Cutaneous Sporotrichosis

Cutaneous Sporotrichosis General Information

Cutaneous Sporotrichosis is a subcutaneous mycotic infection that is caused by the acquisition of Sporothrix schenckii. This is a dimorphic, geophilic and saprophytic fungus that grows in the soil and amidst decaying vegetable matter. Unfortunately, this fungus is worldwide spread. Cutaneous Sporotrichosis is more common in the tropical and temperate climates on the Globe and less common in environments that are semiarid. So, although the distribution is global, the incidence of this fungal infection varies. It is not known that this cutaneous disorder has a predilection for a specific race, but it is sure that it affects more men. But cases of women and children who suffer from Cutaneous Sporotrichosis have also been reported. We also know about this disease that it affects people of any age, although children tend to be more sensitive to it. They often present a solitary nodule that may be sometimes ulcerative. In adults, the classic form of lymphocutaneous is more common. The rate of morbidity of the cutaneous form of Sporotrichosis is very low. But if the disease is not diagnosed in time, the treatment is delayed or not administrated properly and if the fungus affects patients who have a compromised immune system, the mortality and morbidity may both be increased. The association between this disorder and AIDS (the immunodeficiency syndrome) was first studied in 1985. In this type of patients, this medical condition can become a real threat to their life.

Cutaneous Sporotrichosis Symptoms

The disease caused by the fungus Sporothrix schenckii generally manifests as an acute or chronic cutaneous mycotic infection. The most common is the acute stage. The fungus that causes these skin disorders is a fast growing one. At the site where the fungus is implanted, primary lesions may be the first signs and symptoms of Cutaneous Sporotrichosis. These appear at more exposed locations, on the upper extremities, such as the hands, fingers and limbs and sometimes on the face, but with unusual features. When they first appear, the lesions start as a nodule that is painless and becomes palpable. Then, it ulcerates and discharges a purulent or serous fluid. It is very important to have in mind that when you confront with Cutaneous Sporotrichosis, the lesions do not spread to other parts of the body, especially around the lymphangitic channels; they are fixed lesions. They always remain localized around the initial location where they are implanted. Isolates from these types of lesions grow very well especially at 33oC and not at 38oC. In most cases, only a simple minor puncture splinter or wound is enough for the fungus to be inoculated into the tissue. It is known the fact that in the skin, the fungi are not very numerous. In the lymphocutaneous sporotrichosis the lesions do appear along the lymphangitic channels and are considered to be secondary lesions. Some nonspecific symptoms, such as weight loss, cough, fever, and production of sputum (if the fungus is inhaled) may appear as well.

Cutaneous Sporotrichosis Treatment

If you experience any of the symptoms and signs that we have listed above, that may suggest that you suffer of Cutaneous Sporotrichosis, you should immediately call your health care provider. Cutaneous Sporotrichosis can be difficult to diagnose during a clinical evaluation of the individual. This is why a differential diagnosis may be helpful in most cases. So, you might be advised to consult with a dermatologist. For a laboratory diagnosis, the clinical material that must be taken and is considered to be the best represents a tissue biopsy. Specialists use Gram stain, GMS (Grocott's methenamine silver) or PAS digest to stain the tissue sections. They should look for some yeast cells that are very small with a narrow based building. But these may be very hard to find because of their low number. Very significant are the positive cultures from a biopsy. Because it is very difficult to show the existence of the fungi, the scientists are often looking through many serial sections before actually seeing the microorganism. Once they succeed to find the fungus and the exact diagnosis is given, the doctor must proceed immediately with the most adequate form of therapy against this type of disease in order to make sure that the patient does not develop any fatal complications. We must point to the fact that the medical therapy for this condition also represents the standard care for sporotrichosis. The lesions of Cutaneous Sporotrichosis have a good response to saturated iodide of potassium that ought to be given to the patient three times a day, for three to five months, in a dose of 5-7 ml a day.

Other drugs that have proved to be very efficient against Cutaneous Sporotrichosis are terbinafine that should be administrated in a dose of 225 mg, twice a day and Itraconazole. The average dose of this medicine consists in 500 mg that should be given once a day. But these two last methods of treatment, although efficient, may last for a very long period of time. Once the clinical cure is assured, all treatments must be maintained for at least four weeks after this. The lesions provoked by Cutaneous Sporotrichosis seem to be improved by local heat. Adjunctive therapy consisting in warm compresses applied on the patient’s body is also prescribed because it is known for sure that the fungus can not develop well in temperatures that are higher than 38C. When the patient is dealing with an extracutaneous form of this skin disorder, the treatment may consist in a combination of amphotericin B, antifungal drugs and Itraconazole with a surgical debridement. Most of the patients are treated with antifungal agents. These medicines are preferred because their mechanism of action consists in an intracellular accumulation of peroxide that is known to be extremely toxic for the fungal microorganism. Furthermore, these agents may have a role in the alteration of DNA or RNA metabolism. The surgical method is very rarely used to treat this type of fungal infection. You can prevent this disease from happening to you by wearing special equipment when gardening or dealing with plants in general, for example gloves and sleeves.