obsolete lymphocutaneous sporotrichosis

Obsolete Lymphocutaneous Sporotrichosis: A Rare Form of Fungal Infection

Lymphocutaneous sporotrichosis is a rare and obsolete form of fungal infection caused by the dimorphic fungus Sporothrix schenckii. This condition was previously known to affect individuals, particularly in tropical regions.

Characteristics of Obsolete Lymphocutaneous Sporotrichosis

• Primary Systemic Mycosis: Obsolete lymphocutaneous sporotrichosis is a primary systemic mycosis that results from fungal infection located in the skin.
• Small Indurated Papule: The disease presents with a small indurated papule occurring at the site of inoculation, which later becomes erythematous and nodular.
• Crust Formation: After 2 to 3 months, the lesion forms crusts without purulent discharge.

Causes and Risk Factors

The exact causes and risk factors for obsolete lymphocutaneous sporotrichosis are not well-documented. However, it is believed that the disease is acquired through traumatic inoculation of Sporothrix propagules into cutaneous or subcutaneous tissues.

Symptoms and Diagnosis

• Skin Lesions: The primary symptom of obsolete lymphocutaneous sporotrichosis is the appearance of skin lesions at the site of inoculation.
• Systemic Symptoms: In some cases, systemic symptoms such as fever, malaise, and weight loss may occur.
• Diagnosis: A definitive diagnosis can be made through histopathological examination of tissue samples or culture of the fungus.

Treatment and Prognosis

The treatment for obsolete lymphocutaneous sporotrichosis typically involves antifungal medications. The prognosis is generally good if treated promptly, but delayed treatment may lead to complications and prolonged recovery periods.

References:

• [10] Sporotrichosis is an infectious disease caused by Sporothrix schenckii, a dimorphic fungus isolated for the first time in 1896 by Benjamin ...
• [13] Lymphocutaneous sporotrichosis is the most common form of the infection. The disease presents with a small indurated papule occurring ...
• [14] The lesion became erythematous and nodular and later formed crusts without purulent discharge. After 2 to 3 months, he noticed an increasing number of similar ...

Classic Manifestation

The classical manifestation of lymphocutaneous sporotrichosis includes a fixed localized lesion at the site of trauma, accompanied by lymphocutaneous sporotrichosis with fungal spreading along the lymphatic vessels [1]. This typically presents as an ulcerated nodule with a framed border or crusted, verrucous, erythematous lesions [2].

Variable Morphology

The variable morphology of lesions in disseminated-cutaneous sporotrichosis can include ulcerated nodules with framed borders or crusted, verrucous, erythematous lesions [2]. In some cases, the lesion may become erythematous and nodular, forming crusts without purulent discharge [3].

Lymphocutaneous Sporotrichosis

Lymphocutaneous sporotrichosis is characterized by three erythematous, well-delimited plaques, centered by ulceration covered by crusts, 1 to 3 cm in diameter, on the dorsum of the foot or other areas [4].

Other Manifestations

In addition to lymphocutaneous and fixed-cutaneous forms, sporotrichosis infection can manifest as disseminated forms with severe symptoms. These may include multiple nodular lesions arranged in a linear fashion along the skin, accompanied by erythema, hemorrhagic crusts, yellow-orange areas, telangiectasias, and shiny white areas [7][10].

References

[1] OF Gompertz · 2016 [2] BM Garcia · 2021 [3] E Habte-Gabr · 2000 [4] R do Carmo Silva · 2022 [7] F Ursini [10] R Orofino-Costa · 2022

Diagnostic Tests for Lymphocutaneous Sporotrichosis

Lymphocutaneous sporotrichosis, a fungal infection caused by Sporothrix schenckii, can be challenging to diagnose. However, several diagnostic tests can help establish the diagnosis.

• Histopathology: A biopsy of the affected skin or lymph node can be examined under a microscope to identify the presence of fungal elements [3]. This is considered one of the most relevant diagnostic tools for patients with suspicion of sporotrichosis [4].

Treatment Options for Lymphocutaneous Sporotrichosis

Lymphocutaneous sporotrichosis, a fungal infection caused by Sporothrix schenckii, has been treated with various antifungal medications. While itraconazole is considered the drug of choice for this condition, other treatment options have been explored.

Itraconazole: The Drug of Choice

Itraconazole has become the preferred treatment for lymphocutaneous sporotrichosis due to its high success rate (90-100%) [4]. It is typically administered orally at a dose of 200 mg daily for 2-4 weeks after all lesions have resolved [8].

