Candida parapsilosis complex infection in a cutaneous lesion from a dog: Spotlight on an opportunistic pathogen of potential increasing importance

Fine-needle aspirates from a 1.5-cm cutaneous mass in a Cocker Spaniel were submitted for cytologic examination. Marked pyogranulomatous inflammation and fungal organisms were present, identified as Candida parapsilosis complex by MALDI-ToF following fungal culture. The fungal infection was considered secondary or an incidental finding, following the diagnosis of a benign keratinizing lesion by histopathologic examination of the excised mass. This case is presented to increase awareness and describe the cytologic features of a potential pathogen, which is of increasing importance in human medicine but has a limited presence in the veterinary literature despite the potential for a similar significance.     

Cytologic diagnosis of generalized cutaneous sporotrichosis in a hunting hound

A 1-year-old male Foxhound/Walker Hound mix was presented to the small animal internal medicine service at Louisiana State University School of Veterinary Medicine with a 6-week history of progressive, multifocal, ulcerative and draining, well-circumscribed lesions in a generalized distribution. Prior to referral, a presumptive diagnosis was made of sterile pyogranulomatous disease; immunosuppressive therapy was instituted but resulted in clinical deterioration. At presentation, the dog had marked neutropenia (1100 neutrophils/microL), and a mild toxic left shift (400 bands/microL). Cytologic findings in the exudates from a draining skin lesion included high numbers of markedly degenerate neutrophils (about 95% of nucleated cells) as well as low numbers of macrophages, small mature lymphocytes, and eosinophils. Low numbers of intracellular (within neutrophils and macrophages) and extracellular, pleomorphic, cigar-to-ovoid shaped organisms ( approximately 3x9 microm) consistent with Sporothrix were observed. Histopathologic examination of a skin biopsy showed marked, chronic, active, ulcerative, pyogranulomatous dermatitis and panniculitis, with intralesional yeast consistent with Sporothrix sp. The etiologic agent was confirmed as Sporothrix schenckii by macerated tissue fungal culture. The patient was treated with itraconazole, enrofloxacin, and clindamycin, with clinical resolution occurring over a 3-month period. This case is a rare example of the cytologic diagnosis of Sporothrix schenckii in a canine patient. Diagnosis of canine sporotrichosis is often challenging and usually requires tissue culture, as infected dogs typically harbor very few organisms. The patient's prior immunosuppressive therapy likely contributed to higher numbers of organisms in exudates from the cutaneous lesions, facilitating cytologic diagnosis.     

Generalized calcinosis cutis associated with disseminated paecilomycosis in a dog

A 4‐year‐old spayed female mixed breed dog was referred to the Michigan State University, Veterinary Teaching Hospital (MSU‐VTH) with vomiting, lethargy and anorexia of 2 weeks duration. Abdominal radiographs and ultrasonography showed hepatosplenomegaly. Cytological evaluation of ultrasound‐guided fine needle aspirates of the liver and spleen revealed fungal organisms and pyogranulomatous inflammation; fungal culture documented Paecilomyces variotii infection. The dog received antifungal therapy and supportive care. Multiple firm plaque‐like skin lesions, predominantly involving the inguinal region, developed 18 days after initial presentation and were diagnosed histopathologically as calcinosis cutis. While generalized calcinosis cutis has been reported in three dogs with blastomycosis and one dog with leptospirosis, the association with disseminated Paecilomyces spp. infection is novel.     

Histoplasmosis in a dog from New Brunswick

A young dog was presented with a history of chronic diarrhea, anorexia, and weight loss. Histoplasma capsulatum was suspected, based on cytologic examination of lymph node aspirates and peritoneal fluid, and confirmed by fungal culture. To our knowledge, this is the first case of histoplasmosis diagnosed in a dog in Atlantic Canada.     

