Monday, October 2, 2023
|
Definition |
Epidemiology |
Clinical |
Laboratory |
|---|---|---|---|
| Proven | History of trauma or contact with a cat with sporotrichosis | Lesions compatible with sporotrichosis | Positive culture and/or histopathology (microbiological evidence) |
| Probable | History of trauma or contact with a cat with sporotrichosis | Lesions compatible with sporotrichosis | Human: Negative culture and/or histopathology.† |
| Possible | History of trauma or contact with a cat with sporotrichosis | Lesions compatible with sporotrichosis | Absent |
| Non-CTS | History of trauma or contact with a cat with sporotrichosis | Lesions compatible with sporotrichosis | Negative culture and/or histopathology for Sporothrix spp.† |
Table 1. Cat-transmitted sporotrichosis case definitions used in study of human cases in Curitiba, Brazil, 2011–2022*
*Adapted from Guide to Health Surveillance, 5th ed[23–25]. CTS, cat-transmitted sporotrichosis. †Negative culture for Sporothrix spp. alone does not rule out diagnosis (limitation of the culture).
|
Characteristic |
No. (%) patients |
|---|---|
| Sex | |
| F | 140 (65) |
| M | 76 (35) |
| Age range, y | |
| ≤10 | 17 (8) |
| 11–17 | 12 (6) |
| 18–30 | 45 (21) |
| 31–60 | 109 (50) |
| >60 | 33 (15) |
| Occupation | |
| Unemployed | 42 (19) |
| Student | 42 (19) |
| Retired | 23 (11) |
| Domestic worker | 17 (8) |
| Veterinarian or veterinary student | 17 (8) |
| Administrator | 11 (5) |
| Teacher | 3 (1) |
| Pet sitter | 3 (1) |
| Gardener | 2 (1) |
| Butcher | 2 (1) |
| Others | 54 (26) |
Table 2. Sociodemographic characteristics in study of human sporotrichosis cases in Curitiba, Brazil, 2011–2022
Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 1.00 ABIM MOC points
This activity is intended for infectious disease clinicians, dermatologists, ophthalmologists, public health officials, and other clinicians caring for patients with or at risk for cat-transmitted sporotrichosis caused by the emerging pathogen Sporothrix brasiliensis.
The goal of this activity is for learners to be better able to describe 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 Hospital de Clínicas, a tertiary referral hospital in Curitiba, Brazil.
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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).
