Rosani Santos Reis

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.

Sporothrix schenckii isolated from domestic cats with and without sporotrichosis in Rio de Janeiro, Brazil.

A total of 148 cats with a clinical and mycologic diagnosis of sporotrichosis and 84 apparently healthy cats with domiciliary contact with the affected animals were studied. Sporothrix schenckii was isolated from 148 (n = 148; 100%) clinical samples of cutaneous lesion (biopsy, swab or aspiration of purulent secretion), 47(n = 71; 66.2%) nasal cavities, 33 (n = 79; 41.8%) oral cavities, and 15 (n = 38; 39.5%) nails of cats with sporotrichosis. Histopathological examination revealed yeast-like structures in 50 (n = 70; 71.4%) of the biopsies studied. S. schenckii was isolated from the blood culture of one cat (n = 5, 20%) with the disseminated cutaneous form of the disease. On another occasion, the fungus was isolated from the testis of one (n = 7; 14.3%) of the animals submitted to sterilization. In the group of cats with domiciliary contacts, 3(n = 84; 3.57%) oral swabs showed positive cultures. Isolation of S. schenckii from different clinical specimens during both the clinical and preclinical phase reinforces the zoonotic potential of feline sporotrichosis.

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.

Histoplasmosis in a Brazilian center: clinical forms and laboratory tests.

Histoplasmosis, caused by the dimorphic fungus Histoplasma capsulatum, is endemic in many regions of the Americas, Asia and Africa. It has a wide spectrum of clinical manifestations, from asymptomatic infection to severe disseminated disease. A retrospective study was carried out to describe the clinical forms and assess the clinical significance of the laboratory diagnostic tests of patients with histoplasmosis during the period of July 1987 to December 2003 at Instituto de Pesquisa Clínica Evandro Chagas/ FIOCRUZ, RJ, Brazil. Seventy-four patients were included. Forty-nine percent of the cases (n = 36) occurred in HIV positive patients who presented with disseminated disease. The remaining 38 cases were classified in different clinical forms. Histoplasma capsulatum was isolated from 69.5% of the clinical specimens sent to culture. Immunodiffusion and immunoblot were positive in 72.6% and 100% of the performed tests, respectively. Histopathologic findings suggestive of H. capsulatum were found in 63.2% of the performed exams. Serology had a lower proportion of positivity amongst AIDS patients, when compared with HIV negative patients (X2 = 6.65; p lower than 0.008). Statistical differences between AIDS and non-AIDS patients were not observed with culture and histopathology. The specific role of each test varies according to the clinical form. Physicians need to know the value and limitations of the available diagnostic tests, but before that, they have to think about histoplasmosis and consider this clinical entity in their differential diagnosis.

Molecular characterisation of Sporothrix schenckii isolates from humans and cats involved in the sporotrichosis epidemic in Rio de Janeiro, Brazil

An epidemic of sporotrichosis, a subcutaneous mycosis caused by the fungus Sporothrix schenckii, is ongoing in Rio de Janeiro, Brazil, in which cases of human infection are related to exposure to cats. In an attempt to demonstrate the zoonotic character of this epidemic using molecular methodology, we characterised by DNA-based typing methods 19 human and 25 animal S. schenckii isolates from the epidemic, as well as two control strains. To analyse the isolates, the random amplified polymorphic DNA (RAPD) technique was performed using three different primers, together with DNA fingerprinting using the minisatellite derived from the wild-type phage M13 core-sequence. The analyses generated amplicons with considerable polymorphism. Although isolates exhibited high levels of genetic relatedness, they could be clustered into 5-10 genotypes. The RAPD profiles of epidemic S. schenckii isolates could be distinguished from that of the United States isolate, displaying 20% similarity to each primer and 60% when amplified with the M13 primer. DNA fingerprinting of S. schenckii isolated from the nails (42.8%) and the oral cavities (66%) of cats were identical to related human samples, suggesting that there is a common infection source for animals and humans in this epidemic. It is clear that cats act as a vehicle for dissemination of S. schenckii.

