Sporotrichosis

Sporotrichosis

Definition: Sporotrichosis (also known as “rose gardener’s disease”) is a rare type of fungal infection that can occur in both humans and animals. It is an infection caused by a fungus called Sporothrix schenckii. The fungus lives throughout the world in soil, plants, and decaying vegetation. This fungal disease usually affects the skin, although other rare forms can affect the lungs, joints, bones, and even the brain. Because roses can spread the disease, it is one of a few diseases referred to as rose-thorn or rose-gardeners’ disease. Peru, Brazil, the U.S., China, and West Australia are the countries where most infections occur.

Types of sporotrichosis –

  • Cutaneous (skin) sporotrichosis is the most common form of the infection. It usually occurs on a person’s hand or the arm after they have been handling contaminated plant matter.
  • Pulmonary (lung) sporotrichosis is very rare but can happen after someone breathes in fungal spores from the environment.
  • Disseminated sporotrichosis occurs when the infection spreads to another part of the body, such as the bones, joints, or the central nervous system. This form of sporotrichosis usually affects people who have weakened immune systems, such as people with HIV infection.

Sporotrichosis mostly affects people who work with these products, such as:

  • farmers
  • florists
  • gardeners
  • those who work at plant nurseries
  • those who handle bales of hay
  • carpenters

Sporotrichosis progresses slowly – the first symptoms may appear 1 to 12 weeks (average 3 weeks) after the initial exposure to the fungus. Serious complications can also develop in patients who have a compromised immune system.

Causes, Sign and Symptom of Sporotrichosis: The disease, sporotrichosis, is caused by the fungus Sporothrix schenckii, although recent research has shown that several other distinct Sporothrix species also cause the disease. According to the U.S. Centers for Disease Control and Prevention (CDC), the fungus may be found in rose bushes, hay, and moss.

Sporotrichosis usually begins when fungal spores are forced under the skin by a rose thorn or sharp stick. The infection may also begin in the apparently unbroken skin after contact with hay or moss carrying the fungus.

Farmers, nursery workers, landscapers, and gardeners are at higher risk for the disease because of their chance of cuts or puncture wounds while working with soil. People who are immunosuppressed (HIV patients, cancer patients, for example) are also at higher risk to get the disease.

Rarely, cats or armadillos can transmit the disease to humans with scratches from the animal’s claws.

The disease is not transmitted from person to person, and some investigators consider sporotrichosis to be a self-limited mycosis (fungal infection not transmitted to other people).

The first symptom is usually a small painless nodule (bump) resembling an insect bite. The first nodule may appear any time from 1 to 12 weeks after exposure to the fungus. The nodule can be red, pink, or purple in color, and it usually appears on the finger, hand, or arm where the fungus has entered through a break in the skin.

Most Sporothrix infections only involve the skin. However, the infection can spread to other parts of the body, including the bones, joints, and the central nervous system. Usually, these types of disseminated infections only occur in people with weakened immune systems. In rare cases, a pneumonia-like illness can occur after inhaling Sporothrix spores, which can cause symptoms such as shortness of breath, cough, and fever.

Diagnosis and Treatment of Sporothrix: Sporotrichosis is typically diagnosed when a patient’s health care provider takes a small tissue sample (biopsy) of the infected area of the body. The sample is sent to the laboratory for tests (usually a fungal culture) to find out what is causing the infection. Blood tests can help diagnose severe sporotrichosis, but they often can’t diagnose a cutaneous (skin) infection.

Patients with sporotrichosis will have antibody against the fungus S. schenckii, however, due to variability in sensitivity and specificity, it may not be a reliable diagnosis for this disease. The confirming diagnosis remains culturing the fungus from the skin, sputum, synovial fluid, and cerebrospinal fluid. Smears should be taken from the draining tracts and ulcers.

Treatment of sporotrichosis depends on the site infected and the person’s overall medical condition.

  • Infections in the skin only: These infections have traditionally been treated with saturated potassium iodide solution (SSKI). Skin infections may also be treated with itraconazole (Sporanox) for up to six months.
  • Infection in the bones and joints: These infections are much more difficult to treat and rarely respond to potassium iodide. Itraconazole (Sporanox) is often used as an initial medication for several months or even up to a year. The drug amphotericin is also used, but this medicine can only be given through an IV. Amphotericin has more side effects and may need to be administered for many months. Surgery is sometimes needed to remove infected bone.
  • Infection in the lungs: Lung infections are treated with potassium iodide, itraconazole (Sporanox), and amphotericin with varying amounts of success. Sometimes, the infected areas of the lung have to be surgically removed.
  • Infection in the brain: Sporotrichosis meningitis is very rare, so information on treatment is not readily available. Amphotericin plus 5-fluorocytosine is generally recommended, but itraconazole (Sporanox) might also be tried.
  • SSKI and itraconazole should not be used in pregnant patients. Treatment in pregnancy and of children usually requires consultation with infectious disease specialists.
  • Alternative treatments for cutaneous sporotrichosis are mentioned in the lay literature. Fungicidal herbs (such as myrrh, tea tree oil, citrus seed extract, pau d’arco tea, olive oil, and garlic) applied directly to the infected skin are supposed to treat the infection. However, there are few research data to back up these claims.

Prevention of this disease includes wearing long sleeves and gloves while working with soil, hay bales, rose bushes, pine seedlings, and sphagnum moss. Also, keeping cats indoors is a preventative measure.

 

Information Source:

  1. medicinenet.com
  2. emedicinehealth.com
  3. healthline.com
  4. cdc.gov
  5. wikipedia