatos. Los pacientes coinfectados por el virus de la inmunodeficiencia humana (VIH), muchas veces, necesitan de hospitalizaciones y evolucionan a óbito. Este estudio analiza y describe datos de 1992 a 2015, provenientes de bancos de datos del Sistema Único de Salud (SUS). En Brasil, se produjeron 782 hospitalizaciones y 65 óbitos. En un 6% de las hospitalizaciones y 40% de los óbitos, había coinfección por el VIH. En Río de Janeiro, fueron 250 hospitalizaciones y 36 óbitos, con un aumento progresivo a lo largo del período. Se destacaron, incluso, São Paulo y Goiás. Hombres, no blancos, con baja escolaridad evolucionaron más frecuentemente a óbito. Se concluye que la esporotricosis está asociada a hospitalizaciones y óbitos en todo Brasil, destacando Río de Janeiro.

Hospitalizações e óbitos relacionados à esporotricose no Brasil (1992-2015) / Hospitalizations and deaths related to sporotrichosis in Brazil (1992-2015) / Hospitalizaciones y óbitos relacionados con la esporotricosis en Brasil (1992-2015)

Resumo: A esporotricose é uma micose subcutânea de distribuição global e, em geral, os pacientes são tratados ambulatorialmente. Desde 1998, observa-se aumento dos casos no Estado do Rio de Janeiro, Brasil, especialmente por transmissão zoonótica envolvendo gatos. Os pacientes coinfectados pelo vírus da imunodeficiência humana (HIV), muitas vezes, necessitam de hospitalizações e evoluem a óbito. Este estudo analisa e descreve dados de 1992 a 2015, provenientes de bancos de dados do Sistema Único de Saúde. No Brasil, ocorreram 782 hospitalizações e 65 óbitos. Em 6% das hospitalizações e 40% dos óbitos, havia coinfecção pelo HIV. No Rio de Janeiro, foram 250 hospitalizações e 36 óbitos, com aumento progressivo, ao longo do período. Destacaram-se, ainda, São Paulo e Goiás. Homens, não brancos, com baixa escolaridade evoluíram mais frequentemente a óbito. Conclui-se que a esporotricose está associada a hospitalizações e óbitos em todo o Brasil, com destaque para o Rio de Janeiro.

Abstract: Sporotrichosis is a subcutaneous mycosis with global distribution, and patients generally receive outpatient treatment. Since 1998 there has been an increase in cases in the state of Rio de Janeiro, Brazil, mainly via zoonotic transmission involving cats. Patients coinfected with the human immunodeficiency virus (HIV) often require hospitalization and evolve to death. This study analyzes and describes data from 1992 to 2015 obtained from the database of the Brazilian Unified National Health System (SUS). There were 782 hospitalizations and 65 deaths in Brazil. Six percent of the hospitalizations and 40% of the deaths involved coinfection with HIV. There were 250 hospitalizations and 36 deaths in Rio de Janeiro, with a progressive increase over the course of the period. The states of São Paulo and Goiás also showed high numbers. Men, non-whites, and individuals with low schooling evolved more frequently to death. In conclusion, sporotrichosis is associated with hospitalizations and deaths throughout Brazil, especially in the state of Rio de Janeiro.

Resumen: La esporotricosis es una micosis subcutánea de distribución global y, en general, los pacientes son tratados ambulatoriamente. Desde 1998, se observa un aumento de los casos en el estado de Río de Janeiro, Brasil, principalmente por transmisión zoonótica implicando gatos. Los pacientes coinfectados por el virus de la inmunodeficiencia humana (VIH), muchas veces, necesitan de hospitalizaciones y evolucionan a óbito. Este estudio analiza y describe datos de 1992 a 2015, provenientes de bancos de datos del Sistema Único de Salud (SUS). En Brasil, se produjeron 782 hospitalizaciones y 65 óbitos. En un 6% de las hospitalizaciones y 40% de los óbitos, había coinfección por el VIH. En Río de Janeiro, fueron 250 hospitalizaciones y 36 óbitos, con un aumento progresivo a lo largo del período. Se destacaron, incluso, São Paulo y Goiás. Hombres, no blancos, con baja escolaridad evolucionaron más frecuentemente a óbito. Se concluye que la esporotricosis está asociada a hospitalizaciones y óbitos en todo Brasil, destacando Río de Janeiro.

Sporotrichosis between 1898 and 2017: The evolution of knowledge on a changeable disease and on emerging etiological agents.

