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Sporotrichosis 8/6/2011 Sporotrichosis • Alternative name –Rose Handler’s Disease Named due to fungal infection resulting from thorn pricks or barbs, Sporotrichosis handling of sphagnum moss or by slivers from Pam Galioto, Megan Lileas, Tom wood or lumber Mariani, and Katie Olenick – Kingdom: Fungi • Only one active species – Phylum: Ascomycota –Sporothrix schenckii • Thermally dimorphic – Class: Euascomycetes fungus which is distributed worldwide – Order: Ophiostomatales • Isolated from soil, living and decomposing plants, woods, and peat moss – Family: Ophiostomataceae – Genus: Sporothrix Geographical Distribution Life Cycle Phase 1 – Hyphal Phase • Exists worldwide, but uncommon in •25°C, grows slowly United States •Conidospores • Peru has hyperendemicity for infection •Pigmented white, cream, or black • More common in temperate or tropical •Flower formation zones Phase 2 – Yeast Phase •37°C •Pigmented white or greyish-yellow •Spherical/budding yeast colonies 1 8/6/2011 Epidemiology Pathogenesis At risk - Prevention – •Generally enters body through skin •Handling thorny plants, baled •Wear gloves when handling prick, cuts, or small punctures hay, moss wires, bushes, etc. •Can be inhaled •Nursery workers •Avoid contact with •Cutaneous, pulmonary, or •Children playing on baled hay sphagnum moss disseminated infection •Rose gardeners •Proper handling of •Joints, lungs, and central nervous •Greenhouse workers laboratory equipment system have occurred •First nodule in 1 to 12 weeks •Can infect animals •Can cause arthritis, meningitis, pneumonitis, or other visceral infections Diagnosis Histopathology • Microscopic Analysis • Physical Exam – Dimorphic fungus: mold in environment and yeast in the body – Small, painless red lumps – Usually on upper extremities – Microconidia: small, unicellular, round spores that develop laterally along hyphae in ‘sleeve-like’ pattern – Can be delayed up to 3 months – Lesions will ulcerate if left untreated • a secondary bacterial skin infection called cellulitis can • Culture appear – Sample can be taken from pus, sputum, or synovial fluid in joints • Antibody Testing – ‘Gold standard’ of diagnosis – Blood test to detect antibodies to Sporothrix schenckii – Sporothrix schenckii – Variable sensitivity and specificity Clinical Manifestations Treatment and Management of • Cutaneous Lymphatic Type (common) Cutaneous Lymphatic Sporotrichosis – Small, usually painless nodules ranging in color from pink to purple • Saturated Potassium Iodide – Lesion will grow larger and darker, eventually forming – Oral dose for 3 – 6 months an ulcer – Additional bumps may develop along lymphatic • Antifungal medication chains (lymph nodes) – Itraconazole or Fluconazole • Pulmonary Type (rare) • Incision & Drainage – Nodules in the lungs • Heat • Disseminated Type (rare) – May provide temporary pain relief – Immunocompromised patients – Deadliest form 2 8/6/2011 Case Report 1 Case Report 1 (cont) • Admitted with multiple painful • Diagnosing with ascending lymphangitis ulcers spreading from elbow to – Classic sign of cutaneous sporotrichosis armpit • Parents previously noted a scratch on patients • Axillary lymph node was palpable arm made by pet cat • Previously diagnosed with impetigo (No change after given – Noted lesions on cat that did not go away amoxicillin for treatment) • Swab of lesions came back positive for Sporothrix schenckii • Girl sent home with antifungal therapy (itraconazole) Case Report 2 Case Report 2 (cont) • Due to locations of lesions told to • 41 year old female meet with oncology presents with skin ulcer on left chest wall • After biopsies found nothing • Noticed 3 weeks prior patient asked for infectious to clinical visit disease consult • No pathogens present • 10 weeks after original and sent home with appearance specimens were doxycycline submitted for culture – Identified as Sporothrix schenckii with microscopic mold morphology References References (cont) "Sporothrix schenckii - Material Safety Data Sheets (MSDS) ." Public Health Agency of "A Resident's Fungal Morphology." UCSF Departments of Pathology and Canada. Health Canada, 18 Feb 2011. Web. 5 Aug 2011. Laboratory Medicine. Web. 1 Aug. 2011. "Sporothrix Species." Doctor Fungus. N.p., n.d. Web. 5 Aug 2011. <http://labmed.ucsf.edu/education/residency/fung_morph/fungal_site/dimor phpage.html>. "Sporotrichosis: General Information." Center for Disease Control. N.p., 17 Jul 2009. Costa da Silva, Maria do Socorro, Ellem Ramos Ferreira, Leonardo Rodrigues Web. 4 Aug 2011. Campos, Marcio Tadeu Vierira Brito, Patricia Ferreira, and Rodrigo Silva Grilo. "Sporotrichosis - Overview." Health in Plain English. Web. 1 Aug. 2011. "Painful ulcers in a 5-year-old girl." European Journal for Pediatrics 170.7 <http://www.healthinplainenglish.com/health/infectious_diseases/sporotrichosis/ (2011): 949-950. index.htm>. Greenfield M.D., Ronald A. "Sporotrichosis Clinical Presentation." Medscape "Sporotrichosis - PubMed Health." Web. 1 Aug. 2011. Reference. Web. 01 Aug. 2011. <http://emedicine.medscape.com/article/228723-clinical>. <http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002314/>. Smitha Prabhu, et al. "Zoonotic sporotrichosis of lymphocutaneous type in a man Rosenthal, Ken S., and James S. Tan. Rapid Review Microbiology and Immunology. acquired from a domesticated feline source: report of a first case in southern Philadelphia, PA: Mosby/Elsevier, 2007. Print. Karnataka, India." International Journal Of Dermatology 48.11 (2009): 1198- Rees, Rachel, and John Swartzberg. "Feline-trasmitted Sporotrichosis: A case study 1200. MEDLINE with Full Text. EBSCO. Web. 3 Aug. 2011. from California." Dermatology Online Journal 17.6 (2011): 2. Dermatology Online. Spickler, Anna. "Sporotrichosis." Center for Food Security and Public Health. N.p., n.d. Web. 5 Aug 2011. Web. 1 Aug. 2011. "Sporothrix schenkii." Mycology Online. N.p., 2011. Web. 3 Aug 2011. http://pets.webmd.com/cats/slideshow-skin-problems-in-cats http://www.dogsinfo.net/html/Health/2010/1125/Sporotrichosis.html 3 8/6/2011 References (cont) Question 1 http://www.emedmag.com/html/pre/dia/dia/041090029.asp http://www.soomro.us/social_corner/sporotrichosis/sporotrichosis.htm http://diggingri.wordpress.com/2010/02/ What is an alternative name to Sporotrichosis? http://labmed.ucsf.edu/education/residency/fung_morph/fungal_site/dimorphpa ge.html A.) Gardener’s disease http://www.shopihl.com/category/Thyroid-Support B.) Florist’s disease http://dermatology.cdlib.org/1706/2_case_presentations/2_11- 00118/article.html C.) Flower handler’s disease http://dermatology.cdlib.org/1706/2_case_presentations/2_11- 00118/article.html D.) Rose handler’s disease http://web.ebscohost.com.proxy.ohiolink.edu:9099/ehost/imageQuickView?sid=3 696a1f8-9073-4d86-bf62- 537385882c3a@sessionmgr14&vid=7&ui=12836368&id=44757928&parentui =20064175&tag=AN&db=mnh http://jcm.asm.org/cgi/content/full/43/3/1348 http://accessmedicine.net/search/searchAMResultImg.aspx?searchStr=geographi c+helicoid+peripapillary+choroidopathy&fullTextStr=geographic+helicoid+peri papillary+choroidopathy&searchType=2 http://cid.oxfordjournals.org/content/36/1/34.full Question 2 Question 3 How is Sporotrichosis contracted? How is sporotrichosis treated? A.) Solely through inhalation A.) With surgery B.) Through surgery B.) Amphotericin B C.) Through food C.) Potassium Iodide with Intraconazole or D.) Mainly through puncture of the skin Fluconazole D.) Applied heat Question 4 Question 5 Microscopic analysis of Sporothrix Schenckii What does Sporotrichosis present as during a shows what? physical exam? A.) A monomorphic fungi that only grows as a yeast A.) Dark scaly lumps on lower extremities B.) A monomorphic fungi that only grows as a mold B.) Small painless red lumps on upper extremities C.) A dimorphic fungi that grows as a yeast at 25°C C.) Large ulcerated lumps on entire body and a mold at 37°C D.) Large painful lumps on upper extremities D.) A dimorphic fungi that grows as a mold at 25°C and a yeast at 37°C 4.
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