RESEARCH

Rising Incidence of Sporothrix

brasiliensis Infections,
Curitiba, Brazil, 2011–2022
Regielly C.R. Cognialli, Diego H. Cáceres, Fernanda de A.G.D. Bastos, Francelise B. Cavassin,
Bruno P.R. Lustosa, Vânia A. Vicente, Giovanni L. Breda, Izabella Santos-Weiss, Flávio Queiroz-Telles

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Learning Objectives
Upon completion of this activity, participants will be able to:
• Assess cat-transmitted sporotrichosis disease incidence, demographics, and clinical and laboratory findings,
based on a medical record review of 216 sporotrichosis cases diagnosed during 2011 to 2022 in Curitiba, Brazil
• Evaluate cat-transmitted sporotrichosis geographic distribution and incidence trends, based on a medical
record review of 216 sporotrichosis cases diagnosed during 2011 to 2022 in Curitiba, Brazil
• Determine the clinical and public health implications of cat-transmitted sporotrichosis disease incidence, clinical
syndromes, and geographic distribution, based on a medical record review of 216 sporotrichosis cases diagnosed during 2011 to 2022
in Curitiba, Brazil
CME Editor
Tony Pearson-Clarke, MS, Technical Writer/Editor, Emerging Infectious Diseases. Disclosure: Tony Pearson-Clarke, MS, has no relevant
financial relationships.
CME Author
Laurie Barclay, MD, freelance writer and reviewer, Medscape, LLC. Disclosure: Laurie Barclay, MD, has no relevant financial relationships.
Authors
Regielly C.R. Cognialli, MS; Diego H. Cáceres, MS; Fernanda de A.G.D. Bastos, MS; Francelise B. Cavassin, PhD; Bruno P.R. Lustosa,
MS; Vânia A. Vicente, PhD; Giovanni L. Breda, MS; Izabella Santos-Weiss, PhD; and Flávio Queiroz-Telles, PhD.

Author affiliations: Federal University of Paraná Program in Internal Medicine and Health Science, Curitiba, Brazil (R.C.R. Cognialli,
F. de A.G.D. Bastos); Federal University of Paraná Hospital de Clínicas, Curitiba (R.C.R. Cognialli, G.L. Breda); Center of Expertise in
Mycology Radboudumc/CWZ, Nijmegen, the Netherlands (D.H. Cáceres); Universidad del Rosario Studies in Translational
Microbiology and Faculty of Medical Sciences, Emerging Diseases Research Group, Bogota, Colombia (D.H. Cáceres); Faculdades
Pequeno Príncipe, Curitiba (F.B. Cavassin); Federal University of Paraná Basic Pathology Department, Curitiba (B.P.R. Lustosa,
V.A. Vicente); Federal University of Paraná Department of Clinical Analysis, Curitiba (I. Santos-Weiss); Federal University of Paraná
Department of Public Health, Curitiba (F Queiroz-Telles)
DOI: https://doi.org/10.3201/eid2907.230155

1330 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 29, No. 7, July 2023
 Sporothrix brasiliensis, Brazil, 2011–2022

Zoonotic outbreaks of sporotrichosis are increasing in institution, the Hospital de Clínicas of the Federal
Brazil. We examined and described the emergence of University of Paraná (HC/UFPR), a tertiary referral
cat-transmitted sporotrichosis (CTS) caused by the fun- hospital in Curitiba, Paraná’s largest city. Our study
gal pathogen Sporothrix brasiliensis. We calculated in- was approved by the HC/UFPR ethical committee
cidence and mapped geographic distribution of cases (registration no. 12379819.4.0000.0096).
in Curitiba, Brazil, by reviewing medical records from
216 sporotrichosis cases diagnosed during 2011–May Methods
2022. Proven sporotrichosis was established in 84 (39%)
patients and probable sporotrichosis in 132 (61%). In- Study Design
cidence increased from 0.3 cases/100,000 outpatient
We identified cases from the hospital database by
visit-years in 2011 to 21.4 cases/100,000 outpatient visit-
using code B42 from the International Classification
years in 2021; of the 216 cases, 58% (n = 126) were
diagnosed during 2019–2021. The main clinical form of of Diseases, 10th Revision. Our study analyzed data
sporotrichosis was lymphocutaneous (63%), followed by from all proven and probable CTS cases from HC/
localized cutaneous (24%), ocular (10%), multisite infec- UFPR during January 2011–May 2022.
tions (3%), and cutaneous disseminated (<0.5%). Since
the first report of CTS in Curitiba in 2011, sporotrichosis Case Definition
has increased substantially, indicating continuous dis- We used case definitions approved by the Brazilian
ease transmission. Clinician and public awareness of Ministry of Health (23–25). Proven human CTS was
CTS and efforts to prevent transmission are needed. defined as microbiologic evidence (positive culture or
histopathology) of sporotrichosis, presence of lesions

