Sporotrichosis

Sporotrichosis

1. SPOROTRICHOSIS Yuvraj Panth Department of Veterinary Medicine and Public Health Faculty of Animal Science, Veterinary Science and Fisheries Agriculture and Forestry University Course title: VMC 606, Infectious disease I

2. Introduction: Chronic contagious suppurative granulomatous disease of skin and subcutaneous tissue May be characterized by nodules and ulcers, main manifestation being chronic contagious granuloma ( Londero et. al., 1964) Caused by the infection of the   fungus Sporothrix schenckii U sually affects the  skin, although other rare forms can affect the lungs, joints, bones and even the brain AKA   ”rose-thorn  or rose-gardeners' disease ” Occupational hazard for veterinarians 10/25/2018 2

3. Epidemiology: Distribution: S. schenckii can be found worldwide, Sporadic in nature and present in Egypt Mostly prevalent in tropical and sub-tropical zones where temperature is 26-29 degree Centigrade and humidity is 92%-100% Animal susceptibility : Sporotrichosis occurs most often in horses Cases have also been seen in cats, dogs, rodents, cattle, goats, swine, mules, camels, non-human primates, birds, and various wild animals including foxes Seasonal incidence: The disease increase during winter seasons Reported in animals since early part of 20 th century (Ainsworth and Austwick , 1973) 10/25/2018 3

4. Etiology: Caused by the infection of the fungus Sporothrix schenckii First case reported in man by Schenck in 1898 from United States Dimorphic fungi (Yeast, Mycelia) Cigar shaped in appearance and 3-5 micron in length Inhabitant of plant, wood and soil Appear as small yeast in the tissues and exudate As yeast at 37 degree Centigrade and as mycelia at 22 degree Centigrade (Nandi and De, 2010) Cytologic preparation from a case of feline sporotrichosis ; phagocytic cells show numerous variably-shaped yeast Source: https://en.wikipedia.org/wiki/File:Feline_sporotrichosis_4.jpg Conidiophores and conidia of the fungus  Sporothrix schenckii Source: http://phil.cdc.gov/phil_images/20030721/16/PHIL_4208_lores.jpg 10/25/2018 4

5. Mode of Transmission: Contaminated soil or decaying plant materials Infected animals(Pus from the lesions) Susceptible animal (Cutaneous wounds/ abrasions) Indirect Contact Direct Contact Predisposing factors : Cutaneous wounds and presence of the animals in muddy unhygienic stables. 10/25/2018 5

6. Pathogenesis: Infection Contaminated cutaneous Wound Underlying tissues Suppurative inflammation of the skin Ulceration and necrosis of superficial layer of skin Invade tissue and lymphatics Regional lymph nodes Lymphadenitis Granuloma on Skin, Lymph Node and Subcutis Incubation Period: 3-21 days (occasionally upto 3 months) 10/25/2018 6

7. Clinical Findings: Three Clinical Forms: ( Chaterjee , 1989) Cutaneous Lymphatic Systemic The disease has low morbidity, mortality and long course 10/25/2018 7

8. ……............... Clinical Findings: Cutaneous form: Most common form in dog and cat Development of multiple nodules on the skin, which ulcerate and drained with pus ( Dutchfield , 1963) Lesions are mostly located at the extremity especially on the fet -lock joints region Nodules are painless in nature and discharge small amount of reddish serohemorrhagic exudate Exudates dry up and scab are formed Ulcerated Nodules on face Source: https://z-1- lookaside.fbsbx.com / klinikveterinarbidorofficial /posts/112605772782643 Ulcerated nodules at fet -lock joint region Source: https://commons.wikimedia.org/wiki/File:Feline_sporotrichosis_3.jpg Cutaneous and conjunctival sporotrichosis in a 1-year-old male neutered domestic shorthair. (Courtesy University of California, Davis, Veterinary Dermatology Service.) Source: https://veteriankey.com/sporotrichosis-2/ 10/25/2018 8

9. ……............... Clinical Findings: Lymphatic/ Lymphocutaneous form: Most common in horse, donkey and mules Multiple nodules appear in lymph canals like nodular cords Nodules get ulcerated and deep lesions are produced These lesions have got the tendency of retarded healing Dissemination of infection to visceral organ is seen occasionally (horse) 10/25/2018 9

10. ……............... Clinical Findings: Systemic/Disseminated form: Dissemination of infection to different parts of body May involve bone and various internal organs Is rare but potentially fatal and may develop with neglect of cutaneous and lymphocutaneous forms Infection develops via hematogenous or tissue spread from the initial site of inoculation to the bones, lungs, liver, spleen, testes, GI tract, CNS, testes, eyes, joints Mucosal form causes nodules in nose, mouth, pharynx, larynx and trachea 10/25/2018 10

