Immunopathogenesis of Human Sporotrichosis: What We Already Know

Extracutaneous sporotrichosis

SUMMARYSporotrichosis is a subacute-to-chronic infection endemic to tropical and subtropical regions. It usually involves subcutaneous tissue but can occasionally cause extracutaneous infections, especially in hyperendemic areas. Extracutaneous infections are classified based on the anatomic location of the lesion and the route of infection (primary or multifocal). The clinical forms are as follows: (i) pulmonary (primary or multifocal); (ii) osteoarticular (primary or multifocal); (iii) ocular (ocular adnexal lesions including eyelid lesions, conjunctivitis and dacryocystitis, and intraocular infections); (iv) central nervous system; and (v) mucosal (primary or disseminated). Multifocal clinical presentations are observed mainly in immunocompromised individuals. The diagnosis must be confirmed in the laboratory by mycological examination of the clinical samples. Itraconazole and amphotericin B are the most commonly used antifungal agents for treating pulmonary, osteoarticular, ocular, and mucosal forms. Treatment may include surgical excision of the initial lesions in pulmonary and osteoarticular forms. The treatment of neurological involvement is far from optimal and is associated with a high mortality rate despite long treatment periods.

Temporal and spatial distribution of sporotrichosis in the Rio de Janeiro Metropolitan Area, Brazil: a comparison between human and animal cases (2013-2020)

Cat-transmitted sporotrichosis is currently hyperendemic in the Rio de Janeiro Metropolitan Area, Brazil. Despite the zoonotic context, surveillance is fragmented, with human and animal contagion being assessed separately. This study aimed to describe and compare spatial and temporal patterns of sporotrichosis cases in humans and animals (cats and dogs) reported to the Brazilian Information System for Notificable Diseases in the Rio de Janeiro metropolitan area, from 2013 to 2020. We conducted an ecological study based on the spatial and temporal evolution of sporotrichosis in the area. We compared the time series of human and animal cases per month. We also compared the cumulative human incidences and the ratio of animal cases per inhabitant by neighborhood or subdistrict and explored spatial correlation with global and local Moran's I. During the period, 9,552 human and 12,532 animal sporotrichosis suspected cases were reported. Via spatial and temporal exploratory analyses, we verified actions that favored notification during this period, such as establishing mandatory notification and campaigns related to public veterinary care. We also verified the existence of clusters in the west zone of the capital and border cities, and the expansion of sporotrichosis to other disadvantaged areas in the capital and the outskirts of the metropolitan area. Moreover, we observed divergent patterns between human and animal sporotrichosis distribution in time and space. Our findings show a spatial expansion of sporotrichosis in humans and animals; however, they also highlight the limitations of ongoing surveillance, indicating we probably are underestimating magnitude of the problem.

Analyses of the Genetic Diversity and Population Structures of Sporothrix spp. Clinical Isolates from Paraíba, Brazil

Sporotrichosis is a subcutaneous mycosis of global distribution, capable of affecting both humans and animals, and caused by species of the genus Sporothrix spp. This study aimed to evaluate the genetic diversity and mating type distribution of clinical isolates of human sporotrichosis in Paraíba, Brazil, to better understand the population structure, epidemiology, and diversification of this pathogen, as well as to explore possible transmission routes.

METHODS

A total of 36 clinical isolates were morphologically identified, and clinical and demographic data were collected. Fungal DNA extraction was then performed, followed by species-specific PCR using markers targeting the calmodulin gene. The mating type idiomorph of the species was identified by PCR using primers targeting the MAT1-1 and MAT1-2 loci. Amplified Fragment Length Polymorphism (AFLP) was used to evaluate the genetic variability of Sporothrix spp.

RESULTS

The distribution of the disease identified that all cases occurred in João Pessoa and adjacent cities. From the 36 isolates, the majority (75%) being affected females, a prevalent occurrence of the lymphocutaneous form, and 98% zoonotic transmission were confirmed. Micro- and macromorphological structures were similar to each other, confirming Sporothrix spp. All isolates were confirmed as S. brasiliensis and the presence of a single sexual idiomorph, MAT1-2, was detected. The AFLP results indicate the possibility of the circulation of one or two genetic groups in João Pessoa and the metropolitan region.

CONCLUSIONS

To our knowledge, this is the first time isolates in the Paraíba state are genetically characterised, all identified as Sporothrix brasiliensis. It is likely that this species in Paraiba originated from Rio de Janeiro, as all they possess the MAT1-2 idiomorph, indicating low intergenotypic variation.

