Page 202 - Cote clinical veterinary advisor dogs and cats 4th

Aspergillosis 83

with oral itraconazole was reported in four
dogs.
VetBooks.ir time of conclusive diagnosis because of the Diseases and Disorders
• Many affected dogs are euthanized at the
extent of lesions and underlying deficiencies
in immunity.
Canine sinonasal: fair to good
• Clinical signs resolve with a single treatment
in 65% of dogs, and 87% of dogs with a
total of one or more treatments.
• A lesser extent of radiographic lesions is
associated with a better prognosis.
Feline sino-orbital: poor prognosis

PEARLS & CONSIDERATIONS
Comments
• For sinonasal aspergillosis, nasal discharge
ceases (permanently) in most dogs within 2
weeks of treatment. Occasional recurrence
Nasal Aspergillosis Normal of nasal signs due to secondary bacterial
ASPERGILLOSIS Computed tomographic image of the nasal cavities of two dogs. The dog on the left has rhinitis is possible due to destruction of nasal
nasal aspergillosis; there is asymmetrical loss of turbinates. The dog on the right is normal (for comparison). turbinates.
(Courtesy Robert O’Brien, DVM, DACVR, University of Illinois.) • The frontal sinuses should be imaged in any
patient suspected of having nasal aspergillosis.
• Polymerase chain reaction (PCR) is becoming
must be supported by additional tests to of choice, provided the cribriform plate is more common to establish a diagnosis in
make the diagnosis. intact (as assessed on CT). people and may become more available in
• Debridement of the nasal passages/sinuses veterinary medicine in the future.
TREATMENT (by trephination if necessary) improves • Combination therapy with echinocandins
outcome of topical treatment. (antifungal agents that act on the cell wall)
Treatment Overview • Refractory cases or those with damage to plus azoles is currently being studied in
For systemic aspergillosis, treatment consists the cribriform plate can be treated with people.
of long-term systemic antifungal medication long-term posaconazole (5 mg/kg q 12h) • The recent discovery that A. fumigatus has
and supportive care. For sinonasal aspergillosis, and terbinafine (30 mg/kg q 12h). a sexual reproductive cycle may offer future
treatment is usually locally administered treatment options as the genetic basis of the
antifungal medications. No ideal treatment has Possible Complications pathogenicity is elucidated.
been identified for feline sino-orbital disease. • Intractable infection • Although nasal turbinates may have the
• Voriconazole can cause adverse neurologic potential to regrow, there is limited informa-
Acute and Chronic Treatment events in cats and dose-related visual distur- tion in veterinary medicine and no follow-up
Systemic: bances and photophobia in people. Anaphy- studies aimed at assessing this question.
• Voriconazole is the treatment of choice and lactoid reactions have been reported after
associated with improved survival in people. intravenous administration in people. This Technician Tips
A loading dose of 6 mg/kg PO q 12h is is a very new drug to veterinary medicine, CT can be done with minimum to no sedation
given for 2 days, followed by a maintenance and little is known about side effects in dogs. if the VetMousetrap is used (for small dogs
dose of 3-4 mg/kg PO q 12h for several • Resistance to azoles, the first line of treat- and cats).
months after complete resolution of clinical ment, is an emerging concern and appears
signs. Often cost prohibitive in veterinary to be due to long-term treatment as well as Client Education
patients. extended use in agriculture. Diagnosis of aspergillosis is complex but
• A. terreus is resistant to amphotericin B, and important because diagnostic tests help deter-
this drug is no longer recommended for Recommended Monitoring mine the likelihood of success.
treatment of systemic disease from A. terreus Evolution/resolution of clinical signs; serial
in people. titers are not useful. SUGGESTED READING
• Alternative: itraconazole 5 mg/kg PO q 12h Stewart J, et al: Treatment of refractory sino-nasal
indefinitely and often lifelong. Monitor for PROGNOSIS & OUTCOME aspergillosis with posaconazole and terbinafine in
liver adverse effects. Absorption enhanced 10 dogs. J Small Anim Pract 58:504-509, 2017.
substantially by administering with food. Systemic:
Sinonasal: • The prognosis is almost universally poor, AUTHOR: Maureen A. McMichael, DVM, DACVECC
EDITOR: Joseph Taboada, DVM, DACVIM
• Endoscopic/nonsurgical intranasal clotrima- although some dogs may obtain palliation.
zole or enilconazole infusion is the treatment The induction of long-term clinical remission

www.ExpertConsult.com