Literature DB >> 26823625

Phylogeography and evolutionary patterns in Sporothrix spanning more than 14 000 human and animal case reports.

Y Zhang1, F Hagen2, B Stielow3, A M Rodrigues4, K Samerpitak5, X Zhou6, P Feng7, L Yang3, M Chen8, S Deng9, S Li10, W Liao9, R Li11, F Li12, J F Meis13, J Guarro14, M Teixeira15, H S Al-Zahrani16, Z Pires de Camargo4, L Zhang17, G S de Hoog18.   

Abstract

Pathology to vertebrate hosts has emerged repeatedly in the order Ophiostomatales. Occasional infections have been observed in Sporothrix mexicana at a low level of virulence, while the main pathogenic species cluster in a derived clade around S. schenckii s.str. In this paper, phylogeny and epidemiology of the members of this clade were investigated for 99 clinical and 36 environmental strains using four genetic loci, viz. rDNA ITS and partial CAL, TEF1, and TEF3; data are compared with amplified fragment length polymorphism (AFLP) genotyping. The four main species of the pathogenic clade were recognised. The species proved to show high degrees of endemicity, which enabled interpretation of literature data where live material or genetic information is lacking. The clade of four species comprised nine subclusters, which often had limited geographic distribution and were separate from each other in all partitions, suggesting low degrees of interbreeding between populations. In contrast, S. globosa exhibited consistent global distribution of identical AFLP types, suggesting another type of dispersal. Sporothrix brasiliensis is known to be involved in an expanding zoonosis and transmitted by cats, whereas S. globosa infections originated from putrid plant material, causing a sapronosis. Sporothrix schenckii s.str., the most variable species within the clade, also had a plant origin, with ecological similarities to that of S. globosa. A hypothesis was put forward that highly specific conditions in the plant material are required to promote the growth of Sporothrix. Fermented, self-heated plant debris may stimulate the thermodependent yeast-like invasive form of the fungus, which facilitates repeated infection of mammals.

Entities:  

Keywords:  Sporothrix; epidemiology; historical biogeography; phylogeny; sapronosis; sporotrichosis; transmission routes; yeast conversion; zoonosis

Year:  2015        PMID: 26823625      PMCID: PMC4713101          DOI: 10.3767/003158515X687416

Source DB:  PubMed          Journal:  Persoonia        ISSN: 0031-5850            Impact factor:   11.051


INTRODUCTION

Sporotrichosis is a subcutaneous or cutaneous infection caused by traumatic inoculation of contaminated materials carrying inocula of Sporothrix species. Classically, the infection is known as rose ‘gardener’s disease’ (Engle et al. 2007) or ‘reed toxin’ (Song et al. 2013), as plants are often the source of the disease. The infection was first reported in 1898 in the USA by Benjamin R. Schenck (Schenck 1898). A second, similar case was described from Chicago two years thereafter (Hektoen & Perkins 1900) which led to the description of the pathogen as Sporothrix schenckii. During the century that followed (for a review, see Travassos & Lloyd 1980), the etiologic agent was supposed to be a single species that displayed a large diversity of virulence (de Lima et al. 2003), clinical features and routes of infection. Marimón et al. (2006, 2007), however, using molecular phylogenetic analyses showed that several sibling species were concerned. This was later confirmed by others applying additional gene regions (Criseo & Romeo 2010, Madrid et al. 2010, Rodrigues et al. 2014a, d). In retrospect, main groups recognized with multi-locus sequence data proved to correspond with phenotypic characters. Nowadays, the Sporothrix schenckii s.l. clade contains the clinically relevant species S. brasiliensis, S. globosa, and S. luriei in addition to S. schenckii sensu stricto (s.str.), while S. mexicana takes a remote phylogenetic position in the Ophiostoma-Sporothrix complex which is nested within the order Ophiostomatales (de Beer et al. 2003, de Beer & Wingfield 2013, Zhou et al. 2013). Recently de Beer et al. (unpubl. data) delimited the genera Sporothrix and Ophiostoma on the basis of sequence data of four loci (LSU, ITS, CAL, BT2). Their classification matched with main ecological trends, i.e. Ophiostoma species were prevalently associated with bark beetles behind bark, whereas Sporothrix contained all major pathogens and/or occurred in plant debris or in soil. Some intermediate clades showed diverse ecologies and were phylogenetically ambiguous. Traditionally, our understanding of the evolutionary history and phylogenetic relationships within Sporothrix has been fragmented due to the tendency of studying human pathogens and environmental species separately. Only a few studies attempted to integrate strains with dissimilar sources as well as geographic origins, moreover, sampling strategies are usually restricted to a short period of time (Dixon et al. 1991, Vismer & Hull 1997, Mesa-Arango et al. 2002, de Beer et al. 2003). Despite this segregation of information, focal outbreaks due to Sporothrix species are often connected to an environmental source, mainly involving traumatic inoculation of plant material into the cutaneous and subcutaneous tissues of subjects. Furthermore, assumptions of species distribution and ecological niche have been historically based on knowledge of morphological traits. However, common features used to recognize species, such as single-celled conidia disposed on clusters of denticles, are known to overlap among clinical and environmental Sporothrix species. As a result, cryptic entities were long-time overlooked throughout the taxonomic history of this genus. Today, multilocus sequencing provides a more reliable classification and enables in-depth studies of distribution and ecology. When a species described with classical parameters is subdivided into a series of molecular siblings, and material for re-identification is not available, the older literature about this species becomes uninterpretable. This is a rather general consequence of drastic changes of taxonomic criteria. One of the first examples of such a new starting point was the case of Trichosporon, where the commonly used, physiologically defined species T. beigelii became obsolete after a molecular revision of the genus (Guého et al. 1992). In the case of sporotrichosis, abandoning existing literature would be highly inappropriate. Over the past century, large amounts of information have been collected on a worldwide scale. Barros et al. (2011) listed several hundreds of cases published during the last decade alone. In the current study 90 publications with case reports, case series and outbreaks, with a total of over 14 000 patients involved, are analysed. An early sporotrichosis epidemic that included over 200 cases during a 6-year period was reported from France by de Beurmann & Gougerot (1912). In the 1940s, the largest outbreak thus far took place in a gold mine in South Africa, involving over 3 000 miners developing the disease after having been infected via untreated wood contaminated by Sporothrix (Helm & Berman 1947). Other large epidemics were those related to plant materials like Sphagnum moss used in a nursery in the USA (Centers for Disease Control and Prevention 1988), rotten hay in Australia (Feeney et al. 2007), and reed and cornstalks in China (Wang & Sun 1982, Li et al. 1995, Song et al. 2013), with thousands of patients involved. The most recent outbreak of sporotrichosis was reported from south-east Brazil and was found to be caused by S. brasiliensis (Rodrigues et al. 2013b, 2014d). To understand the mechanisms behind the emergence of epidemics, outbreak data should be compared to historical information on Sporothrix infections. Re-interpretation of historical data in the light of modern molecular phylogeny is therefore compulsory. The aim of the present study is to introduce a hypothetical system that enables to interpret and use at least part of the literature where sequence data are lacking. We collected pre-molecular papers, which contained interpretable case reports and geographical information. Available strains from each of these regions were sequenced and identified, and these data were compared to published materials. Frequencies of each of the identified species were compared with the assumption that their distributions in each region had largely remained unaltered. Additionally, clinical and environmental isolates deposited during the last century in the CBS culture collection (CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands) were re-identified with molecular techniques, which enables phylogenetic analysis of the human-pathogenic Sporothrix species in relation to other fungi that belong to the order Ophiostomatales.

MATERIAL AND METHODS

Fungal strains

A total of 205 strains were analysed, of which 109 were of clinical origin and 96 were environmental; all were maintained under the name ‘Sporothrix’ in the reference collection of the Centraalbureau voor Schimmelcultures Fungal Biodiversity Centre (CBS-KNAW), Utrecht, The Netherlands. Of these, 135 isolates comprising clinical (n = 99) and environmental (n = 36) strains belonged to the main pathogenic Sporothrix clade. Data on geographic origins and sources of isolation were collected and are listed in Table 1. All available type strains were included. Stock cultures were maintained on slants of 2 % malt extract agar (MEA) at 24 °C. Data on Ophiostoma species that are included in the current study were collected from GenBank, the accession numbers of used sequences are listed in Table 1.
Table 1

Isolates of Sporothrix and Ophiostoma included in the study.

