Sporotrichosis

Sporotrichosis – General Information

Sporotrichosis is a severe and subacute infection that is generally caused by a certain type of soil fungus called Sporothrix schenckii. In most cases, the main manifestation of the condition is the presence of suppurating subcutaneous nodules that can evolve spreading to the lymphatic channels. There are also rare cases in which the patient can develop pulmonary infections or direct inoculation into the tendons, burse, or joints. Usually, the osteoarticular form of the disease appears due to direct inoculation and hematogenous seeding. In more severe stages, the disease can become disseminated causing cutaneous lesions that can affect the internal organs.These manifestations usually develop more rapidly, causing severe signs and symptoms in patients who suffer from acquired immunodeficiency syndrome, meaning AIDS. The infection with this type of soil fungus, Sporothrix schenckii, is usually made through cutaneous inoculation. Sporotrichosis firstly appears as a reddish, necrotic, nodular papule, which usually develops in the first ten weeks after the patient’s skin injury.

The signs and symptoms of this type of medical condition appear as a suppuration granuloma which is characterized by the presence of histocytes and other giant cells that accumulate in the center, being surrounded by lymphocytes and plasma components. If the disease is not treated properly, the infection can affect the patient’s lymph nodes, leading to the development of a chain of indolent nodular lesions, which usually is a sign of the lymphocutaneous form of the disease. Sporotrichosis can also affect other surrounding tissues such as bones, joints, tendons, sheaths and burse.

Sporotrichosis – Symptoms

Usually, the first signs and symptoms caused by Sporotrichosis are different depending on the type of the disease the patient is suffering from. If the patient presents the cutaneous or lymphocutaneous type he or she may experience lesions that appear in the area where the cutaneous inoculation took place, usually in the distal upper extremities. These manifestations cause little to no pain at all. If the patient is suffering from the pulmonary type of Sporotrichosis, he or she may experience more serious manifestations such as severe COPD and subacute or chronic pneumonia. In these cases, the condition presents no specific signs and symptoms, but if they do appear, the most common are severe cough and little constitutional changes. If the patient suffers from the osteoarticular form of the condition he can also present a chronic arthritis.

This medical disorder usually develops and progresses asymptomatically for more than ten years until the patient experiences a destruction of the adjacent bone or development of draining fistulate. In most cases, the disease starts in a monoarticular form, but, as it evolves, it begins to affect other joints. In most cases, the patient has pain on motion but no other severe manifestations of a bacterial disease. There are cases in which the patient can suffer from the disseminated form of Sporotrichosis, which may usually affect other important organs such as eyes, prostate, paranasal sinuses, oral mucosa, or larynx. In these cases, the signs and symptoms differ depending on the organ that has been affected.

Sporotrichosis – Treatment

It is very important that the doctors diagnose Sporotrichosis in an early stage of evolution because by doing this they can increase the patient’s rate of healing and prevent any complications to develop. In most cases, an exact diagnosis of the disease is made on any area of the patient’s body affected by the disease, collecting a cell culture that is eventually observed on a microscope. Usually, the Sporothrix schenckii can be collected from fungal culture from sputum, pus, subcutaneous tissue biopsy, synovial fluid, synovial biopsy, bone drainage or biopsy, and from the cerebrospinal fluid. To diagnose the disease the patient has to present a low level of synovial and cerebrospinal fluid. There are cases in which the organism can be observed in certain biopsied tissues, specimens that are maintained with several preservative solutions such as acid-Schiff, immunohistochemical stains and Gomori methenamine-silver solution.

In diagnosing Sporotrichosis, some doctors choose to apply certain serologic procedures that can include antibody measurement. These examinations help the doctor to evaluate the patient’s interlaboratory variability in sensitivity and specificity, and that is why these tests play a critical role in the diseases diagnosis. There are cases in which the doctors apply these tests to raise the diagnosis and inspire other more aggressive procedures that serve to culture the specimens. There are cases in which the doctor can apply certain imaging studies such as radiography. This kind of procedure can be made on certain areas of the body that have been affected by Sporotrichosis such as the chest, especially for patients who are suspected to suffer from the pulmonary form of the disease, and other areas, in patients who are suspected to suffer from the osteoarticular form of the condition. Some doctors choose to perform a computed tomography of the patient’s chest.

In most cases, Sporotrichosis is characterized by a granulomatous inflammation in addition to occasional asteroid bodies. The most common treatment option used for this kind of medical condition is antifungal therapy, which can be successfully applied for all forms of the disease. There are more severe cases in which the patient may require a surgical approach, especially in patients that suffer from the osteoarticular form of the disease. The goal of the surgical treatment is similar as in other bone or joint infections, and can include an appropriate drainage of infected joints. In most cases, the cutaneous and lymphocutaneous forms of the disease are treated with a saturated solution of potassium iodide called SSKI, but it rarely bring improvement and causes many side effects. Some patients are treated with an oral treatment consisting in Azole medicine, which is an antifungal agent. For all the forms of Sporotrichosis, doctors use a medicine called Ketoconazole, but lately, it proved to be less effective than other fungal medicines such as Itraconazole and Fluconazole. Follow the prescriptions exactly and avoid losing a dose or overdosing. It is very important to treat the condition in the first stages of development to prevent any severe complications to appear and to increase the healing rate.