Comparison of two minimally invasive enilconazole perendoscopic infusion protocols for the treatment of canine sinonasal aspergillosis

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.

Assessment of the nasal microbiota in dogs with fungal rhinitis before and after cure and in dogs with chronic idiopathic rhinitis.

“…Additional diagnostic procedures consisted of computed tomography of the head, histopathology and fungal culture or polymerase chain reaction (PCR). All dogs were treated with endoscopic debridement of the fungal plaques followed by a 15-minutes enilconazole infusion protocol 55 . Control rhinoscopy was performed 3 to 6 weeks after treatment.…”

Utility of fungal polymerase chain reaction on nasal swab samples in the diagnosis and monitoring of sinonasal aspergillosis in dogs

“…In any case, independently from molecular testing, advanced and invasive procedures, such as CT‐scan and rhinoscopy remain the gold standard for final diagnosis. These represent not‐to‐be‐missed procedures before initiation of sinonasal infusion protocols, which are considered the preferred treatment for SNA in dogs 4,15,26 …”

“…These represent not‐to‐be‐missed procedures before initiation of sinonasal infusion protocols, which are considered the preferred treatment for SNA in dogs. 4 , 15 , 26 …”

“…A 2% enilconazole (Imaverol; Janssen‐Cilag SA) solution was prepared and infused in each sinonasal cavity, as previously described. 15 Briefly, under general anesthesia, the dog was placed in dorsal recumbency with the nasopharyngeal area blocked, nose pointed upward, and the solution was infused until it reached the nostrils in order to immerse both sinonasal cavities, for 15 minutes. Dogs with CT‐scan evidence of cribriform plate damage had rhinotomy with surgical debridement and direct topical enilconazole administration.…”

“…Definitive diagnosis requires imaging studies and rhinoscopy 4 . Furthermore, confirmation of cure after treatment is difficult to assess: follow‐up rhinoscopy to confirm absence of fungal material in the nasal cavities/sinuses is strongly advised even when clinical signs are improved or resolved 14,15 …”