Cats with Central Nervous System Cryptococcosis

Authors

  • Rochana Rodrigues
  • Jenifer Severo Beretta
  • Andréia Spanamberg
  • Mônica Slaviero
  • Luiza Presser Ehlers
  • Luciana Sonne

DOI:

https://doi.org/10.22456/1679-9216.108026

Abstract

Background: Cryptococcosis is a serious fungal infection contracted by humans and animals, and the most common systemic mycosis found in cats. This disease is often contracted through inhalation of fungal propagules. The Central Nervous System (CNS) may be infected through local extension (nasal and frontal sinuses) or via hematogenous route. Similarly to CNS bacterial infection, the clinical signs of neurological dysfunction may be attributed to mass effect (gelatinous mass of fungal microorganisms and fungal granuloma formation) or to a more disseminated inflammatory response to invading microorganisms. The objective of this study is to report one case of a patient with cryptococcal granulomas in the central nervous system and one case of a patient with neurological signs associated to cryptococcosis.

Cases: A 3-year-old male mixed breed feline was admitted Veterinary Clinic, located in Porto Alegre, RS, Southern Brazil. The patient presented unsourced behavioral changes, vestibular ataxia and dysphagia caused by inability of coordination. The following tests were performed: complete blood count test, biochemical analysis, computed tomography scan (CT scan), fluid analysis, radiography and toxoplasmosis test. The following medicine were administrated for treatment: fluconazole, dexamethasone, mannitol, phenobarbital and levetiracetam. Fluid therapy was also part of the treatment. Immediately after death, the cat was submitted for necropsy, and a fungal granulomatous meningoencephalomyelitis was diagnosed.  Cryptococcus sp. was identified as the causal agent through pathological findings, fungal culture and PCR analysis.  One year later, another feline was admitted to the same clinic (a 2-year-old female mixed breed) presenting hypersalivation, tremors and excessive vocalization. The patient had contact with the deceased feline. The following tests were performed: complete blood count test, biochemical analysis, computed tomography scan (CT scan), cerebrospinal fluid analysis, and radiography. The following medicine were administrated for treatment: fluconazole, prednisolone, phenobarbital, potassium citrate and cefalotine. This patient is frequently monitored by a veterinarian and presents adequate health conditions after the occurrence.  Cryptococcus sp. was identified as the causal agent through fungal culture and cytology (cerebrospinal fluid).

Discussion: Cats are the most frequently infected animals with the involvement of the upper and or lower respiratory tract, subcutaneous granuloma, and disseminated infections. These animals present a higher quality of life when the disease is diagnosed and treated early. Peripheral enhancement of intracranial cryptococcal granulomas has been demonstrated in felines. These fungal granulomas often present evidence of significant perilesional edema. The most substantial evidence for diagnosis of cryptococcosis is the identification of the microorganism in Cerebrospinal fluid (CSF) samples. The mechanism of the lesion is cellular death, probably caused by secondary atrophy from distortion and tissue compression due to the expansion of Cryptococcus cysts in the cerebral parenchyma. There are several reports of long-lasting remission or cure of CNS cryptococcosis treated with medicine combinations, including flucytosine and/or triazole antifungal agents (itraconazole and fluconazole.) The isolated use of flucytosine may contribute to development of drug resistance. One controversial alternative that may be beneficial to the patient is the administration of low prednisolone doses to counter perilesional edema in the initial stages of treatment. The utilization of glucocorticoids after diagnosis was associated to higher survival rates in animals.

Downloads

Download data is not yet available.

References

Chen S.C., Meyer W. & Sorrell T.C. 2014. Cryptococcus gattii infections. Clinical Microbiology Reviews. 27(4): 980-1024.

Dewey C.W. 2017. Encefalopatias: distúrbios do encéfalo. In: Dewey C.W. & Costa R.C. (Eds). Neurologia Canina e Felina: guia prático. 3.ed. São Paulo: Guará, pp.230-231.