Current/obsolete nameStrainCountrySourceGenbank accession no.
ITSCALTEF1TEF3
S. brasiliensisCBS 120339(T)BrazilHumanKP017087KP101421KP016994KP017184
CBS 130106BrazilHumanKP101422KP016985KP017204
CBS 130107BrazilHumanKP101456KP016995KP017205
CBS 130109BrazilHumanKP017088KP101455KP016996KP017138
CBS 130110BrazilHumanKP017089KP101423KP016997KP017152
CBS 132985BrazilCatKP101424KP016998KP017185
CBS 132987BrazilHumanKP101425KP016999KP017194
CBS 132988BrazilHumanKP101457KP016986KP017153
CBS 132989BrazilCatKP101426KP016987KP017195
CBS 132990BrazilCatKP101427KP016988KP017154
CBS 132991BrazilHumanKP101428KP017000KP017155
CBS 132992BrazilHumanKP101429KP017001KP017206
CBS 132993BrazilHumanKP101430KP017002KP017186
CBS 132994BrazilDogKP101431KP016989KP017156
CBS 132995BrazilCatKP101432KP016990KP017157
CBS 132996BrazilCatKP101433KP016991KP017158
CBS 132997BrazilCatKP101449KP017003KP017139
CBS 132998BrazilCatKP017090KP101434KP016992KP017159
CBS 132999BrazilCatKP101453KP017004KP017187
CBS 133000BrazilCatKP101450KP017005KP017140
CBS 133010BrazilCatKP101440KP017013KP017145
CBS 133015BrazilCatKP101445KP017018KP017149
CBS 133017BrazilCatKP101458KP017020KP017150
CBS 133001BrazilCatKP101451KP017005KP017141
CBS 133002BrazilCatKP101452KP017005KP017142
CBS 133003BrazilCatKP101454KP016982KP017188
CBS 133004BrazilDogKP101435KP017008KP017189
CBS 133006BrazilCatKP101436KP017009KP017143
CBS 133007BrazilCatKP101437KP017010KP017190
CBS 133008BrazilCatKP101438KP017011KP017144
CBS 133009BrazilCatKP101439KP017012KP017191
CBS 133011BrazilCatKP101441KP017014KP017146
CBS 133012BrazilCatKP101442KP017015KP017147
CBS 133013BrazilCatKP101443KP017016KP017192
CBS 133014BrazilCatKP101444KP017017KP017148
CBS 133016BrazilCatKP101446KP017019KP017193
CBS 133019BrazilCatKP101447KP016993KP017196
CBS 133021BrazilCatKP101448KP017021KP017151
S. globosaCBS 120340(T)SpainHumanKP017084KP101459KP016949KP017165
CBS 129717ChinaHumanKP101460KP016962KP017166
CBS 129718ChinaHumanKP101461KP016950KP017167
CBS 129719ChinaHumanKP017085KP101462KP016951KP017168
CBS 129720ChinaHumanKP101463KP016952KP017169
CBS 129721ChinaHumanKP101478KP016953KP017170
CBS 129722ChinaHumanKP101464KP016964KP017183
CBS 129723ChinaHumanKP101465KP016963KP017171
CBS 129724ChinaHumanKP101466KP016954KP017172
CBS 129725ChinaHumanKP101467KP016955KP017173
CBS 130104SpainHumanKP101468KP016965KP017174
CBS 130105SpainHumanKP101469KP016956KP017175
CBS 130115SpainHumanKP101470KP016966KP017176
CBS 130116SpainHumanKP101471KP016957KP017177
CBS 130117JapanHumanKP101472KP016967KP017178
CBS 132923BrazilHumanKP101473KP016958KP017179
CBS 132924BrazilHumanKP017083KP101474KP016968KP017180
CBS 132925BrazilHumanKP101475KP016959KP017203
CBS 292.55UKHumanKP017086KP101476KP016960KP017181
CBS 340.35JapanHumanKP101477KP016961KP017182
S. lurieiCBS 937.72(T)South AfricaHumanAB128012AM747302KP016948KP017207
S. mexicanaCBS 120341(T)MexicoSoil, rose treeKP017072AM398393KP016931KP017230
CBS 120342MexicoCarnationKP017073AM398392KP016932KP017231
CBS 132927BrazilHumanJF811340KP016933KP017232
CBS 132928BrazilHumanJF811341KP016934KP017234
CBS 133192ItalyDogKP017075JX080721KP016935KP017233
S. schenckiiCBS 125601ColombiaHumanKP101395KP016973KP017120
S. schenckiiCBS 117440South AfricaHumanKP017098KP101386KP017026KP017114
CBS 117842South AfricaHumanKP101387KP017027KP017115
S. sp. / S. schenckiiCBS 115870South AfricaNKKP016930KP017229
CBS 130101PeruHumanKP017095KP101390KP017022KP017197
CBS 130103ArgentinaHumanKP101388KP017025KP017117
CBS 130111ColombiaHumanKP101401KP016974KP017123
CBS 130112PeruHumanKP017096KP101391KP017023KP017132
CBS 130114PeruHumanKP101392KP017024KP017133
CBS 130097BoliviaHumanKP101396KP016969KP017137
CBS 130098PeruHumanKP017091KP101397KP016979KP017121
CBS 130099PeruHumanKP017092KP101398KP016980KP017122
CBS 132926BrazilHumanKP101404KP016981KP017202
CBS 132961BrazilCatKP101402KP016970KP017124
CBS 132962BrazilHumanKP101403KP016975KP017125
CBS 132964BrazilHumanKP101407KP017031KP017118
CBS 132966BrazilHumanKP101400KP017032KP017126
CBS 132969BrazilHumanKP101409KP017029KP017198
CBS 132970BrazilHumanKP101405KP016976KP017127
CBS 132971BrazilHumanKP101411KP016977KP017160
CBS 132972BrazilHumanKP101412KP016978KP017199
CBS 132973BrazilHumanKP101408KP017033KP017200
CBS 132974BrazilHumanKP101410KP016971KP017128
CBS 132975BrazilHumanKP101406KP017034KP017119
CBS 132976JapanHumanKP101415KP017035KP017201
CBS 132977MexicoPlant debrisKP101399KP017030KP017134
CBS 132981BrazilHumanKP101414KP017036KP017129
CBS 132982BrazilHumanKP101416KP016972KP017130
CBS 211.61South AfricaNKKP017093KP101393KP016983KP017135
CBS 345.53The NetherlandsHumanKP101417KP017038KP017161
CBS 356.29GermanyNKKP101413KP017037KP017131
CBS 359.36(T)USANKKP017100KP101420KP017041KP017163
CBS 444.67MozambiqueHumanKP017099KP101389KP017028KP017116
CBS 472.48NKNKKP017097KP101418KP017039KP017162
S. schenckii / S. sp.CBS 498.86NKNKKP101419KP017040KP017164
S. schenckiiCBS 938.72FranceHumanKP017094KP101394KP016984KP017136
S. abietinumCBS 125.89MexicoAbies vejariiAF484453
S. africanumCBS 116566South AfricaProtea caffraDQ316200
S. auroraeCBS 118837(T)South AfricaPinus elliottiiDQ396796
S. brunneoviolaceaCBS 793.73GermanyMeadow soilKP017069KP017106KP017061KP017112
S. brunneoviolacea / S. inflataCBS 101570USAEndophyte in Vitis viniferaKP017068KP017101KP017057KP017108
S. brunneoviolaceaCBS 110895AustriaRoot of Quercus petraeaKP017104KP017062KP017109
CBS 110896AustriaRoot of Quercus roburKP017102KP017058KP017110
CBS 124561(T)SpainSoilFN546959KP017103KP017059KP017113
CBS 124562SpainSoilFN546957
CBS 124564SpainSoilFN546958KP017105KP017060KP017111
S. curviconiaCBS 959.73(T)NKNKKP017047KP017241
S. sp. / S. curviconiaCBS 145.94NKNKKP017071
S. sp. / S. curviconiaCBS 541.84ChilePinus radiata logKC113234KP101483KP017046KP017239
S. dentifundumCBS 115790(T)HungaryQuercus woodAY495434
S. dimorphospora / S. inflataCBS 553.74(T)CanadaSoilKP017082KP017052KP017209
CBS 840.73ChileWoodKP017050KP017210
S. dimorphosporaCBS 125439USASoilKP017080KP017048KP017208
CBS 125440SpainSoilKP017081
CBS 125442SpainSoilFN546961KP017051KP017212
S. foliorumCBS 326.37The NetherlandsIndustrial strainKP017067KP016929KP017240
S. fusiformeCBS 112912AzerbaijanPopulus nigraAY280481
S. gemellusCBS 121959(T)South AfricaTarsonemus sp. fromProtea caffraDQ821560
S. inflataCBS 239.68(T)GermanySoil, wheat fieldAY495426KP017054KP017213
CBS 794.73SwedenHumus in Picea forestKP017079KP017053KP017216
CBS 841.73ChileSoilAY495431KP017055KP017214
S. sp. / S. inflataCBS 156.72The NetherlandsGreenhouse soilKP017056KP017215
S. lignivoraCBS 119147South AfricaEucalyptus wood poleKP017064KP017107KP017063KP017242
CBS 119148(T)South AfricaEucalyptus woodKP017065
CBS 119149South AfricaEucalyptus wood poleKP017066
S. lunatumCBS 112927(T)AustriaCarpinus betulusAY280485
S. pallidaCBS 111110GermanyInsect, ZootermopsisnevadensisAM398382KP016937KP017217
S. pallida / S. stylitesCBS 115868South AfricaEucalyptus camaldulensisEF127881KP016941KP017221
CBS 115869South AfricaWood utility poleEF127884KP016942KP017222
CBS 115872South AfricaWood poleEF127882KP016938KP017220
S. pallida / S. humicolaCBS 118129(T)South AfricaSoilKP017076KP016939KP017223
S. pallida / S. stylitesCBS 118848(T)South AfricaWood poleKP017077KP016943KP017224
S. pallida / S. niveaCBS 131.56(T)JapanStemonitis fuscaEF127880KP016944KP017227
S. pallidaCBS 182.63The NetherlandsSoilKC113233KP016940KP017228
S. pallida / S. schenckiiCBS 201.53South AfricaDecaying grassKP016945KP017225
S. pallida / S. albicansCBS 302.73(T)UKSoilKP017078AM398396KP016946KP017226
S. pallida / S. sp.CBS 622.95NKNKKP016947KP017218
S. pallida / S. sp.CBS 623.95NKNKKP016936KP017219
S. palmiculminatumCBS 119590(T)South AfricaProtea repensDQ316191
S. phasmaCBS 119721(T)South AfricaProtea laurifoliaDQ316219
S. protearumCBS 116567South AfricaProtea caffraDQ316203
S. splendensCBS 116569South AfricaProtea repensDQ316215
S. stenocerasCBS 237.32(T)NorwayPine pulpAF484462
S. variecibatusCBS 121960South AfricaProtea longifoliaDQ821569KP101479KP017042KP017235
CBS 121961(T)South AfricaOodinychus sp. mite fromProtea repensKP017070KP101481KP017043KP017236
CBS 121962South AfricaEucalyptus sp.DQ821567KP101482KP017044KP017237
CBS 123288NKNKKP101480KP017045KP017238
Ceratocystiopsis minutaRJ705PolandPicea abiesEU913697
O. ainoaeCMW 1903NorwayPicea abiesHM031495
O. angusticollisCBS 186.86USAPinus banksianaAY924383
O. arduennenseMUCL 44866BelgiumFagus sylvaticaAY573241
O. bacillisporumMUCL 45378BelgiumFagus sylvaticaAY573258
O. bicolorCBS 492.77USAGallery of Ips sp. inPicea sp.DQ268604
O. bragantinumCBS 430.92BrazilSoilFN546964
CBS 474.91(T)BrazilSoilFN546965
O. breviusculumYCC-522, JCM 12501JapanSingle ascospore isolate from YCC-494AB200423
O. canumCBS 133.51SwedenPinus sylvestrisHM031489
O. catonianumC1084ItalyPyrusAF198243
O. conicolaCBS 127.89MexicoCone with Conophthorus cembroidesAY924384
O. coronatumCBS 497.77NKNKAY924385
O. denticiliatumCMW 29493NorwayScolytus ratzeburgi on Betula sp.FJ804490
O. fasciatumUM 56CanadaPseudotsuga menziesiiEU913720
O. flexuosumCBS 208.83NorwayPicea abiesAY924387
O. floccosumCBS 799.73SwedenSoilAF198231
O. fumeumCMW 26813South AfricaEucalyptus cloezianaHM051412
O. fuscumCMW 23196FinlandPityogenes chalcographus on Picea abiesHM031504
O. ipsCMW 7075NKNKAY546704
O. japonicumYCC-099NKNKGU134169
O. karelicumCMW 23099RussiaScolytus ratzeburgi on Betula pendulaEU443762
O. kryptumDAOM229701NKNKAY304436
O. minusAU58.4CanadaLodgepole pine lumberAF234834
CCMA12NKNKAY934511
O. montiumCMW13221NKNKAY546711
O. multiannulatumMUCL19062NKNKAY934512
O. nigrocarpumATCC22391USADendroctonus sp.AF484474
CBS 637.66(T)USAAbies sp.AY280489
O. nikkoenseYCC-430JapanNKAB506674
O. novoulmiC510USAUlmus sp.AF198236
O. piceaeCBS108.21(T)GermanyNKAF198226
O. piliferumCBS 129.32The NetherlandsScots pineAF221070
O. pluriannulatumMUCL18372NKNKAY934517
O. quercusCMW2467FranceQuercus sp.AY466626
O. rostrocoronatumCBS 434.77(T)USAWoodpulpAY194509
O. saponiodorumCMW29497FinlandIps typographus onPicea abiesHM031507
O. sejunctumOphi 1ANKNKAY934519
O. setosumAU160-38NKNKAF128929
O. subannulatumCBS 188.86USAPinusAY934522
O. tapionisCMW23266FinlandHylastes brunneus onPinus sylvestrisHM031493
O. tenellumCBS 189.86USAPinus banksianaAY934523
O. tetropiiCBS 428.94AustriaBreeding system ofTetropium sp., Picea abiesAY934524
O. triangulosporumDSMZ4934NKNKAY934525
Pesotum australiaeCMW6606AustraliaAcacia mearnsiiEF408603
Pesotum cupulatumC1194USAPseudotsugaAF198230

