Sporotrichosis: A brief review

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.

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Sporotrichosis: An Overview and Therapeutic Options

Dermatology Research and Practice ◽

10.1155/2014/272376 ◽

2014 ◽

Vol 2014 ◽

pp. 1-13 ◽

Cited By ~ 76

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.

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Skin diseases affecting the oro-facial region

Soames' & Southam's Oral Pathology ◽

10.1093/oso/9780199697786.003.0013 ◽

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.

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Neisseria gonorrhoeae

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0110 ◽

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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Multicentric reticulohistiocytosis

Oxford Textbook of Rheumatology ◽

10.1093/med/9780199642489.003.0169 ◽

2013 ◽

pp. 1447-1450

Author(s):

Hermann Einsele ◽

Peter J. Maddison

Keyword(s):

White Women ◽

Systemic Disease ◽

Age At Onset ◽

Giant Cells ◽

Skin Lesions ◽

The Body ◽

Laboratory Findings ◽

Multicentric Reticulohistiocytosis ◽

Recommended Treatment ◽

Underlying Malignancy

Multicentric reticulohistiocytosis (MRH) is a rare systemic disease characterized by the combination of typical papular and nodular skin lesions and a severe and destructive polyarthritis, although virtually any organ system of the body can be involved. MRH most commonly affects middle-aged white women; it is about three times more common in women with a mean age at onset in the fifth decade. MRH is a rare histiocytic proliferative disease of unknown aetiology, characterized by tissue infiltration by histiocytes and multinuclear giant cells. The stimulus for the histiocytic proliferation has not been fully elucidated, although there is an association with internal malignancies and abnormal immunological laboratory findings. The diagnosis is confirmed by skin or synovial biopsy. The disease often runs a waxing and waning course and sometimes stabilizes. Work-up for underlying malignancy cannot be overemphasized. The recommended treatment for MRH is oral methrotrexate plus prednisone tapered gradually over 3–4 months.

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MICs and minimum fungicidal concentrations of amphotericin B, itraconazole, posaconazole and terbinafine in Sporothrix schenckii

Journal of Medical Microbiology ◽

10.1099/jmm.0.007609-0 ◽

2009 ◽

Vol 58 (12) ◽

pp. 1607-1610 ◽

Cited By ~ 32

Author(s):

Carolina Pereira Silveira ◽

Josep M. Torres-Rodríguez ◽

Eidi Alvarado-Ramírez ◽

Francisca Murciano-Gonzalo ◽

Maribel Dolande ◽

...

Keyword(s):

Amphotericin B ◽

Latin American ◽

Geometric Mean ◽

Sporothrix Schenckii ◽

Mycelial Form ◽

Appropriate Treatment ◽

Inappropriate Treatment ◽

Immunosuppressed Patients ◽

Identification Of Species

The in vitro susceptibility of 62 isolates of Sporothrix schenckii in its mycelial form, from Latin-American countries (Peru, Venezuela, Brazil and Uruguay) and Spain, to amphotericin B (AB), itraconazole (IZ), posaconazole (PZ) and terbinafine (TB) was determined by measuring the MICs and minimum fungicidal concentrations (MFCs) using a standardized Clinical and Laboratory Standards Institute method. In general, TB was the most active drug, with the lowest geometric mean (GM) MIC and MFC values amongst isolates from the five countries tested. IZ and PZ showed almost the same activity against all strains tested, except for isolates from Uruguay where IZ gave the highest GM MIC (10.68 mg l−1). AB showed the widest MIC range (0.03–16.0 mg l−1); however, this drug was less active against 79 % of isolates (MICs above 1 mg l−1). MFCs were 5 to 20 times higher than the MICs, but the lowest GM MFC and range values were found for TB. IZ and PZ gave the highest GM MFC. MFC may be a better predictor of therapeutic response than MIC, especially in immunosuppressed patients, making the use of IZ and PZ an inappropriate treatment. There were some differences in susceptibility according to the geographical source of the isolates, with the MIC being lower for TB in Venezuelan strains (P=0.066) and the MFC higher for PZ in Peruvian strains (P=0.02). Thus, geographical origin may be important for appropriate treatment, and may relate to the identification of species of the S. schenckii complex.

