A retrospective study of the range of cutaneous clinical and histological features of erythema multiforme in five ferrets (Mustela putorius furo).

BACKGROUND: Erythema multiforme (EM) is an uncommon cutaneous reaction pattern characterised by panepidermal keratinocyte apoptosis with lymphocytic satellitosis, and is reported in domestic animal species, livestock and rarely ferrets. HYPOTHESIS/OBJECTIVES: The aim of this study was to analyse the spectrum of cutaneous clinical and histological features in ferrets with EM and to evaluate history and treatment outcomes. ANIMALS: Five client-owned ferrets with biopsy-confirmed EM. MATERIALS AND METHODS: Retrospective review of electronic medical records and histopathological reports from 2002 to 2021. Tissue blocks, haematoxylin and eosin re-cuts, and unstained slides were collected to review EM lesions and evaluate for infectious agents with special stains. Immunohistochemical staining was performed to assess cases for viral pathogens. RESULTS: Panepidermal cytotoxic dermatitis consistent with EM was identified in all cases and involved haired skin in four of five and mucous membranes in one of five ferrets. Skin lesions included variably pruritic alopecia, erythema, scaling, crusts and erosions/ulcerations. Histological features included primarily parakeratotic hyperkeratosis, panepidermal keratinocyte apoptosis, lymphocytic satellitosis and interface dermatitis. Superficial colonisation by bacteria, yeasts or by both was a common finding. Four of five ferrets had concurrent adrenal disease, one of which had resolution of skin lesions with deslorelin acetate treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Awareness of the distinct clinical and histological features is key to the diagnosis of EM in ferrets. Clinical resolution was observed with gonadotropin-releasing hormone agonists in two cases, suggesting that adrenal disease should be ruled out as a potential trigger of EM in ferrets.

Rifampicin treatment of canine multidrug-resistant meticillin-resistant staphylococcal pyoderma: A retrospective study of 51 cases.

BACKGROUND: Rifampicin (RFP) is a potential treatment for canine multidrug-resistant (MDR) meticillin-resistant staphylococci (MRS), yet the use of lower doses based on recent MIC data has not been evaluated in vivo. HYPOTHESIS/OBJECTIVES: To provide information on the efficacy and safety of low-dose range RFP (≤6 mg/kg/day) for the treatment of canine MDR MRS pyoderma. ANIMALS: Fifty-one client-owned dogs. MATERIALS AND METHODS: Retrospective review of dogs medical records. Dogs were from 11 US dermatology referral practices and had oral RFP at ≤6 mg/kg/day. Data evaluated included response to treatment, adverse events, and serum changes in alanine aminotransferase (ALT) and alkaline phosphatase (ALP). RESULTS: Complete resolution of pyoderma occurred in 39 of 51 dogs (76.5%). Topical antimicrobials were used concurrently in most cases (47 of 51; 92.2%). ALP elevation >1.5-fold of baseline or the high end of the reference range occurred in nine of 37 (24.3%) dogs, while ALT elevation above baseline and the high end of the reference range occurred in two of 36 (5.6%). Only six of 51 (11.8%) had clinical adverse events during treatment; five of six (83.3%) were mild reactions consisting of lethargy and gastrointestinal signs, while one dog had a possible cutaneous adverse drug reaction. Of those that experienced clinical adverse events, four of six (66.7%) did not have concurrent increased liver enzyme activity, while two of six (33.3%) had elevations in ALP alone. CONCLUSIONS AND CLINICAL RELEVANCE: Low-dose RFP (≤6 mg/kg/day) appears to be a relatively safe and effective single-agent systemic antibiotic in combination with topical antimicrobials for canine MDR MRS pyoderma.

CONTEXTE: La rifampicine (RFP) est un traitement potentiel des staphylocoques canins multirésistants (MDR) résistants à la méticilline (MRS), mais l'utilisation de doses plus faibles sur la base de données récentes sur la CMI n'a pas été évaluée in vivo. Hypothèse/Objectifs : Fournir des informations sur l'efficacité et l'innocuité des RFP à faible dose (≤ 6 mg/kg/jour) pour le traitement de la pyodermite MDR-MR canine. Animaux : Cinquante et un chiens de propriétaires. Matériels et méthodes : Revue rétrospective de chiens ayant reçu RFP par voie orale à des doses ≤ 6 mg/kg/jour provenant des dossiers médicaux de 11 centres de référés en dermatologie aux États-Unis. Les données évaluées comprenaient la réponse au traitement, les événements indésirables et les modifications sériques de l'alanine aminotransférase (ALT) et de la phosphatase alcaline (ALP). Résultats : Une résolution complète de la pyodermite s'est produite chez 39 des 51 chiens (76,5 %). Des antimicrobiens topiques ont été utilisés simultanément dans la plupart des cas (47 sur 51 ; 92,2 %). Une élévation de l'ALP> 1,5 fois la ligne de base ou l'extrémité supérieure de la plage de référence s'est produite chez neuf des 37 (24,3%) chiens, tandis qu'une élévation de l'ALT au-dessus de la ligne de base et de l'extrémité supérieure de la plage de référence s'est produite chez deux des 36 (5,6%). Seuls six sur 51 (11,8 %) ont eu des événements indésirables cliniques pendant le traitement ; cinq des six (83,3 %) étaient des réactions bénignes consistant en une léthargie et des signes gastro-intestinaux, tandis qu'un chien a eu un possible effet indésirable cutané au médicament. Parmi ceux qui ont subi des événements indésirables cliniques, quatre sur six (66,7 %) n'ont pas eu d'augmentation simultanée de l'activité des enzymes hépatiques, tandis que deux sur six (33,3 %) ont présenté des élévations de l'ALP seule. Conclusions et pertinence clinique : La RFP à faible dose (≤ 6 mg/kg/jour) semble être un antibiotique systémique à agent unique relativement sûr et efficace en association avec des antimicrobiens topiques pour la pyodermite MDR MRS canine.