Mastitis caused by Mycobacterium kansasii infection in a dog

A 2‐year, 7‐month‐old female Chihuahua was admitted for a mammary mass measuring one cm in diameter. The dog had a history of demodicosis for 4 months and showed signs of pseudopregnancy at the time of the visit. Cytologic examination of an aspirate of the mass revealed a large number of macrophages containing nonstaining bacterial rods, which were acid‐fast in a Ziehl–Neelsen stain, suggesting mycobacterial infection. Histologic examination of the mass revealed a pyogranulomatous mastitis characterized by an infiltration with macrophages containing acid‐fast bacteria. Mycobacterium kansasii was subsequently cultured and identified by PCR. Surgical excision of the mass resulted in the growth of other dermal masses, but antimycobacterial treatment with rifampin and clarithromycin resolved these masses within 1 month. Three months after discontinuation of the treatment, similar organisms were found in aspirates of the enlarged bilateral inguinal lymph nodes by cytologic examination. Despite antimycobacterial treatment for another 4 months, there was no improvement and demodicosis also recurred. The dog eventually died of lymphoma 5 months after the relapse of mycobacterial infection. Although M kansasii is considered an important pathogen for pulmonary and cutaneous disease in people, there is only one report in a dog with an infection in a pleural effusion. As both adult‐onset demodicosis in dogs as well as mycobacterial infection in people have been associated with T‐lymphocyte deficiency, the M kansasii infection in this dog may have been associated with a condition of immune compromise.     

Detection of Bartonella henselae DNA in two dogs with pyogranulomatous lymphadenitis

CASE DESCRIPTION: 1 dog evaluated because of inappetence and lameness of the left hind limb of 1 day's duration and 1 dog evaluated because of inappetence, fever, and lymphadenopathy of 2 weeks' duration. CLINICAL FINDINGS: Histologic examination of excisional biopsy specimens from lymph nodes revealed pyogranulomatous lymphadenitis in both dogs. Quantitative real-time PCR assays detected Bartonella henselae DNA in blood samples and affected lymph node specimens from both dogs. Antibodies against B. henselae were not detected via immunofluorescent antibody testing during active disease in either dog. TREATMENT AND OUTCOME: 1 dog recovered after 6 weeks of treatment with doxycycline (5 mg/kg [2.3 mg/lb], p.o., q 12 h), whereas the other dog recovered after receiving a combination of azithromycin (14.5 mg/kg [6.6 mg/lb], p.o., q 24 h for 21 days), doxycycline (17.3 mg/kg [7.9 mg/lb], p.o., q 24 h for 4 weeks), and immunosuppressive corticosteroid (prednisone [3 mg/kg {1.4 mg/lb}, p.o., q 24 h], tapered by decreasing the daily dose by 25% every 2 weeks) treatment. CLINICAL RELEVANCE: B. henselae is implicated as a possible cause or a cofactor in the development of pyogranulomatous lymphadenitis in dogs. In dogs with pyogranulomatous lymphadenitis, immunofluorescent assays may not detect antibodies against B. henselae. Molecular testing, including PCR assay of affected tissues, may provide an alternative diagnostic method for detection of B. henselae DNA in pyogranulomatous lymph nodes.     

Disseminated nocardiosis caused by Nocardia abscessus in a dog

Abstract: A 4‐year‐old female spayed Bichon Frise dog that had been receiving cyclosporine A per os 3 times per week for 2 months to control allergic dermatitis developed lethargy, anorexia, fever, and multiple firm subcutaneous masses. Pyogranulomatous inflammation with branching nonseptate filamentous organisms approximately 2 μm in diameter, presumptively fungal organisms, was diagnosed by cytologic evaluation of fine‐needle aspirates from several masses. A partially acid‐fast actinomycete was cultured from 2 of the masses. The organism was identified as Nocardia abscessus (formerly Nocardia asteroides type 1) based on 16S ribosomal DNA sequencing of samples extracted from cultures and unstained cytologic smears. Immunosuppression caused by long‐term administration of cyclosporine A likely predisposed the dog to disseminated infection. To our knowledge, this is the first report of N. abscessus infection in a dog. This case demonstrates that N. abscessus may be mistaken for a fungal organism based on its cytologic appearance and underscores the importance of using molecular techniques for the diagnosis of suspected fungal diseases.     

