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A case of localized cutaneous sporotrichosis is reported. The lesion was granulomatous, without lymphatic metastasis. Histological examination revealed numerous spores and asteroid bodies. Sporotrichin reaction was negative, but after treatment with potassium iodide became positive. The peculiar features of this case seem to be due to some disturbances of cellular immunity.
BACKGROUND: Pulmonary sporotrichosis is a rare event. Sporothrix schenckii is a dimorphic fungus and develops at 37 degrees C in yeast form. Usually hyphae are not observed in tissues, although their presence has been occasionally demonstrated in biopsies. CASE: A 37-year-old man, human immunodeficiency virus-1 positive, with a CD4 cell count of 345/mm3, developed a productive cough. A sputum smear revealed the presence of a large amount of long, thin, septated micelia. The hyphae bore oval, sessile conidia. Cultures of sputum yielded numerous colonies of S schenckii. CONCLUSION: This is the first report of hyphae of S schenckii in sputum. This case emphasizes the possibilities of cytology for the diagnosis of mycotic infections. Fungi have typical morphologies, and it is possible, on the basis of microscopic evidence, to suspect the nature of the infection early and thus to direct culture procedures.
Intravenous miconazole, an investigational, broad-spectrum, antifungal imidazole drug, was clinically effective when used for the first time in a patient with life-threatening sporotrichosis. Miconazole was used after drug resistance and treatment failure occurred in a patient with extensive, cavitary, pulmonary infection with Sporotrichum schenckii. He had first been treated with amphotericin B, and then with amphotericin B and flucytosine in combination. Side effects of miconazole included itching, diarrhea, and phlebitis. Clinical improvement occurred despite plasma concentrations below those needed for complete inhibition of the patient's organisms in vitro.
In a series of 39 cases of cutaneous sporotrichosis, 37 were of the localized cutaneous type and only 2 of the lymphangitic variety. Fungi were identified histologically in every case, most often as asteroid bodies which were found in all but 3 lesions. Cultures were occasionally negative even though asteroids or yeast-like forms were present in tissue sections. A histological diagnosis should be possible in all cases if a sufficient number of serial sections are examined by H & E and the PAS method.
Forty-nine patients with culture-proven sporotrichosis were treated between 1957 and 1986. Infections were lymphocutaneous in 36 patients, pulmonary in two, intraarticular in four, and involved multiple deep tissues in seven. Thirty-six infections involved an upper extremity. Five patients with deep infection had some evidence of being immunocompromised. Delay in diagnosis after presentation averaged 4 months overall and 25 months for those with deep infection. Ten of 12 joint infections resulted in significant functional impairment. Treatment with saturated potassium iodide solution was effective for lymphocutaneous infection. Four patients with infection of deeper tissues remain infected despite multiple operations and systemic courses of antifungal medication.
A 32-year-old white man had a 5-month history of a progressively worsening rash on the dorsal aspect of his left foot. He stated that he engaged in self-tattooing of the left foot prior to the onset of the rash. Further questioning revealed that he had mowed the lawn wearing only sandals on the same day that he had tattooed his foot. The rash was diagnosed as lymphocutaneous sporotrichosis based on clinical appearance, biopsy examination, and fungal culture. Clearing of the lesions was documented following 4 months of therapy with itraconazole. The remaining granulomatous lesions were flattened with intralesional corticosteroid injections.
Unusual ulcerated masses protruding from both nostrils of a 3-year-old terrier were diagnosed histologically as sporotrichosis, and regressed with iodide therapy. Cryptococcus neoformans was recovered from new lesions that appeared near the dog's eye and on the extremities. All lesions regressed with itraconazole therapy.
Cutaneous sporotrichosis is an uncommon infection, usually reported as sporadic cases resulting from inoculation with sharp environmental vegetative matter. We report such a case of multiple primary inoculations acquired from Solenopsis (fire ant) stings in a 54-year-old white man. The patient was treated effectively with itraconazole 200 mg twice a day for 4 months.
A case of cutaneous, lymphatic Sporotrichosis, in a farm labourer, is presented. The diagnosis was established by isolating fungus from the lesion. Dimorphic nature of the fungus was established in vitro by demonstrating the mycelial phase at 25-30 degrees C and yeast phase at 37 degrees C. The patient responded well to oral administration of Potassium iodide.
