You have been diagnosed with disseminated sporotrichosis
A serious fungal infection caused by Sporothrix that has spread to multiple areas of the body
This requires long-term antifungal treatment lasting at least 12 months
Medications
Take itraconazole exactly as prescribed
Capsules: take with a full meal and an acidic beverage (cola or orange juice) to improve absorption
Solution: take on an empty stomach
Do not skip doses; premature discontinuation leads to relapse
Avoid grapefruit juice while taking itraconazole
Report any side effects including nausea, abdominal pain, leg swelling, or yellowing of skin
Exposure precautions
Avoid contact with cats especially stray or sick cats
Wear gloves when gardening or handling soil and plant material
Avoid contact with sphagnum moss, rose bushes, or hay without protective gloves
Follow-up
Infectious disease appointment within 1-2 weeks of discharge is mandatory
Blood test for itraconazole level at 2 weeks after starting medication
Kidney function and electrolytes to be rechecked after completing IV amphotericin B
HIV patients: CD4 count and viral load every 3 months
Return to emergency department immediately for
New or rapidly worsening skin lesions
Fever, chills, or night sweats
Severe headache, neck stiffness, confusion, or vision changes (signs of CNS involvement)
New joint pain or swelling
Cough, coughing up blood, or worsening shortness of breath
Nausea, vomiting, or inability to take oral medications
Rash or yellowing of skin or eyes (itraconazole hepatotoxicity)
References
Guidelines and key sources
ECMM Global Guideline for Endemic Mycoses
Thompson GR, Le T, Chindamporn A, et al. Global Guideline for the Diagnosis and Management of the Endemic Mycoses. Lancet Infectious Diseases. 2021. PMID 34364529
First-line recommendation: L-AmB 3-5 mg/kg/day with itraconazole step-down
IDSA Opportunistic Infections Guidelines (HIV)
Benson C, Brooks J, Dhanireddy S, et al. Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV. IDSA/OARAC 2025
Schapiro S, Pulciano N, Galindo-Ramirez J, et al. Epidemiology and Outcomes of Sporotrichosis: A Descriptive Real-World Analysis From a Global Cohort. Mycoses. 2026. PMID 41732997
One-year mortality 17% overall; 37% in HIV co-infected
HIV co-infection outcomes
Uemura EVG, Rossato L. Sporotrichosis Co-Infection With HIV/AIDS. Mycoses. 2023. PMID 37376902
69.5% of HIV co-infected develop systemic dissemination
Clinical factors for systemic disease
Magalhaes VCR, Colombo SA, Peres NTA, et al. Clinical Factors Associated With Systemic Sporotrichosis in Brazil. Mycoses. 2024. PMID 37743555
Fever (p=.001), weight loss (p=.006), alcohol use (p=.009) associated with systemic disease
Iatrogenic dissemination case
White M, Adams L, Phan C, et al. Disseminated Sporotrichosis Following Iatrogenic Immunosuppression for Suspected Pyoderma Gangrenosum. Lancet Infectious Diseases. 2019. PMID 31473127
Osteoarticular sporotrichosis
Ramirez-Soto MC, Bonifaz A, Tirado-Sanchez A, et al. Differences in Epidemiological and Clinical Findings Between Localized and Systemic Osteoarticular Infection Caused by Sporothrix. Medical Mycology. 2025. PMID 40973070
CNS sporotrichosis
Taborda MH, Costa FB, Kleinubing JR, et al. Teaching NeuroImage: Leptomeningitis With Communicating Hydrocephalus in an Immunocompromised Patient With Disseminated Sporotrichosis. Neurology. 2024. PMID 38889379
Antifungal susceptibility
Dos Santos AR, Bonifaz A, Bombassaro A, et al. Establishment of Epidemiological Cutoff Values for Clinically Relevant Sporothrix Species. Antimicrobial Agents and Chemotherapy. 2026. PMID 41940808
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.