Emerging zoonotic ocular sporotrichosis in southeast Asia: a case series from Thailand and systematic review of regional reports

Abstract Background To describe the clinical features, diagnostic approaches, and treatment outcomes of ocular sporotrichosis through an institutional case series and systematic review of reports from Southeast Asia. Methods Five patients diagnosed with ocular sporotrichosis at a tertiary referral center in Thailand (2020–2024) were retrospectively reviewed for clinical presentation, diagnostic confirmation, and treatment outcomes. A systematic review of PubMed, Embase, Scopus, and MEDLINE (last searched March 20, 2025) identified published cases from Southeast Asia. Eligible reports were narratively synthesized; no meta-analysis was performed due to clinical heterogeneity. Results All five institutional cases presented with chronic granulomatous conjunctivitis, frequently associated with cat exposure. Diagnosis was confirmed by fungal culture and/or histopathology in all patients. Oral itraconazole was prescribed in every case, with adjunctive topical antifungals used selectively. Most patients improved clinically, though several were lost to follow-up. The systematic review included 12 studies comprising 23 patients reported between 2018 and 2024. The median age was 32 years (IQR 22.5–55.0), and 78.3% were female. Most cases were unilateral (91.3%), with microbiological confirmation in 87%. Oral itraconazole was the primary treatment, with topical or intralesional antifungals in some cases. Clinical outcomes were generally favorable, though one patient developed limbal stem cell deficiency. Conclusions Ocular sporotrichosis is an emerging zoonotic infection in Southeast Asia, often linked to cat exposure. Early recognition and prompt antifungal therapy are critical to achieve good outcomes and prevent sight-threatening complications.