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5/16/2018 Systemic Fungal Infections - slidepdf.com
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Systemic Fungal Infections
in Small Animals
Colleen Hock
May 12, 2010
http://atlas.arabslab.com/data/8/blasto10.gif
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The Mycotic Agents
Blastomyces dermatitidis
Histoplasma capsulatum
Coccidioides immitis
– All are dimorphic (mold and yeast forms)
– Cause primarily respiratory disease by
evasion of the host immune response
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Blastomycosis
Blastomyces dermatitidis
South east, south central, and upper
midwest near river valleys and lakes
Moist and shaded areas with increasedorganic matter (soil and wood)
http://www.familyvet.com/Dogs/Fungi.html
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Blastomycosis: Clinical Signs
Dogs: Dyspnea Anorexia
DepressionLamenessLymphadenopathySkin Lesions
+/- occularmanifestations+/- Orchitis
Cats: DyspneaNasal dischargeCough
LethargyWeight loss
**Pneumonia and weight loss are the
most common presentations**
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Blastomycosis
Occular blastomycosis:Panophthalmitis
http://veterinarymedicine.dvm360.com/vetmed/ArticleStandard/Article/detail/596603
http://www.njmoldinspection.com/vetmycology/vetblastomycosis.html
Cutaneous blastomycosis:Dermatitis
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Blastomycosis: Pathogenesis
Inhale spores
Deposit in the alveoli
Acute Pulmonary Phase
Self-limiting control
of asexual reproduction Asexual budding, not eliminated
by the immune system OR the patient
is immunocompromised
PyogranulomatousInflammation within
the lungs
Lymphatic and HematogenousSpread of spores
Inflammation in skin, bones, LN’s,eyes, CNS, and/or reproductive tract
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Blastomycosis: Diagnosis
History, Clinical signs, and Diagnosticfindings
Definitive diagnosis must show the organism
Cytology: TTW, BAL, LN aspirates, fluidfrom the anterior chamber of theeye, draining tracts, prostatic
fluid, and CSF Never Culture Blastomyces because of
danger to personnel
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Blastomycosis: Diagnosis
Serology (AGID) is helpful if the organismcannot be definitively diagnosed.
- Sensitivity and Specificity > 90% Thoracic Radiographs indicated when
respiratory signs present:- interstitial pattern
- nodular interstitial pattern/diffuse miliary
- tracheobronchial lymphadenopathy
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http://www.vet.uga.edu/vpp/clerk/mordecai/index.php
Blastomycosis: Pyogranulomatous
Inflammation
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Nodular InterstitialPattern/Diffuse Milliary Pattern
www.vet.uga.edu/vpp/clerk/mordecai/figure1.jpg
Differentials-Lymphoma-Fungalpneumonia
-Pneumoconiosis-Hematogenousbacterialpneumonia-Metastases fromthyroid or
mammarycarcinoma
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Blastomycosis: Fungal
Granuloma
http://veterinarymedicine.dvm360.com/vetmed/ArticleStandard/Article/detail/596603
Differentials-Tumor metastases-Fungal granuloma
-Parasitic granuloma-Abscesses-Lymphoma-Malignant histiocytosis-Lymphoid granulomatosis-Cysts/Fluid filled bullae
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Fungal Osteomyelitis:Blastomyces dermatitidis
http://cal.vet.upenn.edu/p
rojects/saortho/chapter_37/37mast.htm
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Fungal Osteomyelitis vs. Bone Tumors
http://www.acvs.org/AnimalOwners/HealthConditions/SmallA nimalTopics/BoneTumorsinCatsandDogs/
http://people.upei.ca/lpack/vetrad/VCA%20341/VCA%20
341%20Lecture%207%20Musculoskeletal%20Part%201.ppt#362,49,Fungal Osteomyelitis
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Blastomycosis: Treatment
Amphotercin B- IV, nephrotoxic
- Lipid soluble form that is less toxic Iatroconazole
- less toxic
- oral administration- more expensive
http://www.cvs.com/CVSApp/images/health/A1055050.JPG
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Histoplasmosis
Histoplasma capsulatum
Found in soil near avian species (especiallystarlings) and bats
3 forms in dogs: pulmonary, disseminated,and subclinical
Rare and progressive in cats
http://www.familyvet.com/Dogs/Fungi.html
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Histoplasmosis: Clinical
Signs Dogs
- coughing- dyspnea- anorexia
- weight loss- depression- ascites- ulcerated oral and/ornasal mucosa
- anemia
- lymphadenopathy- thrombocytopenia- fever- diarrhea
Cats- weight loss- lethargy- fever (fluctuant)
http://cat.uab.cat/Publications/2005/SEP05/starlings.jpg
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Histoplasmosis: Pathogenesis
Inhale or ingestmicroconidia or hyhae
Conversion to yeast within the host
Yeasts engulfed by macrophagesand they replicate intracellularly
Immune system isoverwhelmed
Hematogenous andLymphatic spread
Clear infection
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Histoplasmosis: Diagnosis
Cytology: exudates, TTW, FNA (LN’s),
and Bone Marrow
Histopathology
Serology
Blood smear
http://www.google.ca/imgres?imgurl=http://www.vet.uga.edu/vpp/clerk/edison/Fig4ADJ
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Histoplasmosis: Diagnosis
Radiographs:- pulmonary interstitial pattern withmiliary or nodular infiltrates
- Abdomen: hepatomegaly, splenomegaly, andascites
- Gastogram: Barium highlights thickening of theintestinal wall and mucosa
- Abdominal Ultrasound for gi thickening- Bone: osteolysis with periosteal proliferation
