Nasal infection with Scedosporium apiospermum in a dog

CASE HISTORY: A 2-year-old female Siberian Husky was presented with a 6-month history of sneezing and mucous discharge from the right nostril. CLINICAL FINDINGS: Reduced airflow through the right nostril was evident. Radiographs showed subtle loss of detail of turbinates within the right nasal chamber. Rhinoscopy revealed swollen and erythematous turbinates and a white mass within the caudal aspect of the right nasal cavity. Histopathologically, there was a heavy mixed inflammatory infiltrate in the submuscosa of the right turbinate, and the presence of fungal hyphae and spores in the white mass. A heavy growth of Scedosporium apiospermum was cultured from the mass. DIAGNOSIS: Chronic rhinitis of the right nasal cavity and infection with S. apiospermum. CLINICAL RELEVANCE: This is the first reported case of S. apiospermum isolated from the nasal cavity of a dog in New Zealand. Fungal culture is necessary to differentiate this fungus from Aspergillus spp.     

Computed Tomographic Assessment of Noninvasive Intranasal Infusions in Dogs With Fungal Rhinitis

The distribution of infusate administered to 12 dogs with fungal rhinitis, using a noninvasive, intranasal technique, was evaluated by computed tomography (CT). In every dog, contrast medium was identified on the postinfusion CT images, within the frontal sinuses, and throughout all areas of the nasal cavity. Adverse effects were transient and mild. The results of this study indicate that intranasal infusion may be a viable alternative to trephination of the frontal sinuses to administer antifungal medications in dogs with fungal rhinitis.     

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.     

Sinonasal plasmacytoma in a cat.

A 13-year-old female spayed Domestic Shorthair cat presented with a history of right-sided mucopurulent nasal discharge for 18 months. Computed tomography revealed a mass within the right nasal cavity and the right frontal sinus. The animal was euthanized, and a postmortem examination was performed. On macroscopic examination, the right nasal cavity and the right frontal sinus were partially occluded by a soft whitish mass. Microscopically, the mass was composed of well-differentiated plasma cells that were immunopositive for immunoglobulin G and lambda light chains. These findings were consistent with a mature-type sinonasal plasmacytoma. In addition, there was right-sided mucopurulent rhinitis and sinusitis caused by a Pasteurella infection, which probably developed secondary to the sinonasal plasmacytoma. To the authors' knowledge, this is the first report of a sinonasal plasmacytoma in a cat. The present communication shows that feline sinonasal plasmacytomas should be included in the differential diagnosis for tumors located in the upper respiratory tract of cats.     

ACUTE DIFFUSE MYCOTIC PNEUMONIA IN A 7-MONTH-OLD COLT

A 7-month-old Quarter horse colt developed acute diarrhea, laminitis, bilateral uveitis, and severe respiratory distress after intramuscular injection with a bacterial vaccine. Thoracic radiographs revealed diffuse unstructured, nodular interstitial, and peribronchial opacities throughout the lung. Despite intensive supportive therapy, the colt became progressively hypoxemic and died. At postmortem examination, severe multifocal to coalescing hemorrhagic, necrotizing fibrinous pneumonia was found. Histologic study revealed numerous branched septate fungal hyphae diffusely distributed throughout the lung parenchyma. Fungal culture of lung tissue grew Aspergillus fumigatus. This report presents the radiographic, clinical, and pathologic features of acute mycotic pneumonia in horses.     

Idiopathic lymphoplasmacytic rhinitis in dogs: 37 cases (1997-2002)