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The Infection Returns: A Case of Pulmonary Sporotrichosis Relapse after Chemotherapy

Case Reports in Medicine ◽

10.1155/2018/1384029 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Samid M. Farooqui ◽

Houssein Youness

Keyword(s):

Fungal Infections ◽

Left Lung ◽

Sporothrix Schenckii ◽

Computed Tomography Scan ◽

Dimorphic Fungus ◽

Carcinoma Of The Esophagus ◽

Case Presentation ◽

The Past ◽

Thoracic Computed Tomography ◽

Tomography Scan

Background. Pulmonary sporotrichosis is a rare disease caused by a dimorphic fungus, Sporothrix schenckii. It is rarely found in association with malignancy. We present a case of pulmonary sporotrichosis recurrence after chemotherapy. Case Presentation. A 44-year-old man, treated for pulmonary sporotrichosis in the past, presented with dysphagia and was found to have squamous cell carcinoma of the esophagus. After undergoing chemotherapy, extensive cavitary lesions were observed on thoracic computed tomography scan. A bronchoalveolar lavage revealed the presence of Sporothrix schenckii sensu lato. Despite treatment with itraconazole, he eventually required a left pneumonectomy for progressive destructive cavitary lesions involving the left lung. Conclusion. This case highlights the importance of considering past fungal infections, albeit cured, in patients initiating immunosuppressive therapy.

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Canine sporotrichosis: report of 15 advanced cases

Pesquisa Veterinária Brasileira ◽

10.1590/1678-5150-pvb-4562 ◽

2018 ◽

Vol 38 (3) ◽

pp. 477-481 ◽

Cited By ~ 3

Author(s):

Mariana B. Mascarenhas ◽

Natália L. Lopes ◽

Thiago G. Pinto ◽

Thiago S. Costa ◽

André P. Peixoto ◽

...

Keyword(s):

Rio De Janeiro ◽

Skin Diseases ◽

Sporothrix Schenckii ◽

The Body ◽

Nasal Discharge ◽

Fungal Culture ◽

Dimorphic Fungus ◽

Cutaneous Lesions ◽

Distal Aspect ◽

Disseminated Disease

ABSTRACT: Sporotrichosis is a chronic, granulomatous and usually lymphocutaneous infection of animals and humans, caused by a dimorphic fungus, Sporothrix schenckii complex. The disease in dogs is considered rare, however, in the last years a crescent registration of cases was observed in Brazil, especially in the city of Rio de Janeiro. Fifteen dogs with ulcerated cutaneous lesions were seen at the Dermatology Service in the Small Animal’s Hospital at Universidade Federal Rural do Rio de Janeiro, between January 2014 and October 2015. Most lesions were located on the head, mainly the nose. Lesions were even seen on the chest, disseminated on the body and on the limbs. Three dogs (20%) exhibited the cutaneous-lymphatic form, with lesions initially on the distal aspect of one leg and ascending via lymphatics up the leg to the trunk and head. It was not ruled out the disseminated form in at least 3 dogs (20%). They had consistent signs of generalized or disseminated disease exhibiting respiratory symptoms (nasal discharge, sneezing, stertorous breathing), anorexia and weight loss. Draining tracts and cellulitis were very common. Some had large areas of skin necrosis with exposure of muscle and bone. Definitive diagnosis was obtained by cytological examination of exudates, histological examination, and/or isolation of S. schenckii complex by fungal culture. Because of the severity of the lesions that mimic other disorders like neoplasms or autoimmune skin diseases, and due to the difficulties of getting an accurate diagnosis, this study describes 15 advanced cases of canine sporotrichosis.

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Impact of Surgical Treatment on Paranasal Fungal Infections in Bone Marrow Transplant Patients

Otolaryngology ◽

10.1016/s0194-5998(97)70236-5 ◽

1997 ◽

Vol 116 (6) ◽

pp. 610-616 ◽

Cited By ~ 83

Author(s):

Cynthia A. Kennedy ◽

George L. Adams ◽

Joseph R Neglia ◽

G. Scott Giebink

Keyword(s):