Fifty five cases of cutaneous sporotrichosis collected from 35 communities located in the southeast region of the Northern Sierra of Puebla are described. The disease was more prevalent in males (60:40), but this difference was restricted to younger subjects (aged 0-15 years) where 14 cases were male and only 3 were female. No statistical difference regarding gender was observed in elder patients. The prevalence of the disease was significantly lower among patients aged 31 to 45. The most common clinical forms of the disease were lymphocutaneous and fixed. The drug of choice for the treatment of patients in rural communities was potassium iodide. When available, Itraconazol proved to be an excellent option.
Two facial nodules and a pulmonary infiltrate occurred in a twenty-one-year-old man. Tissue cultures from one of the facial lesions showed both Sporothrix schenckii and Blastomyces dermatitidis. Cultures from lung biopsy tissue grew B. dermatitidis. This is the first known reported case of sporotrichosis and blastomycosis occurring concurrently in the same cutaneous lesion.
A new case of lymphocutaneous sporotrichosis is reported. We emphasize the low number of cases reported in the Spanish literature so far. We think that the incidence of this condition is higher than is reported. Because near all published cases had been published by the same authors who are familiarized and possess a high suspicion rate of this condition.
A case of fixed cutaneous sporotrichosis in an urban patient in whom the contagious trauma could not be proved is commented on. Remarkable is the location of the lesions involving the face, which is extremely rare, as well as the morphology of the lesions, adopting the pattern of congestive erythema on which there were crusty-erythematous papules causing an intense itching which also preceded their onset.
A human case of cutaneous sporotrichosis with three chancriform primary lesions and regional lymphangitis is presented in a male patient infected during the hunting of armadillos. The clinical picture shows very well the usual mechanism of infection for the disease in Uruguay, which is a direct contact of man with armadillos and their burrows.
Sporotrichosis is a fungal infection caused by the dimorphic fungus Sporothrix schenckii. Although this fungal microorganism is labeled a true pathogen, its virulence is less than that of other fungal pathogens, such as Coccidioides immitis, Histoplasma capsulatum, and Blastomyces dermatitidis. This article discusses its clinical manifestations, experimental models, diagnosis, and therapy.
Primary sporotrichosis of the eye is very rare; most infections are limited to the conjunctiva or adnexa. We report a case of Sporothrix endophthalmitis associated with necrotizing ethmoid sinusitis developing in a young diabetic man with ketoacidosis. The infection clinically resembled rhino-ophthalmic mycormycosis. Cure followed evisceration and an abbreviated course (215 mg) of amphotericin B. Sporothrix must now be regarded as another fungal agent capable of causing primary rhino-ophthalmic infection similar to Mucor.
Pulmonary infection with Sporothrix schenckii is extremely rare. The small number of reported cases and lack of comparative clinical trials make assessment of treatment regimens difficult. Three modalities should be considered: Saturated solution of potassium iodide (SSKI), amphotericin B, and resective surgery. Available data suggest that SSKI is unlikely to be successful in cavitary disease or disease in immunocompromised hosts. Amphotericin B alone has been successfully used to cure cavitary pulmonary sporotrichosis, but overall cure rates probably are no higher than 50%, and the probability of cure in bilateral apical disease is dismal. Surgical resection has been successful when used alone in a small number of cases. The highest cure rates (70% to 80%) appear to be a result of management with amphotericin B or SSKI combined with resective pulmonary surgery. The dosage and duration of amphotericin B or SSKI to be used in conjunction with surgical resection is unknown.
A 46-year-old man was diagnosed as having pyoderma gangrenosum after special stains and cultures from a skin biopsy specimen were reported as negative. Cutaneous sporotrichosis is usually diagnosed with relative ease on the basis of clinicopathologic features and prompt growth of the fungus in culture, although organisms are difficult to detect in tissue even with special stains. Identification of Sporothrix schenckii was delayed for three months in this patient because of unusual growth characteristics noted in the culture. The report of this patient's clinical course illustrates both the need to frequently reassess the diagnosis of pyoderma gangrenosum in treatment-resistant patients and the fact that S schenckii may be difficult to diagnose clinically and mycologically if the growth characteristics of the fungus are unusual.