Sporotrichosis: Difference between revisions

(Created page with "==Background== *Also known as "Rose gardener's disease"<ref>Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN ...")
 
 
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==Background==
==Background==
*Also known as "Rose gardener's disease"<ref>Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0.</ref>  
*Also known as "Rose gardener's disease"<ref>Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0.</ref>  
*Caused by the fungus ''Sporothrix schenckii''<ref>Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 654–6. ISBN 0-8385-8529-9.</ref>
*Caused by the [[fungus]] ''[[Sporothrix schenckii]]''<ref>Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 654–6. ISBN 0-8385-8529-9.</ref> found on rose thorns
*Usually affects skin, although other rare forms can affect the lungs, joints, bones, and brain
*Usually affects skin, although other rare forms can affect the lungs, joints, bones, and brain
*Enters skin through small cuts and abrasions, and inhalation for pulmonary disease
*Enters skin through small cuts and abrasions, and inhalation for pulmonary disease
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==Clinical Features==
==Clinical Features==
Progresses slowly: first symptoms may appear 1 to 12 weeks (average 3 weeks) after the initial exposure to the fungus
[[File:PMC4295339 DRP2014-272376.002.png|thumb|Fixed cutaneous sporotrichosis. A crusted/verrucous plaque develops at inoculation site, seen here over face of a child.]]
 
[[File:PMC2729227 wjem-10-204f1.png|thumb|Lymphocutaneous sporotrichosis.]]
===Forms and symptoms===
[[File:PMC4295339 DRP2014-272376.001.png|thumb|Lymphocutaneous sporotrichosis. Noduloulcerative lesions appear along the lymphatics proximal to the initial inoculation injury site.]]
* ''Cutaneous or skin sporotrichosis''
''Progresses slowly: first symptoms may appear 1 to 12 weeks (average 3 weeks) after the initial exposure to the fungus''
:This is the most common form of this disease.  Symptoms of this form include nodular lesions or bumps in the skin, at the point of entry and also along lymph nodes and vessels.  The lesion starts off small and painless, and ranges in color from pink to purple.  Left untreated, the lesion becomes larger and look similar to a boil and more lesions will appear, until a chronic [ulcer develops.
===Forms and Symptoms===
 
*''Cutaneous or skin''
:Usually, cutaneous sporotrichosis lesions occur in the finger, hand, and arm.
**Most common form  
 
**Symptoms include nodular [[rash|lesions]] or bumps in the skin, at the point of entry and also along lymph nodes and vessels
***Lesion starts off small and painless, and ranges in color from pink to purple
***Left untreated, lesion becomes larger and looks similar to an [[abscess]].  More lesions will appear until a chronic ulcer develops
*''Pulmonary sporotrichosis''
*''Pulmonary sporotrichosis''
:This rare form of the disease occur when ''S. schenckii'' spores are inhaled.  Symptoms of pulmonary sporotrichosis include productive coughing, nodules and cavitations of the lungs, fibrosis, and swollen hilar lymph nodes.  Patients with this form of sporotrichosis are susceptible to developing tuberculosis and pneumonia
**Rare
 
**From inhalation of spores  
**Symptoms include productive [[cough]]ing, nodules and cavitations of the lungs, fibrosis, and hilar [[lymphadenopathy]] nodes
**May become superinfected with [[pneumonia]] or [[tuberculosis]]
*''Disseminated sporotrichosis''
*''Disseminated sporotrichosis''
:When the infection spreads from the primary site to secondary sites in the body, the disease develops into a rare and critical form called disseminated sporotrichosis.  The infection can spread to joints and bones (called ''osteoarticular sporotrichosis'') as well as the central nervous system (''sporotrichosis meningitis'')
**May affect joints and bones (osteoarticular sporotrichosis) and or CNS (''sporotrichosis [[meningitis]]'')
 
**Symptoms include weight loss, anorexia, and appearance of bony lesions
:The symptoms of disseminated sporotrichosis include weight loss, anorexia, and appearance of bony lesions.


==Differential Diagnosis==
==Differential Diagnosis==
{{SSTI DDX}}
{{Hand Infection DDX}}


==Workup==
==Evaluation==
Patients with sporotrichosis will have [[antibodies|antibody]] against the fungus S. schenckii, however, due to variability in sensitivity and specificity, it may not be a reliable diagnosis for this disease.  The confirming diagnosis remains culturing the fungus from the skin, [[sputum]], [[synovial fluid]], and [[cerebrospinal fluid]].
*Fungal culture of skin, sputum, synovial fluid, or [[CSF]]


==Management==
==Management==
*Saturated [[potassium iodide]] solution
*Antifungal medication
:Although its mechanism is unknown, application of potassium iodide in droplet form can cure cutaneous sporotrichosis.  This usually requires 3 to 6 months of treatment.
**[[Itraconazole]]  
 
