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Barrs VR, Hobi S, Wong A, Sandy J, Shubitz LF, Bęczkowski PM. Invasive fungal infections and oomycoses in cats 2. Antifungal therapy. J Feline Med Surg 2024; 26:1098612X231220047. [PMID: 38189264 PMCID: PMC10949877 DOI: 10.1177/1098612x231220047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
CLINICAL RELEVANCE Invasive fungal infections (IFIs) and oomycoses (hereafter termed invasive fungal-like infections [IFLIs]) are characterised by penetration of tissues by fungal elements. The environment is the most common reservoir of infection. IFIs and IFLIs can be frustrating to treat because long treatment times are usually required and, even after attaining clinical cure, there may be a risk of relapse. Owner compliance with medication administration and recheck examinations can also decline over time. In addition, some antifungal drugs are expensive, have variable interpatient pharmacokinetic properties, can only be administered parenterally and/or have common adverse effects (AEs). Despite these limitations, treatment can be very rewarding, especially when an otherwise progressive and fatal disease is cured. AIM In the second of a two-part article series, the spectrum of activity, mechanisms of action, pharmacokinetic and pharmacodynamic properties, and AEs of antifungal drugs are reviewed, and the treatment and prognosis of specific IFIs/IFLIs - dermatophytic pseudomycetoma, cryptococcosis, sino-orbital aspergillosis, coccidioidomycosis, histoplasmosis, sporotrichosis, phaeohyphomycosis, mucormycosis and oomycosis - are discussed. Part 1 reviewed the diagnostic approach to IFIs and IFLIs. EVIDENCE BASE Information on antifungal drugs is drawn from pharmacokinetic studies in cats. Where such studies have not been performed, data from 'preclinical' animals (non-human studies) and human studies are reviewed. The review also draws on the wider published evidence and the authors' combined expertise in feline medicine, mycology, dermatology, clinical pathology and anatomical pathology. ABBREVIATIONS FOR ANTIFUNGAL DRUGS AMB (amphotericin B); FC (flucytosine); FCZ (fluconazole); ISA (isavuconazole); ITZ (itraconazole); KCZ (ketoconazole); PCZ (posaconazole); TRB (terbinafine); VCZ (voriconazole).
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Affiliation(s)
- Vanessa R Barrs
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong, SAR China
- Centre for Animal Health and Welfare, City University of Hong Kong, Kowloon Tong, Hong Kong, SAR China
| | - Stefan Hobi
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong, SAR China
| | - Angeline Wong
- Shatin Animal Hospital, Tai Wai, New Territories, Hong Kong, SAR China
| | - Jeanine Sandy
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong, SAR China
| | - Lisa F Shubitz
- Valley Fever Center for Excellence, The University of Arizona, AZ, USA
| | - Paweł M Bęczkowski
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong, SAR China
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Wang Z, Daniels JB, Lappin M, Aboellail T, Shropshire S. Sino-orbital aspergillosis with obstructive cervical lymphadenopathy in a cat caused by Aspergillus viridinutans complex. JFMS Open Rep 2023; 9:20551169231181863. [PMID: 37434987 PMCID: PMC10331201 DOI: 10.1177/20551169231181863] [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] [Indexed: 07/13/2023] Open
Abstract
Case summary This report describes an indoor-only cat with a rare form of sino-orbital aspergillosis (SOA) with cervical lymphadenopathy causing local obstruction. Extensive work-up on initial presentation failed to identify the underlying etiology and the diagnosis was not determined until the disease progressed during a prolonged course of glucocorticoid therapy. Relevance and novel information SOA caused by Aspergillus viridinutans complex is increasingly recognized as a significant cause of mortality in cats in recent years, with most cases reported in Australia, Europe and Asia. Feline SOA carries a poor prognosis owing to its invasive nature and resistance to antifungal therapy. This case demonstrates the importance of clinical awareness of SOA as a differential for cats with chronic nasal signs and exophthalmos in the USA. Moreover, it demonstrates a rare form of presentation and potential difficulty in achieving a correct diagnosis.
