Sporotrichosis

Comparative evaluation of the efficacy and safety of two doses of terbinafine (500 and 1000 mg day-1) in the treatment of cutaneous or lymphocutaneous sporotrichosis. Vergleichende Bewertung der Wirksamkeit und Sicherheit zweier Terbinafin-Dosierungen (500 und 1000 mg/Tag) in der Therapie der kutanen und lymphokutanen Sporotrichose

The aim of this study was to evaluate the safety and efficacy of oral terbinafine (500 and 1000 mg day(-1)) in the treatment of cutaneous or lymphocutaneous sporotrichosis. A culture for Sporothrix schenckii was required for inclusion into this multicentre, randomized, double-blind, parallel-group study. Patients received either 250 mg b.i.d. or 500 mg b.i.d. oral terbinafine for up to a maximum of 24 weeks and were assessed up to 24 weeks post-treatment. The main efficacy outcome measure was cure, defined as no lesion and absence of adenopathy at the end of follow-up. Adverse events (AEs), laboratory tests, vital signs and ophthalmological examinations were also assessed. Sixty-three patients (14-85 years of age) were treated with 500 mg day(-1) (n = 28) or 1000 mg day(-1) terbinafine (n = 35). The majority of patients were cured after 12-24 weeks of treatment, and the response was dose-dependent throughout the study and at the end of follow-up. The cure rate was significantly higher in patients treated with 1000 mg day(-1) terbinafine compared with those treated with 500 mg day(-1) terbinafine (87% vs. 52%, respectively; P = 0.004). There were no cases of relapse after 24 weeks of follow-up in the 1000 mg day(-1) terbinafine group, compared with six relapses in the terbinafine 500 mg day(-1) group. Terbinafine was well tolerated and the frequency of drug-related AEs was slightly higher in the 1000 mg treatment group. Both doses of terbinafine were well-tolerated and effective for the treatment of sporotrichosis. The 1000 mg day(-1) terbinafine dose was more efficacious than 500 mg day(-1) in the treatment of cutaneous or lymphocutaneous sporotrichosis.

Cutaneous New World leishmaniasis-sporotrichosis coinfection: report of 3 cases

Three cases of coinfection with Leishmania and Sporothrix spp in the same lesion are described. The patients had ulcers with erythematous borders and regional lymphadenopathy. The diagnosis of leishmaniasis was accomplished by direct visualization of the amastigotes or culture of the promastigotes, or both. The diagnosis of sporotrichosis was proved in two cases by culture of Sporothrix schenckii and by the histopathologic features in one case. All patients had a positive sporotrichin test. Two patients responded successfully to oral potassium iodide. One patient received oral itraconazole 100 mg/day because of intolerance to iodides and was cured. To our knowledge coinfection with Leishmania and Sporothrix spp has not been reported. The use of empirical treatments for leishmaniasis such as poultices or puncturing of the lesion with thorns or woods splinters might introduce Sporothrix and explain the coinfection.

Sporotrichosis presenting as arthritis and subcutaneous nodules

Arthritis is a rare manifestation of systemic sporotrichosis. A patient who had sporotrichal arthritis of both wrists and elbows is described. Predisposing factors included alcoholism, rose gardening, and antecedent trauma. The onset of the arthritis was insidious, and the diagnosis was made 2 1/2 years after his first symptoms were noted. Treatment with surgical debridement and a 23-week course of ketoconazole was unsuccessful. A review of the literature suggests that some combination of intravenous or intraarticular amphotericin B and potassium iodide, ketoconazole, or surgery is necessary for effective treatment.

Ketoconazole treatment of a family with zoonotic sporotrichosis

All 3 members of a family developed lymphocutaneous and cutaneous sporotrichosis after exposure to an infected cat. The lesions resembled acute bacterial lymphadenitis and lymphangitis and responded within 2 weeks to ketoconazole treatment with complete healing and no recurrence over the next 6 months. Immunologically normal children and adults with lymphocutaneous or cutaneous sporotrichosis may respond well to ketoconazole therapy.

Case report 678. Sporotrichal arthritis

A case of articular sporotrichosis occurring in the wrist and ankle of a 39-year-old man is reported. Review of the literature on this disorder confirms the diagnostic difficulties presented by this usually chronic, progressive, fungal arthritis. The diagnosis of this entity should be considered in the evaluation of any patient presenting with a progressive destructive arthritic process. The pathological and radiological features of a typical case are discussed and the mechanisms of infection and type of individual affected by this disease are described.

Preparation of murine monoclonal antibodies against the yeast phase of the dimorphic fungus Sporothrix schenckii

Three murine monoclonal antibodies (Mabs) were raised against a cytoplasmic antigen of the yeast phase of the pathogenic fungus Sporothrix schenckii using a modification of standard hybridoma technology incorporating the immunosuppressive drug cyclophosphamide. When tested for species-specificity within the pathogenic dimorphic fungi one of these Mabs (S5) showed little cross-reactivity by enzyme-linked immunosorbent assay and Western blot, though there was some recognition of Paracoccidioides brasiliensis antigen. This Mab recognized a 70-75 kDa molecule on reduced Western blots of S. schenckii antigen. The other two Mabs (S12 and S15) showed cross-reactivity with all dimorphic fungal antigens tested, though they appeared to recognize a molecule of similar molecular weight. This is the first report of any attempt to raise species-specific Mabs against this important causative agent of dermatological disease.