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Sporotrichosis: Differential Diagnoses & Workup

Author: Scott D Miller, MD, Dermatologist and Dermatologic Surgeon, Department of Dermatology, Carolinas Dermatology Group, PA
Contributor Information and Disclosures

Updated: Mar 19, 2009

Differential Diagnoses

Leishmaniasis
Mycobacterium Marinum Infection of the Skin
Nocardiosis
Syphilis

Other Problems to Be Considered

Tuberculosis verrucosa cutis
Nocardia brasiliensis
Tularemia

Workup

Laboratory Studies

  • Fungal cultures: S schenckii readily grows on Sabouraud dextrose agar at 25°C as a lobated, smooth or verrucous, moist, cream-colored colony with occasional aerial mycelium, maturing to a black leathery colony. Yeast growth at 37°C must be demonstrated to confirm Sporothrix. Inform the laboratory that sporotrichosis is clinically suspected. The organisms are characteristically scarce in tissue and may not be detected with tissue stains alone; therefore, cultures are essential.
  • Mycobacterial cultures: Perform cultures to rule out mycobacterial infection. The laboratory should be alerted to the possibility of an atypical mycobacterial infection, particularly if Mycobacterium marinum is suspected, to ensure that appropriate cultures are performed.
  • Tissue Gram stain: Gram stain is performed to rule out other infective or foreign body processes.
  • Acid-fast stain: Staining of tissue or purulent discharge may assist in the evaluation of possible mycobacterial infection. The paucity of organisms in such infections necessitates the use of cultures if infection is clinically suspected; a negative acid-fast bacillus (AFB) stain does not adequately rule out infection.

Imaging Studies

  • Perform chest radiography if pulmonary symptoms are present.

Other Tests

  • Sporotrichin test: Intradermal skin testing using sporotrichin as an antigen to diagnose sporotrichosis is not routinely used because of its high false-positive and false-negative rates.
  • Urine, semen, and cerebral spinal fluid cultures, as well as fine-needle aspirate or tissue biopsy cultures: Obtain studies as clinically indicated for suspicion of systemic disease.

Procedures

  • Tissue biopsy: Obtain appropriate tissue for hematoxylin and eosin, tissue cultures, Gram stain, Fite stain, and fungal stains.

Histologic Findings

A nonspecific granulomatous reaction with pseudoepitheliomatous hyperplasia is typically present. Rarely, periodic acid-Schiff staining reveals the round to oval, cigar-shaped spores within the granuloma. The rare extracellular asteroid bodies of eosinophilic spicules surrounding a central yeast are specific for sporotrichosis, as asteroid bodies seen in other granulomatous reactions are intracellular, filamentous myelin figures that contain lipid.2,18

More on Sporotrichosis

Overview: Sporotrichosis
Differential Diagnoses & Workup: Sporotrichosis
Treatment & Medication: Sporotrichosis
Follow-up: Sporotrichosis
Multimedia: Sporotrichosis
References
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References

  1. Schenck RB. On refractory subcutaneous abscesses caused by a fungus possibly related to the sporotricha. Bull John Hopkins Hospital. 1898;9:286-90.

  2. Davis BA. Sporotrichosis. Dermatol Clin. Jan 1996;14(1):69-76. [Medline].

  3. Lopes-Bezerra LM, Schubach A, Costa RO. Sporothrix schenckii and sporotrichosis. An Acad Bras Cienc. Jun 2006;78(2):293-308. [Medline].

  4. Saravanakumar PS, Eslami P, Zar FA. Lymphocutaneous sporotrichosis associated with a squirrel bite: case report and review. Clin Infect Dis. Sep 1996;23(3):647-8. [Medline].

  5. Miller SD, Keeling JH. Ant sting sporotrichosis. Cutis. Jun 2002;69(6):439-42. [Medline].

  6. Barros MB, Schubach Ade O, do Valle AC, et al. Cat-transmitted sporotrichosis epidemic in Rio de Janeiro, Brazil: description of a series of cases. Clin Infect Dis. Feb 15 2004;38(4):529-35. [Medline].