S porotrichosis, the most prevalent implantation

mycosis worldwide, is caused by fungi of genus
Sporothrix (1–4). In some regions of Brazil, sporotri-
or other symptoms compatible with sporotricho-
sis, and evidence of CTS transmission, including cat
scratches or bites, contact with feline exudates, or ex-
chosis has been referred to as cat disease because of posure to sneezing by cats (Table 1) (23–26). Probable
its zoonotic transmission from felines. Since 1990, a human CTS was defined as presence of compatible
new Sporothrix species, S. brasiliensis, has emerged clinical manifestations after traumatic injury from or
rapidly as an agent of cat-transmitted sporotrichosis close contact with infected cats but lacking microbio-
(CTS) (5). Initially identified primarily in Rio de Ja- logic evidence of sporotrichosis (Table 1) (23–25). We
neiro, highly virulent S. brasiliensis causes a notable excluded patients with possible CTS or among whom
level of epizootic disease involving cats, dogs, and CTS was ruled out.
humans (5–12) that is emerging and expanding geo-
graphically across Brazil (7–9,11) and is now a major Sporothrix Isolate Molecular Typing
public health problem (12). Originally, CTS was re- We molecularly identified at the species level all Spo-
ported primarily in the South and Southeast regions rothrix isolates obtained from patients and extracted
of Brazil, but by 2022, CTS was reported in 25 of its DNA from isolates using MasterPure Yeast DNA Pu-
26 states, as well as in neighboring Argentina, Chile, rification Kit (Thermo Fisher Scientific). We amplified
and Paraguay (Figure 1) (2,9,13–18). In 2022, a case of the calmodulin (CAL) locus region using the degener-
cutaneous CTS caused by S. brasiliensis was reported ate primers CL1 (5′-GAR TWC AAG GAG GCC TTC
in a veterinarian in the United Kingdom who was in- TC-3′) and CL2A (5′-TTT TTG CAT CAT GAG TTG
fected by an imported cat with sporotrichosis (19,20). GAC-3′), then sequenced amplicons using a BigDye
Rio de Janeiro state, in the Southeast region of Terminator v3.1 Cycle Sequencing Kit (Applied Bio-
Brazil, has the highest prevalence of CTS, >8,900 hu- systems). We visually inspected sequences using the
man cases reported since the beginning of the out- BioEdit version 7.2.5 sequence alignment editor and
break, followed by Rio Grande do Sul (South region) used MAFFT version 7 to align sequences with refer-
with 181 human cases (14,15,21). In Paraná state, also ence strains from the National Center for Biotechnol-
in the South region, public health officials and clini- ogy Information databank and MEGA version 7.0.26
cians have been alarmed by the emergence of CTS, software with Tamura Nei method with 1,500 boot-
but epidemiologic and clinical data on this disease in straps to calculate evolutionary distance.
this jurisdiction are lacking because reporting is not
mandatory (11,22). Therefore, we performed a retro- Data Collection and Statistical Analysis
spective, descriptive study of human CTS to describe From hospital clinical records we collected clinical, lab-
the characteristics of patients with sporotrichosis, oratory, and epidemiologic data from cases and stored
based on a decade of experience in a single medical them using a standardized Microsoft Excel form. We

Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 29, No. 7, July 2023 1331
RESEARCH

version 3.28.3 to map distribution of CTS cases by resi-

dence coordinates (latitude and longitude). We obtained
graphic sources of the vector layer from the Instituto de
Pesquisa e Planejamento Urbano de Curitiba, Instituto
Ambiental do Paraná, and Coordenação da Região Me-
tropolitana de Curitiba. We created kernel density maps
to show hotspot areas for sporotrichosis in Curitiba; for
this analysis, we established a search radius of 750 m.

