Further Outpatient Care
S schenckii strains that cause cutaneous or lymphocutaneous sporotrichosis grow better at 35°C than at 37°C; therefore, topical heat application to lesions may be of adjunctive benefit.
Deterrence/Prevention
Exercise efforts to minimize cutaneous inoculation of S schenckii. This includes wearing gloves and other protective clothing when gardening. Use of gloves when handling animals with skin lesions also minimizes the risk of zoonotic transmission.
Prognosis
- Cutaneous or lymphocutaneous sporotrichosis: Complete recovery without scarring is the expected outcome with appropriate treatment; however, the therapy required to cure the disease is protracted and expensive.
- Pulmonary sporotrichosis
- Limited data are available on the response to treatment; however, evidence suggests that most cases of pulmonary sporotrichosis respond to itraconazole therapy. Those who do not respond to itraconazole require treatment with amphotericin B.
- Pulmonary sporotrichosis contributes to declined respiratory function in patients with COPD.
- Osteoarticular sporotrichosis: More than 70% of patients with osteoarticular sporotrichosis have a clinical response to itraconazole therapy. Relapse may occur. Severe disability can result from unrecognized chronic osteoarticular sporotrichosis.
- Disseminated sporotrichosis: Most patients respond to initial amphotericin B therapy. In patients with AIDS, life-long suppressive itraconazole therapy following induction therapy with amphotericin B appears to be necessary to control infection.
Patient Education
- Patients with all forms of sporotrichosis must be educated about the need for protracted antifungal therapy.
- Multiple sporotrichosis infections can occur in the same patient, suggesting that protective immunity may not always result from treated infection. Instruct patients with persistent occupational or avocational exposure about methods of prevention.
- For excellent patient education resources, visit eMedicine's Yeast and Fungal Infections Center. Also, see eMedicine's patient education article 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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