Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Expectant management
0%
0/9
Ciprofloxacin
11%
1/9
Prednisone
Amphotericin B
Itraconazole
67%
6/9
Select Answer to see Preferred Response
This patient presents with the classic rash of lymphocutaneous sporotrichosis--a reddish nodule that later ulcerates at the site of a thorn prick or skin injury, then spreads along lymphatics, resulting in subcutaneous nodules and ulcers. Sporotrichosis infection is caused by the dimorphic fungus Sporothrix schenckii. Although sporotrichosis is also known as "gardener's disease", any activity with the potential for skin inoculation with soil presents an infection risk. Infection beyond the skin and lymphatics (e.g., osteoarticular, pulmonary, and disseminated sporotrichosis) is rare and typically occurs in immunocompromised patients. Tobin and Jih discuss the etiology, diagnosis, and therapy of sporotrichoid infections. They note that in addition to Sporothrix schenckii, infectious lymphangitis may be caused by Nocardia brasilensis, Mycobacterium marinum, and Leishmania brasilensis. As with this patient, systemic symptoms are usually absent. Francesconi et al. conducted a bidirectional cohort study in which 55 patients with cutaneous sporotrichosis received terbinafine and 249 age- and clinical-form-matched (at a 5:1 ratio) patients received standard of care itraconazole. Cure was observed in 92.7% of terbinafine patients and 92% of itraconazole patients, showing noninferiority (RR 1.01, 95% CI 0.93-1.09). Image A shows the rash of sporotrichosis. Incorrect Answer: Answer 1: Lymphocutaneous sporotrichosis infection warrants treatment with an antifungal agent as discussed above. Answer 2: Ciprofloxacin would be effective against tularemia (another cause of infectious lymphangitis), but this is a much less likely cause of this patient's clinical picture. A fluoroquinolone would not effectively treat sporotrichosis. Answer 3: Steroid treatment would not help this patient's infection and might worsen it. Answer 4: Intravenous amphotericin B is active against S. schenckii, but use is reserved for non-responders to itraconazole and for patients with visceral, disseminated, and/or life-threatening infection.
4.7
(3)
Please Login to add comment