Feline sporotrichosis: A report of five cases with transmission to humans

Volume 15 Number 1 luly, I986

3. 4. 5. 6.

Topical minoxidil in male baldness

Pharmacodynamics measured by laser doppler velocimerry and photopulse plethysmography. J Invest Dermatol 82:515-517, 1984. Olsen EA, Weiner MS, Delong ER, Pinnell SR: Topical minoxidil in early male pattern baldness. J AM ACAD DERMATOL13:185-192, 1985. Vanderveen EE, Ellis CN, Kang S, et al: Topical minoxidil for hair regrowth. J AM ACADDERMATOL11:41642I, 1984. Devillez RL: Topical minoxidil therapy in hereditary androgenic alopecia. Arch Dermatol 121:197-202, 1985. Norwood OT: Male pattern baldness: Classification and incidence. South Med J 68:1359-1365, 1975.

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7. Tatsuka MM: Multivariate analyses: Techniques for educational and psychological research. New York, 1971, John Wiley & Sons, Inc. 8. Groveman HD, Ganiats T, Klauber MR: Lack of efficacy of polysorbate 60 in the treatment of male pattern baldness. Arch Intern Med 145:1454-1458, 1985. 9. Maibach HI: Hair growth measurement in man, in Brown AC, editor: The First Human Hair Symposium. New York, 1974, Medcom Press. 10. Huston TP, Puffer JC, Rodney WM: The athletic heart syndrome. N Engl J Med 313:24-32, 1985.

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Feline sporotrichosis: A report of five cases with transmission to humans Robert W. Dunstan, D . V , M . , M . S . , * Robert F. Langham, D.V.M., P h . D . , * Keith A. R e i m a n n , D . V . M . , * * and Patricia S. Wakenell, D.V.M., P h . D . *

East Lansing, MI Sporotrichosis was diagnosed in five cats. Seven humans exposed to these cats subsequently developed the disease. All feline cases developed draining ulcers, and in four of five cases there was disseminated cutaneous involvement. Histologically, numerous Sporothrix organisms were noted in cutaneous lesions and overlying exudate. The seven humans who became infected were involved in cleaning and medicating cats with the disease; all human patients developed a localized lymphocutaneous form of sporotrichosis. In four of the human cases there was no history of an associated penetrating wound. The large number of Sporothrix organisms is a distinct feature of feline sporotricosis and indicates that the cat may be the only domestic animal species that can readily transmit this disease to humans. In addition, any contact with the draining lesions of affected cats offers the potential for human infection. (J AM ACAD DERMATOL 15:37-45, 1986.)

Sporotrichosis, a chronic fungal disease of ani m a l s and humans, is caused by the dimorphic From the Animal Health Diagnostic Laboratory, the Departmentof Pathology* and the Department of Small Animal Clinical Sciences,** College of Veterinary Medicine, Michigan State University. Accepted for publicationFeb. 19, 1986. Reprint requests to: Dr. Robert W, Dunstan, Department of Pathology, Fee Hall, MichiganState University,EastLansing, M1482241314.

h y p h o m y c e t e Sporothrix schenckii. *'~ This ubiquitous organism is generally considered to be a saprophyte and grows naturally in soil or on vegetation. *'1'2 In humans, sporotrichosis has long been considered a disease limited to individuals who have direct contact with plants or soil, and infection can occur either by dermal inoculation *Lavalle P, MariatF: Sporotriehosis. Bull Inst Pasteur 81:295-322, 1983. 37

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Journal of the American Academy of Dermatology

D u n s t a n et al

T a b l e I. Cases o f feline sporotrichosis associated with transmission to humans

CosolA e .r ,so I Pr,m r.,o ,o.s ,S,,oofsoco° .,os,o s I .J ,op ,ho, C-1

12/M

Abscess commissure of lip

Distal limbs, cheek

Pyogranulomatous; primarily intracellular organisms

C-2

1/M

Punctate lesions posterior metatarsal region

Expansion of primary lesion

As above

C-3

1/M

Distal limbs, tail base, perianal region

As above

C-4

5/spayed F

Draining nodules over left posterior metatarsal region (at site of prior laceration) Punctate lesions at base of tail

