Rare systemic mycoses in cats: blastomycosis, histoplasmosis and coccidioidomycosis

Lloret, Albert; Hartmann, Katrin; Pennisi, Maria Grazia; Ferrer, L.; Addie, Diane; Belák, Sándór; Boucraut-Baralon, Corine; Egberink, Herman; Frymus, Tadeusz; Gruffydd-Jones, Tim; Hosie, Margaret J.; Lutz, Hans; Marsilio, Fulvio; Möstl, Karin; Radford, Alan; Thiry, Étienne; Truyen, Uwe; Horzinek, Marian C.

doi:10.1177/1098612x13489226

Cited by 19 publications

(23 citation statements)

References 25 publications

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“…However, in our case the expected clinical response was not observed. Hence, we chose to combine amphotericin in the treatment since combined antifungal drugs can be more effective (Powers, 2004;Lloret et al, 2013). Although the majority of cats treated today for histoplasmosis receive azole drugs as a first line of therapy, other antifungal drugs, only or combined, may have a role in optimized treatment (Reinhart et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

Feline histoplasmosis: a case of supraorbital involvement

Souza¹,

Gremião²,

Pereira³

et al. 2015

RBCV

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Histoplasmosis is a systemic fungal infection caused by the dimorphic fungus Histoplasma capsulatum that infects humans and a wide variety of mammalian species, including cats. In Brazil only four cases of this disease were reported in domestic cats. The present study reports a case of an indoor cat, rescued from street three years ago, that developed histoplasmosis with supraorbital involvement. The cat presented sneezing, dyspnea and increased respiratory sounds and the diagnosis suspected was allergic rhinitis. Prednisolone and amoxicillin were prescribed. The patient returned to clinic after clinical signs worsened with a swelling of the right supraorbital region, unilateral left side conjunctivitis and enlarged submandibular lymph nodes. Cytology and culture revealed Histoplasma capsulatum. Initially, itraconazole (10 mg/Kg SID orally) was prescribed and due to the worsening of clinical signs, was combined amphotericin B (0.5 mg/kg SC) for two weeks. The therapy with amphotericin was discontinued and itraconazole continued to be administered for six months. The clinical signs were resolved and no recrudescence was reported. It is important that veterinary practitioners to be aware of the clinical features of feline histoplasmosis and consider the possibility of a subclinical infection.Keywords: corticosteroid, cat, involvement supraorbital, Histoplasma capsulatum. ResumoHistoplasmose é uma infecção sistêmica causada pelo fungo dimórfico Histoplasma capsulatum, que infecta humanos e uma ampla variedade de mamíferos, incluindo os gatos. No Brasil, somente quatro casos dessa doença foram relatados em gatos domésticos. O presente estudo relata um caso de um gato, vivendo em ambiente domiciliar sem acesso à rua, mas que tinha sido resgatado das ruas havia três anos, que desenvolveu histoplasmose com envolvimento supraorbital. O paciente apresentava espirros, dispneia e aumento dos sons respiratórios e a suspeita clínica foi rinite alérgica. O animal foi tratado com prednisolona e amoxicilina. Com a piora dos sinais clínicos o paciente retornou apresentando um edema na região supraorbital direita, conjuntivite unilateral do olho esquerdo e linfoadenomegalia na região submandibular. A citologia e a cultura revelaram a presença de Histoplasma capsulatum. Inicialmente, itraconazol (10 mg/kg via oral, uma vez ao dia) foi prescrito e devido à piora dos sinais clínicos, anfotericina B (0,5 mg/Kg via subcutânea) foi administrada por duas semanas associada ao triazólico. A terapia com anfotericina B foi descontinuada e o itraconazol mantido por seis meses até a cura clínica e nenhuma recrudescência foi registrada. É importante ressaltar que veterinários devem estar atentos para os sinais clínicos da histoplasmose e que devem considerar a possibilidade de uma infecção subclínica.Palavras-chave: corticoide, gato, envolvimento supraorbital, Histoplasma capsulatum.

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Section: Discussionmentioning

confidence: 99%

Feline histoplasmosis: a case of supraorbital involvement

Souza¹,

Gremião²,

Pereira³

et al. 2015

RBCV

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“…Em casos potencialmente graves de manifestação da doença, a terapia deve ser associada à utilização da anfotericina B. No entanto, há implicações colaterais no uso desta droga, principalmente devido ao seu potencial nefrotóxico [7,15,16].…”

Section: Introductionunclassified

“…Já a realização da cultura fúngica implica principalmente em risco biológico para os técnicos laboratoriais, além de ser pouco sensível. Outros métodos como a detecção antigênica de Histoplasma no soro, na urina e até mesmo em regiões corporais específicas como os olhos, requerem mais estudos para que possam ser de fato utilizados [1,6,9,11,16,23] assim como a Reação em Cadeia da Polimerase, empregada atualmente em alguns estudos [2,13].…”