Ferreira Neto J.M., Viana E.S. & Magalhães L.M. 1977. Patologia Clínica Veterinária. Belo Horizonte: Rabelo e Brasil Ltda., 279p.

Jeff L.C & Caswell K.J. 2016. Respiratory System. In: Maxie G. (Ed). Jubb, Kennedy and Palmer’s Pathology of Domestic Animals. 6th edn. Ontario: Elsevier, pp.465-592.

Muñana K.R. 2013. Head tilt and nystagmus. In: Platt S. & Olby N. (Eds). BSAVA Manual of Canine and Feline Neurology. Chp. 11. 4th edn. Gloucester: BSAVABritish Small Animal Veterinary Association, pp.195-212

Sanders S.G. 2017. Distúrbios do equilíbrio e da audição: o nervo vestibulococlear (NC VIII) e as estruturas associadas. In: Dewey C.W. & Costa R.C. (Eds). Neurologia Canina e Felina: guia prático. São Paulo: Guará, pp.213-240

Sanders S.G. 2017. Doenças do cerebelo e síndromes de tremor. In: Dewey C.W. & Costa R.C. (Eds). Neurologia Canina e Felina: guia prático. Cap.12. São Paulo: Guará, pp.345-378.

Seyedmousavi S., Bosco S., de Hoog S., Ebel F., Elad D., Gomes R.R., Jacobsen I.D., Jensen H.E., Martel A., Mignon B., Pasmans F., Piecková E., Rodrigues A.M., Singh K., Vicente V.A., Wibbelt G., Wiederhold N.P. & Guillot J. 2018. Fungal infections in animals: a patchwork of different situations. Medical Mycology. 56 (Suppl 1): 165-187.

Stokes J. 2016. Doenças Fúngicas e Causadas por Riquétsias. In: Little S.E. (Ed). O Gato: Medicina Interna. Rio de Janeiro: Editora Roca, pp.978-980.

Sykes J.E. & Malik R. 2015. Criptococose. In: Grenne C.E. (Ed). Doenças Infecciosas em Cães e Gatos. 4th edn. Rio de Janeiro: Guanabara-Koogan, pp.653-667.

Sykes J.E., Sturges B.K., Cannon M.S., Gericota B., Higgins R.J., Trivedi S.R., Dickinson P.J., Vernau K.M., Meyer W. & Wisner E.R. 2010. Clinical signs, imaging features, neuropathology, and outcome in cats and dogs with central nervous system cryptococcosis from California. Journal of Veterinary Internal Medicine. 24(6): 1427-1438.

Trivedi S.R., Malik R., Meyer W. & Sykes J.E. 2011. Feline Cryptococcosis: Impact of Current Research on Clinical Management. Journal of Feline Medicine and Surgery. 13(3): 163-172.

Trivedi S.R., Sykes J.E., Cannon M.S., Wisner E.R., Meyer W., Sturges B.K., Dickinson P.J. & Johnson L.R. 2011. Clinical features and epidemiology of cryptococcosis in cats and dogs in California: 93 cases (1988-2010). Journal of the American Veterinary Medical Association. 239(3): 357-369.

White T.J., Bruns T. & Lee S. 1990. Amplication and direct sequencing of fungal ribosomal RNA genes for phylogenetics. In: Innis M.A., Gelfand D.H. & Sninsky J.J. & White T.J. (Eds). PCR - Protocols and Applications - A Laboratory Manual. San Diego: Academic Press, pp.315-322.

Published

2020-01-01

How to Cite

Rodrigues, R., Severo Beretta, J., Spanamberg, A., Slaviero, M., Presser Ehlers, L., & Sonne, L. (2020). Cats with Central Nervous System Cryptococcosis. Acta Scientiae Veterinariae, 48. https://doi.org/10.22456/1679-9216.108026

Most read articles by the same author(s)

<< < 1 2 3 4 5 > >>