Severe Sporotrichosis Treated with Amphotericin B: A 20-Year Cohort Study in an Endemic Area of Zoonotic Transmission
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Location, Design, and Patients
2.2. Definitions
2.3. Patient Management
2.4. Adverse Events
2.5. Data Collection
2.6. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | Status | N = 73 |
---|---|---|
Sex | Male | 53 (72.6%) |
Female | 20 (27.4%) | |
Age | 46.06 [16.18, 83.95] d | |
Skin color a | Non-white | 54 (75.0%) |
White | 18 (25.0%) | |
Schooling b | 1–7 years | 35 (58.3%) |
>7 years | 21 (35.0%) | |
Non-literate | 4 (6.7%) | |
HIV | 38 (52.1%) | |
Alcoholism | 21 (28.8%) | |
Diabetes | 15 (20.5%) | |
Tuberculosis | 13 (17.8%) | |
Corticosteroid use | 6 (8.2%) | |
Clinical presentation | Disseminated | 54 (73.9%) |
Unifocal extracutaneous | 8 (11.0%) | |
Cutaneous disseminated | 8 (11.0%) | |
Cutaneous localized | 3 (4.1%) | |
Affected organ c | Skin | 72 (98.6%) |
Osteoarticular | 47 (64.4%) | |
Upper airways | 31 (42.5%) | |
Central nervous system | 15 (20.5%) | |
Ocular | 9 (12.3%) | |
Lungs | 6 (8.2%) | |
Deoxycholate total dose (mg) | 750.00 [50.00, 11,250.00] e | |
Lipid complex total dose (mg) | 4500.00 [200.00, 14,700.00] e | |
Total treatment duration (days) | 696.00 [1.00, 4017.00] e | |
Outcome | Cure | 38 (52.1%) |
Death due to sporotrichosis | 16 (21.9%) | |
Death due to other causes | 7 (9.6%) | |
Loss to follow-up | 6 (8.2%) | |
Still under treatment | 6 (8.2%) |
Group | HIV Coinfected Patients | Non-HIV Coinfected Patients | p Value | |
---|---|---|---|---|
n | 38 | 35 | ||
Age a | 38.71 [16.18, 55.26] | 55.62 [19.45, 83.95] | <0.001 | |
Ethnicity | White | 5 (13.2%) | 13 (38.2%) | 0.028 |
Non-white | 33 (86.8%) | 21 (61.8%) | ||
Tuberculosis | 11 (28.9%) | 2 (5.7%) | 0.013 | |
Affected organs and systems | Skin | 38 (100.0%) | 34 (97.1%) | 0.479 |
Osteoarticular | 25 (65.8%) | 22 (62.9%) | 0.812 | |
Upper airways | 18 (47.4%) | 13 (37.1%) | 0.478 | |
CNS | 13 (34.2%) | 0 (0.0%) | - c | |
Ocular | 5 (13.2%) | 3 (8.6%) | 0.712 | |
Lungs | 5 (13.2%) | 1 (2.9%) | 0.201 | |
Amphotericin B indication | Disseminated infection | 34 (89.5%) | 23 (65.7%) | 0.022 |
Low response to itraconazole | 4 (10.5%) | 12 (34.3%) | ||
Number of AMB cycles b | 1.00 [1.00, 7.00] | 1.00 [1.00, 2.00] | <0.001 | |
Amphotericin B total dose b | Deoxycholate | 1465.00 [50.00, 11,250.00] | 400.00 [50.00, 8885.00] | <0.001 |
Lipid complex | 6600.00 [1900.00, 14,700.00] | 3900.00 [200.00, 11,700.00] | 0.005 | |
Treatment duration b | 834.50 [1.00, 4017.00] | 484.00 [7.00, 1899.00] | 0.006 | |
Adverse effects due to AMB | 27 (71.1%) | 16 (45.7%) | 0.034 | |
Other treatments | Itraconazole | 37 (97.4%) | 33 (94.3%) | 0.604 |
Terbinafine | 12 (31.6%) | 11 (31.4%) | 1.000 | |
Posaconazole | 10 (26.3%) | 1 (2.9%) | 0.007 | |
Low compliance to treatment | 22 (59.5%) | 10 (28.6%) | 0.010 | |
Anti-Sporothrix antibody detection | Positive | 12 (60.0%) | 13 (92.9%) | 0.050 |
Negative | 8 (40.0%) | 1 (7.1%) | ||
Cured | 18 (47.4%) | 20 (57.1%) | 0.553 |
Outcome | Cured | Non-Cured | p Value |
---|---|---|---|
N | 38 | 35 | |
Symptoms duration until treatment started a (days) | 60.00 [15.00, 2190.00] | 120.00 [20.00, 365.00] | 0.037 |
Positive hemoculture for sporotrichosis | 0 (0.0%) | 6 (17.1%) | - b |
CNS involvement | 4 (10.5%) | 11 (31.4%) | 0.041 |
Low compliance to treatment | 11 (28.9%) | 21 (61.8%) | 0.009 |
Total dose of amphotericin B (Lipid formulation) a (mg) | 3750.00 [200.00, 10,000.00] | 5225.00 [250.00, 14,700.00] | 0.024 |
Total dose of amphotericin B (Deoxycholate) a (mg) | 575.00 [50.00, 11,250.00] | 1200.00 [50.00, 5390.00] | 0.120 |
Variables | Category | HR (95%CI) | Adjusted HR (95% CI) a |
---|---|---|---|
Bone involvement | No | 2.31 (1.18–4.51) | 2.81 (1.40–5.65) |
Upper airway involvement | No | 2.36 (1.17–4.75) | 2.12 (1.05–4.27) |
CNS involvement | No | 2.74 (0.97–7.73) | 2.70 (0.89–8.14) |
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Fichman, V.; Freitas, D.F.S.; do Valle, A.C.F.; de Souza, R.V.; Curi, A.L.L.; Valete-Rosalino, C.M.; de Macedo, P.M.; Varon, A.G.; Figueiredo-Carvalho, M.H.G.; Almeida-Silva, F.; et al. Severe Sporotrichosis Treated with Amphotericin B: A 20-Year Cohort Study in an Endemic Area of Zoonotic Transmission. J. Fungi 2022, 8, 469. https://doi.org/10.3390/jof8050469
Fichman V, Freitas DFS, do Valle ACF, de Souza RV, Curi ALL, Valete-Rosalino CM, de Macedo PM, Varon AG, Figueiredo-Carvalho MHG, Almeida-Silva F, et al. Severe Sporotrichosis Treated with Amphotericin B: A 20-Year Cohort Study in an Endemic Area of Zoonotic Transmission. Journal of Fungi. 2022; 8(5):469. https://doi.org/10.3390/jof8050469
Chicago/Turabian StyleFichman, Vivian, Dayvison Francis Saraiva Freitas, Antonio Carlos Francesconi do Valle, Rogerio Valls de Souza, André Luiz Land Curi, Cláudia Maria Valete-Rosalino, Priscila Marques de Macedo, Andréa Gina Varon, Maria Helena Galdino Figueiredo-Carvalho, Fernando Almeida-Silva, and et al. 2022. "Severe Sporotrichosis Treated with Amphotericin B: A 20-Year Cohort Study in an Endemic Area of Zoonotic Transmission" Journal of Fungi 8, no. 5: 469. https://doi.org/10.3390/jof8050469