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Sporotrichosis

para>Itraconazole 6 to 10 mg/kg/day to a maximum of 400 mg/day PO is recommended for children with cutaneous or lymphocutaneous sporotrichosis (2)[B].

An alternative for children is SSKI initiated at a dosage of 1 drop (using a standard eye dropper) TID, increasing as tolerated up to a maximum of 1 drop/kg or 40 to 50 drops TID, whichever is lowest dose to achieve clinical response (2)[B].

For children with disseminated sporotrichosis, amphotericin B 0.7 mg/kg/day should be used initially, followed by itraconazole 6 to 10 mg/kg up to 400 mg/day maximum as step-down therapy (2)[B].

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Pregnancy Considerations

  • Treat after delivery if possible (2)[C].
  • Amphotericin B given as a lipid formulation at a dosage of 3 to 5 mg/kg/day or amphotericin B deoxycholate given as 0.7 to 1 mg/kg/day is recommended for severe sporotrichosis if treatment is absolutely necessary during pregnancy. Best used after 12 weeks of gestation to minimize side effects (2)[B]. Azoles are pregnancy Category C (2)[B].
  • Local hyperthermia can be used for cutaneous sporotrichosis in pregnant women (2)[B].
  • Potassium iodide is contraindicated in pregnancy (2)[C].

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Second Line

Terbinafine at 250 mg/day PO, although not approved for treatment of sporotrichosis, may be a reasonable alternative to itraconazole for cutaneous disease (1)[B]. ‚

ISSUES FOR REFERRAL

Consider infectious diseases consultation. ‚

SURGERY/OTHER PROCEDURES

  • Synovectomy may help in refractory cases.
  • Surgical debridement of osteomyelitis
  • Surgical resection of pulmonary lesions

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Check for compliance with long-term drug therapy (SSKI should be continued for 1 to 2 months after lesions heal).
  • Monitor hepatic enzymes periodically in patients receiving azole antifungal treatment for >1 month.

PROGNOSIS

  • Excellent for complete recovery from cutaneous or lymphocutaneous infections (2)
  • Other forms of sporotrichosis demonstrate a chronic indolent course and respond variably to treatment.
  • Immunocompromised patients often have a poor outcome.

COMPLICATIONS

  • Secondary bacterial infection
  • Bone and joint deformities from osteoarticular disease

REFERENCES

11 Barros ‚ MB, de Almeida Paes ‚ R, Schubach ‚ AO. Sporothrix schenckii and sporotrichosis. Clin Microbiol Rev. 2011;24(4):633 " “654.22 Kauffman ‚ CA, Bustamante ‚ B, Chapman ‚ SW, et al. Clinical practice guidelines for the management of sporotrichosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007;45(10):1255 " “1265.33 de Lima Barros ‚ MB, Schubach ‚ AO, de Vasconcellos Carvalhaes de Oliveira ‚ R, et al. Treatment of cutaneous sporotrichosis with itraconazole " ”study of 645 patients. Clin Infect Dis. 2011;52(12):e200 " “e206.44 Xue ‚ S, Gu ‚ R, Wu ‚ T, et al. Oral potassium iodide for the treatment of sporotrichosis. Cochrane Database Syst Rev. 2009;(4):CD006136.

ADDITIONAL READING

  • Aung ‚ AK, Teh ‚ BM, McGrath ‚ C, et al. Pulmonary sporotrichosis: case series and systematic analysis of literature on clinico-radiological patterns and management outcomes. Med Mycol. 2013;51(5):534 " “544.
  • Francesconi ‚ G, Valle ‚ AC, Passos ‚ S, et al. Terbinafine (250 mg/day): an effective and safe treatment of cutaneous sporotrichosis. J Eur Acad Dermatol Venereol. 2009;23(11):1273 " “1276.
  • Kauffman ‚ CA, Hajjeh ‚ R, Chapman ‚ SW. Practice guidelines for the management of patients with sporotrichosis. For the Mycoses Study Group. Infectious Diseases Society of America. Clin Infect Dis. 2000;30(4):684 " “687.
  • Limper ‚ AH, Knox ‚ KS, Sarosi ‚ GA, et al. An official American Thoracic Society statement: treatment of fungal infections in adult pulmonary and critical care patients. Am J Respir Crit Care Med. 2011;183(1):96 " “128.
  • Milby ‚ AH, Pappas ‚ ND, O 'Donnell ‚ J, et al. Sporotrichosis of the upper extremity. Orthopedics. 2010;33(4):273 " “275.
  • Ramos-e-Silva ‚ M, Vasconcelos ‚ C, Carneiro ‚ S, et al. Sporotrichosis. Clin Dermatol. 2007;25(2):181 " “187.

CODES

ICD10

  • B42.9 Sporotrichosis, unspecified
  • B42.1 Lymphocutaneous sporotrichosis
  • B42.7 Disseminated sporotrichosis
  • B42.89 Other forms of sporotrichosis
  • B42.82 Sporotrichosis arthritis
  • B42.0 Pulmonary sporotrichosis

ICD9

117.1 Sporotrichosis ‚

SNOMED

  • Sporotrichosis (disorder)
  • Lymphocutaneous sporotrichosis (disorder)
  • Disseminated sporotrichosis (disorder)
  • cutaneous sporotrichosis (disorder)
  • Extracutaneous sporotrichosis (disorder)

CLINICAL PEARLS

  • Consider cutaneous/lymphocutaneous sporotrichosis in individuals with a history of contact with soil who present with characteristic cutaneous lesions.
  • Disseminated sporotrichosis may develop in immunocompromised individuals.
  • Antifungal agents are generally effective for treating sporotrichosis.