Esporotricose na gestação: relato de cinco casos numa epidemia zoonótica no Rio de Janeiro, Brasil

Abstract

Five cases of sporotrichosis occurring in pregnant women in a zoonotic epidemic in Rio de Janeiro, Brazil, are described. The main clinical features, as well as the challenging therapeutic choices for this specific group of patients, are discussed. Keywords: Amphotericin B; Pregnant women; Sporotrichosis; Therapeutics; Treatment outcome Resumo: Os autores apresentam cinco casos de esporotricose em gestantes numa epidemia zoonótica no Rio de Janeiro. São discutidos principalmente os aspectos clínicos e as dificuldades na escolha terapêutica desse grupo específico de pacientes.

Sporotrichosis: an update on epidemiology, etiopathogenesis, laboratory and clinical therapeutics

“…This is the only drug recommended for pregnant women with severe disease, given that it is not teratogenic, although it may worsen metabolic disorders that are already common during pregnancy. 115 …”

“…The local heat was initially used to treat chromomycosis, it is based on the fungus' thermosensitivity, and may be useful when conventional drugs are contraindicated. 115 , 116 Cryosurgery using liquid nitrogen may be used as a therapeutic complement in refractory cases, especially when lesions are crusty and infiltrate, as well as in isolated cases of localized lesions in immunocompetent patients. Electrosurgery and surgical removal of small lesions constitute other therapeutic options in selected cases.…”

Immunopathogenesis of Human Sporotrichosis: What We Already Know

“…How do they conduct complicated human cases and those presenting atypical clinical manifestations such as the ones described in recent years? [ 20 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. Although the increase in the number of cases has been accompanied by problems for the health system, it has created opportunities to produce knowledge and to deepen the study of human and animal cases that were previously scarce.…”

“…Classically, infection occurs by traumatic inoculation into the skin through wounds produced by spines, barbs, etc. Up to the early 2000s, only some scattered reports have described the possibility of infection from traumatic inoculation through the scratches and bites of infected animals, notably cats, but nowadays there are many descriptions [ 1 , 3 , 11 , 12 , 20 , 23 , 47 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 ]. Some authors have also described the possibility of infection through secretions, mainly between animals [ 56 ] and it has also been suggested that in patients presenting preexistent lesions, the transmission could also occur through licking (mainly by contaminated saliva from cats) or a contaminated environment.…”

“…Previously considered a work-linked mycosis (farmers, gardeners, etc.) and therefore predominantly in adult males, since the late 1990s, the occurrence of cases related to the scratching/bites of domestic felines has increased, especially in Brazil, characterizing the disease as predominantly a zoonosis [ 1 , 3 , 11 , 12 , 20 , 23 , 47 , 53 , 54 , 55 , 56 , 57 , 58 , 59 ]. In this country, the predominant etiological agent in cats is S. brasiliensis , whose habitat has shifted from plants to cats, leading to epidemic sporotrichosis driven by a pathogen with a low genetic diversity [ 16 ].…”