0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:50
Sporotrichosis 1369➣Other studies: Serology may be useful for extracutaneous disease
(particularly central nervous system disease) but is not standard-
ized
Pathology
■Granulomas with cigar-like yeast forms
differential diagnosis
■Single lesions may suggest foreign body granuloma, dermatophytic
infection, blastomycosis, bacterial pyoderma
■Nodular lymphatic spread may suggest non-tuberculous mycobac-
teria, nocardia, leishmania.
■Less commonly, blastomycosis, coccidioidomycosis, cryptococco-
sis, anthrax, tularemia, and streptococcal Group A and Staphylococ-
cus aureus infections
management
What to Do First
■Assess whether or not patient is immunocompromised and is at risk
for dissemination
General Measures
■If fevers or ill-appearing, draw blood cultures; skin biopsy if cuta-
neous disease
specific therapy
Treatment Options
■For cutaneous/localized disease:
➣Iodides such as potassium iodide (SSKI) can be cheap and
effective: start with 5–10 drops po TID, advancing to 40–50 drops
po TID for adults; can mix in juice or other beverage; take for
several months until lesions have cleared
➣OR Itraconazole for more than 2 months
➣Itraconazole cyclodextrin solution has increased bioavailability
➣If relapse, treat again for more prolonged course
■For disseminated disease:
➣Amphotericin B (preferred in meningitis and severe dissemi-
nated disease)
➣OR Itraconazole for 6–18 months
➣Surgery has an uncertain role in treatment; may be necessary in
Pulmonary disease
➣For HIV patients:
➣Treat as above but may need to follow with lifetime suppressive
doses of Itraconazole because of higher likelihood of relapse and
dissemination