scholarly journals Sporotrichosis: An Overview and Therapeutic Options

2014 ◽  
Vol 2014 ◽  
pp. 1-13 ◽  
Author(s):  
Vikram K. Mahajan
Keyword(s):  
Subcutaneous Tissue ◽  
Systemic Disease ◽  
Sporothrix Schenckii ◽  
Poor Countries ◽  
Phylogenetic Studies ◽  
Direct Inoculation ◽  
Immunosuppressed Patients ◽  
The Central Nervous System ◽  
Decaying Wood ◽  
Severe Systemic Disease

Sporotrichosis is a chronic granulomatous mycotic infection caused bySporothrix schenckii, a common saprophyte of soil, decaying wood, hay, and sphagnum moss, that is endemic in tropical/subtropical areas. The recent phylogenetic studies have delineated the geographic distribution of multiple distinctSporothrixspecies causing sporotrichosis. It characteristically involves the skin and subcutaneous tissue following traumatic inoculation of the pathogen. After a variable incubation period, progressively enlarging papulo-nodule at the inoculation site develops that may ulcerate (fixed cutaneous sporotrichosis) or multiple nodules appear proximally along lymphatics (lymphocutaneous sporotrichosis). Osteoarticular sporotrichosis or primary pulmonary sporotrichosis are rare and occur from direct inoculation or inhalation of conidia, respectively. Disseminated cutaneous sporotrichosis or involvement of multiple visceral organs, particularly the central nervous system, occurs most commonly in persons with immunosuppression. Saturated solution of potassium iodide remains a first line treatment choice for uncomplicated cutaneous sporotrichosis in resource poor countries but itraconazole is currently used/recommended for the treatment of all forms of sporotrichosis. Terbinafine has been observed to be effective in the treatment of cutaneous sporotrichosis. Amphotericin B is used initially for the treatment of severe, systemic disease, during pregnancy and in immunosuppressed patients until recovery, then followed by itraconazole for the rest of the therapy.

scholarly journals Sporotrichosis: A brief review

2021 ◽  
Vol 1 ◽  
pp. 10
Author(s):  
Vikram K Mahajan
Keyword(s):  
Systemic Disease ◽  
Sporothrix Schenckii ◽  
Laboratory Culture ◽  
Biochemical Properties ◽  
Dimorphic Fungus ◽  
Recommended Treatment ◽  
Disease Patterns ◽  
Direct Inoculation ◽  
Immunosuppressed Patients ◽  
Causative Fungus

Sporotrichosis is a chronic mycotic infection caused by dimorphic fungus Sporothrix schenckii, a common saprophyte of soil and plant detritus. According to recent phylogenetic studies, it is a complex of at least six cryptic species with distinct biochemical properties, geographical distribution, virulence, disease patterns, and therapeutic response. S. globosa is the commonest isolated strain in India and evidently responsible for most cases of treatment failure. The disease is endemic in tropical/subtropical regions with occasional large breakouts. In India most cases have been reported along the sub-Himalayan regions. The characteristic cutaneous and subcutaneous infection follows traumatic inoculation of the pathogen. Zoonotic transmission attributed to insect/bird bites, fish handling, and bites of animals is perhaps because of wound contamination from infected dressings or indigenous/herbal poultices and so is human-to-human spread. Progressively enlarging papulo-nodule(s) at the inoculation site develop(s) after a variable incubation period which will evolve into fixed cutaneous sporotrichosis or lymphocutaneous sporotrichosis. Primary pulmonary sporotrichosis following inhalation of conidia and osteoarticular sporotrichosis due to direct inoculation are rare forms. Persons with immunosuppression (HIV, immunosuppressive and anticancer therapy) may develop disseminated cutaneous sporotrichosis or systemic sporotrichosis particularly involving central nervous system. Clinical suspicion is the key for early diagnosis and histologic features remain variable. The demonstration of causative fungus in laboratory culture is confirmatory. Oral itraconazole is the currently recommended treatment for all forms of sporotrichosis but saturated solution of potassium iodide is still used as first-line treatment for uncomplicated cutaneous sporotrichosis in resource poor settings. Terbinafine has been found effective in the treatment of cutaneous sporotrichosis in few studies. Amphotericin B is used initially for the treatment of severe or systemic disease, during pregnancy and in immunosuppressed patients until recovery, and follow-on therapy is with itraconazole until complete (mycological) cure. Posaconazole and ravuconazole remain understudied while echinocandins and voriconazole are not effective.

