Evaluation of topically applied enilconazole for the treatment of dermatophytosis in a Persian cattery

Many Persian catteries have long-standing dermatophyte infections and are particularly difficult to treat. Enilconazole is a topical antifungal agent that has demonstrated good efficacy in recent studies. Twenty-two Persian cats naturally infected with Microsporum canis in a breeding cattery were treated with topical 0.2% enilconazole and monitored for 180 days. The treatments were repeated every 3 days for a total of eight applications. All the cats improved clinically and became culture negative by day 28. By day 180, four cats had developed clinical dermatophytosis and all cats had positive fungal cultures. In this study, topical 0.2% enilconazole was generally well tolerated but may have caused hypersalivation, idiopathic muscle weakness and slightly elevated serum alanine aminotransferase (ALT) concentrations. This study suggests that enilconazole may be used safely with little risk to the young, aged and gravid animals.     

Efficacy of itraconazole as a combined continuous/pulse therapy in feline dermatophytosis: preliminary results in nine cases

This study evaluated the efficacy of itraconazole as a combined continuous/pulse therapy for feline dermatophytosis. Nine cats with dermatophytosis caused by Microsporum canis were treated with itraconazole at 10 mg kg(-1) orally once daily for 28 days and then on an alternate week regimen (1 week off, 1 week on) at the same dosage. Cats were re-evaluated by physical examination and fungal culture at days 28, 42, 56 and 70 if necessary. Treatment was stopped when two consecutive negative fungal cultures were obtained. Eight cats were cured after 56 days, with two negative cultures obtained at days 28 and 42. In one case, a positive culture was obtained at day 28, but negative cultures were achieved at days 42 and 56. This protocol appears to be effective in the treatment of feline dermatophytosis, although these preliminary results should be confirmed by a controlled study.     

P-15 Identification of Malassezia spp. isolated from a cat and cattle, including a new species, M. nana

Preliminary studies showed that lufenuron inhibits chitin synthesis, a dermatophyte cell wall constituent, and may be effective in the treatment of dermatophytosis. Our purpose was to evaluate the efficacy of lufenuron in the treatment of feline dermatophytosis. Forty-six cats (Persians and mixed-breed cats from 1-month to 4-years old) naturally infected with Microsporum canis were included in this study. Fifteen cats were treated isolated in cages in the veterinary hospital and 31 were treated in their home environment (some with access to the outdoors). Dermatophyte skin lesions were seen in 29 animals while 17 other cats were asymptomatic carriers. Wood's lamp, direct microscopic examination of hairs, fungal culture and skin biopsies were used for the diagnosis. Affected cats and all in-contact animals received lufenuron at a dose of 120 mg/kg every 21 days for four treatments. Of the 29 symptomatic cats treated with lufenuron, 70% recovered within 21 days and 28% within 42 days of initiation of therapy. One cat had only partial recovery and another was euthanized. Negative fungal culture was recorded only after the fourth dose of lufenuron in 98% of affected cats and 100% of asymptomatic carriers. There was no difference in clinical response to lufenuron between the cats treated in their home environment and those treated in the veterinary hospital. Side effects were not observed, thus the drug proved to be safe and effective for the treatment of dermatophytosis.
Funding: Novartis.     

Use of lime sulphur and itraconazole to treat shelter cats naturally infected with Microsporum canis in an annex facility: an open field trial

Dermatophytosis is the most common contagious and infectious skin disease of cats. It is of particular importance in animal shelters because it is a known zoonosis, highly contagious, and easily transmitted. In this open clinical trial, 58 cats with confirmed Microsporum canis dermatophytosis and 32 uninfected bonded pairs or littermates were treated with a combination of 21 days of oral itraconazole (10 mg kg(-1)) and twice weekly lime sulphur rinses until cured. Cats were not clipped in this treatment programme. Fungal cultures were obtained once weekly on all cats, and cats were considered cured when they had two consecutive negative weekly fungal cultures. Cats were held in the facility and received continued topical treatment until the fungal cultures were finalized. None of the cats developed oral ulcerations as a result of grooming the lime sulphur rinses. Oral ulcerations only developed in cats with clinical signs associated with upper respiratory disease. None of the uninfected cats living in contact with infected cats became culture positive or developed skin lesions. When data were examined retrospectively and the number of days to finalize the cultures was subtracted (21 days) from the total number of days the cats were housed in the annex, the mean number of days of treatment required for cure was 18.4 +/- 9.5 SEM (range 10-49 days). Cats with more severe infections required longer therapy. In this shelter, the combination of oral itraconazole and topical lime sulphur rinses for the treatment of dermatophytosis was effective and safe.     

