Uso de anfotericina B por via intralesional associada ao itraconazol oral para tratamento de recidiva de esporotricose nasal em um gato - relato de caso / Intralesional use of amphotericin B associated with oral itraconazole for the treatment of recurrent nasal sporotrichosis in a cat - case report / Anfotericina B intralesional e itraconazole oral en el tratamiento de un cuadro recidivante de esporotricosis nasal en un gato - relato de caso

A esporotricose nasal é uma afecção de difícil resolução clínica, muitas vezes refratária ao tratamento e possivelmente recidivante em gatos. Neste caso, a anfotericina B foi utilizada por via intralesional em associação ao itraconazol (100 mg/gato/via oral a cada 24 horas) em felino com recidiva de esporotricose nasal. Durante o tratamento foram realizados exames laboratoriais para garantir a segurança do protocolo utilizado. O novo biomarcador para função renal SDMA IDEXXTM foi empregado antes e após o término do protocolo para monitorar a função renal. Os efeitos adversos encontrados foram edema e desconforto no local de aplicação. O tempo total de tratamento foi de três meses e não se observou efeito tóxico renal. Dessa maneira o protocolo utilizado mostrou-se eficaz e seguro no tratamento da esporotricose nasal.

Nasal sporotrichosis is a condition of difficult clinical resolution, which is commonly refractory to treatment and recurrent in cats. In this report, amphotericin B was used intralesionaliy in combination with oral itraconazole (100 mg/per catloral each 24 h) in order to treat a cat with relapse of nasal sporotrichosis. During the treatment, laboratory tests were performed to ensure the safety of the protocol used. The new biomarker for renal function SDMA IDEXX was used before and after the end of the protocol to monitor renal function. Adverse effects were edema and local discomfort. Total treatment duration was 3 months, and no renal toxic effect was observed. This protocol therefore proved to be effective and safe to treat nasal sporotrichosis.

La esporotricosis nasal es una afección de difícil manejo clínico que en muchas ocasiones resulta refractaria a los tratamientos y con importantes tasas de recidiva en gatos. En el presente caso, la anfotericina B se utilizó por vía intralesional en asociación con itraconazole (100 mg/gato/PO/24hs) en un gato con recidiva de esporotricosis nasal. Durante el tratamiento se realizaron exámenes de laboratorio a fin de garantizar la seguridad del protocolo utilizado. Se utilizó un nuevo biomarcador para función renal (SDMA IDEXXTM) antes y después del protocolo terapéutico. Los efectos adversos encontrados fueron edema y molestias en el lugar de aplicación. EI tiempo total de tratamiento fue de tres meses, sin que se hayan observado efectos tóxicos a nivel renal. Así, el protocolo usado se mostró eficiente y seguro para el tratamiento de la esporotricosis nasal.

Uso de anfotericina B por via intralesional associada ao itraconazol oral para tratamento de recidiva de esporotricose nasal em um gato - relato de caso / Intralesional use of amphotericin B associated with oral itraconazole for the treatment of recurrent nasal sporotrichosis in a cat - case report / Anfotericina B intralesional e itraconazole oral en el tratamiento de un cuadro recidivante de esporotricosis nasal en un gato - relato de caso

A esporotricose nasal é uma afecção de difícil resolução clínica, muitas vezes refratária ao tratamento e possivelmente recidivante em gatos. Neste caso, a anfotericina B foi utilizada por via intralesional em associação ao itraconazol (100 mg/gato/via oral a cada 24 horas) em felino com recidiva de esporotricose nasal. Durante o tratamento foram realizados exames laboratoriais para garantir a segurança do protocolo utilizado. O novo biomarcador para função renal SDMA IDEXXTM foi empregado antes e após o término do protocolo para monitorar a função renal. Os efeitos adversos encontrados foram edema e desconforto no local de aplicação. O tempo total de tratamento foi de três meses e não se observou efeito tóxico renal. Dessa maneira o protocolo utilizado mostrou-se eficaz e seguro no tratamento da esporotricose nasal.(AU)

