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Pediatric Sporotrichosis Clinical Presentation

  • Author: William P Baugh, MD; Chief Editor: Russell W Steele, MD  more...
Updated: Jan 31, 2012


To evaluate a patient with possible sporotrichosis, investigate the history of risk factors for acquiring the fungus. Several predisposing factors may place a person at increased risk for developing sporotrichosis. Contact with certain plants known to harbor this fungus (eg, roses, sphagnum moss, salt-marsh hay, prairie hay) places patients at increased risk for the disease. The risk of this contact-acquired infection is increased among people in certain occupations, such as farmers or florists. Typical introduction of S schenckii into the skin has been described as occurring via a thorn or wood splinter. Transmission is also possible from infected cats or scratches from digging animals (ie, armadillos), with notable increased incidence in veterinarians.[8] Cats have been the animal found most common to transmit sporotrichosis. As said prior, they transmit most frequently through bites or scratches, however it is common for the exact transmission point from felines to humans to go unnoticed untilinfection occurs (Cutaneous Sporotrichosis). Infections have also been reported in medical technicians who were exposed to tissue or culture specimens of S schenckii.

Certain diseases, such as diabetes mellitus and alcoholism, also predispose a patient to develop localized disorders. In certain settings, patients who are immunocompromised are at risk for developing disseminated sporotrichosis.



Overall, this fungal infection most commonly affects the dorsum of the hands or fingers. Various primary lesions have been described, ranging from an erythematous papule or pustule to an ulcerating nodule.

Sporotrichosis can be divided clinically into 2 main categories: cutaneous and systemic.

  • Cutaneous sporotrichosis
    • The primary lesion is typically a pustule at the site of implantation. Erythematous papules, nodules, and verrucous plaques may also develop, along with secondary features such as ulceration and serosanguineous fluid drainage. Surprisingly, these lesions produce relatively few symptoms.
    • Lymphangitic cutaneous sporotrichosis is the most common form of the disease.
      • Lymphangitic cutaneous sporotrichosis is usually found on an exposed skin surface at the site of traumatic inoculation. A classic clinical setting would be an adult male who acquired a splinter that, despite removal, continued to produce an area of inflammation.
      • A pustule may slowly grow and may develop into a plaque or nodule. This nodule may eventually ulcerate. Examination proximally along the affected limb usually reveals small, deep-seated, satellite erythematous nodules along lymphatic drainage. If left untreated, the fungal infection continues to spread proximally, producing a significant amount of skin inflammation, abscesses, thickened lymphatic cords, lymphadenitis, and, eventually, systemic spread.
    • Spontaneous resolution may occur. Typically, early in the course of the disease, the patient's health is minimally affected, and the infection site bears minimal symptoms.
    • Cutaneous forms of sporotrichosis also include fixed cutaneous, cellulitic, and mycetomalike. Of these, fixed cutaneous sporotrichosis is the second main cutaneous form of the disease.
      • In its fixed cutaneous form, the fungus remains localized to the implantation site and no proximal lymphangitis or lymphadenopathy develops.
      • The fixed cutaneous form may tend to take on more of a verrucous plaquelike appearance. This form may represent enhanced host immune response to the fungus, possibly because of prior exposure. Skin surveys using the sporotrichin skin test have demonstrated that a positive test result occurs in up to 10% of certain populations, suggesting a history of prior exposure to S schenckii.
  • Systemic sporotrichosis
    • Less common systemic forms of sporotrichosis usually follow inhalation of the fungus. A pulmonary infection ensues, which serves as the primary dissemination route. Systemic sporotrichosis can be divided into a pulmonary form and a disseminated form, both causing higher morbidity and mortality than cutaneous sporotrichosis.
    • Pulmonary infection may remain localized to the lung or may disseminate to other body sites, including the skin, joints, bones, internal organs, and meninges. For instance, one case has been reported of laryngeal and respiratory tract sporotrichosis after steroid inhaler use.
    • This clinical situation has often been found in persons with alcoholism.
    • Erythema nodosum and vascular lesions resembling polyarteritis nodosum have also been reported in patients with sporotrichosis.
  • Clinical types of sporotrichosis
    • Localized cutaneous (chancriform) type: A subcutaneous papule or pustule develops at the site of inoculation after several weeks. Surrounding skin develops a pink-to-violaceous papulonodule, which may subsequently develop into a painless ulcer. The ulcer border is often ragged and undermined and draining a serosanguineous exudate. Draining lymph nodes may become tender and swollen.
    • Chronic lymphangitic (sporotrichoid) type: This is the most common and best recognized form of sporotrichosis; it may follow the chancriform type described above. Lymphangitic spread of the fungus produces nodular swellings in a linear array, spreading proximally up the affected extremity. Palpable lymphadenopathy is often an associated finding.
    • Fixed cutaneous sporotrichosis: Crusted verrucous plaques may occur in this type and are often found on the faces of children or the upper extremities of adults.
    • Disseminated sporotrichosis: The fungus spreads hematogenously to the skin, joints, eyes, and CNS. Multiple crusted and ulcerating papulonodules may occur. This form may have a widespread distribution (sparing the palms of the hands and the soles of the feet). The primary source of infection may be the lungs, or dissemination may occur from a cutaneous site in a patient who is immunocompromised.


