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| '''For patient information on this page, click [[Sporotrichosis (patient information)|here]]''' | | '''For patient information on this page, click [[Sporotrichosis (patient information)|here]]''' |
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| {{CMG}}; {{AE}} {{JH}}. | | {{CMG}}; {{AE}} {{AJL}}, {{JH}}. |
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| {{SK}} Rose gardener's disease; Infection by ''Sporothrix schenckii'' | | {{SK}} Rose gardener's disease; Infection by ''Sporothrix schenckii'' |
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| ==Diagnosis== | | ==Diagnosis== |
| [[Sporotrichosis history and symptoms| History and Symptoms]] | [[Sporotrichosis physical examination | Physical Examination]] | [[Sporotrichosis laboratory findings|Laboratory Findings]] | [[Sporotrichosis other imaging findings|Other Imaging Findings]] | [[Sporotrichosis other diagnostic studies|Other Diagnostic Studies]] | | [[Sporotrichosis history and symptoms| History and Symptoms]] | [[Sporotrichosis physical examination | Physical Examination]] | [[Sporotrichosis laboratory findings|Laboratory Findings]] | [[Sporotrichosis chest x ray|Chest X Ray]] |
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| ==Treatment== | | ==Treatment== |
| [[Sporotrichosis medical therapy|Medical Therapy]] | [[Sporotrichosis surgery|Surgery]] | [[Sporotrichosis primary prevention|Primary Prevention]] | [[Sporotrichosis secondary prevention|Secondary Prevention]] | [[Sporotrichosis future or investigational therapies|Future or Investigational Therapies]] | | [[Sporotrichosis medical therapy|Medical Therapy]] | [[Sporotrichosis surgery|Surgery]] | [[Sporotrichosis primary prevention|Primary Prevention]] | [[Sporotrichosis secondary prevention|Secondary Prevention]] |
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| ==Case Studies== | | ==Case Studies== |
| [[Sporotrichosis case study one|Case#1]] | | [[Sporotrichosis case study one|Case#1]] |
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| ==Forms and symptoms==
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| * ''Cutaneous or skin sporotrichosis''
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| :This is the most common form of this disease. Symptoms of this form include nodular [[lesion]]s or bumps in the skin, at the point of entry and also along [[lymph]] nodes and vessels. The lesion starts off small and painless, and ranges in color from pink to purple. Left untreated, the lesion becomes larger and look similar to a [[boil]] and more lesions will appear, until a chronic [[Ulcer (dermatology)|ulcer]] develops.
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| :Usually, cutaneous sporotrichosis lesions occur in the finger, hand, and arm.
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| *''Pulmonary sporotrichosis''
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| :This rare form of the disease occur when ''S. schenckii'' spores are inhaled. Symptoms of [[pulmonary]] sporotrichosis include productive [[cough]]ing, nodules and cavitations of the lungs, [[fibrosis]], and swollen [[Hilum of lung|hilar]] [[lymph node]]s. Patients with this form of sporotrichosis are susceptible to developing [[tuberculosis]] and [[pneumonia]]
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| *''Disseminated sporotrichosis''
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| :When the infection spreads from the primary site to secondary sites in the body, the disease develops into a rare and critical form called disseminated sporotrichosis. The infection can spread to joints and bones (called ''osteoarticular sporotrichosis'') as well as the [[central nervous system]] and the brain (called ''sporotrichosis meningitis'').
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| :The symptoms of disseminated sporotrichosis include weight loss, [[anorexia (symptom)|anorexia]], and appearance of bony lesions.
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| ==Sporotrichosis in animals==
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| Sporotrichosis can be diagnosed in domestic and wild mammals. In veterinary medicine it is most frequently seen in cats and horses. Cats have a particularly severe form of cutaneous sporotrichosis and also can serve as a source of zoonotic infection to persons who handle them and are exposed to exudate from skin lesions.
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| ==Diagnosis==
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| Sporotrichosis is a [[chronic (medicine)|chronic]] disease with slow progression and often subtle symptoms. It is difficult to diagnose, as many other diseases share similar symptoms and therefore must be ruled out.
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| Patients with sporotrichosis will have [[antibodies|antibody]] against the fungus S. schenckii, however, due to variability in sensitivity and specificity, it may not be a reliable diagnosis for this disease. The confirming diagnosis remains culturing the fungus from the skin, [[sputum]], [[synovial fluid]], and [[cerebrospinal fluid]].
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| Cats with sporotrichosis are unique in that the exudate from their lesions may contain numerous organisms. This makes cytological evaluation of exudate a valuable diagnostic tool in this species. Exudate is pyogranulomatous and phagocytic cells may be packed with yeast forms. These are variable in size, but many are cigar-shaped.
