Maria Clara Gutierrez Galhardo

Cat-Transmitted Sporotrichosis Epidemic in Rio de Janeiro, Brazil: Description of a Series of Cases

Sporotrichosis is the most common subcutaneous mycosis in South America. Classic infection is associated with traumatic inoculation of soil, vegetables, and organic matter contaminated with Sporothrix schenckii. Zoonotic transmission has been described in isolated cases or in small outbreaks. Since 1998, we have been observing an increasing number of cases of sporotrichosis in persons from the city of Rio de Janeiro, Brazil, and surroundings. From 1998 to 2001, 178 cases of culture-proven sporotrichosis had been diagnosed. Female patients predominated, and the median age was 39 years. The most frequent clinical presentation was lymphocutaneous disease. Of the 178 patients, 156 reported domiciliary or professional contact with cats with sporotrichosis, and 97 of these patients had a history of receipt of cat scratch or bite. The patients received itraconazole as first-line treatment. This study suggests that feline transmission of sporotrichosis was associated with a large and long-lasting outbreak of the disease in Rio de Janeiro.

Sporotrichosis: an emergent zoonosis in Rio de Janeiro

During the period from 1987 to 1998, 13 cases of human sporotrichosis were recorded at the Research Center Evandro Chagas Hospital (CPqHEC) in Rio de Janeiro. Two of these patients related scratch by a sick cat. During the subsequent period from July 1998 to July 2000, 66 human, 117 cats and 7 dogs with sporotrichosis were diagnosed at the CPqHEC. Fifty-two humans (78.8%) reported contact with cats with sporotrichosis, and 31 (47%) of them reporting a history of a scratch or bite. This epidemic, unprecedented in the literature, involving cats, dogs and human beings may have started insidiously before 1998.

Sporotrichosis with widespread cutaneous lesions: report of 24 cases related to transmission by domestic cats in Rio de Janeiro, Brazil

Background Sporotrichosis most commonly presents as a localized lymphocutaneous infection following traumatic inoculation of soil, vegetables or organic substrates contaminated with the dimorphic fungus Sporothrix schenckii. Cases of widespread cutaneous lesions are rare. There have been isolated reports of household outbreaks of sporotrichosis involving cats and humans.

Molecular epidemiology and antifungal susceptibility patterns of Sporothrix schenckii isolates from a cat-transmitted epidemic of sporotrichosis in Rio de Janeiro, Brazil

Since 1998 a cat-transmitted epidemic of sporotrichosis has been observed in Rio de Janeiro (RJ), Brazil. Besides the lymphocutaneous and fixed forms, other presentations, such as disseminated cutaneous and mucosal involvement, as well as for the first time, erythema nodosum and erythema multiforme have been reported associated with sporotrichosis. This study investigates the phenotypes and genotypes of Sporothrix schenckii isolates recovered from different clinical forms of the disease noted as part of this epidemic. A total of 88 isolates recovered from 59 cases associated with the epidemic and 29 controls (from cases in other Brazilian regions and Spain) were included in this study. In vitro susceptibility testing was conducted as part of the phenotypic analysis, while the genotypic analysis involved a DNA fingerprinting method with primer M13 and ribosomal DNA sequencing of the internal transcribed spacer (ITS). MIC values of amphotericin B, itraconazole, posaconazole, ravuconazole, and terbinafine were found to be significantly lower (P<0.01) for isolates associated with the epidemic than for control strains. No differences in MIC values were observed related to clinical forms of the infection. Fingerprinting analysis showed that RJ epidemic strains were genetically related. Although nine subtypes were found, they were not associated with specific clinical forms. Similar results were obtained with the ITS sequence analysis. These data suggest that the strains isolated from the epidemic cases of sporotrichosis in RJ all originated from a common source.

