兽研里约热内卢猫孢子丝菌病：巴西主要地方性流行区的时空分析（1998–2018） Anna Barreto Fernandes Figueiredo Instituto Nacional de Infectologia Evandro Chagas (INI) Mônica Avelar Figueiredo Mafra Magalhães Instituto de Comunicação e Informação Científica e Tecnológica em Saúde Daniel Cardoso Portela Câmara Programa de Computação Científica - PROCC Leticia Santana Pereira Instituto Nacional de Infectologia Evandro Chagas (INI) Isabella Dib Ferreira Gremião Instituto Nacional de Infectologia Evandro Chagas (INI) Sandro Antonio Pereira Instituto Nacional de Infectologia Evandro Chagas (INI) 简报 关键词：猫孢子丝菌病。人兽共患病监测。同一健康。空间分析。 发布日期：2026年10月22日 DOI：https://doi.org/10.21203/rs.3.rs-11283995/v1 许可：本作品依据知识共享署名4.0国际许可协议授权。阅读完整许可协议 附加声明：未报告存在利益冲突。第1页/共10页
摘要 由巴西孢子丝菌引起的猫传播型孢子丝菌病是巴西重要的人兽共患病，里约热内卢是主要地方性流行区。本研究分析了1998年至2018年间在Fiocruz诊断的猫孢子丝菌病病例的时空分布。采用生态学研究设计，纳入经真菌培养确诊的病例。对居住地址进行地理编码，并采用核密度估计和Kulldorff时空扫描统计评估空间分布。在5,113例确诊病例中，4,502例成功进行地理编码并纳入空间分析。1998年至2012年间识别出13个具有统计学意义的时空聚集区，主要位于里约热内卢经济欠发达地区及拜沙达弗鲁米嫩塞的邻近市镇。大多数受影响猫为年轻、雄性、混种且未绝育。同一地点反复发生较为常见，且多数记录于一年间隔内，表明存在明显的空间和时间聚集性。2012年后未检测到具有统计学意义的聚集区，可能反映了兽医诊疗服务去中心化后转诊模式的变化。这些发现凸显了持续存在的高风险区域，并为地方性流行城市环境中猫孢子丝菌病的地理靶向监测和防控策略提供了支持。引言 由巴西孢子丝菌引起的猫传播型孢子丝菌病是巴西人兽共患传播的主要途径，尤其是在受影响最严重的里约热内卢州（Rabello等，2022）。该病在巴西境内及向其他南美洲国家的逐步扩散引发了对其地理扩张的担忧（Do Prado等，2023；Etchecopaz等，2021；Thomson等，2023）。尽管地方性流行态势长期存在，但主要受影响区域的长期时空分析仍然匮乏（Ferreira等，2025；Figueiredo等，2022）。本研究旨在分析里约热内卢大都市区20年间猫孢子丝菌病的时空分布，识别该病发生的最高风险区域。材料与方法 采用生态学研究设计，纳入1998年至2018年间在巴西里约热内卢Fundação Oswaldo Cruz（Fiocruz）Evandro Chagas国家传染病研究所（INI）家养动物皮肤人兽共患病临床研究实验室（Lapclin-Dermzoo）经真菌培养确诊的猫孢子丝菌病病例。根据每只动物的居住地址对病例进行地理编码，采用标准化流程，包括地址校正及通过R中Bing Maps API进行地理编码，必要时使用Google Maps进行人工核验和补充。采用5公里半径的核密度估计探索空间分布。使用SaTScan 9.7中实现的时空重排模型识别时空聚集区，基于第2页/共10页
Kulldorff（1997）提出的时空扫描统计量。病例按年份汇总，并在七个三年期间（1998–2000年至2016–2018年）回顾性评估聚集性。最大空间聚集规模限制在1公里半径内，以检测具有流行病学意义的监测区域。显著聚集区使用ArcGIS 10.2进行制图。结果 研究期间共诊断5，113例猫孢子丝菌病病例。在排除记录不可用和地址信息不充分的病例后，4，502例（88.1%）成功进行地理编码并纳入空间分析。病例数随时间增加，2010年达到峰值（502例），2013年至2015年间出现暂时下降（图1）。大多数受影响动物为雄性（68.1%）、年轻（< 48月龄）、混种（88.9%）和未绝育（77.4%）。核密度图显示该病呈渐进性空间扩散，尤其是向与里约热内卢市接壤的市镇扩散，包括Duque de Caxias、Nilópolis、Nova Iguaçu和São João de Meriti（图2）。相比之下，在高收入地区如Zona Sul、Barra da Tijuca和Recreio dos Bandeirantes观察到的病例很少，这些地区合计仅占所有病例的1.0%。时空扫描分析识别出13个显著聚集区（p < 0.05），包括五个一级聚集区和八个二级聚集区。最早的一级聚集区（1998–2000年）位于Penha街区（Zona Norte），相对危险度（RR）为2.31。2013–2015年和2016–2018年期间未检测到显著聚集区（表1）。第3页/共10页
表1 1998年至2018年Lapclin-Dermzoo/INI/Fiocruz诊断的猫孢子丝菌病病例的时空聚集区。期间聚集区半径（km）年份病例数期望病例数RRp值位置 1998– 2000 1（一级聚集区）0.001999166.912.310.000Penha – 里约热内卢 20.9320002012.321.620.017Centro - Nilópolis 30.35199983.462.310.022Parque Analândia – São João de Meriti 2001– 2003 1（一级聚集区）0.00200191.018.940.000Comendador Soares – Nova Iguaçu 20.00200160.678.940.001Pechincha – 里约热内卢 2004– 2006 1（一级聚集区）0.902006102.523.960.002Manguinhos – 里约热内卢 20.97200692.134.220.004Bonsucesso – 里约热内卢 30.95200661.165.150.037Jardim Sumaré – São João de Meriti 40.74200692.523.570.037Centro - Nilópolis 2007– 2009 1（一级聚集区）0.35200761.234.860.027Caioaba – Nova Iguaçu 20.93200771.853.780.049Parque Lafaiete – Duque de Caxias 2010– 2012 1（一级聚集区）0.722012124.042.970.005São José – Belford Roxo 20.74201171.684.170.018Campo Grande – 里约热内卢 2013– 2015 0------- 2016– 2018 0------- 第4页/共10页