Use of itraconazole and either lime sulphur or Malaseb Concentrate Rinse® to treat shelter cats naturally infected with Microsporum canis: an open field trial

In an open non‐randomized study, 90 cats with severe dermatophytosis were treated with 21 days of oral itraconazole at 10 mg/kg and one of three topical antifungal rinses applied twice weekly: lime sulphur (LSO); reformulated lime sulphur with an odour‐masking agent (LSR); or a 0.2% miconazole nitrate and 0.2% chlorhexidine gluconate rinse (MC). Weekly examinations and fungal cultures were used to monitor the cats’ response to therapy. If at day 42 of treatment cats were still strongly fungal culture positive and/or developing new lesions, they were retreated with oral itraconazole and LSO. Cats were not prevented from licking the solutions and none developed oral ulcerations. Thirty‐one cats were treated with LSO, 27 with LSR and 32 with MC. The median number of days to cure was 30 (range 10–69 days) and 34 (range 23–80 days) for LSO and LSR, respectively. Thirty‐two cats were treated with MC, and 13 of 32 cats required repeat treatment because of persistent culture‐positive status and development of new lesions. Median number of days of treatment for the 19 cats that cured with MC was 48 (range 14–93 days). When the number of days to cure was compared between the groups, there was a significant difference between cats treated with LSO and LSR (P = 0.029) and cats treated with LSO and MC (P = 0.031), but no significant difference between the number of days to cure for cats treated with LSR and MC (P = 0.91).     

Use of lufenuron for treating fungal infections of dogs and cats: 297 cases (1997-1999)

OBJECTIVE: To evaluate use of lufenuron for treating cutaneous fungal infections in dogs and cats. DESIGN: Retrospective study. ANIMALS: 156 dogs and 201 cats with dermatophytosis or superficial dermatomycoses. PROCEDURE: Medical records were reviewed for dogs and cats that had been treated for dermatophytosis or other fungal infections by administration of lufenuron and 18 dogs and 42 cats that were not treated and served as a control group. RESULTS: Dogs were treated once by oral administration of lufenuron tablets at doses ranging from 54.2 to 68.3 mg/kg (24.6 to 31.0 mg/lb) of body weight. Samples of skin, scrapings, and hair were obtained daily from 14 dogs with dermatophytosis; mean durations from time of treatment to time of negative fungal culture results and resolution of gross lesions were 14.5 and 20.75 days, respectively. In all treated dogs, gross lesions resolved within approximately 21 days. Cats were treated once by oral administration of lufenuron suspension in doses ranging from 51.2 to 266 mg/kg (23.3 to 120.9 mg/lb). Samples were obtained daily from 23 cats; mean durations from time of treatment to time of negative fungal culture results and resolution of gross lesions were 8.3 and 12 days, respectively. Time to resolution of lesions in most untreated control animals was approximately 90 days. Adverse effects of treatment were not detected. CONCLUSIONS AND CLINICAL RELEVANCE: Results of this study suggest that lufenuron provides an effective, convenient, and rapid method for treating fungal infections in dogs and cats.     