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Affiliation(s)
- Zhe Wang
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Joshua B Daniels
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, USA
| | - Michael Lappin
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Tawfik Aboellail
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, USA
| | - Sarah Shropshire
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
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Bartels C, Alvarez-Sanchez A, Ranganathan B, O’Neill TW, Townsend KL. Ventral cervical subcutaneous Aspergillus species fungal granuloma in a cat. JFMS Open Rep 2022; 8:20551169221121916. [PMID: 36157251 PMCID: PMC9500275 DOI: 10.1177/20551169221121916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Case summary An 8-year-old domestic longhair cat was evaluated for a right ventral subcutaneous cervical mass. Serial bloodwork and contrast-enhanced cranial and thoracic CT initially lacked ethmoturbinate lysis and showed a progressive, vascularized, right ventral cervical mass involving local lymph nodes. The mass was removed surgically on two occasions. Histopathology and fungal culture were diagnostic for a recurring sclerosing fungal granuloma and pyogranulomatous and eosinophilic lymphadenitis, consistent with Aspergillus species. The cat was treated with oral itraconazole; however, owing to the owner’s non-compliance in administering the medication and disease progression, the cat was humanely euthanized 3 years after diagnosis. Relevance and novel information The development of a cervical subcutaneous fungal granuloma of Aspergillus species in a domestic longhair cat before obvious maxillary, orbital or ethmoturbinate lysis on initial diagnostics is rare and suggests an early onset of lymphatic or hematogenous spread from a suspected nidus of infection within the sinonasal cavity.
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Affiliation(s)
- Courtney Bartels
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR, USA
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, MI, USA
| | - Alejandro Alvarez-Sanchez
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR, USA
| | - Bharadhwaj Ranganathan
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR, USA
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, MI, USA
| | - T William O’Neill
- Oregon Veterinary Diagnostic Laboratory, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR, USA
- Digital Pathology, Charles River Laboratories, Ashland, OH, USA
| | - Katy L Townsend
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR, USA
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Jones BA, Cotterill N, Drees R, Dietrich UM, Purzycka K. Tumours involving the retrobulbar space in cats: 37 cases. J Feline Med Surg 2022; 24:e116-e123. [PMID: 35536054 PMCID: PMC11104240 DOI: 10.1177/1098612x221094947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this multicentre retrospective study was to describe the clinical presentation, imaging findings, diagnosis and outcomes of cats with retrobulbar neoplasia. METHODS A total of 37 cats that were diagnosed with retrobulbar neoplasia and underwent advanced imaging were recruited from searches of the clinical records of two referral hospitals. All cats had neoplasia confirmed via cytology or histopathology. Data relating to the signalment, presentation, results of investigations, treatment and outcome were recorded. A review of imaging studies was performed where possible. RESULTS In total, 23 cases (62%) were presented with respiratory signs. Exophthalmos was the most common ophthalmological examination finding, present in 18 cases (49%). Thirty-two cases (86%) had secondary extension of neoplasia to the retrobulbar space (most commonly from the nasal cavities), present in 20 cases (54%), of which 12 were lymphoma. In cases where contrast was administered, 28/35 (80%) had contrast-enhancing masses. Orbital extension was detected in 21 cases (57%), exophthalmos in 22 (59%), globe deformation in 12 (32%) and local lymphadenomegaly in 22 (61%). In total, 36 (97%) retrobulbar tumours were malignant. Thoracic imaging, where it was performed, was concerning for metastasis in 8/25 cases (31%), with abdominal imaging suggestive of metastasis in 5/12 (42%). The most common diagnosis was lymphoma with 19 cases (51%), with nasal lymphoma representing 12 of these, followed by carcinoma in 10 (27%). The median survival time, for cases where death was recorded, was 85 days (range 1-263 days). CONCLUSIONS AND RELEVANCE To the authors' knowledge, this is the largest study of neoplasia affecting the feline retrobulbar space. Retrobulbar tumours in cats are overwhelmingly malignant, and commonly due to secondary extension of tumours originating elsewhere. Lymphoma, particularly arising from the nasal cavities, was the most common cause. Cats presenting with signs suggestive of retrobulbar disease should be assessed for disease affecting any of the structures of the head.
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Affiliation(s)
- Bryn A Jones
- Anderson Moores Veterinary Specialists, Hursley, Winchester, UK
| | - Nicole Cotterill
- Department of Clinical Science and Services, Royal Veterinary College, North Mymms, Hatfield, UK
| | - Randi Drees
- Department of Clinical Science and Services, Royal Veterinary College, North Mymms, Hatfield, UK
| | - Ursula M Dietrich
- Department of Clinical Science and Services, Royal Veterinary College, North Mymms, Hatfield, UK
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Cormack CA, Donahoe SL, Talbot JJ, Beatty JA, Barrs VR. Disseminated invasive aspergillosis caused by Aspergillus felis in a cat. J Vet Intern Med 2021; 35:2395-2400. [PMID: 34414603 PMCID: PMC8478040 DOI: 10.1111/jvim.16245] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 12/12/2022] Open
Abstract
A 2‐year‐old male desexed Ragdoll cat with a 1‐year history of sneezing and nasal discharge presented with a large subcutaneous cervical mass, identified as the right medial retropharyngeal lymph node on computed tomography (CT). A right orbital mass, destructive sino‐nasal cavity disease and multiple pulmonary nodules were also identified. Aspergillus felis was cultured from the lymph node. After treatment with posaconazole and liposomal amphotericin B the lymph node enlargement and orbital mass resolved but left frontal sinus involvement and pulmonary lesions persisted despite additional caspofungin therapy. The cat was euthanized 14 months after diagnosis with dysphagia and chronic progressive exophthalmos. A meningeal granuloma with intravascular fungal hyphae was identified at post‐mortem and A felis was cultured from the left frontal sinus and a right retrobulbar fungal granuloma. This case demonstrates that disseminated disease is a possible sequel to invasive fungal rhinosinusitis caused by A felis in cats.