Bone Marrow ◽

Bone Marrow Transplant ◽

Surgical Intervention ◽

Fungal Infections ◽

Systemic Disease ◽

Marrow Transplant ◽

Unrelated Donor ◽

Fungal Sinusitis ◽

Cell Counts ◽

Immunosuppressed Patients

Invasive fungal sinusitis can develop in immunosuppressed patients. A more complex problem is immunosuppressed patients who have undergone bone marrow transplantation. For a prolonged period, they are both neutropenic and thrombocytopenic. Survival in these patients is poor, and the role for extensive surgical intervention for sinus disease has to be weighed against the risk and the potential that this is a systemic disease. Between January 1983 and June 1993, 29 bone marrow transplant recipients with documented invasive fungal infections of the sinuses and paranasal tissues required surgical intervention. This represents 1.7% of the total 1692 bone marrow transplants performed. There were 22 allogeneic, 6 autologous, and 3 unrelated donor transplants, with two patients receiving two separate grafts. Underlying diseases included 24 hematologic malignancies and 5 other disorders, including 1 aplastic anemia and 1 solid tumor. The mortality rate from the initial fungal infection was 62%. Twenty-seven percent resolved the initial infections but subsequently died of other causes. All patients received medical management, such as amphotericin, rifampin, and colony-stimulating factors, in addition to surgical intervention. Surgical management ranged from minimally invasive procedures to extensive resections including medial maxillectomies. Sixty-one percent of the patients who died of the initial infection had undergone extensive surgical procedures versus 55% of those who resolved the infection. Recovery of neutrophil counts was required to clear the infection but did not necessarily predict a good outcome because 50% of those who died of the infection had experienced neutrophil recovery. White blood cell counts at the time of surgery were not significantly different between the two groups. Prognosis was poor when cranial and orbital involvement and/or bony erosion occurred.

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In Vitro Antifungal Susceptibilities of Sporothrix schenckii in Two Growth Phases

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.49.9.3952-3954.2005 ◽

2005 ◽

Vol 49 (9) ◽

pp. 3952-3954 ◽

Cited By ~ 27

Author(s):

Luciana Trilles ◽

Belkys Fernández-Torres ◽

Márcia dos Santos Lazéra ◽

Bodo Wanke ◽

Armando de Oliveira Schubach ◽

...

Keyword(s):

Significant Influence ◽

Growth Phase ◽

Sporothrix Schenckii ◽

Clinical Isolates ◽

Growth Phases ◽

Dimorphic Fungus ◽

Microdilution Method

ABSTRACT We have determined the antifungal susceptibilities of 34 clinical isolates of the dimorphic fungus Sporothrix schenckii to 11 drugs using a microdilution method. In general, the type of growth phase (mycelial or yeast) and the temperature of incubation (30 or 35°C) exerted a significant influence on the MICs.

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Application of platelet-rich plasma and platelet lysate as blood biomaterials in the treatment of lymphocutaneous sporotrichosis

Current Medical Mycology ◽

10.18502/cmm.5.3.1740 ◽

2019 ◽

Author(s):

Elahe Najafi ◽

Ali Arash Anoushiravani ◽

Nooshin Kalafi ◽

Hamid Reza Mohajerani ◽

Ali Reza Moradabadi ◽

...

Keyword(s):

Platelet Rich Plasma ◽

Sporothrix Schenckii ◽

Antimicrobial Properties ◽

Platelet Lysate ◽

Yeast Cells ◽

Dimorphic Fungus ◽

Clinical Form ◽

Positive Role ◽

Tissue Samples ◽

Methenamine Silver

Background and Purpose: Sporotrichosis is a subcutaneous and chronic fungal infection that is caused by a dimorphic fungus, namely Sporothrix schenckii sensu lato. Lymphocutaneous sporotrichosis is the most clinical form, which accounts for nearly 80% of the cases of cutaneous sporotrichosis. Platelets contain several substances with antimicrobial properties. Regarding this, the present study was performed to investigate the effect of blood-based biomaterials, especially platelets in the treatment of lymphocutaneous sporotrichosis. Materials and Methods: This study was performed on 12 golden hamsters, divided into three groups of control, platelet-rich plasma, and platelet lysate. For the purpose of the study, Sporothrix conidia suspension was injected subcutaneously on the back of the animals. After the induction of subcutaneous lesions, the Gomori methenamine silver method was applied to verify lymphocutaneous sporotrichosis. Subsequently, plasma-rich platelet and platelet lysate were injected into the created lesions in the animals in 3-day intervals (due to the short lifetime of platelets). In the final sage, skin tissue samples were examined to check for the presence of yeast cells and their quantification. Results: The data were indicative of the presence of yeast cells with/without bud in the tissue of lymphocutaneous sporotrichosis lesions in the infected animals. Histological investigation revealed that each of the two biomaterials under study (i.e., plasma-rich platelet and platelet lysate) played a positive role in the removal of the yeast cells of sporotrichosis. Conclusion: The results of this study showed that both plasma-rich platelet and platelet lysate were able to effectively prevent from the progression of cutaneous sporotrichosis. Accordingly, much attention has been given to new therapies, including treatment with blood-derived biomaterials.

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