It is an infection caused by the fungus Sporothrix schenckii (S. schenckii). In older publications, the condition has often been termed as “rose handler’s disease” since it commonly occurs in people who grow roses.
The disorder is usually divided into the following types:
The uncommon type of the disease directly affects the lungs when fungal spores are inhaled by a patient.
Cutaneous or skin sporotrichosis
As the name suggests, the microbes attack the skin and is the most common form of this condition.
The rare type is a severe manifestation of the fungal infection that spreads from the primary organs to various other sites in the body.
The infectious disorder may take a long time to develop as the fungal spores take longer time to move into the skin. The predominant symptom of the condition is a firm bump on the skin. The color of the nodule ranges from pink to purple and is usually painless or slightly tender. In the course of time, the nodule may develop as an ulcer that may cause drainage of clear fluid and undergo slow healing. However, in some cases, the condition may give rise to mycetoma. These nodules and ulcers may transform into painful boils and remain unchanged even after years if left untreated, and this could become a chronic problem for the patients.
Cutaneous form of the fungal infection is normally represented by lesions on the finger, hand, and arms. In most cases, the infection spreads along the lymph nodes. This is more pronounced in pulmonary sporotrichosis that encompasses symptoms like cough, nodules, lung cavitation, fibrosis as well as swollen hilar lymph nodes. Disseminated fungal infection can be extremely life-threatening as it often infects the joints and bones as well as the central nervous system and the brain. A weak immune system facilitates the spreading of the infection to other parts of the body resulting in the following symptoms:
- Loss of appetite
- Drastic weight loss
- Bony lesions
The disorder is caused by several other distinct Sporothrix species that are naturally found in soil, hay, twigs, sphagnum moss, and thorny plants. This infection-causing fungus is related more closely to the mold on stale bread or the yeast used to brew beer. It is dimorphic that can exists as a yeast or a hyphae-producing form. The infection usually begins when the fungal spores are forced under the skin by a rose thorn or sharp stick. However, they may also enter through small cuts and abrasions in the skin. Interestingly, the microbes can invade unbroken skin when in contact with hay or moss carrying the fungus.
Gardeners, farmers, nursery workers, and landscapers are at a greater risk for developing the disease since there is a higher chance of cuts or puncture wounds while working with soil. As discussed earlier, immunocompromised patients are more susceptible to this disease.
The fungal spores enter through the respiratory pathways when inhaled. Accidental ingestion of the microbial spores may lead to infection of other parts of the body.
Sporotrichosis in Animals
Various domestic and laboratory animals are prone to this infection. So far, the sporadic chronic granulomatous disease has been reported in dogs, cats, horses, cows, camels, mules, birds, pigs, rats, and armadillos.
During diagnosis, physicians normally rule out other conditions that share similar symptoms with the infectious disorder. Some of these include:
- Tinea capitis
As the condition progresses slowly, the first symptoms may appear 1 to 12 weeks after the initial exposure to the fungus. Although antibodies are produced against the fungus, a simple blood test may not reveal anything due to variability in sensitivity and specificity. Culturing of infected sputum, synovial fluid, or cerebrospinal fluid may help in the identification of the disorder. Biopsy of the nodule and fluorescent antibody are the other tests carried out by the doctors.
The severity and site of the infection determines the treatment. Depending on the medical condition of the patient the following measures are taken:
The cutaneous lesions may receive saturated potassium iodide droplets three times per day for 3 to 6 months until all the lesions have disappeared. Antifungal drugs like itraconazole (Sporanox) and fluconazole have significant effects on the microbes. Amphotericin B is another antifungal medication administered intravenously to the infected patients. However, the drug may cause side effects like fever, nausea, and vomiting. In order to speed up the healing process, lipid formulations of amphotericin B are usually recommended instead of amphotericin B deoxycholate. At the same time, it can be used for severe infection during pregnancy. Amphotericin B deoxycholate coupled with itraconazole can be given to children with disseminated or severe form of the disorder. On the other hand, a combination of amphotericin B and 5-fluorocytosine/flucytosine can be used for sporotrichosis meningitis-affected patients. Physicians often recommend triazoles such as posaconazole since their vitro activity resembles amphotericin B and itraconazole. In the near future, it may work as an alternative therapy. The susceptibility however, varies in the case of voriconazole. Due to lack of information, the correlation between in vitro data and clinical response cannot be properly demonstrated.
Patients with bone infection and cavitatory nodules in the lungs may have go through a surgical procedure.
Fungal infection in the skin or lymph nodes gets completely ameliorated in the presence of timely and effective health care. However, a few outcomes may range from good to poor if diagnosis and treatment is delayed. In some cases, despite treatment the ailment may take several months or years, and scars may remain at the site of the original infection. However, infections involving the brain, lungs, joints, or other areas of the body are much more difficult to treat.
The condition can cause serious complications in patients with severe infection like:
Sporotrichosis is not a contagious condition and it usually occurs as a self-limited mycosis. People with a suppressed immune system should be exceptionally careful to avoid any contact with rose thorns or soil and moss used for gardening or farm use. Immediately seek a doctor’s advice if you notice any of the signs of the infection.
Pictures of Sporotrichosis