***Drug of choice (more effective than fluconazole)
*[[Itraconazole]] (Sporanox) and [[fluconazole]]
**[[Fluconazole]]
:These are [[Antifungal medication|antifungal]] drugs.  Itraconazole is currently the drug of choice and is significantly more effective than fluconazole. Fluconazole should be reserved for patients who cannot tolerate itraconazole.
***Fluconazole (for patients who cannot tolerate itraconazole)
*[[Amphotericin B]]
**[[Amphotericin B]] IV
:This antifungal medication is delivered intravenously.  Many patients, however, cannot tolerate Amphotericin B due to its potential side effects of fever, nausea, and vomiting.
***For disseminated of severe disease
Lipid formulations of amphotericin B are usually recommended instead of amphotericin B deoxycholate because of a better adverse-effect profile. Amphotericin B can be used for severe infection during pregnancy. For children with disseminated or severe disease, amphotericin B deoxycholate can be used initially, followed by itraconazole.<ref name="dbt.consultantlive.com">Hogan BK, Hospenthal DR. [http://dbt.consultantlive.com/display/article/1145628/1545568 Update on the therapy for sporotrichosis]. Drug Benefit Trends. 2010;22:49-52.</ref>
*Surgery
 
**For [[osteomyelitis]] or cavitary nodules in the lungs
:In case of sporotrichosis meningitis, the patient may be given a combination of Amphotericin B and 5-fluorocytosine/[[Flucytosine]].
*Standard [[antibiotics]]
 
**Lesions sometimes become superinfected, consider as necessary
*Newer [[triazole]]s
Several studies have shown that [[posaconazole]] has in vitro activity similar to that of amphotericin B and itraconazole; therefore, it shows promise as an alternative therapy. However, [[voriconazole]] susceptibility varies. Because the correlation between in vitro data and clinical response has not been demonstrated, there is insufficient evidence to recommend either posaconazole or voriconazole for treatment of sporotrichosis at this time.<ref name="dbt.consultantlive.com"/>
 
*[[Surgery]]
:In cases of bone infection and cavitatory nodules in the lungs, surgery may be necessary.
 
Sometimes become superinfected


==Disposition==
==Disposition==
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==See Also==
==See Also==
*[[Fungal infections]]
*[[Antifungals]]


==Sources==
==References==
<references/>
<references/>
[[Category:Dermatology]]
[[Category:ID]]

Latest revision as of 20:18, 7 June 2022

Background

  • Also known as "Rose gardener's disease"[1]
  • Caused by the fungus Sporothrix schenckii[2] found on rose thorns
  • Usually affects skin, although other rare forms can affect the lungs, joints, bones, and brain
  • Enters skin through small cuts and abrasions, and inhalation for pulmonary disease
  • Can also be acquired from handling cats with the disease

Clinical Features

Fixed cutaneous sporotrichosis. A crusted/verrucous plaque develops at inoculation site, seen here over face of a child.
Lymphocutaneous sporotrichosis.
Lymphocutaneous sporotrichosis. Noduloulcerative lesions appear along the lymphatics proximal to the initial inoculation injury site.

Progresses slowly: first symptoms may appear 1 to 12 weeks (average 3 weeks) after the initial exposure to the fungus

Forms and Symptoms

  • Cutaneous or skin
    • Most common form
    • Symptoms include nodular lesions or bumps in the skin, at the point of entry and also along lymph nodes and vessels
      • Lesion starts off small and painless, and ranges in color from pink to purple
      • Left untreated, lesion becomes larger and looks similar to an abscess. More lesions will appear until a chronic ulcer develops
  • Pulmonary sporotrichosis
  • Disseminated sporotrichosis
    • May affect joints and bones (osteoarticular sporotrichosis) and or CNS (sporotrichosis meningitis)
    • Symptoms include weight loss, anorexia, and appearance of bony lesions

Differential Diagnosis

Skin and Soft Tissue Infection

Look-A-Likes

Hand and finger infections

Look-Alikes

Evaluation

  • Fungal culture of skin, sputum, synovial fluid, or CSF

Management

  • Antifungal medication
    • Itraconazole
      • Drug of choice (more effective than fluconazole)
    • Fluconazole
      • Fluconazole (for patients who cannot tolerate itraconazole)
    • Amphotericin B IV
      • For disseminated of severe disease
  • Surgery
  • Standard antibiotics
    • Lesions sometimes become superinfected, consider as necessary

Disposition

  • Normally treated as outpatient

See Also

References

  1. ↑ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0.
  2. ↑ Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 654–6. ISBN 0-8385-8529-9.
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