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[Feline sporotrichosis: clinical and zoonotic aspects].

The sporotrichosis is a deep mycosis, its course is subacute or chronic, and is caused by the Sporothrix schenckii. It's a very common dermatopathy, generally arising from thorn wounds, insects stings as well as from splinters. The S. schenckii has been described in São Paulo, Brazil, in canines, felines, asinines, bovines, equines and murines. However, its antropozoonotic feature has seldom been mentioned in the international literature, and, in Brazil, there is only one report about a possible transmission cat-human being. The current approach describes a clinical case of feline sporotrichosis transmitted by cat scratch to the owner, the career and the veterinarian. A very offensive three-year-old male mongrel cat showed severe cutaneous lesions in cephalic, thoracic regions and forelimbs. These lesions were ulcerations, exudation, crusts, alopecia worsened by the symptoms of the feline respiratory complex. This cat wounded, in a short time, 5 persons. Three of them had shown symptoms of distinct severity and development. The presumptive clinical diagnosis was corroborated by histopathology (HE, PAS) of skin, lymphnodes, and tonsils fragments obtained "intra-vitam" and "post-mortem". This was true by the isolation of the agent. Finally, this was confirmed as a result of serological (FC, precipitation antibodies) and immunocutaneous (sporotrichina, histoplasmina) tests made in affected patients.

Adult↗

[Epidemiology of sporotrichosis in the central region of Rio Grande do Sul].

Thirty-one cases of sporotrichosis diagnosed in the central region of Rio Grande do Sul from 1988 to 1997 were studied. Clinical data were compared with a study concerning three past decades, clearly showing a decrease in the incidence of the mycosis, and an alteration in the profile of the infection, with a decrease of sporotrichosis in rural patients, children, women and farmers. In the past decade the mycosis was most frequent among urban adults with different professions, with the onset of the disease being associated with rural leisure activities such as fishing and hunting.

Adolescent↗

Roentgenology of sporotrichosis.

Localized cutaneous as well as unifocal and multifocal systemic sporotrichosis may all produce roentgenographic findings. Localized cutaneous nodules may occasionally extend to the bone below producing a locally erosive lesion similar to those more commonly found in blastomycosis. More frequently, sporotrichosis involves the joints, either alone or with accompanying skin nodules. The joint changes are those of a pyogenic arthritis of the knees, elbows, hands, or feet which is difficult to distinguish from pyarthrosis produced by other organisms. The pulmonary findings depend upon whether or not the lung is the only site of infection. If there are no other areas of involvement, the pulmonary findings may be indistinguishable from those of secondary tuberculosis. However, if the skin on joints are also involved, small nodules appear and apparently do not proceed to cavitation.

Adult↗

Evaluation of an epidemic of sporotrichosis in cats: 347 cases (1998-2001).

OBJECTIVE: To evaluate characteristics of a large epidemic of sporotrichosis in cats. DESIGN: Retrospective study. ANIMALS: 347 cats with naturally acquired infection with Sporothrix schenckii. PROCEDURE: Medical records were reviewed for data regarding clinical, mycologic, histopathologic, and routine hematologic and serum biochemical findings; assays for FIV-specific antibodies and FeLV antigen; antifungal treatment; and follow-up. RESULTS: Lesions varied from small papules to extensive zones of necrosis. Ten cats had no skin lesions, 114 had skin lesions at a single site, 86 had skin lesions in 2 sites, and 137 had skin lesions in 3 or more sites. Respiratory tract signs were observed in 154 cats and were the most frequent extracutaneous sign. Anemia, leukocytosis with neutrophilia, hypoalbuminemia, and hyperglobulinemia were the main blood abnormalities. Antibodies against FIV were detected in 28 cats, FeLV antigen was detected in 2 cats, and both were detected in 1 cat among 142 cats tested. During the study, 118 cats were lost to follow-up and 124 died. Of 266 cats that were treated, 68 were cured. Complete healing of the lesions was observed regardless of the presence of extracutaneous signs, general condition, treatment schedule, or coinfection with FIV. CONCLUSIONS AND CLINICAL RELEVANCE: Feline sporotrichosis was evident in subclinical to severe forms; however, cats can respond well to regular and prolonged antifungal treatment.

Animals↗

Multifocal systemic sporotrichosis with lobar pulmonary involvement.

Multifocal systemic sporotrichosis (disseminated sporotrichosis) with lobar pulmonary involvement is uncommon. We describe successful treatment with amphotericin B in such a patient and review data from 1 other similar case previously reported and 7 with nonlobar pulmonary involvement.

Aged↗

Ketoconazole treatment of a family with zoonotic sporotrichosis.

All 3 members of a family developed lymphocutaneous and cutaneous sporotrichosis after exposure to an infected cat. The lesions resembled acute bacterial lymphadenitis and lymphangitis and responded within 2 weeks to ketoconazole treatment with complete healing and no recurrence over the next 6 months. Immunologically normal children and adults with lymphocutaneous or cutaneous sporotrichosis may respond well to ketoconazole therapy.

