Sporotrichosis

A chronic skin infection, caused by a fungus which may become a widespread (disseminated, systemic) infection, particularly in people with weakened immune systems.

Causes of Sporotrichosis

Sporotrichosis is caused by the fungus Sporothrix schenckii, which is found in vegetation. Infection commonly occurs when the skin is broken while handling plant materials such as rosebushes, briars, or mulch-rich dirt.

Sporotrichosis can be an occupational disease (for farmers, horticulturists, rose gardeners, plant nursery workers). Widespread (disseminated) sporotrichosis can develop in immunocompromised people when they inhale spore-laden dust.

Symptoms include a small, painless, red lump that develops at the site of infection and ultimately develops into an ulcer. Lesions are often on the hands and forearm, as these areas are a common site of injury.

The organism follows the lymph flow causing small ulcers to appear in lines on the skin as the infection progresses up the arm (or leg). These lesions do not heal unless treated and may remain ulcerated for years.

Systemic sporotrichosis can cause lung and breathing problems, osteomyelitis, arthritis, and meningitis.

Symptoms Return to top

Description of Sporotrichosis

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.

Symptoms of Sporotrichosis

• Small, painless, red lump that develops at site of a recent injury (up to 3 months following injury).
• A progressive line of ulcers leading away from the initial ulcer.

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 twelve 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 of Sporotrichosis

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 of Sporotrichosis

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 of Sporotrichosis

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 of Sporotrichosis

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 of Sporotrichosis

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