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Bolton TA, Green E, Cecere T. Epistaxis and Facial Swelling Due to Nasal Blastomycosis in a Cat. J Am Anim Hosp Assoc 2024; 60:40-44. [PMID: 38175979 DOI: 10.5326/jaaha-ms-7313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 01/06/2024]
Abstract
A 5 yr old castrated male domestic longhair was examined because of left-sided facial swelling and epistaxis. Head computed tomography with contrast identified a mass within the left nasal cavity and multifocal regions of nasal bone osteolysis. Histopathology of nasal mass biopsies and cytology of the facial swelling revealed pyogranulomatous inflammation due to Blastomyces dermatitidis. The cat experienced resolution of clinical signs following 8 mo of treatment with itraconazole. Although rare, clinicians should include blastomycosis on the differential diagnoses list of infectious causes for feline nasal disease if within an endemic area.
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Affiliation(s)
| | - Emily Green
- From Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia
| | - Thomas Cecere
- From Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia
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2
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Minich DJ, Sula MJ, Zhu X, Ramsay EC, Sheldon J, Cushing A. UTILITY OF URINE ANTIGEN TESTING FOR DIAGNOSIS OF BLASTOMYCOSIS IN NONDOMESTIC FELIDS. J Zoo Wildl Med 2023; 54:143-151. [PMID: 36971639 DOI: 10.1638/2021-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 03/29/2023] Open
Abstract
Blastomycosis caused by the fungus Blastomyces dermatitidis has been reported to cause disease in numerous species of nondomestic felids. Diagnosis of blastomycosis in domestic species often relies on the combination of clinical signs, radiographic findings, and commercial urinary antigen testing. In this report, the sensitivity, specificity, and positive and negative predictive values for urine blastomyces antigen testing for use in nondomestic felids were examined and compared with findings on postmortem examination. The study showed a sensitivity of 100%, specificity of 91.86%, positive predictive value of 50%, and negative predictive value of 100% for urine antigen testing. Furthermore, radiographic and hematologic findings were compared with those of animals diagnosed with blastomycosis. Radiographic evidence consistent with blastomycosis was found in those animals diagnosed via urine antigen testing, but no significant differences in plasma biochemistry parameters between diseased and nondiseased animals were found. This study provides evidence that a positive blastomycosis antigenuria test result should be combined with other diagnostic methods to confirm the presence of infection with B. dermatitidis, whereas a negative antigenuria test result is 100% effective in predicting the absence of disease.
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Affiliation(s)
- David J Minich
- the Veterinary Medical Center, The University of Tennessee, Knoxville, TN 37996, USA
| | - Mee-Ja Sula
- the Veterinary Medical Center, The University of Tennessee, Knoxville, TN 37996, USA
| | - Xiaojuan Zhu
- Office of Information Technology, The University of Tennessee, Knoxville, TN 37996, USA
| | - Edward C Ramsay
- the Veterinary Medical Center, The University of Tennessee, Knoxville, TN 37996, USA
| | - Julie Sheldon
- the Veterinary Medical Center, The University of Tennessee, Knoxville, TN 37996, USA
| | - Andrew Cushing
- the Veterinary Medical Center, The University of Tennessee, Knoxville, TN 37996, USA,
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3
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Cridge H, Tryon E, Burkland E, Moeser A. Negative Antigenuria in a Dog with Suspected Central Nervous System Localized Blastomycosis. J Am Anim Hosp Assoc 2023; 59:40-44. [PMID: 36584318 DOI: 10.5326/jaahams-7256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 01/01/2023]
Abstract
A 7 yr old female spayed mixed-breed dog was presented for a 1 wk history of neck pain and pelvic limb weakness. Examination revealed nonambulatory paraparesis and thoracolumbar hyperesthesia. MRI revealed extensive intramedullary T2-weighted/short tau inversion recovery hyperintensity and diffuse severe T1-post contrast meningeal enhancement of the thoracolumbar spinal cord. An L5-L6 cerebrospinal fluid sample revealed a suppurative pleocytosis (81% neutrophils, total protein 4362.5 mg/dL and nucleated cell count 352,000/μL). While awaiting the results of infectious disease testing, the dog was treated for suspected meningoencephalitis of unknown etiology with corticosteroids, cyclosporine, and a cytarabine arabinoside infusion. The dog neurologically declined and was started on broad-spectrum antibiotics. The dog continued to decline despite antibiotics, and infectious disease titers subsequently revealed serum antibody positivity for blastomycosis. The dog was then referred to a multispecialty referral hospital and was treated with amphotericin B followed by fluconazole. Prednisone was continued at anti-inflammatory doses. Urine blastomycosis antigen testing was submitted for subsequent disease monitoring but was negative. Five months after presentation the dog was clinically doing well with no identifiable neurologic deficits. This case demonstrates that neurologic blastomycosis may have negative urine antigen concentrations in some dogs and that other diagnostic modalities should be pursued when central nervous system fungal disease is suspected.
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Affiliation(s)
- Harry Cridge
- From the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan (H.C., E.T.)
| | - Emily Tryon
- From the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan (H.C., E.T.)
| | - Erica Burkland
- From the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan (H.C., E.T.)
| | - Adam Moeser
- From the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan (H.C., E.T.)
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4
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Washington C, Paulman A, Stapleton BL. Mandibular Blastomycosis in a 5-Year-Old Dog. J Vet Dent 2022; 39:269-277. [PMID: 35502840 DOI: 10.1177/08987564221098166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A case of localized oral mandibular blastomycosis is described in a five-year-old dog. Complete resolution of clinical signs and oral radiographic changes were seen following itraconazole therapy at 5 mg/kg/day for four and a half months. The patient remained free of Blastomyces at the one year follow up based on the Mira Vista Blastomyces urine antigen test by EIA (Enzyme Immunoassay)a. A literature review of localized blastomycosis cases in humans and dogs was performed, available diagnostic tests evaluated, and treatment comparisons made.
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5
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Morris JM, Sigmund AB, Ward DA, Hendrix DVH. Ocular findings in cats with blastomycosis: 19 cases (1978-2019). J Am Vet Med Assoc 2021; 260:422-427. [PMID: 34936573 DOI: 10.2460/javma.21.03.0135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To document ocular findings in cats with blastomycosis. ANIMALS 35 cats with blastomycosis. PROCEDURES Medical records from 1978 through 2019 were reviewed to identify cats with confirmed Blastomyces infection. Cats were grouped as having or not having ocular involvement. Clinical signs, histopathologic findings, and response to treatment were evaluated. RESULTS 21 of the 35 (60%) cats with confirmed blastomycosis had ocular abnormalities. Two of 21 cats with ocular abnormalities also had systemic hypertension and were excluded. Of the remaining 19 cats, 15 (79%) had bilateral ocular signs. Ten (53%) cats had inflammatory ocular lesions, and 9 (47%) had neuro-ophthalmic abnormalities. Six of the 19 (32%) cats appeared to be completely blind, and 5 (26%) appeared to be unilaterally blind. For the 10 cats with inflammatory ocular lesions, the most common lesions were anterior uveitis (9/20 eyes), active chorioretinitis (6/20 eyes), and retinal detachment (4/20 eyes). For the 9 cats with neuro-ophthalmic abnormalities, the most common abnormalities were a negative menace or tracking response (10/18 eyes) and negative pupillary light response (4/18 eyes). CLINICAL RELEVANCE Results suggested that ocular involvement is common in cats with blastomycosis and that both inflammatory lesions and neuro-ophthalmic abnormalities can be seen. Blastomycosis should be considered in the differential diagnosis for cats with anterior uveitis, posterior segment inflammation, or neuro-ophthalmic abnormalities, and a complete ophthalmic examination should be performed in all cats with confirmed or suspected blastomycosis.