OBJECTIVE: To determine clinical signs and rhinoscopic, computed tomographic, and histologic abnormalities in dogs with idiopathic lymphoplasmacytic rhinitis. DESIGN: Retrospective case series. ANIMALS: 37 dogs. PROCEDURE: Clinical information was obtained from medical records. Nasal computed tomographic images and histologic slides of biopsy specimens were reviewed. RESULTS: Dogs ranged from 1.5 to 14 years old (mean, 8 years); most (28) were large-breed dogs. Nasal discharge was unilateral in 11 of 26 (42%) dogs and bilateral in 15 of 26 (58%) dogs. In dogs with unilateral disease, duration of clinical signs ranged from 1.5 to 36 months (mean, 8.25 months; median, 2 months), and in dogs with bilateral disease, duration of signs ranged from 1.25 to 30 months (mean, 6.5 months; median, 4 months). Computed tomography (n = 33) most often revealed fluid accumulation (27/33 [82%]), turbinate destruction (23/33 [70%]), and frontal sinus opacification (14/33 [42%]). Rhinoscopy (n = 37) commonly demonstrated increased mucus and epithelial inflammation; turbinate destruction was detected in 8 of 37 (22%) dogs. Bilateral biopsy specimens from all 37 dogs were examined. Four dogs had only unilateral inflammatory changes. The remaining 33 dogs had bilateral lesions; in 20, lesions were more severe on 1 side than the other. CONCLUSIONS AND CLINICAL RELEVANCE: Findings suggest that idiopathic lymphoplasmacytic rhinitis is a key contributor to chronic nasal disease in dogs and may be more common than previously believed. In addition, findings suggest that idiopathic lymphoplasmacytic rhinitis is most often a bilateral disease, even among dogs with unilateral nasal discharge.     

Eumycetoma in a British cat

A case of feline eumycetoma is described. The lesions principally affected the soft tissues of the right hip and right sublumbar region and were characterized by granulomatous swelling with sinuses, discharging pus containing black granules. The latter consisted of aggregations of fungal hyphae which on culture were identified as belonging to the genus Torula. The cat died before treatment could be instigated. Previous reports of eumycetoma in animals are reviewed.     

COMPUTED TOMOGRAPHIC FINDINGS OF FUNGAL RHINITIS AND SINUSITIS IN CATS

The computed tomographic (CT) findings of fungal rhinitis/sinusitis in cats were characterized. The CT images of 10 cats ranging in age from 7 to 13 years were examined. The mean age was 10.8 years and all were neutered males. Nasal aspergillosis was diagnosed in five cats, cryptococcosis in three cats, hyalohyphomycosis in one cat, and trichosporonosis in one cat. Bilateral disease was present in eight cats, seven had abnormal soft tissue attenuation in two-thirds of the nasal cavity, and six had turbinate lysis. Seven cats had also lysis of the hard palate, nasal septum, or frontal bone. One cat had lysis of the cribriform plate. Five of the nine cats whose lymph nodes were imaged had lymph node enlargement. There was contrast medium enhancement in the nasal cavity in all cats, with either a primarily peripheral rim or heterogeneous pattern. There appears to be an overlap of clinical signs, age, and CT features of cats with nasal neoplasia and those with fungal rhinitis/sinusitis.     

Osteoma of paranasal sinuses of a horse

A 2-year-old Quarter Horse gelding was examined for torticollis, facial protuberances over the frontal and maxillary sinuses, and persistent nasal discharge unresponsive to antibiotics. Radiograph revealed an osseous mass in the right paranasal sinuses. Histologic examination of the biopsied mass led to a diagnosis of osteoma. The mass was removed surgically in sections from the right frontal and maxillary sinuses through separate bone flaps, and sinuses were irrigated with saline solution for 8 days after surgery. Two weeks after surgery, radiography revealed small osseous opacities in the right paranasal sinuses. These opacities remained unchanged in radiographs obtained up to 23 months after surgery.     

Retrobulbar pseudotumor of the orbit in a cat

Idiopathic nonspecific inflammatory disease of the orbit (orbital pseudotumor) was diagnosed detected in a cat. The cat had progressive lagophthalmia, keratitis, and decreased motion of the right eye. Four months later, the left eye was affected in a similar manner. Response to antibiotics and immunosuppressive agents was not detected. Computed tomography of the brain and orbits revealed bilateral thickening of the sclera and episcleral tissues. Bilateral exenteration of the eyes was required because of worsening clinical signs or corneal perforation. Histologic examination revealed proliferation of spindle cells and fibrovascular tissue within and adjacent to the sclera.     

