Guest guest Posted February 6, 2006 Report Share Posted February 6, 2006 Sporotrichosis http://www.cdc.gov/node.do/id/0900f3ec800075b1 Disease Listing | General Information | Technical Information | Additional Information Frequently Asked Questions What is sporotrichosis? Who gets sporotrichosis? How is the fungus spread? What are the symptoms of sporotrichosis? Does sporotrichosis involve any other organs besides the skin? How soon do symptoms appear? How is sporotrichosis diagnosed? If I have symptoms should I see my doctor? How is sporotrichosis treated? How can sporotrichosis be prevented? --------------------------------------------------------------------- ----------- What is sporotrichosis? Sporotrichosis is a fungal infection caused by a fungus called Sporothrix schenckii. It usually infects the skin. Back to Top Who gets sporotrichosis? Persons handling thorny plants, sphagnum moss, or baled hay are at increased risk of getting sporotrichosis. Outbreaks have occurred among nursery workers handling sphagnum moss, rose gardeners, children playing on baled hay, and greenhouse workers handling bayberry thorns contaminated by the fungus. A number of cases have recently occurred among nursery workers, especially workers handling sphagnum moss topiaries. Back to Top How is the fungus spread? The fungus can be found in sphagnum moss, in hay, in other plant materials, and in the soil. It enters the skin through small cuts or punctures from thorns, barbs, pine needles, or wires. It is not spread from person to person. Back to Top What are the symptoms of sporotrichosis? The first symptom is usually a small painless bump resembling an insect bite. It can be red, pink, or purple in color. The bump (nodule) usually appears on the finger, hand, or arm where the fungus first enters through a break on the skin. This is followed by one or more additional bumps or nodules which open and may resemble boils. Eventually lesions look like open sores (ulcerations) and are very slow to heal. The infection can spread to other areas of the body. Back to Top Does sporotrichosis involve any other organs besides the skin? The majority of infections are limited to the skin. Cases of joint, lung, and central nervous system infection have occurred but are very rare. Usually they occur only in persons with previous disorders of the immune system. Back to Top How soon do symptoms appear? The first nodule may appear any time from 1 to 12 weeks after exposure to the fungus. Usually the nodules are visible within 3 weeks after the fungus enters the skin. Back to Top How is sporotrichosis diagnosed? Sporotrichosis can be confirmed when a doctor obtains a swab or a biopsy of a freshly opened skin nodule and submits it to a laboratory for fungal culture. Back to Top If I have symptoms should I see my doctor? Yes. It is important for the diagnosis to be confirmed by a doctor so that proper treatment can be provided. Back to Top How is sporotrichosis treated? Sporotrichosis is generally treated with potassium iodide, taken by mouth in droplet form. A new drug, called itraconazole (Sporanox), is available for treatment, but experience with this drug is still limited. Treatment is often extended over a number of weeks, until the skin lesions are completely healed. Back to Top How can sporotrichosis be prevented? Control measures include wearing gloves and long sleeves when handling wires, rose bushes, hay bales, conifer (pine) seedlings, or other materials that may cause minor skin breaks. It is also advisable to avoid skin contact with sphagnum moss. Moss has been implicated as a source of the fungus in a number of outbreaks. Back to Top Date: October 13, 2005 Content source: National Center for Infectious Diseases/Division of Bacterial and Mycotic Diseases Sporotrichosis http://www.doctorfungus.org/mycoses/human/sporo/sporotrichosis Definition Sporotrichosis refers to the infection caused by the dimorphic fungus Sporothrix schenckii. The disease has been described worldwide, however it is more common in tropical and subtropical America [1876, 2227]. Sporotrichosis