Introducción- la rifampicina (RFP) es un tratamiento potencial para los estafilococos resistentes a múltiples fármacos (MDR) y meticilina (MRS), sin embargo, el uso de dosis más bajas basado en datos recientes de MIC no se ha evaluado in vivo. Hipótesis/Objetivos- Proporcionar información sobre la eficacia y seguridad de RFP en el rango de dosis bajas (≤6 mg/kg/día) para el tratamiento de la pioderma canina MDR MRS. Animales- Cincuenta y un perros propietarios particulares. Materiales y métodos- revisión retrospectiva de perros que recibieron RFP oral a dosis ≤6 mg/kg/día obtenida de historiales clínicos de 11 prácticas de referencia de dermatología de los Estados Unidos. Los datos evaluados incluyeron la respuesta al tratamiento, los eventos adversos y los cambios séricos en la alanina aminotransferasa (ALT) y la fosfatasa alcalina (ALP). Resultados- una resolución completa de la pioderma ocurrió en 39 de 51 perros (76,5 %). Antimicrobianos tópicos se usaron al mismo tiempo en la mayoría de los casos (47 de 51; 92,2%). En nueve de 37 (24,3 %) perros se produjo una elevación de ALP >1,5 veces respecto al valor inicial o el extremo superior del rango de referencia, mientras que en dos de 36 (5,6 %) se produjo una elevación de ALT por encima del valor inicial y en el límite superior del rango de referencia. Solo seis de 51 (11,8%) tuvieron eventos adversos clínicos durante el tratamiento; cinco de seis (83,3 %) fueron reacciones leves que consistieron en letargo y signos gastrointestinales, mientras que un perro tuvo una posible reacción cutánea adversa al medicamento. De los que experimentaron eventos adversos clínicos, cuatro de seis (66,7 %) no tuvieron un aumento simultáneo de la actividad de las enzimas hepáticas, mientras que dos de seis (33,3 %) tuvieron elevaciones en la ALP por sí sola. Conclusiones y relevancia clínica- la dosis baja de RFP (≤6 mg/kg/día) parece ser un antibiótico sistémico de uso único relativamente seguro y efectivo en combinación con antimicrobianos tópicos para la pioderma canina MDR MRS.

Contexto - A rifampicina (RFP) é um tratamento potencial para estafilococos resistentes à meticilina (MRS) multirresistentes (MDR) e a utilização de doses mais baixas baseado em dados recentes de MIC não foi avaliada in vivo. Hipótese/Objetivos: Fornecer informações sobre a eficácia e segurança de RFP em menor dosagem (≤6 mg/kg/dia) para o tratamento de piodermite canina por MRS MDR. Animais: Cinquenta e um cães de clientes. Materiais e métodos: Uma revisão retrospectiva dos prontuários de cães que receberam RFP oral na dose de ≤6 mg/kg/dia em 11 clínicas dermatológicas nos Estados Unidos. Os dados avaliados incluíram resposta ao tratamento, eventos adversos, alterações séricas de alanina aminotransferase (ALT) e fosfatase alcalina (FA). Resultados: Resolução completa da piodermite ocorreu em 39 de 51 dos cães (76,5%). Antimicrobianos tópicos foram utilizados concomitantemente na maioria dos casos (47 de 51; 92,2%). Elevação de mais de 1,5 vezes na FA ou para o limite superior do intervalo de referência ocorreu em nove de 37 cães (24,3%), enquanto a elevação de ALT acima do valor inicial e o limite superior do valor de referência ocorreu em dois de 36 (5,6%). Apenas cinco de 51 (11,8%) apresentaram efeitos adversos durante o tratamento; cinco de seis (83,3%) tiveram reações leves caracterizadas por letargia e sinais gastrointestinais, enquanto um cão apresentou uma possível farmacodermia. Dos que apresentaram eventos adversos, quatro de seis (66,7%) não apresentaram aumento concomitante de enzimas hepáticas, enquanto dois de seis (33,3%) tiveram aumento de FA isoladamente. Conclusões e relevância clínica - RFP em baixa dosagem (≤6 mg/kg/dia) aparenta ser relativamente segura e eficaz em monoterapia no tratamento da piodermite canina por MRS MDR por via sistêmica, associada a antimicrobianos tópicos.