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Affiliation(s)
- Catherine A Cormack
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong, SAR China
| | - Shannon L Donahoe
- Veterinary Pathology Diagnostic Services, Sydney School of Veterinary Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Jessica J Talbot
- Sydney School of Veterinary Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Julia A Beatty
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong, SAR China.,Sydney School of Veterinary Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Vanessa R Barrs
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong, SAR China.,Sydney School of Veterinary Science, The University of Sydney, Sydney, New South Wales, Australia
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Barrs VR, Talbot JJ. Fungal Rhinosinusitis and Disseminated Invasive Aspergillosis in Cats. Vet Clin North Am Small Anim Pract 2019; 50:331-357. [PMID: 31866094 DOI: 10.1016/j.cvsm.2019.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Fungal rhinosinusitis, including sinonasal aspergillosis (SNA) and sino-orbital aspergillosis (SOA), is the most common type of aspergillosis encountered in cats. Other focal forms of aspergillosis including disseminated invasive aspergillosis occur less frequently. SOA is an invasive mycosis that is increasingly recognized and is most commonly caused by Aspergillus felis, a close relative of Aspergillus fumigatus. SNA can be invasive or noninvasive and is most commonly caused by A fumigatus and Aspergillus niger. Molecular methods are required to correctly identify the fungi that cause SNA and SOA. SNA has a favorable prognosis with treatment, whereas the prognosis for SOA remains poor.
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Affiliation(s)
- Vanessa R Barrs
- City University of Hong Kong, Department of Infectious Diseases & Public Health, Jockey Club College of Veterinary Medicine, Kowloon, Hong Kong SAR, China.
| | - Jessica J Talbot
- Faculty of Veterinary Science, University Veterinary Teaching Hospital, Sydney, University of Sydney, Faculty of Science, Sydney School of Veterinary Science, Camperdown, New South Wales 2006, Australia
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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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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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Mawby DI, Whittemore JC, Fowler LE, Papich MG. Posaconazole Pharmacokinetics in Healthy Cats after Oral and Intravenous Administration. J Vet Intern Med 2016; 30:1703-1707. [PMID: 27425589 PMCID: PMC5032877 DOI: 10.1111/jvim.14523] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 05/17/2016] [Accepted: 06/22/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Posaconazole is the most active available azole antifungal drug, but absorption and pharmacokinetics are not available to guide dosing regimens in cats. OBJECTIVE To determine the pharmacokinetics of posaconazole in cats given an IV solution and PO suspension. ANIMALS Six healthy, adult research cats. METHODS After a 12-hour fast, each cat received 15 mg/kg of posaconazole PO suspension with food. Four cats also received 3 mg/kg IV posaconazole after a 7-day washout period. Plasma was collected at predetermined intervals for analysis using high-pressure liquid chromatography (HPLC). Concentration data were analyzed using a 2-compartment pharmacokinetic analysis for IV administration data and a 1-compartment analysis with first-order input for PO administration data using Phoenix® software. RESULTS After IV dosing, volume of distribution (VSS ) was 1.9 (0.3) L/kg (mean, standard deviation), terminal half-life (T½ ) was 57.7 (28.4) hours, and clearance was 28.1 (17.3) mL/kg/h. After PO dosing, peak concentration (CMAX ) was 1.2 (0.5) μg/mL and T½ was 38.1 (15.0) hours. Bioavailability of PO suspension was 15.9% (8.6). No adverse effects were observed with either route of administration. CONCLUSION AND CLINICAL IMPORTANCE Despite low PO absorption, these data allow for simulation of PO dosage regimens that could be explored in clinical studies. Two regimens can be considered to maintain targeted trough concentrations of 0.5-0.7 μg/mL as extrapolated from studies in humans: (1) 30 mg/kg PO loading dose followed by 15 mg/kg q48h, or (2) 15 mg/kg PO loading dose followed by 7.5 mg/kg q24h.
