Press Room

NorthStar VETS Helps Service Animals
New Procedure Revolutionizes IVDD Treatment in Dogs
Canine Total Hip Study
Veterinary Hospital Publishes Pet First Aid Handbook
Veterinary Hospital Studies Total Hip for Dogs
Veterinary Hospital Helps Dogs with Knee Issue
NorthStar VETS Joins Clinical Trial for Canine Lymphoma
NorthStar VETS VECCS Recertification
Hospital Improves Experience for Cats
Feline Marking Clinical Trial
Dog with Half a Face Finds Home in New Jersey
Going the Extra Mile: New Levels of Care for Furry Family Members
Press Room
Zoo's tiger cub recovering after leg injury (PHOTOS)
About the NorthStar VETS Blood Bank for Dogs and Cats
What an Internist Does
Dog with half a face expected to bounce back after surgery
Dr Stobie on Pet Patrol
Friends Begin Rescue Mission To Help Dog
Dr Jackson on Your Pet Matters Radio
Dog with half a face takes first steps towards normal life in NJ
Dog Destined for Dinner Plate in Thailand to Get New Start in NJ
Turtle Back Zoo Preps For Injured Sea Turtle Arrival In NJ
Hamilton Vets Rescue and Help Cat with No Eyelids
Animal Cruelty Investigators Seek Pets Left Out in the Cold
Beloved Jenks Aquarium Seal has Cancer
A Paws for your Pet Interview
Dr Gaemia Tracy 10-28 Radio Interview on Pets and their People
Dr Daniel Stobie and Dr Kimberly Hammer Radio Interview on People and their Pets
Dr John Lewis on Caring for Your Pets Teeth
For pet blood bank, little donations go a long way
Dr Lewis Radio Interview on Dentistry on the Bronc
Veterinary Ophthalmologist James Clinton Retires
Dr. LoScrudato Radio Interview on Rehabilitation on WPST
Dr. Vygantas Radio Interview on Ophthalmology on the Bronc
NorthStar VETS Earns VECCS Level I Center Certification
Internal Medicine Radio Show Interview
Fire Companies Receive Pet Oxygen Masks
Dentistry Radio Show Interview
Interview with NorthStar VETS Kimberly Hammer
Interview with NorthStar VETS Joshua Portner
Preventing Dog Bites in Children
Oxygen masks for pets hope to save more lives
Review: South Jersey Pet Wellness Symposium
WOND Radio Ophthalmology Interview
Pet Chat Interview on WYFL 4-9-16
In the State of Emergency
In a Medical Emergency Every Second Counts Even for your Pets
Medford Veterinary Ophthalmologist Joins NorthStar VETS
Northstar VETS Opens Hospital in Maple Shade NJ
Common Causes of Mucus in Dog Stool
Ten Signs of Kidney Failure in Dogs
NorthStar VETS Sponsors Doggy Dip
Greyhound Deals with Lupus and Needs Home
N.J. man with MS sets up GoFundMe for dog surgery
Vet-i-Care Receives Wells Fargo Community Connections Grant
Your Pet Can Become a NorthStar VETS SuperHero
Feline Urinary Tract Infections [Video]
Plants Poisonous to Pets [Video]
NorthStar VETS Anniversary Event
NorthStar Blood Drive
Blood drive held for people, their dogs in Robbinsville
Animals Participate in Blood Drive
Calling All Super Heroes
Northstar VETS partners with American Red Cross
Warm Weather Pet Safety Dog Parks
Pet Safety Eating
Pet First Aid
NorthStar VETS - A Breed Apart
Police K9 Honored with Final Send Off
Keys to keeping your pets warm in the cold
World Class Cardiac Care For Your Pets Points to NorthStar
River the dog rescued from brutal cold
Blood Bank Superheroes
Protect Your Pets From Holiday Hazards
Dog missing after bizarre Bensalem incident reunited with owners
Winter Pet Safety Tips
Trauma Center Reverification


Newsletter

Click here to subscribe to
our email newsletter.