O = Ophiostoma, S = Sporothrix, NK = Not known, T = type culture.

DNA extraction

DNA was extracted following the Quick CTAB protocol. 1–10 mm3 fungal material was transferred to 2 mL screw-capped tubes filled with 490 μL CTAB-buffer 2× and 6–10 acid-washed glass beads. Ten μL proteinase K [10 mg/mL] (Sigma-Aldrich, St Louis, MO, USA) were added and mixed thoroughly for 10 min using a MoBio vortex (MoBio, Carlsbad, CA, USA). After that, 500 μL chloroform : isoamylalcohol (24 : 1) was added and shaken for 2 min followed by incubation for 60 min at 60 °C. Tubes were centrifuged for 10 min at 14 000 × g. The supernatant was collected in a new tube. To ∼400 μL DNA sample ∼270 μL of ice-cold iso-propanol (Sigma) was added and centrifuged again at 14 000 × g for 10 min and the upper layer was dissolved in 1 mL ice-cold ethanol 70 %. Tubes were centrifuged again at 14 000 × g for 2 min, air-dried and re-suspended in 50 μL TE-buffer (pH 8.0). Quality of genomic DNA was verified by running 2 μL DNA sample in a 0.8 % agarose gel. DNA was quantified with a NanoDrop 2000 spectrophotometer (Thermo Fisher, Wilmington, DE, USA). Samples were stored at −20 °C until further use.

DNA amplification and sequencing

Four gene regions were amplified for inclusion in the multi-locus sequence data analysis, i.e. rDNA internal transcribed spacer (ITS), and the partial genes calmodulin (CAL), translation elongation factor-1 (TEF1) and -3 (TEF3). Primers used for amplification and sequencing of CAL were CL1 and CL2a (O’Donnell et al. 2000). TEF primers were developed by B. Stielow (unpubl. data). PCR reactions were performed in a mixture containing 1.25 μL 10× PCR buffer, 6.7 μL ddH2O, 1 μL dNTP mix (2.5 mM), 0.25 μL of each primer (10 pmol), 0.06 μL Taq DNA polymerase (5 U/μL), 0.625 μL DMSO (Sigma), and 2.5 μL template DNA (100 ng/μL). PCR reactions were performed in a Hybaid Touchdown PCR machine (Hybaid, Middlesex, UK); the used annealing temperatures are listed in Table 2. PCR products were visualized by electrophoresis on a 1 % (w/v) agarose gel. Amplicons were purified using exoSAP-IT (Affymetrix, Santa Clara, CA, USA). The ABI Prism BigDye Terminator v. 3.1 (Applied Biosystems, Foster City, CA, USA) was applied according to the instructions provided by the manufacturer. Reactions were purified by using Sephadex G-50 ultrafine (GE Healthcare Bio-Sciences, Uppsala, Sweden) and sequencing was performed by using an ABI 3730xL automatic sequencer (Applied Biosystems).
Table 2

Success rates of sequencing for each gene.

Contigs (%)S. brasiliensis (n = 44)S. schenckii (n = 43)S. globosa (n = 22)Environmental species (n = 96)
ITS (%)81.810010070.8
CAL (%)95.510090.962.5
TEF1 (%)95.579.110096.9
TEF3 (%)97.797.7100100

Phylogenetic analyses

Consensus sequences were assembled by using SeqMan package of Lasergene software v. 8.1 (DNAStar, Madison, WI, USA) and alignments were made in BioEdit v. 7.0.5.2 software (Hall 1999). The genetically diverse ITS sequences were aligned by using MUSCLE program (www.ebi.ac.uk/Tools/msa/muscle), while sequences of the CAL, TEF1 and TEF3 sequences were aligned by using the server version of the MAFFT program v. 7.0 (www.ebi.ac.uk/Tools/msa/mafft/) (Katoh & Standley 2013). Retrieved alignments were manually checked to avoid mis-paired bases. All sequences determined in this study were deposited in GenBank and the accession numbers are listed in Table 1. The best-fit evolutionary model was determined by application of ModelTest v. 0.1.1. Bayesian analysis was performed with MrBayes v. 3.1.2 (Ronquist et al. 2012). Four MCMC chains were run simultaneously for 1 × 107 generations. Bootstrapped Maximum Likelihood analysis was performed by using RAxML-VI-HPC v. 7.0.3 (Stamatakis et al. 2008) as implemented on the Cipres portal (www.phylo.org/) with non-parametric bootstrapping using 1 000 replicates.

Amplified fragment length polymorphism genotyping

The Sporothrix isolates were subjected to amplified fragment length polymorphism (AFLP) genotyping using a previously described procedure (Chowdhary et al. 2013). However, for the amplification of the DNA fragments the selective cytosine residue of the EcoRI primer was replaced by an adenine residue (5’-Flu-GACTGCGTACCAATTCAA-3’), while the MseI primer remained the same with one selective residue (5’-GATGAGTCCTGACTAAG-3’). After amplification, amplicons were 50× diluted using ddH2O; 1 μL of the diluted amplicon was then added to a mixture of 8.9 μL ddH2O and 0.1 μL LIZ600 (Applied Biosystems) followed by a heating step for 1 min at 96 °C followed by cooling down to 4 °C. Fragment analysis was carried out using an ABI3500xL Genetic Analyzer (Applied Biosystems) according to the manufacturer’s instructions. Raw data were then inspected visually after importation into BioNumerics v. 6.6 (Applied Maths, St. Martens-Latem, Belgium) and analysed by UPGMA clustering using the Pearson correlation coefficient.

Meta-analysis

We analysed the existing medical and veterinary literature on human and veterinary cases of sporotrichosis from the first publication 1898 till present. A search was initiated using the PubMed database for which the MeSH terms ‘Sporothrix’ and ‘sporotrichosis’, yielded in total 705 results. Reports on treatment, immunology, antifungals and virulence factors, as well as book chapters and reports that also include other diseases were neglected. The focus was then placed on cases and case series from 1940 up to now; case reports with insufficient data were discarded. Over 14 000 cases published in 90 reports were collected; the selection covered countries all over the world. The search also included ∼2 827 cases published in Chinese language. Numbers are approximate because some cases had been used in repeated publications; we tried to exclude duplicates when individual cases were numbered. Cases were listed geographically on the basis of identifiable entities, such as Europe, China, or Brazil. The statistical method for Table 5 is the χ2 test.

