Cryptococcal Pneumonia and Meningitis in a Horse

An Arabian mare was referred due to a 4-month history of bilateral mucopurulent nasal discharge, which was unresponsive to multiple courses of antimicrobials and intravenous sodium iodide. Digital radiographs revealed multiple variably sized nodular opacities within the nasopharynx. Upper airway endoscopy showed multiple, ulcerated granulomatous masses originating from the walls of the nasopharynx. Repeat culture of the exudate and from endoscopic biopsies grew only a mixed bacterial population. Standing endoscopic guided laser excision of two granulomas was performed and histopathology and culture from the center of a surgically excised granuloma identified Cryptococcus terrestris. Treatment with fluconazole (14 mg/kg bwt per os once then 5 mg/kg bwt per os q. 12 h) was administered for a total of 11 weeks. Follow-up endoscopic examination was used to guide therapy duration, and the horse has since returned to competition and remained free of infection for >1.5 years. Establishing a diagnosis of cryptococcal infection was difficult in this horse despite multiple culture attempts. This is the first report of Cryptococcus terrestris infection in a horse and treatment with oral fluconazole after surgical de-bulking was successful.

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“…; Del Fava et al . ; Secombe et al . ) although there are several case reports of upper respiratory infections (Watt ; Scott et al .…”

Section: Discussionmentioning

confidence: 99%

Severe cryptococcal granulomas of the nasopharynx in a horse treated with standing endoscopic laser surgery and oral fluconazole

Daniel

Thachil

Savory‐Davis³

2019

Equine Veterinary Education

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Infectious, inflammatory, and immune diseases

2022

Large Animal Neurology

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Equine Pulmonary Cryptococcosis: A Comparative Literature Review and Evaluation of Fluconazole Monotherapy

2016

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Cryptococcus is the most common fungal respiratory pathogen in Australian horses, manifesting primarily as pulmonary granulomas. Disease severity at presentation is dependent on the athletic use of the horse. The diagnosis and estimation of disease severity are centred around clinical findings, cytological evaluation of respiratory tract secretions, diagnostic imaging, and antigen titre testing. Both the lateral flow assay and the latex cryptococcal antigen titre are used, and important similarities and differences between species are discussed. Cryptococcus gattii occurs with greater frequency than Cryptococcus neoformans in equine pulmonic cryptococcosis and can be successfully treated with enteral fluconazole monotherapy, with disease severity determining treatment length.

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Cryptococcal Pneumonia and Meningitis in a Horse

Cited by 4 publications

References 13 publications

Severe cryptococcal granulomas of the nasopharynx in a horse treated with standing endoscopic laser surgery and oral fluconazole

Severe cryptococcal granulomas of the nasopharynx in a horse treated with standing endoscopic laser surgery and oral fluconazole

Infectious, inflammatory, and immune diseases

Equine Pulmonary Cryptococcosis: A Comparative Literature Review and Evaluation of Fluconazole Monotherapy

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