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. 2022 Dec 22;9(1):17.
doi: 10.3390/jof9010017.

Meningeal Sporotrichosis Due to Sporothrix brasiliensis: A 21-Year Cohort Study from a Brazilian Reference Center

Marco A Lima  1   2 , Dayvison F S Freitas  1 , Raquel V C Oliveira  1 , Vivian Fichman  1 , Andréa G Varon  1 , Andréa D Freitas  1 , Cristiane C Lamas  1 , Hugo B Andrade  1 , Valdilea G Veloso  1 , Rodrigo Almeida-Paes  1 , Fernando Almeida-Silva  1 , Rosely Maria Zancopé-Oliveira  1 , Priscila M de Macedo  1 , Antonio C F Valle  1 , Marcus T T Silva  1 , Abelardo Q C Araújo  1   3 , Maria C Gutierrez-Galhardo  1
Affiliations

Meningeal Sporotrichosis Due to Sporothrix brasiliensis: A 21-Year Cohort Study from a Brazilian Reference Center

Marco A Lima et al. J Fungi (Basel). .

Abstract

Meningeal sporotrichosis is rare and occurs predominantly in immunosuppressed individuals. This retrospective study explored clinical and laboratory characteristics, treatment, and prognosis of patients with disseminated sporotrichosis who underwent lumbar puncture (LP) at a Brazilian reference center from 1999 to 2020. Kaplan-Meier and Cox regression models were used to estimate overall survival and hazard ratios. Among 57 enrolled patients, 17 had meningitis. Fifteen (88.2%) had HIV infection, and in 6 of them, neurological manifestations occurred because of the immune reconstitution inflammatory syndrome (IRIS). The most frequent symptom was headache (88.2%). Meningeal symptoms at first LP were absent in 7/17 (41.2%) patients. Sporothrix was diagnosed in cerebrospinal fluid either by culture or by polymerase chain reaction in seven and four patients, respectively. All but one patient received prolonged courses of amphotericin B formulations, and seven received posaconazole, but relapses were frequent. Lethality among patients with meningitis was 64.7%, with a higher chance of death compared to those without meningitis (HR = 3.87; IC95% = 1.23;12.17). Meningeal sporotrichosis occurs mostly in people with HIV and can be associated with IRIS. Screening LP is indicated in patients with disseminated disease despite the absence of neurological complaints. Meningitis is associated with poor prognosis, and better treatment strategies are needed.

Keywords: HIV; Sporothrix brasiliensis; immune reconstitution inflammatory syndrome; meningitis; sporotrichosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Disseminated cutaneous sporotrichosis: nodular ulcerative lesions on the trunk and arms.
Figure 2
Figure 2
Kaplan–Meier survival analysis of the time to death in 53 patients with disseminated sporotrichosis at INI/FIOCRUZ.
Figure 3
Figure 3
Brain CT scan showing (A) ventricular dilatation and basal cisterns contrast enhancement; (B) a parieto-occipital hemorrhagic lesion (white arrow) and (C) left thalamic ischemic lesion (white arrowhead).
See this image and copyright information in PMC

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