ブラジル北東部におけるSporothrix brasiliensisによる致死的な肺胞子嚢胞子嚢胞子症

Fatal pulmonary sporotrichosis caused by Sporothrix brasiliensis in Northeast Brazil.

• Manoella do Monte Alves
• Eveline Pipolo Milan
• Walicyranison Plinio da Silva-Rocha
• Alexandre Soares de Sena da Costa
• Bruno Araújo Maciel
• Pedro Henrique Cavalcante Vale
• Paulo Roberto de Albuquerque
• Soraia Lopes Lima
• Analy Salles de Azevedo Melo
• Anderson Messias Rodrigues
• Guilherme Maranhão Chaves

抄録

背景:

皮膚外傷の既往歴はないが、昼寝時に数匹の野良猫と密接に接触していた50歳の免疫力のある女性に、Sporothrix brasiliensisによる肺胞子嚢胞子症の関連症例が報告されている。この患者は7ヶ月間の発病後に入院した。ブラジルの風土病である肺結核の調査を行った。彼女は複数の中心性肺結節画像を提示し、中心性空洞を認めた。

BACKGROUND: A relevant case of pulmonary sporotrichosis due to Sporothrix brasiliensis is reported in a 50-year-old immunocompetent woman who had no history of skin trauma, but was in close contact with several stray cats at her nap time. The patient was hospitalized after 7 months of illness. The survey was conducted for pulmonary tuberculosis, an endemic disease in Brazil. She presented multiple central pulmonary nodules images, with central cavitation.

方法論/重要な発見:

患者の気管支肺胞洗浄液を培養し、Sporothrix sp.の増殖を得た。その後、種特異的ポリメラーゼ連鎖反応（PCR）を用いて、分離株（LMMM1097）を正確に種レベルまで同定した。分子診断の結果，新種のSporothrix brasiliensisが原発性肺胞子嚢胞子症の病原体であることが判明し，アンホテリシンB脂質複合体による治療を受けたが，重篤な臨床症状を呈し，入院後25日目に致死的転帰が認められた。

METHODOLOGY/PRINCIPAL FINDINGS: The patient bronchoalveolar lavage was cultured and Sporothrix sp. growth was obtained. Then, the isolate (LMMM1097) was accurately identified to the species level by using species-specific polymerase chain reaction (PCR). Molecular diagnosis revealed that the emerging species Sporothrix brasiliensis was the agent of primary pulmonary sporotrichosis and the patient was treated with Amphotericin B lipid complex, but presented severe clinical symptoms and the fatal outcome was observed at day 25 after hospitalization.

結論・意義:

本報告は、ブラジルの異なる地域における本菌の地理的拡大と、免疫不全の女性患者における本菌によるまれな臨床症状（原発性肺胞子嚢胞子嚢胞子嚢胞子嚢胞子嚢胞子嚢胞子嚢胞子嚢胞子嚢症）を示し、本菌の臨床疫学的特徴に重要な貢献をしている。

CONCLUSIONS/SIGNIFICANCE: Our report adds important contributions to the clinical-epidemiological features of sporotrichosis, showing the geographic expansion of the agent within different regions of Brazil and a rare clinical manifestation (primary pulmonary sporotrichosis) caused by the emerging agent S. brasiliensis in an immunocompetent female patient.