Section: Introductionunclassified

“…O citodiagnóstico da histoplasmose pulmonar pode ser realizado através do lavado broncoalveolar, da colheita de líquido pleural ou da punção aspirativa por agulha fina a nível pulmonar [16]. No entanto, o comprometimento respiratório severo impossibilita a realização do lavado, assim busca-se através deste relato encorajar os clínicos a quanto à realização da toracocentense e colheita do líquido pleural nestas ocasiões, visando à obtenção do material de uma forma mais segura para o paciente.…”

Section: Introductionunclassified

“…A anfotericina B pode ainda ser utilizada na dose de 0,5 mg/kg, por via subcutânea, juntamente a solução de cloreto de sódio 0,9% e glicose. No entanto, é necessário considerar o potencial nefrotóxico deste agente antifúngico, mediante o cauteloso monitoramento da creatinina sérica [12,14,16,19,24].…”

Section: Introductionunclassified

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Histoplasmose pulmonar grave em um gato doméstico: tratamento com Anfotericina B e Itraconazol

Jardim

Silva

Jesus

et al. 2018

Acta Scientiae. Vet.

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Background: Histoplasmosis is a systemic mycosis whose etiologic agent is the fungus Histoplasma capsulatum. This fungal infection, which is the second most frequent systemic mycotic fungal disease in felines in the United States, has rarely been found in cats in Brazil. This paper reports on a case of acute pulmonary histoplasmosis in a domestic cat treated with oral itraconazole associated with amphotericin B administered subcutaneously. This treatment resulted in clinical remission of the patient’s symptoms, as evidenced by radiographic follow-ups.Case: A domestic cat suffering from acute dyspnea was taken to a veterinary clinic. The animal was subjected to emergency oxygen therapy, and kept at rest through sedation with midazolam. A physical examination revealed normally colored mucosa, 8% dehydration, bristly fur, body condition score 2/9, tachypnea with respiratory rate of 100 breaths per minute and expiratory dyspnea. The radiographic examination showed marked opacification of all the pulmonary fields, with a mixed pattern (interstitial and alveolar) of heterogeneous appearance and diffuse distribution, which are changes consistent with an inflammatory infectious process (pneumonia). A cytological analysis of the pleural fluid revealed round to oval-shaped intracytoplasmic structures, varying in size from 2 to 4 μm, inside foamy macrophages, consistent with Histoplasma capsulatum. Based on the diagnosis of pulmonary histoplasmosis, and in view of the patient’s acute respiratory distress, it was decided to treat the cat using itraconazole associated with amphotericin B. Itraconazole was administered orally at a dose of 100 mg/cat every 24 h, while amphotericin B was administered subcutaneously at a dose of 0.5 mg/kg, combined with 100 mL of sodium chloride 0.9% and 100 mL of 5% glycated serum, with monitoring of serum concentrations of symmetric dimethylarginine (SDMA). Amphotericin B was administered every 48 h up to the 7th dose, followed by three times a week up to the 11th dose, and then twice a week up to the 16th dose. The animal was released from the veterinary hospital 10 days after its admission, showing a considerably improved respiratory condition and a respiratory rate of 40 breaths per minute. Continuation of the antifungal treatment with itraconazole was prescribed, maintaining the same dose and frequency of administration until a new recommendation would be made, as well as frequent return visits for the administration of amphotericin B and reassessment of the animal. The administration of amphotericin B was discontinued when the animal’s respiratory condition stabilized; hence, the feline received a total of 16 doses of the drug. The animal showed remission of clinical respiratory symptoms, confirmed by follow-up chest X-rays, which revealed significantly less radiodense pulmonary parenchyma in response to treatment with itraconazole and amphotericin B. Five months after beginning its treatment, the cat is being treated orally with itraconazole (100 mg/cat, every 24 h), without recrudescence of the clinical symptoms.Discussion: To date, six cases of feline histoplasmosis have been reported in Brazil, only one of which had pulmonary involvement and was treated successfully. The use of oral itraconazole associated with subcutaneous amphotericin B has proved to be effective for the treatment of acute pulmonary histoplasmosis in domestic cats. Note that a rapid diagnosis of pulmonary disease is essential in order to immediately implement a combined drug therapy linked with monitoring to ensure the protocol is safe for the patient

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Feline Pulmonary Disease

Larson

2020

Feline Diagnostic Imaging

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Rare systemic mycoses in cats: blastomycosis, histoplasmosis and coccidioidomycosis

Abstract: Cat owners travelling to endemic areas should be warned about these diseases. There is no zoonotic risk.

Cited by 19 publications

References 25 publications

Feline histoplasmosis: a case of supraorbital involvement

Feline histoplasmosis: a case of supraorbital involvement

Histoplasmose pulmonar grave em um gato doméstico: tratamento com Anfotericina B e Itraconazol

Feline Pulmonary Disease

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