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Pediatric Sporotrichosis Follow-up

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

Further Outpatient Care

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  • The primary therapeutic approach to managing cutaneous lesions of sporotrichosis involves administration of systemic medications to eradicate the fungus. If a cutaneous plaque, nodule, or ulcer is present, consider teaching the patient about supportive local wound care to facilitate healing. Such education typically involves instruction on keeping lesions clean and free from further contamination. If the lesion is ulcerated, a topical ointment may be applied to prevent occurrence of secondary bacterial infections. Follow up with the patient in the clinic every 1-2 weeks to monitor progress. Instruct the patient about potential sources of this fungus to help avoid further infections.
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Further Inpatient Care

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  • Sporotrichosis is usually managed on an outpatient basis. A few patients with the more severe forms (eg, disseminated sporotrichosis) may require hospitalization.
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Inpatient & Outpatient Medications

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  • See Medical Care.
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Deterrence/Prevention

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  • Educate every patient who has acquired sporotrichosis about the fungus and provide information about how to prevent occurrence of further infections. S schenckii is a saprophytic fungus, usually found in the soil. Instruct patients to be careful when working with soils, sphagnum moss, decaying wood, roses, thorn bushes, and salt marsh or prairie hay. If exposure to these materials or plants is anticipated, instruct patients to wear personal protective equipment, particularly gloves, to minimize thorn or splinter punctures of the skin.
  • Sporotrichosis has also been acquired from pets, particularly cats, so the physician should consider this potential source of acquisition if the aforementioned soil and plant exposures do not apply.
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Prognosis

Prognosis for patients with sporotrichosis depends on its clinical type (eg, fixed cutaneous, localized cutaneous, lymphocutaneous, disseminated), associated underlying diseases, and the patient's immune response to this fungus.

  • Patients with fixed cutaneous and lymphocutaneous sporotrichosis have an excellent prognosis. These lesions usually respond well to therapy and typically resolve after 4-6 weeks of therapy.
  • Patients with the osteoarticular form of sporotrichosis usually have a moderately good prognosis, but they may require higher doses of medication, longer courses of therapy to achieve cure, or both.
  • Patients with pulmonary or disseminated forms of sporotrichosis usually have some underlying medical condition or immune deficit that allows the fungus to grow and spread unchecked. For example, patients who have insulin-dependent diabetes mellitus, chronic alcoholism, or AIDS may be unable to mount an adequate immune response to keep this fungal infection localized. Such patients typically have a worse prognosis and require longer courses of therapy.
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Patient Education

See the list below:

  • See Deterrence/Prevention.
  • For excellent patient education resources, visit eMedicineHealth's Infections Center. Also, see eMedicineHealth's patient education article Sporotrichosis.
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Contributor Information and Disclosures
Author

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.

Coauthor(s)

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.

References
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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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