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Background Sporotrichosis is a subcutaneous or implantation mycosis caused by some species of the genus Sporothrix. Rio de Janeiro state, Brazil, experiences hyperendemic levels of zoonotic sporotrichosis, with increasing cases of disseminated disease, especially in people living with HIV (PLHIV). Involvement of the nasal mucosa is rare and occurs isolated or in disseminated cases, with a delayed resolution. Methodology/Principal findings This study aimed to describe the epidemiological, clinical, and therapeutic profiles of 37 cases of sporotrichosis with involvement of the nasal mucosa treated at the ear, nose, and throat (ENT) outpatient clinic of the Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, from 1998 to 2020. Data were reviewed from the medical records and stored in a database. The Mann–Whitney test was used to compare the means of quantitative variables, and Pearson chi-square and Fisher’s exact tests were used to verify the association between qualitative variables (p Conclusions Immunosuppression was determinant to the outcome, with worse prognosis and lower probability of cure. Notably in this group, the systematization of the ENT examination for early identification of lesions is recommended to optimize the treatment and outcome of the disease.

Background Bone sporotrichosis is rare. The metropolitan region of Rio de Janeiro is hyperendemic for zoonotic sporotrichosis and the bone presentations are increasing. Methods We studied a retrospective cohort of 41 cases of bone sporotrichosis, diagnosed from 1999–2016. The inclusion criteria was fungal culture isolation from any clinical specimen associated to bone involvement (radiography and/or computed tomography) compatible with fungal osteomyelitis or histopathological findings of bone material compatible with sporotrichosis. Molecular identification was performed when possible. Results Male patients represented 58.5% of the cases, with a cohort median age of 43 years. Immunosuppressive conditions were present in 68.3% of the patients, mostly HIV coinfection (51.2%). Multifocal bone involvement (more than one anatomical segment) was diagnosed in 61% of the patients, while 39% presented unifocal involvement. The bones of the hands were the most affected (58.5%), followed by the feet (41.5%) and tibia (26.8%). Multifocal group was characterized by a higher proportion of males (p = 0.0045) with immunosuppressive conditions (p = 0.0014). Amphotericin B followed by oral itraconazole was the main treatment, with a median time of 16.7 months (1.5 to 99.2 months), and cure of 53.7% of the patients (84.6% of immunocompetent and 39.3% of immunocompromised patients). Sequelae occurred in 12.2% of the patients—amputations (7.3%) and ankylosis (4.9%), while 22% died in the course of the disease. Sporothrix brasiliensis was the causative agent in all the 9 (22%) performed cases. Conclusions Bone sporotrichosis is a chronic, challenging condition with prolonged treatment, often with poor results and sequelae., Author summary Sporotrichosis is a subcutaneous mycosis, more common in tropical and subtropical countries, and the involvement of bones is rare. The metropolitan region of Rio de Janeiro is hyperendemic for zoonotic sporotrichosis and the bone presentations are increasing. We evaluated 41 cases of bone sporotrichosis at a reference center in infectious diseases. There was a predominance of men with immunosuppressive conditions, notably HIV infection and alcoholism. Immunosuppression was related to multifocal bone involvement and more severe disease. This form of the disease is a chronic, challenging condition with prolonged treatment, often with poor results and sequelae.

Cases of meningoencephalitis have increased in the zoonotic hyperendemia of sporotrichosis in the state of Rio de Janeiro, Brazil. The gold standard for the diagnosis of sporotrichosis is the isolation of Sporothrix spp. from clinical specimens, not always possible from the cerebrospinal fluid (CSF) of these patients, since fungus recovery in this specimen is difficult in most cases. This limitation led us to pursue a new approach on central nervous system (CNS) sporotrichosis diagnosis based on existing molecular methodologies for the detection of Sporothrix spp. in skin samples. Kano and colleagues (2003) designed species-specific primers for polymerase chain reaction (PCR) based on Sporothrix schenckii sensu lato chitin synthase 1 (CHS1) gene sequence and applied it in skin biopsy paraffin block. Hu and colleagues (2003) used a nested PCR in human clinical samples and samples from infected mice, with the 18S rRNA gene sequence as target. The assay was successfully used to detect S. schenckii DNA from strains from different areas of the world. However, Mendoza and colleagues compared the previously described nested PCR with conventional diagnostic methods, and the molecular methodology presented lower efficacy. Liu and colleagues, using the primer pair S2-R2 targeting the CHS1 gene in the PCR of biopsy tissue, verified positive results in 25 out of 30 cases (83.3%). The nested PCR targeting the partial sequence of the 18S rRNA gene was the best choice in terms of sensitivity due to a low fungal burden in CSF.

