Pulmonary sporotrichosis may be encountered worldwide as the habitat of the pathological agent involves plants and soil, although it is more frequent in subtropical and tropical regions. Landscaping and gardening are the activities associated with the infection while the pulmonary disease occurs when fungal spores are inhaled.

Immunocompromised individuals, those working with hay or wood, and alcohol abusers have a higher risk of developing this condition, so the history inquiry should not miss these aspects [1]. Pulmonary infection is more frequent in chronic obstructive pulmonary disease (COPD) patients. Affected individuals address healthcare facilities for symptoms of subacute or chronic pneumonia with few constitutional signs and aggravated cough [2]. Additional complaints include

Affected individuals address healthcare facilities for symptoms of subacute or chronic pneumonia with relatively few constitutional signs [2]. The manifestations include an aggravating cough, low grade fever, dyspnea, night sweats, weight loss, and chest pain, thus mimicking tuberculosis. The findings of the physical examination may overlap with that of the underlying COPD. For this reason, diagnosis may be delayed, thus postponing therapy initialization and making the prognosis worse [3].

• Outdoor Worker

  Florists, gardeners, and outdoor workers who may suffer injury inflicted by plant thorns, or interact with sphagnum moss and straw, are susceptible to the disease. [consultant360.com]

• Axillary Lymphadenopathy

  Physical examination showed an ulcerated, raised, dry, crusted lesion on the lateral surface of the left thumb, with four proximal raised, erythematous, subcutaneous nodules, without epitrochlear or axillary lymphadenopathy ( Figure 1 ). [westjem.com]

• Cough

  The patient had complains of cough, breathlessness, and evening rise of temperature. There were no skin lesions or lymphadenopathy. [jlponline.org]

  Affected individuals address healthcare facilities for symptoms of subacute or chronic pneumonia with few constitutional signs and aggravated cough. [symptoma.com]

  A 37-year-old man, human immunodeficiency virus-1 positive, with a CD4 cell count of 345/mm3, developed a productive cough. A sputum smear revealed the presence of a large amount of long, thin, septated micelia. [ncbi.nlm.nih.gov]

  Immunodepressed individuals develop disseminated infections and/or pneumonia that can cause shortness of breath, cough, and fever. [medicinenet.com]

  Symptoms of pulmonary sporotrichosis include: Cough Holes and nodules in the lungs Swollen hilar lymph nodes of the lungs Pleural effusion or pooling of blood or lymph fluids into the pleural cavity. [healthinplainenglish.com]

• Chronic Cough

  We should consider the possibility of pulmonary sporotrichosis in patients with chronic cough and cavitary parenchymal disease, particularly in chronic alcoholics, gardeners, and forest workers. [jlponline.org]

• Productive Cough

  A 37-year-old man, human immunodeficiency virus-1 positive, with a CD4 cell count of 345/mm3, developed a productive cough. A sputum smear revealed the presence of a large amount of long, thin, septated micelia. [ncbi.nlm.nih.gov]

• Oral Ulcers

  Recent involvement of the fingers and toes, as well as shallow oral ulcerations in the mouth, resulted in increasing pain and prompted her to seek emergency medical treatment. [consultant360.com]

• Hypersalivation

  (hypersalivation & nausea) • A recommended schedule is five drops initially, increasing to 4–6 mL of saturated potassium iodide three times daily. 27. • If unresponsive, Itraconazole 100–200 mg/day or terbinafine 250 mg/day are both effective and well tolerated [slideshare.net]

• Furunculosis

  Other systemic diseases included in the differential diagnosis are lupus erythematous, tuberculosis, syphilis, leprosy, herpes simplex, furunculosis, catscratch disease, anthrax, tularemia, and cowpox. 5 To alleviate diagnostic uncertainty, the presence [consultant360.com]

• Neglect

  The authors' data strongly support the contention that sporotrichosis is an often-neglected diagnostic entity. Lymphocutaneous sporotrichosis should be considered in any patient with a typical history and characteristic skin lesions. [healio.com]

A positive culture is required in order to make the pulmonary sporotrichosis diagnosis. Sputum, pleural fluid, bronchoalveolar lavage fluid, or biopsy specimens can be cultured. The presence of the pathogen can be pointed out using antibody titer measurements but these techniques do not have the same reliability in different laboratories so they should not be used as a sole diagnostic tool [4].

