• 1.

    Greene RT. Coccidioidomycosis and paracoccidioidomycosis. In: Greene CE, ed. Infectious Diseases of the Dog and Cat. 4th ed. Elsevier; 2012:634645.

    • Search Google Scholar
    • Export Citation
  • 2.

    Shubitz LF, Dial SM. Coccidioidomycosis: a diagnostic challenge. Clin Tech Small Anim Pract. 2005;20(4):220–226. doi:10.1053/j.ctsap.2005.07.002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Clemons KV, Laniado-Laborin R, Stevens DA. Comparative aspects of coccidioidomycosis in animals and humans. In: Proceedings of the Sixth International Symposium on Coccidioidomycosis. New York Academy of Sciences; 2007:395403.

    • Search Google Scholar
    • Export Citation
  • 4.

    Graupmann-Kuzma A, Valentine BA, Shubitz LF, Dial SM, Watrous B, Tornquist SJ. Coccidioidomycosis in dogs and cats: a review. J Am Anim Hosp Assoc. 2008;44(5):226235.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Davidson AP, Shubitz LF, Alcott CJ, Sykes JE. Selected clinical features of coccidioidomycosis in dogs. Med Mycol. 2019;57(suppl 1):S67S75.

  • 6.

    Galgiani JN, Catanzaro A, Cloud GA, et al. Comparison of oral fluconazole and itraconazole for progressive, nonmeningeal coccidioidomycosis. Ann Intern Med. 2000;133(9):676686.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Johnson LR, Herrgesell EJ, Davidson AP, Pappagianis D. Clinical, clinicopathologic, and radiographic findings in dogs with coccidioidomycosis: 24 cases (1995–2000). J Am Vet Med Assoc. 2003;222(4):461466.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Sykes JE. Coccidioidomycosis. In: Ettinger SJ, Feldman EC, Côté E, eds. Textbook of Veterinary Internal Medicine. 8th ed. Elsevier; 2017:10241027.

    • Search Google Scholar
    • Export Citation
  • 9.

    Shubitz LF, Schlacks S, Vishkautsan P, Butkiewicz CD, Worthing KA. Posaconazole treatment for refractory coccidioidomycosis in dogs (Erratum in J Vet Intern Med. 2022;36[2]:837). J Vet Intern Med. 2021;35(6):2772–2777. doi:10.1111/jvim.16282

    • Search Google Scholar
    • Export Citation
  • 10.

    Catanzaro A, Galgiani JN, Levine BE, et al. Fluconazole in the treatment of chronic pulmonary and nonmeningeal disseminated coccidioidomycosis. Am J Med. 1995;98(3):249256.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Graybill JR, Stevens DA, Galgiani JN, Dismukes WE, Cloud GA. Itraconazole treatment of coccidioidomycosis. Am J Med. 1990;89(3):282290.

  • 12.

    Tucker RM, Denning DW, Arathoon EG, Rinaldi MG, Stevens DA. Itraconazole therapy for nonmeningeal coccidioidomycosis: clinical and laboratory observations. J Am Acad Dermatol. 1990;23(3 pt 2):593601.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Pappagianis D, Zimmer BL. Serology of coccidioidomycosis. Clin Microbiol Rev. 1990;3(3):247268.

  • 14.

    Smith CE, Saito MT, Simons SA. Pattern of 39,500 serologic tests in coccidioidomycosis. J Am Med Assoc. 1956;160(7):546552.

  • 15.

    Boothe DM. Treatment of fungal infections. In: Boothe DM, ed. Small Animal Clinical Pharmacology and Therapeutics. 2nd ed. Elsevier; 2012:364397.

    • Search Google Scholar
    • Export Citation
  • 16.

    Mazepa ASW, Trepanier LA, Foy DS. Retrospective comparison of the efficacy of fluconazole or itraconazole for the treatment of systemic blastomycosis in dogs. J Vet Intern Med. 2011;25(3):440445.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Crabtree AC, Keith DG, Diamond HL. Relationship between radiographic hilar lymphadenopathy and serologic titers for Coccidioides sp. in dogs in an endemic region. Vet Radiol Ultrasound. 2008;49(6):501503.

