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   Abstract
   Introduction
   Case report
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CASE REPORT
Year : 1992  |  Volume : 58  |  Issue : 1  |  Page : 45-47

Fixed cutaneous sporotrichosis from North Karnataka




Correspondence Address:
B M Hemashettar


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  Abstract 

Sporotrichosis is a rare disease in the southern part of India. A typical, culture proved case of fixed cutaneous sporotrichosis is reported from North Karnataka.


Keywords: Sporotrichosis


How to cite this article:
Hemashettar B M, Kuchabal D S, Hanchinamani S, P. Fixed cutaneous sporotrichosis from North Karnataka. Indian J Dermatol Venereol Leprol 1992;58:45-7

How to cite this URL:
Hemashettar B M, Kuchabal D S, Hanchinamani S, P. Fixed cutaneous sporotrichosis from North Karnataka. Indian J Dermatol Venereol Leprol [serial online] 1992 [cited 2019 Nov 13];58:45-7. Available from: http://www.ijdvl.com/text.asp?1992/58/1/45/3744



  Introduction Top


Sporotrichosis is a chronic infection caused by sporothrix schenckii, a dimorphic fungus. The disease is world wide in distribution, particularly prevalent in tropical and temperate zones. In India, the disease is endemic in North Eastern hilly region [1] A number of cases have also been reported from Himachal Pradesh [2],[3],[4] and adjoining areas. [5]

However, southern part of India is considered to be relatively free from sporotrichosis and only sporadic case reports are available in the literature. [6],[7],[8] We are reporting a typical case of fixed cutaneous sporotrichosis.


  Case report Top


A 56-year-old housewife developed an ulcer following an injury while wearing bangles on the dorsal aspect of left forearm about 8 months ago. The solitary ulcer measured 3 x 2 cms, borders were raised, surrounding area was indurated and not fixed to the underlying bony structures.

The skin around the lesion was darkly pigmented. The floor was covered with granulation tissue with minimal discharge. There were no satellite lesions or lymphadenitis. Skin and mucous membrane elsewhere on the body were normal. Systemic examination did not reveal any abnormality.

Routine haematology and urine examination were within normal limits. X-ray of the forearm did not reveal any bony abnormality. For culture, the material was obtained from the floor of the ulcer by scraping and inoculated on multiple tubes of Sabouraud's dextrose agar with and without cycloheximide and Chloramphenicol, and incubated at room temperature. Gram stain showed pus cells and sparse, oval yeast cells of 4-5 um in diameter [Figure - 1]. No other organisms were seen.

After 5 to 6 days of incubation all the tubes showed multiple fungal colonies. Initially creamy-white colonies later turned to greyish-black in colour. Colonies were dry and wrinkled with minimal aerial hyphae. Needle mounts and slide culture preparations revealed features consistent with Sp. schenckii.

Subcultures to brain heart infusion (BHI) agar with blood' and incubation at 37 C yielded yeast-like colonies with oval yeast - like cells on gram stain. Based on morphology and conversion studies the isolate was identified as Sp. schenckii. [8] To prove its pathogenicity, a dense suspension of the mycelial phase was infected intraperitoneally into mice. The animal was sacrificed after 15 days. A gram stain from the peritoneal exudate showed numerous yeast cells.

The isolate was examined and the identity confirmed by Dr. A Thammayya, Professor of Medical Mycology, Calcutta School of Tropical Medicine, Calcutta. The culture has been deposited in the University of Alberta Mould Herbarium, Alberta, Canada (Accession No. UAMH 6872).

Oral potassium iodide 1 gm / day was started. The patient failed to report back for followup.


  Comments Top


A review of literature pertaining to sporotrichosis from South India reveals only 3 case reports. In 1967, Nagabhushanam [6] from Kurnool reported a case of cutaneous ulceration which was diagnosed as a case of sporotrichosis based on clinical impression and therapeutic response to potassium iodide. The pathogen was not demonstrated either in the smear or in the biopsy and the fungus was not isolated in culture. Hence the validity of this report is questionable.

In 1976, Pankajalakshmi et al [7] reported a case of sporotrichosis from Madras, which presented as a case of mycetoma but the culture yielded Sp. schenckii. In 1982, Kamalam and Thambiah [8] from Madras reported another culture proved case of cutaneous sporotrichosis. But both the isolates from these cases failed to grow at 37 C producing yeast-like cells on BHI with blood, thus establishing the dimorphic nature of the pathogen. Demonstration of yeast cells in the lesions of sporotrichosis is considered to be very difficult and often it is stated that direct examination of clinical material is unrewarding and not worth attempting. Interestingly, a good number of yeast cells could be demonstrated in the gram stained smear from the lesion in the present case.

The reasons for rarity of the disease in this part of the country are not very evident[9].

 
  References Top

1.Baruah BD, Saikia TC, Bhuyan R N. Sporotrichosis in Assam. J Ind Med Assoc 1976; 67: 223-9.  Back to cited text no. 1    
2.Singh P, Sharma RC, Gupta ML, et al. Sporotrichosis in Himachal Pradesh. Ind J Med Sci 1983; 37 : 101 - 3.  Back to cited text no. 2  [PUBMED]  
3.Sharma NL, Sharma RC, Gupta ML, et al. Sporotrichosis-study of 22 cases from Himachal Pradesh. Ind J Dermatol Venereol Leprol 1990; 56 : 296 - 8.  Back to cited text no. 3    
4.Sharma V K, Kaur 3, Kumar B, et al. Sporotrichosis in North Western India. Ind J Dermatol Venereol and Leprol 1988; 54 : 142 - 7.  Back to cited text no. 4    
5.Sudha K, Pal D, Kowshik T, et al. Sporotrichosis in India: First authentic case report from North Western region and critical literature review. J Med and Vet Mycology 1986; 24: 289-95.  Back to cited text no. 5    
6.Nagabhushanam P. Sporotrichosis. Ind J Dermatol 1967; 33: 276-7.  Back to cited text no. 6    
7.Pankajalakshmi VV, Taralakshmi VV, Subramanian S. Sporotrichosis in Madras. Ind J Dermatol Venereol Leprol 1976; 42: 140-2.  Back to cited text no. 7    
8.Kamalam A, Thambiah AS. Sporotrichosis - first case report from Madras. Mykosen 1982; 25: 576-8.  Back to cited text no. 8  [PUBMED]  
9.Rippon JW. Pathogenic Fungi and pathogenic actinomycetes. In : Medical mycology, 3rd edn. Philadelphia : WB Saunders Company, 1988; 325.  Back to cited text no. 9    


    Figures

[Figure - 1]

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