Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 29, Number 7—July 2023
CME ACTIVITY - Research

Rising Incidence of Sporothrix brasiliensis Infections, Curitiba, Brazil, 2011–2022

On This Page
CME Introduction
Methods
Results
Discussion
CME Follow Up
Cite This Article
Figures
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Tables
Table 1
Table 2
Downloads
Article
Appendix
RIS [TXT - 2 KB]
Article Metrics
Metric Details
Author affiliations: Federal University of Paraná Program in Internal Medicine and Health Science, Curitiba, Brazil (R.C.R. Cognialli, F. de A.G.D. Bastos); Federal University of Paraná Hospital de Clínicas, Curitiba (R.C.R. Cognialli, G.L. Breda); Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, the Netherlands (D.H. Cáceres); Universidad del Rosario Studies in Translational Microbiology and Faculty of Medical Sciences, Emerging Diseases Research Group, Bogota, Colombia (D.H. Cáceres); Faculdades Pequeno Príncipe, Curitiba (F.B. Cavassin); Federal University of Paraná Basic Pathology Department, Curitiba (B.P.R. Lustosa, V.A. Vicente); Federal University of Paraná Department of Clinical Analysis, Curitiba (I. Santos-Weiss); Federal University of Paraná Department of Public Health, Curitiba (F Queiroz-Telles)

Cite This Article

Introduction

CME Logo

Medscape CME ACTIVITY

In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Medscape, LLC designates this Journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 75% minimum passing score and complete the evaluation at https://www.medscape.org/journal/eid; and (4) view/print certificate.

NOTE: It is Medscape's policy to avoid the use of Brand names in accredited activities. However, in an effort to be as clear as possible, the use of brand names should not be viewed as a promotion of any brand or as an endorsement by Medscape of specific products.

Release date: June 16, 2023; Expiration date: June 16, 2024
Learning Objectives

Upon completion of this activity, participants will be able to:

  • Assess cat-transmitted sporotrichosis disease incidence, demographics, and clinical and laboratory findings, based on a medical record review of 216 sporotrichosis cases diagnosed during 2011 to 2022 in Curitiba, Brazil

  • Evaluate cat-transmitted sporotrichosis geographic distribution and incidence trends, based on a medical record review of 216 sporotrichosis cases diagnosed during 2011 to 2022 in Curitiba, Brazil

  • Determine the clinical and public health implications of cat-transmitted sporotrichosis disease incidence, clinical syndromes, and geographic distribution, based on a medical record review of 216 sporotrichosis cases diagnosed during 2011 to 2022 in Curitiba, Brazil

CME Editor

Tony Pearson-Clarke, MS, Technical Writer/Editor, Emerging Infectious Diseases. Disclosure: Tony Pearson-Clarke, MS, has no relevant financial relationships.

CME Author

Laurie Barclay, MD, freelance writer and reviewer, Medscape, LLC. Disclosure: Laurie Barclay, MD, has no relevant financial relationships.

Authors

Regielly C.R. Cognialli, MS; Diego H. Cáceres, MS; Fernanda de A.G.D. Bastos, MS; Francelise B. Cavassin, PhD; Bruno P.R. Lustosa, MS; Vânia A. Vicente, PhD; Giovanni L. Breda, MS; Izabella Santos-Weiss, PhD; and Flávio Queiroz-Telles, PhD.

Top

Abstract

Zoonotic outbreaks of sporotrichosis are increasing in Brazil. We examined and described the emergence of cat-transmitted sporotrichosis (CTS) caused by the fungal pathogen Sporothrix brasiliensis. We calculated incidence and mapped geographic distribution of cases in Curitiba, Brazil, by reviewing medical records from 216 sporotrichosis cases diagnosed during 2011–May 2022. Proven sporotrichosis was established in 84 (39%) patients and probable sporotrichosis in 132 (61%). Incidence increased from 0.3 cases/100,000 outpatient visit-years in 2011 to 21.4 cases/100,000 outpatient visit-years in 2021; of the 216 cases, 58% (n = 126) were diagnosed during 2019–2021. The main clinical form of sporotrichosis was lymphocutaneous (63%), followed by localized cutaneous (24%), ocular (10%), multisite infections (3%), and cutaneous disseminated (<0.5%). Since the first report of CTS in Curitiba in 2011, sporotrichosis has increased substantially, indicating continuous disease transmission. Clinician and public awareness of CTS and efforts to prevent transmission are needed.