P‐13 Dermatophytosis in domestic cats: treatment with lufenuron

Preliminary studies showed that lufenuron inhibits chitin synthesis, a dermatophyte cell wall constituent, and may be effective in the treatment of dermatophytosis. Our purpose was to evaluate the efficacy of lufenuron in the treatment of feline dermatophytosis. Forty‐six cats (Persians and mixed‐breed cats from 1‐month to 4‐years old) naturally infected with Microsporumcanis were included in this study. Fifteen cats were treated isolated in cages in the veterinary hospital and 31 were treated in their home environment (some with access to the outdoors). Dermatophyte skin lesions were seen in 29 animals while 17 other cats were asymptomatic carriers. Wood's lamp, direct microscopic examination of hairs, fungal culture and skin biopsies were used for the diagnosis. Affected cats and all in‐contact animals received lufenuron at a dose of 120 mg/kg every 21 days for four treatments. Of the 29 symptomatic cats treated with lufenuron, 70% recovered within 21 days and 28% within 42 days of initiation of therapy. One cat had only partial recovery and another was euthanized. Negative fungal culture was recorded only after the fourth dose of lufenuron in 98% of affected cats and 100% of asymptomatic carriers. There was no difference in clinical response to lufenuron between the cats treated in their home environment and those treated in the veterinary hospital. Side effects were not observed, thus the drug proved to be safe and effective for the treatment of dermatophytosis. Funding: Novartis.     

Incidence, immunity and treatment of feline dermatophytosis

Feline dermatophytosis is a superficial skin infection characterized by the invasion of cornified tissues such as hair and nails.This infection is nearly always caused by Microsporum canis. Infected animals release infective spores in the environment which will then contaminate other animals or humans. Infected animals usually develop immunity so the infection will spontaneously disappear after a few weeks to months. Long haired and immunocom-promised cats do not have the same ability to acquire resistance and spontaneous recovery does usually not occur. The treatment of such an infection will require topical and systemic treatment of all contaminated and in-contact cats. The use of desinfectants such as bleach or enilconazole has been proven effective to destroy the spores in the environment. In addition, the efficacy of topical and systemic treatments with azole derivates or allylamines has also been demonstrated in several studies. On the contrary, dermatophyte vaccination has never been proven effective in well controlled studies. Regular follow-up and fungal cultures are mandatory to ensure succesfull treatment.     

Evaluation of the efficacy of oral lufenuron combined with topical enilconazole for the management of dermatophytosis in catteries

The efficacy of oral lufenuron, a chitin synthetase inhibitor, combined with topical enilconazole, was evaluated for the management of Microsporum canis infection in 100 cats housed in two catteries in France. The cats were treated with weekly rinses with enilconazole (0.2 per cent) for four weeks and, in each cattery, one group (A) was also treated with micronised griseofulvin (25 mg/kg administered orally twice a day for five weeks) and a second group (B) was treated with 60 mg/kg lufenuron administered orally once on day 0 and again after 30 days. All the cats were examined individually for cutaneous lesions and mycological cultures were made when the treatment began and after 15, 30, 60 and 90 days. In the first cattery, the cats' clinical scores after 30 and 60 days were significantly lower in group B than in group A. In both catteries and both treatment groups, the mean number of fungal colonies decreased rapidly during the first 15 days of treatment, remained stable for the following 45 days but increased from day 60 to the end of the experiment on day 90.     

Efficacy of pre-treatment with lufenuron for the prevention of Microsporum canis infection in a feline direct topical challenge model

Oral lufenuron is reportedly an effective treatment for some cats with dermatophytosis. The purpose of this study was to determine if lufenuron, when used as a pre-treatment prior to challenge exposure, would be protective against the development of infection after the direct topical application of fungal macrocondia (Microsporum canis spores). Three groups (n = 6/group) of juvenile cats were treated with either monthly oral lufenuron (30 or 133 mg/kg) or placebo. After 2 months of treatment, kittens were challenged using 10(5)Microsporum canis spores applied to the skin under occlusion. Cats were examined weekly and the following data collected: Wood's lamp examination; scoring for scale/crust, erythema and induration; lesion size; and the development of satellite lesions. Fungal cultures were performed bi-weekly. All cats became infected; the infections progressed, and then regressed, in a similar fashion in all groups. There were no consistent statistically significant differences in weekly infection scores between treated and untreated cats throughout the study. Treated cats did not recover faster than untreated cats. We conclude that oral lufenuron at the dosing schedule and conditions used in this study did not prevent dermatophytosis or alter the course of infection by direct topical challenge.     

A lufenuron pre-treatment may enhance the effects of enilconazole or griseofulvin in feline dermatophytosis?

