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

Abstract

In the late 90's there was a change in both the route of transmission and the people at risk for sporotrichosis. This zoonotic cat-man alternative transmission route elicited changes in strategies to control the epidemic. There was a progressive increase in the number of cases involving especially children and the elderly. In addition to becoming hyperendemic, uncommon clinical pictures like immunoreactive clinical presentations or severe systemic cases have emerged. New species were identified and classified through molecular tools using more virulent clinical isolates, like S. brasiliensis, compared to the environmental isolates. Likewise, different species of Sporothrix have been associated with different geographic regions. The serological and molecular techniques are used as an auxiliary tool for the diagnosis and/or for species identification, although the isolation and the identification of Sporothrix spp. in clinical specimen is still the gold standard. Currently sporotrichosis epidemics requires the knowledge of the epidemiological-molecular profile to control the disease and the specific treatment. Itraconazole, potassium iodide, terfinafine, and amphotericin B are the available drugs in Brazil to treat sporotrichosis. The drug of choice, its posology, and treatment duration vary according to the clinical presentation, the Sporothrix species, and host immune status. New treatment choices, including a vaccine, are being developed; nevertheless, more clinical trials are required to confirm its efficacy.

Natural killer cells are pivotal for in vivo protection following systemic infection by Sporothrix schenckii

“…13 Also, skin-tissue-resident NK cells express lower levels of CD49b than splenic cNK cells, have constitutive CD69 expression, and are also mature CD11b + CD27 + cells. 13 Also, skin-tissue-resident NK cells express lower levels of CD49b than splenic cNK cells, have constitutive CD69 expression, and are also mature CD11b + CD27 + cells.…”

“…Lastly, in most non-immunocompromised individuals, sporotrichosis manifests as a localized cutaneous/subcutaneous disease lacking haematogenous dissemination to visceral organs. 13 Also, skin-tissue-resident NK cells express lower levels of CD49b than splenic cNK cells, have constitutive CD69 expression, and are also mature CD11b + CD27 + cells. 25 Therefore, NK cells would be expected to respond differently to such localized infections from how they did in our study, even without considering the many differences in the overall immune response that could indirectly affect NK cell activity.…”

“…10,11 Sporotrichosis is an often neglected emerging opportunistic subcutaneous mycosis endemic in many countries but most commonly in those from tropical and subtropical climate regions, 12 which is caused by various thermodimorphic fungi of the Sporothrix genus, including Sporothrix brasiliensis, Sporothrix globosa, Sporothrix luriei and Sporothrix schenckii sensu stricto. 13 The disease follows the traumatic inoculation of the fungus through soilinoculating injuries, inhalation of conidia, or through zoonotic transmission, especially from cats, affecting immunocompromised individuals in an opportunistic fashion. 14 Despite mounting evidence, NK cells are not regarded in the general literature as having a major role in the host immune response against fungal pathogens in general and, specifically for Sporothrix, no previous assessment of their role exists, either in vitro or in vivo.…”

Immunization with recombinant enolase ofSporothrixspp (rSsEno) confers effective protection against sporotrichosis in mice

“…Brazil is the only country that has reported all species of the clinical clade, and S. brasiliensis is the most virulent species 9,10 . This species is also the most prevalent during zoonotic transmission through deep scratches and bites from infected cats 8 . In this country, though sporotrichosis has been reported in most states, the disease is a neglected disease, particularly in the state of Rio de Janeiro (JR), where the largest number of cases has been reported, representing a serious public health problem 3 .…”

Associated factors and spatial patterns of the epidemic sporotrichosis in a high density human populated area: A cross-sectional study from 2016 to 2018

“…Since the first reports of its transmission to humans through contact with infected cats in the 1990s, the number of severe cases of the disease in humans has been increasing. Therefore, this zoonosis has become relevant to public health [1–4]. The infected cats carry the fungus in their injured sites, oral cavities, and nails, and the transmission is made by scratches, bites, and contact with the wound exudates [5–7].…”