Title: Sporotrichosis

{{Infobox medical condition (new)
| name            = Sporotrichosis
| image           = Feline sporotrichosis 4.jpg
| caption         = Cytologic preparation from a case of feline sporotrichosis; phagocytic cells show numerous variably-shaped yeast forms within
| pronounce       =
| field           = [[Infectious disease (medical speciality)|Infectious disease]]
| synonyms        = Rose thorn disease, rose gardener's disease,&lt;ref name=&quot;Milner2020&quot;/&gt; rose handler's disease&lt;ref name=&quot;Proia2020&quot;/&gt;
| symptoms        = Firm painless [[Nodule (medicine)|nodules]] that later [[ulceration|ulcerate]].&lt;ref name=&quot;James2020&quot;/&gt;
| complications   =
| onset           =
| duration        =
| types           =
| causes          = ''[[Sporothrix schenckii]]''&lt;ref name=&quot;Milner2020&quot;/&gt;
| risks           =
| diagnosis       = *Serology&lt;ref name=&quot;Milner2020&quot;/&gt;
* Culture: Skin, sputum, CSF, joint aspirate &lt;ref name=&quot;Milner2020&quot;/&gt;
| differential    = [[Leishmaniasis]], [[nocardiosis]], [[mycobacterium marinum]],&lt;ref name=&quot;James2020&quot;/&gt; [[cat-scratch disease]], [[syphilis]], [[leprosy]], [[sarcoidosis]], [[tuberculosis]]&lt;ref name=&quot;Milner2020&quot;/&gt;
| prevention      =
| treatment       = [[Antifungals]], surgery&lt;ref name=&quot;Milner2020&quot;/&gt;
| medication      = [[Itraconazole]], [[posaconazole]], [[amphotericin B]]&lt;ref name=&quot;Milner2020&quot;/&gt;
| prognosis       = Good with treatment, poor if widespread disease&lt;ref name=&quot;Milner2020&quot;/&gt;
| frequency       =
| deaths          =
}}
&lt;!-- Definition and symptoms --&gt;
'''Sporotrichosis''', also known as '''rose handler's disease''',&lt;ref name=&quot;Proia2020&quot;&gt;{{cite book |last1=Proia |first1=Laurie |editor1-last=Spec |editor1-first=Andrej |editor2-last=Escota |editor2-first=Gerome V. |editor3-last=Chrisler |editor3-first=Courtney |editor4-last=Davies |editor4-first=Bethany |title=Comprehensive Review of Infectious Diseases |date=2020 |publisher=Elsevier |isbn=978-0-323-56866-1 |pages=421–422 |chapter-url=https://books.google.com/books?id=B2O-DwAAQBAJ&amp;pg=PA421 |language=en |chapter=28. The dimorphic mycoses}}&lt;/ref&gt; is a [[fungal infection]] that may be localised to skin, lungs, bone and joint, or become [[systemic infection|systemic]].&lt;ref name=&quot;Proia2020&quot;/&gt;&lt;ref name=John2017&gt;{{cite book|last=Johnstone |first=Ronald B.|title=Weedon's Skin Pathology Essentials |chapter-url=https://books.google.com/books?id=NTE_DAAAQBAJ|year=2017|publisher=Elsevier |edition=2nd|isbn=978-0-7020-6830-0|page=455|chapter=25. Mycoses and Algal infections}}&lt;/ref&gt; It presents with firm painless [[Nodule (medicine)|nodules]] that later [[ulceration|ulcerate]].&lt;ref name=&quot;James2020&quot;&gt;{{cite book |last1=James |first1=William D. |last2=Elston |first2=Dirk |last3=Treat |first3=James R. |last4=Rosenbach |first4=Misha A. |last5=Neuhaus |first5=Isaac |title=Andrews' Diseases of the Skin: Clinical Dermatology |date=2019 |publisher=Elsevier |isbn=978-0-323-54753-6 |pages=314–315 |edition=13th |chapter-url=https://books.google.com/books?id=UEaEDwAAQBAJ&amp;pg=PA314 |language=en |chapter=13. Diseases resulting from fungi and yeasts}}&lt;/ref&gt; Following initial exposure to ''[[Sporothrix schenckii]]'', the disease typically progresses over a period of a week to several months.&lt;ref name=&quot;Milner2020&quot;&gt;{{cite book |last1=Milner |first1=Dan A. |last2=Solomon |first2=Isaac |editor1-last=Milner |editor1-first=Danny A. |title=Diagnostic Pathology: Infectious Diseases |date=2020 |publisher=Elsevier |isbn=978-0-323-61138-1 |chapter=Sporotrichosis
|pages=316–319 |chapter-url=https://books.google.com/books?id=172gDwAAQBAJ&amp;pg=PA316 |language=en}}&lt;/ref&gt; Serious complications may develop in people who have a [[immunosuppression|weakened immune system]].&lt;ref name=&quot;Milner2020&quot;/&gt;