The effectiveness of enilconazole (4 weekly rinses with a 0.2% solution) or griseofulvin (50mg/kg twice daily for 40 days) following a pre-treatment with oral lufenuron (100mg/kg by-weekly for 8 weeks) was tested on 25 (11+14) Microsporum canis infected cats. Control animals were treated with lufenuron, griseofulvin and enilconazole alone. At day 150 pre-treated animals were culturally negative and clinically cured. While lufenuron alone was found to be ineffective against M canis infection, an immunomodulatory effect of the drug can be suggested, as reported in literature. Its use could be reserved to long-lasting infections, unsuccessfully treated with conventional drugs. Further studies are required to clearly establish the possible adjuvant effect of this molecule when used prior to enilconazole or griseofulvin.     

Dermatophytes from skin lesions of domestic animals in Nsukka,Enugu State,Nigeria

Background – Dermatophytes are well‐recognized cutaneous fungi with public health implications. In Nigeria, several studies have been carried out on dermatophytosis in humans; however, data on dermatophytes in animals are lacking. Objectives – This study was conducted to determine the occurrence and species of dermatophytes in skin lesions in domestic animals in Nsukka Agricultural Zone of Enugu State, Nigeria. Animals – Forty‐six domestic animals (dogs, goats, sheep and pigs) presented for sale in the local markets in the study area and with suspected lesions of dermatophytosis were used for the study. Methods – Plucked hairs and epidermal scales from the skin lesions of affected animals were inoculated on Sabouraud dextrose agar slants containing 0.05 mg/mL of chloramphenicol and 0.5 mg/mL of cycloheximide. Inoculated slants were incubated at room temperature (27°C) for up to 4 weeks and examined at 2–3 day intervals for fungal growth. Laboratory identification of the fungal isolates was based on their colonial, microscopic and biochemical characteristics. Results – Of the 46 animals with suspected lesions of dermatophytosis, six (13.0%) were positive for a dermatophyte, and the following dermatophytes were identified: Microsporum gypseum, two of 12 sheep; Microsporum audouinii, one of 16 dogs; Trichophyton mentagrophytes, one of 16 dogs and one of 12 sheep; and Trichophyton schoenleinii, one of 13 goats. Conclusions and clinical importance – Anthropophilic dermatophytes are among the fungal agents associated with dermatophytosis in animals in Nsukka Agricultural Zone. These dermatophytes could constitute health risks to humans in contact with the animals.     

In vitro and in vivo Effects of Lufenuron on Dermatophytes Isolated from Cases of Canine and Feline Dermatophytoses*

Lufenuron is a benzyl‐urea phenol compound that inhibits chitin synthesis and is used as an insecticide. Its efficacy in the therapy of dermatophytosis in dogs and cats was evaluated in several clinical studies, with contradictory results. We assessed the in vitro susceptibility of dermatophytes isolated from dogs and cats to lufenuron, and the clinical response of skin lesions to the drug. Dermatophyte cultures isolated from clinical cases were exposed to lufenuron by three different methods: direct application and application of whole blood or subcutaneous tissue samples obtained from a lufenuron‐treated healthy dog. No inhibition of dermatophyte growth was observed in any of the samples after 1 week of incubation. Eight dogs and six cats with skin lesions were included in the in vivo survey. Results indicated that six of seven skin lesions that were diagnosed as being caused by dermatophytes did not respond to lufenuron whereas six of seven skin lesions that were not caused by dermatophytes improved. We concluded that lufenuron, in the way it was administered in this study, had no inhibitory activity on dermatophytes in vitro or in vivo and its clinical use as an anti‐fungal agent is questionable. An immunomodulatory effect of the drug is, however, possible.     

Intranasal infusion of enilconazole for treatment of sinonasal aspergillosis in dogs

