Dermatologic Manifestations of Sporotrichosis Medication
- Author: Scott D Miller, MD; Chief Editor: Dirk M Elston, MD more...
The goals of pharmacotherapy are to reduce morbidity and prevent complications. Continue systemic therapy until clinical resolution is achieved, typically 4-6 months.
These agents are used for fungicidal or fungistatic eradication of the infective organism S schenkii.
Amphotericin B is produced by a strain of Streptomyces nodosus; it can be fungistatic or fungicidal. Amphotericin B binds to sterols, such as ergosterol, in the fungal cell membrane, causing intracellular components to leak with subsequent fungal cell death. This is the drug of choice for systemic disease, although more recent literature indicates itraconazole or terbinafine may replace amphotericin B as the drug of choice for systemic sporotrichosis.
Itraconazole is a synthetic triazole antifungal agent that slows fungal cell growth by inhibiting cytochrome P-450-dependent synthesis of ergosterol, a vital component of fungal cell membranes. Itraconazole is the drug of choice for cutaneous disease and second drug of choice (likely to soon be first DOC) for systemic disease. It is available as a 100-mg capsule.
Potassium iodide is a saturated solution containing approximately 142 g potassium iodide in 100 mL water. It inhibits thyroid hormone secretion. The mechanism of action against Sporothrix is unknown. It is the third drug of choice for cutaneous disease. Potassium iodide is not effective for systemic disease. It contains 8 mg of iodide per drop and may be mixed with juice or water for intake.
Fluconazole is a synthetic oral antifungal (broad-spectrum bistriazole) that selectively inhibits fungal cytochrome P-450 and sterol C-14 alpha-demethylation. It is the fourth drug of choice for systemic disease, modestly effective and thus reserved for itraconazole-intolerant patients.
Terbinafine is a synthetic allylamine hypothesized to act by inhibiting squalene epoxidase, thus blocking synthesis of ergosterol, a vital component of fungal cell membranes. Terbinafine is an alternative for cutaneous disease, with promise for systemic disease.
Schenck RB. On refractory subcutaneous abscesses caused by a fungus possibly related to the sporotricha. Bull John Hopkins Hospital. 1898. 9:286-90.
Davis BA. Sporotrichosis. Dermatol Clin. 1996 Jan. 14(1):69-76. [Medline].
Lopes-Bezerra LM, Schubach A, Costa RO. Sporothrix schenckii and sporotrichosis. An Acad Bras Cienc. 2006 Jun. 78(2):293-308. [Medline].
Saravanakumar PS, Eslami P, Zar FA. Lymphocutaneous sporotrichosis associated with a squirrel bite: case report and review. Clin Infect Dis. 1996 Sep. 23(3):647-8. [Medline].
Miller SD, Keeling JH. Ant sting sporotrichosis. Cutis. 2002 Jun. 69(6):439-42. [Medline].
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. 2004 Feb 15. 38(4):529-35. [Medline].
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. 1997 Sep 8. 157(16):1885-7. [Medline].
Hajjeh R, McDonnell S, Reef S, et al. Outbreak of sporotrichosis among tree nursery workers. J Infect Dis. 1997 Aug. 176(2):499-504. [Medline].
Ticoras CJ, Schroeter AL, Hornbeck KL. Disseminated ulcerated papules and nodules. Cutaneous disseminated sporotrichosis. Arch Dermatol. 1996 Aug. 132(8):963-4, 966-7. [Medline].
Zhang Z, Liu X, Lv X, Lin J. Variation in genotype and higher virulence of a strain of Sporothrix schenckii causing disseminated cutaneous sporotrichosis. Mycopathologia. 2011 Dec. 172(6):439-46. [Medline].
Howell SJ, Toohey JS. Sporotrichal arthritis in south central Kansas. Clin Orthop Relat Res. 1998 Jan. 207-14. [Medline].
Sanz J, Andreu JL, Martinez-Garcia G, Suarez D, Mulero J, Larrea A. Sporotrichial bursitis. Br J Rheumatol. 1998 Apr. 37(4):461-2. [Medline].
Kim S, Rusk MH, James WD. Erysipeloid sporotrichosis in a woman with Cushing's disease. J Am Acad Dermatol. 1999 Feb. 40(2 Pt 1):272-4. [Medline].
Morgan M, Reves R. Invasive sinusitis due to Sporothrix schenckii in a patient with AIDS. Clin Infect Dis. 1996 Dec. 23(6):1319-20. [Medline].
Ware AJ, Cockerell CJ, Skiest DJ, Kussman HM. Disseminated sporotrichosis with extensive cutaneous involvement in a patient with AIDS. J Am Acad Dermatol. 1999 Feb. 40(2 Pt 2):350-5. [Medline].
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].
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. 2008 Nov. 38(11):3080-9. [Medline].
Rubio G, Sánchez G, Porras L, Alvarado Z. [Sporotrichosis: prevalence, clinical and epidemiological features in a reference center in Colombia]. Rev Iberoam Micol. 2010 Jun 30. 27(2):75-9. [Medline].
Song Y, Li SS, Zhong SX, Liu YY, Yao L, Huo SS. Report of 457 sporotrichosis cases from Jilin province, northeast China, a serious endemic region. J Eur Acad Dermatol Venereol. 2011 Dec 17. [Medline].
Meffert JJ. Cutaneous sporotrichosis presenting as a keratoacanthoma. Cutis. 1998 Jul. 62(1):37-9. [Medline].
Rodriguez G, Sarmiento L. The asteroid bodies of sporotrichosis. Am J Dermatopathol. 1998 Jun. 20(3):246-9. [Medline].
Anonymous. Systemic antifungal drugs. Med Lett Drugs Ther. 1997 Sep 12. 39(1009):86-8. [Medline].
[Guideline] 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].
Infectious Diseases Society of America. Infections by Organism. Available at http://www.idsociety.org/organism/. Accessed: October 9, 2014.