A posteroanterior thoracic radiography should be performed in all suspected cases. Two aspects may be encountered: cavitary, when the pulmonary infection is the primary one, and non-cavitary when the infection is multifocal and the seeding is made by hematogenous or lymphatic routes [5]. Chest X-rays may also prove the existence of tracheobronchial lymphadenopathy [6]. When no cavities exist, the picture consists of basal or diffuse reticulonodular parenchymal infiltrates, which will lead to lung tissue necrosis and cavity formation over time [7]. Upper pulmonary lobes may also be involved. Despite the initial radiological findings, patients may remain asymptomatic for a long period of time. Pleural effusions may be present and prevent visualization of the underlying pathology. Plain radiographs, as well as computed tomography (CT) scanning, are very informative but not specifically diagnostic for pulmonary sporotrichosis.

In uncertain cases, bronchoscopic or open lung biopsy is required. The specimen is examined from a histological point of view in order to establish the presence of caseating or noncaseating granulomas and occasional asteroid bodies. Gomori methenamine silver and periodic acid–Schiff stains can be employed while trying to identify the presence of Sporothrix schenckii in the biopsy specimen of lung tissue. Direct fluorescent antibody staining is another valuable method [8].

• Cavitary Lesion

  lesions resulting from sporotrichosis, following failed medical treatment, and (3) resection of associated pulmonary cavitary lesions in patients in spite of adequte medical control of sporotrichosis. [ncbi.nlm.nih.gov]

  In spite of the medication, his chest X-ray film revealed another cavitary lesion, so he was referred to our hospital. He had been asymptomatic during this period. [jstage.jst.go.jp]

  Cavitary lesions observed in three of the patients were treated by pulmonary resection and chemotherapy with amphotericin B and iodides. [nejm.org]

  Pulmonary sporotrichosis with cavitary lesions also has been described. -A multifocal extracutaneous syndrome has been described, consisting of multijoint involvement, or widely scattered cutaneous lesions. [mayomedicallaboratories.com]

  CT scan revealed single thin-walled cavitary lesion in lower-left lung [Figure 1]. Therefore, three consecutive sputum samples were sent for AFB microscopy and fungal microscopy and culture. [jlponline.org]

• Chest X-Ray Abnormal

  Persistent chest X-ray abnormalities were found in 13% and mycological cure was observed in 87% within the first month of treatment. [doi.org]

• X-Ray Abnormal

  Persistent chest X-ray abnormalities were found in 13% and mycological cure was observed in 87% within the first month of treatment. [doi.org]

Terbinafine was well tolerated and the frequency of drug‐related AEs was slightly higher in the 1000 mg treatment group. Both doses of terbinafine were well‐tolerated and effective for the treatment of sporotrichosis. [doi.org]

However, the benefits and adverse reactions of these treatments have not yet been systematically reviewed. Objectives: To assess the effects of oral potassium iodide for the treatment of sporotrichosis. [cochrane.org]

Terbinafine was well tolerated and the frequency of drug-related AEs was slightly higher in the 1000 mg treatment group. Both doses of terbinafine were well-tolerated and effective for the treatment of sporotrichosis. [ncbi.nlm.nih.gov]

[…] reports and nonrandomized treatment trials. [web.archive.org]

Treatment Oral itraconazole 200 mg po once/day given until 2 to 4 wk after all lesions have resolved (typically 3 to 6 mo) is the treatment of choice. [merckmanuals.com]

(Outcomes/Resolutions) The prognosis of Sporotrichosis is generally good with appropriate treatment Disseminated Sporotrichosis may become fatal for patients with weak immune systems. [dovemed.com]

Depending on the progression of the sporotrichosis at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good. [wikidoc.org]

The prognosis is good in unifocal systemic sporotrichosis, but death may occur when the disease is multifocal. In both types of involvement intravenous amphotericin B is superior to iodide therapy. [annals.org]

For this reason, diagnosis may be delayed, thus postponing therapy initialization and making the prognosis worse. A positive culture is required in order to make the pulmonary sporotrichosis diagnosis. [symptoma.com]

Well-organized Major Infectious Diseases chapters break down content by etiologic agent and epidemiology, clinical signs and their pathophysiology, physical examination findings, diagnosis, treatment and prognosis, immunity, prevention, and public health [books.google.ro]