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6
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Blondeau JM, Rankin SC. Diagnostic clinical microbiology. J Vet Pharmacol Ther 2021; 44:250-269. [PMID: 33686661 DOI: 10.1111/jvp.12962] [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: 10/06/2020] [Revised: 01/27/2021] [Accepted: 02/09/2021] [Indexed: 01/07/2023]
Abstract
Technological advancements have changed the way clinical microbiology laboratories are detecting and identifying bacterial, viral, parasitic, and yeast/fungal pathogens. Such advancements have improved sensitivity and specificity and reduce turnaround time to reporting of clinically important results. This article discusses and reviews some traditional methodologies along with some of the technological innovations introduced into diagnostic microbiology laboratories. Some insight to what might be available in the coming years is also discussed.
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Affiliation(s)
- Joseph M Blondeau
- Division of Clinical Microbiology, Royal University Hospital and Saskatchewan Health Authority, Saskatoon, SK, Canada.,Department of Microbiology and Immunology, University of Saskatchewan, Saskatoon, SK, Canada.,Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, Canada.,Department of Ophthalmology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Shelley C Rankin
- Department of Pathobiology, University of Pennsylvania, School of Veterinary Medicine, Philadelphia, PA, USA
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7
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Motschenbacher LO, Furrow E, Rendahl AK, Nell EG, Anderson KL, Merkel LK, Patterson EE. Retrospective analysis of the effects of Blastomyces antigen concentration in urine and radiographic findings on survival in dogs with blastomycosis. J Vet Intern Med 2021; 35:946-953. [PMID: 33604957 PMCID: PMC7995372 DOI: 10.1111/jvim.16041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/28/2020] [Accepted: 01/14/2021] [Indexed: 11/28/2022] Open
Abstract
Background The Blastomyces antigen concentration in urine (BACU) test is used to diagnose blastomycosis and monitor treatment in dogs. It is unknown if a higher BACU is associated with shorter survival. Objectives To determine if the magnitude of BACU before treatment is associated with survival in dogs with blastomycosis. Animals Fifty‐two dogs with blastomycosis. Methods Retrospective case review. BACU, radiographic lung severity (RLS) score (0‐4 scale), and survival time up to 1 year after diagnosis were obtained through medical record review of dogs with Blastomyces dermatitidis. Results The overall survival was: discharge, 87%; 1 week, 85%; 2 months, 74%; and 6 months, 69%. BACU correlated with RLS score (rs = 0.33, P = .02). BACU and RLS scores were lower in survivors to 2 months than nonsurvivors (average BACU difference of 2.5 ng/mL, 95% confidence interval [CI]: 0.2‐4.8 ng/mL, P = .04; median RLS difference of 2; range, 0‐4, P = .02). Dogs with BACU <5 ng/mL and dogs with mild (0‐1) RLS scores had a greater proportion surviving than those with BACU >5 ng/mL (P = .03) and dogs with severe (3‐4) RLS scores (P = .04). All dogs with a BACU <5 ng/mL or mild RLS score were alive at last follow‐up (median, 365 days; range, 44‐365 days). In all, 68.1% of other dogs survived to 2 months (95% CI, 54.8%‐84.8%). Conclusions and Clinical Importance Dogs with lower BACU and RLS scores have improved survival; however, it is unclear what specific cutoffs should be used for prognosis.
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Affiliation(s)
- Laura O Motschenbacher
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA
| | - Eva Furrow
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA
| | - Aaron K Rendahl
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA
| | - Esther G Nell
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA
| | - Kari L Anderson
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA
| | - Lindsay K Merkel
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA
| | - Edward E Patterson
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA
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Shelnutt LM, Kaneene JB, Carneiro PAM, Langlois DK. Prevalence, distribution, and risk factors for canine blastomycosis in Michigan, USA. Med Mycol 2021; 58:609-616. [PMID: 31732747 PMCID: PMC7326585 DOI: 10.1093/mmy/myz110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/15/2019] [Accepted: 10/18/2019] [Indexed: 11/19/2022] Open
Abstract
Blastomycosis is a systemic fungal infection that most commonly affects dogs and humans. The disease is thought to be endemic in southern regions of Michigan, USA, but epidemiologic investigations have not been reported in detail for this state. The primary aims of this study were to investigate the prevalence and distribution of canine blastomycosis cases in Michigan and to identify risk factors for infection. Over 200 primary care veterinary clinics throughout the state were surveyed regarding blastomycosis prevalence, and demographic information was obtained from medical records of affected dogs that were evaluated at these clinics. A retrospective case control study was conducted for an additional 49 dogs with blastomycosis that were evaluated at specialty referral centers located in the southern mid-Michigan region. Prevalence rates were calculated for each county, and cases were mapped using geocoding software. Univariable and multivariable analyses were used to identify risk factors for infection. Prevalence rates were ≥100 cases per 100,000 dogs in five counties. Most blastomycosis cases originated from the Upper Peninsula or from a high-density area in the northern Lower Peninsula. Multivariable regression analysis identified travel or residence north of the 45th parallel as a strong risk factor for infection (P < .001). Blastomycosis was uncommon in southern counties. These results refute previous speculations and should be of value to both human and animal health. Given that many heightened risk areas are popular tourist destinations, practitioners across the USA should be mindful of the spatial distribution of blastomycosis in Michigan.
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Affiliation(s)
- Leslie M Shelnutt
- Department of Small Animal Clinical Sciences, Michigan State University College of Veterinary Medicine, East Lansing, Michigan, USA
| | - John B Kaneene
- Center for Comparative Epidemiology, Michigan State University College of Veterinary Medicine, East Lansing, Michigan, USA
| | - Paulo A M Carneiro
- Center for Comparative Epidemiology, Michigan State University College of Veterinary Medicine, East Lansing, Michigan, USA
| | - Daniel K Langlois
- Department of Small Animal Clinical Sciences, Michigan State University College of Veterinary Medicine, East Lansing, Michigan, USA
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Gunstra A, Steurer JA, Seibert RL, Dixon BC, Russell DS. Sensitivity of Serologic Testing for Dogs Diagnosed with Coccidioidomycosis on Histology: 52 Cases (2012-2013). J Am Anim Hosp Assoc 2020; 55:238-242. [PMID: 31433229 DOI: 10.5326/jaaha-ms-6772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Coccidioidomycosis, or Valley Fever, is a fungal infection caused by Coccidioides spp., soil-living fungi endemic to the southwest region of the United States. The infection can cause various diseases including respiratory, neurologic, cardiac, dermatologic, and ocular disease as well as osteomyelitis in dogs and many other mammals. Obtaining a definitive diagnosis can be challenging. Serology is commonly used as a screening diagnostic test for disease, but both false-negative and false-positive results have been reported. Fifty-two cases of coccidioidomycosis diagnosed via histopathology were retrospectively evaluated. The sensitivity of serology in the study population was determined to be 87% for immunoglobulin G and 46% for immunoglobulin M. The cases were evaluated for an association between negative serology results and anatomic location of disease, but these variables were found to be independent. This study reports the sensitivity of serology for canine coccidioidomycosis and highlights the importance of using multiple diagnostic tests for definitive diagnosis of infection.
