Sporotrichosis natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Alison Leibowitz [2]

Overview

The incubation period of sporotrichosis varies from a few days to multiple months. ^[1] Complicatiaons of sporotrichosis include bacterial superinfection and sepsis. Depending on the progression of the sporotrichosis at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good. The presence of disseminated sporotrichosis is associated with a particularly poor prognosis among immunodeficient patients and these patients are prone to relapse.

Natural History

The incubation period of sporotrichosis varies from a few days to multiple months. ^[1]

Complications

Cutaneous lesions can become superinfected with bacteria, resulting in cellulitis.
Potassium iodide has potential side effects of gastric intolerance, edema, excessive tear production, salivary gland swelling, skin rash, and erythema nodosum.
5-fluorocytosine therapy may result in photosensitivity^[2]
The hematogenous spread of S. schenckii may lead to chronic meningitis, endophthalmitis, or brain abscesses.
Treatment with amphotericin B may result in nephrocalcinosis as a complication.^[3]

Prognosis

S. schenckii is an apparent opportunistic pathogen, as severe clinical forms of this disease have been linked with immunodeficient patients.
Resistance to S. schenckii is not linked to the host’s inherent ability to fight the fungal infection, but rather results from the level of immunity that the host acquires during the initial stage, which is characterized by a large pathogen presence within the organs.^[4]
Resultantly, depending on the host’s immune system capacity (T-cell immunity is important in limiting the disease) at the time of diagnosis, the prognosis may vary.
In immunocompetent patients, the prognosis for cutaneous and lymphocutaneous sporotrichosis is excellent. The majority of these patients are cured with one bout of therapy and relapses only occur in a low percentage of patients.
As a result of its frequently delayed diagnoses and association with underlying immunosuppressive diseases, forms of extracutaneous sporotrichosis generally do not respond well to therapy.
Pulmonary sporotrichosis does not respond well to antifungal therapy and is patients are prone to relapse.^[1]
The prognosis for disseminated sporotrichosis in immunocompromised patients is particularly poor.

References

↑ ^1.0 ^1.1 ^1.2 Vásquez-del-Mercado E, Arenas R, Padilla-Desgarenes C. Sporotrichosis. Clinics in Dermatology. 2012;30(4):437-443. doi:10.1016/j.clindermatol.2011.09.017.
↑ Shelley WB, Sica PA (1983). “Disseminate sporotrichosis of skin and bone cured with 5-fluorocytosine: Photosensitivity as a complication”. J Am Acad Dermatol. 8 (2): 229–35. PMID 6826816.
↑ FINLAYSON G. Sporotrichosis Treated With Amphotericin B. Arch Dermatol. 1964;89(5):730. doi:10.1001/archderm.1964.01590290096014.
↑ Nascimento RC, Almeida SR (2005). “Humoral immune response against soluble and fractionate antigens in experimental sporotrichosis”. FEMS Immunol Med Microbiol. 43 (2): 241–7. doi:10.1016/j.femsim.2004.08.004. PMID 15681154.

[incubationspor-1] 1.0 ^1.1 ^1.2 Vásquez-del-Mercado E, Arenas R, Padilla-Desgarenes C. Sporotrichosis. Clinics in Dermatology. 2012;30(4):437-443. doi:10.1016/j.clindermatol.2011.09.017.

[pmid6826816-2] Shelley WB, Sica PA (1983). “Disseminate sporotrichosis of skin and bone cured with 5-fluorocytosine: Photosensitivity as a complication”. J Am Acad Dermatol. 8 (2): 229–35. PMID 6826816.

[nephro-3] FINLAYSON G. Sporotrichosis Treated With Amphotericin B. Arch Dermatol. 1964;89(5):730. doi:10.1001/archderm.1964.01590290096014.

[pmid15681154-4] Nascimento RC, Almeida SR (2005). “Humoral immune response against soluble and fractionate antigens in experimental sporotrichosis”. FEMS Immunol Med Microbiol. 43 (2): 241–7. doi:10.1016/j.femsim.2004.08.004. PMID 15681154.

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