Sporothrix Schenkii Research Articles

Anti-Sporothrix Activity of Novel Copper-Itraconazole Complexes.

A series of new metal complexes, [Cu(ITZ)2Cl2] ⋅ 5H2O (1), [Cu(NO3)2(ITZ)2] ⋅ 3H2O ⋅ C4H10O (2) and [Cu(ITZ)2)(PPh3)2]NO3 ⋅ 5H2O (3) were synthesized by a reaction of itraconazole (ITZ) with the respective copper salts under reflux. The metal complexes were characterized by elemental analyses, molar conductivity, 1H and 13C{1H} nuclear magnetic resonance, UV-Vis, infrared and EPR spectroscopies. The antifungal activity of these metal complexes was evaluated against the main sporotrichosis agents: Sporothrix brasiliensis, Sporothrix schenkii, and Sporothrix globosa. All three new compounds inhibited the growth of S. brasiliensis and S. schenckii at lower concentrations than the free azole, with complex 2 able to kill all species at 4 μM and induce more pronounced alterations in fungal cells. Complexes 2 and 3 exhibited higher selectivity and no mutagenic effect at the concentration that inhibited fungal growth and affected fungal cells. The strategy of coordinating itraconazole (ITZ) to copper was successful, since the corresponding metal complexes were more effective than the parent drug. Particularly, the promising antifungal activity of the Cu-ITZ complexes makes them potential candidates for the development of an alternative drug to treat mycoses.

Sporothrix schenckii complex in felines: Analysis of clinical, mycological, environmental and epidemiological factors

Sporotrichosis is an infectious and chronic fungal disease caused by fungi belonging to the Sporothrix schenckii complex that affects humans and animals through traumatic implantation of the fungus in the skin. They are dimorphic, saprophytic and geophilic fungi that are widely distributed in nature, especially in soils rich in organic matter. The aim of this study was to understand the clinical, mycological, environmental and epidemiological aspects of the Sporothrix schenckii complex in felines. In order to meet the objectives of this research, a qualitative, descriptive and exploratory data survey was carried out through a bibliographic review based on works published in the last 23 years. Sporothrix spp. is considered to be a complex of at least six cryptic species, in other words, they have similar morphological characteristics but different genotypes. In cats, the incubation period is variable; it usually lasts 14 days. On penetrating the tissue, the micellar form transforms into yeast, which generates an inflammatory response and proliferation of the microorganism at the site, causing papular and nodular lesions which, in some cases, heal spontaneously. Therefore, it is clear that sporotrichosis is caused by dimorphic fungi of the Sporothrix schenkii complex. It is a zoonotic disease of great importance in the context of public health, since it is still a neglected disease and requires robust measures to control. As well as being the most seriously affected, felines are the main transmitters to humans and animals, making them a key point in controlling outbreaks of the disease.

Sporotrichosis in Argentina: clinical and epidemiological analysis

Sporotrichosis is an implantation mycosis caused by Sporothrix spp. It is distributed worldwide and can be found in vegetation and soil. The most frequent route of infection is by trauma with elements contaminated with fungal propagules. Since domestic cats are the most affected animals and can transmit this infection to humans, sporotrichosis is considered a zoonosis. Clinical presentations include nodular lymphangitis, fixed cutaneous, pulmonary (rare), and disseminated (exceptional). To analyze the epidemiology of sporotrichosis in Argentina during 2010 and 2022. To describe the clinical presentation, diagnostic methods, and treatment of cases diagnosed during this period. To know the circulating genotypes and to observe possible associations with the geographic location where the infection was acquired. Analytical, retrospective, and observational study. We analyzed the medical records of patients with sporotrichosis from 12 health institutions in Argentina, between 2010 and 2022. We present 54 cases in which the most frequent clinical form was nodular lymphangitis, and the treatment of choice was itraconazole. Conventional diagnosis was made in all cases. Culture of clinical samples was more sensitive than direct examination because it allowed the isolation of Sporothrix spp. in all 54 cases. Molecular identification was performed in 22 cases, with Sporothrix schenkii sensu stricto being the most frequently isolated species. This study allowed to know the epidemiology of this mycosis in Argentina, as well as the availability of diagnostic methods and the treatment of choice.

