First clinical-epidemiological profile of zoonotic sporotrichosis in a state capital of Northeast Brazil: evidence of an emerging feline-driven urban epidemic.

Zoonotic sporotrichosis has expanded in Brazil as an urban, cat-associated mycosis, but its human clinical-epidemiological profile remains poorly characterized in Maranhao State, Brazil. This study describes a hospital-based cohort from Greater Sao Luis and defines a regional profile not previously established in the state. We conducted an observational study combining retrospective and prospective data from 2022 to 2025 at a reference hospital for infectious diseases in Sao Luis municipality, Maranhao State, Brazil. Confirmed cases were defined by culture and/or compatible histopathological findings supported by clinical-epidemiological criteria. Demographic, exposure, clinical, laboratory, therapeutic, and outcome variables were analyzed using descriptive statistics and appropriate statistical tests. A total of 189 confirmed cases were analyzed. Cases increased sharply after 2022 and peaked in 2024, with 82 cases. Most patients lived in Sao Luis municipality (84.7%), were female (67.2%), and were aged 30-59 years (47.1%). Feline-associated exposure predominated: 70.9% reported having household cats and 81.5% reported scratches or contact with feline lesions or secretions. The lymphocutaneous form was the main presentation (61.9%), followed by fixed cutaneous disease (29.1%); upper limbs were the most frequently affected sites (73.0%). Culture was positive for Sporothrix spp. in 62.2% of tested samples, and suppurative granulomas were frequent findings on histopathological examination. Itraconazole was the first-line therapy in 92.0% of treated patients. Greater Sao Luis shows the profile of an emerging urban epidemic of zoonotic sporotrichosis of feline origin. These findings provide local evidence to guide surveillance, early diagnosis, integration between human and veterinary health services, and One Health-based control strategies in Maranhao State.