Distal limbs, head, tail, tail base, nasal cavity, gingiva, thoracic region

Pyogranulomatous and necrotizing; primarily extracellular organisms

C-5

ltA/M

Draining nodule posterior metatarsal region

Distal limbs, head, scrotum

Pyogranulomatous and necrotizing; primarily extracellular organisms

I

.e .o°so Lesions resolved completely after 3 mo of ketoconazole-20% KI therapy Lesion resolved completely after 5 mo 20% KI therapy No response after 1 mo 20% KI therapy; euthanatized No response after 1 m o SSKI-amphotericin B therapy; euthanatized Died 8 wk after initial lesions developed

KI: Potassium iodide; SSKI: saturated solution of potassium iodide. o f the English-language literature for the past 20 years revealed only individual case reports. *,8-~° The purpose o f this report is to describe four episodes in which humans e x p o s e d to cats with sporotrichosis subsequently b e c a m e infected.

or, less frequently, by inhalation of the organisms. z'3 T h e first report o f zoonotic transmission f r o m cats o c c u r r e d in 1982, when Read and Sperling 4 described an o u t b r e a k in five humans w h o were e x p o s e d to a cat affected with sporotrichosis. In 1982 and 1985, two other episodes o f cat-to-human transmission were d e s c r i b e d ? '6 T h e s e reports suggested that sporotrichosis may h a v e definite zoonotic potential. T h e i m p o r t a n c e of the cat as a vector in the transmission o f this disease is u n k n o w n because o f the small n u m b e r o f cat-to-human transmissions identified and the lack o f k n o w I e d g e about the clinical and pathologic features o f sporotrichosis in cats. 4'5"7 T h e largest collection of naturally occurring feline cases is in a 1965 study from Brazil in which eight cases were identified.* A review

Feline ease 1. A 12-year-old male American longhair cat (case C-l, Table I) that was frequently allowed outdoors developed a draining subcutaneous abscess at the commissure of the left lip. Over a 1-month period the initial lesion enlarged and became nodular. Additional draining nodules developed over the left cheek, the anterior carpal regions of both forelimbs, and the nail beds of the right front and right rear paws. Affected areas ulcerated and became encrusted. Fungal cultures and a biopsy of an affected site established the diagnosis

*Freitas DC, Moreno G, Saliba AM, et al: Esporotricoseem caes e gatos (sporotrichosisin dogs and cats). Rev Fac MealVet S Paulo 7:381-387, 1965.

*Anderson NV, Ivoghli D, Moore WE, Leipold HW: Cutaneous sporotrichosis in a cat: A case report. J Am Animal Hosp Assoc 9:526-529, 1973.

CASE REPORTS Episode 1

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Fig. 2. Human sporotrichosis, with a large, ulcerated lesion on the dorsal aspect of the distal portion of the left forearm (case H-6, Table II). (Courtesy Dr. S. Shirley, Lansing, MI.)

Fig. 1. Feline sporotrichosis, with multiple cavitated ulcers on the head (case C-4, Table I). of sporotrichosis. The lesions resolved completely after 3 months of ketoconazole therapy followed by 2 months of oral potassium iodide (20% solution) therapy. There has been no recurrence after 1 year. Human ease 1. A 28-year-old female veterinary technician (case H-l, Table II) developed a papular eruption on the second phalanx of the right middle finger of her right hand. The lesion was noticed several days after she had cleaned the lesions of a cat (case C1). The technician had no recollection of having injured the digit before or during the period that the cat was being treated. Over the next 2 weeks the primary lesion enlarged and ulcerated. Small nodules were observed to extend up the arm, and there was lymphadenopathy of the right epitrochlear and right axillary lymph nodes. On initial examination, the technician received antibiotics on the basis of a tentative diagnosis of foreign body cellulitis. The lesions persisted and were surgically debrided. Fungal cultures and biopsies at that time confirmed sporotrichosis. The patient received a saturated solution of potassium iodide, which resulted in progressive resolution of signs. When she was 2 months into therapy and was being maintained on a regimen of 120 drops of potassium iodide (SSKI) daily, she had a relapse, with additional tender nodules on her arm and the formation of abscesses in the primary lesions. The dosage of SSKI was progressively increased to 180 drops daily, and the lesions again resolved. She received SSKI therapy for a total of 10 months. At the

