Pulse - May 2022 - 16

DIMENSIONS IN SURGERY & CRITICAL CARE ANIMAL SPECIALTY & EMERGENCY CENTER
Upon re-examination,
the owners reported
the patient remained
anorexic and appeared
to be disoriented at
home with altered
mental status,
suggesting CNS
involvement.
infection can spread to skin, lungs, lymph
nodes, central nervous system, or eyes and
manifest with signs of uveitis, chorioretinitis,
systemic lymphadenitis, or multi-organ
involvement.1,4
In a study where cats were
inoculated with Cryptococcus neoformans,
CBC and serum biochemical profile
abnormalities were not identified in
any cat. Diagnosis by antigen detection in
blood is fast, reliable and minimally invasive.
Alternatively, cytology, culture, histopathology,
or PCR can be performed on
lesions. Advanced imaging including CT
and MRI may be used for chronic nasal or
CNS signs.4
Antigen titers can aid in monitoring
progress, evaluating prognosis, and
guiding anti-fungal treatment.5
Treatment
for Cryptococcus is recommended until
antigen tests are negative. If antigen testing
is not available, continuation of treatment
2-4 months beyond resolution of clinical
signs is recommended, however cats may
remain seropositive for months to years
after resolution of clinical signs.2
Management of systemic Cryptococcus
was discussed including addition of antifungals
like itraconazole, or amphotericin
16
VD radiographic images reveal increased soft tissue opacities in the lungs bilaterally and dorsal to the
heart base. The cutaneous lesion is detected ventral to the sternum.
B. Amphotericin B, ketoconazole, fluconazole,
and itraconazole have all been used
to treat cats. No significant difference
in outcome was identified between cats
treated with amphotericin B compared to
those treated with azole monotherapy.2
In
another study, with 29 cats with advanced
longstanding or disseminated disease,
response to oral fluconazole (50mg/cat)
PO q12h) produced a good response without
side effects.3
Alternatively, in another
study, cats treated with ketoconazole
became anorexic and experienced weight
loss. These side effects were not seen in cats
treated with itraconazole.4
Cats with CNS
involvement benefited immediately from
short-acting corticosteroids, and were associated
with increased short-term survival.2
In most cases, prognosis can be favorable
if the diagnosis is obtained early and patient
and owners are compliant with long course
treatment. Most cats that recovered presented
with sino-nasal or single lesions at
skin. In one retrospective study, central nervous
system (CNS) involvement impacted
outcome of therapy significantly, and in
another retrospective study, alterations in
mental status was the only negative prognostic
indicator. Cats that did not recover
had CNS or disseminated disease.2
P
References
1 Trivedi SR, Malik R, Meyer W, Sykes JE. Feline cryptococcosis:
impact of current research on clinical management.
J Feline Med Surg. 2011 Mar;13(3):163-72.
doi: 10.1016/j.jfms.2011.01.009. PMID: 21338941.
2 Pennisi MG, Hartmann K, Lloret A, Ferrer L, Addie
D, Belák S, Boucraut-Baralon C, Egberink H, Frymus
T, Gruffydd-Jones T, Hosie MJ, Lutz H, Marsilio
F, Möstl K, Radford AD, Thiry E, Truyen U, Horzinek
MC. Cryptococcosis in cats: ABCD guidelines on prevention
and management. J Feline Med Surg. 2013
Jul;15(7):611-8. doi: 10.1177/1098612X13489224.
PMID: 23813826.
3 R. Malik, D.I. Wigney, D.B. Muir, D.J. Gregory, D.N.
Love, Cryptococcosis in cats: clinical and mycological
assessment of 29 cases and evaluation of treatment
using orally administered fluconazole, Journal of
Medical and Veterinary Mycology, Volume 30, Issue 2,
March 1992, Pages 133-144,
4 Medleau L, Greene CE, Rakich PM. Evaluation of
ketoconazole and itraconazole for treatment of disseminated
cryptococcosis in cats. Am J Vet Res. 1990
Sep;51(9):1454-8. PMID: 2168688.
5 Flatland B, Greene RT, Lappin MR. Clinical and serologic
evaluation of cats with cryptococcosis. J Am
Vet Med Assoc. 1996 Sep 15;209(6):1110-3. PMID:
8800258.
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