A retrospective study of canine persistent nasal disease: 80 cases (1998-2003)

Persistent canine nasal disease is a common complaint in small animal practice; however, an etiologic diagnosis can be difficult to establish. The aim of this retrospective study was to determine the percentage of cases for which the etiology was determined in our hospital population. Medical records from 80 dogs met the criteria of inclusion in the study. Nonspecific rhinitis was identified in 23.7% of cases. Other diagnoses were neoplasia (15.0%), fungal infection (nasal aspergillosis) (8.7%), cleft palate (8.7%), periodontal disease (4.0%), parasites (1.3%), foreign body (1.3%), and primary bacterial disease (1.3%). A definitive diagnosis could not be established in 36.3% of cases. Dogs with neoplastic and mycotic diseases often presented with severe radiographic and rhinoscopic lesions. Despite a systematic approach, numerous cases went undiagnosed. The use of advanced imaging should increase our ability to obtain an etiologic diagnosis in canine nasal disease.     

Immunology of fungal infections in animals

The nature of immunity to fungal infection is discussed predominantly for mammals and birds. T-cell-mediated immunity seems essential for recovery both from cutaneous and mucosal infections (Candida, Malassezia and dermatophytes) and from infections of systemic fungal pathogens (Cryptococcus, Blastomyces, Histoplasma, and Coccidioides). Often chronic progressive disease caused by these fungi is associated with a depression or absence of T-cell-mediated immunity to antigens of the infecting fungus. In contrast recovery from disease, or absence of clinical disease after exposure to these fungi, is associated with the presence of strong T-cell-mediated immune responses to the fungus. The activation of macrophages and the stimulation of epidermal growth and keratinization are the processes induced by T-cell-mediated immunity which result in the resolution of systemic or cutaneous and mucosal disease. Other cell types, for example NK cells and PMNs (polymorphonuclear leucocytes), may be important in these diseases in reducing the effective amount of inoculum to which an animal is exposed and thereby reducing the likelihood of disseminated disease. Invasive opportunistic fungi (Candida, Aspergillus, Mucorales) are resisted by PMNs which attach to the hyphae or pseudohyphae and damage them via an extracellular mechanism. Other host cell types may be important in natural resistance, fungal spores being handled by the macrophages which, under conditions when animals are not immunosuppressed, are likely to be an effective first line of defense. Subcutaneous pathogens and miscellaneous other fungal diseases are discussed from a point of view of host immunity and immunodiagnosis. Vaccine development for ringworm and for other mycoses is discussed.     

Fungal diseases of reptiles.

Fungal infections affecting the integumentary system, the upper and lower respiratory system and the gastro-intestinal tract have been reported in many species of captive reptiles. Systemic mycoses are diagnosed rarely in reptiles, and in most cases, they are a postmortem finding. Commonly, immunocompromised reptiles, kept in suboptimal environmental conditions are affected. In many cases, mixed bacterial and fungal infections of opportunistic organisms may be present. A diagnosis of a primary fungal infection is based on proper selection and collection of diagnostic specimens such as biopsies of infected tissues. Treatment of fungal infections in reptiles includes administration of effective antifungal agents and correction of inappropriate environmental conditions such as poor hygiene, too high or too low temperature and humidity, inadequate diet, and stress from overcrowding. Few studies have investigated effective dosages and dosage intervals of antifungal agents in reptiles.     

Fatal Beauveria bassiana infection in a captive American alligator

The entomopathogenic fungus, Beauveria bassiana, was isolated from pulmonary lesions of a dead American alligator (Alligator mississipiensis) at the Oklahoma City Zoo. Colonies of the fungus, which had sporulated in vivo, were found in the thoracic air spaces. Septate, branching hyphae and fungal spores were seen in stained histologic sections of pleura and lung. Dissemination to other viscera had not occurred. This case indicated that B bassiana, a rare vertebrate pathogen, may be a fatal mycotic agent in captive reptiles.     