present time she has been free of clinical disease for over 1 year. Episode 2 Feline cases 2 and 3. A l-year-old male American shorthair cat (case C-2, Table I) was lost for approximately 10 days and returned with several small, draining puncture wounds over the posterior surface of the right metatarsal region. These lesions became nodular, coalesced, and developed into a large, cavitated ulcer involving the distal posterior surface of the right rear limb. Approximately 11/2 months after the lesions were observed in C-2, a second 1-year-old male cat (case C3, Table i), from the same household, lacerated its left posterior metatarsal region on broken glass. Two weeks later, this cat developed draining ulcerated nodules at the laceration site. These lesions progressed more rapidly than in C-2, and within 1 month similar ulcerated nodules and plaques were observed on the digits of the left limb, on the perianal region, and on the tail base. Four months after the lesions initially developed on C2, fungal cultures and biopsies from both animals were obtained and the diagnosis of sporotrichosis was established. Both animals were given a 20% solution of potassium iodide administered orally. The lesions in C2 resolved after 5 months of therapy. There has been no recurrence for 4 years. C-3 did not respond to oral potassium iodide. The lesions continued to expand, and the animal lost weight and became lethargic. Five months after the initiation of therapy, the animal was euthanized and necropsied. Human ease 2. One month after C-2 developed lesions but before C-3 became affected, the 10-year-old

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D u n s t a n et al

T a b l e II. H u m a n cases o f sporotrichosis associated with affected cats Case

] Age (yr)/sex

,

Association with cat

Degree of exposure

Site of primary lesion

H-1

28/F

Veterinary technician

Treated C-1

Second phalanx of left middle finger

H-2

10/F

Daughter of owner

Treated C-2

H-3 H-4

32/F 29/F

Owner Veterinarian

Treated C-2 and C-3 Bitten by C-4

Dorsal surface of right hand Left calf region Nail bed of right index finger

H-5

25/M

Veterinary student

Bitten by C-4

H-6

23/F

Wore gloves while treating C-4

H-7

41/M

Veterinary technician student Veterinarian

Treated C-5; lesion developed at prior laceration site

Third phalanx of left thumb Dorsal aspect of left wrist Nail bed of right middle finger

+: Positive; - : negative; LN: lymph node; SSKI: saturated solution potassium iodide. daughter (case H-2, Table II) of the cat's owner developed an erythematous papule on the dorsal aspect of her fight hand. She had assisted in medicating and cleaning the lesions of C-2. She denied trauma or penetrating wounds before developing the pustule and wore gloves while handling the cat. Over the next 3 weeks the lesions progressed into an extremely tender, ulcerated plaque with associated lymphadenopathy of the right epitrochlear and right axillary lymph nodes. After medical examination she received oral and intravenous antibiotics with no clinical improvement. S. schenckii was isolated on fungal cultures, and oral potassium iodide (SSKI) was prescribed. The patient avoided contact with both cats after therapy was initiated. The lesions resolved after 3 months of therapy and have not recurred after 4 years. H u m a n case 3. The owner of the cats (case H-3, Table II), a 32-year-old woman, developed a tender, erythematous pustule over the calf region of her left leg. The pustule developed 5 months after C-2 was initially affected and during a period in which both the cats and the owner's daughter were undergoing potassium iodide therapy. The woman was involved in treating C-2 and C-3 but had no recollection of external trauma to the affected site prior to developing the lesion. She reported that 1 month previously the cat had scratched her neck, but the wounds had healed without incident. Over the next 3 weeks the lesion expanded and became raised and ulcerated. Accompanying ten-

demess and swelling of the popliteal lymph nodes were present. Fungal cultures confirmed sporotrichosis. The patient received SSKI therapy for 6 months, resulting in resolution of signs. Three-and-a-half years later there has been no recurrence. Episode 3

