Cutaneous Disseminated and Extracutaneous Sporotrichosis: Current Status of a Complex Disease

Abstract

Sporotrichosis is an implantation or inoculation mycosis caused by species of Sporothrix schenckii complex; its main manifestations are limited to skin; however, cutaneous-disseminated, disseminated (visceral) and extracutaneous variants of sporotrichosis can be associated with immunosuppression, including HIV-AIDS, chronic alcoholism or more virulent strains. The most common extracutaneous form of sporotrichosis includes pulmonary, osteoarticular and meningeal. The laboratory diagnosis requires observing yeast forms and isolating the fungus; the two main causative agents are Sporothrix schenckii (ss) and Sporothrix brasiliensis. Antibody levels and species recognition by Polimerase Chain Reaction using biological samples or cultures are also useful. The treatment of choice for most cases is amphotericin B and subsequent itraconazole for maintenance therapy.

Keywords: AIDS; Sporothrix brasiliensis; Sporothrix schenckii; Sporotrichosis; amphotericin B; disseminated cutaneous sporotrichosis; itraconazole.

Figure 1

Extensive cutaneous disseminated sporotrichosis associated to chronic alcoholism.

Figure 2

Biopsy of disseminated sporotrichosis. Renal biopsy with multiple clusters of lengthened yeast forms “cigar-shaped” (Grocott, 40×).

Figure 3

Culture of Sporothrix schenckii (Sabouraud media, 28 °C) Filamentous state with thin hyphae and denticle microconidia like “daisy flowers” (Erythrosine, 40×).