Pulmonary sporotrichosis: Case series and systematic analysis of literature on clinico-radiological patterns and management outcomes

Pulmonary infections by Sporothrix spp. manifest radiologically as cavitary or non-cavitarydisease depending on whether the infection is primary pulmonary or multifocal sporotrichosis.Despite current guidelines, the optimal management for pulmonary sporotrichosisremains unclear. In order to clarify this, we present two cases of pulmonary sporotrichosis,as well as the results of a comprehensive literature review of treatment outcomes basedon clinico-radiological presentation patterns of the disease. A literature search of all casereports in English language over the last 50 years (1960 – 2010) was conducted. Data onpatient characteristics, risk factors, clinico-radiological patterns, treatment modalities andoutcomes were collected and analyzed. A total of 86 cases were identifi ed, i.e., 64 (74.4%) primary pulmonary and 22 (25.6%) multifocal sporotrichosis. Radiologically, primarypulmonary disease was commonly characterized by cavity formation which was lacking inmultifocal infections ( P 0.0001). Immunosuppressant use was more common in multifocalsporotrichosis ( P 0.0001), while hemoptysis was more common in primary pulmonaryform ( P 0.01). No other differences in patient characteristics or risk factors were noted.Extra-pulmonary multifocal sporotrichosis most commonly involved skin (81.8%) and joints(45.4%). For patients with cavitary primary pulmonary sporotrichosis, outcomes from medicaltherapy alone were inferior to surgical intervention ( P 0.02). However, for both primarypulmonary and multifocal sporotrichosis with non-cavitary disease, medical therapy aloneprovided good outcomes. Only 12 (16.7%) cases were treated with itraconazole. Treatmentof pulmonary sporotrichosis should be guided by the clinico-radiological patterns of presentation.Medical therapy alone is likely suffi cient for non-cavitary disease while early surgeryshould be considered for cavitary primary pulmonary sporotrichosis. The experience in treatingcavitary disease with itraconazole alone is limited and further data are required. K