Lympho-cutaneous sporotrichosis B42.8

Infectious disease occurring worldwide, very rare in Europe, relatively common in developing countries, subacute or chronic, limited to skin and subcutis, caused by pathogens of the Sporotrix schenkii complex.

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. In this respect, 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.

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Occurs mainly with gardeners, farmers or fishermen. More common among immunocompromised people.

Mainly hands and feet, less often face.

Days to months after a frequently unnoticed injury (injured mycosis: e.g. spine injury - in American: rose gardner`s disease) a primary focus develops, usually an inflammatory papule, papulo-pustule, ulcer or cutaneous-subcutaneous nodule. Subsequently, lympho-cutaneous infection, lymphogenically transmitted, usually less symptomatic, multiple, in chains along the lymphatic pathways (lymphogenic spread), bluish-red or brown, 0.2-10.0 cm in size, smooth or scaly, sometimes also verrucous papules, plaques and nodules with a tendency to ulceration or with emptying of purulent secretions. The lesions can grow together to form flat nodular conglomerates.

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.

Clinic with lymphogenic arrangement of the lesions.

Histology: often multiple sampling is necessary to detect the pathogens.

Easy cultivation of the pathogen at room temperature from smear of secretion or from bioptate material. Flower-like arranged conidia on hyphal stems (margarite forms) occur.

tuberculosis cutis luposa; syphilis; cutaneous leishmaniasis; chromomycosis; nocardiosis

S.u. sporotrichosis

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