Feline histoplasmosis presenting with bone and joint involvement: clinical and diagnostic findings in 25 cats

Fielder, Susan E.; Meinkoth, James H.; Rizzi, Theresa E.; Hanzlicek, Andrew S; Hallman, Ruth Mackenzie

doi:10.1177/1098612x18806706

Cited by 9 publications

(15 citation statements)

References 13 publications

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“…This presumption is supported by the false-negative results described in the literature, which include cats with ocular, bone and joint, or gastrointestinal involvement. 7,20,21 Like the present case, antifungal treatment should continue at least 1 month after the first negative urine Histoplasma antigen test and resolution of all clinical signs. 5 The second noteworthy aspect of this case was the geographic locations -California and Washington, which are not areas where histoplasmosis is considered enzootic.…”

Section: Discussionmentioning

confidence: 66%

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Invasive fungal rhinitis with adnexal involvement caused by Histoplasma capsulatum in a cat from a non-enzootic location

Grinstead¹,

Hanzlicek²,

Largura³

et al. 2021

Journal of Feline Medicine and Surgery Open Reports

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Case summary This report describes a cat with a rare form of histoplasmosis: invasive rhinitis with adnexal involvement, mimicking disease more commonly caused by cryptococcosis or aspergillosis. This case is especially noteworthy as it was from an area where histoplasmosis is not enzootic. Relevance and novel information Invasive fungal rhinitis causes significant morbidity in cats. Diagnostic investigation of more common pathogens includes detection of fungal antigen ( Cryptococcus) or antifungal antibodies ( Aspergillus). This case demonstrates that histoplasmosis can present as chronic nasal disease in cats. Histoplasma antigen testing provides a non-invasive diagnostic option. Moreover, this case serves as a reminder that histoplasmosis can affect cats anywhere, even in non-enzootic areas.

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Section: Discussionmentioning

confidence: 66%

“…[2][3][4][5][6] Organs most often involved include the lungs, eyes, lymph nodes, spleen, liver, bone marrow, bones and joints. 2,3,7 Essentially, any organ can be involved. Compared with cryptococcosis and aspergillosis, histoplasmosis is much less likely to involve the nasal cavity, sinuses and central nervous system.…”

Section: Introductionmentioning

confidence: 99%

Invasive fungal rhinitis with adnexal involvement caused by Histoplasma capsulatum in a cat from a non-enzootic location

Grinstead¹,

Hanzlicek²,

Largura³

et al. 2021

Journal of Feline Medicine and Surgery Open Reports

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“…Lameness, arthralgia, and joint swelling have been reported in dogs with H. capsulatum infection [ 1 , 16 ]. Whether this is due to the presence of H. capsulatum organisms within musculoskeletal structures or reflects a secondary immune-mediated response is unclear, although a series of cats with bone and joint infection was recently reported [ 22 ]. The rapid resolution of lameness and swelling with antifungal treatment in the dogs reported here would be compatible with either mechanism, but the recurrent nature of the clinical signs would favor a secondary immune-mediated etiology.…”

Section: Discussionmentioning

confidence: 99%

“…Infection of the carpal bones or joints with H. capsulatum cannot therefore be excluded. Carpal arthrocentesis with joint fluid cytology may have provided additional useful information, as organisms were routinely identified in synovial fluid in a recent series of cats with histoplasmosis and bone or joint involvement [ 22 ]. In addition, it is the opinion of the authors that this dog was not immunocompromised, as he had not received any immunomodulatory therapies prior to the onset of clinical signs and appeared otherwise systemically well.…”

