Polyarticular Arthritis Due to Sporothrix schenckii/Polyartikuläre Arthritis durch Sporothrix schenkii

Summary:  Sporothrix schenckii infection usually presents as cutaneous or lymphocutaneous disease. Rarely, this dimorphic fungus causes isolated osteoarticular infection. The patient described herein had polyarticular sporotrichosis with contiguous osteomyelitis presenting as carpal tunnel syndrome 5 years previously. He relapsed after 2 g of amphotericin B but responded to itraconazole, a new oral antifungal agent. However, he was left with severe limitation of motion in the affected joints due to the long interval from onset of symptoms to diagnosis.
Zusammenfassung:  Die Sporothrix schenckii -Infektion ist gewöhnlich an der Haut oder im Bereich der Haut-Lymphknoten lokalisiert. Selten verursacht dieser dimorphe Pilz eine isolierte osteoartikuläre Infektion. Der hier vorgestellte Patient hatte eine polyartikuläre Sporotrichose mit benachbarter Osteomyelitis, was sich 5 Jahre zuvor als Karpaltunnel-Syndrom dargestellt hatte. Der Patient erlitt nach Verabreichung von insgesamt 2 g Amphotericin B einen Rückfall, sprach jedoch auf Itraconazol an. Es verblieben aber schwere Bewegungseinschränkungen der befallenen Gelenke wegen des langen Zeitraums vom Einsetzen der Symptome bis zur Diagnose.     

A Case of Sporotrichosis with Numerous Fungal Elements Phagocytized by Polymorphonuclear Leukocytes/Bericht über eine Sporotrichose mit ausgeprägter Phagozytose der Pilzzellen durch Granulozyten

Summary: A case of fixed cutaneous sporotrichosis is reported. Histological examination revealed numerous fungal elements, many of which were phagocytized by polymorphonuclear leukocytes (PMNs), and asteroid bodies were found in the phagocytosing PMNs. These findings suggest that blastospores can be phagocytized in human clinical materials and that this PMN phagocytosis is closely related to asteroid formation.
Zusammenfassung: Bericht über einen Patienten mit einer umschriebenen Sporotrichose der Haut. Histologisch fanden sich zahlreiche Pilzelemente, die häufig von neutrophilen Granulozyten phagozytiert waren. In den phagozytierenden Granulozyten waren Asteroidkörperchen sichtbar. Die Befunde zeigen, daß Sproßzellen von Sporothrix schenckii phagozytiert werden in menschlichen Geweben und daß eine enge Beziehung zwischen Phagozytose durch Granulozyten und der Bildung von Asteroidkörperchen besteht.     

Cutaneous sporotrichosis in Thailand: first reported case

A case of cutaneous sporotrichosis is reported for the first time in Thailand. The infection occurred in a 33-year-old Thai female who has been in good health and had no history of previous trauma or contact with any animals. Histopathology revealed pseudoepitheliomatous hyperplasia of the epidermis and a combination of granulomatous and pyogenic reactions in the dermis and subcutaneous tissue. Typical asteroid bodies (Splendore-Hoeppli phenomenon) with central yeast cells were seen. Sporothrix schenckii was recovered from skin biopsy specimens. The patient responded well to the treatment with saturated solutions of potassium iodide within three months. No recurrence was seen after more than six months follow-up.     

Mother-and-child cases of sporotrichosis infection

We report the appearance of lymphocutaneous sporotrichosis on the left arm of a 28-year-old farmer's wife, followed two months later by the same type of lesion on the right upper eyelid of this patient's three-year-old child. According to the mother, the child was accustomed to sleeping with the right side of her face applied to the lesion on the mother's arm, and so it was presumed that the infection had been transmitted by direct contact from mother to child. Cases of person-to-person contagion of this disorder are thought to be extremely rare, but where there has been close contact on a daily basis, such contagion is likely to occur.     

