Atypical Manifestation of Disseminated Sporotrichosis in an AIDS Patient

Ferreira, Thiago Amparo; Trope, Beatriz Moritz; Barreiros, Glória; Quintela, Danielle Carvalho; Ramos‐e‐Silva, Márcia

doi:10.1159/000493181

Cited by 7 publications

(11 citation statements)

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“…Four case reports were of disseminated sporotrichosis, two had a history of alcohol abuse, and two had HIV infection. The outcomes were cure in three cases and death in one [ 18 , 19 , 20 , 21 ]. The fifth report was a fatal case of PPS in an immunocompetent and non-smoker female [ 22 ].…”

Section: Resultsmentioning

confidence: 99%

Pulmonary Sporotrichosis Caused by Sporothrix brasiliensis: A 22-Year, Single-Center, Retrospective Cohort Study

Fichman

Mota-Damasceno

Procópio-Azevedo

et al. 2022

JoF

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Pulmonary sporotrichosis is a rare condition. It can present as a primary pulmonary disease, resulting from direct Sporothrix species (spp). conidia inhalation, or as part of multifocal sporotrichosis with multiple organ involvement, mainly in immunocompromised patients. This study aimed to describe the sociodemographic and epidemiological characteristics and clinical course of patients with positive cultures for Sporothrix spp. from pulmonary specimens (sputum and/or bronchoalveolar lavage) at a reference center in an area hyperendemic for zoonotic sporotrichosis. The clinical records of these patients were reviewed. Fourteen patients were included, and Sporothrix brasiliensis was identified in all cases. Disseminated sporotrichosis was the clinical presentation in 92.9% of cases, and primary pulmonary sporotrichosis accounted for 7.1%. Comorbidities included human immunodeficiency virus infection (78.6%), alcoholism (71.4%), and chronic obstructive pulmonary disease (14.3%). Treatment with amphotericin B followed by itraconazole was the preferred regimen and was prescribed in 92.9% of cases. Sporotrichosis-related death occurred in 42.9% while 35.7% of patients were cured. In five cases there was a probable contamination from upper airway lesions. Despite the significant increase in sporotrichosis cases, pulmonary sporotrichosis remains rare. The treatment of disseminated sporotrichosis is typically difficult. Prompt diagnosis and identification of all affected organs are crucial for better prognosis.

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Section: Resultsmentioning

confidence: 99%

Pulmonary Sporotrichosis Caused by Sporothrix brasiliensis: A 22-Year, Single-Center, Retrospective Cohort Study

Fichman

Mota-Damasceno

Procópio-Azevedo

et al. 2022

JoF

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“…Lymphocutaneous sporotrichosis is the most frequent clinical presentation (60–80 % of cases) of S. schenckii infection and begins with a nodule at the site of inoculation, followed by ulceration and regional lymphangitis [3, 6, 7]. Typical clinical features may include single or multiple ulcers or granulomatous nodules with lymphangitis [8, 10]. The linear arrangement of multiple skin lesions along the lymphatic drainage is a strong clue to sporotrichosis [8, 10].…”

Section: Discussionmentioning

confidence: 99%

“…Typical clinical features may include single or multiple ulcers or granulomatous nodules with lymphangitis [8, 10]. The linear arrangement of multiple skin lesions along the lymphatic drainage is a strong clue to sporotrichosis [8, 10]. S. schenckii infection may also manifest as extra-cutaneous sporotrichosis [6, 7, 11].…”

Section: Discussionmentioning

confidence: 99%

“…Disseminated sporotrichosis typically presents as diffuse, cutaneous, crusty, ulcerated nodular lesions with extra-cutaneous manifestations [6, 7, 12, 13]. Patients infected with HIV with CD4 counts below 200 cells mm −3 are at high risk of developing disseminated sporotrichosis, as seen in this patient, whose CD4 count was 34 cells/mm −3 [8, 10]. S. schenckii is an important opportunistic pathogen in this patient group and the diagnosis may be missed if the clinician’s index of suspicion is low [14].…”

