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Disseminated Cryptococcosis in a Dog

Disseminated Cryptococcosis in a Dog. Presented by: Paul G. Gallagher Co-Authors: Natalie Durrett Crawford, Farrah B. Horowitz, D. Phillip Sponenberg Virginia-Maryland Regional College of Veterinary Medicine Virginia Tech, Duck Pond Drive (0442) Blacksburg, VA 24061. Clinical History.

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Disseminated Cryptococcosis in a Dog

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  1. Disseminated Cryptococcosis in a Dog Presented by: Paul G. Gallagher Co-Authors: Natalie Durrett Crawford, Farrah B. Horowitz, D. Phillip Sponenberg Virginia-Maryland Regional College of Veterinary Medicine Virginia Tech, Duck Pond Drive (0442) Blacksburg, VA 24061 Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  2. Clinical History • “Phoebe” • Six year old spayed female mixed breed dog • Referred on suspicion of cervical disc disease • Past medical problems • History of chronic otitis, UTI, uroliths • One month history • Ataxia • Inability to lift head • Apparent cervical pain Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  3. Clinical Evaluation • Physical / Neurologic Exam • Severe Respiratory distress • Distended abdomen • Neurologic deficits • No cervical pain • Laboratory data • Respiratory arrest - death Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  4. Gross Lesions • Approximately 50 ml serosanguinous fluid in abdomen • Lungs – diffusely red, slightly firm, small off-white lesions • Pancreas – numerous off-white nodules, one limb dark red / friable • Spleen – numerous dark red/black nodules • Eyes, brain, cervical spinal cord – no gross lesions Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  5. Histologic LesionsSpinal Cord Dorsal Horn GM Ventral Horn WM WM Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  6. Histologic LesionsSpinal Cord Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  7. Special StainsSpinal Cord GMS (Grocott’s Methenamine Silver) Mucicarmine Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  8. Diagnosis • Morphologic: Spinal cord, granulomatous meningomyelitis with intralesional yeast • Additional Diagnoses • Brain, granulomatous meningoencephalitis • Liver, granulomatous hepatitis • Kidney, multifocal granulomatous interstitial nephritis and glomerulonephritis • Pancreas, diffuse granulomatous pancreatitis • Heart, granulomatous myocarditis • Lung, granulomatous interstitial pneumonia • Eye, granulomatous uveitis with retinal detachment • Disease Diagnosis: Disseminated Cryptococcosis Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  9. Cryptococcus • Dimorphic fungus • C. neoformans • var. grubii • var. neoformans • C. gatti • Transmission • Pathogenesis • Zoonotic? • Humans vs. domestic animals • Dogs vs. cats Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  10. Virulence Factors • Mucopolysaccharide capsule • Ability to replicate at body temperature • Phenoloxidase (laccase) • Serine protease Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  11. Prognosis • Disseminated, CNS disease – guarded • Localized nasal or cutaneous disease – good if treated early and appropriately; guarded for severe or longstanding disease • Poor for resolution of neurologic deficits Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  12. References • Bovers M, Hagen F, Boekhout T. Diversity of the Cryptococcus neoformans-Cryptococcus gattii species complex. Rev Iberoam Micol 2008;25:S4-S12. • Bartlett KH, Kidd SE, Kronstad JW. The Emergence of Cryptococcus gattii in British Columbia and the Pacific Northwest. Curr Infect Dis Rep 2008;10:58-65. • Duncan CG, Stephen C, Campbell J. Evaluation of risk factors for Cryptococcus gattii infection in dogs and cats. J Am Vet Med Assoc 2006;228:377-382. • Greene CE. Infectious diseases of the dog and cat. 3rd ed. Philadelphia, Pa. ; London: Elsevier Saunders, 2006. • Kerl ME. Update on canine and feline fungal diseases. Vet Clin North Am Small Anim Pract 2003;33:721-747. • Maxie MG, Jubb KVF. Pathology of domestic animals. 5th ed. Edinburgh ; New York: Elsevier Saunders, 2007. • Nielsen K, De Obaldia AL, Heitman J. Cryptococcus neoformans mates on pigeon guano: implications for the realized ecological niche and globalization. Eukaryot Cell 2007;6:949-959. Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  13. Thank You • Dr. Natalie Durrett Crawford • Dr. D. Phillip Sponenberg • Dr. Tanya LeRoith Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  14. Questions? Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

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