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Affiliation(s)
- D I Mawby
- Departments of Small Animal Clinical Sciences, the College of Veterinary Medicine, University of Tennessee, Knoxville, TN.
| | - J C Whittemore
- Departments of Small Animal Clinical Sciences, the College of Veterinary Medicine, University of Tennessee, Knoxville, TN
| | - L E Fowler
- Departments of Small Animal Clinical Sciences, the College of Veterinary Medicine, University of Tennessee, Knoxville, TN
| | - M G Papich
- Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
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Tamborini A, Robertson E, Talbot JJ, Barrs VR. Sinonasal aspergillosis in a British Shorthair cat in the UK. JFMS Open Rep 2016; 2:2055116916653775. [PMID: 28491427 PMCID: PMC5362982 DOI: 10.1177/2055116916653775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 12/02/2022] Open
Abstract
Case summary A 13-year-old, castrated male, British Shorthair cat presented for investigation of chronic, intermittent, bilateral epistaxis and stertor. CT revealed severe asymmetric bilateral intranasal involvement with extensive turbinate lysis, increased soft tissue attenuation and lysis of the sphenopalatine bone and cribriform plate. On retroflexed pharyngoscopy, a plaque-like mass occluded the choanae. Rostral rhinoscopic examination revealed extensive loss of nasal turbinates, necrotic tissue and mucosal fungal plaques in the left nasal cavity. The right nasal cavity was less severely affected. The nasal cavities were debrided extensively of plaques and necrotic tissue. Aspergillus fumigatus was isolated on fungal culture, and species identity was confirmed using comparative sequence analysis of the partial β-tubulin gene. On histopathology of nasal biopsies, there was ulcerative lymphoplasmacytic and neutrophilic rhinitis, and fungal hyphae were identified on nasal mucosa, consistent with a non-invasive mycosis. The cat was treated with oral itraconazole after endoscopic debridement, but signs relapsed 4.5 months from diagnosis. Residual left nasal fungal plaques were again debrided endoscopically and oral posaconazole was administered for 6 months. Fourteen months from diagnosis, the cat remains clinically well with mild intermittent left nasal discharge secondary to atrophic rhinitis. Relevance and novel information This is the first case of rhinoscopically confirmed sinonasal aspergillosis to be diagnosed in a cat in the UK. Endoscopic confirmation of resolution of infection is useful in cases where mild nasal discharge persists after treatment.
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Affiliation(s)
| | | | - Jessica J Talbot
- Faculty of Veterinary Science, School of Life and Environmental Sciences, University of Sydney, Sydney, NSW 2006 Australia
| | - Vanessa R Barrs
- Faculty of Veterinary Science, School of Life and Environmental Sciences, University of Sydney, Sydney, NSW 2006 Australia
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Goodale EC, Outerbridge CA, White SD. Aspergillusotitis in small animals - a retrospective study of 17 cases. Vet Dermatol 2015; 27:3-e2. [DOI: 10.1111/vde.12283] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2015] [Indexed: 01/21/2023]
Affiliation(s)
- Elizabeth C. Goodale
- William R. Pritchard Veterinary Medical Teaching Hospital; School of Veterinary Medicine; University of California - Davis; 1 Garrod Drive Davis CA 95616 USA
| | - Catherine A. Outerbridge
- Department of Medicine and Epidemiology; School of Veterinary Medicine; University of California - Davis; 1 Garrod Drive Davis CA 95616 USA
| | - Stephen D. White
- Department of Medicine and Epidemiology; School of Veterinary Medicine; University of California - Davis; 1 Garrod Drive Davis CA 95616 USA
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Barrs VR, Beatty JA, Dhand NK, Talbot JJ, Bell E, Abraham LA, Chapman P, Bennett S, van Doorn T, Makara M. Computed tomographic features of feline sino-nasal and sino-orbital aspergillosis. Vet J 2014; 201:215-22. [PMID: 24685469 DOI: 10.1016/j.tvjl.2014.02.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/27/2014] [Accepted: 02/10/2014] [Indexed: 12/16/2022]
Abstract
Feline upper respiratory tract aspergillosis (URTA) occurs as two distinct anatomical forms, namely, sino-nasal aspergillosis (SNA) and sino-orbital aspergillosis (SOA). An emerging pathogen, Aspergillus felis, is frequently involved. The pathogenesis of URTA, in particular the relationship between the infecting isolate and outcome, is poorly understood. In this study, computed tomography was used to investigate the route of fungal infection and extension in 16 cases (SNA n = 7, SOA n = 9) where the infecting isolate had been identified by molecular testing. All cases had nasal cavity involvement except for one cat with SNA that had unilateral frontal sinus changes. There was a strong association between the infecting species and anatomic form (P = 0.005). A. fumigatus infections remained within the sino-nasal cavity, while cryptic species infections were associated with orbital and paranasal soft-tissue involvement and with orbital lysis. Cryptic species were further associated with a mass in the nasal cavity, paranasal sinuses or nasopharynx. Orbital masses showed heterogeneous contrast enhancement, with central coalescing hypoattenuating foci and peripheral rim enhancement. Severe, cavitated turbinate lysis, typical of canine SNA, was present only in cats with SNA. These findings support the hypothesis that the nasal cavity is the portal of entry for fungal spores in feline URTA and that the route of extension to involve the orbit is via direct naso-orbital communication from bone lysis. Additionally, a pathogenic role for A. wyomingensis and a sinolith in a cat with A. udagawae infection are reported for the first time.
