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Sporotrichosis Clinical Presentation

  • Author: Nelson Ivan Agudelo Higuita, MD; Chief Editor: Michael Stuart Bronze, MD  more...
 
Updated: Oct 21, 2015
 

History

The presentation of sporotrichosis varies and is determined mainly by the immune status of the host and the location of the infection. Other factors such as the virulence of the infecting species and ability to grow at different temperatures may also play a role.[15, 2, 3]

Sporotrichosis is typically classified as cutaneous or extracutaneous. The cutaneous form is divided into lymphocutaneous, fixed, and disseminated.

Cutaneous sporotrichosis

Lymphocutaneous sporotrichosis: The primary lesion develops at the site of cutaneous inoculation, typically in the distal upper extremities. After several weeks, new lesions appear along the lymphatic tracts. Patients with this form are typically afebrile and not systemically ill. The lesions usually cause minimal pain. Many affected patients have received one or more courses of antibacterial therapy without benefit.[16, 17]

The fixed cutaneous form is characterized by a painless violaceous or erythematous plaque that may ulcerate or become verrucous. This presentation should be considered when a wound fails to heal. There are no satellite lesions.[18]

The disseminated cutaneous form is usually seen in immunosuppressed individuals. This form of the disease can be the initial presentation of HIV infection or may develop as part of an immune reconstitution syndrome.[19, 20, 21]

Hypersensitivity reactions such as erythema nodosum or erythema multiforme have been associated with the zoonotic species Sporothrix brasiliensis.[4]

Extracutaneous sporotrichosis

Pulmonary sporotrichosis

Patients with this form of sporotrichosis usually have severe underlying COPD and present with subacute or chronic pneumonia.[22] The presenting symptoms of pulmonary sporotrichosis are not specific but typically include increased cough and few constitutional symptoms.

Osteoarticular sporotrichosis

Sporotrichosis may present as a chronic arthritis that is often confused with rheumatoid arthritis or other chronic inflammatory arthritis. In many cases, the osteoarticular sporotrichosis persists for 30 or more years until destruction of adjacent bone or the development of draining fistulae encourages efforts to establish the microbial etiology of the chronic osteomyelitis with culture. Cutaneous or lymphocutaneous lesions are not prominent in these patients.

The process generally begins as a monoarticular arthritis, especially of the knee, but other joints may become involved successively. The patient usually has pain upon motion, but not the severe limitation characteristic of bacterial arthritis. Systemic illness is usually absent. Functional impairment due to osteoarticular sporotrichosis may become severe.[23]

Disseminated sporotrichosis

In rare cases, sporotrichosis involves other organs, including the eye, the prostate, the oral mucosa, the paranasal sinuses, and the larynx. In such patients, the clinical manifestations depend on the organs involved.

Central nervous system and meningeal involvement are more common in the AIDS era, but it remains rare. In some cases, the only symptom is subtle changes in mental status. Patients with AIDS who develop disseminated sporotrichosis may present with cutaneous dissemination, which manifests as nodules, ulcers, or both, with or without evidence of visceral involvement and meningitis.[24] Sporotrichosis in persons with AIDS can also manifest as multifocal tenosynovitis or arthritis resembling disseminated gonococcal infection or a seronegative spondyloarthropathy.[25]

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Physical

Cutaneous or lymphocutaneous sporotrichosis: An initial papule or nodule forms at the site of cutaneous inoculation, usually 1-10 weeks after inoculation. The initial small nodule enlarges, reddens, becomes pustular, and ulcerates. In the lymphocutaneous form, an ascending chain of nodules develops along skin lymphatic channels. Older distal lesions ulcerate and drain, while more proximal lesions appear as nodules and undergo the same evolution. See the images below.

Lymphocutaneous sporotrichosis. Lymphocutaneous sporotrichosis.
Lymphocutaneous sporotrichosis. Lymphocutaneous sporotrichosis.
Lymphocutaneous sporotrichosis. Lymphocutaneous sporotrichosis.
Ulcerated lesion in the cheek of a child. Note the Ulcerated lesion in the cheek of a child. Note the satellite lesions. Courtesy of Todd Mollet, MD, University of Texas Southwestern Medical Center.

