Comments
INITIAL SYMPTOMS:
Ulcerated, reddened nodule at the site of a puncture wound that may evolve into chronic nodular lymphangitis without treatment; [Merck Manual, p. 1335] Regional lymph nodes are not usually involved. {Cohen, p. 1865]
FINDINGS:
Sporotrichosis usually follows puncture wounds of the extremities. It is characterized by a growing nodule at the wound site and the development of firm cords in the draining lymphatics. Nodules may ulcerate. Complications are rare except in patients with AIDS or other chronic diseases and include arthritis, osteomyelitis, and pulmonary infections. [CCDM, p. 569] The two types of cutaneous sporotrichosis are the lymphocutaneous form and the fixed cutaneous or plaque form that does not spread by the lymph vessels. In patients with underlying COPD, S. schenkii can cause cavitary lung disease similar to tuberculosis or histoplasmosis. The fungus can also cause chronic infections of bones and joints. Widespread infections are seen in some AIDS patients with CD4+ lymphocyte counts less than 200 cells/mL. [ID, p. 2246-7] Infections may remain localized or spread proximally to involve the regional lymph nodes. Pulmonary sporotrichosis may occur, usually in older patients. From the lungs, the disease can spread to the skin, eyes, and brain. Eye diseases include keratoconjunctivitis, Parinaud's oculoglandular syndrome, and uveitis. [Guerrant, p. 606, 1004-5] Initial skin lesions are red and papulonodular from a few mm to a few cm in size. They may be smooth or verrucous and may ulcerate or develop raised red borders. The most common sites for extracutaneous sporotrichosis are the bones and joints. Immunocompetent patients usually have involvement at only one site and do not have systemic symptoms. Patients with extracutaneous infections often present without a history of previous skin involvement. Common sites are the elbow, ankle, and knee, but not the hip, shoulder, or spine. Leukocytosis and mild anemia may be present. [PPID, p. 2920-22] Pulmonary sporotrichosis is rare; findings include productive cough, fever, weight loss, hemoptysis, and enlargement of perihilar lymph nodes. [CID 2007;45:1255-65] Fever and headache are symptoms in the rare cases of CNS infection. [Wallach, p. 584]
EPIDEMIOLOGY:
Sporotrichosis is mainly a disease of the skin and lymphatics that follows a puncture wound contaminated with soil. Uncommon manifestations are osteoarticular (middle-aged alcoholics), pulmonary (COPD sufferers), and disseminated (AIDS patients). [Harrison ID, p. 1101] Patients with alcoholism, diabetes, and COPD are at risk for osteoarticular and pulmonary infections. [Cecil, p. 1985] Zoonotic transmission has been described from cat bites and scratches or from handling infected cats and horses with skin lesions. [ID, p. 1424, 2246-7] Scratches from digging animals such as armadillos may transmit infection. [CID 2007;45:1255-65] Also case reports of transmission by squirrels, horses, dogs, cats, pigs, insects, and birds; [PPID, p. 2920] Endophthalmitis is rare. [Cohen, p. 1865]
For updated text and symptoms of infectious diseases, see iddx.com.