Common Subcutaneous Mycosis Research Articles

Zoonotic Sporotrichosis outbreak: Emerging public health threat in the Amazon State, Brazil.

Sporotrichosis is the most common subcutaneous mycosis caused by Sporothrix spp. Traditionally, it is transmitted through injuries involving plant debris. However, over the past few decades, there has been an epidemic increase in human cases resulting from contact with infected animals, particularly cats, in various regions of Brazil. In this report, we report a notable increase in both human and animal cases within the Brazilian Amazon state. An ecological study was conducted by analyzing official records of human and animal sporotrichosis diagnosed in the state of Amazon from 2020 to 2023. Data including patient demographics, clinical manifestations, mycological examination results, and species identification through PCR confirmation were evaluated. During this period, a total of 950 human cases and 2,823 animal cases of sporotrichosis were reported at an exponential rate, since no human cases were registered in 2020. The spatial and temporal dispersion of human sporotrichosis followed that of animal cases, moving from downtown areas to the periphery. Contact with infected animals was reported in 77.7% of cases, with cats being the most commonly implicated (73.5%). Only 66.7% of individuals underwent mycological examination. Among the positive cultures for Sporothrix spp., 65.4% were identified as S. brasiliensis. All patients were treated with systemic antifungals. This study highlights a rising incidence of sporotrichosis among animals and humans in the Brazilian Amazon region over the past four years, with S. brasiliensis being the predominant agent. Collaborative efforts involving healthcare professionals, veterinarians, and public health authorities are crucial to implement effective control measures, educate populations at risk, and promote responsible guidance for pet guardians. These measures are essential to mitigate the burden of epidemic sporotrichosis in Brazil.

SPOROTRICHOSIS IN CHILDREN: A FORGOTTEN ENTITY

Sporotrichosis is regarded as the most common subcutaneous fungal mycosis, which occurs following traumatic inoculation of Sporothrix schenckii complex. Albeit rare, sporotrichosis, also known as 'rose gardener's disease', has been reported to involve children whereby active or passive transmission through a vector such as domestic animals has been identified as the main culprit. Herein, we report sporotrichosis in a pair of siblings who presented to the outpatient Otorhinolaryngology clinic in University Malaya Medical Centre with a lower lips skin lesion and submental swelling after kissing their domestic cat. Sporotrichosis was diagnosed following the fungal culture of the skin scrapings of the lower lip’s pustular lesions. Prompt treatment with oral itraconazole (8 mg/kg/day) for six weeks showed the resolution of symptoms. We highlight the pathophysiology of zoonotic sporotrichosis and the mode of management of this entity. Additionally, the management of sporotrichosis should include the veterinarian's assessment of the infected animal.

A new duplex PCR assay for the rapid screening of mating-type idiomorphs of pathogenic Sporothrix species

Sporothrix schenckii and allied species are thermodimorphic fungi widely distributed in nature which causes human and animal sporotrichosis, the most common subcutaneous mycosis globally. Sporotrichosis is acquired after a traumatic inoculation of soil or plant material contaminated with Sporothrix propagules or through bites and scratches from diseased cats. In Ascomycota, the master regulators of sex are MAT genes that lie in a single mating-type locus, in Sporothrix these are determined by two nonhomologous alleles, MAT1-1 and MAT1-2. We assessed the whole-genome sequences of medically relevant Sporothrix to develop a single-tube duplex PCR assay to screen S. brasiliensis, S. schenckii, S. globosa, and S. luriei idiomorphs (MAT1-1 or MAT1-2) and understand the distribution and incidence of mating-type strains from natural populations. Using our duplex PCR assay, a 673 bp amplicon (α-box protein) was consistently amplified from all MAT1-1 isolates, while a 291 bp fragment was only amplified from the isolates harboring MAT1-2 (HMG box). Molecular evidence suggests heterothallism (self-sterility) as the unique mating strategy among the species evaluated. The mating-type identity of 93 isolates revealed a nearly equal distribution (1:1 ratio) of mating type alleles within species but deviating between different outbreak areas. Remarkably, for S. brasiliensis in Rio de Janeiro, we report an overwhelming occurrence of MAT1-2 (1:13 ratio; χ2 = 10.286, P = 0.0013) opposing the high prevalence MAT1-1 in the Rio Grande do Sul (10:1 ratio; χ2 = 7.364, P = 0.0067). Therefore, the population structure of Sporothrix species refers from paucity to regular cycles of sexual recombination in most of the studied regions. Our PCR-based mating-type diagnostic assay is proposed here as an important marker to track the geographical expansion during the long-lasting outbreak of cat-transmitted sporotrichosis driven by S. brasiliensis.

