If i say aspergillus, you say where? (trigger answer)
what kinda fungi is aspergillus?
Ubiquitous filamentous fungi
is aspergillus local or disseminated?
could be either
where does aspergillus LIKE to live in the body?
nasal passages and frontal sinuses (esp of dogs, esp if they are immunocompromised)
WHO is most likely to get aspergillosis? is there any breed disposition?
Young to middle aged mesaticephalic (regular length nose) and dolichocephalic (long nose) breeds. German shepherds tend to get this more because they tend to have inherited immunodeficiencies (IgA defeciency) (remember, IgA= mucosal surfaces)
how would you describe the nasal discharge of a dog infected with aspergillus?
Mucoid to hemorrhagic, crusting
what odd clue on a dogs nose might hint you towards suspecting aspergillosus?
DEPIGMENTATION (depig is either fungi or autoimmune, and then it's dog nose, so high chance it's asper)
what imaging techniques might you use to help dx aspergillosus?
Skull films or CT (CT more helpful), Endoscopy
If you want to do a biopsy to determine if the dog is infected with aspergillus, what must you keep in mind/do?
CLOTTING TEST--- NASAL BIOPSIES BLEED LIKE A BITCH
why might you want to do a CT before determining if you want to locally treat a dog for aspergillus?
CHECK PATENTCY OF CRIBIFORM PLATE-- you dont want antifungals on the brain
what drugs can you use to treat aspergillosis TOPICALLY? what might you want to add orally?
Topical clotrimazole (1% )/enilconazole. +/- oral Itraconazole or fluconazole + terbinafine (Combo therapy in cats as well)
If the dog is immunocompromised, how might you want to treat the aspergillus (what drugs?)
Azoles, +/- Amph B lipid complex, surgical removal of granulomas
what is the prognosis of a immunocompromised pt with aspergillosus?
(discussed with pictures) how could you go about locally treating aspergillosus of the nasal passages?
ensure cribiform is intact. run tube with cuff through mouth, and inflate cuff above soft palate so it blocks the nasal passages from the nasopharynx. Then fill the nasal passages with the antifungal, and rotate dog a 1/4 turn every 10 or so minutes so all the fungus is contacted by the drug. effective the 1st time in 85% of dogs.
what is another name for coccidiomycosis (the dz)?
what is the primary route of infection? other route of infection?
Inhalation primary route, Cutaneous with trauma
WHERE (geography) is coccidiomycoses most common?
ARIZONA!!!!!!! and southern-mid USA
**how should you culture coccidioides?
TRICK QUESTION- NEVER CULTURE EVER EVER! Super DANGEROUS and zoonotic! REPORTABLE IN HUMANS!
explain the lifecycle of coccidioides (roughly)
there is a saphrophytic cycle in the environment, and then a PARASITIC cycle in a host (spores inhaled, develop into immature sphericules--> ensporulating sphericule--> ruptures--> spores infect other tissue)
How do clinical signs present for coccidiomycoses? (vague)
Host immunocompetence plays a big role. Mild clinically silent pulmonary disease can be one presentation, or can be Fatal multisystem dissemination. CSs can also depend on areas of dissemination
who is most at risk for developing coccidiomycoses?
Young, male intact, medium to large outdoor large breed dogs (most likely to free roam)
what are the main clinical signs for coccidiomycoses? (specific)
Cough, Lethargy, Anorexia, Fever, Chronic lameness, Cervical or head pain, Weight loss
coccidiomycoses can cause degenerative/proliferative bone lesions which look similar to osteosarcoma. how might you be able to tell them apart?
osteosarc usually doesnt cross joint spaces, but fungi CAN and WILL
how do you dx coccidiomycoses if you live in an endemic area?
(ARIZONA) Often just CS with lymphadenopathy
what imaging techniques might you use to try to dx coccidiomycoses?
Thoracic radiographs (resp signs), perihilar lymphadenopathy (enlargement of the mediasteinal LNs, around the base of the heart)
what is a test you can use to dx coccidiomycoses? what are you testing and what can it tell you?
Precipitin test is useful EARLY IN THE DZ, since testing for IgM Abs (the first responders). If you test again and find persistance, this can mean there is Persistence can indicate dissemination going on
what does the precipitin test test for?
IgM Abs (first responders) (Persistence can indicate dissemination)
what would you test for with Complement fixation if you want to know if the pt has coccidiomycoses?
which drugs would you use to tx a coccidiomycoses infection?
Azoles, can combine with a amphB lipid complex also.
how long do you treat coccidiomycoses for?
Minimum of 4-6 months BEYOND clinical cure AND relapse is common!!!