Pansinusitis due to Sporothrix schenckii

Summary A case of mucocutaneous sporotrichosis presenting as mycotic pansinusitis with polyposis with intracranial and intraorbital extension in a patient from Punjab, India is described. The patient had nasal discharge, sneezing and nasal obstruction for 12 years, had undergone repeated surgeries (for endoscopic clearance) but had recurrence. Computerized tomography (CT) and magnetic resonance imaging (MRI) findings revealed pansinusitis. A definitive diagnosis of sporotrichosis was established by culture of Sporothrix schenckii, verification of its dimorphic character and a positive pathogenicity test. The patient was successfully treated with potassium iodide and itraconazole.     

Long-time survival and morphological stability of preserved Sporothrix schenckii strains

The survival and stability of morphological traits of 33 Sporothrix schenckii strains were evaluated. Strain subcultures were maintained under mineral oil for different periods of time lasting as long as 41 years, or in sterile distilled water for as long as 23 years. Of the 33 strains preserved under mineral oil, 28 (85%) maintained viability and unchanged macro- and microscopic characteristics. All of the 4 strains maintained in distilled water also remained viable, with no morphological changes. The results confirm the efficiency of the methods used to preserve strains of the pathogenous and anamorphous fungus Sp. schenckii, especially in laboratories of limited resources.     

Symmetrical deforming cutaneous sporotrichosis of long duration

A symmetrical deforming cutaneous sporotrichosis with verrucous lesions on both hands and of long clinical duration is reported. The difficulties in making an etiological diagnosis are considered.     

Linking genes and environmental exposure: why China presents special opportunities

The Human Genome Project will have an enormous impact on our ability to study and understand human disease by providing maps of human genes. However, many of the most prevalent human diseases result from the complex interaction of numerous genes. Even with the use of a catalogue of human genes, the task of analyzing complex genetic and environmental interactions involved in the common human disorders will be formidable. Due to its demographic specificities and large size, the Chinese population offers a unique resource for the study of human genetics and the ability to capitalize upon the recent revolution in biotechnology. Reasons that China provides an exceptional population for genetic studies of complex diseases include: (i) the resource of 1.3 billion people makes obtaining a large number of subjects with rare (and common) diseases possible; (ii) relative genetic homogeneity in many regions has been preserved; (iii) stratification is distinct; (iv) urban/rural and geograph ic contrasts, both in environmental factors and disease occurrence, are quite marked; (v) family members tend to stay congregated; and (vi) epidemiologic study is cost-beneficial.     

Treatment of human cutaneous sporotrichosis with itraconazole

Eighteen adult white male patients with cutaneous sporotrichosis were treated with itraconazole following different daily dose schemes. Cure was obtained in all cases after periods of 15-75 days (median 44 days) with total doses between 3.1 and 14.8 g (median 8.4 g). No serious side effects were observed and no relapses occurred in the follow-up period of between 1 and 26 months (median 14.7). These results show that itraconazole represents a safe and effective drug for the treatment of sporotrichosis. Comparison with other studies leads us to consider a daily dose of 200 mg as the most appropriate. A concomitant warming of the affected limbs should be recommended.     

Genotyping of Sporothrix schenckii by analysis of ribosomal DNA regions

An attempt was made to identify the genotypes of 31 Sporothrix schenckii strains and the relationship between the genotypes, the geographic distributions and clinical manifestations using restriction fragment length polymorphic analysis. The total DNA was extracted by cetyltrimethyl ammonium bromide. The polymorphisms were detected by hybridisation of ApaI-digested Sporothrix genomic DNA with a probe amplified from the small subunit ribosomal DNA and adjacent internal transcribed spacer regions. The band patterns manifested by Southern blotting were explored to investigate the genotypes of the 31 strains of S. schenckii collected from five different areas in China. Of the data from the 31 strains of S. schenckii studied, 15 individual patterns (DNA type A-O) were recognised. Type A-C accounted for 51.61% of all the strains. The DNA typing of S. schenckii by Southern blotting was highly sensitive and highly distinguishable. We also found a significant correlation between DNA patterns and different geographic areas and clinical manifestations.     