is acquired through direct inoculation into the skin and rarely via inhalation of conidia. As a consequence, the majority of cases are localized lesions affecting the skin and subcutaneous tissues with minimal if any systemic manifestation. Skin lesions characteristically follow lymphatic pathways, but the lymph nodes themselves are not usually involved. The initial erythematous papulonodular lesions evolve into either smooth or verrucose painless nodules of about 3 cm that may ulcerate and drain [1887]. There is also a clinical variety called " the fixed form " [239, 1259]. The most common form of extracutaneous sporotrichosis is osteoarthritis. Pulmonary sporotrichosis has also been described. Disseminated forms of disease are seen on occasion, and these classically affect immunosuppressed individuals [1380, 2406]. With the advent of the HIV epidemic the frequency of this presentation has increased [37, 280, 599]. Forms of the disease CATEGORIES NOTES Cutaneous Varieties: Lymphocutaneous sporotrichosis: affects the skin, subcutaneous tissues and regional lymphatics Fixed sporotrichosis: skin lesion evolves locally without spread Osteoarticular Arthritis and tenosynovitis that may affect joints of the hands, elbows, ankles or knees. The spine, hips and shoulders are usually not involved. Sinus tracts and local spread to adjacent bones may develop. Pulmonary Classically produce enlarging cavitary lesions, unilateral or bilateral usually with pulmonary infiltrates. May produce pleural effusion and hilar lymphadenopathy Associated with alcoholism, diabetes, corticosteroid use, sarcoidosis and tuberculosis Meningitis Rare Produce a typical chronic meningitis picture. CSF cultures have a low sensitivity, serologic testing may be necessary Disseminated Varieties: Multifocal tenosynovitis and arthritis that mimic gonococcal infection or seronegative spondyloarthropathy Widespread visceral involvement associated with fungemia. Many organs may be involved, including the central nervous system (meninges or parenchyma), liver, spleen, bone marrow, and colon Prognosis and therapy Special resource: You may also want to refer to the Infectious Disease Society of America-Mycoses Study Group (IDSA-MSG) Practice Guidelines for this disease. It is available at the IDSA website. Sporotrichosis is in general an indolent infection that requires prolonged therapy but usually responds [1156]. Due to the temperature sensitivity of the fungus, local application of hyperthermia can be used for the treatment of cutaneous lesions. However, systemic therapy, especially with oral azoles such as itraconazole, has shown to be very effective [1876, 2062]. Therapy with iodide (given as a saturated solution of potassium iodide, or SSKI) is also effective [1156]. Treatment is continued for 3 to 6 months in cases of skin lesions and at least 12 months for osteoarticular forms [1156]. Prognosis of disseminated disease is grave. Amphotericin B is reserved to treat relapsed lymphocutaneous disease, pulmonary, disseminated sporotrichosis as well as for serious infections presenting during pregnancy [1156]. Antibacterial antibiotics are useful when secondary bacterial infections occur. Histopathology The pattern of inflammation is characteristically well circumscribed and granulomatous with central areas of acute suppuration. In the skin, this pattern is similar to that seen in blastomycosis and coccidioidomycosis. Demonstration of the organism in tissue may be difficult because the fungi are not numerous. It may be necessary to search through many serial sections before observing the organism. The fungus is yeast-like, subglobose to ovoid, and 3-5 µm in diameter. The organisms are often described as cigar-shaped. The yeasts are not encapsulated. An asteroid body may be present and consists of globose to ovoid, basophilic cells, 3-5 µm in diameter with radiating eosinophilic rays up to 10 µm in diameter. An asteroid body formation appears to be more common in secondary lesions than in primary ones. Laboratory Direct examination Typically unrewarding. Fluorescent