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Diagnosis and Treatment of Lymphocutaneous Sporotrichosis: What Are the Options?

  • Advances in Diagnosis of Invasive Fungal Infections (U Binder, Section Editor)
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Abstract

Lymphocutaneous sporotrichosis is the most common clinical form of cutaneous sporotrichosis. Caused by a complex of dimorphic fungi called Sporothrix schenckii complex, it is an occupational disease, present especially in tropical and subtropical areas, and has been reported in all continents. Diagnosis is established by isolation of the causative agent. Therapy of choice for lymphocutaneous sporotrichosis is itraconazole, and in developing countries, potassium iodide solution. In general, the lymphocutaneous form is considered a mild benign form of the disease, and the majority of cases respond well to treatment in about 3–4 months of therapy. In this paper, we have made a general review of the disease, especially of the epidemiology, clinical features and diagnosis of the lymphocutaneous form, as well as a brief analysis of the advantages and disadvantages of diverse treatments.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Kauffman CA. Sporotrichosis. Clin Infect Dis. 1999;29:231–7.

    Article  PubMed  CAS  Google Scholar 

  2. •• Barros MB, de Almeida PR, Shubach AO. Sporothrix schenckii and Sporotrichosis. Clin Microbiol Rev. 2011;24:633–54. A complete review of the disease and the etiological agent.

    Article  PubMed  CAS  Google Scholar 

  3. Schechtman RC. Sporotrichosis: Part I. Skinmed. 2010;8:216–20.

    PubMed  Google Scholar 

  4. • Bonifaz A, Vázquez-González D. Sporotrichosis: an update. G Ital Dermatol Venereol. 2010;145:659–73. A review of the disease, all its clinical forms, diagnosis and treatment.

    PubMed  CAS  Google Scholar 

  5. da Rosa AC, Scroferneker ML, Vettorato R, et al. Epidemiology of sporotrichosis: a study of 304 cases in Brazil. J Am Acad Dermatol. 2005;52(3 pt1):451–599.

    Article  PubMed  Google Scholar 

  6. Marimon R, Cano J, Gene J, et al. Sporothrix brasiliensis, S. globosa, and S. mexicana, three new Sporothrix species of clinical interest. J Clin Microbiol. 2007;45:3198–206.

    Article  PubMed  CAS  Google Scholar 

  7. • Rodrigues AM, de Hoog S, de Camargo ZP. Emergence of pathogenicity in the Sporothrix schenckii complex. Med Mycol. 2012 Sep 19: 1–8. PMID: 22989196. This study evaluated the differences among these species found frequency in the environment and in human hosts, and discuss their diverse pathogenicity.

  8. Hajjeh R, McDonnell S, Reef S, et al. Outbreak of sporotrichosis among tree nursery workers. J Infect Dis. 1997;176:499–504.

    Article  PubMed  CAS  Google Scholar 

  9. Hay RJ, Morris-Jones R. Outbreaks of sporotrichosis. Curr Opin Infect Dis. 2008;21:119–21.

    Article  PubMed  Google Scholar 

  10. Schubach A, Barros MB, Wanke B. Epidemic sporotrichosis. Curr Opin Infect Dis. 2008;21:129–33.

    Article  PubMed  Google Scholar 

  11. Song Y, Li SS, Zhong SX, et al. Report of 457 sporotrichosis cases from Jilin province, northeast China, a serious endemic region. J Eur Acad Dermatol Venereol. 2013;22:313–8.

    Article  Google Scholar 

  12. Barros MB, Costa DL, Schubach TM, et al. Endemic of zoonotic sporotrichosis: profile of cases in children. Pediatr Infect Dis J. 2008;3:246–50.

    Google Scholar 

  13. Freitas DF. do Valle AC, de Almeida Paes R, et al. Zoonotic Sporotrichosis in Rio de Janeiro, Brazil: a protracted epidemic yet to be curbed. Clin Infect Dis. 2010;50:453.

    Article  PubMed  Google Scholar 

  14. Bonifaz A, Saúl A, Paredes-Solís V, et al. Sporotrichosis in childhood. Clinical and therapeutic experience in 25 cases. Pediatr Dermatol. 2007;24:369–72.

    Article  PubMed  Google Scholar 

  15. Pappas PG, Tellez I, Deep AE, et al. Sporotrichosis in Peru: description of an area of hyperendemicity. Clin Infect Dis. 2000;30:65–70.

    Article  PubMed  CAS  Google Scholar 

  16. • López-Romero E, Reyes-Montes Mdel R, Pérez-Torres A, et al. Sporothrix schenckii complex and sporotrichosis, an emerging health problem. Future Microbiol. 2011;6:85–102. A review on the increase of sporotrichosis and how it is becoming a public health problem in some areas.

    Article  PubMed  Google Scholar 

  17. Marimon R, Serena C, Gené J, et al. In vitro antifungal susceptibilities of five species of Sporothrix. Antimicrob Agents Chemother. 2008;52:732–4.

