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sporotrichosis
Etiology:
- infection caused by Sporothrix schenckii.
Epidemiology:
1) occupational hazard for farmers, florists, gardeners, horticulurists & forestry workers
2) infection generally caused by cutaneous inoculation (i.e. thorn)
3) inhalation of organism may cause pulmonary disease
Clinical manifestations:
1) papule appears days to weeks later at the site of inoculum [3]
2) cutaneous & lymphocutaneous nodules along lymphatic drainage in 75% of patients
3) hematogenous dissemination may occur in immunocompromised hosts
4) inhalation-induced pulmonary disease may mimick tuberculosis
a) cavitation
b) empyema
5) meningitis is uncommon
6) monoarthritis [3,4]
* image [6]
Laboratory:
1) biopsy
- synovial biopsy if infectious arthritis suspected
2) Sporothrix schenckii antigen in tissue [5]
3) Sporothrix schenckii serology
4) fungal culture
Management:
1) cutaneous & lymphocutaneous infection
a) itraconazole (73-90% response rate)
b) ketoconazole
c) flucanazole (71% response rate)
d) terbinafine
e) saturated solution of KI (SSKI)
2) disseminated infection (pulmonary & joint): amphotericin B
Related
Sporothrix schenckii
Specific
cutaneous sporotrichosis
disseminated sporotrichosis
General
mycosis; fungal infection
References
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 511, 809
- UpToDate Online 14.2
- Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19.
American College of Physicians, Philadelphia 2012, 2015, 2018, 2021.
- Medical Knowledge Self Assessment Program (MKSAP) 19
Board Basics. An Enhancement to MKSAP19.
American College of Physicians, Philadelphia 2022
- Appenzeller S, Amaral TN, Amstalden EM et al
Sporothrix schenckii infection presented as monoarthritis:
report of two cases and review of the literature.
Clin Rheumatol. 2006 Nov;25(6):926-8. Epub 2005 Dec 7.
PMID: 16333559
- Loinc
- Qin J, Zhang J
Sporotrichosis.
N Engl J Med 2019; 380:771. Feb 21, 2019
PMID: 30786190
https://www.nejm.org/doi/full/10.1056/NEJMicm1809179