Zoonotic sporotrichosis: Systematic review and clinical aspects of feline and canine cases.

Abstract

INTRODUCTION: Sporotrichosis is a worldwide endemic mycosis caused by thermodimorphic fungi of the genus Sporothrix. Of the around 70 Sporothrix species, four are classified within the clinical or pathogenic clade (Sporothrix schenckii, S. brasiliensis, S. globosa, and S. luriei), which are usually isolated from animal and human infections. The disease shows various clinical presentations (fixed and disseminated cutaneous, lymphocutaneous, systemic, or extracutaneous forms), with itraconazole being the antifungal of choice in most cases. The cat is the key player in the zoonotic scenario of sporotrichosis, but despite the high number of felines with sporotrichosis, there are few studies that explore the clinical aspects of the disease in dogs and cats. The objective of this review was to establish associations between clinical aspects and treatment outcomes in feline and canine sporotrichosis. METHODS: Through a systematic review using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) method, scientific articles from Web of Science (WOS) and Scopus databases were collected. The presence of information about the treatment and clinical outcome of feline and canine sporotrichosis was used as inclusion criterion. We included articles in English, Portuguese, or Spanish, published from 1978 to August 5, 2024. The data collected included patient species, sex, country, lifestyle, predisposing factors, diagnosis, sporotrichosis clinical form, disease evolution time, therapy type, treatment, treatment duration, clinical outcomes, and side effects. To analyze the data, we used RStudio and the Python programming language in the Colaboratory (COLAB) environment. Using violin plots, we analyzed the distribution of the time of disease evolution and the duration of treatment according to (1) patient species, (2) sporotrichosis clinical form, (3) diagnosis, and (4) clinical outcome. Additionally, we analyzed the independence between qualitative variables and the strength of the association between nine different groups of variables. RESULTS: Of the total of 508 articles initially found, 54 met the inclusion criteria, of which 152 cases of animal sporotrichosis were reported (131 cat cases and 21 dog cases). Most of the reported cases came from Brazil, with S. brasiliensis being the species found in the highest proportion. A total of 19.73% of the cases were male cats, linked to outdoor behavior. Monotherapies were the most used type of therapy, and itraconazole was the most used antifungal, with high favorable responses and low adverse effects. Analysis of relationship of the treatment duration with the clinical outcomes showed significant association of longer treatment period and favorable clinical outcome, when compared with death or diseases relapse. Furthermore, we found statistically significant associations when the clinical outcomes were correlated with clinical type of sporotrichosis, antifungal therapy type, and antifungal drug side effects. CONCLUSIONS: This work confirms previous finds that S. brasiliensis has a key role in the feline sporotrichosis epidemic ongoing in Brazil and highlights the importance of a thorough initial diagnosis to animal cases, guaranteeing personalized first-line treatment for each patient, increasing cure rates, as well as decreasing S. brasiliensis transmission.