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| {{SI}} | | {{Sporotrichosis}} |
| {{CMG}}; {{AE}} {{JH}}. | | {{About1|Sporothrix schenckii}} |
| | '''For patient information on this page, click [[Sporotrichosis (patient information)|here]]''' |
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| {{SK}}: Rose gardener's. | | {{CMG}}; {{AE}} {{AJL}}, {{JH}}. |
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| ==Overview==
| | {{SK}} Rose gardener's disease; Infection by ''Sporothrix schenckii'' |
| '''Sporotrichosis''' (also known as "Rose gardener's disease"<ref name="Bolognia">{{cite book |author=Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |pages= |isbn=1-4160-2999-0 |oclc= |doi= |accessdate=}}</ref>) is a disease caused by the infection of the [[fungus]] ''[[Sporothrix schenckii]]''.<ref name=Sherris>{{cite book | author = Ryan KJ, Ray CG (editors) | title = Sherris Medical Microbiology | edition = 4th | pages = 654–6 | publisher = McGraw Hill | year = 2004 | isbn = 0-8385-8529-9 }}</ref> This fungal disease usually affects the [[skin]], although other rare forms can affect the [[lung]]s, [[joint]]s, [[bone]]s, and even the [[brain]]. Because [[rose]]s can spread the disease, it is one of a few diseases referred to as ''rose-thorn'' or ''rose-gardeners' disease''.<ref>{{cite web | author = Volk T | title = ''Sporothrix schenckii'', cause of Rose-picker's Disease | work = Tom Volk's Fungus of the Month | url = http://botit.botany.wisc.edu/toms_fungi/feb2003.html | accessdate = 2007-06-16}}</ref>
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| Because ''S. schenckii'' is naturally found in soil, [[hay]], [[sphagnum moss]], and plants, it usually affects [[farmer]]s, gardeners, and agricultural workers.<ref name=Sherris /> It enters through small cuts and abrasions in the skin to cause the infection. In case of sporotrichosis affecting the lungs, the fungal spores enter through the respiratory pathways. Sporotrichosis can also be acquired from handling cats with the disease; it is an occupational hazard for veterinarians.
| | ==[[Sporotrichosis overview|Overview]]== |
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| Sporotrichosis progresses slowly - the first symptoms may appear 1 to 12 weeks (average 3 weeks) after the initial exposure to the fungus. Serious complications can also develop in patients who have a compromised [[immune system]].
| | ==[[Sporotrichosis historical perspective|Historical Perspective]]== |
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| ==Forms and symptoms== | | ==[[Sporotrichosis classification|Classification]]== |
| * ''Cutaneous or skin sporotrichosis''
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| :This is the most common form of this disease. Symptoms of this form include nodular [[lesion]]s or bumps in the skin, at the point of entry and also along [[lymph]] nodes and vessels. The lesion starts off small and painless, and ranges in color from pink to purple. Left untreated, the lesion becomes larger and look similar to a [[boil]] and more lesions will appear, until a chronic [[Ulcer (dermatology)|ulcer]] develops.
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| :Usually, cutaneous sporotrichosis lesions occur in the finger, hand, and arm.
| | ==[[Sporotrichosis pathophysiology|Pathophysiology]]== |
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| *''Pulmonary sporotrichosis''
| | ==[[Sporotrichosis causes|Causes]]== |
| :This rare form of the disease occur when ''S. schenckii'' spores are inhaled. Symptoms of [[pulmonary]] sporotrichosis include productive [[cough]]ing, nodules and cavitations of the lungs, [[fibrosis]], and swollen [[Hilum of lung|hilar]] [[lymph node]]s. Patients with this form of sporotrichosis are susceptible to developing [[tuberculosis]] and [[pneumonia]]
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| *''Disseminated sporotrichosis''
| | ==[[Sporotrichosis differential diagnosis|Differentiating Sporotrichosis from other Diseases]]== |
| :When the infection spreads from the primary site to secondary sites in the body, the disease develops into a rare and critical form called disseminated sporotrichosis. The infection can spread to joints and bones (called ''osteoarticular sporotrichosis'') as well as the [[central nervous system]] and the brain (called ''sporotrichosis meningitis'').
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| :The symptoms of disseminated sporotrichosis include weight loss, [[anorexia (symptom)|anorexia]], and appearance of bony lesions.
| | ==[[Sporotrichosis epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==Sporotrichosis in animals== | | ==[[Sporotrichosis risk factors|Risk Factors]]== |
| Sporotrichosis can be diagnosed in domestic and wild mammals. In veterinary medicine it is most frequently seen in cats and horses. Cats have a particularly severe form of cutaneous sporotrichosis and also can serve as a source of zoonotic infection to persons who handle them and are exposed to exudate from skin lesions. | | |
| | ==[[Sporotrichosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Diagnosis== | | ==Diagnosis== |
| Sporotrichosis is a [[chronic (medicine)|chronic]] disease with slow progression and often subtle symptoms. It is difficult to diagnose, as many other diseases share similar symptoms and therefore must be ruled out.
| | [[Sporotrichosis history and symptoms| History and Symptoms]] | [[Sporotrichosis physical examination | Physical Examination]] | [[Sporotrichosis laboratory findings|Laboratory Findings]] | [[Sporotrichosis chest x ray|Chest X Ray]] |
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| Patients with sporotrichosis will have [[antibodies|antibody]] against the fungus S. schenckii, however, due to variability in sensitivity and specificity, it may not be a reliable diagnosis for this disease. The confirming diagnosis remains culturing the fungus from the skin, [[sputum]], [[synovial fluid]], and [[cerebrospinal fluid]].