Nasal sporotrichosis is a condition of difficult clinical resolution, which is commonly refractory to treatment and recurrent in cats. In this report, amphotericin B was used intralesionaliy in combination with oral itraconazole (100 mg/per catloral each 24 h) in order to treat a cat with relapse of nasal sporotrichosis. During the treatment, laboratory tests were performed to ensure the safety of the protocol used. The new biomarker for renal function SDMA IDEXX was used before and after the end of the protocol to monitor renal function. Adverse effects were edema and local discomfort. Total treatment duration was 3 months, and no renal toxic effect was observed. This protocol therefore proved to be effective and safe to treat nasal sporotrichosis.(AU)

La esporotricosis nasal es una afección de difícil manejo clínico que en muchas ocasiones resulta refractaria a los tratamientos y con importantes tasas de recidiva en gatos. En el presente caso, la anfotericina B se utilizó por vía intralesional en asociación con itraconazole (100 mg/gato/PO/24hs) en un gato con recidiva de esporotricosis nasal. Durante el tratamiento se realizaron exámenes de laboratorio a fin de garantizar la seguridad del protocolo utilizado. Se utilizó un nuevo biomarcador para función renal (SDMA IDEXXTM) antes y después del protocolo terapéutico. Los efectos adversos encontrados fueron edema y molestias en el lugar de aplicación. EI tiempo total de tratamiento fue de tres meses, sin que se hayan observado efectos tóxicos a nivel renal. Así, el protocolo usado se mostró eficiente y seguro para el tratamiento de la esporotricosis nasal.(AU)

Avaliação do uso da timomodulina em gatos naturalmente infectados com esporotricose cutânea disseminada

A esporotricose é uma das micoses de maior relevância para a espécie felina, tanto pelas suas implicações ao gato como pelo seu potencial zoonótico. A diretriz terapêutica referenciada com maior taxa de sucesso é a associação de itraconazol (ITL) com iodeto de potássio (KI). Especificamente sobre a esporotricose, sabe-se que a espécie felina apresenta falhas na imunidade inata e na formação de granulomas que controlem a micose. Desse modo, a utilização de imunomoduladores como a timomodulina pode ser determinante no prognóstico desses pacientes. O objetivo central dessa tese foi avaliar através de um estudo clínico prospectivo, o potencial terapêutico da timomodulina em gatos com esporotricose cutânea disseminada, assim como pesquisar possíveis fatores preditivos de prognóstico na esporotricose nessa população. Durante o desenvolvimento da tese foram desenvolvidos três artigos que resultaram no cumprimento dos objetivos propostos. O primeiro artigo foi oriundo do estudo de um caso clínico de esporotricose tratada com imunomodulador. O artigo 2 foi uma revisão sobre os imunomoduladores utilizados em gatos, e por fim o último artigo apresentou um estudo prospectivo avaliando e comparando o tratamento convencional para a esporotricose com o tratamento convencional acrescido do fármaco imunomodulador timomodulina. No primeiro artigo foi utilizado 5mg/kg de timomodulina associada ao ITL (100mg/gato) e KI (5mg/kg) em felino com esporotricose e após 65 dias observou-se remissão completa das lesões. No terceiro estudo os animais foram segregados em dois grupos, sendo o G1 tratado com ITL (100mg/gato), KI (5mg/kg), uma vez ao dia, associada à timomodulina (4mg/kg) e o G2 ITL (100mg/gato) e KI (5mg/kg) uma vez ao dia. Os felinos foram submetidos a avaliação clínica, hematológica e bioquímica em três momentos: antes do início do tratamento (M0), após 5 a 7 semanas de tratamento (M1) e após 13 a 15 semanas de tratamento (M2). A avaliação clínica envolveu o monitoramento do escore de condição corporal (E.C.C.) e a evolução das lesões no decorrer do tratamento sendo classificada em cura clínica quando houve remissão completa das lesões, estabilização quando não houve melhora nem piora, e piora clínica quando houve aumento do número ou tamanho das lesões. Para avaliação hematológica e bioquímica foram realizadas colheitas de amostras de sangue para realização de hemograma e bioquímicos: alanina aminotransferase, fosfatase alcalina, ureia e creatinina. Ao término do estudo o G1 apresentou significativa maior taxa de sobrevivência (93,6%) que o G2 (53%) (p<0,02), além disso, os pacientes do G1 apresentaram melhora dos parâmetros clínicos precocemente que o G2, especialmente relacionados à remissão dos sinais extra cutâneos e progresso do E.C.C, sendo ambos os fatores associados ao melhor prognóstico (p<0,02). A associação da timomodulina ao itraconazol e ao iodeto de potássio melhorou o prognóstico de gatos com esporotricose cutânea disseminada e não apresentou efeitos colaterais adicionais.

