Sporotrichosis: hyperendemic by zoonotic transmission, with atypical presentations, hypersensitivity reactions and greater severity

Abstract

In recent decades, an alarming increase in the number of sporotrichosis cases has been reported in southern and southeastern Brazil, especially in the state of Rio de Janeiro, has been considered a long-term hyperendemic condition associated with feline transmission. According to phenotypic classifications, the Sporothrix species recovered from cats were classified as S. brasiliensis in 96.5% of the studied cases. This finding has also been demonstrated in humans, which confirms the zoonotic transmission associated with this predominant species in Brazil. The zoonotic transmission of the fungus and its important virulence in the context of the hyperendemic situation in Rio de Janeiro have changed the approach to the disease, which in its classic form was restricted to certain professional groups and very specific regions in the Brazilian territory, into a public health challenge of scientific interest. Its atypical manifestations and hypersensitivity reactions are increasingly frequent, constituting a new sporotrichosis aspect, which deserves attention from the medical community, as well as from other health professionals.

A lateral flow assay for the immunodiagnosis of human cat‐transmitted sporotrichosis

“…These characteristics would increase the risk of exposure to Sporothrix and other fungal pathogens able to produce cross-reactions. 8,19,24 Based on these findings, it is recommended to perform this test only in people who are symptomatic, or with a strong epidemiological link to CTS. In addition, future investigations focusing on product improvement are needed.…”

“…Additionally, most of these volunteers were healthcare workers residing in the endemic region for sporotrichosis. These characteristics would increase the risk of exposure to Sporothrix and other fungal pathogens able to produce cross‐reactions 8,19,24 . Based on these findings, it is recommended to perform this test only in people who are symptomatic, or with a strong epidemiological link to CTS.…”

“…However, CTS epidemic atypical clinical forms have been described as ocular, antigen hyperreactivity, osteoarticular, meningitis and other extracutaneous infections, adding challenges to the diagnosis of this disease. [1][2][3]5,7,[17][18][19] Due to the broad clinical spectrum of this disease, the differential diagnosis of sporotrichosis with other infectious and non-infectious diseases must be carried out, including tegumentary leishmaniasis, tuberculosis, pyoderma, cat scratch disease, chromoblastomycosis, phaeohyphomycosis and mycetoma. 5 Due to the low specificity of the clinical manifestation, the use of specific laboratory assays is key.…”

“…Sporothrix brasiliensis is more virulent than other species of the Sporothrix genus, and the fixed lymphocutaneous and cutaneous forms are the most frequent clinical forms. However, CTS epidemic atypical clinical forms have been described as ocular, antigen hyperreactivity, osteoarticular, meningitis and other extracutaneous infections, adding challenges to the diagnosis of this disease 1–3,5,7,17–19 …”

Tattooing as a gateway to Sporothrix brasiliensis infection

“…Although uncommon, the disease can also develop by contact of mucosa or non-intact skin with contaminated surfaces or fluids [ 2 , 3 ]. Atypical presentations of sporotrichosis associated with these uncommon forms of transmission are described in the Brazilian hyperendemic zoonotic sporotrichosis area, caused by S. brasiliensis [ 1 , 2 , 4 , 5 ].…”