Abstract：
Although rare, disseminated sporotrichosis is increasing in several countries. Despite its limiting toxic potential, amphotericin B is the only intravenous antifungal available to treat severe sporotrichosis. We aimed to describe the effectiveness and safety of amphotericin B treatment for severe sporotrichosis. Clinical records of patients with disseminated sporotrichosis at a reference center were reviewed. This study included 73 patients. Most (53.4%) were men and non-white. HIV coinfection was the main comorbidity (52.1%). Most reported contact with cats (76.7%). Sporothrix brasiliensis was the causative species. Affected sites were skin (98.6%), osteoarticular system (64.4%), upper airway (42.5%), central nervous system (20.5%), eyes (12.3%), and lungs (8.2%). Median doses of amphotericin B used were 750 mg and 4500 mg for deoxycholate and lipid complex formulations, respectively. Amphotericin B discontinuation occurred in 20.5% due to adverse events, mainly azotemia. The outcomes included cure (52.1%), death due to sporotrichosis (21.9%), death due to other causes (9.6%), and loss to follow-up (8.2%). Survival analysis showed an association between cure and the absence of bone, upper airway, and central nervous system involvement. Amphotericin B is the first-choice treatment for disseminated sporotrichosis; however, the severity of systemic dissemination might predict its response. Favorable clinical results depend on prompt diagnosis, investigation of fungal dissemination, and early therapy initiation.
摘要：
虽然罕见，播散性孢子丝菌病在几个国家正在增加。尽管它的潜在毒性有限，两性霉素B是唯一可用于治疗严重孢子丝菌病的静脉内抗真菌药物。我们旨在描述两性霉素B治疗严重孢子丝菌病的有效性和安全性。在参考中心审查了播散性孢子丝菌病患者的临床记录。这项研究包括73名患者。大多数（53.4％）是男性和非白人。HIV合并感染是主要的合并症（52.1％）。大多数报告与猫接触（76.7％）。巴西孢子丝菌是致病物种。受影响的部位是皮肤（98.6%），骨关节系统（64.4%），上呼吸道（42.5%），中枢神经系统（20.5%），眼睛(12.3%)，和肺(8.2%)。对于脱氧胆酸盐和脂质复合物制剂，使用的两性霉素B的中位剂量为750mg和4500mg。分别。由于不良事件，两性霉素B停药的发生率为20.5%，主要是氮质血症。结果包括治愈（52.1%），孢子丝菌病死亡(21.9%),其他原因死亡(9.6%),和后续损失（8.2%）。生存分析显示治愈与骨缺失之间存在关联,上呼吸道,中枢神经系统受累。两性霉素B是播散性孢子丝菌病的首选治疗方法；然而，系统传播的严重程度可以预测其反应。良好的临床结果取决于及时的诊断，真菌传播的调查，和早期开始治疗。
