Clinical factors associated with systemic sporotrichosis in Brazil

Abstract

BackgroundSystemic sporotrichosis occurs when organs, other than subcutaneous tissues and lymph nodes, are infected. Interestingly, systemic sporotrichosis in apparently immunocompetent individuals is increasing in Brazil, but data on clinical manifestations and risk factors are scarce. Most of the existing data on such condition relate to people living with HIV. We aimed to study the risk factors associated with systemic sporotrichosis among HIV‐negative and HIV‐positive patients.MethodsWe performed a retrospective cross‐sectional study with 80 patients from Brazil, diagnosed between 2014 and 2021. The association between disease classification, clinical presentation and risk factors were analysed by logistic regression.ResultsOf the 80 patients, 29 (36.3%) presented with systemic sporotrichosis. All HIV‐positive patients developed the systemic form, with increased mortality (p = .002). Alcohol ingestion (p = .009) and diabetes (p = .010) were associated with systemic disease. Alcohol ingestion seemed to favour pulmonary infection (p = .013) and, diabetes favoured osteoarticular (p = .009) and ocular involvement (p = .033). The occurrence of fever (p = .001) and weight loss (p = .006) were significantly associated with systemic sporotrichosis, while meningeal involvement (p = .001) increased mortality risk. Nine (11.3%) patients died from sporotrichosis. The presence of fungal structures in the mycological examination of the patients' lesions were associated with the systemic form (p = .017) and death (p = .002).ConclusionOur study points to the factors that drive systemic sporotrichosis other than HIV, such as alcohol ingestion and diabetes. Considering the high number of patients presenting severe sporotrichosis, the recognising these factors may contribute to timely diagnosis and proper treatment.

Sporothrix brasiliensis Causing Atypical Sporotrichosis in Brazil: A Systematic Review

“…The first case of atypical zoonotic sporotrichosis was published in 2002. Nearly half of the articles (55%; 35/64) were published in the last five years (2019-2023), which correspond to an increase of 700% in comparison with the number of publications from the first 5 years of our review (Figure 2) [13][14][15][17][18][19][20][21][22][24][25][26][27][28][29]31,32,[34][35][36][37].…”

“…The outcomes were described in case reports of 26 patients, with 85% (22/26) being cured and 15% (4/26) dying. From the 22 cured patients, sequelae (total or partial amputation) occurred in 14% (3/22) (Table 1) [22,37,46,50,56,76,[79][80][81]83].…”

“…was isolated from respiratory samples in mycological cultures (Table 1). In total, 60% of these patients were cured (3/5), including two patients with disseminated disease and one patient with primary lung involvement [18,37,49,51,59,66,68,72,77,81].…”

“…It was reported that 68% and 67% of patients with osteoarthritis plus mucosal or pulmonary involvement were cured, respectively. However, all patients with the following presentations died: osteoarthritis + meningeal; meningeal + pulmonary; osteoarthritis + meningeal + pulmonary; osteoarthritis + meningeal + mucosal; and osteoarthritis + mucosal + pulmonary [18,19,21,22,37,47,58,71,79] (Table 2).…”

“…Similarly, pulmonary and meningeal infection can follow Sporothrix conidia inhalation, after fungal dissemination [18,19,[34][35][36]. Severe atypical presentations of sporotrichosis are often associated with comorbidities, such as AIDS, alcoholism, chronic obstructive pulmonary disease, or diabetes [13,18,37].…”