"Carry-on" dermal baggage: a nodule from a dog. Pyogranulomatous inflammation with intralesional fungal agents

A 2-year-old intact female Australian Cattle Dog presented with a 1-cm diameter nonexudative dermal nodule on the medial aspect of the right thigh. Fine-needle aspiration revealed pyogranulomatous inflammation and many ovoid, 2-4 microm diameter, thin-capsulated, basophilic bodies that appeared to be fungal spores or yeast. Results of CBC, serum chemistry panel, lymph node palpation, and radiographs were unremarkable. Excisional biopsy and histopathology revealed pyogranulomatous folliculitis, furunculosis, and perifolliculitis. Rare fungal hyphae and spore forms were intimately associated with, and occasionally within, hair shafts. A morphologic diagnosis of dermatophytosis was made and Microsporum canis infection was confirmed by fungal culture. M canis is a common infectious agent found within the follicles and superficial keratin layers of canine skin. The kerion-type clinical presentation observed in the dog of this case is uncommonly observed with M canis. Additionally, the cytologic finding of multiple arthroconidia without hyphae is unusual. In the absence of hyphae, M canis arthroconidia may be confused with other fungal yeast bodies; therefore close scrutiny of a cytologic sample for arthroconidia associated with keratin, hair fragments, or hyphal structures is recommended.     

Successful treatment of bilateral paecilomyces pyelonephritis in a German shepherd dog

A six‐year‐old female entire German shepherd dog was investigated for polyuria, polydipsia and lethargy. Investigations revealed a mild azotaemia and abdominal ultrasound revealed marked bilateral dilation of the renal pelves with echogenic material and proximal left hydroureter. Urine cytological examination and aspirates from the right renal pelvis revealed mats of fungal hyphae consistent with fungal bezoar formation. Fungal cultures revealed a profuse growth of Paecilomyces variotii. Initial treatment with oral itraconazole was unsuccessful, leading to bilateral nephrotomies to remove the fungal material. Postoperatively the Paecilomyces infection persisted despite continued itraconazole therapy. Treatment was commenced with amphotericin B, leading to resolution of the dog's clinical signs. To the authors’ knowledge this is the first report of canine Paecilomyces pyelonephritis, without disseminated systemic disease, which documents its successful treatment.     

Hepatic fungal infection in a young beagle with unrecognised hereditary cobalamin deficiency (Imerslund‐Gräsbeck syndrome)

A 12‐month‐old beagle presented for anorexia, pyrexia and vomiting. The dog had been treated intermittently with antibiotics and corticosteroids for inappetence and lethargy since five months of age. Previous laboratory abnormalities included macrocytosis and neutropenia. At presentation, the dog was lethargic, febrile and thin. Laboratory examination findings included anaemia, a left shift, thrombocytopenia, hypoglycaemia and hyperbilirubinaemia. Multiple, small, hypoechoic, round hepatic lesions were observed on abdominal ultrasound. Cytological examination of hepatic fine needle aspirates revealed a fungal infection and associated pyogranulomatous inflammation. The dog's general condition deteriorated despite supportive measures and treatment with fluconazole, and owners opted for euthanasia before hypocobalaminaemia was identified. Subsequent genomic analysis revealed a CUBN:c.786delC mutation in a homozygous state, confirming hereditary cobalamin malabsorption (Imerslund‐Gräsbeck syndrome). Similar to human infants, dogs with Imerslund‐Gräsbeck syndrome may rarely be presented for infectious diseases, distracting focus from the underlying primary disorder.     