&lt;!-- Cause and mechanism--&gt;
Sporotrichosis is caused by fungi of the ''S. schenckii'' [[species complex]].&lt;ref name=ICD-11&gt;{{cite web |title=ICD-11 - ICD-11 for Mortality and Morbidity Statistics |url=https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f579570784 |website=icd.who.int |access-date=11 July 2021}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal
  | journal = Future Microbiology
  | volume = 6
  | issue = 1
  | title = Sporothrix schenckii complex and sporotrichosis, an emerging health problem
  | author-first = Everardo
  | author-last = López-Romero
  | display-authors = etal
  | year = 2010
  | pages = 85–102
 | doi = 10.2217/fmb.10.157
| pmid = 21162638
 }}&lt;/ref&gt; Because ''S. schenckii'' is naturally found in soil, [[hay]], [[sphagnum moss]], and plants, it most often affects [[farmer]]s, gardeners, and agricultural workers.&lt;ref name=Sherris&gt;{{cite book | veditors = Ryan KJ, Ray CG | title = Sherris Medical Microbiology | url = https://archive.org/details/sherrismedicalmi00ryan | url-access = limited | edition = 4th | pages = [https://archive.org/details/sherrismedicalmi00ryan/page/n671 654]–6 | publisher = McGraw Hill | year = 2004 | isbn = 978-0-8385-8529-0 }}&lt;/ref&gt; It enters through small cuts in the skin to cause a fungal infection.&lt;ref name=&quot;Milner2020&quot;/&gt; In cases of sporotrichosis affecting the lungs, the fungal spores enter by [[inhalation]].&lt;ref name=&quot;Milner2020&quot;/&gt; Sporotrichosis can be acquired by handling cats with the disease; it is an occupational hazard for veterinarians.&lt;ref name=&quot;Milner2020&quot;/&gt;

&lt;!--Treatment and outcome--&gt;
Treatment depends on the site and extent of infection.&lt;ref name=&quot;Milner2020&quot;/&gt; [[Topical antifungal]]s may be applied to skin lesions.&lt;ref name=&quot;Milner2020&quot;/&gt; Deep infection in the lungs may require surgery.&lt;ref name=&quot;Milner2020&quot;/&gt;  [[Systemic medication]]s used include [[Itraconazole]], [[posaconazole]] and [[amphotericin B]].&lt;ref name=&quot;Milner2020&quot;/&gt; With treatment, most people will recover,&lt;ref name=&quot;Milner2020&quot;/&gt; but an immunocompromised status and systemic infection carry a worse prognosis.&lt;ref name=&quot;Milner2020&quot;/&gt;

