Sporotrichosis classification: Difference between revisions
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==Overview== | ==Overview== | ||
Sporotrichosis may be classified, according to the location of the lesions, into | Sporotrichosis may be classified, according to the location of the lesions, into particular subtypes: fixed cutaneous, lymphocutaneous, disseminated cutaneous, and extracutaneous/systemic. These subtypes may be further separated into increasingly specific forms based upon clinical manifestations. | ||
==Classification== | ==Classification== | ||
*Presentations vary based upon numerous factors, such as the patient’s immunological status, the severity and depth of the inoculum, and the particular strain’s thermal zone of tolerance and pathogenicity. | *Presentations vary based upon numerous factors, such as the patient’s [[immunological]] status, the severity and depth of the [[inoculum]], and the particular strain’s thermal zone of tolerance and [[pathogenicity]]. | ||
===Cutaneous Forms=== | ===Cutaneous Forms=== | ||
Cutaneous forms of Sporotrichosis typically manifest following minor epidermal trauma. Patients may present with multiple forms of cutaneous lesions. | Cutaneous forms of Sporotrichosis typically manifest following minor epidermal trauma. Patients may present with multiple forms of cutaneous [[lesions]]. | ||
Fixed form: | '''Fixed form:''' | ||
*Staying localized within the subcutaneous tissue, the fungus transforms into its yeast form. | *Staying localized within the [[subcutaneous]] tissue, the [[fungus]] transforms into its [[yeast]] form. | ||
*Manifests at the site of inoculation with at least one, frequently ulcerated, lesion | *Manifests at the site of [[inoculation]] with at least one, frequently [[Ulcerated lesion|ulcerated, lesion]] | ||
*The [[lesions]] are characterized by red edges due to [[capillary]] dilation and congestion. | |||
*Fixed form sporotrichosis may spontaneously regress <ref name="article3">Saha A, De A, Datta P, Das N. Fixed cutaneous sporotrichosis: a diagnostic challenge overcome by incidental discovery of asteroid bodies S. Journal of Pakistan Association of Dermatologists. 2010;(20):120-122.></ref> | *Fixed form sporotrichosis may spontaneously regress <ref name="article3">Saha A, De A, Datta P, Das N. Fixed cutaneous sporotrichosis: a diagnostic challenge overcome by incidental discovery of asteroid bodies S. Journal of Pakistan Association of Dermatologists. 2010;(20):120-122.></ref> | ||
*Fixed form sporotrichosis is the main clinical presentation in child patients. | *Fixed form sporotrichosis is the main clinical presentation in child patients. | ||
*Initially | *Initially manifests as painless [[Nodule (medicine)|nodules]], which then become palpable, purulent, and ulcerated | ||
Lymphocutaneous form: | '''Lymphocutaneous form:''' | ||
*The yeast form of ''S. schenckii'' extends through the nearby lymphatic vessels.<ref name="thisformissupercute">Stalkup J. R., Bell K., Rosen T.. 2002. Disseminated cutaneous sporotrichosis treated with itraconazole. Cutis 69:371–374.></ref> | *The [[yeast]] form of ''S. schenckii'' extends through the nearby [[Lymphatic System|lymphatic]] vessels.<ref name="thisformissupercute">Stalkup J. R., Bell K., Rosen T.. 2002. Disseminated cutaneous sporotrichosis treated with itraconazole. Cutis 69:371–374.></ref> | ||
*Approximately 70% of the cases of sporotrichosis may be classified as lymphocutaneous sporotrichosis.<ref name="lymphomaniarticle">Goncalves AP. Sporotrichosis. In: Canizares O, Harman R, editors. Clinical Tropical Dermatology, 2nd edn. Philadelphia: Blackwell Scientific Publications; 1992. p. 88-93.></ref> | *Approximately 70% of the cases of sporotrichosis may be classified as lymphocutaneous sporotrichosis.<ref name="lymphomaniarticle">Goncalves AP. Sporotrichosis. In: Canizares O, Harman R, editors. Clinical Tropical Dermatology, 2nd edn. Philadelphia: Blackwell Scientific Publications; 1992. p. 88-93.></ref> | ||
*The primary lesion frequently manifests on the upper extremities and is initially painless. | *The primary [[lesion]] frequently manifests on the upper extremities and is initially painless. | ||
*Initially a patient will present with a papule or pustule, which later expands into a subcutaneous nodule.<ref name="lymphomaniarticle" | *Initially a patient will present with a papule or pustule, which later expands into a subcutaneous [[nodule]].<ref name="lymphomaniarticle" /> | ||
*Subepidermal pressure results in ischemia, and the lesion evolves into a palpable, purulent and ulcerated nodule. | *Subepidermal pressure results in ischemia, and the lesion evolves into a palpable, purulent, and ulcerated nodule. | ||
*Secondary lesions manifest along the adjacent lymphatic pathway.<ref name="pmid25614735">{{cite journal| author=Mahajan VK| title=Sporotrichosis: an overview and therapeutic options. | journal=Dermatol Res Pract | year= 2014 | volume= 2014 | issue= | pages= 272376 | pmid=25614735 | doi=10.1155/2014/272376 | pmc=PMC4295339 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25614735 }} </ref> | *Secondary [[lesions]] manifest along the adjacent lymphatic pathway.<ref name="pmid25614735">{{cite journal| author=Mahajan VK| title=Sporotrichosis: an overview and therapeutic options. | journal=Dermatol Res Pract | year= 2014 | volume= 2014 | issue= | pages= 272376 | pmid=25614735 | doi=10.1155/2014/272376 | pmc=PMC4295339 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25614735 }} </ref> | ||