Comparison of results of clinicians' assessments, cytologic examination of fine-needle lymph node aspirates, and flow cytometry for determination of remission status of lymphoma in dogs

OBJECTIVE: To determine interclinician agreement when assessing remission of lymphoma in dogs and the association among results of clinicians' assessments via lymph node palpation, cytologic examination of fine-needle lymph node aspirates, and flow cytometry as determinants of remission. DESIGN: Prospective study. ANIMALS: 23 dogs with untreated lymphoma. PROCEDURE; Two clinicians independently measured large lymph nodes and cytologic examination and flow cytometry of cells from a mandibular or popliteal lymph node were performed 1 week prior to initiating treatment. Lymph node measurements with clinicians' remission assessments and cytologic examination were repeated at weeks 2, 3, and 5; flow cytometry was repeated at week 5. RESULTS: Significant correlation was identified between clinicians' remission assessments. Significant correlation between lymph node palpation and cytologic examination was identified at week 5, but not at weeks 2 and 3. Lymphoma was diagnosed in 16 of 23 (70%) dogs at initial evaluation by use of flow cytometry, although it was of limited use at subsequent evaluations and results were not diagnostic of lymphoma in any dog at week 5, including 1 dog in which lymphoma was diagnosed cytologically. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that physical examination and measurement of lymph node volume may not be sufficient for accurately determining remission, that flow cytometry alone should not be relied on as a means for diagnosis, and that cytologic examination of fine-needle lymph node aspirates should be considered as the most accurate means of determining remission status at times in which treatment modifications are considered.     

Disseminated infection with Phialemonium obovatum in a German shepherd dog

A 4-year-old spayed female German Shepherd Dog was evaluated because of left forelimb lameness. A fungal granuloma on the distal portion of the radius was determined to be the cause of the lameness; the infecting organism was identified as Phialemonium obovatum. Despite aggressive treatment with amphotericin B, itraconazole, and ketoconazole and curettage of the local area, the dog developed systemic disease and was euthanatized 5 months after initial evaluation. Immune dysfunction may have played a role in development of disseminated disease, because although serum concentrations of total IgG, IgA, and IgM were within or greater than reference ranges, results of lymphocyte proliferation assays were abnormal, which indicated cellular immune dysfunction. Infection with Phialemonium obovatum should be considered as a differential diagnosis when branching fungal organisms are detected during histologic, cytologic, or microbiologic evaluation of tissue specimens.     

Goitrous hypothyroidism associated with treatment with trimethoprim-sulfamethoxazole in a young dog

CASE DESCRIPTION: A 16-week-old female Boxer that had been treated for 5 weeks with trimethoprim-sulfamethoxazole and chloramphenicol because of aspiration pneumonia was evaluated for bilaterally symmetric masses in the subcutaneous tissues of the ventral neck, in the region of the larynx. CLINICAL FINDINGS: Fine-needle aspirates were obtained from the neck masses; cytologic examination revealed well-differentiated thyroid epithelial tissue. A blood sample was collected for serum biochemical and thyroid function analyses. Mild hyperphosphatemia, severe hypercholesterolemia, mild hyperkalemia, and a mild increase in creatine kinase activity were identified. Serum concentration of total thyroxine was less than the lower reference limit, and that of thyroid-stimulating hormone was greater than the upper reference limit. Findings were consistent with a diagnosis of clinical hypothyroidism in a skeletally immature dog. TREATMENT AND OUTCOME: Treatment with trimethoprim-sulfamethoxazole was discontinued. The dog was reevaluated 3 weeks later, at which time the neck masses were markedly decreased in size. Serum concentrations of cholesterol and potassium were lower; serum concentrations of total thyroxine and thyroid-stimulating hormone were near or within respective reference ranges. Age-appropriate increases in serum phosphorus concentration and serum alkaline phosphatase activity were also detected. CLINICAL RELEVANCE: To the authors' knowledge, this is the first report of antimicrobial-induced goiter in a dog. Cytologic examination of fine-needle aspirates and interpretation of data from serum biochemical and thyroid function analyses were needed to obtain a definitive diagnosis. Practitioners should include goiter among the differential diagnoses for ventral neck swellings in young dogs receiving potentiated sulfonamide antimicrobials.     