Results
We included 216 CTS cases in this analysis. Case-pa-
tients were more frequently female than male (ratio
1.8:1) except in the 11–17 year age group (Figure 2).
Median age among CTS case-patients was 40 years
(interquartile range 22.5–56.0 years) (Table 2); 29
(13%) patients were <18 years of age. Overall, 11%
of patients had occupations with disease-related risk
factors, including 9 veterinarians, 5 veterinary stu-
dents, 3 pet sitters, and 2 gardeners. The most fre-
quent clinical form of sporotrichosis was lymphocu-
taneous (n = 136, 63%), followed by fixed cutaneous
(n = 53, 25%), ocular (n = 21, 10%), mixed forms (n = 5,
2%), and cutaneous disseminated (n = 1, <0.5%). We
observed that some CTS case-patients had unusual
clinical manifestations (Figure 3).
Overall, 84 (39%) patients had proven CTS and
132 (61%) had probable CTS. Among probable CTS
cases, we tested 18 patients by microscopy and cul-
ture, and all tested negative. Laboratory testing was
Figure 1. Burden of sporotrichosis in South America and distribution not requested for the 14 remaining probable CTS
of cat-transmitted sporotrichosis in humans caused by Sporothrix
case-patients; the main causes for not testing were
brasiliensis, 2022. Cat icons indicate countries where cases of
cat-transmitted sporotrichosis caused by S. brasiliensis have been specimen unavailability for microbiology testing and
reported; arrows indicate transmission from cats to cats, humans, previous initiation of antifungal treatment. Among
and dogs. the proven CTS cases, Sporothrix isolates were collect-
ed from direct swabbing of lesion secretions for 50 pa-
calculated descriptive statistics to record the character- tients, skin biopsy for 29, and aspirate from abscesses
istics of the cases. We also calculated the incidence rate for 5. Average times for positive Sporothrix culture
per 100,000 outpatient all-reason visits per year (outpa- results varied by specimen type: specimens collected
tient visit-years [OPVY]). We performed analyses using using the swab method averaged 6 days (range 3–17
Medcalc version 19.0 statistical software and used Qgis days), compared with 13 days (range 4–30 days) for

Table 1. Cat-transmitted sporotrichosis case definitions used in study of human cases in Curitiba, Brazil, 2011–2021*
Definition Epidemiology Clinical Laboratory
Proven History of trauma or contact Lesions compatible Positive culture and/or histopathology (microbiological
with a cat with sporotrichosis with sporotrichosis evidence)
Probable History of trauma or contact Lesions compatible Human: Negative culture and/or histopathology.†
with a cat with sporotrichosis with sporotrichosis Sick cat: A) sporotrichosis diagnosed by culture and/or
histopathology in a veterinarian laboratory; B) cat resident in a
region with confirmed presence of cats with sporotrichosis
(data verified by public health authorities)
Possible History of trauma or contact Lesions compatible Absent
with a cat with sporotrichosis with sporotrichosis
Non-CTS History of trauma or contact with Lesions compatible Negative culture and/or histopathology for Sporothrix spp.†
a cat with sporotrichosis with sporotrichosis Definition of other case of disease (infectious or noninfectious)
*Adapted from Guide to Health Surveillance, 5th ed (23–25). CTS, cat-transmitted sporotrichosis.
†Negative culture for Sporothrix spp. alone does not rule out diagnosis (limitation of the culture).