See the list below:

  • Sporotrichosis is typically acquired by inoculation of the fungus into the skin during contact with certain plants or animals.
  • Classic scenarios include skin puncture by a splinter or rose thorn.
  • Bites or scratches from infected animals such as cats, dogs, and armadillos represent another source of infection.
Contributor Information and Disclosures

William P Baugh, MD Assistant Clinical Professor of Dermatology, Western University of Health Sciences; Medical Director, Full Spectrum Dermatology; Consulting Staff, Department of Dermatology, St Jude Medical Center

William P Baugh, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Laser Medicine and Surgery, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.


Brad S Graham, MD Consulting Staff, Dermatology Associates of Tyler

Brad S Graham, MD is a member of the following medical societies: Alpha Omega Alpha, Texas Dermatological Society, American Academy of Dermatology, American Society of Dermatopathology

Disclosure: Nothing to disclose.

Cynthia L Chen, DO, DO Intern, Pacific Hospital of Long Beach, California

Cynthia L Chen, DO, DO is a member of the following medical societies: American Osteopathic Association, California Medical Association, American Osteopathic College of Dermatology, Los Angeles County Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Larry I Lutwick, MD Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Gary J Noel, MD Professor, Department of Pediatrics, Weill Cornell Medical College; Attending Pediatrician, New York-Presbyterian Hospital

Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

  1. [Guideline] Kauffman CA, Bustamante B, Chapman SW, Pappas PG. 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].

  2. Vilela R, Souza GF, Fernandes Cota G, Mendoza L. Cutaneous and meningeal sporotrichosis in a HIV patient. Rev Iberoam Micol. 2007 Jun. 24(2):161-3. [Medline].

  3. Zhou CH, Asuncion A, Love GL. Laryngeal and respiratory tract sporotrichosis and steroid inhaler use. Arch Pathol Lab Med. 2003 Jul. 127(7):893-4. [Medline].

  4. 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].

  5. Leme LR, Schubach TM, Santos IB, et al. Mycological evaluation of bronchoalveolar lavage in cats with respiratory signs from Rio de Janeiro, Brazil. Mycoses. 2007 May. 50(3):210-4. [Medline].

  6. 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].

  7. 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].

  8. Almeida-Paes R, Pimenta MA, Pizzini CV, Monteiro PC, Peralta JM, Nosanchuk JD. Use of mycelial-phase Sporothrix schenckii exoantigens in an enzyme-linked immunosorbent assay for diagnosis of sporotrichosis by antibody detection. Clin Vaccine Immunol. 2007 Mar. 14(3):244-9. [Medline].

  9. Sharma NL, Mahajan VK, Verma N, Thakur S. Cutaneous sporotrichosis: an unusual clinico-pathologic and therapeutic presentation. Mycoses. 2003 Dec. 46(11-12):515-8. [Medline].

  10. Bonifaz A, Fierro L, Saul A, Ponce RM. Cutaneous sporotrichosis. Intermittent treatment (pulses) with itraconazole. Eur J Dermatol. 2008 Jan-Feb. 18(1):61-4. [Medline].

  11. Almeida-Paes R, Pimenta MA, Monteiro PC, Nosanchuk JD, Zancope-Oliveira RM. Immunoglobulins G, M, and A against Sporothrix schenckii exoantigens in patients with sporotrichosis before and during treatment with itraconazole. Clin Vaccine Immunol. 2007 Sep. 14(9):1149-57. [Medline].

  12. Baroni A, Palla M, Iovene MR, et al. Sporotrichosis: success of itraconazole treatment. Skinmed. 2007 Jan-Feb. 6(1):41-4. [Medline].

  13. Baum GL, Donnerberg RL, Stewart D. Pulmonary sporotrichosis. N Engl J Med. 1969 Feb 20. 280(8):410-3. [Medline].

  14. Bonifaz A, Peniche A, Mercadillo P. Successful treatment of AIDS-related disseminated cutaneous sporotrichosis with itraconazole. AIDS Patient Care STDS. 2001 Dec. 15(12):603-6. [Medline].

  15. Davis BA. Sporotrichosis. Dermatol Clin. 1996 Jan. 14(1):69-76. [Medline].

  16. De Araujo T, Marques AC, Kerdel F. Sporotrichosis. Int J Dermatol. 2001 Dec. 40(12):737-42. [Medline].

  17. Dolezal JF. Blastomycoid sporotrichosis. Response to low-dose amphotericin B. J Am Acad Dermatol. 1981 May. 4(5):523-7. [Medline].

  18. Dunstan RW, Langham RF, Reimann KA. Feline sporotrichosis: a report of five cases with transmission to humans. J Am Acad Dermatol. 1986 Jul. 15(1):37-45. [Medline].

