SPOROTRICHOSIS (sporotrichosis; synonym: Bermann's disease — Guzhero, sporotrikhozny deprive) — the chronic deep mycosis affecting skin, hypodermic cellulose, mucous membranes, limf nodes, is more rare internals and bones.
For the first time the disease was described by Schenk (V. of R. Schenck) in 1868; Hektuen and Perkins (L. Hektoen, Page F. Perkins) in 1900 allocated the activator; L. de Beurmann and A. Guzhero in 1906 gave it the name Sporothrix schenckii Hektoen a. Perkins (synonym: Sporotrichum beurmanni Matruchot a. Raymond, 1905; Sporotrichum jenselmei Brumpt a. Langeron, 1910). Men at the age of 25 — 40 years are ill preferential. The page meets in many countries of the world, including in the USSR.
the Activator — a dimorphous fungus (see. Fungi parasitic ). Fabric forms in cuts of fabrics and in patol. material have an appearance small oval or cigar-shaped (in the form of chelnochok) cells (from 2 — 5 microns to 15 microns). Across Gram are painted in rozovatofioletovy color. So-called asteroid bodies meet. At cultivation of the activator at t ° 37 ° the barmy form grows. Colonies are smooth, yellowish, similar on bacterial, without air mycelium, during the aging become grayish, folded. Under a microscope roundish or cigar-shaped cells with small kidneys on one or both ends are visible. At cultivation at t ° 25 ° the mitselialny form of a fungus — the velvety white, then blackening colony with the thin mycelium and oval conidiums forming accumulations in the form of sockets grows. The mycelium is branchy, septirovanny. Conidiums are oval, pear-shaped or cylindrical, nek-ry with the pointed ends, up to 8 microns long, up to 3 microns wide. Are located in pairs on a mycelium or groups on 5 — 10 dispute on its end.
the Source of an infection is the soil, nek-ry plants. The activator C. lives in the nature as a saprophyte or vegetirut on plants. The disease is described at flower growers, gardeners, miners, laboratory workers; the cases connected with a sting of dogs, cats, horses, nek-ry insects are known.
Entrance infection atriums usually are the injured skin, mucous membranes of respiratory tracts. Infection is promoted by decrease in reactivity of an organism as a result hron. infections, endocrinopathies, exchange disturbances, hypovitaminoses. The activator can remain in the place of implementation or extend on lymphatic and to blood vessels. Direct infection does not come from sick S.
In the place of implementation of a fungus develops a granuloma from plasmatic, epithelial cells and macrophages. In it distinguish three zones: a zone of the central microabscess with neutrophilic leukocytes; a zone of a necrosis, in a cut between nekrotiziro-bathing collagenic fibers the inflated histiocytes, lymphocytes come to light and it is a lot of huge and especially epithelial cells; the external zone consisting of fibroblasts with infiltration by lymphocytes and a large number of plasmocytes. In perivascular infiltrate obliterating phlebitis is found. Disputes of a fungus are usually in macrophages.
Develop focal pneumonia (see), pleurisy (see), it is sometimes formed cavity (see); there can be a mediastinitis (see). The acute necrosis of pulmonary fabric with a small amount of lymphocytes and polymorphonuclear leukocytes is possible.
A clinical picture
the Incubation interval of 8 — 30 days, sometimes up to 6 months. Distinguish several wedge, forms C.: superficial (epidermal and thermal), (lymphatic), disseminated skin and visceral (system) localized hypodermic. They can be combined and transformed one to another.
At superficial S. on skin in the place of implementation of the activator folliculites, an acne, papules, plaques, microabscesses, beliefs-rukoznye, pagshllomatozny or psoriasiform rashes appear. Erythematic, ulcer papillomatous damages of mucous membranes of an oral cavity, nose, pharynx, throat are possible.
The localized hypodermic S. meets most often. In the beginning in hypodermic cellulose there is a painless node more than 0,5 cm in size which is not soldered to skin, a plotnoelastichesky consistence. Then it increases in sizes, is accustomed to drinking with skin, edges over it becomes cyanotic, nekrotizirutsya, there is an ulcer with the subdug edges (fig. 1) — the sporotrikhozny chancre (a thicket on fingers, a brush and a forearm), from to-rogo on the course taking away limf, a vessel lasts dense tyazh with multiple small knots. Around a chancre and on its surface papillomatous, warty, impetiginous elements can develop. Sometimes there are hillocks and gummous nodes soldered to skin, nekrotiziruyushchiyesya in the center and ulcerating — gummous Page. In some cases nodes do not ulcerate (a tuberculoid form), and sometimes abscess or form linear or star-shaped hems during the healing. Allergic rashes — sporotrikhozida can be observed.
The disseminated skin S. happens ulcer, gummous and ulcer, ulcer and vegetans (fig. 2) and abscessing; on a wedge, he reminds a picture pyoderma (see).
At visceral forms lungs are surprised, went. - kish. path, liver, spleen, muscles, joints. Usually they develop at patients with a cachexia. The symptomatology of damages of lungs reminds pulmonary tuberculosis (see. Pneumomycoses ), the musculoskeletal device — gummous syphilitic defeats, napr, in a look osteomyelitis (see), periostitis (see). Visceral S. often arises at TB patients, malaria, others hron. diseases. It proceeds with high temperature, change gematol. indicators, disturbance of the general state.
the Diagnosis is established on the basis by a wedge, pictures and allocations of typical culture of a sporotrikhum (especially at capture of material from depth of the center). Investigate also a phlegm, a purulent discharge, scrapings from the centers of defeat, punctates limf, nodes, and also pieces of biopsy or autopsiyny material for the purpose of identification of the activator.
Differential diagnosis carry out with other deep mycoses — coccidioidosis (see), histoplasmosis (see), chromomycosis (see), etc., and also with manifestations syphilis (see), tuberculosis (see), leprosies (see), tularemias (see), hron. pyodermas (see). At differentiation of visceral defeats apply serol. reactions and allergy tests.
Treatment, the Forecast, Prevention
carry out Treatment by potassium iodide in the raising doses (from 2 to 6 g a day within 3 — 5 months). Recommend nystatin, levorinum, Amphotericinum In, Bicillinum. Locally appoint lotions and compresses with drugs of iodine, Castellani's liquid (fukortsin), ointments with streptocides.
The forecast localized, and it is frequent also the disseminated forms at early diagnosis and timely treatment favorable. Visceral S. quite often comes to an end letalno.
Bibliography: Veviorovsky A. A. Sporotrichosis and similar to it mycoses, SPb., 1913; To and sh to and P. N. N and Sh e to l and-kov N. D. Guide to a medical mycology, page 220, M., 1978; Skin and venereal diseases, the Atlas, under the editorship of H. M. Turanova, etc., page 302, M., 1977; M and sh to and l of l e y with about L. N N. Infectious and parasitic diseases of skin, page 296, M., 1960; With on ant N. F. and. lake of Manual of clinical mycology, Philadelphia, 1971; Emmons C. W., In i n-ford of Page H. Utz. J. Medical mycology, p. 365, Philadelphia, 1970; Schenck B. R. On refractory subcutaneous abscesses caused by a fungus possibly related to the sporitricha, Johns Hopk Hosp., Bull., v. 9, p. 286, 1898.
V. M. Leshchenko.