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Volume 25, Number 10—October 2019
Research

Sporotrichosis in the Highlands of Madagascar, 2013–20171

Tahinamandranto Rasamoelina, Danièle Maubon, Onivola Raharolahy, Harinjara Razanakoto, Njary Rakotozandrindrainy, Fetra Angelot Rakotomalala, Sébastien Bailly, Fandresena Sendrasoa, Irina Ranaivo, Malalaniaina Andrianarison, Benja Rakotonirina, Abel Andriantsimahavandy, Fahafahantsoa Rapelanoro Rabenja, Mala Rakoto Andrianarivelo, Lala Soavina Ramarozatovo, and Muriel CornetComments to Author 
Author affiliations: Centre d’Infectiologie Charles Mérieux, Université d’Antananarivo, Antananarivo, Madagascar (T. Rasamoelina, F.A. Rakotomalala, M.R. Andrianarivelo); University Grenoble Alpes, Grenoble, France (D. Maubon, S. Bailly, M. Cornet); Unité de Soins de Formation et de Recherche, Centre Hospitalier Universitaire Joseph Raseta Befelatanana, Antananarivo (O. Raharolahy, H. Razanakoto, F. Sendrasoa, I. Ranaivo, M. Andrianarison, F.R. Rabenja, L.S. Ramarozatovo); Unité Para-clinique de Formation et de Recherche, Centre Hospitalier Universitaire Joseph Ravoahangy, Antananarivo (N. Rakotozandrindrainya); Université d’Antananarivo, Antananarivo (B. Rakotonirina, A. Andriantsimahavandy); Pavillon Spécial A Centre Hospitalier Universitaire de Befelatanana, Antananarivo (L.S. Ramarozatovo)

Main Article

Table 1

Criteria used to classify cases of sporotrichosis in the Highlands of Madagascar, 2013–2017*

Criteria Description
Clinical
Major Cutaneous: lymphocutaneous form defined as a papule or pustule or a subcutaneous nodule at the inoculation site, then ulceration with erythematous edges and purulent secretion. Secondary lesions arise along the path of regional lymphatic vessels. Fixed or cutaneously disseminated.
Extracutaneous: disseminated, osteoarticular, ocular.
Minor Mucosal: nasal septum, with bloody secretions and detachment of crusts. Conjunctivitis, with granulomatous lesions accompanied by a serous-purulent discharge, redness, lid edema, and preauricular and submandibular lymph node enlargement.
Primary pulmonary sporotrichosis: similar to that of tuberculosis. Radiologic patterns include cavitary disease, tracheobronchial lymph node enlargement, and nodular lesions. Vegetative, verrucous, infiltrated plaque, or tuberous lesion.
Mycologic and histologic
Major Molecular evidence of Sporothrix schenckii on PCR with specific primers (targeting topoisomerase II) or ITS sequencing, directly from clinical samples or from a positive culture of a fungus morphologically suggestive of Sporothrix spp.
MALDI-TOF mass spectrometry identification of S. schenckii from a positive culture of a fungus morphologically suggestive of Sporothrix spp.
Minor Budding yeast cells with the characteristic cigar-shaped buds observed on direct microscopic examination or histologic analysis.
Direct examination of pus and/or histologic analysis showing asteroid bodies (Splendore-Hoeppli reaction).
Positive culture of a fungus morphologically suggestive of Sporothrix spp. from a clinical sample without molecular or MALDI-TOF mass spectrometry confirmation.
Classification
Confirmed >1 of the major clinical criteria and >1 of the major mycologic criteria or 1 minor clinical criterion and >1 of the major mycologic criteria.
Probable >1 of the major clinical criteria and 1 minor mycologic or histologic criterion and a complete or partial response to antifungal therapy.
Possible >1 of the major clinical criteria without any (major or minor) mycologic or histologic criteria or >1 of the minor clinical criteria without any (major or minor) mycologic or histologic criteria and a complete or partial response to antifungal therapy.
Clinical response to antifungal therapy
Cure Complete resolution of all lesions.
Major response Substantial improvement of most lesions with a substantial decrease in subcutaneous nodules.
Minor response Mild improvement of most lesions with a smaller decrease in subcutaneous nodules than for a major response.
Failure Stabilization of the lesions after >3 months of antifungal therapy or worsening of the lesions after >3 months of antifungal therapy.

*ITS, internal transcribed spacer; MALDI-TOF, matrix-assisted laser desorption/ionization time-of-flight.

Main Article

1Preliminary results from this study were presented at the 20th ISHAM Conference; June 29–July 5, 2018; Amsterdam, the Netherlands (abstract no. S1.4d).

Page created: September 17, 2019
Page updated: September 17, 2019
Page reviewed: September 17, 2019
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