Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:50

1368 Sporotrichosis

SPOROTRICHOSIS

RICHARD A. JACOBS, MD, PhD

history & physical

History

■Chronic infection caused by Sporothrix schenckii, a dimorphic fun-

gus able to grow in yeast form in culture and tissue at 37 degrees

Celsius or as a mold at 25 degrees

■Found in plants, soil, decaying wood, rose thorns; worldwide

➣The organism is usually inoculated into the skin, typically from

a penetrating skin injury; rarely is it inhaled

Signs & Symptoms

■Two main forms: cutaneous and extracutaneous

■Cutaneous:

➣Usually begins as a firm, painless subcutaneous nodule at the

site of inoculation

■This may later ulcerate

■Within several days to weeks, these nodules may extend along the

path of the lymphatics

➣These lesions usually appear and disappear in waves over months

to years; rarely do they regress spontaneously

Extracutaneous:

■Osteoarticular (extremity joint arthritis, carpal tunnel syndrome)

may lead to severe bone and joint destruction if left untreated

■Pulmonary (older males, productive cough, fever and weight loss;

CXR with cavitary lesions)

■Meningitis (usually indolent, CSF with lymphocytic predominance)

■HIV patients:

■Disseminated disease usually in advanced AIDS patients (CD4 <200)

■Skin lesions tend to ulcerate more, are more extensive, and are asso-

ciated with arthritis

■Multiple organs have been described: brain, eye, intestines, liver,

bone marrow

tests

Laboratory

■Basic studies: Blood cultures: positive blood cultures seen in dissem-

inated disease

■Other studies: Tissue culture: diagnostic of infection