Treatment of Mycotic Rhinitis With Itraconazole in Three Horses

Abstract

Itraconazole, a third-generation azole, was evaluated for treatment of resistant nasal mycotic infections in horses. Two horses with Aspergillus spp nasal granulomas and 1 horse with Conidiobolus coronatus nasal infection were treated with itraconazole (3 mg/kg PO bid). One of the horses with nasal aspergillosis was also treated by surgical resection of the nasal septum. The treatment time for the horses ranged from 3 to 4.5 months. No adverse effects were noted in any of the horses during the treatment period. Peak and trough serum itraconazole concentrations were <0.5 fig/mL Itraconazole given orally is an effective treatment for several mycotic infections6 In murine models of aspergillosis, 60% to 70% of animals treated with itraconazole survived to 42 days.6 Aspergillus fumigatus could not be cultured from 7 of the 14 survivors on day 42. In guinea pigs with generalized cryptococcosis, 53 of 55 survived, and 29 were culture-negative. In the same study, guinea pigs infected with histoplasmosis and treated with 40 mg/kg of itraconazole had negative fungal cultures.6 In a horse, itraconazole was used to successfully treat cervical vertebral osteomyelitis caused by Coccidioides immitis.' Itraconazole has also been proven to be an effective therapy in mycotic infections in humans.'-'' Horse 1A 3-year-old thoroughbred filly was admitted for evaluation of noisy respiration and dyspnea during training. The referring veterinarian was unable to pass a 13-mm diameter endoscope through the nares into the laryngeal area. At the time of the initial examination, the filly was normal, with the exception of her upper respiratory disorder. A pediatric 8-mm endoscope was passed into the nares and laryngeal area. There was severe circumferential narrowing of both nasal passages and thickening ofthe nasal septum. The nasal conchae and turbinates were roughened and edematous, and the ventral meatii were decreased in size bilaterally. A thickened nasal septum with slight fluid accumulation in the ventral compartment of the caudal nasal cavity were detected on radiography.A complete blood cell count (CBC) and serum biochemical profile results were within the normal range for our laboratory. Under general anesthesia, the nasal septum was resected and removed to improve airflow by a technique described by McIlwraith." All visible fungal lesions were removed at surgery. However, diffuse multifocal abscesses containing fungal hyphae and fibrosis indicating incomplete removal were observed histopathologically. Grocott's methenamine-silver (GMS)-stained sections had fungal elements compatible with Aspergiilus (ie, septate, dichotomously branched hyphae), and AspergiIlus spp were isolated from the biopsy specimens. Minimum inhibitory and minimum lethal concentrations (MIC/MLC) of ketoconazole and itraconazole were determined (Table 1). Antifungal susceptibility testing was accomplished using a macrobroth dilution method previously described.'* The normal MIC for itraconazole is 0.00 1 -10 pg/mL, and normal MLC is 1 to 2 dilutions greater...

Conidiobolomycosis in Sheep in Brazil

“…22 In humans, C. coronatus is the most common agent isolated causing infections of the upper airways. 2,22,29,35 In animals, conidiobolomycosis caused by C. coronatus, C. lamprauges, and C. incongruus are reported mainly as subcutaneous infections in horses, 6,18 llamas, 11,28 and dogs 12,14 and rhinofacial, nasopharyngeal, or oral infections in horses 3,13,16,21,24,26,27,36 and dogs. 1,12 In sheep, the disease has been reported in Australia 5,18 and Trinidad Tobago.…”

Rinitis piogranulomatosa asociada a <i>Conidiobolus coronatus</i> en un caballo: reporte de caso

“…Además, la conidiobolomicosis comienza como una infección de la submucosa, que se expande hacia el tejido subcutáneo de la piel de la cara, incluyendo la nariz, las bolsas guturales, la faringe, el paladar blando, la tráquea , el espacio retrobulbar, el labio superior, los senos nasales, linfonodos regionales y cerebro (French & Ashworth 1994;Konerek et al 1994;Bauer et al 1997;Robinson et al 2007;Cafarchia et al 2013;Ubiali et al 2013;Mackey et al 2015). En el caso reportado, sólo se observó la descarga nasal bilateral, la lesión granulomatosa sobre el septo nasal sin involucramiento de otra estructura anatómica.…”

“…El tratamiento de elección, en caballos, incluye la remoción quirúrgica de la lesión, administración parenteral y oral de yoduros inorgánicos y orgánicos, itraconazol, y terapia tópica con Anfotericina B, penincilina, y dimetilsulfóxido (DMSO) (Mendoza & Alfaro 1985;Konerek et al 1994;Steiger & Williams 2000;Schumacher & Schumacher 2007;Mackey et al 2015). Sin embargo, las especies de Conidiobolus spp.…”

“…Sin embargo, las especies de Conidiobolus spp. son menos responsivas al tratamiento médico (Konerek et al 1994).…”

Rhinofacial Conidiobolus coronatus Infection Presenting with Nasal Enlargement

“…Different azoles, amphotericin B, and flucytosine have been shown to be effective in vitro [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17], and a number of azoles as well as amphotericin B, potassium iodide, and sulfamethoxazole plus trimethoprime have been described to have a beneficial clinical effect in some patients [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17].…”