1332 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 29, No. 7, July 2023
 Sporothrix brasiliensis, Brazil, 2011–2022

specimens collected by biopsy (p<0.0001). On the ba-

sis of phylogenetic analysis of calmodulin sequence
genes of 38 Sporothrix isolates from patients, we iden-
tified S. brasiliensis as the only etiologic agent (38/38
cases) of CTS during the study period (Figure 4).
In 98% (212) of the 216 total CTS cases, infection
was associated with zoonotic transmission; in those
cases, the patient had direct or indirect contact with
a cat with diagnosed sporotrichosis. In 4 (2%) spo-
radic cases, occurring in 2016, 2017, 2019, and 2021,
infection was associated with saprozoic exposure
with traumatic implantation from an environmental
source. The first observed substantial increase in cas-
es was from 1 in 2015 (0.3 cases/100,000 OPVY) to 12
Figure 2. Age–sex pyramid showing the distribution of
in 2016 (3.5 cases/100,000 OPVY) (Figure 5), and in- cat-transmitted sporotrichosis cases in patients treated at Hospital
cidence rates continued to increase thereafter. There de Clínicas, Federal University of Paraná, Curitiba, Brazil,
were 34 cases (8.3 cases/100,000 OPVY) in 2018, al- 2011–May 2022.
most 3 times as many as in 2016, and 61 cases (21.4
cases/100,000 OPVY) in 2021 (Figure 5). During Janu- of 172,909 inhabitants (density 3.9 habitants/km2);
ary–May 2022, we identified 20 cases from 142,873 it is largely residential, and most residents live in
outpatient visits (14 cases/100,000 OPVY) (Figure 5). houses. CIC is economically characterized as a lower
CTS cases were reported in 15 of the 399 mu- middle–income area, with an average daily income
nicipalities in the state of Paraná (Figure 6, panels of USD $4.7 (27). The second hotspot, in downtown
A, B) and in 11 of the 29 municipalities comprising Curitiba, is a combination of commercial and residen-
the metropolitan region of Curitiba (Figure 6, panel tial areas, composed mostly of apartment buildings.
C). Among the 216 CTS cases identified in the state Curitiba city center comprises 3,310 km2 and is the
of Paraná, the metropolitan region of Curitiba ac- most densely populated (37,234 inhabitants; density
counted for 205 (95%), the city of Curitiba alone for 11.2 inhabitants/km2) part of the city. Average daily
170 (79%) (Figure 6, panel D). We also tracked trien- income among residents is USD $20 (27). The kernel
nial distribution of cases in the city of Curitiba dur- density maps of Curitiba show additional medium-
ing 2011–2013, 2014–2016, 2017–2019, and 2020–May density hotspots for CTS throughout other parts of
2022. The first case of CTS in Paraná was identified the city, especially in the south, southeast, and north-
in 2011 in Campina Grande do Sul, a municipality east parts.
located in the metropolitan region of Curitiba. The
first case of CTS in the city of Curitiba was identi- Table 2. Sociodemographic characteristics in study of human
fied in 2012 in the Mercês neighborhood, located in sporotrichosis cases in Curitiba, Brazil, 2011–2022
the north-central part of the city (Figure 6, panel E). Characteristic No. (%) patients
Sex
Since 2016, cases have spread across the city of Cu- F 140 (65)
ritiba and been reported in 41 of 75 districts; most M 76 (35)
cases have been identified in the northwest region Age range, y
of the city, but during 2020–May 2022, incidence ≤10 17 (8)
11–17 12 (6)
spread throughout the city (Figure 6, panels F, G, 18–30 45 (21)
H). We also observed clusters of CTS cases involv- 31–60 109 (50)
ing members of the same household. Since 2011, a >60 33 (15)
Occupation
total of 10 clusters involving 21 cases were identi- Unemployed 42 (19)
fied; 7/10 CTS clusters (15 cases) occurred after the Student 42 (19)
COVID-19 pandemic began in 2020. Retired 23 (11)
Domestic worker 17 (8)
Kernel density maps identified hotspots for spo- Veterinarian or veterinary student 17 (8)
rotrichosis in the city of Curitiba (Figure 7). The most Administrator 11 (5)
critical hotspots were identified in the western part, Teacher 3 (1)
mainly the Cidade Industrial de Curitiba (CIC) neigh- Pet sitter 3 (1)
Gardener 2 (1)
borhood, and north-central (city center) areas of Curi- Butcher 2 (1)
tiba. CIC has an area of 44,588 km2 and a population Others 54 (26)

Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 29, No. 7, July 2023 1333
RESEARCH