Alternative Treatment Options

Other antifungal medications that have been used to treat lymphocutaneous sporotrichosis include:

• Terbinafine: This allylamine has been shown to be effective in treating cutaneous or lymphocutaneous sporotrichosis that is unresponsive to itraconazole [3].
• Amphotericin B: Although not the first-line treatment, amphotericin B may be used for severe cases of sporotrichosis [2].
• Potassium iodide: This medication has been used in combination with itraconazole or as an alternative treatment option [6].

Historical Treatment Options

In the past, antimonial medications such as sodium stibogluconate and meglumine antimonate were considered the first-line treatment for lymphocutaneous sporotrichosis. However, these treatments have largely been replaced by itraconazole due to its higher success rate [5].

Current Treatment Guidelines

The current treatment guidelines recommend itraconazole as the primary treatment option for lymphocutaneous sporotrichosis. Terbinafine and other antifungal medications may be considered in cases where itraconazole is not effective or tolerated.

References:

[1] by CA Kauffman · Cited by 2 — The agent of choice is itraconazole [2]. [2] Oct 6, 2021 — The classic treatment of sporotrichosis is performed with itraconazole or potassium iodide; second-line medications, such as amphotericin B and ... [3] by VK Mahajan · 2014 · Cited by 246 — Allylamines (Terbinafine). Terbinafine is another alternative agent to treat cutaneous or lymphocutaneous sporotrichosis that is unresponsive to itraconazole or ... [4] by CA Kauffman · 2000 · Cited by 283 — Itraconazole has become the drug of choice for treatment of lymphocutaneous sporotrichosis, with an expected success rate of 90%–100% (these findings are based ... [5] by EH TOBIN · 2001 · Cited by 89 — The drugs of first choice are the pentavalent antimonial sodium stibogluconate or meglumine antimonate. Treatment is given for 20 days, during ... [6] 7 medications found for 'lymphocutaneous sporotrichosis' · iodine strong (lugols) solution · iodine strong solution · lugol's · potassium iodide solution · sski ... [7] Nov 15, 2023 — Sporotrichosis can be treated successfully with antifungal drugs such as itraconazole and terbinafine. Scope of the problem. Sporotrichosis is a ... [8] by CA Kauffman · 2007 · Cited by 600 — 1. For cutaneous and lymphocutaneous sporotrichosis, itraconazole 200 mg orally daily is recommended to be given for 2–4 weeks after all lesions have resolved. [9] 6 days ago — Fungi isolation is the standard for diagnosis; the first-line treatment is itraconazole (24).

Differential Diagnoses for Lymphocutaneous Sporotrichosis

Lymphocutaneous sporotrichosis is a rare fungal infection that can be misdiagnosed and improperly treated. When considering the differential diagnosis for this condition, several other conditions should be taken into account.

• Nocardiosis: This bacterial infection, caused by Nocardia species, can cause symptoms similar to those of lymphocutaneous sporotrichosis. [3][4]
• Cutaneous Leishmaniasis: This parasitic infection can also present with skin lesions and lymphadenopathy, making it a differential diagnosis for lymphocutaneous sporotrichosis. [2][5]
• Atypical Mycobacterial Infection: Certain species of mycobacteria, such as Mycobacterium marinum, can cause skin infections that resemble lymphocutaneous sporotrichosis. [4]
• In-transit Metastases: In some cases, secondary tumors, usually melanoma, can be considered in the differential diagnosis of lymphocutaneous infection. [6]
• Cutaneous Tuberculous and Non-tuberculous Mycobacterial Infections: These infections can cause skin lesions and lymphadenopathy, making them a differential diagnosis for cutaneous sporotrichosis. [7]
• Leprosy: This bacterial infection can also present with skin lesions and nerve involvement, which may be considered in the differential diagnosis of lymphocutaneous sporotrichosis. [7]
• Mycetoma: This chronic infection caused by bacteria or fungi can cause skin lesions and lymphadenopathy, making it a differential diagnosis for cutaneous sporotrichosis. [9]

It's essential to note that these conditions may have overlapping symptoms with lymphocutaneous sporotrichosis, and a thorough diagnostic workup is necessary to determine the correct diagnosis.

References: [1] EH TOBIN · 2001 [2] CA Kauffman · [3] by MJ Burns · 2009 [4] by MJ Burns · 2009 [5] Mar 2, 2021 [6] In-transit metastases are sometimes considered in the differential diagnosis of lymphocutaneous infection, where a secondary tumour – usually melanoma ... [7] Clinical differential diagnosis of cutaneous sporotrichosis includes cutaneous tuberculous and non-‐ tuberculous mycobacterial infections, leprosy, mycetoma ... [8] by A Tirado-Sánchez · 2018 [9] The differential diagnosis of cutaneous sporotrichosis include pyoderma, catscratch disease, folliculitis, mycobacterial diseases, leishmaniasis, tularemia, ...