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Affiliation(s)
- V R Barrs
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, The University of Sydney, Sydney, NSW 2006, Australia.
| | - J A Beatty
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, The University of Sydney, Sydney, NSW 2006, Australia
| | - N K Dhand
- Farm Animal and Veterinary Public Health, Faculty of Veterinary Science, University of Sydney, Sydney, NSW 2570, Australia
| | - J J Talbot
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, The University of Sydney, Sydney, NSW 2006, Australia
| | - E Bell
- University of Melbourne Veterinary Clinic and Hospital, Werribee, Vic. 3030, Australia
| | - L A Abraham
- University of Melbourne Veterinary Clinic and Hospital, Werribee, Vic. 3030, Australia
| | - P Chapman
- Veterinary Speciality and Emergency Centre, Levittown, 301 Veterans Highway, Philadelphia, PA, 19056, USA
| | - S Bennett
- Department of Veterinary Clinical Sciences, Murdoch University, Murdoch, WA 6150, Australia
| | - T van Doorn
- Department of Applied and Industrial Mycology, CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
| | - M Makara
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, The University of Sydney, Sydney, NSW 2006, Australia
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Hartmann K, Lloret A, 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. Aspergillosis in Cats. J Feline Med Surg 2013; 15:605-10. [DOI: 10.1177/1098612x13489223] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Overview: Aspergillosis is a sporadic mycosis that occurs worldwide in mammals and birds and leads to a usually chronic, and only rarely acute, disease that mainly affects the nasal cavity and sinuses. Infection: Aspergillus species infections are commonly associated with predisposing local or systemic factors. Local disease can spread and involve the central nervous system or the lungs. Some Aspergillus species can also disseminate, causing systemic infections. In contrast to dogs, in which (nasal) aspergillosis is relatively common, aspergillosis is rare in cats, but considered an emerging infection. Clinical signs: There are two clinical forms of aspergillosis in cats, the sinonasal form (characterised by signs of chronic nasal infection) and the newly emerging, more invasive sino-orbital form (characterised by signs of orbital and surrounding tissue invasion). Sino-orbital involvement has been described now in approximately half of the reported cases. Disease management: Treatment should consist of local and systemic antifungal therapy.
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Soonthornsit J, Banlunara W, Niyomthum W, Pusoonthornthum R. Penicillium species-induced granuloma in a cat resulting in chronic lower urinary tract disease. J Feline Med Surg 2013; 15:1154-9. [PMID: 23735673 DOI: 10.1177/1098612x13491758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 5-year-old, female neutered Persian cat was admitted to the Small Animal Hospital (Chulalongkorn University, Bangkok, Thailand) with clinical signs of dysuria, haematuria and partial urethral obstruction that had manifested over several months. The animal also had hyperkalaemia and severe azotaemia at the time of presentation. Urinalysis showed haematuria, pyuria and the presence of several transitional cells. In addition, ultrasonography demonstrated an extraluminal mass between the neck of urinary bladder and the colon. Fine-needle aspiration of the mass revealed a fungal form with branching and septate hyphae. Consequently, itraconazole treatment was prescribed and clinical signs of improvement were seen after 7 days. However, 1 month later, the cat died of acute anaemia. Necropsy revealed the presence of extraluminal multifocal fungal granuloma at the neck of the urinary bladder, and contracted kidneys. Histopathological analysis of the fungal granuloma was found to be composed of branching, septate hyphal fungi together with inflammatory cells. Subsequent fungal culture and identification revealed this to be a species of Penicillium.