OBJECTIVE: To determine effectiveness of infusion of 1 and 2% enilconazole for treatment of nasal and sinusal aspergillosis, respectively, in dogs. DESIGN: Case series. ANIMALS: 26 client-owned dogs with aspergillosis. PROCEDURE: All dogs had typical clinical signs of aspergillosis and rhinoscopically visible intrasinusal or intranasal fungal plaques associated with turbinate destruction. During rhinoscopy, affected nasal cavities and frontal sinuses were debrided meticulously. Nineteen dogs (group A) were treated with 1% enilconazole by use of a modified noninvasive infusion procedure. Seven dogs (group B) were treated with 2% enilconazole via catheters that were placed via endoscopic guidance into the frontal sinuses. All dogs underwent follow-up rhinoscopy for determination of further treatment until cure was established. RESULTS: Age, disease duration, clinical score, and rhinoscopic score were similar for both groups before treatment. In group A, 17 of 19 dogs were cured; 9, 6, and 2 dogs were cured after 1, 2, or 3 treatments, respectively. The remaining 2 dogs were euthanatized before the end of the treatment protocol. In group B, all dogs were cured; 6 dogs and 1 dog were cured after 1 or 2 treatments, respectively. Only minor adverse effects such as nasal discharge, epistaxis, and sneezing developed. CONCLUSIONS AND CLINICAL RELEVANCE: After extensive rhinoscopic debridement, 1 and 2% enilconazole infused into the nasal cavities and the frontal sinuses, respectively, were effective for treatment of aspergillosis in dogs. Intrasinusal administration via endoscopically placed catheters appeared to require fewer infusions for success. Follow-up rhinoscopy is strongly advised.     

Drug Efficacy of Terbinafine Hydrochloride (Lamisil®) During Oral Treatment of Cats,Experimentally Infected with Microsporum canis

Cats represent a primary source of Microsporum canis infections in humans. Terbinafine hydrochloride (Lamisil^®) is commonly used in the treatment of microsporosis in humans as its fungicidal action permits short periods of treatment. The aim of the present study was to estimate the efficacy of the drug in cats. Nine cats were experimentally infected with M. canis and treated with terbinafine hydrochloride at a dose of 10–20 mg/kg (once daily, SID; low‐dose group, LDG). Another nine cats were similarly infected and treated with 30–40 mg/kg SID (high‐dose group, HDG) and a further nine cats were also infected and left untreated (control group, CG). The general condition of the cats was observed daily and their clinical symptoms evaluated weekly. The cats recovery was monitored using the Wood's lamp illumination test and microscopic and fungal culture examinations. The general condition of the cats during the study was good. The cure rates of the LDG were not significantly different from the CG at any period during the treatment. However, the HDG cure rates differed significantly from the other two groups. After 109 days of treatment, when all nine cats of the HDG were healed, seven cats of the LDG and all the cats in the CG were still M. canis‐positive. This study shows that dosages of 10–20 mg/kg SID of terbinafine hydrochloride are not sufficient to terminate an experimental M. canis infection in cats within an acceptable period of time. Terbinafine hydrochloride can be used to treat dermatophytosis in cats, but a higher dosage, 30–40 mg/kg SID, should be used to achieve a cure.     

Dermatophytosis and papular eosinophilic/mastocytic dermatitis (urticaria pigmentosa-like dermatitis) in three Devon Rex cats

PRESENTING SIGNS: Three Devon Rex cats were presented with multiple erythematous papules, occasionally associated with crusting and hyperpigmentation, with a linear distribution on the head, neck, chest and abdomen. One cat also had multifocal alopecia with hyperpigmentation on the dorsum. DIAGNOSIS AND TREATMENT: Clinical and histopathological features were suggestive of papular eosinophilic/mastocytic dermatitis (urticaria pigmentosa-like dermatitis). In all cases, dermatophytosis was diagnosed: in cases 1 and 2 there was histopathological evidence of dermatophytosis, while fungal culture was positive for Microsporum canis in cases 2 and 3. In all cats, lesions disappeared following antifungal treatment. CLINICAL SIGNIFICANCE: Papular eosinophilic/mastocytic dermatitis in Devon Rex cats may represent either an atypical presentation of dermatophytosis or a clinical and histological reaction pattern to various diseases, including dermatophytosis and allergic diseases. Clinical differentiation is crucial as there are important implications regarding treatment and, in particular, the use of glucocorticoids, which are contraindicated in cases of dermatophytosis.     