Sporotrichosis, the most prevalent implantation mycosis worldwide, is caused by fungi of genus Sporothrix (1–4). In some regions of Brazil, sporotrichosis has been referred to as cat disease because of its zoonotic transmission from felines. Since 1990, a new Sporothrix species, S. brasiliensis, has emerged rapidly as an agent of cat-transmitted sporotrichosis (CTS) (5). Initially identified primarily in Rio de Janeiro, highly virulent S. brasiliensis causes a notable level of epizootic disease involving cats, dogs, and humans (5–12) that is emerging and expanding geographically across Brazil (7–9,11) and is now a major public health problem (12). Originally, CTS was reported primarily in the South and Southeast regions of Brazil, but by 2022, CTS was reported in 25 of its 26 states, as well as in neighboring Argentina, Chile, and Paraguay (Figure 1) (2,9,13–18). In 2022, a case of cutaneous CTS caused by S. brasiliensis was reported in a veterinarian in the United Kingdom who was infected by an imported cat with sporotrichosis (19,20).

Rio de Janeiro state, in the Southeast region of Brazil, has the highest prevalence of CTS, >8,900 human cases reported since the beginning of the outbreak, followed by Rio Grande do Sul (South region) with 181 human cases (14,15,21). In Paraná state, also in the South region, public health officials and clinicians have been alarmed by the emergence of CTS, but epidemiologic and clinical data on this disease in this jurisdiction are lacking because reporting is not mandatory (11,22). Therefore, we performed a retrospective, descriptive study of human CTS to describe the characteristics of patients with sporotrichosis, based on a decade of experience in a single medical institution, the Hospital de Clínicas of the Federal University of Paraná (HC/UFPR), a tertiary referral hospital in Curitiba, Paraná’s largest city. Our study was approved by the HC/UFPR ethical committee (registration no. 12379819.4.0000.0096).

Methods

Study Design

We identified cases from the hospital database by using code B42 from the International Classification of Diseases, 10th Revision. Our study analyzed data from all proven and probable CTS cases from HC/UFPR during January 2011–May 2022.

Case Definition

We used case definitions approved by the Brazilian Ministry of Health (23–25). Proven human CTS was defined as microbiologic evidence (positive culture or histopathology) of sporotrichosis, presence of lesions or other symptoms compatible with sporotrichosis, and evidence of CTS transmission, including cat scratches or bites, contact with feline exudates, or exposure to sneezing by cats (Table 1) (23–26). Probable human CTS was defined as presence of compatible clinical manifestations after traumatic injury from or close contact with infected cats but lacking microbiologic evidence of sporotrichosis (Table 1) (23–25). We excluded patients with possible CTS or among whom CTS was ruled out.

Sporothrix Isolate Molecular Typing

We molecularly identified at the species level all Sporothrix isolates obtained from patients and extracted DNA from isolates using MasterPure Yeast DNA Purification Kit (Thermo Fisher Scientific). We amplified the calmodulin (CAL) locus region using the degenerate primers CL1 (5′-GAR TWC AAG GAG GCC TTC TC-3′) and CL2A (5′-TTT TTG CAT CAT GAG TTG GAC-3′), then sequenced amplicons using a BigDye Terminator v3.1 Cycle Sequencing Kit (Applied Biosystems). We visually inspected sequences using the BioEdit version 7.2.5 sequence alignment editor and used MAFFT version 7 to align sequences with reference strains from the National Center for Biotechnology Information databank and MEGA version 7.0.26 software with Tamura Nei method with 1,500 bootstraps to calculate evolutionary distance.

Data Collection and Statistical Analysis

From hospital clinical records we collected clinical, laboratory, and epidemiologic data from cases and stored them using a standardized Microsoft Excel form. We calculated descriptive statistics to record the characteristics of the cases. We also calculated the incidence rate per 100,000 outpatient all-reason visits per year (outpatient visit-years [OPVY]). We performed analyses using Medcalc version 19.0 statistical software and used Qgis version 3.28.3 to map distribution of CTS cases by residence coordinates (latitude and longitude). We obtained graphic sources of the vector layer from the Instituto de Pesquisa e Planejamento Urbano de Curitiba, Instituto Ambiental do Paraná, and Coordenação da Região Metropolitana de Curitiba. We created kernel density maps to show hotspot areas for sporotrichosis in Curitiba; for this analysis, we established a search radius of 750 m.

Results

We included 216 CTS cases in this analysis. Case-patients were more frequently female than male (ratio 1.8:1) except in the 11–17 year age group (Figure 2). Median age among CTS case-patients was 40 years (interquartile range 22.5–56.0 years) (Table 2); 29 (13%) patients were <18 years of age. Overall, 11% of patients had occupations with disease-related risk factors, including 9 veterinarians, 5 veterinary students, 3 pet sitters, and 2 gardeners. The most frequent clinical form of sporotrichosis was lymphocutaneous (n = 136, 63%), followed by fixed cutaneous (n = 53, 25%), ocular (n = 21, 10%), mixed forms (n = 5, 2%), and cutaneous disseminated (n = 1, <0.5%). We observed that some CTS case-patients had unusual clinical manifestations (Figure 3).

