Sporotrichosis: Difference between revisions
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Progresses slowly: first symptoms may appear 1 to 12 weeks (average 3 weeks) after the initial exposure to the fungus
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 sporotrichosis''
* ''Cutaneous or skin''
: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.
**Most common form  
 
**Symptoms include nodular lesions or bumps in the skin, at the point of entry and also along lymph nodes and vessels
:Usually, cutaneous sporotrichosis lesions occur in the finger, hand, and arm.
***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 coughing, 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==

Revision as of 05:17, 6 April 2014

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

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
    • Rare
    • From inhalation of spores
    • Symptoms include productive coughing, nodules and cavitations of the lungs, fibrosis, and hilar lymphadenopathy nodes
    • May become superinfected with pneumonia or tuberculosis
  • 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

Workup

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
    • For osteomyelitis or cavitatory nodules in the lungs
  • Standard antibiotics
    • Lesions sometimes become superinfected, consider as necessary

Disposition

  • Normally treated as outpatient

See Also

Sources

  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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