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Affiliation(s)
- Jeerawat Soonthornsit
- 1Department of Veterinary Medicine, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
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Evaluation of serum galactomannan detection for diagnosis of feline upper respiratory tract aspergillosis. Vet Microbiol 2012; 162:180-5. [PMID: 23031342 DOI: 10.1016/j.vetmic.2012.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 08/28/2012] [Accepted: 09/06/2012] [Indexed: 11/21/2022]
Abstract
Measurement of serum galactomannan (GM), a polysaccharide fungal cell-wall component, is a non-invasive test for early diagnosis of invasive aspergillosis in humans. Feline upper respiratory tract (URT) aspergillosis is an emerging infectious disease in cats. Diagnosis requires biopsy for procurement of tissue specimens for cytological or histological detection of fungal hyphae and for fungal culture. The aim of this study was to evaluate serum GM measurement as a non-invasive diagnostic test for URT aspergillosis in cats. A one-stage, immunoenzymatic sandwich ELISA was used to detect serum GM in 4 groups of cats; Group 1 (URT aspergillosis) - confirmed URT aspergillosis (n=13, sinonasal aspergillosis (SNA) n=6 and sino-orbital aspergillosis (SOA) n=7), Group 2 (URT other) - other URT diseases (n=15), Group 3 (β-lactam) - cats treated with β-lactam antibiotics for non-respiratory tract disease (n=14), Group 4a - healthy young cats (≤ 1 y of age, n=28), Group 4b - healthy adult cats (>1 y of age, n=16). One cat with SNA and two cats with SOA caused by an Aspergillus fumigatus-mimetic species, tested positive for serum GM. For a cut-off optical density index of 1.5, the overall sensitivity and specificity of the assay was 23% and 78% respectively. False positive results occurred in 29% of cats in Group 3 and 32% of cats in Group 4a. Specificity increased to 90% when Groups 3 and 4a were excluded from the analysis. Overall, serum GM measurement has a poor sensitivity but is a moderately specific, non-invasive screening test to rule out infection in patients with suspected feline upper respiratory tract aspergillosis.
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18
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Sinonasal and sino-orbital aspergillosis in 23 cats: Aetiology, clinicopathological features and treatment outcomes. Vet J 2012; 191:58-64. [DOI: 10.1016/j.tvjl.2011.02.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 01/26/2011] [Accepted: 02/02/2011] [Indexed: 12/13/2022]
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Abstract
Disease summary Cryptococcosis, principally caused by Cryptococcus neoformans and Cryptococcus gattii, is the most common systemic mycosis of cats worldwide. Cats may be infected following inhalation of spores from the environment, with the nasal cavity suspected as being the initial site of colonization and subsequent infection. Other sites of infection in cats are the skin, lungs, lymph nodes, central nervous system (CNS), eyes and, occasionally, periarticular connective tissue. Cryptococcosis can be diagnosed using serology (antigen testing), cytologic examination of smears, histopathology or culture. Treatment of localized disease is generally successful using azole antifungal drugs; however, cats with CNS involvement or disseminated disease require additional treatment with amphotericin B, with or without flucytosine. The prognosis is variable, depending on host and pathogen factors. Some cats require long-term (>1 year) treatment or indefinite therapy. Patient group Cats of any breed, gender and age may be affected. Retroviral status does not appear to be a risk factor for developing cryptococcosis and indoor cats are not protected from disease. Global importance Feline cryptococcosis occurs worldwide, but is most frequently reported in Australia, western Canada and the western United States. Species and molecular type vary in different geographical regions and may affect clinical presentation and antifungal susceptibility patterns. Clinical challenges Serologic tests that detect cryptococcal antigen in serum are sensitive and specific, but false negatives can occur in cats with localized disease. Long-term drug therapy can be expensive and has the potential for toxicity. The extent to which the pathogenicity and antifungal susceptibility is affected by molecular type is currently under study. Evidence base This review draws on recent literature relating to epidemiology, CNS involvement and advanced diagnostic imaging to update clinicians regarding research findings relevant to clinical practice.
