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    Abstract
    Introduction
    Case Reports
    Mycological inve...
    Animal pathogeni...
    Discussion
    Acknowledgement
    References

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CASE REPORT
Year : 2001  |  Volume : 67  |  Issue : 2  |  Page : 86-88

Sporotrichosis in Manipur: Report of two cases


Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh -160012, India

Correspondence Address:
Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh -160012, India

   Abstract 

Two cases of lymphocutaneous sporotrichosis are reported from Imphal. Sporothrix schenekii was isolated from pus from the lesion and identity was confirmed by mycelial to yeast conversion at 37°C and mice pathogenicity test. One patient gave history of injury with bone of fermented fish (Ngari ). Both the patients were treated successfully with oral administration of potassium iodide. These two cases are the first authentic cases of sporotrichosis from Manipur.

How to cite this article:
Ranjana K H, Chakrabarti A, Kulachandra M, Lokendra K, Devendra H. Sporotrichosis in Manipur: Report of two cases. Indian J Dermatol Venereol Leprol 2001;67:86-8


How to cite this URL:
Ranjana K H, Chakrabarti A, Kulachandra M, Lokendra K, Devendra H. Sporotrichosis in Manipur: Report of two cases. Indian J Dermatol Venereol Leprol [serial online] 2001 [cited 2019 Aug 21];67:86-8. Available from: http://www.ijdvl.com/text.asp?2001/67/2/86/11113



   Introduction Top

Sporotrichosis, caused by the dimorphic fungus Sporothrix schenckii, is a chronic pyogenic granulomatous infection. Clinically it may manifest as lymphocutaneous, fixed cutaneous, mucocuta­neous, extracutaneous and disseminated form or very rarely as primary pulmonary.[1] Trauma to the skin by thorns and splinters, cuts from sedge barbs, handling of soil, sphagnum moss and grasses allow entry of the organism to subcutaneous tissue. Rarely it has also been reported following animal and insect bites.[1] From India cases of sporotrichosis were mainly reported from Himachal Pradesh, Punjab, West Bengal and Assam and a few cases from South India.[2],[3],[4],[5],[6] This paper describes for the first time cases from Manipur, a neighboring state of Assam.

   Case Reports Top

Case 1
A 67-year-old woman attended Dermatol­ogy OPD at J.N. Hospital, Imphal with multiple raised ulcerated lesions of right forearm, not responding to various courses of antibiotics in the last one year. It was a single painless papule to start with, that increased in size with ulceration and discharge of pus. Later it started spreading to other adjacent areas presumably along the lymphatics. She couldn't recollect any history of injury or scratches. Suspecting it to be cutaneous tuberculosis, she was given antituberculous regime for seven months, without any clinical improvement. After ten months of onset, a pathologist conducted histopathological examination and suspecting it to be cutaneous blastomycosis, she was treated with itraconazole. She had been taking the medicine irregularly. After 7 months, pus was collected for microbiological examination. S.schenckii was isolated from pus. She was treated with saturated solution of potassium iodide (5 drops 3 times daily increased by 1 drop/ dose/day till 40 drops 3 times daily for 6 weeks), and she was clinically cured of the disease after about 1 month.
Case 2
A 70-year- old woman, presented with mul­tiple raised ulcerated lesions spreading in an ascend­ing manner from the dorsum of right hand towards the forearm and arm in one month. She gave a history of injury with fishbone of Ngari, name of the fermented fish consumed by the local people. The injury was at the base of the little finger and was followed by pain, induration and ulcertion after about 10 days. She noticed the same type of le­sion on the medial aspect of wrist, then forearm and arm. Inspite of various courses of antibiotics, there was no relief. Pus from the lesions was col­lected for microbiological examination. S. schenckii was isolated from pus. She was treated with saturated solution of potassium iodide (5 drops 3 times daily increased by 1 drop/dose/day till 40 drops 3 times daily for 6 weeks) and the lesion completely healed after 1 month.

   Mycological investigation Top

Pus collected from the lesion was subjected to direct examination of 10% KOH wet mount, Gram and periodic-acid-schiff stained smear. Pus was cultured on two sets of Sabouraud's dextrose agar with chloramphencicol 09.05 mg/ml and cylohexamide-0.5 mg/ml (SDA) and two sets of brain heart infusion agar with chloramphenicol 0.05 mg/ml and cylohexamide 0.5 mg/ml (BHIA). One set each of SDA and BHIA was incubated at 30°C and the other set was incubated at 25°C which showed off-white mycelial colonies after about 5-6 days. Lactophenol cotton blue mount showed thin hyaline delicate mycelia with conidia. On slide typical morphology of saprophytic form of S. schencki was confirmed with conidia arising directly from the mycelium and from small stems giving a flower-like pattern.
To confirm dimorphism, the mycelial form was subcultured on BHI with defbrinated sheep's' blood and incubated at 37° C. Yeast conversion was possible after 5-7 repeated subcultures.

   Animal pathogenicity test Top

About 1 ml saline suspension of each growth was inoculated intraperitoneally into two outbred Swiss albino mice. After about 14-15 days orchitis was observed. Pus from the testes was examined for cigar-shaped bodies and by culture for isolation of S schenckii.

