Incidence and prevalence

This is an uncommon infection and there are few data on prevalence. A problem in estimating exposure is that the frequency of subclinical infection is unknown. Using the crude antigen sporotrichin, it appears that many of the local unaffected population in endemic areas have positive reactions to the skin test (for example 22%)13 but it is not clear if this is the result of exposure to S. schenckii or to cross-reactive fungal species.

By plotting the spread of cases, it appears that sporotrichosis is mainly seen in the tropics and subtropics and in parts of the US. Before the 1940s it was regularly seen in Europe, where it is now uncommon.

It is clear that cutaneous sporotrichosis may occur in the form of isolated cases or in case clusters associated with exposure to a common source of infection such as straw used in packing.14 A major and continued outbreak was associated with contaminated pit props used in mines in South Africa. In addition, it appears that there are areas termed hyperendemic in parts of the world, for example Guatemala. Mexico and Peru. In the Peruvian focus, for instance, there has been an abnormally high frequency of cases in the vicinity of a single valley in the Andean foothills.15 A key feature though is the absence of any obvious association between the infection and any local or geographical feature.

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