Disseminated Cryptococcus neoformans var. neoformans: Infection and Treatment in a Schmidt’s Red-Tailed Guenon (Cercopithecus ascanius schmidti)
American Association of Zoo Veterinarians Conference 2011
Jennifer N. Langan1,2, DVM, DACZM; Michael J. Adkesson2, DVM, DACZM; Carlos R. Sanchez2, DVM, MSc; Martha A. Delaney3, DVM; David A. Rubin4, MD; Michael C. Muhlbauer5, DVM, DACVR; Kathleen M. Colegrove-Calvey3, DVM, DACVP
1Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL, USA; 2Chicago Zoological Society, Brookfield Zoo, Brookfield, IL, USA; 3Zoological Pathology Program, University of Illinois, Maywood, IL, USA; 4Mallinckrodt Institute of Radiology, School of Medicine, Washington University, St. Louis, MO, USA; 5Veterinary Imaging Specialists, St. Louis, MO, USA
A nine-year-old, female, intact Schmidt’s red-tailed guenon (Cercopithecus ascanius schmidti) presented with an acute swelling, consistent with an abscess on her right hip. On physical examination, the animal was mildly febrile (102.8°F), had a leukocytosis (white blood cell count 15,800 cells/µL; reference range 3,406–9,366 cells/µL)1 with a mature neutrophilia and monocytosis. Cytology, culture, and PCR from material within the abscess, and serum titers were all consistent with a Cryptococcus neoformans infection. Thoracic radiographs and computed tomography (CT) revealed a consolidated right caudal lung lobe associated with an endobronchial mass. Systemic and pulmonary fungal disease associated with Cryptococcus was confirmed with positive cytologic brushings and bronchoalveolar lavage (BAL).
Sequential thoracic radiographs, CT scans, bronchoscopy, BAL, serology, and cytology were used to monitor response to therapy. Five months after initial diagnosis, pregnancy was confirmed and the frequency of immobilizations for recheck serology and diagnostic imaging was decreased to lessen radiation exposure and physiologic stress to the dam and fetus.
Culture and sensitivity, MIC values, and serum fluconazole level results were used to develop and monitor treatment efficacy for this animal. Long-term administration of oral fluconazole (6 mg/kg orally once daily) was well-accepted and effective at treating local and systemic Cryptococcus neoformans infection in this non-human primate. No adverse effects of therapy were observed, and invasive and repeated diagnostics were well-tolerated.
Advanced imaging modalities and serum drug levels were critical to assess, monitor, and treat this life-threatening infection in this animal.
1. Reference Ranges for Physiological Values in Captive Wildlife. International Species Information System. International Species Information System. Apple Valley, MN. 2002.