First report of Mycobacteria avium complex (Mycobacteria intracellulare) in a cat from Southeast Asia.

Case summary: A 3-year-old castrated male domestic shorthaired cat, with indoor-outdoor access, was presented for chronic, progressive multinodular to generalised subcutaneous nodules covering much of its body. Previous medical treatment with doxycycline had been unhelpful. Fine-needle aspiration of the nodules revealed intra- and extracellular multibacillary negative staining rods in pyogranulomatous inflammation. Bacterial culture and susceptibility studies isolated Mycobacterium intracellulare, with zimine as the drug of choice for treatment. Initial triple therapy with rifampicin, azithromycin and pradofloxacin was ineffective, and was changed to triple therapy with clofazimine, clarithromycin and doxycycline once drug susceptibility was known, which was given for 3 months, after which long-term therapy with clofazimine and clarithromycin was continued. Relevance and novel information: Slow growing M intracellulare, a member of the Mycobacterium avium complex (MAC), has never been reported to cause disease in cats from Singapore and, by extension, Southeast Asia. The infection in this patient resulted in subcutaneous nodules, which started on the face, then spread to the feet and much of the rest of its body. This is in contrast to that commonly reported for infection with M avium, which is also a member of MAC, and may not only present with similar signs in cats, but also progress to systemic spread. Susceptibility studies suggest clofazimine as the drug of choice when treating this infection, and this case supports its use as empirical therapy for veterinarians treating this disease in this region while awaiting culture and sensitivity results.

Feline sporotrichosis in Asia.

Sporothrix schenckii sensu lato is currently recognized as a species complex with only Sporothrix brasiliensis, Sporothrix schenckii sensu stricto, Sporothrix globosa and Sporothrix pallida identified to cause disease in the cat. Feline sporotrichosis in Asia is mainly reported from Malaysia where a single clonal strain of clinical clade D, Sporothrix schenckii sensu stricto manifesting low susceptibility to major antifungal classes, has been identified as the agent of the disease. Sporothrix globosa has been identified to cause disease from a single cat in Japan while the specific species of agent has not been identified yet for the disease in Thailand. Despite efforts to elucidate and describe the pathogenicity of the agent and the disease it causes, the paucity of data highlights the need for further molecular epidemiological studies to characterize this fungus and the disease it causes in Asia. Its prognosis remains guarded to poor due to issues pertaining to cost, protracted treatment course, zoonotic potential and low susceptibility of some strains to antifungals.

Chrysomya bezziana (Diptera: Calliphoridae) infestation in two Malaysian cats treated with oral lotilaner.

The most common fly species associated with screwworm myiasis in Southeast Asia is Chrysomya bezziana (Ch. bezziana), the Old-World screwworm. Treatment of screwworm myiasis in cats traditionally has comprised subcutaneous injection of ivermectin or oral administration of nitenpyram, combined with aggressive tissue debridement and larval removal under general anaesthesia. Two cats diagnosed with cutaneous myiasis caused by the larvae of Ch. bezziana were treated with lotilaner. In both cats, a single dose of lotilaner at 6-26 mg/kg, killed all larvae within 24 h, negating the need for general anaesthesia. Both cats were simultaneously infested with Lynxacarus radovskyi (L. radovskyi) which also was eradicated with lotilaner. No adverse reactions were observed and both cats recovered without complications.

L'espèce de mouche la plus fréquemment associée à la lucile bouchère en Asie du sud-est est Chrysomya bezziana (Ch. bezziana), espèce du vieux continent. Le traitement chez le chat consiste en une injection sous-cutanée d'ivermectine ou une administration orale de nitenpyram, associé à un débridement tissulaire agressif et retrait des larves sous anesthésie générale. Deux chats avec myase cutanée causée par les larves de Ch. Bezziana ont été traités avec lotilaner. Pour les deux chats, une dose unique de lotilaner à 6-26 mg/kg, a tué toutes les larves en 24h, sans besoin d'anesthésie générale. Les deux chats ont été infestés simultanément par Lynxacarus radovskyi (L. radovskyi) qui a également été éradiqué par le lotilaner. Aucune réaction indésirable n'a été observée chez les deux chats guéris sans complication.