antibody staining techniques may be helpful. Diastase digestion prior to staining with H & E or PAS may be helpful. Isolation Inoculate the aspirates, material from Culturettes, or swabbings from open lesions onto Sabouraud dextrose agar and/or Inhibitory Mould Agar and/or BHI with Gentamycin and Chloramphenicol with 10% sheep blood, and a medium containing cycloheximide. Incubate the media at 30°C. Growth is usually present in 3-5 days. Laboratory confirmation The mould-to-yeast form conversion is necessary since other fungi are morphologically similar. Transfer the fungus to brain heart infusion agar and incubate at 37°C in 5-10 % CO2 Natural habitat Plant material Susceptibility testing Standardized testing procedures are not available. Microbiological resistance has not been demonstrated. Yeast phase of Sporothrhix schenckii lymphocutaneous lesions spreading up the arm Typical colony of Sporothrix schenckii in its mould phase References 37. Al-Tawfiq, J. A., and K. K. Wools. 1998. Disseminated sporotrichosis and Sporothrix schenckii fungemia as the initial presentation of human immunodeficiency virus infection. Clin Infect Dis. 26:1403-1406. 239. Bickley, L. K., I. J. Berman, and A. F. Hoodd. 1985. Fixed cutaneous sporotrichosis: Unusual histopathology following intralesional corticosteroid administration. J. Amer. Acad. Dermatol. 12:1007-1012. 280. Bolao, F., D. Podzamczer, M. Ventin, and F. Gudiol. 1994. Efficacy of acute phase and maintenance therapy with itraconazole in an AIDS patient with sporotrichosis. Eur. J. Clin. Microbiol. Infect. Dis. 13:609-12. 599. Donabedian, H., E. O'Donnell, C. Olszewski, R. D. MacArthur, and N. Budd. 1994. Disseminated cutaneous and meningeal sporotrichosis in an AIDS patient. Diagn. Microbiol. Infect. Dis. 18:111-115. 1156. Kauffman, C. A., R. Hajjeh, S. W. Chapman, and Mycoses Study Group. 2000. Practice guidelines for the management of patients with sporotrichosis. Clin. Infect. Dis. 30:684-687. 1259. Kwon-Chung, K. J. 1979. Comparison of isolates of Sporothrix schenckii obtained from fixed cutaneous lesions with isolates from other types of lesions. J. Infect. Dis. 139:424-431. 1380. Lynch, P. J., J. J. Voorhees, and E. R. Harrell. 1970. Systemic sporotrichosis. Ann. Intern. Med. 73:23-30. 1876. Restrepo, A., J. Robledo, I. Gomez, A. M. Tabares, and R. Gutierrez. 1986. Itraconazole therapy in lymphangitic and cutaneous sporotrichosis. Arch. Dermatol. 122:413-417. 1887. Rex, J. H., and P. C. Okhuysen. 2000. Sporothrix schenckii, p. 2695-2698. In G. L. Mandell, J. E. , and R. Dolin (ed.), Mandell, and 's Principles and Practice of Infectious Diseases, 5th ed. Churchill Livingstone, New York. 2062. Sharkey-Mathis, P. K., C. A. Kauffman, J. R. Graybill, D. A. s, J. S. Hostetler, G. Cloud, W. E. Dismukes, and Other Members of the NIAID Mycoses Study Group. 1993. Treatment of sporotrichosis with itraconazole. Am. J. Med. 95:279-285. 2227. Travassos, L. R., and K. O. Lloyd. 1980. Sporothrix schenckii and related species of Ceratocystis. Microbiol. Rev. 44:683-721. 2406. , D. E., J. J. Mann, J. E. , and J. P. Utz. 1967. Clinical features of extracutaneous sporotrichosis. Medicine. 46:265- 279. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2006 Report Share Posted February 6, 2006 Sporotrichosis http://www.mycology.adelaide.edu.au/Mycoses/Subcutaneous/Sporotrichos is/ Description: Sporotrichosis is primarily a chronic mycotic infection of the cutaneous or subcutaneous tissues and adjacent lymphatics characterized by nodular lesions which may suppurate and ulcerate. Infections are caused by the traumatic implantation of the fungus into the skin, or very rarely, by inhalation into the lungs. Secondary spread to articular surfaces, bone and muscle is not infrequent, and the infection may also occasionally involve the central nervous system, lungs or genitourinary tract. Clinical manifestations: Fixed cutaneous sporotrichosis: Primary lesions develop at the site of implantation of the fungus, usually at more exposed sites mainly the limbs, hands and fingers. Lesions often start out as a