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Hanzlicek AS, KuKanich KS, Cook AK, Hodges S, Thomason JM, DeSilva R, Ramachandran A, Durkin MM. Clinical utility of fungal culture and antifungal susceptibility in cats and dogs with histoplasmosis. J Vet Intern Med 2023; 37:998-1006. [PMID: 37092675 DOI: 10.1111/jvim.16725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 04/08/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Culture can be used for diagnosis and antifungal susceptibility testing in animals with fungal infections. Limited information is available regarding the diagnostic performance of culture and the susceptibility patterns of Histoplasma spp. isolates. HYPOTHESIS/OBJECTIVES Describe the clinical utility of culture and the susceptibility patterns of Histoplasma spp. isolates causing histoplasmosis in cats and dogs. ANIMALS Seventy-one client-owned animals, including 33 cats and 19 dogs with proven or probable histoplasmosis. METHODS Culture was attempted from tissue or fluid samples. Diagnostic performance of culture, cytopathology, and antigen detection were compared with final diagnosis. Susceptibility to antifungal agents was determined for a subset (11 from dogs, 9 from cats) of culture isolates. RESULTS Culture had a diagnostic sensitivity of 17/33 (52%; 95% confidence interval [CI], 34%-69%) and 15/19 (79%; 95% CI, 61%-97%) and specificity of 6/6 (100%; 95% CI, 54%-100%) and 10/10 (100%; 95% CI, 69%-100%) in cats and dogs, respectively. Culture was not positive in any animal in which cytopathology and antigen testing were negative. Target drug exposure (area under the concentration curve [AUC]/minimum inhibitory concentration [MIC] >25) should be easily achieved for all isolates for itraconazole, voriconazole, or posaconazole. Five of 20 (25%) isolates had fluconazole MIC ≥32 μg/mL and achieving target drug exposure is unlikely. CONCLUSIONS AND CLINICAL IMPORTANCE Fungal culture did not improve diagnostic sensitivity when used with cytopathology and antigen detection. Susceptibility testing might help identify isolates for which fluconazole is less likely to be effective.
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Affiliation(s)
- Andrew S Hanzlicek
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Oklahoma State University, Stillwater, Oklahoma, USA
- MiraVista Diagnostics, Indianapolis, Indiana, USA
| | - Kate S KuKanich
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
| | - Audrey K Cook
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Steven Hodges
- Oklahoma Veterinary Specialists, Tulsa, Oklahoma, USA
| | - John M Thomason
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - Rupika DeSilva
- Oklahoma Animal Disease Diagnostic Laboratory, Department of Veterinary Pathobiology, College of Veterinary Medicine, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Akhilesh Ramachandran
- Oklahoma Animal Disease Diagnostic Laboratory, Department of Veterinary Pathobiology, College of Veterinary Medicine, Oklahoma State University, Stillwater, Oklahoma, USA
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Rapid back flushed direct sample injection bio-analytical HPLC-UV method for therapeutic drug monitoring of terbinafine. Anal Biochem 2022; 659:114951. [PMID: 36244510 DOI: 10.1016/j.ab.2022.114951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/02/2022] [Accepted: 10/06/2022] [Indexed: 12/14/2022]
Abstract
A rapid back flushed (BF) direct sample injection (DSI) high-performance liquid chromatography (HPLC) with UV detection (BF-DSI-HPLC-UV) has been developed to determine terbinafine (TERB) in human serum. For online solid phase extraction step, an isocratic mobile phase of phosphate buffer saline (pH 7.4) at 1 mL/min and a short protein-coated ODS column (PC-ODS-column) were used for the purification and enrichment of TERB. Two different chromatographic modes of PC-ODS-column were simultaneously operated. Macromolecular proteins were extracted by size-exclusion liquid chromatography, while TERB trapping and enrichment were achieved through reversed-phase liquid chromatography. The clear fraction containing TERB was transferred from the PC-ODS-column by BF mode onto the quantification step through a high pressure switching valve. An analytical mobile phase consisting of 80% methanol and 1% triethylamine in distilled deionized water (pH) 6 at 1 mL/min was used for the final separation on an ODS analytical column. TERB was quantified and detected by UV-detector at 224 nm. The proposed method showed high correlation coefficient (>0.999) over the concentrations range 4-1600 ng/mL with recoveries ranging from 98.48 to 93.86%. Measurement of TERB concentration in serum after administration of a single dose of 250 mg oral tablet was used to evaluate the applicability of the BF-DSI-HPLC-UV for pharmacokinetic study.
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McEntire MS, Reinhart JM, Cox SK, Keller KA. Single-dose pharmacokinetics of orally administered terbinafine in bearded dragons (Pogona vitticeps) and the antifungal susceptibility patterns of Nannizziopsis guarroi. Am J Vet Res 2021; 83:256-263. [PMID: 34941564 DOI: 10.2460/ajvr.21.02.0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify the antifungal susceptibility of Nanniziopsis guarroi isolates and to evaluate the single-dose pharmacokinetics of orally administered terbinafine in bearded dragons. ANIMALS 8 healthy adult bearded dragons. PROCEDURES 4 isolates of N guarroi were tested for antifungal susceptibility. A compounded oral solution of terbinafine (25 mg/mL [20 mg/kg]) was given before blood (0.2 mL) was drawn from the ventral tail vein at 0, 4, 8, 12, 24, 48, 72, and 96 hours after administration. Plasma terbinafine concentrations were measured with high-performance liquid chromatography. RESULTS The antifungal minimum inhibitory concentrations against N guarroi isolates ranged from 4,000 to > 64,000 ng/mL for fluconazole, 125 to 2,000 ng/mL for itraconazole, 125 to 2,000 ng/mL for ketoconazole, 125 to 1,000 ng/mL for posaconazole, 60 to 250 ng/mL for voriconazole, and 15 to 30 ng/mL for terbinafine. The mean ± SD peak plasma terbinafine concentration in bearded dragons was 435 ± 338 ng/mL at 13 ± 4.66 hours after administration. Plasma concentrations remained > 30 ng/mL for > 24 hours in all bearded dragons and for > 48 hours in 6 of 8 bearded dragons. Mean ± SD terminal half-life following oral administration was 21.2 ± 12.40 hours. CLINICAL RELEVANCE Antifungal susceptibility data are available for use in clinical decision making. Results indicated that administration of terbinafine (20 mg/kg, PO, q 24 to 48 h) in bearded dragons may be appropriate for the treatment of dermatomycoses caused by N guarroi. Clinical studies are needed to determine the efficacy of such treatment.
