Sporotrichosis
Background
- Also known as "Rose gardener's disease"[1]
- Caused by the fungus Sporothrix schenckii[2] found on rose thorns
- Usually affects skin, although other rare forms can affect the lungs, joints, bones, and brain
- Enters skin through small cuts and abrasions, and inhalation for pulmonary disease
- Can also be acquired from handling cats with the disease
Clinical Features
Progresses slowly: first symptoms may appear 1 to 12 weeks (average 3 weeks) after the initial exposure to the fungus
Forms and Symptoms
- Cutaneous or skin
- Most common form
- Symptoms include nodular lesions or bumps in the skin, at the point of entry and also along lymph nodes and vessels
- Lesion starts off small and painless, and ranges in color from pink to purple
- Left untreated, lesion becomes larger and looks similar to an abscess. More lesions will appear until a chronic ulcer develops
- Pulmonary sporotrichosis
- Rare
- From inhalation of spores
- Symptoms include productive coughing, nodules and cavitations of the lungs, fibrosis, and hilar lymphadenopathy nodes
- May become superinfected with pneumonia or tuberculosis
- Disseminated sporotrichosis
- May affect joints and bones (osteoarticular sporotrichosis) and or CNS (sporotrichosis meningitis)
- Symptoms include weight loss, anorexia, and appearance of bony lesions
Differential Diagnosis
Skin and Soft Tissue Infection
- Cellulitis
- Erysipelas
- Lymphangitis
- Folliculitis
- Hidradenitis suppurativa
- Skin abscess
- Necrotizing soft tissue infections
- Mycobacterium marinum
Look-A-Likes
- Sporotrichosis
- Osteomyelitis
- Deep venous thrombosis
- Pyomyositis
- Purple glove syndrome
- Tuberculosis (tuberculous inflammation of the skin)
Hand and finger infections
- Bed bugs
- Closed fist infection (Fight Bite)
- Hand cellulitis
- Hand deep space infection
- Hand-foot-and-mouth disease
- Herpetic whitlow
- Felon
- Flexor tenosynovitis
- Paronychia
- Scabies
- Sporotrichosis
Look-Alikes
Evaluation
- Fungal culture of skin, sputum, synovial fluid, or CSF
Management
- Antifungal medication
- Itraconazole
- Drug of choice (more effective than fluconazole)
- Fluconazole
- Fluconazole (for patients who cannot tolerate itraconazole)
- Amphotericin B IV
- For disseminated of severe disease
- Itraconazole
- Surgery
- For osteomyelitis or cavitary nodules in the lungs
- Standard antibiotics
- Lesions sometimes become superinfected, consider as necessary
Disposition
- Normally treated as outpatient