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Journal of Clinical Microbiology, September 1998, p. 2755-2758, Vol. 36, No. 9
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.
Nasal Granuloma Caused by Scedosporium apiospermum in
a Dog
F. J.
Cabañes,*
X.
Roura,
F.
García,
M.
Domingo,
M. L.
Abarca, and
J.
Pastor
Departament de Patologia i Producció
Animals, Hospital Clínic Veterinari, Facultat de
Veterinària, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain
Received 29 December 1997/Returned for modification 15 April
1998/Accepted 4 June 1998
 |
ABSTRACT |
A 10-month-old male American Staffordshire terrier was presented to
the Autonomous University of Barcelona Veterinary Teaching Hospital
because of a 6-month history of a mucopurulent bilateral nasal
discharge. The dog had not responded to antibiotics. A follow-up X ray
revealed a mixed pattern of osteolysis and increased radiodensity confined to the nasal cavity. Histologic sections of the biopsy specimens revealed the presence of granules containing numerous septate hyphae that were hyaline to pale brown and smooth,
one-celled, subspherical-to-elongate conidia that were hyaline to
brownish green, and bacteria. Cultures yielded numerous colonies
belonging to Scedosporium apiospermum. Susceptibility tests
were performed on the isolated strain. The isolate was sensitive to
ketoconazole, intermediate to clotrimazole, and resistant to
amphotericin B, 5-fluorocytosine, fluconazole, and itraconazole. The
dog was treated with oral ketoconazole. During the treatment a general
improvement in the lesions was observed. To our knowledge, S. apiospermum has not been implicated previously as an etiologic
agent of nasal disease in dogs. This report provides its first
description as such.
 |
TEXT |
Fungal infections are a common cause
of nasal disease in dogs and cats. Aspergillus fumigatus is
the species most commonly isolated from infections in the nasal
cavities of these animals. However, Aspergillus niger,
Aspergillus nidulans, and Aspergillus flavus have
also been recovered from this location. Penicillium spp. are
rarely reported as causing invasive nasal disease (12, 16).
Pseudallescheria boydii is an ubiquitous saprophytic
ascomycete that has two anamorphs. It has been isolated from soil,
water, vegetation, and sewage. The Scedosporium apiospermum
synanamorph is most commonly isolated from clinical cultures
(1) and from all strains of P. boydii
(5).
To our knowledge, S. apiospermum has not been
implicated previously as an etiologic agent of nasal disease in dogs.
This report provides its first description as such.
Case report.
A 10-month-old male American Staffordshire
terrier was presented to the Autonomous University of Barcelona
Veterinary Teaching Hospital because of a 6-month history of a
mucopurulent bilateral nasal discharge and some sneezing. The disorder
started 10 days after the dog suffered a parvoviral enteritis, and the
rinitis persisted for the 6 months before admission. The dog had not
responded to antibiotics.
The animal was mildly depressed and had a temperature of 39.6°C.
There was bilateral thick yellow discharge and deformated external
nares. The dog had a mature neutrophilic leukocytosis (24,000 leukocytes/µl). The serum chemistry profile and urinalysis were
normal. A follow-up X ray revealed a mixed pattern of osteolysis and an
increased radiodensity confined to the nasal cavity that was greater on
the right side. The turbinate pattern was less apparent than in normal
dogs on both sides (Fig. 1). Thoracic and
abdominal radiographies were normal. Rhinoscopic examination of the
nasal chambers revealed the destruction of the vomer bone and a large
mass completely occluding the nasal cavity. Swabs and biopsy specimens
were collected for microbiologic and histologic examinations.
KOH-lactophenol and histologic sections (Fig.
2) of the biopsy specimens revealed the
presence of granules containing numerous septate hyphae that were
hyaline to pale brown, smooth, one-celled, subspherical-to-elongate
conidia that were hyaline to brownish green, and bacteria. Fungal
growth in close contact with bone tissues was observed.

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FIG. 1.
Intraoral radiograph showing lysis of the vomer bone
(arrow) and increased radiodensity confined to the nasal cavity, which
is more pronounced on the right side (asterisks). The turbinate pattern
is less apparent than in normal dogs on both sides (black areas in the
nasal cavity).
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FIG. 2.
Detail of a Grocott-methenamine-silver-stained
section of a tissue biopsy sample showing a granule containing hyphal
and conidial elements. Bar = 10 µm.
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Microbiology.
Cultures on Sabouraud glucose agar (SGA; Difco
Laboratories, Detroit, Mich.) supplemented with chloramphenicol (Fig.
3) and Mycosel agar (BBL Microbiology
Systems, Cockeysville, Md.) yielded numerous cottony colonies in pure
culture that initially were grayish white and became greenish
gray and brownish gray, consistent with what occurs in infection
with Scedosporium species. Culturing of the fungal isolate
on SGA generated colonies which presented characteristic conidial
structures, with annellidic conidiogenesis and with
conidiogenous cells without inflated bases (Fig.
