# Epidemiology and Outcomes of Sporotrichosis: A Descriptive Real‐World Analysis From a Global Cohort

## TL;DR

This study examines the global impact of sporotrichosis, a fungal infection, focusing on patient outcomes, comorbidities, and treatment patterns.

## Contribution

The paper provides the first large-scale global analysis of sporotrichosis epidemiology and outcomes, including HIV-related cases.

## Key findings

- Sporotrichosis has a 17% one-year mortality rate, with higher risk in older adults and those with neoplasms or disseminated disease.
- Itraconazole is the most commonly prescribed antifungal, while amphotericin B use remains low.
- HIV-positive patients are more likely to have severe forms of sporotrichosis, such as pulmonary or disseminated disease.

## Abstract

Sporotrichosis is a dimorphic fungal infection of increasing global relevance. Although usually cutaneous or lymphocutaneous, disseminated disease occurs in immunocompromised hosts. Large‐scale data on its epidemiology, treatment and outcomes remain limited.

To characterise the clinical features, comorbidities, antifungal prescribing patterns and one‐year mortality associated with sporotrichosis, with emphasis on patients with HIV and other forms of immunosuppression.

We performed a retrospective global cohort study using the TriNetX Research Network. Adults (≥ 18 years) diagnosed with sporotrichosis were identified using ICD‐9/10 codes (1995–2024). Demographics, comorbidities, laboratory parameters and antifungal prescriptions were analysed. The primary outcome was all‐cause mortality at 1 year. Secondary outcomes included hospitalisation and admission to the intensive care unit (ICU).

Among 2124 adults, the mean age was 52 years, and 56.5% were female. Nearly half of the cases originated internationally, with the southeastern United States accounting for the majority of domestic cases. Neoplasms (25%) and diabetes (11%) were the most common comorbidities. Lymphocutaneous disease was uncommon (9%), and disseminated infection occurred in 1% of cases. One‐year mortality was 17%, with a higher risk among older adults and those with neoplasms, lymphocutaneous or disseminated infection or hyperferritinemia. Seventeen patients (0.8%) had HIV and were more likely to have pulmonary or disseminated disease. Itraconazole was the most commonly prescribed antifungal (52%), while the use of amphotericin B remained low (< 2%).

Sporotrichosis causes substantial global mortality. Outcomes appear driven by host factors and gaps in guideline‐based management. Earlier recognition, optimised antifungal therapy, and use of inflammatory markers to guide risk stratification may improve outcomes and inform prevention strategies.