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Fawsitt J, Russell O, Alexander A, Peschard AL, Wong H, Kortum A. Clinical remission of feline sino-nasal aspergillosis despite evidence of persistent infection. JFMS Open Rep 2023; 9:20551169231201605. [PMID: 37799297 PMCID: PMC10548797 DOI: 10.1177/20551169231201605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Case summary Feline sino-nasal aspergillosis is a rare condition with only sparse heterogeneous reports in the literature regarding its treatment. This report describes the presentation, treatment and outcome of a cat with sino-nasal aspergillosis treated by meticulous debridement in combination with topical and systemic azole therapy. Diagnosis was based on MRI, in combination with rhinoscopic assessment and visualisation of fungal plaques, followed by histopathology, fungal culture and panfungal PCR. The cat was treated by debridement of fungal plaques via anterior rhinoscopy and frontal sinusotomy and local instillation of 1% clotrimazole solution, followed by a 4-week course of oral itraconazole. Histopathology confirmed fungal rhinitis and culture identified Aspergillus fumigatus and Aspergillus versicolor. Clinical remission was achieved after treatment; however, evidence of persistent infection was confirmed in the post-mortem examination 8 months after the cat was euthanased for unrelated reasons. Relevance and novel information Despite clinical remission, the persistence of fungal infection post mortem highlights the challenges of monitoring the response to treatment and illustrates that the resolution of clinical signs does not necessarily equate with a disease cure.
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Affiliation(s)
- Jack Fawsitt
- The Queen’s Veterinary School Hospital Cambridge University Veterinary School, Cambridge, UK
| | - Oliver Russell
- The Queen’s Veterinary School Hospital Cambridge University Veterinary School, Cambridge, UK
| | - Akash Alexander
- The Queen’s Veterinary School Hospital Cambridge University Veterinary School, Cambridge, UK
| | - Anne-Lorraine Peschard
- The Queen’s Veterinary School Hospital Cambridge University Veterinary School, Cambridge, UK
| | - Hannah Wong
- The Queen’s Veterinary School Hospital Cambridge University Veterinary School, Cambridge, UK
| | - Andre Kortum
- The Queen’s Veterinary School Hospital Cambridge University Veterinary School, Cambridge, UK
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Biénès T, Vangrinsven E, Fastrès A, Garigliany MM, Billen F, Clercx C. Utility of fungal polymerase chain reaction on nasal swab samples in the diagnosis and monitoring of sinonasal aspergillosis in dogs. J Vet Intern Med 2022; 36:1295-1302. [PMID: 35712784 PMCID: PMC9308428 DOI: 10.1111/jvim.16441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/28/2022] [Indexed: 11/27/2022] Open
Abstract
Background In dogs with sinonasal aspergillosis (SNA) the utility of PCR in the diagnosis and monitoring of the disease after treatment has not been assessed. Objectives To evaluate the presence of fungal DNA using quantitative PCR targeting Aspergillus fumigatus (Aspfum) and Aspergillus spp. (PanAsp), and PCR targeting multiple fungal species (PanFun), in samples obtained from nasal cavities of dogs with SNA, other nasal diseases and healthy dogs. Animals Sixty‐two dogs including 20 with SNA, 12 with cured SNA (of which 10 are from the SNA group), 20 dogs with Non‐SNA nasal disease, and 20 healthy dogs. Methods Prospective cross‐sectional study. Aspfum, PanAsp, and PanFun were performed on blindly collected nasal swabs obtained in anesthetized dogs. Results In SNA dogs, Aspfum and PanAsp were positive in 13/20 and 14/20 dogs. In all dogs in the 3 other groups, A. fumigatus DNA was not detected using Aspfum. PanAsp was positive in 3 non‐SNA dogs: 1 with cured SNA and 2 with Non‐SNA nasal disease. A Ct cut‐off value of 33.3 for Aspfum demonstrated 65% sensitivity and 100% specificity. A Ct cut‐off value of 34.5 for PanAsp demonstrated 70% sensitivity and 96.2% specificity. PanFun was positive in 16/20, 12/12, 19/20, and 7/20 dogs in the SNA, cured SNA, Non‐SNA, and healthy groups, respectively. Conclusion and Clinical Importance Aspfum and PanAsp on blindly collected nasal swabs can be useful for the detection of SNA at diagnosis and at cure, especially when more invasive methods are not available.