A retrospective analysis of the concordance of in-house fungal culture and a commercial quantitative PCR from 16 dermatology referral practices across the USA (2018-2019).

BACKGROUND: Commercial quantitative (q)PCR and fungal culture can be used concurrently or individually to test for dermatophytosis with a reported high sensitivity and specificity. HYPOTHESIS/OBJECTIVES: The aims of this retrospective study were: (i) to evaluate the concordance of a commercial qPCR with in-house fungal culture for the initial diagnosis of dermatophytosis and for monitoring for mycological cure during treatment in dermatology private practice; and (ii) determine the sensitivity and specificity of qPCR overall, (iii) for initial diagnosis and (iv) for treatment monitoring in dogs and cats. ANIMALS: Four-hundred and twenty-seven client-owned dogs and 188 client-owned cats. MATERIALS AND METHODS: Retrospective evaluation of electronic medical records from 615 client-owned dogs and cats presented to 16 dermatology referral practices across the USA from 2018 to 2019. Concordance of qPCR with in-house fungal culture and sensitivity and specificity were determined from 667 paired samples. RESULTS: qPCR agreed with in-house fungal culture in 63 of 85 positive tests and 571 of 582 negative tests, with an overall sensitivity and specificity of 74.1% [95% confidence interval (CI) 63.5-83.0] and 98.1% (95%CI 96.6-99.0), respectively. qPCR sensitivity and specificity for the initial diagnosis of dermatophytosis and for treatment monitoring were 72.4% (95%CI 59.1-83.3) and 98.7% (95%CI 97.3-99.5), and 77.8% (95%CI 57.7-91.4) and 92.0% (95%CI 80.1-97.8), respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Compared to in-house fungal culture, qPCR was less sensitive and more specific than reported previously. These findings suggest that a diagnosis of dermatophytosis and determining mycological cure should continue to be based on a combination of complementary diagnostic tests.

CONTEXTE: La PCRq quantitative commerciale et la culture fongique peuvent être utilisées simultanément ou individuellement pour le diagnostic de dermatophytose avec une sensibilité et une spécificité élevées. Hypothèses/Objectifs: Les objectifs de cette étude rétrospective étaient : (i) d'évaluer la concordance d'une PCRq commerciale avec culture fongique interne pour le diagnostic initial de dermatophytose et pour le suivi de la guérison mycologique lors d'un traitement en cabinet libéral de dermatologie ; et (ii) déterminer la sensibilité et la spécificité de la PCRq dans son ensemble, (iii) pour le diagnostic initial et (iv) pour le suivi du traitement chez les chiens et les chats. Animaux: Quatre cent vingt-sept chiens de clients et 188 chats de clients. Matériels et méthodes: Évaluation rétrospective des dossiers médicaux électroniques de 615 chiens et chats appartenant à des clients présentés à 16 consultations de référence en dermatologie aux États-Unis de 2018 à 2019. La concordance de Qpcr avec la culture fongique interne et la sensibilité et la spécificité ont été déterminées à partir de 667 paires d'échantillons. Résultats: La PCRq concordait avec la culture fongique interne dans 63 des 85 tests positifs et 571 des 582 tests négatifs, avec une sensibilité et une spécificité globales de 74,1 % [intervalle de confiance (IC) à 95 % 63,5-83,0] et 98,1 % (95 % IC 96,6-99,0), respectivement. La sensibilité et spécificité de la qPCR pour le diagnostic initial de dermatophytose et pour le suivi du traitement étaient de 72,4 % (IC à 95 % 59,1-83,3) et 98,7 % (IC à 95 % 97,3-99,5), et 77,8 % (IC à 95 % 57,7-91,4) et 92,0 % (IC à 95 % 80,1-97,8), respectivement. Conclusions et pertinence clinique : Par rapport à la culture fongique interne, la PCRq était moins sensible et plus spécifique que celle rapportée précédemment. Ces résultats suggèrent que le diagnostic de dermatophytose et la détermination de la guérison mycologique doivent continuer à reposer sur une combinaison de tests diagnostiques complémentaires.

