Sporotrichosis: an overview and therapeutic options.

Vikram K Mahajan

doi:10.1155/2014/272376

Abstract

Sporotrichosis is a chronic granulomatous mycotic infection caused by Sporothrix schenckii, a common saprophyte of soil, decaying wood, hay, and sphagnum moss, that is endemic in tropical/subtropical areas. The recent phylogenetic studies have delineated the geographic distribution of multiple distinct Sporothrix species causing sporotrichosis. It characteristically involves the skin and subcutaneous tissue following traumatic inoculation of the pathogen. After a variable incubation period, progressively enlarging papulo-nodule at the inoculation site develops that may ulcerate (fixed cutaneous sporotrichosis) or multiple nodules appear proximally along lymphatics (lymphocutaneous sporotrichosis). Osteoarticular sporotrichosis or primary pulmonary sporotrichosis are rare and occur from direct inoculation or inhalation of conidia, respectively. Disseminated cutaneous sporotrichosis or involvement of multiple visceral organs, particularly the central nervous system, occurs most commonly in persons with immunosuppression. Saturated solution of potassium iodide remains a first line treatment choice for uncomplicated cutaneous sporotrichosis in resource poor countries but itraconazole is currently used/recommended for the treatment of all forms of sporotrichosis. Terbinafine has been observed to be effective in the treatment of cutaneous sporotrichosis. Amphotericin B is used initially for the treatment of severe, systemic disease, during pregnancy and in immunosuppressed patients until recovery, then followed by itraconazole for the rest of the therapy.

Highlights

Deep mycoses involving the skin and/or subcutaneous tissue, fascial planes and bones, and/or various organs systems account for almost 1% of the total mycoses cases
This paper presents an overview of sporotrichosis and therapeutic options
Clinical suspicion is the key for early diagnosis and cutaneous lesions need to be differentiated from cutaneous tuberculosis, cutaneous leishmaniasis, nocardiosis, chromoblastomycosis, blastomycosis, paracoccidioidomycosis, and atypical mycobacteriosis [15, 16, 48]

Summary

Introduction

Deep mycoses involving the skin and/or subcutaneous tissue (subcutaneous mycoses), fascial planes and bones, and/or various organs systems (deep mycoses) account for almost 1% of the total mycoses cases. In most instances of subcutaneous mycoses, infection occurs following traumatic implantation of the etiologic fungi that are saprophytes to the soil and plant detritus. Current era of immunosuppression due to HIV infection, immunosuppressive therapy for cancers, autoimmune diseases, or organ transplantation has further contributed towards their increased prevalence. Mycetomas, subcutaneous zygomycosis (entomophthoromycosis and mucormycosis), hyalohyphomycosis, and lobomycosis have limited area-specific presence, sporotrichosis, a subcutaneous mycotic infection from Sporothrix schenckii species complex, perhaps remains the most reported subcutaneous mycosis worldwide. The heterogeneous morphology of lesions (nodules, plaques, noduloulcerative, ulcerative, nodulocystic or warty lesions, discharging sinuses, and subcutaneous swellings or masses) often makes the clinical diagnosis difficult in nonendemic areas leading to delayed treatment and protracted clinical course causing significant morbidity and impact on public health. Extracutaneous sporotrichosis is an emerging mycosis in HIV infected patients [2, 3]. This paper presents an overview of sporotrichosis and therapeutic options

Epidemiology

Clinical Presentations

Diagnosis

Treatment Options

Findings

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