Systemic infection with Geomyces organisms in a dog with lytic bone lesions

CASE DESCRIPTION: A 5-year-old neutered male mixed-breed dog was evaluated by a veterinarian because of a 4-week history of progressive lethargy and poor appetite; the dog was then examined at a referral hospital. CLINICAL FINDINGS: Hyperglobulinemia was identified via serum biochemical analyses performed before and after arrival at the hospital. Lysis of sternebrae 1 and 2 and sternal lymphadenopathy were detected radiographically. Fine-needle aspirates were collected from the affected sternebrae and lymph node for cytologic examination; findings were consistent with pyogranulomatous inflammation associated with fungal infiltrates. Geomyces organisms were identified via microbial culture of sternebral aspirates. TREATMENT AND OUTCOME: Treatment consisted of oral administration of itraconazole. After 6 months, remodeling of the affected sternebrae and resolution of sternebral lysis were evident radiographically. Geomyces organisms and pyogranulomatous infiltrates persisted despite clinical improvement. Treatment with itraconazole was continued for an additional 3 months. CLINICAL RELEVANCE: Infection with Geomyces organisms is typically localized to the skin and nail beds. In the dog of this report, systemic dissemination of Geomyces organisms resulted in lysis of the first 2 sternebrae. Cytologic examination of fine-needle aspirates and microbial culture of samples of the affected sternebrae were important diagnostic tests for successful identification of the organism. Despite 6 months of itraconazole administration and evidence of clinical improvement, fungal organisms persisted in the dog's affected sternebrae. Practitioners should include Geomyces infection among the differential diagnoses for suspected systemic mycosis and should perform cytologic examination and microbial culture of affected tissue throughout treatment of affected dogs.     

Heart failure caused by toxoplasmosis in a fennec fox (Fennecus zerda)

A male fennec fox (Fennecus zerda) kit was examined for lethargy, inappetence, and weight loss. Clinical findings included respiratory distress, a gallop rhythm, and retinochoroiditis. Radiography indicated pleural effusion and cardiomegaly. Echocardiographic findings included left ventricular dilatation, low left ventricular ejection fraction, and atrioventricular valvular regurgitation. Necropsy findings were compatible with a diagnosis of congestive heart failure caused by myocarditis. Histopathology showed a disseminated infection with Toxoplasma gondii causing myocarditis, skeletal polymyositis, gastrointestinal myositis, and panuveitis. Toxoplasma-induced myocarditis should be included in the differential diagnosis of heart failure and retinochoroiditis in the fennec fox.     

P‐87 Alopecia in two guinea pigs due to hypopodes of Acarus farris

Mites are frequent agents of skin diseases in veterinary dermatology, particularly in rodents. The authors report an original case of infestation in two guinea pigs of the same household. Two adult guinea pigs were presented with a 3‐month history of alopecia, matted hair, erythema, scales and mild pruritus. The first guinea pig showed almost complete truncal alopecia with mild scaling, whereas the other one had only recently developed mild alopecia of the abdomen and mild pruritus. Numerous live, long‐legged mites were present both in adhesive tape and skin scrapings. Mycology (Wood's lamp and DTM agar culture) was negative. Histopathological examination of a skin biopsy did not reveal any significant inflammatory disease and morphological changes were limited to hair follicles in the telogen phase. Mites were identified as hypopodes of Acarus farris (Acaridae), but no adult stages were present. Hypopodes were also found in the hay. Control was obtained with acaricidal treatment with Phoxim 0.05% once weekly for 4 weeks, and the elimination of contaminated hay. The lesions and the alopecia resolved rapidly. Hypopodes are additional nymphal stages of some mites of the suborder Astigmata. They develop for dispersing or dormancy under disadvantageous conditions. They can be active or inert, and some can be phoretic on the skin surface or intrafollicular. Although nonparasitic, they may cause dermatitis. Acarus farris have been rarely mentioned in the literature as a cause of dermatitis. This condition could be underdiagnosed or misdiagnosed in veterinary dermatology. Funding: Self‐funded.     