Diagnosis and treatment of blastomycosis affecting the nose and nasopharynx of a dog

CASE DESCRIPTION: A 2-year-old 38.9-kg (85.58-lb) sexually intact male German Shepherd Dog was examined because of a 4-month history of severe nasal swelling and nasal mucosa congestion. The signs were slowly progressive. CLINICAL FINDINGS: Physical examination revealed that the dorsal aspect of the dog's nose was swollen and hard. Mucous membranes in both nostrils were hyperemic and edematous. Diagnostic investigation revealed severe nasal osteolysis and pyogranulomatous rhinitis and nasopharyngitis attributable to blastomycosis. TREATMENT AND OUTCOME: Oral administration of itraconazole was initiated (5 mg/kg [2.27 mg/lb], q 12 h for 5 days and then q 24 h). After a treatment period of 3 months, the nose had regained its normal appearance. After 5 months of treatment, the Blastomyces infection was eliminated as confirmed by results of rhinoscopy and biopsy specimen examination. No relapse was evident within 1 year after discontinuation of treatment. CLINICAL RELEVANCE: In dogs, nasal and nasopharyngeal blastomycosis can result in severe osteolysis of the nasal bone. Resolution of disease can be achieved with oral administration of itraconazole for a period of at least 5 months.     

Diagnosis of systemic cryptococcosis by fecal cytology in a dog

A 3-year-old Boxer was presented with progressive diarrhea, vomiting, and lethargy of 5-months duration. The dog had watery black feces, a mature neutrophilia, and microcytic anemia. Cytologic evaluation of a direct fecal smear stained with Wright's-Giemsa revealed numerous encapsulated, narrow-based, budding organisms consistent with Cryptococcus sp. Pyogranulomatous inflammation and Cryptococcus organisms also were observed in ultrasound-guided fine-needle aspirates of the small intestine and mesenteric lymph nodes, and in histologic sections of colonic biopsies obtained by endoscopy. Multifocal chorioretinitis by fundic examination was consistent with systemic mycosis, and the reciprocal antigen titer (1600) on a cryptococcal antigen latex agglutination test for Cryptococcus neoformans was markedly increased. Using immunohistochemistry, the organism was identified further as C neoformans var. grubii (C neoformans var. neoformans serotype A). After 3 weeks of antifungal treatment, ultrasound examination revealed urinary bladder wall thickening, and Cryptococcus organisms were found in a urine sediment preparation. After 4 months of treatment, the dog was clinically normal and had no abnormal findings on CBC, serum biochemistry, urinalysis, or fecal cytology; however, the antigen titer remained unchanged, mesenteric lymphadenomegaly and jejunal wall thickening were still evident, and cytologic evaluation of fine-needles aspirates of the jejunal wall revealed budding Cryptococcus organisms. Intestinal involvement in dogs with cryptococcosis is rare, and diagnosis by fecal cytology has not been documented previously.     

Diagnostic value of cytologic examination of gastrointestinal tract tumors in dogs and cats: 83 cases (2001-2004)

OBJECTIVE: To determine results of cytologic examination of fine-needle aspirates and impression smears of gastrointestinal tract tumors in dogs and cats. DESIGN: Retrospective case series. ANIMALS: 38 dogs and 44 cats with histologically confirmed gastrointestinal tract tumors. PROCEDURES: Results of cytologic examination of fine-needle aspirates (n = 67) or impression smears (31) were compared with the histologic diagnosis, and extent of agreement was classified as complete, partial, none, or undetermined. RESULTS: For 48 of the 67 (72%) fine-needle aspirates, there was complete or partial agreement between the cytologic and histologic diagnoses. For 12 (18%) aspirates, the extent of agreement could not be determined because the cytologic specimen was considered unsatisfactory. For 29 of the 31 (94%) impression smears, there was complete agreement between the cytologic and histologic diagnoses, and for 2 (6%), there was partial agreement. None of the impression smears were considered unsatisfactory. Proportion of samples with complete agreement and proportion of samples with complete or partial agreement were significantly higher for impression smears than for fine-needle aspirates. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that there was moderate agreement between results of cytologic examination of fine-needle aspirates from dogs and cats with gastrointestinal tract neoplasia and the definitive histologic diagnosis. The agreement between results of cytologic examination of impression smears and the histologic diagnosis appeared to be higher.     

Blastomycosis in nondomestic felids.

