Sporotrichosis
Sporotrichosis
Disease History, Characteristics, and Transmission
Introduction
Sporotrichosis, also known as rose gardener's disease, is a mycotic (fungal) infection that is caused by the fungus Sporothrix schenckii. Humans most often become infected when they are pricked or scratched by plants that harbor the fungus. The resulting infection is usually a cutaneous (skin) infection involving the formation of ulcerous lesions. However, other forms of sporotrichosis can occur when the fungus is inhaled, and include pulmonary sporotrichosis, in which the lungs are infected, and disseminated sporotrichosis, in which the joints, gastrointestinal system, or central nervous system are infected.
Sporotrichosis infection occurs worldwide. Gardeners, florists, or children playing in hay bales who regularly come in contact with plants harboring the fungus are most at risk of becoming infected.
Sporotrichosis is most commonly treated with anti-fungal medication. Treatment may be required for months, and in cases left untreated, severe skin ulceration can occur. Development of the less common forms of the disease, that is pulmonary and disseminated sporotrichosis, can lead to serious complications such as tuberculosis, bone diseases, or swelling of the brain and may potentially be fatal. People with weakened immune systems are most at risk of these potentially fatal complications of sporotrichosis.
Disease History, Characteristics, and Transmission
The fungus was first identified as the causative agent of sporotrichosis by the American physician Benjamin Robinson Schenck (1873–1920) in 1896. For this reason, sporotrichosis is also sometimes known as Schenck's disease. After the French physician Charles Lucien de Beurmann (1851–1923) further explained the role of S. schenckii in causing disease in 1903, some scientists renamed the organism Sporotrichum beurmanni.
After an incubation period of about 1–12 weeks from exposure to the fungus, infection with S. schenckii causes a small painless nodule (bump), similar to an insect bite, to develop on the skin. This nodule can be red, pink, or purple, and tends to be located on the finger, hand, or arm. Eventually, a number of similar lesions form, spreading to other regions of the body.
Most sporotrichosis infections are limited to the skin. However, rarely, the fungus may spread through the lymphatic system after it is inhaled to infect the lungs, joints, or central nervous system. Serious complications can arise in these cases, particularly when the fungus spreads to the central nervous system. In this case, the disease is known as sporotrichosis meningitis, and can cause death. When the joints are affected, the disease is known as osteoarticular sporotrichosis. This condition can cause symptoms such as weight loss, bursitis, and weak, stiff joints. Pulmonary sporotrichosis is more common in middle aged men who have underlying risk factors such as alcoholism and existing pulmonary diseases like emphysema. People with pulmonary sporotrichosis often develop pneumonia.
The fungus is transmitted from plant material such as roses, hay, and sphagnum moss into humans via broken skin. Defensive mechanisms on these plants such as thorns, barbs, and pine needles can cause punctures or cuts in the skin, creating an entry route for transmission of the fungi. Sporotrichosis is not spread from person to person.
Scope and Distribution
Sporotrichosis occurs worldwide. The fungus S. schenckii occurs naturally on thorny plants such as roses, on sphagnum moss, and in hay. Therefore, people who come in contact with these plants are at the greatest risk of becoming infected. This includes gardeners, nursery workers, farmers, and greenhouse workers. In addition, children who often play on baled hay are at risk of contracting the disease.
Treatment and Prevention
The most common form of treatment for sporotrichosis is administration of the anti-fungal drug itraconazole. Oral administration of a saturated potassium iodide solution is sometimes given, and this treatment is given over a period of usually 3–6 months. Other anti-fungal drugs such as fluconazole may also be used. When the lesions have become large and filled with fluid, it is sometimes necessary to drain and remove the lesions surgically.
Other forms of sporotrichosis, such as in the lungs, joints, or central nervous system, may also require itraconazole or surgery. An additional treatment sometimes administered in complicated cases involves amphotericin B.
Wearing protective clothing, such as gloves and long sleeves while handling plants may provide protection against infection by S. schenckii. In particular, the Centers for Disease Control and Prevention (CDC) recommends that workers wear gloves when coming into contact with sphagnum moss due to a number of outbreaks of sporotrichosis associated with this plant.
