Sporotrichosis Clinical Presentation
- Author: Ronald A Greenfield, MD; Chief Editor: Burke A Cunha, MD more...
History
- Cutaneous and lymphocutaneous sporotrichosis: The primary lesion develops at the site of cutaneous inoculation, typically in the distal upper extremities. Patients with these forms 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.[4, 5]
- Pulmonary sporotrichosis: Patients with this form of sporotrichosis usually have severe underlying COPD and present with subacute or chronic pneumonia.[6] 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 10 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, 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.
- 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.
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. - 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 sporotrichosis in a patient with AIDS before and after therapy. (Courtesy of Leonard N. Slater, MD)
Causes
- Sporotrichosis is caused by infection with S schenckii, a fungus widely distributed in the natural environment. It grows on plant debris in soil and on the bark of trees, shrubs, and garden plants.
- 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.[7, 8] This clinical observation, combined with studies in animal models, indicates the importance of cell-mediated immunity in the host defense against sporotrichosis.
Marimon R, Gene J, Cano J, et al. Molecular phylogeny of Sporothrix schenckii. J Clin Microbiol. Sep 2006;44(9):3251-6. [Medline].
Pappas PG, Tellez I, Deep AE, et al. Sporotrichosis in Peru: description of an area of hyperendemicity. Clin Infect Dis. Jan 2000;30(1):65-70. [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. Dec 17 2011;[Medline].
Kauffman CA. Sporotrichosis. Clin Infect Dis. Aug 1999;29(2):231-6; quiz 237. [Medline].
Winn RE. A contemporary view of sporotrichosis. Curr Top Med Mycol. 1995;6:73-94. [Medline].
Ramirez J, Byrd RP, Roy TM. Chronic cavitary pulmonary sporotrichosis: efficacy of oral itraconazole. J Ky Med Assoc. Mar 1998;96(3):103-5. [Medline].
Silva-Vergara ML, Maneira FR, De Oliveira RM, et al. Multifocal sporotrichosis with meningeal involvement in a patient with AIDS. Med Mycol. Mar 2005;43(2):187-90. [Medline].
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. Aug 23 2011;[Medline].
Kauffman CA, Pappas PG, McKinsey DS, et al. Treatment of lymphocutaneous and visceral sporotrichosis with fluconazole. Clin Infect Dis. Jan 1996;22(1):46-50. [Medline].
Sharkey-Mathis PK, Kauffman CA, Graybill JR, et al. Treatment of sporotrichosis with itraconazole. NIAID Mycoses Study Group. Am J Med. Sep 1993;95(3):279-85. [Medline].
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. Feb 2004;47(1-2):62-8. [Medline].
[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. Nov 15 2007;45(10):1255-65. [Medline]. [Full Text].
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. Jan 1 2003;36(1):34-9. [Medline].
Prentice AG, Glasmacher A. Making sense of itraconazole pharmacokinetics. J Antimicrob Chemother. Sep 2005;56 Suppl 1:i17-i22. [Medline].
Smego RA Jr, Castiglia M, Asperilla MO. Lymphocutaneous syndrome. A review of non-sporothrix causes. Medicine (Baltimore). Jan 1999;78(1):38-63. [Medline].
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