Refractory feline sporotrichosis treated with itraconazole combined with potassium iodide

Rocha, Raphael Francisco Dutra Barbosa da; Schubach, Tânia Maria Pacheco; Pereira, Sandro Antônio; Reis, Érica Guerino dos; Carvalho, Beatriz Wanderosck; Gremião, Isabella Dib Ferreira

doi:10.1111/jsap.12852

Cited by 34 publications

(27 citation statements)

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“…Furthermore, no therapeutic failure was observed in cats submitted to the combined therapy in this study, indicating that in contrast to azole monotherapy, the high fungal burden detected before treatment did not affect the healing process in this group. The combination of KI capsules and ITZ has already proven to increase the cure rate of feline sporotrichosis [ 19 , 20 ]. Although the mechanisms whereby KI mediates this process are still unclear, we demonstrate here that KI not only improved the chance of cure but was also related to the prompt control of fungal burden.…”

Section: Discussionmentioning

confidence: 99%

“…It is important to note that treatment of feline sporotrichosis remains a challenge and reports of therapeutic failure and recrudescence are common, even when established protocols with ITZ—the drug of choice—are used [ 17 , 18 ]. Within this context, the combination of potassium iodide (KI) capsules with ITZ for the treatment of feline sporotrichosis has shown high cure rate and has emerged as an effective treatment option [ 19 , 20 ]. However, the fungal burden before and during the treatment with KI combined and ITZ has not been evaluated.…”

Section: Introductionmentioning

confidence: 99%

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Monitoring Fungal Burden and Viability of Sporothrix spp. in Skin Lesions of Cats for Predicting Antifungal Treatment Response

Miranda

Silva

Gremião

et al. 2018

JoF

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Skin lesions in feline sporotrichosis usually present a high fungal burden, making cats an important source of infection. This study evaluated the fungal burden and isolation in skin lesions of feline sporotrichosis during treatment with itraconazole (ITZ), combined with or without potassium iodide (KI). Treatment-naïve cats with culture-confirmed sporotrichosis and presenting skin ulcers were treated for up to 40 weeks with oral ITZ alone (n = 74) or combined with KI (n = 56). These cats were submitted to monthly sampling of the same lesion for mycological culture and cytopathology until healing of lesion or up to twelve weeks. The fungal burden was expressed as the mean yeast cell count in three microscopic fields from imprint smears. The fungal burden before treatment was significantly higher in cats in which the lesion persisted and in cases of treatment failure when using ITZ alone. After twelve weeks, the median fungal burden decreased to zero in both treatment protocols, suggesting a potential decrease in the risk of transmission of Sporothrix spp. from cats. These findings encourage the early treatment of feline sporotrichosis as a control measure. Moreover, the fungal burden in feline sporotrichosis lesions can be a prognostic indicator and a parameter for choosing appropriate therapeutic regimen.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Monitoring Fungal Burden and Viability of Sporothrix spp. in Skin Lesions of Cats for Predicting Antifungal Treatment Response

Miranda

Silva

Gremião

et al. 2018

JoF

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“…It is important to highlight here that, in Brazil, S. brasiliensis is now known as the major etiological agent (> 90% of the cases) of human and feline sporotrichosis [22][23][24][25]. This emerging pathogen is associated to a systemic disease in cats, is highly virulent, shows azole resistance, and is also related to severe clinical cases in humans including hospitalizations and deaths [26][27][28][29][30][31][32][33][34][35][36][37][38].…”

Section: Introductionmentioning

confidence: 99%

Guideline for the management of feline sporotrichosis caused by Sporothrix brasiliensis and literature revision

et al. 2020

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We herein present a Brazilian guideline for the management of feline sporotrichosis, a mycosis caused by Sporothrix brasiliensis. This guideline is an effort of a national technical group organized by the Working Group on Sporothrix and Sporotrichosis of the International Society for Human and Animal Mycology (ISHAM). This publication intends to provide information on clinicalepidemiological aspects of this zoonosis, as well as a literature revision. Moreover, it gives some practical information on diagnosis and treatment of feline sporotrichosis. It also contains information that can be helpful for the prevention and control of S. brasiliensis transmission.

