Alma

41 0011-9059 International IJD Oxford, UK Journal of Dermatology Blackwell Publishing Ltd. Science, 2002

Report

Barros et al. Sporotrichosis with widespread cutaneous lesions

Sporotrichosis with widespread cutaneous lesions: report of 24 cases related to transmission by domestic cats in Rio de Janeiro, Brazil

Mônica Bastos de Lima Barros, MD, MSc, Armando de Oliveira Schubach, MD,PhD, Maria Clara Gutierrez Galhardo, MD, PhD, Tânia Maria Pacheco Schubach, VMD, MSc, Rosani Santos dos Reis, Maria José Conceição, MD, PhD, and Antônio Carlos Francesconi do Valle, MD, PhD

From the Serviço Médico, Serviço de Zoonoses, Serviço de Micologia, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil

Abstract
Background Sporotrichosis mostcommonly presents as a localized lymphocutaneous infection following traumatic inoculation of soil, vegetables or organic substrates contaminated with the dimorphic fungus Sporothrix schenckii. Cases of widespread cutaneous lesions are rare. There have been isolated reports of household outbreaks of sporotrichosis involving cats and humans. Methods We report 24 cases of culture-proven sporotrichosispresenting with widespread cutaneous lesions. Results These 24 cases are part of an epidemic currently occurring in Rio de Janeiro. All patients reported contact with cats with sporotrichosis and 17 reported a history of a scratch or bite. Clinical manifestations included fixed lesions at multiple anatomical sites, and fixed lesions associated with the lymphocutaneous, bilateral lymphocutaneous andmucosal forms of the disease. Two patients were alcoholics and one patient was diabetic, while the remaining patients did not present any immunosuppressing condition. All patients responded to treatment with itraconazole. Conclusions The domestic cat has played an important role in the transmission of sporotrichosis in Rio de Janeiro and seems to have contributed to this unusual clinicalmanifestation.

Correspondence
Mônica Bastos de Lima Barros, MD, Instituto de Pesquisa Clínica Evandro Chagas – Fundação Oswaldo Cruz, Avenue. Brazil 4365, Manguinhos, Rio de Janeiro, Brazil, CEP 21045 – 900. E-mail: mblb@unisys.com.br

Introduction Sporotrichosis is a subcutaneous mycosis caused by the dimorphic fungus Sporothrix schenckii, which is found worldwide, most frequently in soil and plants.Infection generally occurs by fungal implantation into the skin through trauma and is usually associated with certain leisure and occupational activities such as floriculture, agriculture, mining and wood exploitation.1 Some studies have suggested that exposure of intact skin or skin with superficial trauma to a large fungal inoculum may also result in infection.2–4 Less frequently, inhalation ofconidia can result in the pulmonary and systemic forms of the disease. Some animals have been associated with zoonotic transmission of S. schenckii, the most common being armadillos and cats.2,3,5 Cats represent a significant zoonotic potential as a result of the fact that their lesions are rich in parasites and they are proximal to man.6 Since the 1980s, veterinaries, technicians, handlers andowners of sick cats have been
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considered as a new risk group for the acquisition of sporotrichosis.2 In addition to the typical lymphocutaneous form, the disease presents a wide variety of clinical manifestations. Several classifications have been proposed throughout the years, most of them based on morphological and topographical criteria.7,8 Inthis respect, different concepts have been applied to define “disseminated cutaneous sporotrichosis”, with some authors considering it as the presence of disseminated lesions at multiple sites apparently restricted to the skin and subcutaneous tissue.5,9,10 Others have used a definition resembling the concept of “systemic sporotrichosis”, in which the disease also affects internal organs.11,12 In...