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Dermatologa Rev Mex 2011;55(4):200-208

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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.

Correspondencia: Dr. Alexandro Bonifaz. Servicio de Dermatologa,


Hospital General de Mxico. Dr. Balmis 148, colonia Doctores, CP
06720, Mxico, DF. Correo electrnico: a_bonifaz@yahoo.com.mx
Recibido: marzo, 2011. Aceptado: abril, 2011.
Este artculo debe citarse como: Sal A, Bonifaz A. Clasificacin de
la esporotricosis. Una propuesta con base en el comportamiento
inmunolgico. Dermatol Rev Mex 2011;55(4):200-208.



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'HUPDWRORJtD5HY0H[Volumen 55, Nm. 4, julio-agosto, 2011

Clasificacin de la esporotricosis

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Cuadro 1. Clasificacin clnica con base en el comportamiento


inmunolgico de la esporotricosis
Grupos

Formas clnicas

Hiperrgicos o normrgicos (95%)

Cutnea linfangtica, 70%


Cutnea fija, 25%

Hiporgicos o anrgicos (5%)

Cutnea diseminada
(hematgena)
Cutnea superficial
Osteoarticular
Pulmonar y sistmica
(visceral)

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'HUPDWRORJtD5HY0H[ Volumen 55, Nm. 4, julio-agosto, 2011

Figura 1. Esporotricosis cutnea linfangtica (forma clsica).



Sal A y Bonifaz A

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Figura 2. Esporotricosis cutnea fija (forma crnica).

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'HUPDWRORJtD5HY0H[ Volumen 55, Nm. 4, julio-agosto, 2011

Clasificacin de la esporotricosis

Figura 4. Esporotricosis cutnea superficial (forma escrofulosa).

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'HUPDWRORJtD5HY0H[ Volumen 55, Nm. 4, julio-agosto, 2011



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COMPORTAMIENTO

Sal A y Bonifaz A

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REFERENCIAS
Sal A. Lecciones de dermatologa. 14a ed. Mxico: Mndez
editores; 2010.
2. Mayorga J, Tarango MV, Barba-Rubio J. Esporotricosis
100 aos despus (1898-1998). Dermatologa Rev Mex
1999;43:S22-S29.
3. Lavalle P, Mariat F. Sporotrichosis. Bull Inst Pasteur
1983;81:295-322.
4. Bonifaz A, Vzquez-Gonzlez D. Sporotrichosis: an overview.
G Ital Dermatol Venereol 2010;145:6509-6657.
5. Arenas R. Sporotrichosis. In: Merz WG, Hay R, editors. Topley &
Wilsongs microbiology and microbial infections. 10th ed. London:
Hodder-Arnold; 2005:367-384.
6. Marimon R, Cano J, Gen J, Sutton DA, et al. Sporothrix
brasiliensis, S. globosa, and S. mexicana, three new Sporothrix
species of clinical interest. J Clin Microbiol 2007;45:3198-3206.
7. Madrid H, Cano J, Gen J, Bonifaz A, et al. Sporothrix globosa,
a pathogenic fungus with widespread geographical distribution.
Rev Iberoam Micol 2009;26:218-22.
8. Kauffman CA. Sporotrichosis. Clin Infect Dis 1999;29:231-237.
9. Lopes-Bezerra LM, Schubach A, Costa RO. Sporothrix schenckii
and sporotrichosis. An Acad Bras Cienc 2006;78:293-308.
10. Teixeira PA, de Castro RA, Nascimento RC, Tronchin G, et
al. Cell surface expression of adhesins for fibronectin correlates with virulence in Sporothrix schenckii. Microbiology
2009;155:3730-3738.
1.

Cuadro 2. Clasificacin inmunolgica y comportamiento de la esporotricosis

Formas clnicas

Formas parasitarias en examen directo y tejidos


Histopatologa
Esporotricina M (IDR)
Resistencia
Pronstico
Regresin espontnea
Respuesta al tratamiento

I. Casos hiperrgicos y normrgicos

II. Casos hiporgicos y anrgicos

Cutnea linfangtica
Cutnea fija

Cutnea diseminada (hematgena)


Cutnea superficial
Osteoarticular
Pulmonar y visceral

Excepcionales
Granuloma supurativo
Siempre positiva
Alta
Muy bueno
Probable
Muy buena

Frecuentes
Granuloma tuberculoide
Frecuentemente negativa
Baja
Malo
Nunca
Mala

IDR: intradermorreaccin; M: micelial.