painless nodule which soon become palpable and ulcerate often discharging a serous or purulent fluid. Importantly, lesions remain localised around the initial site of implantation and do not spread along the lymphangitic channels. Isolates from these lesions usually grow well at 35C, but not at 37C. Fixed cutaneous sporotrichosis showing an ulcerating lesion on the leg. Lymphocutaneous sporotrichosis: Primary lesions develop at the site of implantation of the fungus, but secondary lesions also appear along the lymphangitic channels which follow the same indolent course as the primary lesion ie they start out as painless nodules which soon become palpable and ulcerate. No systemic symptoms are present. Isolates from these lesions usually grow well at both 35C and 37C. Lymphocutaneous sporotrichosis showing typical elevated subcutaneous nodules developing along the regional lymphatics of the forearm Lymphocutaneous sporotrichosis showing more advanced, ulcerating lesions developing along the lymph system of the forearm. Pulmonary sporotrichosis: This is a rare entity usually caused by the inhalation of conidia but cases of haematogenous dissemination have been reported. Symptoms are nonspecific and include cough, sputum production, fever, weight loss and upper-lobe lesion. Haemoptysis may occur and it can be massive and fatal. The natural course of the lung lesion is gradual progression to death. Osteoarticular sporotrichosis: Most patients also have cutaneous lesions and present with stiffness and pain in a large joint, usually the knee, elbow, ankle or wrist. Osteomyelitis seldom occurs without arthritis; the lesions usually confined to the long bones near affected joints. Other rare forms of sporotrichoisis include endophthalmitis, chorioretinitis and meningitis. Laboratory diagnosis: 1. Clinical material: A tissue biopsy is the best specimen. 2. Direct Microscopy: Tissue sections should be stained using PAS digest, Grocott's methenamine silver (GMS) or Gram stain. Section from a fixed cutaneous lesion showing round Periodic Acid-Schiff (PAS) positive budding yeast-like cells. Sporothrix schenckii is a dimorphic fungus and this is the typical yeast-like form seen in tissue. Interpretation: Look for small narrow base budding yeast cells (2- 5um). Note they are often present in very low numbers and may be difficult to find. PAS and GMS stains are essential. 3. Culture: Clinical specimens should be inoculated onto primary isolation media, like Sabouraud's dextrose agar and Brain heart infusion agar supplemented with 5% sheep blood. Interpretation: A positive culture from a biopsy should be considered significant. 4. Serology: Serological tests are of limited value in the diagnosis of Sporotrichosis. 5. Identification: Hyphomycete characterized by thermal dimorphism and clusters of ovoid, denticulate conidia produced sympodially on short conidiophores. Causative agents: Sporothrix schenckii Management: Cutaneous lesions respond well to saturated potassium iodide [4-6 ml three time a day for 2-4 months], however itraconazole [400 mg/day] and terbinafine [250 mg twice daily] have both proved to be effective, although treatment times may be long. Ideally, treatment needs to be maintained for at least a month after clinical cure is achieved. Local heat has also been shown to improve cutaneous lesions. Extracutaneous forms of sporotrichosis may need a combination of antifungal treatment with Amphotericin B or itraconazole together with surgical debridement. Further reading: Ajello L and R.J. Hay. 1997. Medical Mycology Vol 4 Topley & 's Microbiology and Infectious Infections. 9th Edition, Arnold London. Elewski BE. 1992. Cutaneous fungal infections. Topics in dermatology. Igaku-Shoin, New York and Tokyo. Kwon-Chung KJ and JE 1992. Medical Mycology Lea & Febiger. MD and DW Warnock. 1993. Fungal Infection: Diagnosis and Management. Blackwell Scientific Publications, London. Rippon JW. 1988. Medical Mycology WB Saunders Co. Quote Link to comment Share on other sites More sharing options...
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