Section: Discussionmentioning

confidence: 99%

Mucocutaneous nasal histoplasmosis in an immunocompetent dog

et al. 2021

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Background Histoplasma (H.) capsulatum is a dimorphic fungus, and infection is typically via inhalation of microconidia. After conversion to the yeast phase within the lung, the organism is subsequently disseminated to other tissues by macrophages. Nasal histoplasmosis appears to be a rare condition in dogs. Case presentation We report the clinical case of a 4.5-year-old male neutered Cocker spaniel/Poodle mix, 7.7 kg, body condition score 6/9, that presented with a 3-month history of sneezing and left-sided mucoid nasal discharge. The history also included a mild swelling (transient) of the right carpus with a lameness (grade II-III/IV), coinciding with the onset of sneezing and nasal discharge. The dog lived primarily indoors in the Texas Gulf Coast area. On physical examination, the dog was febrile, and the left nostril was swollen, ulcerative, deformed, and hypopigmented. Mandibular lymph nodes were firm and mildly enlarged bilaterally. Mild lymphopenia, thrombocytopenia, and hyperglobulinemia were noted. Thoracic radiographs were unremarkable. Computed tomography and rhinoscopy revealed swelling of the rostral portion of the left and right nasal passages. Cytology and histology of biopsies of the affected nasal tissue showed pyogranulomatous inflammation and yeast organisms consistent with H. capsulatum. Weak antigenuria was detected on the MVista H. capsulatum antigen test. Treatment with oral itraconazole led to a resolution of the nasal signs and normalization of the appearance of the nostril over 13 weeks, and neither antigenuria nor antigenemia was detected on several recheck examinations. The dog remained in good general and physical condition and showed no signs of disease recurrence more than 6 years after the last examination. Conclusion We report a rare case of nasal mucocutaneous histoplasmosis in an immunocompetent dog, with an excellent clinical response to oral itraconazole. This case documents that histoplasmosis in dogs can affect primarily the nasal cavity, which responds rapidly to triazole antifungal therapy and has a good prognosis. A similar case has only been reported in human medicine in a young adult.

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“…The MV EIA was positive in 7/8 (88%) of these dogs, suggesting that it is the noninvasive test of choice for this subgroup of HP dogs. Interestingly the performance of the MV EIA is likely not completely unaffected by localized disease, as the majority of the few false negative MV EIA test results reported in the literature have included dogs with disease apparently localized to the GI tract or cats with disease apparently localized to the GI tract, eyes, or skeletal system 5,22‐24 …”

Section: Discussionmentioning

confidence: 99%

Evaluation of a novel monoclonal antibody‐based enzyme immunoassay for detection of Histoplasma antigen in urine of dogs

Clark

Hanzlicek

2020

Veterinary Internal Medicne

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Background: Commercially available, noninvasive testing options for histoplasmosis are limited outside of the United States. Objectives: To describe the diagnostic performance of a novel Histoplasma antigen enzyme immunoassay (IM EIA) for the diagnosis of histoplasmosis in dogs. Animals: Twenty dogs with histoplasmosis, 79 dogs without histoplasmosis, and 11 unclassified dogs providing 202 urine samples. Methods: This a prospective study using stored urine samples. Samples were analyzed with the IM EIA and with the commercially available Histoplasma antigen EIA (MV EIA). Dogs were classified based on final proven diagnosis and performance of the IM EIA was described and compared with the MiraVista enzyme immunoassay (MV EIA). Results: The diagnostic sensitivity (DSe), specificity (DSp), and accuracy (DAc) of the IM EIA were 70% (51%-89%), 99% (97%-100%), and 93% (81%-100%), respectively. The DSe, DSp, and DAc for the MV EIA were 95% (85%-100%), 99% (97%-100%), and 98% (95%-100%), respectively. The area under the receiver operator characteristic curve was significantly smaller for IM EIA (0.87) as compared with MV EIA (0.97, P = .03). This was primarily due to 6 false negative IM EIA results, 4 from dogs with disease localized to the gastrointestinal tract. The MV EIA was positive in 5/6 of these dogs. Conclusions and Clinical Importance: The IM EIA might be useful for the diagnosis of disseminated histoplasmosis in dogs, but clinical usefulness will be limited in dogs with histoplasmosis localized to the GI tract.

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Feline histoplasmosis presenting with bone and joint involvement: clinical and diagnostic findings in 25 cats

Cited by 9 publications

References 13 publications

Invasive fungal rhinitis with adnexal involvement caused by Histoplasma capsulatum in a cat from a non-enzootic location

Invasive fungal rhinitis with adnexal involvement caused by Histoplasma capsulatum in a cat from a non-enzootic location

Mucocutaneous nasal histoplasmosis in an immunocompetent dog

Evaluation of a novel monoclonal antibody‐based enzyme immunoassay for detection of Histoplasma antigen in urine of dogs

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