Extracutaneous Sporotrichosis Research Articles

Feline sporotrichosis: Characterization of cutaneous and extracutaneous lesions using different diagnostic methods.

Sporotrichosis is a mycotic infection of the cutaneous and subcutaneous tissues caused by Sporothrix spp. that can also cause extracutaneous manifestations. This study aimed to characterize cutaneous and extracutaneous sporotrichosis lesions in cats. Over 1 year, 102 cats rescued by the Zoonoses Control Center of Belo Horizonte, Brazil, euthanized with clinical suspicion of feline sporotrichosis were evaluated. After euthanasia, the animals were evaluated by macroscopic, cytological, histopathological, and immunohistochemistry (IHC) examinations; fungal culture; and polymerase chain reaction (PCR). Sporothrix infection was identified by at least one diagnostic technique in all cats (n = 102) evaluated by postmortem examination, including 26/28 cases (93%) evaluated by IHC, 66/90 cases (73%) evaluated by cytology, 70/102 cases (68.6%) evaluated by histopathology, and 62/74 cases (84%) evaluated by fungal culture. Two cats had positive results only by fungal culture. Cytology and histopathology examinations were effective in diagnosing sporotrichosis, although IHC was needed to confirm the diagnosis in cats with low fungal loads. Sporothrix brasiliensis was confirmed by the sequencing of 3 samples. Skin lesions were characterized mainly by pyogranulomatous to granulomatous dermatitis (frequently with subcutaneous inflammation) with different intensities of Sporothrix spp. yeast. Extracutaneous findings associated with sporotrichosis included rhinitis or rhinosinusitis, lymphadenitis, pneumonia, meningitis, periorchitis, conjunctivitis, and glossitis. Extracutaneous infections were observed in 74/102 cases, and a possible association between the chronicity of the disease and the higher pathogenicity of this fungal species in cats requires further investigation.

Sporotrichosis: Update on Diagnostic Techniques

Sporotrichosis, the disease caused by Sporothrix spp, ranges from subcutaneous infections to the severe disseminated or invasive diseases. The taxonomy of Sporothrix has been revised. The subcutaneous disease is suspected easily, but the extra-cutaneous disease is diagnosed by chance or with high suspicion. This review provides the overview of currently available diagnostic techniques. Enzyme-linked immunosorbent assay (ELISA) or latex agglutination test with partially purified antigens helps in the diagnosis of extra-cutaneous sporotrichosis. Molecular methods have been used for the identification and typing of the fungus. Calmodulin, beta tubulin, translation elongation factor and chitin synthase genes are targeted for species differentiation. MALDI-TOF MS has been standardized to identify the species. PCR-based molecular techniques and matrix-assisted laser desorption ionisation time of flight mass spectroscopy (MALDI-TOF MS) help in the identification of Sporothrix species, whereas ELISA helps in diagnosing extra-cutaneous form. Utility of molecular techniques for detection of Sporothrix directly from clinical specimen needs to be evaluated.

Cutaneous Disseminated and Extracutaneous Sporotrichosis: Current Status of a Complex Disease.

Sporotrichosis is an implantation or inoculation mycosis caused by species of Sporothrix schenckii complex; its main manifestations are limited to skin; however, cutaneous-disseminated, disseminated (visceral) and extracutaneous variants of sporotrichosis can be associated with immunosuppression, including HIV-AIDS, chronic alcoholism or more virulent strains. The most common extracutaneous form of sporotrichosis includes pulmonary, osteoarticular and meningeal. The laboratory diagnosis requires observing yeast forms and isolating the fungus; the two main causative agents are Sporothrix schenckii (ss) and Sporothrix brasiliensis. Antibody levels and species recognition by Polimerase Chain Reaction using biological samples or cultures are also useful. The treatment of choice for most cases is amphotericin B and subsequent itraconazole for maintenance therapy.