La especie de mosca más común asociada con la miasis de larvas barrenadoras en el sudeste asiático es Chrysomya bezziana (Ch. Bezziana), la larva barrenadora del Viejo Mundo. El tratamiento de la miasis de larva barrenadora en los gatos ha consistido tradicionalmente en inyección subcutánea de ivermectina o administración oral de nitenpiram, combinado con debridamiento agresivo de tejido y eliminación de larvas bajo anestesia general. Dos gatos diagnosticados con miasis cutánea causada por las larvas de Ch. bezziana fueron tratados con lotilaner. En ambos gatos, una dosis única de lotilaner a 6-26 mg/kg, eliminó a todas las larvas en 24 h, evitando la necesidad de anestesia general. Ambos gatos estaban infestados simultáneamente con Lynxacarus radovskyi (L. radovskyi), que también fue erradicada con lotilaner. No se observaron reacciones adversas y ambos gatos se recuperaron sin complicaciones.

A espécie de mosca mais comumente associada à miíase no sudeste da Ásia é a Chrysomya bezziana (Ch. bezziana), a larva de rosca do Velho Mundo. O tratamento da miíase por larva de rosca em gatos tradicionalmente inclui injeção subcutânea de ivermectina ou administração oral de nitempiram, associado com debridamento agressivo do tecido e remoção larval sob anestesia geral. Dois gatos diagnosticados com miíase cutânea causada pelas larvas de Ch. bezziana foram tratados com lotilaner. Nos dois gatos, uma dose única de lotilaner de 6 a 26 mg / kg matou todas as larvas em 24 horas, negando a necessidade de anestesia geral. Ambos os gatos foram infestados simultaneamente com Lynxacarus radovskyi (L. radovskyi), que também foi erradicada com lotilaner. Nenhuma reação adversa foi observada e os dois gatos se recuperaram sem complicações.

Self-induced, noninflammatory alopecia associated with infestation with Lynxacarus radovskyi: a series of 11 cats.

BACKGROUND: Infestation of Lynxacarus radovskyi (Lynxacarosis) on cats is usually asymptomatic - most cats are presented with a dull, dry, dishevelled coat, with easily epilated hairs. The physical presence of the mite gives the coat a "peppered" appearance, and previous reports have described some cats developing pruritus and alopecia. OBJECTIVES: To describe the clinical signs of Lynxacarus radovskyi associated self-induced alopecia. ANIMALS: Eleven client-owned, indoor and naturally infested cats. METHODS AND MATERIALS: Cats with the primary complaint of pruritus and alopecia with sole infestation of Lynxacarus radovskyi, were included in this case series. Their age, sex, breed and clinical presentation were recorded. Cats were treated with selamectin twice, with a 14 day interval, followed by monthly maintenance therapy. RESULTS: Self-induced alopecia was found on the perianal (10 of 11), caudal-lateral thighs (eight of 11), sacral-tail base region, abdomen (each seven of 11), on the flanks (five of 11) and dorsal-lumbar (four of 11) areas. There were no eosinophilic dermatitis lesions nor head and neck pruritus in any cat. CONCLUSION AND CLINICAL IMPORTANCE: Lynxacarus radovskyi infested cats can have lesions which are strikingly similar to flea allergic dermatitis with lesions most commonly found on the perianal area.

Canine and feline cutaneous screw-worm myiasis in Malaysia: clinical aspects in 76 cases.

BACKGROUND: Cutaneous screw-worm myiasis in companion animals either due to the New World screw-worm, Cochliomyia hominivorax or the Old World screw-worm, Chrysomya bezziana, has been reported particularly in tropical and subtropical regions of the world. Although treatment of screw-worm myiasis in dogs has been described, few studies have been conducted regarding its clinical and epidemiological aspects in companion animals. OBJECTIVES: To describe clinical and epidemiological aspects of canine and feline screw-worm myiasis. ANIMALS: Naturally infested dogs and cats, presented to five veterinary clinics in four Malaysian states from September 2017 to February 2018. METHODS AND MATERIALS: Cutaneous screw-worm myiasis was diagnosed based on clinical signs and visual examination of burrowing larvae within lesion. Age, breed, gender, anatomical site of infestation and suspected underlying predisposing causes were investigated. RESULTS: A total of 55 dogs and 21 cats were included in the study. Intact male mixed breed dogs (mean age 58 months) and intact male domestic short hair cats (mean age 24 months) with suspected fight-related wounds were most commonly presented with exudative and ulcerative lesions associated with screw-worm myiasis. The most common anatomical sites of infestation in the dogs were the external ear canals, followed by the perineum and medial canthus. For the cats, the most commonly affected areas were paws and tail. Five cats with screw-worm myiasis were concurrently infected with sporotrichosis. CONCLUSION AND CLINICAL RELEVANCE: Aggression between unneutered animals is a likely underlying cause for cutaneous screw-worm myiasis in both cats and dogs. Sporotrichosis was also a potential predisposing cause for screw-worm myiasis in cats.