Endemic areas: may see patients with calcificationin the thorax or abdomen secondary to persistenceof the organism
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Histoplasmosis
http://www.vet.uga.edu/vpp/clerk/edison/Fig4ADJ.jpg
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Histoplasmosis
http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/51108.htm
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Histoplasmosis
http://www.vet.uga.edu/vpp/clerk/edison/index.php
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Histoplasmosis: Fungal
osteomyelitis
http://cal.vet.upenn.edu/projects/saortho/chapter_37/37F8.jpg
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Histoplasmosis: Treatment
Iatroconazole: lower toxicity
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Coccidiomycosis
Coccidioides immitis
Soil in arid or semi-arid regions
Virulent reputation Epidemics after rainy season followed by a
drought
http://www.familyvet.com/Dogs/Fungi.html
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Coccidiomycosis: Clinical Signs
Dogs- dyspnea- anorexia- cough- weight loss- lameness- draining tracts- abscesses- lymphadenopathy
- meningitis
Signs can range fromflu-like symptoms tosevere pneumoniawhen pulmonary tissueinvolved
Can see extensivedamage to bones, joints, skin, and CNSwhen dissemination
occurs Fatal when
immunocompromised
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Coccidiomycosis: Pathogenesis
Inhalation of infectivearthroconidia
Deposition in the lung
Microenvironment inducesendosporulation
Endospores released
Removed bymononuclear cells
Subclinical or clearance of organisms
Immunocompromised patients
Extensive lungdamage
Dissemination
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Coccidiomycosis: Diagnosis
Cytology: exudate, TTW, LN or bonebiopsy
Wet mount with 10% KOH- endospores 2-5 um- spherules 10-100 um- mycelial form= dangerous
Serology
Radiographs: Thorax and bones
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Coccidiomycosis: wet mount
http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/51104.htm
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Coccidiomycosis
http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/51104.htm
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Coccidiomycosis: Fungal
osteomyelitis
http://www.familyvet.com/Dogs/Fungi.html
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Coccidiomycosis: fungalosteomyelitis
http://cal.vet.upenn.edu/projects/saortho/chapter_37/37mast.htm
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Coccidiomycosis: Treatment
Ketoconazole: helps to prevent
dissemination Iatroconazole
www.amercianvetonline.com
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Systemic mycoses
•Systemic mycoses are fungalinfections affecting internal organs
In the right circumstances the fungi
enter thebody via the lungs throughthe gut,paranasalsinuses or skin.
The fungi can then spread via the
bloodstream to multiple organs including the skin, oftencausing
multiple organs to fail and eventually
resulting in the death of the patient
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Histoplasmosis•
Histoplasma capsulatuma dimorphic fungus exists as a mold in soil and asa yeast intissues.• It forms 2 types :- Macroconidia (finger like projection) imp. Indiagnosis- Microconidia (smooth wall spores) if inhaled
transmit the infection
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Systemic Fungal InfectionsFungus Specimen Source Aspergillis spp. Respiratory secretions, skin, bone, oropharyngealulcers, prostate
Blastomyces dermatitidis Respiratory secretions, skin, bone, oropharyngealulcers, prostateCandidia albicans Respiratory secretions, blood, stool, transtrachealaspiration, CSF, bone, peritoneal fluid, urineCoccidioides immitis Respiratory secretions, skin, bone, CSF, synovialfluid, urine
Cryptococcus neoformans Respiratory secretions, skin, bone, CSF, synovialfluid, urineHistoplasma capsulatum Respiratory secretions, bone marrow, blood, urine,skin, CSF, eye, pleural fluid, liverNocardia spp. Respiratory secretions, skin, blood, brain,conjunctiva, bone
Paracoccidiodes brasiliensis Respiratory secretions, biopsy, lesions, pusRhizopus Respiratory secretions, skin, nose, brain, stool, eye,woundsScedosporium apiospermum Respiratory secretions, skin, corneaSporothrix schenckii Respiratory secretions, skin, subcutaneous tissue,sinuses, bone marrow, CSF, synovial fluid, lymph
f
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References http://www.vet.uga.edu/vpp/clerk/mordecai/index.php
http://www.familyvet.com/Dogs/Fungi.html
http://cal.vet.upenn.edu/projects/saortho/chapter_37/37mast.htm
http://www.acvs.org/AnimalOwners/HealthConditions/SmallAnimalTopics/BoneTumorsinCatsandDogs/
http://www.pharmacy-and-drugs.com/illnessessimages/blastomycosis2.jpg
http://veterinarymedicine.dvm360.com/vetmed/ArticleStandard/Article/detail/596603
http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/51108.htm
http://www.vet.uga.edu/vpp/clerk/edison/Fig4ADJ.jpg
http://www.vet.uga.edu/vpp/clerk/edison/index.php
http://cal.vet.upenn.edu/projects/saortho/chapter_37/37F8.jpg
http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/51104.htm
http://www.vet.uga.edu/vpp/clerk/edison/index Songer, J.G., & Post, K.W. (2003). Veterinary Microbiology. St Louis: Elsevier.
http://www.acvs.org/AnimalOwners/HealthConditions/SmallAnimalTopics/BoneTumorsinCatsandDogs/
http://people.upei.ca/lpack/vetrad/VCA%20341/VCA%20341%20Lecture%207%20Musculoskeletal%20Part%201.ppt#362,49,Fungal Osteomyelitis