Criptococose associada à Aids: a importância do cultivo da urina no seu diagnóstico

In this retrospective study we analyzed 70 HIV patients with cryptococcosis over a 16-years period. The specimens with the best positivity were CSF (97.8%) followed by the culture of urine sediment (86.7%) and blood culture (58.8%). We conclude that the urine could be a useful tool for the diagnosis of cryptococcosis.

Pregnancy during a sporotrichosis epidemic in Rio de Janeiro, Brazil

Sporotrichosis is a subacute or chronic disease that affects animals and humans. It is caused by the dimorphic fungus Sporothrix schenckii and is the primary subcutaneous mycosis in Latin America [1,2]. Zoonotic transmission of sporotrichosis appears to be rare worldwide. An epidemic of sporotrichosis occurred in Rio de Janeiro, Brazil, from 1998 onward. Cats were found to be the main link in the epidemiological chain [1]. From 2005 through 2010, about 1000 patients were diagnosed with sporotrichosis at IPEC–Fiocruz, including 12 pregnant women. The mean age of the 12 patients was 28.3 years (range, 18–40 years). Two clinical forms of the infection, lymphocutaneous sporotrichosis (10 cases) and fixed sporotrichosis (2 cases), were recorded. Fungal culture was positive in all cases (Fig. 1). The patients underwent monthly outpatient assessments and the time of evolution ranged from 4–12 weeks. The upper limbs were the most commonly affected body area and cat scratch or bites were cited in 11 cases, suggesting that the lesions were the putative means of transmission of the fungus. All patients were instructed to perform thermotherapy with warm compresses 3 times a day. Eight patients were cured with thermotherapy, 2 patients had to use itraconazole after delivery, and 2 patients were lost to follow up. The causative fungus can be found in decaying vegetation, soil, moss, and wood and can infect a diversity of animals. The usual mode of transmission is traumatic cutaneous inoculation of the

Utilidade do coágulo sangüíneo para o isolamento de Sporothrix schenckii de gatos naturalmente infectados

The diagnosis of disseminated sporotrichosis is usually obtained by necropsy and the isolation of Sporothrix schenckii from blood is rare. Fungemia was shown in vivo through the isolation of S. schenckii from peripheral blood of 13 (n=38, 34.2%) cats with naturally acquired sporotrichosis. The coinfection with FIV and with FeLV found, respectively, in 6 (n=34, 17.6%) cases and 1 (n=34, 2.9%), apparently did not alter the frequency of the isolation of S. schenckii from peripheral blood. There was agreement of 84.2% comparing these results to the blood culture results simultaneously achieved. In this way, we propose the clot culture as a practical alternative method, efficient and cheap for the diagnosis of disseminated sporotrichosis in cats in vivo.

Cell-free antigens of Sporothrix brasiliensis: antigenic diversity and application in an immunoblot assay.

Sporotrichosis is a subcutaneous mycosis diagnosed by isolation of the fungus in culture. Serological tests for help in diagnosis in general do not use purified or recombinant antigens, because there is a paucity of described immunoreactive proteins, especially for the new described Sporothrix species, such as Sporothrix brasiliensis. This study aims to characterise antigens from S. brasiliensis and verify their application in serodiagnosis of sporotrichosis. An immunoblot assay allied with computer‐based analysis was used to identify putative antigenic molecules in a cell‐free extracts of both morphological phases of this fungus, and to delineate antigenic polymorphism among seven S. brasiliensis isolates and one S. schenckii Brazilian strain. The mycelial and yeast phase of the fungus originated 14 and 23 reactive bands, respectively, which were variable in intensity. An 85 kDa antigen, verified in the yeast phase of the fungus, was observed in all strains used and the immunodominant protein was identified. This protein, however, cross‐react with serum samples from patients infected with other pathogens. The results show that the S. brasiliensis cell‐free antigen extract is a single and inexpensive source of antigens, and can be applied on the sporotrichosis serodiagnosis.