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Key Features

  • Sporotrichosis is a chronic fungal infection caused by organisms of the Sporothrix schenckii complex

  • Found worldwide; most patients have had contact with soil, sphagnum moss, or decaying wood

  • Infection occurs via skin inoculation, usually on the hand, arm, or foot, especially during gardening

  • Disseminated sporotrichosis is rare in immunocompetent patients but occurs in immunocompromised patients, especially those with cellular immunodeficiencies, including AIDS and alcohol abuse

Clinical Findings

  • Begins with a hard, nontender subcutaneous nodule, which later adheres to overlying skin and ulcerates

  • Within days to weeks, lymphocutaneous spread along the lymphatics draining the area occurs, which may result in ulceration

  • Cavitary pulmonary disease occurs in individuals with underlying chronic lung disease

  • Disseminated sporotrichosis presents with widespread cutaneous, lung, bone, joint, and CNS involvement

Diagnosis

  • Cultures are needed to establish the diagnosis

  • Serologic tests may be helpful in diagnosing disseminated disease, especially meningitis, but usefulness is limited

Treatment

  • Itraconazole, 200–400 mg orally once daily, for several months for localized lymphocutaneous disease and mild cases of disseminated disease

  • Terbinafine, 500 mg orally twice daily, also appears to have good efficacy in lymphocutaneous disease

  • Amphotericin B intravenously, 0.7–1.0 mg/kg/day, or a lipid amphotericin B preparation, 3–5 mg/kg/day are used for severe systemic infection

  • Surgery may be indicated for complicated pulmonary cavitary disease

  • Joint involvement may require arthrodesis

  • Lymphocutaneous sporotrichosis has a good prognosis; pulmonary, joint, and disseminated sporotrichosis respond less favorably

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