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 *** .