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Sporotrichosis of the larynx: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Sporotrichosis is a relatively rare human disease, affecting primarily the skin and subcutaneous tissue, in rare cases, spreading to the mucous membrane of the upper respiratory tract, in particular the nose, throat and larynx.
Sporotrichosis can also affect nails, eyes, muscles, tendons, joints, bones and internal organs.
[What causes sporotrichosis of the larynx?
Sporotrichosis of the larynx is caused by the fungus of the Sporotrichium family - a filamentous sporiferous fungus. The causative agent has many varieties, including the "Russian white Streptorichon", described by the Russian dermatologist AA Viviorovsky (1913). Sporotrihon vegetates on grasses, bushes and trees. It can be found on cereals, in flour and street dust, on food and animals. Infection occurs when the fungus hits the damaged skin or mucous membrane, or it enters the body with food, water and inhaled dust. In the first case, there is a localized form of sporotrichosis, in the second - the disseminated form of this disease.
Pathogenesis of sporotrichosis of the larynx
When the pathogen is introduced into the damaged area of the skin or mucous membrane, a primary lesion (sporotrichozal chancre) is formed at the site of implantation, leading to lymphangites and new foci. When ingested in the gastrointestinal tract and respiratory tract, the fungus, spreading by hematogenous way, causes various forms of generalized gummous sporotrichosis. Superficial cutaneous sporotrichosis can resemble ringworm, eczema, impetigo and some other skin diseases. A typical focus of sporotrichosis consists of three zones: a central micro-process; middle zone, characterized by a predominance among numerous giant and plasma cells of acidophilic epithelioid cells; external fibroblastic zone, permeated with a lymphocytic-plasma infiltrate. On the soft palate, epiglottis, cherpalodnagortannye and vestibule folds is manifested in the form of infiltrates containing the same elements as the infiltrate in the defeat of the skin.
Symptoms of sporotrichosis of the larynx
Symptoms of sporotrichosis of the larynx differ little from those of other fungal diseases of the larynx, except for actinomycosis. With sporotrichosis of the larynx, patients complain of burning in the throat and larynx, the sensation of a foreign body, the phenomenon of dysphagia, and sometimes difficulty breathing. Under unfavorable external and internal conditions (humid hot climate, reinfection, weakening of the body's resistance, etc.), the disease can progress, spreading along the extension to the trachea and bronchi, by hematogenous pathways - everywhere. The course of the disease with sporotrichosis is chronic, requiring long-term and systematic treatment.
Diagnosis of sporotrichosis of the larynx
Diagnosis of sporotrichosis of the larynx, if it proceeds in isolation, is very difficult and with a certainty the diagnosis of "sporotrichosis of the larynx" can be made only with the help of a histological examination of a biopsy taken from a spirotrichous infiltrate. The direct diagnosis is facilitated by skin manifestations that differ from infectious granulomas (tuberculosis, syphilis), as well as other mycosis - Gilchrist's blastomycosis and chronic pyoderma, in that in sporotrichosis there is a multiplicity of foci, frequent localization of them on the upper limbs, the presence of lymphangites, most cases of a tendency to spontaneous ulceration, the opening of each node by several small fistula apertures, the absence of a core of abscesses and curds with dark purple rash. On the healing of ulcers are small irregular scars with dentate and pigmented edges. Bacteriographic studies are ineffective, since in pus it is rare to detect fungal elements. To confirm the diagnosis, the fungus culture is isolated and allergic skin and subcutaneous reactions are carried out with the filtrate of the fungal culture, as well as the spore agglutination reaction with the serum of the patient.
What do need to examine?
Treatment of sporotrichosis of the larynx
Sporotrichosis of the larynx is treated with the appointment of repeated courses of antifungal agents (Itraconazole, Irunium, Fluconazole, Fluminon, Fungolon), combining them with sulfadimezin, 50% potassium iodide solution in droplets. The foci are treated with fucorcium (Castellani liquid, Lugol solution and 5% silver nitrate solution). Removal of affected lymph nodes or their dissection is contraindicated. With sporotrichosis of the larynx, local symptomatic treatment is applied, directed to reducing unpleasant subjective sensations. The cure for sporotrichosis of the larynx depends on the effectiveness of the overall treatment.
How to prevent sporotrichosis of the larynx?
Prevention of sporotrichosis of the larynx consists in the careful and timely treatment of damaged skin, as well as the use of respirators that can detain dust particles containing fungal spores, especially those engaged in agricultural labor.
What prognosis is the sporotrichosis of the larynx?
With early diagnosis and treatment, sporotrichosis of the larynx has a favorable prognosis even in disseminated form; it is much worse if the mucous membrane, internal organs or bones are involved in the process.