RESULTS

Judging from literature data, the most endemic regions are China (3 299 cases), South Africa (3 154 cases), and Brazil (5 814 cases). Less frequently, sporotrichosis occurs in Japan, Australia, India, and the remaining Americas outside the eastern part of South America. The disease is less prevalent in Europe, except for the unique outbreak involving 200 cases occurring in France over a period of six years at the beginning of last century (Beurmann & Gougerot 1912). Outside the recent Brazilian epidemic, nearly all cases and case series were published to be caused by Sporothrix schenckii s.l.; the subdivision of this taxon into four molecular siblings occurred only in 2006 (Marimón et al. 2006). We aimed to recognise the individual siblings retrospectively by comparing contemporary distributions of molecular species with historical biogeography abstracted from published data. A comparison of the number of published cases (Fig. 1; grey circles) and the number of sequenced strains in the same area (Fig. 1; coloured) is given. Distributions of molecular species as percentages of the total numbers of sequenced cases in the same defined area are given in Table 3 and Fig. 1. In most of the defined areas a single molecular species is preponderant (> 80 %). Main calculated endemic areas with their prevalent species are as follows: Asia S. globosa (99.3 %), Australia and southern Africa S. schenckii (94 %), south-eastern South America S. brasiliensis (88 %), western part of South America and Central and North America S. schenckii (89 %). The percentages indicate statistical probabilities that the prevalent endemic species was concerned in historical publications without sequence data. In European countries the low number of cases hinders to ascertain predominant species.
Fig. 1

Geographic distribution of sporotrichosis caused by S. brasiliensis, S. schenckii, and S. globosa according to case reports published over 70 years, compared with sequenced isolates and with expression of statistical probabilities that the prevalent endemic species was concerned in historical publications without sequence data. Samples were categorised as sequenced and non-sequenced specimens. The sizes of circumferences are roughly proportional to the numbers of cases / strains included. Numbers reported within the pies denote the number of strains examined. Main endemic areas indicated by dotted lines.

Table 3

Estimated distributions of molecular species on the basis of percentages of sequenced strains compared to the total number of published cases in the respective area.

Continent / regionCountryReported casesSequenced isolatesS. brasiliensis %S. globosa %S. schenckii %S. mexicana %S. luriei
AsiaChina3299121121: 100 %
India6211212: 100 %
Japan35576: 86 %1: 14 %
AustraliaAustralia1441010: 100 %
AfricaSouth Africa315476: 86 %1
Mozambique11: 100 %
Western and southern parts of South America, Central and North AmericaPeru3421515: 100 %
Argentina33: 100%
Bolivia11: 100 %
Mexico157281: 4 %25: 89 %2: 7 %
Venezuela1331313: 100 %
Guatemala5522: 100 %
Columbia6062: 33 %4: 67 %
USA287233: 13 %20: 87 %
Eastern South AmericaBrazil5814352312: 88.4 %4: 1.1 %33: 9.3 %3: 0.8 %
Europe62417: 71 %5: 21 %2: 8 %
Total62531216813771
In order to have a complete overview of molecular species occurring in humans and animals and their potential routes of transmission, we sequenced all strains deposited in the CBS collection over the last hundred years under the name ‘Sporothrix’. Using standard primers, sequencing efficiency proved to differ slightly between species. Success rates of sequencing for each gene are listed in Table 2. In clinical strains, the largest percentages of poor sequences were encountered in TEF1 and ITS in S. schenckii and S. brasiliensis, viz. 20.9 % and 18.2 %, respectively. Strains of environmental species outside the S. schenckii clade generally generated good results with TEF1 and TEF3, but a somewhat higher percentages of failure were obtained with ITS and CAL (Table 2). ITS sequences could be aligned confidently over the entire order Ophiostomatales; a general tree is presented in Fig. 2, using Ceratocystiopsis minuta RJ705 as outgroup. The complete alignment included 101 sequences for ITS, 37 generated in this study and 64 retrieved from GenBank. ITS sequences produced an 807 bp-long alignment (327 for ITS1, 191 for ITS2), and included 334 invariable characters, 246 variable parsimony-informative sites (34 %), and 72 singletons. Several highly confident clades could be recognized, one of which (Fig. 2) consisted of Ophiostoma species associated with bark beetles (bootstrap support 86 %). Outside this clade several more bark beetle-associated species were noted, at significant distance and separated by Ophiostoma species with other habitats. Several intermediary lineages were found in soil and in Protea infructescences, intermingled with occasional wood-inhabiting taxa (Fig. 2). The ultimate clade contained four potentially human-pathogenic Sporothrix species. Sporothrix stenoceras represented a separate clade, with 99 % statistical support and distinct from the clades containing pathogenic species (Marimón Clades I–III and VI) and a saprophytic clade (Marimón Clade IV) (Marimón et al. 2006).
Fig. 2

Phylogenetic relationships inferred from PhyML based on ITS sequences of 101 strains belonging to Sporothrix and Ophiostoma. The numbers close to the branches represent indices of support (ML/NJ/MP) based on 1 000 bootstrap replications. Branches with bootstrap support value higher than 80 % are indicated in bold.

A multilocus tree (Fig. 3) excluding the major part of Ophiostoma was based on 135 selected isolates including 99 clinical strains and 36 representative environmental strains of species having all three genes for multilocus studies. Lengths of generated amplicons were 792 bp, 526 bp, and 255 bp for CAL, TEF1, and TEF3, respectively. Of the 1 573 nucleotides sequenced, 942 (59.9 %) were constant, 464 (29.5 %) were parsimony-informative, and 146 (9.3 %) were variably parsimony non-informative sites. Over the entire dataset, the lowest number of variable sites was 92 (17.5 %) in the TEF1 fragment, and the highest was 432 (54.5 %) in the CAL fragment; extended data per gene are provided in Table 4.
Fig. 3

Phylogenetic relationship inferred from Bayesian statistics based on concatenated CAL, TEF1 and TEF3 sequences of 135 strains of Sporothrix species. Bootstrap and posterior probabilities values were added to respective branches (BI/ML/NJ). Branches with bootstrap support values higher than 80 % are indicated in bold.

Table 4

Variability of loci used in 136 Sporothrix isolates examined.

LocusNo. of bp sequenced% variable sites% parsimony-informative sites% singleton sites
CAL79254.542.811.7
TEF152617.513.54.0
TEF325533.721.212.5
Combined genes157338.829.59.28
Phylogenetic trees were analysed using independent and combined datasets. All 135 sequences generated in this study, except for one CAL which was retrieved from GenBank. Gene trees of CAL, TEF1, and TEF3 presented a higher discriminatory power and similar topologies to the ITS tree. Sequences could be aligned confidently over the entire dataset. The combined tree based on CAL, TEF1, and TEF3 data of 135 strains is given in Fig. 3, basically comprising the upper part (Sporothrix s.str.) of the ITS tree (Fig. 2) and using Sporothrix foliorum, CBS 326.37 as outgroup. The best-fit model of evolution was estimated to be HKY+GAMMA. Fig. 3 shows the majority-rule consensus trees, deduced by Bayesian inferences sampled by MCMC and were selected to demonstrate the tree topology. The combined tree of 135 isolates was subdivided into several main groups (Fig. 3), five of which were also observed in previous studies (Marimón et al. 2006, 2007, Madrid et al. 2009, Rodrigues et al. 2013b, 2014d). Each described species could be distinguished at high bootstrap values. Five subclades were discernible within S. schenckii, which almost entirely matched with AFLP groups A–E (below; Fig. 4) and were mostly geographically restricted (Fig. 5). CBS 130103 was the single strain from Argentina clustering in AFLP group B from South Africa with small deviations in AFLP profile (Fig. 4) as well as in sequence data (Fig. 3). In S. brasiliensis several small sets of strains had bootstrap support, but groups were too similar to allow meaningful distinction. Sporothrix globosa was homogeneous. Sporothrix mexicana was found to be nested in an environmental clade comprising saprobic species (Fig. 2; Marimón Clade IV).
Fig. 4

Amplified fragment length polymorphism (AFLP) profiles of 122 strains of Sporothrix. Clustering of AFLP banding pattern of isolates of Sporothrix was done by UPGMA. Red vertical bars represents cut-off for distinction of clusters. Strains of S. mexicana and below are phylogenetically unrelated.

Fig. 5

Minimum spanning tree of AFLP data showing the relationships among 135 Sporothrix isolates, showing prevalent endemism of subclusters. Each dot corresponds to a unique genotype.

