Use of computed tomography to predict the outcome of a noninvasive intranasal infusion in dogs with nasal aspergillosis

Computed tomography (CT) was performed on 36 dogs with nasal aspergillosis to assess whether this imaging technique can be used to predict the success of a noninvasive intranasal infusion of enilconazole. A CT score based on the severity of the disease was given to each dog, prior to treatment, by dividing the nasal cavities and frontal sinuses into 8 anatomical regions. After therapy, the dogs were classified into 2 response groups (success group: dogs cured after 1 treatment; failure group: dogs needing more than 1 treatment or with treatment failure). No significant relationship on the logistic scale was found between the CT score and the response to treatment. High sensitivity (treatment failures correctly predicted) and specificity (treatment successes correctly predicted) could not be obtained at the same time, whatever the cut-off value chosen. The results of this study suggest that CT cannot predict the therapeutic success of nasal aspergillosis in dogs treated with a 1-hour infusion of enilconazole. However, dogs with a low score seem to be good candidates to respond after 1 treatment.     

Efficacy of intrasinusal administration of bifonazole cream alone or in combination with enilconazole irrigation in canine sino-nasal aspergillosis: 17 cases

This study evaluated the effect of 1% bifonazole cream in the treatment of canine sino-nasal aspergillosis (SNA). The cream was instilled through perendoscopically placed catheters into the frontal sinuses and was used either as single therapy after debridement (DC) or as adjunctive therapy after 2% enilconazole infusion (DEC). Twelve dogs were treated initially with DEC: 7 and 3 of these dogs were free of disease after 1 and 2 procedures, respectively, while 2 dogs were cured after DC was used as a second procedure. Five dogs were treated with DC only: in 3 dogs with moderate disease, cure was obtained after a single procedure while, in 2 debilitated patients, cure could not be confirmed. Topical administration of 1% bifonazole cream appears as an effective therapy in SNA, either as an adjunctive therapy to enilconazole infusion or as sole therapy in moderately affected patients.     

Combined clotrimazole irrigation and depot therapy for canine nasal aspergillosis

OBJECTIVES: To evaluate the effect of short duration 1 per cent clotrimazole flush when combined with 1 per cent clotrimazole cream instilled into the frontal sinuses for the treatment of nasal aspergillosis in 14 dogs. METHODS: Fourteen dogs with clinical, radiological, serological and rhinoscopic findings consistent with nasal aspergillosis were treated by frontal sinus trephination and a short, five-minute flushing of 1 per cent topical clotrimazole solution followed by a 1 per cent clotrimazole cream instilled as a depot agent. RESULTS: Twelve of the 14 dogs (86 per cent) responded well to treatment and either had no clinical signs after treatment or had signs consistent with mild rhinitis during a minimum follow-up period of six months. Only one dog required multiple treatments. Treatment was well tolerated by all patients, with minimal complications. CLINICAL SIGNIFICANCE: This treatment compares favourably to previously published data using one-hour topical clotrimazole or enilconazole flushing treatment protocols. The treatment technique significantly reduced treatment time under anaesthesia.     

Clotrimazole and enilconazole distribution within the frontal sinuses and nasal cavity of nine dogs with sinonasal aspergillosis

Objectives: Multiple topical treatments are often required for clinical cure of mycotic rhinosinusitis in dogs. The objective of this study was to describe the distribution and retention of enilconazole and clotrimazole solutions using a temporary trephination protocol. Methods: Nine client-owned dogs diagnosed with mycotic rhinosinusitis between March 2008 and December 2009 were prospectively enrolled and were sequentially allocated to receive treatment with either clotrimazole (1% in polyethylene glycol) or enilconazole (10% solution), after imaging and rhinoscopic assessment. Both frontal sinuses were trephined, debrided and flushed with saline. Infusion was administered via frontal sinuses with dogs in sternal recumbency and computed tomography (CT) performed 5 minutes after completion. Distribution was scored 1 to 4 at the canine tooth, premolar 4, cribriform plate and frontal sinus on both sides, for a maximum score of 32. Results: Distribution of antifungal agents to all regions of the nasal cavity and frontal sinuses was achievable, but varied considerably. Retention was poor in 10 of 18 regions assessed. Clinical Significance: Distribution of antifungal agents within the frontal sinuses is achievable using temporary trephination; however, distribution is variable and retention is often poor.     