Molecular identification of the Sporothrix schenckii complex

Sporothrix schenckii, an ascomycetous dimorphic organism that for over a century was recognized as the sole agent of sporotrichosis, a subcutaneous mycosis with a worldwide distribution. However, it has been proposed, based on physiologic and molecular aspects, that S. schenckii is a complex of distinct species: Sporothrix brasiliensis, Sporothrix mexicana, Sporothrix globosa, S. schenckii sensu strictu, Sporothrix luriei, and Sporothrix albicans (formerly Sporothrix pallida). Human disease has a broad range of clinical manifestations and can be classified into fixed cutaneous, lymphocutaneous, disseminated cutaneous, and extracutaneous sporotrichosis. The gold standard for the diagnosis of sporotrichosis is the culture; however, serologic, histopathologic and molecular approaches have been recently adopted for the diagnosis of this mycosis. Few molecular methods have been applied to the diagnosis of sporotrichosis to detect S. schenckii DNA from clinical specimens, and to identify Sporothrix spp. in culture. Until now, Sporothrix is the unique clinically relevant dimorphic fungus without an elucidated genome sequence, thus limiting molecular knowledge about the cryptic species of this complex, and the sexual form of all S. schenckii complex species. In this review we shall focus on the current diagnosis of the sporotrichosis, and discuss the current molecular tools applied to the diagnosis and identification of the Sporothrix complex species.This manuscript is part of the series of works presented at the “V International Workshop: Molecular genetic approaches to the study of human pathogenic fungi” (Oaxaca, Mexico, 2012).

Amphotericin B: spectrum and resistance.

Amphotericin B is a polyene macrolide antibiotic derived from the actinomycete Streptomyces nodosus. Of the 200 known polyene agents, amphotericin B is the only one with toxicities that are sufficiently limited to permit intravenous administration. All polyenes have a common mechanism of action in that they preferentially bind to ergosterol, the primary sterol in the fungal cell membrane. The consequence of this binding includes disruption of the osmotic integrity of the membrane, with leakage of intracellular potassium and magnesium, and also the disruption of oxidative enzymes in target cells. Amphotericin B has a relatively broad spectrum of action and is useful in treating cases of candidosis, cryptococcosis, histoplasmosis, blastomycosis, paracoccidioidomycosis, coccidioidomycosis, aspergillosis, extracutaneous sporotrichosis and mucormycosis, and some cases of hyalohyphomycosis and phaeohyphomycosis. Resistance (MIC > 2 mg/L) tends to be species-dependent and emerges uncommonly and slowly in isolates from patients treated with amphotericin B. These include some individual strains of Candida albicans, Candida tropicalis, Candida parapsilosis and Candida lusitaniae, which may acquire resistance during treatment. Some isolates of Scedosporium apiospermum, Fusarium spp. and Sporothrix schenckii also show primary resistance, whereas all strains of Scedosporium prolificans demonstrate resistance. The main problems associated with the use of conventional amphotericin B have always been due to its poor aqueous solubility and toxicity rather than antifungal resistance.

Immunoblot analysis of antibody responses to Sporothrix schenckii.

The serologic response to Sporothrix schenckii was investigated in patients with sporotrichosis by solid-phase enzyme-linked immunosorbent assays (ELISAs) and Western immunoblot techniques. A soluble antigen preparation derived from an S. schenckii isolate contained 15 protein staining components ranging in molecular size from 22 to 70 kilodaltons (kDa) by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Sera from 40 patients with sporotrichosis demonstrated Sporothrix immunoglobulin G antibody by ELISA with titers between 128 and 65,200. No sera from 300 healthy individuals or 100 patients with various systemic mycoses other than sporotrichosis had ELISA titers greater than 64. By Western immunoblotting of the antigens separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, sera from 10 patients with cutaneous sporotrichosis reacted with 8 to 10 antigen components (range, 40 to 70 kDa), while sera from 15 patients with extracutaneous sporotrichosis reacted with a greater number of antigen components (15 to 20 bands) over a wider range of molecular sizes (22 to 70 kDa). Antibody to 40- and 70-kDa antigen components was detected by immunoblots in all sera tested from patients with sporotrichosis. Antibody to 22- to 36-kDa antigen components was present in sera from 13 of 15 patients with extracutaneous sporotrichosis, but these lower-molecular-weight components were not detected by sera from patients with cutaneous sporotrichosis. Antibody to these components was not detected by Western blotting in sera from 19 of 20 patients with other fungal diseases or from 30 healthy individuals. Purification of these specific antigen fractions could provide the basis of a sensitive and specific serodiagnostic test to indicate the presence and activity of extracutaneous sporotrichosis.