Feline ease 4. A 5-year-old spayed female American shorthair cat (case C-4, Table I) that was frequently allowed outdoors had a 5-month history of disseminated ulcerated plaques and nodules that drained a seropurulent fluid. These lesions were present over the base of the tail, all four limbs, the dorsolateral portion of the thorax, the head, and the ears (Fig. 1). There was also gingival ulceration, and nodular masses extended into the nasal cavity. The lesions originated from several small punctate wounds at the base of the tail. Fungal cultures, as well as cytologic and histopathologic studies, established the diagnosis of sporotrichosis. Oral SSKI therapy was instituted for 3 weeks. Although some initial improvement was noted, the skin lesions expanded. SSKI therapy was discontinued, and the cat was given amphotericin B for 1 week. The cat's condition continued to deteriorate, and she was euthanatized and necropsied. Human case 4. A 29-year-old gravid female veterinarian (case H-4, Table II) was bitten on the third phalanx of the right index finger by a cat (C-4). Four weeks after the initial injury, a tender, draining pustular

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Feline sporotrichosis

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schenckii was identified by fungal culture. SSKI was Method(s) of diagnosis [ Culture- + Biopsy- +

Culture-

+

Culture- + LN culture - + LN biopsy - -

Culture-

+

Culture- + Biopsy- + Culture- + Biopsy - -

Response to SSKI Resolved after 2 mo, then relapsed; complete resolution after additional 8 mo therapy Resolved after 3 mo Resolved after 5 mo Resolved after 6 wk, then relapsed; complete resolution after addditional 3 mo of therapy Resolved after 3 mo Resolved after 3 mo Resolved after 3 mo

lesion developed on the nail bed of the right index finger and tender lymphadenopathy was noted. Cultures grew Pasteurella sp. and Streptococcus sp. Fungal growth was not observed. Biopsy of a lymph node was consistent with septic inflammation, but sporotrichosis could not be confirmed. Because the patient was in the twenty-sixth week of pregnancy, treatment was withheld until after delivery. Following a normal delivery, SSKI was administered orally for 6 weeks, resulting in part!al remission of the primary lesion and the lymphadenopathy. Six weeks after the cessation of therapy, a relaPse occurred, with the formation of abscesses in the .primary lesions and the lymph nodes. Sporothrix schenckii was isolated from an abscessed lymph node. Potassium iodide therapy was reinstituted for another 3 months, resulting in complete reso!ution of signs. The patient has been healthy and without recurrence for 20 months. Human case 5. A 25-year-old male veterinary student (case H-5, Table I1) incurred a single puncture bite wound on the medical aspect of the third phalanx of the left thumb while treating C-4. The wound was scrubbed with povidol!e-iodine, and antibiotics were prescribed for 5 days. A nontender papular lesion remained at the site of the wound. Three weeks later the patient was bitten on the same digit by a dog. Five weeks after the second bite wound, the patient was hospitalized with a nonhealing lesion at the site of the cat bite, lymphadenopathy of the left axillary lymph nodes, and nontender nodules extending UP the arm. S.

