Table of contents
Sporotrichosis
Background
Overview
Definition
Sporotrichosis is a subacute or chronic infection caused by the dimorphic fungus Sporothrix schenckii. It primarily affects the skin, subcutaneous tissues, and lymphatic system but can disseminate to other organs, particularly in immunocompromised individuals.
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Pathophysiology
Sporothrix schenckii enters the body through minor skin trauma, such as a thorn prick, or through bites and scratches of animals. In the environment, it exists as a mold and converts to a yeast form at body temperature, inducing a granulomatous inflammatory response. This response leads to the formation of nodules and ulcers. The infection can also spread along lymphatic vessels, causing lymphocutaneous sporotrichosis.
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Epidemiology
Sporotrichosis is a rare disease, predominantly occurring in tropical and subtropical regions. The estimated rate of sporotrichosis-associated hospitalizations in the US is 0.35 per 1,000,000 person-years. The incidence of sporotrichosis in South America is estimated at 48-60 per 100,000 person-years.
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Risk factors
Risk factors for sporotrichosis include occupational and recreational activities involving soil, wood, and plants, such as gardening, farming, and hunting, exposure to infected animals (particularly in veterinarians), recent travel to endemic regions, and immunocompromising conditions, such as HIV/AIDS, diabetes, alcohol use disorder, and immunosuppressive therapy.
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Disease course
The incubation period ranges from 1 to 12 weeks. The cutaneous form typically starts as a papule and evolves into nodular lesions that may ulcerate. In lymphocutaneous sporotrichosis, patients present with nodules along lymphatic drainage tracts. Pulmonary sporotrichosis manifests with symptoms such as cough, hemoptysis, fever, and weight loss, resembling pulmonary tuberculosis. Disseminated sporotrichosis often involves the bones, joints, and CNS.
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Prognosis and risk of recurrence
Different genotypes of Sporothrix schenckii may be associated with varying clinical forms and levels of virulence. Sporotrichosis generally responds well to antifungal therapy, with a relatively poor prognosis observed in disseminated and meningeal forms in immunocompromised patients.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of sporotrichosis are prepared by our editorial team based on guidelines from the European Confederation of Medical Mycology (ECMM/ISHAM 2021), the American Thoracic Society (ATS 2011), and the Infectious Diseases Society of America (IDSA 2007).
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Diagnostic investigations
Culture and histopathology
As per ECMM/ISHAM 2021 guidelines:
Obtain culture and histopathological evaluation of skin or tissue aspirates or biopsies in patients with suspected sporotrichosis.
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Obtain imaging in patients with skin and soft tissue sporotrichosis only if there is concern for spread to contiguous bone or deeper structures.
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Medical management
Management of cutaneous and lymphocutaneous sporotrichosis: as per ECMM/ISHAM 2021 guidelines, administer itraconazole (200 mg PO daily) for 2-4 weeks after resolution of lesions, typically for a duration of 3-6 months, in patients with cutaneous or lymphocutaneous sporotrichosis.
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More topics in this section
Management of osteoarticular sporotrichosis
Management of pulmonary sporotrichosis
Management of meningeal sporotrichosis
Management of disseminated sporotrichosis