Sporotrichosis

Last Updated: 2023-07-07

Author(s): Anzengruber F., Navarini A.

ICD11: 1F2J.Z

  • Schenck, 1898
  • Lutz and Splendore, 1907

De Beurmann-Gougerot's disease.

Fungal infection of the cutis and subcutis caused by Sporotrix schenckii.

  • Division:
    • Fixed cutaneous form
    • Lymphocutaneous form
    • Disseminated cutaneous form
    • Extracutaneous disseminated form
    • Note: in the disseminated and extracutaneous form, bones, joints, the lungs, meninges or other visceral organs are usually affected
  • Occurring worldwide, but a rare disease in Europe
  • Current especially in the tropics and subtropics
  • Mexico: most common, deep fungal infection
  • The infection is mainly observed in the rural population
  • 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 goes into the deeper skin layers and lymph nodes/nodes. Aerogenic inoculation or ingestion usually lead to an extracutaneous manifestation (lungs, bones, etc.).
  • Animals can be affected, transmission to humans, like human-to-human transmission, is not possible
  • Erythematous-brownish, mostly asymptomatic linearly arranged, discreetly scaling, partly verrucous, occasionally ulcerating papules, plaques and nodules
  • Clinical, especially the lymphogenic arrangement of the efflorescences is indicative
  • Myco. smear
  • Bact. smear (e.g. secondary impetigisation)
  • Biopsy (both dermatopathological and microbiological work-up (e.g. of a MOTT)) recommended
  • Mostly hands and feet are affected
  • Rarely: Geischt and torso
  • Recurrences are not rare
  • No immunity
  • Rare spontaneous healings
Therapy of 1st choice after Lebwohl
Itraconazole A
Terbinafine A
Potassium iodide B
Amphotericin B (in the disseminated form) E
Therapy of the 2nd choice after Lebwohl
Fluconazole B
Heat therapy D
Cryotherapy D

  • Always combine topical therapy and systemic therapy

Topical therapy

  • e.g.: Clotrimazole cream 2x a day

Systhemotherapy

form Therapy of 1st choice Therapy of 2nd choice Comment

Fixed cutaneous form/

Lymphocutaneous form

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

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

Terbinafine (Lamisil®, Myconormin®) p.o.500 mg 2x tgl.

Potassium iodide p.o. 0.5-1.0 ml 3x tgl (increase to 6 ml 3x tgl if necessary). ↑ edible if given with milk.

Local hyperthermia

 Therapy should be given for 2-4 weeks after initial symptom relief.
Disseminated cutaneous form

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

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

 Amphotericin B i.v. 0.7 -1.0 mg/kg bw/d, then itraconazole (e.g. Sporanox®) p.o. 200 mg 2x tgl. Minimum duration of therapy: 12 months, longer if necessary
Extracutaneous disseminated form

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

Amphotericin B i.v. 0.7 -1.0 mg/kg bw/d

 Minimum duration of therapy: 12 months, longer if necessary
Pregnant

Amphotericin B i.v. 0.7 -1.0 mg/kg bw/d

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

 - If possible, it is advisable to wait with therapy until after birth
Children

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

Amphotericin B i.v. 0.7 mg/kg bw/d

 Potassium iodide p.o. 0.5-1.0 ml 3x tgl (increase to 6 ml 3x tgl if necessary). ↑ edible if given with milk. In severe forms, therapy with first amphotericin B, then itraconazole recommended.

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

Other therapeutic options

  • Posaconazole shows therapeutic success against Sporotrichon schenckii in vitro and in mouse models. In addition, one 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.

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