Severe Sporotrichosis Treated with Amphotericin B: A 20-Year Cohort Study in an Endemic Area of Zoonotic Transmission

Abstract

Although rare, disseminated sporotrichosis is increasing in several countries. Despite its limiting toxic potential, amphotericin B is the only intravenous antifungal available to treat severe sporotrichosis. We aimed to describe the effectiveness and safety of amphotericin B treatment for severe sporotrichosis. Clinical records of patients with disseminated sporotrichosis at a reference center were reviewed. This study included 73 patients. Most (53.4%) were men and non-white. HIV coinfection was the main comorbidity (52.1%). Most reported contact with cats (76.7%). Sporothrix brasiliensis was the causative species. Affected sites were skin (98.6%), osteoarticular system (64.4%), upper airway (42.5%), central nervous system (20.5%), eyes (12.3%), and lungs (8.2%). Median doses of amphotericin B used were 750 mg and 4500 mg for deoxycholate and lipid complex formulations, respectively. Amphotericin B discontinuation occurred in 20.5% due to adverse events, mainly azotemia. The outcomes included cure (52.1%), death due to sporotrichosis (21.9%), death due to other causes (9.6%), and loss to follow-up (8.2%). Survival analysis showed an association between cure and the absence of bone, upper airway, and central nervous system involvement. Amphotericin B is the first-choice treatment for disseminated sporotrichosis; however, the severity of systemic dissemination might predict its response. Favorable clinical results depend on prompt diagnosis, investigation of fungal dissemination, and early therapy initiation.

Special Issue “Sporothrix and Sporotrichosis 2.0”

“…Median doses of amphotericin B were 750 mg and 4500 mg for deoxycholate and lipid complex formulations, respectively, and 52.1%s of patients were cured [ 17 ]. The sporotrichosis-associated mortality was observed in 21.9%, while mortality by other causes was reported in 9.6% of patients [ 17 ]. It was concluded from the study that infection severity might predict the success of amphotericin B [ 17 ].…”

“…The sporotrichosis-associated mortality was observed in 21.9%, while mortality by other causes was reported in 9.6% of patients [ 17 ]. It was concluded from the study that infection severity might predict the success of amphotericin B [ 17 ]. Another study, but this set in a different brazilian sporotrichosis epidemic area (Rio Grande do Sul state) aimed to analyze the treatment of 28 cases of S. brasiliensis -caused cutaneous sporotrichosis [ 18 ].…”

“…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 ]. The study included 73 patients and, as reported in other studies, human immunodeficiency virus infection was the main comorbidity [ 15 , 17 ].…”

“…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 ]. The study included 73 patients and, as reported in other studies, human immunodeficiency virus infection was the main comorbidity [ 15 , 17 ]. Median doses of amphotericin B were 750 mg and 4500 mg for deoxycholate and lipid complex formulations, respectively, and 52.1%s of patients were cured [ 17 ].…”

“…The study included 73 patients and, as reported in other studies, human immunodeficiency virus infection was the main comorbidity [ 15 , 17 ]. Median doses of amphotericin B were 750 mg and 4500 mg for deoxycholate and lipid complex formulations, respectively, and 52.1%s of patients were cured [ 17 ]. The sporotrichosis-associated mortality was observed in 21.9%, while mortality by other causes was reported in 9.6% of patients [ 17 ].…”