Revisiting Pulmonary Sporotrichosis: A Comprehensive Systematic Review of an Overlooked Fungal Infection

Abstract Introduction Pulmonary sporotrichosis (PST) is a rare and neglected but severe disease. Its optimal management remains challenging, as recommendations are primarily derived from case reports. This study summarizes PST patients' presentation, diagnosis, management, and outcome. Methods Studies were identified through a search on Google Scholar and PubMed. The collected data included study characteristics, demographic data, risk factors, comorbidities, clinical status, presentations, imaging findings, diagnostic methods, disease focality, fungal species, treatment methods, complications, ICU admission status, and outcomes. Results Most of the studies were conducted in the USA (71.7%). In total, 34.7% of the cases were smokers, 30.7% had occupational exposure to dust and soil, 5.3% had contact with pets or roses or wooden materials, and 2.7% had environmental exposure. Overall, 32% of the patients were alcoholic, 29.3% had bacterial infections, 24% had respiratory or pulmonary diseases, and 17.3% were found to have HIV. The most frequently reported symptom was coughing (61.3%). The most common imaging finding was cavitary lesions (53.3%). The most commonly utilized diagnostic approach was sputum culture (69.3%). A combined conservative regimen was the treatment of choice in 26 patients (34.7%). The survival rate was 69.3%, with a recurrence rate of 5.8%. Conclusion The coexistence of multiple risk factors may trigger the disease. Its low incidence in endemic areas suggests the potential for missed or misdiagnosed cases. Treatment approaches include a combined conservative regimen or in combination with surgery. The survival rate is high, but the mortality rate should not be overlooked.