Definition – A chronic or more rarely an acute, infectious disease caused by local inoculation, and followed by multiple cutaneous and subcutaneous nodules which suppurate and ulcerate.
Symptoms – This condition in man was first described by Schenck in 1898, and about one hundred cases have so far been reported. Accidental inoculation is followed by a fairly uniform period of incubation of from six to twelve days. The site of the primary infection is usually on the hand and forearm, although the neck, face, feet and other regions may be involved. The cutaneous manifestation consists of firm, indolent, superficial or deep nodules which in the course of from three to six weeks soften and ulcerate, giving forth a serous discharge which may come from fistulous communication with deep seated abscesses. These sporotrichotic gummata are usually multiple and commonly develop along the line of the lymphatic vessels, and when once ulceration has been established, the lesions are surrounded by a deep or purplish-red areola. Adenitis often complicates and the deeper structures, such as the bones and muscles, may be affected. Two divisions of these cases have been made clinically; those that run a chronic afebrile course with little general disturbance, and a rare form which is acute with high fever, loss of weight, prostration and digestive disturbances.
Etiology and Pathology – The causal factor is a fungus, the sporotrichium, discovered by Schenck. While this can rarely be found in the lesions, it is readily cultured on almost any of the ordinary media, of which Sabouraud’s peptone-glucose-agar is the best. De Beurmann and others have produced the disease experimentally in the guinea pig, cat, rat, mouse and monkey. Pathologically this disease is a chronic, nodular, suppurative condition which presents a mixture of three types of reaction – (1) the lymphoconnective tissue or syphiloid; (2) an epitheloid or tuberculoid; and (3) a polynuclear or suppurative.
Diagnosis should always be affirmed or disproved by cultural methods, because the different stages of the disease present varying symptoms which make it hard to establish a positive diagnosis. Syphilis, tuberculosis cuts, furunculosis and blastomycosis may need to be considered.
Prognosis and Treatment – Most cases recover under appropriate treatment which may be summed up as potassium iodid in moderate or large doses, plus the local application to open lesions of Lugol’s solution or any other weak iodin preparation. The X-rays have been recommended and surgical interference may be necessary where pus needs to be evacuated. Bier’s suction cups are useful in this procedure.