Sporotrichosis in renal transplant patients: two case reports and a\xa0review of the\xa0literature

IntroductionSporotrichosis is a rare fungal infection in transplant patients; among these patients, it occurs mostly in renal transplant patients. Sporothrix schenkii is the primary pathogen responsible. A high index of suspicion is required to make the diagnosis keeping important differential diagnoses in mind. History of trauma through recreational or occupational exposure to the fungus may assist in making the diagnosis. Treatment is difficult, with long-term use of potentially nephrotoxic and cytochrome P450 inhibitor antifungal agents leading to potential calcineurin inhibitors toxicity. We describe two renal transplant patients presenting with distinct sporotrichosis infection: “Case 2” being only the second reported case ever of meningeal sporotrichosis. We subsequently review the general aspects of sporotrichosis, specifically in renal transplant patients as described in the medical literature.Case presentationCase 1, a 43-year-old mixed ancestry male patient presented with a non-healing ulcer on the left arm for 1 year, he was diagnosed with cutaneous sporotrichosis and was successfully treated with itraconazole monotherapy. Case 2, a 56-year-old mixed ancestry male patient presented with a slow decline in functions, confusion, inappropriate behavior, rigors and significant loss of weight and appetite over the past 4 months, he was diagnosed with meningeal sporotrichosis and was successfully treated with a combination of deoxycholate amphotericin B and itraconazole.ConclusionPhysicians taking care of renal transplant patients should have a high index of suspicion for sporotrichosis infection particularly when conventional therapy for common conditions fails. Susceptibility testing is recommended to identify the most effective antifungal agent and its dose. The slow nature of growth of Sporothrix schenkii necessitates patients to be on amphotericin B until the time results are available. Finally, there is a need to be aware of potential drug-drug interactions of the azoles with calcineurin inhibitors and the required dose adjustments to prevent therapy related adverse events.

Molecular epidemiology of Sporothrix schenkii isolates in Malaysia.

Sporothrix schenkii is a dimorphic fungus that causes infections in both humans and animals. We report on 25 S. schenkii isolates collected in 2017 from humans and cats clinically diagnosed with sporotrichosis, in Malaysia. These isolates were phenotypically identified as S. schenkii sensu lato and further defined as S. schenckii sensu stricto based on partial calmodulin gene sequence. Isolates from both humans and cats were genotypically identical but displayed phenotypic variation. Phylogenetic analyses based on partial calmodulin sequence showed that the Malaysian isolates clustered with global S. schenkii sensu stricto strains, in particular, of the AFLP type E. This analysis also revealed that partial calmodulin sequence alone was sufficient for classifying global S. schenckii sensu stricto strains into their respective AFLP types, from A to E. The genetically conserved S. schenkii sensu stricto species isolated from humans and cats is suggestive of a clonal strain present in Malaysia. To the best of our knowledge, this is the first report on molecular identification of Sporothrix schenkii strains from human infections in Malaysia. Further studies are required in order to elucidate the clonal nature of Malaysian S. schenkii isolates. Our findings indicate the presence of a predominant S. schenkii genotype in the environment, causing infections in both cats and humans in Malaysia.

Microbiological and Physicochemical Analysis of Old Sokoto Abattoir Wastewater (Sewage) Contaminated with Blacksmith Activities

The physicochemical and microbiological characteristics of wastewater samples from Old Sokoto Abattoir in Sokoto North Local Government Area, Sokoto state, Nigeria were studied over four weeks period. The physicochemical parameters of the wastewater samples studied namely pH, temperature, biochemical oxygen demand (BOD), dissolved oxygen (DfO), phosphate, nitrate, and chemical oxygen demand (COD) were within the standard limit for wastewater to be discharged into the environment. Heavy metals like nickel, copper, and lead were not detected (ND) except for iron with a concentration range from 0-0.64 mg/L. Wastewater samples for week 1 had a higher bacterial count of 270x105 CFU/mL than wastewater samples for the other weeks. The total viable count for all the samples exceeded the limit of 1x102 CFU/mL, which was between 4.1x105 – 27.0x105. All the wastewater samples were found to harbour coliform organisms in numbers greater than the required WHO standard (1x102 CFU/mL) for water. The MPN count of wastewater was ranged from 190-1100 MPN/100 mL. The bacterial species isolated were E. coli (33.3%), E. aerogenes (20%), S. aureus (6.66%), K. pneumoniae (6.66%), Proteus vulgaris (13.3%), Citrobater freundii (6.66%), Bacillus licheniformis (6.66%), and Bacillus spp. The fungal isolates were Mucor spp (12.5%), Aspergillus niger (37.5%), Aspergillus terreus (12.5%), Sporothrix schenkii (12.5%), Rhodotorula spp. (12.5%), and Penicillium spp. (12.5%). This study showed that the isolation and population of microorganisms from wastewater in Old Sokoto Abattoir is an indication that the wastewater was highly polluted with microbial load and can cause an environmental hazard if not treated.