    Article  PubMed  CAS  Google Scholar 

  18. • Zhang X, Huang H, Feng P, et al. In vitro activity of itraconazole in combination with terbinafine against clinical strains of itraconazole-insensitive Sporothrix schenckii. Eur J Dermatol. 2011;21:573–36. This in- vitro study proves synergism of itraconazole and terbinafine.

    PubMed  CAS  Google Scholar 

  19. Vásquez-del-Mercado E, Arenas R, Padilla-Desgarennes C. Sporotrichosis. Clin Dermatol. 2012;30:437–43.

    Article  PubMed  Google Scholar 

  20. Takenaka M, Sato S, Nishimoto K. Survey of 155 sporotrichosis cases examined in Nagasaki Prefecture from 1951 to 2007. Nihon Ishinkin Gakkai Zasshi. 2009;50:101–8.

  21. Bustamante B, Campos PE. Endemic sporotrichosis. Curr Opin Infect Dis. 2001;14:145–9.

    Article  PubMed  CAS  Google Scholar 

  22. Madrid IM, Mattei A, Martins A, et al. Feline sporotrichosis in the southern region of rio grande do sul, Brazil: clinical, zoonotic and therapeutic aspects. Zoonoses Public Health. 2010;57:151–4.

    Article  PubMed  CAS  Google Scholar 

  23. Orofino-Costa R, Bóia MN, Magalhães GA, et al. Arthritis as a hypersensitivity reaction in a case of sporotrichosis transmitted by a sick cat: clinical and serological follow up of 13 months. Mycoses. 2010;53:81–3.

    Article  PubMed  CAS  Google Scholar 

  24. Liu X, Zhang Z, Hou B, et al. Rapid identification of Sporothrix schenckii in biopsy tissue by PCR. J Eur Acad Dermatol Venereol. 2012. doi:10.1111/jdv.12030.

    Google Scholar 

  25. Hu S, Chung WH, Hung SI. Detection of Sporothrix schenckii in clinical samples by a nested PCR assay. J Clin Microbiol. 2003;41:1414–8.

    Article  PubMed  CAS  Google Scholar 

  26. Kawasaki M, Anzawa K, Mochizuki T, Ishizaki H. New strain typing method with Sporothrix schenckii using mitochondrial DNA and polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) technique. J Dermatol. 2012;39:362–5.

    Article  PubMed  CAS  Google Scholar 

  27. Zhang YQ, Xu XG, Zhang M, et al. Sporotrichosis: clinical and histopathological manifestations. Am J Dermatopathol. 2011;33:296–302.

    Article  PubMed  Google Scholar 

  28. Novales SJ, Navarrete FG, Ramos GA. Esporotricosis. Aspectos histológicos de 50 casos. Rev Centr Dermatol Pascua. 1995;4:149–52.

    Google Scholar 

  29. • Quintella LP, Passos SR, do Vale AC, et al. Histopathology of cutaneous sporotrichosis in Rio de Janeiro: a series of 119 consecutive cases. J Cutan Pathol. 2011;38:25–32. A large series of sporotrichosis and histopathological behavior.

    Article  PubMed  Google Scholar 

  30. Bustamante B, Campos PE. Sporotrichosis: a forgotten disease in the drug research agenda. Expert Rev Anti Infect Ther. 2004;2:85–94.

    Article  PubMed  CAS  Google Scholar 

  31. Schechtman RC. Sporotrichosis: Part II. Skinmed. 2010;8:275–80.

    PubMed  Google Scholar 

  32. Cabezas C, Bustamante B, Holgado W, Begue RE. Treatment of cutaneous sporotrichosis with one daily dose of potassium iodide. Pediatr Infect Dis J. 1996;15:352–4.

    Article  PubMed  CAS  Google Scholar 

  33. Xue SL, Li L. Oral potassium iodide for the treatment of sporotrichosis. Mycopathologia. 2009;167:355–6.

    Article  PubMed  CAS  Google Scholar 

  34. • Yamada K, Zaitz C, Framil VM, Muramatu LH. Cutaneous sporotrichosis treatment with potassium iodide: a 24 year experience in São Paulo State, Brazil. Rev Inst Med Trop Sao Paulo. 93;53:89. A large experience of the potassium iodide treatment.

    Google Scholar 

  35. Kauffman CA, Bustamante B, Chapman SW, et al. Clinical practice guidelines for the management of sporotrichosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007;45:1255–65.

    Article  PubMed  CAS  Google Scholar 

  36. Xiao T, Lin J, Chen HD. Prominent facial edema caused by potassium iodide solution in a patient with sporotrichosis. J Dermatol. 2009;36:111–3.

    Article  PubMed  Google Scholar 

  37. Conti-Díaz IA, Civila E, Gezuele E, et al. Treatment of human cutaneous sporotrichosis with itraconazole. Mycoses. 1992;35:153–6.

    Article  PubMed  Google Scholar 

  38. Sharkey-Mahis PK, Kauffman CA, Grabyl JR, et al. Treatment of sporotrichosis with itraconazole. Am J Med. 1993;95:279–85.

