title: Epidemiological investigation of an outbreak of cutaneous sporotrichosis, Northern Territory, Australia.
abstract: BACKGROUND
  An outbreak of cutaneous sporotrichosis occurred in the Darwin region of the Northern Territory (NT) in 2014. We aimed to determine the source and risk factors associated with the outbreak and describe the clinical spectrum of cases seen.
  
  
  METHODS
  Epidemiological investigation of cases of cutaneous sporotrichosis identified through the Royal Darwin Hospital was undertaken to investigate risk factors and potential sources of infection. Data were collected through chart review and individual patient interviews. Environmental investigation followed identification of a common risk factor.
  
  
  RESULTS
  Nine confirmed cases of cutaneous sporotrichosis caused by Sporothrix schenckii were identified with onset of symptoms between April and July 2014. Patients were aged 29 to 70 years and seven were male (78%). Two strains of S. schenckii were identified, neither of which have been previously documented. One common risk factor was identified: all patients were occupational or recreational gardeners, with each reporting exposure to mulching hay, originating from a single NT farm. Local environmental health officers visited the farm and the owners confirmed that the implicated hay had been stored over the monsoon season and had been affected by rain. Storage of hay over the wet season was a new practice.
  
  
  CONCLUSIONS
  This constitutes the third reported outbreak of S. schenckii sporotrichosis attributable to contaminated hay in Australia and the first outbreak of sporotrichosis in the NT. This outbreak prompted public health interventions, including distribution of information to general practitioners, farmers and suppliers in the Top End. Media reporting led to the identification and treatment of an additional case. Local practitioners should remain alert to the possibility of further occurrences of sporotrichosis.
authors.affiliation: Centre for Disease Control, Department of Health, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, Darwin, NT, 0810, Australia.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: McGuinness
authors.affiliation: Centre for Disease Control, Department of Health, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, Darwin, NT, 0810, Australia.
authors.forename: Rowena
authors.initials: R
authors.lastname: Boyd
authors.affiliation: National Mycology Reference Centre, Microbiology & Infectious Diseases, SA Pathology, Frome Road, Adelaide, SA, 5000, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Kidd
authors.affiliation: Royal Darwin Hospital, Rocklands Drive, Tiwi, Darwin, NT, 0810, Australia.
authors.forename: Charlie
authors.initials: C
authors.lastname: McLeod
authors.affiliation: Centre for Disease Control, Department of Health, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, Darwin, NT, 0810, Australia.
authors.forename: Vicki L
authors.initials: VL
authors.lastname: Krause
authors.affiliation: Royal Darwin Hospital, Rocklands Drive, Tiwi, Darwin, NT, 0810, Australia. anna.ralph@menzies.edu.au.|Global and Tropical Health, Menzies School of Health Research, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, Darwin, NT, 0810, Australia. anna.ralph@menzies.edu.au.
authors.forename: Anna P
authors.initials: AP
authors.lastname: Ralph
mesh_terms: D000328:Adult; D000368:Aged; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015876:Northern Territory / Q000453:epidemiology; D012307:Risk Factors; D012621:Seasons; D013175:Sporothrix / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology; D013174:Sporotrichosis / Q000453:epidemiology* / Q000382:microbiology*