Impacts and Issues
Sporotrichosis also occurs in other mammals such as cats and dogs, and pet owners, especially those living on a farm, are advised to seek treatment for pets showing nodules. Humans can become infected by coming in contact with the open sores present on animals. Therefore, veterinarians responsible for treating animals infected with sporotrichosis are also at risk of contracting this infection.
While disseminated variations of sporotrichosis rarely occur, they occur most commonly in people with compromised immune systems such as people living with diseased or weakened organs, cancer, diabetes, or AIDS. Therefore, these persons are at a greater risk of developing potentially fatal forms of sporotrichosis.
WORDS TO KNOW
CUTANEOUS: Pertaining to the skin.
DISSEMINATED: Disseminated refers to the previous distribution of a disease-causing microorganism over a larger area.
INCUBATION PERIOD: Incubation period refers to the time between exposure to disease causing virus or bacteria and the appearance of symptoms of the infection. Depending on the microorganism, the incubation time can range from a few hours (an example is food poisoning due to Salmonella) to a decade or more (an example is acquired immunodeficiency syndrome, or AIDS).
MYCOTIC: Mycotic means having to do with or caused by a fungus. Any medical condition caused by a fungus is a mycotic condition, also called a mycosis.
See AlsoAIDS (Acquired Immunodeficiency Syndrome); Immune Response to Infection; Mycotic Disease; Pneumonia; Tuberculosis.
BIBLIOGRAPHY
Periodicals
Coles FB, et al. “A Multistate Outbreak of Sporotrichosis Associated with Sphagnum Moss.” American Journal of Epidemiology (1992): 136, 475–487.
Web Sites
Centers for Disease Control and Prevention (CDC). “Sporotrichosis.” October 13, 2005 <http://www.cdc.gov/ncidod/dbmd/diseaseinfo/sporotrichosis_g.htm#How%20is%20sporotrichosis%20treated> (accessed March 12, 2007).
Department of Health, New York State. “Sporotrichosis.” June 2004 <http://www.health.state.ny.us/diseases/communicable/sporotrichosis/fact_sheet.htm> (accessed March 12, 2007).
Sporotrichosis
Sporotrichosis
Definition
Sporotrichosis is a chronic infection caused by the microscopic fungus Sporothrix schenckii. The disease causes ulcers on the skin that are painless but do not heal, as well as nodules or knots in the lymph channels near the surface of the body. Infrequently, sporotrichosis affects the lungs, joints, or central nervous system and can cause serious illness.
Description
The fungus that causes sporotrichosis is found in spagnum moss, soil, and rotting vegetation. Anyone can get sporotrichosis, but it is most common among nursery workers, farm laborers, and gardeners handling spagnum moss, roses, or barberry bushes. Cases have also been reported in workers whose jobs took them under houses into crawl spaces contaminated with the fungus. Children who played on baled hay have also gotten the disease. Sporotrichosis is sometimes called spagnum moss disease or alcoholic rose gardener's disease.
Causes and symptoms
The fungus causing sporotrichosis enters the body through scratches or cuts in the skin. Therefore, people who handle plants with sharp thorns or needles, like roses, barberry, or pines, are more likely to get sporotrichosis. Sporotrichosis is not passed directly from person to person, so it is not possible to catch sporotrichosis from another person who has it.
The first signs of sporotrichosis are painless pink, red, or purple bumps usually on the finger, hand, or arm where the fungus entered the body. These bumps may appear anywhere from one to 12 weeks after infection, but usually appear within three weeks. Unlike many other fungal infections sporotrichosis does not cause fever or any feelings of general ill health.
The reddish bumps eventually expand and fester, creating skin ulcers that do not heal. In addition, the infection often moves to nearby lymph nodes. Although most cases of sporotrichosis are limited to the skin and lymph channels, occasionally the joints, lungs, and central nervous system become infected. In rare cases, death may result.
