Candida infection in cetaceans shows various symptoms in many organs.1-4 The lack of specific signs for candidiasis often delays definitive diagnosis and effective treatments. We report a candidiasis in a female bottlenose dolphin; major symptoms were respiratory problem (Feb 17– Mar 30, 2013), corneal problem (Mar 3– Jul 31, 2013) and persistent fever, the highest being 38°C (Mar 3–Apr 27, 2013).
Plaques of mucinous yellow substances inside blowhole were found (Day 1). Her behavior and appetite were normal. Sputum cytology by Gram stain revealed unusually increased numbers of gram-negative rods and gram-positive cocci, some Candida elements and white blood cells.5 Blood test was normal except for a mild neutrophilia. Bacterial respiratory disease was suspected and amoxicillin (10 mg/kg PO BID 19 days)6 was prescribed. Pseudomonas spp. and Candida albicans were isolated from blow cultures. Antibiotics were changed to ciprofloxacin (28 mg/kg PO BID 4 days)6 to especially target gram-negative rods including P. aeruginosa. However, clinical signs did not disappear and fever got higher. Frequent blood tests showed a gradual reduction in lymphocyte count and finally progressed to severe lymphopenia. The medication was switched to itraconazole (4 mg/kg PO SID 14 days) because anecdotal evidence suggested lymphopenia was one of the specific symptoms of fungal infection.7 Yellow substances disappeared after a day of administering itraconazole. After cessation of itraconazole, fungal elements were no longer found on the blowhole.
Fever persisted even after normalization of sputum cytology. Antibiotics were changed to amoxicillin clavulanate potassium [11 mg/kg combined dose (AMPC/CVA = 10/1) PO BID 14 days]6 to cover anaerobes that were out of ciprofloxacin spectrum, but fever was not resolved. The fever spontaneously resolved one month after the resolution of clinical signs.
White spots appeared on the right eye cornea on Day 12. She refused to open her right eye from Day 19 and subsequently her left eye as well. Topical erythromycin drops were administrated, but edema appeared in her eyelids on the next day, so we discontinued the treatment. Corneal swab cytology on Day 34 revealed some yeasts and C. albicans was isolated from same swab. Topical administration of pimaricin (2–3 drops, 6 times in a day) was prescribed for 4 months. Eyes opened halfway from Day 57, but corneal opacities were serious and photophobia also attended. The sight gradually improved and healed. However, corneal opacities and slight photophobia are remaining even up to Jan 28, 2014.
Why Candida affected multiple organs in this case is unknown. Lymphopenia may reflect lower immune status at that time and some relationships with the etiology. In bacterial corneal ulcer of the cetacean, pain, blepharospasm, photophobia, corneal edema and changes in the transparency might be shown.8 However, in this case, some symptoms are lacking. Corneal candidiasis tends to show different signs. Prognosis of ophthalmic disease depends on early appropriate treatments. Delayed diagnosis as Candida keratitis postponed administrating topical antifungal medicine. I hope this report will help veterinarians treat dolphins, which have similar symptoms in the future.
The authors wish to thank Dr. Carmen MH Colitz, DVM, PhD, Diplomate ACVO of the Animal Health Quest Solutions, LLC, All Animal Eye Care and Jupiter Pet Emergency and Speciality Center; Makio Yanagisawa of the Churaumi aquarium in Okinawa Japan; Hajime Iwao of the Niigata City Aquarium in Niigata, Japan.
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