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Affiliation(s)
- Michael S McEntire
- 1Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Champaign-Urbana, Urbana, IL
| | - Jennifer M Reinhart
- 1Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Champaign-Urbana, Urbana, IL
| | - Sherry K Cox
- 2Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN
| | - Krista A Keller
- 1Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Champaign-Urbana, Urbana, IL
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Abstract
Antifungals are effective antimicrobial agents broadly used in medical practice. Severe acute liver failure from oral or IV administration of antifungals is a rare but long-standing clinical challenge. We aimed to approximate the risk of clinical acute liver injury among users of oral antifungals in the general population. This review was completed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six articles were included, comprising case reports and cohort studies, after eliminating duplicate publications. No randomized control studies were found. In all studies, the duration of antifungal use was associated with significantly increased liver enzyme levels. Although it is not very common for patients on antifungals to develop acute liver failure, the prognosis is often good with swift discontinuation of the drug and proper treatment. Liver function evaluation before treatment and periodic monitoring every three to six weeks after commencement of treatment is suggested.
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Affiliation(s)
- Eyad Gadour
- Gastroenterology and Hepatology, University Hospitals of Morecambe Bay National Health Service (NHS) Foundation Trust, Lancaster, GBR
| | - Ahmed Kotb
- Hepatobiliary Surgery, Glan Clwyd Hospital, Wales, GBR
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TERBINAFINE PHARMACOKINETICS FOLLOWING SINGLE-DOSE ORAL ADMINISTRATION IN RED-EARED SLIDER TURTLES ( TRACHEMYS SCRIPTA ELEGANS): A PILOT STUDY. J Zoo Wildl Med 2021; 52:520-528. [PMID: 34130394 DOI: 10.1638/2020-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 11/21/2022] Open
Abstract
In this pilot study, the pharmacokinetics of terbinafine were determined in six apparently healthy red-eared slider turtles (Trachemys scripta elegans) after a single PO administration. Terbinafine suspension (15 mg/kg, once) was administered via gavage tube to all turtles. Blood samples were collected immediately before (time 0) and at 1, 2, 4, 8, 24, and 48 h after drug administration. Plasma terbinafine concentrations were quantified by ultra-performance liquid chromatography-mass spectrometry, and noncompartmental pharmacokinetic analysis was performed. None of the animals showed any adverse responses following terbinafine administration. Mean area under the curve from time 0 to 24 h was 1,213 h × ng/ml (range 319-7,309), mean peak plasma concentration was 201.5 ng/ml (range 45.8-585.3), mean time to maximum plasma concentration was 1.26 h (range 1-4), mean residence time was 7.71 h (range 3.85-14.8), and mean terminal half-life was 5.35 h (range 2.67-9.83). The administration of terbinafine (15 mg/kg, PO) may be appropriate for treatment of select fungal organisms with low minimum inhibitory concentrations in red-eared slider turtles but may require q12h administration even for organisms with low minimum inhibitory concentrations. Multiple-dose studies as well as clinical studies are needed to determine ideal dosages and efficacy.
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Rojo-Solís C, García-Párraga D, Montesinos A, Ardiaca-García M, Álvaro T, Valls M, Barros-García C, Encinas T. Pharmacokinetics of single dose oral Terbinafine in common shelducks (Tadorna tadorna). J Vet Pharmacol Ther 2020; 44:510-515. [PMID: 33377208 DOI: 10.1111/jvp.12942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/06/2020] [Indexed: 11/27/2022]
Abstract
Fungal disease is a major cause of morbidity and mortality in avian species; thus, antifungals are the treatment of choice. Despite widely used in clinical practice, terbinafine pharmacokinetic studies are scarce in literature and only cover some avian families, with marked differences between them. This study evaluates the pharmacokinetic behaviour of terbinafine after a single oral administration of 60 mg/kg in 7 healthy adult common shelducks (Tadorna tadorna) by measuring plasma concentrations through high-performance liquid chromatography (HPLC) at times 0, 30 min, 1, 2, 4, 6, 8, 10, 12, 24, 36 and 48 hr postadministration. Noncompartmental analyses of the data showed a Cmax (geometric mean) of 5.43 µg/ml, tmax (median) 1.0 hr and AUC0-∞ 29.70 mg h/L. Elimination half-life was 6.33 hr and MRT 6.61 hr. Plasma concentrations remained above previously described MIC for terbinafine in some fungal species for at least 6 to 8 hr. A single oral administration of 60 mg/kg terbinafine did not produce adverse effects and could be a good treatment choice for fungal diseases in anatids.
