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

2022; Multidisciplinary Digital Publishing Institute; Volume: 9; Issue: 1 Linguagem: Inglês

10.3390/jof9010017

2309-608X

Marco Antônio Lima, Dayvison Francis Saraiva Freitas, Raquel de Vasconcellos Carvalhães de Oliveira, Vivian Fichman, Andréa G. Varon, Andrea D’Ávila Freitas, Cristiane da Cruz Lamas, Hugo Boechat Andrade, Valdiléa G. Veloso, Rodrigo Almeida‐Paes, Fernando Almeida‐Silva, Rosely Maria Zancopé‐Oliveira, Priscila Marques de Macedo, Antônio Carlos Francesconi do Valle, Marcus Tulius T. Silva, Abelardo Araújo, Maria Clara Gutierrez‐Galhardo,

Antifungal resistance and susceptibility

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.