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Affiliation(s)
- Amber Gunstra
- From Southwest Veterinary Surgical Service, P.C., Gilbert, Arizona (A.G., J.A.S., R.L.S., B.C.D.); and the Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon (D.S.R.)
| | - Jeffrey A Steurer
- From Southwest Veterinary Surgical Service, P.C., Gilbert, Arizona (A.G., J.A.S., R.L.S., B.C.D.); and the Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon (D.S.R.)
| | - Rachel L Seibert
- From Southwest Veterinary Surgical Service, P.C., Gilbert, Arizona (A.G., J.A.S., R.L.S., B.C.D.); and the Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon (D.S.R.)
| | - Bradford C Dixon
- From Southwest Veterinary Surgical Service, P.C., Gilbert, Arizona (A.G., J.A.S., R.L.S., B.C.D.); and the Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon (D.S.R.)
| | - Duncan S Russell
- From Southwest Veterinary Surgical Service, P.C., Gilbert, Arizona (A.G., J.A.S., R.L.S., B.C.D.); and the Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon (D.S.R.)
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10
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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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11
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Holbrook ED, Greene RT, Rubin SI, Renschler JS, Book BP, Hanzlicek AS, Durkin MM, Smedema ML, Wheat LJ. Novel canine anti-Coccidioides immunoglobulin G enzyme immunoassay aids in diagnosis of coccidioidomycosis in dogs. Med Mycol 2020; 57:800-806. [PMID: 30649403 DOI: 10.1093/mmy/myy157] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 11/20/2018] [Accepted: 12/20/2018] [Indexed: 11/15/2022] Open
Abstract
The diagnosis of coccidioidomycosis (CM) in dogs is typically based on clinical presentation, serology, and (less frequently) spherule identification. Agar gel immunodiffusion (AGID) is the most commonly employed serological method, but AGID is slow (requiring up to a week for titer). A Coccidioides antigen enzyme immunoassay (EIA) is also available; however, sensitivity is low in CM dogs. An antibody EIA was developed to detect canine immunoglobulin G (IgG) reacting to Coccidioides antigens. Serum was evaluated from dogs with pathology proven CM and/or AGID positive CM, as well as dogs with histoplasmosis, blastomycosis, non-fungal infections, or healthy dogs. A standard curve was used to convert optical density (OD) values into EIA units (EU). Serum and urine samples from CM dogs were also tested in the antigen EIA. Sensitivity and specificity for IgG were 89.2% and 97.2%, respectively, upon evaluation of dogs with proven or probable CM and control dogs. Cross-reactivity was observed in 7.7% and in 6.4% of dogs with histoplasmosis or blastomycosis, respectively. The antigen EIA alone was insensitive (33.8%). Combined IgG and antigen testing increased sensitivity to 93.2%, as three dogs were IgG-negative but had detectable serum or urine antigen. In 22 dogs with proven CM, sensitivity was statistically similar for antibody EIA and AGID (86% and 73%; P = .487). The MiraVista® canine Coccidioides antibody IgG EIA may aid in the diagnosis of CM by improving turnaround time with comparable sensitivity to AGID. Serial or concurrent testing by antibody and antigen EIAs may be beneficial when screening dogs for CM.
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Affiliation(s)
| | - Russell T Greene
- Phoenix Veterinary Internal Medicine Services, Phoenix, Arizona, USA
| | - Stanley I Rubin
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana Champaign, Urbana, Illinois, USA
| | | | - Bradley P Book
- South Texas Veterinary Specialists, San Antonio, Texas, USA
| | - Andrew S Hanzlicek
- Department of Veterinary Clinical Sciences, Oklahoma State University, Stillwater, Oklahoma, USA
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Blastomyces dermatitidis Antibody and Antigen Detection: Comparison of Four Lysate Antigens and Antibodies Prepared from Human Isolates from a Blastomycosis Outbreak. Mycopathologia 2019; 184:661-666. [PMID: 31583528 DOI: 10.1007/s11046-019-00385-0] [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: 04/30/2018] [Accepted: 09/14/2019] [Indexed: 10/25/2022]
Abstract
Blastomycosis is a systemic fungal disease of humans and other animals produced by the thermally dimorphic fungal organism, Blastomyces dermatitidis. Recent studies have focused on the utilization of antibody and antigen detection in the development of immunoassays for the diagnosis of blastomycosis. This study was designed to evaluate four B. dermatitidis yeast lysate antigenic preparations from human isolates (591, 592, 597, 598) from an outbreak of blastomycosis in Eagle River, Wisconsin. The indirect enzyme-linked immunosorbent assay (ELISA) was used to compare these four antigens for their ability to detect antibodies in 28 serum specimens from immunized rabbits and in 18 sera from dogs with blastomycosis. This study also compared antibodies prepared from each of the four B. dermatitidis lysate antigens for their ability to detect antigen using the competitive enzyme-linked immunosorbent assay in 18 urine specimens from the same dogs as above with blastomycosis. All four reagents proved to be immunoreactive and were able to detect antibody in the rabbit and dog sera and antigen in each of the urine specimens with only slight variations in the mean absorbance values evidenced. Antibody detection, mean absorbance values with the four lysates, ranged from 1.522 (592 antigen) to 2.047 (597 antigen) in the rabbit sera and from 1.504 (591 antigen) to 1.878 (597 antigen) in the dog sera. Antigen detection, sensitivity values obtained with the antibodies prepared from the four lysates, ranged from 89% (598 serum) to 100% (591 and 592 serum specimens).
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13
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Hussaini SMQ, Madut D, Tong BC, Pavlisko EN, Schell WA, Perfect JR, Thielman NM. Pulmonary blastomycosis presenting as primary lung cancer. BMC Infect Dis 2018; 18:336. [PMID: 30021526 PMCID: PMC6052517 DOI: 10.1186/s12879-018-3244-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 07/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Blastomycosis is an endemic mycosis in North America that is caused by the dimorphic fungus Blastomyces dermatitidis. The illness is a systemic disease with a wide variety of pulmonary and extra-pulmonary manifestations. The initial presentation of blastomycosis may easily be mistaken for other infectious or non-infectious etiologies. CASE PRESENTATION We present the case of a 52-year-old African-American male and former smoker that presented to his primary care provider with a 2-week history of non-productive cough, night sweats and weight loss. Initially diagnosed with primary lung malignancy, the patient was subsequently found to have pulmonary blastomycosis mimicking lung cancer. The patient underwent a successful course of treatment with posaconazole. CONCLUSIONS Chronic blastomycosis can present with clinical and radiographic features indistinguishable from thoracic malignancies. There is no clinical syndrome specific for blastomycosis, thus a high degree of suspicion is required for early diagnosis. In this case report, we review recent evidence in radiographic features, diagnostic considerations and treatment of the disease.
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Affiliation(s)
- Syed Mohammed Qasim Hussaini
- Duke University School of Medicine, Durham, North Carolina, 27710, USA.,Duke-NUS Medical School, Singapore, 510568, Singapore
| | - Deng Madut
- Division of Infectious Diseases, Department of Medicine, Duke Global Health Institute, Duke University Medical Center, 310 Trent Drive, Durham, NC, 27710, USA
| | - Betty C Tong
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, 27710, USA
| | | | - Wiley A Schell
- Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - John R Perfect
- Division of Infectious Diseases, Department of Medicine, Duke Global Health Institute, Duke University Medical Center, 310 Trent Drive, Durham, NC, 27710, USA
| | - Nathan M Thielman
- Division of Infectious Diseases, Department of Medicine, Duke Global Health Institute, Duke University Medical Center, 310 Trent Drive, Durham, NC, 27710, USA.
