A Candida glabrata Bronchopneumonia Treated with Voriconazole in a Tursiops truncatus
IAAAM Archive
C.E. van Elk1; S.J.M. Gans2; N. Epping2
1Dolfinarium Harderwijk, Harderwijk, The Netherlands; 2St Jansdal Hospital, Harderwijk, Netherlands


Candida infections occur sporadically as localized or systemic infections in bottlenose dolphins. Candida glabrata has been reported once as a disseminated infection and once as an infection of the brain and cranial sinuses in this species.

On the 6th of November 2005 a 15-year-old mother, with a 18-month-old calf, lost appetite. Within two days she became completely anorexic despite antibiotic (amoxycilline with clavulanic acid) therapy. The animal was difficult to approach in her large lagoon exhibit. On the 10th of November we succeeded in isolating her in the medical pool and separated her from her calf.

The cow was severely neutropenic (1,8 106/ml), with slightly elevated breathing frequency (16/5mins vs 13/5mins) and elevated, sed rate (20 mm / 60 minutes), liver enzymes (ASAT 1.5 * normal; ASAT 5 * normal) and decreased sodium values (146 vs 154 mEq/l). She was lethargic. Palliative (force feeding, fresh water plus NaCl orally) and antibiotic treatment (amykacine and enrofloxacine) was begun.

During the first week WBC count went up to 8.6 106/ml, and the animal became slightly less lethargic. All other blood parameters remained the same as did the breathing frequency and the anorexia. The liver enzymes increased. The increased liver enzymes were interpreted as hepatic reaction towards the toxic substances released by the inflammation. Decreased sodium was thought to be due to gastrointestinal loss due to vomiting or diarrhoea.

On the 17th of November a bronchoscopy was done which showed white raised nodules in the proximal trachea and in the bronchi passed the carina. The nodules appeared typical for a mycotic infection. The mucosa of bronchi and trachea were covered with white yellow exudates and were hyperaemic. Antibiotic and antimycotic treatment was started according to the outcome of bronchial lavage sample cultures and resistance patterns. Large amounts (++) of Staphylococcus aureus, Shewanella putrefaciens, Pseudomonas aeruginosa and Candida glabrata were cultured. Amoxycilline with clavulanic acid, clindamycine and voriconazole were the therapeutics used.

After 7 days of voriconazole therapy bronchoscopy was repeated. Most white raised nodules had disappeared; a few had remained in the trachea. Little exudate was present on the mucosa of bronchi and trachea, which was less hyperaemic. The culture of the bronchiolar lavage samples revealed sporadic Candida glabrata and large amounts of Shewanella putrefaciens, Pseudomonas aeruginosa and Vibrio parahaemolyticus. Voriconazole therapy was continued for another 13 days together with amikacine. After two days without medication the third bronchoscopy was done. No white nodules were observed, the mucosa was without exudates and of normal colour. Candida glabrata was still found sporadically in the bronchial lavage samples as was a mixed bacterial fauna. Continuing partial lack of appetite was blamed on side effects of the medication. There was an ongoing continuous increase of creatinine (doubled to 168) for which amikacine was held responsible. All medication was stopped and a small dosage of diazepam was given as an appetizer. Creatinine values and appetite normalized over a ten day period.

Candida sp infections are mostly a problem of immuno incompetent creatures. It is not possible to state whether the Candida glabrata infection was a primary or a secondary infection. The broncho-pneumonia found was a mixed infection. The Candida glabrata infection might have occurred after an immunosuppresion of unidentified origin or a primary bacterial respiratory infection might have exhausted the immune system and thus created the opportunity for a secondary Candida glabrata infection. In this respect it is remarkable this cow has had a previous Aspergillus sp pneumonia diagnosed during a previous lactation (1998).

Candida glabrata is known for its resistance versus fluconazole. In human medicine voriconazole is used as a first choice medication in a Candida glabrata infection. It has a more fungicidal effect then the more ancient azoles like itraconazole and fluconazole. A relatively short period of therapy (20 days) appeared effective in this case. No side effects of voriconazole were observed.

Therapeutics mentioned were given in the underneath mentioned dosages: The animal weighed 180 kg.


Brand name


Amoxicilline plus clavulanic acid


10mg/kg BID PO



5mg/kg BID PO



8mg/kg BID PO



14mg/kg SID IM

Diazepam (appetizer)


5mg BID PO



300 mg BID PO

Speaker Information
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Cornelis E. van Elk

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