Sporothrix schenckii - Revision history

Aidan: /* Lymphocutaneous */

2020-08-05T13:59:51Z

Lymphocutaneous

← Older revision		Revision as of 13:59, 5 August 2020
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	*Common cause of [[nodular lymphangitis]]		*Common cause of [[nodular lymphangitis]]
	*Incubation period 7 to 30 days		*Incubation period [[Usual incubation period::7 to 30 days]]
	*Nodules can be 2 to 4 cm, and appear along the lymphatics, typically in the arms and legs (and face, in children)		*Nodules can be 2 to 4 cm, and appear along the lymphatics, typically in the arms and legs (and face, in children)
	**They become indurated, then ulcerated		**They become indurated, then ulcerated

Aidan at 14:35, 2 August 2020

2020-08-02T14:35:35Z

Show changes

Aidan: Text replacement - "== Clinical Presentation" to "== Clinical Manifestations"

2020-08-02T12:13:57Z

Text replacement - "== Clinical Presentation" to "== Clinical Manifestations"

← Older revision		Revision as of 12:13, 2 August 2020
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	* Hosts include humans, cats, horses, dogs, rodents, cattle swine, camels, etc.		* Hosts include humans, cats, horses, dogs, rodents, cattle swine, camels, etc.

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==
	=== Lymphocutaneous ===		=== Lymphocutaneous ===
	* Common cause of [[nodular lymphangitis]]		* Common cause of [[nodular lymphangitis]]

Aidan: /* Management */

2019-11-21T14:53:47Z

Management

← Older revision		Revision as of 14:53, 21 November 2019
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	* First-line: [[Is treated by::itraconazole]] 100 to 200 mg po daily until 2 to 4 weeks after the lesions resolve (around 3 to 6 months)		* First-line: [[Is treated by::itraconazole]] 100 to 200 mg po daily until 2 to 4 weeks after the lesions resolve (around 3 to 6 months)
	** Dose may be increased to 400 mg if there's a poor response, there are extracutaneous infections including osteoarticular or pulmonary disease, or the host is immunocompromised		** Dose may be increased to 400 mg if there's a poor response, there are extracutaneous infections including osteoarticular or pulmonary disease, or the host is immunocompromised
			** Check for drug-drug interactions
	* Alternatives include [[Is treated by::amphotericin B]], [[Is treated by::fluconazole]], and maybe [[Is treated by::terbinafine]]		* Alternatives include [[Is treated by::amphotericin B]], [[Is treated by::fluconazole]], and maybe [[Is treated by::terbinafine]]
	* Can also do [[Is treated by::local hyperthermia]], especially for patients who are unable to take the above medications		* Can also do [[Is treated by::local hyperthermia]], especially for patients who are unable to take the above medications

Aidan: /* Special populations */

2019-11-21T14:52:55Z

Special populations

← Older revision		Revision as of 14:52, 21 November 2019
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	=== Special populations ===		=== Special populations ===
	* For pregnant women, use [[Is treated by::amphotericin B]]		* For '''pregnant women''', use [[Is treated by::amphotericin B]]
	* For osteoarticular ~~infection~~, use [[itraconazole]] 200 mg po bid		* For '''osteoarticular infections''', use [[itraconazole]] 200 mg po bid
	** Can use [[amphotericin B]] as induction		** Can use [[amphotericin B]] as induction
	** Duration is at least 12 months		** Duration is at least 12 months
	* For severe pulmonary infection, use [[amphotericin B]] 3 to 5 mg/kg daily (liposomal), stepped down to [[itraconazole]] 200 mg po bid when better, to complete at least 12 months total		* For '''severe pulmonary infection''', use [[amphotericin B]] 3 to 5 mg/kg daily (liposomal), stepped down to [[itraconazole]] 200 mg po bid when better, to complete at least 12 months total
	* Same treatment for disseminated disease		* Same treatment for '''disseminated disease'''
	* For meningeal infection, use [[amphotericin B]] 5 mg/kg daily for 4 to 6 weeks, followed by [[itraconazole]] 200 mg po bid until at least 12 months		* For '''meningeal infection''', use [[amphotericin B]] 5 mg/kg daily for 4 to 6 weeks, followed by [[itraconazole]] 200 mg po bid until at least 12 months
	* For children, use [[itraconazole]] 6 to 10 mg/kg (max 400 mg) daily		* For '''children''', use [[itraconazole]] 6 to 10 mg/kg (max 400 mg) daily
	* For severe disease in children, use [[amphotericin B]] 0.7 mg/kg daily induction then [[itraconazole]] 6 to 10 mg/kg (max 400 mg) daily		* For '''severe disease in children''', use [[amphotericin B]] 0.7 mg/kg daily induction then [[itraconazole]] 6 to 10 mg/kg (max 400 mg) daily

	=== Potassium iodide ===		=== Potassium iodide ===

Aidan: /* Management */ added KKI

2019-11-21T14:51:34Z

Management: added KKI

← Older revision		Revision as of 14:51, 21 November 2019
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	** Dose may be increased to 400 mg if there's a poor response, there are extracutaneous infections including osteoarticular or pulmonary disease, or the host is immunocompromised		** Dose may be increased to 400 mg if there's a poor response, there are extracutaneous infections including osteoarticular or pulmonary disease, or the host is immunocompromised
	* Alternatives include [[Is treated by::amphotericin B]], [[Is treated by::fluconazole]], and maybe [[Is treated by::terbinafine]]		* Alternatives include [[Is treated by::amphotericin B]], [[Is treated by::fluconazole]], and maybe [[Is treated by::terbinafine]]
		⚫	* Can also do [[Is treated by::local hyperthermia]], especially for patients who are unable to take the above medications