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Affiliation(s)
- Tom Biénès
- Department of Clinical Sciences, Faculty of Veterinary Medicine, FARAH, University of Liège, Liège, Belgium
| | - Emilie Vangrinsven
- Department of Clinical Sciences, Faculty of Veterinary Medicine, FARAH, University of Liège, Liège, Belgium
| | - Aline Fastrès
- Department of Clinical Sciences, Faculty of Veterinary Medicine, FARAH, University of Liège, Liège, Belgium
| | - Mutien-Marie Garigliany
- Department of Veterinary Pathology, Faculty of Veterinary Medicine, FARAH, University of Liège, Liège, Belgium
| | - Frédéric Billen
- Department of Clinical Sciences, Faculty of Veterinary Medicine, FARAH, University of Liège, Liège, Belgium
| | - Cécile Clercx
- Department of Clinical Sciences, Faculty of Veterinary Medicine, FARAH, University of Liège, Liège, Belgium
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Pilkington EJ, De Decker S, Mojarradi A, Rossanese M, Brockman DJ, Van den Steen N, Cahalan SD, Fenn JT. Sinonasal mycosis following transfrontal craniotomy in three dogs. J Am Vet Med Assoc 2022; 260:643-649. [PMID: 34986118 DOI: 10.2460/javma.21.03.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION Three dogs were presented for investigation of chronic nasal discharge and epistaxis 141, 250, and 357 days after undergoing transfrontal craniotomy to treat an intracranial meningioma (2 dogs) or a meningoencephalocele (1 dog). CLINICAL FINDINGS CT findings were consistent with destructive rhinitis and frontal sinusitis in all 3 dogs, with results of histologic examination and fungal culture of samples obtained during frontal sinusotomy confirming mycotic infection. Frontal sinusotomy revealed fungal plaques covering a combination of bone and residual surgical tissue adhesive at the site of the previous craniotomy in all 3 dogs. Aspergillus spp were identified in all 3 dogs, and Chrysosporium sp was also identified in 1 dog. TREATMENT AND OUTCOME Surgical curettage was followed by antifungal treatment (topical clotrimazole in 2 dogs and oral itraconazole for 3 months in 1 dog). Nasal discharge improved in the short-term but recurred in all dogs 99, 118, and 110 days after frontal sinusotomy. One dog received no further treatment, 1 dog received an additional 8.5 months of oral itraconazole treatment, and 1 dog underwent 2 additional surgical debridement procedures. At last follow-up, 2 dogs were alive 311 and 481 days after frontal sinusotomy; the third dog was euthanized because of status epilepticus 223 days after frontal sinusotomy. CLINICAL RELEVANCE Sinonasal mycosis should be considered as a potential complication in dogs developing persistent mucopurulent nasal discharge, intermittent epistaxis, and intermittent sneezing following transfrontal craniotomy. The pathophysiology may be multifactorial, and potential risk factors, including use of surgical tissue adhesive in the frontal sinus, require further investigation.