Potential use of Nikkomycin Z as an anti- Sporothrix spp. drug.

Sporotrichosis is a subcutaneous and lymphatic infection, caused by fungi of Sporothrix spp. Our study shows the potential of NikZ to inhibiting Sporothrix species in vitro. Further studies are needed to understand the future application of this drug to sporotrichosis treatment.

ESPOROTRICOSE, O GATO E A COMUNIDADE

Dermatozoonoses have a worldwide occurrence, being more prevalent in tropical and subtropical countries. Epidemiological data indicate that sporotrichosis is the most common subcutaneous mycosis in Latin America. Its importance for public health as an emerging disease is mainly associated with cases involving zoonotic transmission by domestic felines in Brazil. The disease is caused by species of the genus Sporothrix, being the one of greater occurrence in Brazil, Sporothrix brasiliensis. The most common clinical picture in mammals is acute or chronic, with the presence of cutaneous lesions and, in humans, it has a social impact during its active phase with an unpleasant appearance causing discomfort to the affected person. The disease has a cure, however the treatment of this mycosis, in general, is related to the prolonged use of systemic antifungals. The treatment of cats with sporotrichosis is a challenge due to several factors, among them occurrence of therapeutic failures, besides the high cost. Sporotrichosis presents with importance in the environmental health theme, with emphasis in the context of the sociocultural aspects of the disease, which can be observed mainly in hot and humid places, with high population density, poor sanitary conditions or lack of responsible custody of dogs and cats.

A prospective clinico mycological study of deep mycoses in a tertiary centre in Tamil Nadu

<p class="abstract"><strong>Background:</strong> Deep mycoses which<strong> </strong>includes subcutaneous mycoses and systemic mycoses, accounts for about 1% of the all the fungal infections seen in human beings. Though rare, these infections assume significance due to the increased morbidity and mortality associated with them. The objective of the study was to study the incidence, clinical presentation, aetiological agents and histopathological findings of deep mycoses in patients attending the mycology section, department of dermatology of a tertiary centre in Chennai.</p><p class="abstract"><strong>Methods:</strong> All Patients with clinical suspicion of deep mycoses who presented to mycology section during the period from November 2015 to September 2016 were screened. The samples from these patients were subjected to direct microscopy by potassium hydroxide wet mount, culture and histopathology.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among the 8250 patients who attended mycology OPD, 41 patients (0.5%) had deep mycoses. The commonly affected age group was 41-50 yrs (29.7%). Males (73.2%) were predominantly affected. Of the 41 patients, 26.8% were immunocompromised. 37 patients (90.2%) had subcutaneous infection and 4 (9.8%) had opportunistic mycoses. Mycetoma (43.2%) was the most common subcutaneous mycoses. Mucormycosis (75%) and aspergillosis (25%) were the opportunistic mycoses observed. KOH positivity was 100%, while culture positivity was 65.7%. <em>Madurella mycetomatis,</em> <em>Phialophora verrucosa</em>, <em>Rhizopus arrhizus</em> and <em>Aspergillus fumigatus</em> were the common organisms isolated in this study.</p><p class="abstract"><strong>Conclusions:</strong> Mycetoma is the most common subcutaneous mycoses in this part of India. Eumycetoma is more common than actinomycetoma. Phaeohyphomycosis is on the rise. Simple KOH examination would pave way for an early diagnosis and prompt treatment of deep mycoses.</p>

Epidemiology of Subcutaneous Mycoses in Northeast India: A Retrospective Study.