People who have weakened immune systems, either from a disease such as acquired immune deficiency syndrome (AIDS ) or leukemia, or as the result of medications they take (corticosteroids, chemotherapy drugs), are more likely to get sporotrichosis and are more at risk for the disease to spread to the internal organs. Alcoholics and people with diabetes mellitus or a pre-existing lung disease are also more likely to become infected. Although sporotrichosis is painless, it is important for people with symptoms to see a doctor and receive treatment.
Diagnosis
The preferred way to diagnose sporotrichosis is for a doctor to obtain a sample of fluid from a freshly opened sore and send it to a laboratory to be cultured. The procedure is fast and painless. It is possible to confirm the presence of advanced sporotrichosis through a blood test or a biopsy. Doctors may also take a blood sample to perform tests that rule out other fungal infections or diseases such as tuberculosis or bacterial osteomyelitis.
Dermatologists and doctors who work with AIDS patients are more likely to have experience in diagnosing sporotrichosis. In at least one state, New York, the laboratory test to confirm this disease is provided free through the state health department. In other cases, diagnosis should be covered by health insurance at the same level as other diagnostic laboratory tests.
Treatment
When sporotrichosis is limited to the skin and lymph system, it is usually treated with a saturated solution of potassium iodine that the patient dilutes with water or juice and drinks several times a day. The iodine solution can only be prescribed by a physician. This treatment must be continued for many weeks. Skin ulcers should be treated like any open wound and covered with a clean bandage to prevent a secondary bacterial infection. The drug itraconazol (Sporanox), taken orally, is also available to treat sporotrichosis.
In serious cases of sporotrichosis, when the internal organs are infected, the preferred treatment is the drug amphotericin B. Amphotericin B is a strong anti-fungal drug with potentially severe toxic side effects. It is given intravenously, so hospitalization is required for treatment. The patient may also receive other drugs to minimize the side effects of the amphotericin B.
Alternative treatment
Alternative treatment for fungal infections focuses on maintaining general good health and eating a diet low in dairy products, sugars, including honey and fruit juice, and foods, such as beer, that contain yeast. This is complemented by a diet high in raw food. Supplements of and vitamins C, E, and A, B complex, and pantothenic acid may also be added to the diet, as may Lactobacillus acidophilus, bifidobacteria, and garlic capsules.
Fungicidal herbs such as myrrh (Commiphora molmol ), tea tree oil (Melaleuca spp.), citrus seed extract, pau d'arco tea, and garlic (Allium sativum ) may also be applied directly to the infected skin.
Prognosis
Most cases of sporotrichosis are confined to the skin and lymph system. With treatment, skin sores begin healing in one to two months, but complete recovery often takes six months or more. People who have AIDS are also more likely to have the fungus spread throughout the body, causing a life-threatening infection. In people whose bones and joints are infected or who have pulmonary lesions, surgery may be necessary.
Prevention
Since an opening in the skin is necessary for the sporotrichosis fungus to enter the body, the best way to prevent the disease is to avoid accidental scrapes and cuts on the hands and arms by wearing gloves and long sleeves while gardening. Washing hands and arms well after working with roses, barberry, spagnum moss, and other potential sources of the fungus may also provide some protection.
KEY TERMS
Acidophilus— The bacteria Lactobacillus acidophilus, usually found in yogurt.
Bacterial osteomyelitis— An infection of the bone or bone marrow that is caused by a bacterium.
Bifidobacteria— A group of bacteria normally present in the intestine. Commercial supplements are available.
Corticosteroids— A group of hormones produced naturally by the adrenal gland or manufactured synthetically. They are often used to treat inflammation. Examples include cortisone and prednisone.
Lymph channels— The vessels that transport lymph throughout the body. Lymph is a clear fluid that contains cells important in forming antibodies that fight infection.
Resources
PERIODICALS
Dillon, Gary P., et. al. "Handyperson's Hazard: Crawl Space Sporotrichosis." The Journal of the American Medical Association 274 (December 6, 1995): 1673+.