Epidemiologic Notes and Reports
Multistate Outbreak of Sporotrichosis in Seedling Handlers, 1988
Between April 23 and June 30, 1988, 84 cases of cutaneous
sporotrichosis occurred in persons who handled conifer seedlings
packed
in Pennsylvania with sphagnum moss that had been harvested in
Wisconsin. An outbreak-related case was defined as
physician-diagnosed
sporotrichosis in a person who had handled seedlings and/or moss.
Confirmed cases occurred in 14 states: New York, 29 cases;
Illinois,
23; Pennsylvania, 12; Ohio, five; Wisconsin, three; Connecticut,
North
Carolina, and Vermont, two each; and Indiana, Iowa, Massachusetts,
Michigan, New Hampshire, and Virginia, one each. Each of these
persons
handled seedlings from April 4 to May 16; symptoms developed
between
April 23 and June 30.
Thirty-one (37%) cases occurred in state forestry workers and
garden
club members who participated in annual tree distributions in which
seedlings were separated from one another, repacked in moss, and
distributed to area residents. In addition, 12 patients had
received
seedlings through these distributions, 38 had purchased seedlings
directly from nurseries, and three were nursery workers. All
patients
had contact with seedlings distributed by two Pennsylvania
nurseries.
Sporothrix schenckii was cultured from skin lesions of 38 persons
and
from five samples of unopened bales of moss obtained from one
nursery.
Sphagnum moss harvested in Wisconsin is shipped to nurseries in
more
than 15 states, and the involved Pennsylvania nurseries ship
seedlings
and moss to 47 states. Further epidemiologic and laboratory
investigations are under way.
Reported by: T England, MD, MJ Kasten, MD, Mercy Hospital,
Champaign; R
Martin, DVD, T Cote, MD, Illinois State Dept of Health. DL Morse,
MD,
State Epidemiologist, New York State Dept of Health. R David, MD,
Acting State Epidemiologist, Pennsylvania State Dept of Health. JP
Davis, MD, State Epidemiologist, Wisconsin Dept of Health and
Social
Svcs. Div of Field Svcs, Epidemiology Program Office; Meningitis
and
Special Pathogens Br, Div of Bacterial Diseases, and Div of Mycotic
Diseases, Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note: Sporothrix schenckii is a dimorphic fungus found
in
moss, hay, soil, and decaying vegetation. Previous outbreaks
associated
with Wisconsin sphagnum moss have occurred (1-3). The largest
reported
U.S. outbreak involved 17 forestry workers in 1976 (2).
Sporotrichosis most commonly presents as papules or skin ulcers on
the
upper extremities with lymphangitic spread and painful
lymphadenopathy.
It is frequently misdiagnosed, resulting in delay of appropriate
oral
potassium iodide therapy. Incision and drainage are contraindicated
as
they may worsen skin lesions. Amphotericin B is reserved for
disseminated disease, which occurs rarely.
Clinicians should consider sporotrichosis in patients with chronic
cutaneous lesions and appropriate exposure histories. Protective
clothing (e.g., gloves and long-sleeved shirts) should be worn when
potentially infected materials such as sphagnum moss or seedlings
are
handled.
References
D'Alessio DJ, Leavens LJ, Strumpf GB, Smith CD. An outbreak of
sporotrichosis in Vermont associated with sphagnum moss as the
source
of infection. N Engl J Med 1965;272:1054-8.
Powell KE, Taylor A, Phillips BJ, et al. Cutaneous
sporotrichosis in
forestry workers: epidemic due to contaminated sphagnum moss. JAMA
1978;240:232-5.
CDC. Sporotrichosis associated with Wisconsin sphagnum moss.
MMWR
1982;31:542-4.
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