Sporotrichosis in Children: Case series and Narrative Review

Abstract

Purpose of Review Pediatric sporotrichosis has not been sufficiently studied; this review aims to evaluate the risk and prognostic factors related to the development of sporotrichosis associated to this age group. Also, we want to evaluate the causes of the increased number of cases of sporotrichosis in the pediatric population such as environmental changes in endemic areas, the biodiversity, and virulence among the pathogenic clade causing sporotrichosis in different areas of the globe, and especially the progression of the zoonotic transmission of infections caused by Sporothrix brasiliensis infections, associated to zoonotic transmission in Brazil and other endemic sporotrichosis countries. Recent Findings After evaluating a case series of 40 patients, we found that pediatric sporotrichosis in Mexico is mainly caused by Sporothrix schenckii which prevails in rural areas and is mainly sapronotically transmitted. In Brazil, the longest and largest pediatric sporotrichosis outbreak is caused by Sporothrix brasiliensis , etiologically related to sick cats, directly from lesions containing a high yeast cell burden. When affecting children S. schenckii and S. brasiliensis may cause distinct clinical manifestations especially in the onset of the disease and affected anatomical site. In Mexico, most of the patients are successfully treated with potassium iodide, whereas in Brazil, all patients respond to itraconazole. Summary Sporothrix schenckii is the major etiologic agent in Mexico, being sapronotically transmitted, while in Brazil, Sporothrix brasiliensis is only transmitted by cats. In Mexico, the disease prevails in male patients (60%) from rural areas; in Brazil, the disease is more frequent in females (60%) from an urban region. Due to the zoonotic sporotrichosis outbreak in Brazil, the time of evolution seems to be shorter in Brazilian patients than in Mexican patients. Most Brazilian patients presented with facial lesions, including ocular involvement, while in Mexico, most of the children presented upper limbs involvement. In Mexico, treatment with potassium iodide in children was observed to induce faster remission than itraconazole, but controlled studies are lacking to evaluate this versus itraconazole, due to the low number of cases. A comparative study should be designed to evaluate the best and safest antifungal therapy for pediatric sporotrichosis. Supplementary Information The online version contains supplementary material available at 10.1007/s12281-022-00429-x.

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

“…27,32 Ageing could be the factor that affects assay sensitivity. 24,31,34 In this study, we observed a lower frequency of false negatives in children (12%) compared with adults (18%), but this was not statistically significant. To increase the chance of detecting cases, it is recommended to evaluate acute and convalescent specimens.…”

“…CTS was defined following the guidelines of the Brazilian ministry of health (Appendix A). 24,25 Mycological studies were done with those patients where access to specimens was possible. All CTS cases were treated and followed during their time at the HC-UFPR.…”

“…1,2,16,18 The standard method for the diagnosis of sporotrichosis is the isolation of the fungus by culture, but this method is timeconsuming, requires well-trained professionals, and has variable sensitivity. 1,20,23,24 Direct examination and histopathological study have low sensitivity; less than 30%. 8,20 Intradermal reactivity using sporotrichin is not commercially available and its use is limited to some few highly specialised medical centres.…”

“…8,20 Some in-house enzyme immunoassays (EIA) have been developed, showing high sensitivity and specificity, but these assays are limited to just a few laboratories. 8,23,24 CTS caused by Sporothrix brasiliensis is an emerging health problem in Brazil and a threat to bordering countries. 1,7,8 The aim of this study was to evaluate the performance of a lateral flow assay (LFA) for the rapid detection of anti-Sporothrix antibodies in human sera.…”

“…LFA bands in the test zone observed in Group #3 were less intense than bands observed from specimens in Groups #1 and #2. 24,25 Abbreviations: −, Negative; ♀, Female; ♂, Male; DO, disease onset; WCo, Without comorbidities; YO, Years old.…”