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  Discussion on Research Study: Successful fungal sinusitis treatment
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DrO

Posted on Friday, Nov 20, 2009 - 8:26 am:

There are several fungi, usually found in our southern coastal states, that have very resistant to treatment. One of these is Cryptococcus. Here is a case study where huge efforts were made at both local and systemic treatment and as of 2 years out was successful.
DrO


J Am Vet Med Assoc. 2009 Sep 15;235(6):723-30.
Multimodal treatment of recurrent sinonasal cryptococcal granulomas in a horse.

Stewart AJ, Salazar T, Waldridge BM, Schumacher J, Welles EG, Hanson RR, Sartin EA, Lenz SD, Holland M, Beard DM.

Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL 36849.

Case Description-A 7-year-old 509-kg (1,120-lb) Tennessee Walking Horse mare was evaluated because of bilateral mucosanguinous nasal discharge, intermittent right-sided epistaxis, and worsening dyspnea of 9 months' duration. Clinical Findings-Multiple masses in the nasopharynx were detected via endoscopic and radiographic examinations. Cytologic and histologic examinations of biopsy specimens of 1 mass revealed round yeasts with thick nonstaining capsules and occasional narrow-based budding that resembled cryptococcal organisms. Treatment and Outcome-Oral administration of fluconazole and organic ethylenediamine dihydriodide and intermittent intralesional injections with fluconazole, amphotericin B, and formalin resulted in resolution of lesions for a period of 2.5 years. The horse then developed exophthalmos, recurring clinical signs, and extensive nasopharyngeal masses. The masses were surgically debulked via a large frontonasal bone flap, and the horse was treated with IV injections of amphotericin B and long-term oral administration of fluconazole. Clinical signs did not recur in the following 2-year period. A presumptive diagnosis of cryptococcosis was made following cytologic and histologic evaluations of the masses; results of serologic analysis and fungal culture confirmed infection with Cryptococcus neoformans. Clinical Relevance-Cryptococcal infection of the upper respiratory tract in horses has previously been described as a uniformly fatal disease. As this case report illustrates, medical and surgical treatment of sinonasal cryptococcal granulomas in horses may be successful, but the importance of long-term follow-up and the potential for disease recrudescence should be considered. As efficacious antifungal agents become less expensive, their increased use will likely decrease mortality rates in horses with fungal infections.
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