Pulmonary sporotrichosis: The physical examination findings in patients with pulmonary sporotrichosis are typically dominated by their underlying COPD. No physical findings are specific for pulmonary sporotrichosis.

Osteoarticular sporotrichosis: Patients typically have a subacute or chronic inflammatory monoarticular arthritis. The involved joint has an effusion, may be warm, and may have overlying erythema. Draining sinus tracts that complicate adjacent osteomyelitis may be apparent.

Disseminated sporotrichosis: Physical findings vary depending on the site of involvement. Cutaneous dissemination may appear as subcutaneous mass lesions, diffuse purplish papules and nodules, or disseminated ulcerative lesions. See the image below.

This photo depicts cutaneous disseminated sporotri This photo depicts cutaneous disseminated sporotrichosis in a patient with AIDS before and after therapy. Courtesy of Leonard N. Slater, MD.
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Causes

Sporotrichosis is caused by infection with one of the species of the S schenckii complex. More than six species, such as S schenckii sensu stricto, S brasiliensis, Sporothrix globosa, Sporothrix mexicana, and Sporothrix albicans, have been identified via molecular techniques.[1, 26]

Splinters, thorns, or woody fragments of plants usually provide the penetrating trauma that introduces the fungal conidia into the human host; however, contact with any plant or plant product (eg, sphagnum peat moss, mulch, hay, timber) that causes minor skin trauma may initiate infection.

Activities associated with the acquisition of sporotrichosis include gardening, landscaping, farming, berry-picking, horticulture, and carpentry.

Zoonotic transmission can occur from infected animals (eg, cats, horses with extensive skin lesions) to their animal handlers.

Both pulmonary and disseminated sporotrichosis are more common in persons with a history of alcoholism.

Immunosuppressing states such as HIV infections and AIDS predispose to disseminated cutaneous sporotrichosis and hematogenously disseminated sporotrichosis, including sporotrichotic meningitis.[27, 24] This clinical observation, combined with studies in animal models, indicates the importance of cell-mediated immunity in the host defense against sporotrichosis.

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Contributor Information and Disclosures
Author

Nelson Ivan Agudelo Higuita, MD Assistant Professor, Department of Internal Medicine, Section of Infectious Diseases, Associate Program Director, Internal Medicine Residency, University of Oklahoma Health Sciences Center; Attending Physician, Infectious Diseases Consultation Service, Department of General Internal Medicine, Oklahoma University Medical Center

Nelson Ivan Agudelo Higuita, MD is a member of the following medical societies: Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Thomas M Kerkering, MD Chief of Infectious Diseases, Virginia Tech Carilion School of Medicine

Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, Wilderness Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Program Director of Infectious Disease Fellowship, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgements

This article is an updated version of Dr. Ronald Greenfield's work.

In memory of a great physician and mentor.

References
  1. Marimon R, Cano J, Gené J, Sutton DA, Kawasaki M, Guarro J. Sporothrix brasiliensis, S. globosa, and S. mexicana, three new Sporothrix species of clinical interest. J Clin Microbiol. 2007 Oct. 45(10):3198-206. [Medline]. [Full Text].

  2. Kong X, Xiao T, Lin J, Wang Y, Chen HD. Relationships among genotypes, virulence and clinical forms of Sporothrix schenckii infection. Clin Microbiol Infect. 2006 Nov. 12(11):1077-81. [Medline].

  3. Fernandes GF, dos Santos PO, Rodrigues AM, Sasaki AA, Burger E, de Camargo ZP. Characterization of virulence profile, protein secretion and immunogenicity of different Sporothrix schenckii sensu stricto isolates compared with S. globosa and S. brasiliensis species. Virulence. 2013 Apr 1. 4(3):241-9. [Medline]. [Full Text].

  4. Almeida-Paes R, de Oliveira MM, Freitas DF, do Valle AC, Zancopé-Oliveira RM, Gutierrez-Galhardo MC. Sporotrichosis in Rio de Janeiro, Brazil: Sporothrix brasiliensis Is Associated with Atypical Clinical Presentations. PLoS Negl Trop Dis. 2014 Sep. 8(9):e3094. [Medline]. [Full Text].

