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Sporotrichosis is an emerging zoonosis in Rio de Janeiro, Brazil. From 1998 to 2003, 497 humans and 1,056 cats with culture-proven sporotrichosis were studied. A total of 421 patients, 67.4% with a history of a scratch or bite, reported contact with cats that had sporotrichosis.
Eleven cases of sporotrichosis treated in our clinic were statically evaluated and two cases suffered by farmers are presented. In urban areas, because of the great popularity of gardening, patients with sporotrichosis are increasing among gardeners. Because sporotrichosis is an occupational skin disease, enlightenment of farmers and gardeners regarding the importance of prevention of skin injury as a route to infection during farm work or gardening is necessary. In addition, dermatologists have to spread information regarding the fungal infections to the public.
An adult female nine-banded armadillo (Dasypus novemcinctus) died in the quarantine station of a private Swiss zoo. Multifocal ulcerative skin lesions and multiple hemorrhages in the lungs were found at necropsy. The spleen was enlarged and dark red. Histologically, there was diffuse granulomatous infiltration, including multinucleated giant cells, of the skin lesions, lungs, spleen, liver, heart, and kidneys. Abundant periodic acid-Schiff-positive yeastlike cells were demonstrated intracellularly in giant cells and extracellularly scattered throughout the tissues. Morphology of the cells varied, with some nonbudding cells resembling Cryptococcus neoformans and others resembling Sporothrix schenckii. A diagnosis of sporotrichosis was confirmed by immunofluorescence studies. This is the first report of sporotrichosis in an armadillo in a zoological garden and the third report of sporotrichosis in D. novemcinctus.
Sporotrichosis is a subcutaneous (rarely extracutaneous) fungal disease caused by Sporothrix schenckii. Cutaneous sporotrichosis has two well-defined forms: lymphocutaneous and stable. In lymphocutaneous sporotrichosis, lesions arise along lymphatic vessels, generally in limbs. The stable form is rarer and consists of a single, generally facial, lesion. We report the case of a 70-year-old male farmer with a single lesion on the right nostril that had been removed repeatedly. After 5 years, new, linearly distributed lesions appeared. Fungal cultures of biopsy tissues revealed S. schenckii. The evolution and response to treatment with itraconazole, potassium iodide, terbinafine, and surgery is discussed.
BACKGROUND: Sporotrichosis is a chronic, granulomatous, deep mycosis caused by the dimorphic fungus Sporothrix schenckii that usually results in indolent cutaneous lesions. OBJECTIVE: To describe four cases of human sporotrichosis transmitted by domestic cats in south-eastern Brazil. METHODS: Confirmation of the diagnosis was performed by histopathology, culture, and/or inoculation of hamsters. RESULTS: In all cases, the clinical findings in both cat and human groups were highly distinctive of the disease. In all human cases, there was a previous history of cat scratching before the development of lymphocutaneous lesions. Histopathology of the human lesions demonstrated the classical granulomatous and exudative pattern with scarce or absent fungal elements. Conversely, in cats, the cutaneous lesions were multiple, extensive, necrotic, exudative, and ulcerated. Histopathology revealed a widespread histiocytic reaction with a large number of fungal organisms. Disseminated lymphatic and visceral mycotic infection was observed in two necropsied cats. CONCLUSIONS: Domestic cats may be an important carrier of agents of sporotrichosis to humans.
Two rare forms of sporotrichosis were seen in one hospital within a two-year period. One, a case of primary sporotrichosis of the lung, represents the eighth case on record, to our knowledge. The other, a case of articular sporotrichosis, is not as rare, but is still uncommon manifestation of the disease. The problems in management of these two patients are of interest because of the challenge of conventional concepts of therapy.
Potassium iodide, itraconazole (ITCZ), and terbinafine are widely known as oral antifungal agents for the treatment of sporotrichosis. Although potassium iodide has been used as the antifungal agent of first choice in Japan due to its high efficacy, its use is not covered by the health insurance programs. In this report, we present the disease course of 3 patients with sporotrichosis in which ITCZ was remarkably effective. By reviewing cases reported in the past, we found sufficient therapeutic effects of ITCZ against sporotrichosis. We also conducted a simple comparison of the efficacy of ITCZ in clinical trials with that of its post-market release; finding the latter to be lower. This seems to be attributable to the problem of compliance or the administration method.
