Cerebral Candida albicans Infection in Two dogs

Abstract

Background: Candida spp. are pleomorphic fungi that are commensal inhabitants of the oral, gastrointestinal, upper respiratory and urogenital mucosa of mammals. Candida albicans is described as the most important species. This opportunistic pathogen may produce local or systemic infections in dogs. Local infections have been reported in several tissues and systemic infection is rare in dogs with few reports in the literature describing this presentation. The aim of the present study was to report two cases of cerebral Candida albicans infection in dogs in Brazil.

Case: Two cases of cerebral Candida albicans infection in dogs that showed nervous signs are described. In both cases, the brain showed marked asymmetry of the telencephalic hemispheres with multifocal to coalescing yellowish or reddish areas and a partial loss of distinction between gray and white matter. In Case 1, the mediastinal, tracheobronchial and mesenteric lymph nodes, as well as the right kidney and adrenal gland, showed altered architecture due to numerous whitish gray nodules. Histological lesions were characterized by granulomatous (case 1) or pyogranulomatous (case 2) necrotizing meningoencephalitis with intralesional fungal organisms. In case 1, similar granulomatous infiltrate with intralesional fungal organisms was also seen in the lymph nodes, kidney and adrenal gland. In case 2, there was evidence consistent with an underlying infection of canine distemper virus. Were observed lymphoplasmocytic interstitial pneumonia, lymphoid rarefaction in lymph nodes, and viral intracytoplasmic inclusion bodies in the epithelial cells of the stomach and vesical urothelium. In these two cases, the fungal organisms displayed three different morphological patterns. The first pattern was characterized by delicate tubular structures with thin parallel walls that were rarely septate and tended to undulate slightly, and measured approximately 4-20 µm (true hyphae). The second pattern was characterized by chains of elongated yeast, separated by constrictions at septal sites, and measured approximately 4-10 µm (pseudohyphae). The other morphological pattern, which was rarely observed, was characterized by round budding yeast cells that measured 3-4 µm in diameter and were often elongated by the germ tube. Sections were also stained using immunohistochemical antibodies against Candida albicans. The fungi revealed strong immunolabelling of the cytoplasm and wall for Candida albicans.

Discussion: The diagnosis was based on the histomorphological and immunohistochemical characteristics of the agent, which were consistent with Candida albicans. In these two cases, immunocompromise appeared to have been an important factor in the progression of the infection. In case 1, the dog was senile and treated with corticosteroids, conditions that could effectively limit innate, humoral and cell-mediated immune response to infection. In case 2, the dog displayed cachexia and was infected by canine distemper virus, evidenced by the presence of viral inclusion bodies. The inflammatory reactions in both cases were characteristic of fungal infections, but were distinct due to differences in the infectious process. In case 1, there was a subacute to chronic progression; while in case 2 neutrophilic infiltrate predominated, suggesting an acute progression. The different morphological patterns of the fungi suggested a pleomorphic fungi and the immunohistochemistry allowed us to identify the infectious agent. In conclusion, opportunistic infections caused by Candida albicans should be considered when diagnosing diseases that affect the central nervous system of dogs, particularly in immunosuppressed animals.