title: Sporotrichosis (Sporothrix schenckii infection) in the New South Wales mid-north coast, 2000-2010.
abstract: OBJECTIVE
  To determine the geographical, epidemiological and clinical features of sporotrichosis (a cutaneous fungal infection caused by Sporothrix schenckii) in the New South Wales mid-north coast.
  
  
  METHODS
  We undertook a retrospective case review of S. schenckii infections that occurred during the period 2000-2010. Microbiology laboratory staff and medical practitioners in the NSW mid-north coast were contacted to identify cases through database searches and clinical data collection.
  
  
  RESULTS
  Thirty-one cases of S. schenckii infection were identified. Twenty-one occurred in males, the mean age of patients was 59 years, and all cases with data available involved cutaneous disease affecting the limbs (multiple lesions in 18 of 20 cases). Despite an impression of temporal clustering (eight cases in 1 year), this was not statistically significant (P = 0.3). Most cases occurred in months with higher rainfall (13 of 14 cases with data available). Inoculating events included injuries in gardens, in bushland and on farms, and possible bites. Symptom duration before correct diagnosis ranged from 4 to 30 weeks (median, 8 weeks; data available for 15 cases), unnecessary antibacterial therapy was common (13 of 19 cases with data available), and morbidity occurred in the form of recurrence (three cases) and mild itraconazole-induced hepatotoxicity (two cases). In all cases with recorded treatment details, the patients received itraconazole, and the median duration of itraconazole treatment was 24 weeks.
  
  
  CONCLUSIONS
  These data highlight that health providers on the NSW mid-north coast should consider sporotrichosis when patients present with characteristic lesions after an inoculating injury sustained from or contaminated by decaying vegetation. The risk may be higher in older people and in wetter months. Fungal culture to confirm the diagnosis needs to be specifically requested. In contrast to outbreaks reported from other states, the epidemiological pattern in NSW appears most consistent with sporadic occurrence in an endemic setting.
authors.affiliation: Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, NSW. Shobini.Sivagnanam@swahs.health.nsw.gov.au
authors.forename: Shobini
authors.initials: S
authors.lastname: Sivagnanam
authors.forename: Aiveen M
authors.initials: AM
authors.lastname: Bannan
authors.forename: Sharon C-A
authors.initials: SC
authors.lastname: Chen
authors.forename: Anna P
authors.initials: AP
authors.lastname: Ralph
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D002648:Child; D057210:Delayed Diagnosis; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D011891:Rain; D012189:Retrospective Studies; D012621:Seasons; D013174:Sporotrichosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole