Sporotrichosis
Last Updated: 2019-08-27
ICD11: -
Last Updated: 2019-08-27
Author(s): Anzengruber F., Navarini A.
ICD11: -
Rose gardener's disease
Fungal infection of the cutis and subcutis by Sporotrix schenckii.
Note: in the disseminated and extracutaneous form, bones, joints, lungs, meninges or other visceral organs are usually affected.
The infection is mainly observed in the rural population.
More common in immunocompromised individuals (alcohol abuse, diabetes mellitus, COPD, HIV/AIDS).
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.
Bakt. smear (e.g. of a secondary impetigation)
Biopsy (both dermatopathological and microbiological processing (e.g. MOTT)) recommended.
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
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.
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