Esporotricose: Revisão

Sporotrichosis is a zoonotic mycosis caused by the traumatic inoculation of material carrying species of the Sporothrix schenkii complex. The characteristic nodular lesions occur in the cutaneous, subcutaneous, lymphatic tissues and sometimes spread through the organs. Sporotrichosis is a public health problem, as it also affects humans, especially in endemic areas. In Brazil, it is known that the untreated disease in animals has a relevant participation in its dissemination. For this reason, it is extremely important that veterinarians recognize this mycosis, so that a laboratory diagnosis of the suspect animals can be carried out, and the correct clinical conduct, and conduction of epidemiological studies, that allow to know the reality of this disease and information.In this context, the objective of the study was to carry out a bibliographic survey of the works produced on sporotrichosis in recent years.

Disseminated cutaneous sporotrichosis: an unusual case

Sporotrichosis is a subcutaneous mycosis caused by Sporothrix schenckii with endemic regions in the American continent. Clinical features depend on the immunological patient state and some characteristics of the fungus. Disseminated cutaneous sporotrichosis is a rare variant usually described in immunocompromised patients. A 42-year-old man was admitted with multiple verrucous and erythematous papules and plaques of the face and limbs. Many lesions showed an ulcerated and crusted component, some papules displayed linear arrangement, and some verrucous plaques exhibited black spots. Skin biopsy revealed pseudoepitheliomatous hyperplasia and granulomas in the papillary dermis. Culture of a skin sample grew Sporothrix schenkii. We report an unusual presentation of disseminated cutaneous sporotrichosis, which was a diagnostic challenge owing to polymorphism and spread of the lesions in a patient without an immunosuppressive state.

Virulencia de Sporothrix globosa en modelos murinos

IntroductionThe sporothricosis disease is an infection caused by species included in Sporothrix schenkii complex. ObjectiveVerify the virulence of a strain of S. globosa using two different concentrations of inoculum by intraperitoneally and subcutaneously, into a mouse model. Materials and methodsNonrandomized pilot study, in murine inoculated with a strain of S. globosa (CBS 14.076M) by intraperitoneally and subcutaneously with inoculum concentrations of 0.5 and 4 McFarland. For this purpose 18 rodents CF-1 (ISP, Santiago, Chile) were used. ResultsThe studied strain did not induce illness or injury on animals, they all survived and neither the tissue culture nor the histopathological analysis showed fungal growth or suggestive infection by organ abnormalities. ConclusionsThe S. globosa strain did not present any virulence enough to cause disease at 0.5 and 4.0 McFarland concentration inoculum when inoculated in both intraperitoneally and subcutaneously, in murine models.

Atypical Cutaneous Sporotrichosis in an Immunocompetent Adult: Response to Potassium Iodide.

Cutaneous sporotrichosis, also known as “Rose Gardener's disease,” caused by dimorphic fungus Sporothrix schenkii, is usually characterized by indolent nodular or nodulo-ulcerative lesions arranged in a linear pattern. We report bizarre nonlinear presentation of Sporotrichosis, in an immunocompetent adult occurring after a visit to Amazon rain forest, speculating infection with more virulent species of Sporothrix. The diagnosis was reached with the help of periodic acid-Schiff positive yeast cells and cigar shaped bodies seen in skin biopsy along with the therapeutic response to potassium iodide.

