Results of rhinoscopy alone or in conjunction with sinuscopy in dogs with aspergillosis: 46 cases (2001–2004)

Lynelle R. Johnson Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA 95616.
Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616.

Search for other papers by Lynelle R. Johnson in
Current site
Google Scholar
PubMed
Close
 DVM, PhD, DACVIM
,
Tracy L. Drazenovich Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA 95616.

Search for other papers by Tracy L. Drazenovich in
Current site
Google Scholar
PubMed
Close
 DVM
,
Melissa A. Herrera Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616.

Search for other papers by Melissa A. Herrera in
Current site
Google Scholar
PubMed
Close
 DVM
, and
Erik R. Wisner Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA 95616.
Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616.

Search for other papers by Erik R. Wisner in
Current site
Google Scholar
PubMed
Close
 DVM, DACVR

Abstract

Objective—To determine results of diagnostic testing, including detection of nasal or frontal sinus fungal plaques, in dogs with nasal aspergillosis.

Design—Retrospective case series.

Animals—46 dogs with nasal aspergillosis.

Procedures—Medical records were reviewed for information on computed tomographic findings; rhinoscopic findings, including whether fungal plaques were seen in the nasal cavity; results of frontal sinus trephination and sinuscopy, including whether fungal plaques were seen in the frontal sinus; and results of histologic examination of biopsy specimens.

Results—In 38 (83%) dogs, fungal plaques were seen in the nasal cavity during rhinoscopy, whereas in the remaining 8 (17%), fungal plaques were not seen in the nasal cavity but were seen in the frontal sinus. Duration of clinical signs, proportions of dogs in which the referring veterinarian had performed a nasal examination prior to referral, proportions of dogs with computed tomographic evidence of nasal cavity cavitation or sinus involvement, and proportions of dogs with rhinoscopic evidence of destructive rhinitis were not significantly different between dogs with nasal fungal plaques and dogs with fungal plaques only in the frontal sinus.

Conclusions and Clinical Relevance—Results confirm that frontal sinus involvement is common in dogs with nasal aspergillosis and suggest that frontal sinus trephination and sinuscopy may aid in the diagnosis of aspergillosis in dogs, particularly dogs with rhinoscopic evidence of destructive rhinitis and computed tomographic evidence of sinus involvement that lack detectable fungal plaques in the nasal cavity.

Abstract

Objective—To determine results of diagnostic testing, including detection of nasal or frontal sinus fungal plaques, in dogs with nasal aspergillosis.

Design—Retrospective case series.

Animals—46 dogs with nasal aspergillosis.

Procedures—Medical records were reviewed for information on computed tomographic findings; rhinoscopic findings, including whether fungal plaques were seen in the nasal cavity; results of frontal sinus trephination and sinuscopy, including whether fungal plaques were seen in the frontal sinus; and results of histologic examination of biopsy specimens.

Results—In 38 (83%) dogs, fungal plaques were seen in the nasal cavity during rhinoscopy, whereas in the remaining 8 (17%), fungal plaques were not seen in the nasal cavity but were seen in the frontal sinus. Duration of clinical signs, proportions of dogs in which the referring veterinarian had performed a nasal examination prior to referral, proportions of dogs with computed tomographic evidence of nasal cavity cavitation or sinus involvement, and proportions of dogs with rhinoscopic evidence of destructive rhinitis were not significantly different between dogs with nasal fungal plaques and dogs with fungal plaques only in the frontal sinus.

Conclusions and Clinical Relevance—Results confirm that frontal sinus involvement is common in dogs with nasal aspergillosis and suggest that frontal sinus trephination and sinuscopy may aid in the diagnosis of aspergillosis in dogs, particularly dogs with rhinoscopic evidence of destructive rhinitis and computed tomographic evidence of sinus involvement that lack detectable fungal plaques in the nasal cavity.

Nasal aspergillosis can result from implantation of the fungus in association with a nasal foreign body or can occur in dogs with preexisting nasal disease or defects of local immunity.1 Nasal infection with Aspergillus spp in immunocompetent dogs presumably results from inhalation of a large number of fungal spores, which overwhelm local defense mechanisms,2,3 causing locally extensive disease. In affected dogs, infection often progresses throughout the nasal cavity and can extend into the frontal sinuses, as is the case for humans with chronic invasive aspergillosis or noninvasive destructive aspergillosis.4

Various combinations of diagnostic tests, such as radiography, computed tomography, rhinoscopy, histologic examination of nasal tissues, fungal culture, and fungal serology, are used clinically to confirm the diagnosis of nasal aspergillosis.5–11 Because of the time delay in obtaining results of histologic examination and the need for dogs to be anesthetized when instilling topical antifungal medications, dogs are often treated before results of histologic examination of nasal biopsy specimens are obtained. Thus, detection of fungal plaques or granulomas is often critical for therapeutic decision-making.