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Affiliation(s)
- Carlos Rojo-Solís
- Veterinary Services, Oceanogràfic, Ciudad de las Artes y las Ciencias, València, Spain.,Pharmacology & Toxicology Department, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
| | - Daniel García-Párraga
- Veterinary Services, Oceanogràfic, Ciudad de las Artes y las Ciencias, València, Spain
| | - Andrés Montesinos
- Pharmacology & Toxicology Department, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain.,Centro Veterinario los Sauces, Madrid, Spain
| | | | - Teresa Álvaro
- Veterinary Services, Oceanogràfic, Ciudad de las Artes y las Ciencias, València, Spain
| | - Mónica Valls
- Veterinary Services, Oceanogràfic, Ciudad de las Artes y las Ciencias, València, Spain
| | - Carlos Barros-García
- Veterinary Services, Oceanogràfic, Ciudad de las Artes y las Ciencias, València, Spain
| | - Teresa Encinas
- Pharmacology & Toxicology Department, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
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Bond R, Morris DO, Guillot J, Bensignor EJ, Robson D, Mason KV, Kano R, Hill PB. Biology, diagnosis and treatment of Malassezia dermatitis in dogs and cats Clinical Consensus Guidelines of the World Association for Veterinary Dermatology. Vet Dermatol 2020; 31:28-74. [PMID: 31957204 DOI: 10.1111/vde.12809] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND The genus Malassezia is comprised of a group of lipophilic yeasts that have evolved as skin commensals and opportunistic cutaneous pathogens of a variety of mammals and birds. OBJECTIVES The objective of this document is to provide the veterinary community and other interested parties with current information on the ecology, pathophysiology, diagnosis, treatment and prevention of skin diseases associated with Malassezia yeasts in dogs and cats. METHODS AND MATERIAL The authors served as a Guideline Panel (GP) and reviewed the literature available prior to October 2018. The GP prepared a detailed literature review and made recommendations on selected topics. The World Association of Veterinary Dermatology (WAVD) Clinical Consensus Guideline committee provided guidance and oversight for this process. The document was presented at two international meetings of veterinary dermatology societies and one international mycology workshop; it was made available for comment on the WAVD website for a period of six months. Comments were shared with the GP electronically and responses incorporated into the final document. CONCLUSIONS AND CLINICAL IMPORTANCE There has been a remarkable expansion of knowledge on Malassezia yeasts and their role in animal disease, particularly since the early 1990's. Malassezia dermatitis in dogs and cats has evolved from a disease of obscurity and controversy on its existence, to now being a routine diagnosis in general veterinary practice. Clinical signs are well recognised and diagnostic approaches are well developed. A range of topical and systemic therapies is known to be effective, especially when predisposing factors are identified and corrected.
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Affiliation(s)
- Ross Bond
- Department of Clinical Sciences and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, AL9 7TA, UK
| | - Daniel O Morris
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancy Street, Philadelphia, PA, 19104, USA
| | - Jacques Guillot
- École nationale vétérinaire d'Alfort, BioPôle Alfort, EA 7380 Dynamyc, UPEC, EnvA, Maisons Alfort, Ile-de-France, France
| | | | - David Robson
- Animal Skin and Ear Specialists, Melbourne Veterinary Specialist Centre, 70 Blackburn Road, Glen Waverley, Victoria, 3150, Australia
| | - Kenneth V Mason
- Dermcare-vet PTY LTD, 7 Centenary Road, Slacks Creek, Queensland, 4127, Australia
| | - Rui Kano
- Department of Veterinary Pathobiology, Nihon University College of Bioresource Sciences, 1866 Kameino, Fujisawa, Kanagawa, 252-0880, Japan
| | - Peter B Hill
- Department of Veterinary Science, University of Adelaide, Adelaide, South Australia, 5005, Australia
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Gnat S, Łagowski D, Nowakiewicz A, Osińska M, Kopiński Ł. Population differentiation, antifungal susceptibility, and host range of Trichophyton mentagrophytes isolates causing recalcitrant infections in humans and animals. Eur J Clin Microbiol Infect Dis 2020; 39:2099-2113. [PMID: 32607909 PMCID: PMC7561545 DOI: 10.1007/s10096-020-03952-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/10/2020] [Indexed: 02/05/2023]
Abstract
The major problems in determining the causative factors of the high prevalence of dermatophytoses include the lack of a well-standardized antifungal susceptibility testing method, the low consistency of in vitro and clinical minimal inhibitory concentration values, the high genomic diversity of the population, and the unclear mechanism of pathogenicity. These factors are of particular importance when the disease is recalcitrant and relapses. Herein, we identified and characterized Trichophyton mentagrophytes isolates obtained from therapy-resistant cases in humans and animals. We used genomic diversity analysis of 17 human and 27 animal clinical isolates with the MP-PCR technique, determined their phenotypic enzymatic activity and host range, and performed antifungal susceptibility testing to currently available antifungal drugs from various chemical groups. Genomic diversity values of 35.3% and 33.3% were obtained for clinical isolates from humans and animals, respectively, yet without any relationship to the host species or antifungal drug to which resistance in therapy was revealed. The highest activity of keratinase enzymes was recorded for fox, guinea pig, and human hairs. These hosts can be considered as the main species in the host range of these isolates. A phenyl morpholine derivative, i.e. amorolfine, exhibited superior activity against strains obtained from both humans and animals with the lowest MIC50. Interestingly, high compliance of terbinafine in vitro resistance with clinical problems in the treatment with this substance was shown as well. The high resistance of dermatophytes to drugs is the main cause of the recalcitrance of the infection, whereas the other features of the fungus are less important.
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Affiliation(s)
- Sebastian Gnat
- Faculty of Veterinary Medicine, Institute of Biological Bases of Animal Diseases, Department of Veterinary Microbiology, University of Life Sciences, Akademicka 12, 20-033, Lublin, Poland.
| | - Dominik Łagowski
- Faculty of Veterinary Medicine, Institute of Biological Bases of Animal Diseases, Department of Veterinary Microbiology, University of Life Sciences, Akademicka 12, 20-033, Lublin, Poland.