Fatal fungaemia due to Sporothrix schenckii

Summary. A clinical case is reported of a 78-year-old male with antecedents of diabetes and alcoholism who was hospitalized because he showed cutaneous lesions on the face and extremities suggesting cutaneous tuberculosis, but after a first histological study cutaneous leishmaniasis was erroneously diagnosed. Because of some unusual characteristics of the patient, the skin biopsies were carefully re-examined, as well as blood smears, which revealed elongated yeast form-like cells suggestive of Sporothrix schenckii . The diagnosis was confirmed when the fungus grew in mice and in Sabouraud cultures inoculated with blood samples from the patient. It is recommended that Sp. schenckii is included in the differential diagnosis of ulcerative cutaneous lesions in patients from Mexican humid areas.
Zusammenfassung. Es wird über einen 78 Jahre alten männlichen Patienten mit Diabetes und Alkoholismus in der Anamnese berichtet, der wegen Hautläsionen im Gesicht und an den Extremitäten hospitalisiert wurde. Das klinische Bild sprach für eine Hauttuberkulose, wurde aber zunächst irrtümlich für eine Leishmaniasis gehalten. Wegen ungewöhnlicher Auffälligkeiten wurden die Hautbiopsien und die Blutausstriche erneut durchgesehen. Darin wurden elongierte hefeartige, auf Sporothrix schenckii verdächtige Pilzzellen gesehen. Die Verdachtsdiagnose wurde aus Blutproben über Tierversuche an Mäusen sowie kulturell bestätigt. Es wird daher empfohlen, bei ulzerierenden Hautläsionen an Patienten aus den Feuchtgebieten Mexikos Sp. schenckii in die Differentialdiagnose einzubeziehen.     

Cell-free antigens of Sporothrix brasiliensis: antigenic diversity and application in an immunoblot assay

Sporotrichosis is a subcutaneous mycosis diagnosed by isolation of the fungus in culture. Serological tests for help in diagnosis in general do not use purified or recombinant antigens, because there is a paucity of described immunoreactive proteins, especially for the new described Sporothrix species, such as Sporothrix brasiliensis. This study aims to characterise antigens from S. brasiliensis and verify their application in serodiagnosis of sporotrichosis. An immunoblot assay allied with computer‐based analysis was used to identify putative antigenic molecules in a cell‐free extracts of both morphological phases of this fungus, and to delineate antigenic polymorphism among seven S. brasiliensis isolates and one S. schenckii Brazilian strain. The mycelial and yeast phase of the fungus originated 14 and 23 reactive bands, respectively, which were variable in intensity. An 85 kDa antigen, verified in the yeast phase of the fungus, was observed in all strains used and the immunodominant protein was identified. This protein, however, cross‐react with serum samples from patients infected with other pathogens. The results show that the S. brasiliensis cell‐free antigen extract is a single and inexpensive source of antigens, and can be applied on the sporotrichosis serodiagnosis.     

Sporotrichosis with bilateral lesions. A case report

We report on a case of sporotrichosis in which lesions occurred bilaterally on upper limbs at different periods. The patient was an 84-year-old farmer living in Tsukuba City, Japan. The first lesion appeared on the left upper arm and remained untreated. The second lesion appeared on the back of the right hand 5 years later. Findings suggesting internal metastasis could not be confirmed in various examinations. We judged that the lesion of the left upper arm was primary and the lesion at the back of the right hand was caused by autoinoculation.     

Tissue response in sporotrichosis: light and electron microscopy studies

On the basis of electron microscopy examination of human tissue affected by sporotrichosis, we have proposed a classification, at the light microscopy level, of fungal cells in tissue. Light and electron microscopy observations clarified the following five points: (1) in sporotrichosis lesions in man, the fungal cells are frequently phagocytized by polymorphonuclear leucocytes (PMNs); (2) phagocytosis of phagocytes by other phagocytes was common, and giant cells phagocytized both fungal cells and PMNs; (3) fungal cells in the tissues of lesions were thought to be highly viable, and their budding was frequently observed within macrophages and giant cells; (4) it was highly probable that PMNs participated in asteroid body formation; (5) few free fungal cells were present in the tissues. We believe that the classification of fungal cells in sporotrichosis tissue into the five categories below is useful for correctly understanding the pathological condition in a sporotrichosis lesion: (1) fungal cells in PMNs, (2) fungal cells in PMNs within macrophages, (3) fungal cells in macrophages, (4) fungal cells in giant cells, and (5) free fungal cells.     

