Sporotrichosis in Sub-Himalayan India

Citation: Verma S, Verma GK, Singh G, Kanga A, Shanker V, et al. (2012) Sporotrichosis in Sub-Himalayan India. PLoS Negl Trop Dis 6(6): e1673. doi:10.1371/journal.pntd.0001673
Published: June 12, 2012

Sporotrichosis is endemic in the Sub-Himalayan belt, which ranges from the northern to the north-eastern Indian subcontinent. Similar to many parts of the developing world, sporotrichosis is commonly recognized clinically in this region however consolidated epidemiological data is lacking. We report epidemiological, clinical and microbiological data from a hundred culture positive cases of sporotrichosis. Out of 305 clinically suspicious cases of sporotrichosis, a total of 100 isolates were identified as Sporothrix schenckii species complex (S. schenckii) on culture. Out of the culture proven cases 71% of the cases presented with lymphocutaneous type of lesions while 28% had fixed localized type and 1% had disseminated sporotrichosis. Presentation with lesions on hands was most frequently seen in 32% with arm (23%) and face (21%) in that sequence. The male to female ratio was 1:1.27. Age ranged from 1 ½ years to 88 years. Mean age was 43.25 years. Disease was predominantly seen in the fourth to sixth decade of life with 58% cases between 31 and 60 years of age. Since the first report from the region there has been a steady rise in the number of cases of sporotrichosis. Seasonal trends reveal that most of the patients visited for consultation in the beginning of the year between March and April. This is the first study, from the most endemic region of the Sub-Himalayan belt, to delve into epidemiological and clinical details of such a large number of culture proven cases over a period of more than eighteen years which would help in the understanding of the local disease pattern of sporotrichosis.

Author Summary
Sporotrichosis is a sub-acute or chronic granulomatous fungal infection involving mainly the skin and subcutaneous tissue with neighbouring lymphatics. It is caused by thermally dimorphic fungus, Sporothrix schenckii, which is prevalent worldwide. Consequent to trauma, the fungus establishes itself in skin and subcutaneous tissue of gardeners, forestry workers, farmers, carpenters, and others who are involved in outdoor activities. Sporotrichosis is the most frequently encountered sub-cutaneous mycosis in the sub-Himalayan belt and all previous reports are based on clinical review. It is imperative to understand the epidemiology of sporotrichosis as an accurate diagnosis, and prompt initiation of the appropriate treatment would prevent chronic debility. This is the first extensive compilation of culture proven cases from Himachal Pradesh in India. It thus justifies our interest in analysing data from our institute seen over 18 years and 7 months, with the objective to compare the demographic factors, briefing the clinical aspects and the culture characteristics of the isolates obtained from the clinical material.

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