Molecular Epidemiology and Antifungal Susceptibility of Sporothrix Isolates from Shanxi, China: A Retrospective Study and National Comparison

This study characterizes the molecular epidemiology of Sporothrix species in Shanxi Province, a low-prevalence region in China, providing real data on genetic profiles and antifungal susceptibility patterns. Clinical records of sporotrichosis cases from a tertiary hospital in Shanxi (2019-2024) were retrospectively analyzed. Isolates were identified through multilocus sequencing targeting the internal transcribed spacer (ITS), calmodulin (CAL), β-tubulin (TUB), and mating-type locus (MAT) genes, with phylogenetic analysis. Antifungal susceptibility testing against seven agents was performed for both yeast and mycelial phases. Additionally, a review of Chinese case reports (2015-2025) was conducted to collect and summarize data on Sporothrix species identification across the country. All 11 isolates were confirmed as Sporothrix globosa, displaying high genetic similarity to the strains reported in most regions of China in previous studies. Terbinafine, ketoconazole, and itraconazole demonstrated good activity. Yeast-phase susceptibility was significantly higher for amphotericin B, itraconazole, and voriconazole (P<0.05, compared to the mycelial phase). Geospatial analysis indicated S. globosa dominance in reported areas, with persistent surveillance gaps in western China. This study from Shanxi provides a comprehensive overview of S. globosa as the predominant etiological agent in the region, consistent with the distribution pattern observed throughout China. Terbinafine demonstrated the highest in vitro activity against S. globosa.