Sporotrichosis (Rose Gardener's Disease)

How sporotrichosis is caught

Sporotrichosis is one of the deeper fungal skin infections.

Sporothrix fungi live in the environment worldwide. Infection usually happens when the fungus is pushed into the skin by a thorn, splinter, wire or scratch. People at higher risk include:

• gardeners, especially those handling roses, sphagnum moss, hay or mulch
• farmers, landscapers, nursery workers and forestry workers
• people who handle cats, especially in Brazil, Argentina and nearby countries, where Sporothrix brasiliensis spreads through cat scratches and bites and has caused large outbreaks
• veterinarians and animal workers

Inhaling spores rarely causes lung infection. Sporotrichosis generally does not spread from person to person.

Types and symptoms

Lymphocutaneous sporotrichosis (most common)

1. 1 to 12 weeks after injury, a small, firm, painless pink, red or purple bump appears at the site.
2. The bump enlarges and may break down into an open sore that drains fluid.
3. New bumps appear along the lymph channels running up the arm or leg, in a line (sometimes called sporotrichoid spread), a pattern similar to lymphangitis.
4. Fever and feeling unwell are uncommon.

Fixed cutaneous sporotrichosis

A single plaque or ulcer that stays at the site, often on the face or limbs, more common in people with prior exposure.

Disseminated and other forms

Rare, mainly in people with weakened immune systems such as advanced HIV, diabetes, alcohol use disorder or immune-suppressing medicines:

• joints and bones (osteoarticular): painful, swollen joints
• lungs (pulmonary): cough, breathlessness and fever, often in people with lung disease
• brain (meningitis)
• eyes: conjunctivitis, particularly with cat-transmitted infection
• widespread skin lesions

Diagnosis

• fungal culture of pus, fluid or a tissue sample: the gold standard. Growth takes days to weeks
• skin biopsy with special stains
• PCR tests in some laboratories
• blood tests are not routinely used

Other infections that cause similar chains of bumps include atypical mycobacteria (such as Mycobacterium marinum from fish tanks), nocardia, cutaneous leishmaniasis and tularemia. Bacterial skin infections such as cellulitis usually spread faster and are painful and hot.

Treatment

• Itraconazole by mouth is the treatment of choice for skin and lymph forms, usually for 3 to 6 months and continuing 2 to 4 weeks after all lesions have healed, according to IDSA guidelines. It interacts with many medicines and needs food or acid for absorption, so a pharmacist review is important.
• Terbinafine or a saturated solution of potassium iodide are alternatives in some settings.
• Amphotericin B intravenously for severe, lung, bone, brain or disseminated infection, followed by itraconazole.
• Local heat therapy has been used in pregnancy, when itraconazole is avoided.
• Treating infected cats under veterinary care is important in areas with cat-transmitted disease.

Healing is slow, and scars may remain.

Prevention

• wear thick gloves and long sleeves when handling roses, moss, hay, mulch and soil
• clean and cover cuts promptly
• in areas with cat-transmitted sporotrichosis, wear gloves when handling sick cats, take cats with non-healing sores to a vet, and avoid scratches and bites

Frequently asked questions

What is sporotrichosis?

Sporotrichosis is a fungal infection caused by Sporothrix species found in soil and plants. It usually enters through a small cut, causing a skin bump that becomes a sore, often followed by more bumps along the lymph channels of the arm or leg.

Why is it called rose gardener's disease?

It is called rose gardener's disease because many infections occur after being pricked by rose thorns, which can carry the fungus. Handling sphagnum moss, hay, mulch and soil can also cause infection.

Can you get sporotrichosis from cats?

Yes. In parts of South America, especially Brazil, a species called Sporothrix brasiliensis spreads from infected cats to people through scratches, bites or contact with wounds. Cats with non-healing skin sores should see a vet.

How is sporotrichosis treated?

Most skin infections are treated with itraconazole tablets for 3 to 6 months, continuing until several weeks after the lesions heal. Severe or widespread infections need intravenous amphotericin B in hospital, followed by itraconazole.

Is sporotrichosis contagious?

It does not usually spread between people. It is caught from the environment through cuts and scratches, or from infected animals, mainly cats. Covering wounds and wearing gloves when gardening reduce the risk.