Background:Subcutaneous mycoses, although rare, are frequently reported from northeast India. Their spectrum varies with geographic region.Materials and Methods:We evaluated clinical records and histopathological features of subcutaneous mycoses cases seen during April 2013 to March 2017.Results:A total of 70 patients (44 males and 26 females) of subcutaneous mycoses were analyzed. Sixty-one percent of patients were 20–60 years old. Duration of the disease ranged from 3 months to 25 years. Most common site of involvement was the lower limb (32, 46%), followed by the upper limb (25, 36%). A history of trauma was obtained from 76% of patients. Eighty-seven percent of patients were from rural area. Ninety-two percent of patients were agricultural workers. There were 30 established cases of chromoblastomycosis and 16 cases of sporotrichosis. In 24 cases, subcutaneous mycosis was suspected clinically and showed some improvement to empirical itraconazole therapy. Multifocal lesions were seen in six patients. Complication of subcutaneous mycoses in the form of invasive squamous cell carcinoma was seen in one patient. On histopathological examination, verrucous hyperplasia was seen in 93% of cases. Granulomas with suppuration were seen in 77% of cases and granulomas without suppuration were seen in 14.3% of cases. Copper penny bodies were appreciated in 42.8% of cases. Fungal culture was positive only in 55.7% of cases. There was growth of Sporothrix schenckii in 16 patients, Fonsecaea sp. in 19, Cladosporium sp. in 3, and Curvularia sp. in 1.Conclusion:Chromoblastomycosis was the most common subcutaneous mycoses seen in northeast India followed by sporotrichosis. The diagnosis remained a challenge in a few cases as the culture positivity was very low. Suppurative granulomas in histopathology played a corroborative role. Therapeutic trial of itraconazole for 2 months was worth trying in such cases.

Subcutaneous mycoses in Peru: a systematic review and meta-analysis for the burden of disease.

There is a worrying lack of epidemiological data on the geographical distribution and burden of subcutaneous mycoses in Peru, hindering the implementation of surveillance and control programs. This study aimed to estimate the disease burden of subcutaneous mycoses in Peru and identify which fungal species were commonly associated with these mycoses. We performed a meta-analysis after a systematic review of the published literature in PubMed, LILACS, and SciELO to estimate the burden of subcutaneous mycoses in 25 regions in Peru. The disease burden was determined in terms of prevalence (number of cases per 100,000 inhabitants) and the number of reported cases per year per region. A total of 26 studies were eligible for inclusion. Results showed that sporotrichosis was the most common subcutaneous mycosis (99.7%), whereas lobomycosis, chromoblastomycosis, and subcutaneous phaeohyphomycosis were rare. Cases of eumycetoma and subcutaneous zygomycosis were not found. Of the 25 regions, the burden of sporotrichosis was estimated for four regions classified as endemic; in nine regions, only isolated cases were reported. The highest burden of sporotrichosis was in Apurimac (15 cases/100,000 inhabitants; 57 cases/year), followed by Cajamarca (3/100,000 inhabitants; 30/year), Cusco (0.5/100,000 inhabitants; 4/year), and La Libertad (0.2/100,000 inhabitants; 2/year). In two regions, the mycoses predominantly affected children. Sporotrichosis is the most common subcutaneous mycosis in Peru, with a high disease burden in Apurimac. Chromoblastomycosis, lobomycosis, and subcutaneous phaeohyphomycosis are rare mycoses in Peru.

Fungal infection control by garlic extracts (Allium sativum L.) and modulation of peritoneal macrophages activity in murine model of sporotrichosis.

Garlic (Allium sativum L.) is grown all over the world as seasoning and medicinal vegetable since 3,000 BC. Allicin is the main component of garlic, being attributed to it the most of its biological activities, such as bactericidal, antifungal and antiviral actions. However, other compounds of garlic present antioxidant, hypocholesterolemic, vasodilator activities, protective action against different types of cancer, and immunomodulatory. Fungal infections are important causes of morbidity and mortality in people mainly in immunosuppressed ones. Sporothrix schenckii, the causing agent of Sporotrichosis (most common subcutaneous mycosis in Latin America), is dimorphic fungus, of saprophytic life in soil or plants, infecting people and animals mainly through skin injuries and bruises. The main of this work was to evaluate the influence of garlic consuming on immune modulation of healthy and infected Swiss mice in induced way by S. schenckii, since these animals functioning of peritoneal macrophages as well as the nitric oxide and cytokines' production (IL-1β, IL-10 and IL-12) and to evaluate the antifungal potential of garlic with S. schenckii through minimum inhibitory concentration test and colony-forming units. The results showed that garlic offers antifungal potential with S. schenckii. The oral taking of garlic extracts influences the releasing of cytokines by macrophages, regular consuming shows anti-inflammatory effect, and its acute use may take to an inflammatory response. Mice that consumed garlic responded more effectively to fight against the infection.

