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Surgical Treatment for Aspergillus Infection

Clinician's Brief (Capsule)

Infectious Disease

|July 2014

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Aspergillus spp are known to infect dogs, causing local or systemic disease. Sinonasal aspergillosis is more common than systemic disease and usually occurs in healthy middle-aged mesocephalic and dolichocephalic canine breeds. This case study described a dog with spontaneous pneumothorax following pulmonary aspergillosis.

A previously healthy 3-year-old neutered mixed-breed dog in eastern Oregon presented for spontaneous pneumothorax. The dog had no prior history of coughing, nasal discharge, or travel. Initial treatment involved multiple thoracenteses and removal of air from the pleural space. A thoracostomy tube was placed, broad-spectrum antibiotics started, and the dog transferred to a specialty center. CT revealed right-sided pneumothorax with atelectasis of the entire right lung. One large bulla and multiple smaller bullae were identified in the right caudal lung lobe. Thoracotomy revealed multiple emphysematous areas in the right middle lung lobe; a lobectomy was performed. Lung lobe histology showed severe diffuse bronchopneumonia with necrotizing pleuritis. There was marked fungal proliferation with morphology resembling Aspergillus spp; however, the owners declined culture.

After diagnosis of aspergillosis, antibiotics were discontinued and the dog was started on itraconazole for 4 months. At follow-up appointment 18 months after diagnosis, the dog had fully recovered. This case study was the first to describe successful medical and surgical management of Aspergillus spp pulmonary infection and associated pneumothorax.

Commentary

This case report served as a useful reminder that spontaneous pneumothorax (nontraumatic) in dogs is typically a surgical disease (ie, underlying pulmonary pathology results in air leakage). Medical management, such as periodic thoracentesis, is rarely curative. The report also highlighted the growing usefulness of CT in identification of pulmonary disease and for preoperative surgical planning. Finally, the report illustrated that uncommon infections may play an emerging role in canine disease. The source of this dog’s suspected aspergillosis was not found. The owners declined pulmonary culture, which may have impacted long-term prognosis or, at minimum, the ability to provide a final diagnosis. While financial constraints are common in veterinary medicine, limiting diagnostics may influence a clinician’s ability to accurately prognosticate and treat individual patients.—Elizabeth A. Rozanski, DVM, DACVIM, DACVECC

Source

Spontaneous pneumothorax associated with Aspergillus bronchopneumonia in a dog. Trempala CL, Herold LV. JVECC 23:624-630, 2013.

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