Sporotrichosis Subcutaneous mycoses

 1-Mycetoma  2-Sporotrichosis

 3-Chromoblastomycosis

 4-Subcutaneous phaeohyphomycosis

 5-Cerebral phaeohyphomycosis Definition: Rose gardener’s disease Rose thorn disease Rose handler's disease a chronic mycotic infection cutaneous or subcutaneous tissues .lymphatics . nodular lesions .ulcerate.pus traumatic implantation the skin or by inhalation into the lungs (rarely) Secondary spread ..bone and muscle . central nervous system, lungs or genitourinary tract.(rare) Agent:

Sporothrix schenckii Thermal dimorphic In soil On decaying vegetation Plants Plant products: Straw Wood Mine timbers Rose bushes Sphagnum moss

Predisposing factors: In pulmonary sporotrichosis:

Alcoholic Pulmonary tuberculosis Diabetes mellitus Sarcoidosis Steroid therapy Clinical manifestations:

1-lymphocutaneous 2-Fixed cutaneous 3-Mucocutaneous 4-Pulmonary 5-Systemic Lymphocutaneous sporotrichosis Gumatose (%75) Primary infection shancre Lymphocutaneous sporotrichosis Lymphocutaneous sporotrichosis no fever, no pain

2-Fixed cutaneous sporotrichosis: Fixed cutaneous verrucous-type sporotrichosis Fixed cutaneous sporotrichosis (similar to chromoblastomycosis)

3-Mucocutaneous sporotrichosis:

Mouth. Nose….pain…local

Differential diagnosis: Lichen planus Secondry cutaneous leishmaniasis lymphocutaneous sporotrichosis Nocardiosis Non tuberculous mycobacterial infections Cutaneous leishmanisis Mycobacterium marinum Infection 4-Pulmonary sporotrichosis Alcoholic primary

Pulmonary tuberculosis, diabetes mellitus, or steroid use

Normal Occasionally asymptomatic but usually:

A productive cough Low-grade fever Cavitary lesions Parenchymal infiltrate Hillar lymphadenopathy bilateral large irregular cavities in the right and left upper lobes 5-Systemic sporotrichosis:

• Rare • Bone.. common.. spread cutaneous.. knee

• osteomyelitis . arthritis Animal

• Lympho cutaneous sporotrichosis: • Horse. similar to human • Donkey • Differential diagnosis Lymphangitis (histoplasma farsiminosum) Epidemiology:

South Africa Occupation France Exposure USA World-wide Canada Tropical regions Iran Temperate regions  No Transmission Mexico human to human except… Brazile  M > F  >30 Occupational disease:

Farmers Horticulturists Timber workers Gardeners Florists Laboratory Diagnosis: 1-Collection of samples: Drainage from skin lesions Exudates Pus Blood Pulmonary secretions Tissue biopsy specimens 2-Direct examination Gram

PAS

GMS

H & E

Cells: 2-3 × 3-5 µm Wright's stain, 1000x Skin section: Yeast cells. PAS Finger section: Cigar-shaped yeast cells (1-3 µm × 3-10 µm) . PAS Asteroid body 3-Culture: Media: SCC BHIA + blood

BA SDA: 19 days Thermal dimorphic: simillar to Geotricum 25°C 37°C Daisy like Rosette like Sleeve form Triangular

Yeast cells in vitro, 37°C 4-Serology In extra cutaneous and systemic forms:

LA Enzyme immunoassay (EIA) Sporothrix Latex Agglutination System for Antibody Detection In cutaneous form:

Skin test: Usually positive Treatment: Lympho cutaneous: Saturated solution of potassium iodine (SSKI): 6-12 weeks

Itraconazole: 3-6 months

Local heat therapy Osteoarticular: Amphotericin B

Itraconazole

Surgical debridement Pulmonary: SSKI or Amphotericin B Patients with AIDS:

Itraconazole (drug of choice)

Lifetime suppressive itraconazole therapy ***