Fatal pulmonary sporotrichosis caused by Sporothrix brasiliensis in Northeast Brazil

Abstract

Background A relevant case of pulmonary sporotrichosis due to Sporothrix brasiliensis is reported in a 50-year-old immunocompetent woman who had no history of skin trauma, but was in close contact with several stray cats at her nap time. The patient was hospitalized after 7 months of illness. The survey was conducted for pulmonary tuberculosis, an endemic disease in Brazil. She presented multiple central pulmonary nodules images, with central cavitation. Methodology/Principal findings The patient bronchoalveolar lavage was cultured and Sporothrix sp. growth was obtained. Then, the isolate (LMMM1097) was accurately identified to the species level by using species-specific polymerase chain reaction (PCR). Molecular diagnosis revealed that the emerging species Sporothrix brasiliensis was the agent of primary pulmonary sporotrichosis and the patient was treated with Amphotericin B lipid complex, but presented severe clinical symptoms and the fatal outcome was observed at day 25 after hospitalization. Conclusions/Significance Our report adds important contributions to the clinical-epidemiological features of sporotrichosis, showing the geographic expansion of the agent within different regions of Brazil and a rare clinical manifestation (primary pulmonary sporotrichosis) caused by the emerging agent S. brasiliensis in an immunocompetent female patient.

Exploring genetic diversity, population structure, and phylogeography in Paracoccidioides species using AFLP markers

“…, São Paulo, Espírito Santo, and Minas Gerais), or even those areas spanning over 2 000 km from the epicentre, such as Pernambuco, Rio Grande do Norte, and Ceará ( Zhang et al. 2015 , do Monte Alves et al. 2020 , de Oliveira Bento et al.…”

Epidemiology of Clinical Sporotrichosis in the Americas in the Last Ten Years

“…A total of 68 publications with 11,050 cases of sporotrichosis were found in South America [ 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 …”

“…Of these, 4 reports were found in Argentina during the analyzed period with 38 cases, of which 9 were caused by S. schenckii sensu stricto (23.68%), 26 by S. brasiliensis (68.52%), 1 by S. globosa (2.6%), 1 by S. schenckii (2.6%), and 1 by S. schenckii complex (2.6%) [ 61 , 62 , 63 , 64 ]. Brazil reported 42 articles with 5546 analyzed cases [ 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 ], identifying Sporothrix spp. and S. schenckii complex as the causative agent in 4906 cases (88.46%), S. schenckii in 302 (5.45%), S. brasiliensis in 125 (2.25%), Sporothrix sensu lato in 110 (1.98%), S. globosa plus S. schenckii in 91 cases (1.64%) Sporothrix sensu stricto in 5 (0.09%), S. globosa in 4 (0.07%), and S. mexicana in 3 (0.05%) during the studied period.…”

“…In Brazil, the main pathogenic agent was Sporothrix spp. with 95.56%, S. brasiliensis 2.25%, S. globosa plus S. schenckii 1.64%, S. schenckii 0.41%, S. globosa 0.07%, and S. mexicana 0.05% [ 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 ]. In Colombia, S. schenckii 44.00%, Sporothrix spp.…”

Old and New Insights into Sporothrix schenckii Complex Biology and Identification

“…If not limited to skin (cutaneous-lymphatic or cutaneous-fixed sporotrichosis), sporotrichosis manifestations include cutaneous-disseminated, disseminated (visceral), and extracutaneous forms (pulmonary, osteoarticular, and meningeal), which are prominently diagnosed in immunocompromised (human immunodeficiency virus (HIV)-AIDS, chronic alcoholism, diabetes, hematological cancer, or transplantation) patients [ 10 ]. Primary pulmonary sporotrichosis, which results from inhalation of conidia, may lead to a disseminated disease and is often fatal [ 11 ]. In feline sporotrichosis, uniquely when compared to the infections caused by other endemic dimorphic fungi (e.g., Onygenales), transmission seems to occur directly through the fungus’s yeast phase that is present at a high burden in the infected animal’s lesions [ 10 ].…”