The effector cells of the immune response are involved in the clinical course of bacterial, viral and mycotic infections. Previous publications have reported that some mycotic infections, including sporotrichosis, can produce a negative modulation of the immune response unfavorable for the host. In this work T and B lymphocytes capable to form direct and indirect rosettes respectively with sheep erythrocytes in gerbils with experimental sporotrichosis, were measured. It was found a significant rise in the number to T and B lymphocytes which means normal immunological reactivity. These results are not in accordance with the idea that sporotrichosis can depress the immune response of the host.
Four culture-documented cases of pulmonary sporotrichosis, three primary infections and one with multisystem involvement, are presented. Two of these patients are the first reported cases of primary lung disease treated with ketoconazole. This antifungal agent appears to be ineffective in eradicating this infection. The four cases, as well as a review of the literature, illustrate several important aspects of this rare disease. Pulmonary sporotrichosis is most commonly found in males with a history of alcohol abuse who are between the ages of 30 and 60. The infection is usually confined to the parenchyma of the lung but can involve hilar and mediastinal lymph nodes, pleura, skin, subcutaneous tissue, and joints. All but two cases have been reported in the United States, and the majority reside within states bordering the Missouri or Mississippi rivers. Direct occupational or environmental exposure appears to be an important predisposing risk factor. The onset of the disease is insidious, presenting in a manner similar to many other granulomatous or neoplastic diseases. Tuberculosis is the most common suspected diagnosis before confirmation of sporotrichosis. The chest radiograph most commonly demonstrates upperlobe cavitary disease with surrounding parenchymal infiltrates. The diagnosis can be suspected with high serologic titers or skin-test positivity, but needs to be confirmed by culture. The organism can usually be grown from sputum, as well as routine bronchoscopic procedures, open-lung biopsy specimens or pleural fluid. Histologic examination shows granulomas of both the caseating and noncaseating varieties. Frequently, organisms can be seen in necrotic areas of the lung tissue by diastase-modified GMS or PAS staining. Staining by direct fluorescent antibody technique can also be done and appears to be highly specific. Treatment is controversial, but total surgical resection of diseased lung as well as a perioperative regimen of SSKI or amphotericin B appears to be the most efficacious therapy. Medical therapy alone with SSKI or amphotericin B may be useful in selected cases but has been disappointing in the majority of reports. The imidazoles are usually ineffective, and the search for more effective medical therapy continues.
In December 1975 and January and February 1976, an epidemic of cutaneous sporotrichosis occurred in Mississippi among forestry workers and other persons exposed to sphagnum moss used in packing pine seedlings. Seventeen cases were identified, 15 of which were from patients who had been exposed to sphagnum moss from a single source. Attack rates were significantly higher among workers exposed to this moss than among those not exposed. Sporothrix schenckii was cultured from the implicated batch of sphagnum moss but not from other batches. The source of contamination of the sphagnum moss that caused this epidemic and sphagnum moss associated with similar epidemics is unknown. One worker without cutaneous sporotrichosis may have had asymptomatic pulmonary sporotrichosis.
Sporotrichosis is usually considered a fungal infection affecting adults, but it can also affect children. A case of sporotrichosis in an 18-month-old boy is presented which is unusual in that the patient was extremely young and had a relatively atypical clinical presentation. His condition responded rapidly to potassium iodide therapy at a very low dosage. A brief review of childhood sporotrichosis in the American literature is included.
A case of lymphocutaneous sporotrichosis initially diagnosed by fine-needle aspiration (FNA) cytology and confirmed by tissue biopsy and culture study is presented. Asteroid bodies and yeast cells with budding, highly suggestive of the disease, were seen in the cytologic and histologic preparations. The pathology of this unusual fungal disease and the role of cytology in the diagnosis are discussed. This is the first case of lymphocutaneous sporotrichosis reported in the cytologic literature as diagnosed by FNA cytology.