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14
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Blastomycosis in Mammals. EMERGING AND EPIZOOTIC FUNGAL INFECTIONS IN ANIMALS 2018. [PMCID: PMC7122209 DOI: 10.1007/978-3-319-72093-7_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Blastomycosis is a serious fungal disease of dogs, humans, and occasionally other mammals caused by geographically restricted, thermally dimorphic Blastomyces species. Blastomycosis is primarily a canine disease, with approximately ten dogs diagnosed for every human case. Dogs also develop disease more rapidly, thus becoming sentinels for possible human disease. Human and canine blastomycosis may differ according to epidemiology/epizoology, clinical features, performance and use of diagnostics, and management.
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15
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Bentley RT, Taylor AR, Thomovsky SA. Fungal Infections of the Central Nervous System in Small Animals: Clinical Features, Diagnosis, and Management. Vet Clin North Am Small Anim Pract 2017; 48:63-83. [PMID: 28988704 DOI: 10.1016/j.cvsm.2017.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Small animal mycoses vary geographically. Different clinical presentations are seen in animals with infection of the central nervous system (CNS), including multifocal meningoencephalomyelitis, intracranial lesions that accompany sinonasal lesions, rapidly progressive ventriculitis, or solitary granuloma of the brain or spinal cord. Systemic, nasal, or extraneural clinical signs are common but, especially in granuloma cases, do not always occur. Surgery may have a diagnostic and therapeutic role in CNS granuloma. There have been recent advancements in serology. Fluconazole, voriconazole, and posaconazole cross the blood-brain barrier, but voriconazole is neurotoxic to cats. Liposomal and lipid-encapsulated formulations of amphotericin B are preferred.
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Affiliation(s)
- R Timothy Bentley
- Neurology and Neurosurgery, Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, Purdue University, Lynn Hall, 625 Harrison Street, West Lafayette, IN 47907, USA.
| | - Amanda R Taylor
- Neurology and Neurosurgery, Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn University, Greene Hall, 1130 Wire Road, Auburn, AL 36849, USA
| | - Stephanie A Thomovsky
- Neurology and Neurosurgery, Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, Purdue University, Lynn Hall, 625 Harrison Street, West Lafayette, IN 47907, USA
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McFadden RA, Heinrich NA, Haarstad AC. Successful treatment of chronic canine blastomycosis in a Labrador retriever with sterile histopathology. VETERINARY RECORD CASE REPORTS 2017. [DOI: 10.1136/vetreccr-2016-000390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mourning AC, Patterson EE, Kirsch EJ, Renschler JS, Wolf LA, Paris JK, Durkin MM, Wheat LJ. Evaluation of an enzyme immunoassay for antibodies to a recombinant Blastomyces adhesin-1 repeat antigen as an aid in the diagnosis of blastomycosis in dogs. J Am Vet Med Assoc 2016; 247:1133-8. [PMID: 26517616 DOI: 10.2460/javma.247.10.1133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the sensitivity and specificity of an enzyme immunoassay (EIA) for antibodies to a recombinant Blastomyces adhesin-1 repeat antigen (rBAD-1) to aid in the diagnosis of blastomycosis in dogs and compare the findings with results from other tests used for this purpose. DESIGN Prospective analytic study. SAMPLE Serum and urine from 70 dogs with and without blastomycosis. PROCEDURES Serum and urine samples were collected from dogs with blastomycosis (n = 21), histoplasmosis (8), or nonfungal pulmonary disease (21) and from healthy control dogs living in a blastomycosis-endemic area (20). Serum was tested for antibodies against Blastomyces dermatitidis with the rBAD-1 antibody EIA and an A-antigen antibody agar gel immunodiffusion (AGID) assay. Serum and urine were tested for B dermatitidis antigen with a quantitative EIA. RESULTS Sensitivity of the quantitative antigen EIA was 100% in serum and urine samples from dogs with blastomycosis, with specificity of 95% in urine samples from dogs with nonfungal pulmonary disease and 100% in urine samples from healthy dogs. Sensitivity of the rBAD-1 antibody EIA (95%) was significantly greater than that of the A-antigen antibody AGID assay (65%). Specificity of the antibody EIA was 88% in dogs with histoplasmosis, 95% in healthy dogs, and 100% in dogs with nonfungal pulmonary disease. CONCLUSIONS AND CLINICAL RELEVANCE The rBAD-1 antibody EIA had greater sensitivity than the A-antigen antibody AGID assay in dogs with blastomycosis. This antibody EIA may assist in distinguishing histoplasmosis from blastomycosis. Further evaluation in a larger prospective study is needed to verify these results.
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Vap LM, Shropshire SB. Urine Cytology: Collection, Film Preparation, and Evaluation. Vet Clin North Am Small Anim Pract 2016; 47:135-149. [PMID: 27562934 DOI: 10.1016/j.cvsm.2016.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cytologic examination of the urine sediment in animals suspected of having urinary tract disease or lower urinary tract masses is one of the best means of distinguishing inflammation, infection, and neoplasia and can help determine if a positive dipstick result for hemoglobin/blood is due to hemorrhage or blood contamination. The quality of the specimen collection and handling plays an important role in the quality of results, the validity of interpretations, and selection of appropriate course of action. The method of sample collection aids localization of pathology. Air dry but do not heat fix, freeze, or expose films to formalin fumes, temperature extremes, or condensation.
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Affiliation(s)
- Linda M Vap
- Department of Microbiology, Immunology, and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 300 West Drake Road, Fort Collins, CO 80523, USA.
| | - Sarah B Shropshire
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 300 West Drake Road, Fort Collins, CO 80523, USA
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21
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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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Panciera DL, Troy GC, Purswell BJ. Blastomycosis in a postpartum dog. Med Mycol Case Rep 2014; 6:29-30. [PMID: 25379395 PMCID: PMC4216323 DOI: 10.1016/j.mmcr.2014.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 08/29/2014] [Accepted: 09/02/2014] [Indexed: 11/30/2022] Open
Abstract
Transplacental infection with Blastomyces dermatitidis is rare in humans and unknown in the dog. A Doberman pinscher bitch was diagnosed with blastomycosis 25 days after whelping. Clinical signs were noted after whelping and were progressive. All 9 pups were free of clinical signs and had negative urine Blastomyces antigen tests at 6 weeks of age and remained free of signs of illness through 11 months of age. The bitch responded to treatment with itraconazole.
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Affiliation(s)
- David L Panciera
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, VA 24061, USA
| | - Gregory C Troy
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, VA 24061, USA
| | - Beverly J Purswell
- Department of Large Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, VA 24061, USA
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23
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Darrow BG, Mans C, Drees R, Pinkerton ME, Sladky KK. Pulmonary Blastomycosis in a Domestic Ferret (Mustela putorius furo). J Exot Pet Med 2014. [DOI: 10.1053/j.jepm.2014.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Imai DM, McGreevey N, Anderson JL, Meece JK. Disseminated Blastomyces dermatitidis, genetic group 2, infection in an alpaca (Vicugna pacos). J Vet Diagn Invest 2014; 26:442-447. [PMID: 24621845 DOI: 10.1177/1040638714523773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 7-year-old, female Huacaya alpaca presented with a 3-week history of left-sided head tilt and mild ataxia. Despite aggressive supportive therapy with empirical antibiotic, anti-inflammatory, thiamine, and anthelminthic therapy, neurologic signs progressed to a right-sided head tilt, positional nystagmus, and episodes of severe ataxia and obtundation. On necropsy, discrete expansile to poorly delineated infiltrative masses with tan, creamy to grumous exudate were observed in the right petrous temporal bone, right middle and inner ear, right cerebellum and medulla as well as in lung, kidney, liver, spleen, lymph nodes, and the gastrointestinal tract. Impression cytology and histology revealed a myriad of intralesional yeast, 10-25 μm in diameter, with double-contoured walls, granular protoplasm, and broad-based budding. Culture characteristics, including conidial morphology and temperature-dependent yeast phase transformation, were consistent with Blastomyces sp. Positive Blastomyces antigenuria was identified on a postmortem sample of urine. Microsatellite typing and sequencing of the internal transcribed spacer region 2 identified the infecting strain as a genetic group 2 isolate of Blastomyces dermatitidis. The present report of camelid blastomycosis adds intracranial blastomycosis to the differential list for camelid neurologic disease in endemic regions.