Drug to genome to drug: a computational large-scale chemogenomics screening for novel drug candidates against sporotrichosis

Sporotrichosis is recognized as the predominant subcutaneous mycosis in South America, attributed to pathogenic species within the Sporothrix genus. Notably, in Brazil, Sporothrix brasiliensis emerges as the principal species, exhibiting significant sapronotic, zoonotic and enzootic epidemic potential. Consequently, the discovery of novel therapeutic agents for the treatment of sporotrichosis is imperative. The present study is dedicated to the repositioning of pharmaceuticals for sporotrichosis therapy. To achieve this goal, we designed a pipeline with the following steps: (a) compilation and preparation of Sporothrix genome data; (b) identification of orthologous proteins among the species; (c) identification of homologous proteins in publicly available drug-target databases; (d) selection of Sporothrix essential targets using validated genes from Saccharomyces cerevisiae; (e) molecular modeling studies; and (f) experimental validation of selected candidates. Based on this approach, we were able to prioritize eight drugs for in vitro experimental validation. Among the evaluated compounds, everolimus and bifonazole demonstrated minimum inhibitory concentration (MIC) values of 0.5 µg/mL and 4.0 µg/mL, respectively. Subsequently, molecular docking studies suggest that bifonazole and everolimus may target specific proteins within S. brasiliensis- namely, sterol 14-α-demethylase and serine/threonine-protein kinase TOR, respectively. These findings shed light on the potential binding affinities and binding modes of bifonazole and everolimus with their probable targets, providing a preliminary understanding of the antifungal mechanism of action of these compounds. In conclusion, our research advances the understanding of the therapeutic potential of bifonazole and everolimus, supporting their further investigation as antifungal agents for sporotrichosis in prospective hit-to-lead and preclinical investigations.

Itraconazole in human medicine and veterinary practice

Diagnosis and management of fungal infections are challenging in both animals and humans, especially in immunologically weakened hosts. Due to its broad spectrum and safety profile when compared to other antifungals, itraconazole (ITZ) has been widely used in the treatment and prophylaxis of fungal infections, both in human and veterinary medicine. The dose and duration of management depend on factors such as the type of fungal pathogen, the site of infection, sensitivity to ITZ, chronic stages of the disease, the health status of the hosts, pharmacological interactions with other medications and the therapeutic protocol used. In veterinary practice, ITZ doses generally vary between 3 mg/kg and 50 mg/kg, once or twice a day. In humans, doses usually vary between 100 and 400 mg/day. As human and veterinary fungal infections are increasingly associated, and ITZ is one of the main medications used, this review addresses relevant aspects related to the use of this drug in both clinics, including case reports and different clinical aspects available in the literature.

Cutaneous disseminated sporotrichosis in an immunocompetent farmer

Sporotrichosis is an implantation mycosis due to the genus Sporothrix. Cutaneous disseminated sporotrichosis is an unusual clinical form that often affects immunocompromised patients. We report a case of cutaneous disseminated sporotrichosis in an immunocompetent famer from a rural region of Madagascar, treated successfully with Itraconazole 200mg twice a day. This case highlights the role of multiple inoculation affecting different parts of the body as a risk factor of cutaneous disseminated sporotrichosis in an immunocompetent individually.

A Randomized Clinical Trial Comparing Itraconazole and a Combination Therapy with Itraconazole and Potassium Iodide for the Treatment of Feline Sporotrichosis

Feline sporotrichosis is an endemic disease with high occurrence in Brazil. Itraconazole (ITZ) remains the drug of choice for treating this disease in cats, despite the increasing reports of therapeutic failure. A controlled, randomized clinical trial was performed on 166 naive cats with sporotrichosis to assess the effectiveness and safety of the combination therapy with ITZ and potassium iodide (KI) compared with ITZ monotherapy. Cats were randomly allocated into two treatment groups: G1-ITZ 100 mg/cat/day-and G2-ITZ 100 mg/cat/day + KI 2.5-20 mg/kg/day. Cats treated in G2 presented 77% more risk of reaching a clinical cure (a positive effect) than those treated in G1, even when controlled by negative predictors. The survival curves of the two treatment protocols indicate that a clinical cure was achieved faster in G2. An increase in the KI dose was necessary in 28 cats due to the persistence of clinical signs. Adverse reactions were equally frequent in both groups and manageable with a temporary drug suspension and/or a hepatoprotective therapy. The combination therapy was associated with a higher cure rate and a shorter treatment time, suggesting that ITZ+KI arises as a better option for treating feline sporotrichosis and should be considered the first-line treatment, especially in the presence of negative predictors.

Clinical factors associated with systemic sporotrichosis in Brazil

BACKGROUND

Systemic sporotrichosis occurs when organs, other than subcutaneous tissues and lymph nodes, are infected. Interestingly, systemic sporotrichosis in apparently immunocompetent individuals is increasing in Brazil, but data on clinical manifestations and risk factors are scarce. Most of the existing data on such condition relate to people living with HIV. We aimed to study the risk factors associated with systemic sporotrichosis among HIV-negative and HIV-positive patients.