A case of feline phaeohyphomycosis due to Fonsecaea pedrosoi

The first report of a case of feline phaeohyphomycosis due to Fonsecaea pedrosoi is presented. Fonsecaea pedrosoi is an aetiologic agent of both human phaeohyphomycosis and chromoblastomycosis. In our cat, the lesion was confined to the skin and appeared as a firm swelling on the bridge of the nose. Diagnosis was based on histological examination of a cutaneous biopsy and fungal culture of a tissue sample on Sabouraud's dextrose agar. Further diagnostic tests failed to reveal an underlying immunosuppression. Two treatment cycles with itraconazole, at the oral dose of 5 mg kg-1 given twice daily, induced complete clinical remission, but relapses occurred.     

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.     

Comparison of pulse administration versus once daily administration of itraconazole for the treatment of Malassezia pachydermatis dermatitis and otitis in dogs

OBJECTIVE To compare clinical efficacy of pulse administration with itraconazole versus once daily administration for the treatment of cutaneous and otic M pachydermatis infection in dogs. DESIGN: Randomized controlled trial. ANIMALS: 20 dogs. PROCEDURE: Dogs were treated with itraconazole orally (n = 10/group), using a pulse administration regimen (5 mg/kg [2.3 mg/lb], PO, q 24 h for 2 consecutive days per week for 3 weeks) or once daily administration (5 mg/kg, PO, q 24 h for 21 days). No other treatment was permitted. On days 0 and 21, clinical severity of cutaneous and otic disease was assessed, and samples were collected for cytologic examination and yeast culture. Cytology (sum of the mean number of yeast organisms per oil immersion field for affected sites) and culture (mean of the score for extent of yeast growth for samples from affected sites) scores were calculated. RESULTS: For dogs in both treatment groups, clinical severity of cutaneous and otic disease was significantly decreased by day 21, but decrease in severity was not significantly different between groups. Similarly, skin cytology, skin culture, and ear culture scores were significantly decreased on day 21, compared with day 0, for both groups, but decreases were not significantly different between groups except that dogs in the pulse administration group had a significantly greater decrease in ear culture scores than did dogs in the daily administration group. However, when cytology scores only for ear samples were analyzed, day 21 score was not significantly decreased, compared with day 0 score, for either group. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that both pulse administration and once daily administration of itraconazole were efficacious in the treatment of M pachydermatis cutaneous infection in dogs. However, adjunctive treatment may be needed in dogs with M pachydermatis otitis.     

Systemic mycosis in a California sea lion (Zalophus californianus) with detection of cystofilobasidiales DNA

A 6-yr-old, intact male California sea lion (Zalophus californianus) with a systemic mycosis died after 5 wk of antifungal drug therapy. Antemortem clinical findings included hind flipper swelling, ring-lesions on skin of the flippers, and dermal nodules that increased in size and number spreading from the hind flippers and ventral abdomen to the foreflippers and muzzle. Lesions were accompanied by severe lymphadenopathy and development of systemic clinical signs despite therapy using itraconazole and later voriconazole. Histopathologic evaluation of biopsies revealed granulomatous dermatitis due to infection by fungus-producing yeast cells in tissue. Isolation attempts, using biopsied skin and tissue samples collected at necropsy, failed to yield growth of a fungus producing yeast cells like those in histologic section. Consensus polymerase chain reaction (PCR) tests of biopsied skin for fungal DNA produced an amplicon having significant sequence identity with a Cystofilobasidiales, a fungus belonging to a subclade that includes several Cryptococcus spp. Histopathologic evaluation of necropsy tissues revealed a systemic mycosis with yeast cells disseminated throughout subcutis, lymph nodes, and viscera. Hepatic necrosis was identified associated with acute liver failure, possibly from the voriconazole administration. This is the first report documenting the clinical presentation, treatment, and pathologic findings of infection associated with Cystofilobasidiales in a marine mammal and serves to expand the understanding of mycoses in pinnipeds.     

Dermatomycosis caused by Paranannizziopsis australasiensis in five tuatara (Sphenodon punctatus) and a coastal bearded dragon (Pogona barbata) in a zoological collection in New Zealand

CASE HISTORY: Health monitoring of tuatara (Sphenodon punctatus) at Auckland Zoo between 2001 and 2009 showed that 58/93 tuatara had been affected by dermatitis of unknown origin. From 2011 onwards, cases of suspected fungal dermatitis underwent extensive diagnostic investigations.