Sporotrichosis is a chronic, indolent, fungal infection that rarely involves the musculoskeletal system. The etiologic agent, Sporothrix schenckii, is ubiquitous in nature and has been isolated from soil, timber, decaying vegetation, and a variety of foliage. The organism gains entrance to the body through trauma to the skin or, in rare instances, by inhalation. The vast majority of infections in humans is characterized by nodular or ulcerated lesions of the cutaneous tissues and adjacent lymphatics. Osteoarticular involvement may occur either by contiguous spread from a cutaneous focus, through direct inoculation of tissue by the organism, or by hematogenous dissemination. The rarity of musculosketetal sporotrichosis often causes a delay in diagnosis which leads to inappropriate therapy and permanent deformity in some patients. Three cases which show a spectrum of bone and joint involvement are presented.
A ten year old boy developed lymphocutaneous sporotrichosis following a wild rodent bite. The infection was successfully treated with potassium iodide. Sporotrichosis in humans has followed bites, pecks and stings inflicted by a variety of animals, birds and insects. Many species of animals are susceptible to infection by Sporothrix schenkii, but transmission from infected animals to man is uncommon.
A 56-year-old female with an eight-year history of corticosteroid therapy for rheumatoid arthritis presented with large, deep, painful ulcers on the left buttock and thigh. The lesions appeared typical of pyoderma gangrenosum. Nine separate cultures of the exudate grew Sporothrix schenckii. During the course of iodide therapy, the patient expired due to Escherichia coli pneumonia. This is the third case report of sporotrichosis presenting as pyoderma gangrenosum and the first report from China. Sporotrichosis presenting as pyoderma gangrenosum is a special form of this disease. It develops quickly and must be treated promptly. Only two cases have been reported in the world literature. This is the first case reported from China.
In 1979 Kwon Chung described two varieties of Sporothrix schenckii based on the thermotolerance of isolates from fixed cutaneous (35 degrees C) and that of disseminated cutaneous forms (37 degrees C) of sporotrichosis. Since we had not noted such a difference previously in a study of 100 cases of this disease (55% localized and 45% disseminated) wherein all the isolates grew at 37 degrees C, we decided to repeat this work. Our results differ from those reported by Kwon Chung, since the isolates of both the fixed and disseminated forms of sporotrichosis grew at 37 and 38 degrees C, even when we used inocula of 30 conidia (20-50) which according to Kwon Chung were needed to observe this difference.
A survey of 150 cases with sporotrichosis seen at the Dermatological Clinic of Kurume University Hospital from February 1962 to October 1986 was reported. The proportion of cases with sporotrichosis to the total number of outpatients was 0.17%. Greater percentage of cases fell into the less than 10 years old or more than 40 years old groups. The male to female ratio was 1:1.46, and 38 cases occurred in farmers. Geographic distribution was remarkable, especially around the Chikugo and Yabe river. Sixty-four cases showed the cutaneous lymphangitic type and 85 cases the localized cutaneous type and one case atypical type. The face and upper extremities were the most affected. The sporotrichin test was positive in 117 of 131 cases. The causative organism was demonstrated in tissue sections in 69% of the cases.
Sporotrichosis is a mycosis which in our country has been described as only producing cutaneous and subcutaneous infections; in other countries it has been reported as causing pulmonary, bone, joint and meningeal infections. Possibly the systemic form also occurs in Venezuela since, along with the causative agent, all other factors considered as predisposing to systemic infection exist here. Through immunodiffusion (ID) and immunoelectrophoresis (IEP) and using a filamentous form metabolic antigen from Sporothrix schenckii, we were able to demonstrate precipitating antibodies against this fungus both in patients with cutaneous sporotrichosis, diagnosed by culture of the infecting agent, and in patients with pulmonary lesions. The IEP test showed the presence of an anodic arc which we have called the 'S' arc, which could be one of the specific antigens of S. schenckii.