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| Cats with sporotrichosis are unique in that the exudate from their lesions may contain numerous organisms. This makes cytological evaluation of exudate a valuable diagnostic tool in this species. Exudate is pyogranulomatous and phagocytic cells may be packed with yeast forms. These are variable in size, but many are cigar-shaped.
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| ==Prevention==
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| The majority of sporotrichosis cases occur when the fungus is introduced through a cut or puncture in the skin while handling vegetation containing the fungal spores. Prevention of this disease includes wearing long sleeves and gloves while working with soil, hay bales, rose bushes, pine seedlings, and sphagnum moss.
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| ==Physical examination==
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| ===Gallery===
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| ====Skin====
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| =====Head=====
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| <gallery>
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| Image: Sporotrichosis_01.jpeg| Sporotrichosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=429>
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| Image: Sporotrichosis_02.jpeg| Sporotrichosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=429>
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| </gallery>
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| =====Extremities=====
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| <gallery>
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| Image: Sporotrichosis_03.jpeg| Sporotrichosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=429>
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| Image: Sporotrichosis_04.jpeg| Sporotrichosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=429>
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| Image: Sporotrichosis_05.jpeg| Sporotrichosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=429>
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| </gallery>
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| =====Trunk=====
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| <gallery>
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| Image: Sporotrichosis_06.jpeg| Sporotrichosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=429>
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| Image: Sporotrichosis_07.jpeg| Sporotrichosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=429>
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| Image: Sporotrichosis_08.jpeg| Sporotrichosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=429>
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| Image: Sporotrichosis_09.jpeg| Sporotrichosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=429>
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| </gallery>
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| ==Treatment== | | ==Treatment== |
| Treatment of sporotrichosis depends on the severity and location of the disease. The following are treatment options for this condition:<ref>{{cite journal |author=Lortholary O, Denning DW, Dupont B |title=Endemic mycoses: a treatment update |journal=J. Antimicrob. Chemother. |volume=43 |issue=3 |pages=321–31 |year=1999 |pmid=10223586 |url=http://jac.oxfordjournals.org/cgi/content/full/43/3/321 |doi=10.1093/jac/43.3.321}}</ref>
| | [[Sporotrichosis medical therapy|Medical Therapy]] | [[Sporotrichosis surgery|Surgery]] | [[Sporotrichosis primary prevention|Primary Prevention]] | [[Sporotrichosis secondary prevention|Secondary Prevention]] |
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| *Saturated [[potassium iodide]] solution
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| :Although its mechanism is unknown, application of potassium iodide in droplet form can cure cutaneous sporotrichosis. This usually requires 3 to 6 months of treatment.
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| *[[Itraconazole]] (Sporanox) and [[fluconazole]]
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| :These are [[Antifungal medication|antifungal]] drugs. Itraconazole is currently the drug of choice and is significantly more effective than fluconazole. Fluconazole should be reserved for patients who cannot tolerate itraconazole.
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| *[[Amphotericin B]]
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| :This antifungal medication is delivered intravenously. Many patients, however, cannot tolerate Amphotericin B due to its potential side effects of fever, nausea, and vomiting.
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| Lipid formulations of amphotericin B are usually recommended instead of amphotericin B deoxycholate because of a better adverse-effect profile. Amphotericin B can be used for severe infection during pregnancy. For children with disseminated or severe disease, amphotericin B deoxycholate can be used initially, followed by itraconazole.<ref name="dbt.consultantlive.com">Hogan BK, Hospenthal DR. [http://dbt.consultantlive.com/display/article/1145628/1545568 Update on the therapy for sporotrichosis]. Drug Benefit Trends. 2010;22:49-52.</ref>
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| :In case of sporotrichosis meningitis, the patient may be given a combination of Amphotericin B and 5-fluorocytosine/[[Flucytosine]].
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| *Newer [[triazole]]s
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| Several studies have shown that [[posaconazole]] has in vitro activity similar to that of amphotericin B and itraconazole; therefore, it shows promise as an alternative therapy. However, [[voriconazole]] susceptibility varies. Because the correlation between in vitro data and clinical response has not been demonstrated, there is insufficient evidence to recommend either posaconazole or voriconazole for treatment of sporotrichosis at this time.<ref name="dbt.consultantlive.com"/>
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| *[[Surgery]]
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| :In cases of bone infection and cavitatory nodules in the lungs, surgery may be necessary.