| | - Aneta Nowakiewicz
- Faculty of Veterinary Medicine, Institute of Biological Bases of Animal Diseases, Department of Veterinary Microbiology, University of Life Sciences, Akademicka 12, 20-033, Lublin, Poland
| | - Marcelina Osińska
- Faculty of Veterinary Medicine, Institute of Biological Bases of Animal Diseases, Department of Veterinary Microbiology, University of Life Sciences, Akademicka 12, 20-033, Lublin, Poland
| | - Łukasz Kopiński
- Faculty of Agrobioengineering, Department of Management and Marketing, University of Life Sciences, Dobrzanskiego 37, 20-626, Lublin, Poland
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MIC and Upper Limit of Wild-Type Distribution for 13 Antifungal Agents against a Trichophyton mentagrophytes-Trichophyton interdigitale Complex of Indian Origin. Antimicrob Agents Chemother 2020; 64:AAC.01964-19. [PMID: 32015042 DOI: 10.1128/aac.01964-19] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/22/2020] [Indexed: 12/21/2022] Open
Abstract
Dermatophytosis due to the Trichophyton mentagrophytes-Trichophyton interdigitale complex is being increasingly reported across India. Reports of therapeutic failure have surfaced recently, but there are no clinical break points (CBP) or epidemiological cutoffs (ECVs) available to guide the treatment of dermatophytosis. In this study, a total of 498 isolates of the T. mentagrophytes -interdigitale complex were collected from six medical centers over a period of five years (2014 to 2018). Antifungal susceptibility testing of the isolates was carried out for itraconazole, fluconazole, ketoconazole, voriconazole, luliconazole, sertaconazole, miconazole, clotrimazole, terbinafine, amorolfine, naftifine, ciclopirox olamine, and griseofulvin. The MICs (in mg/liter) comprising >95% of the modeled populations were as follows: 0.06 for miconazole, luliconazole, and amorolfine; 0.25 for voriconazole; 0.5 for itraconazole, ketoconazole, and ciclopirox olamine; 1 for clotrimazole and sertaconazole; 8 for terbinafine; 16 for naftifine; 32 for fluconazole; and 64 for griseofulvin. A high percentage of isolates above the upper limit of the wild-type MIC (UL-WT) were observed for miconazole (29%), luliconazole (13.9%), terbinafine (11.4%), naftifine (5.2%), and voriconazole (4.8%), while they were low for itraconazole (0.2%). Since the MICs of itraconazole were low against the T. mentagrophytes -interdigitale complex, this could be considered the choice of first-line treatment. The F397L mutation in the squalene epoxidase (SE) gene was observed in 77.1% of isolates with a terbinafine MIC of ≥1 mg/liter, but no mutation was detected in isolates with a terbinafine MIC of <1 mg/liter. In the absence of CBPs, evaluation of the UL-WT may be beneficial for managing dermatophytosis and monitoring the emergence of isolates with reduced susceptibility.
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Van Vertloo LR, Gettinger MR, Naiman JH, Haynes JS. Upper Airway Obstruction Due to Primary Laryngeal Blastomycosis in a Dog. J Am Anim Hosp Assoc 2020; 56:181. [PMID: 32182114 DOI: 10.5326/jaaha-ms-6984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 9 yr old female spayed Labrador retriever presented for progressive dyspnea. Inspiratory stridor and inspiratory and expiratory dyspnea were present, consistent with an upper airway obstruction. A laryngeal exam revealed severe thickening of the arytenoid cartilages and masses associated with the arytenoids. A tracheostomy tube was placed, and the masses were biopsied. Histopathology showed pyogranulomatous inflammation secondary to Blastomyces dermatitidis. The dog was initially treated with amphotericin B and terbinafine in the hospital until the airway obstruction resolved and the tracheostomy tube could be removed. The dog experienced complete recovery after long-term treatment with itraconazole and terbinafine. This is the first report of laryngeal obstruction secondary to primary laryngeal blastomycosis in a dog. Blastomycosis should be considered for cases of obstructive laryngeal disease, and a good outcome can be achieved with antifungal treatment.
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Kloezen W, Parel F, Brüggemann R, Asouit K, Helvert-van Poppel M, Fahal A, Mouton J, van de Sande W. Amphotericin B and terbinafine but not the azoles prolong survival in Galleria mellonella larvae infected with Madurella mycetomatis. Med Mycol 2019; 56:469-478. [PMID: 28992315 DOI: 10.1093/mmy/myx064] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 08/08/2017] [Indexed: 11/12/2022] Open
Abstract
Mycetoma is a tropical neglected disease characterized by large subcutaneous lesions in which the causative organisms reside in the form of grains. The most common causative agent is Madurella mycetomatis. Antifungal therapy often fails due to these grains, but to identify novel treatment options has been difficult since grains do not form in vitro. We recently used Galleria mellonella larvae to develop an in vivo grain model. In the current study, we set out to determine the therapeutic efficacy of commonly used antifungal agents in this larval model. Pharmacokinetics of ketoconazole, itraconazole, voriconazole, posaconazole, amphotericin B, and terbinafine were determined in the hemolymph of G. mellonella larvae. Antifungal therapy was given either therapeutically or prophylactic on three consecutive days in therapeutically equivalent dosages. Survival was monitored for 10 days and colony-forming units (cfu) and melanization were determined on day 3. Measurable concentrations of antifungal agents were found in the hemolymph of the larvae. None of the azole antifungal agents prolonged survival when given therapeutically or prophylactically. Amphotericin B and terbinafine did prolong survival, even at concentrations below the minimal inhibitory concentration of M. mycetomatis. The cfu and melanization did not differ between any of the treated groups and phosphate-buffered saline (PBS) treated groups. Grains were still present in surviving larvae but appeared to be encapsulated. This study demonstrated for the first time a comparison between the efficacy of different antifungal agents toward grains of M. mycetomatis. It appeared that amphotericin B and terbinafine were able to prolong larval survival.