Results of rhinoscopy alone or in conjunction with sinuscopy in dogs with aspergillosis: 46 cases (2001-2004)

OBJECTIVE: To determine results of diagnostic testing, including detection of nasal or frontal sinus fungal plaques, in dogs with nasal aspergillosis. DESIGN: Retrospective case series. ANIMALS: 46 dogs with nasal aspergillosis. PROCEDURES: Medical records were reviewed for information on computed tomographic findings; rhinoscopic findings, including whether fungal plaques were seen in the nasal cavity; results of frontal sinus trephination and sinuscopy, including whether fungal plaques were seen in the frontal sinus; and results of histologic examination of biopsy specimens. RESULTS: In 38 (83%) dogs, fungal plaques were seen in the nasal cavity during rhinoscopy, whereas in the remaining 8 (17%), fungal plaques were not seen in the nasal cavity but were seen in the frontal sinus. Duration of clinical signs, proportions of dogs in which the referring veterinarian had performed a nasal examination prior to referral, proportions of dogs with computed tomographic evidence of nasal cavity cavitation or sinus involvement, and proportions of dogs with rhinoscopic evidence of destructive rhinitis were not significantly different between dogs with nasal fungal plaques and dogs with fungal plaques only in the frontal sinus. CONCLUSIONS AND CLINICAL RELEVANCE: Results confirm that frontal sinus involvement is common in dogs with nasal aspergillosis and suggest that frontal sinus trephination and sinuscopy may aid in the diagnosis of aspergillosis in dogs, particularly dogs with rhinoscopic evidence of destructive rhinitis and computed tomographic evidence of sinus involvement that lack detectable fungal plaques in the nasal cavity.     

Treatment of canine nasal aspergillosis with a new non-invasive technique. Failure with enilconazole

A new, non-Invasive technique recently described for the treatment of canine nasal aspergillosis was performed on four dogs. The antimycotic agent used was a 10 per cent enilconazole suspension, with the drug left in situ for a period of one hour. None of the dogs responded to single treatment. One dog died from an acute septic response secondary to pyelonephritis and bacterial endocarditis eight days after a second treatment. A second dog responded completely to a second treatment and remained free of fungal disease for a follow-up period of H months. In the remaining two dogs, extensive and profuse fungal growth was seen on rhinoscopic reexamination. Conventional treatment, with tube Implantation into the frontal sinuses and nasal irrigation for two weeks, was performed. Successful resolution of infection was obtained. Although the new, non-invasive technique was simple to carry out and well tolerated by the dogs, instillation of 10 per cent enilconazole appears to have poor therapeutic efficacy and exacerbated fungal growth in two of the animals.     

Surgical treatment of canine nasal aspergillosis by rhinotomy combined with enilconazole infusion and oral itraconazole

OBJECTIVES: To evaluate the effectiveness of rhinotomy and surgical debridement associated with topical administration of 2 per cent enilconazole and oral itraconazole in dogs with severe or recurrent sinonasal aspergillosis. METHODS: A standard rhinotomy was performed on seven dogs. In the initial study, the bone flap was left attached cranially and replaced at the end of the procedure. In the main study group, the bone flap was discarded. Nasal passages were debrided and irrigated with enilconazole solution for one hour. Oral itraconazole was administered to four dogs for one month postoperatively. Follow-up rhinoscopy was performed in all dogs. RESULTS: All three dogs in the initial study had recurrence of the disease and two dogs had a second surgery to remove the flap. The main study group included four dogs in which the flap was initially removed, and the two dogs from the initial study that required a second surgery. At follow-up rhinoscopy, five dogs were free of aspergillus but had bacterial or inflammatory rhinitis and one dog had a small aspergilloma but was subsequently asymptomatic. Telephone follow-up revealed that four dogs were asymptomatic, one dog had intermittent sneezing and serous nasal discharge, and one dog had intermittent epistaxis. CLINICAL SIGNIFICANCE: Rhinotomy with removal of the flap combined with one-hour infusion of 2 per cent enilconazole and oral itraconazole resulted in satisfactory outcome in dogs with severe or recurrent aspergillosis.     

