Epidemiology and Outcomes of Sporotrichosis: A Descriptive Real-World Analysis From a Global Cohort

Abstract

Background: Sporotrichosis is a dimorphic fungal infection of increasing global relevance. Although usually cutaneous or lymphocutaneous, disseminated disease occurs in immunocompromised hosts. Large-scale data on its epidemiology, treatment and outcomes remain limited.

Objectives: To characterise the clinical features, comorbidities, antifungal prescribing patterns and one-year mortality associated with sporotrichosis, with emphasis on patients with HIV and other forms of immunosuppression.

Patients/methods: We performed a retrospective global cohort study using the TriNetX Research Network. Adults (≥ 18 years) diagnosed with sporotrichosis were identified using ICD-9/10 codes (1995-2024). Demographics, comorbidities, laboratory parameters and antifungal prescriptions were analysed. The primary outcome was all-cause mortality at 1 year. Secondary outcomes included hospitalisation and admission to the intensive care unit (ICU).

Results: Among 2124 adults, the mean age was 52 years, and 56.5% were female. Nearly half of the cases originated internationally, with the southeastern United States accounting for the majority of domestic cases. Neoplasms (25%) and diabetes (11%) were the most common comorbidities. Lymphocutaneous disease was uncommon (9%), and disseminated infection occurred in 1% of cases. One-year mortality was 17%, with a higher risk among older adults and those with neoplasms, lymphocutaneous or disseminated infection or hyperferritinemia. Seventeen patients (0.8%) had HIV and were more likely to have pulmonary or disseminated disease. Itraconazole was the most commonly prescribed antifungal (52%), while the use of amphotericin B remained low (< 2%).

Conclusions: Sporotrichosis causes substantial global mortality. Outcomes appear driven by host factors and gaps in guideline-based management. Earlier recognition, optimised antifungal therapy, and use of inflammatory markers to guide risk stratification may improve outcomes and inform prevention strategies.

Keywords: HIV infections; United States; antifungal agents; mortality; mycoses; sporotrichosis.