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Dermatologic Manifestations of Sporotrichosis

  • Author: Scott D Miller, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: May 17, 2016
 

Background

Sporotrichosis is a subcutaneous or systemic infection caused by Sporothrix schenckii, a rapidly growing dimorphic fungus. The organism derives its name from R B Schenck, who first reported the infection in 1898. Sporothrix species typically exist as a saprophytic mold on vegetative matter in humid climates worldwide. A dimorphic fungus, the organism exhibits mycelial forms at 25°C and a yeast form at 37°C.[1, 2, 3]

Cutaneous infection often results from a puncture wound involving infected cats, thorns or other plant matter. Other more unusual reported causes include insect stings, squirrel bites, and trauma induced by liposuction.[4, 5] Any compromise of the skin barrier with subsequent seeding could potentially cause infection. Sporotrichosis usually occurs sporadically as isolated cases. Occasionally, groups of individuals are infected after being exposed to the organism.[6, 7, 8]

Since approximately the beginning of the 21st century, an outbreak of increasing numbers of cases has been occurring in Rio de Janeiro, Brazil. From 1998-2004, 759 culture-proven cases have been identified and treated, predominantly among women at a median age of 39 years and predominantly among those with domiciliary or professional contact with infected cats.[6]

An outbreak in the United States in 1988 affected 84 people who handled sphagnum moss.[8] An unusually large outbreak occurred in Africa in the 1940s in more than 3000 miners who had frequent physical contact with wood timber supports. This contributed significantly to the current understanding of Sporothrix schenckii, its growth patterns, and its mechanisms of dissemination.[2, 3]

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Pathophysiology

Sporotrichosis infections can be either cutaneous or extracutaneous. Cutaneous infections are most common and are subclassified into fixed cutaneous and lymphocutaneous. A few authors refer to a rarely included third subclass of cutaneous sporotrichosis in which diffuse cutaneous involvement occurs.

Fixed cutaneous infections occur at the site of inoculation and remain confined entirely to the skin. Lymphocutaneous disease results from lymphangitic spread of an infection. Satellite lesions develop along the path of the lymphatic vessels (sporotrichoid spread) and associated lymphadenopathy occurs. Extracutaneous, or disseminated sporotrichosis, can present as pyelonephritis, orchitis, mastitis, synovitis, meningitis, or osseous infection.[1, 2, 3, 9, 10]

Sporotrichosis can cause a monoarthritis, typically involving the knee.[11, 12] Many affected individuals are immunosuppressed by alcoholism or HIV infection.[13, 14, 15] Pulmonary involvement is rare.[2, 3]

Under study is the mechanism of pathogen-host interaction, including a 70-kd (Gp70) glycoprotein from the cell wall of S schenckii, which is involved in fungal adherence to the dermal extracellular matrix.[16] This protein shows promise as a possible target for passive immunity therapies.[17]

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Epidemiology

Frequency

United States

The incidence of sporotrichosis is unknown. As an unreported, sporadic disease, its incidence is difficult to estimate. The mold itself is endemic to the Missouri and the Mississippi River Valleys.[2, 3]

International

Sporotrichosis is the most common subcutaneous mycosis in South America.[18, 19] Most reported cases occur in Mexico, followed by the remaining Americas, Australia, Asia, and Africa. Sporotrichosis is rare in Europe.[2, 3] However, it has been described as endemic in northeast China.[20]

Sex

In the past, males were affected more often than females due to occupational-related risks for puncture wounds. With the 1998 outbreak in Rio de Janeiro, Brazil, women with exposure to infected cats currently account for the predominant number of new cases.[2, 3]

Age

Sporotrichosis may occur in any age, but it typically affects adults, reflecting their more frequent participation in veterinary care, gardening, woodworking, and occupational situations in which puncture wounds may occur.[2, 3, 6, 7, 8]

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Prognosis

Localized disease responds well to treatment. The morbidity of cutaneous infections is generally low, although therapy can be prolonged and can have potentially serious adverse effects. Scarring can result at ulcerated sites.[1] Systemic infections can be life threatening, especially in the immunocompromised host.[2, 13, 14, 15]  Systemic disease requires prolonged treatment with potentially toxic systemic therapy.

 

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Patient Education

For excellent patient education resources, visit eMedicineHealth's Infections Center. Additionally, see eMedicineHealth's patient education article Sporotrichosis.

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Contributor Information and Disclosures
Author

Scott D Miller, MD Dermatologist and Dermatologic Surgeon, High Plains Dermatology Center

Scott D Miller, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster 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, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

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, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

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: Women's Dermatologic Society, American Contact Dermatitis Society, Medical Dermatology Society, Dermatology Foundation, Alpha Omega Alpha, American Academy of Dermatology

Disclosure: Nothing to disclose.

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

  3. Lopes-Bezerra LM, Schubach A, Costa RO. Sporothrix schenckii and sporotrichosis. An Acad Bras Cienc. 2006 Jun. 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. 1996 Sep. 23(3):647-8. [Medline].

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

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  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. 1997 Sep 8. 157(16):1885-7. [Medline].

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  10. 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].

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

  12. 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].

  13. 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].

  14. 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].

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  16. 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].

  17. 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].

  18. 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].

  19. Barros MB, de Almeida Paes R, Schubach AO. Sporothrix schenckii and Sporotrichosis. Clin Microbiol Rev. 2011 Oct. 24(4):633-54. [Medline]. [Full Text].

  20. 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].

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

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

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

  24. [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].

  25. Infectious Diseases Society of America. Infections by Organism. Available at http://www.idsociety.org/organism/. Accessed: October 9, 2014.

 
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Close-up of an ulcerated nodule reveals the satellite lesions characteristic of lymphangitic (sporotrichoid) spread.
 
 
 
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