Abstract
Sporotrichosis is a global implantation or subcutaneous mycosis caused by several members of the genus Sporothrix, a thermo-dimorphic fungus. This disease may also depict an endemic profile, especially in tropical to subtropical zones around the world. Interestingly, sporotrichosis is an anthropozoonotic disease that may be transmitted to humans by plants or by animals, especially cats. It may be associated with rather isolated or clustered cases but also with outbreaks in different periods and geographic regions. Usually, sporotrichosis affects immunocompetent hosts, presenting a chronic to subacute evolution course. Less frequently, sporotrichosis may be acquired by inhalation, leading to disseminated clinical forms. Both modes of infection may occur in immunocompromised patients, especially associated with human immunodeficiency virus (HIV) infection, but also diabetes mellitus, chronic alcoholism, steroids, anti-TNF treatment, hematologic cancer and transplanted patients. Similar to other endemic mycoses caused by dimorphic fungi, sporotrichosis in immunocompromised hosts may be associated with rather more severe clinical courses, larger fungal burden and longer periods of systemic antifungal therapy. A prolonged outbreak of cat-transmitted sporotrichosis is in progress in Brazil and potentially crossing the border to neighboring countries. This huge outbreak involves thousands of human and cats, including immunocompromised subjects affected by HIV and FIV (feline immunodeficiency virus), respectively. We reviewed the main epidemiologic, clinical, diagnostic and therapeutic aspects of sporotrichosis in immunocompromised hosts.
Highlights
Sporotrichosis is a subacute to chronic fungal infection caused by several species of genusSporothrix, a group of thermal dimorphic fungi
Human immunodeficiency virus (HIV)/AIDS changes the natural history of sporotrichosis and its opportunistic character depends on the immune status of the host
Therapy of patients patientswith withsporotrichosis sporotrichosis associated with impaired defenses doesdiffer not Therapy of associated with impaired host host defenses does not differ from treatment modalities applied for immunocompetent individuals, except for inclusion from treatment modalities applied for immunocompetent individuals, except for inclusion of of specific interventions underlying conditions leading to opportunistic disease
Summary
Sporotrichosis is a subacute to chronic fungal infection caused by several species of genus. During the last three decades, a new, probable mutant species, S. brasiliensis, has emerged in the state of Rio de Janeiro, Brazil This species is transmitted to humans by infected cats (zoonosis), causing the largest outbreak of sporotrichosis ever reported [6,7,8]. In opportunistic sporotrichosis (OS), conventional serology may reveal false negative antibodies levels and long courses of systemic antifungal therapy are usually required This mycosis can affect anyone regardless of age, gender or comorbidities, mostly depending on exposure [1]. Human immunodeficiency virus (HIV)/AIDS changes the natural history of sporotrichosis and its opportunistic character depends on the immune status of the host Comorbidities such as diabetes mellitus, chronic alcoholism, steroid treatment, hematologic cancer and organ transplantation have been sporadically described as risk factors for severe forms of the disease and case reports have focused on unusual manifestations in these scenarios. In an attempt to better understand why certain comorbidities may predispose to OS, we performed a critical review of the data on the immune response in sporotrichosis
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