Rhinoscopy

This article presents a diagnostic protocol for nasal disease evaluation that provides consistent success in diagnosis of chronic cases. The protocol includes history, physical examination, blood clinical pathology assessment, radiographs, culture and sensitivity tests, rhinoscopy, histopathology, fungal serology, and allergy screening. The sequence of diagnostic procedures and their techniques are discussed, and rhinoscopic appearance of the normal nasal cavity is presented, along with findings of commonly seen nasal diseases, including neoplasia, mycotic rhinitis and sinusitis, foreign body obstruction, dental disease, allergic rhinitis, bacterial rhinitis, and idiopathic rhinitis. Rhinoscopy is a highly effective diagnostic technique with minimal morbidity and mortality that has virtually eliminated the need for exploratory rhinotomy.     

A case series of unilateral orbital aspergillosis in three cats and treatment with voriconazole

Feline orbital aspergillosis is increasingly described in the published reports and may be an emerging disease. Orbital mycotic infections were diagnosed in three cats with exophthalmos, significant dorso‐temporal globe deviation and pronounced resistance to retropulsion. Advanced imaging was performed in all three cases to evaluate the extent of disease as well as to obtain guided orbital biopsies in two cases. Surgical intervention in the form of a lateral orbitotomy was pursued in the first case with the other two cases treated with enucleation or medical management alone. The available published reports concerning sino‐orbital aspergillosis are reviewed. Oral therapy with a novel triazole, voriconazole, was instituted in two cases. Although voriconazole was apparently effective against the fungal organisms, it is also resulted in adverse reactions.     

Fungal diseases of rabbits.

Although fungal diseases in rabbits are reported, they are encountered infrequently in clinical practice. The most common fungal disease is a superficial dermatophytosis, with deep mycotic infections being rare. Rabbits can be asymptomatic carriers of dermatophytes and should be considered a potential source of zoonotic exposure. Treatment protocols often are based on common small animal regimes. Rabbits also have normal gastrointestinal yeast that often is found on routine fecal examinations.     

Feline systemic fungal infections.

Systemic fungal diseases are important diagnostic considerations in all sick cats, particularly in cats with ocular symptoms. The most common ocular manifestation of these diseases is posterior uveitis (choroiditis); however, anterior uveitis is sometimes present and is usually secondary to the inflammation in the posterior segment. Occasionally, adnexal diseases such as blepharitis, inflammation of the nictitating membrane, and ocular discharge may be present in cats with systemic mycoses. The prognosis for cats with systemic fungal diseases has changed with the advent of the triazole antifungal drugs. In the past, the prognosis was guarded to poor for survival of the cat. Today, with prolonged antifungal therapy, many cats recover completely from their disease. The prognosis for return of vision for eyes affected with systemic fungal disease is still guarded. Often, even if the infection is controlled systemically, the retina is severely damaged and may remain nonfunctional.     

Geotrichum candidum as etiological agent of horse dermatomycosis

Fungi of the genus Geotrichum are commonly found in the environment and, in some circumstances, they may cause diseases in humans and animals. Although these fungi have been isolated from skin lesions of some animal species, their pathogenic role in horses remains uncertain. With the aim to investigate the role of Geotrichum candidum as etiological agent of dermatomycoses, a retrospective study of 64 horses presenting skin lesions and suspected to have fungal infections was carried out. For each animal, anamnestic data were recorded and fungal culture were performed using hair. Out of 64 cases, 18 (28.1%) were positive for G. candidum and only two (3.1%) for dermatophytes (i.e., one for Microsporum equinum and the other for Microsporum canis). Alopecia, desquamation, and pruritus localized mainly on head and neck were frequently observed in G. candidum infected animals. Most of G. candidum infections were recorded during spring (44.4%). Out of the 18 animals presenting G. candidum infections, eight were treated using a disinfectant with antifungal properties. After one month of treatment, the clinical lesions were healed and fungal cultures resulted negative. The high prevalence of G. candidum in skin lesions of horses and the clinical recover following antifungal treatment indicated that these yeast-like fungi might play a role as etiological agents of horse cutaneous mycoses.     

