Cutaneous sporotrichosis in Himachal Pradesh, India

Abstract

During the period 1990-2002 in Himachal Pradesh, India, 103 new patients with cutaneous sporotrichosis were detected. Lymphocutaneous and fixed cutaneous varieties were the most common and seen in 49% and 43% respectively. Chronic non-specific inflammation without granuloma formation was seen in 46% skin biopsy specimens, 29% showed acute or chronic inflammation and tuberculoid granuloma formation was seen in 25%. In 32% of cases Sporothrix schenckii growth was seen on Sabouraud glucose agar. A saturated solution of potassium iodide was used as first-line treatment and in 93% patients healing of lesions occurred in 4-32 weeks (average 8.7 weeks) without significant side-effects. Itraconazole, used in 12 patients, was highly effective in recommended doses. Rapid healing was seen with higher than previously used doses of fluconazole in one patient who also had unusual exacerbation of lesional inflammation with saturated solution of potassium iodide.

Sporotrichosis Treatment: Overview and Update

“…No adequately designed clinical trial has compared the efficacy and safety of KI with that of the preferred therapy. The success rate of KI in treating subcutaneous sporotrichosis has been reported to be 89% to 100%, with only a few failures unrelated to lack of compliance or loss of follow-up [34,35]. Because of its efficacy rate and accessible price, KI is still the regimen of choice for treating subcutaneous sporotrichosis in Brasil, Colombia, Peru, India, Japan, and other countries with endemic regions [3,18,19,36].…”

“…The mean duration of treatment has ranged from 32.3 days [37] to 8.7 weeks [35], which on average is usually shorter than the duration required when itraconazole or terbinafine is used [34,36]. The main limiting factor for the use of KI is the presence of adverse events, which are common during therapy and affect treatment compliance.…”

Efficacy and safety of itraconazole use in infants

“…No adverse events were described in the case reports except mild diarrhea became moderate in one infant. [12,15,21,22,[27][28][29]33,[36][37][38][42][43][44][45][46]48,50,51,53,54,56,58,59] There were mild to moderate gastrointestinal diseases (nausea, vomiting, diarrhea, and constipation), elevated transaminases, headache, abdominal pain, fever, rash, and epistaxis. [8,9,12,41,46,49,63,64] Convulsions as serious adverse events were observed in 7 patients, but none of them was defi nitely or probably related to ITR except for 3 cases.…”

“…[27] Another two infants with sporotrichosis were cured with ITR at a dose of 3 mg/kg or 5 mg/kg per day separately. [28,29] Mucosal fungal infections ITR is widely used in the treatment of mucosal fungal infections in children, which are frequently caused by Candida or Aspergillus species. An ITR-OS given at a dose of 5 mg/kg per day showed potentially therapeutic concentrations in plasma for infants with mucosal fungal infections or at risk for the development of invasive fungal disease.…”

What is deep tropical mycosis? An underestimated entity with serious problems

“…27,28 Paucity of sporotrichosis in tissue makes its identification by special stains like PAS, difficult. Confirmation of the diagnosis is made through culture, which initially reveals white yeastlike, later on changes to buffed color forms and finally to grayish-black growth.…”