Sporotrichosis is one of the most important mycoses for the feline species, both for its implications for the cat and for its zoonotic potential. The most successful referenced therapeutic guideline is the association of itraconazole (ITL) with potassium iodide (KI). Specifically about sporotrichosis, feline species are known to have failures in innate immunity and formation of ringworm-controlling granulomas. Thus, the use of immunomodulators such as thymomodulin may be determinant in the prognosis of these patients. The aim of this thesis was to evaluate, through a prospective clinical study, the therapeutic potential of thymomodulin in cats with disseminated cutaneous sporotrichosis, as well as to investigate possible prognostic predictors of sporotrichosis in this population. During the development of the thesis, four articles were developed that resulted in the fulfillment of the proposed objectives. The first article came from the study of a clinical case of immunomodulator-treated sporotrichosis. Article 2 was a review on immunomodulators used in cats, and finally the last article presented a prospective study evaluating and comparing conventional treatment for sporotrichosis with conventional treatment plus the immunomodulatory drug timomodulin. In the first article, 5mg / kg of ITL-associated timomodulin (100mg / cat) and KI (5mg / kg) were used in feline with sporotrichosis and after 65 days complete remission of the lesions was observed. In the third study the animals were segregated into two groups: G1 treated with ITL (100mg / cat), KI (5mg / kg) once daily associated with thymomodulin (4mg / kg) and G2 ITL (100mg / cat) cat and KI (5mg / kg) once a day. The cats were submitted to clinical, hematological and biochemical evaluation at three moments: before the beginning of treatment (M0), after 5 to 7 weeks of treatment (M1) and after 13 to 15 weeks of treatment (M2). The clinical evaluation involved monitoring the body condition score (ECC) and the evolution of the lesions during the treatment, being classified as clinical cure when there was complete remission of the lesions, stabilization when there was no improvement or worsening, and clinical deterioration when there was an increase in the condition. number or size of lesions. For hematological and biochemical evaluation, blood samples were collected for blood count and biochemical tests: alanine aminotransferase, alkaline phosphatase, urea and creatinine. At the end of the study, G1 had a significantly higher survival rate (93.6%) than G2 (53%) (p <0.02). In addition, patients in G1 showed earlier improvement in clinical parameters than G2. especially related to remission of extra-cutaneous signs and ECC progress, both factors being associated with better prognosis (p <0.02). The combination of timomodulin with itraconazole and potassium iodide improved the prognosis of cats with disseminated cutaneous sporotrichosis and had no additional side effects.