The diagnosis was delayed due to the fungal etiological agent was not initially considered in the differential diagnosis. A good clinical and radiological evolution was obtained with the antifungal therapy. [ncbi.nlm.nih.gov]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

As it is difficult to verify an etiology, it is possible that some undiagnosed pulmonary granulomas could represent pulmonary sporotrichosis of the chronic type. [link.springer.com]

Well-organized Major Infectious Diseases chapters break down content by etiologic agent and epidemiology, clinical signs and their pathophysiology, physical examination findings, diagnosis, treatment and prognosis, immunity, prevention, and public health [books.google.ro]

(Etiology) Sporotrichosis is a skin infection caused by the fungus Sporothrix schenckii This fungus is found on rose thorns, hay, sphagnum moss, twigs and decaying vegetables The fungus enters the skin through cuts or scrapes made by thorns, barbs, pine [dovemed.com]

An increase in awareness of the disease among dermatologists and mycologists are essential to bridge many gaps in the understanding taxonomy, ecology and epidemiology of this fungal disease. [aspergillus.org.uk]

Current understanding regarding S. schenckii biology, epidemiology, immunopathology, clinical diagnostics, and treatment options has been evolving in the recent years with increased availability of molecular sequencing techniques. [ncbi.nlm.nih.gov]

Global epidemiology of sporotrichosis. Med Mycol. 2015;53:3–14. CrossRef PubMed Google Scholar 9. Aung AK, Teh BM, McGrath C, Thompson PJ. [link.springer.com]

The third symposium on "Topics in Mycology" brought together 265 experts from 32 countries to discuss the epidemiology, immmunological and pathogenetic aspects of AIDS and its opportunistic infections in general and fungal infections in particular. [books.google.ro]

Well-organized Major Infectious Diseases chapters break down content by etiologic agent and epidemiology, clinical signs and their pathophysiology, physical examination findings, diagnosis, treatment and prognosis, immunity, prevention, and public health [books.google.ro]

Pathophysiology S. schenckii is usually transmitted via posttraumatic inoculation to the human host, however, infrequently sporotrichosis may also develop as a result of spore inhalation. [wikidoc.org]

Useful For Suggests clinical disorders or settings where the test may be helpful Aiding in the diagnosis of extracutaneous sporotrichosis Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory [mayomedicallaboratories.com]

A thorough review of the topic was published by Barros et al in 2011. [5] Pathophysiology Infection with the dimorphic soil fungus S schenckii is usually acquired from organic matter through cutaneous inoculation. [emedicine.com]

How Can I Prevent Sporotrichosis? There is no vaccine to prevent sporotrichosis. [medicinenet.com]

The small number of patients suffering from pulmonary involvement with Sporothrix schenckii has prevented prospective controlled studies that could determine the optimal therapy for this chronic infection. [ncbi.nlm.nih.gov]

Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets [books.google.ro]

1. Dooley DP, Bostic PS, Beckius ML. Spook house sporotrichosis: a point-source outbreak of sporotrichosis associated with hay bale props in a Halloween haunted-house. Arch Intern Med. 1997;157:1885-1887
2. Ramirez J, Byrd RP, Roy TM. Chronic cavitary pulmonary sporotrichosis: efficacy of oral itraconazole. J Ky Med Assoc. 1998;96(3):103-105.
3. Kauffman CA, Pappas PG, McKinsey DS, et al. Treatment of lymphocutaneous and visceral sporotrichosis with fluconazole, Clin Infect Dis. 1996;22:46-50.
4. Bernardes-Engemann AR, Costa RC, Miguens BR, et al. Development of an enzyme-linked immunosorbent assay for the serodiagnosis of several clinical forms of sporotrichosis. Med Mycol. 2005;43(6):487-493.
5. Yang DJ, Krishnan RS, Guillen DR, et al. . Disseminated sporotrichosis mimicking sarcoidosis, Int J Derm. 2006;45:450-453.
6. Breeling JL, Weinstein L. Pulmonary sporotrichosis treated with itraconazole. Chest. 1993;103:313–314.
7. de Lima Barros MB, de Almeida Paes R, Schubach AO. Sporothrix schenckii and sporotrichosis. Clin Microbiol Rev. 2011;24:633-654.
8. Pluss JL, Opal SM. Pulmonary sporotrichosis: review of treatment and outcome. Medicine. 1986;65(3):143-153.