Clinically, we have identified some dogs with nasal aspergillosis in which fungal plaques were not seen during rhinoscopy but were subsequently identified in the frontal sinus. In this population of dogs, frontal sinus trephination and sinuscopy resulted in valuable diagnostic information and allowed treatment with topical antifungal medication to be instituted at the time of initial diagnostic testing. The purpose of the study reported here was to determine results of diagnostic testing, including detection of nasal and frontal sinus plaques, in dogs with nasal aspergillosis.

Criteria for Selection of Cases

Medical records of dogs examined at the University of California Veterinary Medical Teaching Hospital between January 2001 and December 2004 in which a diagnosis of nasal aspergillosis had been made were included in the study. A diagnosis of nasal aspergillosis was made if results of at least 2 of 3 diagnostic tests (ie, computed tomography, rhinoscopy, and histologic examination of nasal biopsy specimens) were consistent with the diagnosis. Cases were excluded from the study if a nasal foreign body was found in conjunction with identification of nasal aspergillosis.

Procedures

Information obtained from medical records included in the study consisted of signalment; duration of clinical signs; treatments administered by the referring veterinarian; and results of computed tomography, rhinoscopy, sinuscopy, serologic testing for Aspergillus antibodies, fungal culture, and histologic examination of nasal biopsy specimens.

During the period of the study, all dogs suspected to have nasal aspergillosis underwent nasal computed tomography, whereas nasal radiography, although reported to be useful in the diagnosis of aspergillosis,12 was not typically performed. Dogs were anesthetized for computed tomography. Various agents were used for induction of anesthesia, but isoflurane was typically used for anesthetic maintenance.

Computed tomographic images were acquired with dogs in sternal recumbency with a helical scanner.a Examinations consisted of acquisition of contiguous, transverse, 5- or 7-mm-thick helical or incremental images; an edge-enhancing reconstruction algorithm was used for image acquisition. All studies were acquired at 150 mAs and 120 kVp. In some instances, additional high-resolution, thinly collimated images were obtained from regions of interest; these consisted of contiguous, 1- to 3-mm-thick collimated images.

For purposes of the present study, computed tomographic images were reviewed in an unmasked fashion by a board-certified radiologist (ERW) for imaging features characteristic of nasal aspergillosis.10,12,13 Computed tomographic changes considered supportive of a diagnosis of nasal aspergillosis included cavitating turbinate lysis, nasal soft tissue opacity, reactive bone remodeling or osteolysis, and the presence of a mixed opacity in the frontal sinus or nasal cavity suggestive of a fungal granuloma.10,12,13 Individual features (ie, turbinate destruction, cavitation of the nasal cavity secondary to turbinate destruction, soft tissue or fluid opacity, sinus involvement, bone destruction, bone remodeling, and cribriform involvement) were scored as present or absent and, if present, as unilateral or bilateral. An overall assessment of unilateral or bilateral involvement was then made. In addition, an ordinal score was assigned to convey the level of certainty that the combination of imaging features represented nasal aspergillosis (1 = definitely not, 2 = unlikely, 3 = equivocal, 4 = likely, and 5 = definitely).

Rhinoscopy was also performed in all dogs suspected to have nasal aspergillosis during the study period. Dogs were anesthetized, and a 5.0-mm flexible endoscopeb was used to examine the nasopharynx. A 2.8-mm rigid endoscopec with a 0° or 30° viewing angle was then used to examine the nasal cavity. Abnormalities recorded during rhinoscopic examination included turbinate destruction and identification of fungal plaques. All rhinoscopy procedures were performed, attended, or reviewed by one of the authors (LRJ).