Esporotricose felina no município de Itaporanga, estado da Paraíba, Brasil: relato de um caso / Feline sporotrichosis in the city of Itaporanga, state of Paraíba, Brazil: a case report / Esporotricosis felina en el município de Itaporanga, estado de la Paraíba, Brasil: relato de caso

No sentido de contribuir com dados relacionados à presença da esporotricose felina na região Nordeste do Brasil, o trabalho objetivou descrever um caso de esporotricose em gato doméstico nativo do município de Itaporanga, Paraíba. Um felino, macho, da raça Siamês, 11 anos de idade, apresentava o histórico de aumento de volume nasal, de caráter crônico. Clinicamente observou-se uma neoformação localizada na região nasal dorsal, com abrangência subcutânea e base de inserção séssil. Optou-se por realizar exame citológico e cultura fúngica do tecido nasal neoformado. Posteriormente executou-se biópsia excisional da lesão localizada em região nasal, encaminhando-se a amostra obtida para análise histopatológica com a utilização de colorações pelos métodos de Hematoxilina-Eosina e Ácido Periódico de Schiff. A análise citopatológica detectou inflamação granulomatosa. Na cultura microbiológica não se observou crescimento fúngico. Devido ao resultado de tais exames complementares, justificou-se a biópsia excisional da lesão nasal. A análise histopatológica demonstrou (com o auxílio da coloração do Ácido Periódico de Schiff), a presença de estruturas compatíveis com Sporothrix schenkii. Nesse sentido, foi estabelecido o diagnóstico de esporotricose e realizou-se a prescrição do itraconazol. Observou-se involução inicial da lesão. Contudo, após algumas semanas do seguimento com o tratamento antifúngico, o animal veio a óbito e não foi possível realizar necropsia. A esporotricose deve ser considerada em felinos que apresentam lesões cutâneas características da doença e oriundos do município de Itaporanga, estado da Paraíba, Brasil.(AU)

In order to contribute with data related to the presence of feline sporotrichosis in northeastern Brazil, the study aimed to describe a case of sporotrichosis in a domestic native cat of Itaporanga city, Paraíba, Brazil. An eleven-year-old, male, Siamese cat had a history of chronic condition of an increased nasal volume. Clinically, a neoformation located in the nasal dorsum with subcutaneous coverage and sessile insertion base was observed. A cytological examination of the nasal change was chosen and then some of the collected material was sent for fungal culture. Subsequently, excisional biopsy of the lesion in the nasal region was performed, and the obtained sample was sent for histological analysis with the use of staining methods with hematoxylin-eosin and periodic acid-Schiff. The cytological analysis detected granulomatous inflammation. Microbiological culture did not show fungal growth. Due to the results of such complementary exams, excisional biopsy of the nasal injury was justified. A histopathologic analysis showed (with the help periodic acid-Schiff) the presence of structures compatible to Sporothrix schenkii. Accordingly, the diagnosis of sporotrichosis was reached and itraconazole was prescribed. Regression of the early lesions was observed. However, after a few weeks of the beginning of the antifungal treatment, the animal died and no autopsy was possible. Sporotrichosis should be considered in cats which present skin lesions with characteristics of this disease and from the city of Itaporanga, state of Paraiba, Brazil

En el sentido de contribuir con datos relacionados a la presencia de esporotricosis felina en la región Nordeste de Brasil, este estudio ha tenido por objetivo describir un caso de esporotricosis en gato doméstico nativo del municipio de Itaporanga, Paraíba. Un felino, macho, de la raza siamés, 11 años de edad, presentaba histórico de aumento de volumen nasal, de carácter crónico. Clínicamente se observó una neo formación localizada en la región nasal dorsal, con alcance subcutáne y base de inserción sésil. Se ha elegido realizar examen citológico y cultura fúngica del tejido nasal neo formado. Posteriormente se ha ejecutado biopsia por escisión de la lesión localizada en la región nasal, encaminando la muestra para análisishistopatológico con utilizaciones de coloraciones por los métodos de Hematoxilina- Eosina y Ácido Periódico de Schiff. El análisis cito patológica ha encontrado inflamación granulo matosa. En la cultura microbiológica no se ha observado crecimiento fúngico. Debido al resultado de tales exámenes complementares, se justificó la biopsia por escisión de lesión nasal. El análisis histopatológico demostró (con el auxilio de coloración de Ácido Periódico de Schiff), la presencia de estructuras compatibles con Sporothrix schenkii. Así, se estableció el diagnóstico de esporotricosis y se ha realizado la prescripción de itraconazol. Se observó involución inicial de la lesión. Todavía, tras algunas semanas del seguimiento con el tratamiento anti fúngico, el animal vino a óbito y no fue posible realizar necropsia. La esporotricosis debe ser considerada en felinos que presentan lesiones cutáneas características de la enfermedad y oriundos del municipio de Itaporanga, estado de la Paraíba, Brasil.(AU)

