Osteoarticular Sporotrichosis in a Brazilian Endemic Setting: Associated Factors and Outcomes

Osteoarticular infection is an emerging complication of sporotrichosis, often leading to a significant increase in morbidity and longer treatment.

We conducted a retrospective cohort study of osteoarticular sporotrichosis (OS) in southeastern Brazil (2014-2024) using clinical, epidemiological, and molecular data.

Among 252 patients, 20 (7.9%) had OS, including 10 (4%) with osteomyelitis. The median age of patients with OS was 58 years (IQR 39-64; range 18-83) and 55% were male. Hypertension (45%), diabetes (40%), alcohol use (40%), smoking (40%), and HIV infection (15%) were the most frequent conditions identified. Cutaneous lesions occurred in 95% of cases, and 90% of patients presented with arthralgia and edema. Multifocal OS was observed in 50% of cases, most commonly affecting the knees, fingers, and wrists. The mean time to diagnosis was 14.2 months. Most patients were treated with itraconazole combined with amphotericin B; 13 required surgical intervention, including 2 amputations. The mean treatment duration was 21 months. Multisystem involvement due to sporotrichosis was observed in 45% of cases, including pulmonary involvement. Mortality was 15%. Diabetes (OR = 4.11; 95% CI, 1.50-11.38; p = 0.006) was independently associated with OS.

OS is associated with substantial morbidity and prolonged treatment. Diabetes may increase the risk of OS, while delayed diagnosis jeopardizes outcomes, underscoring the need for early management.