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Dermatologic Manifestations of Sporotrichosis Workup

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

Laboratory Studies

Fungal cultures

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.

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.

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Imaging Studies

Perform chest radiography if pulmonary symptoms are present.

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Other Tests

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.

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Procedures

Obtain appropriate tissue for hematoxylin and eosin, tissue cultures, Gram stain, Fite stain, and fungal stains.

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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, 22]

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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.

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