Introducción- la (q)PCR cuantitativa comercial y el cultivo de hongos se pueden usar de forma simultánea o individual para detectar dermatofitosis con una alta sensibilidad y especificidad reportadas. Hipótesis/Objetivos- Los objetivos de este estudio retrospectivo fueron: (i) evaluar la concordancia de una qPCR comercial con cultivo fúngico interno para el diagnóstico inicial de dermatofitosis y para el seguimiento de la curación micológica durante el tratamiento en la práctica privada de dermatología; y (ii) determinar la sensibilidad y especificidad de la qPCR en general, (iii) para el diagnóstico inicial y (iv) para el seguimiento del tratamiento en perros y gatos. Animales- 427 perros y 188 gatos de propietarios particulares. Materiales y métodos: evaluación retrospectiva de historiales clínicos electrónicos de 615 perros y gatos de propietarios particulares presentados en 16 prácticas de referencia de dermatología en los EE.UU. de 2018 a 2019. La concordancia de qPCR con el cultivo y la sensibilidad y especificidad de cada uno se determinó en 667 muestras pareadas. Resultados: qPCR presentó concordancia con el cultivo fúngico interno en 63 de 85 pruebas positivas y 571 de 582 pruebas negativas, con una sensibilidad y especificidad generales del 74,1 % [95 % intervalo de confianza (IC) 63,5-83,0] y 98,1 % (IC 95 % 96,6-99,0), respectivamente. La sensibilidad y especificidad de qPCR para el diagnóstico inicial de dermatofitosis y para el seguimiento del tratamiento fueron 72,4% (IC 95% 59,1-83,3) y 98,7% (IC 95% 97,3-99,5), y 77,8% (IC 95% 57,7-91,4) y 92,0% (IC 95% 80,1-97,8 ), respectivamente. Conclusiones y relevancia clínica- en comparación con el cultivo de hongos interno, la qPCR fue menos sensible y más específica que lo informado anteriormente. Estos hallazgos sugieren que el diagnóstico de dermatofitosis y la determinación de la curación micológica debe seguir basándose en una combinación de pruebas diagnósticas complementarias.

A survey of primary care practitioners' referral habits and recommendations of allergen-specific immunotherapy for canine and feline patients with atopic dermatitis.

BACKGROUND: A recent pilot study of primary care veterinarians' attitudes regarding canine atopic dermatitis and initiation of allergen-specific immunotherapy (ASIT) revealed several barriers to specialist referral (in the USA) and use of ASIT as a treatment modality. HYPOTHESIS/OBJECTIVES: The primary objective was to collect data on referral habits and ASIT practices among a much larger cohort of primary care veterinarians located around the world, and to explore barriers to referral and management of atopic diseases of dogs and cats with ASIT. METHODS AND MATERIALS: An online survey, administered through the Veterinary Information Network (VIN, Davis, CA, USA), asked participants to self-report their referral habits and immunotherapy recommendations, and rate barriers and motivating factors using Likert-scale responses. RESULTS: Of 827 survey responses, 97.6% identified as primary care practitioners. A larger number of practitioners (84.5%) reported seeing atopic dogs often, compared with atopic cats (9.7%). Fewer of these veterinarians (56.6%) referred atopic cats for specialist care, compared to atopic dogs (73.5%). Timely communication, sharing long-term management of the case, and provision of local continuing education were identified as factors associated with increased willingness to refer. A higher proportion of practitioners reported recommending ASIT for dogs (44.3%) than for cats (16.0%). Only 56.0% of respondents considered success rates of ASIT to be acceptable, while 27.9% were neutral on the topic. CONCLUSIONS AND CLINICAL RELEVANCE: Dermatology specialists might build stronger relationships with referring veterinarians through timely case follow-up and provision of continuing education regarding the long-term benefits of ASIT and symptomatic management practices.

Breeder-reported patterns of antimicrobial use and point prevalence of methicillin-resistant Staphylococcus spp. among breeding bitches in the southwestern United States.

Methicillin-resistant Staphylococcus pseudintermedius skin infections are an increasing concern in veterinary medicine, especially when found in juvenile dogs with no prior antimicrobial exposure. The objectives of this study were to assess the prevalence of methicillin-resistant staphylococci in breeding bitches and survey antimicrobial administration by their breeders. A total of 17 breeders and 54 bitches were included. Bitches were housed in diverse environments throughout the Phoenix, Arizona, USA metropolitan region. Nasal and oral gingival swabs were submitted for selective culture. Methicillin-resistant Staphylococcus aureus was not present, while methicillin-resistant Staphylococcus pseudintermedius was found in only 1/54 (1.9%) dogs. Survey results revealed that 16 bitches, which did not include the 1 MRSP-positive dog, had received antimicrobials within 6 months prior to sampling. Regardless of the low point prevalence identified, veterinarians and breeders should be cognizant of risks for bacterial resistance with the overuse of antimicrobials.