    • Crossref
    • Search Google Scholar
    • Export Citation

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Retrospective evaluation of the efficacy of fluconazole for the treatment of coccidioidomycosis in dogs: 49 cases (2015–2020)

Todd D. Carter DVM, DACVIM1, Brenley D. Fuller2, Stephanie L. Shaver DVM, DACVS, MS1, and Daniel S. Foy MS, DVM, DACVIM, DACVECC1
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  • 1 Department of Specialty Medicine, College of Veterinary Medicine, Midwestern University, Glendale, AZ
  • | 2 College of Veterinary Medicine, Midwestern University, Glendale, AZ

Abstract

OBJECTIVE

To characterize the clinical course and therapeutic response in dogs with coccidioidomycosis treated with fluconazole.

ANIMALS

49 client-owned dogs with coccidioidomycosis that were treated with fluconazole and had ≥ 2 follow-up examinations.

PROCEDURES

Medical records were retrospectively searched to identify dogs in which coccidioidomycosis was diagnosed between January 2015 and May 2020. Data recorded from each dog included signalment, clinical signs, diagnostic test results, and treatment.

RESULTS

Dogs were treated with fluconazole at a median initial dosage of 19.7 mg/kg/d. Median treatment duration was 298.5 days, with 26 of the 49 dogs completing treatment during the study period. Respiratory signs, lethargy, and hyporexia were the most common clinical signs. Frequency of lethargy decreased after 30 days, whereas frequency of hyporexia and respiratory signs decreased after 90 days. Median IgG titer at diagnosis was 1:32 and was significantly decreased, compared with baseline titer, at all recheck intervals after 90 days. Hyperglobulinemia, monocytosis, and neutrophilia were the most common clinicopathologic abnormalities. Hyperglobulinemia resolved within 30 days, neutrophilia resolved within 90 days, and monocytosis resolved after 180 days.

CLINICAL RELEVANCE

Improvements in clinical signs, titers, and clinicopathologic abnormalities were observed after initiation of treatment with fluconazole. Improvement began as early as the first 3 months of treatment, but some variables did not resolve until after 6 to 9 months of treatment. This information provides clinical guidance and describes expectations when prescribing fluconazole to treat coccidioidomycosis in dogs.

Abstract

OBJECTIVE

To characterize the clinical course and therapeutic response in dogs with coccidioidomycosis treated with fluconazole.

ANIMALS

49 client-owned dogs with coccidioidomycosis that were treated with fluconazole and had ≥ 2 follow-up examinations.

PROCEDURES

Medical records were retrospectively searched to identify dogs in which coccidioidomycosis was diagnosed between January 2015 and May 2020. Data recorded from each dog included signalment, clinical signs, diagnostic test results, and treatment.

RESULTS

Dogs were treated with fluconazole at a median initial dosage of 19.7 mg/kg/d. Median treatment duration was 298.5 days, with 26 of the 49 dogs completing treatment during the study period. Respiratory signs, lethargy, and hyporexia were the most common clinical signs. Frequency of lethargy decreased after 30 days, whereas frequency of hyporexia and respiratory signs decreased after 90 days. Median IgG titer at diagnosis was 1:32 and was significantly decreased, compared with baseline titer, at all recheck intervals after 90 days. Hyperglobulinemia, monocytosis, and neutrophilia were the most common clinicopathologic abnormalities. Hyperglobulinemia resolved within 30 days, neutrophilia resolved within 90 days, and monocytosis resolved after 180 days.

CLINICAL RELEVANCE

Improvements in clinical signs, titers, and clinicopathologic abnormalities were observed after initiation of treatment with fluconazole. Improvement began as early as the first 3 months of treatment, but some variables did not resolve until after 6 to 9 months of treatment. This information provides clinical guidance and describes expectations when prescribing fluconazole to treat coccidioidomycosis in dogs.

Contributor Notes

Corresponding author: Dr. Carter (tcarte@midwestern.edu)