Sporotrichosis cases in HIV-infected patients have increased in recent decades [1, 2]. A systematic review has showed that, compared with exogenous endophthalmitis caused by Sporothrix, endogenous endophthalmitis (EE) is more common in HIV-infected patients from hyperendemic areas [3]. These findings suggest that HIV infection may predispose to an increased risk for progression to EE in patients with sporotrichosis [3]. However, EE rate and factors associated with this condition in patients co-infected by HIV and sporotrichosis has not been described. Here we investigate this rate and factors associated with this condition using data collected from the published literature.

Methods

We performed a systematic review in multiple databases (including PubMed, MEDLINE, EMBASE, and Scopus) to Dec 20, 2017, to identify all case reports and case series describing patients co-infected by HIV and sporotrichosis. This systematic review was performed in accordance with the Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) [4]. Our inclusion criteria included patients with sporotrichosis confirmed by positive Sporothrix culture from tissue or clinical samples and infection by HIV confirmed by laboratory tests. Patients were classified as having EE if they had intraocular inflammation with a positive intraocular Sporothrix culture or positive Sporothrix culture from tissue or clinical samples (skin biopsy and/or exudate, cerebrospinal fluid, sputum, blood and synovial fluid). Patients demographic (gender, age and please residence), clinical characteristics (sporotrichosis clinical form, and the median CD4+ T-cell lymphocyte count) and microbial data were recorded. To assess the independent association between EE and characteristics of these patients, we compared patients with and without EE using univariate analysis with χ2 and t tests. Statistical analysis was conducted using the PSS software (Chicago, IL, USA).

Results

A total of 43 publications reporting 65 individual case reports were included for data extraction and analysis (supplementary information) [1, 3, 5,6,7]. The EE rate in patients co-infected by HIV and sporotrichosis was 7.7% (7 eyes of 5 patients). Choroiditis was the most common clinical manifestation (5 eyes), followed by retinochoroiditis (1 eye), and granulomatous uveitis (1 eye). Culture of ocular specimens was Sporothrix positive in 1 of 5 patients with EE. All patients with EE had disseminated sporotrichosis. S. schenckii was causative fungus from all cases of the non-EE group (P < 0.0001) (Table 1). There were no independent association in demographic characteristics, sporotrichosis clinical form, and the median CD4+ T-cell lymphocyte count between the patients with and without EE (P > 0.05) (Table 1).

Table 1 Demographics and clinical characteristics from patients HIV/sporotrichosis co-infected with and without EE
Full size table

Discussion

Endophthalmitis due to Sporothrix species is extremely rare, with only few published case reports. This could have influenced on EE rate in patients co-infected by HIV and sporotrichosis, and our study could have either underestimated or overestimated the EE rate, resulting in possible bias. Therefore, EE rate in patients co-infected by HIV and sporotrichosis found in this study was low, it is less likely to recover Sporothrix fungus of ocular specimens, and there were no association between the clinical factors and EE. Although these findings limited, the development of EE only seems to be one of the manifestations of disseminated sporotrichosis in patients HIV-infected, therefore, better-designed studies with a well-selected population are essential.