L48: fungal diseases

what systems are at risk with the use of Amphotericin B?

1. Nephrotoxicity

2. Hepatotoxicity

what are the common clinical uses of itraconazole?

1. dermatophytosis

2. cryptococidiosis

what agent causes Blastomycosis?

Blastomyces dermatitidis

where is Blastomycosis found?

water!

which fungus appears as a broad based budding under the microscope?

blastomycosis

which animal do we see blastomycosis in?

sporting/hunting dog breeds

what area does blastomycosis prefer in dogs?

1. bones

2. eyes

3. lungs

4. lymph nodes

5. skin

6. prostate

what cells are activated by blastomycosis?

macrophages

what may we see on bloodwork in an animal with blastomycosis?

hypercalcemia

what is the incubation time for blastomycosis?

5-12 weeks

what fungus is shown in the image?

blastomycosis

what fungus is shown in the image?

blastomycosis

what are the clinical signs of blastomycosis?

1. pulmonary signs (dry cough)

2. lameness

3. lymphadenopathy

4. ophthalmologic signs

what clinical signs of blastomycosis are more seen in cats?

1. cutaneous signs

2. neurological

what diagnostic test is useful for monitoring a fungal disease?

antigen test

what diagnostic tests can be performed for fungal organism identfication?

1. cytology

2. histopathology

3. culture

what clinical sign is shown in the image?

anterior uveitis

what clinical sign is shown in the image?

panophtalmitis

what clinical sign is shown in the image?

chorioretinitis

what clinical sign is shown in the image?

optic neuritis

what clinical sign is shown in the image?

retinal detachment

what optical manifestations can occur with blastomycosis?

1. anterior uveitis

2. panophtalmitis

3. chorioretinitis

4. retinal detachment

5. optic neuritis

what is the treatment of choice for blastomycosis?

itraconazole with food

how long is the treatment for blastomycosis?

atleast 3-6 months until there are no clinical signs

what is done at the start of treatment for blastomycosis?

use a loading dose for first 3-5 days

what alternative drug can you use in the treatment of blastomycosis if money is an issue?

fluconazole

what additional treatment do you provide if the animal with blastomycosis is severely hypoxemic?

amphotericin B lipid complexed

what makes a more poor prognosis of blastomycosis?

if patient is hypoxic and more than 3 systems are affected

what fungal agent causes histoplasmosis?

 Histoplasma capsulatum

what are outbreaks of histoplasmosis associated with?

1. chicken coops

2. bird roosts

3. bat habitats

what is the incubation period for histoplasmosis?

12-16 days

where is the preferred site for histoplasmosis?

lungs or GI

which animal is typically affected by histoplasmosis?

animals younger than 4 years

what fungal agent is shown?

histoplasmosis

what are the clinical signs of histoplasmosis in cats?

1. depression

2. fever

3. pale mm

4. hepatomegaly

5. splenomegaly

6. ophthalmologic

what ophthalmologic signs can be seen in cats from histoplasmosis?

1. retinal pigment proliferation or edema

2. chorioretinitis

3. anterior uveitis

4. panophthalmitis

what are the clinical signs of histoplasmosis in dogs?

1. large intestinal diarrhea early on

2. small intestines signs as disease progresses

3. fever

4. anorexia

5. severe weight loss

what fungal infection is shown in the image?

histoplasmosis

what fungal infection is shown in the image?

histoplasmosis

what is the treatment for histoplasmosis?

itraconazole for 4-6 months until clinical signs gone

what GI supportive care may you provide in an animal that has histoplasmosis?

1. proper nutrition

2. highly digestible diet

3. pre and pro-biotics

what fungal agen causes coccidiodomycosis?

Coccidioides immitis or posadasii

what is the primary route of coccidiodomycosis infection?

inhalation

what animals do we see coccidiomycosis in?

Young, male intact, medium to large outdoor large breed dogs

what are the clinical signs of coccidiomycosis?

● Hilar lymphadenopathy

● Coughing

● Difficulty swallowing

● Lethargy

● Anorexia

● Fever

● Chronic lameness

● Cervical or head pain

● Weight los

what fungal agent is shown?

coccidiomycosis

what test do we NOT perform with coccidiomycosis?

culture as it is dangerous and reportable disease in humans

what tests do we do to diagnose coccidiomycosis?

1. IMMY

2. precipitin test

3. complement fixation

what is the treatment of coccidiomycosis if the patient is not near death?

1. itraconazole

2. fluconazole

what is the treatment of coccidiomycosis if it is life threatening?

amphotericin B

what drug can be used as an add-on in the treatment of coccidiomycosis?

allylamine

how long is treatment for coccidiomycosis?

4-6 months BEYOND clinical cure

what fungal agent is shown?

cryptococcosis

what fungal agent causes cryptococcosis?

1. Cryptococcus neoformans

2. C. gattii

what type of fungus is cryptococcus?

saphrophytic yeast

where do we see cryptococcosis?

avian habitats (pigeon droppings)

what is the most common fungal infection of cats?

cryptococcus

where do we see cryptococcus in cats?

1. nasal cavity

2. skin

3. sinuses

4. paranasal tissues

5. lungs

what are the clinical signs of cryptococcus?

1. nasal discharge

2. nasopharyngeal proliferative masses

3. snoring

4. stertor

5. anorexia

6. CNS

7. ocular signs

what is the treatment for cryptococcus?

fluconazole (if CNS) or itraconazole

what is the treatment for cryptococcus if the infection is systemic?

1. azole

2. amphotericin B

3. flucytosine

how long is the treatment for cryptococcus?

2 months after clinical signs gone

what fungal agent is shown?

aspergillosis

what fungal agent causes aspergillosis?

Aspergillus fumigatus

what fungal agent prefers dog noses?

aspergillosis

where does aspergillosis like to go in the host?

nasal passages and frontal sinuses

what two clinical signs would make you think aspergillosis?

1. nasal discharge

2. depigmentation of nose

how do you tell if an aspergillosis infection has spread to the brain?

cribiform plate has been destroyed

what is the treatment for aspergillosis?

Topical clotrimazole (1% )/enilconazole

why do we see aspergillosis more commonly in german sheperds?

they have an immunodeficiency of IgA

what fungal agent causes sporothrix?

 Sporothrix schenckii

what is the order of most likely to get sporothrix?

1. cats

2. dogs

3. humans

what is the point of entry for sporothrix?

skin

what is important to know about the treatment of sporothrix in cats?

cannot use potassium iodide like dogs

what is the treatment for sporothrix?

itraconazole

what fungal agent is shown?

sporothrix

what fungal agent is shown?

candidiasis

what is the treatment for candidiasis?

1. itraconazole

2. fluconazole

3. amphotericin B lipid complex

what fungal agent causes pythiosis?

Oomycetes

where do we see pythiosis?

southeast usa

what tests can we use to diagnose pythiosis?

1. histology

2. culture

3. antibody ELISA

4. PCR

what is the prognosis for pythiosis?

poor

what is the treatment for pythiosis?

1. surgical resection with wide margins

2. itraconazole, terbinafine, and prednisone

what fungal agent causes lagenidiosis?

Oomycetes Lagenidium

what clinical sign of lagenidiosis?

great vessel rupture (aorta)