对同一地点重复发生的分析显示，1，657例（36.8%）发生在共享地址，分布于586个地点。大多数地点出现两例或三例，但部分地点记录多达49例。在这些地点中，74.85%的病例发生在间隔不超过一年的时间内，表明存在明显的时间聚集性。讨论 本研究首次应用时空扫描分析评估里约热内卢州猫孢子丝菌病的时空动态。结果描述了1998年至2018年间在INI/Fiocruz（巴西主要的真菌病转诊中心）诊断病例的分布和主要流行病学特征。本研究中观察到的流行病学特征——以年轻、雄性、未去势和混种猫为主——与既往猫孢子丝菌病研究一致（Pereira et al. 2014; Davies and Troy 1996; Han and Kano 2021）。这些特征可能与行为因素有关，包括雄性猫更大的活动范围和攻击性互动，这可能有利于通过抓伤和咬伤传播。空间分析显示，疾病从里约热内卢市逐步扩展至拜沙达弗鲁米嫩塞地区的邻近市镇，形成一条传播带，与先前描述的人类和犬孢子丝菌病模式相似（Figueiredo et al. 2022; Silva et al. 2012）。相比之下，该市高收入地区记录的病例很少，那里的猫可能更常室内饲养，接触街道的机会有限。在首都经济欠发达地区和拜沙达弗鲁米嫩塞各市镇，房屋是主要居住类型（Silva et al. 2012; Schubach et al. 2005），这可能促进猫更多地接触户外环境。在Penha、Manguinhos和Bonsucesso等街区检测到的聚集区位于经济欠发达地区，以房屋为主，动物接触户外环境的可能性更大。此外，这些街区靠近INI/Fiocruz，这可能在该流行病早期促进了获得兽医诊疗的机会。2013年后无显著聚集区也可能反映了2014年兽医服务分散化后转诊模式的变化，当时里约热内卢市开始提供免费诊断和治疗。本研究的主要发现之一是同一地点发生的病例比例很高，表明存在明显的空间聚集性。这一模式与超级传播现象中描述的异质性传播动态相符，即相对少数的宿主可能对传播做出不成比例的贡献（Lloyd-Smith et al. 2005; Woolhouse et al. 1997）。然而，本研究未直接评估传播链或识别个体超级传播者。家庭内猫的高密度，通常与不受限制的户外接触和有限的兽医诊疗相结合，可能促进持续传播和同一地址多例病例的发生。第5/10页
还观察到明显的时间聚集性。同一地点记录的大多数病例发生在相对较短的间隔内：约75%在一年内发现，约80%在两年内发现。约20%的病例观察到超过四年的较长间隔。这些模式可能反映了易感动物的反复引入、局部持续传播或孢子丝菌属的环境持久性，尽管本研究无法确定这些机制的相对贡献。孢子丝菌的环境检测仍然有限，在持续聚集地区进行进一步研究可能有助于阐明环境来源的作用（Rabello et al. 2022; Poester et al. 2018）。在Lapclin-Dermzoo/INI/Fiocruz记录的病例系列代表了研究期间里约热内卢诊断的猫孢子丝菌病的相当大比例。直到2014年，INI是该州唯一系统提供免费诊断、临床监测和患病动物治疗的机构。在解释病例的空间分布时，应考虑这种转诊模式，尤其是在距离该机构较近的地区。总体而言，这些发现支持在猫孢子丝菌病持续聚集的地区，特别是在猫自由活动数量大的密集城市环境中，实施地理针对性的监测和控制策略。声明 利益冲突 作者无相关财务或非财务利益需要披露。CRediT作者贡献声明 Anna B. F. Figueiredo 概念化；方法学；形式分析；调查；写作——初稿；可视化。Daniel C. P. Câmara 写作——审阅与编辑。Isabella D. F. Gremião 写作——审阅与编辑。Leticia Santana Pereira 写作——审阅与编辑。第6/10页
Mônica A. F. M. Magalhães负责资源、写作——审阅与编辑、监督、项目管理、资金获取。Sandro A. Pereira负责资源、写作——审阅与编辑、监督、项目管理、资金获取。伦理声明 本回顾性研究完全基于现有兽医病历中获得的数据，未对动物进行任何前瞻性干预。资金 本研究得到里约热内卢州研究资助基金会（FAPERJ；JCNE E-26/202.737/2019）的支持。Sandro Antonio Pereira是国家科学技术发展委员会（CNPq）生产力奖学金获得者（316975/2023-0）。本研究未获得其他外部资金。作者贡献 A.B.F.F.参与了概念构思、方法学、形式分析、调查、原始草案撰写和可视化。M.A.F.M.M.参与了资源、稿件审阅与编辑、监督、项目管理和资金获取。D.C.P.C.、L.S.P.和I.D.F.G.参与了稿件审阅与编辑。S.A.P.参与了资源、稿件审阅与编辑、监督、项目管理和资金获取。所有作者审阅并批准了最终稿件。致谢 作者感谢Fiocruz Evandro Chagas国家传染病研究所伴侣动物皮肤动物疫病临床研究实验室提供的机构支持以及为本研究提供必要的基础设施。数据可用性 当前研究中分析的数据集可在合理请求下从通讯作者处获得。第7/10页
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14. Thomson P, González C, Blank O, Ramírez V, del Río C, Santibáñez S等 (2023) 智利麦哲伦地区家猫中由巴西孢子丝菌引起的孢子丝菌病暴发：一项同一健康方法研究。J Fungi 9:226. https://doi.org/10.3390/jof9020226 15. Woolhouse MEJ, Dye C, Etard JF, Smith T, Charlwood JD, Garnett GP等 (1997) 传染因子传播的异质性：对控制规划设计的启示。Proc Natl Acad Sci USA 94:338–342. https://doi.org/10.1073/pnas.94.1.338 图 图1 按研究期间在Lapclin-Dermzoo/INI/Fiocruz诊断的猫孢子丝菌病病例的时间序列 第9/10页
图2 通过对里约热内卢州大都市区猫孢子丝菌病病例进行地理参照获得的核密度图（1998-2018）第10/10页
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Feline sporotrichosis in Rio de Janeiro: Space-time analysis of the main enzootic region in Brazil (1998–2018) Anna Barreto Fernandes Figueiredo Instituto Nacional de Infectologia Evandro Chagas (INI) Mônica Avelar Figueiredo Mafra Magalhães Instituto de Comunicação e Informação Científica e Tecnológica em Saúde Daniel Cardoso Portela Câmara Programa de Computação Científica - PROCC Leticia Santana Pereira Instituto Nacional de Infectologia Evandro Chagas (INI) Isabella Dib Ferreira Gremião Instituto Nacional de Infectologia Evandro Chagas (INI) Sandro Antonio Pereira Instituto Nacional de Infectologia Evandro Chagas (INI) Short Report Keywords: Feline sporotrichosis. Zoonosis Surveillance. One Health. Spatial Analysis. Posted Date: October 22nd, 2026 DOI: https://doi.org/10.21203/rs.3.rs-11283995/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Additional Declarations: No competing interests reported. Page 1/10