  7. Dooley DP, Bostic PS, Beckius ML. Spook house sporotrichosis. A point-source outbreak of sporotrichosis associated with hay bale props in a Halloween haunted-house. Arch Intern Med. Sep 8 1997;157(16):1885-7. [Medline].

  8. Hajjeh R, McDonnell S, Reef S, et al. Outbreak of sporotrichosis among tree nursery workers. J Infect Dis. Aug 1997;176(2):499-504. [Medline].

  9. Ticoras CJ, Schroeter AL, Hornbeck KL. Disseminated ulcerated papules and nodules. Cutaneous disseminated sporotrichosis. Arch Dermatol. Aug 1996;132(8):963-4, 966-7. [Medline].

  10. Howell SJ, Toohey JS. Sporotrichal arthritis in south central Kansas. Clin Orthop Relat Res. Jan 1998;207-14. [Medline].

  11. Sanz J, Andreu JL, Martinez-Garcia G, Suarez D, Mulero J, Larrea A. Sporotrichial bursitis. Br J Rheumatol. Apr 1998;37(4):461-2. [Medline].

  12. Kim S, Rusk MH, James WD. Erysipeloid sporotrichosis in a woman with Cushing's disease. J Am Acad Dermatol. Feb 1999;40(2 Pt 1):272-4. [Medline].

  13. Morgan M, Reves R. Invasive sinusitis due to Sporothrix schenckii in a patient with AIDS. Clin Infect Dis. Dec 1996;23(6):1319-20. [Medline].

  14. Ware AJ, Cockerell CJ, Skiest DJ, Kussman HM. Disseminated sporotrichosis with extensive cutaneous involvement in a patient with AIDS. J Am Acad Dermatol. Feb 1999;40(2 Pt 2):350-5. [Medline].

  15. Ruiz-Baca E, Toriello C, Perez-Torres A, Sabanero-Lopez M, Villagomez-Castro JC, Lopez-Romero E. Isolation and some properties of a glycoprotein of 70 kDa (Gp70) from the cell wall of Sporothrix schenckii involved in fungal adherence to dermal extracellular matrix. Med Mycol. July 2008;4:1-13. [Medline].

  16. Nascimento RC, Espindola NM, Castro RA, et al. Passive immunization with monoclonal antibody against a 70-kDa putative adhesin of Sporothrix schenckii induces protection in murine sporotrichosis. Eur J Immunol. Nov 2008;38(11):3080-9. [Medline].

  17. Meffert JJ. Cutaneous sporotrichosis presenting as a keratoacanthoma. Cutis. Jul 1998;62(1):37-9. [Medline].

  18. Rodriguez G, Sarmiento L. The asteroid bodies of sporotrichosis. Am J Dermatopathol. Jun 1998;20(3):246-9. [Medline].

  19. Anonymous. Systemic antifungal drugs. Med Lett Drugs Ther. Sep 12 1997;39(1009):86-8. [Medline].

  20. Kauffman C, Bustamante B, Chapman S, Pappas P. Clinical Practice Guidelines for the Management of Sporotrichosis: 2007 Update by the Infectious Disease Society of America. Clin Infect Dis. November 2007;45(10):1255-65. [Medline]. [Full Text].

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Further Reading

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Keywords

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Contributor Information and Disclosures

Author

Scott D Miller, MD, Dermatologist and Dermatologic Surgeon, Department of Dermatology, Carolinas Dermatology Group, PA
Scott D Miller, MD is a member of the following medical societies: American Academy of Dermatology and American Society for Dermatologic Surgery
Disclosure: Nothing to disclose.

Medical Editor

Kathryn Schwarzenberger, MD, Associate Professor of Medicine, Division of Dermatology, University of Vermont College of Medicine; Consulting Staff, Division of Dermatology, Fletcher Allen Health Care
Kathryn Schwarzenberger, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, American Dermatological Association, Dermatology Foundation, Medical Dermatology Society, and Women's Dermatologic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Lester F Libow, MD, Dermatopathologist, South Texas Dermatopathology Laboratory
Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
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