Chronic Laryngotracheal Granulomatous Disease Secondary to Sporothrix schenckii in an Immunocompromised Patient

Objective: To describe a rare presentation of laryngotracheal granulomatous disease secondary to sporotrichosis. Methods: The authors report a case of laryngeal sporotrichosis in an immunocompromised patient, with accompanying endoscopic images and pathology. Results/case: A 72-year-old immunocompromised female with a history of rose-handling presented with a year of hoarseness and breathy voice. Flexible nasolaryngoscopy showed diffuse nodularity; biopsy of the lesions demonstrated granulomatous inflammatory changes, and fungal culture grew Sporothrix schenkii. Long-term itraconazole treatment was initiated, with improvement in dysphonia and few residual granulomas on follow-up examination. Conclusion: When evaluating granulomatous disease of the airway, a broad differential including infectious or inflammatory etiologies should be considered, especially in immunocompromised patients. Adequate tissue samples should be collected to facilitate special staining. The current recommendations for laryngeal sporotrichosis include treatment with a prolonged course of itraconazole.

Complement-Mediated Differential Immune Response of Human Macrophages to Sporothrix Species Through Interaction With Their Cell Wall Peptidorhamnomannans

In this study, the human immune response mechanisms against Sporothrix brasiliensis and Sporothrix schenckii, two causative agents of human and animal sporotrichosis, were investigated. The interaction of S. brasiliensis and S. schenckii with human monocyte-derived macrophages (hMDMs) was shown to be dependent on the thermolabile serum complement protein C3, which facilitated the phagocytosis of Sporothrix yeast cells through opsonization. The peptidorhamnomannan (PRM) component of the cell walls of these two Sporothrix yeasts was found to be one of their surfaces exposed pathogen-associated molecular pattern (PAMP), leading to activation of the complement system and deposition of C3b on the Sporothrix yeast surfaces. PRM also showed direct interaction with CD11b, the specific component of the complement receptor-3 (CR3). Furthermore, the blockade of CR3 specifically impacted the interleukin (IL)-1β secretion by hMDM in response to both S. brasiliensis and S. schenckii, suggesting that the host complement system plays an essential role in the inflammatory immune response against these Sporothrix species. Nevertheless, the structural differences in the PRMs of the two Sporothrix species, as revealed by NMR, were related to the differences observed in the host complement activation pathways. Together, this work reports a new PAMP of the cell surface of pathogenic fungi playing a role through the activation of complement system and via CR3 receptor mediating an inflammatory response to Sporothrix species.

The Heat Shock Protein 60 and Pap1 Participate in the Sporothrix schenckii-Host Interaction

Sporothrixschenckii is one of the etiological agents of sporotrichosis, a worldwide-distributed subcutaneous mycosis. Its cell wall contains a glycoconjugate composed of rhamnose, mannose, glucuronic acid, and proteins, named peptidorhamnomannan, which harbors important Sporothrix-specific immunogenic epitopes. Although the peptidorhamnomannan carbohydrate moiety has been extensively studied, thus far, little is known about the protein core. Here, using LC-MS/MS, we analyzed the S.schenckii peptidorhamnomannan peptide fraction and generated mass signals of 325 proteins, most of them likely to be moonlighting proteins. Among the identified proteins, chaperonin GroEL/Hsp60 and the uncharacterized protein Pap1 were selected for further analysis. Both proteins were heterologously expressed in bacteria, and they showed adhesive properties to the extracellular matrix proteins laminin, elastin, fibrinogen, and fibronectin, although Pap1 also was bound to type-I and type-II collagen. The inoculation of concentrations higher than 40 μg of these proteins, separately, increased immune effectors in the hemolymph of Galleriamellonella larvae and protected animals from an S.schenckii lethal challenge. These observations were confirmed when yeast-like cells, pre-incubated with anti-rHsp60 or anti-rPap1 antibodies were used to inoculate larvae. The animals inoculated with pretreated cells showed increased survival rates when compared to the control groups. In conclusion, we report that Hsp60 and Pap1 are part of the cell wall peptidorhamnomannan, can bind extracellular matrix components, and contribute to the S.schenckii virulence. To our knowledge, this is the first report about moonlighting protein in the S.schenckii cell wall with an important role during the pathogen–host interaction.

Sporotrichosis in a U.S. Army Basic Trainee

ABSTRACT Lymphocutaneous sporotrichosis is a mycotic disease caused by traumatic inoculation of the dimorphic fungus Sporothrix schenckii, found ubiquitously in decaying vegetation. The potential for outbreaks, difficulty with timely diagnosis, as well as the prolonged treatment course and recovery from surgical intervention can have a substantial impact on the medical readiness of service members. Treatment with the antifungal therapy of choice, itraconazole, requires close patient monitoring for the duration of treatment for clinical response, drug tolerance, as well as therapeutic drug levels. We present a case of a U.S. Army enlistee with sporotrichosis contracted during basic training, highlighting the impact of delayed diagnosis and prolonged treatment course and recovery on medical readiness.