Tropical and travel-related dermatomycoses : Part 2: cutaneous infections due to yeasts, moulds, and dimorphic fungi

Besides dermatophytoses, a broad range of cutaneous infections due to yeasts and moulds may occur in subtropical and tropical countries where they can affect travellers. Not to be forgotten are endemic occurring dimorphic or biphasic fungi in countries with hot climate, which cause systemic and secondary cutaneous infections in immunosuppressed and immunocompetent people. In the tropics, the prevalence of pityriasis versicolor, caused by the lipophilic yeast Malassezia spp., is about 30-40 %, in distinct areas even 50 %. Increased hyperhidrosis under tropical conditions and simultaneously humidity congestion have to be considered as significant disposing factors for pityriasis versicolor. In tropical countries, therefore, an exacerbation of a preexisting pityriasis versicolor in travellers is not rare. Today, mostly genital yeast infections due to the new species Candida africana can be found worldwide. Due to migration from Africa this yeast pathogen has reached Germany and Europe. Eumycetomas due to mould fungi are rarely diagnosed in Europe. These deep cutaneous mould infections are only found in immigrants from African countries. The therapy of eumycetoma is protracted and often not successful. Cutaneous cryptococcoses due to the yeast species Cryptococcus neoformans and Cryptococcus gattii occur worldwide; however, they are found more frequently in the tropics. Immunosuppressed patients, especially those with HIV/AIDS, are affected by cryptococcoses. Furthermore, Cryptococcus gattii also causes infections in immunocompetent hosts in Central Africa, Australia, California, and Central America.Rarely found are infections due to dimorphic fungi after travel to countries where these fungal pathogens are endemic. In individual cases, cutaneous or lymphogenic transferred sporotrichosis due to Sporothrix schenkii can occur. Furthermore, scarcely known is secondary cutaneous coccidioidomycosis due to Coccidioides immitis after travelling to desert-like endemic regions in southwestern states of the United States and in Latin America, where primary respiratory infection due to this biphasic fungus can be acquired. The antifungal agent itraconazole is the treatment of choice for sporotrichosis and coccidioidomycosis. Talaromyces marneffei-until recently known as Penicillium marneffei-is only found in Southeastern Asia. Mycosis due to this dimorphic fungus has to be considered as an AIDS-defining opportunistic infection. After hematogeneous spread, Talaromyces marneffei affects the skin and mucous membranes of the mouth. Amphotericin B and itraconazole can be used for therapy.

In vitro inhibitory activity of terpenic derivatives against clinical and environmental strains of the Sporothrix schenkii complex.

Sporotrichosis is a subacute or chronic subcutaneous infection, caused by the fungus Sporothrix schenkii complex, occurring in human and animal tissues. Potassium iodide and itraconazole have been used as effective therapy for first-choice treatment, while amphotericin B may be indicated for disseminated infection. However, the adverse effects of potassium iodide and amphotericin B or the long duration of therapy with itraconazole often weigh against their use, leading to the search for alternatives for the treatment of severe infections. Terpinen-4-ol and farnesol are components of essential oils present in many plant species and have been described to have antifungal activity against microorganisms. In this study, 40 strains of Sporothrix spp. were tested for the susceptibility to terpinen-4-ol and farnesol. Changes in cytoplasmic membrane permeability were also investigated. Terpenes inhibited all Sporothrix strains with MIC values ranging from 87.9 to 1,429.8 μg/ml for terpinen-4-ol and from 0.003 to 0.222 μg/ml for farnesol. The MFC values ranged from 177.8 to 5,722.6 μg/ml and from 0.027 to 0.88 μg/ml, respectively, for terpinen-4-ol and farnesol. Farnesol was the most active compound for the Sporothrix strains. Significant loss of 260 and 280 nm-absorbing material did not occur after treatment with concentrations equivalent to the MIC and sub-MIC of the tested terpenes, when compared to corresponding untreated samples. The failure of terpenes to lyse Sporothrix cells suggests that their primary mechanism of action is not by causing irreversible cell membrane damage. Thus, new studies are needed to better understand the mechanisms involved in the antifungal activity.

Severe generalized skin lesions due to mixed infection with Sporothrix schenkii and Dermatophilus congolensis in a bull from Jos, Nigeria

Sporothrix schenkii and Dermatophilus congolensis were isolated from a bull with severe generalized skin lesions. The lesions were thick, crusty and scabby on the dorsal part while few scabby and several nodular lesions were seen on the lower limbs especially the thighs. Scab samples and exudates from the nodules were aseptically collected and processed for bacteriology and mycology. Gram stained smears revealed Gram-positive, filamentous organism that had longitudinal and transverse septa suggestive of D. congolensis. Colonies on 5% defibrinated sheep blood agar were small, rough, grayish-white, β-hemolytic and adherent to the medium. It was catalase positive, urease positive and fermented glucose and maltose but not sucrose, lactose, mannitol, sorbitol and xylose. Colonies on Sabouraud's dextrose agar were small, round, white and opaque, delicate and smooth. It liquefied gelatin and fermented glucose and sucrose but not galactose, menite, and glycerin. The isolate was Gram-positive, cigar-shaped and yeast-like suggestive of S. schenkii. Dermatophilosis is common in domesticated ruminants while sporotrichosis is very rare in cattle. This may be the first report of bovine sporotrichosis from Africa.