The comparative efficacy of afoxolaner, spinosad, milbemycin, spinosad plus milbemycin, and nitenpyram for the treatment of canine cutaneous myiasis.

BACKGROUND: Canine screw-worm myiasis due to Cochliomyia hominivorax or Chrysomya bezziana has traditionally been treated with extra-label use of ivermectin. The larvicidal activities of nitenpyram and spinosad/milbemycin also have been described, but there have been no reports to describe the efficacy of isoxazolines such as afoxolaner. OBJECTIVES: To evaluate and compare the efficacy of spinosad, spinosad/milbemycin, milbemycin, nitenpyram and afoxolaner for the treatment of canine screw-worm myiasis. ANIMALS: Forty client-owned and naturally infested dogs. METHODS: Cases were randomized into five groups of eight dogs, with each receiving an insecticide at the dose recommended by the manufacturer. Each case was evaluated hourly for 7 h and then again 24 h after treatment. Scores of 0 (no visualized effect), 0.5 (partial eradication) or 1 (complete kill and eradication) were recorded at each observation and compared between groups. Time to complete killing of all larvae was recorded for each dog and compared between treatment groups. RESULTS: Nitenpyram killed all larvae at 6 h post-consumption and spinosad/milbemycin at 7 h. In groups receiving afoxolaner or spinosad, all larvae were killed within 24 h. For those receiving milbemycin, two cases were still infested with live larvae at 24 h. Shih tzus and their crosses were most commonly affected. CONCLUSION: Spinosad/milbemycin or nitenpyram seem to be effective drugs for the treatment of canine screw-worm myiasis. Afoxolaner and milbemycin are effective but exhibited slower larvicidal activity. Synergism between spinosad and milbemycin was observed.

The first report of terbinafine resistance Microsporum canis from a cat.

A 2-year-old, exotic shorthair cat presented with baldness and mild scaling on trunk that was confirmed as Microsporum canis (M. canis) infection by the following methods. Wood's lamp and trichogram were used to demonstrate fungal elements suggestive of dermatophytosis consistent with M. canis. Dermatophyte test medium (DTM) and polymerase chain reaction (PCR) were used for identification. E-test and broth microdilution test were then utilized to estimate antifungal minimal inhibitory concentrations (MICs) towards ITZ and TRF respectively. The strain was isolated from the patient and revealed TRF MIC >32 µg/ml and ITZ MIC 0.023 µg/ml. Patient was cured of dermatophytosis with systemic ITZ.

Resistance Mechanism in a Terbinafine-Resistant Strain of Microsporum canis.

To clarify the terbinafine (TRF) resistance mechanism in a TRF-resistant strain of Microsporum canis, the expression of the pleiotropic drug resistance (PDR1), multidrug resistance (MDR1), MDR2 and MDR4 genes were investigated by real-time quantitative PCR (RT-qPCR) analysis, given the known interaction of the corresponding proteins with antifungals and with the efflux blocker FK506. The expression of the PDR1, MDR1, MDR2 and MDR4 genes was 2-4 times higher in the TRF-resistant strain grown in the presence of 0.14 µg/mL of TRF than in TRF-susceptible strains cultured in the absence of TRF. The TRF-resistant strain exhibited MICs of > 32 µg/mL for TRF alone; this resistance was attenuated to an MIC of 8 µg/mL in the presence of FK506, indicating that the TRF inhibitory concentration index value was < 0.75. The additive effect of the efflux blocker FK506 on TRF resistance was detected in the TRF-resistant strain. These results indicated that the TRF resistance in this strain reflects overexpression of genes encoding ABC transporter proteins.

Correction to: Resistance Mechanism in a Terbinafine-Resistant Strain of Microsporum canis.

In the initial online publication, the name of author Hock Siew Han was given incorrectly as Han Hock Siew. The original article has been corrected.

Comparison of two in vitro antifungal sensitivity tests and monitoring during therapy of Sporothrix schenckii sensu stricto in Malaysian cats.