METHODS

We performed a retrospective cross-sectional study with 80 patients from Brazil, diagnosed between 2014 and 2021. The association between disease classification, clinical presentation and risk factors were analysed by logistic regression.

RESULTS

Of the 80 patients, 29 (36.3%) presented with systemic sporotrichosis. All HIV-positive patients developed the systemic form, with increased mortality (p = .002). Alcohol ingestion (p = .009) and diabetes (p = .010) were associated with systemic disease. Alcohol ingestion seemed to favour pulmonary infection (p = .013) and, diabetes favoured osteoarticular (p = .009) and ocular involvement (p = .033). The occurrence of fever (p = .001) and weight loss (p = .006) were significantly associated with systemic sporotrichosis, while meningeal involvement (p = .001) increased mortality risk. Nine (11.3%) patients died from sporotrichosis. The presence of fungal structures in the mycological examination of the patients' lesions were associated with the systemic form (p = .017) and death (p = .002).

CONCLUSION

Our study points to the factors that drive systemic sporotrichosis other than HIV, such as alcohol ingestion and diabetes. Considering the high number of patients presenting severe sporotrichosis, the recognising these factors may contribute to timely diagnosis and proper treatment.

Cutaneous disseminated sporotrichosis associated with diabetes: A case report and literature review

BACKGROUND

Cutaneous disseminated sporotrichosis (CDS), also called hematogenous sporotrichosis, is a rare condition that usually affects immunocompromised patients. The current work presents the case of a woman with diabetes mellitus associated with CDS.

CASE PRESENTATION

A 59-year-old woman with diabetes mellitus presented with a two-year history of ulcerated rashes on the left ankle and both sides of the jaw. Physical examination revealed three annular areas of erythematous and raised plaque with an ulcer over the left ankle and both sides of the jaw. Based on laboratory findings, elevated blood glucose concentration and decreased white cell count were observed. Sporothrix globosa was identified in the mycological culture of biopsied tissue from the three lesions and this was confirmed by DNA sequencing. The skin lesions healed after two-month itraconazole therapy.

CONCLUSIONS

Diabetes is a risk factor for disseminated sporotrichosis, which may be induced by hematogeneous spread, repeated inoculation, or autoinoculation. This study raises awareness among clinicians, with regard to the notion that people with possibly altered immune function are potentially vulnerable to severe clinical forms of sporotrichosis.

Cell compensatory responses of fungi to damage of the cell wall induced by Calcofluor White and Congo Red with emphasis on Sporothrix schenckii and Sporothrix globosa. A review

The cell wall (CW) of fungi exhibits a complex structure and a characteristic chemical composition consisting almost entirely of interacting crystalline and amorphous polysaccharides. These are synthesized by a number of sugar polymerases and depolymerases encoded by a high proportion of the fungal genome (for instance, 20% in Saccharomyces cerevisiae). These enzymes act in an exquisitely coordinated process to assemble the tridimensional and the functional structure of the wall. Apart from playing a critical role in morphogenesis, cell protection, viability and pathogenesis, the CW represents a potential target for antifungals as most of its constituents do not exist in humans. Chitin, β-glucans and cellulose are the most frequent crystalline polymers found in the fungal CW. The hexosamine biosynthesis pathway (HBP) is critical for CW elaboration. Also known as the Leloir pathway, this pathway ends with the formation of UDP-N-GlcNAc after four enzymatic steps that start with fructose-6-phosphate and L-glutamine in a short deviation of glycolysis. This activated aminosugar is used for the synthesis of a large variety of biomacromolecules in a vast number of organisms including bacteria, fungi, insects, crustaceans and mammalian cells. The first reaction of the HBP is catalyzed by GlcN-6-P synthase (L-glutamine:D-fructose-6-phosphate amidotransferase; EC 2.6.1.16), a critical enzyme that has been considered as a potential target for antifungals. The enzyme regulates the amount of cell UDP-N-GlcNAc and in eukaryotes is feedback inhibited by the activated aminosugar and other factors. The native and recombinant forms of GlcN-6-P synthase has been purified and characterized from both prokaryotic and eukaryotic organisms and demonstrated its critical role in CW remodeling and morphogenesis after exposure of some fungi to agents that stress the cell surface by interacting with wall polymers. This review deals with some of the cell compensatory responses of fungi to wall damage induced by Congo Red and Calcofluor White.