Figure 3. Unusual clinical

manifestations of cat-transmitted
sporotrichosis in patients treated
at Hospital de Clínicas, Federal
University of Paraná, Curitiba,
Brazil, 2011–May 2022. A)
Fixed cutaneous manifestation
in the thumb with osteoarticular
involvement. B) Fixed cutaneous
manifestation in forearm
with ulcer similar to primary
cutaneous leishmaniasis. C)
Lymphocutaneous manifestation
in the knee with a large
ulceration, mimicking cutaneous
leishmaniasis. D) Ocular form
with Parinaud ocular-glandular
syndrome and dacryocystitis.
E) Erythema nodosum
resulting from immunoreactive
sporotrichosis manifestation
in the leg (same patient
from panel D). F) Cutaneous
disseminated manifestation in
immunocompromised patient.

Discussion Lymphocutaneous and fixed cutaneous forms

During the 10-year study period, sporotrichosis inci- were the most frequently identified clinical manifes-
dence increased substantially, suggesting uncontrolled tations of sporotrichosis, consistent with findings in
spread in the city of Curitiba. Brazil is facing the larg- previous literature (1,22). However, since the sporo-
est reported current zoonotic outbreak of CTS globally trichosis epidemic in Brazil began, reports of unusual
(9,11,13,28). CTS is a public health issue exacerbated by clinical manifestations have been increasing (1,6,34).
insufficient public health activities, such as case surveil- It should be highlighted that cutaneous disseminated
lance, animal control, and diagnostic capacity, and by sporotrichosis is a rare manifestation that mostly oc-
lack of disease awareness among health professionals curs in immunocompromised persons; it differs from
and the general population (9,13,25,29). Our study adds cutaneous manifestations caused by multiple trau-
relevant epidemiologic information to promote better matic implantations, as also happens in CTS cases
understanding of CTS in the state of Paraná, Brazil. (35–37). We also found a relatively high frequency of
We found a higher prevalence of CTS among female ocular sporotrichosis, which occurred in 10% of cases.
patients, especially in adult women involved in domes- Ocular sporotrichosis occurs mainly because of direct
tic activities. This finding is similar to those of other pre- contact of the ocular mucosa of a person with secre-
vious reports and is likely related to close contact with in- tions from an infected cat, usually because of cutane-
fected domestic cats (30–33). In this study, we observed ous exudates or respiratory droplets expelled during
an increased proportion of pediatric CTS cases; 29 cases cat sneezing (5,12,26). Ocular sporotrichosis is char-
(13%) occurred in patients <18 years of age, likely re- acterized by acute or chronic conjunctivitis, includ-
flecting the close nature of interactions between children ing Parinaud ocular syndrome and dacryocystitis
and domestic pets, especially cats (23). In addition, we (2,12,38–41). We also observed that unusual clinical
found that >10% of cases occurred in persons working manifestations of CTS increased from 2018 onward,
in professional animal care disciplines (2,11,22), who coinciding with the epidemic increase in the number
are at increased risk for CTS because of close contact of cases of the disease. On the basis of those findings,
with and exposure to contaminated body fluids from the current guidelines in Brazil recommend use of
infected animals. Those professionals would benefit personal protective equipment, including glasses or a
from increased awareness that infection in humans can face shield, during contact with sick cats (24).
occur through direct contact with body fluids from cats Proven cases of CTS in this study made up slightly
contaminated with S. brasiliensis yeast (26). more than one third (39%) of all cases, compared with

1334 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 29, No. 7, July 2023
 Sporothrix brasiliensis, Brazil, 2011–2022

Figure 4. Phylogenetic analysis

of Sporothrix spp. isolates from
cat-transmitted sporotrichosis
patients treated at Hospital de
Clínicas, Federal University of
Paraná, Curitiba, Brazil, 2011–
May 2022. Tree shows analysis
of clades based on calmodulin
near-complete genes
constructed with maximum-
likelihood implemented in
MEGA 7.0.26. Bootstrap values
>80 from 1,500 resampled
datasets are shown. Bold
indicates strains isolated in
this study; yellow shading
represents S. schenckii isolates
and S. brasiliensis isolates.
GenBank accession numbers
are shown in Appendix Table
1 (https://wwwnc.cdc.gov/EID/
article/29/7/23-0155-App1.pdf).
Scale bar represents number of
substitutions per site.

Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 29, No. 7, July 2023 1335
RESEARCH

generates results in half the time compared with testing

specimens obtained by biopsy. In addition, that type of
sample is noninvasive, simple, and inexpensive. HC/
UFPR has a medical institute with extensive experi-
ence in the diagnosis of sporotrichosis, and its medical
professionals consequently have a high index of sus-
picion for this disease, increasing the chances of early
detection of cases in which culture and microscopy are
generally negative. On the basis of this experience, we
highlight the importance of the probable case classifica-
tion, because recognizing probable CTS enables rapid
initiation of treatment, resulting in a positive effect on
the quality of life of patient with sporotrichosis (23,25).
Figure 5. Epidemiologic curve and incidence rate (cases/100,000
Molecular typing identified a single species, S.
outpatient visit-years) of cat-transmitted sporotrichosis patients
treated at Hospital de Clínicas, Federal University of Paraná, brasiliensis, in all proven cases in our study. The iso-
Curitiba, Brazil, 2011–2021. lates were related to the species that caused the CTS
outbreak in the state of Rio de Janeiro in the early 2000s
65.3% in other case-series studies of sporotrichosis and is primarily causing outbreaks throughout Brazil
(22,23). This difference may have resulted from using (5,11,13,17, 42–44). Those isolates were identified by
a case definition not based solely on culture and mi- phylogenetic analysis of the near-complete calmodu-
croscopy results, which are suboptimal assays for de- lin gene sequencing, showing a high degree of simi-
tecting sporotrichosis in humans. Cultures from pus or larity with previously sequenced isolates from Rio de
secretion from lesions could be a feasible alterna- Janeiro. Additional analyses, such as microsatellite
tive; that type of test shows good performance and typing, multilocus sequence typing, and amplified

Figure 6. Locations of human cat-transmitted sporotrichosis cases (red dots) treated at Hospital de Clínicas, Federal University of
Paraná, Curitiba, Brazil, during 2011–May 2022, and evolution of spatial distribution of cases in the city of Curitiba. A–D) Locations of
all human cases in Brazil (A), Paraná state (B), Metropolitan Region of Curitiba (C), and Curitiba (D). E–H) Distribution of new human
cases in Curitiba during 2011–2013 (E), 2014–2016 (F), 2017–2019 (G), and 2020–May 2022 (H).

1336 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 29, No. 7, July 2023
 Sporothrix brasiliensis, Brazil, 2011–2022