During rhinoscopy, nasal biopsy specimens were obtained from 1 or both sides of the nasal cavity with 2- or 3-mm cup biopsy instrumentsd and submitted for histologic examination and fungal culture. For the present study, it was not possible to determine whether individual biopsy specimens consisted of fungal plaques or nasal mucosa. Specimens submitted for histologic examination were immersion-fixed in neutralbuffered 10% formalin, routinely processed, embedded in paraffin, and sectioned at a thickness of 4 μm. Sections of all specimens were stained with H&E. In addition, sections from selected specimens were stained at the pathologist's discretion with trichrome, periodic acid Schiff, Grocott methenamine silver, or Brown and Brennan stain. Specimens collected for fungal culture were submitted to the University of California Microbiology Service, where they were plated on mold inhibitory agar. Fungal growth that was obtained was speciated.

Beginning in May 2002, sinus trephination and sinuscopy were performed in some cases at the discretion of the attending clinician, and sinus material was submitted for histologic examination and fungal culture. For trephination, a 3 × 3-cm area dorsal to the eye was clipped and surgically prepared. A small skin and subcutaneous incision was made halfway between the dorsal midline and the zygomatic process of the frontal bone. Sinus trephination was then performed with a Jacob chuck and 4/32-inch intramedullary pin. A rigid endoscopec with a 0° viewing angle was used to examine the lateral compartment of the frontal sinus. No attempt was made to enter additional compartments of the sinus. Fungal material was obtained with an endoscopic biopsy instrument or bone curette. The skin incision was allowed to heal by second intention. Following rhinoscopy, with or without sinuscopy, methadone (0.2 to 0.5 mg/kg [0.09 to 0.23 mg/lb], IM) or morphine (0.3 to 0.5 mg/kg [0.14 to 0.23 mg/lb], IM) was administered for pain control.

Statistical analysis—A Student t test was used to compare mean age of dogs with visible fungal plaques in the nasal cavity with mean age of dogs without nasal fungal plaques but with fungal plaques in the frontal sinus. A Mann-Whitney U test was used to compare duration of clinical signs between groups, and a χ2 test was used to compare number of dogs in which the nasal cavity had been evaluated prior to referral, results of serologic testing, number of dogs in which fungal organisms were seen histologically, and results of fungal culture between groups. For all analyses, standard softwaree was used. Values of P < 0.05 were considered significant.

Results

The review of the medical records identified 55 cases in which a diagnosis of nasal aspergillosis had been made. In 9 of these cases, however, nasal foreign bodies were identified in conjunction with identification of nasal aspergillosis, and these cases were excluded from the study. The remaining 46 cases were included in the study.

In 38 of the 46 (83%) dogs included in the study, fungal plaques were seen in the nasal cavity during rhinoscopy. In the remaining 8 (17%), fungal plaques were not seen in the nasal cavity, but were seen in the frontal sinus during sinuscopy. Dogs in which fungal plaques were seen in the nasal cavity consisted of 12 spayed females, 4 sexually intact males, and 22 castrated males. Dogs in which fungal plaques were seen only in the frontal sinus consisted of 3 spayed females and 5 castrated males. Mean age of dogs with fungal plaques in the nasal cavity (mean ± SD, 5 ± 3.7 years) was not significantly (P = 0.61) different from mean age of dogs with fungal plaques only in the frontal sinus (6.4 ± 3.3 years).

For all dogs, body weight ranged from 10 to 58 kg (22 to 128 lb; median, 33 kg [73 lb]) and duration of clinical signs ranged from 1 to 19 months (median, 3 months). Duration of clinical signs in dogs with fungal plaques in the nasal cavity (mean ± SD, 4.7 ± 4.1 months; median, 3 months; range, 1 to 19 months) was not significantly (P = 0.10) different from duration for dogs with fungal plaques only in the frontal sinus (7.5 ± 4.7 months; median, 6.5 months; range, 2 to 14 months).

Five of the 38 dogs with fungal plaques in the nasal cavity had been treated by the referring veterinarian prior to referral to the teaching hospital; treatment consisted of oral administration of ketoconazole in 3, IV administration of amphotericin in 1, and intranasal administration of clotrimazole in 1. One of the 8 dogs with fungal plaques only in the frontal sinus had been treated by the referring veterinarian prior to referral (oral administration of itraconazole). Thirty of the 46 dogs had undergone a nasal examination by the referring veterinarian with an otoscope or a rhinoscope, and 2 dogs had undergone surgical exploration prior to referral. Nasal biopsy specimens had been collected from 20 of 46 dogs. The proportion of dogs in which a nasal examination had been performed prior to referral was not significantly (P = 0.52) different between dogs with fungal plaques in the nasal cavity (24/38) and dogs with fungal plaques only in the frontal sinus (6/8).

