v letu 2014  je bil ponovno organiziran Slovenski veterinarski kongres, največje strokovno in znanstveno srečanje slovenskih veterinarjev. Kongres je, že 5. po vrsti, bil priložnost za srečanje s kolegi, izmenjavo mnenj in seznanitev z najnovejšimi znanstvenimi ter strokovnimi spoznanji na področju veterinarske medicine. V sklopu kongresa je bil predstavlje prispevek v obliki posterja.

TWO CASES OF CUTANEUS PHAEOHYPHOMYCOSIS IN CATS-
DVA PRIMERA KOŽNE FEOHIFOMIKOZE PRI MAČKAH

Metka Šimundić1, Zlata Čop2, Majda Golob3, Mitja Gombač4, Tanja Švara4, Igor Firm5, Sabina Stariha Pipan1, Polona Zalar6, Milan Pogačnik4, Irena Zdovc3

1 Prva-K, klinika za male živali, Gorkičeva ulica 6, Ljubljana
2 Veterinarska klinika Lesce, Alpska 49, 4248 Lesce,
3 Inštitut za mikrobiologijo in parazitologijo, Veterinarska fakulteta, Gerbičeva 60, 1115 Ljubljana,
4 Inštitut za patologijo, sodno in upravno veterinarstvo, Veterinarska fakulteta, Gerbičeva 60, 1115 Ljubljana,
5 Firm, Veterinarska interna medicina, Igor Firm s.p., Nove Loke 35, 3330 Mozirje,
6 Biotehniška fakulteta, Oddelek za biologijo, Večna pot 111, 1000 Ljubljana

 INTRODUCTION

Phaeohyphomycosis are uncommon opportunistic infections with characteristic pigmented hyphal and yeast-like elements in the tissue. Several fungal genera have been reported as etiological agents, including Alternaria, Bipolaris, Curvularia and others. Phaeohyphomycosis may occur in both immunosuppressed and immunocompetent organisms. In cats it is most often presented as slowly growing cutaneous nodules, plaques or non-healing cutaneous lesions. Diagnosis is made by cytology or histology and mycological culture. Therapy depends on the severity of lesions and the eventual presence of underlying disease. In case of a single cutaneous lesion, surgical excision is usually the first choice of therapy. Antifungal therapy is indicated in cases when the lesions are not amenable for surgery and the underlying disease has been treated. If the patient is receiving immunosuppressive medications at the time of antifungal therapy, they have to be reduced. Two cases of cutaneous phaeohyphomycosis caused by Alternaria sp.in cats are presented.

 CLINICAL CASE No. 1

The first case was diagnosed in a 7-year old European shorthaired cat, that had been treated for immune mediated haemolytic anaemia with immunosuppressive doses of corticosteroids. After four months of therapy, alopecia occurred and a darkish red lesion measuring 1 cm in diameter and rough surface developed on the skin of the abdomen (Fig. 1).

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Figure 1. Case No. 1. An ulcerated cutaneous lesion, measuring 1 cm in diameter developed in the abdominal region.

CLINICAL CASE No. 2

The second case was diagnosed in a 9-year old castrated European shorthaired cat, which was admitted due toswelling on the right side of the nose. The skin was ulcerated and covered with crusts (Fig. 2).

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Figure 2. Case No. 2. An ulcerated cutaneuos lesion developed in the nasal region.

CYTOLOGY

A cytopathological examination was performed on smears stained with Giemsa and Periodic acid-Schiff(PAS). In both cases we diagnosed pyogranulomatous inflammation with numerous PAS-positive septated and pigmented hyphae and spores (Fig. 3, 4).

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Fig. 3. Cytology revealed pyogranulomatous inflammation with numerous neutrophils and macrophages. Note septate fungal hyphae in the background. Giemsa, x 400.

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Figure 4. A. Alternaria infectoria was determined in case No. 1. B. Alternaria alternata was diagnosed in case No. 2.

MYCOLOGY

Scrapings and smears taken from the cutaneous lesions were cultured on the Sabouraud agar with dextrose and chloramphenicol, and incubated at 26 and 37°C. In the first case, brown pigmented fungus Alternaria infectoria, and in the second case Alternaria alternata were isolated.

DIAGNOSIS

Cutaneous phaeohyphomycosis was diagnosed in both cats. The etiology in case No. 1 was Alternaria infectoria and in case No. 2 Alternaria alternata.

TREATMENT AND OUTCOME No. 1

Immune mediated haemolytic anaemia was first treated with methylprednisolone, but due to the side effects that manifested as hypercorticism and diabetes mellitus, the treatment was changed to prednisolone and the medication was reduced. The cutaneous lesions that were treated topically with chlorhexidine and parenterally with cefovecin, healed in two weeks, therefore we did not use antimycotics.

TREATMENT AND OUTCOME No. 2

In spite of the extraction of two teeth and systemic antibiotic therapy the cat’s condition did not improve after one month of therapy.

The cat was treated systemically with itraconazole and topically with diluted betadine. After three weeks, the cat’s condition mildly improved, but the swelling spread to the left side of the face bellow the eye. Mycological examination, which was repeated 5 weeks after the beginning of therapy, was negative. The cat was euthanized after 3 months of therapy and cutaneous squamous cell carcinoma was diagnosed with histopathological examination of the lesion.

CONCLUSIONS

Phaeohyphomycosis is a rare pathological condition in cats. It should be considered in cases of non-healing or slowly growing, poorly circumscribed plaques in immunosuppressed cats with underlying diseases. Diagnosis should be confirmed with cytology or histology and microbiology. Using the combination of topical treatment with chlorhexidine or betadine with or without itraconazole and reducing immunosuppressive medications is successful.

LITERATURE

  1. Grooters A M, Foil C S. Miscellaneous Fungal Infections In: Green CE, ed Infectious disease in Dog and Cat. Missouri: Saunders Elsevier, 2012: 675-701
  2. Dye C, Johnson M E, Gruffydd-Jones T J. Alternaria species infection in nine domestic cats. Journual of Feline Medicine and Surgery 2009; 11: 332-336.
  3. Miller R I. Nodular granulomatous fungal skin diseases of cats in the United Kingdom: a retrospective review. Veterinary Dermatology 2009; 21: 130-135

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