November 1, 2007

IDSA Publishes Updated Guidelines on Sporotrichosis

sporotrichosisNew IDSA practice guidelines on the management of sporotrichosis have been published in the November 15 issue of Clinical Infectious Diseasesnow available online.

The new guidelines replace previous guidelines that were published in 2000 and include recommendations for lymphocutaneous, cutaneous, osteoarticular, pulmonary, disseminated disease, and meningitis. Additionally, the new guidelines include recommendations for treatment of pregnant women and children.

As with the previous guidelines, itraconazole is still the treatment of choice for patients with lymphocutaneus, cutaneous, or osteoarticular sporotrichosis. If using itraconazole, serum levels should be taken to determine that the patient has adequate absorption of the drug.

New published data show that terbinafine is effective in high doses and thus is now recommended as a second-line therapy. In contrast to the earlier guidelines, the panel preferred lipid formulations of amphotericin B over amphotericin B deoxycholate for treatment of meningeal, disseminated, and severe pulmonary sporotrichosis.

“Most people with sporotrichosis do fine and can be treated by a primary care physician,” said lead author Carol A. Kauffman, MD, FIDSA, of the University of Michigan Medical School and the Ann Arbor Veterans Affairs Healthcare System. “However, patients whose infections have reached the bones, joints, lungs, or central nervous system are exceedingly difficult to treat and probably should be seen by an infectious diseases consultant.”

Sporotrichosis is a fungal infection caused by the fungus Sporothrix schenckii, which is found throughout the world in decaying vegetation, sphagnum moss, and soil. The disease is fairly common in Brazil and Peru, particularly in places where people come in regular close contact with soil. In the U.S., it is often seen among landscapers, forestry workers, and people who have had motor vehicle accidents—particularly with dirt bikes—that exposed their wounds to soil. Symptoms include the development of  painless or mildly painful nodules resembling insect bites that appear where the fungus enters through a break in the skin. Eventually, the lesions ulcerate and are very slow to heal. Although the infection will not resolve by itself, it usually responds well to treatment, but can cause more serious problems for patients with compromised immune systems.

See: Clinical Practice Guidelines for the Management of Sporotrichosis: 2007 Update by the Infectious Diseases Society of America, CID 2007:45 1255-1265.

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