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Affiliation(s)
- Wendy Kloezen
- ErasmusMC Department of Medical Microbiology and Infectious Diseases Wytemaweg 80 3015 CE Rotterdam, The Netherlands
| | - Florianne Parel
- ErasmusMC Department of Medical Microbiology and Infectious Diseases Wytemaweg 80 3015 CE Rotterdam, The Netherlands
| | - Roger Brüggemann
- Radboud University Medical Centre Pharmacy PO BOX 9101 6500 HB Nijmegen, The Netherlands
| | - Khalid Asouit
- Radboud University Medical Centre Pharmacy PO BOX 9101 6500 HB Nijmegen, The Netherlands
| | - Marilyn Helvert-van Poppel
- St Elisabeth Ziekenhuis Department of clinical pathology Hilvarenbeekseweg 60 5022 GC Tilburg, The Netherlands
| | | | - Johan Mouton
- ErasmusMC Department of Medical Microbiology and Infectious Diseases Wytemaweg 80 3015 CE Rotterdam, The Netherlands
| | - Wendy van de Sande
- ErasmusMC Department of Medical Microbiology and Infectious Diseases Wytemaweg 80 3015 CE Rotterdam, The Netherlands
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Davidson AP, Shubitz LF, Alcott CJ, Sykes JE. Selected Clinical Features of Coccidioidomycosis in Dogs. Med Mycol 2019; 57:S67-S75. [PMID: 30690600 DOI: 10.1093/mmy/myy113] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 10/04/2018] [Indexed: 11/13/2022] Open
Abstract
Canine coccidioidomycosis, a systemic fungal infection endemic to arid and semiarid regions of North, Central, and South America, is commonly diagnosed in dogs living in or traveling through lower Sonoran life zones in the states of California and Arizona. Canine and human cases have geographic overlap. Similarities between clinical coccidioidomycosis in dogs and humans include asymptomatic infection, primary respiratory disease and disseminated disease. Differences include a high rate of dissemination in dogs, differences in predilection of dissemination sites, and a granulomatous or diffuse meningoencephalopathic form in the canine central nervous system (CNS) without the obstructive component seen in humans. Dogs presenting with CNS coccidioidomycosis most commonly experience seizures. Prior disease history and serology are unreliable indicators of CNS coccidioidomycosis. Magnetic resonance imaging (MRI) is advantageous for diagnosis of CNS coccidioidomycosis in dogs. Long-term administration of antifungal medication is promoted for treatment of both primary and disseminated coccidioidomycosis in dogs. Supportive treatment addressing pain, fever, inappetance, coughing, and other clinical signs improves patient care. Glucocorticoids and or anticonvulsants are also recommended for canine disseminated CNS disease. Protracted treatment times, lack of owner compliance, failure of the disease to respond to the first antifungal drug selected, and high cost are challenges of successfully treating dogs.
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Affiliation(s)
- Autumn P Davidson
- School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Lisa F Shubitz
- Valley Fever Center for Excellence, The University of Arizona, Tucson, Arizona, USA
| | - Cody J Alcott
- Veterinary Specialty Center of Tucson, Tucson, Arizona, USA
| | - Jane E Sykes
- School of Veterinary Medicine, University of California-Davis, Davis, California, USA
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Babu PR, S Pravin AJ, Deshmukh G, Dhoot D, Samant A, Kotak B. Author's reply. Indian J Dermatol 2017; 62:667-669. [PMID: 29263546 PMCID: PMC5724320 DOI: 10.4103/ijd.ijd_496_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- P Ravindra Babu
- Consultant Dermatologist, Raga Skin Care, Bengaluru, Karnataka, India
| | - A J S Pravin
- Department of Dermatology and Venerology, Kanyakumari Government Medical College, Nagercoil, Tamil Nadu, India
| | - Gaurav Deshmukh
- Medical Services Glenmark Pharmaceuticals, Mumbai, Maharashtra, India. E-mail:
| | - Dhiraj Dhoot
- Medical Services Glenmark Pharmaceuticals, Mumbai, Maharashtra, India. E-mail:
| | - Aniket Samant
- Medical Services Glenmark Pharmaceuticals, Mumbai, Maharashtra, India. E-mail:
| | - Bhavesh Kotak
- Medical Services Glenmark Pharmaceuticals, Mumbai, Maharashtra, India. E-mail:
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Moriello KA, Coyner K, Paterson S, Mignon B. Diagnosis and treatment of dermatophytosis in dogs and cats.: Clinical Consensus Guidelines of the World Association for Veterinary Dermatology. Vet Dermatol 2017; 28:266-e68. [PMID: 28516493 DOI: 10.1111/vde.12440] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Dermatophytosis is a superficial fungal skin disease of cats and dogs. The most common pathogens of small animals belong to the genera Microsporum and Trichophyton. It is an important skin disease because it is contagious, infectious and can be transmitted to people. OBJECTIVES The objective of this document is to review the existing literature and provide consensus recommendations for veterinary clinicians and lay people on the diagnosis and treatment of dermatophytosis in cats and dogs. METHODS The authors served as a Guideline Panel (GP) and reviewed the literature available prior to September 2016. The GP prepared a detailed literature review and made recommendations on selected topics. The World Association of Veterinary Dermatology (WAVD) provided guidance and oversight for this process. A draft of the document was presented at the 8th World Congress of Veterinary Dermatology (May 2016) and was then made available via the World Wide Web to the member organizations of the WAVD for a period of three months. Comments were solicited and posted to the GP electronically. Responses were incorporated by the GP into the final document. CONCLUSIONS No one diagnostic test was identified as the gold standard. Successful treatment requires concurrent use of systemic oral antifungals and topical disinfection of the hair coat. Wood's lamp and direct examinations have good positive and negative predictability, systemic antifungal drugs have a wide margin of safety and physical cleaning is most important for decontamination of the exposed environments. Finally, serious complications of animal-human transmission are exceedingly rare.
