Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Instituto de Educação Médica, Rio de Janeiro, Brazil.
PLoS Negl Trop Dis. 2023 Mar 27;17(3):e0011212. doi: 10.1371/journal.pntd.0011212. eCollection 2023 Mar.
Sporotrichosis is a subcutaneous or implantation mycosis caused by some species of the genus Sporothrix. Rio de Janeiro state, Brazil, experiences hyperendemic levels of zoonotic sporotrichosis, with increasing cases of disseminated disease, especially in people living with HIV (PLHIV). Involvement of the nasal mucosa is rare and occurs isolated or in disseminated cases, with a delayed resolution.
METHODOLOGY/PRINCIPAL FINDINGS: This study aimed to describe the epidemiological, clinical, and therapeutic profiles of 37 cases of sporotrichosis with involvement of the nasal mucosa treated at the ear, nose, and throat (ENT) outpatient clinic of the Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, from 1998 to 2020. Data were reviewed from the medical records and stored in a database. The Mann-Whitney test was used to compare the means of quantitative variables, and Pearson chi-square and Fisher's exact tests were used to verify the association between qualitative variables (p<0.05). Most patients were males, students or retirees, with a median age of 38 years, residents in the municipality of Rio de Janeiro, and infected through zoonotic transmission. Disseminated sporotrichosis forms in patients with comorbidities (mostly PLHIV) were more common than the isolated involvement of the mucosa. The main characteristics of lesions in the nasal mucosa were the presence/elimination of crusts, involvement of various structures, mixed appearance, and severe intensity. Due to therapeutic difficulty, itraconazole was combined with amphotericin B and/or terbinafine in most cases. Of the 37 patients, 24 (64.9%) healed, with a median of 61 weeks of treatment, 9 lost follow-up, 2 were still treating and 2 died.
Immunosuppression was determinant to the outcome, with worse prognosis and lower probability of cure. Notably in this group, the systematization of the ENT examination for early identification of lesions is recommended to optimize the treatment and outcome of the disease.
孢子丝菌病是一种由申克孢子丝菌属的某些种引起的皮下或植入性真菌感染。巴西里约热内卢州经历了动物源孢子丝菌病的高度地方性流行，散发性疾病的病例不断增加，尤其是在艾滋病毒感染者（PLHIV）中。鼻腔黏膜受累较为罕见，可单独发生或在播散性疾病中发生，且缓解较迟。
方法/主要发现：本研究旨在描述 1998 年至 2020 年期间在巴西国立传染病研究所奥萨斯科·克鲁兹基金会耳鼻喉科门诊治疗的 37 例鼻腔黏膜受累的孢子丝菌病的流行病学、临床和治疗特征。从病历中回顾数据并存储在数据库中。采用曼-惠特尼检验比较定量变量的均值，采用皮尔逊卡方检验和 Fisher 确切检验验证定性变量之间的关联（p<0.05）。大多数患者为男性、学生或退休人员，中位年龄为 38 岁，居住在里约热内卢市，通过动物源传播感染。合并症（主要是 PLHIV）患者中更常见播散性孢子丝菌病，而黏膜受累则较为孤立。鼻腔黏膜病变的主要特征是存在/消除结痂、涉及多种结构、混合外观和严重程度。由于治疗困难，伊曲康唑联合两性霉素 B 和/或特比萘芬是大多数情况下的治疗方法。37 例患者中，24 例（64.9%）治愈，中位治疗时间为 61 周，9 例失访，2 例仍在治疗中，2 例死亡。
免疫抑制是预后的决定因素，预后较差，治愈的可能性较低。特别是在这组患者中，建议系统地进行耳鼻喉检查以早期识别病变，从而优化疾病的治疗和预后。