CLINCAL FINDINGS: Six cases of dermatomycosis were attributed to Paranannizziopsis australasiensis, five in tuatara and one in a coastal bearded dragon (Pogona barbata). Cases presented typically as raised, yellow to brown encrustations on the skin. Severe cases progressed to necrotising ulcerative dermatitis, and in the bearded dragon to fatal systemic mycosis. Following topical and systemic treatments, lesions resolved in all five tuatara.

LABORATORY FINDINGS: Histopathological examination of skin biopsy samples revealed dermatitis with intralesional septate branching hyphae. Fungal culture yielded isolates morphologically resembling Chrysosporium species, and isolates were submitted for molecular confirmation and sequencing of DNA.

DIAGNOSIS: All six cases were confirmed as dermatitis due to infection with P. australasiensis, on the basis of fungal culture and DNA sequencing of isolates.

CLINICAL RELEVANCE: These are the first reported cases of dermatomycosis associated with P. australasiensis infection in tuatara, and the first cases in which systemic therapeutic agents have been used in the treatment of such disease. Tuatara at the Auckland Zoo are now routinely examined every 3 months and tissue samples from any lesions sent for histopathology and fungal culture. Further work to elucidate the epidemiology and significance of P. australasiensis infections in reptiles in New Zealand is important for both welfare and conservation purposes.     

Severe cryptococcal granulomas of the nasopharynx in a horse treated with standing endoscopic laser surgery and oral fluconazole

An Arabian mare was referred due to a 4-month history of bilateral mucopurulent nasal discharge, which was unresponsive to multiple courses of antimicrobials and intravenous sodium iodide. Digital radiographs revealed multiple variably sized nodular opacities within the nasopharynx. Upper airway endoscopy showed multiple, ulcerated granulomatous masses originating from the walls of the nasopharynx. Repeat culture of the exudate and from endoscopic biopsies grew only a mixed bacterial population. Standing endoscopic guided laser excision of two granulomas was performed and histopathology and culture from the center of a surgically excised granuloma identified Cryptococcus terrestris. Treatment with fluconazole (14 mg/kg bwt per os once then 5 mg/kg bwt per os q. 12 h) was administered for a total of 11 weeks. Follow-up endoscopic examination was used to guide therapy duration, and the horse has since returned to competition and remained free of infection for >1.5 years. Establishing a diagnosis of cryptococcal infection was difficult in this horse despite multiple culture attempts. This is the first report of Cryptococcus terrestris infection in a horse and treatment with oral fluconazole after surgical de-bulking was successful.     

Cutaneous Alternaria infectoria infection in a dog in association with therapeutic immunosuppression for the management of immune‐mediated haemolytic anaemia

A 4‐year‐old, ovariohysterectomized, English springer spaniel on immunosuppressive therapy was re‐examined for the review of its immune‐mediated haemolytic anaemia and the recent development of skin lesions. For the 3 months since hospital discharge, the dog had been receiving 1.3 mg/kg prednisolone and 2.6 mg/kg ciclosporin, both administered orally twice daily. Physical examination revealed hepatomegaly and multiple, purulent, crusting, erosive to ulcerative lesions over different body areas. Onychorrhexis had occurred on one digit and the underlying corium had blackened. There were two proliferative and one plaque‐like lesions in the mouth. Thick walled fungal hyphae were detected in impression smears from all skin lesions and staining with periodic acid–Schiff’s stain confirmed the presence of multiple fungal hyphae and spores in all biopsies examined. Fungal culture isolated a heavy, pure growth of an Alternaria sp. which was identified as A. infectoria by sequencing the internal transcribed spacer 1 region of the rRNA gene. The animal’s condition prevented detailed investigation of the oral lesions. Withdrawal of the ciclosporin and reduction of the prednisolone dosage resulted in spontaneous resolution of the skin lesions within 40 days. Further gradual decrements in the prednisolone dosage to zero were carried out without recurrence of the immune‐mediated haemolytic anaemia. After 12 months, there has been no recurrence of either the skin lesions or the anaemia. To the authors’ knowledge, this is the first reported case of A. infectoria infection in a dog.     

