Sporotrichosis, Plain of Jars, Lao People's Democratic Republic.
S. schenckii is a dimorphic fungus found in soil, hay, decaying vegetation, and moss. Persons exposed to these environmental foci, such as farmers and gardeners, are especially at risk. Percutaneous inoculation is presumably the main method of infection, although inhalation and insect and mammal bites and scratches, especially from armadillos and cats, have been implicated (3,4). Our patient presumably contracted the fungus from the wood frame of the milling machine. In the 1940s, contamination from untreated wood was responsible for an epidemic that affected [approximately equal to]3,000 gold miners in South Africa (from timbers in the mine). Lymphocutaneous sporotrichosis is the most frequent presentation, and the traditional treatments are oral saturated potassium iodide solution and local hyperthermia, but oral itraconazole for 3 to 6 months is now recommended (3,4).
Sporotrichosis has been described from North and South America, Europe, and Japan. In Asia and Australasia, it has been described from India (5), Taiwan (1), Australia (6), and Thailand (7), but apparently not from Laos, Cambodia, and Burma (Myanmar). Serologic evidence for human sporotrichosis infection is found in highland areas of southwest Vietnam (8). At least in part, the relative paucity of reports probably refects the lack of sophisticated fungal diagnostic techniques in much of Southeast Asia. Some evidence suggests that sporotrichosis is more prevalent in tropical environments with relatively cool temperatures and high humidity such the Peruvian Andes (9), northwest India (5), southwestern Vietnam (8), and in Laos in the Plain of Jars. If this environmental association is correct, sporotrichosis may occur more extensively in the cooler humid areas of Asia, such as the highlands of China, Laos, Vietnam, and Burma. Sporotrichosis can disseminate in HIV-infected patients, and this syndrome may increase as the prevalence of HIV infection rises in these areas.
With 73% of the Lao population living on <US$2/day (10) and one accessible microbiologic culture laboratory in Laos, PCR is not an available local routine diagnostic technique. We were fortunate to have access to an overseas diagnostic facility, which allowed confirmation of the clinical diagnosis before the patient received a prolonged course of a drug with adverse effects and drug interactions.
Diagnosis by histopathologic examination and culture may be difficult, and identifying laboratories in different regions of the subtropics and tropics with an interest in diagnosis of sporotrichoid lesions and the capability to perform culture and PCR would facilitate the diagnosis and awareness of this disease. Itraconazole, which has become the drug of choice for lymphocutaneous sporotrichosis, is expensive. Saturated solution of potassium iodide is an inexpensive alternative and appears to be effective, although adverse effects occur frequently (3,4).
We thank the patient and Chanpheng Thammavong, Tran Xuan Mai, Mayfong Mayxay, and Tran Duc Si for their help.
This study was part of the Wellcome Trust-Mahosot Hospital--Oxford Tropical Medicine Research Collaboration, funded by the Wellcome Trust of Great Britain.
Paul N. Newton, *([dagger]) Wen-Hung Chung, ([DAGGER]) Rattanaphone Phetsouvanh, * and Nicholas J. White * ([dagger]) ([section])
* Mahosot Hospital, Vientiane, Lao People's Democratic Republic; ([dagger]) Churchill Hospital, Oxford, United Kingdom; ([DAGGER]) Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China; and ([section]) Mahidol University, Bangkok, Thailand
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(2.) Telenti A, Marchesi F, Balz M, Bally F, Bottger EC, Bodmer T. Rapid identification of mycobacteria to the species level by polymerase chain reaction and restriction enzyme analysis. J Clin Microbiol. 1993;31:175-8.
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(4.) Kauffman CA, Hajjeh R, Chapman SW. Practice guidelines for the management of patients with sporotrichosis. Clin Infect Dis. 2000;30:684-7.
(5.) Ghosh A, Chakrabarti A, Sharma VK, Singh K, Singh A. Sporotrichosis in Himachal Pradesh (north India). Trans R Soc Trop Med Hyg. 1999;93:41-5.
(6.) Pinn TG. Sporotrichosis in a Queensland bushwalker. Med J Aust. 1998; 169:287.
(7.) Kwangsukstith C, Vanittanakom N, Khanjanasthiti P, Uthammachai C. Cutaneous sporotrichosis in Thailand: first reported case. Mycoses. 1990;33:513-7.
(8.) Tran Xuan M, Tran Thi H, Tran Thi KD. Diagnosis of sporothrix by direct slide agglutination method and immunoperoxidase ELISA. Journal of the University of Medicine and Pharmacology of Ho Chi Minh City, Vietnam. 1994;(Suppl 2): 280-8. [Vietnamese]
(9.) Pappas PG, Tellez I, Deep AE, Nolasco D, Holdago W, Bustamante B. Sporotrichosis in Peru--description of an area of hyperendemicity. Clin Infect Dis. 2000;30:65-70.
(10.) United Nations Development Programme. Human development indicators, 2004. [Available from http://hdr.undp.org/reports/ global/2004/(cited 17 Jul 2005)].
Address for correspondence: Nicholas J. White, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd, Bangkok 10400, Thailand; fax: 66-2-354-9169; email: nickw@ tropmedres.ac
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|Author:||White, Nicholas J.|
|Publication:||Emerging Infectious Diseases|
|Article Type:||Letter to the Editor|
|Date:||Sep 1, 2005|
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