Sign Up Now

New Fungal Infections



Update on Fungal Infections: Cryptococcus and Histoplasma


This year, we have seen a few cases of infections with these organisms that were treated here at NorthStar VETS. These are uncommon infections especially without travel history and can be easily missed or misdiagnosed for other conditions. For that reason, we wanted to provide an update and reminder about these diseases.

Histoplasmosis


Overview:
  • Fungal infection that can infect dogs, cats and humans
  • Spread by inhalation of the SOIL form meaning it is not contagious or transmissible from patient to patient. Only infected from environment
  • Worldwide; but especially the Ohio and Mississippi river valleys and more common in the Southeast USA
  • Major clinical signs: cough, tachypnea, GI signs, anemia (and/or pancytopenia), organomegaly, uveitis
  • Can look like neoplasia, feline asthma, IBD, heart failure in cats, etc.
  • Can be treated and managed with a long course of appropriate anti-fungals
Causative agent:
  • Histoplasma capsulatum is a dimorphic, soil-borne fungus that is found worldwide but mostly along the Mississippi river bed and Latin America. Known to be endemic from western Virginia to central Texas within the United States.
    • There have been a few cases in the NJ/NY/PA areas without known travel history but not commonly found in this area
  • Primary reservoir is in the intestinal tracts and guano of bats
  • Dimorphic meaning two forms of the organism: the soil phase (called mycelial) is the infectious phase the tissue phase (conidia) is what is found in mammalian hosts
    • Histoplasma has to go through the soil phase to be infectious. It is NOT contagious from patients/hosts
    • Transmitted via inhalation of the soil (mycelial) phase that then enters the macrophages in the lungs and spreads to other organs
    • Can be latently infected and later immune suppression can lead to reactivation of infection years later
      • Any travel history even years prior can be considered significant for risk of infection
      • Cats are slightly more susceptible than dogs. Ages range from 2 months to 15 years with mean age being 4-9 years.
    • Forms granulomatous inflammation in lungs and lymph nodes which then can disseminate to liver, spleen, bone marrow, intestinal tract, pancreas, skin, bones, central nervous system and eyes
Signs and symptoms:
  • Cats typically have vague and nonspecific signs such as weight loss, inappetence, weakness, fever
  • Dogs typically have GI signs, anemia and fever
  • 40-50% will have respiratory signs (tachypnea and dyspnea)
    • Primary respiratory infections are more common in cats than dogs but seen in both
  • Chorioretinitis and uveitis
  • Nodular, ulcerated, draining skin lesions
  • Peripheral lymphadenopathy
  • Organomegaly from liver and spleen involvement with possible icterus noticed
  • Anemia and pancytopenia with possible intracellular organisms on blood smear
  • Rarely, neurologic signs such as ataxia, obtundation, head tilt
Testing:
  • CBC: Anemia, pancytopenia, neutrophilia
  • Chemistry: Hypoalbuminemia (75%), elevated liver enzymes, hyperbilirubinemia (uncommon), hyperglobulinemia
  • Radiographs: Diffuse, nodular or military interstitial pattern on chest radiographs; lymph node involvement
  • Ultrasound: Enlarged liver and spleen, enlarged abdominal lymph nodes, thickened intestinal loops; can be normal
  • Cytology or histopathology or lesions can directly show the organisms
  • Antigen (ELISA) assay in urine and blood (Miravista Labs) has excellent sensitivity and specificity *** Most common way for diagnosis and used for treatment monitoring***
  • Fungal culture is rarely indicated and there is risk of laboratory acquired infections as it goes through soil (infectious) phase once cultured
Treatment:
  • Antifungal drugs include azole drugs and amphotericin B
  • Itraconazole and fluconazole are the most commonly used. Consider fluconazole with CNS or ocular involvement. Much cheaper than itraconazole but can be slightly less efficient and some resistance has developed
    • Takes 1-2 weeks for full effect
    • Needs to be treated a minimum of 6 months and many require 1-2 years of treatment
    • Monitor liver values from drug reaction while on this medication
    • Monitor resolution of original signs in addition to decreasing urine antigen titers
  • Amphotericin B is helpful for initial treatment in patients with severe, acute pulmonary and/or disseminated infections
    • Followed up with azole treatment after this is started
    • Close monitoring of kidney values is required prior to each dose, and lipid complexed form is less toxic to kidneys
  • Supportive care required based on original signs. Occasionally, anti-inflammatory steroids are necessary from inflammation from the initial treatment but this is controversial