AFLP data of 116 strains of the potentially human- and animal-pathogenic species (Pathogenic clade in Fig. 2) are listed in Fig. 4. At a cut-off level of 70 % 13 groups could be recognised. All strains of S. globosa clustered in a single group. Sporothrix brasiliensis consisted of three groups, and S. schenckii of five groups (AFLP A–E; Fig. 4), the members of which matched with the groups found with multilocus sequence data (Fig. 3). In AFLP, Sporothrix mexicana contained two groups that could not be seen in the combined tree, and the single available strain of S. luriei deviated from all remaining species. In each of the groups of S. brasiliensis and S. schenckii, strains were clustered according to their geographic origin at low geographic distances, but numerous strains of S. globosa with identical profiles were repeatedly found to originate from different continents (Fig. 4). Table 3 shows the number of sequences analysed, relative to the geography of isolation of the respective strain. In most cases, one species is predominant in each defined area. On the basis of this predominance, the probability of attribution of a given strain from that area was calculated. Using this probability, historical case reports without sequence data could be attributed to either S. brasiliensis, S. globosa, or S. schenckii; cases reported as S. luriei and S. mexicana were too rare for this calculation and were left blank in Table 3. Probability of Chinese strains as S. globosa, for example, was 100 %, whereas in Europe none of the species was predominant and thus such calculation was impossible. Sporotrichosis is rare in Europe, and etiologic agents may have been imported, which would explain the relatively high species diversity in this continent. Table 5 provides an overview of cases of sporotrichosis published in the world literature with an accent on case series and including the great majority of cases published to date. Sporotrichosis classically was reported to occur in temperate and subtropical climates with a relatively high humidity. From Table 5 it appears that this holds true for S. schenckii. Hyperendemic areas are Brazil, Peru, Uruguay, Venezuela, and South Africa. In the hyperendemic area of north-east China and Japan, where S. globosa is prevalent, the climate is relatively cold (p = 10-6). In Asian countries, where S. globosa is prevalent, a preponderance of female patients is noted (p = 10-6). In Australia and South Africa more males are involved, partly associated with outdoor work, such as was the case with the miner epidemic in Witwatersrand by S. schenckii. In American countries male : female ratios are variable; no significant deviation from an equal ratio was noted in S. brasiliensis (Table 5).
Table 5

Overview of published cases and case series of sporotrichosis with possible identification on the basis of regional sequence data.

SpeciesYearCountrynHostM/F pre-ponderanceClimateOccupationProbable transmissionClinical form (D, F, LC, SYS, other)Reference
S. brasiliensis1989Brazil5HumanWarm, humidCat owner, veterinarianCatLCLarsson et al. 1989
1998Brazil1HumanMWarm, humidDAl-Tawfiq & Wools 1998
2001Brazil66HumanFWarm, humidCatF, LCBarros et al. 2001
2003Brazil24HumanFWarm, humidHousewifeCatDBarros et al. 2003
2004Brazil178HumanFWarm, humidHousewife, studentCatD, F, LCBarros et al. 2004
2005Brazil304HumanMWarm, humidFarmer, teacher, studentF, LCda Rosa et al. 2005
2005Brazil2HumanFWarm, humidCatConjunctiva, FSchubach et al. 2005
2006Brazil2HumanMWarm, humidArthritisAppenzeller et al. 2006
2008Brazil81ChildFWarm, humidCatLCBarros et al. 2008a
2008Brazil94HumanFWarm, humidHousewifeCatD, F, LC, SYSarros et al. 2008b
2008Brazil759HumanFWarm, humidCarSchubach et al. 2008
2010Brazil10HumanMWarm, humidFarmerArmadillo huntingF, LCAlves et al. 2010
2011Brazil5HumanFWarm, humidCatLCCosta et al. 2011
2012Brazil1848HumanFWarm, humidCatSilva et al. 2012
2012Brazil21Human (HIV)MWarm, humidD, F, LCFreitas et al. 2012
2012Brazil92CatWarm, humidD, F, SYSMadrid et al. 2012
11DogMWarm, humidF, D, LC
2013Brazil4HumanFWarm, humidCatF with dacryocystitisFreitas et al. 2013
2014Brazil3804CatWarm, humidPereira et al. 2014
S. globosa1982China273HumanCoolWorker in paper factoryDecaying reedF, LCWang & Sun 1982
1986China232HumanFWarm, humidWu 1986
1997China142HumanCoolF, LCJin et al. 1997
1998China400HumanFCoolFarmerReedF, LCSong et al. 1998
1999China237HumanWarm, humidRan et al. 1999
2005China224HumanCoolF, LCYang et al. 2005
2007China48HumanCoolF, LCGao et al. 2007
2008China447HumanCoolF, LCZhang & Lin 2008
2008China226HumanCoolF, LCFu et al. 2008
2011China585HumanCoolF, LCLi et al. 2011
2011China15InfantFCoolF, LCSong et al. 2011
2013China457HumanFCoolD, F, LCSong et al. 2013
1992India1HumanFCoolPulmonaryPadhye et al. 1992
1994India12HumanFHumidFarmerLCChakrabarti et al. 1994
1998India17HumanMCoolKhaitan et al. 1998
1999India25HumanFCool, humidHorticulture, forest, farmingGhosh et al. 1999
2007India21HumanFCool, humidF, LCMehta et al. 2007
2008India9HumanFCoolAgarwal et al. 2008
2009India1HumanMCoolMedical attendantCatLCYegneswaran et al. 2009
2011India224HumanFCool, humidPlantF, LCBhutia et al. 2011
2012India1HumanFCoolFTilak et al. 2012
2012India305HumanFCool, humidF, LCVerma et al. 2012
1986Japan200HumanFCoolFarmerPlantF, LCItoh et al. 1986
2009Japan155Human1/1CoolF, LCTakenaka et al. 2009
1990Malaysia5HumanMWarm, humidVet student, cat ownerCatLCZamri-Saad et al. 1990
2012Malaysia19HumanFWarm, humidD, F, LCTang et al. 2012
2005Laos1HumanFWarm, humidFarmerWoodLCNewton et al. 2005
S. mexicana2011Portugal1HumanMWarm, dryDDias et al.2011
S. schenckii1940South Africa3000HumanWarm, humidUntreated mine woodHelm & Berman 1947
1997South Africa154HumanMCool, dryRecreational, farmerF, LCVismer & Hull 1997
2010Brazil120DogWarm, humidBarros et al. 2010
1965USA148HumanMTemperateNurseryPlant thornAlessio et al. 1965
1977USA1HumanFTemperateLab technicianYeast of SporothrixFThompson & Kaplan 1977
1978USA17HumanMTemperateForestry workerSphagnum mossPulmonaryPowell et al. 1978
1987USA1HumanMTemperateSYSGullberg et al. 1987
1991USA84HumanMTemperateForestry workerSphagnum mossDixon et al. 1991
1992USA1HumanFTemperateLab technicianYeast of SporothrixFCooper et al. 1992
1997USA9HumanMTemperateTree nurserySphagnum mossLCHajjeh et al. 1997
1997USA5HumanMTemperateHay baleDooley et al. 1997
2002USA1HumanMTemperateFire antLCMiller & Keeling 2002
2003USA1InfantFTemperateF, larynxKhabie et al. 2003
2007USA1Human(HIV)MTemperateDVilela et al. 2007
2007USA1DogFTemperateFWhittemore & Webb 2007
2009USA14CatTemperateF, D, LCCrothers et al. 2009
4DogTemperateF, D, LC
4HorseTemperateF, LC
1DonkeyTemperateLC
2009USA1InfantTemperateFTlougan et al. 2009
2011USA1HumanFTemperateCatFRees & Swartzberg 2011
1998Australia16HumanMWarm, dryMouldy hayF, LCConias & Wilson 1998
2007Australia11HumanMWarm, dryHayFeeney et al. 2007
2012Australia31HumanMHumidPlant debrisSivagnanam et al. 2012
2013Australia86Human (lower immune)Warm, dryPulmonaryAung et al. 2013
1994Mexico4HumanRust-stained tentCampos et al. 1994
2001Mexico50HumanFFarmer, housewifeLCEspinosa-Texis et al. 2001
2006Mexico55HumanMF, LCMacotela-Ruiz & Nochebuena-Ramos 2006
2007Mexico25ChildPlant, soil, squirrel, cat, ratD, F, LCBonifaz et al. 2007
2007Mexico13HumanMLCArenas et al. 2007
1943Uruguay46HumanMCool, humidMackinnon 1943
1969Uruguay157HumanMWarmArmadilloMackinnon et al. 1969
2004Uruguay42HumanMWarmArmadilloF, LCCivila et al. 2004
2000Peru238HumanMCool, dryFarmer, student, housewife, infantD, F, LCPappas et al. 2000
2011Peru20HumanMCool, dryFRamírez-Soto et al. 2011
2010Columbia60HumanMWarm, humidFarmerF, LCRubio et al. 2010
2013Venezuela87HumanMWarm, humidFarmer, student, housewifePlant, insect, metalF, LCMata-Essayag et al. 2013

NC = No comparison; NK = Not known; D = disseminated; F = fixed; LC = lymphocutaneous; SYS = systemic; S = Sporothrix.

Globally the most common clinical form is lymphocutaneous (LC) sporotrichosis, but in China the fixed cutaneous form is prevalent (p = 0.037). The mode of transmission of sporotrichosis often remains unclear. Trauma was mentioned in many cases, but was difficult to define in some cases because small traumata are easily neglected by patients. In some cases absence of trauma was explicitly mentioned (Table 5) and thus subcutaneous inoculation does not need to be apparent for the onset of sporotrichosis. Contact with decaying plant material was frequently noted in S. globosa and S. schenckii, whereas S. brasiliensis was significantly more associated with cat-transmission (p = 10-6). Other animal sources, such as fish, squirrel, armadillo, rat, dog, or insect, were mentioned in S. schenckii and S. brasiliensis, but not in S. globosa (Table 5). Many of the reports listed in Table 5 were case series from a common substrate during a fixed period. These outbreaks outnumber case series from various sources (Table 5). The total number of cases series and outbreaks reported in the literature comprises > 14 000 cases, while the number of reports of single cases is relatively low; this low number is only partially influenced by the fact that single cases with insufficient data were discarded from our meta-analysis. The outbreak-character of sporotrichosis is further demonstrated in Fig. 6, where case series during intervals of 5 years are listed. Several large outbreaks, such as by S. brasiliensis in south-east Brazil and S. globosa in Jilin, north-east China, are still ongoing. Fig. 6 does not list the case series of 200 infections in France during the years 1904–1911 (Beurmann & Gougerot 1912).
Fig. 6

Timeline of epidemics and case series caused by three main pathogenic Sporothrix species since 1940. Vertical bars represent gross number of cases, vertical arrows denote case series and sapronoses or zoonoses.

