VSPN AOW : Dermatophytoses in Dogs a... |
Dermatophytoses in Dogs and CatsToday's Vet Pract. Sep-Oct 2021;11(5):56-64. 40 Refs1 College of Veterinary Medicine, University of Florida-Gainesville, Gainesville, FL 32608, USA.
Author AbstractDermatophytoses have a variety of clinical presentations, and a step-by-step logical approach is crucial for proper diagnosis.
Companion NotesOverview on dermatophytoses in dogs and cats
Dermatophytes are pathogenic fungi - causing a significant problem in 2 groups of animals - shelter animals - household pets with extensive exposure to an outdoor environment - most common dermatophytes diagnosed in small animals - Microsporum canis (most common sources are cats) - in shelter cats infections with other dermatophytes is rare - Microsporum gypseum (most common source is soil) - Trichophyton mentagrophytes (most common source is rodents) - infection is more likely in very young, geriatric, or stressed animals
Clinical Signs - dermatophytes, because they are keratinophilic, localize to hairs and nails - when they affect hairs, they lead to folliculitis - papules and pustules which rapidly rupture, leaving the following: - epidermal collarettes - circular areas of alopecia - crusts - differential diagnoses for folliculitis - Staphylococcal infection - demodicosis, particularly in dogs - in dogs with signs of folliculitis - perform cytology to look for intracellular bacteria - perform deep skin scrapings for demodicosis - gray skin discoloration may be present with demodicosis - due to comedone formation - due to plugging of hair follicles filled with mites - other causes of pustular disease not oriented to follicles - such as pemphigus foliaceus - nodular lesions - sometimes occur when dermatophytes are inoculated into the dermis (injury) - causing a severe inflammatory response and a nodular lesion called a kerion - typically found on bridge of the nose of dogs that like to dig - inflammatory response can persist even after dermatophytes die - often require histopathology and culture for diagnosis - impression smears can be diagnostic however - dermatophytic mycetoma, also called pseudomycetoma - manifests as nodules with draining tracts, typically on the back - primarily occurs on Persian cats - nail lesions - nails and footpads can be affected - infected nails become brittle and deformed - especially in dogs with M gypseum infection - differential diagnoses for deformed and brittle nails can include the following: - systemic lupoid onychodystrophy - genetically inherited dystrophies that are not immune mediated - begin working up these cases by collecting samples of affected nails (nail clippings) - before considering biopsies or other invasive tests - submit for fungal culture
Diagnostic testing - recently clinical consensus paper concluded there’s no gold standard for diagnosis - diagnosis requires complementary methods to confirm a active infection - direct examination of arthrospores on infected hairs - fungal culture of hairs collected with a sterile toothbrush - Wood’s lamp is recommended as a screening tool - most M canis infections will fluoresce apple green - reported positivity ranges: 91-100% - ability to fluoresce develops after 1st week of infection - can persist at hair tips after resolution of the infection - exam should start at the animal’s head - then moving slowly back while holding the lamp 2-4 cm from the skin - a false blue fluorescence can be seen with scaling and some topical products - fungal culture - procedure simply indicates the presence or absence of spores on the hairs - results depends partly on sampling technique and the area selected for culture - toothbrush approach may detect asymptomatic carrier animals - pressing the toothbrush onto the plate is best way to maximize M canis growth - and minimize contaminant growth - direct examination by plucking hairs from margins of an existing lesion - considered useful for specifically assessing if lesion may be caused by a dermatophyte - however, hair plucks can still lead to negative results - slides with 10 to 20 plucked hairs in mineral oil can be examined for arthrospores - polymerase chain reaction (PCR); positive does not confirm active infection - results of studies on PCR differ, depending on the PCR studied - in 1 report of quantitative PCR (qPCR) of toothbrush fungal culture samples (of lesions on shelter cats) - found it to be a reliable test for confirming disease - qPCR and fungal culture matched in 94% of cases - qPCR correctly identified 2 uninfected cats - in another study - one step-PCR - high accuracy for dogs (area under the curve [AUC] >90) - moderate accuracy for cats (AUC = 78.6) - nested PCR - accurate for cats (AUC = 93.6) - in dogs - specificity: 94.1% - sensitivity: 100% - in cats - specificity: 94.4% - sensitivity: 94.9% - in another study comparing nested PCR with direct microscopy and culture - degree of agreement for nested PCR and direct microscopy: 94.4% - degree of agreement for nested PCR and culture: 83.3% - recent study reported PCR is less sensitive than previously reported - but that it is more specific, thus increasing risk for false-negatives
