Dacryocystitis due to<i>Sporothrix brasiliensis</i>: a case report of a successful clinical and serological outcome with low-dose potassium iodide treatment and oculoplastic surgery

Macedo, Priscila Marques de; Sztajnbok, Denise C. N.; Camargo, Zoilo Pires de; Rodrigues, Anderson Messias; Lópes-Bezerra, Leila M.; Bernardes-Engemann, Andréa Reis; Orofino-Costa, Rosane

doi:10.1111/bjd.13378

Cited by 25 publications

(20 citation statements)

References 13 publications

(37 reference statements)

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“…This emerging virulence could explain the recent appearance of atypical and more severe cases of sporotrichosis during zoonotic episodes in areas where S . brasiliensis is endemic [ 46 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

Exploring virulence and immunogenicity in the emerging pathogen Sporothrix brasiliensis

et al. 2017

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Sporotrichosis is a polymorphic chronic infection of humans and animals classically acquired after traumatic inoculation with soil and plant material contaminated with Sporothrix spp. propagules. An alternative and successful route of transmission is bites and scratches from diseased cats, through which Sporothrix yeasts are inoculated into mammalian tissue. The development of a murine model of subcutaneous sporotrichosis mimicking the alternative route of transmission is essential to understanding disease pathogenesis and the development of novel therapeutic strategies. To explore the impact of horizontal transmission in animals (e.g., cat-cat) and zoonotic transmission on Sporothrix fitness, the left hind footpads of BALB/c mice were inoculated with 5×106 yeasts (n = 11 S. brasiliensis, n = 2 S. schenckii, or n = 1 S. globosa). Twenty days post-infection, our model reproduced both the pathophysiology and symptomology of sporotrichosis with suppurating subcutaneous nodules that progressed proximally along lymphatic channels. Across the main pathogenic members of the S. schenckii clade, S. brasiliensis was usually more virulent than S. schenckii and S. globosa. However, the virulence in S. brasiliensis was strain-dependent, and we demonstrated that highly virulent isolates disseminate from the left hind footpad to the liver, spleen, kidneys, lungs, heart, and brain of infected animals, inducing significant and chronic weight loss (losing up to 15% of their body weight). The weight loss correlated with host death between 2 and 16 weeks post-infection. Histopathological features included necrosis, suppurative inflammation, and polymorphonuclear and mononuclear inflammatory infiltrates. Immunoblot using specific antisera and homologous exoantigen investigated the humoral response. Antigenic profiles were isolate-specific, supporting the hypothesis that different Sporothrix species can elicit a heterogeneous humoral response over time, but cross reaction was observed between S. brasiliensis and S. schenckii proteomes. Despite great diversity in the immunoblot profiles, antibodies were mainly derived against 3-carboxymuconate cyclase, a glycoprotein oscillating between 60 and 70 kDa (gp60-gp70) and a 100-kDa molecule in nearly 100% of the assays. Thus, our data broaden the current view of virulence and immunogenicity in the Sporothrix-sporotrichosis system, substantially expanding the possibilities for comparative genomic with isolates bearing divergent virulence traits and helping uncover the molecular mechanisms and evolutionary pressures underpinning the emergence of Sporothrix virulence.

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Section: Discussionmentioning

confidence: 99%

Exploring virulence and immunogenicity in the emerging pathogen Sporothrix brasiliensis

et al. 2017

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“…35 Moreover, S. brasiliensis is associated with zoonotic transmission and atypical clinical presentations in humans. [36][37][38] However, the isolates of S. brasiliensis from Rio Grande do Sul differ molecularly of those from Rio de Janeiro, São Paulo and Minas Gerais, 1,12 which deserves more investigation.…”

Section: Discussionmentioning

confidence: 99%

Sporothrix brasiliensis outbreaks and the rapid emergence of feline sporotrichosis

Sanchotene

Madrid

Klafke

et al. 2015

Mycoses

140

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Sporotrichosis is the main subcutaneous mycosis in Brazil, and is caused by Sporothrix schenckii and allied species. Sporothrix propagules present on soil and plant debris may be traumatically inoculated into the cutaneous/ subcutaneous tissues of the warm-blooded host. An alternative route involves direct animal-animal and animal-human transmissions through deep scratches and bites of diseased cats. Sporotrichosis is much more common than previously appreciated with several cases emerging over the years especially in South and Southeast Brazil. We conducted an epidemiological surveillance in endemic areas of feline sporotrichosis in the southern region of Rio Grande do Sul state, Brazil. Over the last 5-year period the number of feline sporotrichosis in Rio Grande increased from 0.75 new cases per month in 2010 to 3.33 cases per month in 2014. The wide geographic distribution of diagnosed cases highlights the dynamics of Sporothrix transmission across urban areas with high population density. Molecular identification down to species level by PCR-RFLP of cat-transmitted Sporothrix revealed the emergence of the clonal offshoot S. brasiliensis during feline outbreaks; this scenario is similar to the epidemics taking place in the metropolitan areas of Rio de Janeiro and São Paulo. Controlling and preventing sporotrichosis outbreaks are essential steps to managing the disease among humans and animals.

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“… 53 - 55 When the lacrimal duct is affected, dacryocystitis may occur as sequela. 56 , 57 The retrobulbar lesions, such as chorioretinitis, are more frequently related to hematogenous spread, and anterior lesions are associated with the fungal innoculation. The simultaneous affection of the ocular mucosa and the regional lymph nodes is not rare, and it is one of the causes of the Parinaud syndrome.…”

Section: Clinical Aspectsmentioning

confidence: 99%

“… 59 , 85 There is an effective clinical-serological correlation which allow therapeutic monitoring, and can be used whether to maintain or suspend the treatment of difficult cases. 57 , 67 , 71 An exoantigen isolated from the filamentous form of S. schenckii was used in the ELISA test, with 97% of sensitivity, and 89% of specificity, when evaluating different serum samples from patients with sporotrichosis. 86 …”

Section: Laboratory Diagnosismentioning

confidence: 99%

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

Orofino-Costa

Macedo

Rodrigues

et al. 2017

An. Bras. Dermatol.

268

397

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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.

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Dacryocystitis due toSporothrix brasiliensis: a case report of a successful clinical and serological outcome with low-dose potassium iodide treatment and oculoplastic surgery

Cited by 25 publications

References 13 publications

Exploring virulence and immunogenicity in the emerging pathogen Sporothrix brasiliensis

Exploring virulence and immunogenicity in the emerging pathogen Sporothrix brasiliensis

Sporothrix brasiliensis outbreaks and the rapid emergence of feline sporotrichosis

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

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