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Bray RN, Raghu CL, Leuin AS, Barry-Heffernan CA, Pritchard JC. Oral administration of voriconazole with surgical fungal plaque debridement for the treatment of sinonasal aspergillosis with cribriform plate lysis in three dogs. J Am Vet Med Assoc 2020; 256:111-116. [PMID: 31841098 DOI: 10.2460/javma.256.1.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION 3 dogs with chronic sinonasal signs (sneezing, nasal discharge, or epistaxis [or a combination of signs]) were examined. CLINICAL FINDINGS For all 3 dogs, CT revealed variable degrees of nasal turbinate destruction and frontal sinus involvement with cribriform plate lysis. Fungal plaques were detected during rhinoscopy or sinusoscopy. Results of fungal culture (2 dogs) or cytologic examination of a plaque specimen (1 dog) supported a diagnosis of sinonasal aspergillosis. TREATMENT AND OUTCOME All dogs underwent surgical rhinotomy or sinusotomy (or both) for fungal plaque debridement followed by oral treatment with voriconazole and periodic physical examinations, clinicopathologic analyses, and assessments of serum drug concentrations for a period ≥ 22 weeks. All dogs had considerable to complete reduction of their clinical signs and tolerated voriconazole treatment with minimal adverse effects. Adverse effects included development of reversible neurotoxicosis (associated with high serum voriconazole concentration) and mildly high serum liver enzyme activities. The dosage of voriconazole administered to achieve therapeutic serum concentrations (2.5 to 3.3 mg/kg [1.1 to 1.5 mg/lb], PO, q 12 h) was substantially lower than dosages suggested by previously published studies in dogs. The 3 dogs remained clinically normal or had mild clinical signs after voriconazole discontinuation for follow-up times of 6 to 15 months. CLINICAL RELEVANCE Findings in these 3 dogs indicated that surgical fungal plaque debridement followed by oral treatment with voriconazole may be an effective treatment option for dogs with sinonasal aspergillosis and cribriform plate lysis. Further evaluation of this treatment regimen with repeated CT examinations and longer follow-up times is warranted.
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Barrs VR, Talbot JJ. Fungal Rhinosinusitis and Disseminated Invasive Aspergillosis in Cats. Vet Clin North Am Small Anim Pract 2019; 50:331-357. [PMID: 31866094 DOI: 10.1016/j.cvsm.2019.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Fungal rhinosinusitis, including sinonasal aspergillosis (SNA) and sino-orbital aspergillosis (SOA), is the most common type of aspergillosis encountered in cats. Other focal forms of aspergillosis including disseminated invasive aspergillosis occur less frequently. SOA is an invasive mycosis that is increasingly recognized and is most commonly caused by Aspergillus felis, a close relative of Aspergillus fumigatus. SNA can be invasive or noninvasive and is most commonly caused by A fumigatus and Aspergillus niger. Molecular methods are required to correctly identify the fungi that cause SNA and SOA. SNA has a favorable prognosis with treatment, whereas the prognosis for SOA remains poor.
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Affiliation(s)
- Vanessa R Barrs
- City University of Hong Kong, Department of Infectious Diseases & Public Health, Jockey Club College of Veterinary Medicine, Kowloon, Hong Kong SAR, China.
| | - Jessica J Talbot
- Faculty of Veterinary Science, University Veterinary Teaching Hospital, Sydney, University of Sydney, Faculty of Science, Sydney School of Veterinary Science, Camperdown, New South Wales 2006, Australia
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Abstract
Nasal disease in dogs is common and is often accompanied by chronic nasal discharge with or without other clinical signs. A thorough history and physical examination often guide the most appropriate choice of diagnostic testing to provide the best chance of attaining a diagnosis as to cause, and therefore, the most appropriate treatment. The purpose of this article is to guide the practitioner through a logical approach to the evaluation of dogs that are presented with signs of nasal disease.
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Affiliation(s)
- Leah A Cohn
- Department of Veterinary Medicine and Surgery, University of Missouri, 900 East Campus Drive, Columbia, MO 65211, USA.
