We herein present a Brazilian guideline for the management of feline sporotrichosis, a mycosis caused by Sporothrix brasiliensis. This guideline is an effort of a national technical group organized by the Working Group on Sporothrix and Sporotrichosis of the International Society for Human and Animal Mycology (ISHAM). This publication intends to provide information on clinicalepidemiological aspects of this zoonosis, as well as a literature revision. Moreover, it gives some practical information on diagnosis and treatment of feline sporotrichosis. It also contains information that can be helpful for the prevention and control of S. brasiliensis transmission.

Although atopy and blood eosinophilia both influence exhaled nitric oxide (eNO) measurements, no study has quantified their single or combined effect. We assessed the combined effect of atopy and blood eosinophilia on eNO in unselected schoolchildren. In 356 schoolchildren (boys/girls: 168/188) aged 9.0-11.5 yr, we determined eNO, total serum IgE, blood eosinophil counts and did skin prick tests (SPT) and spirometry. Parents completed a questionnaire on their children's current or past respiratory symptoms. Atopy was defined by a SPT >3 mm and eosinophilia by a blood cell count above the 80th percentile (>310 cells/ml). eNO levels were about twofold higher in atopic-eosinophilic subjects than in atopic subjects with low blood eosinophils [24.3 p.p.b. (parts per billion) vs. 14.1 p.p.b.] and than non-atopic subjects with high or low blood eosinophils (24.3 p.p.b. vs. 12.2 p.p.b. and 10.9 p.p.b.) (p <0.001 for both comparisons). The additive effect of atopy and high eosinophil count on eNO levels remained unchanged when subjects were analyzed separately by sex or by a positive history of wheeze (n=60), respiratory symptoms other than wheeze (n=107) or without respiratory symptoms (n=189). The frequency of sensitization to Dermatophagoides (Dpt or Dpf) was similar in atopic children with and without eosinophilia (66.2% and 67.4%, respectively); eosinophilia significantly increased eNO levels in Dp-sensitized children as well in children sensitized to other allergens. In a multiple linear regression analysis, eNO levels were mainly explained by the sum of positive SPT wheals and a high blood eosinophil count (t=4.8 and 4.3, p=0.000), but also by the presence of respiratory symptoms (especially wheeze) and male sex (t=2.6 and 2.0, p=0.009 and 0.045, respectively). Measuring eNO could be a simple, non-invasive method for identifying subjects at risk of asthma in unselected school populations.

American Thoracic Society (ATS) guidelines recommend to refrain from spirometry or exercise before measuring fractional exhaled nitric oxide (FENO) because forced breathing maneuvers might influence FENO values. However the few studies already reported in children have given conflicting results. The aim of the study was to observe to what extent spirometry or exercise could affect FENO in asthmatic children. Twenty-four asthmatic children (mean age 12.8 yr) were enrolled. Measurements of FENO were performed before and 5, 15, 30, 45 and 60 min after spirometry or a 6-min walk test, on two separate days in random order. Geometric mean FENO at baseline was 25.6 parts per billion (ppb) before spirometry and 23.5 ppb before exercise. A small drop of FENO to 24.2 and 23.7 ppb was found 5 and 15 min after spirometry (both p = 0.04). After exercise, FENO values showed a larger drop to 18.5 ppb after 5 min and 20.7 ppb after 15 min (p < 0.001; p = 0.004 respectively). Changes in FENO occurred after exercise irrespective of baseline FENO and values returned to baseline within 30 min. We conclude that both spirometry and exercise affect FENO in asthmatic children. As the changes after exercise may lead to erroneous interpretations, children should refrain from physical exercise during at least 30 min before FENO measurements.

Lay Summary Cat-transmitted sporotrichosis is a zoonosis in geographic expansion from Brazil to other Latin American countries, and considered a public health problem. Data suggest that transmission can occur through the sneeze of an infected cat. The One Health approach is necessary to control the disease.

