Sporotrichosis natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
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. | 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 [[Immunodeficiency|immunodeficient]] patients and these patients are prone to relapse. | ||
==Natural History== | ==Natural History== | ||
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==Complications== | ==Complications== | ||
*Cutaneous lesions can become superinfected with bacteria, resulting in cellulitis. | *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. | *[[Potassium iodide]] has potential side effects of gastric intolerance, [[edema]], excessive tear production, [[Salivary gland enlargement|salivary gland swelling]], skin rash, and [[erythema nodosum]]. | ||
*5-fluorocytosine therapy may result in photosensitivity<ref name="pmid6826816">{{cite journal| author=Shelley WB, Sica PA| title=Disseminate sporotrichosis of skin and bone cured with 5-fluorocytosine: Photosensitivity as a complication. | journal=J Am Acad Dermatol | year= 1983 | volume= 8 | issue= 2 | pages= 229-35 | pmid=6826816 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6826816 }} </ref> | *5-fluorocytosine therapy may result in [[photosensitivity]]<ref name="pmid6826816">{{cite journal| author=Shelley WB, Sica PA| title=Disseminate sporotrichosis of skin and bone cured with 5-fluorocytosine: Photosensitivity as a complication. | journal=J Am Acad Dermatol | year= 1983 | volume= 8 | issue= 2 | pages= 229-35 | pmid=6826816 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6826816 }} </ref> | ||
*The hematogenous spread of ''S. schenckii'' may lead to chronic [[meningitis]], [[endophthalmitis]], or brain abscesses. | *The hematogenous spread of ''S. schenckii'' may lead to chronic [[meningitis]], [[endophthalmitis]], or [[Brain abscess|brain abscesses]]. | ||
*Treatment with amphotericin B may result in nephrocalcinosis as a complication.<ref name="nephro">FINLAYSON G. Sporotrichosis Treated With Amphotericin B. Arch Dermatol. 1964;89(5):730. doi:10.1001/archderm.1964.01590290096014.</ref> | *Treatment with [[amphotericin B]] may result in [[nephrocalcinosis]] as a complication.<ref name="nephro">FINLAYSON G. Sporotrichosis Treated With Amphotericin B. Arch Dermatol. 1964;89(5):730. doi:10.1001/archderm.1964.01590290096014.</ref> | ||
==Prognosis== | ==Prognosis== | ||
*''S. schenckii'' is an apparent opportunistic pathogen, as severe clinical forms of this disease have been linked with immunodeficient patients. | *''S. schenckii'' is an apparent [[opportunistic pathogen]], as severe clinical forms of this disease have been linked with [[Immunodeficiency|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.<ref name="pmid15681154">{{cite journal| author=Nascimento RC, Almeida SR| title=Humoral immune response against soluble and fractionate antigens in experimental sporotrichosis. | journal=FEMS Immunol Med Microbiol | year= 2005 | volume= 43 | issue= 2 | pages= 241-7 | pmid=15681154 | doi=10.1016/j.femsim.2004.08.004 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15681154 }} </ref> | *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.<ref name="pmid15681154">{{cite journal| author=Nascimento RC, Almeida SR| title=Humoral immune response against soluble and fractionate antigens in experimental sporotrichosis. | journal=FEMS Immunol Med Microbiol | year= 2005 | volume= 43 | issue= 2 | pages= 241-7 | pmid=15681154 | doi=10.1016/j.femsim.2004.08.004 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15681154 }} </ref> | ||
*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. | *Resultantly, depending on the host's immune system capacity ([[T cell|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. | *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. | *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.<ref name="incubationspor" /> | *Pulmonary sporotrichosis does not respond well to [[Antifungal drug|antifungal therapy]] and is patients are prone to relapse.<ref name="incubationspor" /> | ||
*The prognosis for disseminated sporotrichosis in immunocompromised patients is particularly poor. | *The prognosis for disseminated sporotrichosis in [[Immunocompromised host|immunocompromised patients]] is particularly poor. | ||
==References== | ==References== | ||
Revision as of 15:50, 28 January 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Alison Leibowitz [2]
Overview
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 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.