Sporotrichosis in the nasal mucosa: A single-center retrospective study of 37 cases from 1998 to 2020

Abstract

Background Sporotrichosis is a subcutaneous or implantation mycosis caused by some species of the genus Sporothrix. Rio de Janeiro state, Brazil, experiences hyperendemic levels of zoonotic sporotrichosis, with increasing cases of disseminated disease, especially in people living with HIV (PLHIV). Involvement of the nasal mucosa is rare and occurs isolated or in disseminated cases, with a delayed resolution. Methodology/Principal findings This study aimed to describe the epidemiological, clinical, and therapeutic profiles of 37 cases of sporotrichosis with involvement of the nasal mucosa treated at the ear, nose, and throat (ENT) outpatient clinic of the Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, from 1998 to 2020. Data were reviewed from the medical records and stored in a database. The Mann–Whitney test was used to compare the means of quantitative variables, and Pearson chi-square and Fisher’s exact tests were used to verify the association between qualitative variables (p<0.05). Most patients were males, students or retirees, with a median age of 38 years, residents in the municipality of Rio de Janeiro, and infected through zoonotic transmission. Disseminated sporotrichosis forms in patients with comorbidities (mostly PLHIV) were more common than the isolated involvement of the mucosa. The main characteristics of lesions in the nasal mucosa were the presence/elimination of crusts, involvement of various structures, mixed appearance, and severe intensity. Due to therapeutic difficulty, itraconazole was combined with amphotericin B and/or terbinafine in most cases. Of the 37 patients, 24 (64.9%) healed, with a median of 61 weeks of treatment, 9 lost follow-up, 2 were still treating and 2 died. Conclusions Immunosuppression was determinant to the outcome, with worse prognosis and lower probability of cure. Notably in this group, the systematization of the ENT examination for early identification of lesions is recommended to optimize the treatment and outcome of the disease.

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].…”

“…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].…”

“…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).…”

“…Although most zoonotic sporotrichosis is clinically evidenced by the typical known fixed or lymphocutaneous lesions, reports of atypical presentations have been described in hyperendemic areas, which may result in a worse prognosis [13][14][15][16][17][18][19][20][21]. Mucosal involvement, hypersensitivity reactions (HRs), osteoarthritis, and pulmonary and meningeal involvement are highlighted as atypical presentations of sporotrichosis [17][18][19][20][21][22]. S. brasiliensis is more likely to cause atypical clinical manifestations of sporotrichosis than the sapronotic species, S. schenckii and S. globosa [14].…”

“…Intraocular sporotrichosis can be presented as endophthalmitis, granulomatous uveitis, scleritis, retinitis, choroiditis, or iridocyclitis [15,[29][30][31][32]. Nasal involvement is another manifestation of mucosal zoonotic sporotrichosis, which varies from mild to severe, progressing to a perforation of the septum [21].…”