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184 Coccidioidomycosis

Dogs: 251-908 ng/L, cats: 290- If the underlying disease process has resolved
■ PEARLS & CONSIDERATIONS
1500 ng/L and cobalamin body stores have been replen- Comments
VetBooks.ir • Measurement of methylmalonic acid (MMA) be supranormal at the time of re-evaluation. • Patients with severe cobalamin deficiency
ished, serum cobalamin concentration should
Other laboratories may have different
■
reference ranges.
often do not respond to therapy of the
• If serum cobalamin concentration is in the
in serum or urine: not routinely available
should be continued at least monthly
supplemented.
○ Increased serum or urinary MMA indicates normal range, cobalamin supplementation underlying GI disorder until cobalamin is
cobalamin deficiency at the cellular level. (parenteral) or daily (oral). • Monitoring of serum cobalamin in geriatric
• Serum trypsin-like immunoreactivity to rule • If serum cobalamin concentration at the time cats is recommended as part of routine evalu-
out EPI of recheck is subnormal, further investigation ation because they may become deficient due
• Serum folate to rule out SIBO/ARD is required to identify the underlying disease to decreased ability to absorb B 12 .
process. Cobalamin supplementation should • A study has shown that cats with chronic
TREATMENT be continued weekly or biweekly (parenteral) GI disease and cobalamin deficiency unre-
or daily (oral). Dogs or cats with chronic sponsive to previous therapy responded
Treatment Overview disease often require lifelong therapy to with weight gain quickly after beginning
The goal is to correct cobalamin deficiency maintain appropriate cobalamin levels. cobalamin supplementation.
at the cellular level and correct clinical signs • Cobalamin deficiency on a cellular level may
(i.e., GI, hematologic, immunologic, and Possible Complications occur even when serum cobalamin concentra-
neurologic). Cobalamin is nontoxic and can be administered tion is at the low end of the normal range
in large doses with minimal risk of side effects. (<350 ng/L); parenteral or oral cobalamin
Chronic Treatment supplementation should be considered for
Repeated high doses of cobalamin by parenteral Recommended Monitoring these patients.
administration or daily oral supplementation are • Depending on the underlying cause of
necessary; lifelong parenteral dosing is manda- cobalamin deficiency and the clinical signs, Technician Tip
tory for patients with congenital cobalamin measure serum cobalamin concentration Multivitamin preparations contain an insuf-
deficiency because they cannot absorb orally every few months. ficient amount of cobalamin and are not
administered cobalamin. • In animals with the congenital form, more recommended for supplementation.
• Cyanocobalamin is the preferred form, but frequent checks may be necessary until an
hydroxycobalamin can also be used. optimal dose regimen has been established. SUGGESTED READING
Recommended empirical parenteral dosing Toresson L, et al: Oral cobalamin supplementation in
schedule of cyanocobalamin: PROGNOSIS & OUTCOME dogs with chronic enteropathies and hypocobala-
• 150-250 mcg per injection in cats; minemia. J Vet Intern Med 30:101, 2016.
250-1200 mcg per injection in dogs • In the congenital form, the response to par-
• Dose every 7 days for 6 weeks, then one enteral cyanocobalamin is usually excellent, AUTHOR: Jan S. Suchodolski, MedVet, Dr. Med. Vet.,
PhD, DACVM
dose after 30 days, and retesting 30 days leading to reversal of clinical abnormalities. EDITOR: Rance K. Sellon, DVM, PhD, DACVIM
after the last dose • In the acquired form, prognosis depends on
Recommended empirical oral dosing schedule the underlying disease.
of cyanocobalamin: ○ Usually excellent in animals with EPI
• 250 mcg in cats and 250-1000 mcg in dogs, in combination with pancreatic enzyme
depending on the size of the patient replacement therapy
• Daily oral administration for total of 12 ○ Hypocobalaminemia has been associated
weeks and recheck serum cobalamin con- with a poor outcome in dogs with severe
centration 1 week after the last dose. chronic enteropathies.

Coccidioidomycosis Bonus Material Client Education
Sheet
Online

BASIC INFORMATION RISK FACTORS CONTAGION AND ZOONOSIS
• Amount of roaming space > 1 acre • Coccidioidomycosis occurs in humans,
Definition • Walking in the desert (in endemic areas, who can become infected from the same
A respiratory or systemic fungal infection caused a decreased risk has been associated with environmental source as animals.
by Coccidioides immitis or Coccidioides posadasii; walking preferentially on sidewalks) • Direct transmission from infected animals
occurs predominantly in the southwestern • Being predominantly outdoors during the to humans is unlikely because the spherule
United States day phase (present at body temperature) is not
• Travel to Arizona, New Mexico, west Texas, transmitted by aerosol. Transmission of
Synonyms or the central valley of California Coccidioides to a human from a cat bite has
San Joaquin Valley fever, valley fever • Young adult age been reported.
• Digging behavior • Conversion of the yeast phase to the
Epidemiology • ± Immunosuppression mycelial phase, which produces infectious
SPECIES, AGE, SEX • A retrospective study suggested that Hun- spores (arthroconidia) that can be inhaled,
Young adult, male, medium- to large-breed garian Vizslas, Dalmatians, Weimaraners, could occur on stored necropsy specimens,
outdoor dogs are more commonly infected. greyhounds, English pointers, bull terriers, old bandages, tissue specimens, or instru-
Cats are less frequently diagnosed with Brittany spaniels, and boxers might be at ments; such material should be dealt with
coccidioidomycosis and often have severe increased risk when compared with the safely and immediately (e.g., disinfected/
disseminated disease at the time of diagnosis. hospital background population. autoclaved).
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