Osteomyelitis caused by Sporothrix schenckii in an immunocompetent patient

Sporotrichosis is the most common subcutaneous mycosis in South America and its association with zoonotic transmission remains a relevant public health problem in Rio de Janeiro, Brazil. The disease most commonly presents as subacute or chronic cutaneous lesions, although dissemination to various organs and systems occurs in rare cases, mainly in immunosuppressed individuals. This report describes a case of sporotrichosis with severe bone and subcutaneous damage in an immunocompetent patient who did not exhibit the characteristic skin lesions of sporotrichosis, including ulcers, nodules, and lymphangitis.

Clinical features of 10 cases of eyelid sporotrichosis in Jilin Province (Northeast China)

ObjectiveSporotrichosis is a common subcutaneous mycosis caused by an infection with dimorphic fungus Sporothrix schenckii. We present a series of patients with eyelid sporotrichosis and study the clinical and histopathological presentation, microbiology, treatment options, and outcome. MethodsA retrospective case-series study of patients with a clinical diagnosis of eyelid sporotrichosis. Records were examined to obtain information regarding patient demographics, presenting symptoms and signs, histopathological examination, microbiology, management, and outcomes. ResultsTen patients (4 men, 6 women; mean age 46.5 years, range 3–81 years) were included. Based on their clinical manifestations, eyelid sporotrichosis was classified into 3 major forms: (i) fixed cutaneous (6/10 cases), (ii) lymphocutaneous (3/10 cases), and (iii) eyelid abscess (1/10 cases). All the cases were treated with a terbinafine 12-week regimen. Nodules, papules, and abscesses regressed after treatment. No recurrence was discovered after a 12-week follow-up. ConclusionsEyelid sporotrichosis has typical features of clinical manifestations. Histopathological examination and tissue culture are helpful for diagnosis. Confirmed cases normally require long-term systematic treatment with antifungal agents, but surgical removal is normally unnecessary.

A Case of Sporotrichosis Caused by Sporothrix globosa in Japan.

Dear Editor: Sporotrichosis is the most common subcutaneous mycosis. Sporothrix schenckii was once considered a single species, but a recent study has demonstrated that S. schenckii is actually a complex of distinct species with similar morphological features, called the S. schenckii complex1. To our knowledge, this is the first case report of sporotrichosis caused by S. globosa, a member of the S. schenckii complex, in Japan. A 77-year-old Japanese man presented to our department with a three month history of crusted erythematous nodules on the dorsum of his right hand and forearm, in a linear arrangement (Fig. 1A). The right hand was scratched by a cat two weeks before the onset. Because sporotrichosis was suspected, a skin biopsy was performed. Histopathological examination demonstrated a mixed granulomatous reaction with focal neutrophilic microabscesses. Spores were identified in the tissue sections using periodic acid-Schiff stains (Fig. 1B). The biopsy specimen was also submitted for culturing, using enriched glucose-containing media and Sabouraud's agar, at two different conditions, 25℃~27℃ and 35℃~37℃. Microscopic morphology obtained from the 25℃ culture showed septate hyphae and hyaline or slightly pigmented conidia that grouped in rosettes at the tips of the conidiophores (Fig. 1C). Interestingly, there was no conversion to the yeast form in the 37℃ culture. Because the features was atypical of classical S. schenckii, we considered the causative microorganism as another member of S. schenckii complex. Genetic analysis of DNA by polymerase chain reaction identified this agent as S. globosa with 99% homology compared to the known genetic sequence. Thus, we diagnosed this case as sporotrichosis caused by S. globosa. Three months of oral potassium iodide (1,200 mg/day) and two months of oral itraconazol (200 mg/day) achieved the resolution of the symptom. Fig. 1 (A) Skin lesion on the dorsum of right hand and forearm with multiple erythematous crusted nodules along lymphatics. (B) Periodic acid-Schiff stain (×200). (C) Microscopic morphology obtained from 25℃ culture showing septate hyphae and ... Recent molecular biological studies have revealed that S. schenckii complex comprises at least six closely related dimorphic fungi including S. brasiliensis, S. globosa, S. mexicana, S. albicans, S. luriei, and S. schenckii sensu stricto1,2. Retrospective studies using strains isolated from patients with sporotrichosis revealed that many cases deemed of classical S. schenckii morphology were not necessarily caused by S. schenckii in a strict sense, but by other species of the S. schenckii complex. Through DNA analysis, Marimon et al.2 examined 112 cases of sporotrichosis that were originally considered to be caused by classical S. schenckii. They found that almost half of the isolates were other S. schenckii complex members such as S. globosa and S. brasiliensis. A similar study was also performed in Japan, and 15 strains out of 20 cases were identified as S. globosa3. Our causative agent neither grew at 37℃ on Sabouraud's agar nor converted to the yeast form. Referring to species identification methods proposed by Marimon et al.2, these are typical features of S. globosa. Thus far, it is not known that if there are differences in clinical features and treatment sensitivity between species4,5. Therefore, detailed identification of causative species in each individual case of sporortrichosis may prove useful for future research and treatment.

