Ketoconazole for successful treatment of cryptococcosis in a cat

Cryptococcosis affecting the skin and a lymph node in a 1 1/2-year-old cat was treated successfully with ketoconazole as the sole therapeutic agent. The cat was lesion-free 1 year after treatment.     

Ketoconazole for treatment of dermatophytosis in cats.

Twelve cats with generalized dermatophytosis were treated with ketoconazole (10 mg/kg of body weight, PO, with food, q 24 h). This treatment was successful in 8 cats, with resolution of lesions and negative findings on mycologic evaluation after 2 to 10 weeks (median duration, 6 weeks). One additional cat failed to improve initially, but complete resolution was achieved after the dosage of ketoconazole was doubled. Adverse effects in 3 cats included anorexia, weight loss, vomiting, and diarrhea.     

Ketoconazole in the treatment of dermatomycosis in cats and dogs

Ketoconazole (Nizoral^®, Janssen Pharmaceutica) a new systemic antimycotic was tested in dermatomycosis in cats and dogs. The daily dose (10 mg/kg body weight) was administered for 10 or 20 days without any other measures being taken. After the 20‐day treatments new hair growth was observed in 96.7 per cent of the cats and 89.9 percent of the dogs. Clinical cure was complete in 96.8 per cent of the cats and 90.5 per cent of the dogs.

Particularly the good tolerance in the cat was appreciated. There were practically no side‐effects in dogs (except vomiting in two pups) or in cats.     

Ketoconazole in the treatment of dermatomycosis in cats and dogs

Ketoconazole (Nizoral, Janssen Pharmaceutica) a new systemic antimycotic was tested in dermatomycosis in cats and dogs. The daily dose (10 mg/kg body weight) was administered for 10 or 20 days without any other measures being taken. After the 20-day treatments new hair growth was observed in 96.7 per cent of the cats and 89.9 per cent of the dogs. Clinical cure was complete in 96.8 per cent of the cats and 90.5 per cent of the dogs. Particularly the good tolerance in the cat was appreciated. There were practically no side-effects in dogs (except vomiting in two pups) or in cats.     

Ketoconazole therapy in a dog with systemic cryptococcosis

A 2-year-old dog had bilateral chorioretinitis and a cough. Systemic cryptococcosis was diagnosed by evaluating a trans-tracheal aspirate and a cryptococcal latex-particle agglutination antigen titer. Clinical remission was achieved with ketoconazole administration, an imidazole antifungal agent. Serial antigen titers were used to monitor treatment, which was continued for 12 months. Ketoconazole therapy was well tolerated by the dog.     

Cutaneous cryptococcosis in three cats

Cutaneous cryptococcosis was diagnosed in 3 cats. No other organ involvement was found. One cat has remained healthy after surgical excision of the cryptococcal skin lesion. One cat was euthanatized after diagnosis. The third cat was treated successfully with a 5-month course of ketoconazole.     

Evaluation of ketoconazole and itraconazole for treatment of disseminated cryptococcosis in cats

During the first part of a study, cats were inoculated with Cryptococcus neoformans via the following routes: intradermal, intranasal, IV, and intracisternal. Only use of the IV route of inoculation consistently induced disseminated cryptococcosis. In the second part of the study, disseminated cryptococcosis was experimentally induced in cats via IV inoculation of C neoformans. One month after inoculation, 3 cats were treated with ketoconazole (10 mg/kg of body weight/d) and 3 cats were treated with itraconazole (10 mg/kg/d) for 3 months. One of the ketoconazole-treated and 2 of the itraconazole-treated cats also had cryptococcosis of the CNS when treatment was begun. During treatment, serum cryptococcal antigen titer progressively decreased in all cats. Abnormalities in CBC values or the serum biochemical profile were not found in any cat during treatment. However, all ketoconazole-treated cats became anorectic and lost weight. Side effects were not seen in itraconazole-treated cats. During the 3-month posttreatment observation period, all cats remained healthy. At necropsy, histologic evidence of cryptococcosis was not found in the 3 ketoconazole-treated cats or in 2 of the itraconazole-treated cats. In the third itraconazole-treated cat, cryptococcal organisms were found in the kidneys.     

Treatment of cryptococcosis in three cats, using ketoconazole

Ketoconazole was effective in the treatment of cryptococcosis in 3 cats. A dosage of 10 to 15 mg/kg of body weight was given once or twice daily with a meal for 11 to 33 weeks. Fungal cultures and serotesting were used to assess the efficacy of treatment and resolution of active infection. In some of the cats, the treatment was associated with gastrointestinal signs and increased serum liver enzyme activity. Ketoconazole has been used in human beings, dogs, and cats for the treatment of systemic mycoses.     

Peripheral vestibular disease associated with cryptococcosis in three cats.

Peripheral vestibular disease referable to otitis media/interna was the main reason for presentation in three cats with cryptococcosis. In two cats, Cryptococcus neoformans var neoformans was isolated from the tympanic bulla. In the remaining cat, otitis media/interna was considered to be secondary to occlusion of the auditory tube by a nasopharyngeal granuloma associated with a C neoformans var gattii infection. This report emphasises the importance of maintaining an index of suspicion for a fungal aetiology in cats with signs of otitis media/interna, particularly in countries with a high prevalence of cryptococcosis. The presence of C neoformans may be overlooked with potentially fatal consequences where only standard methods for bacterial isolation are used to examine samples obtained from the middle ear.     