Abstract Feline-transmitted sporotrichosis caused by Sporothrix brasiliensis is an important zoonosis in Brazil, with Rio de Janeiro representing a major endemic area. This study analyzed the spatiotemporal distribution of feline sporotrichosis cases diagnosed at Fiocruz between 1998 and 2018. An ecological study was conducted using cases confirmed by fungal culture. Residential addresses were georeferenced, and spatial distribution was assessed using kernel density estimation and Kulldorff’s space-time scan statistics. Of 5,113 diagnosed cases, 4,502 were successfully georeferenced and included in the spatial analyses. Thirteen significant space-time clusters were identified between 1998 and 2012, mainly in economically disadvantaged areas of Rio de Janeiro and neighboring municipalities in the Baixada Fluminense. Most affected cats were young, male, mixed-breed, and unneutered. Repeated occurrences at the same locations were frequent, and most were recorded within a one-year interval, indicating marked spatial and temporal aggregation. No significant clusters were detected after 2012, possibly reflecting changes in referral patterns following decentralization of veterinary care. These findings highlight persistent high-risk areas and support geographically targeted surveillance and control strategies for feline sporotrichosis in endemic urban settings. Introduction Feline-transmitted sporotrichosis, caused by Sporothrix brasiliensis, represents the main route of zoonotic transmission in Brazil, particularly in Rio de Janeiro, the most affected state (Rabello et al. 2022). The progressive spread of the disease within Brazil and to other South American countries has raised concern about its geographic expansion (Do Prado et al. 2023; Etchecopaz et al. 2021; Thomson et al. 2023). Despite the long-standing enzootic scenario, long-term spatiotemporal analyses in the main affected region remain scarce (Ferreira et al. 2025; Figueiredo et al. 2022). This study aimed to analyze the spatiotemporal distribution of feline sporotrichosis in the Metropolitan Region of Rio de Janeiro over a 20-year period, identifying areas of highest risk for occurrence of the disease. Materials and Methods An ecological design was adopted, including feline sporotrichosis cases diagnosed by fungal culture at the Laboratório de Pesquisa Clínica em Dermatozoonoses em Animais Domésticos (Lapclin-Dermzoo), Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil, between 1998 and 2018. Cases were georeferenced according to the residence address of each animal using a standardized process that included address correction and geocoding through the Bing Maps API in R, followed by manual verification and completion using Google Maps when necessary. Spatial distribution was explored using kernel density estimation with a 5-km radius. Space-time clusters were identified using the space-time permutation model implemented in SaTScan 9.7, based on the Page 2/10