Zoonotic Sporotrichosis in Rio de Janeiro, Brazil: A Protracted Epidemic yet to Be Curbed

514 used in 184 (23%) patients. Amphotericin B was very seldom used (6 patients). Al- most 2% of clinically cured patients had clinical relapses (reemergence of their le- sions), whereas 11% ( ) of the pa- n p 90 tients did not need to be treated, because of spontaneous cure. Patients were fol- lowed from 3-6 months after the end of therapy. Nine percent of the patients were lost to follow-up. Six patients were hos- pitalized, with 2 deaths. Irrespective of the drug regimens, 89% of the cases were cured. It is still not certain how the infectious agent has been disseminated throughout the Rio de Janeiro municipality and its outskirts, but it is beyond reasonable doubt that the close interaction with cats represents a key form of transmission of the fungus. Felines have very close contact with contaminated soil and organic matter and constitute a reservoir of this agent (4, 5). An improper destination given to ill or dead cats was mentioned by 71% of their current/former owners (most cats were just abandoned or died without receiving a proper burial or cremation). Such non- hygienic practices most likely foster the sustained dissemination of the mycosis, contributing to its current epidemic (en route to endemization?) status, which has yet to be curbed in Rio de Janeiros met- ropolitan area.

Sporotrichosis Caused By Sporothrix globosa in Rio De Janeiro, Brazil: Case Report

This report describes the first isolation of Sporothrix globosa from a Brazilian patient. A 77-year-old woman was examined for sporotrichosis infection. Histopathological examination of skin biopsy revealed chronic granulomatous infiltrate with microabcess. Furthermore, S. schenckii-like yeasts were evident as demonstrated by PAS and Grocott stains. The fungus was identified based on colony morphology on Sabouraud Dextrose Agar slants, Potato Dextrose Agar, and Corn Meal Agar, microscopic morphology on slides cultures, and assimilation of different carbon sources. The species confirmation was made by molecular methodology.

Esporotricose urbana: epidemia negligenciada no Rio de Janeiro, Brasil

In the scientific literature, sporotrichosis has traditionally been associated with agricultural work, since the causative agent is found naturally in the soil. However, cases have been reported recently in an urban area, related to zoonotic transmission. The current study aimed to contribute to knowledge on sporotrichosis in an urban area through an exploratory analysis of its socio-spatial distribution in Rio de Janeiro, Brazil, from 1997 to 2007, identifying the areas with the heaviest transmission. The database from the Health Surveillance Service at the Evandro Chagas Institute for Clinical Research, Oswaldo Cruz Foundation, was used to estimate incidence rates and spatial distribution. During the study period, 1,848 cases of sporotrichosis were reported, predominantly in adult women not currently in the labor market. The leading source of infection was wounds caused by domestic cats, which contributed to the spread of sporotrichosis in this urban area. Georeferencing of 1,681 cases showed a transmission belt along the border between the city of Rio de Janeiro and the adjacent municipalities in the Greater Metropolitan Area.

Histopathology of cutaneous sporotrichosis in Rio de Janeiro: a series of 119 consecutive cases

Background: Sporotrichosis is the most common subcutaneous mycosis in Rio de Janeiro. Histopathological examination reveals diffuse granulomatous and suppurative dermatitis, and the fungus is rarely identifiable in tissue. We describe the histopathological features of cutaneous sporotrichosis, and investigate the association between them and the lack of visualization of the fungus.

Terbinafine (250 mg/day): an effective and safe treatment of cutaneous sporotrichosis.

Background  There are a few studies on the treatment of sporotrichosis. The standard drug used is itraconazole. However, the use of itraconazole is limited by its interaction with other drugs.

Sporothrix schenckii meningitis in AIDS during immune reconstitution syndrome

Sporotrichosis is a fungal disease usually restricted to the cutaneous and lymphatic systems. Visceral involvement is unusual. To date, only 21 cases of sporotrichosis meningitis have been reported, some of these associated with immunosuppression. According to the reported cases, difficulty establishing the correct diagnosis is almost the rule which, undoubtedly, is associated with a worse prognosis. In this report, two HIV infected patients are described who developed meningitis due to Sporothrix schenckii associated with immune reconstitution inflammatory syndrome. This is the first report of sporotrichosis meningitis associated with immune reconstitution inflammatory syndrome in AIDS patients.