Good with treatment, poor if widespread disease[1]
Sporotrichosis, also known asrose handler's disease,[2] is afungal infection that may be localised to skin, lungs, bone and joint, or becomesystemic.[2][4] It presents with firm painlessnodules that laterulcerate.[3] Following initial exposure toSporothrix schenckii, the disease typically progresses over a period of a week to several months.[1] Serious complications may develop in people who have aweakened immune system.[1]
Sporotrichosis is caused by fungi of theS. schenckiispecies complex.[5][6] BecauseS. schenckii is naturally found in soil,hay,sphagnum moss, and plants, it most often affectsfarmers, gardeners, and agricultural workers.[7] It enters through small cuts in the skin to cause a fungal infection.[1] In cases of sporotrichosis affecting the lungs, the fungal spores enter byinhalation.[1] Sporotrichosis can be acquired by handling cats with the disease; it is an occupational hazard for veterinarians.[1]
S. schenkii, the causal fungus, is found worldwide.[1] The species was named for Benjamin Schenck, a medical student who, in 1896, was the first to isolate it from a human specimen.[8]
Sporotrichosis has been reported in cats,[1] mules, dogs, mice and rats.[3]
This is the most common form of this disease. Symptoms of this form include nodularlesions or bumps in the skin, at the point of entry and also alonglymph 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 aboil and more lesions will appear, until a chroniculcer develops.[citation needed]
Usually, cutaneous sporotrichosis lesions occur in the finger, hand, and arm.[citation needed]
Pulmonary sporotrichosis
This rare form of the disease occurs whenS. schenckii spores are inhaled. Symptoms ofpulmonary sporotrichosis include productivecoughing, nodules and cavitations of the lungs,fibrosis, and swollenhilarlymph nodes. Patients with this form of sporotrichosis are susceptible to developingtuberculosis andpneumonia[citation needed]
Disseminated sporotrichosis
When the infection spreads from the initial site to secondary sites in the body, the disease develops into an uncommon and potentially life-threatening form, calleddisseminated sporotrichosis. The infection can spread to joints and bones (calledosteoarticular sporotrichosis) as well as thecentral nervous system and the brain (calledsporotrichosis meningitis).[citation needed]
Some symptoms of disseminated sporotrichosis include weight loss,anorexia, and bone lesions.
Conidiophores and conidia of the fungusSporothrix schenckii
Sporotrichosis is anacute infection with slow progression and often subtle symptoms. It is often difficult to diagnose, as many other diseases share similar symptoms and therefore must be ruled out.[citation needed]
Patients with sporotrichosis will haveantibodies against the fungusS. schenckii; however, due to variability in sensitivity and specificity, antibody detection may not be a reliable diagnostic test for this disease. The confirming diagnosis remainsculturing the fungus from the skin,sputum,synovial fluid, andcerebrospinal fluid.Smears should be taken from any drainingfistulas or ulcers.[citation needed]
Cats with sporotrichosis are unique in that theexudate from their lesions may contain numerous infectious organisms. This makes cytological evaluation of exudate a valuable diagnostic tool in this species. Exudate ispyogranulomatous, andphagocytic cells may be packed withyeast forms. These yeast cells are variable in size; many are cigar-shaped.[citation needed]
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.
The risk of sporotrichosis in cats is increased in male cats that roam outdoors.[10] Accordingly, the risk may be reduced by keeping cats indoors or neutering them.[11] Isolating infected animals can also be a preventive measure.[11][12] The risk of spread from infected cats to humans can be reduced by appropriate biosafety measures, including wearingpersonal protective equipment when handling a cat with suspected sporotrichosis and by washing hands, arms and clothing after handling the cat.[12]
Potassium iodide is an anti-fungal drug that is widely used as a treatment for cutaneous sporotrichosis. Despite its wide use, there is no high-quality evidence for or against this practice. Further studies are needed to assess the efficacy and safety of oral potassium iodide in the treatment of sporotrichosis.[14]
These areantifungal 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.
This antifungal medication is delivered intravenously. Many patients, however, cannot tolerate Amphotericin B due to its potential side effects of fever, nausea, and vomiting.
Lipid formulations of amphotericin B are usually recommended instead ofamphotericin 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.[15]
In case of sporotrichosis meningitis, the patient may be given a combination of Amphotericin B and 5-fluorocytosine/Flucytosine.
Several studies have shown thatposaconazole 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.[15]
Heat creates higher tissue temperatures, which may inhibit fungus growth while the immune system counteracts the infection. The "pocket warmer" used for this purpose has the advantage of being able to maintain a constant temperature of 44 degrees-45 degrees C on the skin surface for several hours, while permitting unrestricted freedom of movement. The duration of treatment depends on the type of lesion, location, depth, and size. Generally, local application for 1-2 h per day, or in sleep time, for 5-6 weeks seems to be sufficient.[17]
Ulcerative skin disease in a cat with sporotrichosis; a cat with this disease must be handled with caution as this form can be contagious to other animals and to humans
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. Infected cats may exhibit abscesses, cellulitis, or draining wounds that fail to respond to antibiotic treatment.[10]
Sporotrichosis can spread from nonhuman animals to humans (zoonosis). Infected cats in particular exude large quantities ofSporothrix organisms from their skin leasions and can spread the infection to people who handle them.[10][18] Although cats are the most common animal source, the infection has also been known to spread to humans from dogs, rats, squirrels, and armadillos.[19]
^López-Romero, Everardo; et al. (2010). "Sporothrix schenckii complex and sporotrichosis, an emerging health problem".Future Microbiology.6 (1):85–102.doi:10.2217/fmb.10.157.PMID21162638.
^Chapman SW, Pappas P, Kauffmann C, Smith EB, Dietze R, Tiraboschi-Foss N, Restrepo A, Bustamante AB, Opper C, Emady-Azar S, Bakshi R (February 2004). "Comparative evaluation of the efficacy and safety of two doses of terbinafine (500 and 1000 mg day(-1)) in the treatment of cutaneous or lymphocutaneous sporotrichosis".Mycoses.47 (1–2):62–8.doi:10.1046/j.1439-0507.2003.00953.x.hdl:2027.42/74074.PMID14998402.S2CID7319396.
^Takahashi S, Masahashi T, Maie O (October 1981). "[Local thermotherapy in sporotrichosis]".Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und Verwandte Gebiete (in German).32 (10):525–8.PMID7298332.