*The presence of | *The presence of systemic symptoms is rare. | ||
Disseminated cutaneous form: | '''Disseminated cutaneous form:''' | ||
*Manifests upon the hematogenous dissemination of the yeast form of ''S. schenckii'' | *Manifests upon the hematogenous dissemination of the yeast form of ''S. schenckii'' | ||
*Not associated with extracutaneous involvement | *Not associated with extracutaneous involvement | ||
*Characterized by | *Characterized by greater than or equal to three epidermal [[lesions]], which form on at least two noncontiguous sites on the body | ||
'''Mucosal Form''': | |||
*Typically manifests with enlargement of the submandibular and [[Preauricular deep parotid lymph nodes|preauricular]] (anterior to ear tragus) lymph nodes | |||
*Nasal mucosa is a variant of mucosal form sporotrichosis, which frequently involves septum [[lesions]] characterized by bloody discharge and crustal detachment.<ref name="pmid25614735" /> | |||
===Extracutaneous | ===Extracutaneous/Systemic Sporotrichosis=== | ||
The extracutaneous forms of sporotrichosis are more likely to manifest following the onset of [[AIDS]]. These forms are uncommon and difficult to diagnose, but are almost always associated with [[Immunological deficiency|immunological impairment]]<ref name="pmid25614735" /> | |||
====Osteoarticular form:==== | |||
*Most common extracutaneous form of sporotrichosis | |||
*Cutaneous [[lesion|lesions]] rarely manifest in cases of osteoarticular sporotrichosis. | |||
*Usually starts as monoarticular disease without systemic illness | |||
*May manifest by contiguity or hematogenous spread<ref name="pmid25614735" /> | |||
*Characterized by the involvement of bones and joints | |||
*Usually affects joints in the knee, wrist, elbow, and ankle | |||
*May manifest with tenosynovitis or [[bursitis]]<ref name="pmid17968818">{{cite journal| author=Kauffman CA, Bustamante B, Chapman SW, Pappas PG, Infectious Diseases Society of America| title=Clinical practice guidelines for the management of sporotrichosis: 2007 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2007 | volume= 45 | issue= 10 | pages= 1255-65 | pmid=17968818 | doi=10.1086/522765 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17968818 }} </ref> | |||
*Frequently associated with [[arthritis]] | |||
**In these cases of coexisting diagnoses, [[lesions]] typically manifest along bones adjacent to affected joints. <ref name="ellias">Ellis D. Mycology Online | Sporotrichosis. Mycologyadelaideeduau. 2016. Available at: http://www.mycology.adelaide.edu.au/Mycoses/Subcutaneous/Sporotrichosis/. Accessed January 8, 2016.></ref> | |||
====Primary pulmonary form:==== | |||
*Patients present with primary pulmonary sporotrichosis following the inhalation of ''S. schenckii''. | |||
*Typically associated with [[alcoholism]], [[chronic obstructive pulmonary disease]], chronic [[corticosteroid]] use, and [[immunosuppressive]] diseases<ref name="pmid25614735">{{cite journal| author=Mahajan VK| title=Sporotrichosis: an overview and therapeutic options. | journal=Dermatol Res Pract | year= 2014 | volume= 2014 | issue= | pages= 272376 | pmid=25614735 | doi=10.1155/2014/272376 | pmc=PMC4295339 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25614735 }} </ref> | |||
*High risk of delayed diagnosis as a result of the rarity of pulmonary involvement in sporotrichosis manifestation and nonspecific symptoms | |||
====Disseminated form:==== | |||
*Characterized by the involvement of at least two sites in the body | |||
*Manifests as a result of hematogenic dissemination of ''S. schenckii,'' resulting in multifocal or widespread infection | |||
*May initially manifest as another form of extracutaneous sporotrichosis | |||
*Strongly associated with [[immunodeficiency]] | |||
Other rare forms of sporotrichosis: | |||
*endophthalmitis | |||
*chorioretinitis | |||
==References== | ==References== | ||
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[[Category:Disease]] | [[Category:Disease]] | ||
Latest revision as of 19:06, 18 September 2017
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Sporotrichosis Microchapters |
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Sporotrichosis classification On the Web |
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American Roentgen Ray Society Images of Sporotrichosis classification |
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Risk calculators and risk factors for Sporotrichosis classification |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Alison Leibowitz [2]
Overview
Sporotrichosis may be classified, according to the location of the lesions, into particular subtypes: fixed cutaneous, lymphocutaneous, disseminated cutaneous, and extracutaneous/systemic. These subtypes may be further separated into increasingly specific forms based upon clinical manifestations.
