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Aiding in the diagnosis of extracutaneous sporotrichosis
Sporotrichosis is an endemic fungal infection caused by the dimorphic fungus Sporothrix schenckii. Most cases of sporotrichosis have been reported from the subtropical and tropical regions of the Americas, but a global distribution is likely. The organism is often isolated from soil, plants, or plant products (wood), and occupational or recreational exposure to these materials is often implicated in infected individuals.
Infections due to Sporothrix schenckii can be differentiated into several distinct syndromes:
-The cutaneous form of the disease is most common, often arising from sites of minor skin trauma. The primary erythematous, papulonodular lesion may range from several millimeters to 4 cm in size. Secondary lesions develop proximally along lymphatic channels. These generally painless lesions usually do not involve lymph nodes, although lymphadenopathy may develop.
-Extracutaneous sporotrichosis can be manifested as osteoarticular involvement of a single joint. Major joints of the extremities (ankle, knee, elbow, hand) are most often involved. The affected joint is swollen and painful, with an attendant effusion. Systemic symptoms are minimal.
-Pulmonary sporotrichosis with cavitary lesions also has been described.
-A multifocal extracutaneous syndrome has been described, consisting of multijoint involvement, or widely scattered cutaneous lesions. Constitutional symptoms (fever, weight loss) are often noted, and spread to bone and central nervous system may occur. Underlying immune system suppression is often a contributing factor. Untreated infection is ultimately fatal.(1)
Any titer should be considered clinically significant, however, clinical correlation must be present.
Extracutaneous infections, including disseminated and articular infections, produce positive tests.
No significant cautionary statements
1. Rex JH, Okhuysen PC: Sporothrix schenckii. In Principles and Practice of Infectious Diseases. Edited by GL Mandell, RG Douglas, JE Bennet. Philadelphia, Churchill Livingstone, 2000, pp 2695-2699
2. Blumer SO, Kaufman L, Kaplan W, et al: Comparative evaluation for 5 serological methods for the diagnosis of sporotrichosis. Appl Microbiol 1973 July;26(1):4-8