Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 36-11: Sporotrichosis + Key Features Download Section PDF Listen +++ ++ 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 or puncture from a rose thorn Disseminated sporotrichosis is rare in immunocompetent patients but occurs in immunocompromised patients, especially those with cellular immunodeficiencies, including AIDS and alcohol abuse + Clinical Findings Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ Cultures are needed to establish the diagnosis Serologic tests may be helpful in diagnosing disseminated disease, especially meningitis, but usefulness is limited + Treatment Download Section PDF Listen +++ ++ 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, has 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