Treatment of Malassezia pachydermatis-associated seborrhoeic dermatitis in Devon Rex cats with itraconazole--a pilot study

Treatment of Malassezia pachydermatis-associated seborrhoeic dermatitis with oral itraconazole was investigated in six Devon Rex cats (DRC). The cutaneous populations of Malassezia were determined using contact plates and a swab-wash method before and after 21 days of pulse treatment with itraconazole (5 mg kg-1 once daily, 7 days on, 7 days off, 7 days on). Before treatment, all cats had greasy seborrhoeic dermatitis involving the axillae, groin, claw folds and palmar and plantar interdigital skin, and two had similar lesions on the ventral neck. After treatment, there was a significant (P<0.05) reduction in overall clinical scores and in scores at all individual sites assessed, except for the interdigital skin (P=0.068). Population sizes of M. pachydermatis in the left and right axillae, left and right groin and palmar interdigital skin were significantly (P<0.05) reduced, whereas the reduction in claw fold counts did not reach significance (P=0.068). The dramatic reduction in yeast counts and an associated marked clinical improvement of the seborrhoeic dermatitis provide important pilot data on the potential value of oral itraconazole in the management of seborrhoeic dermatitis associated with M. pachydermatis in DRC.     

P-89 Aeromonas hydrophila-associated skin lesions and septicaemia in a Nile crocodile

Mites are frequent agents of skin diseases in veterinary dermatology, particularly in rodents. The authors report an original case of infestation in two guinea pigs of the same household. Two adult guinea pigs were presented with a 3-month history of alopecia, matted hair, erythema, scales and mild pruritus. The first guinea pig showed almost complete truncal alopecia with mild scaling, whereas the other one had only recently developed mild alopecia of the abdomen and mild pruritus. Numerous live, long-legged mites were present both in adhesive tape and skin scrapings. Mycology (Wood's lamp and DTM agar culture) was negative. Histopathological examination of a skin biopsy did not reveal any significant inflammatory disease and morphological changes were limited to hair follicles in the telogen phase. Mites were identified as hypopodes of Acarus farris ( Acaridae ), but no adult stages were present. Hypopodes were also found in the hay. Control was obtained with acaricidal treatment with Phoxim 0.05% once weekly for 4 weeks, and the elimination of contaminated hay. The lesions and the alopecia resolved rapidly. Hypopodes are additional nymphal stages of some mites of the suborder Astigmata . They develop for dispersing or dormancy under disadvantageous conditions. They can be active or inert, and some can be phoretic on the skin surface or intrafollicular. Although nonparasitic, they may cause dermatitis. Acarus farris have been rarely mentioned in the literature as a cause of dermatitis. This condition could be underdiagnosed or misdiagnosed in veterinary dermatology.
Funding: Self-funded.     

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.     

Pseudomycetoma caused by Microsporum canis in a Persian cat: lack of response to oral terbinafine.

An eight-year-old neutered female Persian cat with a four-year history of relapsing skin disease, characterised by ulcerated nodules with a yellow granular discharge, was examined. A diagnosis of granulomatous dermatitis and panniculitis (pseudomycetoma) caused by Microsporum canis was made on the basis of history, clinical signs, histopathological examination of skin biopsy specimens and culture of macerated tissue. Because previous therapy, comprising repeated surgical excision and the administration of griseofulvin and itraconazole, had not been successful, terbinafine was administered for an eight-month period. However, lesions progressed despite this treatment and the cat was euthanased.     

Eradication of feline dermatophytosis in a shelter: a field study

Enzootic dermatophytosis in a shelter with approximately 140 cats was treated according to a protocol combining identification, isolation and treatment of subclinical carrier and affected animals in accordance with a three‐area system: healthy animals (no lesions and negative cultures), subclinical carrier animals (no lesions but with positive cultures) and clinically affected animals (lesions and positive cultures). The cats were examined and inspected under a Wood’s lamp and had samples taken for fungal culture every 2 weeks. Thirty‐three per cent of the cats had a positive fungal culture at the start of the study. Clinically affected animals and carriers were treated with a 0.2% enilconazole lotion (Imaverol^®) twice a week and given itraconazole (Itrafungol^®) 5 mg/kg SID orally every other week. The environment was treated once a day with a 1% bleach solution and once a week with a 0.6% enilconazole (Clinafarm^®) solution. Treated animals were considered cured after two consecutive negative fungal cultures. All cats were cured within 56 days. Prophylactic measures against dermatophytosis were implemented for new arrivals consisting of individual quarantine and the systematic taking of fungal cultures. No relapses were observed based on the fungal cultures taken from the animals and the environment over the first 10 months.     

