Sporotrichosis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Sporotrichosis is an endemic mycosis with worldwide distribution caused by the dimorphic Sporothrix schenckii fungal complex.
The vast majority of sporotrichosis infections are lymphocutaneous or fixed cutaneous forms, although osteoarticular, pulmonary, meningeal, and disseminated sporotrichosis may occur, especially in patients with diabetes, alcohol use disorder, HIV, and hematologic malignancies, but also in normal hosts.
Lymphocutaneous sporotrichosis is caused by traumatic inoculation of the fungus into the skin and results in an initial nodular lesion that usually ulcerates, which is followed by ascending nodular lymphangitis.
The definitive test for diagnosis of lymphocutaneous sporotrichosis is culture of the fungus from skin lesions.
Because of their nonspecific presentation and relative rarity, a high index of clinical suspicion is required for diagnosis of extracutaneous forms of sporotrichosis, which is typically delayed.

Ascending "sporotrichoid" distribution of skin lesions across the proximal lymphatic channels

From the collection of Richard J. Hamill, MD and Edward Septimus, MD, Baylor College of Medicine, Houston, TX

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Definition

Epidemiology

Etiology

Pathophysiology

Images

Mold form of S schenckii exhibiting conidia arranged in a characteristic "bouquet-like" appearance along delicate hyphal structures, typically found in the environment at 77°F to 86°F (25°C to 30°C)
Cigar- and oval-like yeast form of Sporothrix schenckii typically found in vivo in patient tissues at 98.6°F (37°C)
Ascending "sporotrichoid" distribution of skin lesions across the proximal lymphatic channels
Ulcerated primary sporotrichosis lesion
Proximal lymphangitic spread of primary lesion

Citations

Key Articles

Rex JH, Okhuysen PC. Sporothrix schenckii. In Bennett JE, Dolin R, Blaser MJ, eds. Principles and practice of infectious diseases. 9th ed. Philadelphia, PA: Elsevier, 2020: 3131-6.
Orofino-Costa R, Macedo PM, Rodrigues AM, et al. Sporotrichosis: an update on epidemiology, etiopathogenesis, laboratory and clinical therapeutics. An Bras Dermatol. 2017 Sep-Oct;92(5):606-20.[Abstract][Full Text]
Kauffman CA, Bustamante B, Chapman SW, et al. Clinical practice guidelines for the management of sporotrichosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007 Nov 15;45(10):1255-65.[Abstract][Full Text]
Sharkey-Mathis PK, Kauffman CA, Graybill JR, et al. Treatment of sporotrichosis with itraconazole. NIAID Mycoses Study Group. Am J Med. 1993 Sep;95(3):279-85.[Abstract]

Referenced Articles

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25. Boehm D, Lynch JM, Hodges GR, et al. Case report. Disseminated sporotrichosis presenting as sarcoidosis: electron microscopic and immunologic studies. Am J Med Sci. 1982 Mar-Apr;283(2):71-8.[Abstract]
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27. Barros NM, Pessoa AS, Brotas AM. Systemic sporotrichosis in an alcoholic patient. An Bras Dermatol. 2020 May-Jun;95(3):376-8.[Abstract][Full Text]
28. Moreira JA, Freitas DF, Lamas CC. The impact of sporotrichosis in HIV-infected patients: a systematic review. Infection. 2015 Jun;43(3):267-76.[Abstract]
29. Gottlieb GS, Lesser CF, Holmes KK, et al. Disseminated sporotrichosis associated with treatment with immunosuppressants and tumor necrosis factor-alpha antagonists. Clin Infect Dis. 2003 Sep 15;37(6):838-40.[Abstract][Full Text]
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31. Kostman JR, DiNubile MJ. Nodular lymphangitis: a distinctive but often unrecognized syndrome. Ann Intern Med. 1993 Jun 1;118(11):883-8.[Abstract]
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33. Hu S, Chung WH, Hung SI, et al. Detection of Sporothrix schenckii in clinical samples by a nested PCR assay. J Clin Microbiol. 2003 Apr;41(4):1414-8.[Abstract][Full Text]
34. Scott EN, Kaufman L, Brown AC, et al. Serologic studies in the diagnosis and management of meningitis due to Sporothrix schenckii. N Engl J Med. 1987 Oct 8;317(15):935-40.[Abstract]
35. Galhardo MC, Silva MT, Lima MA, et al. Sporothrix schenckii meningitis in AIDS during immune reconstitution syndrome. J Neurol Neurosurg Psychiatry. 2010 Jun;81(6):696-9.[Abstract][Full Text]
36. Kauffman CA, Bustamante B, Chapman SW, et al. Clinical practice guidelines for the management of sporotrichosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007 Nov 15;45(10):1255-65.[Abstract][Full Text]
37. Sharkey-Mathis PK, Kauffman CA, Graybill JR, et al. Treatment of sporotrichosis with itraconazole. NIAID Mycoses Study Group. Am J Med. 1993 Sep;95(3):279-85.[Abstract]
38. Restrepo A, Robledo J, Gómez I, et al. Itraconazole therapy in lymphangitic and cutaneous sporotrichosis. Arch Dermatol. 1986 Apr;122(4):413-7.[Abstract]
39. Conti Díaz IA, Civila E, Gezuele E, et al. Treatment of human cutaneous sporotrichosis with itraconazole. Mycoses. 1992 May-Jun;35(5-6):153-6.[Abstract]
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41. Cabezas C, Bustamante B, Holgado W, et al. Treatment of cutaneous sporotrichosis with one daily dose of potassium iodide. Pediatr Infect Dis J. 1996 Apr;15(4):352-4.[Abstract]
42. Itoh M, Okamoto S, Kariya H. Survey of 200 cases of sporotrichosis. Dermatologica. 1986;172(4):209-13.[Abstract]
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44. Chapman SW, Pappas P, Kauffmann C, et al. Comparative evaluation of the efficacy and safety of two doses of terbinafine (500 and 1000 mg day(-1)) in the treatment of cutaneous or lymphocutaneous sporotrichosis. Mycoses. 2004 Feb;47(1-2):62-8.[Abstract]
45. Francesconi G, Francesconi do Valle AC, Passos SL, et al. Comparative study of 250 mg/day terbinafine and 100 mg/day itraconazole for the treatment of cutaneous sporotrichosis. Mycopathologia. 2011 May;171(5):349-54.[Abstract]
46. Kauffman CA, Pappas PG, McKinsey DS, et al. Treatment of lymphocutaneous and visceral sporotrichosis with fluconazole. Clin Infect Dis. 1996 Jan;22(1):46-50.[Abstract]
47. Winn RE, Anderson J, Piper J, et al. Systemic sporotrichosis treated with itraconazole. Clin Infect Dis. 1993 Aug;17(2):210-7.[Abstract]
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49. Hiruma M, Kawada A, Noguchi H, et al. Hyperthermic treatment of sporotrichosis: experimental use of infrared and far infrared rays. Mycoses. 1992 Nov-Dec;35(11-12):293-9.[Abstract]
50. Hiruma M, Kagawa S. Effects of hyperthermia on phagocytosis and intracellular killing of Sporothrix schenckii by polymorphonuclear leukocytes. Mycopathologia. 1986 Aug;95(2):93-100.[Abstract]
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