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.
Treatment of sporotrichosis varies with the type of disease . Since most manifestations are subacute to chronic and localized, oral antifungal agents are usually preferred. The agent of choice is itraconazole . The rare cases of life-threatening, visceral, or disseminated infection require therapy with intravenous amphotericin B, which is also used in patients who do not respond to itraconazole.
The treatment of the various manifestations of sporotrichosis will be reviewed. The approach is consistent with the 2007 Infectious Diseases Society of America clinical practice guidelines for the management of sporotrichosis (table 1) .
The basic biology, epidemiology, clinical manifestations, and diagnosis of sporotrichosis are discussed separately. (See "Basic biology and epidemiology of sporotrichosis" and "Clinical features and diagnosis of sporotrichosis".)
CHOICE OF ANTIFUNGAL AGENT
The choice of antifungal agent in patients with sporotrichosis is limited. In vitro susceptibility studies show good activity for amphotericin B, itraconazole, and terbinafine and reasonable activity for posaconazole; both fluconazole and voriconazole have poor activity in vitro against S. schenckii [4,5]. Clinical experience has shown that itraconazole is the treatment of choice for patients with most localized forms of sporotrichosis, and amphotericin B is the preferred treatment for patients who are severely ill . Fluconazole and ketoconazole are poor second-line choices [6-8]. There is no experience with voriconazole, primarily because of the lack of activity in vitro. Posaconazole has activity in vitro [4,9] and has been shown effective in a murine model of sporotrichosis . However, to date, only one patient has been described in whom posaconazole was used successfully .