Rose Gardener Disease

Background

The rose gardener disease, also known as Sporotrichosis, is an infection caused by a fungus called Sporothrix 1. The fungus is found within the environment since it lives within the soil and plant matter such as rose bushes, wood, and hay. Sporothrix is a single genus that diversifies genetically, ecologically, and biologically.  It is a dimorphic fungus as it exists in the hyphal and yeast form. The hyphal form occurs in the environment temperature or when the fungus is grown in the laboratory, while yeast is found in host tissues at temperature or grown in the laboratory 1. The most common infection from the fungus takes a lymphocutaneous form which affects the skin and the lymphatic system. It is a unique form of fungi that has the biological capacity for transmission. In addition, the lymphocutaneous route is the standard presentation of Sporotrichosis. Through this, Sporotrichosis appears as the implantation of conidia in a wound. It mainly appears on exposed skin on the arm and hand 2.

Transmission

The main form of transmission is when people contact the fungus in the environment. The most mutual is the direct cutaneous skin infection that occurs when the fungal conidiospores go into the skin. The fungus may get through the skin via a small cut, scrape, or touching the contaminated plant matter. The hands and arm’s skin are the most affected regions. There are different types of Sporotrichosis based on the means of transmission and the body parts affected. They include cutaneous, pulmonary, and disseminated Sporotrichosis 2. Cutaneous Sporotrichosis occurs when individuals touch a contaminated plant matter with their hands or arms. Pulmonary Sporotrichosis takes place when one breathes in the fungal spores within the environment. It is a rare type of Sporotrichosis that occurs occasionally.

The disseminated Sporotrichosis takes place when the fungi infection spreads to different body parts such as the joints, bones, and the central nervous system 2. The disseminated Sporotrichosis affects individuals with various health problems taking medicines that affect their body’s immunity to combat germs and microorganisms that causes sickness. Sporotrichosis outbreaks have transpired among people who touch sphagnum moss and hay-like forestry workers, garden center workers, and tree nursery workers. Also, it might affect individuals who work or play on hay bales. The United States, Australia, Brazil, China, Guatemala, and South Africa experience the outbreak of the rose gardener disease 4. In addition, outdoor cats are becoming a common cause of the disease among humans through scratches and bites.

Mechanism of Pathogenicy

The virulence factors determine the ability of pathogens to infect and damage the host tissues. The virulence factors of Sporotrichosis are;

  1. Thermotolerance
  2. Melanin production

Thermotolerance

Thermotolerance is a virulence factor within the biomass of a self-healing composite. It can thrive at high temperatures, which makes it a unique virulence aspect 3. Sporothrix produces melanin compounds from yeast cells, which produce murine monoclonal antibodies. Melanin increases the fungal survival in the host and creates cell resistance to phagocytosis. The ergosterol peroxide is formed when the fungus attempt to evade reactive oxygen.

Dimorphism

Dimorphism of fungus is another virulence factor that relates to the Sporothix. Dimorphism is the ability of fungi to parade dualism, which leads to a cellular differentiation progression related to pathogenicity. The thermotolerance virulence factor enables the fungus to grow and survive within high temperatures within hay, the human body, and wood.

Melanin production

Melanin enhances fungal survival by making the cells resistant to phagocytosis, facilitating their growth. The dimorphism of the fungus facilitates the growth of the microorganisms on the different parts they land on, which contributes to their spread to other parts of the body 3. As a result, the virulence factors of Sporothix contribute to the adverse effects of the disease on individuals and animals.

Symptoms and complications

The initial symptom of the Rose Gardener Disease is a small bump that appears on a finger, arm, and hand after 12 weeks of exposure 2. With time the bump becomes larger to resemble a sore that takes time to heal. Also, more bumps may appear near the affected region and may spread to other parts of the body. Pulmonary sporotrichosis symptoms consist of chest pain, shortness of breath, and fever. Furthermore, the Rose Gardener Disease symptoms are based on the type of body part that is affected. For example, when an infection on the joints causes joint pain, the central nervous system infections result in headaches, seizures, and difficult thinking 2. Pneumonia is a rare symptom of Sporotrichosis once an individual inhales Sporothrix spores in the environment.

