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].

• Veterinarian

  Sporotrichosis can also be acquired from handling cats with the disease; it is an occupational hazard for veterinarians. [en.wikipedia.org]

  Zoonotic transmission of sporotrichosis occurs most frequently from handling infected cats, making this an occupational hazard for veterinarians. [4] Sporotrichosis progresses slowly - the first symptoms may appear 1 to 12 weeks (average 3 weeks) following [wikidoc.org]

  Cats have been responsible for cases among veterinarians [6] and for a large outbreak in Rio de Janeiro, Brazil. [7] See the image below. Photomicrograph that shows the conidiophores and conidia of the fungus Sporothrix schenckii. [emedicine.com]

  At present, veterinarians, technicians, caretakers, and owners of cats with sporotrichosis are regarded as a new risk category for the acquisition of the disease. [doi.org]

• Intravenous Drugs

  The latter finding was consistent with the history of intravenous drug abuse. [ncbi.nlm.nih.gov]

  Amphotericin B This is an intravenous drug with serious potential side effects, including fever, chills, nausea, and vomiting. Surgery Surgery may be required to remove the infected bone. [healthinplainenglish.com]

• Cough

  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]

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

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

  Symptoms of pulmonary sporotrichosis include productive coughing, nodules and cavitations of the lungs, fibrosis, and swollen hilar lymph nodes. [en.wikipedia.org]

• Aspiration

  Sporotrichosis is frequently primary in the lungs, caused by inhalation or aspiration of spores of Sporothrix schenckii. [ncbi.nlm.nih.gov]

  In an attempt to clarify the pathogen, percutaneous lung aspiration (PLA) was performed. The PLA smaple yielded a positive culture of Sporothrix shenckii. After the diagnosis, S. schenckii was also cultured from sputa. [jstage.jst.go.jp]

  Aspiration is likely to lead to false negative results as organisms are scanty. [life-worldwide.org]

  Purulent material was aspirated from one of the nodules; gram, fungal and mycobacterial stains showed no organisms. [westjem.com]

  One patient whose elbow was aspirated had no impairment. Discussion Compared with other infections, sporotrichosis is relatively uncommon. [healio.com]

• 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]

  Symptoms of pulmonary sporotrichosis include productive coughing, nodules and cavitations of the lungs, fibrosis, and swollen hilar lymph nodes. [en.wikipedia.org]

• 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]

• Cutaneous Manifestation

  We report a case of "primary" pulmonary sporotrichosis diagnosed incidentally, in a chronic alcoholic farmer from the sub-Himalayan region with no cutaneous manifestations. [jlponline.org]

  Infection due to Penicillium marneffei: systemic mycosis with cutaneous manifestations associated to AIDS. Journal de Mycologie Médicale 5, Suppl. 1, 21 –34. 73. Duong, T. A. ( 1996 ). [doi.org]

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]

  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]

  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]

• 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]

• 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]

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