Treatment of dermatophytosis in dogs and cats: review of published studies

The recent literature on the treatment of dermatophytosis in dogs and cats was reviewed. Based upon in vitro studies using isolated infected hairs and controlled or field in vivo studies, the following topical treatments were consistently found to be antifungal (i.e. antidermatophyte): lime sulfur (1:16), 0.2% enilconazole rinses, and a combined 2% miconazole/chlorhexidine shampoo. Animals or hairs were either bathed or rinsed once or twice weekly. Itraconazole, griseofulvin and terbinafine were evaluated in controlled or field studies, most commonly involving cats. Griseofulvin (50 mg kg(-1)) was reported to cure infected animals in 41-70 days. Itraconazole (10 mg kg(-1) once daily or in a combined daily/pulse therapy 10 mg kg(-1) once daily for 28 days and then week on/week off) was reported to cure infected animals in 56-70 days. Low-dose itraconazole (1.5-3.0 mg kg(-1)) in 15-day cycles required 1-3 cycles (15-45 days). Various doses of terbinafine (5-40 mg kg(-1)) were reportedly used to treat dogs or cats. The higher doses of terbinafine (> 20 mg kg(-1)) were required to achieve a mycological cure; the number of treatment days to cure varied from 21 to > 126 days. Lufenuron was reported anecdotally to be an effective cure, however, this was not substantiated in controlled studies. Finally, fungal vaccines were not found to be effective against challenge exposure, however, there is evidence that they may be useful in treatment protocols.     

Isolation of fungal flora from the hair coats of shelter cats in the Pacific coastal USA

Two-hundred shelter cats from the Pacific western coastal USA were sampled in four different geographical regions to determine the fungal organisms most commonly found on the hair coat and the prevalence of these organisms. Data on the cats' health, age, hair coat length, gender, and geographical location were collected and analysed. The overall prevalence of dermatophytosis was 5.5% (11 of 200 cats), with Microsporum canis isolated in 90.9% (10 of 11) of the samples from positive cats. This was a lower isolation rate or prevalence of dermatophytes than previous studies conducted on shelter cats in other regions of the USA. Ten of 11 of the cats were lesion free (either subclinical infection or mechanical carriage). Cats in the Los Angeles, California area ( P  = 0.001) and neutered male cats ( P  = 0.047) had a higher prevalence of a positive dermatophyte culture. The numbers and types of saprophytes isolated from cats in this study were found to be consistent with previous feline reports in the USA and with an equine study previously conducted in this area.     

Dermatophytosis in red pandas (Ailurus fulgens fulgens): a review of 14 cases.

Fourteen cases of dermatophytosis were identified from medical records of red pandas (Ailurus fulgens fulgens) housed at the Knoxville Zoo between 1980 and 1996. The median age of affected animals on initial presentation was 8.5 wk (3 wk-11 mo). Clinical signs included crusting, purulent exudate, alopecia, thickening of affected skin, ulceration, and necrosis. Seven animals had mild lesions with signs restricted to crusting and/or alopecia, and six animals had more severe infections, with ulceration, skin necrosis, and purulent exudate. Five of the severely affected pandas had tail involvement. The severity of disease affecting one individual was not recorded. Dermatophytosis was confirmed by culture, cytology, histopathology, or culture followed by histopathology. Microsporum gypseum was the only fungal organism cultured. Six animals were treated for mild disease, and all clinical signs resolved. Partial tail amputation was required as part of the treatment regimen for two of the six severely affected animals, and two others had ulcerated tail lesions that left circumferential scarring after resolution of infection. Itraconazole (5 mg/kg p.o. q 12-24 hr) was the most frequently used systemic antifungal agent in animals with severe lesions. All fungal infections resolved, although one panda died from unrelated causes early in the treatment period.     

Dermatophytosis due to Microsporum persicolor: a retrospective study of 16 cases

A retrospective study of 16 cases of dermatophytosis due to Microsporum persicolor in dogs is reported. Hunting dogs were overrepresented (12/16). Skin lesions were observed on the face in all cases, but also on other locations (limbs, neck). The lesions included alopecia (15/16), erythema (13/16), scales (14/16), and crusts (13/16). Histopathology was performed in 10 cases and showed folliculitis and a lichenoid interface dermatitis. Fungal culture was positive in all cases and clinical resolution was achieved with standard antifungal agents (enilconazole, ketoconazole, griseofulvin). Two recurrences were observed (new contacts with rodents).