Serologic testing for antifungal (Aspergillus) antibodies was performed by means of agar gel immunodiffusion in 13 dogs. Seropositivity rate was not significantly (P = 0.93) different between dogs with fungal plaques in the nasal cavity (5/8) and dogs with fungal plaques only in the frontal sinus (3/5).

Results of computed tomographic imaging were available for all 46 dogs. Unilateral turbinate destruction was seen in 39 of the 46 (85%) dogs, with the remaining 7 (15%) having bilateral turbinate destruction. Unilateral cavitation of the nasal cavity secondary to severe turbinate destruction (Figure 1) was present in 38 dogs (83%) and bilateral cavitation was present in 6 (13%); in the remaining 2 dogs (4%), cavitation was not seen. A unilateral nasal soft tissue or fluid opacity was present in 33 dogs (72%), and bilateral opacities were present in 10 (22%); in the remaining 3 dogs (6%), a soft tissue or fluid opacity was not seen. Unilateral sinus involvement was identified in 29 dogs (63%), and bilateral involvement was identified in 4 (9%); in the remaining 13 dogs (28%), the sinuses did not appear to be involved. Bone destruction was evident in 22 (48%) and was unilateral in all 22; bone destruction was not seen in the remaining 24 (52%) dogs. Unilateral bone remodeling was seen in 31 dogs (67%), and bilateral bone remodeling was seen in 1 (2%); the remaining 14 dogs (30%) did not have evidence of bone remodeling. Pinpoint destruction of the cribriform plate was evident in 9 dogs (20%). Overall, the disease process was classified as unilateral in 39 (85%) dogs and bilateral in 7 (15%). Computed tomographic findings were considered likely representative of nasal aspergillosis in 9 (20%) dogs and definitely representative of nasal aspergillosis in 34 (74%). In the remaining 3 dogs (6%), computed tomographic findings were considered equivocal for nasal aspergillosis. However, in all 3 of these dogs, fungal plaques were seen in the nasal cavity, and hyphae were observed in biopsy specimens from 1 of 2 dogs.

Figure 1—
Figure 1—

Computed tomographic images of the nasal cavity (A) and frontal sinuses (B) of a dog with unilateral (left-sided) nasal aspergillosis. Notice that in the left side of the nasal cavity, destruction and atrophy of the turbinates have resulted in cavitation of that side of the nasal cavity. A mixed soft tissue and gas density is irregularly adhered to the interior of the left frontal sinus and may represent a fungal plaque in the frontal sinus.

Citation: Journal of the American Veterinary Medical Association 228, 5; 10.2460/javma.228.5.738

Rhinoscopy revealed destructive rhinitis in 34 of 46 dogs (74%), including 6 of the 8 dogs with fungal plaques only in the frontal sinus. The extent or severity of disease could not be determined from the medical records, although all dogs with rhinoscopically evident destructive rhinitis also had computed tomographic evidence of cavitation of the nasal cavity. Sinus involvement was evident on computed tomographic images from all 8 dogs with fungal plaques only in the frontal sinus, and computed tomographic findings were considered likely representative of nasal aspergillosis in 3 of the 8 dogs and definitely representative of nasal aspergillosis in the other 5.

Frontal sinus trephination and sinuscopy were performed in all 8 dogs with fungal plaques only in the frontal sinus, and plaques were seen in all 8 (Figure 2). Twenty-eight dogs with fungal plaques in the nasal cavity had computed tomographic evidence of sinus involvement. Frontal sinus trephination and sinuscopy were performed in 11 of these 28 dogs, and fungal plaques were identified in 8 of the 11. In the 3 remaining dogs, no specific comments were available regarding the presence of fungal plaques, although during follow-up treatment consisting of topical application of antifungal medication, plaques were identified after trephination and sinuscopy in 2 of the 3 dogs.

Figure 2—
Figure 2—

Sinuscopic view of a fungal plaque in the frontal sinus of a dog with aspergillosis.