Zoonotic Sporotrichosis Epidemic Affects Children in Brazil

Sporotrichosis is caused by the dimorphic fungus Sporothrix schenckii and was first described by Benjamin Schenck in 1898. It is the most common subcutaneous mycosis in Latin America. The infection is usually acquired by inoculation of the fungus through the skin. Zoonotic transmission of sporotrichosis seems to be rare worldwide. However, since 1998, an increasing number of cases have been reported in humans in Rio de Janeiro, Brazil; the vast majority of these cases have been associated with contact with cats affected by the same condition. Itraconazole is the drug of choice for treatment.

Genotyping species of the Sporothrix schenckii complex by PCR-RFLP of calmodulin

Sporotrichosis is one of the most common subcutaneous mycosis in Latin America and is caused by 4 pathogenic thermodimorphic fungi in the genus Sporothrix. From both therapeutic and epidemiological perspectives, it is essential to identify the causative agents down to the species level. Traditional parameters may overlap among closely related species, and we propose polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) as an alternative approach. In the present study, the calmodulin gene was amplified and digested with HhaI to yield 5 different electrophoretic patterns representing all medically important Sporothrix species: Sporothrix brasiliensis, Sporothrix schenckii sensu stricto, Sporothrix globosa, and Sporothrix luriei. The PCR-RFLP protocol described here is a simple and inexpensive method and is highly suitable for accurate routine genotyping of relevant Sporothrix species.

Epidemiology of sporotrichosis in Venezuela

Sporotrichosis is one of the most common subcutaneous mycoses in Venezuela. It is a granulomatous chronic infection with cutaneous or subcutaneous tissue lesions. Regional lymphatic involvement may be present; extracutaneous disease is rare. The causal fungus Sporothrix schenckii has been isolated from soil, vegetation, and animals on numerous occasions and in many localities throughout the world. The aim of this study is to describe clinical and epidemiological features of cases of sporotrichosis observed in Venezuela and review of the literature. We included the demographic data, clinical features, diagnostic methods, treatment, and follow-up of patients with sporotrichosis from 1963 to 2009, diagnosed at the Department of Medical Mycology. One-hundred and thirty-three sporotrichosis cases were diagnosed. Most patients were under the age of 30years (66.15%). In 61.6% of them, the mode of transmission was not identified. The predominant clinical form in this population was lymphocutaneous (63.15%). Direct microscopic diagnosis was performed in 123 cases, and 57.9% yielded positive results for asteroid body. Sporotrichosis is an endemic subcutaneous mycosis in Venezuela. There are no reports to this date of disseminated forms of the disease, even amongst patients with acquired immunodeficiency syndrome. Direct microscopic examination of wet mount slides with saline solution or distilled water in the search for asteroid bodies is paramount. Saturated sodium and potassium iodine solutions continue to be extremely efficacious and affordable to most of our patients, therefore our treatment of choice.