			=== Special populations ===
	* For pregnant women, use [[Is treated by::amphotericin B]]		* For pregnant women, use [[Is treated by::amphotericin B]]
	* For osteoarticular infection, use [[itraconazole]] 200 mg po bid		* For osteoarticular infection, use [[itraconazole]] 200 mg po bid
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	* For children, use [[itraconazole]] 6 to 10 mg/kg (max 400 mg) daily		* For children, use [[itraconazole]] 6 to 10 mg/kg (max 400 mg) daily
	* For severe disease in children, use [[amphotericin B]] 0.7 mg/kg daily induction then [[itraconazole]] 6 to 10 mg/kg (max 400 mg) daily		* For severe disease in children, use [[amphotericin B]] 0.7 mg/kg daily induction then [[itraconazole]] 6 to 10 mg/kg (max 400 mg) daily

⚫	* Can also do [[Is treated by::local hyperthermia]], especially for patients who are unable to take the above medications
			=== Potassium iodide ===
			* Used more outside of developed countries, since it is cheap
			* Poorly tolerated, though, with numerous side effects

	== Further Reading ==		== Further Reading ==

Aidan: /* Management */ typo

2019-11-21T14:50:13Z

Management: typo

← Older revision		Revision as of 14:50, 21 November 2019
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	== Management ==		== Management ==
	* First-line: [[Is treated by::~~Itraconazole~~]] 100 to 200 mg po daily until 2 to 4 weeks after the lesions resolve (around 3 to 6 months)		* First-line: [[Is treated by::itraconazole]] 100 to 200 mg po daily until 2 to 4 weeks after the lesions resolve (around 3 to 6 months)
	** Dose may be increased to 400 mg if there's a poor response, there are extracutaneous infections including osteoarticular or pulmonary disease, or the host is immunocompromised		** Dose may be increased to 400 mg if there's a poor response, there are extracutaneous infections including osteoarticular or pulmonary disease, or the host is immunocompromised
	* Alternatives include [[Is treated by::amphotericin B]], [[Is treated by::fluconazole]], and maybe [[Is treated by::terbinafine]]		* Alternatives include [[Is treated by::amphotericin B]], [[Is treated by::fluconazole]], and maybe [[Is treated by::terbinafine]]

Aidan: /* Disseminated or multifocal */

2019-11-21T14:47:21Z

Disseminated or multifocal

← Older revision		Revision as of 14:47, 21 November 2019
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	=== Disseminated or multifocal ===		=== Disseminated or multifocal ===
	* Only occurs in patients with immunodeficiency, including alcoholism, diabetes, sarcoidosis, tuberculosis, transplantation, malignancy, immunosuppressive medication, or advanced HIV		* Only occurs in patients with immunodeficiency, including alcoholism, diabetes, sarcoidosis, tuberculosis, transplantation, malignancy, immunosuppressive medication, or advanced HIV
			** Can be in the context of HIV IRIS
	* Lesions can include ulcerations, aceniform, plaques, or crusts		* Lesions can include ulcerations, aceniform, plaques, or crusts
	* Worst prognosis is with dissemination to lungs or meninges		* Worst prognosis is with dissemination to lungs or meninges

Aidan: /* Fixed cutaneous */ typo

2019-11-21T14:46:50Z

Fixed cutaneous: typo

← Older revision		Revision as of 14:46, 21 November 2019
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	=== Fixed cutaneous ===		=== Fixed cutaneous ===
	* Only a single lesion, fixed at the point of inoculation		* Only a single lesion, fixed at the point of inoculation
	* Lesions may be papular, plaques, nodular, ~~verrucoud~~, or ulcerated		* Lesions may be papular, plaques, nodular, verrucous, or ulcerated

	=== Disseminated or multifocal ===		=== Disseminated or multifocal ===

Aidan: /* Extracutaneous */

2019-11-21T14:43:36Z

Extracutaneous

← Older revision		Revision as of 14:43, 21 November 2019
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	=== Extracutaneous ===		=== Extracutaneous ===
	* Rare presentation without skin lesions, caused either by inhalation or deep inoculation		* Rare presentation without skin lesions, caused either by inhalation or deep inoculation
	* Musculoskeletal infections are the most common, with septic arthritis followed by osteomyelitis or tenosynovitis		* Musculoskeletal infections are the most common, with '''septic arthritis''' followed by osteomyelitis or tenosynovitis
	* Pulmonary sporotrichosis is more common in men aged 30 to 60 years, and presents similarly to [[pulmonary tuberculosis]]		* '''Pulmonary sporotrichosis''' is more common in men aged 30 to 60 years, and presents similarly to [[pulmonary tuberculosis]]
			** Major risk factors: alcohol (1/3); sarcoidosis, TB, or diabetes (1/3); otherwise healthy (1/3)
	* Sporotrichotic meningitis is rare and occurs in immunocompromised patients		* '''Sporotrichotic meningitis''' is rare and occurs in immunocompromised patients
	* Can also affect eyes, genitals, or oropharyngeal mucosa		* Can also affect eyes, genitals, or oropharyngeal mucosa