Systemic Sporotrichosis Polytenosynovitis With Median and Ulnar Nerve Entrapment

SPOROTRICHOSIS is a granulomatous fungal infection, usually confined to cutaneous and subcutaneous tissue. The extracutaneous manifestations, either unifocal or multifocal, are rare. Of 3,300 cases of cutaneous sporotrichosis reported by Lurie,¹only five showed lesions involving muscles, bones, and viscera. Crout et al²described the clinical features of seven cases of sporotrichosis arthritis diagnosed from 1954 to 1975, indicating the rarity of the disease. We report a case of extracutaneous sporotrichosis polytenosynovitis without arthritis, involving the tendons of the tibialis anterior at both ankles, of the left flexor carpi ulnaris, and of the fourth and fifth digitorum profundus, producing median and ulnar nerve entrapment. <h3>Report of a Case</h3> A 37-year-old man, a long-term alcoholic, was seen in Harper Hospital, Detroit, in December 1977 with a three-year history of pain and swelling of the volar aspect of the left distal forearm, wrist, and left fourth and fifth fingers and

Disseminated sporotrichosis

EXTRACUTANEOUS sporotrichosis is an uncommon manifestation of this fungal infection. A patient with disseminated sporotrichosis had<i>Sporotrichum schenckii</i>in multiple sites, including skin, urine, bone marrow, and brain. <h3>Report of a Case</h3> A 60-year-old alcoholic man was admitted to the hospital with generalized weakness, progressive edema, ascites, and skin lesions. Two weeks before admission, he had noted painless erythematous lesions on his distal extremities that gradually became nodular and drained purulent bloody material. He had had no chills, fever, or headache. He drank a fifth of whiskey each day. During the previous five years, he had been found to have ascites, abnormal results of liver function studies, esophageal varices, enlarged liver with patchy isotope uptake shown by liver scan, and macrocytic anemia. He denied exposure to animals, gardening, or trips into fields or woods; there was no known trauma or insect bites to his skin. At the time of admission,

Sporotrichosis Arthritis and Tenosynovitis

A case of extracutaneous sporotrichosis causing arthritis of a metacarpophalangeal joint of the hand, and tenosynovitis of the extensor carpi ulnaris has been reported. Iodide therapy, as is frequently the case, was not successful and the toxicity of amphotericin B precluded the administration of a curative dose. However, the combination of synovectomy and amphotericin-B therapy was effective, with no evidence of residual infection three years after the completion of treatment.

The serologic diagnosis of extracutaneous sporotrichosis.

The diagnosis of extracutaneous sporotrichosis often presents a serious problem. This disease often mimics other mycotic and bacterial infections. A simply prepared complement-fixation antigen was developed and examined by screening a large number of known cases of sporotrichosis. This proved to be very useful and specific for the serologic diagnosis of extracutaneous sporotrichosis. No false positive reactions were observed when the antigen was allowed to react with sera from patients having other mycotic infections. The simplicity of the preparation and the specificity of the antigen allows it to be used in the hospital laboratory for rapid, accurate diagnosis of a rather atypical sporotrichosis.

Treatment of Extracutaneous Sporotrichosis

Six of 9 patients with extracutaneous sporotrichosis in the present series, and, to our knowledge, 15 patients previously reported in the literature were treated with amphotericin B. Of 21 patients treated with the drug, five of the seven with pulmonary disease alone and eight of the 14 with disseminated extrapulmonary disease responded well to amphotericin B alone or in combination with other therapy. Eleven of the 21 patients were given iodides alone or together with hydroxystilbamidine isethionate or griseofulvin. All responded poorly to these drugs or relapsed. These data suggest that amphotericin B is more effective than iodides in the treatment of extracutaneous sporotrichosis. However, a prospective study comparing amphotericin B with iodide therapy is needed to determine if the apparent superiority of amphotericin B is real.

Treatment of extracutaneous sporotrichosis

Treatment of extracutaneous sporotrichosis

Clinical features of extracutaneous sporotrichosis.

WILSON, DANA E. M.D.2; MANN, JOHN J. M.D.3; BENNETT, JOHN E. M.D.3; UTZ, JOHN P. M.D. Author Information