Disseminated Disseminated Cryptococcosis in a Cryptococcosis in a

DogDog

Presented by: Paul G. GallagherCo-Authors: Natalie Durrett Crawford, Farrah B.

Horowitz, D. Phillip Sponenberg

Virginia-Maryland Regional College of Veterinary Medicine

Virginia Tech, Duck Pond Drive (0442)Blacksburg, VA 24061Presented at SEVPAC 2008 –

Permission granted for use on SEVPAC website only

Clinical HistoryClinical History

“Phoebe” Six year old spayed female mixed breed dog

Referred on suspicion of cervical disc disease

Past medical problems History of chronic otitis, UTI, uroliths

One month history Ataxia Inability to lift head Apparent cervical painPresented at SEVPAC 2008 –

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Clinical EvaluationClinical Evaluation

Physical / Neurologic Exam Severe Respiratory distress Distended abdomen Neurologic deficits No cervical pain

Laboratory data

Respiratory arrest - deathPresented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Gross LesionsGross Lesions

Approximately 50 ml serosanguinous fluid in abdomen

Lungs – diffusely red, slightly firm, small off-white lesions

Pancreas – numerous off-white nodules, one limb dark red / friable

Spleen – numerous dark red/black nodules

Eyes, brain, cervical spinal cord – no gross lesionsPresented at SEVPAC 2008 –

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Histologic LesionsHistologic LesionsSpinal CordSpinal Cord

Dorsal Horn

Ventral Horn

GM

WMWM

Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Histologic LesionsHistologic LesionsSpinal CordSpinal Cord

Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

MucicarmineGMS

(Grocott’s Methenamine Silver)

Special StainsSpecial StainsSpinal CordSpinal Cord

Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

DiagnosisDiagnosis

Morphologic: Spinal cord, granulomatous meningomyelitis with intralesional yeast

Additional Diagnoses Brain, granulomatous meningoencephalitis Liver, granulomatous hepatitis Kidney, multifocal granulomatous interstitial

nephritis and glomerulonephritis Pancreas, diffuse granulomatous pancreatitis Heart, granulomatous myocarditis Lung, granulomatous interstitial pneumonia Eye, granulomatous uveitis with retinal

detachment

Disease Diagnosis: Disseminated CryptococcosisPresented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

CryptococcusCryptococcus

Dimorphic fungus

C. neoformans

var. grubii

var. neoformans

C. gatti

Transmission

Pathogenesis

Zoonotic?

Humans vs. domestic animals

Dogs vs. catsPresented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Virulence FactorsVirulence Factors

Mucopolysaccharide capsule

Ability to replicate at body temperature

Phenoloxidase (laccase)

Serine protease

Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

PrognosisPrognosis

Disseminated, CNS disease – guarded

Localized nasal or cutaneous disease – good if treated early and appropriately; guarded for severe or longstanding disease

Poor for resolution of neurologic deficits

Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

ReferencesReferences

Bovers M, Hagen F, Boekhout T. Diversity of the Cryptococcus neoformans-Cryptococcus gattii species complex. Rev Iberoam Micol 2008;25:S4-S12.

Bartlett KH, Kidd SE, Kronstad JW. The Emergence of Cryptococcus gattii in British Columbia and the Pacific Northwest. Curr Infect Dis Rep 2008;10:58-65.

Duncan CG, Stephen C, Campbell J. Evaluation of risk factors for Cryptococcus gattii infection in dogs and cats. J Am Vet Med Assoc 2006;228:377-382.

Greene CE. Infectious diseases of the dog and cat. 3rd ed. Philadelphia, Pa. ; London: Elsevier Saunders, 2006.

Kerl ME. Update on canine and feline fungal diseases. Vet Clin North Am Small Anim Pract 2003;33:721-747.

Maxie MG, Jubb KVF. Pathology of domestic animals. 5th ed. Edinburgh ; New York: Elsevier Saunders, 2007.

Nielsen K, De Obaldia AL, Heitman J. Cryptococcus neoformans mates on pigeon guano: implications for the realized ecological niche and globalization. Eukaryot Cell 2007;6:949-959.

Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Thank YouThank You

Dr. Natalie Durrett Crawford

Dr. D. Phillip Sponenberg

Dr. Tanya LeRoith

Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Questions?Questions?

Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only