&lt;!--Epidemiology and history --&gt;
''S. schenkii'', the causal fungus, is found worldwide.&lt;ref name=&quot;Milner2020&quot;/&gt; The species was named for Benjamin Schenck, a medical student who, in 1896, was the first to isolate it from a human specimen.&lt;ref&gt;{{cite journal | vauthors = Barros MB, de Almeida Paes R, Schubach AO | title = Sporothrix schenckii and Sporotrichosis | journal = Clinical Microbiology Reviews | volume = 24 | issue = 4 | pages = 633–54 | date = October 2011 | pmid = 21976602 | pmc = 3194828 | doi = 10.1128/CMR.00007-11 }}&lt;/ref&gt;

&lt;!--Other animals --&gt;
Sporotrichosis has been reported in cats,&lt;ref name=&quot;Milner2020&quot;/&gt; mules, dogs, mice and rats.&lt;ref name=&quot;James2020&quot;/&gt;

==Signs and symptoms==
[[File:Sporotrichosis by the fungus Sporothrix schenckii PHIL 3940 lores.jpg|thumb|Sporotrichosis by the fungus ''Sporothrix schenckii'']]
* ''Cutaneous or skin sporotrichosis''
:This is the most common form of this disease.  Symptoms of this form include nodular [[lesion]]s or bumps in the skin, at the point of entry and also along [[lymph]] nodes and vessels.  The lesion starts off small and painless, and ranges in color from pink to purple.  Left untreated, the lesion becomes larger and look similar to a [[boil]] and more lesions will appear, until a chronic [[Ulcer (dermatology)|ulcer]] develops.{{cn|date=January 2023}}

:Usually, cutaneous sporotrichosis lesions occur in the finger, hand, and arm.{{cn|date=January 2023}}
* ''Pulmonary sporotrichosis''
:This rare form of the disease occurs when ''S. schenckii'' spores are inhaled.  Symptoms of [[pulmonary]] sporotrichosis include productive [[cough]]ing, nodules and cavitations of the lungs, [[fibrosis]], and swollen [[Hilum of lung|hilar]] [[lymph node]]s.  Patients with this form of sporotrichosis are susceptible to developing [[tuberculosis]] and [[pneumonia]]{{cn|date=January 2023}}
* ''Disseminated sporotrichosis''
:When the infection spreads from the initial site to secondary sites in the body, the disease develops into an uncommon and potentially life-threatening form, called [[Disseminated disease|disseminated]] sporotrichosis.  The infection can spread to joints and bones (called ''osteoarticular sporotrichosis'') as well as the [[central nervous system]] and the brain (called ''sporotrichosis meningitis'').{{cn|date=January 2023}}

:Some symptoms of disseminated sporotrichosis include weight loss, [[anorexia (symptom)|anorexia]], and bone lesions.

===Complications===

Open sporotrichosis lesions on the skin will on occasion become [[superinfection|superinfected]] with bacteria.&lt;ref name=&quot;konemans&quot;&gt;{{Cite book
  | title = Koneman's Color Atlas and Textbook of Diagnostic Microbiology
  | author-first = Gary W.
  | author-last = Procop
  | display-authors = etal
  | year = 2020
  | url = https://books.google.com/books?id=HF3sDwAAQBAJ&amp;pg=PA1377
  | page = 1377
  | publisher = Jones &amp; Bartlett Learning
 | isbn = 978-1-284-32237-8
}}&lt;/ref&gt; [[Cellulitis]] may also occur.&lt;ref name=&quot;konemans&quot;/&gt;

==Diagnosis==
[[Image:Conidiophores and conidia of the fungus Sporothrix schenckii PHIL 4208 lores.jpg|thumb|Conidiophores and conidia of the fungus ''Sporothrix schenckii'']]
Sporotrichosis is an [[acute (medicine)|acute]] infection with slow progression and often subtle symptoms. It is often difficult to diagnose, as many other diseases share similar symptoms and therefore must be ruled out.{{cn|date=January 2023}}