DISCUSSION

For the present study, four gene regions were analysed: the rDNA ITS domain, the partial calmodulin (CAL) gene, and two regions in the translation elongation factor (TEF1 and TEF3). Molecular taxonomy of Sporothrix is particularly based on CAL (Marimón et al. 2006), although ITS performs equally well in distinguishing the main species, as demonstrated by Zhou et al. (2013) and Rodrigues et al. (2014b, d) and confirmed with a larger dataset in the present study. The tree topology of three combined genes CAL, TEF1, and TEF3 proved to be similar to that of the ITS tree. The most variable gene is CAL (variable sites 54.5 %) followed by TEF3 (33.7 %) and TEF1 (17.5 %). A similar range of variability was found with the number of parsimony-informative sites (CALTEF3TEF1). Diagnostics with CAL is optimal because intraspecific variability is small compared to barcoding gaps between species, yielding a highly resolved phylogenetic tree (data not shown). The genes analysed tend to differ in PCR performance, although ITS may present a higher number of negatives than usual in fungi (Table 2) (Schoch et al. 2012). The genus Sporothrix is embedded in the order Ophiostomatales. The core genus is Ophiostoma, which is classically known to comprise fungi that live in association with bark beetles. De Beer et al. (unpubl. data) delimited the two genera, maintaining nearly all arthropod-associated species in Ophiostoma. Ecologies of the 32 accepted Sporothrix species were quite diverse. Virulence to mammals is nearly exclusively found in a small group of species around S. schenckii. The ITS tree combining these groups demonstrate that phylogenetic distances are moderate and comply with classification in a single order; ITS was alignable with reasonable confidence over the entire dataset. The maximum ITS distance (measured by similarity in BioNumerics) from S. brasiliensis CBS 133019 to S. foliorum CBS 326.37 was 15 %. The span over diversity within the clade with pathogenic species (S. brasiliensis CBS 133019 to S. mexicana CBS 120342) was 4.3 % for ITS and 8 % for three genes analysed. We randomly sequenced all strains deposited in the CBS collection over a century and found that only 3 isolates might represent undescribed species (Table 1). It is questionable whether S. inflata and S. dimorphospora are different species. Within the habitats analysed sampling has apparently been sufficient to cover extant biodiversity. The occurrence of two pronounced types of ecology within the Ophiostomatales, viz. human pathogenicity and bark beetle association, is remarkable. In the ITS tree (Fig. 2) the species living inside bark beetle galleries constitute a well-supported clade, matching Ophiostoma (de Beer et al. 2003). Some of the species in Fig. 2 have been isolated from sapwood and a role of the bark beetle has then usually not been proven. Outside this clade explicit bark beetle-association is uncommon. Arthropod dispersal remains common in other clades, however, as exemplified by clades with species from mites in Protea infructescences. As the intermediate species in the phylogenetic trees (Fig. 2) exhibit other types of ecology, there is no obvious link between bark beetle-association and human pathogenicity. The remaining groups compose a polytomy from an unresolved backbone with bootstrap values below 80 % (Fig. 2). Comparing the clades over the entire tree, we observe a consistent decrease of bark beetle association outside Ophiostoma, concomitantly with an increasing vertebrate infectivity. Inside Ophiostoma, a single case of human infection in a leukemic patient was described in Ophiostoma piceae (Bommer et al. 2009). Outside the pathogenic clade (Fig. 3), two cases were reported by S. stenoceras (Mariat et al. 1968), while S. pallida infections are represented by sporadic cases related to impairment of the immune system, e.g. in transplant recipients (Morrison et al. 2013). In all these species, human pathology is highly exceptional (white crosses in Fig. 2), except for several S. mexicana cases (Dias et al. 2011, Rodrigues et al. 2013a) where human infection is relatively common, but mild. Sporothrix luriei is a very rare species, with a single proven case from South Africa (Ajello & Kaplan 1969) and two cases with unproved culture from Italy and India, respectively (Alberici et al. 1989, Padhye et al. 1992). The species is reported to be highly virulent (Fernández-Silva et al. 2012). The remaining species of the pathogenic clade (Guarro et al. 1999), S. schenckii, S. globosa and S. brasiliensis occur in epidemic proportions with several thousands of cases each. Virulence has been tested in animal inoculations (Arrillaga-Moncrieff et al. 2009, Castro et al. 2013, Fernandes et al. 2013) using mice as model animal. Sporothrix brasiliensis presented more fungal burden, dissemination capacity and massive infiltration in infected tissues compared to S. schenckii and S. globosa. Highest virulence was observed in S. brasiliensis which correlates with high degree of pathogenicity in felines (Rodrigues et al. 2013b) and humans (Silva-Vergara et al. 2012). A connection among disease severity, humoral response and protein secretion revealed a common immunogenic protein of 60 kDa recognised by antisera in all virulent isolates of Sporothrix (Fernandes et al. 2013). Further, this molecule was also shown to be a component of the cell wall of S. brasiliensis and S. schenckii (Castro et al. 2013) and appears to be relevant during infection. Sporothrix brasiliensis shows low degrees of variability and has been suggested to be clonal (Rodrigues et al. 2013b, 2014d). The low variability of this taxon is also supported by low chromosomal polymorphisms (Sasaki et al. 2014) and homogeneous susceptibility profiles to antifungal agents (Rodrigues et al. 2014c). In our dataset (Fig. 3) a supported clade matched with AFLP group A and mainly contained strains from southern Brazil; strains of the top clade had the preponderant AFLP type B. The occurrence of separate genotypes among strains indicated that the Brazilian S. brasiliensis epidemic has at least two distinct sources as was proposed earlier by Rodrigues et al. (2013b) and confirmed here by AFLP data. Sporothrix globosa strains analysed were strictly identical. Isolates studied by Yu et al. (2013) were divided into two highly supported subclades (S. globosa I and S. globosa II). Group I comprised the majority of Chinese clinical isolates, three Chinese environmental isolates from reed, corn stalks, and soil, the type strain of S. globosa, and some isolates from the USA, India, Japan, Brazil, and the UK. Sporothrix globosa II included a small part of Chinese clinical isolates and a single isolate from Italy. More material is needed to establish whether S. globosa is preponderantly clonal. As noticed earlier (Marimón et al. 2006, 2007), S. schenckii is the likely ancestral, most variable species within the pathogenic clade. This genetic variability is reflected in significant differences in genome size and chromosome profiles generated by pulsed-field gel electrophoresis that usually display 4 to 7 chromosomal bands, ranging from 2.0 to 7.0 Mb (Sasaki et al. 2014). In our dataset, five supported subgroups were visible in all partitions (Fig. 3), which were also recognisable in AFLP data (Fig. 4). This suggests that the groups are separate lineages with limited gene flow. Nearly all lineages A–E of S. schenckii have restricted geographic distributions (Fig. 5). Four of the clusters are concurrent with groups distinguished by Marimón et al. (2006, 2007). As can be concluded from combined AFLP and MLST data, remarkable differences between species are noted. Sporotrichosis in Brazil dates back to 1907, when the disease was first diagnosed in naturally infected mice (Lutz & Splendore 1907). Sporothrix brasiliensis strains with closely similar AFLP profiles have very limited distribution. Despite the large expansion of populations during the Rio de Janeiro zoonotic epidemic, strains with identical genotypes are found at small geographic distances (Rodrigues et al. 2014d). The species thus seems to have a slow vector of dispersal. Several authors (Barros et al. 2004, Madrid et al. 2012, Rodrigues et al. 2013b) have demonstrated a role of felines in transmission of S. brasiliensis. Cats are relatively sedentary, and thus the zoonosis is expected to expand geographically at a slow pace. Sporothrix globosa also shows low degrees of variation, but a significant difference with S. brasiliensis is observed in that identical multilocus genotypes are repeatedly found at very large geographic distances. For example, molecularly identical strains CBS 125438, CBS 129719, and CBS 132923 originated from Colombia, China, and Brazil, respectively, while also strains from UK, Japan, Spain, Brazil, and China had identical genotypes. Obviously a rapid vector of dispersal is at work in S. globosa. Given the large distances between identical strains, airborne distribution seems likely. The absence of S. globosa from Africa and Australia then remains puzzling, but this perhaps can be explained by sampling effects. Notably, S. globosa infections are derived from plant debris (Wang & Sun 1982, Li et al. 1995, Song et al. 2013) and is classically known as ‘reed toxin’ (Song et al. 2013). Cats have never been observed as sources of infection in endemic areas of S. globosa. Conversely, plants have never been observed as sources of infection by S. brasiliensis. In this respect, S. schenckii seems intermediate. Classically the infection is known as ‘rose gardener’s disease’, suggesting a plant source of infection and traumatic inoculation (Rodrigues et al. 2014d). In our dataset, CBS 132977 in group A originated from plant material in Mexico, while the remaining strains of that group were of clinical origin. In the literature a connection between S. schenckii and plants has been made many times. Dixon et al. (1991) described a sapronosis of 84 cases, studying 21 clinical isolates which proved to be identical to strains from Sphagnum moss by RFLP. A similar report was that of Hajjeh et al. (1997) in an outbreak of sporotrichosis from Sphagnum moss among nine out of 65 nursery workers. Feeney et al. (2007) described an outbreak of sporotrichosis from hay in Australia, where S. schenckii was shown to be the etiologic agent by ITS sequencing. The large epidemic from South Africa in the forties of the previous century, with more than 3 000 cases, was proven to have untreated mining wood as source of infection, and disappeared after the wood had been impregnated with creosote (Helm & Berman 1947). From the above it is obvious that historical outbreak data are needed to understand the behaviour of individual Sporothrix species. Data of Feeney et al. (2007) and Yu et al. (2013) could be verified as S. schenckii and S. globosa, respectively by GenBank submissions, but in many cases neither molecular data nor strains were available for study. Given the geographic structuring of almost all Sporothrix populations, we used geographically defined sets of sequenced strains (Fig. 1) to deduce the most probable identity of historical strains in the same region. Ratios of numbers of strains sequenced per region, compared to the number of reported cases from the same region, are illustrated in Fig. 1. For example, all strains from China sequenced thus far, i.e. 112 strains from Yu et al. (2013) and Tan et al. (2013), plus nine from the present study, were identified as S. globosa. Thus, the historical probability in China to be S. globosa is 100 %, while in the USA the strains are expected to be S. schenckii with a probability of 87 %. Data are summarised in Table 3, where we took 80 % as cut-off below which percentage historical data could not be interpreted. Summarising published cases since 1940 (Table 5), a remarkable phenomenon becomes apparent. Most of the published cases concerned case series or outbreaks, either with plant origins (sapronoses) or feline origins (zoonoses). Fig. 6 shows all cases since 1940 in a histogram accumulatively in 5-year intervals. The great majority of cases were part of an outbreak, the numbers of cases per series varying from 5 to 3 069. The smallest outbreak concerns patients being infected from the same heap of hay stored in an old house (Dooley et al. 1997). Although neglected by the present study, individual cases are uncommon, even in older literature when only few cases had been published. The oldest outbreak is that in France during the period 1906–1911, which started 8 yr after the first description of Sporothrix by Hektoen & Perkins in 1900. Since then, sporotrichosis has remained rare in Europe, and part of the etiologic agents may have been imported, which would explain the relatively high species diversity in this continent. How can we explain this outbreak behaviour observed in all Sporothrix species irrespective of their different modes of transmission? The plant-borne species (S. schenckii and S. globosa) are found on decaying plant material or wood. In each plant-borne species, large differences are observed in type of plant material. In S. schenckii, for example, this was mining wood, rose thorns, and Sphagnum moss. In Sporothrix species with plant material as source of infection we have to assume that not the host plant species, but the condition of the plant material is significant. This condition has to be highly special. Notably, Sphagnum moss is used worldwide in large quantities, but only a few outbreaks of sporotrichosis have been described. As another example, decaying hay is ubiquitous material, and thus infections with regular intervals over time would be expected, but we consistently observe occasional infections from a common source, i.e. outbreaks. Therefore we hypothesise that Sporothrix species are not plant pathogens, but require particular conditions in decaying plant material, which are reached only occasionally. We postulate that a particular state of decay and fermentation of the plant material promotes excessive growth of Sporothrix. High temperature and humidity, associated with metabolic changes (induction of respiratory system) and oxidative stress due decay and fermentation may shift the morphology, favouring the invasive yeast growth form (Klein & Tebbets 2007). This hypothesis is illustrated in Fig. 7. In a small-scale study in The Netherlands (Y. Zhang, unpubl. data) we were unable to detect Sporothrix in growing corn plants. The species is hypothesised to grow exponentially in corn debris (Fig. 7b) serving as a potential inoculum for corn harvesters; the prevalent clinical type in north-east China is facial (Xia et al. 2009). At disappearance of the infectious material, the human sapronosis will die out with some delay (Fig. 7d), matching with the observation that most cases in China’s Jilin Province become apparent during winter (Song et al. 2013).
Fig. 7