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Affiliation(s)
- Karen A Moriello
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive West, Madison, WI, 53706, USA
| | - Kimberly Coyner
- Dermatology Clinic for Animals, 8300 Quinault Drive NE Suite A, Lacey, WA, 98516, USA
| | - Susan Paterson
- Department of Veterinary Dermatology, Rutland House Referral Hospital, Abbotsfield Road, St Helens, WA9 4HU, UK
| | - Bernard Mignon
- Department of Infectious and Parasitic Diseases, Veterinary Mycology, FARAH (Fundamental and Applied Research for Animals & Health), Faculty of Veterinary Medicine, University of Liège, Quartier Vallée 2, Avenue de Cureghem 10, B43A, 4000, Liège, Belgium
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Kane LP, Allender MC, Archer G, Leister K, Rzadkowska M, Boers K, Souza M, Cox S. Pharmacokinetics of nebulized and subcutaneously implanted terbinafine in cottonmouths (Agkistrodon piscivorus
). J Vet Pharmacol Ther 2017; 40:575-579. [DOI: 10.1111/jvp.12406] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 02/23/2017] [Indexed: 11/30/2022]
Affiliation(s)
- L. P. Kane
- Wildlife Epidemiology Lab; Department of Comparative Biosciences; College of Veterinary Medicine; University of Illinois; Urbana IL USA
| | - M. C. Allender
- Wildlife Epidemiology Lab; Department of Comparative Biosciences; College of Veterinary Medicine; University of Illinois; Urbana IL USA
| | - G. Archer
- Wildlife Epidemiology Lab; Department of Comparative Biosciences; College of Veterinary Medicine; University of Illinois; Urbana IL USA
| | - K. Leister
- Wildlife Epidemiology Lab; Department of Comparative Biosciences; College of Veterinary Medicine; University of Illinois; Urbana IL USA
| | - M. Rzadkowska
- Wildlife Epidemiology Lab; Department of Comparative Biosciences; College of Veterinary Medicine; University of Illinois; Urbana IL USA
| | - K. Boers
- Wildlife Epidemiology Lab; Department of Comparative Biosciences; College of Veterinary Medicine; University of Illinois; Urbana IL USA
| | - M. Souza
- Department of Biomedical and Diagnostic Sciences; University of Tennessee; Knoxville Tennessee USA
| | - S. Cox
- Department of Biomedical and Diagnostic Sciences; University of Tennessee; Knoxville Tennessee USA
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Paskiabi FA, Bonakdar S, Shokrgozar MA, Imani M, Jahanshiri Z, Shams-Ghahfarokhi M, Razzaghi-Abyaneh M. Terbinafine-loaded wound dressing for chronic superficial fungal infections. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 73:130-136. [DOI: 10.1016/j.msec.2016.12.078] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/19/2016] [Accepted: 12/16/2016] [Indexed: 01/08/2023]
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Ivaskiene M, Matusevicius AP, Grigonis A, Zamokas G, Babickaite L. Efficacy of Topical Therapy with Newly Developed Terbinafine and Econazole Formulations in the Treatment of Dermatophytosis in Cats. Pol J Vet Sci 2017; 19:535-543. [PMID: 27760032 DOI: 10.1515/pjvs-2016-0067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the field of veterinary dermatology dermatophytosis is one of the most frequently occurring infectious diseases, therefore its treatment should be effective, convenient, safe and inexpensive. The aim of this study was to evaluate the efficacy of newly developed topical formulations in the treatment of cats with dermatophytosis. Evaluation of clinical efficacy and safety of terbinafine and econazole formulations administered topically twice a day was performed in 40 cats. Cats, suffering from the most widely spread Microsporum canis-induced dermatophytosis and treated with terbinafine hydrochloride 1% cream, recovered within 20.3±0.88 days; whereas when treated with econazole nitrate 1% cream, they recovered within 28.4±1.14 days. A positive therapeutic effect was yielded by combined treatment with local application of creams and whole coat spray with enilconazole 0.2% emulsion "Imaverol". Most cats treated with econazole cream revealed redness and irritation of the skin at the site of application. This study demonstrates that terbinafine tended to have superior clinical efficacy (p<0.001) in the treatment of dermatophytosis in cats compared to the azole tested.
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Sardana K, Gupta A. Rational for Drug Dosimetry and Duration of Terbinafine in the Context of Recalcitrant Dermatophytosis: Is 500 mg Better than 250 mg OD or BD? Indian J Dermatol 2017; 62:665-667. [PMID: 29263545 PMCID: PMC5724319 DOI: 10.4103/ijd.ijd_435_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Kabir Sardana
- Department of Dermatology, Dr. Ram Manohar Lohia Hospital, New Delhi, India. E-mail:
| | - Aastha Gupta
- Department of Dermatology, Dr. Ram Manohar Lohia Hospital, New Delhi, India. E-mail:
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Bexton S, Nelson H. Comparison of two systemic antifungal agents, itraconazole and terbinafine, for the treatment of dermatophytosis in European hedgehogs (Erinaceus europaeus). Vet Dermatol 2016; 27:500-e133. [PMID: 27620985 DOI: 10.1111/vde.12378] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dermatophytosis caused by Trichophyton erinacei is a common scaling and crusting skin disease affecting European hedgehogs (Erinaceus europaeus) admitted to wildlife rescue centres. The application of topical therapy can be challenging because wild hedgehogs are subject to stress and often roll into a ball when handled. Systemic antifungal therapy is more convenient but has not been evaluated in this species. HYPOTHESIS/OBJECTIVES To compare the efficacy of oral itraconazole versus oral terbinafine for the treatment of dermatophytosis affecting hedgehogs. ANIMALS A treatment trial was undertaken in a wildlife hospital involving 165 hedgehogs with naturally occurring dermatophytosis. METHODS Animals were randomly divided into two groups and treated with either itraconazole or terbinafine orally for 28 days. The therapeutic efficacy was evaluated after 14 and 28 days by mycological culture and clinical dermatological lesion scores. RESULTS Both drugs were well tolerated and clinically effective. After 14 and 28 days of treatment, the respective mycological cure rate was 36.6% and 65.9% for the itraconazole-treated group and 92.8% and 98.8% for the terbinafine-treated group. CONCLUSION AND CLINICAL IMPORTANCE Itraconazole and terbinafine were both effective for the treatment of dermatophytosis affecting hedgehogs; however, terbinafine was more effective.
