The Historical Burden of Sporotrichosis in Brazil: a Systematic Review of Cases Reported from 1907 to 2020

Abstract

Sporotrichosis is a cosmopolitan subcutaneous mycosis caused by Sporothrix species. Recently, this mycosis has gained notoriety due to the appearance of new endemic areas, recognition of new pathogenic species, changes in epidemiology, occurrence of outbreaks, and increasing numbers of cases. The purpose of this study is to analyze the peculiarities of sporotrichosis cases in Brazil since its first report in the country until 2020. In this work, ecological, epidemiological, clinical, and laboratorial characteristics were compiled. A systematic review of human sporotrichosis diagnosed in Brazil and published up to December 2020 was performed on PubMed/MEDLINE, SciELO, Web of Science, and LILACS databases. Furthermore, animal sporotrichosis and environmental isolation of Sporothrix spp. in Brazil were also evaluated. The study included 230 papers, resulting in 10,400 human patients. Their ages ranged from 5 months to 92 years old and 55.98% were female. The lymphocutaneous form was predominant (56.14%), but systemic involvement was also notably reported (14.34%), especially in the lungs. Besides, hypersensitivity manifestations (4.55%) were described. Most patients had the diagnosis confirmed by isolation of Sporothrix spp., mainly from skin samples. Sporothrix brasiliensis was the major agent identified. HIV infection, cardiovascular diseases, and diabetes were the most common comorbidities. Cure rate was 85.83%. Concerning animal sporotrichosis, 8538 cases were reported, mostly in cats (90.77%). Moreover, 13 Sporothrix spp. environmental strains were reported. This review highlights the burden of the emergent zoonotic sporotrichosis in Brazil, reinforcing the importance of "One Health" based actions to help controlling this disease.

Keywords: Brazil; Clinical manifestation; Diagnosis; Sporothrix; Sporotrichosis.

Fig. 1

Flowchart demonstrating the methodology used in this systematic review and the number of Brazilian sporotrichosis papers included in this study published from 1907 up to December 2020

Fig. 2

Sporotrichosis: number of publications (orange bars) and number of cases (blue line) in Brazil, 1907–2020

Fig. 3

Geographic distribution of the number of sporotrichosis cases diagnosed in Brazil (1907–2020)

Fig. 4

Diagnostic methods employed in the sporotrichosis diagnosis in Brazil during the period of 1907 to 2020

Fig. 5

Isolation of Sporothrix spp. from clinical sample

Fig. 6

Sites of the body and organs involved in the sporotrichosis cases

Fig. 7

Geographic distribution of domestic animals with sporotrichosis reported in Brazil until 2020