Schematic overview of the hypothesis for the dissemination of the plant-born pathogen Sporothrix globosa, applied to the large human epidemics occurring in corn crops in north-east China. a. The species has not been found as an endophyte. b. Specific conditions in decaying plant material, such as fermentation, may stimulate excessive growth of the thermodependent yeasts, which facilitates infections in mammals. c. Onset of facial infections during transportation of corn debris. d. Delayed development of human infection during decline of growth in plant debris.

Occasionally, Sporothrix infections have been described that transmitted by animals very different from cats, which may be warm-blooded vertebrates but also arthropods: bites by squirrels, bats, fire ants, and spiders have been recorded (Moaven et al. 1999, Miller & Keeling 2002, Alves et al. 2010, Rodrigues et al. 2014a). The fungus was also isolated from plant material in armadillo burrows (Mackinnon et al. 1969, Rodrigues et al. 2014a). The conditions of plant decay in the burrow may be suitable for the development of Sporothrix, and subsequent dispersal by the armadillo may be expected. Thus, despite the preponderance of cat vectors, the animal host species may vary, just as the plant host species did. This leads us to a hypothesis of wild animals occasionally providing conditions similar to those in fermented plant material. Cats take up propagules from the soil and easily transmit them to their mouth by licking. Conditions in animal saliva at the feline body temperature (normal range 37.7–39.1 °C) might be a stimulating factor for the production of the Sporothrix yeast phase. Cat saliva has a pH of 7.5–8.0, which is similar to that of self-heating bulk corn debris (around 8.0) and optimal for the mould-to-yeast conversion. With a hypothesis of conditional similarities between fermenting plant material and animal digestive tracts, the unique host shift of Sporothrix from plant to animal becomes understandable. In south-east Brazil, transmission occurs nearly always by cats. Cat saliva is a stable environment, and despite the presence of antibodies – which generally have a low impact on fungal infections – repeated colonisation by Sporothrix once it has adapted to these conditions may be expected. The large outbreak in this area (da Rosa et al. 2005, Schubach et al. 2004, 2008, Silva et al. 2012, Pereira et al. 2014) suggests that the number of cases increases relative to the number of patients and cat vectors. Several peculiarities of cats may facilitate the dispersal of the fungus in the environment within limited endemic areas. Firstly, they are the most common pet animals with close contact to humans. Secondly, given the hypothesized origin of Sporothrix in cat saliva and its transmission to claws during licking, cat mobility and clawing enable them to take up and transmit the fungus, either each other during play or fight with house cats or stray cats, or transmit the fungus to human hosts via scratches or bites (Madrid et al. 2012). Cat-transmitted cases also occur in S. schenckii, but at a much lower frequency (Rodrigues et al. 2013b), suggesting that this is not an exclusive relationship between S. brasiliensis and the feline host. In 1952, a first cat-transmitted case was reported from the USA. Until 1988, cat-associated cases and reports of transmission to human were sporadic. Four Malaysian veterinary students and one cat owner developed lesions of sporotrichosis after being bitten or scratched by cats with apparent fight wounds (Zamri-Saad et al. 1990). Crothers et al. (2009) described a series of 14 cases in cats, six of which were disseminated. The few outbreaks involving cats during this period invariably was limited to people in close contact with cats (Zamri-Saad et al. 1990, Cooper et al. 1992). This condition changed considerably since around 1998 in Brazil, when the incidence of cat and cat-transmitted cases increased dramatically to more than 5 000 human and feline cases in an expanding area around Rio de Janeiro and São Paulo (Barros et al. 2004, 2008b, Schubach et al. 2008, Pereira et al. 2014). Sporothrix schenckii has been supposed to be the ancestral species on phylogenetic grounds, mainly because of its high degree of variability in all markers, its wide distribution, and hypothetical presence of sexuality as judged from a balanced mating type distribution (Teixeira et al. In press). The species seems preponderantly plant-transmitted. The share of cat-transmitted cases is much lower than in S. brasiliensis, and much higher than in S. globosa, where it is zero. In humans, disseminated cases occur almost only in immunocompromised patients, while cats seem to be relatively susceptible to infection. Host-shifts from plant material to animals are likely to have occurred already within S. schenckii, which diminishes the value of genomic comparisons between species. The main (preponderantly) clonal offshoots S. brasiliensis and S. globosa seem to have adapted successfully to their respective new habitats. This evolutionary hypothesis is summarised in Fig. 8. The ancestral species S. schenckii contains divergent genotypes with different behaviour. The clonal offshoot S. brasiliensis on average has increased virulence and is cat-transmitted; thus a shift from sapronoses to zoonoses takes place. The clonal offshoot S. globosa has lower virulence and has maintained sapronotic behaviour, but its vector of distribution seems to have changed.
Fig. 8

Diagram of hypothetical processes of evolution from highly diverse ancestral species S. schenckii and clonal offshoots S. globosa and S. brasiliensis. Due to differential selection processes, the derived species differ significantly in virulence, transmission and type of epidemic caused.

Sporothrix mexicana is phylogenetically distant to the main pathogenic clade of S. schenckii, S. globosa, and S. brasiliensis, and thus is unlikely to have played a role in the evolutionary host shift described above. Information on the few clinical strains available from the 1950s and 1970s decade is very limited (Rodrigues et al. 2013a). Dias et al. (2011) described one disseminated case without history of trauma from Portugal in an immunocompetent patient. A certain degree of gender predominance was discernible which differed between species (Table 5). Considering all publications with > 1 case, we noticed that in S. globosa in 11 case series female hosts were predominant, vs zero times male hosts. This is in agreement with Verma et al. (2012) who reported a female preponderance in the epidemiology of sporotrichosis in Himachal Pradesh, a small hill state in north-west India, usually related to agriculture practice. In S. schenckii these figures were opposite: one female vs eight males. In S. brasiliensis female / male ratios were more or less equal (7/9). Gender ratios have been reported to differ, mainly related to urban migration. In Brazil, many housewives stay at home and tend to be in charge of caring cats, while males have a larger chance to be infected during outdoor activities (Schubach et al. 2008). In rural areas of north-east China, most males go to cities to find jobs, leaving females, elderly and children at home, having increased chance of infection. Sporothrix schenckii infection classically seems to be connected with male agricultural activities (Rodrigues et al. 2014d). As most publications are unclear about gender ratios, more epidemiological study is necessary.

