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Sporotrichosis

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

Background

Sporotrichosis is a subacute or chronic infection caused by the saprophytic dimorphic fungus Sporothrix schenckii. Although only one species of Sporothrix was classically described, phenetic and genetic studies have identified additional Sporothrix species.[1] Knowledge of the geographic distribution, virulence, clinical presentation, and response to antifungal therapy of these newly identified species is an area of active research.[2, 3, 4]

The characteristic infection involves suppurating subcutaneous nodules that progress proximally along lymphatic channels (lymphocutaneous sporotrichosis). Primary pulmonary infection (pulmonary sporotrichosis) is rare, as is direct inoculation into tendons, bursae, or joints. Osteoarticular sporotrichosis is caused by direct inoculation or hematogenous seeding. In rare cases, disseminated S schenckii infection (disseminated sporotrichosis) occurs, characterized by disseminated cutaneous lesions and involvement of multiple visceral organs; this occurs most commonly in persons with AIDS. A thorough review of the topic was published by Barros et al in 2011.[5]

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Pathophysiology

Infection with the dimorphic soil fungus S schenckii is usually acquired from organic matter through cutaneous inoculation. The mycosis has also been transmitted from animals through bites or scratches. Cats have been responsible for cases among veterinarians[6] and for a large outbreak in Rio de Janeiro, Brazil.[7] See the image below.

Photomicrograph that shows the conidiophores and c Photomicrograph that shows the conidiophores and conidia of the fungus Sporothrix schenckii. Courtesy of CDC Public Health Image Library.

The initial reddish, necrotic, nodular papule of cutaneous sporotrichosis generally appears 1-10 weeks after a penetrating skin injury. The lesion is a suppurating granuloma that consists of histiocytes and giant cells, with neutrophils that accumulate in the center and that are surrounded by lymphocytes and plasma cells.

The fungal infection spreads from the initial lesion along lymphatic channels, forming the chain of indolent nodular and ulcerating lesions typical of lymphocutaneous sporotrichosis.

Other tissues are involved by direct extension and, less often, by hematogenous dissemination. The most common extracutaneous infection sites are in the bones, joints, tendon sheaths, and bursae. Hematogenous dissemination—particularly in immunocompromised hosts—results in widely disseminated cutaneous and visceral infection, including meningitis.

A rare form of sporotrichosis appears to result from inhalation of the organism. This form is characterized by a chronic cavitary pneumonia that is clinically and radiographically indistinguishable from tuberculosis and histoplasmosis. This form of sporotrichosis is most common in individuals with severe underlying chronic obstructive pulmonary disease (COPD) and alcoholism.[8] Sporotrichal infections affecting the sinuses, kidney, subglottic region, and retina have been described.[9, 10]

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Epidemiology

Frequency

United States

The incidence of sporotrichosis is not precisely known but is estimated at 1-2 cases per million population. An estimated 200-250 cases occur per year. A large outbreak associated with Wisconsin-grown sphagnum moss involving 15 states occurred in 1988.[11]

International

Sporotrichosis occurs worldwide, with focal areas of hyperendemicity. The global incidence is unknown. In the highlands of Peru, the incidence of sporotrichosis is approximately 1 case per 1000 people.[12] China is a serious endemic region.[13] Epidemics have been described in western Australia,[14] Brazil,[7] and South Africa.

Mortality/Morbidity

Spontaneous resolution of cutaneous and lymphocutaneous forms of sporotrichosis has been documented.

The prognosis is excellent for complete recovery after therapy, although the response to therapy may vary.

Pulmonary sporotrichosis may contribute to declining pulmonary function in patients with COPD.

Osteoarticular sporotrichosis may result in significant morbidity in the form of chronic osteomyelitis and arthritis with significant loss of joint function and deformity.

Disseminated sporotrichosis is associated with significant morbidity and, possibly, mortality in immunocompromised hosts.

Race

Sporotrichosis has no known racial predilection.

Sex

Sporotrichosis is slightly more common in males than in females, presumably due to an increased exposure risk rather than to a difference in susceptibility.

Age

In developed nations, sporotrichosis is most common among adults. However, in tropical regions and in areas of hyperendemicity, sporotrichosis may be more common in children and adolescents. See the Medscape Reference article Pediatric Sporotrichosis for more information.

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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
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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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