  5. Barros MB, de Almeida Paes R, Schubach AO. Sporothrix schenckii and Sporotrichosis. Clin Micro Rev. Oct/2011. 24:633-654. [Medline].

  6. Reed KD, Moore FM, Geiger GE, Stemper ME. Zoonotic transmission of sporotrichosis: case report and review. Clin Infect Dis. 1993 Mar. 16(3):384-7. [Medline].

  7. Barros MB, Schubach Ade O, do Valle AC, Gutierrez Galhardo MC, Conceição-Silva F, Schubach TM, 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].

  8. Pluss JL, Opal SM. Pulmonary sporotrichosis: review of treatment and outcome. Medicine (Baltimore). 1986 May. 65(3):143-53. [Medline].

  9. Friedman SJ, Doyle JA. Extracutaneous sporotrichosis. Int J Dermatol. 1983 Apr. 22(3):171-6. [Medline].

  10. Font RL, Jakobiec FA. Granulomatous necrotizing retinochoroiditis caused by Sporotrichum schenkii. Report of a case including immunofluorescence and electron microscopical studies. Arch Ophthalmol. 1976 Sep. 94(9):1513-9. [Medline].

  11. Dixon DM, Salkin IF, Duncan RA, Hurd NJ, Haines JH, Kemna ME, et al. Isolation and characterization of Sporothrix schenckii from clinical and environmental sources associated with the largest U.S. epidemic of sporotrichosis. J Clin Microbiol. 1991 Jun. 29(6):1106-13. [Medline]. [Full Text].

  12. Pappas PG, Tellez I, Deep AE, et al. Sporotrichosis in Peru: description of an area of hyperendemicity. Clin Infect Dis. 2000 Jan. 30(1):65-70. [Medline].

  13. 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].

  14. Feeney KT, Arthur IH, Whittle AJ, Altman SA, Speers DJ. Outbreak of sporotrichosis, Western Australia. Emerg Infect Dis. 2007 Aug. 13(8):1228-31. [Medline]. [Full Text].

  15. Kwon-Chung KJ. Comparison of isolates of Sporothrix schenckii obtained from fixed cutaneous lesions with isolates from other types of lesions. J Infect Dis. 1979 Apr. 139(4):424-31. [Medline].

  16. Kauffman CA. Sporotrichosis. Clin Infect Dis. 1999 Aug. 29(2):231-6; quiz 237. [Medline].

  17. Winn RE. A contemporary view of sporotrichosis. Curr Top Med Mycol. 1995. 6:73-94. [Medline].

  18. Vásquez-del-Mercado E, Arenas R, Padilla-Desgarenes C. Sporotrichosis. Clin Dermatol. 2012 Jul-Aug. 30(4):437-43. [Medline].

  19. Carvalho MT, de Castro AP, Baby C, Werner B, Filus Neto J, Queiroz-Telles F. Disseminated cutaneous sporotrichosis in a patient with AIDS: report of a case. Rev Soc Bras Med Trop. 2002 Nov-Dec. 35(6):655-9. [Medline].

  20. Chang S, Hersh AM, Naughton G, Mullins K, Fung MA, Sharon VR. Disseminated cutaneous sporotrichosis. Dermatol Online J. 2013 Nov 15. 19(11):20401. [Medline].

  21. Gutierrez-Galhardo MC, do Valle AC, Fraga BL, Schubach AO, Hoagland BR, Monteiro PC, et al. Disseminated sporotrichosis as a manifestation of immune reconstitution inflammatory syndrome. Mycoses. 2010 Jan. 53(1):78-80. [Medline].

  22. Ramirez J, Byrd RP, Roy TM. Chronic cavitary pulmonary sporotrichosis: efficacy of oral itraconazole. J Ky Med Assoc. 1998 Mar. 96(3):103-5. [Medline].

  23. Crout JE, Brewer NS, Tompkins RB. Sporotrichosis arthritis: clinical features in seven patients. Ann Intern Med. 1977 Mar. 86(3):294-7. [Medline].

