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Sporotrichosis

Last reviewed: 6 Oct 2024
Last updated: 10 May 2023

Summary

Definition

History and exam

Key diagnostic factors

  • primary skin lesion
  • nodular lymphangitis lesions
Full details

Other diagnostic factors

  • respiratory symptoms
  • joint swelling/erythema
  • male 30 to 60 years old
  • fever
  • lymphadenopathy
  • meningitis-like symptoms
Full details

Risk factors

  • trauma to the skin
  • outdoor occupation/hobbies
  • animal bites and scratches
  • alcohol use disorder
  • diabetes mellitus
  • HIV/AIDS
  • COPD
  • corticosteroid treatment
  • chemotherapy in patients with hematologic malignancy
  • hematopoietic stem cell/solid organ transplantation
  • tumor necrosis factor (TNF)-alpha inhibitor therapy
Full details

Diagnostic tests

1st tests to order

  • skin lesion fungal culture
  • skin lesion histopathology (Gomori methenamine silver, periodic acid-Schiff staining)
  • CBC
  • erythrocyte sedimentation rate
  • joint x-ray
  • fungal culture of arthrocentesis synovial fluid
  • sputum or bronchoalveolar lavage (BAL) fungal culture
  • lumbar puncture for cerebrospinal fluid analysis
  • cerebrospinal fluid (CSF) fungal culture
  • fungal blood culture
Full details

Tests to consider

  • synovial tissue biopsy for fungal culture
  • synovial tissue histopathology (Gomori methenamine silver, periodic acid-Schiff staining)
  • bronchial biopsy fungal culture
  • bronchial biopsy histopathology
  • CXR
  • CT of chest
  • serum itraconazole levels
  • serum BUN
  • serum creatinine
  • LFTs
Full details

Emerging tests

  • immunohistochemical staining
  • polymerase chain reaction (PCR)

Treatment algorithm

ACUTE

nonpregnant: lymphocutaneous/cutaneous

nonpregnant: extracutaneous mild/moderate disease

nonpregnant: extracutaneous severe/life-threatening disease

pregnant: cutaneous

pregnant: lymphocutaneous

pregnant: extracutaneous

Contributors

Authors

Michail Lionakis, MD, ScD

Chief

Fungal Pathogenesis Section

Laboratory of Clinical Immunology and Microbiology

National Institutes of Allergy and Infectious Diseases

National Institutes of Health

Bethesda

MD

Disclosures

ML declares that he has no competing interests.

John E. Bennett, MD

Chief

Clinical Mycology Section

Laboratory of Clinical Immunology and Microbiology

National Institute of Allergy and Infectious Diseases

National Institutes of Health

Bethesda

MD

Disclosures

JEB declares that he has no competing interests.

Peer reviewers

George Samonis, MD

Professor of Internal Medicine/Infectious Diseases

University of Crete

Department of Internal Medicine

Gallos University Campus

Crete

Greece

Disclosures

GS declares that he has no competing interests.

​Amy Xu, MD, MA

Assistant Professor of Medicine

Section of Dermatology

University of Chicago

Chicago

IL

Disclosures

AX declares that she has no competing interests.

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