Freitas Dayvison Francis Saraiva, Cunha Rodrigo Pernas, de Oliveira Raquel de Vasconcellos Carvalhaes, de Macedo Priscila Marques, do Valle Antonio Carlos Francesconi, Rezende Ana Paula Marinho Barbosa, Eiras Rosangela Vieira, Curi André Luiz Land, Carvalho Erika Moreira, de Moraes Raissa Lima, Almeida-Paes Rodrigo, Zancopé-Oliveira Rosely Maria, Gutierrez-Galhardo Maria Clara
Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Rio de Janeiro, Brazil.
Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Pós-graduação em Pesquisa Clínica em Doenças Infecciosas, Rio de Janeiro, Brazil.
PLoS Negl Trop Dis. 2024 Dec 20;18(12):e0012670. doi: 10.1371/journal.pntd.0012670. eCollection 2024 Dec.
Pregnant women constitute a vulnerable population occasionally affected by zoonotic sporotrichosis. Treatment is challenging due to potentially teratogenic oral medications (itraconazole and saturated potassium iodide solution) or lack of clinical experience during pregnancy (terbinafine). Literature is scarce on sporotrichosis and pregnancy, mainly consisting of case reports.
METHODOLOGY/PRINCIPAL FINDINGS: This study consists of a cohort of 58 cases of pregnant women with sporotrichosis attended in a reference center in Rio de Janeiro from 1998 to 2023. The median age was 27 years old; the majority were black (64.4%); comorbidities prior to pregnancy were reported by 20.7% (including two people living with HIV/AIDS-PLHIV) and 6.8% developed conditions that are unique to pregnancy. In 75.9% of patients, they were pregnant when they acquired sporotrichosis, with a median gestational age of 17 weeks, and 24.1% became pregnant during treatment for sporotrichosis. The lymphocutaneous form occurred in 63.8% of patients, followed by the fixed form (19%), disseminated cutaneous form (12%) and extracutaneous/disseminated forms (5.2%). Thermotherapy was indicated for all (except 2) patients and cryosurgery was performed in 22 (37.9%). Amphotericin B was indicated for a patient with external ocular sporotrichosis and for the PLHIV with osteomyelitis in the right tibia. Cure occurred in 100% of those followed (n = 44) with the remainder lost to follow-up (n = 14).
Pregnant women with cutaneous sporotrichosis in this study recovered following physical therapies, suggesting these therapies may be effective. In cases of extracutaneous and disseminated forms, amphotericin B was indicated due to its safety profile in this population. Management of sporotrichosis during pregnancy requires a delicate assessment of the balance between maternal benefit and fetal risks.
孕妇是偶尔会感染人畜共患孢子丝菌病的弱势群体。由于口服药物（伊曲康唑和饱和碘化钾溶液）可能具有致畸性，或孕期缺乏临床经验（特比萘芬），治疗颇具挑战性。关于孢子丝菌病与妊娠的文献稀少，主要是病例报告。
方法/主要发现：本研究纳入了1998年至2023年在里约热内卢一家参考中心就诊的58例妊娠合并孢子丝菌病的孕妇队列。中位年龄为27岁；大多数为黑人（64.4%）；20.7%的孕妇在妊娠前有合并症（包括两名艾滋病毒/艾滋病感染者），6.8%出现了孕期特有的情况。75.9%的患者在感染孢子丝菌病时已怀孕，中位孕周为17周，24.1%在孢子丝菌病治疗期间怀孕。63.8%的患者为淋巴管型，其次是固定型（19%）、播散性皮肤型（12%）和皮肤外/播散型（5.2%）。所有患者（除2例）均采用温热疗法，22例（37.9%）接受了冷冻手术。1例眼外孢子丝菌病患者和1例右胫骨骨髓炎的艾滋病毒感染者使用了两性霉素B。随访的患者（n = 44）全部治愈，其余患者（n = 14）失访。
本研究中患有皮肤孢子丝菌病的孕妇经物理治疗后康复，表明这些疗法可能有效。对于皮肤外和播散型病例，鉴于两性霉素B在该人群中的安全性，可予以使用。孕期孢子丝菌病的管理需要仔细评估母体获益与胎儿风险之间的平衡。
