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Pulmonary sporotrichosis in Oklahoma in susceptibilities in vitro
Abstract:
Six cases of pulmonary sporotichosis were observed in 2 institutions in Oklahoma City, Okla. Three of the patients were treated with iodides with or without surgery. Although one patient required a second course of iodides, the patients have remained well after at least 34 months of follow-up. Three patients treated with amphotericin B, single course as well as multiple courses, and other antifungal agents (hydroxystilbamidine and miconazole) have all relapsed. These cases and a reviewed of more than 40 cases of pulmonary sporotrichosis susceptibilities of Sporothrix schenckii that we observed in vitro suggest that amphotericin B is not an effective agent for the treatment of pulmonary sporotrichosis. It is our opinion that the treatment of choice for pulmonary sporotrichosis is a supersaturated solution of potassium iodide. If the patient is allergic to the medication or fails to respond, then a combination of amphotericin B plus flucytosine may be tried.
Insights
Potassium iodide is the preferred treatment for pulmonary sporotrichosis, showing better outcomes than amphotericin B. Patients treated with iodides remained well, while those on amphotericin B relapsed, indicating its ineffectiveness.
Area of Science:
- Pulmonology
- Mycology
- Infectious Diseases
Background:
- Pulmonary sporotrichosis is a rare fungal infection.
- Treatment options for pulmonary sporotrichosis have varied, with inconsistent outcomes.
Purpose of the Study:
- To evaluate the effectiveness of different antifungal agents for pulmonary sporotrichosis.
- To determine the optimal treatment strategy for this infection.
Main Methods:
- Retrospective analysis of six pulmonary sporotrichosis cases.
- Review of over 40 additional cases from the literature.
- In vitro susceptibility testing of Sporothrix schenckii.
Main Results:
- Three patients treated with iodides showed sustained recovery after at least 34 months.
- Three patients treated with amphotericin B, hydroxystilbamidine, or miconazole experienced relapses.
- In vitro studies suggested limited efficacy of amphotericin B against Sporothrix schenckii.
Conclusions:
- Potassium iodide is recommended as the primary treatment for pulmonary sporotrichosis.
- Amphotericin B appears ineffective for pulmonary sporotrichosis.
- Combination therapy with amphotericin B and flucytosine may be considered for refractory cases.