Gastric Toxoplasmosis as the Presentation of Acquired Immunodeficiency Syndrome

2005 ◽  
Vol 129 (4) ◽  
pp. e87-e90 ◽  
Author(s):  
Mihai Merzianu ◽  
Steven M. Gorelick ◽  
Voltaire Paje ◽  
Donald P. Kotler ◽  
Corazon Sian
Keyword(s):  
Acquired Immunodeficiency Syndrome ◽  
English Literature ◽  
Human Immunodeficiency Virus Status ◽  
Old West ◽  
Immunosuppressed Patients ◽  
The Central Nervous System ◽  
Acquired Immunodeficiency ◽  
High Index Of Suspicion ◽  
Immunodeficiency Syndrome ◽  
Disseminated Disease

Abstract We report a case of a 39-year-old West African man with unknown human immunodeficiency virus status diagnosed with gastric toxoplasmosis as the presenting manifestation of acquired immunodeficiency syndrome. Toxoplasma gondii is common in severely immunosuppressed patients and most frequently involves the central nervous system, followed by the eye, myocardium and skeletal muscle, lungs, bone marrow, and peripheral blood. For unclear reasons, gastrointestinal involvement is exceedingly rare and occurs in the context of severe immunosuppression and disseminated disease. To our knowledge, this is the first report in the English literature of a patient with isolated, manifest gastric toxoplasmosis without evidence of concomitant cerebral or extracerebral involvement. It is important for both the clinician and the pathologist to maintain a high index of suspicion for toxoplasmosis in immunosuppressed patients presenting with nonspecific symptoms of gastritis and radiologic and endoscopic presence of thickened gastric folds with or without ulceration.

scholarly journals Outbreaks of canid herpesvirus 1 disease in puppies in southern Brazil

2015 ◽  
Vol 35 (6) ◽  
pp. 557-561 ◽  
Author(s):  
Juliana F. Cargnelutti ◽  
Eduardo K. Masuda ◽  
Mariana G. Neuls ◽  
Rudi Weiblen ◽  
Eduardo F. Flores
Keyword(s):  
Phylogenetic Analyses ◽  
Systemic Disease ◽  
Reproductive Age ◽  
Nucleotide Sequencing ◽  
Southern Brazil ◽  
Virus Identification ◽  
Clinicopathological Findings ◽  
Antibody Titers ◽  
Herpesvirus 1 ◽  
Severe Systemic Disease

Abstract: Canid herpesvirus 1 (CHV-1) is a widespread pathogen of dogs and produces infertility, abortions and severe systemic disease in young puppies. Clinical data indicate the circulation of CHV-1 among Brazilian dogs yet definitive diagnosis has rarely been accomplished. This article describes the clinicopathological findings of four independent cases/outbreaks of neonatal disease by CHV-1 in Bulldog puppies followed by virus identification and genetic characterization. Three events occurred in a kennel holding dogs of different breeds at reproductive age (March 2013, October 2013 and April 2014). Puppies from three French or English Bulldog litters, aging 9 to 30 days were affected, presenting dyspnea, agonic breathing, pale mucous, abdominal pain and tension, evolving to death within about 24 hours. At necropsy, the puppies presented necrohemorrhagic hepatitis, multifocal and moderate necrohemorrhagic nephritis and fibrinonecrotic interstitial pneumonia. Virus isolation was positive in clinical specimens from one litter and CHV-1 DNA was detected by PCR in tissues from all four cases. Virus-neutralizing assays with samples of the affected kennel revealed 9/12 adult animals with high antibody titers to CHV-1. Nucleotide sequencing of glycoprotein B, C and D genes revealed 99-100% of identity among the viruses and with CHV-1 sequences available in GenBank. Phylogenetic analyses of gC sequences showed a segregation of the samples, even among three isolates from the same kennel. These findings support CHV-1 infection as the cause of disease and death in these dog litters, reinforcing the need for correct etiologic diagnosis, prevention and immunization against CHV-1 in dogs from Southern Brazil.

scholarly journals Neurologic and Neuroscientific Evidence in Aged COVID-19 Patients

2021 ◽  
Vol 13 ◽  
Author(s):  
Shraddha Mainali ◽  
Marin E. Darsie
Keyword(s):  
Elderly Patients ◽  
Systemic Disease ◽  
Respiratory Illness ◽  
The Elderly ◽  
Cerebrovascular Diseases ◽  
Medical Comorbidities ◽  
Viral Illness ◽  
Atypical Presentations ◽  
Severe Systemic Disease

