Sporotrichosis: A Clinicopathologic Study of 89 Consecutive Cases, Literature Review, and New Insights About Their Differential Diagnosis

Abstract

Background: Sporotrichosis is the most common and least severe of deep mycoses. This disease has varied clinic presentation as well as several differential diagnosis. Methods: A cross-sectional and retrospective, individually based, observational study, based on records from the dermatopathology service of a university hospital in Brazil. A total of 175 patients were identified with clinical suspicion of sporotrichosis, from 2009 to 2017. Statistical analysis using prevalence ratios was conducted to characterize the clinicopathologic and epidemiological aspects. Results: The disease was suspected in 175 patients given the clinical presentation. Of these, 86 cases (49.14%) were sporotrichosis, 39 (22.29%) chronic granulomatous inflammatory processes of unidentified etiology, and 5 squamous cell carcinomas (2.86%). The majority of cases (52 or 60.46%) occurred in the upper limbs. A total of 40 samples presented a suppurative chronic granulomatous inflammatory process (46.51%). Only 5 samples (12.50%) showed positive staining (periodic-Schiff acid or GROCOTT). Conclusions: The sporotrichosis cases underwent both cumulative and linear growth, especially in the group above 60 years. Squamous cell carcinomas appeared several times as a misdiagnosis of sporotrichosis by dermatologists, so it should be considered as an important differential diagnose due to the current context of skin cancers.

Clinical and Epidemiological Characteristics of Sporotrichosis in a Reference Center of Uruguay

“…The high prevalence of cases from the metropolitan area of Rio de Janeiro has created a sporotrichosis belt. The majority are female patients and from poor socioeconomic backgrounds who acquire the disease through domiciliary or professional contact (bite or scratch) with cats infected with sporotrichosis [ 5 , 32 , 36 , 37 ].…”

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.…”

“…The most frequent types of disease were lymphocutaneous with 3293 cases (29.47%), fixed cutaneous with 1947 (17.43%), disseminated cutaneous with 34 (0.30%), systemic form with 18 (0.16%), and others with 177 cases (1.60%). However, there were 5702 cases (51.04%) with undetermined types from all the cases diagnosed as sporotrichosis [ 56 , 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 ,…”