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  Discussion on Gutteral pouch fungal infection
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Posted on Wednesday, Aug 23, 2000 - 10:21 am:

Hi, Dr O. I have read through several threads and the article in this section, but needed some clarification. A friend's horse was just diagnosed with a fungal infection of his gutteral pouch, which is eating away at his carotid artery, which has been causing his very slight nose bleed for the last several weeks. According to her vet, who has never actually seen this before, consultations with folks in Blacksburg reveal that anti-fungal medications don't seem to have much effect on this - why is that, if that is indeed the case? Surgery seems to be the only option. This is an older horse (early 20's, I think), who is also likely Cushingoid. He is turned out 24/7 on a retirement farm, and leads a fairly stress-free life - a few other horses with him on a 10 acre pasture. What are your opinions on this?

Posted on Wednesday, Aug 23, 2000 - 11:14 am:

The reason for the poor responsivenenss to antifungal therapy is not well understood but these are some of the factors that others and I have thought up:

1) By the time of the diagnosis the disease is in an advanced stage with fatal hemmorage just days or weeks away. It may be that the fungus, usually a membranous looking structure, is part of what is holding things together and when it is killed the defect left behind is actually weaker.

2) Much of the fungus is living on the surface of the guttaral pouch so difficult to reach with just systemic antifungals while part of the fungus is in close association to the blood supply and receiving so much nutrient is resistant to topical treatment.

3) Antifungals are just not as effective as our antibacterials are.

If surgery is not an option there have been some successes with medical treatment: but the prognosis is poor. I would recommend both systemic and topical itraconizole be considered.
DrO

Posted on Friday, Aug 25, 2000 - 10:53 am:

Thanks Dr O. I found out a bit more about the horse's condition - apparently there is already a huge pool of blood that is being held in place by a clot. The vet said that just about any treatment - flushing, surgery, medication - is about as likely to immediatly kill the horse as the next, so I guess it's up to his owner to decide what, if anything, to do. Thank you for you explanations.
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