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Affiliation(s)
- Steve Bexton
- Royal Society for the Prevention of Cruelty to Animals (RSPCA) East Winch Wildlife Centre, Station Road, East Winch, Kings Lynn, Norfolk, PE32 1NR, UK
| | - Helen Nelson
- Royal Society for the Prevention of Cruelty to Animals (RSPCA) East Winch Wildlife Centre, Station Road, East Winch, Kings Lynn, Norfolk, PE32 1NR, UK
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Gimmler JR, White AG, Kennis RA, Cruz-Espindola C, Boothe DM. Determining canine skin concentrations of terbinafine to guide the treatment of Malassezia dermatitis. Vet Dermatol 2015; 26:411-6, e95-6. [PMID: 26286855 DOI: 10.1111/vde.12245] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Terbinafine (TBF) is known to concentrate and persist in human skin. Its use is increasing in veterinary medicine, but there are limited data concerning its tissue concentration and efficacy in dogs. HYPOTHESIS/OBJECTIVES (i) Describe TBF accumulation in canine skin; (ii) Integrate pharmacokinetic data with historical minimum inhibitory concentration (MIC) results for Malassezia pachydermatis to verify the currently used dosage of TBF for the treatment of Malassezia dermatitis. ANIMALS Ten healthy, client-owned dogs. METHODS Dogs were given TBF (generic preparation, 250 mg tablets) 30 mg/kg per os (p.o.) once daily for 21 days. Serum, sebum and stratum corneum (SC) samples were collected on days 1, 5, 7, 11, 14, 21, 28 and 35. High-pressure liquid chromatography was used to determine drug concentrations in samples. RESULTS Relevant (mean ± standard deviation) parameters for TBF in serum, paw SC, thorax SC and sebum, respectively, were: maximum concentration (Cmax , μg/mL) 23.59 ± 10.41, 0.31 ± 0.26, 0.30 ± 0.32 and 0.48 ± 0.25; half-life (t1/2 , d) 4.49 ± 2.24, 6.34 ± 5.33, 4.64 ± 3.27 and 5.12 ± 3.33; time to maximum concentration (Tmax , d) 10.40 ± 6.98, 13.20 ± 5.16, 11.90 ± 8.62 and 10.60 ± 3.69. CONCLUSIONS AND CLINICAL IMPORTANCE These results suggest that TBF does not achieve high concentrations in canine SC or sebum compared to serum. The mean Cmax of all skin tissues (paw SC, thorax SC and sebum) barely exceeded the reported Malassezia MIC90, of 0.25 μg/mL, which indicates that doses higher than 30 mg/kg p.o. once daily may be necessary.
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Affiliation(s)
- Jacqueline R Gimmler
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, 1220 Wire Rd, Auburn, AL, 36849, USA
| | - Amelia G White
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, 1220 Wire Rd, Auburn, AL, 36849, USA
| | - Robert A Kennis
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, 1220 Wire Rd, Auburn, AL, 36849, USA
| | - Crisanta Cruz-Espindola
- Department of Anatomy, Physiology, and Pharmacology, College of Veterinary Medicine, Auburn University, 109 Greene Hall, Auburn, AL, 36849, USA
| | - Dawn M Boothe
- Department of Anatomy, Physiology, and Pharmacology, College of Veterinary Medicine, Auburn University, 109 Greene Hall, Auburn, AL, 36849, USA
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Cox S, Hayes J, Hamill M, Martin A, Pistole N, Yarbrough J, Souza M. Determining Terbinafine in Plasma and Saline Using HPLC. J LIQ CHROMATOGR R T 2015. [DOI: 10.1080/10826076.2014.922479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Sherry Cox
- a Department of Biomedical and Diagnostic Sciences , College of Veterinary Medicine, University of Tennessee , Knoxville , Tennessee , USA
| | - Joan Hayes
- a Department of Biomedical and Diagnostic Sciences , College of Veterinary Medicine, University of Tennessee , Knoxville , Tennessee , USA
| | - Mallery Hamill
- a Department of Biomedical and Diagnostic Sciences , College of Veterinary Medicine, University of Tennessee , Knoxville , Tennessee , USA
| | - Ali Martin
- a Department of Biomedical and Diagnostic Sciences , College of Veterinary Medicine, University of Tennessee , Knoxville , Tennessee , USA
| | - Nealy Pistole
- a Department of Biomedical and Diagnostic Sciences , College of Veterinary Medicine, University of Tennessee , Knoxville , Tennessee , USA
| | | | - Marcy Souza
- a Department of Biomedical and Diagnostic Sciences , College of Veterinary Medicine, University of Tennessee , Knoxville , Tennessee , USA
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22
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Milley CD, Labelle P, Tolar E, Griffin J, Reeder C. Prototheca wickerhamii
in a dog with cutaneous, ocular and systemic manifestations and treatment with terbinafine. VETERINARY RECORD CASE REPORTS 2015. [DOI: 10.1136/vetreccr-2015-000225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | | | - Erica Tolar
- Department of OphthalmologyBlue Pearl Veterinary PartnersLouisvilleKentuckyUSA
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Clinical, morphological, and molecular characterization of Penicillium canis sp. nov., isolated from a dog with osteomyelitis. J Clin Microbiol 2014; 52:2447-53. [PMID: 24789186 DOI: 10.1128/jcm.03602-13] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Infections caused by Penicillium species are rare in dogs, and the prognosis in these cases is poor. An unknown species of Penicillium was isolated from a bone lesion in a young dog with osteomyelitis of the right ilium. Extensive diagnostic evaluation did not reveal evidence of dissemination. Resolution of lameness and clinical stability of disease were achieved with intravenous phospholipid-complexed amphotericin B initially, followed by long-term combination therapy with terbinafine and ketoconazole. A detailed morphological and molecular characterization of the mold was undertaken. Sequence analysis of the internal transcribed spacer revealed the isolate to be closely related to Penicillium menonorum and Penicillium pimiteouiense. Additional sequence analysis of β-tubulin, calmodulin, minichromosome maintenance factor, DNA-dependent RNA polymerase, and pre-rRNA processing protein revealed the isolate to be a novel species; the name Penicillium canis sp. nov. is proposed. Morphologically, smooth, ovoid conidia, a greenish gray colony color, slow growth on all media, and a failure to form ascomata distinguish this species from closely related Penicillium species.