ESPOROTRICOSE OCULAR : UMA DOENÇA DE CARÁTER ZOÓNOTICO E EPIDÊMICO - REVISÃO BIBLIOGRÁFICA

Introdução: A esporotricose é uma doença causada pelo fungo dimórfico Sporothrix schenckii. É uma zoonose de caráter epidêmico e com enfrentamento no estado do Rio de Janeiro. No Brasil, a espécie mais frequente é S.brasilienses. A incidência em grupos de risco como proprietários de animais e médicos veterinários tem crescido. É transmitida para o homem através do contato direto como a arranhadura pelo gato doméstico ,com acesso a rua onde é a principal fonte de infecção. Pode ser encontrado no solo e em restos vegetais. As duas formas em seu ciclo de vida: micelial e levedura. A levedura pode parasitar o homem e os animais. Essa micose atinge a pele, o tecido subcutâneo e os vasos linfáticos, e pode disseminar-se por via linfática ou hematogênica. Observa-se a conjuntivite granulomatosa e a mucosa ocular é afetada, outras estruturas são acometidas, como o ducto lacrimal ocasionando a dacriocistite como sequela. A disseminação hematogênica em pacientes imunocomprometidos já foram descritas. Neste contexto a esporotricose ocular tem sido de caráter epidêmico a um grupo de risco. Objetivo: Teve como objetivo realizar uma revisão sobre os aspectos gerais como: etiologia, epidemiologia, diagnóstica e tratamento. Materiais e Métodos: Esta pesquisa bibliográfica foi de caráter descritivo. A busca foi através nas bases de dados como : Pubmed ,Scielo e Google acadêmico ,através da análise de teses, dissertações e artigos científicos. Resultados: A esporotricose urbana tornou-se um problema de saúde pública , um estudo foram analisados o perfil de trabalhadores, e foi de 80,3% infectados, todos com contato com o felino doméstico. As manifestações cutâneas são vistas , porém pode acometer via mucosa. As características oculares são conjuntivite granulomatosa uveíte, coroidite e lesões retrobulbares. O diagnóstico é através das manifestações clínicas e exame oftalmológico completo. No diagnóstico laboratorial a cultura para identificação é o padrão ouro. O tratamento é através da administração de antifúngicos, a droga de eleição é o Itraconazol. Conclusão: A manifestação cutânea tem maior incidência, porém a ocular pode ocorrer e a dacriocistite é uma das sequelas observadas. Espera-se que o conhecimento da etiologia, diagnóstico e tratamento com esse levantamento bibliográfico possa contribuir para maiores lacunas de estudos futuros.

Conhecimento quanto à infecção por esporotricose em humanos entre tutores de gatos no município de São Paulo, Brasil

A esporotricose é uma infecção fúngica subcutânea que pode acometer humanos e animais, principalmente felinos. O principal fungo responsável pela infecção é o Sporothrix schenckii podendo ser encontrado no solo e em matéria orgânica. A transmissão em seres humanos ocorre pela arranhadura ou mordedura de gatos infectados e o principal sintoma são as lesões cutâneas. O número de casos vem crescendo no município de São Paulo e em 2020 se tornou uma zoonose de notificação obrigatória. O presente estudo teve como objetivo fazer um levantamento do conhecimento dos tutores em relação a doença e como resultado foi identificado que apesar da maioria responder corretamente o que é uma zoonose, qual a definição e qual o agente etiológico da esporotricose esses tutores não souberam identificar a forma de transmissão e a sintomatologia da doença, o que evidencia a necessidade de informações e ações educativas para ajudar identificar e controlar os casos de esporotricose.

Phytopathogen transmitted from plant to human causing peritoneal dialysis-associated peritonitis

We report the first case of peritoneal dialysis (PD)-associated peritonitis due to Sporothrix schenckii, a thermally dimorphic black fungus transmitted from epiphytotic disease. The patient presented with PD-associated peritonitis and fungal colonisation inside the PD catheter’s lumen after an exposing ‘wet contamination’ event with a phytopathogen 11 days prior to the onset of infection. The human pathogen and phytopathogen were confirmed the same species by nucleotide sequences of the internal transcribed spacer and large subunit regions of the ribosomal RNA gene. A ‘wet contamination’ should be closely monitored for an extended period, and a broader spectrum of organisms might lead to peritonitis, particularly in centres with a high prevalence of fungal infection. PD patients and their caregivers should have periodic retraining of aseptic technique and personnel hygiene. We also recommend a long course of antifungal medication in eradicating peritoneal sporotrichosis to prevent unfavourable outcomes and relapsing peritonitis from this organism.

Uncommon Clinical Presentations of Sporotrichosis: A Two-Case Report

Sporotrichosis is a subcutaneous endemic mycosis caused by species of the Sporothrix schenckii complex. The most common clinical form of the disease is lymphocutaneous, while the fixed cutaneous and disseminated cutaneous forms are rare. Moreover, it is more prevalent in immunocompetent individuals. In this study, we present two cases of sporotrichosis with uncommon clinical forms: fixed cutaneous (Case 1) and disseminated cutaneous (Case 2). Both cases were diagnosed in immunocompetent males from endemic regions in Mexico, who had at least 1 year of evolution without improvement in response to prior nonspecific treatments. The diagnosis of sporotrichosis caused by S. schenckii sensu stricto was established through the isolation of the pathogen and its identification through the amplification of a 331 bp fragment of the gene encoding calmodulin. In both cases, improvement was observed after treatment with potassium iodide. Cases 1 and 2 illustrate the rarity of these clinical forms in individuals residing in endemic areas; hence, it is important to ensure a high index of clinical suspicion for the diagnosis of mycosis, as the differential diagnoses vary widely.