Long-term outcome of therapy for 59 cats and 11 dogs with cryptococcosis

OBJECTIVE: To determine the outcome of therapy in cats and dogs with naturally occurring cryptococcosis. Design Retrospective study of 59 cats and 11 dogs at the University Veterinary Centre Sydney from 1986 to 2004. METHOD: Following detailed analysis of case notes potential associations between patient characteristics, cryptococcal species, retroviral status (cats), disease severity and type of therapy were examined in relation to duration and success of therapy. Treatment protocols based on amphotericin B, fluconazole and itraconazole were compared. RESULTS: Seventy-six percent of feline patients were successfully treated. For cats, the presence of central nervous system disease was the only factor found to influence outcome. Cats with neurological involvement, disseminated disease or refractory disease treated with amphotericin B containing protocols did as well, on average, as cats with less severe disease treated with azole monotherapy. Amphotericin B was thus an effective agent for treating severe cases of cryptococcosis. The median cumulative dose of amphotericin B for cats cured at the first attempt was 16 mg/kg (range 7 to 23 mg/kg). The median duration of treatment required to effect a cure at first attempt was significantly shorter for fluconazole (4 months; range 1 to 8 months) than for itraconazole (9 months; range 3 to 24 months; P = 0. 0191; Mann Whitney U test). The success rate for treatment of canine cases was 55%. No factor appeared to influence disease outcome in dogs. Large cumulative doses of amphotericin B could be administered via the subcutaneous route in both species and generally with minimal nephrotoxicity. Recrudescence occurred in a significant proportion of animals, in some cases despite a reduction of serum latex cryptococcal antigen agglutination test to zero. CONCLUSION: Although the prognosis of cryptococcosis should be described as guarded, a majority of the canine and especially feline patients can be expected to be cured, although treatment is protracted and expensive.     

Clinical evaluation of a cryptococcal antigen latex agglutination test for diagnosis of cryptococcosis in cats

A commercial cryptococcal antigen latex agglutination test was used to evaluate sera from 20 cats with cryptococcosis and 184 cats without cryptococcosis. Cryptococcal antigen was detected in the sera from 19 of 20 cats with cryptococcosis. Antigen was not detected in sera from any of the cats without cryptococcosis. The test had sensitivity of 95% and specificity of 100%.     

Successful treatment of invasive nasal cryptococcosis in a ferret

Invasive cryptococcal rhinitis due to Cryptococcus neoformans var gattii was diagnosed in a castrated, 5-year-old, albino ferret with subcutaneous swelling of the nasal bridge. The diagnosis was based on histology, needle aspirate cytology and positive culture on Sabouraud's dextrose agar and birdseed agar. The ferret was successfully treated using a long course of itraconazole (25 to 33 mg orally once daily with food) subsequent to surgical debulking of the lesion, using sequential cryptococcal antigen titre determinations to guide therapy.     

Successful treatment of four cases of feline cryptococcosis

Four cases of feline cryptococcosis, with lesions mainly confined to the nasal passages and skin, were treated orally with the antifungal agent, 5-fluorocytosine, augmented in two cases by intradermal injections of an autogeneous vaccine. The cats were all Siamese. Treatment was successful although one cat showed recurrence of skin lesions when 5-fluorocytosine therapy was discontinued, but the condition cleared after a further course of the agent. No untoward side-effects were observed.     

Analysis of leucocytes and lymphocyte subsets in cats with naturally-occurring cryptococcosis but differing feline immunodeficiency virus status

SUMMARY: Although cryptococcosis is a well-characterised disease of cats, the factors predisposing individuals to infection are unknown. As an indication of the immune status of an individual, lymphocyte subsets can be analysed. Reference ranges for feline lymphocyte subsets (Pan T+, CD4+, CDS+ and B cells) were established using a rapid whole blood technique and flow cytometry. There were no effects of age or sex on lymphocyte subset values. The numbers of circulating leucocytes and lymphocyte subsets were determined in FIV-positive and FIV-negative cats with cryptococcosis and compared with a group of healthy control cats.
There were only minor differences in the numbers of lymphocyte subsets among the subgroups of cats examined in the study and the predisposition to cryptococcosis in cats could not be explained by deficiencies in lymphocyte subsets. There was a tendency for FIV-negative cats with cryptococcosis to have reduced numbers of circulating CD4+ cells and lower CD4:CD8 ratios compared with normal cats, although the interpretation of this finding was complicated by the wide reference range for normal cats. The extent to which this is the cause of the fungal infection was not determined.
The only difference in leucocyte or lymphocytes subset values between FIV-negative cats with cryptococcosis and FIV-positive cats with cryptococcosis was that the CD4+ percentage was lower in the FIV-positive cats. The absolute CD4+ count was similar however, in FIV-positive and FIV-negative cryptococcosis cases. On the basis of this and other available information, the categorisation of cryptococcosis as a disease defining the AIDS phase of FIV infection may be incorrect.     

Radio-iodine treatment of hyperthyroid cats

Thirty-two elderly domestic shorthaired cats (mean age 12.9 years) were treated with radioiodine (131I). The dose of 131I administered ranged from 39 mBq to 134 mBq. Twenty-eight cats became euthyroid after treatment, one became hypothyroid and three remained hyperthyroxaemic. Two of the hyperthyroxaemic cats were successfully re-treated with 131I. Five cats died from concurrent diseases within one year of treatment. The administration of a dose of 131I selected by assessing the severity of the clinical signs, the size of the thyroid gland(s) and the serum level of thyroxine was an effective treatment for hyperthyroidism.