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 . 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 . Additional complaints include
Affected individuals address healthcare facilities for symptoms of subacute or chronic pneumonia with relatively few constitutional signs . 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 .
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 .
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 . Chest X-rays may also prove the existence of tracheobronchial lymphadenopathy . 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 . 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 .