Withania somnifera (L.) Dunal whole-plant extracts exhibited anti-sporotrichotic effects by destabilizing peripheral integrity of Sporothrix globosa yeast cells

Chronic topical cases of Sporotrichosis, a chronic fungal infection caused by the ubiquitously present cryptic members of the Sporothrix species complex, are treated with oral administrations of itraconazole. However, severe pulmonary or disseminated cases require repeated intra-venous doses of amphotericin B or even surgical debridement of the infected tissue. The unavoidable adverse side-effects of the current treatments, besides the growing drug resistance among Sporothrix genus, demands exploration of alternative therapeutic options. Medicinal herbs, due to their multi-targeting capacity, are gaining popularity amidst the rising antimicrobial recalcitrance. Withania somnifera is a well-known medicinal herb with reported antifungal activities against several pathogenic fungal genera. In this study, the antifungal effect of the whole plant extract of W. somnifera (WSWE) has been explored for the first time, against an itraconazole resistant strain of S. globosa. WSWE treatment inhibited S. globosa yeast form growth in a dose-dependent manner, with IC₅₀ of 1.40 mg/ml. Minimum fungicidal concentration (MFC) was found to be 50 mg/ml. Sorbitol protection and ergosterol binding assays, revealed that anti-sporotrichotic effects of WSWE correlated well with the destabilization of the fungal cell wall and cell membrane. This observation was validated through dose-dependent decrease in overall ergosterol contents in WSWE-treated S. globosa cells. Compositional analysis of WSWE through high performance liquid chromatography (HPLC) exhibited the presence of several anti-microbial phytochemicals like withanone, withaferin A, withanolides A and B, and withanoside IV and V. Withanone and withaferin A, purified from WSWE, were 10–20 folds more potent against S. globosa than WSWE, thus, suggesting to be the major phytocompounds responsible for the observed anti-sporotrichotic activity. In conclusion, this study has demonstrated the anti-sporotrichotic property of the whole plant extract of W. somnifera against S. globosa that could be further explored for the development of a natural antifungal agent against chronic Sporotrichosis.

Sporotrichosis, commonly known as ‘rose gardener’s disease’ is a rare but chronic fungal infection caused by several pathogenic members of Sporothrix. Although rare, Sporotrichosis can spread to the lungs or whole body, and thus, could be fatal. However, due to low frequency of its occurrence, scientific research on Sporotrichosis has been rather limited. To exacerbate the situation, many Sporothrix members have developed resistance against the common anti-fungal agents used to treat fungal infections. Many medicinal herbs are being explored for their effectiveness against drug-resistant microorganisms. In this connection, the well-known medicinal plant, Withania somnifera, commonly known as Winter cherry in English and Ashwagandha in Hindi, has been explored for its anti-fungal potentials against several pathogenic fungi. However, to the best of our knowledge, anti-fungal effect of W. somnifera against Sporothrix has not been assessed yet. Therefore, this study was conducted to investigate the anti-fungal potentials of Withania somnifera whole plant extract (WSWE) against Sporothrix globosa, known to cause Sporotrichosis in Asia. This study demonstrated significant anti-sporotrichotic effect of WSWE, which could be further explored for developing an alternative natural treatment for Sporotrichosis.

Sporothrix schenckii regulates macrophage inflammatory responses via the c-JUN-induced Dab2 transcription

Macrophages, which serve as a bridge between innate and adaptive immunity, play an important role in sporotrichosis. Sporothrix schenckii infections can produce immune responses such as macrophage polarization and inflammatory factor secretion. In the early stages of inflammation, the expression of DAB2 in macrophages is increased, which controls the secretion of inflammatory factors and affects the polarization of macrophages. However, the expressions and mechanisms of DAB2 in sporotrichosis are not clear. In this study, we examined the expression of DAB2 and its regulation of inflammatory factors under conditions of Sporothrix schenckii infection. Our results indicated that the Sporothrix schenckii infection increased the expression of DAB2 and revealed a mixed M1/M2-like type of gene expression in BMDMs with the inhibited Il6, Il1β and Arg1, and induced Tnfα, Il10 and Mgl1. The deficiency of Dab2 gene suspended the changes of cytokines. In addition, JNK activity in BMDMs was inhibited by Sporothrix schenckii infection, leading to an increase in c-JUN. We also identified c-JUN as a transcription factor for Dab2 through chromatin immunoprecipitation and luciferase reporter assays. In an in vivo mouse model, sporotrichosis induced skin lesions were accompanied with an upregulation of c-JUN and inhibition of JNK activity, which were in accord with findings from in vitro experiments. Taken together, these findings indicate that in the early stages of Sporothrix schenckii infection there is a promotion of DAB2 expression through the JNK/c-JUN pathway, effects which can then control the expression of inflammatory factors.