Overall, 84 (39%) patients had proven CTS and 132 (61%) had probable CTS. Among probable CTS cases, we tested 18 patients by microscopy and culture, and all tested negative. Laboratory testing was not requested for the 14 remaining probable CTS case-patients; the main causes for not testing were specimen unavailability for microbiology testing and previous initiation of antifungal treatment. Among the proven CTS cases, Sporothrix isolates were collected from direct swabbing of lesion secretions for 50 patients, skin biopsy for 29, and aspirate from abscesses for 5. Average times for positive Sporothrix culture results varied by specimen type: specimens collected using the swab method averaged 6 days (range 3–17 days), compared with 13 days (range 4–30 days) for specimens collected by biopsy (p<0.0001). On the basis of phylogenetic analysis of calmodulin sequence genes of 38 Sporothrix isolates from patients, we identified S. brasiliensis as the only etiologic agent (38/38 cases) of CTS during the study period (Figure 4).

In 98% (212) of the 216 total CTS cases, infection was associated with zoonotic transmission; in those cases, the patient had direct or indirect contact with a cat with diagnosed sporotrichosis. In 4 (2%) sporadic cases, occurring in 2016, 2017, 2019, and 2021, infection was associated with saprozoic exposure with traumatic implantation from an environmental source. The first observed substantial increase in cases was from 1 in 2015 (0.3 cases/100,000 OPVY) to 12 in 2016 (3.5 cases/100,000 OPVY) (Figure 5), and incidence rates continued to increase thereafter. There were 34 cases (8.3 cases/100,000 OPVY) in 2018, almost 3 times as many as in 2016, and 61 cases (21.4 cases/100,000 OPVY) in 2021 (Figure 5). During January–May 2022, we identified 20 cases from 142,873 outpatient visits (14 cases/100,000 OPVY) (Figure 5).

CTS cases were reported in 15 of the 399 municipalities in the state of Paraná (Figure 6, panels A, B) and in 11 of the 29 municipalities comprising the metropolitan region of Curitiba (Figure 6, panel C). Among the 216 CTS cases identified in the state of Paraná, the metropolitan region of Curitiba accounted for 205 (95%), the city of Curitiba alone for 170 (79%) (Figure 6, panel D). We also tracked triennial distribution of cases in the city of Curitiba during 2011–2013, 2014–2016, 2017–2019, and 2020–May 2022. The first case of CTS in Paraná was identified in 2011 in Campina Grande do Sul, a municipality located in the metropolitan region of Curitiba. The first case of CTS in the city of Curitiba was identified in 2012 in the Mercês neighborhood, located in the north-central part of the city (Figure 6, panel E). Since 2016, cases have spread across the city of Curitiba and been reported in 41 of 75 districts; most cases have been identified in the northwest region of the city, but during 2020–May 2022, incidence spread throughout the city (Figure 6, panels F, G, H). We also observed clusters of CTS cases involving members of the same household. Since 2011, a total of 10 clusters involving 21 cases were identified; 7/10 CTS clusters (15 cases) occurred after the COVID-19 pandemic began in 2020.

Kernel density maps identified hotspots for sporotrichosis in the city of Curitiba (Figure 7). The most critical hotspots were identified in the western part, mainly the Cidade Industrial de Curitiba (CIC) neighborhood, and north-central (city center) areas of Curitiba. CIC has an area of 44,588 km2 and a population of 172,909 inhabitants (density 3.9 habitants/km2); it is largely residential, and most residents live in houses. CIC is economically characterized as a lower middle–income area, with an average daily income of USD $4.7 (27). The second hotspot, in downtown Curitiba, is a combination of commercial and residential areas, composed mostly of apartment buildings. Curitiba city center comprises 3,310 km2 and is the most densely populated (37,234 inhabitants; density 11.2 inhabitants/km2) part of the city. Average daily income among residents is USD $20 (27). The kernel density maps of Curitiba show additional medium-density hotspots for CTS throughout other parts of the city, especially in the south, southeast, and northeast parts.

Discussion

During the 10-year study period, sporotrichosis incidence increased substantially, suggesting uncontrolled spread in the city of Curitiba. Brazil is facing the largest reported current zoonotic outbreak of CTS globally (9,11,13,28). CTS is a public health issue exacerbated by insufficient public health activities, such as case surveillance, animal control, and diagnostic capacity, and by lack of disease awareness among health professionals and the general population (9,13,25,29). Our study adds relevant epidemiologic information to promote better understanding of CTS in the state of Paraná, Brazil.

We found a higher prevalence of CTS among female patients, especially in adult women involved in domestic activities. This finding is similar to those of other previous reports and is likely related to close contact with infected domestic cats (30–33). In this study, we observed an increased proportion of pediatric CTS cases; 29 cases (13%) occurred in patients <18 years of age, likely reflecting the close nature of interactions between children and domestic pets, especially cats (23). In addition, we found that >10% of cases occurred in persons working in professional animal care disciplines (2,11,22), who are at increased risk for CTS because of close contact with and exposure to contaminated body fluids from infected animals. Those professionals would benefit from increased awareness that infection in humans can occur through direct contact with body fluids from cats contaminated with S. brasiliensis yeast (26).

