- This systemic fungal infection is caused by the soil fungus Sporothrix schenckii.
- Sporothrix is found in plant debris and in soil throughout the world, particularly in the Americas, East Asia and South Africa, but is uncommon in Europe.
- The most common clinical presentation is a localized lymphocutaneous disease after direct inoculation.
- Inflammatory nodules may proceed proximally along the extremity which has given rise to the term "sporotrichoid spread".
- Lymphocutaneous: The classic sporotrichoid spread after direct inoculation.
- Fixed Cutaneous: Fixed infection after direct inoculation without sporotrichoid spread. This usually reflects a high degree of immunity on the part of the patient.
- Cutaneous Disseminated: A disseminated form may occur, e.g. in HIV positive patients [JAAD 1999;40;350].
A history of minor trauma, e.g. from thorns or splinters, or cat scratches is typical.
Consultation with an infectious disease specialist is in order. Saturated solution of potassium iodide remains a first line treatment for uncomplicated cutaneous sporotrichosis in resource-poor countries. Itraconazole is currently recommended for all forms of sporotrichosis, e.g. 200 mg/day x 3-6 months. Terbinafine is effective for cutaneous sporotrichosis. Amphotericin B is used initially for the treatment of severe, systemic disease, during pregnancy and in immunosuppressed patients until recovery, then followed by itraconazole for the rest of the therapy [Dermatol Res Pract. 2014; 2014: 272376].
Nice image of lymphangiitic spread up the leg. Dermatol Res Pract. 2014; 2014: 272376
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