Volume 25, Number 10—October 2019
Sporotrichosis in the Highlands of Madagascar, 2013–20171
|Major||Cutaneous: lymphocutaneous form defined as a papule or pustule or a subcutaneous nodule at the inoculation site, then ulceration with erythematous edges and purulent secretion. Secondary lesions arise along the path of regional lymphatic vessels. Fixed or cutaneously disseminated.|
|Extracutaneous: disseminated, osteoarticular, ocular.|
|Minor||Mucosal: nasal septum, with bloody secretions and detachment of crusts. Conjunctivitis, with granulomatous lesions accompanied by a serous-purulent discharge, redness, lid edema, and preauricular and submandibular lymph node enlargement.|
|Primary pulmonary sporotrichosis: similar to that of tuberculosis. Radiologic patterns include cavitary disease, tracheobronchial lymph node enlargement, and nodular lesions. Vegetative, verrucous, infiltrated plaque, or tuberous lesion.
|Mycologic and histologic|
|Major||Molecular evidence of Sporothrix schenckii on PCR with specific primers (targeting topoisomerase II) or ITS sequencing, directly from clinical samples or from a positive culture of a fungus morphologically suggestive of Sporothrix spp.|
|MALDI-TOF mass spectrometry identification of S. schenckii from a positive culture of a fungus morphologically suggestive of Sporothrix spp.|
|Minor||Budding yeast cells with the characteristic cigar-shaped buds observed on direct microscopic examination or histologic analysis.|
|Direct examination of pus and/or histologic analysis showing asteroid bodies (Splendore-Hoeppli reaction).|
|Positive culture of a fungus morphologically suggestive of Sporothrix spp. from a clinical sample without molecular or MALDI-TOF mass spectrometry confirmation.
|Confirmed||>1 of the major clinical criteria and >1 of the major mycologic criteria or 1 minor clinical criterion and >1 of the major mycologic criteria.|
|Probable||>1 of the major clinical criteria and 1 minor mycologic or histologic criterion and a complete or partial response to antifungal therapy.|
|Possible||>1 of the major clinical criteria without any (major or minor) mycologic or histologic criteria or >1 of the minor clinical criteria without any (major or minor) mycologic or histologic criteria and a complete or partial response to antifungal therapy.|
|Clinical response to antifungal therapy|
|Cure||Complete resolution of all lesions.|
|Major response||Substantial improvement of most lesions with a substantial decrease in subcutaneous nodules.|
|Minor response||Mild improvement of most lesions with a smaller decrease in subcutaneous nodules than for a major response.|
|Failure||Stabilization of the lesions after >3 months of antifungal therapy or worsening of the lesions after >3 months of antifungal therapy.|
*ITS, internal transcribed spacer; MALDI-TOF, matrix-assisted laser desorption/ionization time-of-flight.
1Preliminary results from this study were presented at the 20th ISHAM Conference; June 29–July 5, 2018; Amsterdam, the Netherlands (abstract no. S1.4d).