Sporotrichosis

Background

• Also known as "Rose gardener's disease"
• Caused by the fungus Sporothrix schenckii 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

Fixed cutaneous sporotrichosis. A crusted/verrucous plaque develops at inoculation site, seen here over face of a child.

Lymphocutaneous sporotrichosis.

Lymphocutaneous sporotrichosis. Noduloulcerative lesions appear along the lymphatics proximal to the initial inoculation injury site.

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
  • Hand cellulitis
  • Facial cellulitis
  • Orbital cellulitis
• Erysipelas
• Lymphangitis
• Folliculitis
• Abscess
  • Anorectal abscess
  • Bartholin gland abscess
  • Scrotal abscess
• Necrotizing soft tissue infections
  • Necrotizing fasciitis
  • Necrotizing myositis
  • Necrotizing cellulitis
• Mycobacterium marinum

Look-A-Likes

• Sporotrichosis
• Osteomyelitis
• Deep venous thrombosis
• Pyomyositis
• Purple glove syndrome

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

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
• Surgery
  • For osteomyelitis or cavitary nodules in the lungs
• Standard antibiotics
  • Lesions sometimes become superinfected, consider as necessary

Disposition

• Normally treated as outpatient