Esporotricose cutânea felina no Estado de Santa Catarina: relato de casos / Cutaneous feline sporotrichosis in Santa Catarina, Brazil: cases report

Descreve-se, pela primeira vez em Santa Catarina, a ocorrência de um surto de esporotricose felina, em machos e fêmeas, da raça Siamês. Os animais apresentavam secreção nasal sero-mucosa, dispneia, espirros frequentes, deformidade de plano nasal e lesões cutâneas ulceradas, exsudativas e crostosas na cabeça, cauda e membros. À citologia observaram-se estruturas pleomórfi cas, arredondadas e ovaladas no interior dos macrófagos. As alterações histológicas caracterizaram-se por ulceração da epiderme com infi ltrado inflamatório difuso da derme com predomínio de macrófagos com citoplasma espumoso e estruturas ovais, no interior dos macrófagos. Na coloração especial pelo Grocott, observou-se a presença de hifas de fungo ovais ou arredondadas, algumas com esporulação. Sporothrix schenckii foi isolado das lesões cutâneas. O tratamento não foi efi caz devido à dificuldade de administração do mesmo pelo proprietário

For the first time in Santa Catarina State, Brazil, it is described the occurrence of sporot¬richosis in male and female felines (Siamese breed). Animals showed nasal secretion, dyspnea, sneezes, nasal plan deformation and ulcers, exudation and crusts on head, tail, forelegs and hind legs. By cytological examination were observed rounded and oval pleomorphic structures in the interior of the macrophages. Histological alterations were characterized by epidermis ulceration with diffuse infl ammatory infiltration of the skin and the predominance of macrophages showing foamy cytoplasm and oval structures in the interior of the macrophages. In special coloration by Grocott technique was observed the predominance of hyphas from oval or rounded fungus, some of them with sporulation. Sporothrix was isolated from the cutaneous lesions. Treatment was not successful due to difficulties with its administration by the owner of the animals

Esporotricose cutânea felina no Estado de Santa Catarina: relato de casos / Cutaneous feline sporotrichosis in Santa Catarina, Brazil: cases report

Descreve-se, pela primeira vez em Santa Catarina, a ocorrência de um surto de esporotricose felina, em machos e fêmeas, da raça Siamês. Os animais apresentavam secreção nasal sero-mucosa, dispneia, espirros frequentes, deformidade de plano nasal e lesões cutâneas ulceradas, exsudativas e crostosas na cabeça, cauda e membros. À citologia observaram-se estruturas pleomórfi cas, arredondadas e ovaladas no interior dos macrófagos. As alterações histológicas caracterizaram-se por ulceração da epiderme com infi ltrado inflamatório difuso da derme com predomínio de macrófagos com citoplasma espumoso e estruturas ovais, no interior dos macrófagos. Na coloração especial pelo Grocott, observou-se a presença de hifas de fungo ovais ou arredondadas, algumas com esporulação. Sporothrix schenckii foi isolado das lesões cutâneas. O tratamento não foi efi caz devido à dificuldade de administração do mesmo pelo proprietário(AU)

For the first time in Santa Catarina State, Brazil, it is described the occurrence of sporot¬richosis in male and female felines (Siamese breed). Animals showed nasal secretion, dyspnea, sneezes, nasal plan deformation and ulcers, exudation and crusts on head, tail, forelegs and hind legs. By cytological examination were observed rounded and oval pleomorphic structures in the interior of the macrophages. Histological alterations were characterized by epidermis ulceration with diffuse infl ammatory infiltration of the skin and the predominance of macrophages showing foamy cytoplasm and oval structures in the interior of the macrophages. In special coloration by Grocott technique was observed the predominance of hyphas from oval or rounded fungus, some of them with sporulation. Sporothrix was isolated from the cutaneous lesions. Treatment was not successful due to difficulties with its administration by the owner of the animals(AU)

