Minimally invasive treatment of sino‐nasal aspergillosis in dogs

Abstract

Background: Sino‐nasal aspergillosis is a common nasal disease in dogs. Recommended treatment protocols typically involve trephination of the frontal sinuses or the use of an antifungal solution instilled into the frontal sinus under anesthesia, both of which have associated morbidity and complications. Objectives: To assess a minimally‐invasive topical treatment protocol for sino‐nasal aspergillosis in dogs. Animals: Twelve client‐owned dogs diagnosed with sino‐nasal aspergillosis that completed recommended treatment. Methods: Medical records were retrospectively reviewed to identify dogs with sino‐nasal aspergillosis that received treatment. Fungal plaques were manually debrided and irrigated via frontal sinuscopy in 12 dogs that then were treated topically with 1% topical clotrimazole cream. Irrigation and topical medication application was achieved using a catheter placed retrograde directly into the frontal sinuses using the Seldinger technique over a guidewire, thereby avoiding the need for frontal sinus trephination. Invasion into the calvarium was recorded before treatment but was not considered a criterion for exclusion. Debridement and cream deposition was repeated every 2 weeks as needed until negative culture and histopathologic findings were obtained. Results: All dogs were cured (negative results for Aspergillus on endoscopy, fungal culture, and histopathology) with a median of 2 treatments. Treatments were well tolerated, with minimal adverse effects reported. Three dogs had evidence of erosion into the calvarium on computed tomography imaging. Conclusions and Clinical Importance: This protocol appears to be an effective and well‐tolerated minimally invasive treatment for sino‐nasal aspergillosis, including in dogs with erosion into the calvarium. Only mild adverse effects were noted.

Otoscopic evaluation of epithelial remnants in the tympanic cavity after total ear canal ablation and lateral bulla osteotomy

“…The goal of intraoperative endoscopy in this study was to improve visualization. The use of endoscopy in our study was in line with prior research in dogs in which investigators used frontal sinuscopy to aid in debridement and irrigation of fungal plaques, subsequently allowing for direct visualization of the frontal sinus and higher cure rates of sinonasal aspergillosis 13 . The endoscope allowed for improved visualization within the tympanic cavity and evaluation of epithelial remnants that otherwise were not appreciated grossly prior to use of the endoscope.…”

“…Video‐otoscopy allowed consistent identification of epithelial remnants after standard TECA‐LBO in the 10 normal specimens used in our study. Endoscopic instrumentation is widely used in minimally invasive soft tissue surgery because of a number of reported advantages, including its ability to increase the visibility, magnification, and illumination for the surgeon in areas that are typically difficult to access 13‐15 . Endoscopic techniques have been used in prior research and clinically for second‐look arthroscopies after tibial plateau leveling osteotomy to evaluate meniscal pathology, cruciate ligament fraying, and articular cartilage abnormalities 14 .…”

Otitis externa canina por Aspergillus niger patogénico: reporte de caso

“…En caninos y felinos se presentan principalmente tres formas de aspergilosis: nasal, pulmonar e infecciones diseminadas. La aspergilosis nasal presenta frecuentemente sinusitis invasiva, ocasionada por las especies A. flavus, A. fumigatus y A. niger (Ballber et al, 2018;Belda et al, 2018). La de tipo pulmonar es de rara presentación y es causada por similares especies, además de A. versicolor (Maniam et al, 2017), mientras que la forma diseminada es una infección infrecuente, pero potencialmente fatal en perros, siendo las especies más aisladas A. terreus, A. deflectus y A. caninus (Kano et al, 2019;Yang et al, 2019), seguido en menor frecuencia por A. fumigatus (Brocal et al, 2019).…”

The sino-nasal warzone: transcriptomic and genomic studies on sino-nasal aspergillosis in dogs

“…Proper diagnosis of SNA requires a combination of computed tomography (CT), rhinoscopy, histopathology, cytology, fungal culturing, and serology 2 . Topical administration of azole drugs remains the most widely used and successful treatment for SNA in dogs although reports of its use are limited 2,3,5 . SNA has been associated with upregulation of Th1 cytokines like interleukin (IL)-8 and TNF-α [6][7][8] .…”

“…Infections with Aspergillus fumigatus occur in a wide variety of animal species including humans, birds, cows, horses, cats, and dogs 1 , 2 . In dogs, sino-nasal aspergillosis (SNA) is the most common Aspergillus infection 3 . The fungus can reside in the host for an extended period of time (e.g., months) before manifesting clinical signs, which include sneezing, mucoid nasal discharge, nasal depigmentation, epistaxis, and turbinate destruction 2 , 4 .…”