Mycotic disease in the common New Zealand gecko (Hoplodactylus maculatus)

Two adult female geckoes (Hoplodactylus maculatus) from the National Wildlife Centre, Mt Bruce, Masterton, died within the period of a month and were presented to the Department of Veterinary Pathology and Public Health at Massey University for necropsy. The first gecko had numerous 1-2 mm diameter punctate ulcers of the skin over the ventral and dorsal regions of the body. The second animal had slight discolouration of some of the scales. Skin swabs were taken from each case for culture. There were no other gross lesions apparent at necropsy. Histologically, the only lesions in the first gecko were areas of epidermal and dermal ulceration involving fungi and bacteria. In the second gecko, there was limited inflammation in the skin, but in the lungs there was necrosis of the pulmonary septae and constituent muscle bundles caused by fungi whose septate mycelia extended into adjacent large blood vessels and caused mycotic thrombi; hyphae were also found in the spleen and liver. Paecilomyces sp. septate fungus was recovered from both geckoes and Pseudomonas spp. and a mixed Gram-negative flora were recovered from the cutaneous lesions on culture. The death of the first gecko was considered to be due to widespread ulcerative dermatitis, while that of the second gecko was thought to be due to mycotic pneumonitis and mycotic septicaemia. It is believed that environmental factors, such as cold temperature and high humidity, contributed to a reduction in the immune response in the affected geckoes, with the consequent development of overwhelming fungal infections.     

Effect of sampling method and incubation temperature on fungal culture in canine sinonasal aspergillosis

O bjectives : To evaluate the most appropriate sampling procedure and the effect of incubation temperature on fungal culture in the diagnosis of canine sinonasal aspergillosis (SNA).
M ethods : Sixteen dogs with SNA and 20 dogs with non-fungal nasal disease entered a prospective study. Nasal secretions and mucosal biopsies were collected in all dogs. Fungal plaques were also sampled in dogs with SNA. Each specimen was taken in duplicate from each dog and incubated at room temperature and 37°C.
R esults : In dogs with SNA, nasal secretions, mucosal biopsies and fungal plaques yielded fungal growth at room temperature in one, one and seven dogs, respectively, whereas fungal growth was obtained at 37°C in three, 12 and 14 dogs, respectively. No specimen collected from any dog with non-fungal nasal disease yielded fungal growth at room temperature or at 37°C.
C linical S ignificance : The diagnosis of canine SNA is more likely to be confirmed following culture of mucosal biopsies or fungal plaques than nasal secretions sampled blindly with swabs. Incubating cultures at 37°C is more likely to provide a diagnostic outcome than when samples are cultured at room temperature. Fungal culture of nasal specimens has good specificity for the diagnosis of SNA in dogs.     

Chronic ovine laryngitis

Two adult female geckoes (Hoplodactylus maculutus) from the National Wildlife Centre, Mt Bruce, Masterton, died within the period of a month and were presented to the Department of Veterinary Pathology and Public Health at Massey University for necropsy. The first gecko had numerous 1–2 mm diameter punctate ulcers of the skin over the ventral and dorsal regions of the body. The second animal had slight discolouration of some of the scales. Skin swabs were taken from each case for culture. There were no other gross lesions apparent at necropsy. Histologically, the only lesions in the first gecko were areas of epidermal and dermal ulceration involving fungi and bacteria. In the second gecko, there was limited inflammation in the skin, but in the lungs there was necrosis of the pulmonary septae and constituent muscle bundles caused by fungi whose septate mycelia extended into adjacent large blood vessels and caused mycotic thrombi; hyphae were also found in the spleen and liver. Paecilomyces sp. septate fungus was recovered from both geckoes and Pseudomonas spp. and a mixed Gram-negative flora were recovered from the cutaneous lesions on culture. The death of the first gecko was considered to be due to widespread ulcerative dermatitis, while that of the second gecko was thought to be due to mycotic pneumonitis and mycotic septicaemia. It is believed that environmental factors, such as cold temperature and high humidity, contributed to a reduction in the immune response in the affected geckoes, with the consequent development of overwhelming fungal infections.     

Amphibian virology.