The description of cryptic species with different pathogenic potentials has changed the perspectives on sporotrichosis. Sporothrix schenckii causes a benign chronic subcutaneous mycosis, Sporothrix brasiliensis is highly virulent, and Sporothrix globosa mainly causes fixed cutaneous lesions. Furthermore, S. brasiliensis is the prevalent species related to cat-transmitted sporotrichosis. Sources of infection, transmission, and distribution patterns also differ between species, and variability differs between species because of different degrees of clonality. The present review article will cover several aspects of the biology of clinically relevant agents of sporotrichosis, including epidemiological aspects of emerging species. Genomic information of Sporothrix spp. is also discussed. The cell wall is an essential structure for cell viability, interaction with the environment, and the host immune cells and contains several macromolecules involved in virulence. Due to its importance, aspects of glycosylation and cell wall polysaccharides are reviewed. Recent genome data and bioinformatics analyses helped to identify specific enzymes of the biosynthetic glycosylation routes, with no homologs in mammalian cells, which can be putative targets for development of antifungal drugs. A diversity of molecular techniques is available for the recognition of the clinically relevant species of Sporothrix. Furthermore, antigens identified as diagnostic markers and putative vaccine candidates are described. Cell-mediated immunity plays a key role in controlling infection, but Sporothrix species differ in their interaction with the host. The adaptive branch of the immune response is essential for appropriate control of infection.

Domestic feline contribution in the transmission of Sporothrix in Rio de Janeiro State, Brazil: a comparison between infected and non-infected populations.

BACKGROUND: Sporotrichosis is a neglected zoonosis caused by pathogenic fungi belonging to the Sporothrix schenckii complex. In Rio de Janeiro state, this disease reached an epidemic status with over 4700 domestic felines and around 4000 humans affected since the mid-90s. The present study evaluated clinical and epidemiological aspects and also the frequency of colonization and infection by these fungi in healthy cats and among those with suspicious cutaneous lesions, inhabiting four Rio de Janeiro state distinct areas. RESULTS: Three hundred and seventy-one cats were included in two groups: 175 healthy cats [CRG] and 196 cats showing lesions suggesting sporotrichosis [SSG]. Mycological diagnosis allowed SSG animals to be divided in positive [104 cats; +SG] and negative [92 cats; -SG] groups. Nails, oral mucosa and lesions swabs were submitted to culture and potential colonies were subculture for micromorphologycal analysis, dimorphism and molecular tests. In the CRG, only one cat was colonized in the oral cavity [0.57%]; in the -SG group, four animals showed colonization of the nail and/or oral cavity [4.3%]; while the highest frequency of colonization [39.4%] was observed in the +SG. All molecularly typed isolates were identified as S. brasiliensis. CONCLUSION: The results obtained here indicate that healthy cats have a minor role in sporotrichosis transmission within the state of Rio de Janeiro. Conversely, a higher participation of diseased feline in sporotrichosis transmission was evidenced, especially by the colonization of their oral cavity. Sporothrix brasiliensis equally affects and colonizes animals from distinct Rio de Janeiro state areas. Thus, we hypothesize that sporotrichosis is a uniform endemic throughout the state, whose transmission depends mainly on the contact with cats with sporotrichosis. Since Rio de Janeiro displays a world unique epidemic model of the disease, not fully understood, data on the infected and non-infected animals can be of major importance for future strategies of sporotrichosis prevention and control. Finally, considering the importance of the current concept of "one health", the experience here observed can be helpful for distinct epizootias and/or zoonosis.

The Current Status of Feline Sporotrichosis in Malaysia.

Feline sporotrichosis has been reported in Malaysia since the 1990's. Since then, studies have revealed that clinical clade D, Sporothrix schenckii sensu stricto, of a single clonal strain is the most common cause of this disease in Malaysia. The prevalence of a single clonal strain from a clinical clade was never before reported in Asia in a specific geographical niche. This raises the possibility of a process of purifying selection and subsequent clonal proliferation. While agricultural practices may serve as the selective pressure, direct causality has yet to be established. Studies into the thermo-tolerability of the Malaysian clonal strain of S. schenckii sensu stricto revealed that a small minority of clinical isolates have the capacity to grow at 37℃, while the majority displayed low susceptibility to commonly used antifungals in clinical practice, such as itraconazole (ITZ) and terbinafine (TRB). Despite unestablished breakpoints, suspected resistance (MIC > 4 mg/mL) towards amphotericin B (AMB) and fluconazole (FLC) was recorded in the isolates. This explains the often lack of clinical response in feline patients treated with recommended doses of antifungals, including ITZ. Coupled with the potential zoonotic transmission to clients and veterinarians, protracted treatment period, and subsequent cost of treatment, prognosis of feline sporotrichosis is often regarded to be poor. The use of a higher dose of ITZ has been reported, and an adoption of this high-dose treatment regime is reported in this manuscript, with complete cure achieved in cases of recalcitrant and/or unresponsive feline sporotrichosis, which would otherwise be euthanized.