Blastomycosis was diagnosed in six nondomestic felids from eastern Tennessee, including two Asian lions (Panthera leo persicus), one African lion (Panthera leo), one Siberian tiger (Panthera tigris), one cheetah (Acinonyx jubatus), and one snow leopard (Panthera uncia). Clinical signs included lethargy, anorexia, weight loss, dyspnea, sneezing. ataxia, and paresis. Variable nonspecific changes included leukocytosis, monocytosis, moderate left shift of neutrophils, moderate hypercalcemia, hyperproteinemia, and hyperglobulinemia. Thoracic radiographs revealed interstitial and alveolar changes, consolidation or collapse of a lung lobe, bullae formation, and a pulmonary mass. Agar gel immunodiffusion (AGID) serology for Blastomyces dermatitidis was performed in five felids and was positive in three. The tiger had cerebral blastomycosis and was positive for AGID serologic tests of both cerebrospinal fluid and serum. One percutaneous lung aspirate in the snow leopard and one bronchial aspirate in an Asian lion demonstrated B. dermatitidis organisms. whereas tracheal wash samples and a nasal discharge were nondiagnostic in others. Treatment with itraconazole was attempted in four cats. The tiger improved before euthanasia, whereas the others did not survive beyond initial treatments. In four felids, B. dermatitidis was found in the lungs and tracheobronchial lymph nodes associated with a florid pyogranulomatous reaction; the tiger had a pyogranulomatous encephalomyelitis, and the cheetah had a single pulmonary granuloma. Thoracic radiography, cytologic examination of lung lesion aspirates, and B. dermatitidis AGID serology should be performed on clinically ill zoo felids in endemic areas to rule out blastomycosis.     

Distribution of Malassezia organisms on the skin of unaffected psittacine birds and psittacine birds with feather-destructive behavior

OBJECTIVE: To ascertain whether Malassezia organisms can be detected via cytologic examination and fungal culture of samples from the skin surface of psittacine birds and determine whether the number of those organisms differs between unaffected psittacines and those that have chronic feather-destructive behavior or differs by body region. DESIGN: Prospective study. ANIMALS: 50 unaffected psittacines and 53 psittacines that had feather-destructive behavior. PROCEDURE: Samples were collected by use of acetate tape strips from the skin of the head, neck, proventer, propatagium, inguinal region, and preen gland area of each bird; 0.5-cm(2) sample areas were examined microscopically for yeast, and samples were also incubated on Sabouraud dextrose agar. Polymerase chain reaction assays specific for Malassezia spp, saprophytic fungi, and Candida albicans were performed on DNA prepared from cultured colonies; nested PCR evaluation for Malassezia pachydermatis was then performed. RESULTS: Microscopically, 63 of 618 (10%) tape-strip samples contained yeast. Thirty cultured colonies were assessed via PCR assays, and all yielded negative results for Malassezia spp; C albicans was identified in 2 colony samples. The numbers of yeast identified microscopically in psittacines with feather-destructive behavior and in unaffected birds did not differ significantly, and numbers did not differ by body region. CONCLUSIONS AND CLINICAL RELEVANCE: Yeast were identified infrequently via cytologic examination of samples from the skin surface of unaffected psittacine birds or those that had chronic feather-destructive behavior. If yeast are identified on the skin of birds with feather-destructive behaviors, fungal culture of skin samples should be performed to identify the organism.     

Disseminated Scedosporium prolificans infection in a German Shepherd dog

Disseminated Scedosporium prolificans infection in a 1-year-old female spayed German Shepherd dog is described. Clinical signs were predominantly associated with fungal pyelonephritis and the organism was cultured from the urine. The dog was treated with itraconazole and later, terbinafine was added. Subsequent antifungal susceptibility testing of the isolate showed it to be resistant to all available antifungal drugs. The dog was euthanased because of acute abdominal haemorrhage and associated clinical deterioration. Postmortem examination revealed extensive pyogranulomas containing fungal organisms in the renal parenchyma, myocardium, bone marrow, skeletal muscle, liver, lung, spleen, multiple lymph nodes and pancreas.