Amphibians are a diverse group of species; much work remains to be done to elucidate the viruses of amphibians. Viral diseases may play an important role in wild and captive amphibian populations. Iridoviruses are a leading cause of wild amphibian mortality events in the United States and are a common cause of amphibian mortality events worldwide. In addition to frank viral diseases, viral infections may play a role in the establishment of bacterial, fungal, and parasitic diseases and are an underlying cause of neoplasia. It is important for the amphibian clinician to recognize disease syndromes and pathology that are consistent with viral etiology.     

Sonographic evaluation of the normal and abnormal pancreas

Pancreatic disorders in dogs and cats are recognized with increasing frequency, and abdominal ultrasonography has assumed an important role in their diagnosis. The normal pancreas is a small, inconspicuous organ of comparable echogenicity to surrounding mesentery and may be difficult to identify. Therefore, knowledge of anatomic landmarks such as portal vein and contributing vessels, duodenum, and stomach is necessary to facilitate identification and examination. Pancreatic diseases and abnormalities frequently investigated by means of ultrasonography include pancreatitis, pseudocysts, abscesses, neoplastic lesions, and nodular hyperplasia. Disorders less commonly seen include exocrine pancreatic insufficiency, pancreatolithiasis, congenital anomalies, and pancreatic edema. Unfortunately, ultrasonographic findings in various pancreatic disorders overlap, and incidental findings or age-related changes may mimic pancreatic disease. On the other hand, pancreatic disorders may not cause changes in ultrasonographic appearance. Ultrasonographic findings, therefore, have to be judged in light of signalment, history, and laboratory data. Cytology or histopathology may be needed to establish a definite diagnosis. Despite these limitations, ultrasonography is useful in diagnosing pancreatic disease, guiding aspirates and biopsies, and monitoring response to treatment.     

Fungal diagnostics: current techniques and future trends.

The diagnosis of fungal disease is a challenge that requires diligent attention to history and clinical signs as well as an astute ability to interpret laboratory data. Because fungal disease can mimic other infectious and neoplastic diseases in clinical presentation, the clinician has to be aware of fungal diseases common locally as well as in other regions of the country. A global approach to the diagnosis of fungal disease that correlates clinical signs as well as physical examination, clinical pathology, and histopathology findings with serology, culture, and the newer immunohistochemical and molecular techniques, where available, is the best approach to optimize the identification of the underlying agent.     

Diseases of the pinna

Many diseases can affect the pinna of the dog and cat. These diseases represent most categories of cutaneous disease, from infectious to neoplastic. Although some diseases affect primarily the pinna, most pinnal dermatoses occur in conjunction with other integumentary disorders. One should approach the diagnostic work-up of pinnal disease in an organized manner, obtaining first a thorough history and physical examination. A systematic approach is required in the diagnostic evaluation in order to arrive at a tentative or definitive diagnosis. Skin scrapings, cytologic examination, and culture for dermatophytes provide the minimum database. A variety of diagnostic tests, including hematology, serum biochemical profiles, urinalysis, serology, intradermal skin testing, hypoallergenic diet trials, histopathology, and direct immunofluorescence, may be necessary in some cases before a definitive diagnosis is reached. The ears are somewhat difficult to biopsy, although in many instances histopathologic examination is essential to the diagnosis. In this author's opinion, it is preferable to use a no. 15 scalpel blade rather than a punch biopsy when obtaining a pinnal biopsy. This allows the veterinarian to obtain an elliptical or wedge biopsy, which can frequently be sutured. In some instances, biopsies are required from the ear margin and a full ear thickness biopsy is obtained. Sutures may not hold in this situation, and cautery may be necessary for hemostasis. As in other situations in which the ear is bleeding (aural hematomas, vasculitis, fly bite dermatitis, and so on), bandaging and immobilization of the ear may be necessary to prevent further trauma. Although symptomatic therapy is sometimes helpful when treating pinnal diseases, a definitive diagnosis is preferred. This is especially important following the second or third presentation of an animal for ear disease. Although ear diseases are frequently viewed as a nuisance rather than a serious condition, anyone who has owned or worked closely with an animal suffering from chronic otitis externa should appreciate the animal's discomfort and the owner's frustration. All too frequently, the chronic otitis externa is the result of a hypersensitivity (either inhalant or food) that has been overlooked in the attempt to treat the subsequent infectious otitis. Thus, in animals with recurrent otitis externa, every attempt should be made to identify and treat the underlying etiology.     

