Sporotrichosis in Older Adults: A Cohort Study of 911 Patients from a Hyperendemic Area of Zoonotic Transmission in Rio de Janeiro, Brazil

Abstract

Generally, older people tend to suffer from more severe infections than younger adults. In addition, there are accumulations of comorbidities and immune senescence in some cases. This cohort study evaluated the clinical and epidemiological characteristics of older adults (≥60 years old) with sporotrichosis. The cohort consisted of 911 patients with a median age of 67 years, most of whom were female (72.6%), white (62.1%), and afflicted with comorbidities (64.5%). The lymphocutaneous form occurred in 62% of the patients, followed by the fixed form (25.7%), cutaneous disseminated form (8.9%), and extracutaneous/disseminated forms (3.3%). In this study, we draw attention to the frequency of osteoarticular involvement (2.1%) secondary to skin lesions such as osteomyelitis and/or tenosynovitis. A clinical cure was achieved in 87.3% of cases. Itraconazole was used in 81.1% of cases, while terbinafine was used in 22.7% of cases, usually in low doses. Survival analysis showed that the median treatment time was 119 days, and the multiple Cox model demonstrated that the presentation of a black coloration and diabetes was associated with a longer treatment time required to establish a cure. Therefore, these subgroups should be monitored more closely to reduce possible difficulties during treatment. It would be interesting to conduct more studies analyzing older adults with sporotrichosis from different geographic areas to better comprehend the disease in this group.

Sporothrix brasiliensis Causing Atypical Sporotrichosis in Brazil: A Systematic Review

“…As demonstrated in this systematic review, osteoarthritis caused by S. brasiliensis was an important atypical manifestation of zoonotic sporotrichosis, resulting in relevant impacts on the quality of life and prognosis of the patients [22,37,50,56,76,79,81,83]. Its consequences, like partial or total amputation, are unfortunately also common in patients with other neglected fungal diseases, such as mycetoma and chromoblastomycosis, and these are often associated with a late diagnosis [101].…”

“…Erythema nodosum or multiforme represented 88% of the HRs (327/370), followed by Sweet's syndrome in 10% (35/370) and arthritis in 2% (8/370) (Table 1). The patients being cured was the outcome in all zoonotic sporotrichosis cases that developed HRs (n = 318) [14,17,[24][25][26][27][28]42,47,54,69,76,81].…”

“…Mucosal involvement occurred as a primary disease in the majority of the patients (92%, n = 230/251), while the remaining (8%, n = 21) developed mucosal sporotrichosis due to a hematogenous dissemination of Sporothrix spp. Even though all such patients were cured, 12% (23/193) had sequelae of the mycosis, such as chronic dacryocystitis, corneal changes, cutaneous fistula, lagophthalmos, ectropion, entropion, pannus 180 • , symblepharon, conjunctival fibrosis, paracentral leucoma or eyelid retraction (ocular), and hyperrhynolalia and retraction of the right ala nasi (nasal) (Table 1) [15,20,21,29,31,32,41,42,47,48,52,53,57,60,61,[63][64][65]67,70,71,[73][74][75]78,79,81,82].…”

“…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].…”