Patients with sporotrichosis will have [[antibodies]] against the fungus ''S. schenckii''; however, due to variability in sensitivity and specificity, antibody detection may not be a reliable diagnostic test for this disease.  The confirming diagnosis remains [[Microbiological culture|culturing]] the fungus from the skin, [[sputum]], [[synovial fluid]], and [[cerebrospinal fluid]]. [[smear test|Smears]] should be taken from any draining [[fistula]]s or ulcers.{{cn|date=January 2023}}

Cats with sporotrichosis are unique in that the [[exudate]] from their lesions may contain numerous infectious organisms. This makes cytological evaluation of exudate a valuable diagnostic tool in this species. Exudate is [[pyogenic granuloma|pyogranuloma]]tous, and [[phagocyte|phagocytic cells]] may be packed with [[Yeast#Pathogenic_yeasts|yeast forms]]. These yeast cells are variable in size; many are cigar-shaped.{{cn|date=January 2023}}

===Differential diagnosis===
Differential diagnoses includes: [[leishmaniasis]], [[nocardiosis]], [[mycobacterium marinum]],&lt;ref name=&quot;James2020&quot;/&gt; [[cat-scratch disease]], [[leprosy]], [[syphilis]], [[sarcoidosis]] and [[tuberculosis]].&lt;ref name=&quot;Milner2020&quot;/&gt;

==Prevention==
The majority of sporotrichosis cases occur when the fungus is introduced through a cut or puncture in the skin while handling vegetation containing the fungal spores.  Prevention of this disease includes wearing long sleeves and gloves while working with soil, hay bales, rose bushes, pine seedlings, and sphagnum moss.

The risk of sporotrichosis in cats is increased in male cats that roam outdoors.&lt;ref name=&quot;saunders-small&quot;/&gt; Accordingly, the risk may be reduced by keeping cats indoors or neutering them.&lt;ref name=&quot;sykes-2013&quot;&gt;{{Cite book
  | url = https://books.google.com/books?id=cb0kTIlb8HgC&amp;pg=PA629
  | page = 629
  | isbn = 978-0-323-24194-6
  | title = Canine and Feline Infectious Diseases
  | author-first = Jane E.
  | author-last = Sykes
  | publisher = Elsevier Health Sciences
  | year = 2013
}}&lt;/ref&gt; Isolating infected animals can also be a preventive measure.&lt;ref name=&quot;sykes-2013&quot;/&gt;&lt;ref name=&quot;greenes-infectious&quot;&gt;{{Cite book
  | isbn = 978-0-323-50933-6
  | title = Greene's Infectious Diseases of the Dog and Cat
  | author-first = Jane E.
  | author-last = Sykes
  | publisher = Elsevier Health Sciences
  | year = 2022
  | url = https://books.google.com/books?id=Tyl3EAAAQBAJ&amp;pg=PA1054
  | page = 1054
}}&lt;/ref&gt; The risk of spread from infected cats to humans can be reduced by appropriate biosafety measures, including wearing [[personal protective equipment]] when handling a cat with suspected sporotrichosis and by washing hands, arms and clothing after handling the cat.&lt;ref name=&quot;greenes-infectious&quot;/&gt;

