Pulmonary Sporotrichosis Caused by Sporothrix brasiliensis: A 22-Year, Single-Center, Retrospective Cohort Study

Abstract

Pulmonary sporotrichosis is a rare condition. It can present as a primary pulmonary disease, resulting from direct Sporothrix species (spp). conidia inhalation, or as part of multifocal sporotrichosis with multiple organ involvement, mainly in immunocompromised patients. This study aimed to describe the sociodemographic and epidemiological characteristics and clinical course of patients with positive cultures for Sporothrix spp. from pulmonary specimens (sputum and/or bronchoalveolar lavage) at a reference center in an area hyperendemic for zoonotic sporotrichosis. The clinical records of these patients were reviewed. Fourteen patients were included, and Sporothrix brasiliensis was identified in all cases. Disseminated sporotrichosis was the clinical presentation in 92.9% of cases, and primary pulmonary sporotrichosis accounted for 7.1%. Comorbidities included human immunodeficiency virus infection (78.6%), alcoholism (71.4%), and chronic obstructive pulmonary disease (14.3%). Treatment with amphotericin B followed by itraconazole was the preferred regimen and was prescribed in 92.9% of cases. Sporotrichosis-related death occurred in 42.9% while 35.7% of patients were cured. In five cases there was a probable contamination from upper airway lesions. Despite the significant increase in sporotrichosis cases, pulmonary sporotrichosis remains rare. The treatment of disseminated sporotrichosis is typically difficult. Prompt diagnosis and identification of all affected organs are crucial for better prognosis.

Clinical factors associated with systemic sporotrichosis in Brazil

“…6 On the other hand, Fichman et al found that 78.6% of patients using alcohol in a cohort of 12 patients with pulmonary sporotrichosis. 7 Besides reporting the alcohol consumption by the patients, those studies did not point to the statistical association between alcohol and SF. Malacco et al demonstrated, in a murine model of aspergillosis, that chronic alcohol consumption reduces neutrophils' recruitment to the lungs, favouring fungal growth.…”

“…In addition, atypical and more severe manifestations of sporotrichosis have been associated with S . brasiliensis 7,16–18 …”

Special Issue “Sporothrix and Sporotrichosis 2.0”

“…Systemic infections, such as pulmonary sporotrichosis, are rare and usually are established in immunosuppressed patients [ 1 ]. Fichman et al reported here a 22-year, retrospective cohort study on pulmonary sporotrichosis carried out in the Instituto Nacional de Infectologia Evandro Chagas (Rio de Janeiro, Brazil), and found that during the analyzed period, only 14 patients fulfilled all the inclusion criteria (all of which were diagnosed with an S. brasiliensis -caused infection) [ 16 ]. This is a surprising figure considering that the clinical center is placed in the heart of a sporotrichosis hyperepidemic area.…”

“…This is a surprising figure considering that the clinical center is placed in the heart of a sporotrichosis hyperepidemic area. Primary pulmonary sporotrichosis was observed only in 7.1% of patients, whilst the rest were associated with disseminated infection [ 16 ]. Human immunodeficiency virus infection, alcoholism, and chronic obstructive pulmonary disease were the main comorbidities in these patients.…”

“…Human immunodeficiency virus infection, alcoholism, and chronic obstructive pulmonary disease were the main comorbidities in these patients. It is noteworthy to mention that the mortality rate was 42.9%, and 35.7% of patients were cured [ 16 ]. A similar retrospective study conducted in the same National Institute with data collected from 1998 to 2018 looking for patients with disseminated sporotrichosis and treated with amphotericin B is also included in this Special Issue [ 17 ].…”