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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

  1. 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.

  2. Powell KE, Taylor A, Phillips BJ, et al. Cutaneous sporotrichosis in forestry workers: epidemic due to contaminated sphagnum moss. JAMA 1978;240:232-5.

  3. CDC. Sporotrichosis associated with Wisconsin sphagnum moss. MMWR 1982;31:542-4.

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