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Affiliation(s)
- Sameer R Trivedi
- Animal Surgical and Emergency Center, 1535 S Sepulveda Blvd, Los Angeles, CA 90025, USA
| | - Richard Malik
- Centre for Veterinary Education, B22, The University of Sydney, NSW 2006, Australia
| | - Wieland Meyer
- Molecular Mycology Research Laboratory, Center for infectious Diseases and Microbiology, Westmead Millennium Institute, Sydney Medical School — Westmead Hospital, The University of Sydney, Westmead, NSW 2145, Australia
| | - Jane E Sykes
- Department of Medicine and Epidemiology, University of California, Davis, Davis, CA 95616, USA
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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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Malik R, O'Brien C, Whitehead M. The fight against some formidable fungal foes. J Feline Med Surg 2010; 12:669-71. [PMID: 20800207 DOI: 10.1016/j.jfms.2010.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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22
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Krockenberger MB, Martin P, Halliday C, Rothwell TLW, Clarke K, Malik R. Localised microsphaeropsis arundinis infection of the subcutis of a cat. J Feline Med Surg 2010; 12:231-6. [PMID: 20193914 DOI: 10.1016/j.jfms.2010.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
UNLABELLED CLINICAL PRESENTATION AND DIAGNOSIS: An 11-year-old spayed domestic crossbred cat was presented for two focal lesions affecting the subcutis that developed 3 weeks after a cat fight. Lesions consisted of swelling of the subcutaneous tissues over the bridge of the nose and a focal swelling of the dewclaw pad of the left thoracic limb. Both lesions were attributable to localised infections with the unusual fungal pathogen Microsphaeropsis arundinis, based on direct microscopy of smear cytology, histology, fungal culture, internal transcribed spacer-polymerase chain reaction (ITS-PCR) and sequence analysis of formalin-fixed tissue and colonial material from primary culture. TREATMENT The dewclaw pad lesion resolved following cytoreductive surgery and a course of itraconazole (50 mg once daily). The nasal bridge lesion was treated in a similar fashion, except that a range of different antifungal agents (itraconazole, fluconazole, posaconazole) were used, administered sequentially. Despite this, the infection recurred on three subsequent occasions, and the cat has been prescribed indefinite azole therapy. PRACTICAL RELEVANCE This report of a refractory localised infection of the subcutis in an apparently immune-competent cat illustrates the value of using a mycology reference laboratory, and PCR and sequence analysis for organism identification, and the therapeutic potential of new antifungal agents such as posaconazole.
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Affiliation(s)
- Mark B Krockenberger
- Faculty of Veterinary Science, The University of Sydney, B14, NSW 2006, Australia
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Smith LN, Hoffman SB. A case series of unilateral orbital aspergillosis in three cats and treatment with voriconazole. Vet Ophthalmol 2010; 13:190-203. [DOI: 10.1111/j.1463-5224.2010.00780.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Furrow E, Groman RP. Intranasal infusion of clotrimazole for the treatment of nasal aspergillosis in two cats. J Am Vet Med Assoc 2010; 235:1188-93. [PMID: 19912040 DOI: 10.2460/javma.235.10.1188] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION 2 cats (13 and 11 years old) were evaluated to determine the cause of nasal discharge of varying duration (4 days and 5 months, respectively). CLINICAL FINDINGS Computed tomography revealed marked turbinate destruction and soft tissue densities in the nasal passages. Histologic examination of nasal specimens revealed chronic active inflammation and branching fungal hyphae consistent with Aspergillus spp. Fungal culture of nasal specimens resulted in growth of Aspergillus spp. Testing yielded negative results for antibodies against Aspergillus spp. TREATMENT AND OUTCOME Both cats were anesthetized and treated with a 1-hour intranasal infusion of clotrimazole. Recovery from the procedure was uncomplicated, and both cats had complete resolution of clinical signs. CLINICAL RELEVANCE Little information is available on the treatment of nasal aspergillosis in cats, and the prognosis for affected animals is considered poor. The procedure for local intranasal infusion of clotrimazole in 2 cats was described here. Results and follow-up monitoring for both cats suggested that this may be a safe, effective, and durable treatment for cats with nasal aspergillosis.