The mite Demodex injai causes demodicosis, an uncommon, chronic, and recurrent parasitic dermatopathy in dogs. Demodicosis is characterized by an excessive proliferation of the Demodex injai mite in the pilosebaceous unit. Typically, demodicosis occurs in adults, and is associated with an underlying disease or a specific host immunodeficiency. Here, we describe the epidemiological, clinical, dermatological, and therapeutic aspects of Demodex injai demodicosis in dogs (n=8) at the Hospital Unit for Companion Animals of the Pontifical Catholic University of Paraná in Brazil. The affected dogs were predominantly purebred, had a mean age of eight years, and showed no gender predisposition. The lesions were predominantly alopecic and erythematous-desquamatory, associated with follicular dyskeratosis and greasiness of the coat, and mainly affected the facial region, in addition to the back and limbs. The animals had a history of allergic, dyskeratotic, endocrine, neoplastic, and immunosuppressive comorbidities. The diagnosis of demodicosis was based on multiple skin scrapings, trichogram, and acetate tape impression of the lesion areas, macroscopic observation, and morphological characterization of the mite. Macrocyclic lactones were effectively used for treatment in most cases; however, improvement of the condition may be related to adjunctive treatment of the underlying disease. Key words: Canine. Clinical signs. Demodectic mange. Dermatopathy. Mites. ResumoDemodiciose provocada pelo ácaro Demodex injai é uma dermatopatia parasitária, crônica, recorrente, incomum em cães, caracterizada pela proliferação excessiva do ácaro na unidade pilossebácea. É frequentemente caracterizada como de surto adulto, generalizada e associada a uma doença de base ou a uma imunodeficiência específica inerente ao hospedeiro. O presente relato tem como objetivo descrever os aspectos epidemiológicos, clínico-dermatológicos e o tratamento da demodiciose por Demodex injai em cães (n=8) atendidos na Unidade Hospitalar para Animais de Companhia da Pontifícia Universidade Católica do Paraná, em São José dos Pinhais, Paraná, Brasil. Os animais acometidos apresentaram idade média de oito anos, predominantemente de raças puras e não houve predisposição sexual. As lesões tinham características predominantemente alopécicas e eritêmato-descamativas, associadas à disqueratose folicular e untuosidade da pelagem, acometendo principalmente a região da face, mas também o dorso e os membros. Os animais apresentavam histórico de comorbidades alérgicas, disqueratóticas, endócrinas, neoplásicas ou imunossupressivas de base. O diagnóstico da demodiciose foi estabelecido por múltiplos raspados de pele, tricograma e técnica de beliscamento por fita adesiva em áreas lesionais, seguindo à observação macroscópica e caracterização morfológica do ácaro. Instituiu-se tratamento com lactonas macrocíclicas, que se mostraram eficazes na maioria dos casos, entretanto, a involução do quadro pode estar relacionado ao tratamento adjunto das doenças de base.

Spirometry in adult subjects can induce a fall in concentration of exhaled nitric oxide (FE(NO)). Scarce information is available on the FE(NO) decrease after spirometry or after other forced lung-function maneuvers in children. We compared changes in FE(NO) induced by repeated spirometry and testing of maximal expiratory pressures (P(Emax)). Twenty-four sex- and age-matched children aged 9-18 years (mean age +/- SD, 13.3 +/- 2.8 years; 12 healthy, 12 asthmatic) were allocated to 1-week-apart sessions of repeated maneuvers of either forced vital capacity (FVC) or P(Emax). Baseline FE(NO) measurements were followed by FVC or P(Emax) maneuvers every 15 min for 45 min, whereas FE(NO) was measured at each step for 60 min. After repeated P(Emax) but not after FVC maneuvers, FE(NO) values decreased significantly from baseline in both groups. In healthy children, geometric mean FE(NO) (95% confidence intervals) decreased from 9.1 (7.0-11.8) ppb at baseline to 8.2 (6.3-10.6) ppb at 15 min and 7.7 (5.6-10.6) ppb at 30 min (P < 0.05 and P < 0.01, respectively), and remained unchanged at 45 and 60 min. In asthmatic children, FE(NO) levels fell from 21.6 (13.3-34.9) ppb at baseline to 15.1 (9.1-25.1) ppb at 15 min and remained low at 30, 45, and 60 min: 17.8 (10.7-29.5) ppb, 17.5 (10.2-30.1) ppb, and 17.6 (10.6-29.2) ppb, P < 0.01, for all differences from baseline. Repeated P(Emax) and FVC maneuvers increased FE(NO) variability, as compared with repeated FE(NO) measurements alone. Previous forced lung-function maneuvers may affect FE(NO) measurements in children. Although P(Emax) testing has a greater influence than spirometry on FE(NO) levels in children, both procedures should be avoided before measuring FE(NO).

Sporotrichosis has become an important zoonosis in Brazil and Sporothrix brasiliensis is the primary species transmitted by cats. Improvement of animal treatment will help control and limit the spread and geographic expansion of sporotrichosis. Accordingly, buparvaquone, an antiprotozoal hydroxynaphthoquinone agent marketed as Butalex®, was evaluated in vitro and in vivo against feline-borne isolates of S. brasiliensis . Buparvaquone inhibited in vitro fungal growth at concentrations 4-fold lower than itraconazole (the first-choice antifungal used for sporotrichosis) and was 408 times more selective for S. brasiliensis than mammalian cells. Yeasts treated with a subinhibitory concentration of buparvaquone exhibited mitochondrial dysfunction, ROS and neutral lipid accumulation, and impaired plasma membranes. Also, scanning electron microscopy images revealed buparvaquone altered cell wall integrity and induced cell disruption. I n vivo experiments in a Galleria mellonella model revealed that buparvaquone (single dose of 5 mg/kg) is more effective than itraconazole against infections with S. brasiliensis yeasts. Combined, our results indicate that buparvaquone has a great in vitro and in vivo antifungal activity against S. brasiliensis , revealing the potential application of this drug as an alternative treatment for feline sporotrichosis.

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