|
Mycotic Pneumonia: Introduction |  |
| Fungal infection of the lung results in an acute to chronic active, pyogranulomatous pneumonia. |
| Etiology: |
|
Cryptococcus
neoformans
,
Histoplasma
capsulatum
,
Coccidioides
immitis
,
Blastomyces
dermatiditis
,
Pneumocystis
carinii
,
Aspergillus
spp
,
Candida
spp,
and other less common fungi have been identified as causative agents of mycotic pneumonia in domestic animals (see also
fungal infections,
Fungal Infections: Introduction). Often these agents are found in immunocompromised hosts, but can cause disease in healthy individuals as well. Infection is typically caused by inhalation of spores, which can lead to hemolymphatic dissemination. Pulmonary tissues and secretions are an excellent environment for these organisms. The source of most fungal infections is believed to be soil-related rather than horizontal transmission. Considering
the high rate of exposure to these pathogens in certain environments, there are unresolved questions on the epidemiology of the condition, including individual susceptibility, pathogenicity of organisms, the immune response of the host, and concurrent disease.
Blastomyces
and
Histoplasma
are prevalent in the Mississippi and Ohio River valleys, whereas
Coccidioides
is found in the southwestern USA and northwestern Mexico.
Cryptococcus
is often associated with accumulation of pigeon excreta. |
|  |
| Clinical Findings : |
| Mycotic pneumonia is more commonly seen in small animals.
Blastomyces
infections typically occur in young, male, large-breed dogs. In cats,
Cryptococcus
has a predilection for the nasal cavity where it causes a granulomatous rhinitis and sinusitis. Acute, fulminant clinical presentations do occur but are rare, and the most common course of disease is chronic. A short, moist cough is characteristic. A thick, mucoid nasal discharge may be present. As the disease progresses, dyspnea, emaciation, and generalized weakness become increasingly evident. Respiration may become abdominal, resembling that of a diaphragmatic
hernia (
Diaphragmatic Hernia: Introduction). On auscultation, harsh respiratory sounds are heard. In advanced cases, breath sounds are decreased or almost inaudible. Tracheobronchial lymphadenopathy can cause extrinsic airway compression. Neutrophilic leukocytosis or neutropenia with a left shift, nonregenerative anemia, and periodic fever can occur, possibly concurrent with bacterial infections. Radiography will show enlargement of tracheobronchial lymph nodes and variable,
nodular to linear, interstitial infiltrates. |
Lesions:
| Multifocal to coalescing lesions of granulomatous to pyogranulomatous inflammation are present in the lungs. Abscess formation and cavitation may be seen in conjunction with yellow or gray areas of necrosis. Causative organisms are present within macrophages or areas of intense inflammation. Dissemination to multiple organ systems (eg, skin, eyes, peripheral lymph nodes, bones, CNS, male genitalia, oral cavity, nasal cavity) may occur. |
| |
| Diagnosis: |
|
A tentative diagnosis of mycotic pneumonia can be made if an animal with chronic respiratory disease exhibits the clinical signs described and does not respond to antibiotic therapy. Definitive diagnosis requires laboratory confirmation. Radiography may be useful. Serology can provide a presumptive diagnosis. Some antigens (eg, histoplasmin, blastomycin) have been developed and are an aid in diagnosis. Cytologic examinations of the sputum or
exudates from sites of extrapulmonary inflammation may reveal the infective organism. The clinical diagnosis can be confirmed at necropsy by appropriate microbiology and histopathology. Special stains can be used to highlight the organisms. |
| |
| Treatment: |
| There is no entirely satisfactory method of treating systemic mycotic infections. Amphotericin may be helpful but is undesirably nephrotoxic. Ketoconazole, and several newer antifungal agents such as itraconazole and fluconazole, show better, but variable, results against fungal pathogens in companion animals. Protracted therapy, at least 2 mo beyond clinical resolution, is usually necessary for resoluton of the infection. |
| |
;)