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Home :: Sporotrichosis
Sporotrichosis
Sporotrichosis commonly follows accidental inoculation of the skin and is characterized by ulceronodule formation at the inoculation site, chronic nodular lymphangitis, and regional lymphadenitis. In the immunocompromised host, disseminated infection can occur from the skin involvement or from primary pulmonary infection.
Causes of Sporotrichosis
After subcutaneous inoculation, S.schenckii grows locally. Infection can be limited to the site of inoculation (plaque sporotrichosis) or extend along the proximal lymphatic channels (lymphangitic sporotrichosis). Spread beyond an extremity is rare; hematogenous dissemination from the skin remains unproven. The portal for osteoarticular, pulmonary, and other extracutaneous forms is unknown but is probably the lung.
Symptoms of Sporotrichosis
The first symptom is a small pink, red or purple painless bump resembling an insect bite. The bump, or lesion, usually appears on the finger, hand or arm where the fungus first entered through a break in the skin. This is followed by the appearance of one or more additional raised bumps or nodules which open and may resemble a boil. Eventually, the skin lesions look like ulcers and are very slow to heal.
- Small, painless, red lump that develops at site of a recent injury (up to 3 months following injury).
- A progressive line of ulcers leading away from the initial ulcer.
Diagnosis
Clinical suspicion and isolation of organism on culture.
Treatment
Oral antifungal agents
Itraconazole 200 to 600 mg qd. Very effective for lymphocutaneous infection; not as effective for bone/joint and pulmonary infection.
Fluconazole 200-400 mg/d reported to be effective.
Ketoconazole 400-800 mg/d reported to be effective.
Saturated solution of potassium iodide 3-4 g tid effective for lymphocutaneous infection; less effective than oral antifungal agents.
Intravenous therapy
Amphotericin B For those with pulmonary or disseminated infection or who are unable to tolerate oral therapy for lymphocutaneous disease.
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