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| ==Prevention==
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| The majority of sporotrichosis cases occur when the fungus is introduced through a cut or puncture in the skin while handling vegetation containing the fungal spores. Prevention of this disease includes wearing long sleeves and gloves while working with soil, hay bales, rose bushes, pine seedlings, and sphagnum moss.
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| ==Physical examination==
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| ===Gallery===
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| ====Skin====
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| =====Head=====
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| <gallery>
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| Image: Sporotrichosis_01.jpeg| Sporotrichosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=429>
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| Image: Sporotrichosis_02.jpeg| Sporotrichosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=429>
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| </gallery>
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| =====Extremities=====
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| <gallery>
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| Image: Sporotrichosis_03.jpeg| Sporotrichosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=429>
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| Image: Sporotrichosis_04.jpeg| Sporotrichosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=429>
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| Image: Sporotrichosis_05.jpeg| Sporotrichosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=429>
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| </gallery>
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| =====Trunk=====
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| <gallery>
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| Image: Sporotrichosis_06.jpeg| Sporotrichosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=429>
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| Image: Sporotrichosis_07.jpeg| Sporotrichosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=429>
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| Image: Sporotrichosis_08.jpeg| Sporotrichosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=429>
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| Image: Sporotrichosis_09.jpeg| Sporotrichosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=429>
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| </gallery>
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| ==Treatment==
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| Treatment of sporotrichosis depends on the severity and location of the disease. The following are treatment options for this condition:<ref>{{cite journal |author=Lortholary O, Denning DW, Dupont B |title=Endemic mycoses: a treatment update |journal=J. Antimicrob. Chemother. |volume=43 |issue=3 |pages=321–31 |year=1999 |pmid=10223586 |url=http://jac.oxfordjournals.org/cgi/content/full/43/3/321 |doi=10.1093/jac/43.3.321}}</ref>
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| *Saturated [[potassium iodide]] solution
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| :Although its mechanism is unknown, application of potassium iodide in droplet form can cure cutaneous sporotrichosis. This usually requires 3 to 6 months of treatment.
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| *[[Itraconazole]] (Sporanox) and [[fluconazole]]
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| :These are [[Antifungal medication|antifungal]] drugs. Itraconazole is currently the drug of choice and is significantly more effective than fluconazole. Fluconazole should be reserved for patients who cannot tolerate itraconazole.
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| *[[Amphotericin B]]
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| :This antifungal medication is delivered intravenously. Many patients, however, cannot tolerate Amphotericin B due to its potential side effects of fever, nausea, and vomiting.
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| Lipid formulations of amphotericin B are usually recommended instead of amphotericin B deoxycholate because of a better adverse-effect profile. Amphotericin B can be used for severe infection during pregnancy. For children with disseminated or severe disease, amphotericin B deoxycholate can be used initially, followed by itraconazole.<ref name="dbt.consultantlive.com">Hogan BK, Hospenthal DR. [http://dbt.consultantlive.com/display/article/1145628/1545568 Update on the therapy for sporotrichosis]. Drug Benefit Trends. 2010;22:49-52.</ref>
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| :In case of sporotrichosis meningitis, the patient may be given a combination of Amphotericin B and 5-fluorocytosine/[[Flucytosine]].
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| *Newer [[triazole]]s
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| Several studies have shown that [[posaconazole]] has in vitro activity similar to that of amphotericin B and itraconazole; therefore, it shows promise as an alternative therapy. However, [[voriconazole]] susceptibility varies. Because the correlation between in vitro data and clinical response has not been demonstrated, there is insufficient evidence to recommend either posaconazole or voriconazole for treatment of sporotrichosis at this time.<ref name="dbt.consultantlive.com"/>
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| *[[Surgery]]
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| :In cases of bone infection and cavitatory nodules in the lungs, surgery may be necessary.