An Extracellular Substance of Sporothrix Schenckii in Human Infection/Eine extrazelluläre Substanz von Sporothrix schenckii bei menschlichen Infektionen

Summary: The ultrastructure of tissue forms of Sporothrix schenckii in human clinical material was described and illustrated by electron micrographs. Such cells were characterized by the presence of an osmiophilic precipitate surrounding the in vivo cell which is believed to represent an antigen-antibody complex. This substance was not reactive with electron cytochemical modifications of the PAS stain, but appeared to react with a rhodamine antihuman IgG conjugate. No unusual or novel tissue forms were identified in thin sections which might account for the rarity of organisms in biopsy materials from lymphocutaneous disease.
Zusammenfassung: Die Ultrastruktur der Gewebeformen von Sporothrix schenckii in menschlichem klinischem Material wird beschrieben und durch Elektronenmikroskopbilder veranschaulicht. Derartige Zellen sind durch das Vorhandensein eines osmiophilen Niederschlages gekennzeichnet, der die Zelle in vivo umgibt und von dem man annimmt, daß er einen Antigen-Antikörper-Komplex darstellt. Mit einer ultracytochemischen Modifikation der PAS-Färbung hat diese Substanz nicht reagiert, wohl aber schien sie mit Rhodamin-konjugiertem Antihuman-IgG zu reagieren. An den Ultradünnschnitten wurden keine ungewöhnlichen oder neuartigen Gewebselemente gefunden, welche die Seltenheit der Pilze im Biopsiematerial lymphocutaner Erkrankungen erklären könnte.     

Sporotrichosis - First Case Report from Madras

Summary: A case of localised sporotrichosis of the right forearm in a 36 year old female housewife is reported. This is the first case recorded in our department, Madras. Localised infection without a lymphatic spread is probably related to the inability of this isolate, Sporothrix schenckii, to grow at 37°C in vitro.
Zusammenfassung: Bericht über eine lokalisierte kutane Sporotrichose am rechten Unterarm bei einer 36 jähr. Frau. Es handelt sich um die erste Beobachtung aus Madras. Die Tatsache, daß die Infektion lokalisiert blieb und sich nicht über die Lymphbahnen ausbreitete, wird von den Autoren mit der Unfähigkeit des von hen isolierten Stammes von Sporothrix schenckii, bei 37°C in vitro zu wachsen, erklärt.     

Human sporotrichosis beyond the epidemic front reveals classical transmission types in Espírito Santo,Brazil

Sporotrichosis has emerged as the main subcutaneous mycosis of humans and animals around the world. With particular differences in frequency, the major species includes Sporothrix brasiliensis, S. schenckii, S. globosa and S. luriei. In Brazil, the main aspect of this epidemic is based on the zoonotic transmission through the scratches and bites of diseased cats contaminated with S. brasiliensis. Areas free of feline sporotrichosis are poorly characterised in Brazil. We investigated by molecular tools the epidemiology of human sporotrichosis in the Espírito Santo (ES) state, an area adjacent to Rio de Janeiro where is the epicentre of the long‐lasting outbreak of cat‐transmitted sporotrichosis. The human cases in the ES state reveal the prevalence of classical transmission types where subjects are mainly infected by accidental traumatic inoculation during manipulation of contaminated plant material. In agreement with an environmental source, Sporothrix schenckii was the major aetiological agent in the classical transmission. Unlike Rio de Janeiro, this study shows that cat‐transmitted epidemic in Espírito Santo is still scanty, although the geographic proximity and similar climatic features. Sporothrix brasiliensis was the agent in the feline‐transmitted cases. Sporothrix globosa was isolated from a patient with fixed cutaneous lesions that did not report any contact with diseased animals. In conclusion, beyond the borders of Rio de Janeiro epidemic, agents of sporotrichosis in Espírito Santo show a scattered occurrence with high species diversity.