Surgical treatment of canine nasal aspergillosis by rhinotomy combined with enilconazole infusion and oral itraconazole

Claeys, Stéphanie; Lefebvre, Jordan S.; Schüller, Simone; Hamaide, Annick; Clercx, Cécile

doi:10.1111/j.1748-5827.2006.00154.x

Cited by 27 publications

(26 citation statements)

References 16 publications

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“…7). Others propose combining local and systemic antifungal therapy with surgical rhinotomy and debridement of fungal plaques and necrotic turbinate bone [13], although procedures such as rhinotomy, sinusotomy and turbinectomy are now discouraged in the management of this disease. Imaging evidence of erosion of the cribriform plate is a contraindication for topical infusions.…”

Section: Therapy and Outcomementioning

confidence: 98%

“…Any breed of dog may be affected, particularly those of medium to large size and dolichocephalic or mesaticephalic head conformation, and there is no specific age or gender predisposition, although many are young to middle-aged animals. A recent series of three case series from the UK [11], Italy [12] and Belgium [13] reported a total of 36 affected animals. Breeds represented more than once amongst this European sample included the German Shepherd Dog (n05) and Golden Retriever (n 03).…”

Section: Clinical Presentationmentioning

confidence: 98%

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Canine sino-nasal aspergillosis: parallels with human disease

Day

2009

Med Mycol

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Canine sino-nasal aspergillosis (SNA) is characterized by the formation of a superficial mucosal fungal plaque within the nasal cavity and/or frontal sinus of systemically healthy dogs. The most common causative agent is Aspergillus fumigatus. The fungus does not invade beneath the level of mucosal epithelium but incites a severe chronic inflammatory response that leads to local destruction of nasal bone. These clinicopathological features are equivalent to those of human chronic erosive non-invasive fungal sinusitis. The clinical diagnosis of canine SNA relies on multiple modalities but local instillation of anti-fungal agents is an effective therapy with high cure-rate. Recent studies have investigated the immunopathogenesis of canine SNA. The mucosal inflammatory infiltrate involves a mixture of CD4+ and CD8+ T lymphocytes, IgG+ plasma cells and activated macrophages and dendritic cells expressing class II molecules of the major histocompatibility complex. There is active recruitment of blood monocytes and neutrophils. Real-time quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) analysis of mucosal tissue samples has revealed up-regulation of Th1 (IL-12, IL-18 and IFN-gamma), Th17-related (IL-23) and pro-inflammatory (IL-6, TNF-alpha) cytokine mRNA with evidence of expression of genes encoding monocyte chemoattractant proteins 1-4. Additionally, there is significant transcription of the IL-10 gene consistent with local immunosuppression that prevents secondary immune-mediated sequelae whilst permitting chronicity of the infection. The source of this IL-10 may be a T regulatory population or a Th1 population that switches phenotype during the course of disease. This understanding of the immunopathogenesis of canine SNA establishes this disorder as a valuable model for the equivalent human pathology.

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Section: Therapy and Outcomementioning

confidence: 98%

Section: Clinical Presentationmentioning

confidence: 98%

Canine sino-nasal aspergillosis: parallels with human disease

Day

2009

Med Mycol

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“…Povidone‐iodine (10%) painted onto turbinates or povidine‐iodine impregnated cadexomer dressings (Iodoflex; Smith and Nephew) following rhinotomy and debridement both proved successful in small numbers of dogs (Pavletic and Clark , Moore ). Combination treatment with surgical rhinotomy, enilconazole soak and adjunctive oral itraconazole has also been evaluated (Claeys and others ). Dogs initially treated had recurrence of disease associated with the bone flap and cerclage wires, but therapy in additional cases was successful where bone flaps were discarded (Claeys and others ).…”

Section: Topical Therapymentioning

confidence: 99%

“…Combination treatment with surgical rhinotomy, enilconazole soak and adjunctive oral itraconazole has also been evaluated (Claeys and others ). Dogs initially treated had recurrence of disease associated with the bone flap and cerclage wires, but therapy in additional cases was successful where bone flaps were discarded (Claeys and others ).…”

Section: Topical Therapymentioning

confidence: 99%

Sinonasal aspergillosis in dogs: a review

Sharman

Mansfield

2012

J of Small Animal Practice

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Sinonasal aspergillosis is an uncommon, yet debilitating and often frustrating condition to treat in dogs despite years of research evaluating pathogenesis, diagnosis and treatment. The disease is most commonly caused by non‐invasive fungal infection, thought to be secondary to altered innate and/or adaptive immune responses. Attempts to confirm this have however failed. A variety of conflicting opinions regarding the diagnosis and treatment of sinonasal aspergillosis exist. Often the use of a particular treatment protocol is based upon personal or regional preference. Evaluation of the veterinary literature demonstrates that the evidence base in support of individual treatment recommendations is weak. A number of recent publications have helped to expand the current knowledge base and therefore our understanding of important practicalities for both diagnostic options and treatment protocols. The following review examines the current evidence for the pathogenesis of sinonasal aspergillosis in dogs, as well as the various diagnostic options. The available evidence for frequently utilised ‐therapeutic options and their likely outcomes is also explored.

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“…One could wish to end on such a note of optimism, but the contribution from Claeys and others (2006), in Liege, highlights the confusion surrounding the aims of treatment that disappointingly still persists for some. The concept that if you combine three proven unsatisfactory treatments, you might come up with one single successful treatment is woefully naïve.…”

Section: Treatmentmentioning

confidence: 99%