Development of experimental sporothrichosis in a murine model with yeast and mycelial forms of Sporothrix schenkii

Sporotrichosis is a subcutaneous disease that affects both men and a variety of animals caused by the dimorphic fungus Sporothrix schenckii. The aims of this study were to observe differences in virulence between inocula containing the yeast (Y) or mycelial (M) forms, to compare the reactions induced by the two inocula injected in different anatomical sites, and to verify the possibility of horizontal transmission of the disease by contact between infected and healthy animals. All animals were observed during a period of nine weeks. Mice were inoculated subcutaneously in the paw pads and in the regions of the hip and shoulder joints. Another group of non-inoculated healthy mice was kept in direct contact with mice developing the subcutaneous lesions. Animals of groups Y and M developed lesions due to infections and clinical symptoms very characteristic of sporothrichosis. Lesions were more prominent and with longer duration when occurring in the pads than in any other site of inoculation. Non-inoculated mice remained healthy as it occurred to animals in the control group. The development of typical clinical symptoms for sporothrichosis in all inoculated groups suggests that no difference exists in virulence between the yeast and mycelial forms of the same isolated of S. schenckii. Moreover, the paw pads appear to be the site of choice for the inoculation for experimental sporot

Development of experimental sporothrichosis in a murine model with yeast and mycelial forms of Sporothrix schenkii

Sporotrichosis is a subcutaneous disease that affects both men and a variety of animals caused by the dimorphic fungus Sporothrix schenckii. The aims of this study were to observe differences in virulence between inocula containing the yeast (Y) or mycelial (M) forms, to compare the reactions induced by the two inocula injected in different anatomical sites, and to verify the possibility of horizontal transmission of the disease by contact between infected and healthy animals. All animals were observed during a period of nine weeks. Mice were inoculated subcutaneously in the paw pads and in the regions of the hip and shoulder joints. Another group of non-inoculated healthy mice was kept in direct contact with mice developing the subcutaneous lesions. Animals of groups Y and M developed lesions due to infections and clinical symptoms very characteristic of sporothrichosis. Lesions were more prominent and with longer duration when occurring in the pads than in any other site of inoculation. Non-inoculated mice remained healthy as it occurred to animals in the control group. The development of typical clinical symptoms for sporothrichosis in all inoculated groups suggests that no difference exists in virulence between the yeast and mycelial forms of the same isolated of S. schenckii. Moreover, the paw pads appear to be the site of choice for the inoculation for experimental sporot

Development of experimental sporothrichosis in a murine model with yeast and mycelial forms of Sporothrix schenkii

Sporotrichosis is a subcutaneous disease that affects both men and a variety of animals caused by the dimorphic fungus Sporothrix schenckii. The aims of this study were to observe differences in virulence between inocula containing the yeast (Y) or mycelial (M) forms, to compare the reactions induced by the two inocula injected in different anatomical sites, and to verify the possibility of horizontal transmission of the disease by contact between infected and healthy animals. All animals were observed during a period of nine weeks. Mice were inoculated subcutaneously in the paw pads and in the regions of the hip and shoulder joints. Another group of non-inoculated healthy mice was kept in direct contact with mice developing the subcutaneous lesions. Animals of groups Y and M developed lesions due to infections and clinical symptoms very characteristic of sporothrichosis. Lesions were more prominent and with longer duration when occurring in the pads than in any other site of inoculation. Non-inoculated mice remained healthy as it occurred to animals in the control group. The development of typical clinical symptoms for sporothrichosis in all inoculated groups suggests that no difference exists in virulence between the yeast and mycelial forms of the same isolated of S. schenckii. Moreover, the paw pads appear to be the site of choice for the inoculation for experimental sporot