Radiographic, magnetic resonance imaging, computed tomographic, and rhinoscopic features of nasal aspergillosis in dogs

OBJECTIVE: To determine radiographic, magnetic resonance imaging (MRI), computed tomography (CT), and rhinoscopic features of nasal aspergillosis in dogs. DESIGN: Prospective study. ANIMALS: 15 client-owned dogs. PROCEDURE: All dogs had clinical signs of chronic nasal disease; the diagnosis of nasal aspergillosis was made on the basis of positive results for at least 2 diagnostic tests (serology, cytology, histology, or fungal culture) and detection of typical intrasinusal and intranasal fungal colonies and turbinate destruction via rhinoscopy. Radiography, MRI, and CT were performed under general anesthesia. Rhinoscopy was repeated to evaluate lesions and initiate treatment. Findings of radiography, MRI, CT, and rhinoscopy were compared. RESULTS: MRI and CT revealed lesions suggestive of nasal aspergillosis more frequently than did radiography. Computed tomography was the best technique for detection of cortical bone lesions; the nature of abnormal soft tissue, however, could not be identified. Magnetic resonance imaging allowed evaluation of lesions of the frontal bone and was especially useful for differentiating between a thickened mucosa and secretions or fungal colonies; however, fungal colonies could not be differentiated from secretions. Rhinoscopy allowed identification of the nature of intranasal and intrasinusal soft tissue but was not as useful as CT and MRI for defining the extent of lesions and provided no information regarding bone lesions. CONCLUSIONS AND CLINICAL RELEVANCE: The value of CT and MRI for diagnosis of nasal aspergillosis was similar and greater than that of radiography. Rhinoscopy is necessary because it is the only technique that allows direct visualization of fungal colonies.     

Treatment of Canine Nasal Aspergillosis with Enilconazole

Twenty-four dogs with nasal aspergillosis were treated with enilconazole (10 mg/kg bid for 7–14 days) administered topically through tubes surgically implanted into the nasal chambers. Aspergillosis was eliminated in 19 dogs over a median follow-up period of 18 months. Another dog died, but at necropsy there was no evidence of causative fungus. Two of the four dogs that were not cured had infection of periorbital soft tissues. An additional seven dogs received 6 weeks ketoconazole (5 mg/kg bid PO) and enilconazole therapy topically. Six of these dogs were disease-free over a median follow-up period of 35 months. The seventh dog responded to repeated treatment with enilconazole. Twenty-six of the 29 dogs (90%)without extranasal aspergillosis were cured.     

Distribution of Topical Agents in the Frontal Sinuses and Nasal Cavity of Dogs: Comparison Between Current Protocols for Treatment of Nasal Aspergillosis and a New Noninvasive Technique

To document and compare patterns of distribution of topically applied antifungal medication, heads from 42 canine cadavers were assigned to seven treatment groups which included two current surgical treatment protocols for nasal aspergillosis, and a new, noninvasive method. Catheters (8 Fr) were placed through trephine holes into the frontal sinuses and nasal cavity. Dilute dye was injected through the catheters and the heads were sectioned sagittally. The administration of 5 mL of dye into the lateral frontal sinus and nasal cavity (group IA, 10 mL total) was compared with 25 mL injected through catheters placed bilaterally in the lateral frontal sinus and nasal cavity (group II, 100 mL total). Both were compared with the administration of 50 mL of dye through a catheter placed in the dorsal nasal meatus via each nostril (group III). The heads in group III had significantly ( P <.05) better dye distribution to all cavities than group IA and better distribution to the rostral frontal sinus than group II. Groups IV to VI were designed to show the pattern of distribution of dye to the contralateral nasal cavity and frontal sinuses. In all groups, dye injected into the lateral frontal sinus did not cross into the ipsilateral rostral frontal sinus or vice versa unless the transverse septum dividing the compartments had been penetrated during trephination.     

COMPARISON OF RADIOGRAPHY AND COMPUTED TOMOGRAPHY FOR THE DIAGNOSIS OF CANINE NASAL ASPERGILLOSIS

To compare the radiographic and computed tomographic (CT) findings and to evaluate the sensitivity of radiography and CT for diagnosis of nasal aspergillosis in dogs, the radiographic and CT studies of 48 dogs with chronic nasal disease were reviewed separately. The radiographic and CT findings were recorded, and a diagnosis was made. The results obtained in the dogs with nasal aspergillosis (n = 25) were used. Based on definite aspergillosis as diagnosis, CT had a sensitivity of 88% and radiography of 72%. Considering definite and probable aspergillosis as equivalent, CT had a sensitivity of 92% and radiography of 84%. The sensitivity was higher in dogs with lesions affecting the entire nasal cavity and frontal sinus on at least one side (n = 20) with a sensitivity of 100% for CT and 90-95% for radiography than in dogs with lesions restricted to the nasal cavities (n = 5) where CT had a sensitivity of 60-80% and radiography of 0-40%. CT was superior to radiography for evaluation of the nasal cavities (mucosal thickening along the nasal bones, surrounding bone hyperostosis/lysis), frontal sinuses (mucosal thickening along the frontal bone, fluid/soft tissue, frontal bone hyperostosis/lysis), and differentiation between a cavitated-like or a mass-like process. This study suggests that CT is more sensitive than radiography for diagnosis of nasal aspergillosis in the dog because of a better demonstration of some changes suggestive of nasal aspergillosis. A diagnosis of a nasal aspergillosis restricted to the nasal cavities or associated with an FB is challenging, even with the use of CT.     

