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aiming to elucidate disease distribution&#46; All cases with clinical suspicion of sporotrichosis that were confirmed through the gold standard diagnostic method&#44; a positive culture for fungi from lesion secretions or fragments&#44; were included in the study&#46; For each included case&#44; the following clinical and epidemiological characteristics were analyzed&#58; age&#44; sex&#44; origin&#44; previous contact with a sick animal&#44; and year of diagnosis&#46; The study was submitted to the institution&#8217;s Research Ethics Committee and approved according to CAAE n&#46; 35820920&#46;4&#46;0000&#46;5479&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Twenty patients were included&#44; aged two to 81 years &#40;mean 32&#46;2&#8239;&#177;&#8239;25&#46;10 years&#41;&#44; 55&#37; females and 45&#37; males&#46; As for zoonotic surveillance&#44; 30&#37; denied contact with an animal&#44; and 70&#37; reported the previous contact with a sick cat&#44; with no other animals being mentioned&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">As for the epidemiological aspects&#44; there were 19 autochthonous cases from greater S&#227;o Paulo and one allochthonous case &#40;from the state of Bahia&#41;&#46; There was a progressive increase in the number of autochthonous cases over the years&#58; one in 2012&#44; none in 2013&#44; one in 2014&#44; two per year in 2015 to 2017&#44; three in 2018&#44; five in 2019&#44; and three in the first four months of 2020&#46; Over the years&#44; there was a progression from the initial cases located in neighborhoods in the eastern area of S&#227;o Paulo to neighborhoods in other areas of the city&#44; as well as to the neighboring municipalities that constitute Greater S&#227;o Paulo&#44; such as Po&#225;&#44; Guarulhos&#44; Ferraz de Vasconcelos and Diadema &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">When analyzing the described epidemiological aspects&#44; it is noteworthy that most patients &#40;70&#37;&#41; reported contact with sick cats&#46; Another fact to be highlighted is that the majority of cases &#40;60&#37;&#41; occurred in patients at the extremes of age&#44; corresponding to the population with greater contact with sick animals&#44; compatible with what is described in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The zoonotic transmission of sporotrichosis by contaminated animals&#44; especially felines&#44; has been a matter of concern in several regions of the country&#46; In the 1990s&#44; the first publications on the epidemic appeared in the state of Rio de Janeiro&#44; followed by a considerable increase in the number of cases in felines and humans over the years&#44; making it currently be considered hyperendemic in the state&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Since 2013&#44; notification has become mandatory in the state of Rio de Janeiro&#44; which does not happen in other states in Brazil&#59; therefore&#44; epidemiological estimates are obtained mainly based on cases reported in the literature&#44; underestimating the actual situation found in these places&#46; Recently&#44; other states in the southern and southeastern regions of Brazil&#44; such as Rio Grande do Sul<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and Esp&#237;rito Santo&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> reported an epidemic situation of sporotrichosis&#44; indicating disease progression throughout the country&#44; and even affecting neighboring countries&#44; such as Argentina&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The emergence and spread of sporotrichosis cases in Brazil have been neglected for several years&#44; making it a frequent and uncontrolled disease that was previously rare in many regions&#46; Ongoing socio-economic and environmental difficulties&#44; with urban agglomeration and poor basic sanitation&#44; together with scarce and inadequate health services&#44; are promoting this expansion&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In S&#227;o Paulo&#44; there have been few studies that mapped the disease progression in humans&#46; In 2011&#44; an outbreak of zoonotic sporotrichosis was detected in the administrative district of Itaquera&#44; in the eastern area of S&#227;o Paulo&#44; with a number of feline cases of sporotrichosis known to be emerging in this region&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The geographic progression of cases in humans diagnosed from that date onwards suggests a possible spread from the focus in the eastern area of the city to other neighborhoods and neighboring cities&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Public health actions aimed at improving human and animal health are required&#44; including educational programs for health professionals that will help to increase the clinical suspicion of human and feline disease&#44; so that infected animals can be screened&#46; More reliable epidemiological data on the prevalence and incidence can be obtained through mandatory reporting of cases&#44; thus facilitating the work of the epidemiological surveillance by zoonoses center to eradicate the disease and control new cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> Moreover&#44; actions to promote the availability of easily accessible veterinary services and antifungal treatment for the population of pets are necessary&#44; as well as better control programs for stray animals and the correct destiny of animals that die due to sporotrichosis&#44; since the fungus is geophilic and ends up perpetuating itself in the environment when the dead animal is dumped in vacant lots or the animal is buried&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Socio-economic and environmental difficulties&#44; associated with the lack of policies such as the population awareness and free access to examination and treatment of animals&#44; have contributed to the spread of the disease&#46; This study highlights epidemiological characteristics of great importance&#44; reaffirming previous concepts and presenting ideas that should be analyzed in future similar studies in the city&#44; aiming to obtain greater knowledge and control of the disease&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Financial support</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Authors&#8217;contributions</span><p id="par0060" class="elsevierStylePara elsevierViewall">John Verrinder Veasey&#58; Design and planning of the study&#59; drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#59; approval of the final version of the manuscript&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Gustavo de S&#225; Menezes Carvalho&#58; Collection&#44; analysis&#44; and interpretation of data&#59; approval of the final version of the manuscript&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Ligia Rangel Barbosa Ruiz&#58; Intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#59; approval of the final version of the manuscript&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Milton Ferreira Neves Neto&#58; Drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Clarisse Zaitz&#58; Intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#59; approval of the final version of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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            2 => "Healthcare policies"
            3 => "Sporotrichosis"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Sporotrichosis is the most frequent subcutaneous mycosis in Latin America&#44; where it is considered endemic&#46; At the end of the 20th century&#44; the first cases of zoonotic transmission were described in Rio de Janeiro&#44; triggering an epidemic outbreak that spread to other regions of Brazil&#46; The lack of disease notification omits its real occurrence in the country&#44; which happens in its most populous city&#44; S&#227;o Paulo&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">To evaluate the epidemiological aspects of the patients seen at a hospital in S&#227;o Paulo aiming at establishing the geographic distribution of this disease&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This is a retrospective study that analyzed data from medical records of patients with a clinical and laboratory diagnosis of sporotrichosis attended at a tertiary hospital in the city of S&#227;o Paulo between 2012 and 2020&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Twenty patients were included&#46; As for zoonotic surveillance&#44; 30&#37; denied contact with an animal&#44; and 70&#37; reported previous contact with a sick cat&#44; with no other animals being mentioned&#46; One case was allochthonous and the others autochthonous&#44; showing a dissemination behavior from a focus in the eastern area of the capital&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Study limitations</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The present study was based on data from only one hospital&#46; Studies that include data from other hospitals and other regions must be carried out to obtain a complete picture of this disease&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusions</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">As in other regions of the country&#44; zoonotic sporotrichosis presents itself as an endemic disease with an increase in the number of cases&#46; The findings highlight epidemiological characteristics of great importance so that public health policies can contain disease progression&#46;</p></span>"
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