IMAGING DIAGNOSIS: COMPUTED TOMOGRAPHIC FINDINGS IN A CASE OF ADENOSQUAMOUS CARCINOMA OF THE HEAD AND NECK IN A CAT

A 15‐year‐old female spayed domestic long‐haired cat was referred for trismus, hypersalivation, and bilateral ocular discharge. On examination, the cat showed pain on palpation of the left zygomatic arch, palpable crepitus of the frontal region, and limited retropulsion of both globes. A contrast‐enhanced sinonasal computed tomographic study was performed, showing facial distortion and extensive osteolysis of the skull, extending beyond the confines of the sinonasal and paranasal cavities. Additionally, soft tissue and fluid accumulation were observed in the nasal cavities and paranasal sinuses. Postmortem biopsy samples acquired from the calvarium yielded a histologic diagnosis of sinonasal adenosquamous carcinoma, a rare and particularly aggressive neoplasm previously only reported in the esophagus of one cat.     

Transmaxillary anchored silicon embedded gauze plug in the post-operative treatment of a large oromaxillary fistula caused by a supernumerary cheek tooth

A 9-year-old Hungarian sport horse gelding was presented to the clinic in poor condition displaying malodorous bilateral purulent nasal discharge. Oral examination revealed the presence of supernumerary 111 and 211. Bilateral diastema formation between the third maxillary molars and the supernumerary teeth with deep periodontal pockets and massive food impactions were diagnosed endoscopically. Radiography revealed inhomogenous sinus opacities in the left and right paranasal sinuses. Following bilateral oral extractions of the supernumerary cheek teeth and third maxillary molars, bilateral oromaxillary fistula formations were diagnosed (about 17 mm diameter on the right side). Bilateral frontal and right-sided maxillary trephinations and resection of the right bulla of the maxillary septum were performed. Massive food impactions of the left and right paranasal sinuses were removed under endoscopic control. Repeated trans-endoscopic sinus lavage was performed post-operatively. After 2.5 months, the large right-sided oromaxillary communication was temporarily closed with a transmaxillary anchored, gauze-cored silicon plug on an outpatient basis. Follow-up examination after 187 days revealed complete closure of the oromaxillary fistula and absence of sinusitis. In a 1.5-year follow-up control, no pathological conditions were found.     

Nasal infection with Scedosporium apiospermum in a dog

CASE HISTORY: A 2-year-old female Siberian Husky was presented with a 6-month history of sneezing and mucous discharge from the right nostril.

CLINICAL FINDINGS: Reduced airflow through the right nostril was evident. Radiographs showed subtle loss of detail of turbinates within the right nasal chamber. Rhinoscopy revealed swollen and erythematous turbinates and a white mass within the caudal aspect of the right nasal cavity. Histopathologically, there was a heavy mixed inflammatory infiltrate in the submus- cosa of the right turbinate, and the presence of fungal hyphae and spores in the white mass. A heavy growth of Scedosporium apiospermum was cultured from the mass.

DIAGNOSIS: Chronic rhinitis of the right nasal cavity and infection with S. apiospermum.

CLINICAL RELEVANCE: This is the first reported case of S. apiospermum isolated from the nasal cavity of a dog in New Zealand. Fungal culture is necessary to differentiate this fungus from Aspergillus spp.     

Intracranial epidural mucocele in a cat

An 18-month-old, spayed female, domestic shorthaired cat was presented with clinical signs of depression and reluctance to walk, which progressed to nonambulatory tetraparesis. Increased opacification of both frontal sinuses and a cyst-like abnormality causing compression and displacement of the right frontal lobe were seen on computed tomography. Bilateral frontal sinus trephination and right transfrontal craniotomy revealed clear, viscous fluid in the right frontal sinus and rostral fossa, compatible with an intracranial mucocele. At a 6-month follow-up examination, no signs of recurrence were appreciated.     

Cystic nasal adenocarcinoma in a cat treated with piroxicam and chemoembolization

A 13-year-old, castrated male Siamese cat was presented with a 4-month history of recurrent seizures and bilateral conjunctivitis and rhinitis. Computed tomography of the brain and nose revealed a cystic lesion in the cranial cavity that compressed the brain and invaded the nose. Nasal biopsy revealed a nasal adenocarcinoma. The cat was treated with intermittent antibiotics, phenobarbital, piroxicam, and chemoembolization; it survived for 2 years after diagnosis.     