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Cadoré JL, Tortereau A, Belluco S, Segard É, Leroux C. Guttural pouch mycosis in horses: An intriguing and mysterious disease. EQUINE VET EDUC 2019. [DOI: 10.1111/eve.12771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J.-L. Cadoré
- Equine Department; VetAgro Sup; Université de Lyon; Marcy l'Etoile France
- IVPC UMR754, INRA; Univ Lyon, Université Claude Bernard Lyon1, EPHE; Lyon France
| | - A. Tortereau
- Department of Pathology; Univ Lyon, Université Claude Bernard Lyon1, EPHE; Lyon France
| | - S. Belluco
- Department of Pathology; Univ Lyon, Université Claude Bernard Lyon1, EPHE; Lyon France
| | - É. Segard
- Equine Department; VetAgro Sup; Université de Lyon; Marcy l'Etoile France
| | - C. Leroux
- IVPC UMR754, INRA; Univ Lyon, Université Claude Bernard Lyon1, EPHE; Lyon France
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Vangrinsven E, Girod M, Goossens D, Desquilbet L, Clercx C, Billen F. Comparison of two minimally invasive enilconazole perendoscopic infusion protocols for the treatment of canine sinonasal aspergillosis. J Small Anim Pract 2018; 59:777-782. [PMID: 30362215 DOI: 10.1111/jsap.12933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 07/31/2018] [Accepted: 08/08/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare two minimally invasive enilconazole infusion protocols for the treatment of canine sinonasal aspergillosis and evaluate the importance of complete endoscopic debridement in determining first treatment success rate. MATERIALS AND METHODS Data for 48 dogs with confirmed sinonasal aspergillosis treated with endoscopic debridement followed by per-endoscopic enilconazole infusion were collected. Twenty-four dogs were treated according to the previously published 1-hour infusion protocol and 24 dogs underwent a simplified 15-minute infusion protocol. Completeness of debridement, evaluated as partial or complete at the end of the procedure and outcome after one or several treatments were assessed in all dogs. Multi-variable analysis was performed to derive odds ratios and 95% confidence intervals. RESULTS The median duration of the simplified protocol - 92∙3 minutes (range 40 to 140) - was substantially shorter than the duration of the previous protocol - 201∙3 minutes (range 120 to 265). First treatment success rates were 58 and 62∙5% for the previous and simplified protocol, respectively. Overall treatment success rate was similar in both groups (96%). Complete debridement was associated with an improved first treatment success rate compared to partial debridement. CLINICAL SIGNIFICANCE The simplified protocol is a valid alternative approach to the treatment of sinonasal aspergillosis. Completeness of endoscopic debridement before infusion is an important step for the success of treatment in canine sinonasal aspergillosis.
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Affiliation(s)
- E Vangrinsven
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, 4000 Liège, Belgium
| | - M Girod
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, 4000 Liège, Belgium
| | - D Goossens
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, 4000 Liège, Belgium
| | - L Desquilbet
- Clinical Epidemiology and Biostatistics Unit, National Veterinary School of Alfort, University of Paris-Est, 94704 Paris, France
| | - C Clercx
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, 4000 Liège, Belgium
| | - F Billen
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, 4000 Liège, Belgium
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Belda B, Petrovitch N, Mathews KG. Sinonasal aspergillosis: Outcome after topical treatment in dogs with cribriform plate lysis. J Vet Intern Med 2018; 32:1353-1358. [PMID: 29957889 PMCID: PMC6060319 DOI: 10.1111/jvim.15219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 03/29/2018] [Accepted: 04/25/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Cribriform lysis has been considered a contraindication for topical treatment of sinonasal aspergillosis (SNA) because of concerns about drug extravasation with resultant neurologic signs or death. OBJECTIVE/HYPOTHESIS To describe dogs with SNA and cribriform plate lysis treated with topical antifungal medications. Our hypothesis was that the conventional dogma that topical therapy should be avoided in these cases is incorrect. ANIMALS Nine client-owned dogs with SNA and lysis of the cribriform plate, lysis of the floor of a frontal sinus or both detected by computed tomography (CT). METHODS A retrospective review of medical records was performed. Dogs that met inclusion criteria (ie, SNA confirmed by at least 1 laboratory test, braincase affected on CT, and topical treatment applied) were included. Size of lesions, ancillary diagnostic test results, topical therapy, and adjuvant PO treatments were recorded. Outcome was determined by phone calls. RESULTS Four dogs were alive at the time of the manuscript submission with follow-up ranging from 188 to 684 days without neurological signs observed. All dogs were discharged without major complication 1-7 days postoperatively. One dog that had presented with a history of seizures experienced seizure activity 2 months after treatment. CONCLUSIONS AND CLINICAL IMPORTANCE Topical therapy did not result in complications in these dogs in which lytic regions as large as 16 × 22 mm2 were noted. Sinonasal aspergillosis associated lysis of the cribriform plate; lysis of the floor of a frontal sinus or both detected on CT is not necessarily a contraindication to topical therapy.
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Affiliation(s)
- Beatriz Belda
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNorth Carolina
| | - Nicholas Petrovitch
- Department of Molecular Biomedical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNorth Carolina
| | - Kyle G. Mathews
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNorth Carolina
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Vedrine B, Fribourg-Blanc LA. Treatment of Sinonasal Aspergillosis by Debridement and Sinonasal Deposition Therapy with Clotrimazole Under Rhinoscopic Guidance. J Am Anim Hosp Assoc 2018; 54:103-110. [PMID: 29372867 DOI: 10.5326/jaaha-ms-6648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Rhinoscopy was performed on 10 dogs with sinonasal aspergillosis (SNA). Direct access to the sinus via the nasal ostium was possible with a flexible endoscope to allow sinuscopy. Debridement of fungal plaques in the frontal sinus and the nasal cavity was performed, and a sinus and nasal deposition therapy with clotrimazole (1%) cream was made under rhinoscopic guidance. No oral medication was administered following the procedure. A rhinoscopic follow-up was performed monthly until cure. Six of ten (60%) dogs presented fungal plaques in the nasal cavity and in the frontal sinus and 4/10 (40%) dogs presented fungal plaques only in the frontal sinus. Five of ten (50%) dogs were considered to be cured at the first follow-up rhinoscopy, 4/10 (40%) after the second follow-up, and 1/10 (10%) after the third. Two dogs had delayed recurrence of SNA rhinoscopically assessed 12 and 21 mo, respectively, after the last clotrimazole treatment. Endoscopic debridement of fungal plaques and clotrimazole (1%) cream deposition therapy seems to be a valuable minimally invasive technique for SNA treatment in dogs without the use of complementary oral medication. Delayed recurrence is a potential finding following treatment of SNA.