Síndrome oculoglandular de Parinaud causada por esporotricose

A sindrome oculoglandular de Parinaud e uma doenca ocular rara causada por diferentes agentes etiologicos, entre eles bacterias, virus e fungos. E caracterizada por uma conjuntivite granulomatosa, acompanhada de linfadenopatia pre-auricular adjacente e pode trazer sequelas caso nao seja prontamente tratada. Neste artigo e relatado o caso de uma jovem tecnica de enfermagem e estudante de medicina veterinaria apresentando a sindrome oculoglandular de Parinaud causada pelo fungo Sporothrix schenkii apos contaminacao com gatos infectados. Sua apresentacao clinica e evolucao desfavoravel ate o correto diagnostico etiologico e instituicao do tratamento especifico, ressaltam a importância da investigacao laboratorial em casos de evolucao atipica da doenca.

Evaluation of antioxidant, immunomodulating, cytotoxic and antimicrobial properties of different strains of Basidiomycetes from Northeastern Mexico

A great variety of mushrooms (Basidiomycetes) grow in the Mexican territory, but most of their properties, including pharmacological ones, have been scarcely investigated. Samples of culture broth of ten different strains of Mexican Basidiomycetes cultured in four growing times were taken and lyophilized; then, their antioxidant, immunomodulating, cytotoxic and antimicrobial properties were studied, the antioxidant activity was measured with the dichlorodihydrofluorescein diacetate (DCFDA) assay, the immunomodulating properties were evaluated with the Cunningham´s technique in BALB/c male mice, cytotoxicity was estimated with the 3-(4,5-dimethythiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay in Chang liver cells and the antimicrobial activity was evaluated with the microdilution method against Escherichia coli, Staphylococcus aureus, Candida albicans, Mycobacterium smegmatis and Sporothrix schenkii. Samples of the 1st and 2nd month of growth of Suillus luteus, Lentinus lepideus, and Suillus lakeidemonstrated relevant antioxidant activity (20 - 80%); sample of S. lakei showed significant immunostimulation, near 130% with Cunningham´s technique; none of the samples showed cytotoxicity. Ganoderma applanatum, Armillaria mellea andS. lakei demonstrated antimicrobial activity. The phytochemical screening was assayed for the most active sample (S. lakei at two months of growth) and it was positive for: alkaloids and tannins; the content of proteins, carbohydrates and total phenols were calculated. The most active sample was fractionated and the fractions were biologically evaluated. Phytochemical screening, content of proteins, carbohydrates and total phenols were determined, and an IR spectra was carried out. Key words: Basidiomycetes, antioxidant, immunomodulator, antimicrobial.

Zoonotic sporotrichosis of lymphocutaneous type in a man acquired from a domesticated feline source: report of a first case in southern Karnataka, India

Sporotrichosis is commonly encountered due to traumatic implantation of thorns or decayed vegetation with the dimorphic fungi, Sporothrix schenckii. Zoonotic spread of Sporotrichosis is rare and we describe here the first case of feline transmission of lymphocutaneous sporotrichiosis encountered in India. An excision biopsy of nodulo-ulcerative lesion from the patients right elbow and forearm were collected for histopathology and portion of the specimen processed for mycological work up. Animal pathogenicity test performed in Swiss albino mice with intraperitoneal & foot pad inoculation. In addition an investigation of the ulcerative skin lesion from the domesticated cat was carried out. Histopathology examination of tissue sample from the patient and feline lesion revealed granulomatous reaction and a few slender elongated yeast cells consistent with Sporotrichosis. The diagnosis was confirmed by culturing Sporothrix schenkii and demonstration of thermal dimorphism. Pathogenicity testing in mice lead to orchitis in 12-15 days and the organism was re-isolated in pure culture. The patient was treated with oral saturated potassium iodide solution with complete resolution of the lesions. Close contact with infected domesticated feline can be a potential source of transmission for Sporotrichosis as evidenced in this report.

