Feline-transmitted sporotrichosis (FTS) is currently a mandatory notifiable disease in Brazil and is considered an epizootic affecting humans, cats, and dogs throughout the country, with expansion in South American countries. The main drugs used to treat FTS include itraconazole (ITZ), potassium iodide (KI), amphotericin B (AM-B), and terbinafine (TBF). Among these, ITZ and KI are contraindicated during pregnancy due to teratogenic potential, whereas AM-B and TBF are considered safe for both pregnant women and fetuses and are classified as FDA pregnancy category B. Although oral TBF is already classified as category B by the U.S. FDA, more robust data are needed to consolidate its use as a therapeutic option in pregnant women with FTS. This study aims to present efficacy and safety data of pregnant women treated with TBF. Three clinical cases of pregnant women treated at referral centers in Paraná and São Paulo between 2021 and 2024 are described. The patients were aged 16, 25, and 43 years and were diagnosed with proven lymphocutaneous FTS, with Sporothrix brasiliensis identified by calmodulin gene sequencing in two cases. All patients initiated TBF during the second trimester of pregnancy (between 20 and 23 weeks of gestation) at a dose of 500 mg daily, with treatment duration ranging from 4 to 6 months. One patient completed treatment with itraconazole for one month postpartum due to medication availability in the public healthcare system. In all cases, delivery occurred at term, and newborns were healthy and asymptomatic. All three patients achieved clinical cure of sporotrichosis. Recent epidemiological studies and systematic reviews, including a cohort of more than 1.6 million pregnancies with 891 systemic (oral) TBF exposures, demonstrated no significant increase in the risk of congenital malformations, spontaneous abortion, preterm birth, low birth weight, or stillbirth. The reported cases, together with current literature, suggest that TBF may be used in pregnant women with FTS as an effective and safe oral therapeutic alternative, as indicated in the 6th edition of the Brazilian Ministry of Health’s Health Surveillance Guide.
Schaitza et al. (Sun,) studied this question.