==Treatment==
Treatment of sporotrichosis depends on the severity and location of the disease.  The following are treatment options for this condition:&lt;ref&gt;{{cite journal | vauthors = Lortholary O, Denning DW, Dupont B | title = Endemic mycoses: a treatment update | journal = The Journal of Antimicrobial Chemotherapy | volume = 43 | issue = 3 | pages = 321–31 | date = March 1999 | pmid = 10223586 | doi = 10.1093/jac/43.3.321 | doi-access = free }}&lt;/ref&gt;
* Oral [[potassium iodide]]
:Potassium iodide is an anti-fungal drug that is widely used as a treatment for cutaneous sporotrichosis. Despite its wide use, there is no high-quality evidence for or against this practice. Further studies are needed to assess the efficacy and safety of oral potassium iodide in the treatment of sporotrichosis.&lt;ref&gt;{{cite journal | vauthors = Xue S, Gu R, Wu T, Zhang M, Wang X | title = Oral potassium iodide for the treatment of sporotrichosis | journal = The Cochrane Database of Systematic Reviews | issue = 4 | article-number = CD006136 | date = October 2009 | volume = 2009 | pmid = 19821356 | doi = 10.1002/14651858.CD006136.pub2 | url = http://www.cochrane.org/CD006136/SKIN_oral-potassium-iodide-for-the-treatment-of-sporotrichosis | pmc = 7388325 }}&lt;/ref&gt;
* [[Itraconazole]] (Sporanox) and [[fluconazole]]
:These are [[Antifungal medication|antifungal]] drugs.  Itraconazole is currently the drug of choice and is significantly more effective than fluconazole. Fluconazole should be reserved for patients who cannot tolerate itraconazole.
* [[Amphotericin B]]
:This antifungal medication is delivered intravenously.  Many patients, however, cannot tolerate Amphotericin B due to its potential side effects of fever, nausea, and vomiting.
:Lipid formulations of amphotericin B are usually recommended instead of [[amphotericin B deoxycholate]] because of a better adverse-effect profile. Amphotericin B can be used for severe infection during pregnancy. For children with disseminated or severe disease, amphotericin B deoxycholate can be used initially, followed by itraconazole.&lt;ref name=&quot;dbt.consultantlive.com&quot;&gt;{{cite journal | vauthors = Hogan BK, Hospenthal DR | title = Update on the therapy for sporotrichosis | journal = Patient Care | date = March 2011 | volume = 22 | pages = 49–52 | url = https://www.patientcareonline.com/hiv-aids/update-therapy-sporotrichosis | access-date = 2019-05-05 | archive-date = 2020-05-22 | archive-url = https://web.archive.org/web/20200522230000/https://www.patientcareonline.com/hiv-aids/update-therapy-sporotrichosis }}&lt;/ref&gt;

:In case of sporotrichosis meningitis, the patient may be given a combination of Amphotericin B and 5-fluorocytosine/[[Flucytosine]].
* [[Terbinafine]]
:500mg and 1000mg daily dosages of terbinafine for twelve to 24 weeks has been used to treat cutaneous sporotrichosis.&lt;ref name=&quot;ncbi.nih.gov chapman&quot;&gt;{{cite journal | vauthors = Chapman SW, Pappas P, Kauffmann C, Smith EB, Dietze R, Tiraboschi-Foss N, Restrepo A, Bustamante AB, Opper C, Emady-Azar S, Bakshi R | title = Comparative evaluation of the efficacy and safety of two doses of terbinafine (500 and 1000 mg day(-1)) in the treatment of cutaneous or lymphocutaneous sporotrichosis | journal = Mycoses | volume = 47 | issue = 1–2 | pages = 62–8 | date = February 2004 | pmid = 14998402 | doi = 10.1046/j.1439-0507.2003.00953.x| hdl = 2027.42/74074 | s2cid = 7319396 | hdl-access = free }}&lt;/ref&gt;
* Newer [[triazole]]s
:Several studies have shown that [[posaconazole]] has in vitro activity similar to that of amphotericin B and itraconazole; therefore, it shows promise as an alternative therapy. However, [[voriconazole]] susceptibility varies. Because the correlation between in vitro data and clinical response has not been demonstrated, there is insufficient evidence to recommend either posaconazole or voriconazole for treatment of sporotrichosis at this time.&lt;ref name=&quot;dbt.consultantlive.com&quot;/&gt;
* [[Surgery]]
:In cases of bone infection and cavitary nodules in the lungs, surgery may be necessary.
* [[Thermotherapy|Heat therapy]]
:Heat creates higher tissue temperatures, which may inhibit fungus growth while the immune system counteracts the infection. The &quot;pocket warmer&quot; used for this purpose has the advantage of being able to maintain a constant temperature of 44 degrees-45 degrees C on the skin surface for several hours, while permitting unrestricted freedom of movement.  The duration of treatment depends on the type of lesion, location, depth, and size. Generally, local application for 1-2 h per day, or in sleep time, for 5-6 weeks seems to be sufficient.&lt;ref name=&quot;pmid7298332&quot;&gt;{{cite journal | vauthors = Takahashi S, Masahashi T, Maie O | title = [Local thermotherapy in sporotrichosis] | language = de | journal = Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und Verwandte Gebiete | volume = 32 | issue = 10 | pages = 525–8 | date = October 1981 | pmid = 7298332 }}&lt;/ref&gt;

