Sporotrichosis in Rio de Janeiro, Brazil: Sporothrix brasiliensis is associated with atypical clinical presentations

PLoS Negl Trop Dis. 2014 Sep 18;8(9):e3094. doi: 10.1371/journal.pntd.0003094. eCollection 2014 Sep.

Abstract

Background: There have been several recent changes in the taxonomy of Sporothrix schenckii as well as new observations regarding the clinical aspects of sporotrichosis. In this study, we determined the identification of the Sporothrix species associated with both classic and unusual clinical aspects of sporotrichosis observed in the endemic area of sporotrichosis in Rio de Janeiro, Brazil.

Methodology/principal findings: To verify whether S. brasiliensis is associated with clinical manifestations of sporotrichosis, a cross-sectional study was performed in which Sporothrix isolates from 50 patients with different clinical manifestations were analyzed and their isolates were studied by phenotypic and genotypic methods. Data from these patients revealed a distinct clinical picture and therapeutic response in infections caused by Sporothrix brasiliensis (n = 45) compared to patients with S. schenckii sensu stricto (n = 5). S. brasiliensis was associated with disseminated cutaneous infection without underlying disease, hypersensitivity reactions, and mucosal infection, whereas patients with S. schenckii presented with less severe and more often localized disease, similar to the majority of previously described sporotrichosis cases. Interestingly, S. brasiliensis-infected patients overall required shorter durations of itraconazole (median 16 weeks) compared to the individuals with S. schenckii (median 24 weeks).

Conclusions/significance: These findings suggest that Sporothrix species are linked to different clinical manifestations of sporotrichosis and that S. brasiliensis is effectively treated with oral itraconazole.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antifungal Agents / administration & dosage
  • Antifungal Agents / therapeutic use
  • Brazil / epidemiology
  • Cross-Sectional Studies
  • Drug Administration Schedule
  • Female
  • Genotype
  • Humans
  • Itraconazole / administration & dosage
  • Itraconazole / therapeutic use
  • Male
  • Species Specificity
  • Sporothrix / classification*
  • Sporotrichosis / drug therapy
  • Sporotrichosis / epidemiology
  • Sporotrichosis / parasitology*
  • Sporotrichosis / pathology

Substances

  • Antifungal Agents
  • Itraconazole

Grant support

This work was supported by Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro [E-26/110.619/2012 and E-26/103.157/2011 to RMZO], Conselho Nacional de Desenvolvimento Científico e Tecnológico [350338/2000-0 to RMZO], Papes/FIOCRUZ - Papes VI(APQ)[407693/2012-2 to RMZO], and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior [2445/11-5 to MMEdO]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.