'HUPDWRORJtD5HY0H[ Volumen 55, Nm. 4, julio-agosto, 2011

Clasificacin de la esporotricosis

11. Travassos LR, Mendoza PL. Synthesis of monorhamnosyl


L-ramno-D-manosas by conidia of Sporothrix schenckii. Infect
Inmun 1978;19:1107-1109.
12. Figueiredo CC, De Lima OC, De Carvalho L, Lopes-Bezerra
LM, Morandi V. The in vitro interaction of Sporothrix schenckii
with human endothelial cells is modulated by cytokines
and involves endothelial surface molecules. Microb Pathog
2004;36:177-188.
13. Madrid IM, Xavier MO, Mattei AS, Fernandes CG, et al. Role
of melanin in the pathogenesis of cutaneous sporotrichosis.
Microbes Infect 2010;12:162-165.
14. Uenotsuchi T, Takeuchi S, Matsuda T, Urabe K, et al. Differential induction of Th1-prone immunity by human dendritic cells
activated with Sporothrix schenckii of cutaneous and visceral
origins to determine their different virulence. Int Immunol 2006;
18:1637-1646.
15. Sass MF, Saturi AE, Souza LF, Ribeiro LC, et al. Response
of macrophage Toll-like receptor 4 to a Sporothrix schenckii
lipid extract during experimental sporotrichosis. Immunology
2009;128:301-309.
16. Berson SD, Brandt FA. Primary pulmonary sporotrichosis with
unusual morphology. Thorax 1977;32:505-508.
17. Marimon R, Serena C, Gen J, Cano J, Guarro J. In vitro antifungal susceptibilities of five species of Sporothrix. Antimicrob
Agents Chemother 2008;52:732-734.
18. Sal A. Sporotrichosis. In: Jacobs PH, Nall L, editors.
Antifungal drug therapy. New York: Marcel Dekker Inc.;
1990:53-59.
19. De Araujo T, Marques AC, Kerdel F. Sporotrichosis. Int J Dermatol 2001;40:737-742.
20. Bonifaz A, Sal A, Paredes-Sols V, Fierro L, et al. Sporotrichosis
in childhood. Clinical and therapeutic experience in 25 cases.
Pediatr Dermatol 2007;24:369-372.
21. Padilla-Desgarennes MC, Medina-Castillo DE, Corts-Lozano
N. Esporotricosis en edad peditrica: experiencia del Centro
Dermatolgico Pascua. Piel 2004;19:350-363.
22. Takenaka M, Sato S, Nishimoto K. Survey of 155 sporotrichosis
cases examined in Nagasaki Prefecture from 1951 to 2007.
Nippon Ishinkin Gakkai Zasshi 2009;50:101-108.
23. Itoh M, Okamoto S, Kariya H. Survey of 200 cases of sporotrichosis. Dermatologica 1986;172:209-213.
24. Werner AH, Werner BE. Sporotrichosis in man and animal. Int
J Dermatol 1994;33:692-700.
25. Aronson EN. Disseminated sporotrichosis. JAMA
1992;268:2021-2022.
26. Bonifaz A, Sal A, Montes de Oca G, Mercadillo P. Superficial
cutaneous sporotrichosis in specific anergic case. Int J Dermatol 1999;38:700-703.
27. Bustamante B, Campos PE. Sporotrichosis: a forgotten disease in the drug research agenda. Expert Rev Anti Infect Ther
2004;2:85-94.

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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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El Consejo Mexicano de Dermatologa, A.C. otorgar dos puntos con


validez para la recertificacin a quienes enven correctamente contestadas
las evaluaciones que aparecen en cada nmero de Dermatologa Revista
Mexicana.
El lector deber enviar las siete evaluaciones, una por una o todas juntas,
a la siguiente direccin:
Dermatologa Revista Mexicana
Jos Mart 55, colonia Escandn, CP 11800, Mxico, DF.
Fecha lmite de recepcin de evaluaciones: 31 de enero de 2012.



'HUPDWRORJtD5HY0H[ Volumen 55, Nm. 4, julio-agosto, 2011