The COVID-19 pandemic continues to prevail as a catastrophic wave infecting over 111 million people globally, claiming 2. 4 million lives to date. Aged individuals are particularly vulnerable to this disease due to their fraility, immune dysfunction, and higher rates of medical comorbidities, among other causes. Apart from the primary respiratory illness, this virus is known to cause multi-organ dysfunction including renal, cardiac, and neurologic injuries, particularly in the critically-ill cohorts. Elderly patients 65 years of age or older are known to have more severe systemic disease and higher rates of neurologic complications. Morbidity and mortality is very high in the elderly population with 6–930 times higher likelihood of death compared to younger cohorts, with the highest risk in elderly patients ≥85 years and especially those with medical comorbidities such as hypertension, diabetes, heart disease, and underlying respiratory illness. Commonly reported neurologic dysfunctions of COVID-19 include headache, fatigue, dizziness, and confusion. Elderly patients may manifest atypical presentations like fall or postural instability. Other important neurologic dysfunctions in the elderly include cerebrovascular diseases, cognitive impairment, and neuropsychiatric illnesses. Elderly patients with preexisting neurologic diseases are susceptibility to severe COVID-19 infection and higher rates of mortality. Treatment of neurologic dysfunction of COVID-19 is based on existing practice standards of specific neurologic condition in conjunction with systemic treatment of the viral illness. The physical, emotional, psychologic, and financial implications of COVID-19 pandemic have been severe. Long-term data are still needed to understand the lasting effects of this devastating pandemic.

scholarly journals Sporothrix schenckii complex biology: environment and fungal pathogenicity

Microbiology ◽  
2014 ◽  
Vol 160 (11) ◽  
pp. 2352-2365 ◽  
Author(s):  
M. D. Téllez ◽  
A. Batista-Duharte ◽  
D. Portuondo ◽  
C. Quinello ◽  
R. Bonne-Hernández ◽  
...  
Keyword(s):  
Environmental Factors ◽  
Subcutaneous Tissue ◽  
Sporothrix Schenckii ◽  
Aetiological Agent ◽  
Natural Habitats ◽  
Fungal Pathogenicity ◽  
Adverse Conditions ◽  
Outdoor Environments ◽  
Animal Hosts ◽  
Medical Importance

Sporothrix schenckii is a complex of various species of fungus found in soils, plants, decaying vegetables and other outdoor environments. It is the aetiological agent of sporotrichosis in humans and several animals. Humans and animals can acquire the disease through traumatic inoculation of the fungus into subcutaneous tissue. Despite the importance of sporotrichosis, it being currently regarded as an emergent disease in several countries, the factors driving its increasing medical importance are still largely unknown. There have only been a few studies addressing the influence of the environment on the virulence of these pathogens. However, recent studies have demonstrated that adverse conditions in its natural habitats can trigger the expression of different virulence factors that confer survival advantages both in animal hosts and in the environment. In this review, we provide updates on the important advances in the understanding of the biology of Spor. schenckii and the modification of its virulence linked to demonstrated or putative environmental factors.

Sporothrix brasiliensis meningitis in an immunocompetent patient

2021 ◽  
pp. practneurol-2020-002915
Author(s):  
Marco A Lima ◽  
Renan Vallier ◽  
Marcos M Silva
Keyword(s):  
Differential Diagnosis ◽  
Lymph Nodes ◽  
Subcutaneous Tissue ◽  
Rare Condition ◽  
Immunocompetent Patient ◽  
Diagnosis And Treatment ◽  
Chronic Meningitis ◽  
Regional Lymph Nodes ◽  
Sporothrix Brasiliensis ◽  
Immunosuppressed Patients

Sporothrix brasiliensis usually causes infection limited to the skin, subcutaneous tissue and regional lymph nodes. Contamination occurs through inhalation or accidental inoculation from animal scratches and bites. Meningitis is rare and mostly occurs in immunosuppressed patients. Here, we describe an immunocompetent person who developed chronic meningitis and discuss the diagnosis, differential diagnosis and treatment of this rare condition.

