eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Sporotrichosis: Follow-up

Author: William P Baugh, MD, Assistant Clinical Professor of Dermatology, University of California Irvine School of Medicine and Western School of Medicine; Medical Director, Full Spectrum Dermatology; Consulting Staff, Department of Dermatology, St Jude Medical Center
Coauthor(s): Brad S Graham, MD, Consulting Staff, Dermatology Associates of Tyler; Cynthia L Chen, Western University of Health Sciences College of Osteopathic Medicine of the Pacific
Contributor Information and Disclosures

Updated: Aug 28, 2009

Follow-up

Further Inpatient Care

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

Further Outpatient Care

  • 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.

Inpatient & Outpatient Medications

Deterrence/Prevention

  • 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.

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.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Medicolegal problems associated with clinical cases of sporotrichosis are unusual but may occur for a few basic reasons.
    • Failure to establish the appropriate diagnosis, resulting in delay of care or provision of inappropriate care, may result in litigation.
    • The dome-shaped nature of a cutaneous ulcer produced by sporotrichosis, combined with its abrupt clinical course, may mimic a keratoacanthoma. This may result in an unnecessary surgical procedure or inadvertent use of an injectable chemotherapeutic agent to treat the suspected skin cancer. These procedures only worsen the situation.
    • Failure to provide appropriate treatment or medications is another example of a medicolegal pitfall because resolution of this fungal infection may be delayed, resulting in unnecessary inflammation and scarring.
    • Failure to follow up with the affected patient to assure complete resolution of sporotrichosis may result in recurrence or undue morbidity or mortality. Patients should be scheduled for follow-up after clinical resolution of sporotrichosis to monitor for recurrence.
 


More on Sporotrichosis

Overview: Sporotrichosis
Differential Diagnoses & Workup: Sporotrichosis
Treatment & Medication: Sporotrichosis
Follow-up: Sporotrichosis
Multimedia: Sporotrichosis
References
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References

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Further Reading

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Keywords

Sporothrix schenckii, S schenckii, dimorphic fungal infection, lymphocutaneous sporotrichosis, fixed cutaneous sporotrichosis, disseminated sporotrichosis, Schenck disease, laryngeal and respiratory tract sporotrichosis, cutaneous sporotrichosis, lymphangitic cutaneous sporotrichosis, cellulitic sporotrichosis, mycetomalike sporotrichosis, systemic sporotrichosis, acquired immunodeficiency syndrome, AIDS, erythema nodosum, polyarteritis nodosum, treatment, diagnosis

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Contributor Information and Disclosures

Author

William P Baugh, MD, Assistant Clinical Professor of Dermatology, University of California Irvine School of Medicine and Western School of Medicine; 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, and Christian Medical & Dental Society
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, American Academy of Dermatology, American Medical Association, American Society of Dermatopathology, and Texas Dermatological Society
Disclosure: Nothing to disclose.

Cynthia L Chen, Western University of Health Sciences College of Osteopathic Medicine of the Pacific
Disclosure: Nothing to disclose.

Medical Editor

Gary J Noel, MD, Department of Pediatrics, Clinical Associate Professor, Weill Medical College of Cornell University
Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

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 and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
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, and Southern Medical Association
Disclosure: None None None

 
 
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