Patron d'utilisation des antimicrobiens rapporté par les éleveurs et prévalence ponctuelle de Staphylococcus spp. résistant à la méthicilline parmi des chiennes de reproduction dans le Sud-Ouest des États-Unis. Les infections cutanées dues à Staphylococcus pseudintermedius résistant à la méthicilline sont une préoccupation grandissante en médecine vétérinaire, surtout lorsque retrouvée chez des chiens juvéniles sans exposition préalable aux antibiotiques. Les objectifs de la présente étude étaient d'évaluer la prévalence de staphylocoques résistants à la méthicilline chez des chiennes reproductrices et sonder l'administration d'antimicrobiens par les éleveurs. Un total de 17 éleveurs et de 54 chiennes furent inclus. Les chiennes étaient logées dans divers environnements de la région métropolitaine de Phoenix, Arizona, USA. Des écouvillons du nez et des gencives orales furent soumis pour une culture sélective. Aucun Staphylococcus aureus résistant à la méthicilline ne fut détecté, alors que S. pseudintermedius fut trouvé chez seulement 1/54 chiens (1,9 %). Les résultats du sondage ont révélé que 16 chiennes, qui n'incluaient pas la chienne positive pour MRSP, avaient reçu des antimicrobiens à l'intérieur des 6 mois précédant l'échantillonnage. Indépendamment de la faible prévalence ponctuelle identifiée, les vétérinaires et les éleveurs devraient être au fait des risques pour la résistance bactérienne associée avec la surutilisation des antimicrobiens.(Traduit par Dr Serge Messier).

A pilot study to identify perceived barrier and motivating factors of primary veterinarians in the USA for specialty referral and management of atopic dermatitis with allergen-specific immunotherapy.

BACKGROUND: Allergen-specific immunotherapy (ASIT) may decrease clinical signs and potential neosensitization in dogs with canine atopic dermatitis (cAD). Identification of barriers to referral and specialty level case management may improve clinical outcome and satisfaction for both clients and primary veterinarians. HYPOTHESIS/OBJECTIVES: The objective of this cross-sectional, descriptive, survey-based pilot study was to identify factors influencing a veterinarian's decision to recommend dermatology referral and prescribe ASIT for management of cAD. METHODS AND MATERIALS: An online survey was administered to small animal veterinarians through two veterinary associations in the western United States. Participants were asked to rate factors using Likert scales. RESULTS: Of 60 responses, 18 (30%) rarely or never recommended ASIT. The top three factors against recommending ASIT included successful pharmaceutical management (100%), clients' concern for cost (94.4%) and veterinarians' perceptions that immunotherapy is unable to reduce pharmacological dependency (83.4%). The top three motivating factors included concerns for glucocorticoid adverse effects (83.3%), animal/owner quality of life (77.8%) and risk of antimicrobial resistant infection (55.6%). Results of the secondary objective revealed that 19 of 60 (31.7%) respondents rarely or never refer atopic pets to a dermatologist, citing cost of referral, availability of serological testing, and perception of limited benefits as the greatest barriers. CONCLUSIONS AND CLINICAL SIGNIFICANCE: Numerous factors appear to influence decisions to recommend referral or ASIT for management of pets with cAD. Further work is needed to determine if these can be generalized to larger populations with a goal of providing suggestions to bridge these gaps and improve outcomes.

Dorsal thermal necrosis in dogs: a retrospective analysis of 16 cases in the southwestern USA (2009-2016).

BACKGROUND: Prolonged sun exposure in high ambient temperatures has been recognized as a cause of thermal burns on the dorsal skin of dogs, termed dorsal thermal necrosis (DTN). HYPOTHESES/OBJECTIVES: To characterize the clinical presentation, histopathology and outcomes of 16 dogs diagnosed with DTN and to identify associated risk factors. ANIMALS: Sixteen dogs diagnosed with DTN. METHODS: Medical records from 2009 to 2016 were reviewed retrospectively. Inclusion criteria included: (i) historical solar exposure; (ii) dorsal burn injuries and (iii) histopathological findings consistent with DTN. RESULTS: The majority of cases (15 of 16) occurred during warmer months (May-September) in the southwestern USA. Affected dogs had predominantly dark, short hair coats, whereas four of 16 dogs had lighter coat colours. Five dogs had naturally longer hair, but two hair coats had been recently clipped. Signs consistent with heat exhaustion or heatstroke were reported prior to the development of cutaneous lesions in four of 16 dogs. The most common skin lesions were alopecia, erythema, ulcerations, eschars/necrosis and crusts. Histological findings were consistent with other types of partial and full-thickness thermal burns, and included coagulation necrosis in the majority of cases. Most dogs were treated supportively with analgesics and antimicrobial therapies. The majority of DTN wounds healed via second intention, although surgery was performed on two dogs. CONCLUSIONS AND CLINICAL IMPORTANCE: Dorsal thermal necrosis should be considered as a differential diagnosis for dogs with dorsal cutaneous burns and a history of sun exposure in high external temperatures. Dogs with dark, short hair coats may be at an increased risk.

Investigation of subclinical bacteriuria in cats with dermatological disease receiving long-term glucocorticoids and/or ciclosporin.

