Sporotrichosis: Difference between revisions
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==Background== | ==Background== | ||
*Also known as "Rose gardener's disease"<ref>Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0.</ref> | *Also known as "Rose gardener's disease"<ref>Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0.</ref> | ||
*Caused by the fungus ''Sporothrix schenckii''<ref>Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 654–6. ISBN 0-8385-8529-9.</ref> | *Caused by the [[fungus]] ''[[Sporothrix schenckii]]''<ref>Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 654–6. ISBN 0-8385-8529-9.</ref> found on rose thorns | ||
*Usually affects skin, although other rare forms can affect the lungs, joints, bones, and brain | *Usually affects skin, although other rare forms can affect the lungs, joints, bones, and brain | ||
*Enters skin through small cuts and abrasions, and inhalation for pulmonary disease | *Enters skin through small cuts and abrasions, and inhalation for pulmonary disease | ||
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Progresses slowly: first symptoms may appear 1 to 12 weeks (average 3 weeks) after the initial exposure to the fungus | Progresses slowly: first symptoms may appear 1 to 12 weeks (average 3 weeks) after the initial exposure to the fungus | ||
===Forms and | ===Forms and Symptoms=== | ||
* ''Cutaneous or skin | *''Cutaneous or skin'' | ||
**Most common form | |||
**Symptoms include nodular [[rash|lesions]] or bumps in the skin, at the point of entry and also along lymph nodes and vessels | |||
***Lesion starts off small and painless, and ranges in color from pink to purple | |||
***Left untreated, lesion becomes larger and looks similar to an [[abscess]]. More lesions will appear until a chronic ulcer develops | |||
*''Pulmonary sporotrichosis'' | *''Pulmonary sporotrichosis'' | ||
**Rare | |||
**From inhalation of spores | |||
**Symptoms include productive [[cough]]ing, nodules and cavitations of the lungs, fibrosis, and hilar [[lymphadenopathy]] nodes | |||
**May become superinfected with [[pneumonia]] or [[tuberculosis]] | |||
*''Disseminated sporotrichosis'' | *''Disseminated sporotrichosis'' | ||
**May affect joints and bones (osteoarticular sporotrichosis) and or CNS (''sporotrichosis [[meningitis]]'') | |||
**Symptoms include weight loss, anorexia, and appearance of bony lesions | |||
: | ==Differential Diagnosis== | ||
===General=== | |||
{{Template:SSTI DDX}} | |||
== | ===Hand Infection=== | ||
{{Template:Hand Infection DDX}} | |||
==Workup== | ==Workup== | ||
Fungal culture of skin, sputum, synovial fluid, or [[CSF]] | *Fungal culture of skin, sputum, synovial fluid, or [[CSF]] | ||
==Management== | ==Management== | ||
*Antifungal medication | *Antifungal medication | ||
**Itraconazole | **[[Itraconazole]] | ||
***Drug of choice (more effective than fluconazole) | ***Drug of choice (more effective than fluconazole) | ||
**Fluconazole | **[[Fluconazole]] | ||
***Fluconazole (for patients who cannot tolerate itraconazole) | ***Fluconazole (for patients who cannot tolerate itraconazole) | ||
**[[Amphotericin B]] IV | **[[Amphotericin B]] IV | ||
***For disseminated of severe disease | ***For disseminated of severe disease | ||
* | *Surgery | ||
**For osteomyelitis or | **For [[osteomyelitis]] or cavitary nodules in the lungs | ||
*Standard antibiotics | *Standard [[antibiotics]] | ||
**Lesions sometimes become superinfected, consider as necessary | **Lesions sometimes become superinfected, consider as necessary | ||
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==See Also== | ==See Also== | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:Dermatology]] | |||
[[Category:ID]] |
Revision as of 01:38, 28 September 2019
Background
- Also known as "Rose gardener's disease"[1]
- Caused by the fungus Sporothrix schenckii[2] found on rose thorns
- Usually affects skin, although other rare forms can affect the lungs, joints, bones, and brain
- Enters skin through small cuts and abrasions, and inhalation for pulmonary disease
- Can also be acquired from handling cats with the disease
Clinical Features
Progresses slowly: first symptoms may appear 1 to 12 weeks (average 3 weeks) after the initial exposure to the fungus
Forms and Symptoms
- Cutaneous or skin
- Most common form
- Symptoms include nodular lesions or bumps in the skin, at the point of entry and also along lymph nodes and vessels
- Lesion starts off small and painless, and ranges in color from pink to purple
- Left untreated, lesion becomes larger and looks similar to an abscess. More lesions will appear until a chronic ulcer develops
- Pulmonary sporotrichosis
- Rare
- From inhalation of spores
- Symptoms include productive coughing, nodules and cavitations of the lungs, fibrosis, and hilar lymphadenopathy nodes
- May become superinfected with pneumonia or tuberculosis
- Disseminated sporotrichosis
- May affect joints and bones (osteoarticular sporotrichosis) and or CNS (sporotrichosis meningitis)
- Symptoms include weight loss, anorexia, and appearance of bony lesions
Differential Diagnosis
General
Skin and Soft Tissue Infection
- Cellulitis
- Erysipelas
- Lymphangitis
- Folliculitis
- Hidradenitis suppurativa
- Skin abscess
- Necrotizing soft tissue infections
- Mycobacterium marinum
Look-A-Likes
- Sporotrichosis
- Osteomyelitis
- Deep venous thrombosis
- Pyomyositis
- Purple glove syndrome
- Tuberculosis (tuberculous inflammation of the skin)
Hand Infection
Hand and finger infections
- Bed bugs
- Closed fist infection (Fight Bite)
- Hand cellulitis
- Hand deep space infection
- Hand-foot-and-mouth disease
- Herpetic whitlow
- Felon
- Flexor tenosynovitis
- Paronychia
- Scabies
- Sporotrichosis
Look-Alikes
Workup
- Fungal culture of skin, sputum, synovial fluid, or CSF
Management
- Antifungal medication
- Itraconazole
- Drug of choice (more effective than fluconazole)
- Fluconazole
- Fluconazole (for patients who cannot tolerate itraconazole)
- Amphotericin B IV
- For disseminated of severe disease
- Itraconazole
- Surgery
- For osteomyelitis or cavitary nodules in the lungs
- Standard antibiotics
- Lesions sometimes become superinfected, consider as necessary
Disposition
- Normally treated as outpatient