space-time scan statistic proposed by Kulldorff (1997). Cases were aggregated by year, and clusters were retrospectively evaluated across seven three-year periods (1998–2000 to 2016–2018). The maximum spatial cluster size was restricted to a 1-km radius to detect epidemiologically meaningful areas for surveillance. Significant clusters were mapped using ArcGIS 10.2. Results A total of 5,113 feline sporotrichosis cases were diagnosed during the study period. After excluding unavailable records and cases without sufficient address information, 4,502 cases (88.1%) were successfully georeferenced and included in the spatial analyses. The number of cases increased over time, reaching a peak in 2010 (502 cases), with a temporary decline between 2013 and 2015 (Fig. 1). Most affected animals were male (68.1%), young (< 48 months), mixedbreed (88.9%), and unneutered (77.4%). Kernel density maps revealed a progressive spatial expansion of the disease, particularly toward municipalities bordering the city of Rio de Janeiro, including Duque de Caxias, Nilópolis, Nova Iguaçu, and São João de Meriti (Fig. 2). In contrast, few cases were observed in higher-income areas such as Zona Sul, Barra da Tijuca, and Recreio dos Bandeirantes, which together accounted for only 1.0% of all cases. Space-time scan analysis identified 13 significant clusters (p < 0.05), including five primary clusters and eight secondary clusters. The earliest primary cluster (1998–2000) was located in the Penha neighborhood (Zona Norte), with a relative risk (RR) of 2.31. No significant clusters were detected in the periods 2013–2015 and 2016–2018 (Table 1). Page 3/10
Table 1 Space-time clusters of cases of feline sporotrichosis diagnosed at Lapclin-Dermzoo/INI/Fiocruz from 1998 to 2018. PeriodClusterRadius (km) YearCasesExpected cases RRpvalue Location 1998– 2000 1 (primary cluster) 0.001999166.912.310.000Penha – Rio de Janeiro 20.9320002012.321.620.017Centro - Nilópolis 30.35199983.462.310.022Parque Analândia – São João de Meriti 2001– 2003 1 (primary cluster) 0.00200191.018.940.000Comendador Soares – Nova Iguaçu 20.00200160.678.940.001Pechincha – Rio de Janeiro 2004– 2006 1 (primary cluster) 0.902006102.523.960.002Manguinhos – Rio de Janeiro 20.97200692.134.220.004Bonsucesso – Rio de Janeiro 30.95200661.165.150.037Jardim Sumaré – São João de Meriti 40.74200692.523.570.037Centro - Nilópolis 2007– 2009 1 (primary cluster) 0.35200761.234.860.027Caioaba – Nova Iguaçu 20.93200771.853.780.049Parque Lafaiete – Duque de Caxias 2010– 2012 1 (primary cluster) 0.722012124.042.970.005São José – Belford Roxo 20.74201171.684.170.018Campo Grande – Rio de Janeiro 2013– 2015 0------- 2016– 2018 0------- Page 4/10
Analysis of repeated occurrences at the same location showed that 1,657 cases (36.8%) occurred at shared addresses, distributed across 586 locations. Most locations presented two or three cases, although some sites recorded up to 49 cases. In 74.85% of these locations, cases occurred within an interval of up to one year, indicating marked temporal aggregation. Discussion This study represents the first application of space-time scan analysis to evaluate the spatiotemporal dynamics of feline sporotrichosis in the state of Rio de Janeiro. The results describe the distribution and main epidemiological characteristics of cases diagnosed at INI/Fiocruz, a major referral center for mycoses in Brazil, between 1998 and 2018. The epidemiological profile observed in the present study, with a predominance of young, male, unneutered, and mixed-breed cats, is consistent with previous studies on feline sporotrichosis (Pereira et al. 2014; Davies and Troy 1996; Han and Kano 2021). These characteristics may