Treatment

The most common treatment for Sporotrichosis is itraconazole medication, which is taken orally for 3-6 months until the lesions disappear. Also, the saturated potassium iodide solution is used to treat Sporotrichosis which infects different parts of the body such as skin, bones, lungs, joints, and the central nervous system. The Sporotrichosis that affects the lungs incubates the lung tissues. Therefore, the best treatment for lungs infection is surgery that involves cutting away the infected tissue. Different body infections respond to different kinds of treatment. The skin infection responds to saturated potassium iodide solution, itraconazole, and terbinafine 1, 5. Bones and joint infections respond to itraconazole and surgery. Lung infections respond to surgery, itraconazole, amphotericin, and potassium iodide at varying levels of success, while brain infections respond to amphotericin plus 5-fluorocytosine.

Antifungal medications that can be used to treat sporotrichosis forms are fluconazole, amphotericin B, itraconazole and terbinafine. Itraconazole is the most commonly used microbial used in treating Sporotrichosis as it is effective, with low toxicity and goof tolerance which facilitates its use in long-term treatment. Amphotericin B is an antibiotic that binds to the fungal cytoplasmic membrane of the fungus, which causes the interruption of the cell membrane permeability 5. It is highly recommended during the initial stage of therapy. It is safe during pregnancy and is accompanied by side effects such as fever, headaches, vomiting, and malaise. Terbinafine is an alternative used when itraconazole is unresponsive—new antifungals that are being evaluated for the treatment of Sporotrichosis; posaconazole and ravuconazole. There is no vaccine available to prevent Sporotrichosis 5.

However, different ways may reduce the risk of getting Sporotrichosis. Some of these ways include wearing shielding clothing such as gloves and long sleeves when handling the different factors that contribute to the spread of fungi. Sporotrichosis is diagnosed through tests when a doctor identifies a swab. Microscopy and fungi culture is performed on the tissue of the infected parts to identify the presence of Sporothrix 4. Skin biopsy is also a relevant laboratory technique to reveal the infection as it involves the use of special stains. Serological tests are sometimes used. However, they are not as effective due to their limited sensitivity and specificity. Nonetheless, cases of sporotrichosis diagnosis are rare among nations. As a result, it is challenging to determine the number of cases due to the lack of national surveillance in the United States. In Brazil, more cases of Sporotrichosis are a result of contact with cats.

Conclusion

Cat bites and scratches contribute to the spread of fungus among individuals. Individuals exposed to agriculture, horticulture, forestry, and gardening are at an increased risk of getting infected with Sporotrichosis. Therefore, this group of people must take caution while conducting their daily operations to prevent the spread of the disease.

References

Bogin, M. H., & Saleh, O. M. A. (2020, December). A Red, Swollen Finger. In Mayo Clinic Proceedings (Vol. 95, No. 12, pp. 2799-2800). Elsevier Limited.

CDC C. Fungal diseases. Retrieved online at: http://www. cdc. gov/ncezid/dfwed/mycotics. 2018;2.

De Aquino Araújo A, Codeço C, Freitas DF, de Macedo PM, Pereira SA, Gremião ID, Coelho F. Transmission dynamics and control of Sporotrichosis in domestic felines. bioRxiv. 2021 Jan 1.

Sellera FP, Larsson CE. Sporothrix [spor’o-thriks] schenckii. Emerging Infectious Diseases. 2019 Sep 1;25(9):1631-2.

Victor N, Davidson RH, Miller CS, Boer BD. Rose Gardener’s Lung: Primary Cavitary Pulmonary Sporotrichosis with Co-Existing Lung Cancer: A Diagnostic, Staging, and Treatment Dilemma. InC54. ENDEMIC AND UNUSUAL FUNGAL INFECTION CASES 2020 May (pp. A5487-A5487). American Thoracic Society.