Pulmonary sporotrichosis.

Sporotrichosis is frequently primary in the lungs, caused by inhalation or aspiration of spores of Sporothrix schenckii. The clinical features and roentgenographic changes are nonspecific and usually indistinguishable from reactivated pulmonary tuberculosis. Therefore, pulmonary sporotrichosis should be considered when the tuberculin test and sputum cultures for Mycobacterium tuberculosis are persistently negative. Direct fluorescent antibody is a reliable, rapid, and specific method of identifying organisms in specimens and tissue biopsies. While the agglutination test is very sensitive in detecting sporotrichosis, it does not differentiate active disease from inactive disease. The complement fixation test, when positive, may suggest the presence of systemic sporotrichosis. Potassium iodide may be used initially in the nonimmunocompromised host with limited, noncavitary pulmonary disease. Amphotericin B should be given to patients who fail to respond to potassium iodide. Initial amphotericin B therapy is indicated in immunocompromised patients, in patients with multifocal systemic sporotrichosis. and in those with cavitary pulmonary sporotrichosis. Resectional surgery with perioperative medical therapy is indicated in patients with persistent cavitary disease unresponsive to amphotericin B, or when cavitary disease is associated with bleeding.