administered orally for 3 months, and the lesion resolved. The patient is healthy without recurrence 2 years later. H u m a n case 6. A 23-year-old female veterinary technician student (case H-6, Table II) routinely cared for C-4 for 1 week. No penetrating wounds were known to have occurred during this period, and examination gloves were worn whenever the cat was handled. Three weeks after the first exposure to the cat, a pustule developed on the dorsal aspect of the technician's left wrist. The lesion increased in size over the next 2 weeks and was lanced by a physician. Six weeks after the initial exposure to the cat, the patient was hospitalized with a single 5-cm nonhealing ulcerated lesion of the left wrist (Fig. 2). Regional lymphadenopathy was present. Fungal culture and a biopsy established the diagnosis of sporotrichosi s. In addition, serologic examination revealed a Sporothrix titer of 1 : 16. The lesion resolved after oral administration of SSKI for 3 months. The patient is healthy and without recurrence 2 years later.

Episode 4 Feline case 5. A 1½-year-old male American shorthair cat (case C-5, Table I) that was frequently allowed outdoors had draining ulcerated nodules involving the dorsal aspect of the distal right rear limb of 3 weeks' duration. The lesion was cleaned, the animal was castrated, and antibiotics were prescribed. Over the next 3 weeks the primary lesions expanded, with the development of crusts and cavitating ulcers at the castration site and on the distal extremities of the three other limbs, the fac e , and the ears. The cat became anorexic and depressed; it died approximately 5 weeks after initial examination. A necropsy was performed, and S. schenckii was observed on histologic evaluation of the skin and multiple internal organs and was identified on fungal culture. H u m a n case 7. A 41-year-old male veterinarian (case H-7, Table II) examined and castrated a cat (C5). There was no history that the veterinarian had been bitten or scratched by the animal during handling; however, he recalled having been scratched at the nail bed of the right middle finger prior to examining C-5. Approximately 3 weeks following initlal exposure to C5, the patient developed an erythematous papule at the site of the prior laceration. The lesion ulcerated and was associated with lymphadenopathy of the right epitrochlear and right axillar7 lymph nodes. On medical examination the affected skin was cultured and a biopsy was done. Fungal cultures establish.ed the diagnosis of

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Dunstan et al

Journal of the American Academy of Dermatology

Fig. 3. Photomicrograph of a cavitated ulcer from C-1. There are numerous Sporothrix organisms present within macrophages in the superficial dermis (arrowheads). (Hematoxylin-eosin stain; x 125.)

Fig. 4. Photomicrograph subjacent to an ulcer in C-5. The microscopic field is filled with extracel|ular Sporothrix organisms. (Hematoxylin-eosin stain; × 250.) sporotrichosis. No organisms were noted on histologic evaluation of the biopsy. The patient received SSKI orally for 3 months, and the lesions resolved. There has been no recurrence after 1 year. HISTOLOGI C EXAMINATION Feline cases Histologic examination was performed on all affected cats. In all cats there was a pyogranulomatous inflammatory reaction involving the dermis, the panniculus, and the subjacent skeletal muscles. This reaction was associated with superficial to cavitating ul-

ceration overlaid by a purulent exudate. Numerous fungal organisms were observed within the overlying exudate and in all inflamed areas. These organisms were characterized as spherical to oval and, at times, cigarshaped yeasts (4 to 12 ix in diameter) that produced single and (rarely) multiple buds. Asteroid bodies were not observed. Organisms were so numerous that they were easily detected on hematoxylin-and-eosin-stained sections. They were stained with periodic acid-Schiff, Gomori's methenamine silver, and Gram's stains. In three cats (C-1, C-2, and C-3) the pyogranulomatous inflammatory response was intense and the organisms

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Feline sporotrichosis

43

Fig. 5. Photomicrograph of an impression smear from an ulcerated lesion on C-4. Both round and ovoid Sporothrix organisms are seen within the cytoplasm of a macrophage and extracellularly. (Wright's stain; x 1250.) were intra- and extracellular (Fig. 3). In C-4 and C-5 there were large zones of necrosis containing dense aggregates of extracellular Sporothrix organisms, with a less extensive inflammatory response (Fig. 4). In all three necropsied cats (C-3, C-4, C-5) there was evidence of systemic involvement. In C-3 and C4, organisms were observed in the lower part of the respiratory tract, the spleen, the hepatic sinusoids, the interstitium of the kidney, the subcapsular and medullary sinuses of lymph nodes, and the afferent nodal lymphatic vessels. In each of these organs, extra- and intracellular fungi were scarce and widely scattered. Extracellular organisms were generally associated with little tissue reaction; intracellular organisms were present within macrophages that aggregated to form microgranulomas. In C-5, organisms were also observed in multiple organs; however, the organisms were more numerous, and a pyogranulomatous inflammatory reaction was present in the lungs, kidneys, adrenal glands, and lymph nodes. In all necropsied cats there was no evidence of an enteritis; however, intact Sporothrix organisms were seen within the colonic feces. Impression smears from ulcerated skin lesions in C4 revealed a mixture of neutrophils and macrophages. Numerous Sporothrix organisms were present within macrophages and extracellularly (Fig. 5).

periodic acid-Schiff staining after diastase digestion was required to identify a small number of Sporothrix organisms. In one patient (H-6), no organisms were observed. Lymph node biopsies were performed on another patient (H-5) and revealed a suppurative lymphadenitis; no organisms were noted.

H u m a n cases

*Freitas DC. MorenoG, Saliba AM, et al: Esporotricoseem caes e gatos (sporotrichosisin dogs and cats). Rev Fac Med Vet S Paulo 7:381-387, 1965. tAnderson NV, Ivoghli D, Moore WE, Leipold HW: Cutaneous sporotrichosis in a cat: A case report. J Am Animal Hosp Assoc 9:526-529, 1973.

Biopsies from affected skin were examined in three humans (H-I, H-4, and H-6). In all three of them the major alteration was a diffuse pyogranulomatous inflammatory process. In two patients (H-1 and H-4),

DISCUSSION Considering the geophilous nature of S. schenckii, feline sporotrichosis appears to be a disease of cats that are allowed outdoors. All cats in this study h a d such exposure. In C-2 and C-4 the initial lesions were small, draining puncture wounds, suggesting that cats b e c o m e infected by derma| inoculation of the organism by scratch or bite wounds, possibly acquired by fighting. This suspected mode o f infection m a y also explain w h y intact male cats were p r e d o m i n a n t l y affected in our study (Table I), as well as in ten o f twelve previously reported cases.*'t"'4'~ '~''° The lesions in the five cats ulcerated, b e c a m e encrusted, and drained a purulent to seropurulent exudate. C o m m o n sites for these lesions were the distal extremities (five cats), the h e a d (three cats),

44

Dunstan et al

the base of the tail (two cats), and the scrotum (two cats). In four cats, ulcerated areas developed at a site distant from the primary site. Histologically, the most striking feature was the large number of organisms in the cutaneous lesions and overlying exudate. In C-l, C-2, and C-3 these organisms were both intra- and extracellular; in C-4 and C-5 the fungi were present as relatively pure populations within large zones of necrosis. Both histologic patterns have been described in the cat, and the presence of a large number of organisms appears to be the predominant histologic presentation in the cat...~-L0 This feature differs markedly from sporotrichosis in most other species, including humans, horses, and dogs, in which organisms are notoriously difficult to identify histologically. ~0-~4 The large number of organisms suggests that the cat may be the only domestic animal that offers a major potential for transmission of sporotrichosis to humans or other animals. The only other welldocumented case of transmission from domestic animal to human occurred in a veterinarian who developed sporotrichosis after he punctured his hand while operating on a mule with the disease. 15 Cats inoculated with S. schenckii in the footpads had lymphocutaneous spread similar to localized sporotrichosis in humans. 1~ Four of the cats that we describe had disseminated cutaneous lesions that apparently developed from an initial cutaneous focus. Three of these cats were necropsied, and organisms were present in internal organs and coIonic feces in each cat, but the organisms were associated with a significant inflammatory response in only one cat. The systemic presence of organisms associated with no or minimal inflammation has not been described in humans. The systemic spread of Sporothrix organisms in cats may explain the development of the multiple cutaneous lesions; however, all cats with disseminated cutaneous disease had secondary lesions on multiple distal extremities, indicating that Sporothrix organisms may be spread by self-trauma and grooming. Disseminated cutaneous and systemic forms of sporotrichosis in humans generally *Anderson NV, Ivoghli D, Moore WE, Leipold HW: Cutaneous sporotrichosis in a cat: A case report. J Am Animal Hosp Assoc 9:526-529, 1973.