be associated with behavioral factors, including greater mobility and aggressive interactions among male cats, which may favor transmission through scratches and bites. Spatial analysis revealed a progressive expansion of the disease from the municipality of Rio de Janeiro to neighboring municipalities in the Baixada Fluminense region, forming a belt of transmission similar to patterns previously described in human and canine sporotrichosis (Figueiredo et al. 2022; Silva et al. 2012). In contrast, few cases were recorded in higher-income areas of the city, where cats may more frequently live indoors with limited access to the streets. In economically disadvantaged areas of the capital and in the Baixada Fluminense municipalities, houses are the predominant type of dwelling (Silva et al. 2012; Schubach et al. 2005), which may facilitate greater outdoor access by cats. Clusters detected in neighborhoods such as Penha, Manguinhos, and Bonsucesso were located in economically disadvantaged areas with a predominance of houses and greater potential access of animals to the outdoor environment. In addition, these neighborhoods are located close to INI/Fiocruz, which may have facilitated access to veterinary care during the early years of the epidemic. The absence of significant clusters after 2013 may also reflect changes in referral patterns following the decentralization of veterinary services in 2014, when the municipality of Rio de Janeiro began offering free diagnosis and treatment. One of the main findings of this study was the high proportion of cases occurring at identical locations, indicating marked spatial aggregation. This pattern is compatible with heterogeneous transmission dynamics described in superspreading phenomena, in which a relatively small proportion of hosts may contribute disproportionately to transmission (Lloyd-Smith et al. 2005; Woolhouse et al. 1997). However, the present study did not directly assess transmission chains or identify individual superspreaders. High densities of cats within households, often combined with unrestricted outdoor access and limited veterinary care, may contribute to sustained transmission and the occurrence of multiple cases at the same address. Page 5/10
A clear temporal aggregation was also observed. Most cases recorded at the same locations occurred within relatively short intervals: approximately 75% were identified within one year and about 80% within two years. Longer intervals of more than four years were observed in approximately 20% of cases. These patterns may reflect repeated introduction of susceptible animals, persistent local transmission, or environmental persistence of Sporothrix spp., although the relative contribution of these mechanisms could not be determined in the present study. Environmental detection of Sporothrix remains limited, and further studies in areas with persistent clustering could help clarify the role of environmental sources (Rabello et al. 2022; Poester et al. 2018). The case series recorded at Lapclin-Dermzoo/INI/Fiocruz represents a substantial proportion of feline sporotrichosis cases diagnosed in Rio de Janeiro during the study period. Until 2014, INI was the only institution in the state that systematically provided free diagnosis, clinical monitoring, and treatment of affected animals. This referral pattern should be considered