Successful Treatment of Invasive Pulmonary Aspergillosis in a Neonatal Foal

Abstract

A 55 kg, 14-day-old, Thoroughbred colt foal was examined because of acute respiratory distress of 4 hours duration. The colt had been born at 320 days gestation and parturition was normal. Serum IgG 48 hours after birth was 4800 mg/dL. a The colt was hospitalized for treatment of diarrhea 7 days after birth; acidemia (pH 7.247; reference range 7.32-7.44), hyponatremia (108 mEq/L; reference range 132-146 mEq/L), hypo-chloremia (89 mEq/L; reference range 99-109 mEq/L), and leukocytosis (22,500 cells/mL; reference range 5,300-14,000 cells/mL) due to neutrophilia (18,913 neutrophils/ mL; reference range 3,400-11,900 neutrophils/mL) were documented. Thoracic radiography performed during hospitalization identified a thin-walled gas-filled structure within the right caudo-dorsal lung field and increased soft-tissue opacity consistent with regional pulmonary consolidation (Fig 1). The radiographic diagnosis was congenital pulmonary bulla. The foal responded to IV administration of fluids and antibiotic therapy but a CBC identified continued leukocytosis on days 2 and 4 of hospitalization (19,690 and 23,650 cells/ mL, respectively). The foal was discharged from the hospital with a recommendation for administration of ceftiofur sodium (10 mg/kg SQ q12h for 14 days) and amikacin (21 mg/kg IM q24h for 7 days). The foal presented for examination 24 hours after discharge with signs of respiratory distress including marked abdominal effort and nostril flare. Heart rate was 120 bpm, respiratory rate 60 bpm, and rectal temperature 100.11F. Mucous membranes were pale and cyanotic. Thoracic auscultation identified reduced bronchovesicular sounds bilaterally. Thoracic ultrasono-graphy and radiography identified free gas and pulmonary collapse within the right and left pleural cavities consistent with bilateral pneumothorax. The previously identified pulmonary bulla in the right ca-udo-dorsal lung field appeared attached to the dorsal parietal pleura (Fig 2). Bilateral thoracocentesis and aspiration of pleural gas relieved respiratory distress. Thoracic radiographs performed after thoracocentesis revealed bilateral inflation of the lungs with minimal residual free air within the thoracic cavity. A CBC identified anemia (28.3%; reference range 30-46%), leukocytosis (34,640 cells/mL) because of neutrophilia (32,562 cells/mL) and hyperfibrinogenemia (600 mg/dL; reference range 100-400 mg/dL). Serum biochemistry identified hyperglycemia (304 mg/dL; reference range 122-205 mg/dL), venous blood gas analysis indicated acidemia (pH 7.219) with both respiratory and metabolic components (PvCO 2 70.5 mmHg; reference range 40-50 mmHg, lactate 2.1 mmol/L; reference range 0-2 mmol/L). A diagnosis of bilateral pneumothorax secondary to rupture of the pulmonary bulla was suspected based on the clinical presentation, diagnostic imaging findings, and previous identification of the pulmonary bulla. Within 1 hour of the initial stabilization, the foal was again noted to be in respiratory distress. A 2nd thor-acocentesis was performed and an indwelling ...

Bullous emphysema with haemorrhage in a premature foal

“…2008). Cavitary lung disease resulting from pulmonary aspergillosis has been described in the foal; however, there were no fluid lines reported (Hilton et al . 2009).…”

“…Other possible origins of cavitary lung lesions include congenital, traumatic, fungal and neoplastic lesions (Butler et al . 2008; Hilton et al . 2009).…”

Gliotoxin – bane or boon?

“…The high temperature environment during the maturation along with the relative humidity is a perfect habitat for thermotolerant organisms like A. fumigatus, which could finally lead to a contamination of the food stock and entry to the food chain. The fact that horse and poultry feed samples had the greatest contamination frequency (Pena et al, 2010) might explain the infection of horses (Hilton et al, 2009;Headley et al, 2014) and turkey poults with A. fumigatus. The isolates from different tissues showed the ability to produce GT.…”

Clinical pharmacology of the respiratory system

“…Although itraconazole is reported to have high oral bioavailability in the horse, this does "not" apply to the compounded formulation but only to the Sporanox ® solution (Janssen Pharmaceutica NV, Olen, Belgium). A recent study determined that voriconazole is well distributed to multiple body fluids, including the PELF, after a daily oral dose of 4 mg/kg bwt, and it has been reported to have been used in the successful treatment of invasive pulmonary aspergillosis in a foal [29,30]. Fluconazole has good penetration into equine plasma; however, its penetration into respiratory secretions and tissues has not been determined in horses [28].…”