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Affiliation(s)
- Denise M Imai
- Departments of Pathobiological Sciences (Imai), School of Veterinary Medicine, University of Wisconsin, Madison, WIMedical Sciences (McGreevey), School of Veterinary Medicine, University of Wisconsin, Madison, WIMarshfield Clinic Research Foundation, Marshfield, WI (Anderson, Meece)
| | - Nikole McGreevey
- Departments of Pathobiological Sciences (Imai), School of Veterinary Medicine, University of Wisconsin, Madison, WIMedical Sciences (McGreevey), School of Veterinary Medicine, University of Wisconsin, Madison, WIMarshfield Clinic Research Foundation, Marshfield, WI (Anderson, Meece)
| | - Jennifer L Anderson
- Departments of Pathobiological Sciences (Imai), School of Veterinary Medicine, University of Wisconsin, Madison, WIMedical Sciences (McGreevey), School of Veterinary Medicine, University of Wisconsin, Madison, WIMarshfield Clinic Research Foundation, Marshfield, WI (Anderson, Meece)
| | - Jennifer K Meece
- Departments of Pathobiological Sciences (Imai), School of Veterinary Medicine, University of Wisconsin, Madison, WIMedical Sciences (McGreevey), School of Veterinary Medicine, University of Wisconsin, Madison, WIMarshfield Clinic Research Foundation, Marshfield, WI (Anderson, Meece)
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Blastomyces dermatitidis: Antibody Detection in Sera from Dogs with Blastomycosis with Yeast Lysate Antigens Produced from Human and Dog Isolates. Vet Med Int 2014; 2014:376725. [PMID: 24724039 PMCID: PMC3958655 DOI: 10.1155/2014/376725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/13/2014] [Accepted: 01/14/2014] [Indexed: 11/17/2022] Open
Abstract
Dogs are common hosts to the fungal organism Blastomyces dermatitidis, which causes the systemic disease blastomycosis. The goal of our study was to compare the reactivity of two B. dermatitidis yeast lysate antigens prepared from dog isolates (ERC-2, Wisconsin; T-58, Tennessee) and two lysate antigens prepared from human isolates (B5931 and B5896, Minnesota) against 48 serum specimens from dogs with confirmed blastomycosis using the indirect enzyme-linked immunosorbent assay (ELISA). Secondarily, we used three different ELISA substrates (Ultra TMB: A, SureBlue: B, and SureBlue Reserve: C) to compare the effectiveness of each substrate. Mean absorbance values ranged from 0.446 (B) to 0.651 (C) for the B5931 antigen and from 0.393 (B) to 0.540 (C) for the ERC-2 antigen in Trial 1. In Trial 2, the absorbance values ranged from 0.628 (B) to 0.909 (A) for the B5896 antigen and from 0.828 (B) to 1.375 (C) for the T-58 antigen. In Trial 1, the lysate antigen prepared from the human isolate B5931 exhibited the highest absorbance value and in Trial 2 the lysate prepared from the dog isolate T-58 was the most reactive. The overall results thus indicated that the T-58 lysate was the optimal reagent when used to detect antibody with the Sure-Blue Reserve substrate. Our laboratory is continuing to study B. dermatitidis antigen and substrate combinations for the reliable immunodiagnosis of blastomycosis in humans and animals.
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Foy DS, Trepanier LA, Kirsch EJ, Wheat LJ. Serum and urine Blastomyces antigen concentrations as markers of clinical remission in dogs treated for systemic blastomycosis. J Vet Intern Med 2014; 28:305-10. [PMID: 24495193 PMCID: PMC4857981 DOI: 10.1111/jvim.12306] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 11/08/2013] [Accepted: 12/17/2013] [Indexed: 11/28/2022] Open
Abstract
Background Serum and urine Blastomyces antigen concentrations can be used to diagnose blastomycosis in dogs. Objectives Blastomyces antigen concentrations correlate with clinical remission in dogs during antifungal treatment, and detect disease relapse after treatment discontinuation. Animals 21 dogs with newly diagnosed blastomycosis monitored until clinical remission (Treatment Phase), and 27 dogs monitored over 1 year from the time of antifungal discontinuation or until clinical relapse (After Treatment Phase). Methods Prospective study. Dogs were monitored monthly during treatment and every 3 months after treatment discontinuation, with a complete history, physical exam, chest radiographs, and ocular exam. Urine and serum Blastomyces antigen concentrations were measured at each visit using a quantitative enzyme immunoassay. Results At enrollment in the Treatment Phase, Blastomyces antigen was positive in all 21 urine samples (100% sensitivity; 95% CI 85–100%), and in 18 of 20 serum samples (90% sensitivity; 95% CI 70–97%). At 2–4 months of treatment, urine antigen was more sensitive for clinically detectable disease (82%; CI 60–94%) than serum antigen (18%; CI 6–41%). The sensitivity of the urine test for clinical relapse was 71% (CI 36–92%), with close to 100% specificity (CI 84–100%) during after treatment surveillance in this population. Conclusions Urine Blastomyces antigen testing has high sensitivity for active disease at the time of diagnosis and during treatment, and moderate sensitivity but high specificity for clinical relapse. Urine testing should be useful at the time of diagnosis, when treatment discontinuation is being considered, and anytime there is poor clinical response or suspicion of relapse.
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Affiliation(s)
- D S Foy
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI
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Boyd AR, VanDyke JL, Scalarone GM. Blastomyces dermatitidis Yeast Lysate Antigen Combinations: Antibody Detection in Dogs with Blastomycosis. Vet Med Int 2013; 2013:940126. [PMID: 24236239 PMCID: PMC3817632 DOI: 10.1155/2013/940126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 09/16/2013] [Accepted: 09/18/2013] [Indexed: 11/19/2022] Open
Abstract
The systemic fungal infection, blastomycosis, which infects both humans and animals has presented a diagnostic challenge for clinicians for many years. The aim of this study was to evaluate the diagnostic sensitivity of Blastomyces dermatitidis yeast lysate antigens with respect to antibody detection in dogs with blastomycosis. Lysate antigens were prepared from B. dermatitidis isolates T-58 and T-66 (dogs, Tennessee) and WI-R and WI-J (dogs, Wisconsin). Based on results obtained from a preliminary comparative study, five combinations of these isolates and one individual isolate were tested against 92 serum specimens from dogs with culture-proven or histologically-confirmed blastomycosis, using the indirect enzyme-linked immunosorbent assay (ELISA). Mean absorbance values obtained from the sera ranged from 0.905 with the individual T-58 antigen to 1.760 using an antigen combination (T-58 + T-66 + WI-R). All of the 6 antigenic preparations were able to detect antibody in the serum specimens, but the antigen combinations detected antibody to a higher degree than the individual antigen. This study provides evidence that combinations of the yeast lysate reagents seem to be more efficacious for antibody detection in dog sera, but our laboratory is continuing to evaluate antigen lysate combinations for detection of antibodies in blastomycosis.
