Clinical Observation On Itraconazole In Treating 113 Cases Of Sporotrichosis In Children

Sporotrichosis is a cutaneous,subcutaneous and lymphangial infection caused by Sporothrix shenckii,which is a subacute or chronic deep mycoses.Sporothrix shenckii is a dimorphic fungus,which widely discributed in environment,and acts as parasites on the plants, Soils, marsh land and so on. So the high risk group are people who expose frequently to the natural environment, such as farmers,gardeners and forestry workers.The disease usually begins after trauma that inoculates Sporothrix shenckii into the skin, mucosa, respiratory organs and the alimentary canal. The disease can also be Transmitted by animals such as cats,dogs. Sporotrichosis mostly occurs in the developing countries in tropical, subtropical, temperate zone like India and China.There are four clinical presentation:the lympho-cutaneous form,the fixed cutaneous form, the disseminated form and extracutaneous form. The lympho-cutaneous form is also named Gum swelling form,and previous studies have shown that it is the most common type, accounting for 75% of the total cases of various types. After the invasion of pathogens at the injury, dark red or black painless subcutaneous nodules may appear during 5 to 180 days.The nodules may increase and become into abscess, granuloma. Then quickly oozing ulceration, and the edges of ulcer are mostly purple or purple-brown. The typical performance of the lympho-cutaneous form is beaded arranged nodules on the limbs.It mostly occrus on unilateral of the body,and bilateral cases are rare.The lesions of the fixed cutaneous form are similar to those of the lympho-cutaneous form. However, the lesions may be confined to the primary site for a long-term.The fixed cutaneous form accounts for 20%～25% of the total cases of various types.The disseminated form and extracutaneous form are rare to see. Sporotrichosis is more common in adults,but in the recent years the incidence of Sporotrichosis in children is in upward trend. Clinically,the fixed cutaneous form is most common in children, and the lesions mostly occuer on the face.Medication, physical therapy,and surgical treatment are usually used for treatment of sporotrichosis. Drugs therapy is the first-line choice, supplenented by thermotherapy as a supportive therapy.Saturated potassium iodide solution is the first choice for Sporotrichosis in many areas,which has a significant effect on sporotrichosis and low prices. However there are more side effects of it, such as irritation metallic taste, nausea, fever, rash. The side effects are especially prominent for pregnant women and patients with kidney or thyroid disease. Itraconazole is a new triazole antifungal with very significant effect and fewer side effects for Sporotrichosis,and it is recommended as the preferred drug by more and more scholars are now.There are capsules,oral solution, intravenous fluids of Itraconazole,so it is very convenient to take, especially for children.The object of this study is to evaluate the effectiveness and safety of Itraconazole for the treatment of sporotrichosis in children, and to provide a scientific basis for the effective treatment of Sporotrichosis in children.Methods:113 cases of children witn sporotrichosis who came from Dermatology of our hospital during September 2008 to September 2010 were observated.All of them were asked to take itraconazole capsules 5mg/kg body weight,once a day for 12 weeks.During the course of treatment and 2 weeks after treatment,we make assessment of the efficacy and safety of Itraconazole once every 2 weeks. Cure rate and side effects are recorded after each follow-up. After treatment,1 month,3 months, and 6 months follow-up are made to observe the side effects,recurrence and re-infection.Results:The effect of Itraconazole for treating sporotrichosis in children is Significant. The total effective rates after 2 weeks,4weeks,6 weeks, and 8 weeks are respectively 5.31%, 40.71%,92.04%,98.23%,and there are significant sex differences among them.With the gradual extension of treatment (2-8 weeks),the total effective rate rising. After8 weeks, the total efficiency stayed the same,and the number of cases who were cured continued to increase.Of all 113 cases, Only 8 patients had varying degrees of nausea, abdominal pain, diarrhea and other gastrointestinal symptoms during the process of taking itraconazole.These symptoms disappeared soon after stopping or reducting Itraconazole,and the treatments were made constantly.6 patients suffed form mild temporary liver dysfunction during treatment,4 cases of them occurred after taking itraconazole for 2 weeks, two occurred after 4 weeks. Liver functions of all of the 6 patients were back to normal, Only 1 patient of 113 with mild renal dysfunction, after treatment returned to normal. Recurrence or re-infection is no longerfound during subsequent follow-up after 6 months withdrawal. Conclusion:Itraconazole is efficacy in treating sporotrichosis in children, with fewer side effects and low incidence of liver and kidney dysfunction,whic is also easy to take. So, Itraconazole is a better choice for the treatment of sporotrichosis in children.