  19. Gordhan A, Ramdial PK, Morar N. Disseminated cutaneous sporotrichosis: a marker of osteoarticular sporotrichosis masquerading as gout. Int J Dermatol. 2001 Nov. 40(11):717-9. [Medline].

  20. Hajjeh R, McDonnell S, Reef S. Outbreak of sporotrichosis among tree nursery workers. J Infect Dis. 1997 Aug. 176(2):499-504. [Medline].

  21. Horii KA, Jackson MA, Sharma V. Localized cutaneous sporotrichosis in a child. Arch Dermatol. 2006 Oct. 142(10):1369-70. [Medline].

  22. Karakayali G, Lenk N, Alli N. Itraconazole therapy in lymphocutaneous sporotrichosis: a case report and review of the literature. Cutis. 1998 Feb. 61(2):106-7. [Medline].

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

  24. Lynch PJ, Voorhees JJ, Harrell ER. Systemic sporotrichosis. Ann Intern Med. 1970 Jul. 73(1):23-30. [Medline].

  25. Meffert JJ. Cutaneous sporotrichosis presenting as a keratoacanthoma. Cutis. 1998 Jul. 62(1):37-9. [Medline].

  26. Mohan N, Jayaseelan E, Abraham A. Cutaneous sporotrichosis in Bangalore, southern India. Int J Dermatol. 43(4):269-72. [Medline].

  27. O'Reilly LC, Altman SA. Macrorestriction analysis of clinical and environmental isolates of Sporothrix schenckii. J Clin Microbiol. 2006 Jul. 44(7):2547-52. [Medline].

  28. Rodriguez G, Sarmiento L. The asteroid bodies of sporotrichosis. Am J Dermatopathol. 1998 Jun. 20(3):246-9. [Medline].

  29. Sandhu K, Gupta S. Potassium iodide remains the most effective therapy for cutaneous sporotrichosis. J Dermatolog Treat. 2003 Dec. 14(4):200-2. [Medline].

  30. Sanz J, Andreu JL, Martinez-Garcia G. Sporotrichial bursitis. Br J Rheumatol. 1998 Apr. 37(4):461-2. [Medline].

  31. Sharma NL, Mahajan VK, Verma N, Thakur S. Cutaneous sporotrichosis: an unusual clinico-pathologic and therapeutic presentation. Mycoses. 2003 Dec. 46(11-12):515-8. [Medline].

  32. Ticoras CJ, Schroeter AL, Hornbeck KL. Disseminated ulcerated papules and nodules. Cutaneous disseminated sporotrichosis. Arch Dermatol. 1996 Aug. 132(8):963-4, 966-7. [Medline].

  33. Ware AJ, Cockerell CJ, Skiest DJ. Disseminated sporotrichosis with extensive cutaneous involvement in a patient with AIDS. J Am Acad Dermatol. 1999 Feb. 40(2 Pt 2):350-5. [Medline].

  34. Werner AH, Werner BE. Sporotrichosis in man and animal. Int J Dermatol. 1994 Oct. 33(10):692-700. [Medline].

  35. Whitfeld MJ, Faust HB. Lymphocutaneous sporotrichosis. Australas J Dermatol. 1995 Aug. 36(3):161-3. [Medline].

  36. Zaharopoulos P. Fine-needle aspiration cytologic diagnosis of lymphocutaneous sporotrichosis: a case report. Diagn Cytopathol. 1999 Feb. 20(2):74-7. [Medline].

Sporotrichosis with cutaneous necrosis and lymphangitic (sporotrichoid) spread. A 28-year-old white man presented for evaluation of a poorly healing, asymptomatic, round plaque acquired on the dorsum of his left hand. The lesion had been present for approximately 3 weeks.
Glucose-peptone agar culture plates revealing colony growth of Sporothrix schenckii. The left plate reveals older colonies as dark brown or black, and the right plate reveals younger white colonies with a brown center, characteristic of this fungus.
Microscopic examination of a blue dye preparation from the colony surface reveals elongated septate hyphae with groups of microconidia in a flowerlike arrangement.
A well-circumscribed, moderately elevated, erythematous plaque with central ulceration is found on the dorsum of this patient's left hand. Potassium chloride (KOH) stain was negative for fungal elements.
A 2 X 2 cm, dome-shaped, well-circumscribed, erythematous plaque is shown proximal to the left ring finger. The lesion was draining a serosanguineous fluid. No purulence was noted.
Biopsy rarely reveals the 6-mcg cigar-shaped yeast within tissue macrophages as shown in this histologic section. This is the morphology that Sporothrix schenckii assumes at 37°C.
Moist cream-colored colonies with a central, dark, leathery, and wrinkled surface growing at 25°C is highly suggestive of Sporothrix schenckii.
A fresh agar slant of Sporothrix schenckii reveals moist, white-to-cream–colored, yeastlike colonies.
Cutaneous, ulcerating, painless nodule on the hand and a classic sporotrichoid lymphangitic pattern spreading proximally up the arm.
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