Sporotrichosis

Key Points
Condition is a fungal infection of the skin caused by the fungus Sporothrix schenckii, which is found typically in flora and infects people through small cuts, punctures or scratches.
Condition results in lesions appearing on exposed area surrounding the site of infection and occasionally following the lymph nodes.

Sporotrichosis is a fungal infection of the skin caused by the fungus sporothrix schenckii, which is found on decaying vegetation, rosebushes, twigs, hay, sphagnum moss and mulch-rich soil. The most common route of infection is via the skin through small cuts, scratches or punctures from thorns, barbs, pine needles or wires. Sporotrichosis does not appear to be transmitted from person to person but there are reported cases of transmission from infected cats to humans. In very rare cases, spore-laden dust can be inhaled or ingested and in people with a weakened immune system cause widespread sporotrichosis. People at risk of contracting sporotrichosis include farmers, nursery workers, landscapers and gardeners. Adult males are, by their occupation, most exposed to the risk of infection.

This most common presentation of sporotrichosis occurs following the implantation of spores in a wound. Lesions usually appear on exposed skin and often the hand or forearm is affected, as these areas are a common site of injury. The first lesion can take up to 20-90 days to appear. The first sign is a firm bump (nodule) on the skin that can range in color from pink to nearly purple. It is usually painless or only mildly tender. The nodule gradually grows bigger, reddens, becomes pustular, and ulcerates. The open sore (ulcer) may drain clear fluid. Depending on the severity of infection and the overall well-being of the individual, sporotrichosis can present in several ways. Skin disease is the most common.

Differential Diagnosis (Other conditions with similar appearance)
Leishmaniasis
Nocardiosis
Syphilis

Diagnosis
Key Points
Microscopic study and culture of infected tissue is necessary to correctly identify the presence of the right bacteria.
Other infections often mimic the sporotrichosis.

Microscope study and culture of infected tissue is performed to identify the presence of Sporothrix schencki. Other infections can mimic the lesions of sporotrichosis so it is important to perform tests to confirm diagnosis. Other possible infections include bacteria related to tuberculosis or leprosy, cowpox, herpes simplex, other fungi and bacteria and non-infectious diseases such as lupus erythematosus.

Treatment
Key Points
Treatment depends on the site infected and should continue until all lesions have resolved.
Preventative measures should be taken when handling potentially infectious materials such as flora.

Treatment of sporotrichosis depends on the site infected. Treatment can be prolonged but should continue until all lesions have resolved. This may take months or years, and Scars may remain at the original site of infection. However, most people can expect a full recovery. Sporotrichosis that infects organs or bodily systems usually more difficult to treat and in some cases life-threatening for people with weakened immune systems.

Patients should be advised of measures to take to prevent sporotrichosis. These include wearing gloves, boots and clothing that covers the arms and legs when handling rose bushes, hay bales, pine seedlings or other materials that may scratch or break the skin surface. It is also advisable to avoid skin contact with sphagnum moss.