Journal of the American Academy of Dermatology

originate from initial pulmonary infection and only rarely are a sequela of fixed or localized cutaneous disease? ,n Why the cat exhibits such an unusual response to S. schenckii is unknown. Generalized immunosuppression or a Sporothrix-specific anergy is suggested. 17The peripheral blood of C-1 and C-4 was negative for the presence of feline leukemia virus,* indicating that this immunosuppressive virus was not a factor in two feline cases. Although Sporothrix antibody titers were not determined, their evaluation in future cases would be useful in defining the cat's humoral response to this fungus. Exposure to the large number of organisms associated with the ulcerated and draining lesions of affected cats characterizes the zoonotic potential of feline sporotrichosis. In all seven humans the lesions occurred in individuals who had cleaned or medicated affected cats. The lesions developed on the upper distal extremities in all but one of these patients, indicating that there was direct exposure to affected humans by the numerous organisms present in the draining exudate. In two humans the lesions were associated with bite wounds from an affected cat with oral ulcerations, and in one case sporotrichosis developed after an affected animal was handled by an individual who had recently lacerated his finger. These cases can be readily attributed to direct implantation of the organisms into the skin. However, in the remaining four cases there was no history of prior trauma or of a penetrating wound from affected cats at the site of the primary lesion. This inability to correlate lesion site with traumatic injury has been described in nine of the eleven previously described human cases in which sporotrichosis was acquired from cats. 4-6 These observations indicate that any direct contact with the draining lesions of cats offers the potential for human infection, perhaps by implantation through only mildly irritated skin. Smith 18described a similar form of transmission in humans handling infected dressings of other human patients with sporotrichosis and also reported a case in which the disease was transmitted by direct contact from the cheek of a mother to the cheek of a child. In all affected humans the lesions were of a *Feleuk Test, National VeterlnaryLaboratory, Franklin Lakes, NJ.

Volume 15 Number 1 July, 1986

localized, lymphocutaneous type. Histologic evaluation of the skin lesions was performed in three o f these individuals and revealed a nodular to diffuse pyogranulomatous dermatitis with either no or few organisms.*.2,~l.12.19.2° In all seven cases the lesions resolved after a 3- to 12-month regimen of oral potassium iodide (SSKI). However, human sporotrichosis may not always respond so favorably to therapy, and systemic disease may be fatal. 3 Because cats appear to continuously shed fungal organisms in exudates from cutaneous lesions and in their feces, there appears to be the potential for inhalation and the subsequent development of disseminated disease in immunocompromised humans who share their environment with an affected cat. Although feline sporotrichosis is a rare disease, both physicians and veterinarians should be aware o f its significant zoonotic potential. Physicians should consider sporotrichosis in patients who develop papular, nodular, or ulcerated skin lesions with lymphadenopathy and who have a history of exposure to cats with a suppurative or ulcerative dermatitis. The inability to associate a penetrating injury with the primary site of involvement should not preclude the diagnosis of sporotrichosis. Veterinarians and their support personnel should recognize that they are most at risk for contracting this disease and should consider sporotrichosis in any cat with suppurative or ulcerative skin lesions, especially when the lesions are refractory to conventional antibiotic therapy. Wearing gloves is strongly recommended when one is examining such cats. One of the humans in this study wore gloves during the periods of contact with an affected cat. In this individual the initial lesion developed near the cuffed end of one of the gloves. Therefore, even when gloves are utilized, care should be taken when they are removed, and hands and wrists should be washed after cats suspected o f having sporotrichosis are handled. Cytologic evaluation was performed on only one cat. However, the large number of organisms associated with feline sporotrichosis suggests that rounded or oval fungal organisms characteristic of *Lavalle P, MariatF: Sporotrichosis.Bull Inst Pasteur81:295-322, 1983.