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Armentano RA, Cooke KL, Wickes BL. Disseminated mycotic infection caused byWesterdykellaspecies in a German Shepherd Dog. J Am Vet Med Assoc 2013; 242:381-7. [DOI: 10.2460/javma.242.3.381] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Berger DJ, Lewis TP, Schick AE, Stone RT. Comparison of once-daily versus twice-weekly terbinafine administration for the treatment of canine Malassezia dermatitis - a pilot study. Vet Dermatol 2012; 23:418-e79. [PMID: 22823935 DOI: 10.1111/j.1365-3164.2012.01074.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Terbinafine, an allylamine antifungal, is used in pulsatile dose regimens for superficial mycoses in human medicine. OBJECTIVES To compare the clinical efficacy of twice-weekly versus once-daily terbinafine administration to determine whether preliminary proof-of-concept evidence exists for pulsatile administration of terbinafine in the treatment of canine Malassezia dermatitis and to determine whether twice-weekly treatment results in fewer clinical and owner-perceived adverse events. ANIMALS Twenty client-owned dogs with Malassezia dermatitis. METHODS In this randomized, single-blinded clinical trial, dogs were randomly assigned to receive terbinafine (30 mg/kg) either once daily for 21 days (n = 10) or once daily on two consecutive days per week for six doses (n = 10). On day 0 and day 21, a mean yeast count was calculated from eight anatomical locations via adhesive tape-strip cytology, clinical lesion scores were assigned to the same locations, and owners assessed pruritus using a visual analog scale. RESULTS There was no significant difference between treatment groups with respect to the reduction in mean yeast count (P = 0.343) and clinical lesion scores (P = 0.887). Pruritus measured by visual analog scale was significantly decreased in the twice-weekly treatment group compared with the daily treatment group (P = 0.047). Seven of 20 dogs had a clinically measurable or owner-reported adverse event during treatment that included gastrointestinal disturbances, excessive panting and elevated hepatic enzymes, with no significant difference noted between treatment groups. CONCLUSIONS AND CLINICAL IMPORTANCE This pilot study indicates that twice-weekly terbinafine administration may be an effective alternative treatment for canine Malassezia dermatitis and merits further investigation.
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Olsen GL, Deitz KL, Flaherty HA, Lockhart SR, Hurst SF, Haynes JS. Use of Terbinafine in the Treatment Protocol of Intestinal Cryptococcus neoformans in a Dog. J Am Anim Hosp Assoc 2012; 48:216-20. [DOI: 10.5326/jaaha-ms-5813] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 2.5 yr old sexually intact male vizsla was admitted to the Iowa State University Veterinary Teaching Hospital for persistent diarrhea, weight loss, and panhypoproteinemia. Examination revealed an emaciated condition and melena. Two masses were palpated in the cranial abdomen. Hematology and serum biochemistry exhibited a regenerative anemia and confirmed the presence of panhypoproteinemia, suggestive of a protein-losing eneteropathy. Distinct areas of thickened intestinal wall and enlarged mesenteric lymph nodes were found on abdominal ultrasound. Cytology from those nodes showed the presence of suspected Cryptococcus spp., and infection was confirmed utilizing a cryptococcal antigen titer. Medical therapy with lipid-complexed amphotericin B and fluconazole was unsuccessful. Two surgical procedures were performed to remove the affected areas of intestine and lymph nodes, but the disease persisted as evidenced by a persistently elevated cryptococcal antigen titer. Terbinafine was prescribed, which resulted in complete resolution of clinical signs and a steadily decreasing cryptococcal antigen titer. Very few cases of intestinal cryptococcosis have been reported. In this case, infection resulted in a protein-losing enteropathy. In addition, this article describes the use of terbinafine in the treatment of intestinal cryptococcal infection in the dog, which has not been previously reported.
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Affiliation(s)
- Gavin L. Olsen
- Department of Veterinary Clinical Sciences, Internal Medicine Services, Iowa State University Veterinary Teaching Hospital, Ames, IA (G.O., K.D., H.F., J.H.); and Antifungal Drug Unit, Fungal Reference Unit, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA (S.L., S.H.)
| | - Krysta L. Deitz
- Department of Veterinary Clinical Sciences, Internal Medicine Services, Iowa State University Veterinary Teaching Hospital, Ames, IA (G.O., K.D., H.F., J.H.); and Antifungal Drug Unit, Fungal Reference Unit, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA (S.L., S.H.)
| | - Heather A. Flaherty
- Department of Veterinary Clinical Sciences, Internal Medicine Services, Iowa State University Veterinary Teaching Hospital, Ames, IA (G.O., K.D., H.F., J.H.); and Antifungal Drug Unit, Fungal Reference Unit, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA (S.L., S.H.)
| | - Shawn R. Lockhart
- Department of Veterinary Clinical Sciences, Internal Medicine Services, Iowa State University Veterinary Teaching Hospital, Ames, IA (G.O., K.D., H.F., J.H.); and Antifungal Drug Unit, Fungal Reference Unit, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA (S.L., S.H.)
| | - Steven F. Hurst
- Department of Veterinary Clinical Sciences, Internal Medicine Services, Iowa State University Veterinary Teaching Hospital, Ames, IA (G.O., K.D., H.F., J.H.); and Antifungal Drug Unit, Fungal Reference Unit, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA (S.L., S.H.)
| | - Joseph S. Haynes
- Department of Veterinary Clinical Sciences, Internal Medicine Services, Iowa State University Veterinary Teaching Hospital, Ames, IA (G.O., K.D., H.F., J.H.); and Antifungal Drug Unit, Fungal Reference Unit, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA (S.L., S.H.)
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