Lymphocutaneous and fixed cutaneous forms were the most frequently identified clinical manifestations of sporotrichosis, consistent with findings in previous literature (1,22). However, since the sporotrichosis epidemic in Brazil began, reports of unusual clinical manifestations have been increasing (1,6,34). It should be highlighted that cutaneous disseminated sporotrichosis is a rare manifestation that mostly occurs in immunocompromised persons; it differs from cutaneous manifestations caused by multiple traumatic implantations, as also happens in CTS cases (35–37). We also found a relatively high frequency of ocular sporotrichosis, which occurred in 10% of cases. Ocular sporotrichosis occurs mainly because of direct contact of the ocular mucosa of a person with secretions from an infected cat, usually because of cutaneous exudates or respiratory droplets expelled during cat sneezing (5,12,26). Ocular sporotrichosis is characterized by acute or chronic conjunctivitis, including Parinaud ocular syndrome and dacryocystitis (2,12,38–41). We also observed that unusual clinical manifestations of CTS increased from 2018 onward, coinciding with the epidemic increase in the number of cases of the disease. On the basis of those findings, the current guidelines in Brazil recommend use of personal protective equipment, including glasses or a face shield, during contact with sick cats (24).

Proven cases of CTS in this study made up slightly more than one third (39%) of all cases, compared with 65.3% in other case-series studies of sporotrichosis (22,23). This difference may have resulted from using a case definition not based solely on culture and microscopy results, which are suboptimal assays for detecting sporotrichosis in humans. Cultures from pus or secretion from lesions could be a feasible alternative; that type of test shows good performance and generates results in half the time compared with testing specimens obtained by biopsy. In addition, that type of sample is noninvasive, simple, and inexpensive. HC/UFPR has a medical institute with extensive experience in the diagnosis of sporotrichosis, and its medical professionals consequently have a high index of suspicion for this disease, increasing the chances of early detection of cases in which culture and microscopy are generally negative. On the basis of this experience, we highlight the importance of the probable case classification, because recognizing probable CTS enables rapid initiation of treatment, resulting in a positive effect on the quality of life of patient with sporotrichosis (23,25).

Molecular typing identified a single species, S. brasiliensis, in all proven cases in our study. The isolates were related to the species that caused the CTS outbreak in the state of Rio de Janeiro in the early 2000s and is primarily causing outbreaks throughout Brazil (5,11,13,17,42–44). Those isolates were identified by phylogenetic analysis of the near-complete calmodulin gene sequencing, showing a high degree of similarity with previously sequenced isolates from Rio de Janeiro. Additional analyses, such as microsatellite typing, multilocus sequence typing, and amplified fragment-length polymorphic fingerprinting, can improve understanding of the expansion of cases in Paraná and the city of Curitiba (13,45). Moreover, analysis of whole-genome sequencing results is a tool relevant for elucidating central concerns about the differences in infectious potential between closely related species. Comparative genomic analysis of data on tissue invasion and transmission of pathogenic sibling species has been applied to highlight genes involved in fungal adaptation to an animal-associated lifestyle (11,46,47).

We observed an exponential increase in the incidence rate of sporotrichosis, from 0.3 OPVY in 2011 to 21.4 OPVY in 2021, a trend similar to that for data reported recently in a review of the burden of sporotrichosis in Brazil (9,15,22,29,30,48). In Brazil, the largest number of CTS cases is concentrated in the southwest and south of Brazil, including the states of Rio de Janeiro, Rio Grande do Sul, São Paulo, Espírito Santo, and Minas Gerais. However, cases of CTS have also been described in the Midwest, Federal District, and Northeast regions and in Pernambuco and Rio Grande do Norte states, clearly showing the spread of the disease throughout Brazil (22,32,49).

Most cases in this study occurred in the city of Curitiba. The first case identified at HC/UFPR was in the center-north part of the city in 2012, but the first substantial increase in the number of cases, a trend that continued, was observed in 2016. After the World Health Organization declared COVID-19 a pandemic in March 2020 and lockdowns started, we observed a 37% increase in cases and also an increase in CTS clusters. The increase may have been related to higher rates of pet adoption aimed at reducing anxiety and depression because of the lockdowns (23). We identified 2 areas of the city of Curitiba as CTS hotspots, one area characterized by high population density and the other by social inequalities. In addition, the kernel density estimate showed low or medium CTS expanded practically throughout the city, especially during 2020–2022; areas of medium density were located in the south, southeast, and northeast parts of the city.

The main limitation of our study was that data came from a single center; however, the data covered a decade of experience, and our findings add information based on actual case numbers rather than estimates. Since March 7, 2022, the State Department of Health of Paraná, has provided guidelines (resolution no. 093/2022) for mandatory notification of human and animal sporotrichosis cases in the state.

