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Sporotrichosis

Sporotrichosis is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Subacute or chronic fungal infection due to Sporothrix schenckii
  • Most frequent; least severe deep mycosis
  • Typically presents as pustules or papules that progress to form a subcutaneous nodules with ulceration and purulent drainage; untreated, the fungus can spread via local lymphatics.
  • Occurs in the following forms:
    • Cutaneous/lymphocutaneous (most common)
    • Disseminated
      • Osteoarticular (80% of extracutaneous disease), testicular/penile, meningeal, ocular (rare); pulmonary
  • Most likely to occur in gardeners, farmers, and horticulturists
  • System(s) affected: skin/exocrine, hematologic/lymphatic/immunologic, musculoskeletal, renal, respiratory
  • Synonym(s): Schenck disease; rose gardener disease

Epidemiology

Incidence
  • ~<1/100,000 persons/year; not reportable (1)
  • Worldwide occurrence: most prevalent in temperate climates; endemic in Japan, India, Central and South America (1)
  • Most U.S. cases from the Mississippi River Valley (1)

Etiology and Pathophysiology

  • S. schenckii is a dimorphic aerobic fungus that exists in hyphal form at temperatures <37°C and as yeast >37°C; the organism is a ubiquitous saprophyte found on soil, sphagnum moss, wood, marine animals, and decaying vegetation.
  • Thermotolerance allows the fungus to grow at 37°C.
  • Virulence factors include melaninogenica and ergosterol peroxide. Surface lipids impede phagocytosis, and the organism has the ability to adhere to epithelium and endothelium (1).
  • Lymphocutaneous infection: Primary lesion forms 3 weeks to 6 months after traumatic inoculation into the skin and spreads along lymphatic channels.
  • Disseminated sporotrichosis: hematogenous spread
  • Pulmonary diseases: inhalation of spores (conidia)

Risk Factors

  • Contact with soil, mulch, sphagnum moss, pine needles, hay, timber, or thorny plants (rose bushes)
  • Occupational activities: gardeners, florists, horticulturists, landscapers, carpenters, farmers, fishermen, miners, veterinarians or other animal handlers—especially cats, armadillos, and squirrels
  • Immunocompromised patients (e.g., HIV, hematologic malignancy); chronic obstructive pulmonary disease, alcoholism, and diabetes mellitus increase risk of disseminated disease.

General Prevention

  • Wear gloves and long sleeves when handling soil or other high-risk plant materials.
  • Avoid contact with infected animals.

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Citation

Stephens, Mark B., et al., editors. "Sporotrichosis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816093/all/Sporotrichosis.
Sporotrichosis. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816093/all/Sporotrichosis. Accessed March 19, 2019.
Sporotrichosis. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816093/all/Sporotrichosis
Sporotrichosis [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 March 19]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816093/all/Sporotrichosis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Sporotrichosis ID - 816093 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816093/all/Sporotrichosis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -