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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] - primary lesion located at the site of inoculation may progress to an ulcerated nodule [3] - can also present as a plaque-like or verrucous-like lesion that typically appears on the face [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

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 511, 809
  2. UpToDate Online 14.2
  3. 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 - Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025
  4. 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
  5. Loinc
  6. 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