Background Chromoblastomycosis (CBM) is a difficult-to-treat chronic subcutaneous mycosis. In Brazil, the main agent of this disease is Fonsecaea pedrosoi, which is phenotypically very similar to other Fonsecaea species, differing only genetically. The correct species identification is relevant since different species may differ in their epidemiologic aspects, clinical presentation, and treatment response. Methodology/Principal findings Partial sequencing of the internal transcribed spacer (ITS) was used to identify twenty clinical isolates of Fonsecaea spp. Their in vitro antifungal susceptibility was determined using the broth microdilution method, according to the M38-A2 protocol. Amphotericin B (AMB), flucytosine (5FC), terbinafine (TRB), fluconazole (FLC), itraconazole (ITC), ketoconazole (KTC), posaconazole (POS), voriconazole (VRC), ravuconazole (RVC), caspofungin (CAS), and micafungin (MFG) were tested. The association between ITC/TRB, AMB/5FC, and ITC/CAS was studied by the checkerboard method to check synergism. The available patients’ data were correlated with the obtained laboratory results. Fonsecaea monophora (n = 10), F. pedrosoi (n = 5), and F. nubica (n = 5) were identified as CBM’ agents in the study. TRB and VRC were the drugs with the best in vitro activity with minimal inhibitory concentrations (MIC) lower than 0.25 mg/L. On the other hand, FLC, 5FC, AMB, and MFG showed high MICs. The AMB/5FC combination was synergistic for three F. monophora strains while the others were indifferent. Patients had moderate or severe CBM, and ITC therapy was not sufficient for complete cure in most of the cases, requiring adjuvant surgical approaches. Conclusions/Significance F. monophora, the second most frequent Fonsecaea species in South America, predominated in patients raised and born in Rio de Janeiro, Brazil, without cerebral involvement in these cases. TRB, VRC, and the AMB/5FC combination should be further investigated as a treatment option for CBM., Author summary Chromoblastomycosis is a disfiguring disease usually occurring in rural workers from poor and remote communities. In Brazil, the most frequent agents of this neglected disease are the species belonging to the genus Fonsecaea. The disease occurs after traumatic inoculation during work. As the lesions progress, itching becomes severe, and scratching may result in further inoculation to other body sites. When patients seek medical help, the lesions are usually extensive and disfiguring. For this reason, a more effective and less time-consuming treatment is important. Oral antifungal therapy is not very effective, must be taken for months or years, it is costly for most patients and often unavailable. Hence, it is important to determine the in vitro antifungal susceptibility and correlate it with the isolated species. In this study, Fonsecaea monophora was the predominant species and, differently from some studies, dissemination to the central nervous system was not observed. In vitro analysis showed that the most effective antifungal drugs were terbinafine and voriconazole, followed by itraconazole, the most used drug in the treatment of this disease. The combination of amphotericin B and flucytosine may be synergistic, depending on the infective strain.

Background Pregnant women with sporotrichosis should not receive systemic antifungal therapy except in severe cases when amphotericin B is recommended. Thermotherapy is the most reported treatment described in this group of patients. It entails weeks of daily self-application of heat to the lesions, requires that the patient faithfully apply it, and it could cause skin burns. Cryosurgery is a useful therapeutic tool for many cutaneous infectious diseases, safe for pregnant women, but not well evaluated for sporotrichosis treatment in this group. Methodology The authors conducted a retrospective study describing epidemiological, clinical, and therapeutic data related to four pregnant patients with sporotrichosis treated with cryosurgery. The authors reviewed the clinical records of four pregnant patients diagnosed with cutaneous sporotrichosis and treated with cryosurgery. The sessions were carried out monthly up to clinical cure. Molecular identification of the Sporothrix species was performed in two cases using T3B PCR fingerprinting assays. Principal findings All patients were in the second trimester of pregnancy and their age ranged from 18 to 34 years. With regard to clinical presentation, two patients had lymphocutaneous and two had the fixed form. S. brasiliensis was identified in two cases as the causative agent. Cryosurgery was well tolerated and the number of sessions ranged from 1 to 3. All the patients reached a complete clinical cure. Conclusions Cryosurgery was a safe, easy to perform and well tolerated method, and therefore it is suggested to be a suitable option for the treatment of cutaneous sporotrichosis in pregnant women., Author summary Sporotrichosis is a cosmopolitan disease, considered the most important subcutaneous mycosis in Latin America. Since 1998, there is an ongoing cat-transmitted zoonotic epidemic of sporotrichosis occurring in Rio de Janeiro, Brazil. Pregnant women are a vulnerable population occasionally affected that require special attention regarding sporotrichosis treatment. Antifungal drugs should be avoided because of their potential risks to the fetus, unless in severe cases when amphotericin B (an intravenous antifungal drug) can be indicated. In this context, local measures are the treatment of choice. Cryosurgery consists in local application of intense cold using liquid nitrogen to destroy some infectious, tumoral and inflammatory cutaneous diseases. It is scarcely reported in the literature for the treatment of sporotrichosis, especially in pregnant women for whom local heat is most used. This works aims to describe the clinical response and outcome of cryosurgery for the treatment of sporotrichosis in four pregnant women. All patients reached clinical cure after one to three sessions. These results suggest that cryosurgery can be a well-tolerated, safe, and efficient method for the treatment of sporotrichosis in pregnancy.