Clinical Epidemiology of Sporotrichosis in Jilin Province, China (1990–2019): A Series of 4969 Cases

Introduction

Methods

Results

Discussion

Leukocytoclastic Vasculitis Caused by Disseminated Cutaneous Sporotrichosis: A Case Report and Review of the Literature

ABSTRACT

Cutaneous leukocytoclastic vasculitis (CLV) is a vasculitis that involves mainly small blood vessels in the skin. CLV has different causes (drugs, infections, or neoplastic or systemic inflammatory diseases). Sporotrichosis has rarely been associated with CLV. We report a case of disseminated cutaneous sporotrichosis caused by microorganisms in the Sporothrix clade in a Chinese woman with a tuberculous peritonitis history. Her lesions included many ulcers with crusts on the limbs. A skin biopsy yielded a histologic diagnosis of leukocytoclastic vasculitis. Periodic acid-Schiff and Grocott methenamine silver stains revealed numerous round-to-oval, thick-walled yeast cells in the necrotic tissue of the dermis. Mycological cultures grew pure dark brown wrinkled and villous fungus colonies morphologically and microscopic characteristics suggestive of the pathogenic Sporothrix clade which was followed confirmed as Sporothrix globosa (S. globosa) by the PCR method and sequencing based on calmodulin gene. Although infrequently, Sporothrix clade may cause CLV and should be considered in its differential diagnosis.

Disseminated sporotrichosis in a person with human immunodeficiency virus disease

Introduction

Disseminated sporotrichosis is an incapacitating infection caused by the dimorphic fungus Sporothrix schenckii. Because this condition may mimic the presentation of tuberculosis, syphilis and other bacterial infections, the diagnosis may be missed or delayed.

Case Presentation

We describe a case of disseminated sporotrichosis in a patient with poorly controlled human immunodeficiency virus infection. The patient was initially treated for bacterial skin infections. The differential diagnosis also included tuberculosis and syphilis. Only after appropriate specimens had been sent for microbiological and histopathological investigations was the diagnosis of disseminated sporotrichosis made and appropriate treatment started. The patient showed a good clinical response to itraconazole.

Conclusion

This report highlights the importance of having a high index of suspicion of endemic mycoses when managing immunocompromised patients. The report also demonstrates that a delay in the diagnosis of sporotrichosis increases morbidity and results in unnecessary and inappropriate treatment with associated costs and adverse effects.

The spread of cat-transmitted sporotrichosis due to Sporothrix brasiliensis in Brazil towards the Northeast region

BACKGROUND

Sporotrichosis is a worldwide subcutaneous mycosis caused by Sporothrix spp. In the past, this infection was associated with armadillo hunting, horticulturists, miners, and gardeners, being considered an implantation mycosis acquired by plant debris injury. Nevertheless, since the late nineties, it has been considered a zoonotic disease in Brazil. Here we report a case series of 121 patients with cat-transmitted sporotrichosis seen in Northeast Brazil.

METHODOLOGY/PRINCIPAL FINDINGS

Patient's demographic, clinical data, and length of treatment were recorded. In addition, a mycological examination and further PCR confirmation of species identification were performed. One hundred and twenty two patients were diagnosed with subcutaneous sporotrichosis from October 2016 to December 2019, while PCR revealed that 71 of them were due to S. brasiliensis. The majority of the individuals were female (n = 86; 70.5%). Patient's age ranged from 5 to 87 years old. The clinical forms found were lymphocutaneous (58.2%) and fixed cutaneous (39.4%). Interestingly, 115 patients reported previous contact with cats diagnosed with sporotrichosis. Patients were successfully treated with itraconazole and potassium iodide.

CONCLUSIONS/SIGNIFICANCE

Our study adds important contributions for the investigation of the spread of cat-transmitted subcutaneous sporotrichosis in Brazil, specifically towards the Northeast region of a continental-size country. It will also help clinicians to be aware of the existence and importance to accurately diagnose sporotrichosis and treat patients with this infectious disease in the lowest income region of Brazil.

Map of dimorphic switching‑related signaling pathways in Sporothrix schenckii based on its transcriptome

Sporothrix schenckii (S. schenckii) induces sporotrichosis, which has gained attention in recent years due to its worldwide prevalence. The dimorphic switching process is essential for the pathogenesis of S. schenckii. Previously, overexpression of several signal transduction genes, including SsDRK1 and SsSte20, was observed during the mycelium‑to‑yeast transition; these were necessary for asexual development, yeast‑phase cell formation, cell wall integrity and melanin synthesis. However, the mechanisms of the signaling pathways during dimorphic switching of S. schenckii remain unclear. In the present study, transcriptome sequencing of the 48‑h induced yeast forms and mycelium of S. schenckii was performed. In total, 24,904,510 high‑quality clean reads were obtained from mycelium samples and 22,814,406 from 48‑h induced yeast form samples. Following assembly, 31,779 unigene sequences were obtained with 52.98% GC content (The proportion of guanine G and cytosine C to all bases in nucleic acid). The results demonstrated that 12,217 genes, including genes involved in signal transduction and chitin synthesis, were expressed differentially between the two stages. According to these results, a map of the signaling pathways, including two‑component and heterotrimeric G‑protein signaling systems, Ras and MAPK cascades associated with the dimorphic switch, was drawn. Taken together, the transcriptome data and analysis performed in the present study lay the foundation for further research into the molecular mechanisms controlling the dimorphic switch of S. schenckii and support the development of anti‑S. schenckii strategies targeting genes associated with signaling pathways.

