Sporotrichosis: Difference between revisions
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==Case Studies== | ==Case Studies== | ||
[[Sporotrichosis case study one|Case#1]] | [[Sporotrichosis case study one|Case#1]] | ||
==Forms and symptoms== | ==Forms and symptoms== | ||
Revision as of 14:25, 11 August 2015
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Sporotrichosis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Sporotrichosis On the Web |
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American Roentgen Ray Society Images of Sporotrichosis |
For patient information on this page, click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jesus Rosario Hernandez, M.D. [2].
Synonyms and keywords: Rose gardener's disease; Infection by Sporothrix schenckii
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Sporotrichosis from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms | Physical Examination | Laboratory Findings | Other Imaging Findings | Other Diagnostic Studies
Treatment
Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Future or Investigational Therapies
Case Studies
Forms and symptoms
- Cutaneous or skin sporotrichosis
- This is the most common form of this disease. Symptoms of this form include nodular lesions 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 develops.
- Usually, cutaneous sporotrichosis lesions occur in the finger, hand, and arm.
- Pulmonary sporotrichosis
- This rare form of the disease occur when S. schenckii spores are inhaled. Symptoms of pulmonary sporotrichosis include productive coughing, nodules and cavitations of the lungs, fibrosis, and swollen hilar lymph nodes. Patients with this form of sporotrichosis are susceptible to developing tuberculosis and pneumonia
- Disseminated sporotrichosis
- 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).
- The symptoms of disseminated sporotrichosis include weight loss, anorexia, and appearance of bony lesions.
Sporotrichosis in animals
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.
Diagnosis
Sporotrichosis is a 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.
Patients with sporotrichosis will have 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.
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.
Prevention
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.
Physical examination
Gallery
Skin
Head
Extremities
Trunk
Treatment
Treatment of sporotrichosis depends on the severity and location of the disease. The following are treatment options for this condition:[1]
- Saturated potassium iodide solution
- 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.
- Itraconazole (Sporanox) and fluconazole
- These are 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.
- This antifungal medication is delivered intravenously. Many patients, however, cannot tolerate Amphotericin B due to its potential side effects of fever, nausea, and vomiting.
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.[2]
- In case of sporotrichosis meningitis, the patient may be given a combination of Amphotericin B and 5-fluorocytosine/Flucytosine.
- Newer triazoles
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.[2]
- In cases of bone infection and cavitatory nodules in the lungs, surgery may be necessary.
Antimicrobial Regimen
- Sporotrichosis[3]:
- 1.Lymphocutaneous/cutaneous
- Preferred regimen: Itraconazole 200mg PO qd
- Alternative regimen (1): Itraconazole 200 mg PO bid
- Alternative regimen (2): Terbinafine 500 mg bid
- Alternative regimen (3): Saturated solution potassium iodide(SSKI) with increasing doses
- Alternative regimen (4): Fluconazole 400–800 mg qd
- Alternative regimen (5): local hyperthermia
- Note(1): Treat for 2–4 weeks after lesions resolved
- 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
- 2.Osteoarticular
- Preferred regimen: Itraconazole 200mg PO bid for 12 months
- Alternative regimen (1): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg/day
- Alternative regimen (2): Amphotericin B deoxycholate 0.7–1 mg/kg/day
- Note(1): Switch to Itraconazole after favorable response if AmB used
- Note(2): Treat for a total of at least 12 months
- 3.Pulmonary
- 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
- Preferred regimen(2): Itraconazole 200 mg PO bid for 12 months for less severe disease
- Alternative regimen: Amphotericin B deoxycholate 0.7–1 mg/kg/d, then Itraconazole 200 mg PO bid OR surgical removal
- Note(1): Treat severe disease with an AmB formulation followed by Itraconazole
- Note(2): Treat less severe disease with Itraconazole
- Note(3): Treat for a total of at least 12 monthsSurgery combined with amphotericin B therapy is rec- ommended for localized pulmonary disease
- 4.Meningitis
- Preferred regimen: Lipid amphotericin B (Lipid AmB) 5 mg/kg daily for 4–6 weeks, then Itraconazole 200 mg PO bid
- Alternative regimen: Amphotericin B deoxycholate 0.7–1 mg/kg/d, then Itraconazole 200 mg PO bid
- Note(1): Length of therapy with AmB not established, but therapy for at least 4–6 weeks is recommended.
- Note(2): Treat for a total of at least 12 months.
- Note(3): May require long-term suppression with Itraconazole.
- 5.Disseminated
- Preferred regimen: Lipid amphotericin B (Lipid AmB) 3–5 mg/kg/day, then Itraconazole 200 mg PO bid
- Alternative regimen: Amphotericin B deoxycholate 0.7–1 mg/kg/day, then Itraconazole 200 mg PO bid
- Note(1): Therapy with AmB should be continued until the patient shows objective evidence of improvement.
- Note(2): Treat for a total of at least 12 months.
- Note(3): May require long-term suppression with Itraconazole.
- 6.Pregnant women
- 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
- Preferred regimen(2): Local hyperthermia for cutaneous disease.
- Note(1): It is preferable to wait until after delivery to treat non–life-threatening forms of sporotrichosis.
- Note(2): Azoles should be avoided.
- 7.Children
- Preferred regimen:
- Mild disease: Itraconazole 6–10 mg/kg/day (400 mg/day maximum)
- 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
- 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
References
- ↑ Lortholary O, Denning DW, Dupont B (1999). "Endemic mycoses: a treatment update". J. Antimicrob. Chemother. 43 (3): 321–31. doi:10.1093/jac/43.3.321. PMID 10223586.
- ↑ 2.0 2.1 Hogan BK, Hospenthal DR. Update on the therapy for sporotrichosis. Drug Benefit Trends. 2010;22:49-52.
- ↑ Kauffman, C. A.; Bustamante, B.; Chapman, S. W.; Pappas, P. G. (2007). "Clinical Practice Guidelines for the Management of Sporotrichosis: 2007 Update by the Infectious Diseases Society of America". Clinical Infectious Diseases. 45 (10): 1255–1265. doi:10.1086/522765. ISSN 1058-4838.
Complications
Cutaneous lesions can become superinfected with bacteria, resulting in cellulitis.