BACKGROUND: Feline sporotrichosis is common in Malaysia. Thermosensitivity and effects of azole treatment on fungal susceptibility are unknown. OBJECTIVES: To evaluate thermotolerance and antifungal susceptibility of feline Malaysian Sporothrix isolates, compare microdilution (MD) and E-test results, and investigate changes in susceptibility during azole therapy. METHODS: Sporothrix schenckii sensu stricto was isolated from 44 cats. Thermotolerance was determined via culture at 37°C for 7 days. Susceptibility to itraconazole (ITZ), ketoconazole (KTZ) and terbinafine (TRB) was assessed in 40 isolates by MD; to amphotericin B (AMB), KTZ, ITZ, fluconazole (FLC) and posaconazole (POS) by E-test. Results were statistically compared by Pearson's Product Moment. In eight ketoconazole treated cats, susceptibility testing to itraconazole and ketoconazole was repeated every two months for six months. RESULTS: Thermotolerance was observed in 36 of 44 (82%) isolates. Assuming that isolates growing at antifungal concentrations ≥4 mg/mL were resistant, all were resistant on E-test to FLC and AMB, 11 (28%) to POS, 6 (15%) to ITZ and 1 (3%) to KTZ. On MD, 27 of 40 (68%) were resistant to TRB, 2 (5%) to ITZ and 3 (8%) to KTZ. There was no correlation between E-test and MD results (KTZ r = 0.10, P = 0.54, and ITZ r = 0.11, P = 0.48). MD values for ITZ and KTZ did not exceed 4 mg/L during KTZ therapy. CONCLUSION: The majority of feline isolates in Malaysia are thermosensitive. Lack of correlation between E-test and MD suggests that the E-test is unreliable to test antifungal susceptibility for Sporothrix spp. compared to MD. KTZ was the antifungal drug with the lowest MIC. Prolonged KTZ administration may not induce changes in antifungal susceptibility.

Chrysomya bezziana (Diptera: Calliphoridae) infestation: case report of three dogs in Malaysia treated with spinosad/milbemycin.

BACKGROUND: Infestation of wounds with the larvae of Callophorid flies is relatively common in countries where these parasites are found. The most common species associated with infections in Southeast Asia is Chrysomya bezziana (Ch. bezziana), the Old World screw worm. Treatment consists of either subcutaneous injection of ivermectin or oral administration of nitenpyram combined with aggressive tissue debridement under general anaesthesia. OBJECTIVES: To describe the treatment of cutaneous myiasis in three dogs caused by the larvae of Ch. bezziana in Malaysia and their treatment with spinosad plus milbemycin. RESULTS: In all dogs, a single oral dose of spinosad plus milbemycin at the recommended dosage of 31-62 mg/kg and 0.5-1.0 mg/kg, respectively, was able to kill all larvae within 8 h. Most dead larvae fell off the host and those remaining on the host were dead and easily removed with simple saline flushing and gentle debridement. Neither general anaesthesia nor aggressive mechanical debridement were needed in any patient. CONCLUSIONS AND CLINICAL IMPORTANCE: Oral spinosad plus milbemycin is a safe, licensed and effective treatment at the recommended dose for the rapid elimination of Ch. bezziana myiasis, with no need for sedation or anaesthesia.

Efficacy and duration of action of oral fluralaner and spot-on moxidectin/imidacloprid in cats infested with Lynxacarus radovskyi.

BACKGROUND: Lynxacarus radovskyi has been observed in cats in Malaysia; previously treatment with fipronil and moxidectin/imidacloprid spot-on has been described. OBJECTIVES: To compare the efficacy of two spot-on treatments of moxidectin/imidacloprid, two weeks apart to a single oral dose of fluralaner against Lynxacarus radovskyi and evaluate time to re-infestation. METHODS: Thirty cats were assigned to three groups of ten cats each. Group 1 received one 250 mg fluralaner tablet. Group 2 received two doses of moxidectin/imidacloprid spot-on two weeks apart. Group 3 consisted of untreated controls. For each cat, three plucks of about 50 hairs each were collected from three sites (dorsal neck, lateral thigh and perineal/tail region) for a total of nine pluckings every two weeks. Severity of infestation was scored from 0 (no parasite), to 1 (only nonhatched eggs), 2 (both hatched and nonhatched eggs), 3 (<50 mites) and 4 (>50 mites). Efficacy was compared between treatment groups and over time in the same group, and results analysed statistically. Re-infestation was defined as the identification of new eggs or mites on hair pluckings. RESULTS: Moxidectin/imidacloprid spot-on and oral fluralaner achieved 100% eradication within 28 days. No significant difference was observed between groups 1 and 2; re-infestation occurred by Day 56 in both treatment groups. CONCLUSION: A single dose of oral fluralaner or two moxidectin/imidacloprid spot-on treatments two weeks apart are efficacious in the eradication of L. radovskyi in cats and able to prevent re-infestation for at least 42 days post-treatment.