Dermatologic Manifestations of Sporotrichosis Workup
- Author: Scott D Miller, MD; Chief Editor: Dirk M Elston, MD more...
S schenckii readily grows on Sabouraud dextrose agar at 25 º 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 º 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.
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.
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.
Perform chest radiography if pulmonary symptoms are present.
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 are indicated based on suspicion of systemic disease.
Obtain appropriate tissue for hematoxylin and eosin, tissue cultures, Gram stain, Fite stain, and fungal stains.
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, 22]
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.