The Role of Macrophages in the Host's Defense against Sporothrix schenckii

The role of immune cells associated with sporotrichosis caused by Sporothrix schenckii is not yet fully clarified. Macrophages through pattern recognition receptors (PRRs) can recognize pathogen-associated molecular patterns (PAMPs) of Sporothrix, engulf it, activate respiratory burst, and secrete pro-inflammatory or anti-inflammatory biological mediators to control infection. It is important to consider that the characteristics associated with S. schenckii and/or the host may influence macrophage polarization (M1/M2), cell recruitment, and the type of immune response (1, 2, and 17). Currently, with the use of new monocyte-macrophage cell lines, it is possible to evaluate different host-pathogen interaction processes, which allows for the proposal of new mechanisms in human sporotrichosis. Therefore, in order to contribute to the understanding of these host-pathogen interactions, the aim of this review is to summarize and discuss the immune responses induced by macrophage-S. schenckii interactions, as well as the PRRs and PAMPs involved during the recognition of S. schenckii that favor the immune evasion by the fungus.

An Uncommon Rash in the Emergency Department: Sporothrix schenckii

The authors present a case of Sporothrix schenckii diagnosed in the emergency department, based on a thorough history. The patient presented with skin nodules that had spread proximally up the arm in various stages of healing. He reported minimal pain for the unhealed ulcer and no pain for the healing ulcers, and no other concerning symptoms. The history of a thorn prick followed by the initial red nodule on the forearm has led to the diagnosis - as it was consistent with the classic presentation of lymphocutaneous sporotrichosis. A high index of suspicion and carefully noting occupational history is required for a diagnosis of sporotrichosis. Clinicians should recommend long sleeves and gloves to their patients when they are handling soil.

Sporotrichosis in Mexico

Sporotrichosis is an endemic mycosis caused by the species of the Sporothrix genus, and it is considered one of the most frequent subcutaneous mycoses in Mexico. This mycosis has become a relevant fungal infection in the last two decades. Today, much is known of its epidemiology and distribution, and its taxonomy has undergone revisions. New clinical species have been identified and classified through molecular tools, and they now include Sporothrix schenckii sensu stricto, Sporothrix brasiliensis, Sporothrix globosa, and Sporothrix luriei. In this article, we present a systematic review of sporotrichosis in Mexico that analyzes its epidemiology, geographic distribution, and diagnosis. The results show that the most common clinical presentation of sporotrichosis in Mexico is the lymphocutaneous form, with a higher incidence in the 0-15 age range, mainly in males, and for which trauma with plants is the most frequent source of infection. In Mexico, the laboratory diagnosis of sporotrichosis is mainly carried out using conventional methods, but in recent years, several researchers have used molecular methods to identify the Sporothrix species. The treatment of choice depends mainly on the clinical form of the disease, the host's immunological status, and the species of Sporothrix involved. Despite the significance of this mycosis in Mexico, public information about sporotrichosis is scarce, and it is not considered reportable according to Mexico's epidemiological national system, the "Sistema Nacional de Vigilancia Epidemiológica." Due to the lack of data in Mexico regarding the epidemiology of this disease, we present a systematic review of sporotrichosis in Mexico, between 1914 and 2019, that analyzes its epidemiology, geographic distribution, and diagnosis.

Tregs in the immune response of BALB/c mice experimentally infected with species of the Sporothrix genus

Background: Sporotrichosis occurs through contact with contaminated soil and plant. However, the incidence of sporotrichosis as a zoonotic epidemic has increased, particularly in Rio de Janeiro. Aim: In this work, we decided to evaluate some T-cell phenotypes involved in the immune response. Materials & methods: We used flow cytometry to quantify TCD4⁺ and TCD8⁺ and Treg from immunocompetent and immunosuppressed mice infected with Sporothrix species with different levels of virulence and pathogenicity. Results: It was demonstrated the predominance of TCD4⁺ over the TCD8⁺ cells in both groups, inoculated with all the species, and percentages of Treg observed in infected immunocompetent mice. Conclusion: This regulatory phenotype can be associated with a protective immunity in the initial periods of infection.

