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

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.