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| ===Antimicrobial Regimen===
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| *'''Sporotrichosis'''<ref name="KauffmanBustamante2007">{{cite journal|last1=Kauffman|first1=C. A.|last2=Bustamante|first2=B.|last3=Chapman|first3=S. W.|last4=Pappas|first4=P. G.|title=Clinical Practice Guidelines for the Management of Sporotrichosis: 2007 Update by the Infectious Diseases Society of America|journal=Clinical Infectious Diseases|volume=45|issue=10|year=2007|pages=1255–1265|issn=1058-4838|doi=10.1086/522765}}</ref>:
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| :*'''Lymphocutaneous/cutaneous'''
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| ::*Preferred regimen: [[Itraconazole]] 200mg PO/day
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| ::*Alternative regimen: [[Itraconazole]] 200 mg PO bid {{or}} [[Terbinafine]] 500 mg bid {{or}} Saturated solution potassium iodide(SSKI) with increasing doses {{or}} [[Fluconazole]] 400–800 mg/day {{or}} local hyperthermia
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| ::*Note(1): Treat for 2–4 weeks after lesions resolved
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| ::*Note(2): SSKI initiated at a dosage of 5 drops (using a standard eyedropper) 3 times daily, increasing as tolerated to 40–50 drops 3 times daily
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| :*'''Osteoarticular'''
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| ::*Preferred regimen: [[Itraconazole]] 200mg PO bid for 12 monthes
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| ::*Alternative regimen: Lipid amphotericin B (Lipid AmB) 3–5 mg/kg/day {{or}} [[Amphotericin B]] deoxycholate 0.7–1 mg/kg/day
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| ::*Note(1): Switch to [[Itraconazole]] after favorable response if AmB used
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| ::*Note(2): Treat for a total of at least 12 months
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| :*'''Pulmonary'''
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| ::*Preferred regimen(1): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg/day, then [[Itraconazole]] 200 mg PO bid
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| ::*Preferred regimen(2): [[Itraconazole]] 200 mg PO bid
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| ::*Alternative regimen: [[Amphotericin B]] deoxycholate 0.7–1 mg/kg/d, then [[Itraconazole]] 200 mg PO bid {{or}} surgical removal
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| ::*Note(1): Treat severe disease with an AmB formulation followed by [[Itraconazole]]
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| ::*Note(2): Treat less severe disease with [[Itraconazole]]
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| ::*Note(3): Treat for a total of at least 12 months
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| :*'''Meningitis'''
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| ::*Preferred regimen: Lipid amphotericin B (Lipid AmB) 5 mg/kg/day, then [[Itraconazole]] 200 mg PO bid
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| ::*Alternative regimen: [[Amphotericin B]] deoxycholate 0.7–1 mg/kg/d, then [[Itraconazole]] 200 mg PO bid
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| ::*Note(1): Length of therapy with AmB not established, but therapy for at least 4–6 weeks is recommended.
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| ::*Note(2): Treat for a total of at least 12 months.
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| ::*Note(3): May require long-term suppression with [[Itraconazole]].
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| :*'''Disseminated'''
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| ::*Preferred regimen: Lipid amphotericin B (Lipid AmB) 3–5 mg/kg/day, then [[Itraconazole]] 200 mg PO bid
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| ::*Alternative regimen: [[Amphotericin B]] deoxycholate 0.7–1 mg/kg/day, then [[Itraconazole]] 200 mg PO bid
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| ::*Note(1): Therapy with AmB should be continued until the patient shows objective evidence of improvement.
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| ::*Note(2): Treat for a total of at least 12 months.
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| ::*Note(3): May require long-term suppression with [[Itraconazole]].
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| :*'''Pregnant women'''
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| ::*Preferred regimen(1): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg/day {{or}} [[Amphotericin B]] deoxycholate 0.7–1 mg/kg/day for severe sporotrichosis
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| ::*Preferred regimen(2): Local hyperthermia for cutaneous disease.
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| ::*Note: It is preferable to wait until after delivery to treat non–life-threatening forms of sporotrichosis.
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| :*'''Children'''
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| ::*Mild disease
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| :::*Preferred regimen: [[Itraconazole]] 6–10 mg/kg/day (400 mg/day maximum)
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| ::*Severe disease
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| :::*Preferred regimen: [[Amphotericin B]] deoxycholate 0.7 mg/kg/day
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| ::*Alternative regimen: Saturated solution potassium iodide(SSKI) with increasing doses for mild disease
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| ==References==
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| {{Reflist|2}}
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| ==Complications== | | ==Case Studies== |
| Cutaneous lesions can become superinfected with bacteria, resulting in cellulitis.
| | [[Sporotrichosis case study one|Case#1]] |