    Article  Google Scholar 

  39. Baroni A, Palla M, Iovene MR, et al. Sporotrichosis: success of itraconazole treatment. Skinmed. 2007;6:41–4.

    Article  PubMed  Google Scholar 

  40. •• de Lima Barros MB, Schubach AO, de Vasconcellos Carvalhaes de Oliveira R, et al. Treatment of cutaneous sporotrichosis with itraconazole--study of 645 patients. Clin Infect Dis. 2011;52:200–6. The largest series reported on the experience of itraconazole in skin sporotrichosis.

    Article  Google Scholar 

  41. Bonifaz A, Fierro L, Saúl A, Ponce RM. Cutaneous sporotrichosis. Intermittent treatment (pulses) with itraconazole. Eur J Dermatol. 2007;18:61–4.

    PubMed  Google Scholar 

  42. • Song Y, Zhong SX, Yao L, et al. Efficacy and safety of itraconazole pulses vs. continuous regimen in cutaneous sporotrichosis. J Eur Acad Dermatol Venereol. 2011;25:302–5. The only study comparing itraconazole continuous therapy and intermittent or pulse treatment.

    Article  PubMed  CAS  Google Scholar 

  43. Kauffman CA, Pappas PG, McKinsey DS, et al. Treatment of lymphocutaneous and visceral sporotrichosis with fluconazole. Clin Infect Dis. 1996;22:46–50.

    Article  PubMed  CAS  Google Scholar 

  44. Castro LG, Belda W, Cucé LC, et al. Successful treatment of sporotrichosis with oral fluconazole: a report of three cases. Br J Dermatol. 1993;128:352–6.

    Article  PubMed  CAS  Google Scholar 

  45. Chapman SW, Pappas P, Kauffman C, et al. Comparative evaluation of the efficacy and safety of two doses of terbinafine (500 and 1000 mg/day) in the treatment of cutaneous or lymphocutaneous sporotrichosis. Mycoses. 2004;47:62–8.

    Article  PubMed  CAS  Google Scholar 

  46. Francesconi G, Valle AC, Passos S, Reis R, Galhardo MC. Terbinafine (250 mg/day): an effective and safe treatment of cutaneous sporotrichosis. J Eur Acad Dermatol Venereol. 2009;23:1273–6.

    Article  PubMed  CAS  Google Scholar 

  47. Antunes Tde A, Nobre Mde O, Faria RO, et al. Experimental cutaneous sporotrichosis: in vivo evaluation of itraconazole and terbinafine. Rev Soc Bras Med Trop. 2009;42:706–10.

    Article  PubMed  Google Scholar 

  48. Heidrich D, Stopiglia CD, Senter L, et al. Successful treatment of terbinafine in a case of sporotrichosis. An Bras Dermatol. 2011;86(4 Suppl 1):S182–185.

    Article  PubMed  Google Scholar 

  49. •• Francesconi G, Francesconi do Valle AC, Passos SL, et al. Comparative study of 250 mg/day terbinafine and 100 mg/day itraconazole for the treatment of cutaneous sporotrichosis. Mycopathologia. 2011;171:349–54. The only comparative study between itraconazole and terbinafine in the management of sporotrichosis.

  50. Cullen S, Maucer AA, Warner N. Successful treatment of disseminated cutaneous sporotrichosis with ketoconazole. J Am Acad Dermatol. 1992;27:463–4.

    Article  PubMed  CAS  Google Scholar 

  51. Fernández-Silva F, Capilla J, Mayayo E, Guarro J. Efficacy of posaconazole in murine experimental sporotrichosis. Antimicrob Agents Chemother. 2012;56:2273–7.

    Article  PubMed  Google Scholar 

  52. Bunce PE, Yang L, Chun S, et al. Disseminated sporotrichosis in a patient with hairy cell leukemia treated with amphotericin B and posaconazole. Med Mycol. 2012;50:197–201.

    Google Scholar 

  53. Pavón N, Bonifaz A, Ponce RM. Termoterapia en esporotricosis cutánea infantil. Comunicación de dos cases. Dermatología Rev Mex. 2007;51:68–72.

    Google Scholar 

  54. Badgwell Doherty C, Doherty SD, Rosen T. Thermotherapy in dermatologic infections. J Am Acad Dermatol. 2010;62:909–27.

    Article  PubMed  Google Scholar 

  55. Ferreira CP, Galhardo MC, Valle AC. Cryosurgery as adjuvant therapy in cutaneous sporotrichosis. Braz J Infect Dis. 2011;15:181–3.

    PubMed  Google Scholar 

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Alexandro Bonifaz declares that he has no conflict of interest.

Denisse Vázquez-González declares that she has no conflict of interest.

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Bonifaz, A., Vázquez-González, D. Diagnosis and Treatment of Lymphocutaneous Sporotrichosis: What Are the Options?. Curr Fungal Infect Rep 7, 252–259 (2013). https://doi.org/10.1007/s12281-013-0140-3

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