Because of the zoonotic transmission of this disease, a One Health approach is necessary to control the public health effects of CTS. Integrating human, animal, and environmental health approaches through coordinated actions among microbiologists, veterinarians, physicians, epidemiologists, and surveillance authorities could benefit control efforts. Potential actions include owners restricting cats from going outside homes and having contact with street cats, providing no-cost neutering of cats in regions where S. brasiliensis is endemic to prevent expansion of feral cat populations, widely establishing compulsory notification of CTS cases, increasing awareness of the disease among clinicians and the public, providing easy access to treatment in human and animal cases, and cremating cat remains (12,36,50). Additional interventions to control CTS outbreaks could include providing access to rapid, accurate diagnostic assays and antifungal drugs, developing vaccines specifically for cats, and evaluating novel treatment strategies, particularly for treating feline sporotrichosis. Enacting those and other prevention and control measures in a timely manner is urgently needed to repress the increased incidence and spread of this serious health condition.

Top

Acknowledgment

We thank Lili Volochen Lopuch and Adriana de Fátima Gabriel for all support with collecting and preparing samples and Regiane Cognialli Born for the map design. We also thank Jeremy Gold for reviewing the manuscript.‬‬

Top

References

  1. Orofino-Costa  R, Macedo  PM, Rodrigues  AM, Bernardes-Engemann  AR. Sporotrichosis: an update on epidemiology, etiopathogenesis, laboratory and clinical therapeutics. An Bras Dermatol. 2017;92:606–20.
  2. Queiroz-Telles  F, Bonifaz  A, Rossow  J, Chindamporn  A. Sporothrix and sporotrichosis. In: Encyclopedia of infection and immunity. New York: Elsevier Science; 2021.
  3. Queiroz-Telles  F, Fahal  AH, Falci  DR, Caceres  DH, Chiller  T, Pasqualotto  AC. Neglected endemic mycoses. Lancet Infect Dis. 2017;17:e367–77.
  4. Chakrabarti  A, Bonifaz  A, Gutierrez-Galhardo  MC, Mochizuki  T, Li  S. Global epidemiology of sporotrichosis. Med Mycol. 2015;53:3–14.
  5. Gremião  ID, Miranda  LH, Reis  EG, Rodrigues  AM, Pereira  SA. Zoonotic epidemic of sporotrichosis: cat to human transmission. PLoS Pathog. 2017;13:e1006077.
  6. Schechtman  RC, Falcão  EMM, Carard  M, García  MSC, Mercado  DS, Hay  RJ. Sporotrichosis: hyperendemic by zoonotic transmission, with atypical presentations, hypersensitivity reactions and greater severity. An Bras Dermatol. 2022;97:1–13.
  7. Barros  MB, Schubach  AO, do Valle  AC, Gutierrez Galhardo  MC, Conceição-Silva  F, Schubach  TM, et al. Cat-transmitted sporotrichosis epidemic in Rio de Janeiro, Brazil: description of a series of cases. Clin Infect Dis. 2004;38:529–35.
  8. de Lima Barros  MB, Schubach  TM, Galhardo  MC, de Oliviera Schubach  A, Monteiro  PC, Reis  RS, et al. Sporotrichosis: an emergent zoonosis in Rio de Janeiro. Mem Inst Oswaldo Cruz. 2001;96:777–9.
  9. Gremião  IDF, Oliveira  MME, Monteiro de Miranda  LH, Saraiva Freitas  DF, Pereira  SA. Geographic expansion of sporotrichosis, Brazil. Emerg Infect Dis. 2020;26:621–4.
  10. Pereira  SA, Gremião  ID, Kitada  AA, Boechat  JS, Viana  PG, Schubach  TM. The epidemiological scenario of feline sporotrichosis in Rio de Janeiro, state of Rio de Janeiro, Brazil. Rev Soc Bras Med Trop. 2014;47:392–3.
  11. Rodrigues  AM, Della Terra  PP, Gremião  ID, Pereira  SA, Orofino-Costa  R, de Camargo  ZP. The threat of emerging and re-emerging pathogenic Sporothrix species. 2020;185:813–42.
  12. Rossow  JA, Queiroz-Telles  F, Caceres  DH, Beer  KD, Jackson  BR, Pereira  JG, et al. A One Health approach to combatting Sporothrix brasiliensis: narrative review of an emerging zoonotic fungal pathogen in South America. J Fungi (Basel). 2020;6:247.
  13. Rodrigues  AM, Gonçalves  SS, de Carvalho  JA, Borba-Santos  LP, Rozental  S, Camargo  ZP. Current progress on epidemiology, diagnosis, and treatment of sporotrichosis and their future trends. J Fungi (Basel). 2022;8:776.