Beyond conidiobolomycosis – the other ‘zygomycoses’

Disease resulting from infection by Zygomycetes fungi (including two groups of coenocytic fungal pathogens: the Mucormycota and the Entomophthoramycota) has been collectively referred to as zygomycosis. Clinical disease associated with both the Mucormycota and the Entomophthoramycota is rarely encountered in horses. Potentially life-threatening, mucormycosis is an angioinvasive disease that principally affects immunocompromised individuals. The order of Entomophthorales include two genera: Conidiobolus and Basidiobolus. The most common of these, Conidiobolus coronatus, typically causes chronic necrohaemorrhagic tumefactions in the nostrils, nasal passages and nasopharyngeal walls of immunocompetent equine hosts, most commonly seen in the south-eastern USA and parts of Australia. Infection by Basidiobolus ranarum is reported less frequently and usually causes solitary ulcerative skin lesions with pruritus. This short commentary intends to complement the accompanying review of conidiobolomycosis by summarising reported cases of mucormycosis and basidiobolomycosis in horses. Moreover, some new information regarding taxonomic challenges to traditional ‘Zygomycosis’ classification is presented.     

Adiaspiromycosis in suspected cases of pulmonary tuberculosis in the common brushtail possum (Trichosurus vulpecula)

Pulmonary adiaspiromycosis was diagnosed in 15 of 17 common brushtail possums (Trichosurus vulpecula) examined for bovine tuberculosis. Emmonsia crescens was isolated from two of the affected animals. This is the first reported isolation of this dimorphic fungus in New Zealand. The infections varied from light to heavy with sparsely distributed, focal, 1-2 mm diameter, grey-white spherical granulomas in the lightly infected cases to innumerable foci throughout the lungs in the heavily infected cases. Histologically, the lesions were characterised by a central fungal adiaspore consistent in morphology with E. crescens located in alveolar spaces or bronchioles. These were surrounded by a cuff of granulomatous inflammation which varied in density and extent in proportion to the degree of degeneration exhibited by the organism. The lesions in most cases of adiaspiromycosis in the possum are sufficiently distinctive to allow their differentiation from tuberculosis by gross examination, but where any doubt exists over the possibility of dual infection by Emmonsia and Mycobacterium species differentiation should be made on the basis of a histological examination of the tissue and culture for mycobacterial organisms.     

Fatal mycotic dermatitis in captive brown tree snakes (Boiga irregularis).

Cutaneous fungal infections occurred in four captive brown tree snakes (Boiga irregularis). The ventral scales were most commonly affected, and lesions began as areas of erythema and edema with vesicle formation, followed by development of caseous brown plaques. Lesions usually started where ventral scales overlapped and spread rapidly. All snakes died within 14 days after clinical signs were first noted. The deaths of three of the snakes were directly attributable to the cutaneous disease; the other snake died from renal failure and visceral gout, most likely induced by gentamicin therapy. Histologically, lesions consisted of epidermal hyperplasia and hyperkeratosis, with foci of epidermal necrosis, intraepidermal vesicle formation, and subacute inflammation of the underlying dermis. These lesions were associated with bacteria and numerous septate, branched fungal hyphae within the epidermis and overlying serocelluar crusts. Hyphae that penetrated through the superficial surface of the epidermis often formed terminal arthroconidia. The same species of fungus was isolated in pure culture from the skin of three snakes, but fungal cultures were not performed on samples from the fourth snake. The fungus has been identified as the Chrysosporium anamorph of Nannizziopsis vriesii based on its formation of solitary dermatophytelike aleurioconidia and alternate and fission arthroconidia. The source of the fungus in this outbreak was not determined; however, the warm, moist conditions under which the snakes were housed likely predisposed them to opportunistic cutaneous fungal infections.