when interpreting the spatial distribution of cases, particularly in areas located closer to the institution. Overall, these findings support geographically targeted surveillance and control strategies in areas with persistent clustering of feline sporotrichosis, particularly in densely populated urban settings with large free-roaming cat populations. Declarations Competing Interests The authors have no relevant financial or non-financial interests to disclose. CRediT authorship contribution statement Anna B. F. Figueiredo Conceptualization; Methodology; Formal Analysis; Investigation; Writing – Original Draft; Visualization. Daniel C. P. Câmara Writing – Review & Editing. Isabella D. F. Gremião Writing – Review & Editing. Leticia Santana Pereira Writing – Review & Editing. Page 6/10
Mônica A. F. M. Magalhães Resources; Writing – Review & Editing; Supervision; Project Administration; Funding Acquisition. Sandro A. Pereira Resources; Writing – Review & Editing; Supervision; Project Administration; Funding Acquisition. Ethics Statement This retrospective study was based exclusively on data obtained from existing veterinary medical records and did not involve any prospective intervention in animals. Funding This study was supported by Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ; JCNE E-26/202.737/2019). Sandro Antonio Pereira is a recipient of a Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) productivity fellowship (316975/2023-0). No additional external funding was received for this study. Author Contribution A.B.F.F. contributed to conceptualization, methodology, formal analysis, investigation, preparation of the original draft, and visualization. M.A.F.M.M. contributed to resources, review and editing of the manuscript, supervision, project administration, and funding acquisition. D.C.P.C., L.S.P., and I.D.F.G. contributed to review and editing of the manuscript. S.A.P. contributed to resources, review and editing of the manuscript, supervision, project administration, and funding acquisition. All authors reviewed and approved the final manuscript. Acknowledgement The authors thank the Laboratório de Pesquisa Clínica em Dermatozoonoses em Animais Domésticos of the Instituto Nacional de Infectologia Evandro Chagas/Fiocruz for institutional support and for providing the infrastructure necessary for this study. Data Availability The datasets analyzed during the current study are available from the corresponding author on reasonable request. Page 7/10
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14. Thomson P, González C, Blank O, Ramírez V, del Río C, Santibáñez S et al (2023) Sporotrichosis Outbreak Due to Sporothrix brasiliensis in Domestic Cats in Magallanes, Chile: A One-Health- Approach Study. J Fungi 9:226. https://doi.org/10.3390/jof9020226 15. Woolhouse MEJ, Dye C, Etard JF, Smith T, Charlwood JD, Garnett GP et al (1997) Heterogeneities in the transmission of infectious agents: implications for the design of control programs. Proc Natl Acad Sci USA 94:338–342. https://doi.org/10.1073/pnas.94.1.338 Figures Figure 1 Time series of feline sporotrichosis cases diagnosed at Lapclin-Dermzoo/INI/Fiocruz according to study period Page 9/10
Figure 2 Kernel density map obtained by georeferencing of feline sporotrichosis cases in the Metropolitan Region of the state of Rio de Janeiro (1998-2018) Page 10/10