Skin diseases affecting the oro-facial region

2018 ◽  
Author(s):  
Max Robinson ◽  
Keith Hunter ◽  
Michael Pemberton ◽  
Philip Sloan
Keyword(s):  
Skin Diseases ◽  
Systemic Disease ◽  
Lymphatic Vessels ◽  
Medical Practitioner ◽  
Skin Tumours ◽  
Facial Region ◽  
Malignant Skin ◽  
Common Skin ◽  
The Face ◽  
Direct Inoculation

Examination of the face and hands can identify significant skin diseases and also provide clues to the presence of underlying systemic disease. Many patients ignore even malignant skin tumours because they are often painless, subtle in appearance, and may be slow-growing. Dental healthcare professionals should be aware of how to recognize malig­nant skin tumours. If suspicious, but unsure of the nature of the lesion, the patient should be referred to their general medical practitioner for further evaluation. If malignancy is obvious, then an urgent referral to an appropriate specialist (dermatologist, plastic surgeon, or oral and max­illofacial surgeon) should be made using the ‘2-week wait’ (2WW) path­way (Chapter 1). Benign lesions and inflammatory diseases are more common and are important considerations in the differential diagnosis of head and neck skin abnormalities. It is important that the dental healthcare professional should be able to recognize common skin infections involving the oro-facial region. Some infections, such as erysipelas, can mimic cellulitis associated with a dental infection. When infection is diagnosed, it is vital to consider the underlying or predisposing factors, as these may be not only important diagnoses, but also may require treatment to achieve an effective clin­ical outcome. The adage ‘infection is the disease of the diseased’ is a useful reminder when dealing with patients presenting with infection. Direct inoculation of Streptococcus into skin through minor trauma is the most common initiating factor for erysipelas, which occurs in iso­lated cases. Infection involves the upper dermis and, characteristically, spreads to involve the dermal lymphatic vessels. Clinically, the disease starts as a red patch that extends to become a fiery red, tense, and indurated plaque. Erysipelas can be distinguished from cellulitis by its advancing, sharply defined borders and skin streaking due to lymphatic involvement. The infection is most common in children and the elderly, and whilst classically a disease affecting the face, in recent years it has more frequently involved the leg skin of elderly patients. Although a clinical diagnosis can be made without laboratory testing, and treat­ment is antibiotic therapy, when the diagnosis is suspected in dental practice, referral to a medical practitioner is recommended.

Case 14

2020 ◽  
pp. 87-92
Author(s):  
Hilary Humphreys
Keyword(s):  
Point Of Care ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Poor Countries ◽  
Treatment Regimens ◽  
Bird Droppings ◽  
Opportunist Infection ◽  
Immunosuppressed Patients ◽  
Respiratory Specimens

Cryptococcosis is an opportunist infection that should be considered in HIV/AIDS and in other at risk immunosuppressed patients such as those following solid organ transplantation. Cryptococcus neoformans is found in bird droppings and is the commonest cause in temperate climates but C. gattii is increasingly recognized in warmer climates. Diagnosis is usually via antigen detection, microscopy, and culture of blood, respiratory specimens and cerebrospinal fluid (CSF), in addition to histological analysis of appropriate tissue with specialised stains. New antigen assays facilitate point-of-care testing in resource-poor countries. Management includes initial treatment regimens with liposomal amphotericin B (the echinocandins have little activity) followed by follow-up antifungal therapy for up to a year, usually with fluconazole.

Neisseria gonorrhoeae

2020 ◽  
pp. 1025-1032
Author(s):  
Jackie Sherrard ◽  
Magnus Unemo
Keyword(s):  
Neisseria Gonorrhoeae ◽  
Sexual Activity ◽  
Antimicrobial Therapy ◽  
Genital Tract ◽  
Systemic Disease ◽  
Gonococcal Infection ◽  
Gram Negative ◽  
Lower Genital Tract ◽  
Direct Inoculation ◽  
Sex With Men

Neisseria gonorrhoeae is a Gram-negative, intracellular diplococcus that is transmitted by direct inoculation of infected secretion from one mucosa to another. It primarily colonizes the columnar epithelium of lower genital tract, only occasionally spreading to the upper genital tract or causing systemic disease. Oropharyngeal and rectal infections are common in men who have sex with men but also occur in women. N. gonorrhoeae is almost exclusively transmitted by sexual activity. Oropharyngeal and rectal infections usually produce no symptoms; disseminated gonococcal infection is a comparatively benign bacteraemia affecting joints (particularly shoulder and knee) and skin; traditionally more common in women than men. The gonococcus has adapted rapidly to prevalent antimicrobial usage, leading to resistance to all antibiotics used for treatment, notably penicillins, fluoroquinolones, macrolides, tetracycline, and cephalosporins. This development has resulted in major concerns internationally and the introduction of international and national action/response plans as well as dual antimicrobial therapy.

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