Sporotrichosis hyperendemic in Southern Brazil: twelve years of challenges

Abstract Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Feline and zoonotic sporotrichosis has been described since the 1990s in the Rio Grande do Sul state (RS), southern Brazil. In reported cases, this region has the second-highest number of cases proven due to Sporothrix brasiliensis in the country. Objective We update the current situation of sporotrichosis in Southern Brazil and report measures taken to face the epidemiological threat of zoonotic sporotrichosis over 12 years. Methods Activities developed by the Laboratory of Mycology of the Universidade Federal do Rio Grande (LabMyco/FURG) and their results are described. Database from the LabMyco/FURG was consulted and all cases of proven sporotrichosis (required fungal isolation in culture) from humans and animals (cats and dogs) diagnosed between January 2010 and March 2022 were included. Results During the 12 years of the study, four educational events to discuss the regional emergence of sporotrichosis were promoted (in the years 2011, 2013, 2017, and 2018). Before these meetings, health professionals were interviewed, and approximately half were unfamiliar with the regional hyperendemicity, etiological agent, source of infection, and/or the main clinical presentation of sporotrichosis. With these events, a total of 144 health professionals were instructed to diagnose and treat the disease. Additionally, in 2017, along with the municipal health system, we implemented a public specialized reference service (SRS) at the University Hospital (UH) of FURG/Empresa brasileira de serviços hospitalares (EBSERH) to treat human sporotrichosis cases. The diagnosis of sporotrichosis was confirmed in 47 patients referred to UH-FURG/EBSERH. All were clinically evaluated by periodic follow-up until clinical cure and received free antifungal treatment by the Brazilian System of Health. A positive impact of the SRS was demonstrated by the decrease of 235% in the interval between the beginning of the lesions and diagnosis (before SRS, mean of 206 days versus after SRS implementation, 79.5 days). Since the start of sporotrichosis diagnosis by LAbMyco/FURG, January 2010-March 2022, 914 cases of proven sporotrichosis were diagnosed by fungal culture: 721 in cats, 135 in humans, and 58 in dogs. Conclusion In a region with >500 000 inhabitants, 914 cases of sporotrichosis were diagnosed in the last 12 years. Since all of these cases are from just a single laboratory service, we believe this number is underestimated, and the threat even greater. Although some improvements regarding the diagnosis and treatment of this mycosis in our region could be achieved by the educational activities and the implementation of SRS, the numbers are still alarming and there are several obstacles that urgently need attention. Our region has the second most important port of the country, thus, more efforts, with public health politics directed to the treatment of cats with sporotrichosis, are urgently needed to control the spread and fungal dissemination not just to local and regional populations, but also to other countries.