BACKGROUND: Dogs receiving long-term glucocorticoids or ciclosporin have an increased frequency of bacteriuria. No studies have investigated the frequency of bacteriuria in cats receiving long-term glucocorticoids and/or ciclosporin. HYPOTHESES/OBJECTIVES: To document whether subclinical bacteriuria occurs in cats receiving long-term glucocorticoid and/or ciclosporin for management of chronic disease. ANIMALS: Thirty two cats treated with parenteral glucocorticoids and/or oral glucocorticoids and/or ciclosporin were included. METHODS: Thirty two cats receiving oral glucocorticoids and/or ciclosporin for at least three months or at least two injections of long-acting glucocorticoids within the preceding six months were evaluated. Thirty four healthy cats were used as a control group. Urinalysis and urine culture was performed on urine samples collected by cystocentesis from each cat. RESULTS: In the glucocorticoid/ciclosporin group, none of 32 cats had a positive urine culture. In the control group, one of 34 cats had a positive urine culture. There were no statistically significant differences between the urinalyses from either group. CONCLUSIONS AND CLINICAL IMPORTANCE: There was no evidence to suggest that administration of long-term glucocorticoids and/or ciclosporin is associated with bacteriuria in cats.

Quality assessment of fluconazole capsules and oral suspensions compounded by pharmacies located in the United States.

OBJECTIVE To evaluate pharmaceutical characteristics (strength or concentration, accuracy, and precision), physical properties, and bacterial contamination of fluconazole compounded products. SAMPLE Fluconazole compounded products (30- and 240-mg capsules; 30- and 100-mg/mL oral suspensions) from 4 US veterinary compounding pharmacies. PROCEDURES Fluconazole compounded products were ordered 3 times from each of 4 pharmacies at 7- or 10-day intervals. Generic fluconazole products (50- and 200-mg tablets; 10- and 40-mg/mL oral suspensions) served as references. Compounded products were evaluated at the time of receipt; suspensions also were evaluated 3 months later and at beyond-use dates. Evaluations included assessments of strength (concentration), accuracy, precision, physical properties, and bacterial contamination. Acceptable accuracy was defined as within ± 10% of the labeled strength (concentration) and acceptable precision as within ± 10%. Fluconazole was quantified by use of high-performance liquid chromatography. RESULTS Physical characteristics of compounded products differed among pharmacies. Aerobic bacterial cultures yielded negative results. Capsules (30 and 240 mg) had acceptable accuracy (median, 96.3%; range, 87.3% to 135.2%) and precision (mean ± SD, 7.4 ± 6.0%). Suspensions (30 and 100 mg/mL) had poor accuracy (median, 73.8%; range, 53.9% to 95.2%) and precision (mean ± SD, 15.0 ± 6.9%). Accuracy and precision were significantly better for capsules than for suspensions. CONCLUSIONS AND CLINICAL RELEVANCE Fluconazole compounded products, particularly suspensions, differed in pharmaceutical and physical qualities. Studies to evaluate the impact of inconsistent quality on bioavailability or clinical efficacy of compounded fluconazole products are indicated, and each study should include data on the quality of the compounded product evaluated.

Retrospective analysis of cutaneous lesions in 23 canine and 17 feline cases of coccidioidomycosis seen in Arizona, USA (2009-2015).

BACKGROUND: Coccidioidomycosis is a fungal disease caused by the dimorphic saprophytic fungus Coccidioides immitis or C. posadasii. Primary pulmonary infection can disseminate to cutaneous and subcutaneous tissues, or less commonly direct cutaneous inoculation may occur. HYPOTHESIS/OBJECTIVES: To characterize the historical, clinical, diagnostic and treatment findings in dogs and cats with cutaneous manifestation of coccidioidomycosis. ANIMALS: Twenty three dogs and seventeen cats diagnosed between 2009 and 2015 in Arizona, USA. METHODS: Retrospective review of medical records from dogs and cats from an endemic area with a confirmed diagnosis via histopathology, cytology and/or culture, and skin lesions. RESULTS: Age of affected dogs ranged from 14 weeks to 13 years (median = 7 years), whereas cats ranged from 3 to 17 years (median = 9 years). Subcutaneous nodules were the most common lesions in both species. Lesions were distributed widely and not often found over sites of bone infection. In 75% of dogs and 54.5% of cats with cutaneous lesions there were clinical signs of systemic illness, supporting the diagnosis of cutaneous disseminated disease. Four dogs and four cats had localized lesions with no systemic illness, consistent with possible primary cutaneous infection. The most common mode of diagnosis was cytology identification in both species. Fluconazole was the most commonly prescribed antifungal drug. CONCLUSIONS AND CLINICAL IMPORTANCE: Coccidioidomycosis is the most common mycosis of dogs and cats in endemic regions and cutaneous signs of the disease may be an initial presenting complaint. This study identified a variety of cutaneous manifestations of the disease in dogs and cats and should be recognized by clinicians.

Evaluation of Bacterial Contamination of Clipper Blades in Small Animal Private Practice.