Comparison of serologic evaluation via agar gel immunodiffusion and fungal culture of tissue for diagnosis of nasal aspergillosis in dogs

OBJECTIVE: To compare the sensitivity and specificity of serologic evaluation and fungal culture of tissue for diagnosis of nasal aspergillosis in dogs. DESIGN: Prospective study. ANIMALS: 58 dogs with nasal discharge and 26 healthy dogs. PROCEDURES: Dogs with nasal discharge were anesthetized and underwent computed tomography and rhinoscopy; nasal tissues were collected for histologic examination and fungal culture. Sera were assessed for antibodies against Aspergillus spp (healthy dog sera were used as negative control specimens). Nasal aspergillosis was diagnosed in dogs that had at least 2 of the following findings: computed tomographic characteristics consistent with aspergillosis, fungal plaques detected during rhinoscopy, and histologically detectable fungal hyphae in nasal tissue. Histologic characteristics of malignancy were diagnostic for neoplasia. Without evidence of neoplasia or fungal disease, nonfungal rhinitis was diagnosed. RESULTS: Among the 58 dogs, 21 had nasal aspergillosis, 25 had nonfungal rhinitis, and 12 had nasal neoplasia. Fourteen aspergillosis-affected dogs and 1 dog with nonfungal rhinitis had serum antibodies against Aspergillus spp. Fungal culture results were positive for Aspergillus spp only for 17 dogs with aspergillosis. With regard to aspergillosis diagnosis, sensitivity, specificity, and positive and negative predictive values were 67%, 98%, 93%, and 84%, respectively, for serum anti-Aspergillus antibody determination and 81%, 100%, 100%, and 90%, respectively, for fungal culture. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that seropositivity for Aspergillus spp and identification of Aspergillus spp in cultures of nasal tissue are highly suggestive of nasal aspergillosis in dogs; however, negative test results do not rule out nasal aspergillosis.     

Correlation of rhinoscopic signs of inflammation with histologic findings in nasal biopsy specimens of cats with or without upper respiratory tract disease

OBJECTIVE: To investigate the correlation of cumulative rhinoscopic findings of hyperemia, mucus accumulation, and turbinate destruction with the type and severity of inflammatory infiltrates in nasal biopsy specimens of cats with or without upper respiratory tract disease. DESIGN: Prospective study. ANIMALS: Cats with (n = 11) and without (6) upper respiratory tract disease and cats with unknown medical histories (27). PROCEDURES; Lesions of hyperemia, mucus accumulation, and turbinate destruction detected rhinoscopically were each scored (scale, 0 [absent] to 3 [severe]), and a cumulative rhinoscopic score for each nasal cavity was calculated. Fifty biopsy specimens were examined histologically, and inflammatory infiltrates (lymphoplasmacytic or neutrophilic) were graded as absent, mild, moderate, or severe. Cumulative rhinoscopic scores and inflammation grades were compared for each specimen-cavity combination. RESULTS: In cats of known disease status, there was a positive but weak correlation between cumulative rhinoscopic scores and inflammation grades in biopsy specimens. In cats of unknown disease status, there was no similar correlation. Biopsy specimens with minimal inflammation were commonly obtained from nasal cavities with low rhinoscopic scores; specimens with moderate or severe inflammatory changes were frequently obtained from cavities that appeared normal rhinoscopically. Type of inflammatory infiltrates was not correlated with rhinoscopic signs of inflammation. CONCLUSIONS AND CLINICAL RELEVANCE: The correlation of rhinoscopic findings with inflammation severity in nasal biopsy specimens (determined histologically) was weak or lacking in cats of known and unknown disease status, respectively. Results indicated that rhinoscopy with biopsy provides more complete evaluation of nasal disease than rhinoscopy alone in cats.     

Evaluation of rhinoscopy and rhinoscopy-assisted mucosal biopsy in diagnosis of nasal disease in dogs: 119 cases (1985-1989).