Treatment requires topical treatment, systemic treatment, and environmental disinfection - topical therapy is essential as dermatophytosis is transmitted by contact with arthrospores - clipping was once thought a necessary part of treatment - practice is currently being reconsidered - whole-body clipping is stressful - common microtrauma to the skin can worsen infection - not necessary for short-coated animals - dips, shampoos, and rinses - lime sulfur dips still recommended in USA (efficacy shown in several studies) - twice weekly use more effective than once weekly - dip has residual activity - common side effects in the author’s experience - dryness - yellow discoloration - if clients object to the smell, other options available in USA - combination of miconazole and chlorhexidine twice weekly - most effective topical treatment - topical enilconazole is effective but currently not available in USA - generally well tolerated, but reported to cause adverse events in Persians - in vitro studies support effectiveness of ketoconazole shampoos - no clinical trial published - in vitro studies showed good residual activity of 0.5% climbazole with chlorhexidine - 1 study on topical terbinafine reported a good response - systemic therapy - most effective systemic treatments for both dogs and cats - oral itraconazole - long half-life in cats and a propensity to accumulate in hairs and skin - allowing for use of pulse therapy, decreasing the cost of therapy - most common dose for itraconazole in dogs and cats: 5 mg/kg sid - avoid compounded formulations - generic itraconazole seems to be better - therapeutic monitoring is helpful as concentration can be very variable - with treatment failure, switch to human formulation - at higher doses, reported to trigger vasculitis in dogs - liquid formulation available for use in cats - oral terbinafine; accumulates in hairs - pulse therapy also possible - excellent activity against dermatophytes - shown effective and a suitable cheaper choice for shelter cats - commonly used dose range for terbinafine: 20-40 mg/kg - higher doses more effective - ketoconazole is effective but is typically not well tolerated in cats - best used for dogs and is typically prescribed at 5 mg/kg PO q12h with food - fluconazole has poor activity against dermatophytes in vitro - griseofulvin used historically but there’s safer and more effective choices - lufenuron; studies have found no efficacy - vaccines do not prevent development of dermatophytosis - environmental decontamination - use minimizes false-positive fungal culture results - separating animals to minimize contamination has been advocated for decades - do cautiously as it can be very stressful, particularly for the young - minimize duration of isolation - need for extended isolation can be decreased by weekly cleaning - and topical therapy - most important part is the actual hard cleaning - that removes debris and hairs - over-the-counter household detergents can be used for cleaning - hard surfaces can be disinfected with 1:100 concentration household bleach - or accelerated hydrogen peroxide - for machine washing of soft fabrics use the longest cycle Monitoring Treatment Success - clinical cure does not always mean mycological cure - monitor therapy - establish a complete cure based on the following: - resolution of clinical signs - negative fungal culture - extent of infection can be monitored with weekly cultures - PCR can detect dead fungal organisms - animals can pick up spores from a contaminated environment - but they may have developed immunity and are not actively infected - these animals may be a source of infection - indicating further environmental decontamination may be warranted - fungal culture can be repeated to make sure results are truly negative - long-haired cats may be potential carriers - outbreaks in a multicat household - every cat should be cultured to find out which are truly negative - and which are clinically normal but carrying arthrospores on their coats
“Dermatophytosis can represent a significant challenge in dogs of certain breeds, such as Yorkshire terriers. It is very important to go through the list of differential diagnoses and work up each case in a step-by-step logical manner.”
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