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Pulmonary Sporotrichosis

Pulmonary sporotrichosis is a rare form of sporotrichosis, a subacute or chronic fungal infection caused by Sporothrix schenckii. The cutaneous form of the disease is significantly more common.


Presentation

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]
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]

Workup

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

Treatment

  • 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]
  • 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]
  • Treatment of pulmonary sporotrichosis should be guided by the clinico-radiological patterns of presentation.[ncbi.nlm.nih.gov]

Prognosis

  • (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]
  • 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]
  • 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]
  • Outlook and prognosis Excellent for cutaneous and lymphocutaneous disease, with cure rates exceeding 95%.[life-worldwide.org]

Etiology

  • 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]
  • The identity of the etiologic agent was confirmed by application of a fluorescent-antibody reagent specific for S. schenckii.[ncbi.nlm.nih.gov]
  • 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]
  • (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]
  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]

Epidemiology

  • 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]
  • 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]
  • 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]
  • We report epidemiological, clinical and microbiological data from a hundred culture positive cases of sporotrichosis.[journals.plos.org]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • This contributed significantly to the current understanding of Sporothrix schenckii, its growth patterns, and its mechanisms of dissemination. [2, 3] Pathophysiology Sporotrichosis infections can be either cutaneous or extracutaneous.[emedicine.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]
  • 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]

Prevention

  • 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]
  • Prevention of this disease includes wearing long sleeves and gloves while working with soil, hay bales, rose bushes, pine seedlings, and sphagnum moss. Also, keeping cats indoors is a preventative measure.[en.wikipedia.org]
  • The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.[cdc.gov]
  • How Can I Prevent Sporotrichosis? There is no vaccine to prevent sporotrichosis.[medicinenet.com]
  • 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]

References

Article

  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.

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Last updated: 2019-07-11 20:34