No abstract

Dermal and systemic infections caused by the Chrysosporium anamorph of Nannizziopsis vriesii (CANV) are highly prevalent in reptiles and may result in severe disease and high mortality. Due to the high incidence of therapeutic failures, optimizing treatment is required. We first determined in this study the minimal inhibitory concentrations (MIC) of itraconazole, voriconazole, amphotericin B and terbinafine against 32 CANV isolates. For voriconazole, amphotericin B and terbinafine a monomodal MIC distribution was seen, whereas a bimodal MIC distribution was present for itraconazole, indicating acquired resistance in one isolate. Fourteen naturally-infected bearded dragons (Pogona vitticeps), from the same owner, were treated orally with either itraconazole (5 mg/kg q24h) or voriconazole (10 mg/kg q24h). The clinical condition, drug plasma concentrations and the presence of CANV in skin samples were followed. The animals were treated until complete clearance of the fungus. The plasma concentrations of voriconazole and itraconazole exceeded the minimal inhibitory concentrations of the CANV isolates. Elimination of CANV was achieved on average after 27 and 47 days of treatment with itraconazole and voriconazole, respectively. Whereas only 2 out of 7 survived after itraconazole treatment, only a single animal died in the voriconazole treated group. In conclusion, based on a limited number of animals, voriconazole applied at a regimen of 10 mg/kg bodyweight (BW) q24h seems to be a safe and effective antimycotic drug to eliminate CANV infections in bearded dragons.

Aspergillosis is a major cause of mortality in captive birds and its prognosis is often poor due to treatment failure. Voriconazole is a novel triazole antifungal agent that may be useful for the treatment of this infection in birds as it has shown promise in other animal models of the disease. We examined the pharmacokinetic behaviour of voriconazole in racing pigeons (Columbia livia forma domestica). Intravenous, oral and aerosol administration were investigated in single (10 mg/kg BW PO; 10, 5, 2.5 mg/kg BW IV), multiple dose (10, 20 mg/kg BW PO q12h, q24h) and nebulization (15 min, 10 mg/ml NaCl 0.9%) experiments. Quantitative measurements of voriconazole in plasma, as well as in lung tissue, collected at several time points, were done with a validated high performance liquid chromatography method using ultraviolet detection. Designing a treatment schedule with voriconazole is complicated by dose-dependent pharmacokinetics and induction of its biotransformation. Moreover, hepatic changes were seen in the oral multiple dose regimen at 10 and 20 mg/kg BW twice a day. Taking all features into account our study suggests that the oral dosage schedules of 10 mg/kg BW twice a day or 20 mg/kg BW once a day could be most appropriate in treating pigeons with aspergillosis.

The in vitro susceptibilities of 59 avian Aspergillus fumigatus strains to amphotericin B, itraconazole, and voriconazole were determined using the standard microdilution broth method (CLSI M38-A2). Four isolates showed acquired resistance to itraconazole and voriconazole, harboring implications for the treatment of aspergillosis in both birds and humans.

The Chrysosporium anamorph of Nannizziopsis vriesii was associated with dermatomycosis and high mortality in a group of captive giant girdled lizards (Cordylus giganteus). Treatment of one of the infected girdled lizards with voriconazole, which was selected on the basis of in vitro sensitivity testing of the isolate, resulted in resolution of lesions and negative fungal cultures from the skin. Three hours after oral administration of 10 mg/kg, the plasma level of voriconazole exceeded the 0.25-μg/mL minimal inhibitory concentration tenfold. In conclusion, administration of voriconazole at 10 mg/kg of body weight once daily for 10 weeks resulted in clinical cure and was well tolerated. A longer follow-up time and larger studies will be necessary to determine the long-term efficacy and safety of this treatment in giant girdled lizards.