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Cutaneous sporotrichosis in Himachal Pradesh, India.

During the period 1990-2002 in Himachal Pradesh, India, 103 new patients with cutaneous sporotrichosis were detected. Lymphocutaneous and fixed cutaneous varieties were the most common and seen in 49% and 43% respectively. Chronic non-specific inflammation without granuloma formation was seen in 46% skin biopsy specimens, 29% showed acute or chronic inflammation and tuberculoid granuloma formation was seen in 25%. In 32% of cases Sporothrix schenckii growth was seen on Sabouraud glucose agar. A saturated solution of potassium iodide was used as first-line treatment and in 93% patients healing of lesions occurred in 4-32 weeks (average 8.7 weeks) without significant side-effects. Itraconazole, used in 12 patients, was highly effective in recommended doses. Rapid healing was seen with higher than previously used doses of fluconazole in one patient who also had unusual exacerbation of lesional inflammation with saturated solution of potassium iodide.

Adolescent↗

Lymphocutaneous sporotrichosis.

Lymphocutaneous sporotrichosis presented in a 10 year old child 1-2 weeks after an abrasion. A series of nodules, two of which ulcerated, appeared along the arm with tender unilateral axillary lymphadenopathy in the absence of systemic symptoms. Biopsy showed a granulomatous infiltrate but failed to reveal the organism; however, culture was positive for Sporothrix schenckii. The primary lesion healed with a scar after 3 months of systemic therapy with potassium iodide.

Child↗

Ritual Samoan body tattooing and associated sporotrichosis.

A 36 year old Samoan male who developed cutaneous sporotrichosis as a result of traditional body tattooing is reported. It is considered that the tattooing procedure was responsible for introducing the infection. He was treated with itraconazole, which produced resolution of the lesions.

Adult↗

Facial sporotrichosis in children.

We examined two patients with facial lesions of fixed cutaneous sporotrichosis. That condition should be considered in the differential diagnosis of persistent nodules or plaques in this anatomic location.

Child↗

Sporotrichosis: success of itraconazole treatment.

An 82-year-old man with hypothyroidism presented with an ulcerated nodule on the dorsum of his left hand (Figure 1). The lesion had been present for about 3 months. Similar lesions were present along the lymphatic distribution of the dorsum of his left forearm, proximal to the first lesion, as well as the dorsum of his right forearm. Laboratory findings were normal. Immune complexes, complement 3, and complement 4 were negative. A biopsy from an ulcerated nodule was taken for both histologic examination and culture. Hematoxylin and eosin sections showed a nonspecific chronic granulomatous reaction. No fungi were detected by periodic acid-Schiff stain and methenamine silver stain. Culture of tissue obtained from a skin biopsy of 1 lesion placed directly on Sabouraud agar produced colonies of Sporothrix schenckii (Figure 2). The diagnosis of lymphocutaneous sporotrichosis was confirmed.

Aged, 80 and over↗

Clinical and immunological aspects of sporotrichosis cutanea.

A series of 14 cases of sporotrichosis cutanea is reported. Epidemiological and clinical aspects of the disease are discussed in the light of recent data. In addition to cultures, the diagnostic methods to be considered include an indirect immunofluorescence test, which is positive at variable titre and for which use may be made of normal human antiserum or anti-immunoglobulin, mainly IgG and IgM, antisera. The mainstay of the treatment is preparations of iodine, with trimethoprim- sulpha-methoxazole as a possible alternative.

Adolescent↗

Mother-and-child cases of sporotrichosis infection.

We report the appearance of lymphocutaneous sporotrichosis on the left arm of a 28-year-old farmer's wife, followed two months later by the same type of lesion on the right upper eyelid of this patient's three-year-old child. According to the mother, the child was accustomed to sleeping with the right side of her face applied to the lesion on the mother's arm, and so it was presumed that the infection had been transmitted by direct contact from mother to child. Cases of person-to-person contagion of this disorder are thought to be extremely rare, but where there has been close contact on a daily basis, such contagion is likely to occur.

Adult↗

Cutaneous sporotrichosis in Thailand: first reported case.

A case of cutaneous sporotrichosis is reported for the first time in Thailand. The infection occurred in a 33-year-old Thai female who has been in good health and had no history of previous trauma or contact with any animals. Histopathology revealed pseudoepitheliomatous hyperplasia of the epidermis and a combination of granulomatous and pyogenic reactions in the dermis and subcutaneous tissue. Typical asteroid bodies (Splendore-Hoeppli phenomenon) with central yeast cells were seen. Sporothrix schenckii was recovered from skin biopsy specimens. The patient responded well to the treatment with saturated solutions of potassium iodide within three months. No recurrence was seen after more than six months follow-up.

Adult↗

Sporotrichosis with bilateral lesions. A case report.

We report on a case of sporotrichosis in which lesions occurred bilaterally on upper limbs at different periods. The patient was an 84-year-old farmer living in Tsukuba City, Japan. The first lesion appeared on the left upper arm and remained untreated. The second lesion appeared on the back of the right hand 5 years later. Findings suggesting internal metastasis could not be confirmed in various examinations. We judged that the lesion of the left upper arm was primary and the lesion at the back of the right hand was caused by autoinoculation.