Sporotrichosis

Sporotrichosis is the most common subcutaneous mycosis. It is usually acquired by traumatic inoculation, and it is caused by one of the species of the Sporothrix schenckii complex. More than 6 species, such as S schenckii sensu stricto, Sporothrix brasiliensis, Sporothrix globosa, Sporothrix mexicana, and Sporothrix albicans, have been identified by molecular techniques. The most common presentation is cutaneous disease, which is classified into fixed and lymphocutaneous forms. Osteoarticular, pulmonary, mucosal, disseminated, and systemic infections are less common and usually occur in immunosuppressed individuals. The diagnosis is suggested by biopsy specimen and confirmed by tissue culture. Itraconazole is considered the treatment of choice, although in some undeveloped countries potassium iodide is still used, owing to its safety and low cost. For systemic or disseminated cases, amphotericin B is the treatment of choice.

Sporothrix schenckii associated with armadillo hunting in Southern Brazil: epidemiological and antifungal susceptibility profiles

Sporotrichosis is the most common subcutaneous mycosis observed in Brazil and it is generally consequent to a little trauma caused by vegetal particles or spines which inoculate the fungi in the subcutaneous area. Although sporotrichosis had been frequently mentioned with armadillo hunting this form has not been widely reported in Brazil until now. In this study we report ten cases of sporotrichosis evolving the armadillo's hunting diagnosed in some towns located in the central and west regions of Rio Grande do Sul State. The cases were established based on clinical and classic mycological laboratorial techniques. The susceptibility tests were conducted by microdilution technique according to M38-A2 CLSI documents. Ten cases of sporotrichosis associated with armadillo hunting detected in the State of Rio Grande do Sul were diagnosed by mycological methods. The susceptibility tests of Sporothrix schenckii isolates to antifungal agents itraconazole, ketoconazole and terbinafine showed that all the isolates were susceptible. The paper discusses some cultural aspects related to hunting of this wild animal as well as possible causes of this unexpected occurrence in southern Brazil.

Histopathology of cutaneous sporotrichosis in Rio de Janeiro: a series of 119 consecutive cases

Sporotrichosis is the most common subcutaneous mycosis in Rio de Janeiro. Histopathological examination reveals diffuse granulomatous and suppurative dermatitis, and the fungus is rarely identifiable in tissue. We describe the histopathological features of cutaneous sporotrichosis, and investigate the association between them and the lack of visualization of the fungus. A total of 119 samples of confirmed sporotrichosis cases were studied. The characteristics of the inflammatory infiltrate, the presence of epidermal changes, necrosis and fibrosis, and the parasite burden were analyzed. The association between histopathological changes and the lack of visualization of the fungus was evaluated using prevalence ratios. Granulomas were observed in all samples, suppurative granulomas in 100 (84%) and diffuse dermatitis in 114 (95.8%). Liquefaction and caseous necrosis were present in 78 (65.5%) and 52 (43.7%) samples, respectively. The fungus was not seen in 77 (64.7%) samples. Epithelioid, tuberculoid or foreign-body-type granulomas, caseous, fibrinoid or absent necrosis, predominance of lymphocytes among nonphagocytic cells and fibrosis were associated with the lack of visualization of the fungus. The histopathological characteristics of sporotrichosis were variable when the causative fungus was not seen. In a proper context, the diagnosis of sporotrichosis remains a potential consideration even in the absence of demonstrable yeast.

Exfoliative cytology as a rapid diagnostic tool for lobomycosis

Lobomycosis is a common subcutaneous mycosis in South America. It is caused by Lacazia loboi. We report two cases of lobomycosis which were diagnosed by exfoliative cytology without any special staining. We highlight this diagnostic tool as a simple, low-cost, painless, non-invasive and fast method for the diagnosis of lobomycosis.

Subcutaneous fungal infections

Subcutaneous mycoses are caused by a variety of mostly tropical organisms, usually when they are implanted into the dermis or the subcutaneous tissue. They rarely disseminate or become systemic. Sporotrichosis, mycetoma, and chromoblastomycosis are more common subcutaneous mycoses than are rhinosporidiosis, zygomycosis, pheohyphomycosis, and lobomycosis.