Sporotrichosis: Difference between revisions
 
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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> found on rose thorns
*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.]]
[[File:PMC4295339 DRP2014-272376.001.png|thumb|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===
===Forms and Symptoms===
*''Cutaneous or skin''
*''Cutaneous or skin''
**Most common form  
**Most common form  
**Symptoms include nodular lesions or bumps in the skin, at the point of entry and also along lymph nodes and vessels
**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
***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
***Left untreated, lesion becomes larger and looks similar to an [[abscess]].  More lesions will appear until a chronic ulcer develops
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**Rare  
**Rare  
**From inhalation of spores  
**From inhalation of spores  
**Symptoms include productive coughing, nodules and cavitations of the lungs, fibrosis, and hilar lymphadenopathy nodes
**Symptoms include productive [[cough]]ing, nodules and cavitations of the lungs, fibrosis, and hilar [[lymphadenopathy]] nodes
**May become superinfected with pneumonia or tuberculosis
**May become superinfected with [[pneumonia]] or [[tuberculosis]]
*''Disseminated sporotrichosis''
*''Disseminated sporotrichosis''
**May affect joints and bones (osteoarticular sporotrichosis) and or CNS (''sporotrichosis meningitis'')
**May affect joints and bones (osteoarticular sporotrichosis) and or CNS (''sporotrichosis [[meningitis]]'')
**Symptoms include weight loss, anorexia, and appearance of bony lesions
**Symptoms include weight loss, anorexia, and appearance of bony lesions


==Differential Diagnosis==
==Differential Diagnosis==
===General===
{{SSTI DDX}}
{{Template:SSTI DDX}}
{{Hand Infection DDX}}
 
===Hand Infection===
{{Template:Hand Infection DDX}}


==Workup==
==Evaluation==
Fungal culture of skin, sputum, synovial fluid, or [[CSF]]
*Fungal culture of skin, sputum, synovial fluid, or [[CSF]]


==Management==
==Management==
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***For disseminated of severe disease
***For disseminated of severe disease
*Surgery
*Surgery
**For [[osteomyelitis]] or cavitatory nodules in the lungs
**For [[osteomyelitis]] or cavitary nodules in the lungs
*Standard antibiotics
*Standard [[antibiotics]]
**Lesions sometimes become superinfected, consider as necessary
**Lesions sometimes become superinfected, consider as necessary


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


==References==
==References==

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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