Treatment of sporotrichosis
- Carol A Kauffman, MD
Carol A Kauffman, MD
- Section Editor — Fungal Infections
- Professor of Internal Medicine
- University of Michigan Medical School
- Veterans Affairs Ann Arbor Healthcare System
- Section Editors
- Kieren A Marr, MD
Kieren A Marr, MD
- Section Editor — Compromised Host Infections; Fungal Infections
- Professor of Medicine and Oncology
- Johns Hopkins University School of Medicine
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
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 and clinical experience support itraconazole as the treatment of choice for patients with most forms of localized sporotrichosis, and amphotericin B as the preferred treatment for patients who are severely ill [3-5]. Fluconazole and ketoconazole are poor second-line choices [6-8].
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- Kauffman CA, Bustamante B, Chapman SW, et al. Clinical practice guidelines for the management of sporotrichosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis 2007; 45:1255.
- Galhardo MC, De Oliveira RM, Valle AC, et al. Molecular epidemiology and antifungal susceptibility patterns of Sporothrix schenckii isolates from a cat-transmitted epidemic of sporotrichosis in Rio de Janeiro, Brazil. Med Mycol 2008; 46:141.
- Alvarado-Ramírez E, Torres-Rodríguez JM. In vitro susceptibility of Sporothrix schenckii to six antifungal agents determined using three different methods. Antimicrob Agents Chemother 2007; 51:2420.
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- Conti Díaz IA, Civila E, Gezuele E, et al. Treatment of human cutaneous sporotrichosis with itraconazole. Mycoses 1992; 35:153.
- Chapman SW, Pappas P, Kauffmann C, et al. Comparative evaluation of the efficacy and safety of two doses of terbinafine (500 and 1000 mg day(-1)) in the treatment of cutaneous or lymphocutaneous sporotrichosis. Mycoses 2004; 47:62.
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- Cabezas C, Bustamante B, Holgado W, Begue RE. Treatment of cutaneous sporotrichosis with one daily dose of potassium iodide. Pediatr Infect Dis J 1996; 15:352.
- Hiruma M, Kawada A, Noguchi H, et al. Hyperthermic treatment of sporotrichosis: experimental use of infrared and far infrared rays. Mycoses 1992; 35:293.
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- 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.
- Winn RE, Anderson J, Piper J, et al. Systemic sporotrichosis treated with itraconazole. Clin Infect Dis 1993; 17:210.
- Downs NJ, Hinthorn DR, Mhatre VR, Liu C. Intra-articular amphotericin B treatment of Sporothrix schenckii arthritis. Arch Intern Med 1989; 149:954.
- Gottlieb GS, Lesser CF, Holmes KK, Wald A. Disseminated sporotrichosis associated with treatment with immunosuppressants and tumor necrosis factor-alpha antagonists. Clin Infect Dis 2003; 37:838.
- Rotz, LD, Slater, LN, Wack, MF, et al. Disseminated sporotrichosis with meningitis in a patient with AIDS. Infect Dis Clin Prac 1996; 5:566.
- al-Tawfiq JA, Wools KK. Disseminated sporotrichosis and Sporothrix schenckii fungemia as the initial presentation of human immunodeficiency virus infection. Clin Infect Dis 1998; 26:1403.
- 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.
- CHOICE OF ANTIFUNGAL AGENT
- LYMPHOCUTANEOUS AND CUTANEOUS SPOROTRICHOSIS
- PULMONARY SPOROTRICHOSIS
- Severe or life-threatening disease
- Mild to moderate disease
- OSTEOARTICULAR SPOROTRICHOSIS
- MENINGEAL SPOROTRICHOSIS
- DISSEMINATED SPOROTRICHOSIS
- Treatment of HIV-infected patients
- TREATMENT OF PREGNANT WOMEN
- TREATMENT OF CHILDREN
- SUMMARY AND RECOMMENDATIONS