Conclusions

Our data and the review of the existing literature have shown that Sporothrix is unique in the fungal kingdom by its prevalent occurrence in the form of outbreaks, and that these outbreaks differ fundamentally from each other. In S. brasiliensis a huge zoonosis is taking place today, while the contemporary outbreak of similar dimensions in China is a sapronosis. In the ancestral species S. schenckii most outbreaks are sapronoses, but small zoonoses with cats as prime susceptible hosts have also been observed. It is significant to public health to consider these distinctions. Sapronoses, providing very special conditions promoting fungal growth, basically can be controlled by removal of the plant biomass allowing this contamination. In contrast, the zoonoses of cats compose a much more diffuse source of infection, which is more difficult to control. In addition, the ancestral species S. schenckii contains a mixture of strains that are susceptible to antifungals widely used in cutaneous infections, e.g. terbinafin, ketoconazole, and itraconazole, and strains with decreased susceptibility (Stopiglia et al. 2014). A large difference is noted particularly with azoles between the highly susceptible species S. brasiliensis and the resistant species S. globosa (Marimón et al. 2008). Selection and clonal expansion of resistant strains during epidemics may increase the significance of sporotrichosis as a human disease.
  117 in total

1.  [Urban sporotrichosis: a neglected epidemic in Rio de Janeiro, Brazil].

Authors:  Margarete Bernardo Tavares da Silva; Mônica Motta de Mattos Costa; Carla Carrilho da Silva Torres; Maria Clara Gutierrez Galhardo; Antonio Carlos Francesconi do Valle; Mônica de Avelar F M Magalhães; Paulo Chagastelles Sabroza; Rosely Magalhães de Oliveira
Journal:  Cad Saude Publica       Date:  2012-10       Impact factor: 1.632

Review 2.  Epidemiology of sporotrichosis: a study of 304 cases in Brazil.

Authors:  Ana Cecília Michel da Rosa; Maria Lúcia Scroferneker; Rodrigo Vettorato; Roberto Lopes Gervini; Gerson Vettorato; Analupe Weber
Journal:  J Am Acad Dermatol       Date:  2005-03       Impact factor: 11.527

3.  Infant sporotrichosis in northeast China: a report of 15 cases.

Authors:  Yang Song; Lei Yao; Shu-Xia Zhong; Ya-Ping Tian; Yuan-Yuan Liu; Shan-Shan Li
Journal:  Int J Dermatol       Date:  2011-05       Impact factor: 2.736

4.  Asexual propagation of a virulent clone complex in a human and feline outbreak of sporotrichosis.

Authors:  Marcus de Melo Teixeira; Anderson Messias Rodrigues; Clement K M Tsui; Luiz Gonzaga Paulo de Almeida; Anne D Van Diepeningen; Bert Gerrits van den Ende; Geisa Ferreira Fernandes; Rui Kano; Richard C Hamelin; Leila Maria Lopes-Bezerra; Ana Tereza Ribeiro Vasconcelos; Sybren de Hoog; Zoilo Pires de Camargo; Maria Sueli Soares Felipe
Journal:  Eukaryot Cell       Date:  2014-12-05

5.  Sporotrichosis in north-west India.

Authors:  A Chakrabarti; S K Roy; S Dhar; B Kumar
Journal:  Indian J Med Res       Date:  1994-08       Impact factor: 2.375

6.  Fatal Ophiostoma piceae infection in a patient with acute lymphoblastic leukaemia.

Authors:  Martin Bommer; Marie-Luise Hütter; Stephan Stilgenbauer; G Sybren de Hoog; Z Wilhelm de Beer; Nele Wellinghausen
Journal:  J Med Microbiol       Date:  2009-03       Impact factor: 2.472

7.  Isolation and characterization of Sporothrix schenckii from clinical and environmental sources associated with the largest U.S. epidemic of sporotrichosis.

Authors:  D M Dixon; I F Salkin; R A Duncan; N J Hurd; J H Haines; M E Kemna; F B Coles
Journal:  J Clin Microbiol       Date:  1991-06       Impact factor: 5.948

8.  [Feline sporotrichosis: clinical and zoonotic aspects].

Authors:  C E Larsson; M de A Gonçalves; V C Araujo; M L Dagli; B Correa; C Fava Neto
Journal:  Rev Inst Med Trop Sao Paulo       Date:  1989 Sep-Oct       Impact factor: 1.846

9.  Cutaneous sporotrichosis in forestry workers. Epidemic due to contaminated Sphagnum moss.

Authors:  K E Powell; A Taylor; B J Phillips; D L Blakey; G D Campbell; L Kaufman; W Kaplan
Journal:  JAMA       Date:  1978-07-21       Impact factor: 56.272

10.  Outbreak of sporotrichosis, Western Australia.

Authors:  Kynan T Feeney; Ian H Arthur; Amanda J Whittle; Shelley A Altman; David J Speers
Journal:  Emerg Infect Dis       Date:  2007-08       Impact factor: 6.883

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  63 in total

1.  Evolution of virulence-related phenotypes of Sporothrix brasiliensis isolates from patients with chronic sporotrichosis and acquired immunodeficiency syndrome.

Authors:  Ingrid Ludmila Rodrigues Cruz; Dayvison Francis Saraiva Freitas; Priscila Marques de Macedo; Maria Clara Gutierrez-Galhardo; Antonio Carlos Francesconi do Valle; Marcos de Abreu Almeida; Rowena Alves Coelho; Fábio Brito-Santos; Maria Helena Galdino Figueiredo-Carvalho; Rosely Maria Zancopé-Oliveira; Rodrigo Almeida-Paes
Journal:  Braz J Microbiol       Date:  2020-05-22       Impact factor: 2.476

2.  Human serum proteins bind to Sporothrix schenckii conidia with differential effects on phagocytosis.

Authors:  Silvia Guzman Beltrán; Jazmín Sanchez Morales; Augusto González Canto; Alma Escalona Montaño; Haydee Torres Guerrero
Journal:  Braz J Microbiol       Date:  2020-05-07       Impact factor: 2.476

Review 3.  Fungal infections in animals: a patchwork of different situations.

Authors:  Seyedmojtaba Seyedmousavi; Sandra de M G Bosco; Sybren de Hoog; Frank Ebel; Daniel Elad; Renata R Gomes; Ilse D Jacobsen; Henrik Elvang Jensen; An Martel; Bernard Mignon; Frank Pasmans; Elena Piecková; Anderson Messias Rodrigues; Karuna Singh; Vania A Vicente; Gudrun Wibbelt; Nathan P Wiederhold; Jacques Guillot
Journal:  Med Mycol       Date:  2018-04-01       Impact factor: 4.076

Review 4.  The Historical Burden of Sporotrichosis in Brazil: a Systematic Review of Cases Reported from 1907 to 2020.

Authors:  Vanessa Brito Souza Rabello; Marcos Abreu Almeida; Andrea Reis Bernardes-Engemann; Rodrigo Almeida-Paes; Priscila Marques de Macedo; Rosely Maria Zancopé-Oliveira
Journal:  Braz J Microbiol       Date:  2021-11-26       Impact factor: 2.476

5.  Phenotypic and molecular characterisation of Sporothrix globosa of diverse origin from India.

Authors:  Shivaprakash M Rudramurthy; Shamanth A Shankarnarayan; Basavaraj M Hemashetter; Santwana Verma; Smriti Chauhan; Reema Nath; Jayanthi Savio; Malini Capoor; Harsimran Kaur; Anup K Ghosh; Arunaloke Chakrabarti
Journal:  Braz J Microbiol       Date:  2020-07-30       Impact factor: 2.476

6.  Geographical distribution and ecological niche modeling of the etiological agents of human sporotrichosis in Venezuela.

Authors:  Laura Barreto; Grisel Velásquez; Mireya Mendoza; Emma Camacho; Estefany Goncalves; Sabrina Rodríguez; Gustavo A Niño-Vega
Journal:  Braz J Microbiol       Date:  2020-05-29       Impact factor: 2.476

Review 7.  Epidemiology of fungal infections in China.

Authors:  Min Chen; Yuan Xu; Nan Hong; Yali Yang; Wenzhi Lei; Lin Du; Jingjun Zhao; Xia Lei; Lin Xiong; Langqi Cai; Hui Xu; Weihua Pan; Wanqing Liao
Journal:  Front Med       Date:  2018-01-11       Impact factor: 4.592

Review 8.  Molecular Components of the Sporothrix schenckii Complex that Induce Immune Response.

Authors:  Carlos A Alba-Fierro; Armando Pérez-Torres; Conchita Toriello; Yolanda Romo-Lozano; Everardo López-Romero; Estela Ruiz-Baca
Journal:  Curr Microbiol       Date:  2016-04-27       Impact factor: 2.188

9.  Atypical Clinical Presentation of Sporotrichosis Caused by Sporothrix globosa Resistant to Itraconazole.

Authors:  Olga Fischman Gompertz; Anderson M Rodrigues; Geisa F Fernandes; Henri D L Bentubo; Zoilo Pires de Camargo; Valéria Petri
Journal:  Am J Trop Med Hyg       Date:  2016-04-25       Impact factor: 2.345

Review 10.  Guideline for the management of feline sporotrichosis caused by Sporothrix brasiliensis and literature revision.

Authors:  Isabella Dib Ferreira Gremião; Elisabeth Martins da Silva da Rocha; Hildebrando Montenegro; Aroldo José Borges Carneiro; Melissa Orzechowski Xavier; Marconi Rodrigues de Farias; Fabiana Monti; Wilson Mansho; Romeika Herminia de Macedo Assunção Pereira; Sandro Antonio Pereira; Leila M Lopes-Bezerra
Journal:  Braz J Microbiol       Date:  2020-09-29       Impact factor: 2.476

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