Aged↗

Efficacies of four antifungal agents in experimental murine sporotrichosis.

Four antifungal agents, amphotericin B, SDZ 89-485, itraconazole, and terbinafine, were tested for efficacy in a murine model of systemic sporotrichosis. Survival in the groups treated with amphotericin B, SDZ 89-485, and itraconazole was significantly better than that of control infected mice. However, these agents did not wholly protect the infected mice, as tail and paw lesions, whole-body radiographs, and positive cultures from survivors showed evidence of dissemination. Terbinafine-treated mice had the same or poorer survival as control infected mice, despite documented drug absorption.

Amphotericin B↗

Experimental sporotrichosis in Syrian hamsters.

Syrian hamsters were infected with Sporothrix schenckii by subcutaneous footpad inoculation. Two types of infection could be uniformly induced: a self-limited, lymphatic infection resembling the classical disease in humans, and a generalized nonfatal infection. An infecting dose of approximately 5,300 yeast cells produced the localized subcutaneous-lymphatic disease which was limited to a single limb. In contrast, a 1,000-fold increase in the inoculum temporarily overwhelmed the animals' defense mechanisms, producing a systemic infection involving the liver and spleen. These models were used to demonstrate the development of increased resistance to subsequent infection following either infection or active immunization with ribosomal fractions or trypsinized cell wall antigens of S. schenckii incorporated in Freund complete adjuvant. Agglutination titers were detectable in all animals that were either infected or immunized. In one group of infected animals, the titers persisted for at least 1 year after three booster doses of Formalin-killed S. schenckii. The ability to produce an infection in hamsters which closely resembles the disease seen in humans makes the animal a good model with which to study experimental sporotrichosis.

Agglutinins↗

Isolation and characterization of Sporothrix schenckii from clinical and environmental sources associated with the largest U.S. epidemic of sporotrichosis.

The largest recorded epidemic of sporotrichosis in the United States occurred in 1988 and involved a total of 84 cases in 15 states. All cases were associated with Wisconsin-grown sphagnum moss. Twenty-one clinical isolates of Sporothrix schenckii and 69 environmental isolates of Sporothrix spp. from the epidemic were characterized and compared. The environmental isolates were recovered from 102 samples of sphagnum moss and other material by using direct plating techniques. Characteristics examined included macroscopic and microscopic morphology, conversion to a yeast phase, exoantigen reactions, and virulence in mice. On the basis of these studies, eight environmental isolates were identified as S. schenckii, five were identified as Ophiostoma stenoceras, and the remainder were identified as Sporothrix species. The environmental isolates of S. schenckii were recovered from moss samples from one Pennsylvania nursery and from three New York State Soil and Water Conservation districts, but none were recovered from moss directly from the bogs in Wisconsin.

Disease Outbreaks↗

Use of a mouse model to evaluate clinical and environmental isolates of Sporothrix spp. from the largest U.S. epidemic of sporotrichosis.

Five clinical and 69 environmental isolates from the largest U.S. epidemic of sporotrichosis were evaluated in NYLAR male mice following intravenous injection of 5 x 10(6) to 2 x 10(8) conidia per mouse. The clinical isolates and eight environmental isolates produced 100% mortality in groups of three mice each between 12 and 24 days after injection. These virulent isolates grew at 37 degrees C, were dematiaceous by virtue of melanin (melanized) on permissive media (e.g., potato dextrose agar), produced ovoid conidia borne sympodially on lateral conidiophores and pleurogenously about the main hyphal axis, and were identified as Sporothrix schenckii. Two melanized environmental isolates that grew at 35 degrees C but not at 37 degrees C were not virulent and had subtle morphological differences from S. schenckii. The remaining environmental isolates were not melanized, were not virulent, and were not S. schenckii; five were identified as Ophiostoma stenoceras and the remainder were identified as Sporothrix spp. Quantitative organ cultures revealed that clinical isolates grew exponentially in livers and testes, in contrast to an isolate of O. stenoceras that was eliminated from liver, lung, and spleen but that persisted in the testes throughout the 14-day sample period. This model helped to confirm the identification of S. schenckii isolates obtained from the environment.

Animals↗

DNA typing of isolates associated with the 1988 sporotrichosis epidemic.

DNA typing techniques were used to examine selected clinical and environmental isolates of Sporothorix spp. recovered from the 1988 sporotrichosis epidemic in multiple states of the United States. Previous studies indicated that isolates in one of the six morphologically or physiologically distinct groups (group I) obtained from environmental sources were Sporothrix schenckii and were the possible etiologic agents responsible for the epidemic. To assess this hypothesis at the genetic level, whole-cell DNA was extracted from selected clinical isolates and representative members of each of the six environmental groups subjected to endonuclease digestion and then analyzed by gel electrophresis. DNA types were assigned on the basis of restriction fragment length polymorphism patterns. One DNA type was common to clinical and group I isolates but was dissimilar from the DNA types exhibited by groups II to VI. In contrast, a variety of DNA types were associated with isolates in groups II to VI. The latter groups appeared to make up a heterogeneous collection of fungi, with some members of the same group having different DNA types but with others from different groups possessing identical DNA types. Thus, DNA typing studies confirmed that group I environmental isolates are indistinguishable from clinical isolates and that group II to VI isolates represent a complex of related fungi with similar Sporothrix anamorphs.