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Affiliation(s)
- Alex R. Boyd
- Department of Biological Sciences, Idaho State University, P.O. Box 8007 921 S. 8th Avenue, Pocatello, ID 83209, USA
| | - Jamie L. VanDyke
- Department of Biological Sciences, Idaho State University, P.O. Box 8007 921 S. 8th Avenue, Pocatello, ID 83209, USA
| | - Gene M. Scalarone
- Department of Biological Sciences, Idaho State University, P.O. Box 8007 921 S. 8th Avenue, Pocatello, ID 83209, USA
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Abstract
Patients with inflammatory bowel disease are susceptible to complications from pharmacologic treatment of their disease. Tumor necrosis factor (TNF)-α inhibitors are being used increasingly in the treatment of inflammatory bowel disease and can be associated with adverse events, including common infections, and rarely the development of serious life-threatening opportunistic infections. TNF-α inhibitors have the ability to prevent an effective patient granulomatous response, and this may be associated with an increased risk of developing mycobacterial and certain fungal infections, including histoplasmosis, blastomycosis, and coccidioidomycosis, endemic in several parts of the United States. The concern for invasive fungal infection was realized during clinical trials and further demonstrated after the marketing of TNF-α inhibitors. Because of this awareness, the Food and Drug Administration developed an adverse event-reporting system to capture cases of infections associated with the use of TNF-α inhibitors. These opportunistic fungi have a great degree of regional variability, and it has been very difficult to quantify the incidence of infection in patients treated with TNF-α inhibitors. Currently, there are no formal guidelines regarding the use of TNF-α inhibitors and these fungal infections. Considering that gastroenterologists have embraced the use TNF-α inhibitors as a valuable armamentarium in the treatment of inflammatory bowel disease, they must be aware of therapy-related infectious complications, including appropriate diagnostic, therapeutic, and preventive strategies. In this article, we explore the association of these fungal entities in relation to the TNF-α inhibitor therapy by considering information provided in the gastroenterology, infectious diseases, rheumatology, and transplant literature. Finally, we provide some recommendations on diagnosis and treatment.
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Lloret A, Hartmann K, Pennisi MG, Ferrer L, Addie D, Belák S, Boucraut-Baralon C, Egberink H, Frymus T, Gruffydd-Jones T, Hosie MJ, Lutz H, Marsilio F, Möstl K, Radford AD, Thiry E, Truyen U, Horzinek MC. Rare systemic mycoses in cats: blastomycosis, histoplasmosis and coccidioidomycosis: ABCD guidelines on prevention and management. J Feline Med Surg 2013; 15:624-7. [PMID: 23813828 PMCID: PMC11148945 DOI: 10.1177/1098612x13489226] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
OVERVIEW Rare fungal infections, including those hitherto not reported in Europe, may occur sporadically in non-endemic areas, or imported cases may be seen. INFECTIONS Blastomycosis is mainly seen in North America; no cases have been reported in Europe. Histoplasmosis, which is endemic in the eastern US, Central and South America, has been diagnosed in Japan and Europe. Coccidioidomycosis is endemic in the southwestern US, Central and South America; only one imported case has been reported in Europe. The primary mode of transmission is inhalation of conidia or spores from the environment. DISEASE SIGNS Most feline cases present with a combination of clinical signs (mainly respiratory, along with skin, eye, central nervous system and bone). Lymphadenopathy and systemic signs may be present. DIAGNOSIS Diagnosis is based on fungal detection by cytology and/or histology. Commercial laboratories do not routinely perform fungal culture. Diagnosis of coccidioidomycosis, which is more difficult, may be supported by antibody detection. TREATMENT Treatment consists of prolonged systemic antifungal therapy, with itraconazole as the first-choice agent for histoplasmosis and blastomycosis. The prognosis is good if owner compliance is adequate and adverse drug effects do not occur. PREVENTION Cat owners travelling to endemic areas should be warned about these diseases. There is no zoonotic risk.
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Bentley RT, Reese MJ, Heng HG, Lin TL, Shimonohara N, Fauber A. EPENDYMAL AND PERIVENTRICULAR MAGNETIC RESONANCE IMAGING CHANGES IN FOUR DOGS WITH CENTRAL NERVOUS SYSTEM BLASTOMYCOSIS. Vet Radiol Ultrasound 2013; 54:489-96. [PMID: 23663013 DOI: 10.1111/vru.12049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 04/02/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- R. Timothy Bentley
- Department of Veterinary Clinical Sciences; Purdue University College of Veterinary Medicine; West Lafayette; IN; 47907
| | - Michael J. Reese
- Department of Veterinary Clinical Sciences; Purdue University College of Veterinary Medicine; West Lafayette; IN; 47907
| | - Hock Gan Heng
- Department of Veterinary Clinical Sciences; Purdue University College of Veterinary Medicine; West Lafayette; IN; 47907
| | - Tsang Long Lin
- Department of Comparative Pathobiology; Purdue University College of Veterinary Medicine; West Lafayette; IN; 47907
| | - Nozomi Shimonohara
- Department of Comparative Pathobiology; Purdue University College of Veterinary Medicine; West Lafayette; IN; 47907
| | - Amy Fauber
- Department of Veterinary Clinical Sciences; Purdue University College of Veterinary Medicine; West Lafayette; IN; 47907
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Pratt CL, Sellon RK, Spencer ES, Johnson TW, Righter DJ. Systemic mycosis in three dogs from nonendemic regions. J Am Anim Hosp Assoc 2012; 48:411-6. [PMID: 23033460 DOI: 10.5326/jaaha-ms-5799] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Three dogs were examined for clinical signs ultimately attributed to systemic fungal infections. One dog was evaluated for chronic, ulcerated dermal lesions and lymphadenomegaly; one dog was examined for acute onset of unilateral blepharospasm; and one dog had diarrhea and hematochezia. Two of the dogs were diagnosed with blastomycosis (one with disseminated disease and the other with the disease localized to the left eye). The third dog was diagnosed with disseminated histoplasmosis. None of the dogs originated from, or had traveled to, typical regions endemic for these fungal diseases. All diagnoses were established from histopathology and either polymerase chain reaction (PCR) or cytology and culture. The two dogs diagnosed with blastomycosis were treated with either itraconazole or ketoconazole with apparent resolution of the infections. The dog with ocular involvement had an enucleation prior to beginning therapy. The dog diagnosed with histoplasmosis was euthanized without treatment. In patients with characteristic clinical features, systemic fungal infections should still be considered as differential diagnoses regardless of their travel history.
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Affiliation(s)
- Carmela L Pratt
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, USA.
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Taylor AR, Barr JW, Hokamp JA, Johnson MC, Young BD. Cytologic Diagnosis of Disseminated Histoplasmosis in the Wall of the Urinary Bladder of a Cat. J Am Anim Hosp Assoc 2012; 48:203-8. [DOI: 10.5326/jaaha-ms-5735] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 10 yr old domestic longhair presented with a 2.5 mo history of recurrent hematuria. Abdominal ultrasound examination demonstrated a thickened urinary bladder, abdominal lymphadenopathy, and a thickened and rounded spleen. Cytologic examination of fine-needle aspirate samples revealed Histoplasma capsulatum organisms in the urinary bladder wall and spleen. The cat was treated with itraconazole (10 mg/kg per os q 24 hr for 2.5 wk). The cat was euthanized after 19 days of treatment because of lack of improvement. To the authors’ knowledge, this is the first documented case of feline disseminated histoplasmosis diagnosed in the urinary bladder wall.
