Clinical features and diagnosis of sporotrichosis
- Carol A Kauffman, MD
Carol A Kauffman, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Fungal Infections
- Professor of Internal Medicine
- University of Michigan Medical School
- Veterans Affairs Ann Arbor Healthcare System
Sporotrichosis is a subacute to chronic infection caused by the dimorphic fungus Sporothrix schenckii. Infection usually involves cutaneous and subcutaneous tissues but can occasionally occur in other sites, primarily in immunocompromised patients. Activities associated with the development of sporotrichosis include landscaping, rose gardening, and other activities that involve inoculation of soil through the skin.
The typical and atypical clinical manifestations of sporotrichosis and the diagnosis and treatment of these infections will be reviewed here. Mycology and epidemiology of sporotrichosis are discussed separately. (See "Basic biology and epidemiology of sporotrichosis" and "Treatment of sporotrichosis".)
Sporotrichosis usually arises after soil, moss, or other organic material containing the fungus is inoculated into the skin or subcutaneous tissue . Patients with pulmonary infection develop infection after inhalation of S. schenckii conidia; some cases of disseminated infection presumably also follow inhalation.
The typical host with lymphocutaneous sporotrichosis is a healthy individual with an outdoor occupation or avocation that provides exposure to the fungus. Infections involving osteoarticular structures, lungs, meninges, and other viscera are uncommon and occur most often in individuals with underlying illnesses including [2-6]:
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- Kwon-Chung KJ, Bennett JE. Sporotrichosis. In: Medical Mycology, Lea & Febiger, Philadelphia 1992. p.707.
- Kauffman CA. Sporotrichosis. Clin Infect Dis 1999; 29:231.
- Pluss JL, Opal SM. Pulmonary sporotrichosis: review of treatment and outcome. Medicine (Baltimore) 1986; 65:143.
- Kauffman CA, Pappas PG, McKinsey DS, et al. Treatment of lymphocutaneous and visceral sporotrichosis with fluconazole. Clin Infect Dis 1996; 22:46.
- Sharkey-Mathis PK, Kauffman CA, Graybill JR, et al. Treatment of sporotrichosis with itraconazole. NIAID Mycoses Study Group. Am J Med 1993; 95:279.
- Bustamante B, Lama J, Mosquera C, et al. Sporotrichosis in human immunodeficiency virus infected Peruvian patients. Two case reports and literature review. Infect Dis Clin Pract 2009; 17:78.
- Pappas PG, Tellez I, Deep AE, et al. Sporotrichosis in Peru: description of an area of hyperendemicity. Clin Infect Dis 2000; 30:65.
- Kostman JR, DiNubile MJ. Nodular lymphangitis: a distinctive but often unrecognized syndrome. Ann Intern Med 1993; 118:883.
- Smego RA Jr, Castiglia M, Asperilla MO. Lymphocutaneous syndrome. A review of non-sporothrix causes. Medicine (Baltimore) 1999; 78:38.
- da Rosa AC, Scroferneker ML, Vettorato R, et al. Epidemiology of sporotrichosis: a study of 304 cases in Brazil. J Am Acad Dermatol 2005; 52:451.
- Tiwari A, Malani AN. Primary pulmonary sporotrichosis: Case report and review of the literature. Infect Dis Clin Pract 2012; 20:25.
- Aung AK, Teh BM, McGrath C, Thompson PJ. Pulmonary sporotrichosis: case series and systematic analysis of literature on clinico-radiological patterns and management outcomes. Med Mycol 2013; 51:534.
- Donabedian H, O'Donnell E, Olszewski C, et al. Disseminated cutaneous and meningeal sporotrichosis in an AIDS patient. Diagn Microbiol Infect Dis 1994; 18:111.
- Freitas DF, de Siqueira Hoagland B, do Valle AC, et al. Sporotrichosis in HIV-infected patients: report of 21 cases of endemic sporotrichosis in Rio de Janeiro, Brazil. Med Mycol 2012; 50:170.
- Hessler C, Kauffman CA, Chow FC. The upside of bias: a case of chronic meningitis due to Sporothrix schenckii in an immunocompetent host. The Neurohospitalist 2016.
- Bolao F, Podzamczer D, Ventin M, Gudiol F. Efficacy of acute phase and maintenance therapy with itraconazole in an AIDS patient with sporotrichosis. Eur J Clin Microbiol Infect Dis 1994; 13:609.
- Kurosawa A, Pollock SC, Collins MP, et al. Sporothrix schenckii endophthalmitis in a patient with human immunodeficiency virus infection. Arch Ophthalmol 1988; 106:376.
- Wilson DE, Mann JJ, Bennett JE, Utz JP. Clinical features of extracutaneous sporotrichosis. Medicine (Baltimore) 1967; 46:265.
- Gutierrez-Galhardo MC, do Valle AC, Fraga BL, et al. Disseminated sporotrichosis as a manifestation of immune reconstitution inflammatory syndrome. Mycoses 2010; 53:78.
- Barros MB, de Almeida Paes R, Schubach AO. Sporothrix schenckii and Sporotrichosis. Clin Microbiol Rev 2011; 24:633.
- Kosinski RM, Axelrod P, Rex JH, et al. Sporothrix schenckii fungemia without disseminated sporotrichosis. J Clin Microbiol 1992; 30:501.
- Liu X, Zhang Z, Hou B, et al. Rapid identification of Sporothrix schenckii in biopsy tissue by PCR. J Eur Acad Dermatol Venereol 2013; 27:1491.
- Hu S, Chung WH, Hung SI, et al. Detection of Sporothrix schenckii in clinical samples by a nested PCR assay. J Clin Microbiol 2003; 41:1414.
- Bernardes-Engemann AR, Costa RC, Miguens BR, et al. Development of an enzyme-linked immunosorbent assay for the serodiagnosis of several clinical forms of sporotrichosis. Med Mycol 2005; 43:487.
- Scott EN, Kaufman L, Brown AC, Muchmore HG. Serologic studies in the diagnosis and management of meningitis due to Sporothrix schenckii. N Engl J Med 1987; 317:935.
- CLINICAL FEATURES
- Lymphocutaneous sporotrichosis
- Pulmonary sporotrichosis
- Osteoarticular sporotrichosis
- Meningeal sporotrichosis
- Disseminated sporotrichosis and other localized visceral infections
- Sporotrichosis in patients with HIV infection
- Polymerase chain reaction (PCR)