4). S. apiospermum,
the nonsynnematous synanamorph of P. boydii (5) was identified. The isolate failed to produce the sexual state on corn
meal agar (Oxoid Ltd., Basingstoke, England) and potato dextrose agar
(Difco) culture media. Bacteriological cultures yielded
Escherichia coli and Proteus mirabilis.
Susceptibility tests on the isolated strain were performed with
antifungal tablets (Neo-Sensitabs; Rosco Diagnostica, Taastrup,
Denmark) and Shadomy agar (4). The strain was sensitive to
ketoconazole, intermediate to clotrimazole, and resistant to
amphotericin B, 5-fluorocytosine, fluconazole, and itraconazole.

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FIG. 3.
Pure culture of S. apiospermum growing
on an SGA plate supplemented with chloramphenicol and inoculated with
material from a biopsy after 8 days of incubation at 37°C.
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FIG. 4.
Conidiogenesis of S. apiospermum.
Note the conidia situated terminally on annellides without swollen
bases. Phase-contrast microscopy was used. Bar = 10 µm.
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Treatment.
The dog was treated with oral ketoconazole (10 mg/kg of body weight, twice a day) and amoxicillin plus clavulanic acid
(20 mg/kg of body weight, orally, twice a day for 30 days). The
baseline laboratory analysis (complete blood count, chemistry profile, and urinalysis) were normal. After a month, the nasal discharge decreased and the sneezing disappeared. During treatment (the last
examination was at 7 months) a general improvement of the lesions was
observed. Unfortunately, 1 month after the last checkup, the dog died
in a car crash and the owners did not want to do the necropsy.
Discussion.
Reported cases of S. apiospermum
infections in dogs are few. This species has been recognized as a
causative agent of mycosis mainly in the abdominal cavity (1, 6,
8, 15). A disseminated infection has been reported
(2). It has been cited in other locations such as the
epidermis (chronic eczematous lesion) (10), eyes
(keratomycosis) (14), and testicles (1).
Additionally, in horses, two reports of P. boydii causing
infection of the nasal chamber have been published (3, 7).
In humans, the wide spectrum of diseases caused by
P. boydii
includes sinusitis, brain abscess, meningitis, pulmonary colonization,
fungus ball, invasive pneumonitis, endocarditis, arthritis,
osteomyelitis,
thyroid abscess, endophthalmitis, disseminated
systemic disease,
cutaneous and subcutaneous granulomata,
keratomycosis, and mycetoma
(
9). Infection in humans most
frequently occurs in soil-contaminated
wounds on the hands or feet.
However, especially in a compromised
host, infection by inhalation
causing sinusitis is not uncommon.
Pulmonary lesions may also occur,
and the angioinvasive nature
of the fungus may result in spread to
other areas of the body
(
3).
In our report, except for the parvoviral enteritis process and
antibiotic treatment, no other predisposing factors such as
neoplasia,
immunodeficiency, depression, trauma, and exposure
to high levels of
fungal spores were identified. No sign of disseminated
systemic disease
was detected. The infection was limited to the
nasal chambers.
Nevertheless, lysis of the vomer bone was observed.
Some authors (
13) have stated that in the treatment of
canine nasal aspergillosis, topically administered enilconazole (via
indwelling tubes, implanted bilaterally through trephine holes
in each
frontal sinus) is more effective than the oral administration
of
thiabendazole, ketoconazole, fluconazole, or itraconazole.
In our case
the isolate belonging to
S. apiospermum was sensitive
only to ketoconazole, and for this reason the dog was treated
with oral
ketoconazole.
Although antifungal susceptibility tests for filamentous fungi
remain unstandardized and the in vivo outcome cannot always
be
extrapolated from the in vitro results, the resistance of
P. boydii to different antifungal agents such as
amphotericin B,
clotrimazole, 5-fluorocytosine, griseofulvin, and
nystatin and
its mixed responses to ketoconazole, miconazole, and
natamycin
have been mentioned (
14). On the other hand,
different strains
of
S. apiospermum and
P. boydii appear to have various degrees
of sensitivity to antifungal
agents (
11) (for these strains
the MICs of miconazole,
ketoconazole, and itraconazole are lowest)
and they appear to be
resistant to fluconazole.
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FOOTNOTES |
*
Corresponding author. Mailing address: Facultat de
Veterinària, Universitat Autònoma de Barcelona, E-08193
Bellaterra, Barcelona, Spain. Phone: 3493 5811749. Fax: 3493 5812006. E-mail: F.J.CABANES{at}CC.UAB.ES.
 |
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Journal of Clinical Microbiology, September 1998, p. 2755-2758, Vol. 36, No. 9
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.
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