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Clasificacin de la esporotricosis. Una propuesta con base en el
comportamiento inmunolgico
Amado Sal,* Alexandro Bonifaz**
RESUMEN
La esporotricosis es una micosis subcutnea causada por un complejo de hongos dimrficos denominado Sporothrix schenckii. Se ha
reportado en todos los continentes y es frecuente en Mxico. Se comunica una propuesta de clasificacin clnica de la esporotricosis con
base en su comportamiento inmunolgico, en la cual se divide en dos grupos: el primero hiperrgico-normrgico, que tiene respuesta
normal al antgeno intradrmico o esporotricina M y poca cantidad de formas parasitarias, e incluye a las dos variedades clnicas ms
frecuentes, cutnea linfangtica y cutnea fija; y el segundo grupo o hiporgico-normrgico, con baja o nula respuesta al antgeno intradrmico y presencia de levaduras, incluye las formas menos frecuentes y con comportamiento oportunista, que son: cutnea diseminada,
cutnea superficial, osteoarticular, pulmonar y visceral.
Palabras claves: esporotricosis, Sporothrix schenckii, clasificacin, comportamiento inmunolgico.
ABSTRACT
Sporotrichosis is a subcutaneous mycosis caused by a dimorphic complex of fungi called Sporothrix schenkii; it is a common disease in
our country and has been reported in all continents. This paper presents a proposal of clinical classification of sporotrichosis based on its
immunologic behavior, and which is divided into two groups, the first one hyperergic/normergic that presents a normal immune response
to the intradermic antigen (sporotrichin M) and poor parasitic forms, and includes the most frequent clinical pictures: cutaneous-lymphatic
and fixed-cutaneous; the second group or hypoergic/normergic, with low or no response to the intradermic antigen and presence of yeasts,
includes the less frequent clinical pictures with opportunistic behavior: cutaneous-disseminated (hematogenous), cutaneous-superficial,
osteoarticular, pulmonar and visceral.
Key words: sporotrichosis, Sporothrix schenckii, classification, immunological behavior.
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PATOGENIA
*
**
Servicio de Dermatologa.
Departamento de Micologa.
Hospital General de Mxico, Mxico, DF.
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Clasificacin de la esporotricosis
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Clasificacin de la esporotricosis
CLASIFICACIONES
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REFERENCIAS
Sal A. Lecciones de dermatologa. 14a ed. Mxico: Mndez
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4. Bonifaz A, Vzquez-Gonzlez D. Sporotrichosis: an overview.
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Wilsongs microbiology and microbial infections. 10th ed. London:
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6. Marimon R, Cano J, Gen J, Sutton DA, et al. Sporothrix
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species of clinical interest. J Clin Microbiol 2007;45:3198-3206.
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1.
Formas clnicas
Cutnea linfangtica
Cutnea fija
Excepcionales
Granuloma supurativo
Siempre positiva
Alta
Muy bueno
Probable
Muy buena
Frecuentes
Granuloma tuberculoide
Frecuentemente negativa
Baja
Malo
Nunca
Mala
Clasificacin de la esporotricosis
28. Wilson DE, Mann JJ, Bennett JE, Utz JP. Clinical features
of extracutaneous sporotrichosis. Medicine (Baltimore)
1967;46:265-279.
29. Steele RW, Cannady PB, Moore WL, Gentry LO. Skin test and
blastogenic responses to Sporotrichun schenckii. J Clin Invest
1976;57:156-160.
30. Pappas PG, Tellez I, Deep AE, Nolasco D, et al. Sporotrichosis
in Peru: description of an area of hyperendemicity. Clin Infect
Dis 2000;30:65-70.
31. Padilla-Gonalves A. Sporotrichosis. In: Caizares O, Harman
R, editors. Clinical tropical dermatology. Boston: Blackwell
Scientific Publications; 1992:88-93.
32. Gougerot H. New insight gained in general pathology and
practical medicine by the study of sporotrichoses. Ann NY
Acad Sci 1950;50:1348-1356.
33. Rippon JW. Sporothricosis. Medical mycology. The pathogenic
fungi and the pathogenic actinomycetes. 3rd ed. Philadelphia:
WB Saunders; 1988:325-352.
34. Emmons C, Binforrd C, Utz JP, Kwon-Chung KJ. Sporotrichosis. In: Kwon-Chung KJ, Bennet J, editors. Medical Mycology.
3rd ed. Philadelphia: Lea & Febiger; 1977:406-424.
35. Padilla-Gonalves A. Geopathology of sporotrichosis. Int J
Dermatol 1973;12:115-118.
36. De Bermann L, Gougerot H. Les esporotrichoses. Paris: Felix
Alcan; 1912.
37. Conant N, Smith D, Baker R, Calawax J. Micologa mdica.
3a ed. Mxico: Interamericana; 1972:325-349.
38. Gonzlez-Ochoa A. Contribuciones recientes al conocimiento
de la sporotricosis. Gac Med Mex 1965;95:463-474.
39. Lavalle P. Mycoses in Mexico. Proc VII Ann. Meeting Pacific
Dermat Ass 1955;22:45-47.
40. Lavalle P, Mariat F. Sporotrichosis. Bull Inst Pasteur
1983;81:295-322.
41. Smith WC, Saunderson P. Leprosy Clin Evid (Online) 2010,
Jun 28;2010.
42. Gonzlez-Ochoa A, Soto-Figueroa E. Polisacridos de Sporotrichum schenckii. Intradermorreaccin en el diagnstico de la
esporotricosis. Rev Inst Salub Enferm Trop Mex 1947;8:143-153.
43. Toriello C, Reyes-Montes R, Taylor ML. Production of fungal
antigens from local strains for the immunodiagnosis of mycoses
in Mexico. Rev Invest Clin 1997;49:501-505.
44. Novales SJ, Navarrete FG, Ramos GA. Esporotricosis. Aspectos histolgicos de 50 casos. Rev Centr Dermatol Pascua
1995;4:149-152.
45. Mercadillo-Prez P, Rodrguez-Patio G. Histopatologa de las
micosis. En: Mndez-Tovar LJ, Lpez-Martnez R, HernndezHernndez F, editores. Actualidades en micologa mdica. 3
ed. Mxico: UNAM; 2006:59-70.
46. Quintella LP, Passos SR, do Vale AC, Galhardo MC, et al.
Histopathology of cutaneous sporotrichosis in Rio de Janeiro: a
series of 119 consecutive cases. J Cutan Pathol 2011;38:25-32.
Sal A y Bonifaz A
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