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| ===Antimicrobial Regimen===
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| *'''Sporotrichosis'''<ref name="KauffmanBustamante2007">{{cite journal|last1=Kauffman|first1=C. A.|last2=Bustamante|first2=B.|last3=Chapman|first3=S. W.|last4=Pappas|first4=P. G.|title=Clinical Practice Guidelines for the Management of Sporotrichosis: 2007 Update by the Infectious Diseases Society of America|journal=Clinical Infectious Diseases|volume=45|issue=10|year=2007|pages=1255–1265|issn=1058-4838|doi=10.1086/522765}}</ref>:
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| :*1.'''Lymphocutaneous/cutaneous'''
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| ::*Preferred regimen: [[Itraconazole]] 200mg PO qd
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| ::*Alternative regimen (1): [[Itraconazole]] 200 mg PO bid
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| ::*Alternative regimen (2): [[Terbinafine]] 500 mg bid
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| ::*Alternative regimen (3): Saturated solution potassium iodide(SSKI) with increasing doses
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| ::*Alternative regimen (4): [[Fluconazole]] 400–800 mg qd
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| ::*Alternative regimen (5): local hyperthermia
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| ::*Note(1): Treat for 2–4 weeks after lesions resolved
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| ::*Note(2): SSKI initiated at a dosage of 5 drops (using a standard eyedropper) 3 times daily, increasing as tolerated to 40–50 drops 3 times daily
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| :*2.'''Osteoarticular'''
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| ::*Preferred regimen: [[Itraconazole]] 200mg PO bid for 12 months
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| ::*Alternative regimen (1): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg/day
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| ::*Alternative regimen (2): [[Amphotericin B]] deoxycholate 0.7–1 mg/kg/day
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| ::*Note(1): Switch to [[Itraconazole]] after favorable response if AmB used
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| ::*Note(2): Treat for a total of at least 12 months
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| :*3.'''Pulmonary'''
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| ::*Preferred regimen(1): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg/day for severe or life-threatening pulmonary sporotrichosis, then [[Itraconazole]] 200 mg PO bid
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| ::*Preferred regimen(2): [[Itraconazole]] 200 mg PO bid for 12 months for less severe disease
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| ::*Alternative regimen: [[Amphotericin B]] deoxycholate 0.7–1 mg/kg/d, then [[Itraconazole]] 200 mg PO bid {{or}} surgical removal
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| ::*Note(1): Treat severe disease with an AmB formulation followed by [[Itraconazole]]
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| ::*Note(2): Treat less severe disease with [[Itraconazole]]
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| ::*Note(3): Treat for a total of at least 12 monthsSurgery combined with amphotericin B therapy is rec- ommended for localized pulmonary disease
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| :*4.'''Meningitis'''
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| ::*Preferred regimen: Lipid amphotericin B (Lipid AmB) 5 mg/kg daily for 4–6 weeks, then [[Itraconazole]] 200 mg PO bid
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| ::*Alternative regimen: [[Amphotericin B]] deoxycholate 0.7–1 mg/kg/d, then [[Itraconazole]] 200 mg PO bid
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| ::*Note(1): Length of therapy with AmB not established, but therapy for at least 4–6 weeks is recommended.
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| ::*Note(2): Treat for a total of at least 12 months.
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| ::*Note(3): May require long-term suppression with [[Itraconazole]].
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| :*5.'''Disseminated'''
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| ::*Preferred regimen: Lipid amphotericin B (Lipid AmB) 3–5 mg/kg/day, then [[Itraconazole]] 200 mg PO bid
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| ::*Alternative regimen: [[Amphotericin B]] deoxycholate 0.7–1 mg/kg/day, then [[Itraconazole]] 200 mg PO bid
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| ::*Note(1): Therapy with AmB should be continued until the patient shows objective evidence of improvement.
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| ::*Note(2): Treat for a total of at least 12 months.
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| ::*Note(3): May require long-term suppression with [[Itraconazole]].
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| :*6.'''Pregnant women'''
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| ::*Preferred regimen(1): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg/day {{or}} [[Amphotericin B]] deoxycholate 0.7–1 mg/kg/day for severe sporotrichosis
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| ::*Preferred regimen(2): Local hyperthermia for cutaneous disease.
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| ::*Note(1): It is preferable to wait until after delivery to treat non–life-threatening forms of sporotrichosis.
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| ::*Note(2): Azoles should be avoided.
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| :*7.'''Children'''
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| ::*Preferred regimen:
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| :::*Mild disease: [[Itraconazole]] 6–10 mg/kg/day (400 mg/day maximum)
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| :::*Severe disease: [[Amphotericin B]] deoxycholate 0.7 mg/kg/day followed by [[Itraconazole]] 6–10 mg/kg up to a maximum of 400 mg PO daily, as step-down therapy
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| ::*Alternative regimen: Saturated solution potassium iodide(SSKI) with increasing doses for mild disease initiated at a dosage of 1 drop (using a standard eyedropper) 3 times daily and increased as tolerated up to a maximum of 1 drop/kg or 40–50 drops 3 times daily, whichever is lowest
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| ==References==
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| {{Reflist|2}}
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| ==Complications==
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| Cutaneous lesions can become superinfected with bacteria, resulting in cellulitis.
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