Pulmonary Sporotrichosis: An Evolving Clinical Paradigm

Abstract

In recent decades, sporotrichosis, caused by thermally dimorphic fungi Sporothrix schenckii complex, has become an emerging infection in many parts of the world. Pulmonary infection with S. schenckii still remains relatively uncommon, possibly due to underrecognition. Pulmonary sporotrichosis presents with distinct clinical and radiological patterns in both immunocompetent and immunocompromised hosts and can often result in significant morbidity and mortality despite treatment. Current understanding regarding S. schenckii biology, epidemiology, immunopathology, clinical diagnostics, and treatment options has been evolving in the recent years with increased availability of molecular sequencing techniques. However, this changing knowledge has not yet been fully translated into a better understanding of the clinical aspects of pulmonary sporotrichosis, as such current management guidelines remain unsupported by high-level clinical evidence. This article examines recent advances in the knowledge of sporotrichosis and its application to the difficult challenges of managing pulmonary sporotrichosis.

Sporotrichosis: an update on epidemiology, etiopathogenesis, laboratory and clinical therapeutics

“…61 - 64 Probably the disease is misdiagnosed in areas with high endemicity, either due to the lack of knowledge by the medical doctors, or to the unspecific clinical signs and symptoms. 65 …”

Immunopathogenesis of Human Sporotrichosis: What We Already Know

“…The main forms of clinical presentation are lymphocutanous sporotrichosis (LC) and fixed sporotrichosis (F) ( Figure 1 ). Although less common, mucosal, cutaneous disseminated, and extracutaneous forms (including osteoarticular, pulmonary, meningitis, exogenous, and endogenous endophthalmitis) have also been described ( Table 1 ) [ 11 , 12 , 22 , 24 , 30 , 47 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ].…”

Cutaneous Disseminated and Extracutaneous Sporotrichosis: Current Status of a Complex Disease

“…It is believed that yeast propagation from cats is so intense that sometimes no trauma is detected. Cases of cutaneous-disseminated and disseminated sporotrichosis can be launched from a cutaneous or a pulmonary focus [ 4 , 32 , 33 ].…”

“…The incubation period depends on the size of the inoculums; for cutaneous cases, an average incubation time of three weeks is reported. In lung cases, it is uncertain, since most of cases are asymptomatic [ 3 , 33 ].…”

“…Pulmonary sporotrichosis is launched by primo-contact with the fungus, which needs an important inoculum; this results in an asymptomatic, limited pneumonic disease, and later, depending on the immune status, may be the focus of systemic spread [ 4 , 33 ].…”