Granulomatous and eosinophilic rhinitis in a cow caused by Pseudallescheria boydii species complex (Anamorph Scedosporium apiospermum)

A 2-year-old Hereford cow was presented to the teaching hospital for increased respiratory noise and bilateral bloody nasal discharge. A nodular rhinitis was detected clinically, and the nasal biopsy revealed a granulomatous and eosinophilic rhinitis with intralesional fungi. The cow was euthanized due to financial constraints. Grossly multifocal-to-coalescing, raised, ulcerated firm nodules were present in both nares. Histologically, the lamina propria was expanded by intense infiltrates of eosinophils, epithelioid macrophages, multinucleate giant cells, lymphocytes, and plasma cells. Associated with the inflammatory cells were variably sized, septate hyphae, 5-8 microm in diameter, admixed with numerous, terminal conidia, 6-30 microm in diameter, with a discrete outer wall identified by culture as Pseudallescheria boydii species complex (anamorph Scedosporium apiospermum). The infection was localized to the nasal cavity with no gross or microscopic evidence of a systemic dissemination.     

Fungal rhinitis and sinusitis in three cats

Localized infection of the nasal or paranasal cavities caused by Aspergillus spp or Penicillium spp was diagnosed in 3 cats. Clinical signs included chronic mucopurulent nasal discharge, epistaxis, and mandibular lymphadenopathy. Rhinoscopic and diagnostic imaging findings were compatible with severe inflammation of the nasal mucosa and destruction of the turbinates. Fungal plaques were observed rhinoscopically in 2 cats, and histologic examination of biopsy specimens revealed fungal colonies with surrounding inflammatory infiltrates in all 3. Results of fungal culture were negative for all 3 cats. Results of serum immunoelectrophoresis for antibodies against Aspergillus spp were positive in 2 cats. Treatment with itraconazole was effective in controlling clinical signs in 1 cat, but hepatotoxicosis developed. A single intranasal infusion of clotrimazole subsequently led to long-term resolution of clinical signs in this cat. Localized aspergillosis-penicilliosis is clinically indistinguishable from other pathologic conditions of the nasal and paranasal cavities in cats and should be considered when examining cats with chronic nasal discharge.     

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.     

Mucoid Pseudomonas aeruginosa infection in a cat with severe chronic rhinosinusitis

A 6‐year‐old male neutered Bengal cat was presented to the University of Wisconsin Veterinary Care Hospital with a history of severe chronic rhinitis that was unresolved from kittenhood. In weeks prior to presentation, the cat's upper respiratory signs had significantly worsened and a left‐sided facial swelling overlying the left frontal sinus was noted. Skull computed tomography, rhinoscopy, bilateral nasal biopsies, bacterial and fungal cultures of fluid from the left frontal sinus, and cryptococcal fungal antigen testing were performed. The cat was diagnosed with severe chronic rhinosinusitis and determined to have an infection with a mucoid variant of Pseudomonas aeruginosa (P aeruginosa). This case highlights an atypical cytomorphologic appearance of the well‐known bacterial pathogen, P aeruginosa, an appearance that could be confused cytologically with other microorganisms, such as septate fungi. Mucoid variants of P aeruginosa are often associated with progressive lung or airway disease in people with cystic fibrosis and have not been previously documented in feline respiratory tract disease. This report also presents a brief review of chronic rhinosinusitis (CRS) in cats and describes a novel interventional treatment approach to feline CRS via sinusotomy and sinus flushing for severely affected cats.     

Aspergillus flavus keratomycosis in a cat treated with topical 1% voriconazole solution

An 8-year-old male castrated Domestic Short-haired cat was examined for a 1-week history of blepharospasm and mucoid ocular discharge OS. Examination revealed ulcerative keratitis with stromal loss, stromal infiltrate, corneal edema, perilimbal vascularization and miosis. Cytology of the cornea revealed multiple dichotomously branching, septate fungal hyphae and severe, predominantly neutrophilic inflammation. PCR of the cytology samples confirmed the presence of Aspergillus flavus while fungal and bacterial cultures were negative. Treatment with topical 1% voriconazole solution was successful in resolving the keratomycosis.