Voriconazole-Clindamycin as First-Line Treatment for Suspected Pulmonary Aspergillosis in Tursiops Truncatus
Pulmonary aspergillosis is one of the most commonly reported mycotic diseases in marine mammals, and Aspergillus fumigatus has been isolated from most of the reported cases in bottlenose dolphins (Tursiops truncatus). The purpose of these case studies is to determine and establish an effective therapeutic option for pulmonary aspergillosis in bottlenose dolphins. Two cases of suspected pulmonary aspergillosis in bottlenose dolphins were observed at Delphinus Xcaret in Riviera Maya, Mexico. Both were 3-yr-old females presenting with anorexia, cough, tachypnea and an increased white blood cell count. The diagnosis of aspergillosis was based on serological tests. Treatment with voriconazole (V-fend®) and clindamycin (Dalacin C®) was initiated. The initial dose of voriconazole was 2.2 mg/kg BID for two days. The maintenance dose, given for four months, was 1.7 mg/kg BID. Clindamycin was administered at a dose of 9.25 mg/kg/day. The dolphins increased their food intake and both showed clinical improvement by decreasing the coughing and normalizing the total white blood cell count. Voriconazole-clindamycin seems to be an effective therapy for suspected pulmonary aspergillosis. The level of toxicity is low and there may be a complementary effect between antimycotic and antibiotic activities of both drugs.