Sporotrichosis among children of a hyperendemic area in Peru: an 8-year retrospective study.

BACKGROUND: The clinical and epidemiologic characteristics of pediatric sporotrichosis are poorly understood. OBJECTIVE: To describe the incidence and clinical characteristics of cases of sporotrichosis in children 14 years of age and younger reported in Abancay from 2004 to 2011, stratified according to age. METHODS: We performed a retrospective review of pediatric patients 14 years of age and younger who were diagnosed with sporotrichosis in a referral center at Abancay, a poor area located in the south central highlands of Peru, to estimate the incidence rates (per 100,000 person-years) according to age and sporotrichosis type (lymphocutaneous and fixed), and clinical characteristics of these patients. RESULTS: Of the 240 pediatric cases identified, 131 (54.6%) were male. The median age at baseline was 6 years. The mean incidence rate was 81.4 cases per 100,000 person-years for the period from 2004 to 2011, and was highest among children ranging in age from 5-9 years. The incidence of lymphocutaneous sporotrichosis and fixed sporotrichosis was 55 and 27 cases per 100,000 person-years, respectively, and the face was the most commonly affected anatomic site. Ninety-six of the 240 patients (40%) reported previous contact with cats, and 46 (19.2%) had a clear history of traumatic inoculation with plant material. The therapeutic response to treatment with potassium iodide was satisfactory. CONCLUSION: In this retrospective study, we described a high incidence of sporotrichosis in children in the south central highlands of Peru, which increased with age. Lymphocutaneous sporotrichosis was the more common type with an incidence rate twice that of the fixed type. The face was the most commonly affected anatomic site, and infection appeared to be acquired predominantly through contact with cats.

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.

Origin and distribution of Sporothrix globosa causing sapronoses in Asia.

PURPOSE: The aim of the study was to evaluate the main sources and epidemiological patterns and speculate on the evolutionary origin of Sporothrix globosa in Asia. METHODOLOGY: Case and case series literature on sporotrichosis in Asia from January 2007 onwards were reviewed using meta-analysis. Phylogenetic analysis of relevant S. globosa was carried out on the basis of concatenated sequences of ITS, TEF3 and CAL. A haplotype network of CAL sequences of 281 Sporothrix isolates was analysed to determine the population structure of S. globosa. RESULTS: Nearly all cases of sporotrichosis caused by S. globosa in Asia were human. In contrast to the remaining pathogenic Sporothrix species, feline transmission was exceptional; nearly all regional cat-associated cases were caused by Sporothrix schenckii. While the latter species was highly variable and showed recombination, S. globosa seemed to be a clonal offshoot, as was Sporothrix brasiliensis. The origin of the segregants was located in an area of high variability in S. schenckii with a relatively high frequency of Asian strains. CONCLUSION: In Asia, S. globosa was the prevalent species. The low diversity of S. globosa suggested a recent divergence with a founder effect of low variability from the variable ancestral species, S. schenckii.

Refractory sporotrichosis due to Sporothrix brasiliensis in humans appears to be unrelated to in vivo resistance.

Sporotrichosis is a subacute to chronic infection caused by members of the Sporothrix schenckii complex. Itraconazole is the first choice antifungal drug for treating this infection, with terbinafine and potassium iodide as alternatives and amphotericin B used in cases of severe infections. Correlation of antifungal susceptibility data with the clinical outcome of the patients is scarce. The aim of this study was to correlate clinical and mycological data in patients with refractory sporotrichosis. In this work, antifungal susceptibilities, determined according to the reference M38-A2 CLSI protocol, of 25 Sporothrix strains, isolated from seven human cases of sporotrichosis with adversities in the treatment, are presented. Tested drugs included itraconazole, ketoconazole, posaconazole, voriconazole, terbinafine, and amphotericin B. Fungi were identified using the T3B PCR fingerprinting. This method identified all strains as Sporothrix brasiliensis and also demonstrated a high degree of similarity between the strains. In general, voriconazole was ineffective against all strains, and elevated minimal inhibitory concentrations (MICs) were observed for amphotericin B. High itraconazole and terbinafine MICs were not observed in S. brasiliensis isolates from patients of this study. Moreover, a significant increase in itraconazole and terbinafine MIC values from strains isolated from the same patient in different periods was not observed. The results suggest that the antifungal susceptibility to terbinafine and itraconazole determined by the reference method does not play an important role in therapeutic failure of sporotrichosis and that acquisition of resistance during prolonged antifungal treatment is not likely to occur in S. brasiliensis.