Sporotrichosis

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

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

Cultures are needed to establish the diagnosis

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

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