Sporotrichosis in patients with diabetes mellitus: A systematic review of individual participant data

Duani H., PhD; Bonifaz A., PhD; Tirado-Sánchez A., PhD; Magalhães V.C.R., PhD; Ramírez-Soto M.C., PhD · Medical Mycology (2026) · DOI: 10.1093/mmy/myag060

Resumen

Sporotrichosis is a globally distributed subcutaneous mycosis caused by fungi of the Sporothrix complex, and is associated with worse outcomes in immunocompromised individuals, including those with diabetes mellitus. The impact of diabetes mellitus on the clinical presentation and outcomes of sporotrichosis remains poorly characterized. We conducted a systematic review of individual participant data to assess this association. Eight databases (Cochrane Library, Embase, LILACS, MEDLINE/PubMed, Scopus, Global Index Medicus/WHO, SciELO, and Web of Science) were searched without restrictions on publication date, country, language, sex, or age. The retrieved case data were divided into two groups: (1) localized disease and (2) systemic disease. We identified 122 cases of sporotrichosis in patients with diabetes mellitus from 64 articles and from 28 unpublished cases from Brazil and Mexico. Most patients were male (62.3%), with a mean age of 56.6 years, and 73% were from hyperendemic countries. Among cutaneous presentations, lymphocutaneous and fixed cutaneous forms were most frequent (41%), while osteoarticular multifocal disease was the leading extracutaneous manifestation (22.1%). Alcohol use disorder was independently associated with systemic disease (adjusted OR 4.76, 95% CI 1.45–18.05; P = .014). Compared with localized disease, systemic disease more commonly presented with joint symptoms (40.6% vs. 13.5%; P < .001), lesions with lower limb involvement (80% vs. 20%; P < .001), head involvement (81.3% vs. 18.8%; P < .001), and trunk involvement (84.6% vs. 15.4%; P < .001). Itraconazole monotherapy was the main treatment (45.9%), followed by amphotericin B-based regimens (33.6%). There were better outcomes for patients with localized disease than for those with systemic disease (cure rate 86.6% vs. 56.4%; P < .001). Systemic disease carried a 20% mortality rate in this population. These findings underscore the challenges posed by sporotrichosis in patients with diabetes mellitus and highlight the need for further research on risk factors for systemic disease and optimal treatment strategies for this population. © The Author(s) 2026. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site-for further information please contact journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights)

Instituciones: Universidad de San Martín de Porres