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Affiliation(s)
- Ed J Pilkington
- 1Department of Clinical Science and Services, Royal Veterinary College, University of London, North Mymms, Hertfordshire, England
| | - Steven De Decker
- 1Department of Clinical Science and Services, Royal Veterinary College, University of London, North Mymms, Hertfordshire, England
| | | | - Matteo Rossanese
- 1Department of Clinical Science and Services, Royal Veterinary College, University of London, North Mymms, Hertfordshire, England
| | - Daniel J Brockman
- 1Department of Clinical Science and Services, Royal Veterinary College, University of London, North Mymms, Hertfordshire, England
| | - Nele Van den Steen
- 3Cave Veterinary Referrals, West Buckland, North Wellington, Somerset, England
| | - Stephen D Cahalan
- 1Department of Clinical Science and Services, Royal Veterinary College, University of London, North Mymms, Hertfordshire, England
| | - Joe T Fenn
- 1Department of Clinical Science and Services, Royal Veterinary College, University of London, North Mymms, Hertfordshire, England
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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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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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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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Ballber C, Hill TL, Bommer NX. Minimally invasive treatment of sino-nasal aspergillosis in dogs. J Vet Intern Med 2018; 32:2069-2073. [PMID: 30325062 PMCID: PMC6271301 DOI: 10.1111/jvim.15311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/12/2018] [Accepted: 07/31/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Sino‐nasal aspergillosis is a common nasal disease in dogs. Recommended treatment protocols typically involve trephination of the frontal sinuses or the use of an antifungal solution instilled into the frontal sinus under anesthesia, both of which have associated morbidity and complications. Objectives: To assess a minimally‐invasive topical treatment protocol for sino‐nasal aspergillosis in dogs. Animals: Twelve client‐owned dogs diagnosed with sino‐nasal aspergillosis that completed recommended treatment. Methods: Medical records were retrospectively reviewed to identify dogs with sino‐nasal aspergillosis that received treatment. Fungal plaques were manually debrided and irrigated via frontal sinuscopy in 12 dogs that then were treated topically with 1% topical clotrimazole cream. Irrigation and topical medication application was achieved using a catheter placed retrograde directly into the frontal sinuses using the Seldinger technique over a guidewire, thereby avoiding the need for frontal sinus trephination. Invasion into the calvarium was recorded before treatment but was not considered a criterion for exclusion. Debridement and cream deposition was repeated every 2 weeks as needed until negative culture and histopathologic findings were obtained. Results: All dogs were cured (negative results for Aspergillus on endoscopy, fungal culture, and histopathology) with a median of 2 treatments. Treatments were well tolerated, with minimal adverse effects reported. Three dogs had evidence of erosion into the calvarium on computed tomography imaging. Conclusions and Clinical Importance: This protocol appears to be an effective and well‐tolerated minimally invasive treatment for sino‐nasal aspergillosis, including in dogs with erosion into the calvarium. Only mild adverse effects were noted.
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Affiliation(s)
- Clara Ballber
- Wood Street Veterinary Hospital, London, United Kingdom
| | - Tracy L Hill
- College of Veterinary Medicine, University of Georgia, Athens, Georgia, 30602
| | - Nick X Bommer
- Hospital for Small Animals, University of Edinburgh, Edinburgh, EH25 9RG, United Kingdom
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Stewart J, Bianco D. Treatment of refractory sino-nasal aspergillosis with posaconazole and terbinafine in 10 dogs. J Small Anim Pract 2017; 58:504-509. [PMID: 28485470 DOI: 10.1111/jsap.12686] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 02/11/2017] [Accepted: 02/22/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To determine the safety and efficacy of posaconazole and terbinafine for the treatment of naturally occurring sino-nasal aspergillosis in dogs refractory to conventional topical and systemic treatment. MATERIALS AND METHODS Ten client-owned dogs with sino-nasal aspergillosis and not responsive to conventional treatments were prospectively enrolled to receive a dose of 5 mg/kg posaconazole orally every 12 hours for six months. All dogs were concurrently treated with doses of 30 mg/kg terbinafine orally every 12 hours and 5 mg/kg doxycycline orally every 12 hours for 6 to 18 months. RESULTS All 10 enrolled dogs completed the study. The treatment response was defined as complete clinical remission (n=7) or partial clinical remission (n=3). Two dogs relapsed after cessation of combination therapy. All dogs lived more than one year after starting combination therapy and eight dogs are alive at the time of writing. No clinically relevant adverse reactions or increases in hepatic enzyme activity occurred during the combination therapy. CLINICAL SIGNIFICANCE The results of this study suggest that this combination therapy appears safe and well-tolerated for the treatment of refractory sino-nasal aspergillosis in dogs. Long-term survival is possible with prolonged treatment, but relapse is possible. Larger prospective studies are warranted to further evaluate these preliminary findings.
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Affiliation(s)
- J Stewart
- Advanced Critical Care Emergency and Specialty Services, 20051 Ventura Blvd., Woodland Hills, CA 91364, USA
| | - D Bianco
- Advanced Critical Care Emergency and Specialty Services, 20051 Ventura Blvd., Woodland Hills, CA 91364, USA
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