In-vitro antifungal susceptibility of the genus Sporothrix and correlation with treatment options for sporotrichosis: a systematic review

Abstract

Sporotrichosis is an infection with global distribution caused by the dimorphic fungi of the genus Sporothrix, whose main pathogenic species include Sporothrix schenckii, Sporothrix brasiliensis, Sporothrix globosa, and Sporothrix luriei. Itraconazole and amphotericin B are the most used antifungals for the treatment. The aim of this review was to compile the in-vitro susceptibility data of Sporothrix spp. found in literature and correlate this data with the treatment guidelines for sporotrichosis. The systematic review was performed according to the Cochrane methodology and with PICOS (Participants, Intervention, Comparators, Outcomes, Study Design) strategy. Thirty-six studies were included that used the filamentous and/or the yeast phases to perform the susceptibility tests. Three studies that evaluated the association of antifungals using the checkerboard method were also included. The data found were, whenever possible, compared with the defined Epidemiological Cutoff Values (ECVs). Analyzing only the minimum inhibitory concentration (MIC) values, the most effective antifungal in vitro was terbinafine. However, this is not the same result as observed in vivo. Both itraconazole and amphotericin B presented in-vitro activity. However, many studies have shown that isolates can acquire resistance mechanisms to these antifungals (MIC > ECV), which deserves attention. Further studies are needed to translate in-vitro susceptibility data into clinical practice, and also to determine ECVs for more antifungals and Sporothrix species.

A Randomized Clinical Trial Comparing Itraconazole and a Combination Therapy with Itraconazole and Potassium Iodide for the Treatment of Feline Sporotrichosis

“…Many potential drug candidates showed in vitro activity against Sporothrix [15,[34][35][36][37][38], but in spite of that, there are few available antifungal agents that are effective in vivo against feline sporotrichosis [30].…”

Clinical-epidemiological characteristics of Sporotrichosis cases in Rio Grande do Sul, Brazil: a 16-year study

“…The treatment of sporotrichosis must be defined considering the type of clinical manifestation, the immunological situation of the host and also the causal species of Sporothrix 1 , as the species of the genus present different responses to antifungals in vitro 1,7 .…”

“…Amphotericin B is used as a second-line treatment for cutaneous and lymphocutaneous sporotrichosis, in addition to being used in disseminated, systemic, pulmonary and osteoarticular forms. Terbinafine is suggested as a potent antifungal against S. brasiliensis, however, more studies are needed to confirm the effectiveness and safety of its use 1,7,8 .…”

“…Sporotrichosis is widespread throughout the world, however, in some places the disease is more frequent, such as in America, Asia and Africa [9][10][11] . In recent years, in Brazil, sporotrichosis in humans and cats by S. brasiliensis has become a public health problem, reaching epidemic levels mainly in the South and Southeast regions 1,5,7,10 . In other endemic regions, the disease is mainly related to environmental transmission by inoculation by contaminated plant debris and by zoonotic transmission, and the main etiological agents are S. schenckii and S. globosa 7,[10][11][12] .…”