Prognosis
The outcome of sporotrichosis is dictated by the clinical form and extent of the infection as well as by the underlying host; specifically, infections confined to the skin and subcutaneous tissue have better prognosis than extracutaneous infections. In immunosuppressed patients with advanced HIV infection or hematologic malignancies/transplantation, sporotrichosis may be life threatening and carries a worse prognosis than infections in immunocompetent individuals.[13]
Lymphocutaneous/cutaneous sporotrichosis
Lymphocutaneous/cutaneous sporotrichosis is not life threatening.[1][2] Prognosis is excellent with response rates of 90% to 100% to itraconazole treatment. Clinical response to treatment is typically seen within 4 weeks of therapy initiation. A small proportion of patients may recur after discontinuation of antifungal therapy, but, when treated with higher doses of itraconazole or other alternative antifungal regimens such as saturated solution of potassium iodide, they typically respond well to treatment.
Osteoarticular sporotrichosis
Isolated osteoarticular sporotrichosis is not life threatening.[1][4][5] However, due to delays in diagnosis and in initiation of appropriate treatment, preservation of articular function is uncommon. Treatment for less than 6 months has been associated with high relapse rates; hence treatment duration should be at least 12 months.
Pulmonary sporotrichosis
Isolated pulmonary sporotrichosis has a chronic progressive clinical course if left untreated.[1][6] Outcome is usually poor.[36] Best outcomes are seen with combination of antifungal therapy and surgical resection, although the latter is not usually feasible as most affected patients have underlying poor pulmonary functional status.
Meningeal sporotrichosis
Meningeal sporotrichosis has an indolent clinical course leading to delayed diagnosis and initiation of treatment.[1][7] Thus, prognosis is very poor with high mortality, especially in patients with advanced HIV infection. Overall mortality of HIV-infected patients with sporotrichosis is 30%, but there is a strong correlation between meningeal infection and death (90% mortality in those with infection of the central nervous system).[28] Lifelong suppressive itraconazole treatment is recommended because of the high relapse rate in patients with HIV and other immunocompromised conditions if antifungal treatment is discontinued.
Disseminated sporotrichosis
Prognosis is poor in immunosuppressed patients with advanced HIV infection or hematologic malignancies/transplantation. Chronic suppressive itraconazole treatment is needed to prevent relapse in patients with HIV.
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