Pulmonary sporotrichosis: case series and systematic analysis of literature on clinico-radiological patterns and management outcomes

Abstract

Pulmonary infections by Sporothrix spp. manifest radiologically as cavitary or non-cavitary disease depending on whether the infection is primary pulmonary or multifocal sporotrichosis. Despite current guidelines, the optimal management for pulmonary sporotrichosis remains unclear. In order to clarify this, we present two cases of pulmonary sporotrichosis, as well as the results of a comprehensive literature review of treatment outcomes based on clinico-radiological presentation patterns of the disease. A literature search of all case reports in English language over the last 50 years (1960-2010) was conducted. Data on patient characteristics, risk factors, clinico-radiological patterns, treatment modalities and outcomes were collected and analyzed. A total of 86 cases were identified, i.e., 64 (74.4%) primary pulmonary and 22 (25.6%) multifocal sporotrichosis. Radiologically, primary pulmonary disease was commonly characterized by cavity formation which was lacking in multifocal infections (P = 0.0001). Immunosuppressant use was more common in multifocal sporotrichosis (P = 0.0001), while hemoptysis was more common in primary pulmonary form (P = 0.01). No other differences in patient characteristics or risk factors were noted. Extra-pulmonary multifocal sporotrichosis most commonly involved skin (81.8%) and joints (45.4%). For patients with cavitary primary pulmonary sporotrichosis, outcomes from medical therapy alone were inferior to surgical intervention (P = 0.02). However, for both primary pulmonary and multifocal sporotrichosis with non-cavitary disease, medical therapy alone provided good outcomes. Only 12 (16.7%) cases were treated with itraconazole. Treatment of pulmonary sporotrichosis should be guided by the clinico-radiological patterns of presentation. Medical therapy alone is likely sufficient for non-cavitary disease while early surgery should be considered for cavitary primary pulmonary sporotrichosis. The experience in treating cavitary disease with itraconazole alone is limited and further data are required.

Diagnosis and Management of Systemic Endemic Mycoses Causing Pulmonary Disease

“…Symptoms and radiographic appearance are similar to pulmonary tuberculosis and other chronic fungal infections (Fig. 15) [26].…”

Presencia de agentes potenciales causantes de infecciones subcutáneas humanas en suelo y plantas en el estado de Puebla, México

“…De no recibir atención médica, en las heridas se puede establecer un agente fúngico o bacteriano y desarrollarse el proceso infeccioso. En el caso de la esporotricosis, se ha reportado también la inhalación de conidios y micelio como otro mecanismo de infección, aunque son pocos los casos reportados con esta modalidad clínica (Aung et al, 2013). La cromoblastomicosis y el eumicetoma generalmente se presentan en hombres, a diferencia de la esporotricosis que tiene una incidencia similar entre hombres y mujeres (Vásquez del Mercado et al, 2012).…”

Sporotrichosis

“…If the patient is seriously ill, amphotericin B, preferably as a lipid formulation, 3-5 mg/kg daily, should be used initially [32,41]. When the patient is stable, therapy can be changed to oral itraconazole, 200 mg twice daily.…”

“…Pulmonary sporotrichosis is a subacute to chronic illness that usually occurs in patients who have chronic obstructive pulmonary disease [31][32][33]. The symptoms mimic those of reactivation tuberculosis.…”