  14. Brandolt  TM, Madrid  IM, Poester  VR, Sanchotene  KO, Basso  RP, Klafke  GB, et al. Human sporotrichosis: a zoonotic outbreak in southern Brazil, 2012–2017. Med Mycol. 2018;57:myy082.
  15. Poester  VR, Mattei  AS, Madrid  IM, Pereira  JTB, Klafke  GB, Sanchotene  KO, et al. Sporotrichosis in southern Brazil, towards an epidemic? Zoonoses Public Health. 2018;65:815–21.
  16. Etchecopaz  AN, Lanza  N, Toscanini  MA, Devoto  TB, Pola  SJ, Daneri  GL, et al. Sporotrichosis caused by Sporothrix brasiliensis in Argentina: case report, molecular identification and in vitro susceptibility pattern to antifungal drugs. J Mycol Med. 2020;30:100908.
  17. Etchecopaz  A, Toscanini  MA, Gisbert  A, Mas  J, Scarpa  M, Iovannitti  CA, et al. Sporothrix brasiliensis: a review of an emerging South American fungal pathogen, its related disease, presentation and spread in Argentina. J Fungi (Basel). 2021;7:170.
  18. Thomson  P, González  C, Blank  O, Ramírez  V, Río  Cd, Santibáñez  S, et al. Sporotrichosis outbreak due to Sporothrix brasiliensis in domestic cats in Magallanes, Chile: a One-Health-approach study. J Fungi (Basel). 2023;9:226.
  19. Rachman  R, Ligaj  M, Chinthapalli  S, Serafino Wani  R. Zoonotic acquisition of cutaneous Sporothrix braziliensis infection in the UK. BMJ Case Rep. 2022;15:e248418.
  20. Barnacle  JR, Chow  YJ, Borman  AM, Wyllie  S, Dominguez  V, Russell  K, et al. The first three reported cases of Sporothrix brasiliensis cat-transmitted sporotrichosis outside South America. Med Mycol Case Rep. 2022;39:14–7.
  21. Marinho Falcão  EMM, Rocha Romão  A, de Avelar Figueiredo Mafra Magalhães  M, de Lima Filho  JB, Francesconi do Valle  AC, Bastos  FI, et al. A spatial analysis of the spread of hyperendemic sporotrichosis in the state of Rio de Janeiro, Brazil. J Fungi (Basel). 2022;8:434.
  22. Rabello  VBS, Almeida  MA, Bernardes-Engemann  AR, Almeida-Paes  R, de Macedo  PM, Zancopé-Oliveira  RM. The historical burden of sporotrichosis in Brazil: a systematic review of cases reported from 1907 to 2020. Braz J Microbiol. 2022;53:231–44.
  23. Queiroz-Telles  F, Bonifaz  A, Cognialli  R, Lustosa  BPR, Aparecida Vicente  V, Ramírez-Marín  HA. Sporotrichosis in children: case series and narrative review. Curr Fungal Infec Rep. 2022;33–46.
  24. Ministry of Health of Brazil. Guide to health surveillance [in Portuguese]. 5th ed. Brasilia (Brazil): Ministry of Health of Brazil; 2022.
  25. Cognialli  R, Bloss  K, Weiss  I, Caceres  DH, Davis  R, Queiroz-Telles  F. A lateral flow assay for the immunodiagnosis of human cat-transmitted sporotrichosis. Mycoses. 2022;65:926–34.
  26. de Andrade Galliano Daros Bastos  F, Raimundo Cognialli  RC, Rodrigues de Farias  M, Dos Santos Monti  F, Wu  K, Queiroz-Telles  F. Spread of Sporothrix spp. through respiratory droplets from infected cats: a potential route of transmission. Med Mycol. 2022;60:myac079.
  27. Viezzer  J, Moraes  E, Biondi  D, Martini  A, Scarano  F. Green areas, population and income in Curitiba, PR, Brasil [in Portuguese]. Rev Soc Bras Arb Urb. 2022;17:37–49.
  28. Queiroz-Telles  F, Buccheri  R, Benard  G. Sporotrichosis in immunocompromised hosts. J Fungi (Basel). 2019;5:8.
  29. Munhoz  LS, Poester  VR, Severo  CB, Trápaga  MR, Madrid  IM, Benelli  JL, et al. Update of the epidemiology of the sporotrichosis epidemic in the state of Rio Grande do Sul, Brazil. Mycoses. 2022;65:1112–8.
  30. Alzuguir  CLC, Pereira  SA, de Avelar Figueiredo Mafra Magalhães, Almeida-Paes R, Freitas DFS, Oliveira LFA, et al. Geo-epidemiology and socioeconomic aspects of human sporotrichosis in the municipality of Duque de Caxias, Rio de Janeiro, Brazil, between 2007 and 2016. Trans R Soc Trop Med Hyg. 2020;114:99–106.
  31. Barros  MB, de Almeida Paes  R, Schubach  AO. Sporothrix schenckii and sporotrichosis. Clin Microbiol Rev. 2011;24:633–54.
  32. de Oliveira Bento  A, de Sena Costa  AS, Lima  SL, do Monte Alves  M, de Azevedo Melo  AS, Rodrigues  AM, et al. The spread of cat-transmitted sporotrichosis due to Sporothrix brasiliensis in Brazil towards the northeast region. PLoS Negl Trop Dis. 2021;15:e0009693.