fragment-length polymorphic fingerprinting, can im-

prove understanding of the expansion of cases in Paraná
and the city of Curitiba (13,45). Moreover, analysis of
whole-genome sequencing results is a tool relevant for
elucidating central concerns about the differences in in-
fectious potential between closely related species. Com-
parative genomic analysis of data on tissue invasion
and transmission of pathogenic sibling species has been
applied to highlight genes involved in fungal adapta-
tion to an animal-associated lifestyle (11,46,47).
We observed an exponential increase in the inci-
dence rate of sporotrichosis, from 0.3 OPVY in 2011
to 21.4 OPVY in 2021, a trend similar to that for data
reported recently in a review of the burden of spo-
rotrichosis in Brazil (9,15,22,29,30,48). In Brazil, the
largest number of CTS cases is concentrated in the
southwest and south of Brazil, including the states of
Rio de Janeiro, Rio Grande do Sul, São Paulo, Espírito
Santo, and Minas Gerais. However, cases of CTS have
also been described in the Midwest, Federal District,
and Northeast regions and in Pernambuco and Rio
Grande do Norte states, clearly showing the spread of
the disease throughout Brazil (22,32,49).
Most cases in this study occurred in the city of
Curitiba. The first case identified at HC/UFPR was in
the center-north part of the city in 2012, but the first
substantial increase in the number of cases, a trend
that continued, was observed in 2016. After the World
Health Organization declared COVID-19 a pandemic
in March 2020 and lockdowns started, we observed
a 37% increase in cases and also an increase in CTS
clusters. The increase may have been related to higher Figure 7. Heatmap of human cat-transmitted sporotrichosis cases
rates of pet adoption aimed at reducing anxiety and using kernel density estimation in Curitiba, Brazil, 2011–May 2022.
depression because of the lockdowns (23). We identi- Kernel density map was created using a search radius of 750 m.
fied 2 areas of the city of Curitiba as CTS hotspots, one
area characterized by high population density and approaches through coordinated actions among
the other by social inequalities. In addition, the kernel microbiologists, veterinarians, physicians, epide-
density estimate showed low or medium CTS expand- miologists, and surveillance authorities could ben-
ed practically throughout the city, especially during efit control efforts. Potential actions include owners
2020–2022; areas of medium density were located in restricting cats from going outside homes and hav-
the south, southeast, and northeast parts of the city. ing contact with street cats, providing no-cost neu-
The main limitation of our study was that data tering of cats in regions where S. brasiliensis is en-
came from a single center; however, the data covered demic to prevent expansion of feral cat populations,
a decade of experience, and our findings add infor- widely establishing compulsory notification of CTS
mation based on actual case numbers rather than es- cases, increasing awareness of the disease among
timates. Since March 7, 2022, the State Department of clinicians and the public, providing easy access to
Health of Paraná, has provided guidelines (resolution treatment in human and animal cases, and cremat-
no. 093/2022) for mandatory notification of human ing cat remains (12,36,50). Additional interventions
and animal sporotrichosis cases in the state. to control CTS outbreaks could include providing
Because of the zoonotic transmission of this access to rapid, accurate diagnostic assays and an-
disease, a One Health approach is necessary to tifungal drugs, developing vaccines specifically for
control the public health effects of CTS. Integrat- cats, and evaluating novel treatment strategies, par-
ing human, animal, and environmental health ticularly for treating feline sporotrichosis. Enacting

Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 29, No. 7, July 2023 1337
RESEARCH

those and other prevention and control measures 10. Pereira SA, Gremião ID, Kitada AA, Boechat JS, Viana PG,
in a timely manner is urgently needed to repress Schubach TM. The epidemiological scenario of feline
sporotrichosis in Rio de Janeiro, state of Rio de Janeiro,
the increased incidence and spread of this serious Brazil. Rev Soc Bras Med Trop. 2014;47:392–3.
health condition. https://doi.org/10.1590/0037-8682-0092-2013
11. Rodrigues AM, Della Terra PP, Gremião ID, Pereira SA,
Orofino-Costa R, de Camargo ZP. The threat of emerging and
Acknowledgments re-emerging pathogenic Sporothrix species. 2020;185:813–42.
We thank Lili Volochen Lopuch and Adriana de Fátima 12. Rossow JA, Queiroz-Telles F, Caceres DH, Beer KD,
Gabriel for all support with collecting and preparing Jackson BR, Pereira JG, et al. A One Health approach to
combatting Sporothrix brasiliensis: narrative review of an
samples and Regiane Cognialli Born for the map design. emerging zoonotic fungal pathogen in South America.
We also thank We also thank Jeremy Gold for reviewing J Fungi (Basel). 2020;6:247. https://doi.org/10.3390/
the manuscript. jof6040247
13. Rodrigues AM, Gonçalves SS, de Carvalho JA,
Borba-Santos LP, Rozental S, Camargo ZP. Current progress
on epidemiology, diagnosis, and treatment of sporotrichosis
About the Author and their future trends. J Fungi (Basel). 2022;8:776.
Ms. Cognialli is a mycologist at Hospital de Clínicas of https://doi.org/10.3390/jof8080776
14. Brandolt TM, Madrid IM, Poester VR, Sanchotene KO,
Federal University of Paraná and a PhD student at Federal
Basso RP, Klafke GB, et al. Human sporotrichosis: a
University of Paraná, Curitiba, Paraná, Brazil. Her primary zoonotic outbreak in southern Brazil, 2012–2017. Med
interest is in neglected endemic mycosis. Mycol. 2018;57:myy082. https://doi.org/10.1093/mmy/
myy082
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University of Paraná, 280 Padre Camargo, Curitiba, Paraná, Brazil;
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https://doi.org/10.1016/j.mmcr.2022.05.003 email: queiroz.telles@uol.com.br

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