Q: I am in the UK. While on holiday in France my mother had a rose thorn cut into her ankle in March/April this year. Since then, she has been very poorly and has had treatment to her ankle with little progress being made. All the doctors do is clean and cover the wound area but it doesn’t seem to be getting any better and they are no where nearer to finding what is causing the infection. She keeps it covered but hours afterward it oozes pus and the shooting pains up her leg are very painful.
For a 76-year-old, this is very distressing. Is there anything you could advise? She has been to her doctor and to specialists but as yet no progress has been made. I worry for my mother. Is covering it the best thing? She has it cleaned three times a week but an hour after having it cleaned, it is back to how it was before. Again, I know you are not in the UK but any advice would be appreciated.
A: The dilemma to which you refer is likely rose thorn or rose gardener’s disease, a fungal infection that occurs when the skin’s surface is compromised and penetrated by a rose thorn; however, there are instances reported when hay, sphagnum moss, a twig or soil can cause the infection without the skin being broken. In very rare cases, the organism can be inhaled or ingested, a situation that leads to an infection in parts of the body other than the skin. The infection is known as Sporothrix schenckii. Rare forms of the fungal infection have also been known to affect the lungs, joints, bones and in rare instances, the brain. Even more rarely, a cat (or armadillos) are able to transmit the infection to humans through a scratch.
The fungus is known to progress slowly with initial symptoms appearing approximately three weeks following exposure to the fungus. In some instances, it may take as long as 12 weeks for symptoms to appear which may include a nodule at the point of entry that may develop into an open lesion that, as your mother is experiencing, may drain a clear fluid. If left untreated, the lesion may become chronic and continue for years. In almost 60% of all cases, the mold spreads along the lymph nodes. Because the symptoms are progressive, lesions often appear in a line as successive areas of the lymphatic channels become infected. In fact, the spread may resemble a long plant stem with smaller stems branching off both sides in a flower-like pattern. Diagnosis may be made by performing a biopsy of one of the nodules to identify the mold, yet there are other infections that can mimic sporotrichosis. They may include herpes, candidiasis, histoplasmosis, sarcoidosis, and more, yet with the exception of whitlow near the nail, these diseases have more generalized manifestations.
As a general rule, sporotrichosis in the lymph nodes or skin is not dangerous, nor is it life-threatening. When open ulcers become infected with bacteria, a different condition known as bacterial cellulitis may occur. If an area of pain, warmth and redness follows, the person should be seen in a hospital setting.
Treatment in a health care setting will likely begin with saturated potassium iodide solution given three times each day for between three and six months until all the lesions have disappeared or skin infections may also be treated with a variety of antifungal medications including Sporanox (itraconazole) for up to six months. When the bones and joints are infected Sporanox will be ineffective and intravenous amphotericin will likely be recommended, despite its many potential side effects.
If your mother’s infection is only in the skin or lymph nodes, she should have complete recovery with the appropriate treatment. However, if treatment is delayed, recovery may take months or years and scars could remain at the infection site. If an organ is infected, serious complications could result.
Your mother should be seen by an infection specialist in a large medical facility. Because of the time lost already, she may wish to make the appointment sooner than later.