Date: 26 November 2013
Nasal, sinus and orbital aspergillosis in a cat. The left nasal cavity and sinus were full of pus and debris and there was severe bone erosion from the nasal cavity into the rostromedial orbitthrough which pus was protruding
Copyright:
(Kindly provided by Martin L. Whitehead, BSc, PhD, BVSc, CertSAM, MRCVS & Peter W. Kettlewell, BVSc, MSc, MRCVS. Chipping Norton Veterinary Hospital, Albion Street, Chipping Norton, Oxon, OX7 5BN.)
Notes:
History : Nasal aspergillosis is relatively common in dogs but rare in cats. Our veterinary hospital in Oxfordshire was recently presented with a 13-year old female Burmilla cat with a history of left-side unilateral nasal discharge, a watery left eye with slight blepharospasm, occasional ‘twitching movements’ of the head, weight loss, inappetance and depression. Clinical examination was unremarkable except for left-side mucopurulent nasal discharge, left-side mild serous ocular discharge, and a soft subcutaneous swelling over the left frontal sinus. Haematology, blood biochemistry and urinalysis revealed diabetes mellitus but was otherwise unremarkable. Radiography under general anaesthesia revealed a diffuse soft tissue density within the left nasal cavity and left frontal sinus. Rhinoscopy revealed mucopurulent discharge on the left side but was otherwise unremarkable. Aspiration of the swelling over the left frontal sinus produced pus and this abscess was lanced and flushed. The frontal sinus was trephined and the sinus and nasal cavity flushed with saline. Tests for feline immunodeficiency virus and feline leukaemia virus and serology for Aspergillus were not carried out. The cat was started on insulin, ibafloxacin (Ibaflin, Intervet) and meloxicam (Metacam, Boehringer). Cytology of the material flushed from the frontal sinus and nasal cavity revealed fungal hyphae consistent with Aspergillus species and culture of this material yielded growth of a fungus which was morphologically similar to A. candidus (Awaiting molecular typing results). The cat was then started on oral itraconazole (Itrafungol, Janssen) 10 mg/kg p.o. SID. The abscess over the rostral frontal sinus did not heal and a second abscess appeared over the nasal bone just dorsal to the nose. Infusion of the frontal sinus and nasal cavity with topical antifungal medication was discussed with the owners, but as the cat was deteriorating they requested euthanasia. On post-mortem examination the right nasal cavity, frontal sinus and orbit were unaffected. The left nasal cavity and sinus were full of pus and debris and there was severe bone erosion from the nasal cavity into the rostromedial orbit through which pus was protruding. There was also severe bone erosion rostrally through the nasal bone and less severe bone erosion dorsally over the rostral part of the frontal sinus, these sites of bone erosion being at the location of the two subcutaneous abscesses.Feline nasal aspergillosis is extremely rare in the UK and to our knowledge this is the first reported case of orbital aspergillosis in the UK although nasal aspergillosis has been reported in other countries.
Images library
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Domestic crossbred cat with disseminated aspergillosis. Diff Quik stained squash preparation of material obtained from thoracotomy of a 3 year old domestic crossbred cat with invasive Aspergillus fumigatus infection. The cat had marked enlargement of the hilar lymph nodes that resulted in a partial tracheal obstruction. This smear was made from portions of the hilar lymph node resected at thoracotomy. Magnification x 132.
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English Pointer with nasal aspergillosis. Diff Quik stained cytological smear of material obtained from the frontal sinus of a 7 year old English Pointer with nasal aspergillosis. This infection was caused by Aspergillus fumigatus. Fungal hyphae are beautifully demonstrated by the Diff Quik stain. Magnification x 200.
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Nasal aspergillosis in a Schnauzer. Histological section of fungal plaques removed surgically from the frontal sinus of a 5 year old Schnauzer with nasal aspergillosis. This infection was caused by Aspergillus fumigatus. H & E; x 200.
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Disseminated aspergillosis in a German Shepherd. Masses of fungal hyphae in the renal pelvis of both kidneys in a young German Shepherd dog with disseminated Aspergillus terreus infection.
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Nasal aspergillosis. KOH preparation of fungal plaques surgically removed from the frontal sinus of a Schnauzer with nasal aspergillosis due to Aspergillus fumigatus.
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English Pointer with nasal aspergillosis. English Pointer with nasal aspergillosis treated by topical enilconazole injected through surgically inserted indwelling plastic tubes.
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German Shepherd with disseminated aspergillosis. Unilateral pyelonephritis in a German Shepherd dog with disseminated Aspergillus terreus infection.
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Rottweiler treated with indwelling plastic tubes. Photograph of a Rottweiler crossbred dog treated with indwelling plastic tubes placed surgically into the nasal cavity and frontal sinuses.
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Rottweiler crossbred dog with nasal aspergillosis. A Rottweiler crossbred dog with nasal aspergillosis due to Aspergillus fumigatus infection. Note the loss of pigment below the nostril on the worst affected side – this finding is suggestive of a diagnosis of chronic nasal aspergillosis in the dog.
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Disseminated aspergillosis in a German Shepherd. Hyphae of Aspergillus terreus in the urine of a young German Shepherd dog with disseminated aspergillosis. White blood cells are present in addition to the fungal hyphae. Wet preparation of urine; magnification x 132.
