Esporotricose pulmonar em paciente imunocompetente: relato de caso

Lauar, Isabela Dias; Nascimento, Victor Adalberto Machado; Soares, José Eduardo Palacio; Matos, Marcelle Amaral de; Faria, Kathleen Emerick Paiva; Nogueira, Luiz Paulo Arreguy; Parreiras, Guilherme Cardoso

doi:10.5935/2238-3182.2021e31415

Cited by 2 publications

(3 citation statements)

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“…Pulmonary sporotrichosis is, fortunately, still considered a rare condition, but it is associated with unspecific symptoms that overlap with other lung infections (including tuberculosis and histoplasmosis) [104]. This factor contributes to delays in its diagnosis, potentially leading to severe lung parenchyma destruction, which is associated with high rates of death, bringing the necessity to add sporotrichosis to the differential diagnosis of pulmonary fungal infections, particularly in hyperendemic areas in Brazil [72].…”

Section: Discussionmentioning

confidence: 99%

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Sporothrix brasiliensis Causing Atypical Sporotrichosis in Brazil: A Systematic Review

Poester,

Xavier,

Munhoz

et al. 2024

JoF

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Zoonotic sporotrichosis, a subcutaneous mycosis caused by Sporothrix brasiliensis, has become hyperendemic and a serious public health issue in Brazil and an emerging disease throughout the world. Typical sporotrichosis is defined as fixed or lymphocutaneous lesion development, however, reports of atypical presentations have been described in hyperendemic areas, which may result in a worse prognosis. Thus, considering an increase in atypical cases and in more severe extracutaneous cases and hospitalizations reported in Brazil, we aimed to perform a systematic review to search for hypersensitivity reactions (HRs) and extracutaneous presentations associated with zoonotic sporotrichosis. A systematic review was performed, following the PRISMA guidelines to search for atypical/extracutaneous cases (mucosal, osteoarthritis, HRs, pulmonary, meningeal) of zoonotic sporotrichosis. A total of 791 published cases over 26 years (1998–2023) in eleven Brazilian states were reviewed. Most cases corresponded to a HR (47%; n = 370), followed by mucosal (32%; n = 256), multifocal (8%; n = 60), osteoarthritis (7%; n = 59), meningeal (4%; n = 32), and pulmonary (2%; n = 14) infections. When available (n = 607), the outcome was death in 7% (n = 43) of cases. Here, we show a frequent and worrisome scenario of zoonotic sporotrichosis in Brazil, with a high and dispersed incidence of atypical/extracutaneous cases throughout the Brazilian territory. Therefore, educational measures are necessary to make health professionals and the overall population aware of this fungal pathogen in Brazil as well as in other countries in the Americas.

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Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Pulmonary Casesmentioning

confidence: 99%

Sporothrix brasiliensis Causing Atypical Sporotrichosis in Brazil: A Systematic Review

Poester,

Xavier,

Munhoz

et al. 2024

JoF

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“…Sporotrichosis, caused by Sporothrix spp., is also globally distributed and rarely involves the lungs, but can be indistinguishable from pulmonary TB, including cavitation. 61,62 Outbreaks have been linked to contaminated hay, and in South America to feral cats.…”

Section: Differential Diagnosismentioning

confidence: 99%

Chronic Pulmonary Aspergillosis: Clinical Presentation and Management

Evans,

Lawal,

Kosmidis

et al. 2023

Semin Respir Crit Care Med

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Chronic pulmonary aspergillosis (CPA) refers to a number of clinical syndromes resulting from the presence and local proliferation of Aspergillus organisms in the lungs of patients with chronic lung disease. CPA is more common than was realized two decades ago. Recognition remains poor, despite recent studies from many countries highlighting the high prevalence in at-risk populations. In low- and middle-income countries, CPA may be misdiagnosed and treated as tuberculosis (TB). In addition, CPA may develop following successful TB treatment. The coronavirus disease pandemic has resulted in significant disruption to provision of TB care, likely leading to more extensive lung damage, which could increase the risk for CPA.Although CPA refers to various syndromes, the classic presentation is that of chronic cavitary pulmonary aspergillosis, which manifests as one or more progressive cavities with or without a fungal ball, accompanied by systemic and respiratory symptoms for at least 3 months. Diagnosis relies on Aspergillus immunoglobulin G in serum, as sputum culture lacks sensitivity. Differential diagnosis includes mycobacterial infection, bacterial lung abscess or necrotizing pneumonia, lung cancer, and endemic fungi.The aim of antifungal treatment in CPA is to improve symptoms and quality of life, and to halt progression, and possibly reverse radiological changes. Current recommendations suggest treatment for 6 months, although in practice many patients remain on long-term treatment. Improvement may manifest as weight gain and improvement of symptoms such as productive cough, hemoptysis, and fatigue. Surgical management should be considered in cases of diagnostic uncertainty, in significant hemoptysis, and when there is concern for lack of response to therapy. Itraconazole and voriconazole are the first-line azoles, with more experience now accumulating with posaconazole and isavuconazole. Side effects are frequent and careful monitoring including therapeutic drug monitoring is essential. Intravenous antifungals such as echinocandins and amphotericin B are used in cases of azole intolerance or resistance, which often develop on treatment. Relapse is seen after completion of antifungal therapy in around 20% of cases, mostly in bilateral, high-burden disease.Several research priorities have been identified, including characterization of immune defects and genetic variants linked to CPA, pathogenetic mechanisms of Aspergillus adaptation in the lung environment, the contribution of non-fumigatus Aspergillus species, and the role of new antifungal agents, immunotherapy, and combination therapy.

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Esporotricose pulmonar em paciente imunocompetente: relato de caso

Cited by 2 publications

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Sporothrix brasiliensis Causing Atypical Sporotrichosis in Brazil: A Systematic Review

Sporothrix brasiliensis Causing Atypical Sporotrichosis in Brazil: A Systematic Review

Chronic Pulmonary Aspergillosis: Clinical Presentation and Management

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