   Discussion Top

Sporotrichosis was once considered a rare disease in India and had been reported only from Assam and Bengal.[2],[3] But with the increase in awareness more endemic foci are recorded from this country.[4],.[6],[7] In Manipur, though adjacent to the state of Assam, clinicians were not aware of this entity. Therefore, though the disease was reported from Assam since 1950s,[2] these two cases were diagnosed for the first time from Manipur. It is likely that sporotrichosis is widely prevalent in this country and population based exploratory study and greater awareness may help us to know exact prevalence of this disease in India.
During evaluation of the geo-climatic conditions in which sporotrichosis is prevalent in In­dia it was found that the disease is common in villages of north India that have lower average temperature (15.5-23.6°C) and higher rainfall (3364mm).[7] In Manipur, the meteorological data shows average temperature of 21°C and rainfall of 1550 mm/year [Table - 1]. It is still not clear which climatic condition helps in growth of S schetckii in the environment. In South Africa, it was found that the fungus grew well at 26-27°C and a relative humidity of 92-100%. However, in Mexico greatest frequency of infection coincided with the dry and cooler parts of the year.[8] Thus it is still not clear which climate condition exactly helps the growth of S. scheckii.
Sporotrichosis is usually initiated by outdoor activities where thorn prick or cut or blunt injury helps in implantation of the organism in subcutaneous tissue. Florists, gardners, forestry workers, miners and laboratory personnel have been typically considered most at risk for developing sporotrichosis.[9].[10] However, infection has also been associated with insect stings, fish handling and the bites of birds, dogs, horses, reptiles and rats, even though clinical symptoms may not be present in those animals.[1],[10],[11] Our second patient gave history of injury by fish bone of fermentation fish (Ngari). Similar case of injury by fishbone of fresh unfrozen fish initiating sporotrichosis was reported from India.[5] People of Manipur have the habit of eating fermented fish (Ngari) and this may be an important source for transmission of the disease in this region. Extensive epidemiological study is being proposed to probe such a hypothesis.
Cutaneous spotrichosis may clinically re­semble cutaneous leishmaniasis, tuberculosis, chromoblastomycosis, blastomycosis and even chronic staphylococcal skin lesions.[1] In our first case, one pathologist thought it to be a case of cutane­ous blastomycosis. The patient received antituberculosis therapy initially suspecting it to be a case of cutaneous tuberculosis. Thus, the overlap in clinical presentation necessitates that accurate diagnosis of cutaneous sporotrichosis be based upon isolating the fungus from clinical specimens.
The therapy of cutaneous sporotrichosis still largely relies on saturated solution of potassium iodide though it is difficult to administer and is frequently associated with side effects. Itraconazole has been used in a few cases with response rate of >90%.[12],[13] Our first patient took itraconazole irregularly for 7 months without any improvement. However, it cannot be called a case of treatment failure. We need to evaluate itraconazole in more number of patients before substituting it for potassium iodide therapy.

   Acknowledgement Top

The authors are grateful to the Medical Superintendent, J.N.Hospital, Imphal for permission to publish the paper. 

   References Top

1.Rippon JW. The Pathogenic Fungi and the Pathogenic Actinomycetes. 3rd edition. Philadelphia: WB Saunders; 1988: 325-352.  Back to cited text no. 1    
2.Dey NC, Saikia T, Majumdar CT. Sporotrichiosis in Assam (India). Indian 3 Dermatol 1958;3: 103-109.  Back to cited text no. 2    
3.Baruah BD, Saikia TC, Bhuyan RN. Sporotrichiosis in Assam. 3 Indian Med Assoc 1970; 67: 223-229.  Back to cited text no. 3    
4.Kin! S, Pal D, Kaushik T, et al. Sporotrichiosis in India: First authentic case report from north region and a critical literature review. J Med Vet Mycol 1986; 24: 289-295.  Back to cited text no. 4    
5.Jacob T, Nair PR, Usha P, et al. Sporotrichosis. J Indian Med Assoc. 1993; 91: 210-211.  Back to cited text no. 5    
6.Chakrabarti A, Roy SK, Dhar S, et al. Sporotrichosis in northwest India. Indian J Med Res 1994; 100: 62-65.  Back to cited text no. 6    
7.Ghosh A, Chakrabarti A, Sharma VK, et al. Sporotrichosis in Himachal Pradesh (North India). Trans Roy Soc Trop Med Hyg 1999 ; 93 : 41-45.  Back to cited text no. 7    
8.Gonzalez-Ochoa A. Contribucions recients al conociemiento de la esprotrichosis. Grac Med Mexico 1965; 95: 463-474.  Back to cited text no. 8    
9.Thomson DW, Kaplan W. Laboratory acquired sporotrichosis. Sabouraudia 1997; 15: 167-170.  Back to cited text no. 9    
10.Werner AH, Werner BE. Sporotrichosis in man and animal. Int J Dermatol 1994; 33: 692-700.  Back to cited text no. 10  [PUBMED]  
11.Nusbaum BP, Gulbas N, Horwitz SN. Sporotrichosis acquired from a cat. J Am Acad Dermatol 1983; 8: 386-391.  Back to cited text no. 11    
12.Ebihara T, Sugiura M, Masuda M, et al. Successful treatment of sporotrichosis with itraconazole. J Derm Treat 1991; 2: 31-33.   Back to cited text no. 12    
13.Kaufman CA. Old and new therapies for sporotrichosis. Clin Infect Dis 1995; 21: 981-985.  Back to cited text no. 13    

 

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