  33. Barros  MB, Schubach  AO, Schubach  TM, Wanke  B, Lambert-Passos  SR. An epidemic of sporotrichosis in Rio de Janeiro, Brazil: epidemiological aspects of a series of cases. Epidemiol Infect. 2008;136:1192–6.
  34. Mialski  R, de Almeida  JN Jr, da Silva  LH, Kono  A, Pinheiro  RL, Teixeira  MJ, et al. Chronic meningitis and hydrocephalus due to Sporothrix brasiliensis in immunocompetent adults: a challenging entity. Open Forum Infect Dis. 2018;5:ofy081.
  35. Bonifaz  A, Tirado-Sánchez  A. Cutaneous disseminated and extracutaneous sporotrichosis: current status of a complex disease. J Fungi (Basel). 2017;3:6.
  36. Orofino-Costa  R, Freitas  DFS, Bernardes-Engemann  AR, Rodrigues  AM, Talhari  C, Ferraz  CE, et al. Human sporotrichosis: recommendations from the Brazilian Society of Dermatology for the clinical, diagnostic and therapeutic management. An Bras Dermatol. 2022;97:757–77.
  37. Queiroz-Telles  F, Cognialli  RC, Salvador  GL, Moreira  GA, Herkert  PF, Hagen  F. Cutaneous disseminated sporotrichosis in immunocompetent patient: case report and literature review. Med Mycol Case Rep. 2022;36:31–4.
  38. Arinelli  A, Aleixo  A, Freitas  DFS, do Valle  ACF, Almeida-Paes  R, Gutierrez-Galhardo  MC, et al. Ocular sporotrichosis: 26 cases with bulbar involvement in a hyperendemic area of zoonotic transmission. Ocul Immunol Inflamm. 2019;28:764–71.
  39. Ferreira  TA, Sodré  CT, Costa  JM, Setta  CRP. Ramos-E-Silva M. Primary conjunctival sporotrichosis: an atypical presentation of the disease. JAAD Case Rep. 2018;4:497–9.
  40. Lacerda Filho  AM, Cavalcante  CM, Da Silva  AB, Inácio  CP, de Lima-Neto  RG, Liete de Andrade  MC, et al. High-virulence cat-transmitted ocular sporotrichosis. Mycopathologia. 2019;184:547–9.
  41. Aidar  MN, Rebeschini  BM, Salgado Silveira da Mata  CT, Borges  TC, Dos Santos Araújo  MEX. The importance of considering the possibility of ocular sporotrichosis in areas with high incidence rates of sporotrichosis. Arq Bras Oftalmol. 2022;•••:S0004–27492022005006208.
  42. Marimon  R, Cano  J, Gené  J, Sutton  DA, Kawasaki  M, Guarro  J. Sporothrix brasiliensis, S. globosa, and S. mexicana, three new Sporothrix species of clinical interest. J Clin Microbiol. 2007;45:3198–206.
  43. Della Terra  PP, Rodrigues  AM, Fernandes  GF, Nishikaku  AS, Burger  E, Pires de Camargo  Z. Exploring virulence and immunogenicity in the emerging pathogen Sporothrix brasiliensis. PLoS Negl Trop Dis. 2017;11:e0005903.
  44. Almeida-Paes  R, de Oliveira  MM, Freitas  DF, do Valle  AC, Zancopé-Oliveira  RM, Gutierrez-Galhardo  MC. Sporotrichosis in Rio de Janeiro, Brazil: Sporothrix brasiliensis is associated with atypical clinical presentations. PLoS Negl Trop Dis. 2014;8:e3094.
  45. de Carvalho  JA, Hagen  F, Fisher  MC, de Camargo  ZP, Rodrigues  AM. Genome-wide mapping using new AFLP markers to explore intraspecific variation among pathogenic Sporothrix species. PLoS Negl Trop Dis. 2020;14:e0008330.
  46. Teixeira  MM, Almeida-Paes  R, Bernardes-Engemann  AR, Nicola  AM, de Macedo  PM, Valle  ACF, et al. Single nucleotide polymorphisms and chromosomal copy number variation may impact the Sporothrix brasiliensis antifungal susceptibility and sporotrichosis clinical outcomes. Fung Gen Biol. 2022;163:103743.
  47. Huang  M, Ma  Z, Zhou  X. Comparative genomic data provide new insight on the evolution of pathogenicity in Sporothrix species. Front Microbiol. 2020;11:565439.
  48. Sanchotene  KO, Madrid  IM, Klafke  GB, Bergamashi  M, Della Terra  PP, Rodrigues  AM, et al. Sporothrix brasiliensis outbreaks and the rapid emergence of feline sporotrichosis. Mycoses. 2015;58:652–8.
  49. Valeriano  CAT, Ferraz  CE, Marques Evangelista Oliveira  M, Inácio  CP, de Oliveira  EP, Lacerda  AM, et al. Cat-transmitted disseminated cutaneous sporotrichosis caused by Sporothrix brasiliensis in a new endemic area: case series in the northeast of Brazil. JAAD Case Rep. 2020;6:988–92.
  50. Andrade  EHP, Bastos  CV, Silva  AVD, Moreira  SM, Costa  TGA, Salvato  LA, et al. Household outbreak of sporotrichosis: towards the One Health approach. Rev Soc Bras Med Trop. 2022;55:e0021.