Cryptoccosis

Overview:
  • Fungal infection that can infect cats, dogs and humans (mainly seen in feline patients)
  • Multiple species with the most common being Cryptococcus gattii and Cryptococcus neoformans
  • Worldwide distribution; C. neoformans seen throughout the country but rarely infects cats in US; C. gattii is an emerging pathogen most commonly seen on the west coast of the United States and Canada
  • Spread by inhalation from the soil/environment; spread from animal to animal is NOT reported
  • Major clinical signs: upper respiratory tract signs, nodular or ulcerative cutaneous lesions, chorioretinitis, neurologic signs (meningoencephalitis)
    • In dogs, Cryptococcus can also disseminate to abdominal organs and cause GI signs
Causative agent:
  • Crypotoccus is a dimorphic fungus that is a budding yeast in the host and filamentous (infectious) form in the environment
  • There are at least 19 species that are found worldwide
    • C. neoformans and C. gattii are most common infections in cats and dogs
    • C. neoformans account for most of the canine infections but infection of cats with this species is rare; more common in dogs and cats in Australia
    • C. gatti is the most common species that infects cats in the United States. It is endemic on the west coast of US, Canada, Australia, Asia, Latin America, etc.
  • Cats affected much more commonly than dogs; all ages but young adults appear to be at increased risk
  • Spread by inhalation of spores and germination in upper and/or lower respiratory tracts
    • Spores can be in environment for years
    • Not spread from patient to patient
    • Incubation period can range from 2 to 13 months
    • Can be latently infected and later immune suppression can lead to reactivation of infection years later
      • Any travel history even years prior can be considered significant for risk of infection
Signs and symptoms:
  • Nasal cavity is primary site of infection and causes unilateral or bilateral rhinitis that can also lead to epistaxis, facial deformity with lesions on the bridge of the nose, lymphadenopathy and cutaneous lesions
  • Neurologic involvement can happen after osteomyelitis and extension from nasal cavity to brain
  • In contrast to cats, dogs usually develop severe disseminated disease in nasal cavity, skin, lungs, lymph nodes, kidneys, eye and CNS. Often non-specific signs including weight loss, lethargy, inappetence, rhinitis, tachypnea/dyspnea, etc.
Testing:
  • CBC, chemistry and UA: Typically normal or non-specific
  • Radiographs: Often normal chest radiographs with occasional large pulmonary nodules or enlarged lymph nodes
  • CT: Best feature to assess nasal involvement ?EUR" aggressive mass lesions with osteolysis common
  • Cytology or histopathology from skin lesion aspirates, nasal discharge or nasal biopsies can show organisms. Can be false negatives, especially with cytology
  • Antigen assay by latex agglutination on blood or CSF has good sensitivity and specificity
  • Fungal culture from aspirates, biopsies or affected tissues helpful but can take several days to weeks of incubation
Treatment
  • Cats typically treated successfully with an azole anti-fungal drug such as fluconazole
    • Treatment is often 6-12 months or longer
    • Monitor antigen titers every few months
    • Monitor liver enzymes during treatment for reaction from drugs
  • Can consider amphotericin B as well in severe, acute infections followed by azole therapy
    • However, penetration into CNS and eyes is poor. If this is considered likely, need to combine with 5-flucytosine
  • Dogs should be treated with amphotericin B and fluconazole as their infections are typically systemic and severe
    • Depending on the locations of their granulomas/lesions, surgical debridement can be considered
Works cited:
Sykes, JE. Histoplasmosis. Canine and Feline Infectious Diseases. Saunders. 2014.
Sykes, JE. Cryptococcosis. Canine and Feline Infectious Diseases. Saunders. 2014.
Greene, CE et al. Leptospirosis. Greene Infectious Diseases of the Dog and Cat: Third edition. Saunders. 2006.