Association of itraconazole and potassium iodide in the treatment of feline sporotrichosis: a prospective study.

Feline sporotrichosis is an endemic disease in Rio de Janeiro, Brazil, where zoonotic transmission of Sporothrix spp. has been reported since 1998. Itraconazole (ITZ) remains the first choice for treating this disease in cats. However, there have been reports of therapeutic failure and a long-term endeavor. Potassium iodide (KI), considered in the past as a drug with variable effectiveness in cats with sporotrichosis, arises as an important option in the treatment of cats from the endemic area of Rio de Janeiro. In order to evaluate the effectiveness of the association of ITZ and KI in naive cats with sporotrichosis, a prospective cohort study was conducted on 30 cats receiving ITZ 100 mg/day and KI 2.5 mg-20 mg/kg/day. Clinical and laboratory adverse effects were assessed once a month according to the standard care protocol. The cure rate was 96.15% within a median of 14 weeks of treatment. Adverse effects were observed in 50% of cats and were managed with a temporary drug suspension and/or a hepatoprotective therapy. The association of ITZ and KI emerges as an effective option for the treatment of feline sporotrichosis.

Feline histoplasmosis: a case of supraorbital involvement / Histoplasmose felina: relato de caso com envolvimento supraorbital

Histoplasmosis is a systemic fungal infection caused by the dimorphic fungus Histoplasma capsulatum that infects humans and a wide variety of mammalian species, including cats. In Brazil only four cases of this disease were reported in domestic cats. The present study reports a case of an indoor cat, rescued from street three years ago, that developed histoplasmosis with supraorbital involvement. The cat presented sneezing, dyspnea and increased respiratory sounds and the diagnosis suspected was allergic rhinitis. Prednisolone and amoxicillin were prescribed. The patient returned to clinic after clinical signs worsened with a swelling of the right supraorbital region, unilateral left side conjunctivitis and enlarged submandibular lymph nodes. Cytology and culture revealed Histoplasma capsulatum. Initially, itraconazole (10 mg/Kg SID orally) was prescribed and due to the worsening of clinical signs, was combined amphotericin B (0.5 mg/kg SC) for two weeks. The therapy with amphotericin was discontinued and itraconazole continued to be administered for six months. The clinical signs were resolved and no recrudescence was reported. It is important that veterinary practitioners to be aware of the clinical features of feline histoplasmosis and consider the possibility of a subclinical infection.

Histoplasmose é uma infecção sistêmica causada pelo fungo dimórfico Histoplasma capsulatum, que infecta humanos e uma ampla variedade de mamíferos, incluindo os gatos. No Brasil, somente quatro casos dessa doença foram relatados em gatos domésticos. O presente estudo relata um caso de um gato, vivendo em ambiente domiciliar sem acesso à rua, mas que tinha sido resgatado das ruas havia três anos, que desenvolveu histoplasmose com envolvimento supraorbital. O paciente apresentava espirros, dispneia e aumento dos sons respiratórios e a suspeita clínica foi rinite alérgica. O animal foi tratado com prednisolona e amoxicilina. Com a piora dos sinais clínicos o paciente retornou apresentando um edema na região supraorbital direita, conjuntivite unilateral do olho esquerdo e linfoadenomegalia na região submandibular. A citologia e a cultura revelaram a presença de Histoplasma capsulatum. Inicialmente, itraconazol (10 mg/kg via oral, uma vez ao dia) foi prescrito e devido à piora dos sinais clínicos, anfotericina B (0,5 mg/Kg via subcutânea) foi administrada por duas semanas associada ao triazólico. A terapia com anfotericina B foi descontinuada e o itraconazol mantido por seis meses até a cura clínica e nenhuma recrudescência foi registrada. É importante ressaltar que veterinários devem estar atentos para os sinais clínicos da histoplasmose e que devem considerar a possibilidade de uma infecção subclínica.

Feline sporotrichosis: epidemiological and clinical aspects.

Feline sporotrichosis, which is caused by species of the Sporothrix schenckii complex, is endemic to Rio de Janeiro, Brazil. More than 4000 cases of the disease were diagnosed at Fundação Oswaldo Cruz, Brazil, between 1998 and 2012. Sporotrichosis in cats has been reported in several countries, but nowhere has an outbreak of animal sporotrichosis been as large as that seen in Brazil. The clinical manifestations of the disease range from an isolated skin lesion that can progress to multiple skin lesions and even fatal systemic involvement. Nodules and ulcers are the most common types of lesions, and respiratory signs and mucosa involvement are frequent. The definitive diagnosis depends on isolation of the etiologic agent in culture. Cytology, histopathology, and serology are useful tools for preliminary diagnosis. Severe pyogranulomatous inflammatory infiltrate, high fungal load, and extension of lesions to mucosa, cartilage, and bone in the nose of cats are indicative of an agent of high virulence in this endemic region. Itraconazole is the drug of choice, while, in refractory cases, amphotericin B or potassium iodide might be alternative treatments; however, recurrence after discharge may occur. Sporotrichosis persists as a neglected disease in Rio de Janeiro, and the treatment of cats remains a challenging and long-term endeavor.