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Affiliation(s)
- Bertrand Vedrine
- From the Clinique Vétérinaire Seinevet, 5 Place Cauchoise, 76000 Rouen, France
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Preston TJ, Hosgood GL, Paul A. Surgical management of refractory nasal aspergillosis using iodine cadexomer dressings in three dogs. Aust Vet J 2018; 94:405-410. [PMID: 27785803 DOI: 10.1111/avj.12508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 11/09/2015] [Accepted: 01/06/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND This case series describes surgical management of nasal aspergillosis refractory to conventional medical management or with evidence of cribriform plate osteolysis in three dogs. METHODS All dogs had surgical debridement of mucosa, nasal turbinates and necrotic debris via dorsal sinusotomy/rhinotomy. Sinuses were packed with iodine cadexomer-impregnated bandages for several weeks and affixed with tie-over bandages. Bandage changes were performed under sedation in 2/3 cases. Once mature granulation tissue covered all exposed bone, the tie-over bandages were removed and the sinusotomy/rhinotomy closed by apposing the skin edges. CONCLUSION This technique was well tolerated, effective and afforded a cure in all three patients. It should be considered in cases of cribriform lysis or lack of clinical response to conventional medical management.
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Affiliation(s)
- T J Preston
- Murdoch University, College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch, Western Australia, Australia
| | - G L Hosgood
- Murdoch University, College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch, Western Australia, Australia.
| | - Aeh Paul
- Murdoch University, College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch, Western Australia, Australia
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Hazuchova K, Neiger R, Stengel C. Topical treatment of mycotic rhinitis-rhinosinusitis in dogs with meticulous debridement and 1% clotrimazole cream: 64 cases (2007–2014). J Am Vet Med Assoc 2017; 250:309-315. [DOI: 10.2460/javma.250.3.309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Krautwald-Junghanns ME, Vorbrüggen S, Böhme J. Aspergillosis in Birds: An Overview of Treatment Options and Regimens. J Exot Pet Med 2015. [DOI: 10.1053/j.jepm.2015.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Sinonasal aspergillosis is an uncommon, yet debilitating and often frustrating condition to treat in dogs despite years of research evaluating pathogenesis, diagnosis and treatment. The disease is most commonly caused by non-invasive fungal infection, thought to be secondary to altered innate and/or adaptive immune responses. Attempts to confirm this have however failed. A variety of conflicting opinions regarding the diagnosis and treatment of sinonasal aspergillosis exist. Often the use of a particular treatment protocol is based upon personal or regional preference. Evaluation of the veterinary literature demonstrates that the evidence base in support of individual treatment recommendations is weak. A number of recent publications have helped to expand the current knowledge base and therefore our understanding of important practicalities for both diagnostic options and treatment protocols. The following review examines the current evidence for the pathogenesis of sinonasal aspergillosis in dogs, as well as the various diagnostic options. The available evidence for frequently utilised -therapeutic options and their likely outcomes is also explored.
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Affiliation(s)
- M J Sharman
- Veterinary Science, University of Melbourne, 250 Princes Highway, Werribee, Victoria, 3030, Australia
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Vieson MD, Piñeyro P, LeRoith T. A review of the pathology and treatment of canine respiratory infections. VETERINARY MEDICINE-RESEARCH AND REPORTS 2012; 3:25-39. [PMID: 30155431 DOI: 10.2147/vmrr.s25021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Numerous infectious agents are responsible for causing primary or secondary respiratory disease in dogs. These agents can cause upper or lower respiratory infections commonly observed in veterinary practices. Clinical signs might vary from mild dyspnea, sneezing, and coughing to severe pneumonia with systemic manifestations. Depending on the etiologic agent, the gross and microscopic changes observed during these infections can be rather unspecific or have highly characteristic patterns. While histopathology and cytology are not always required for diagnosis of respiratory infections, they are often useful for establishing a definitive diagnosis and identifying specific etiologic agents. Research regarding epidemiology, pathogenesis, diagnostics, and clinical manifestations related to these infectious pathogens provides valuable information that has improved treatments and management of the diseases they cause. This review discusses the epidemiology, general clinical characteristics, and pathologic lesions for some of the important viral, bacterial, fungal, and parasitic etiologies of canine respiratory disease.
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Affiliation(s)
- Miranda D Vieson
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech University, Blacksburg, VA, USA,
| | - Pablo Piñeyro
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech University, Blacksburg, VA, USA,
| | - Tanya LeRoith
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech University, Blacksburg, VA, USA,
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