Section: Discussionmentioning

confidence: 99%

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Disseminated sporotrichosis in a person with human immunodeficiency virus disease

Tshisevhe

Skosana

Motse

et al. 2021

Access Microbiology

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Introduction. Disseminated sporotrichosis is an incapacitating infection caused by the dimorphic fungus Sporothrix schenckii. Because this condition may mimic the presentation of tuberculosis, syphilis and other bacterial infections, the diagnosis may be missed or delayed. Case Presentation. We describe a case of disseminated sporotrichosis in a patient with poorly controlled human immunodeficiency virus infection. The patient was initially treated for bacterial skin infections. The differential diagnosis also included tuberculosis and syphilis. Only after appropriate specimens had been sent for microbiological and histopathological investigations was the diagnosis of disseminated sporotrichosis made and appropriate treatment started. The patient showed a good clinical response to itraconazole. Conclusion. This report highlights the importance of having a high index of suspicion of endemic mycoses when managing immunocompromised patients. The report also demonstrates that a delay in the diagnosis of sporotrichosis increases morbidity and results in unnecessary and inappropriate treatment with associated costs and adverse effects.

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“…The most common clinical forms of the disease are lymphocutaneous and fixed cutaneous [6]. The disseminated form is uncommon but more severe, can affect multiple organs and systems and is primarily related to immunosuppression (e.g., HIV) [7][8][9][10][11][12]. There are also cases of disseminated sporotrichosis as a manifestation of immune reconstitution inflammatory syndrome (IRIS) after the initiation of antiretroviral therapy in people living with HIV (PLHIV) [13].…”

Section: Introductionmentioning

confidence: 99%

Sporotrichosis in the nasal mucosa: A single-center retrospective study of 37 cases from 1998 to 2020

et al. 2023

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Background Sporotrichosis is a subcutaneous or implantation mycosis caused by some species of the genus Sporothrix. Rio de Janeiro state, Brazil, experiences hyperendemic levels of zoonotic sporotrichosis, with increasing cases of disseminated disease, especially in people living with HIV (PLHIV). Involvement of the nasal mucosa is rare and occurs isolated or in disseminated cases, with a delayed resolution. Methodology/Principal findings This study aimed to describe the epidemiological, clinical, and therapeutic profiles of 37 cases of sporotrichosis with involvement of the nasal mucosa treated at the ear, nose, and throat (ENT) outpatient clinic of the Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, from 1998 to 2020. Data were reviewed from the medical records and stored in a database. The Mann–Whitney test was used to compare the means of quantitative variables, and Pearson chi-square and Fisher’s exact tests were used to verify the association between qualitative variables (p<0.05). Most patients were males, students or retirees, with a median age of 38 years, residents in the municipality of Rio de Janeiro, and infected through zoonotic transmission. Disseminated sporotrichosis forms in patients with comorbidities (mostly PLHIV) were more common than the isolated involvement of the mucosa. The main characteristics of lesions in the nasal mucosa were the presence/elimination of crusts, involvement of various structures, mixed appearance, and severe intensity. Due to therapeutic difficulty, itraconazole was combined with amphotericin B and/or terbinafine in most cases. Of the 37 patients, 24 (64.9%) healed, with a median of 61 weeks of treatment, 9 lost follow-up, 2 were still treating and 2 died. Conclusions Immunosuppression was determinant to the outcome, with worse prognosis and lower probability of cure. Notably in this group, the systematization of the ENT examination for early identification of lesions is recommended to optimize the treatment and outcome of the disease.

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Atypical Manifestation of Disseminated Sporotrichosis in an AIDS Patient

Cited by 7 publications

References 11 publications

Pulmonary Sporotrichosis Caused by Sporothrix brasiliensis: A 22-Year, Single-Center, Retrospective Cohort Study

Pulmonary Sporotrichosis Caused by Sporothrix brasiliensis: A 22-Year, Single-Center, Retrospective Cohort Study

Disseminated sporotrichosis in a person with human immunodeficiency virus disease

Sporotrichosis in the nasal mucosa: A single-center retrospective study of 37 cases from 1998 to 2020

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