RESUMEN
Sporotrichosis is the main subcutaneous mycosis in the world. In the last two decades, zoonotic sporotrichosis transmitted by cats has become hyperendemic in Rio de Janeiro, Brazil. Renal transplant recipients are subject to invasive fungal infection because of the effects of immunosuppressive therapy, but sporotrichosis is rarely reported. The authors conducted a retrospective study describing epidemiological, clinical, and therapeutic data related to adult renal-transplant-recipient patients diagnosed with sporotrichosis. The molecular identification of fungal isolates was performed. Minimal inhibitory concentration (MIC) of amphotericin B (AMB), itraconazole (ITZ), posaconazole (POS), isavuconazole, and terbinafine (TRB) against the strains was determined using the protocol described by the Clinical and Laboratory Standards Institute (CLSI). Six cases were identified from a cohort with 2429 sporotrichosis patients. They were five men and one woman, with a mean age of 44.2 years (range: 34-54 years). Four of them had cutaneous limited forms, and two patients had disseminated forms. The mean time between transplant and the onset of sporotrichosis symptoms was 25.5 (range: 6-36) months. Sporothrix brasiliensis was identified as the causative agent. The isolates were classified as wild type for all antifungal drugs tested. Treatment schemes included AMB (deoxycholate and liposomal), ITZ, and TRB. Five patients evolved to cure, and one died as a result of disseminated disease. Renal transplant recipients may be a vulnerable group for sporotrichosis in endemic countries. The authors highlight the importance of sporotrichosis prevention, early diagnosis, and treatment to prevent disseminated disease and poor prognosis.
Asunto(s)
Trasplante de Riñón , Esporotricosis , Animales , Antifúngicos/uso terapéutico , Brasil , Gatos , Humanos , Estudios Retrospectivos , Sporothrix , Esporotricosis/tratamiento farmacológicoRESUMEN
En la mayoría de las veces, la esporotricosis es una infección cutánea,granulomatosa, crónica y benigna. De modo más raro, la enfermedad puedeafectar las articulaciones. El comprometimiento articular en general secaracteriza por monoartrite sin síntomas sistémicos con presentación clínicahabitual de lesiones cutáneas y con frecuencia despunta en las personasinmunodeprimidas. El caso descrito es de una paciente sana que presentóartritis en la rodilla sin lesiones cutáneas, con el diagnostico de esporotricosisy que fue tratada con itraconazol oral. En este caso se concluye que lasorología es una herramienta valiosa para el diagnóstico de la artritis sinlesiones cutáneas producida por el hongo Sporothrix schenckii(AU)
Sporotrichosis is a generally cutaneous, granulomatous, chronic and benigninfection. Less frequently the disease may affect the joints. Articularinvolvement is usually characterized by monoarthritis in the absence ofsystemic symptoms, generally preceded by skin lesions, and frequently affectsimmunosuppressed individuals. We describe here the case of a healthy patientpresenting knee arthritis without skin lesions, diagnosed as sporotrichosis, andtreated with oral itraconazole. Serology used in this case was an invaluabletool for the diagnosis of sporotrichosis arthritis lacking skin lesions(AU)