Nosocomial infections are a growing concern in veterinary hospitals, and identifying fomites is imperative to reducing the risk of pathogen transmission. In veterinary medicine, shaving of hair is necessary prior to many procedures. Contaminated clipper blades have been cited as potential fomites involved in the transmission of pathogens in veterinary and human medicine. The primary goal of this study was to evaluate bacterial contamination of clipper blades in veterinary practices. A secondary goal was to assess whether there was an association between bacterial contamination of clipper blades and clipper blade cleaning solutions, clipper blade cleaning protocols, clipper blade storage, and type of practice. Sixty clipper blades from 60 different practices were cultured. Information regarding blade cleaning solutions, protocols, and storage was collected from each practice. Fifty-one percent (31/60) of clipper blades sampled were contaminated with bacteria. Category of cleaning solutions had a significant association with bacterial contamination (P < 0.02). Cleaning frequency (P = 0.55), storage location (P = 0.26), and practice type (P = 0.06) had no significant association with bacterial contamination. This study documented bacterial contamination of clipper blades in veterinary practices, and clipper blades should be considered potential fomites.

Canine alopecia secondary to human topical hormone replacement therapy in six dogs.

Alopecia is a common presenting complaint in veterinary medicine and is known to occur secondary to numerous primary conditions. In this report, six unrelated dogs from three households were subsequently determined to have developed alopecia as a result of accidental transdermal exposure to their owners' topical hormone replacement therapy (THRT). All cases presented with alopecia ranging in duration from 2 mo to 2.5 yr. All dogs demonstrated alopecia affecting the ventral neck, thoracic and abdominal surfaces, proximal lateral extremities, and lateral trunk. At the time of initial presentation, five of six dogs were also noted to have physical exam findings suggestive of feminization. In all cases, serum total thyroxine was within normal reference range. Affected skin was biopsied in five dogs, and all samples demonstrated four similar histological characteristics: basal melanosis, epidermal and infundibular follicular hyperkeratosis, kenogen hair follicles, and small sebaceous glands. All dogs had elevated baseline estradiol levels, and four dogs had concurrent elevations of baseline progesterone. Average time to onset of clinical signs in those dogs was 5.5 mo after the owners started THRT. Following discontinuation of THRT by the owners, all dogs had complete resolution of their clinical signs by 5.5 mo.

Absorption of transdermal and oral cyclosporine in six healthy cats.

Cyclosporine is commonly used orally to treat feline dermatoses. Due to difficulties administering oral medications, veterinarians sometimes prescribe compounded transdermal cyclosporine, despite studies showing limited absorption. The study objective was to compare cyclosporine blood concentrations after oral administration to concentrations after transdermal application of cyclosporine (prepared in pluronic lecithin organogel [PLO]) in six cats using a controlled, cross-over design with a 2 wk washout period. Cats were dosed at 5.1-7.4 mg/kg of cyclosporine q 24 hr either per os for 7 days or transdermally for 21 days. Cyclosporine blood concentrations were measured q 7 days and after the washout period. A monoclonal-based immunoassay (lower limit of quantitation was 25 ng/mL) was used. Median concentrations on the seventh day were 2,208 ng/mL (range, 1,357-3,419 ng/mL) 2 hr after orally administered cyclosporine and 37 ng/mL (range, 25-290 ng/mL) 2 hr after transdermally applied cyclosporine. Median concentration on day 21 was 58 ng/mL (range, 51-878 ng/mL) 2 hr after transdermally applied cyclosporine. Concentrations were quantifiable for transdermally applied cyclosporine, but considered therapeutic in only one of six cats. Based on those results, transdermally applied cyclosporine was not recommended in cats because of inconsistent absorption.

Comparison of once-daily versus twice-weekly terbinafine administration for the treatment of canine Malassezia dermatitis - a pilot study.

BACKGROUND: Terbinafine, an allylamine antifungal, is used in pulsatile dose regimens for superficial mycoses in human medicine. OBJECTIVES: To compare the clinical efficacy of twice-weekly versus once-daily terbinafine administration to determine whether preliminary proof-of-concept evidence exists for pulsatile administration of terbinafine in the treatment of canine Malassezia dermatitis and to determine whether twice-weekly treatment results in fewer clinical and owner-perceived adverse events. ANIMALS: Twenty client-owned dogs with Malassezia dermatitis. METHODS: In this randomized, single-blinded clinical trial, dogs were randomly assigned to receive terbinafine (30 mg/kg) either once daily for 21 days (n = 10) or once daily on two consecutive days per week for six doses (n = 10). On day 0 and day 21, a mean yeast count was calculated from eight anatomical locations via adhesive tape-strip cytology, clinical lesion scores were assigned to the same locations, and owners assessed pruritus using a visual analog scale. RESULTS: There was no significant difference between treatment groups with respect to the reduction in mean yeast count (P = 0.343) and clinical lesion scores (P = 0.887). Pruritus measured by visual analog scale was significantly decreased in the twice-weekly treatment group compared with the daily treatment group (P = 0.047). Seven of 20 dogs had a clinically measurable or owner-reported adverse event during treatment that included gastrointestinal disturbances, excessive panting and elevated hepatic enzymes, with no significant difference noted between treatment groups. CONCLUSIONS AND CLINICAL IMPORTANCE: This pilot study indicates that twice-weekly terbinafine administration may be an effective alternative treatment for canine Malassezia dermatitis and merits further investigation.