==Other animals==
[[File:Feline sporotrichosis 3.jpg|thumb|Ulcerative skin disease in a cat with sporotrichosis; a cat with this disease must be handled with caution as this form can be contagious to other animals and to humans]]

Sporotrichosis can be diagnosed in domestic and wild mammals. In veterinary medicine it is most frequently seen in cats and horses.  Cats have a particularly severe form of cutaneous sporotrichosis. Infected cats may exhibit abscesses, cellulitis, or draining wounds that fail to respond to antibiotic treatment.&lt;ref name=&quot;saunders-small&quot;&gt;{{Cite book
  | title = Saunders Manual of Small Animal Practice
  | edition = 3rd
  | author1-first = Stephen J.
  | author1-last = Birchard
  | author2-first = Robert G.
  | author2-last = Sherding
  | publisher = Elsevier Health Sciences
  | year = 2005
  | isbn = 978-1-4160-6429-9
  | url = https://books.google.com/books?id=Kom2IMIQr6YC&amp;pg=PA440
  | page = 440
}}&lt;/ref&gt;

Sporotrichosis can spread from nonhuman animals to humans ([[zoonosis]]). Infected cats in particular exude large quantities of ''Sporothrix'' organisms from their skin leasions and can spread the infection to people who handle them.&lt;ref name=&quot;saunders-small&quot;/&gt;&lt;ref name=&quot;Merck&quot;&gt;{{cite web | title=Sporotrichosis | work=The Merck Veterinary Manual | url=https://www.merckvetmanual.com/generalized-conditions/fungal-infections/sporotrichosis | access-date=2019-06-17 }}&lt;/ref&gt; Although cats are the most common animal source, the infection has also been known to spread to humans from dogs, rats, squirrels, and armadillos.&lt;ref&gt;{{Cite journal
  | journal = Journal of Fungi
  | title = Emerging Animal-Associated Fungal Diseases
  | author-last = Carpouron
  | author-first = Julia E.
  | display-authors = etal
  | year = 2022
  | volume = 8
  | issue = 6
  | page = 611
  | doi = 10.3390/jof8060611
| pmid = 35736094
 | pmc = 9225262
 | doi-access = free
 }}&lt;/ref&gt;

== See also ==
* [[Mucormycosis]]
* [[List of cutaneous conditions]]
{{-}}

== References ==
{{Reflist}}

== External links ==
{{Medical resources
|   ICD10          = {{ICD10|B|42||b|35}}
|   ICD9           = {{ICD9|117.1}}
|   ICDO           =
|   OMIM           =
|   DiseasesDB     = 29797
|   MedlinePlus    = 001338
|   eMedicineSubj  = med
|   eMedicineTopic = 2161
|   eMedicine_mult = {{eMedicine2|derm|400}}
|   MeshID         = D013174
}}
{{Mycoses}}

[[Category:Animal fungal diseases]]
[[Category:Bird diseases]]
[[Category:Bovine diseases]]
[[Category:Cat diseases]]
[[Category:Horse diseases]]
[[Category:Mycosis-related cutaneous conditions]]
[[Category:Rodent diseases]]
[[Category:Sheep and goat diseases]]
[[Category:Swine diseases]]
[[Category:Zoonoses]]
[[Category:Fungal diseases]]