Sporotrichosis in HIV-infected patients: report of 21 cases of endemic sporotrichosis in Rio de Janeiro, Brazil

Abstract

Sporotrichosis is endemic in Rio de Janeiro, Brazil, and cases have been reported to be associated with HIV. This article describes the clinical manifestations and evolution of sporotrichosis in HIV-positive patients and constitutes the largest case series reported to date. There were 21 HIV-positive patients with sporotrichosis diagnosed by the recovery of the etiologic agent from 1999-2009. Sixteen patients (76.2%) were men and five (23.8%) were women, with a mean age of 41.2 years. Seven of these individuals were previously unaware of their HIV infection. Mean CD4 count was 346.4 cells/μl. The most frequent clinical presentations of sporotrichosis in these patients were the lymphocutaneous and disseminated form (seven patients each, 33.3%), followed by the widespread cutaneous form in five (23.8%), and fixed form in the remaining two (9.5%). In patients with the disseminated forms, clinical manifestations involved the skin in six, mucosa (nasal, oral, or conjunctival) in four, bone in two, and meninges in two. Eleven (52.4%) patients received itraconazole and eight (38.1%) amphotericin B contributing to an overall cure rate of 81%. Spontaneous cure was observed in one patient. The clinical forms of sporotrichosis varied according to the patients' immune status. The results demonstrate the importance of sporotrichosis as an opportunistic infection associated with AIDS in countries where the mycosis occurs.

Characterization of virulence profile, protein secretion and immunogenicity of differentSporothrix schenckii sensu strictoisolates compared withS. globosaandS. brasiliensisspecies

“…20 Disseminated sporotrichosis is the most severe infection that has been reported with increasing frequency in recent years mainly in immunosuppressed patients. [21][22][23][24][25][26] Many studies have been conducted to better understand the pathogenesis of sporotrichosis in experimental infection. The decrease in cellular immune response 27 and IL-1 and TNF-α levels 28 between the fourth and sixth week post-infection were reported, thereby providing the colonization of some organs of infected mice by the fungus.…”

Sporotrichosis

“…Antibody appears unimportant in immunity, but cell-mediated immunity is crucial in containing infection with S. schenckii [22,23]. The importance of cell-mediated immunity is supported by the clinical reports of disseminated sporotrichosis occurring in AIDS patients [24,25], in patients who have hairy cell leukemia [26], in those receiving tumor necrosis factor antagonists [27], and in one patient who had a prior history of lepromatous leprosy [28].…”

“…Disseminated sporotrichosis is very uncommon, and may present with fungemia [36]. Almost all patients have had cellular immune deficiencies, and most cases have occurred in persons with AIDS [24][25][26][27][28]36]. S. schenckii has been reported very rarely to cause infection of eye, larynx, breast, pericardium, spleen, liver, bone marrow, lymph nodes, rectum, and epididymis.…”

“…Meningitis, a rare manifestation of sporotrichosis, occurs almost always in those with cellular immune defects and must be differentiated from tuberculosis or cryptococcosis [24]. Fever and headache are prominent symptoms, and the cerebrospinal fluid findings are those of lymphocytic meningitis with mild hypoglycorrhachia.…”

In Vitro and In Vivo Efficacy of Amphotericin B Combined with Posaconazole against Experimental Disseminated Sporotrichosis

“…The Sporothrix schenckii complex encompasses four species able to cause sporotrichosis in humans (3,4). Treatment of disseminated infections is carried out with amphotericin B and maintenance with itraconazole, showing various outcomes (5)(6)(7). Posaconazole has shown low MICs against Sporothrix spp.…”