DNA, Fungal↗

Fatal pulmonary sporotrichosis caused by Sporothrix schenckii var. luriei in India.

The first case of fatal pulmonary sporotrichosis caused by Sporothrix schenckii var. luriei in a patient from the northwestern region of India is described. In the absence of cultures, the diagnosis was suspected by notation, in lung tissue, of large, thick-walled, hyaline fungal cells that divided internally by septation or a budding process. The thick-walled, internally septated cells often became muriform. The presence of an "eyeglass" configuration of incompletely separated cells characteristic of S. schenckii var. luriei in large numbers aided the diagnosis. The identity of the etiologic agent was confirmed by application of a fluorescent-antibody reagent specific for S. schenckii.

Adult↗

Phenotyping and genotyping of Sporothrix schenckii isolates according to geographic origin and clinical form of Sporotrichosis.

Sporothrix schenckii isolates of fixed and lymphocutaneous clinical forms from Mexico (MX), Guatemala (GT), and Colombia (CO) as well as environmental isolates from MX were studied by analyzing their phenotypic characteristics (conidial length, thermotolerance by percent growth inhibition [GI] at 35 and 37 degrees C, median lethal dose [LD(50)]) and genotypic characteristics (by random amplified polymorphic DNA [RAPD] analysis-PCR). A significant difference (P < 0.01) in the mean conidial length of S. schenckii clinical isolates from CO ( = 4.03 +/- 1.04 microm) compared with those of clinical isolates from MX ( = 2.06 +/- 0.53 microm) and GT ( = 2.68 +/- 0.83 microm) was observed. The lowest thermotolerance, as determined by measurement of percent GI, was exhibited by isolates from CO at 35 degrees C ( = 50.1% +/- 15.9%) and 37 degrees C ( = 72.7% +/- 10.9%). In general, the highest virulence, as determined by measurement of the LD(50) for mice, was observed for the MX environmental isolates. RAPD analysis-PCR with 10-mer primers OPBG-01, OPBG-14, and OPBG-19 generated 52 reproducible bands. The 44 Sporothrix isolates fell into four major groups by hierarchical cluster analysis. The first group (group I), formed by 25 (of 27) isolates from MX, had two subgroups: subgroup Ia with 10 environmental isolates and subgroup Ib with 14 clinical isolates. The second group (group II) had two subgroups: subgroup IIa, formed by isolates from CO, and subgroup IIb, formed by isolates from GT. Groups III and IV each had only one clinical isolate from MX. A principal-component analysis of the same data yielded three distinct groups, depending on the geographical origins of the isolates, including the isolates in groups III and IV from MX, which were grouped with the isolates from MX by principal-component analysis. This study revealed that isolates from CO had low thermotolerances at 35 and 37 degrees C and could be associated with superficial skin lesions in patients with fixed clinical forms of sporotrichosis, the most frequent form of the disease in CO. Distinct patterns dependent on geographical origins were also revealed by RAPD analysis-PCR, but these had no relation to the clinical form of the disease.

Colombia↗

Epidemiology of human sporotrichosis investigated by amplified fragment length polymorphism.

Amplified fragment length polymorphism (AFLP) was used to analyze the genetic diversity of Peruvian strains of Sporothrix schenckii and to compare them to a panel of non-Peruvian strains. AFLP analysis suggests that the Peruvian strains can be divided into two homogeneous clusters with no reference to geographical origin or the clinical form of sporotrichosis. The strains from abroad present heterogeneous profiles, with the Bolivian strain and the Colombian strains related to one of the Peruvian population. Sequencing of internal transcribed spacer 2, used to examine the relationships over a longer distance, confirmed the division of Peruvian strains into two populations that can be identified on the basis of a single but specific sequence divergence. This paper introduces automated AFLP analysis as a valuable tool for further investigation of the epidemiology and ecology of S. schenckii.

Base Sequence↗

Pathology of sporotrichosis in 10 cats in Rio de Janeiro.

Ten cats with sporotrichosis were examined clinically and pathologically. They were in very poor general condition, and had widespread ulcerated cutaneous lesions and respiratory signs. Gross internal abnormalities were found only in the lungs and lymph nodes. Histologically, an inflammatory infiltrate and yeast-like structures were observed in the skin, lungs, liver and lymph nodes. The spleen was congested and contained fungal elements. No microscopical changes were observed in the pancreas, kidneys and heart. Sporothix schenckii was isolated from all the skin samples and nasal swabs obtained in vivo, and from all the samples of lung, liver, spleen, lymph nodes, heart and kidney taken postmortem.

Animals↗