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Affiliation(s)
- Amanda R. Taylor
- James L. Voss Veterinary Teaching Hospital, Colorado State University, Fort Collins, CO (A.T.); and Veterinary Teaching Hospital, Texas A&M University, College Station, TX (J.B., J.H., M.J., B.Y.)
| | - James W. Barr
- James L. Voss Veterinary Teaching Hospital, Colorado State University, Fort Collins, CO (A.T.); and Veterinary Teaching Hospital, Texas A&M University, College Station, TX (J.B., J.H., M.J., B.Y.)
| | - Jessica A. Hokamp
- James L. Voss Veterinary Teaching Hospital, Colorado State University, Fort Collins, CO (A.T.); and Veterinary Teaching Hospital, Texas A&M University, College Station, TX (J.B., J.H., M.J., B.Y.)
| | - Mark C. Johnson
- James L. Voss Veterinary Teaching Hospital, Colorado State University, Fort Collins, CO (A.T.); and Veterinary Teaching Hospital, Texas A&M University, College Station, TX (J.B., J.H., M.J., B.Y.)
| | - Benjamin D. Young
- James L. Voss Veterinary Teaching Hospital, Colorado State University, Fort Collins, CO (A.T.); and Veterinary Teaching Hospital, Texas A&M University, College Station, TX (J.B., J.H., M.J., B.Y.)
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Evaluation of Coccidioides antigen detection in dogs with coccidioidomycosis. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2012; 19:343-5. [PMID: 22278324 DOI: 10.1128/cvi.05631-11] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Antigen detection has been reported to be a promising method for rapid diagnosis of coccidioidomycosis in humans. Coccidioides antigen detection has not been previously reported in dogs with coccidioidomycosis and was evaluated in 60 cases diagnosed based on detection of anti-Coccidioides antibodies at titers of 1:16 or more in serum. Controls included dogs with presumed histoplasmosis or blastomycosis, other fungal infections, or nonfungal diseases and healthy dogs. Urine and serum specimens were tested using an enzyme immunoassay for Coccidioides galactomannan antigen. Antibody testing was performed at commercial veterinary reference laboratories. Antigen was detected in urine or serum of 12 of 60 (20.0%), urine only in 2 of 57 (3.5%), and serum only in 11 of 58 (19.0%) dogs with coccidioidomycosis. Antigen was detected in the urine of 3 of 43 (7.0%) and serum of 1 of 37 (2.7%) dogs with histoplasmosis or blastomycosis but not in 13 dogs with other fungal infections (serum, 9; urine, 13), 41 dogs with nonfungal diseases (urine, 41; serum, 18), or healthy dogs (serum, 21; urine, 21). Detection of antigen was an insensitive method for diagnosis of coccidioidomycosis in dogs in which the diagnosis was based primarily upon detection of antibodies at titers of 1:16 or higher, and the highest sensitivity was in serum.
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Lappin MR. Microbiology and Infectious Disease. SMALL ANIMAL CLINICAL DIAGNOSIS BY LABORATORY METHODS 2012. [PMCID: PMC7155555 DOI: 10.1016/b978-1-4377-0657-4.00015-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Infectious Diseases. THE CAT 2012. [PMCID: PMC7161403 DOI: 10.1016/b978-1-4377-0660-4.00033-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Disseminated infection with Histoplasma capsulatum was diagnosed in a 7-yr-old female Bengal tiger (Panthera tigris). Clinical signs were nonspecific with the exception of brief periods of tachypnea for 5 days prior to death. H. capsulatum organisms were found in the lungs, tracheobronchial lymph nodes, and liver. Diagnosis was confirmed by tracheal wash, urine H. capsulatum enzyme immunoassay, and necropsy results. This report represents the first published account of disseminated histoplasmosis in a tiger.
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Blastomyces dermatitidis antigen detection by quantitative enzyme immunoassay. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2011; 19:53-6. [PMID: 22116687 DOI: 10.1128/cvi.05248-11] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The second-generation MVista Blastomyces antigen enzyme immunoassay was not quantitative; therefore, specimens obtained previously were tested in the same assay as new specimens to assess the change in antigen levels. Furthermore, the sensitivity in serum had not been fully evaluated. The purpose of this study was to evaluate a quantitative Blastomyces antigen assay and detection of antigen in serum. Calibrators containing known concentrations of Blastomyces galactomannan were used to quantify antigen in urine and serum from patients with proven blastomycosis and from controls. Paired current and previously obtained urine specimens were tested to determine if quantification eliminated the need for concurrent testing to assess change in antigen. Pretreatment of serum with EDTA at 104°C was evaluated to determine if dissociation of immune complexes improved detection of antigenemia. Antigenuria was detected in 89.9% of patients with culture- or histopathology-proven blastomycosis. Specificity was 99.0% in patients with nonfungal infections and healthy subjects, but cross-reactions occurred in 95.6% of patients with histoplasmosis. Change in antigen level categorized as increase, no change, or decrease based on antigen units determined in the same assay agreed closely with the category of change in ng/ml determined from different assays. Pretreatment increased the sensitivity of detection of antigenemia from 35.7% to 57.1%. Quantification eliminated the need for concurrent testing of current and previously obtained specimens for assessment of changes in antigen concentration. Pretreatment increased the sensitivity for detection of antigenemia. Differentiation of histoplasmosis and blastomycosis is not possible by antigen detection.
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Hecht S, Adams WH, Smith JR, Thomas WB. Clinical and Imaging Findings in Five Dogs with Intracranial Blastomycosis (Blastomyces dermatiditis). J Am Anim Hosp Assoc 2011; 47:241-9. [DOI: 10.5326/jaaha-ms-5573] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fungal infections affecting the central nervous system are rare. The purpose of this study was to describe clinical and imaging findings in dogs with intracranial blastomycosis (Blastomyces dermatiditis). The radiology database was searched retrospectively for patients with a diagnosis of intracranial blastomycosis which had computed tomography performed as part of their diagnostic work-up. Medical records and imaging studies were reviewed. Five dogs met the inclusion criteria. Major presenting complaints were stertor/nasal discharge (n=2), exophthalmos (n=1), and seizures (n=2). Clinical and laboratory findings were variable. Computed tomographic examination revealed a single contrast-enhancing intra-axial mass (n=1), a nasal mass disrupting the cribriform plate (n=3), and an intracranial mass extending into the orbit and nasal cavity (n=1). Findings in intracranial blastomycosis in dogs are variable, and the disease may mimic other inflammatory disorders or neoplasia.
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Affiliation(s)
- Silke Hecht
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN (S.H., W.A., W.T.); and Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA (J.S.)
| | - William H. Adams
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN (S.H., W.A., W.T.); and Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA (J.S.)
| | - Joanne R. Smith
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN (S.H., W.A., W.T.); and Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA (J.S.)
| | - William B. Thomas
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN (S.H., W.A., W.T.); and Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA (J.S.)