Detection of serum antibodies against Bartonella species in cats with sporotrichosis from Rio de Janeiro, Brazil.

Cat scratch disease is a zoonosis caused by Bartonella species, transmitted to humans through scratches or bites from infected cats and via direct contact with infected feces. Sporotrichosis, caused by the fungal complex Sporothrix, is transmitted by traumatic inoculation of the fungus. Cats are important in zoonotic transmission. Serum samples from 112 domestic cats with sporotrichosis and 77 samples from healthy cats were analyzed by indirect immunofluorescence assay (IFA), using the commercial kit Bartonella henselae IFA IgG (Bion). The presence of antibodies against feline leukemia virus (FeLV) and of feline immunodeficiency virus (FIV) core antigens was detected using the commercial kit Snap Combo FIV-FeLV (Idexx). The group of animals with sporotrichosis contained 93 males with a median age of 22 months, eight (7.1%) of which were positive for FIV and 15 (13.4%) for FeLV. The group of animals without sporotrichosis contained 36 males with a median age 48 months, 10 (13.0%) of which were positive for FIV and eight (10.4%) for FeLV. Of the 112 cats with sporotrichosis and 77 cats without mycosis, 72 (64.3%) and 35 (45.5%), respectively, were IFA reactive. No association was found between age, sex, FIV/FeLV and the presence of antibodies to Bartonella species. The results suggest that the study population can be considered a potential source of zoonotic infection for both diseases.

Disseminated intravascular coagulation in a dog naturally infected by Leishmania (Leishmania) chagasi from Rio de Janeiro - Brazil.

BACKGROUND: Disseminated intravascular coagulation (DIC) is an acquired disorder characterized by the activation of intravascular coagulation and excessive fibrin formation. It always occurs in association with other clinical conditions, including parasitic diseases. DIC has been described as a unusual complication in human and canine visceral leishmaniasis. CASE PRESENTATION: DIC was found in a seven-year-old male mongrel dog naturally infected by Leishmania (Leishmania) chagasi. Haemostasis parameters demonstrated changes in primary and secondary haemostasis and fibrinolysis. CONCLUSION: DIC is a unusual condition described in canine visceral leishmaniasis and it seems to be associated with several immunological and pathological mechanisms involved in the disease.

Potassium iodide capsule treatment of feline sporotrichosis.

Sporotrichosis is a mycosis caused by Sporothrix schenckii. The most affected animal is the cat; it has played an important role in the zoonotic transmission of this disease, especially in Rio de Janeiro, Brazil, since 1998. In order to evaluate the treatment of feline sporotrichosis with potassium iodide, an observational cohort was conducted in 48 cats with sporotrichosis at Instituto de Pesquisa Clínica Evandro Chagas, Fiocruz. All cats received potassium iodide capsules, 2.5 mg/kg to 20 mg/kg q24h. The cure rate was 47.9%, treatment failure was 37.5%, treatment abandonment was 10.4% and death was 4.2%. Clinical adverse effects were observed in 52.1% of the cases. Thirteen cats had a mild increase in hepatic transaminase levels during the treatment, six of them presented clinical signs suggestive of hepatotoxicity. Compared to previous studies with itraconazole and iodide in saturated solution, potassium iodide capsules are an alternative for feline sporotrichosis treatment.

Sensitivity of cytopathological examination in the diagnosis of feline sporotrichosis.

Sporotrichosis is caused by Sporothrix schenckii. The cat is the animal species most affected by this mycosis and plays an important role in the zoonotic transmission of this disease. The definitive diagnosis is made by isolation of the fungus in culture; however, cytopathological examination is frequently used in cats. Medical records from cats treated at Instituto de Pesquisa Clínica Evandro Chagas/Fiocruz, Rio de Janeiro, Brazil, between 2004 and 2006 were reviewed. Criteria for inclusion were a diagnosis by isolation of S schenckii in culture and cytopathological examination of the same lesion as that used for collection of the culture material. Eight hundred and six cats were included in the study. Yeast-like structures suggestive of S schenckii were observed in 636 cases. The sensitivity of the method was 78.9%. Its practicality, low cost and sensitivity validate cytopathology as a safe technique for the presumptive diagnosis of sporotrichosis in cats.

Intralesional amphotericin B in a cat with refractory localised sporotrichosis.

The present report concerns a case of sporotrichosis in a 3-year-old male crossbred cat. After 9 months of oral itraconazole (20mg/kg) therapy, all skin lesions had resolved with the exception of a single nodular lesion located on the bridge of the nose. Therefore, a combined therapy that included intralesional (IL) amphotericin B (1mg/kg) was started. The lesion resolved completely after three weekly administrations of IL amphotericin B, given in concert with oral itraconazole. The cat remains well 1 year after discontinuing therapy, with no signs of recurrence.