Background There have been several recent changes in the taxonomy of Sporothrix schenckii as well as new observations regarding the clinical aspects of sporotrichosis. In this study, we determined the identification of the Sporothrix species associated with both classic and unusual clinical aspects of sporotrichosis observed in the endemic area of sporotrichosis in Rio de Janeiro, Brazil. Methodology/Principal Findings To verify whether S. brasiliensis is associated with clinical manifestations of sporotrichosis, a cross-sectional study was performed in which Sporothrix isolates from 50 patients with different clinical manifestations were analyzed and their isolates were studied by phenotypic and genotypic methods. Data from these patients revealed a distinct clinical picture and therapeutic response in infections caused by Sporothrix brasiliensis (n = 45) compared to patients with S. schenckii sensu stricto (n = 5). S. brasiliensis was associated with disseminated cutaneous infection without underlying disease, hypersensitivity reactions, and mucosal infection, whereas patients with S. schenckii presented with less severe and more often localized disease, similar to the majority of previously described sporotrichosis cases. Interestingly, S. brasiliensis-infected patients overall required shorter durations of itraconazole (median 16 weeks) compared to the individuals with S. schenckii (median 24 weeks). Conclusions/Significance These findings suggest that Sporothrix species are linked to different clinical manifestations of sporotrichosis and that S. brasiliensis is effectively treated with oral itraconazole., Author Summary Sporothrix brasiliensis is a dimorphic fungus that is responsible for an ongoing epidemic of cat-transmitted sporotrichosis in Rio de Janeiro, Brazil. More than 4,100 human cases have been diagnosed in only one health institution since 1998. Most patients are children or housewives with frequent contact with domestic and/or stray cats. The patients usually live under poverty conditions in suburban regions of the metropolitan area with poor access to health care and unsanitary living conditions. For instance, most patients report that they need to have cats in their houses as a control against invasion by rodents. It is important to study the clinical aspects of S. brasiliensis infection in order to improve patient management, including optimizing therapeutic and prophylactic approaches. We have found that S. brasiliensis is responsible for some unusual clinical manifestations of sporotrichosis, such as disseminated infection in immunocompetent patients and hypersensitivity reactions. Also, treatment with itraconazole appears to be extremely effective in most cases of infection by S. brasiliensis. Our study will contribute for the management of the infection caused by S. brasiliensis, bringing benefits to the patients with sporotrichosis.

Sporotrichosis associated with zoonotic transmission remains a relevant public health problem in Rio de Janeiro, Brazil, affecting a large at-risk population, which includes HIV-infected individuals. We assessed patients co-infected by Sporothrix spp. and HIV over time in the context of an unabated sporotrichosis epidemic. A retrospective cohort retrieved information from a National reference institute for infectious diseases regarding 48 patients with sporotrichosis-HIV co-infection (group 1) as well as 3,570 patients with sporotrichosis (group 2), from 1987 through March 2013. Most patients from group 1 were male (68.8%), whereas women were predominant in group 2 (69.1%; p, Author Summary Sporotrichosis is a subcutaneous, worldwide-distributed mycosis, endemic in some areas and is caused by dimorphic fungi from the complex Sporothrix schenckii. Its association with zoonotic transmission remains a relevant public health problem in Rio de Janeiro, Brazil, affecting a large at-risk population, which includes HIV-infected individuals. A comprehensive search of a National reference institute for infectious diseases' database retrieved information regarding 48 patients with sporotrichosis-HIV co-infection (group 1), as well as 3,570 patients with sporotrichosis (group 2), registered from 1987 through March 2013. Group 1 mainly comprised young, non-white men, while group 2 was predominantly comprised of white middle-aged women. HIV infection aggravates sporotrichosis, as seen with patients from group 1, who presented more severe disseminated sporotrichosis, a higher need for hospitalization and risk of death due to this mycosis. Due to its aggressive presentation, sporotrichosis elicited HIV testing and subsequent diagnosis in 19/48 patients. Underserved populations, among whom sporotrichosis has propagated, have been affected by different transmissible (e.g., HIV) and non-transmissible diseases. These populations should be targeted by community development programs and entitled to integrated management and care of their superimposed burdens.