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Affiliation(s)
- Eva Furrow
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Intra-lesional amphotericin B—Worth a try, maybe for lots of things, but we need more data! J Feline Med Surg 2009; 11:621-3. [DOI: 10.1016/j.jfms.2009.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2009] [Indexed: 11/23/2022]
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Barachetti L, Mortellaro CM, Di Giancamillo M, Giudice C, Martino P, Travetti O, Miller PE. Bilateral orbital and nasal aspergillosis in a cat. Vet Ophthalmol 2009; 12:176-82. [PMID: 19392877 PMCID: PMC7169333 DOI: 10.1111/j.1463-5224.2009.00695.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 12‐year‐old, 4 kg, castrated male Persian cat was referred with a 2‐month history of sneezing and bilateral mucopurulent nasal discharge. Rhinoscopically acquired nasal biopsies at this time revealed bilateral lymphoplasmacytic rhinitis. A tapering dose of oral prednisone caused the complete remission of the clinical signs, but 2 months after discontinuation of the therapy, the rhinitis recurred and the OD became exophthalmic. Computed tomography showed a soft tissue mass in both sides of the nasal cavity, both frontal sinuses, the right orbit, and to a lesser extent the left orbit. A fine needle aspirate of the right orbit revealed pyogranulomatous inflammation and Aspergillus spp. hyphae. Repeat nasal biopsy demonstrated multi‐focal necrosis and a mixed inflammatory cell process which now included macrophages and scattered septate fungal hyphae. A few days later the cat became bilaterally blind and a contrast enhancing lesion involving the optic chiasm was found on magnetic resonance imaging. Despite a poor prognosis, therapy consisted of exenteration of the right orbit and trephination of both frontal sinuses before the planned initiation of medical antifungal therapy. Unfortunately, the cat died of cardiac arrest intraoperatively. Aspergillus fumigatus was cultured from both orbits at necropsy. Orbital aspergillosis has been rarely reported in cats and its relationship with lymphoplasmacytic rhinitis is unclear. In this patient lymphoplasmacytic rhinitis or previous antibiotic/corticosteroid therapy may have allowed secondary fungal invasion of the nasal mucosa and subsequently both orbits and the brain. Alternatively, Aspergillus infection may have preceded the lymphoplasmacytic rhinitis.
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Affiliation(s)
- Laura Barachetti
- Dipartimento di Scienze Cliniche Veterinarie, Università degli Studi di Milano, Milano, Italy.
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Dye C, Johnson EM, Gruffydd-Jones TJ. Alternaria species infection in nine domestic cats. J Feline Med Surg 2008; 11:332-6. [PMID: 18848796 DOI: 10.1016/j.jfms.2008.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2008] [Indexed: 10/21/2022]
Abstract
A case series of nine domestic cats with culture-confirmed Alternaria species infection is presented, with conclusions drawn regarding signalment, clinical signs, treatment and outcome. Middle aged neutered males were over-represented and all presented with cutaneous lesions involving the extremities (nose, pinnae and digits). Lesions were mainly slow-growing, poorly circumscribed nodules or plaques but some also presented as non-healing wounds. A combination of surgical excision with adjunctive medical therapy appeared to be the most successful treatment option but long courses of medical therapy were generally required and recurrence was common.
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Affiliation(s)
- Charlotte Dye
- The Feline Centre, Department of Veterinary Clinical Science, University of Bristol, Langford, Bristol, UK.
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Wray JD, Sparkes AH, Johnson EM. Infection of the subcutis of the nose in a cat caused by Mucor species: successful treatment using posaconazole. J Feline Med Surg 2008; 10:523-7. [PMID: 18676168 DOI: 10.1016/j.jfms.2008.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2008] [Indexed: 11/24/2022]
Abstract
A 14-year-old neutered female domestic shorthair cat was presented for investigation of a non-painful subcutaneous swelling of the nasal dorsum at the site of a scratch injury. Cytological evaluation demonstrated a granulomatous reaction and many variably shaped organisms consistent with yeasts/fungi. Subsequent biopsy and culture yielded a pure growth of a Mucor species. The cat was treated with the second-generation triazole antifungal agent posaconazole for 5 months. Complete resolution was seen with no recurrence 12 months after discontinuing treatment.
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Affiliation(s)
- Jonathan D Wray
- Centre for Small Animal Studies, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk, United Kingdom.
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Abstract
Posaconazole is a lipophilic triazole antifungal agent that is structurally similar to itraconazole but has an expended spectrum of activity including yeast, molds, and dimorphic fungi. Posaconazole was licensed by the European Commission for the treatment of invasive aspergillosis, fusariosis, mycetoma, chromoblastomycosis, and coccidioidomycosis in adults who are refractory, or intolerant to other antifungal agents. Posaconazole was recently indicated for prophylaxis of invasive fungal infections in the following patients: patients receiving remission-induction chemotherapy for acute myelogenous leukemia (AML) or myelodysplastic syndromes (MDS) expected to result in prolonged neutropenia and hematopoietic stem cell transplant (HSCT) recipients who are undergoing high-dose immunosuppressive therapy for versus host disease. The spectacular activity of posaconazole against refractory infections due to zygomycetes is encouraging and suggests using posaconazole in this case. Posaconazole is only available in oral suspension formulation. Posaconazole was well tolerated in clinical trials and has lower drug interaction profile compared to other available azoles.
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Affiliation(s)
- A Paugam
- Laboratoire de Parasitologie-Mycologie, hopital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
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