The case records of 149 dogs examined from 1985 to 1989 with clinical signs of nasal disease were reviewed. Gross rhinoscopy was performed in 119 dogs, and rhinoscopy-assisted pinch biopsy was performed in 109. Rhinoscopy was performed by use of a 2.7-mm rigid fiberoptic endoscope. Mucosal biopsy specimens were obtained with rhinoscopic guidance by use of a 2 x 3-mm biopsy forcep. Gross, cytologic, and histologic findings are summarized. Ninety-four of 119 cases could be evaluated on the basis of diagnostic and follow-up criteria established by the authors. The diagnostic success rate of gross rhinoscopy with rhinoscopy-assisted biopsy was 83% (78 of 94 evaluated cases). Protracted hemorrhage was a complication in 2 of 109 cases in which rhinoscopy-assisted biopsy was performed. It was concluded that rhinoscopy with rhinoscopy-assisted biopsy contributes important diagnostic information in dogs with nasal disease without the relative invasiveness, expense, and risk of surgery.     

Computed tomography or rhinoscopy as the first-line procedure for suspected nasal tumor: A pilot study

There are no evidence-based guidelines as to whether computed tomography (CT) or endoscopy should be selected as the first-line procedure when a nasal tumor is suspected in a dog or a cat and only one examination can be performed. Computed tomography and rhinoscopic features of 17 dogs and 5 cats with a histopathologically or cytologically confirmed nasal tumor were retrospectively reviewed. The level of suspicion for nasal neoplasia after CT and/or rhinoscopy was compared to the definitive diagnosis. Twelve animals underwent CT, 14 underwent rhinoscopy, and 4 both examinations. Of the 12 CT examinations performed, 11 (92%) resulted in the conclusion that a nasal tumor was the most likely diagnosis compared with 9/14 (64%) for rhinoscopies. Computed tomography appeared to be more reliable than rhinoscopy for detecting nasal tumors and should therefore be considered as the first-line procedure.     

Open Nasal Cavity and Frontal Sinus Treatment of Chronic Canine Aspergillosis

Five dogs with nasal aspergillosis were treated by surgical exposure and delayed closure of the nasal cavity and involved frontal sinus. Diseased tissue was excised, and 10% povidone-iodine solution was applied three times daily with cotton-tipped applicators. Skin wounds were closed at weeks 6 through 8. In one dog, the frontal sinus was partially obliterated with a temporalis muscle flap before skin closure. At months 6 through 34, all dogs were clinically free of aspergillosis. Open treatment has potential clinical application as a primary approach to nasal aspergillosis or for cases that are unresponsive to previous medical management.     

Long-term outcomes in dogs with sinonasal aspergillosis treated with intranasal infusions of enilconazole

Long-term outcomes (mean 38+/-17 months) were evaluated in 27 dogs with sinonasal aspergillosis after successful medical treatment using intranasal infusions of 1% or 2% enilconazole (1%, n=15; 2%, n=12). Long-term outcomes with both treatment protocols were good, with half of the dogs being asymptomatic throughout the follow-up period. The remaining dogs showed mild clinical signs compatible with chronic rhinitis/sinusitis. These clinical signs were interpreted as chronic lymphoplasmacytic rhinitis/sinusitis and episodes of bacterial rather than fungal infection. Three dogs had confirmed reinfection or relapse 2 to 36 months after clinical resolution.     

Frontal sinus depth at four landmarks in breeds of dog typically affected by sinonasal aspergillosis

The objective of this study was to assess whether the frontal sinuses in dogs with aspergillosis and of breeds typically affected by this condition were deeper at a more caudal location. CT scans of the head performed at the Small Animal Teaching Hospital, University of Liverpool, between April 2007 and March 2009 for dogs diagnosed with aspergillosis (group 1) and unaffected dogs of similar breeds (group 2) were selected for study. Sinus depth was measured at four standardised locations from reconstructed images of these CT scans. Data were compared for differences in sinus depth between groups and between landmarks. No significant difference was found between measurements within individual dogs or for each of the various landmarks between groups. Difference in depth of the sinuses between landmarks was significant (P<0.001). Sinus depth was significantly greater at the more caudal landmarks and was shallowest at the previously recommended landmark for sinus entry. In 54 per cent of dogs, the frontal sinus depth measured less than or equal to 2 cm at one or more of the landmarks. Sinus entry at the deepest point will reduce the risk of accidentally damaging underlying structures. This may be approximately 1 cm caudal, in breeds of dog that typically develop aspergillosis, to a previously suggested landmark.