Feline sporotrichosis

45

S. sehenckii should be easily d e t e c t e d by cytologic evaluation of impression s m e a r s made from draining or ulcerated skin lesions. Precautions could then be taken in advance to m i n i m i z e contact by individuals required to handle potentially affected animals while microbiologic confirmation is pending. REFERENCES l. Jungerman JF, Schwartzman FM: Veterinary medical myco/ogy.Philadelphia, 1972, Lea & Febiger, pp. 31-39. 2. Rippon JW: Medical mycology: The pathogenic fungi and the pathogenic actinomycetes, ed. 2. Philadelphia, 1982, W. B. Saunders Co., pp. 277-302. 3. Lynch PL, Voorhees JJ, HarreU ER: Systemic sporotrichosis. Ann Intern Med 73:23-30, 1970. 4. Read SI, Sperling LC: Feline sporotrichosis: Transmission to man. Arch Dermatol 118:429-431, 1982, 5. Nusbaum BP, Gulbas N, Horwitz SN: Sporotrichosis acquired from a cat. J AM ACADDERMATOL8:386-391, 1983. 6. Schiappaeasse RH, Colville JM, Wong PK, Markowitz A: Sporotrichosis associated with an infected cat. Cutis 36:268-270, 1985. 7. Kunkle GA: Feline dermatology. Vet Clin North Am 14:1065-1087, 1984. 8. Garrison RG, Boyd KS, Kier AB, et al: Spontaneous feline sporotrichosis: A fine structural study. Myeopathologia 69:57-62, 1979. 9, Kier AB, Mann PC, Wagner JE: Disseminated sporotrichosis in a cat. J Am Vet Med Assoc 175:202-204, 1979. 10. Werner RE, Levine BG, Kaplan W, et al: Sporotrichosis in a cat. J Am Vet Med Assoc 159:407-412, 1971. 11. Lever WF, Schaumburg-Lever G: Histopathology of the skin, ed. 6. Philadelphia, 1983, J. B. Lippincott Co., pp. 328-355. 12. Pinkus H, Mehregan AH: A guide to dermatohistopathology, ed. 3. New York, 1981, Appleton-CenturyCrofts, pp. 247-259. 13. Blackford J: Superficial and deep mycoses in horses. Vet Clin North Am (Large Anim Prac) 6:47-58, 1984. 14. Scott DW, Bentinck-Smith J, Haggerty GF: Sporotrichosis in 3 dogs. Cornell Vet 64:416-426, 1974. 15. Meyer KF: The relation of animal to human sporotrichosis: Studies on American sporotrichosis III. JAMA 65:579-585, 1915. 16. Barbee WC, Ewert A, Davidson EM: Animal model: Sporotrichosis in the domestic cat. Am J Pathol 86:281284, 1977. 17. Bickley LK, Berman IJ, Hood AF: Fixed cutaneous sporotrichosis: Unusual histopathology following in~'alesional corticosteroid administration. J AM ACADDERMATOL12:1007-1012, t985. 18. Smith LM: Sporotrichosis: Report of 4 clinically atypical cases. South Med J 38:505-515, 1945. 19. Lurie HI: Histopathology of sporotrichosis. Arch Pathol 75:421-437, 1963. 20. Segal RJ, Jacobs PH: Sporotrichosis. Int J Dermatol 18:639-644, 1979.