Adult↗

[A case of fixed sporotrichosis with recurred in a child following itraconazole treatment].

We report a case of fixed sporotrichosis in a 2-year-old girl who showed a reddish nodule on her left cheek for 1 year without trauma. Fungi flora-Y staining showed fungal elements from the exudate onthe erosion of this nodule. Sporothrix schenckii was isolated from a culture of the fungus taken from the biopsy specimen. Treatment with itraconazole 4.5 mg/kg/day for 16 weeks resulted in an atrophic scar after 2.1 mg/kg/day for 8 weeks without side effects. Six months later, her eruption recurred and wastreated with potassium iodide for 21 weeks with complete resolution. During the 1 year follow up period, there was no recurrence. Six cases of sporotrichosis in children including ours have been reported in Japan. Each case showed complete resolution and no recurrence. However, careful follow-up is believed to be necessary based on our case.

Antifungal Agents↗

[A case of lymphocutaneous sporotrichosis].

We report a case of lymphocutaneous sporotrichosis in a 69-year old man who had nodular-ulcerated lesions on the right hand and forearm. Small nodules remained on the right hand after 8 weeks of 0.5 g daily treatment with potassium iodide. Alternatively, terbinafine therapy (125 mg/day) resulted in healing with atrophic scars after 9 weeks without side effects. We reviewed 67 patients of cutaneous sporotrichosis in Japan from 1993 to 1999. Those cure rates (and mean durations of treatments in parentheses) are 90.9% (8.1 weeks) with potassium iodide, 86.6% (12.6 weeks) with itraconazole (100 mg/day) and 71.4% (12.8 weeks) with terbinafine (125 mg/day) treatments, respectively. These results lead us to consider a daily dose of 250 mg as more appropriate for terbinafine.

Aged↗

Sporotrichosis of the knee. A case report.

Articular infections due to the fungus Sporothrix schenkii are rare. Only 46 cases of Sporotrichosis arthritis have been well-documented in the English literature to date. The presentation may be limited to a monoarticular synovitis, hence the diagnosis may be confused with other more common causes resulting in costly delays in proper treatment. Reported is a case of Sporotrichosis of the knee misdiagnosed multiple times over a three-year period yet illustrating important clinical features that could lead to earlier diagnosis and management.

Adult↗

Sporotrichosis arthritis: clinical features in seven patients.

A review of the clinical features of seven patients with sporotrichosis arthritis showed that six had joint infection without previous skin or lung involvement and that one with myelofibrosis had joint and skin infection. The average time from onset of joint symptoms to diagnosis was 25 months, resulting in joint damage that required arthrodesis in four patients. Tissue from open synovial biopsy was superior to synovial fluid for obtaining a positive culture; concomitant synovial fluid and synovial tissue cultures were superior to either one alone. Granulomatous inflammation was seen in synovial tissue in six patients biopsied. Amphotericin B with surgical debridement of the affected joint was successful treatment in four patients. Although an uncommon cause of joint disease, sporotrichosis arthritis may go unrecognized and mimic other forms of arthritis, resulting in irreparable damage in an otherwise curable form of arthritis.

Adult↗

Oral manifestation of sporotrichosis in AIDS patients.

A wide spectrum of oral lesions has been associated with human immunodeficiency viral infection (HIV), or AIDS. This report describes the case of an HIV-infected patient who developed a case of disseminated sporotrichosis whose first clinical sign was the presence of orofacial lesions. A histopathological study of this patient's biopsy specimens taken from the oropharyngeal lesions revealed a number of rounded and/or oval free-spore forms of Sporothrix schenkii, the identification of which was corroborated by culturing skin lesion exudate on Sabouraud's glucose agar. To the best of our knowledge to date, this is the first time a case of the oral manifestation of sporotrichosis in association with HIV infection has been described in the dental literature.

AIDS-Related Opportunistic Infections↗

[Ecology of Sporothrix schenckii and of Ceratocystis stenoceras in Corsica and Alsace, French provinces free of sporotrichosis].

The study was conducted in 2 French Provinces free of sporotrichosis. Of 40 samples (soil, plant fragments, . . .) taken from Corsica, 59 isolations were obtained. All of these contained S. schenckii type of growth. Of 30 retained for further study, 14 were later identified as Ceratocystis stenoceras. All 14 needed pyrimidine as a growth factor. They developed well at 37 degrees and gave a yeast-like growth in shaken medium at 35 degrees and 25 degrees. One of the strains was pathogenic to mice. From 422 small mammals trapped in Alsace 37 isolations were made which morphologically were identified as S. schenckii. From these 31 were identified as C. stenoceras. Six isolations were considered as S. schenckii. The presence of nature of C. stenoceras and S. scheckii is discussed. Both fungi were isolated from various materials collected in tropical areas where sporotrichosis is endemic but also in such temperate areas as Corsica and Alsace where the mycosis is non-existent.