Sebaceous adenitis in Havanese dogs: a retrospective study of the clinical presentation and incidence.

Sebaceous adenitis is a suspected immune-mediated disease that targets and destroys sebaceous glands. This retrospective study evaluated the clinical presentation and incidence of sebaceous adenitis in Havanese dogs. Sebaceous adenitis was diagnosed in 35% (12 of 34) of Havanese dogs presented over a 5-year period. Onset of clinical signs occurred during young adulthood. Follicular casts were present in 92% (11 of 12) of affected dogs. Other common clinical signs included alopecia and hypotrichosis. The trunk, head and ears were commonly affected, with 67% (8 of 12) of cases having pinnal and/or external ear canal involvement. Secondary pyoderma was seen in 42% (5 of 12) of dogs. Histopathology revealed absent sebaceous glands in 83% (10 of 12) and a lymphoplasmacytic periadnexal infiltrate in 92% (11 of 12) of samples. Treatment included multiple modalities. Cyclosporin was prescribed in 83% (10 of 12) of cases. Other systemic therapies included vitamin A and fatty acid supplementation. Topical therapies included antiseborrhoeic shampoos and sprays, and oil soaks. Follow-up ranging from 2 months to 3 years was obtained in 67% (8 of 12) of dogs. Improvement ranged from minimal to marked, with better clinical response associated with longer duration of treatment. Owners with follow-up of more than 1 year commonly reported occasional flares of the clinical signs. This study found that sebaceous adenitis was a common diagnosis in Havanese dogs, that the ears were commonly affected and that a lymphoplasmacytic periadnexal infiltrate associated with absent sebaceous glands was frequently seen on dermatohistopathological examination.

Evaluation of fungal flora in normal and diseased canine ears.

This study was undertaken to characterize otic fungal flora encountered in normal dogs, atopic dogs with no clinical or cytological evidence of otitis and dogs with otitis externa. Forty-two normal dogs, 23 atopic dogs and 32 dogs with otitis were included in the study. Samples for otic fungal culture and cytology were obtained from all animals, for a total of 194 ears. Sixty-seven ear samples (34%) were culture positive for saprophytic fungal organisms, as follows: 43 (64%) Penicillium species, 13 (19%) Aspergillus species and the remaining 17% comprised of various other saprophytic fungal organisms. Cytological evidence of saprophytic fungal colonization or infection was not found in any animal. There was no relationship between positive saprophytic fungal culture and any study group. Thirty-three ear samples (17%) were positive for Malassezia pachydermatis. Cytological findings of Malassezia were significantly associated with positive culture for Malassezia (P = 0.006 left ear; P = 0.019 right ear). Furthermore, increased numbers of Malassezia led to a higher chance of positive culture (P = 0.003 left ear; P = 0.008 right ear; McNemar's test). Malassezia pachydermatis was more likely to be cultured from ears with increased cerumen. Ear type (erect or pendulous) was not significantly associated with positive culture for Malassezia or saprophytic fungal organisms. There was no relationship between positive Malassezia culture and any study group; however, Malassezia was more likely to be cultured from individual dogs in the atopic or otitis groups that also had other dermatological signs consistent with allergic dermatitis and/or pyoderma (P = 0.031 left ear; P = 0.005 right ear).

Variability of laboratory identification and antibiotic susceptibility reporting of Pseudomonas spp. isolates from dogs with chronic otitis externa.

The purpose of this study was to evaluate interlaboratory variation in isolation and antibiotic susceptibility pattern of Pseudomonas spp. as reported to veterinarians for cases of canine chronic bacterial otitis externa. Twenty-six dogs with unilateral or bilateral bacterial otitis externa from multiple referral practices were included in this prospective study. Triplicate samples collected simultaneously from the same location in the external ear canal were randomly submitted to three laboratories for culture and susceptibility testing. Pseudomonas spp. were isolated from 18 of 34 (53%) ears. All three laboratories agreed on the presence of Pseudomonas spp. in 15 (83.3%) ears sampled. However, two laboratories agreed on two (11.1%) occasions, and on one occasion (5.5%) Pseudomonas spp. were identified in only one laboratory. Minimum inhibitory concentration (MIC) susceptibilities to 11 antibiotics were compared between laboratories B and C. Using laboratory-defined susceptibility of sensitive (S), intermediate (I) and resistant (R), none of the 16 Pseudomonas spp. with MIC data reported had identical patterns of antibiotic susceptibility. Agreement in susceptibility to individual antibiotics was observed in 13 of 16 (81%) occasions for amikacin and gentamicin, 10 of 16 (63%) occasions for ticarcillin, and nine of 16 (56%) for enrofloxacin. These results indicate that Pseudomonas spp. were identified by all three laboratories chosen for this study in 83% of the time. Moreover, antibiotic susceptibility patterns and MIC values reported to veterinarians may not agree between laboratories. Veterinarians should interpret bacterial culture and susceptibility results with multiple caveats including variability between laboratories.