Transcriptome Analysis of Dimorphic Fungus Sporothrix schenckii Exposed to Temperature Stress

PURPOSE

Sporothrix schenckii is a thermally dimorphic fungus. In a saprotrophic environment or culturing at 25 °C, it grows as mycelia, whereas in host tissues or culturing at 37 °C, it undergoes dimorphic transition and division into pathogenic yeast cells. S. schenckii can cause serious disseminated sporotrichosis in immunocompromised hosts and presents an emerging global health problem. The mycelium-to-yeast transition was a consequence of the adaptive process to different environment. Some studies showed that the transition was significantly related to the virulence and pathogenesis of dimorphic fungi. However the genetic mechanisms of this complicated biological process are poorly understood.

METHOD

Our study presented a comparative transcriptomic analysis perspective on temperature stress in a visceral isolates of S. schenckii, obtaining more genetic information related to dimorphic transition.

RESULTS

The 9.38 Gbp dataset was generated and assembled into 14,423 unigenes. Compared with gene and protein databases, 9561 unigenes were annotated. Comparative analysis identified 1259 genes expressed differentially in mycelium and yeast phase, and were categorized into a number of important biological processes, such as synthesis and metabolism, transmembrane transport, biocatalysis, oxidation reduction, and cellular signal transduction.

CONCLUSIONS

The findings suggested that temperature-dependent transition was tightly associated with stress adaptation, growth and development, signal regulation, adhesion, and colonization, which was predicted to be related with virulence and pathogenesis. Collection of these data should offer fine-scale insights into the mechanisms of dimorphism and pathogenesis of S. schenckii, and meanwhile facilitate the evolutionary and function studies of other dimorphic fungi.

Human serum proteins bind to Sporothrix schenckii conidia with differential effects on phagocytosis

Serum is an important source of proteins that interact with pathogens. Once bound to the cell surface, serum proteins can stimulate the innate immune system. The phagocytosis of Sporothrix schenckii conidia by human macrophages is activated through human serum opsonisation. In this study, we have attempted to characterise human blood serum proteins that bind to the cell wall of S. schenckii conidia. We systematically observed the same four proteins independent of the plasma donor: albumin, serum amyloid protein (SAP), α-1 antitrypsin (AAT), and transferrin were identified with the help of tandem mass spectrometry. Phagocytosis depended on the concentration of the SAP or α-1 antitrypsin that was used to opsonise the conidia; however, transferrin or albumin did not have any effect on conidia internalisation. The presence of mannose did not affect macrophage phagocytosis of the conidia opsonised with SAP or α-1 antitrypsin, which suggests that these proteins are not recognised by the mannose receptor.

Ste20 is crucial for dimorphic switching of sporothrix schenckii and affects its global transcriptome

Sporothrix schenckii induced sporotrichosis has gained importance in recent years because of its worldwide prevalence. The dimorphic switching process is required for the pathogenesis of S. schenckii. Previously, we found that STE20-like protein kinase (SsSte20) was overexpressed in the early yeast stage, but not in the mycelial stage of S. schenckii, which suggested its involvement in morphogenesis of this fungal pathogen. It remains unclear, however, whether SsSte20 is essential for dimorphic switching of S. schenckii and what are its related genes. In this study, the function of SsSte20 was investigated using double-stranded RNA interference (dsRNAi) mediated by Agrobacterium tumefaciens. We evaluated its effects on normal asexual development, yeast-phase cell formation, and cell wall composition and integrity. In addition, by transcriptome analysis of the SsSte20 knockdown (SsSte20-i) mutant and the standard S. schenckii strain, we further investigated the genes and pathways that were affected by SsSte20. Our results showed that inactivation of SsSte20 significantly affected the growth and internal components of S. schenckii conidia and impaired the dimorphic switching process. RNA transcriptome analysis of the standard S. schenckii strain and the SsSte20-i mutant revealed that SsSte20 inhibition affected the genes that were not only involved in the biological process, but also in the cellular component, and the molecular functions of S. schenckii. It mainly affected the expression of iron/ion-binding transporter genes, oxidation-reduction-related genes, 1, 3-beta-glucosidase, and methylsterol monooxygenase, which are highly associated with environmental information processing and the biosynthesis of cell wall components. Overall, our research supports the claim that SsSte20 plays an essential role in the dimorphism of S. schenckii and affects its global transcriptome.