Animals↗

Immunohistochemical localization of activated and mature CD83+ dendritic cells in granulomas of sporotrichosis.

Dendritic cells (DC) are considered to be the most potent antigen-presenting cells (APC) and CD83 is expressed at a high level on immune-competent, activated and mature DC. In order to obtain insight into the immune response in sporotrichosis, we searched immunohistochemically for CD83+ DC in the granulomatous skin lesions of patients. A small but significant subpopulation of CD83+ DC (approximately 0.2 to 0.8% of inflammatory cells) was found. The most common distribution pattern of CD83+ DC was as clusters with mononuclear lymphoid cells within the granulomas. In addition, CD83+ DC were occasionally scattered around the granulomas. High-intensity staining of CD83 antigens was detected not only on the surface, but also in the cytoplasm of DC. No CD83+ DC were observed in the epidermis. A considerable amount of CD1a+ cells were detected in the epidermis, papillary dermis and around the granulomas, but CD1a+ cells were rarely found within the granulomas. There were large numbers of CD68+ monocytes and macrophages in the granulomas. These results indicate that activated and mature DC may play a role in the immune response to sporotrichosis.

Antigens, CD↗

Disseminated cutaneous sporotrichosis treated with itraconazole.

A 72-year-old Hispanic man with diabetes presented with a 4-week history of a tender non-healing ulcer on the fifth digit of the left hand and a 3-day history of fever, chills, malaise, anorexia, and tender fluctuant nodules on the abdomen and left elbow. The patient, an avid gardener, was using prednisone and methotrexate for a debilitating seronegative polyarthropathy. A diagnosis of disseminated cutaneous sporotrichosis was made based on epidemiologic risk factors, clinical appearance, histopathologic examination, and a positive fungal culture. Use of prednisone was discontinued, the dosage of methotrexate was decreased, and use of oral itraconazole 400 mg/day was instituted. The patient's lesions cleared within 5 months, and no recurrence was noted during a 3-month follow-up. This case illustrates the typical association of the rare entity of disseminated cutaneous sporotrichosis with immunosuppression, an unusual lack of internal involvement, and a gratifying response to itraconazole.

Antifungal Agents↗

Disseminated cutaneous sporotrichosis associated with anergic immuno-suppression due to miliary tuberculosis.

A 52-years-old policeman suffering from tuberculous meningitis, developed pseudo-umbilicated nodular skin lesions which increased rapidly in size during the course of his illness. Histology revealed cutaneous sporotrichosis. Human immuno-deficiency virus infection was excluded by absence of history of exposure and repeated negative serological test for HIV antibodies. The tuberculin test was also negative. Anti-tuberculous therapy failed to prevent a fatal outcome 3 months after admission to hospital. The possibility that the usually presentation of disseminated cutaneous sporotrichosis was an opportunistic infection facilitated by immuno-deficiency accompanying anergy of miliary tuberculosis is discussed.

Biopsy↗

[Unknown fixed cutaneous sporotrichosis].

Sporotrichosis is the most frequent subcutaneous mycosis in Mexico. The clinical forms are commonly described as lympho-cutaneous and cutaneous-fixed. The case of a male patient who developed an eritematous plaque with radial growth is reported. The patient received empirical therapy and topic steroids which modified the clinical picture with vesicles to vesicles, ulcers and blood and honey crusts. Diagnosis of fixed cutaneous sporotrichosis incognito was established by clinical, mycological and histopathological studies. Delayed cellular immunity in vitro and in vivo were normal. The patient received oral itraconazole showing clinical and mycological cure after four months.

Aged↗

Fatal sporotrichosis.

Disseminated sporotrichosis is a serious fungal infection caused by the soil inhabitant Sporothrix schenckii. It is seen in immunocompromised patients, with a substantial number of recent cases involving patients with acquired immunodeficiency syndrome (AIDS). However, individuals with other conditions that affect the immune system also are at increased risk. We report a case of fatal disseminated sporotrichosis in a patient with liver disease and a diagnosis of a granulomatous condition presumed to be sarcoidosis; the patient was receiving systemic corticosteroid therapy. The various presentations of S schenckii infection, the risk of disseminated disease in immunocompromised hosts, and the importance of making accurate histologic diagnoses are reviewed.

Adrenal Cortex Hormones↗

Fixed cutaneous sporotrichosis in an adolescent boy: a case report.

We present a case of an adolescent boy with a 3-week history of 3 painless purulent erythematous ulcers with raised hyperkeratotic borders associated with regional lymphadenopathy on the medial aspect of the right antecubital fossa. There were no known initiating factors and no other significant associated signs or symptoms. The patient initially was treated with antibiotics, with no improvement. Bacterial and fungal cultures of biopsy specimens demonstrated the presence of Sporothrix schenckii and confirmed the diagnosis of sporotrichosis. Itraconazole was initiated with an appropriate response. This case demonstrates the importance of understanding the clinical presentation of sporotrichosis in children without a history of the disease.

Adolescent↗