Top

Figures
Tables

Top

Follow Up

Earning CME Credit

To obtain credit, you should first read the journal article. After reading the article, you should be able to answer the following, related, multiple-choice questions. To complete the questions (with a minimum 75% passing score) and earn continuing medical education (CME) credit, please go to https://www.medscape.org/journal/eid. Credit cannot be obtained for tests completed on paper, although you may use the worksheet below to keep a record of your answers.

You must be a registered user on http://www.medscape.org. If you are not registered on http://www.medscape.org, please click on the “Register” link on the right hand side of the website.

Only one answer is correct for each question. Once you successfully answer all post-test questions, you will be able to view and/or print your certificate. For questions regarding this activity, contact the accredited provider, CME@medscape.net. For technical assistance, contact CME@medscape.net. American Medical Association’s Physician’s Recognition Award (AMA PRA) credits are accepted in the US as evidence of participation in CME activities. For further information on this award, please go to https://www.ama-assn.org. The AMA has determined that physicians not licensed in the US who participate in this CME activity are eligible for AMA PRA Category 1 Credits™. Through agreements that the AMA has made with agencies in some countries, AMA PRA credit may be acceptable as evidence of participation in CME activities. If you are not licensed in the US, please complete the questions online, print the AMA PRA CME credit certificate, and present it to your national medical association for review.

Article Title: 
Rising Incidence of Sporothrix brasiliensis Infections, Curitiba, Brazil, 2011–2022
CME Questions

  • You are advising a tropical medicine practice about cat-transmitted sporotrichosis (CTS). On the basis of the medical record review of 216 sporotrichosis cases diagnosed during 2011 to 2022 in Curitiba, Brazil, by Cognialli and colleagues, which one of the following statements about CTS disease incidence, demographics, and clinical and laboratory findings is correct?

    • Proven sporotrichosis was established in one quarter of sporotrichosis cases

    • Ocular was the main clinical form of sporotrichosis

    • CTS was more frequent in males than females

    • 11% of patients had occupational risk factors

  • On the basis of the medical record review of 216 sporotrichosis cases diagnosed during 2011 to 2022 in Curitiba, Brazil, by Cognialli and colleagues, which one of the following statements about CTS incidence trends and geographic distribution is correct?

    • Incidence rate rose from 0.3 cases per 100,000 outpatient visit-years (OPVY) in 2011 to 21.4 cases per 100,000 OPVY in 2021

    • CTS was associated with zoonotic transmission in three quarters of cases

    • The first substantial increase in the number of cases and incidence was in 2020

    • Critical CTS hotspots were mostly in affluent areas of the city

  • According to the medical record review of 216 sporotrichosis cases diagnosed during 2011 to 2022 in Curitiba, Brazil, by Cognialli and colleagues, which one of the following statements about clinical and public health implications of CTS disease incidence, clinical syndromes, and geographic distribution is correct?

    • A One Health approach is unlikely to help control CTS

    • CTS control depends primarily on veterinarians

    • Development of anti-CTS vaccines, specifically for cats, is needed to help control CTS

    • Recent stabilization of sporotrichosis incidence indicates successful efforts to prevent CTS transmission

Top

Cite This Article

DOI: 10.3201/eid2907.230155

Original Publication Date: June 16, 2023

Related Links

Table of Contents – Volume 29, Number 7—July 2023

EID Search Options
presentation_01 Advanced Article Search – Search articles by author and/or keyword.
presentation_01 Articles by Country Search – Search articles by the topic country.
presentation_01 Article Type Search – Search articles by article type and issue.

Top

Comments

Please use the form below to submit correspondence to the authors or contact them at the following address:

Flávio Queiroz-Telles, Federal University of Paraná, 280 Padre Camargo, Curitiba, Paraná, Brazil

Send To

10000 character(s) remaining.

Top

Page created: March 15, 2023
Page updated: June 16, 2023
Page reviewed: June 16, 2023
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external