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Sporotrichosis

Sporotrichosis is a long-term (chronic ) skin infection that is caused by a fungus called Sporothrix schenckii.

Causes

Sporothrix schenckii is found in plants. Infection commonly occurs when the skin is broken while handling plant materials such as rosebushes, briars, or dirt that contains a lot of mulch.

Sporotrichosis can be a job-related disease for people who work with plants, such as farmers, horticulturists, rose gardeners, and plant nursery workers. Widespread (disseminated) sporotrichosis can develop in people with a weakened immune system when they inhale dust filled with spores of the fungus.

Symptoms

Symptoms include a small, painless, red lump that develops at the site of infection. As time passes, this lump will turn into an ulcer  (sore). The lump may develop up to 3 months after an injury.

Most sores are on the hands and forearms because these areas are commonly injured when handling plants.

The fungus follows the channels in your body's lymph system. Small ulcers appear as lines on the skin as the infection moves up an arm or leg. These sores do not heal unless they are treated, and they may last for years. The sores may sometimes drain small amounts of pus.

Body-wide (systemic) sporotrichosis can cause lung and breathing problems, bone infection, arthritis, and infection of the nervous system.

Exams and Tests

A physical examination  will show the typical sores caused by the fungus. Sometimes, a small sample of affected tissue is removed, examined under a microscope, and tested in a lab to identify the fungus.

Treatment

The skin infection is usually treated with an antifungal medicine called itraconazole. It is taken by mouth and continued for 2 to 4 weeks after the skin sores have cleared. You may have to take the medicine for 3 to 6 months. A medicine called terbinafine may be used instead of itraconazole.

Infections that have spread or affect the entire body are often treated with amphotericin B, or sometimes itraconazole. Therapy for body-wide (systemic) disease can last up to 12 months.

Outlook (Prognosis)

With treatment, full recovery is likely. Disseminated sporotrichosis is more difficult to treat and requires several months of therapy. Disseminated sporotrichosis can be life-threatening for people with a weakened immune system.

Possible Complications

People with a normal immune system may have:

  • Discomfort
  • Secondary skin infections (such as staph or strep)

People with a weakened imune system  may develop:

  • Arthritis
  • Bone infection
  • Complications from medications -- amphotericin B can have serious side effects
  • Lung and breathing problems (such as pneumonia )
  • Meningitis
  • Widespread (disseminated) disease

When to Contact a Medical Professional

Make an appointment with your health care provider if you develop persistent skin lumps or skin ulcers. Tell your health care provider if you know that you have been exposed to plants.

Prevention

People with a weakened immune system should try to reduce risk of skin injury. Wearing thick gloves while gardening can help.

References

Hsu LY, Wijaya L, Shu-Ting E, Gotuzzo E. Tropical fungal infections. Infec Dis Clin N Am. June 2012;26(2):497-512.

Kauffman CA. Sporotrichosis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 345.

Kauffman CA, Bustamante B, Chapman SW, et al. Clinical practice guidelines for the management of sporotrichosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007;45:1255-1265.

Rex JH, Okhuysen PC. Sporothrix schenckii. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2009:chap 260.

Updated: 5/12/2014

Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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