Proteomic analysis of Sporothrix schenckii cell wall reveals proteins involved in oxidative stress response induced by menadione

Sporotrichosis is an emergent subcutaneous mycosis that is a threat to both humans and other animals. Sporotrichosis is acquired by the traumatic implantation of species of the Sporothrix genus. Added to the detoxification systems, pathogenic fungi possess different mechanisms that allow them to survive within the phagocytic cells of their human host during the oxidative burst. These mechanisms greatly depend from the cell wall (CW) since phagocytic cells recognize pathogens through specific receptors associated to the structure. To date, there are no studies addressing the modulation of the expression of S. schenckii CW proteins (CWP) in response to reactive oxygen species (ROS). Therefore, in this work, a proteomic analysis of the CW of S. schenckii in response to the oxidative agent menadione (O₂•^-) was performed. Proteins that modulate their expression were identified which can be related to the fungal survival mechanisms within the phagocyte. Among the up-regulated CWP in response to the oxidative agent, 13 proteins that could be involved in the mechanisms of oxidative stress response in S. schenckii were identified. The proteins identified were thioredoxin1 (Trx1), superoxide dismutase (Sod), GPI-anchored cell wall protein, β-1,3-endoglucanase EglC, glycoside hydrolase (Gh), chitinase, CFEM domain protein, glycosidase crf1, covalently-linked cell wall protein (Ccw), 30 kDa heat shock protein (Hsp30), lipase, trehalase (Treh), fructose-bisphosphate aldolase (Fba1) and citrate synthase (Cs). The identification of CWP that modulates their expression in response to superoxide ion (O₂•^-) in S. schenckii is a useful approach to understand how the fungus defends itself against ROS, in order to evade the phagocytic cells from the host and cause the infection.

The Still Underestimated Problem of Fungal Diseases Worldwide

In the past few years, fungal diseases caused estimated over 1.6 million deaths annually and over one billion people suffer from severe fungal diseases (Brown et al., 2012; Anonymous, 2017b). Public health surveillance of fungal diseases is generally not compulsory, suggesting that most estimates are conservative (Casadevall, 2017; Anonymous, 2017a). Fungal disease can also damage plants and crops, causing major losses in agricultural activities and food production (Savary et al., 2012). Animal pathogenic fungi are threatening bats, amphibians and reptiles with extinction (Casadevall, 2017). It is estimated that fungi are the highest threat for animal-host and plant-host species, representing the major cause (approximately 65%) of pathogen-driven host loss (Fisher et al., 2012). In this complex scenario, it is now clear that the global warming and accompanying climate changes have resulted in increased incidence of many fungal diseases (Garcia-Solache and Casadevall, 2010). On the basis of all these factors, concerns on the occurrence of a pandemic of fungal origin in a near future have been raised (Casadevall, 2017). In this context, to stop forgetting and underestimating fungal diseases is mandatory.

Sporotrichosis In Immunocompromised Hosts

Sporotrichosis is a global implantation or subcutaneous mycosis caused by several members of the genus Sporothrix, a thermo-dimorphic fungus. This disease may also depict an endemic profile, especially in tropical to subtropical zones around the world. Interestingly, sporotrichosis is an anthropozoonotic disease that may be transmitted to humans by plants or by animals, especially cats. It may be associated with rather isolated or clustered cases but also with outbreaks in different periods and geographic regions. Usually, sporotrichosis affects immunocompetent hosts, presenting a chronic to subacute evolution course. Less frequently, sporotrichosis may be acquired by inhalation, leading to disseminated clinical forms. Both modes of infection may occur in immunocompromised patients, especially associated with human immunodeficiency virus (HIV) infection, but also diabetes mellitus, chronic alcoholism, steroids, anti-TNF treatment, hematologic cancer and transplanted patients. Similar to other endemic mycoses caused by dimorphic fungi, sporotrichosis in immunocompromised hosts may be associated with rather more severe clinical courses, larger fungal burden and longer periods of systemic antifungal therapy. A prolonged outbreak of cat-transmitted sporotrichosis is in progress in Brazil and potentially crossing the border to neighboring countries. This huge outbreak involves thousands of human and cats, including immunocompromised subjects affected by HIV and FIV (feline immunodeficiency virus), respectively. We reviewed the main epidemiologic, clinical, diagnostic and therapeutic aspects of sporotrichosis in immunocompromised hosts.

Special Issue "Sporothrix and Sporotrichosis"

Sporotrichosis is a neglected, deep-seated fungal infection traditionally associated with Sporothrixschenckii, a dimorphic organism that was first described more than a century ago in human andrat specimens [1].[...].

A Case of Acute Granulomatous Conjunctivitis Caused by Cat-transmitted Sporothrix schenckii

In human, sporotrichosis infection commonly manifests as skin lesions through direct inoculation. It is rarely associated with ocular manifestation via a zoonotic transmission. We describe a young lady who presented with acute left eye granulomatous conjunctivitis who had a history of exposure to her sick cat diagnosed with sporotrichosis infection. Sporothrix schenckii was isolated from the culture of the excised conjunctival tissue. The patient recovered fully after six months of oral anti-fungal treatment. Clinicians should be aware of this new zoonotic infection transmitted by infected felines as it is reversible with timely diagnosis and initiation of anti-fungal therapy.