11. Lesions: Macroscopic lesions Nodular, Ulcerative and necrotic Microscopic lesions Granulomatous inflammatory changes with a purulent centre, encircled by epitheloid granulation tissues and encapsulated by connective tissue capsule (Smith et al., 1972) Cellular infiltration is comprised of macrophages, epitheloid cells, multinucleated giant cells and lymhocytes Red oblong bodies can be identified within the cytoplasm of giant cells (Andrews et al., 1983) 10/25/2018 11

12. Diagnosis: Field diagnosis : It depends on history, epidemiology and clinical signs of the disease 10/25/2018 12

13. …………..Diagnosis: Laboratory diagnosis : Samples : Pus, blood and serum sample Laboratory examinations : Direct microscopic examination of stained pus smear to detect cigar shape, gram positive spores PAS stain to demonstrate organism: Oval, round or cigar shape Isolation of the organism on Sabaurod’s dextrose agar containing chloramphenicol and cyclohexamide : smooth white colony will appear, which will show thin septate hyphae with microconidia under microscope https:// www.slideshare.net / Prbn /dimorphic-fungi 10/25/2018 13

14. …………..Diagnosis: FAT gives positive result with samples of infected animal Animal inoculation, inoculation of rat and mice I/P with pus material of infected animal, local lesion ( granuloma ) can be observe after 3 w of inoculation and peritoneal exudate contain cigar-shape fungi in peritoneal cavity Serological test as latex agglutination test 10/25/2018 14

15. Differential diagnosis: Epizootic lymphangitis Lesions in extremities, mucous membrane of nostrils and upper respiratory tract Diagnosis confirmed by identification of the organism Histoplasma farciminosum , which is demonstrable as double walled capsule This disease may be misdiagnosed clinically with glanders , epizootic lymphangitis and ulcerative lymphangitis 10/25/2018 15

16. Treatment: Various antifungal drugs, such as itraconazole , ketoconazole, amphotericin B and fluconazole Itraconazole is referred as drug of choice Systemic treatment with iodides Potassium iodide orally (0.5-1 mg/kg, bw ) as 1-2 dose daily for 7 days Sodium iodide I/V (40 mg/kg, bw ) as 2-5 doses then one dose daily till cure or NaI @ 1gm /40 kg bw as 10% solution I/V During treatment, the animal should be monitored for signs of iodide toxicity—anorexia, vomiting, depression, muscle twitching, hypothermia, cardiomyopathy , cardiovascular collapse, and death; The dose of iodides may be stopped or reduced if signs of iodism appear Local application of iodides daily to ulcers after evacuation of contents Griseofulvin orally Amphoterecin -B I/V for disseminated sporotrichosis S urgical removal, cryotherapy and thermotherapy, either alone or in conjunction with antifungal drugs, for cutaneous sporotrichosis 10/25/2018 16

17. Sporotrichosis as Zoonosis Source: http://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1005638 10/25/2018 17

18. Source: Chakrabarti et al, 2015; Medical Mycology; ISHAM 10/25/2018 18

19. Control: Early diagnosis, isolation and treatment of infected animals Isolation and segregation of infected animals Prompt treatment of cuts, wounds and abrasions with Tincture Iodine Treatments of sheds with antifungal agents Adequate hygiene to prevent spread of infection 10/25/2018 19

20. Summary : Chronic contagious suppurative granulomatous disease of skin and subcutaneous tissue, caused by the fungus Sporothrix schenckii Worldwide distributed, occuring most often in horses Transmitted through contaminated soil and infected animals Show cutaneous, lymphatic and systemic forms Granulomatous lesions Diagnosed by epidemiology, signs, sample tests using PAS stain, SDA, FAT, etc. Treated with common antifungals and iodides Has zoonotic importance Early diagnosis,isolation and treatment of infected animals are the control measures 10/25/2018 20

21. References: Answorth , G.C. and Austwick , P.K.C. (1973). Fungal Diseases in Animals, 2 nd Ed., C.A.B. Andrews, A.H. et al., (1983). Vet. Rec. 112: 614 Chakrabart et al., (2015). ISHAM. Medical Mycology. 53:3-14 Chaterjee , A. (1989). Skin Infection in Domestic Animals, Moitri Publication, Kolkata Ditchfield , J. (1963). Equine Medicine and Surgery, St. Ed. Amer. Vet. Publication. IWC Londero A.T. et al., Sabouraudia 3: 273 Nandi, S. and De, U.K. (2010). Veterinary Public Health at a glance. First Edition. IBDC publishers, India. Pp. 154-155 Smith, H.A. et. al., (1972). Vet. Sath . 4 th Edition. Lea and Febiger , Philadelphia 10/25/2018 21

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