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Management of Canine Nasal Aspergillosis

M. K. Srivastava Ashish Srivastava Barkha Sharma
Vol 2(2), 276-278
DOI-

Destructive rhinitis and sinusitis caused by Aspergillus spp. is of greatest clinical significance in the dog. Profuse serous to mucopurulent nasal discharge, nasal pain, epistaxis, ulceration, hyperkeratosis and discoloration of external nares are reported clinical signs in dogs suffering from nasal aspergillosis (Sharp, 1989). Present report documents the cure of nasal aspergillosis with combination therapy by using topical (clotrimazole) and systemic (itraconazole) antifungal therapy.


Keywords : Canine Nasal Aspergillosis

Introduction

Destructive rhinitis and sinusitis caused by Aspergillus spp. is of greatest clinical significance in the dog. Profuse serous to mucopurulent nasal discharge, nasal pain, epistaxis, ulceration, hyperkeratosis and discoloration of external nares are reported clinical signs in dogs suffering from nasal aspergillosis (Sharp, 1989). Present report documents the cure of nasal aspergillosis with combination therapy by using topical (clotrimazole) and systemic (itraconazole) antifungal therapy.

Case History and Clinical Examination

Two German shepherd dogs aged between 5-6 year were presented to Teaching Veterinary Clinical Complex, DUVASU, Mathura with history of chronic sneezing and muco-purulent to sanguinopurulent nasal discharge which was unilateral in first case and bilateral (initially unilateral but later on bilateral) in second case. Episodic epistaxis, stridor and open mouth breathing, which was progressive in nature in both cases, since one month back in first case and for 4 months in second case was evident. Previous medicinal therapy with antibiotics, prednisolone, antipyretics and antiallergic drugs had not given any fruitful results. Closed mouth ability of breathing was assessed with cotton wisp held up to each nostril. Palpation of the head, nasal planum, and palate regions revealed pain along with depigmentation and ulceration of nasal planum. Epiphora (Fig-1), retropulsion of the eyes and facial deformity (Fig-2) was additional finding giving clue for the presence of a mass lesion in nasal cavity which restricted movement of the globe in second case.

Diagnosis

Tentative diagnosis was made on the basis of history and clinical examination for nasal neoplasia, fungal sinorhinitis, nasal foreign body and rhinitis secondary to dental disease. The history of progressive and chronic nasal discharge, with or without epistaxis refractory to antimicrobial therapy is quite suggestive for aspergillosis (Sharp, 1989). Clinical signs like unilateral or bilateral nasal discharge, chronic sneezing, pain on palpation of nasal area, facial swelling and asymmetry in cases of nasal aspergillosis as recorded in present cases were similar to Bendangla et al. (2008). All the haemato-biochemical parameters like complete blood count, serum biochemistry profile, and urinalysis, blood clotting time and blood pressure measurement were unremarkable except neutrophillia and leucocytosis. Nasal cytology was employed in order to identify fungal elements which confirmed aspergillosis. Radiology to assess the extent of bone destruction (Saunders et al., 2004) revealed loss of fine nasal turbinate detail and an increase in nasal chamber and radiolucency in the first case while in the second case loss of turbinates, nasal septum erosion and periosteal reaction was recorded.

Necropsy of the second dog revealed localized fungal infection in the nasal cavity and paranasal sinuses. The mucosa of the nasal and paranasal sinuses was covered by a layer of grey-black necrotic material with severe chronic inflammatory response causing local destruction of nasal bone (Fig-3) with a swelling of sinus budging in hard palate.

Treatment and discussion

Nasal debridement of fungal plaques and necrotic turbinate bone was done. Treatment was done by combining local and systemic antifungal therapy (Sharp and Sullivan, 1989). Treatment was started with Itraconazole @ 10mg/kg b wt. daily P.O., along with topical single prolonged exposure to clotrimazole (Friend et al., 2002) for fifteen days (McCullough et al., 1998). No improvement was seen in the second case which finally expired after twenty days of therapy. In the first case, appreciable improvement like relief in breathing and reduction in frequency of sneezing and nasal discharge was noticed after one month of therapy. Nasal swelling was reduced but still present without any episode of epistaxis during period of therapy. Abnormality of breathing was almost non-existent and further reduction in swelling and sneezing was evident. The owner was advised to continue the treatment for 3 months after which the surviving dog was found perfect in all aspect but owner was advised to continue the topical clotrimazole therapy with monthly evaluation of the dog for reoccurrence and monitoring of hepatotoxicity associated with itraconazole therapy. The sensitivity and specificity of fungal culture has been reported as 81% and 100%, respectively (Pomrantz, et al., 2007). Present cases of nasal aspergillosis were recorded in 5-6 year of age in German shepherds breed. Similar finding was reported in German Shepherds and Rottweilers breeds (Noemi B., 2006) with mean age 5.1 year (Claeys et al.,  2006).  Dogs of any age may be affected, but approximately 40% are 3 years or younger and 80% are 7 years or younger (Sharp et al., 1991). The three hallmarks of canine nasal aspergillosis recorded in present cases were profuse mucoid to hemorrhagic chronic nasal discharge that alternated with periods of epistaxis, ulceration of the external nares with crusting, and pain or discomfort in the facial region (Noemi B., 2006). Early stage of nasal aspergillosis can be managed by oral ketokonazole therapy (Bendangla et al., 2008), but reported efficacy of this drug (50 %) is less than itraconazole, which has efficacy upto 70% (Legendre and Taol, 2000). Systemic treatments with oral antifungal agents require prolonged administration and have poor efficacy (Claeys et al., 2006).

Summary

Destructive rhinitis and sinusitis caused by Aspergillus spp. is of greatest clinical significance in the dog characterized by profuse serous to mucopurulent nasal discharge, nasal pain, epistaxis, ulceration, hyperkeratosis and discoloration of external nares. Present report documents the cure of nasal aspergillosis with combination therapy by using topical (clotrimazole) and systemic (itraconazole) antifungal therapy in two dogs.

References

Bendangla, Varshney, J.P. and S.Chaudhari .( 2008). Ind.J. Vet. Med., 28(1):

Claeys, S., Lefebvre, J.B., Schuller, S., Hamaide, A. and Clercx, C. (2006).   J.Small Ani.Pract. 47: 320–324.

Friend, E.J., Williams, J.M. and White, R.A.( 2002). Vet. Rec., : 151:298-299.

Legendre, A. M. and  Toal, R. L. (2000). Diagnosis and treatment of fungal diseases of the respiratory system. In: Kirk’s Current Veterinary Therapy. 13th edn. Ed J. D.Bonagura. W. B. Saunders, Philadelphia,. pp 815-819.

Mc Cullough, S. H., McKiernan, B.C. and Brodsky, B.S. (1998). J Am Vet Med Assoc.,212:67.

Noemi Benitah (2006). Clin Tech Small Anim Pract 21:82-88.

Pomrantz, J.S., Johnson, L.R., Nelson, R.W. and Wisner ER.(2007). J Am Vet Med Assoc ; 230: 1319-1323.

Saunders, J.H., Clercx, C., Snaps, F.R. (2004). J Am Vet Med Assoc; 225: 1703-1712.

Sharp, N.J.H. and Sullivan, M. (1989). J Am Vet Med Assoc; 194: 782-786.

Sharp, N.J.H., Harvey, C.E. and Sullivan, M. (1991). Compend Cont Educ Pract Vet 13:41-49.

Sharp, N. J. H. (1989). Nasal apergillosis. In: Current Veterinary Therapy. 10th edn. Ed R. W. Kirk. W. B. Saunders, Philadelphia, PA, USA. pp 1106-1109.

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