What are the skin manifestations and other symptoms of sporotrichosis?

Skin Manifestations and Symptoms of Sporotrichosis

Sporotrichosis primarily manifests as cutaneous or lymphocutaneous lesions that typically do not resolve without antifungal treatment, with the potential for dissemination in immunocompromised individuals. 1

Primary Cutaneous Manifestations

Fixed Cutaneous Form

• Initial lesion appears as a progressively enlarging papulo-nodule at the inoculation site
• May evolve into a painless, non-healing ulcer or verrucous plaque
• Typically occurs on exposed body areas (hands, arms, legs, face)
• Heat-intolerant strains of Sporothrix schenckii tend to cause this form 1, 2

Lymphocutaneous Form (Most Common)

• Primary nodule at inoculation site followed by development of multiple secondary nodules along proximal lymphatic channels
• Creates a characteristic "sporotrichoid spread" pattern
• Nodules may ulcerate and drain purulent material
• Typically affects upper extremities, particularly hands and arms 1, 2

Disseminated Cutaneous Form

• Multiple painful ulcerated nodules distributed across various body sites
• Not limited to a single lymphatic chain
• May be accompanied by systemic symptoms
• Usually occurs in immunocompromised patients, though rarely can affect immunocompetent individuals 3

Extracutaneous Manifestations

Osteoarticular Sporotrichosis

• Chronic granulomatous tenosynovitis and arthritis
• May involve single or multiple joints
• Most commonly affects alcoholic patients
• Presents with joint pain, swelling, and decreased range of motion
• Poor joint function outcomes due to delayed diagnosis 1, 4

Pulmonary Sporotrichosis

• Rare manifestation acquired through inhalation of conidia
• Presents as chronic cavitary fibronodular disease
• Typically affects middle-aged men with underlying alcoholism and COPD
• Poor prognosis due to delayed diagnosis and underlying conditions 1

Other Rare Manifestations

• Meningeal involvement (especially in immunocompromised patients)
• Laryngeal sporotrichosis
• Ocular manifestations (e.g., nasolacrimal duct obstruction) 5

Systemic Symptoms

When dissemination occurs, patients may experience:

• Low-grade fever
• Night sweats
• Loss of appetite
• Weight loss
• Malaise 3

Epidemiological Considerations

• Most common in tropical and subtropical regions
• Increasing prevalence in Brazil due to Sporothrix brasiliensis zoonotic transmission
• Risk factors include gardening, handling decaying vegetation, and contact with infected cats 1, 6
• Different Sporothrix species may cause varying clinical presentations:
  • S. schenckii: typically causes chronic subcutaneous mycosis
  • S. globosa: commonly causes fixed or lymphocutaneous infection
  • S. brasiliensis: often causes more severe infections
  • S. mexicana/S. pallida: typically present with subcutaneous nodules or draining lesions 1

Diagnostic Pearls

• Incubation period is variable (days to months)
• Lesions are generally painless unless secondarily infected
• Diagnosis confirmed by culture (most sensitive method) or histopathology
• Microscopic examination may reveal oval to cigar-shaped yeast cells (3-5 μm)
• "Asteroid bodies" (eosinophilic projections from yeast) may be visible on histopathology 1

Clinical Course

Without treatment, cutaneous and lymphocutaneous forms rarely resolve spontaneously and can persist for years. Extracutaneous forms, particularly in immunocompromised patients, can lead to significant morbidity and mortality if not properly treated 1, 2.