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