Disseminated sporotrichosis B42.8

Sporotrichosis is a worldwide occurring, in Europe very rare, in developing countries relatively common (so-called injured mycosis), subacute or chronic infectious disease, caused by pathogens of the Sporotrix schenkii complex. The representatives are dimorphic fungi. They are culturally detectable within a few days at room temperature. The disseminated form often develops with a poor immune system.

The dimorphic fungus Sporotrix schenckii (Sporotrichon schenckii sensu strictu ) is a soil saprophyte that lives in a climate with an average temperature of 20-25C° on rotting wood and dying plants. Therefore, the infection occurs mainly in the rural population.

Besides Sporotrix schenckii sensu stricto, the sporotrichon complex comprises 4 other species:

• S. albicans
• S.brasiliensis
• S.globosa
• S. Mexicana

Animals represent a reservoir of pathogens. Starting from dogs, cats, horses, muskrats, pigs, birds, reptiles (zoonosis), scratching or biting injuries can lead to infection.

Worldwide, North America, Japan, mainly tropics and subtropics, only sporadically in Europe. The only epidemic to date occurred in South Africa in the middle of the 20th century in mineworkers who were infected by mine wood infected by Sporotrix schenckii.

Inoculation of the pathogen through skin wounds (e.g. plant sting); subsequently mostly ascendancy in the lymphatic system. Transmission through insect stings or as a zoonosis is also described. Like lympho-cutaneous sporotrichosis, disseminated sporotrichosis develops first in a localized manner, then in a lymphogenic manner and later in a generalized manner.

Manifestation occurs mainly in gardeners, farmers or fishermen. Occurs more frequently in immunocompromised people.

Incubation period: In disseminated sporotrichosis, usually in immunocompromised individuals, days to months after a frequently unnoticed injury (injured mycosis: e.g. spine injury - in American: rose gardner`s disease) a disseminated seed of subcutaneous nodes develops from a crusty inflammatory primary focus. These tend to melt down centrally, break through to the outside and form disseminated, often deep and punched-out (ecthymata-like), chronic, therapy-resistant ulcers with a tendency to peripheral progression.

Mixed-cell inflammatory reaction of the dermis with lymphocytes, granulocytes, histiocytes and plasma cells Occasionally smaller and larger abscesses. With increasing duration of the infection an increasing granulomatous inflammatory character develops with histiocytes, plasma cells and giant cells. In HE sections, so-called "asteroid bodies" can be detected in approx. 30% of cases. These consist of one or more fungal cells in the centre surrounded by a ring of spine-like, red, eosinophilic extensions (see Splendore-Hoeppli phenomenon). Fungal cells are usually only found in the acute phase of infection. The cells of S. schenckii are 2-10 µm in size in the tissue, both yeast-like round to oval, and elongated (the elongated elements are also called "cigar bodies"). Detection by Grocott staining is recommended.

Atypical mycobacterioses; cutaneous lymphoma

S.u. sporotrichosis

de Beurmann CL, Gougerot H (1912) Les sporotrichoses. F. Alcan, Paris

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