Equine Bacterial and Fungal Diseases: A Diagnostic and Therapeutic Update

Bacterial and fungal skin diseases are important in the horse. Bacterial skin diseases (pyoderma) are most often caused by Staphylococcus species, Corynebacterium pseudotuberculosis or Dermatophilus congolensis . The most common clinical signs associated with bacterial skin infections are crusts, papules, abscesses, and draining tracts; the latter two lesions are more commonly associated with C. pseudotuberculosis . Ideally, antibiotic treatment should be based on bacterial culture and sensitivity. Fungal infections are most commonly caused by dermatophytes (“ringworm”) or Sporothrix schenkii , although the role of Malassezia in equine skin disease is beginning to be investigated. The clinical signs of fungal infections are variable and may include alopecia, crusts, papules, pruritus, nodules, ulcers, and draining tracts. The latter three lesions are more commonly associated with S. schenkii infection. Treatment is dependent on the organism cultured and may include both topical and/or systemic treatment.

Antifungal activities of six South African Terminalia species (Combretaceae)

A serial microplate dilution method developed for bacteria was modified slightly and gave good results with several fungi. The antifungal activity of acetone, hexane, dichloromethane and methanol leaf extracts of six Terminalia species ( Terminalia prunioides, Terminalia brachystemma, Terminalia sericea, Terminalia gazensis, Terminalia mollis and Terminalia sambesiaca) were tested against five fungal animal pathogens ( Candida albicans, Cryptococcus neoformans, Aspergillus fumigatus, Microsporum canis and Sporothrix schenkii). Methanol extracted the highest quantity, but the acetone extracts had the highest antifungal activity. Some of the extracts had antioxidant activity. Most of the antifungal extracts had MIC values of c. 0.08 mg/ml, some were with MIC values as low as 0.02 mg/ml. Microsporum canis was the most susceptible microorganism and Terminalia sericea extracts were the most active against nearly all microorganisms tested.

The diversity of antifungal compounds of six South African Terminalia species (Combretaceae) determined by bioautography

A bioautography method was developed to determine the number of antifungal compounds in Terminalia species extracts. Acetone, hexane, dichloromethane and methanol leaf extracts of six Terminalia species (T. prunioides, T. brachystemma, T. sericea, T. gazensis, T. mollis and T. sambesiaca) were tested against five fungal animal pathogens (Candida albicans, Cryptococcus neoformans, Aspergillus fumigatus, Microsporum canis and Sporothrix schenkii). The Rf values and relative activities of separated compounds were determined. Hexane and dichloromethane extracts had at least three times more antifungal compounds than the other extracts indicating the nonpolar character of the antifungal compounds. From the Rf values, the non-polar character of the antifungal compounds was confirmed indicating that the antifungal activity is not due to tannins. M. canis had the highest number, up to ten, of antifungal compounds. All Terminalia species contained a compound (Rf =0.46 in benzene/ethanol/ammonium hydroxide (90/10/1) active against all tested pathogens. T. sericea and T. brachystemma were the most promising candidates for isolating antifungal compounds. The results demonstrate the value of bioautography in examining plant extracts with antifungal activity, selecting species for further study and dereplicating the isolation of compounds.

Zoonotic sporotrichosis transmitted by cats in Rio de Janeiro, Brazil. A case report.

Sporotricosis is a ubiquitous mycosis characterized by nodular lesions of the cutaneous or subcutaneous tissues and adjacent lymphatics that usually suppurate and ulcerate. Secondary spread to the articular surface and bone or dissemination to the central nervous system, genitourinary tract or lungs is also possible. All forms of sporothricosis are caused by a single species, Sporothrix schenkii. In the great majority of cases the fungus gains entrance into the body through trauma to the skin with some kind of plant materials such as thorns or splinters. Zoonotic transmission is also possible and several animals are implicated. This kind of transmission is most frequently a professional hazard of people dealing with animals but in some parts of the world, including Rio de Janeiro city and metropolitan region, an increase in transmission by pet cats has been noted. In these cases the infection may be observed in the family environment, an important epidemiological consideration to clinicians.