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Fungal Infections

Disease name and synonyms

Sporotrichosis

Fungi responsible 

Sporothrix schenckii complex: Sporothrix albicans, Sporothrix brasiliensis, Sporothrix globosa, Sporothrix luriei, Sporothrix mexicana and S. schenckii.

Disease description

The vast majority of cases of sporotrichosis have lymphocutaneous disease or localised ulceration of the skin, without nodules or lymph node swelling. Disseminated disease occasionally occurs with multiple skin nodules, osteoarticular disease, especially affecting large joints, and meningitis. Pulmonary sporotrichosis is also reported by rare, presenting similarly to subacute invasive pulmonary aspergillosis.

Frequency and global burden

Sporotrichosis has been reported worldwide with most reported cases from Central and

South America (Mexico, Colombia, Brazil, Peru and part of China). Hyperendemic rural areas may have attack rates of 1 case per 1000 of the population. In northern India, ~30% of inhabitants in villages where sporotrichosis had been reported had evidence of exposure to the organism compared with 6% in villages without clinical cases. Occasionally point source outbreaks occur, related to infected cats, moss used for planting and hay.  

Underlying problems and at risk patients

Farmers, gardeners and forestry workers are at increased risk of sporotrichosis. Those affected are usually healthy adults under the age of 30 but young children may also be infected. S. schenckii most commonly enters the body through traumatic implantation but a minority of patients recall any history of trauma. AIDS may lead to disseminated sporotrichosis.

Diagnostic testing

Skin biopsy with both histopathological examination and fungal culture is the diagnostic test of choice. Aspiration is likely to lead to false negative results as organisms are scanty. Antibody directed against S. schenckii may be detected in blood in those with disease but are particularly valuable to diagnose meningitis due to S. schenckii, as CSF cultures are invariably negative, but yield specific antibody.

Treatments

Saturated solution of potassium iodide and itraconazole are the treatments of choice. Side-effects of potassium iodide  include metallic taste, salivary gland enlargement and rash. Terbinafine 250 mg twice daily is also highly effective. Fluconazole is less effective, as all isolates are resistant. Amphotericin B is useful for disseminated and meningeal disease initially, although micfungin may be more active, followed by itraconazole. Sporothrixio spp are resistant to voriconazole. In pregnancy, local heat (42-43ºC) application to the lesions over several months may be effective.

Outlook and prognosis

Excellent for cutaneous and lymphocutaneous disease, with cure rates exceeding 95%. Meningeal and pulmonary sporotrichosis are difficult to diagnose and treat, with less positive outcomes.

2015 review: Global Epidemiology of Sporotrichosis

Images

Appearance of a nodule in the skin lesion which is an early feature of sporotrichosis

An ulcerated case of sporotrichosis in a gardener

Multiple lesions on the arm typical of the lymphocutaneous form of sporotrichosis.

Another example of an ulcerated lesion caused by S. schenkii.

 

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