Elizabeth Anne VanderPutten - My Sister Jean's Page on Sporotrichosis


SPOROTHRIX

Sporotrichosis is a chronic infection usually limited to the cutaneous and subcutaneous tissues, although it may become disseminated. The lesions of the cutaneous form of the disease develop where Sporothrix schenckii is introduced to sites of skin injury and appear as an erythematous, ulcerated, or verrucous nodule. Subsequent nodular Lymphangitic spread is a common development. Pulmonary sporotrichosis presumably results from inhalation of the fungus and occurs only rarely. The infection may also be hematogenously disseminated and involves the bones, joints, skin, eyes, central nervous system, or genitourinary tract.

ETIOLOGY

Sporotrichosis is caused by Sporothrix schenckii. A variety of the species, S . schenckii var. luriei, which was first isolated from a sporotrichosis case in South Africa, has been identified in a case of sporotrichosis in Italy.

HISTORICAL REVIEW

The first report of sporotrichosis, which included a thorough clinical picture and isolation of the fungus, was made in 1898 by Scheck at the Johns Hopkins Hospital in Baltimore.l02 He described the fungus as "related to Sporotricha" because the plant pathologist E.F. Smith, to whom a culture had been submitted, identified it as a species of Sporotrichum. The second report of the disease was published in 1900 by Hektoen and Perkins, from Chicago; the case involved a boy who had developed a lesion on a finger that had been hit with a hammer.48 They isolated the fungus and created a new name, Sporothrix schenckii. The new name, however, was not used in the text and appeared only in the title of their report. Although the name Sporothrix schenckii was used in a few of the early reports, after 1910, the binomial Sporotrichum schenckii (after Matruchot) was in use for about 50 years. The currently accepted name Sporothrix schenckii has many synonyms, and the history of its nomenclature is discussed in the mycology section of this chapter.

During the early 1900s in France, sporotrichosis was a common disease. In a series of important papers beginning in 1903, Beurmann, Ramond, Gougerot, and others contributed many facts about the fungus and described the less-common generalized forms in addition to the cutaneous form of the disease. The use of potassium iodide to treat sporotrichosis was suggested by Sabouraud to Beurmann and Gougerot in 1903, and it remains a satisfactory therapy. Beurmann and Gougerot published a monograph, Les Sporotrichoses, based on a review of about 250 French cases.15 The high incidence of the disease in France declined after the first 2 decades of this century.

In 1908 in Brazil, Splendore described the asteroid bodies seen around Sporothrix schenckii that became very useful in the histologic diagnosis of sporotrichosis. In 1927, Pijper and Pullinger reported a sporotrichosis outbreak involving 14 gold mine workers in Witwatersrand, a town near Johannesburg, South Africa. Between 1941 and 1944 in the mines in that same locale, nearly 3000 workers were infected, the largest outbreak recorded in anyone area. The origin of infection in this epidemic was traced to the mine timbers, which served as a reservoir of the saprobically growing fungus. The outbreak was brought under control by treating the timbers with fungicides and using potassium iodide as therapy for the affected miners. There were no fatalities. A valuable study of this epidemic was published as a monograph by the Transvaal Mine Medical Officers' Association in 1947.121