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Bone sporotrichosis: 41 cases from a reference hospital in Rio de Janeiro, Brazil
Vanessa Ramos1, Guis S-M Astacio2, Antonio C F do Valle2
1Pós-Graduação em Medicina Tropical, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Plos Neglected Tropical Diseases
|March 17, 2021
Summary
Bone sporotrichosis, a rare fungal infection, is increasingly seen in Rio de Janeiro. This study highlights its challenging nature, prolonged treatment, and significant sequelae, especially in immunocompromised individuals.
Area of Science:
- Mycology
- Infectious Diseases
- Osteomyelitis
Background:
- Bone sporotrichosis is a rare clinical manifestation of Sporothrix infection.
- The metropolitan region of Rio de Janeiro is hyperendemic for zoonotic sporotrichosis, with increasing bone involvement.
- Zoonotic sporotrichosis is primarily caused by Sporothrix species, with Sporothrix brasiliensis being a significant agent in Brazil.
Purpose of the Study:
- To describe the clinical characteristics, treatment, and outcomes of bone sporotrichosis.
- To identify risk factors and patterns of bone involvement in a cohort of patients.
- To analyze the efficacy of treatment regimens and associated sequelae.
Main Methods:
- Retrospective cohort study of 41 bone sporotrichosis cases diagnosed between 1999 and 2016.
- Inclusion criteria involved fungal culture isolation from clinical specimens with radiographic or histopathological evidence of bone involvement.
- Molecular identification of the causative agent was performed when feasible.
Main Results:
- The majority of patients (58.5%) were male, with a median age of 43 years.
- Immunosuppressive conditions, particularly HIV coinfection (51.2%), were present in 68.3% of patients.
- Multifocal bone involvement (61%) was common, with hands (58.5%), feet (41.5%), and tibia (26.8%) being most affected. Sporothrix brasiliensis was identified in 22% of cases.
- Treatment with Amphotericin B followed by itraconazole yielded a 53.7% cure rate, significantly lower in immunocompromised patients (39.3%) compared to immunocompetent ones (84.6%).
- Sequelae included amputations (7.3%) and ankylosis (4.9%), with a 22% mortality rate.
Conclusions:
- Bone sporotrichosis is a chronic and complex infection requiring prolonged treatment.
- Outcomes are often poor, with significant sequelae and mortality, particularly in immunocompromised individuals.
- The increasing incidence and challenging management underscore the need for heightened awareness and effective therapeutic strategies.
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