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“…Adicionalmente, autores descreveram a associação bem-sucedida de KI e ITZ em gatos com esporotricose, sugerindo que os iodetos têm uma maior efetividade associado ao ITZ que quando administrado isoladamente. Em gatos refratários ao ITZ, principalmente em casos de lesões em mucosas nasais e sinais respiratórios, a taxa de cura clínica da associação foi 63,2% [28]. Além disso, este esquema terapêutico também foi usado com sucesso no tratamento de gatos virgens de tratamento, sendo a taxa de cura de 96,2% e tempo mediano de tratamento de 14 semanas [27].…”

Section: Discussionunclassified

Sodium Iodide: an Alternative Treatment Option for Feline Sporotrichosis?

Carvalho

Pereira

Figueiredo

et al. 2018

Acta Scientiae. Vet.

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Background: Sporotrichosis is caused by pathogenic fungi of the genus Sporothrix. The clinically relevant species are S. schenckii, S. globosa and S. brasiliensis. In Brazil, S. brasiliensis is the most prevalent etiological agent among humans and cats. In cats with sporotrichosis, skin lesions are mainly characterized by nodules and ulcers, usually located in the head, nasal region and limbs. The presence of respiratory signs concomitantly with cutaneous lesions is frequent, especially sneezing, and may be associated with lesions located in the nasal mucosa. Ketoconazole (KTZ), itraconazole (ITZ), potassium iodide (KI), sodium iodide (NaI), terbinafine (TRB), fluconazole (FLZ) and amphotericin B (AMB) are the drugs currently available for treating feline sporotrichosis. ITZ remains the drug of choice. ITZ combined with KI has been successfully used in the treatment of naïve cats (especially cases with lesions in the nasal region), cases of recurrence and refractory to ITZ. Clinical cure with NaI has been described in some cases, but its use has been limited by adverse reactions. The conventional formulation is the saturated solution and the recommended dose in the treatment of feline sporotrichosis is 10 mg/kg every 12 h. Cats are sensitive to iodide preparations and should be carefully monitored for clinical evidence of iodism, such as apathy, anorexia, vomiting, diarrhea, hypothermia, hyperthermia, cardiomyopathy, hyperexcitability, muscular spasms and ptyalism. The purpose of this study was to evaluate the therapeutic response of NaI capsules in feline sporotrichosis.Materials, Methods & Results: An observational cohort study was conducted in cats with sporotrichosis at the Laboratory of Clinical Research in Dermatozoonoses in Domestic Animals (Lapclin-Dermzoo), Evandro Chagas National Institute of Infectious Diseases (INI)/Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil. Twenty-eight cats with sporotrichosis confirmed by isolation of Sporothrix spp. in culture, no previous systemic antifungal therapy, and weight above 3.0 kg, were included in the study. The treatment consisted of NaI oral capsules (5 mg/kg/once daily). In cats without clinical improvement after one month of treatment, the dose was increased (10 mg/kg/once daily). The cats were followed up monthly by clinical examination, complete blood count and biochemical analysis (urea, creatinine, alanine aminotransferase - ALT, aspartate aminotransferase - AST, alkaline phosphatase - FA). All procedures were approved by the Animal Ethics Committee (CEUA/Fiocruz), number LW 56/13, and the informed consent term was obtained from all tutors. Clinical cure was achieved in six (21.4%) cases and treatment failure was observed in 13 (46.4%) animals. Seven (25%) cats were lost during follow up, and unknown causes of death occurred in two cases (7.1%). Ten animals (35.7%) presented clinical adverse reactions at some point during treatment. Hyporexia and weight loss were the most frequent ones. Three cats presented alteration in renal function.Discussion: Treatment of feline sporotrichosis in epizootic areas has been a challenge for veterinarians and tutors. Additionally, there are few studies evaluating treatment regimens for this mycosis in animals. In this study, NaI was compounded in capsules, because it is easier to administer when compared to the solution, as previously described for KI. Despite the low cost and the convenient administration of the capsule, NaI presented a low cure rate with the dose used. The study of new pharmaceutical forms and lower doses of low-cost drugs is necessary in a scenario of epizootic sporotrichosis, where investments for the development of new antifungal agents are scarce.

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Refractory feline sporotrichosis treated with itraconazole combined with potassium iodide

Cited by 34 publications

References 5 publications

Monitoring Fungal Burden and Viability of Sporothrix spp. in Skin Lesions of Cats for Predicting Antifungal Treatment Response

Monitoring Fungal Burden and Viability of Sporothrix spp. in Skin Lesions of Cats for Predicting Antifungal Treatment Response

Guideline for the management of feline sporotrichosis caused by Sporothrix brasiliensis and literature revision

Sodium Iodide: an Alternative Treatment Option for Feline Sporotrichosis?

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