Classification
- Presentations vary based upon numerous factors, such as the patient’s immunological status, the severity and depth of the inoculum, and the particular strain’s thermal zone of tolerance and pathogenicity.
Cutaneous Forms
Cutaneous forms of Sporotrichosis typically manifest following minor epidermal trauma. Patients may present with multiple forms of cutaneous lesions.
Fixed form:
- Staying localized within the subcutaneous tissue, the fungus transforms into its yeast form.
- Manifests at the site of inoculation with at least one, frequently ulcerated, lesion
- The lesions are characterized by red edges due to capillary dilation and congestion.
- Fixed form sporotrichosis may spontaneously regress [1]
- Fixed form sporotrichosis is the main clinical presentation in child patients.
- Initially manifests as painless nodules, which then become palpable, purulent, and ulcerated
Lymphocutaneous form:
- The yeast form of S. schenckii extends through the nearby lymphatic vessels.[2]
- Approximately 70% of the cases of sporotrichosis may be classified as lymphocutaneous sporotrichosis.[3]
- The primary lesion frequently manifests on the upper extremities and is initially painless.
- Initially a patient will present with a papule or pustule, which later expands into a subcutaneous nodule.[3]
- Subepidermal pressure results in ischemia, and the lesion evolves into a palpable, purulent, and ulcerated nodule.
- Secondary lesions manifest along the adjacent lymphatic pathway.[4]
- The presence of systemic symptoms is rare.
Disseminated cutaneous form:
- Manifests upon the hematogenous dissemination of the yeast form of S. schenckii
- Not associated with extracutaneous involvement
- Characterized by greater than or equal to three epidermal lesions, which form on at least two noncontiguous sites on the body
Mucosal Form:
- Typically manifests with enlargement of the submandibular and preauricular (anterior to ear tragus) lymph nodes
- Nasal mucosa is a variant of mucosal form sporotrichosis, which frequently involves septum lesions characterized by bloody discharge and crustal detachment.[4]
Extracutaneous/Systemic Sporotrichosis
The extracutaneous forms of sporotrichosis are more likely to manifest following the onset of AIDS. These forms are uncommon and difficult to diagnose, but are almost always associated with immunological impairment[4]
Osteoarticular form:
- Most common extracutaneous form of sporotrichosis
- Cutaneous lesions rarely manifest in cases of osteoarticular sporotrichosis.
- Usually starts as monoarticular disease without systemic illness
- May manifest by contiguity or hematogenous spread[4]
- Characterized by the involvement of bones and joints
- Usually affects joints in the knee, wrist, elbow, and ankle
- May manifest with tenosynovitis or bursitis[5]
- Frequently associated with arthritis
Primary pulmonary form:
- Patients present with primary pulmonary sporotrichosis following the inhalation of S. schenckii.
- Typically associated with alcoholism, chronic obstructive pulmonary disease, chronic corticosteroid use, and immunosuppressive diseases[4]
- High risk of delayed diagnosis as a result of the rarity of pulmonary involvement in sporotrichosis manifestation and nonspecific symptoms
Disseminated form:
- Characterized by the involvement of at least two sites in the body
- Manifests as a result of hematogenic dissemination of S. schenckii, resulting in multifocal or widespread infection
- May initially manifest as another form of extracutaneous sporotrichosis
- Strongly associated with immunodeficiency
Other rare forms of sporotrichosis:
- endophthalmitis
- chorioretinitis
References
- ↑ Saha A, De A, Datta P, Das N. Fixed cutaneous sporotrichosis: a diagnostic challenge overcome by incidental discovery of asteroid bodies S. Journal of Pakistan Association of Dermatologists. 2010;(20):120-122.>
- ↑ Stalkup J. R., Bell K., Rosen T.. 2002. Disseminated cutaneous sporotrichosis treated with itraconazole. Cutis 69:371–374.>
- ↑ 3.0 3.1 Goncalves AP. Sporotrichosis. In: Canizares O, Harman R, editors. Clinical Tropical Dermatology, 2nd edn. Philadelphia: Blackwell Scientific Publications; 1992. p. 88-93.>
- ↑ 4.0 4.1 4.2 4.3 4.4 Mahajan VK (2014). "Sporotrichosis: an overview and therapeutic options". Dermatol Res Pract. 2014: 272376. doi:10.1155/2014/272376. PMC 4295339. PMID 25614735.
- ↑ Kauffman CA, Bustamante B, Chapman SW, Pappas PG, Infectious Diseases Society of America (2007). "Clinical practice guidelines for the management of sporotrichosis: 2007 update by the Infectious Diseases Society of America". Clin Infect Dis. 45 (10): 1255–65. doi:10.1086/522765. PMID 17968818.
- ↑ Ellis D. Mycology Online | Sporotrichosis. Mycologyadelaideeduau. 2016. Available at: http://www.mycology.adelaide.edu.au/Mycoses/Subcutaneous/Sporotrichosis/. Accessed January 8, 2016.>