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Pfister JR, Archer JR, Hersil S, Boers T, Reed KD, Meece JK, Anderson JL, Burgess JW, Sullivan TD, Klein BS, Wheat LJ, Davis JP. Non-rural point source blastomycosis outbreak near a yard waste collection site. Clin Med Res 2011; 9:57-65. [PMID: 20974888 PMCID: PMC3134434 DOI: 10.3121/cmr.2010.958] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Blastomycosis is a potentially fatal infection caused by the fungus Blastomyces dermatitidis. During January 1 through March 5, 2006, twenty-one laboratory confirmed cases of blastomycosis were reported among residents of an endemic area in north-central Wisconsin; a striking increase compared with previous years. The objective of the study was to determine if an observed increase in blastomycosis among residents of an urban area in north-central Wisconsin was caused by a point-source exposure and to identify its source. METHODS We compared epidemiologic features, and signs and symptoms of B. dermatitidis infection among 46 historic (1999-2005) and 21 possible outbreak case patients. In addition, a case-control study was conducted to compare risk factors of the outbreak case patients with those of 64 age, gender, and geographically-matched control subjects. We conducted site inspections, evaluated meteorological data, genetically compared outbreak and non-outbreak isolates, and attempted environmental detection of B. dermatitidis using polymerase chain reaction, in vitro isolation, and in vivo isolation by tail vein injection of mice. RESULTS The unusual risk profile of this outbreak included: residence within non-rural city limits with limited time spent outdoors and an equivalent gender ratio and young median age among case patients consistent with common source rather than unrelated exposures. Thirteen of fourteen outbreak-associated clinical isolates of B. dermatitidis clustered in the same genetic group by PCR-RFLP analysis. Inspections near the cluster center suggested a yard waste collection site as the probable exposure source. B. dermatitidis nucleic acid was detected in one of 19 environmental samples. Environmental and meteorological conditions and material management practices were identified that may have facilitated growth and dispersal of B. dermatitidis conidia near this residential area. CONCLUSIONS Results of our investigation of this large non-rural outbreak of blastomycosis suggest bioaerosol hazards may exist near yard waste collection and composting facilities, especially where pine tree litter is present, in B. dermatitidis endemic areas.
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Affiliation(s)
| | - John R. Archer
- Bureau of Communicable Disease and Emergency Response, Wisconsin Division of Public Health, Madison, WI, USA
| | | | - Tammi Boers
- Lincoln County Health Department, Merrill, WI, USA
| | - Kurt D. Reed
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Thomas D. Sullivan
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Bruce S. Klein
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | | | - Jeffrey P. Davis
- Bureau of Communicable Disease and Emergency Response, Wisconsin Division of Public Health, Madison, WI, USA
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Mazepa A, Trepanier L, Foy D. Retrospective Comparison of the Efficacy of Fluconazole or Itraconazole for the Treatment of Systemic Blastomycosis in Dogs. J Vet Intern Med 2011; 25:440-5. [DOI: 10.1111/j.1939-1676.2011.0710.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Baron ML, Hecht S, Westermeyer HD, Mankin JM, Novak JM, Donnell RL. Intracranial extension of retrobulbar blastomycosis (Blastomyces dermatitidis) in a dog. Vet Ophthalmol 2011; 14:137-41. [DOI: 10.1111/j.1463-5224.2010.00850.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Invasive mould infections of the naso-orbital region of cats: a case involving Aspergillus fumigatus and an aetiological review. J Feline Med Surg 2010; 12:714-23. [PMID: 20800212 DOI: 10.1016/j.jfms.2010.07.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2010] [Indexed: 12/31/2022]
Abstract
UNLABELLED CASE AND CONTEXT: This report describes a cat diagnosed with sinonasal-orbital Aspergillus fumigatus infection using advanced imaging, histopathology and culture. Aetiology, clinical aspects and treatment of this rare and devastating infection are discussed with reference to a literature review of invasive mould (ie, filamentous fungal) infections involving tissues of the naso-orbital region of cats. PRESENTATIONS Invasive fungal infections can present with different localisations (nasal passages, sinuses, orbits, subcutaneous space, palate, etc) depending on the species involved and its means of introduction into the tissues. Localised subcutaneous lesions (swellings, ulcerations, masses, nodules, etc), without concomitant signs of nasal/orbital disease, generally result from traumatic injuries and subsequent inoculation of fungal spores into the subcutaneous space. In contrast, naso-ocular involvement and concurrent signs of nasal disease (nasal discharge, sneezing, masses protruding from the nostrils) generally result from inhalation of spores, with subsequent spread of infection into the nasal planum or penetration of overlying bone and invasion of the subcutaneous space. Aspergillus species typically show such an invasion mechanism and frequently affect orbital tissues. Dematiaceous fungi (ie, filamentous fungi with brown/black hyphae) are reported to cause solitary, less invasive, slowly developing lesions, probably as a result of traumatic injuries with inoculation of fungal propagules. Accordingly, the subcutaneous space is more frequently primarily involved. TREATMENT AND OUTCOME Whatever the mould species, reported treatment options include surgery and a series of antifungal drugs. The outcome is frequently poor, especially for Aspergillus infections, although various measures can be taken to maximise the chances of success, as discussed in this report.
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Lipitz L, Rylander H, Forrest LJ, Foy DS. Clinical and magnetic resonance imaging features of central nervous system blastomycosis in 4 dogs. J Vet Intern Med 2010; 24:1509-14. [PMID: 20738772 DOI: 10.1111/j.1939-1676.2010.0581.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- L Lipitz
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706, USA
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Oshin A, Griffon D, Lemberger K, Naughton J, Barger A. Patellar blastomycosis in a dog. J Am Anim Hosp Assoc 2009; 45:239-44. [PMID: 19723847 DOI: 10.5326/0450239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 4-year-old, spayed female, mixed-breed dog was presented for evaluation of chronic left hind-limb lameness. Lytic lesions were observed in the left patella on radiographs of the stifle. A biopsy of the patella led to a histopathological diagnosis of blastomycosis. Surgical debridement followed by a 90-day course of itraconazole and physical rehabilitation resolved the clinical signs and stopped the progression of radiographic lesions. Blastomycosis should be considered as a differential diagnosis for stifle joint lameness with lytic lesions in the patella.
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Affiliation(s)
- Abimbola Oshin
- Department of Small Animal Surgery, Affiliated Veterinary Specialists, 1668 Mallory Lane, Brentwood, Tennessee 37027, USA
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McKinnell JA, Pappas PG. Blastomycosis: new insights into diagnosis, prevention, and treatment. Clin Chest Med 2009; 30:227-39, v. [PMID: 19375630 DOI: 10.1016/j.ccm.2009.02.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The basic science and clinical understanding of infection with Blastomyces dermatitidis has been a field of constant evolution and continued revision of hypotheses. This article highlights some areas in which recent progress has the potential for significant impact on the clinical care of patients. Specifically, this article examines the application of modern technology to epidemiologic studies, the development of novel vaccine candidates, emerging populations at risk for the disease, rapid diagnostic tools, and the application of novel antifungal agents in the treatment of blastomycosis.
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Affiliation(s)
- James A McKinnell
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL 35294-0006, USA.
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Abstract
A 10-month-old spayed female Doberman Pinscher was presented for lameness. On physical examination, the dog was lethargic and febrile and had a 2-cm raised subcutaneous mass at the base of the left ear. Fluid from the mass was drained. Direct smears of the fluid, stained with modified Wright's and new methylene blue, were highly cellular and contained large numbers of degenerate neutrophils with moderate numbers of macrophages. Large numbers of round yeast organisms, 8-20 mum in diameter, were observed extracellularly. The organisms had a thick blue wall and granular internal contents and broad-based budding was seen frequently. Branching hyphae or pseudohyphae, with parallel sides and 2-4 mum in diameter, appeared to extend from the surface of the yeast. The morphology of the yeast organisms was consistent with Blastomyces dermatitidis, with atypical hyphae formation. Culture results were not definitive because it was not possible to induce transition from the mycelial to the yeast form at 37 degrees C and because the morphology of the mycelial form of B. dermatitidis could not be differentiated from that of Emmonsia parvae. The organism was confirmed as Ajellomyces dermatitidis (the mycelial form of B. dermatitidis) using 18S ribosome RNA gene sequencing and comparison with an available databank. The mycelial form of B. dermatitidis is rarely found in the tissue of dogs, and may have been induced in this case by low environmental temperatures and the time delay between sample collection and slide preparation.
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Affiliation(s)
- Camilo Bulla
- College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
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