  24. Freitas DF, de Siqueira Hoagland B, Do Valle AC, Fraga BB, de Barros MB, de Oliveira Schubach A, et al. Sporotrichosis in HIV-infected patients: report of 21 cases of endemic sporotrichosis in Rio de Janeiro, Brazil. Med Mycol. 2011 Aug 23. [Medline].

  25. Oscherwitz SL, Rinaldi MG. Disseminated sporotrichosis in a patient infected with human immunodeficiency virus. Clin Infect Dis. 1992 Sep. 15(3):568-9. [Medline].

  26. Oliveira MM, Almeida-Paes R, Gutierrez-Galhardo MC, Zancope-Oliveira RM. Molecular identification of the Sporothrix schenckii complex. Rev Iberoam Micol. 2014 Jan-Mar. 31(1):2-6. [Medline].

  27. Silva-Vergara ML, Maneira FR, De Oliveira RM, et al. Multifocal sporotrichosis with meningeal involvement in a patient with AIDS. Med Mycol. 2005 Mar. 43(2):187-90. [Medline].

  28. Bernardes-Engemann AR, Costa RC, Miguens BR, Penha CV, Neves E, Pereira BA, et al. Development of an enzyme-linked immunosorbent assay for the serodiagnosis of several clinical forms of sporotrichosis. Med Mycol. 2005 Sep. 43(6):487-93. [Medline].

  29. Scott EN, Kaufman L, Brown AC, Muchmore HG. Serologic studies in the diagnosis and management of meningitis due to Sporothrix schenckii. N Engl J Med. 1987 Oct 8. 317(15):935-40. [Medline].

  30. Kauffman CA, Pappas PG, McKinsey DS, et al. Treatment of lymphocutaneous and visceral sporotrichosis with fluconazole. Clin Infect Dis. 1996 Jan. 22(1):46-50. [Medline].

  31. Sharkey-Mathis PK, Kauffman CA, Graybill JR, et al. Treatment of sporotrichosis with itraconazole. NIAID Mycoses Study Group. Am J Med. 1993 Sep. 95(3):279-85. [Medline].

  32. Chapman SW, Pappas P, Kauffmann C, et al. Comparative evaluation of the efficacy and safety of two doses of terbinafine (500 and 1000 mg day(-1)) in the treatment of cutaneous or lymphocutaneous sporotrichosis. Mycoses. 2004 Feb. 47(1-2):62-8. [Medline].

  33. [Guideline] Kauffman CA, Bustamante B, Chapman SW, et al. Clinical practice guidelines for the management of sporotrichosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007 Nov 15. 45(10):1255-65. [Medline]. [Full Text].

  34. Mølgaard-Nielsen D, Pasternak B, Hviid A. Use of oral fluconazole during pregnancy and the risk of birth defects. N Engl J Med. 2013 Aug 29. 369(9):830-9. [Medline].

  35. Lyon GM, Zurita S, Casquero J, et al. Population-based surveillance and a case-control study of risk factors for endemic lymphocutaneous sporotrichosis in Peru. Clin Infect Dis. 2003 Jan 1. 36(1):34-9. [Medline].

  36. Prentice AG, Glasmacher A. Making sense of itraconazole pharmacokinetics. J Antimicrob Chemother. 2005 Sep. 56 Suppl 1:i17-i22. [Medline].

  37. Smego RA Jr, Castiglia M, Asperilla MO. Lymphocutaneous syndrome. A review of non-sporothrix causes. Medicine (Baltimore). 1999 Jan. 78(1):38-63. [Medline].

 
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This photo depicts cutaneous disseminated sporotrichosis in a patient with AIDS before and after therapy. Courtesy of Leonard N. Slater, MD.
Photomicrograph that shows the conidiophores and conidia of the fungus Sporothrix schenckii. Courtesy of CDC Public Health Image Library.
Lymphocutaneous sporotrichosis.
Lymphocutaneous sporotrichosis.
Lymphocutaneous sporotrichosis.
Cigar-shaped yeast of Sporothrix schenckii in tissue macrophages in a biopsy specimen.
Ulcerated lesion in the cheek of a child. Note the satellite lesions. Courtesy of Todd Mollet, MD, University of Texas Southwestern Medical Center.
 
 
 
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