Cutaneous Serratia marcescens infection in two dogs

We describe two canine cases of cutaneous infection caused by Serratia marcescens. A 2-year-old castrated male mixed dog (Case 1) presented with multiple ulcerations on the dorsal trunk, which were observed 4 days after shampooing. A 4-year-old male wolf shepherd mix dog (Case 2) presented with ulceration and purulent discharge on the nasal bridge. Cytological examination of both cases revealed pyogranulomatous inflammatory cells with rod-like infectious agents identified as S. marcescens in aerobic bacterial culture. Both patients were treated with oral antibiotics and topical chlorhexidine. Case 1 received enrofloxacin 10 mg/kg once daily for 1 week, followed by trimethoprim/sulfamethoxazole 15 mg/kg twice daily for 3 weeks. Case 2 received doxycycline 10 mg/kg twice daily for 4 weeks. No skin lesions were detected 2 weeks after the initial administration. The antibiotics were discontinued after a total 4 weeks of administration, and the skin lesions did not reappear.     

Frequency, body distribution, and population size of Malassezia species in healthy dogs and in dogs with localized cutaneous lesions.

Malassezia species are commensal organisms of human and animal skin that occasionally act as opportunistic pathogens. The lipid-dependent species are associated with human skin disorders, whereas the non-lipid-dependent species (Malassezia pachydermatis) is considered as an opportunistic secondary pathogen affecting the canine skin surface and ear canal. This study evaluated the relationship between Malassezia yeasts, their population size, and the occurrence of skin lesions from healthy and skin-diseased dogs. The efficiency of cytological examination and fungal culture for Malassezia detection was also evaluated. From March 2002 to July 2003, 33 healthy dogs and 54 dogs with pruritic localized skin diseases were examined; skin swabs (1218) were collected from 7 anatomical sites for culture and cytological examination. Malassezia prevalence according to anatomical site and the agreement between cytological results and fungal cultures were statistically analyzed. Differences in mean colony forming unit counts between positive healthy and diseased dogs were evaluated using the Bonferroni test for post hoc pair-wise comparisons. In healthy dogs, Malassezia yeasts were most frequently isolated in the perianal and perioral areas. The frequency of isolation and population size of Malassezia species were higher in dogs with localized dermatitis, especially in affected areas, indicating a role for Malassezia in the occurrence of skin lesions. Malassezia pachydermatis was the species most commonly cultured from the skin and external ear canal of healthy and diseased dogs; isolation of lipid-dependent yeasts from healthy dogs was less frequent. Using fungal culture as the gold standard, cytological examination showed good relative specificity (95%) but very low relative sensitivity (30%).     

Clinical Picture and Antibody Response to Experimental Sarcoptes scabiei var. vulpes Infection in Red Foxes (Vulpes vulpes)

Three red foxes (Vulpes vulpes) were experimentally infected with Sarcoptes scabiei isolated from a naturally infected wild red fox. A fourth red fox served as a control. The first signs of sarcoptic mange became evident on the 31st day post infection (dpi). The signs gradually increased thereafter and between dpi 49 and 77 characteristic lesions of hyperkeratosis developed. Two of the infected foxes developed severe sarcoptic mange, and one of these animals died on dpi 121. The third fox developed a chronic hyperkeratotic lesion on its back, at the site where the mites had been applied. On dpi 127 the surviving foxes were treated systemically with ivermectin, and within 4 weeks the skin lesions had healed except on the pinnae of one animal.Antibodies to S. scabiei var. vulpes were demonstrated in the infected foxes by an ELISA with which seroconversion was seen around 4 weeks post infection (wpi). Western blot analysis of sequential sera of the infected animals demonstrated antibody activity consistently after the 2nd wpi.The fourth, non-infected, fox did not show any skin lesions throughout the experimental period nor any specific antibodies to S. scabiei var. vulpes. kw|Keywords|k]sarcoptic mange; k]red fox; k]serodiagnosis; k]ELISA     

Chronic monolateral otomycosis in a dog caused by Aspergillus ochraceus

Aspergillus ochraceus, a widely distributed filamentous fungus, was isolated and identified by cytology and culture as the cause of unilateral ceruminous purulent otitis in a 4‐year‐old male mixed‐breed dog. The pathogenic role of the fungal isolate was confirmed by a good response to antifungal therapy and the absence of other pathogens. No underlying diseases were identified and the dog recovered after 3 weeks of therapy with oral itraconazole and topical miconazole.