Sporotrichosis

Last Updated: 2019-08-27

Author(s): -

  • Schenck 1898
  • Lutz u. Splendore 1907

Rose gardener's disease

Fungal infection of the cutis and subcutis by Sporotrix schenckii.

  • Categorisation
    • Fixed cutaneous shape
    • Lymphocutaneous form
    • Disseminated cutaneous form
    • Extracutaneous disseminated form.
    • Note: in the disseminated and extracutaneous form, bones, joints, lungs, meninges or other visceral organs are usually affected. 

  • Occurs worldwide, but is a rare disease in Europe.
  • Especially in the tropics and subtropics.
  • Mexico: most common, deep fungal infection.
  • The infection is mainly observed in the rural population.

  • More common in immunocompromised individuals (alcohol abuse, diabetes mellitus, COPD, HIV/AIDS). 

  • Pathogen: The dimorphic fungus Sporotrix schenckii (Sporotrichon schenckii).
  • Incubation period: days months.

  • The dimorphic soil saprophyte Sporotrix schenckii lives on wood and plants. The pathogen can penetrate through injuries (e.g. during gardening) and reaches the deeper layers of the skin and lymph nodes. Aerogenic inoculation or ingestion usually lead to an extracutaneous manifestation (lung, bone, etc.).

  • Animals may be affected. A transmission from animal to human as well as a human to human transmission is not possible.

  • Erythematous-brownish, usually asymptomatic, linearly arranged, discreetly scaly, sometimes verrucous, occasionally ulcerating papules, plaques and nodules.
      

  • Clinic, especially the lymphogenic arrangement of efflorescences is indicative
  • Myco. smear
  • Bakt. smear (e.g. of a secondary impetigation)

  • Biopsy (both dermatopathological and microbiological processing (e.g. MOTT)) recommended. 

  • Hands and feet are particularly affected.
  • Rarely: Face and trunk.
  • Recurrences are not uncommon.

  • No immunity.

  • Rarely spontaneous healings.

Therapy of the 1st choice after Lebwohl

 
Itraconazole A
Terbinafin A

Potassium iodide

B

Amphotericin B (in the disseminated form)

E
   
Therapy of the 2nd choice after Lebwohl  
Fluconazole B
Thermotherapy D
Cryotherapy D

 

  •  Always a combination of topical therapy and systemic therapy

  • Topical Therapy

  • e.g.: Clotrimazole cream (Canesten® cream) 2x daily

  • System therapy

 
Form

Therapy of the 1st choice

Therapy of the 2nd choice

Comment

Fixed cutaneous shape/

Lymphocutaneous form

Itraconazole (e.g. Sporanox®) p.o. 200 mg 1x per day

Itraconazole (e.g. Sporanox®) p.o. 200 mg 2x a day

Terbinafin (Lamisil®, Myconormin®) p.o.500 mg 2x a day

Potassium iodide p.o. 0,5-1,0 ml 3x daily (if necessary increase up to 6 ml 3x daily). Better if added with milk and sugar. 

Local Hyperthermia

Therapy should take place 2-4 weeks after the first symptom-free treatment.

Disseminated cutaneous form

Amphotericin B (lipid formulations) intravenously 3-5 mg/kg bw/d, then

Itraconazole (e.g. Sporanox®) p.o. 200 mg 1x per day

Amphotericin B intravenously 0.7 -1.0 mg/kg bw/d, then itraconazole (e.g. Sporanox®) p.o. 200 mg 2x daily.

Minimum therapy duration: 12 months, possibly longer

Extracutaneous disseminated form

Itraconazole (e.g. Sporanox®) p.o. 200 mg 1x daily for 7 days

Amphotericin B intravensously 0.7 -1.0 mg/kg bw/d

 

Minimum therapy duration: 12 months, possibly longer

Expectant mother

Amphotericin B intravensously 0.7 -1.0 mg/kg bw/d

Itraconazole p.o. 6-10 mg/kg bw/d

-

If possible, it makes sense to wait until after the birth before starting the therapy.

Offsprings

Itraconazole p.o. 6-10 mg/kg bw/d

Amphotericin B intravensously 0.7 mg/kg bw/d

Potassium iodide p.o. 0,5-1,0 ml 3x daily (if necessary increase up to 6 ml 3x per day). Better if added with milk and sugar.  

For severe forms of therapy with amphotericin B first, then itraconazole recommended.

Source: Kauffmann, C. (2016). Retrieved 30 May 2016, from http://www.uptodate.com/contents/treatment-of-sporotrichosis?source=search_result&search=sporotrichose&selectedTitle=2~43

 

  • Further therapy options

  • Posaconazole (Noxafil®) shows therapeutic successes against sporotrichon schenckii in vitro and in the mouse model. In addition, a case was published in which a patient was successfully treated with posaconazole.

  • Fluconazole and Ketoconazole have shown little success so far and are therefore only to be used in exceptional cases.

  1. Galhardo MC, De Oliveira RM, Valle AC, et al. Molecular epidemiology and antifungal susceptibility patterns of Sporothrix schenckii isolates from a cat-transmitted epidemic of sporotrichosis in Rio de Janeiro, Brazil. Med Mycol 2008;46:141-51.
  2. Marimon R, Serena C, Gene J, Cano J, Guarro J. In vitro antifungal susceptibilities of five species of sporothrix. Antimicrob Agents Chemother 2008;52:732-4.
  3. Fernandez-Silva F, Capilla J, Mayayo E, Guarro J. Efficacy of posaconazole in murine experimental sporotrichosis. Antimicrob Agents Chemother 2012;56:2273-7.
  4. Bunce PE, Yang L, Chun S, Zhang SX, Trinkaus MA, Matukas LM. Disseminated sporotrichosis in a patient with hairy cell leukemia treated with amphotericin B and posaconazole. Med Mycol 2012;50:197-201.
  5. Kauffman CA, Pappas PG, McKinsey DS, et al. Treatment of lymphocutaneous and visceral sporotrichosis with fluconazole. Clin Infect Dis 1996;22:46-50.
  6. Horsburgh CR, Jr., Cannady PB, Jr., Kirkpatrick CH. Treatment of fungal infections in the bones and joints with ketoconazole. J Infect Dis 1983;147:1064-9.
  7. Calhoun DL, Waskin H, White MP, et al. Treatment of systemic sporotrichosis with ketoconazole. Rev Infect Dis 1991;13:47-51.
  8. Kauffman CA. Old and new therapies for sporotrichosis. Clin Infect Dis 1995;21:981-5.
  9. Hiruma M, Kawada A, Noguchi H, Ishibashi A, Conti Diaz IA. Hyperthermic treatment of sporotrichosis: experimental use of infrared and far infrared rays. Mycoses 1992;35:293-9.
  10. Kauffman CA. Sporotrichosis. Clin Infect Dis 1999;29:231-6; quiz 7.
  11. Pluss JL, Opal SM. Pulmonary sporotrichosis: review of treatment and outcome. Medicine (Baltimore) 1986;65:143-53.
  12. Sharkey-Mathis PK, Kauffman CA, Graybill JR, et al. Treatment of sporotrichosis with itraconazole. NIAID Mycoses Study Group. Am J Med 1993;95:279-85.
  13. Kauffmann, C. (2016). Retrieved 30 May 2016, from http://www.uptodate.com/contents/treatment-of-sporotrichosis?source=search_result&search=sporotrichose&selectedTitle=2~43
  14. Lebwohl, Mark. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. Elsevier, 2014. Print.