Citation: Journal of the American Veterinary Medical Association 228, 5; 10.2460/javma.228.5.738

Nasal biopsy specimens from 41 dogs were submitted for histologic examination, and fungal hyphae were seen in specimens from 17 of the 41 (41%). In all cases, hyphae were visible in sections stained with H&E. Fungal hyphae were detected histologically in nasal biopsy specimens from 16 of 34 (47%) dogs with fungal plaques in the nasal cavity and 1 of 7 (14%) dogs with fungal plaques only in the frontal sinus. These proportions were not significantly (P = 0.07) different. Sinus biopsy specimens from 2 dogs with fungal plaques in the nasal cavity and 1 dog with fungal plaques only in the frontal sinus were submitted for histologic examination, and fungal hyphae were seen in specimens from all 3 dogs. All hyphae were considered consistent with Aspergillus spp.

Results of fungal culture of nasal specimens were positive for Aspergillus spp in 7 of 18 (39%) dogs with fungal plaques in the nasal cavity and 2 of 5 (40%) dogs with fungal plaques only in the frontal sinus; these proportions were not significantly (P = 0.96) different. Aspergillus organisms were cultured from sinus specimens obtained from 1 of 2 dogs with fungal plaques in the nasal cavity and 2 of 5 dogs with fungal plaques only in the frontal sinus.

Discussion

Findings of the present study confirm that sinus involvement is relatively common in dogs with nasal aspergillosis. Sinus involvement was evident on computed tomographic images from 26 of 38 dogs with fungal plaques in the nasal cavity, and fungal plaques were seen in the frontal sinus in 8 of 11 dogs with nasal fungal plaques that underwent sinus trephination and sinuscopy. Overall, plaques were definitively identified in the frontal sinus in 16 of 19 dogs that underwent sinuscopy, suggesting that the term sinonasal aspergillosis9 or fungal rhinosinusitis might be more appropriate for this condition than nasal aspergillosis.

To the authors' knowledge, this is the first study examining the value of sinus trephination and sinuscopy in supporting the diagnosis of nasal aspergillosis. In the present study, computed tomographic findings were considered likely representative of nasal aspergillosis in 3 of the 8 dogs with fungal plaques only in the frontal sinus and definitely representative of nasal aspergillosis in the other 5. All 8 of these dogs had computed tomographic evidence of turbinate destruction, nasal cavity cavitation, and sinus involvement, and 6 had evidence of bony destruction or remodeling. Sinus aspergillosis was confirmed in all 8 of these dogs by means of direct visualization of fungal plaques in the frontal sinus. Although the diagnosis was supported by other test results in 3 dogs (positive serologic test results in 2 dogs with negative fungal culture results and positive serologic test and fungal culture results in 1 dog), these tests are not considered highly sensitive or specific in the diagnosis of aspergillosis.8,9,14 Rhinoscopy confirmed destructive rhinitis in 6 of 8 of these dogs; however, all lacked endoscopically detectable fungal plaques in the nasal cavity, and only 1 had fungal hyphae visible histologically in nasal biopsy specimens.

In 1 dog in the present study, a flexible endoscope could be guided into the sinus through the rostral portion of the nasal cavity. Previous reports9,11 describe examination of the nasal cavity and frontal sinus by means of rigid rhinoscopy in dogs with aspergillosis; however, these reports do not indicate the number of dogs with frontal sinus disease that could be examined in this fashion. The opening to the sinus is visible via the nasal cavity only in dogs with severe destructive rhinitis,9 and manipulation of a rigid endoscope within the nasal cavity is limited, making it difficult to examine this region.

Histologic identification of fungal hyphae in biopsy specimens has traditionally been used to confirm the diagnosis of aspergillosis.6–8 However, a recent investigation11 suggested that nasal aspergillosis in dogs is not associated with mucosal invasion. Thus, histologic evidence of disease may not be obtained in all cases, and detection of plaques, along with histologic examination of plaque material, is of critical importance in confirming the diagnosis. Interestingly, although plaques were not seen in the nasal cavity in any of these dogs, fungal hyphae were seen histologically in nasal biopsy specimens from 1 of 7 dogs with fungal plaques only in the frontal sinus.

Previous studies have suggested that results of fungal culture are typically (ie, up to 90% of the time) positive in dogs8 and humans4 with nasal aspergillosis. However, false-positive culture results have been reported in dogs with neoplasia.14 Thus, fungal culture is not always reliable in confirming the diagnosis. Two of 5 dogs in the present study with fungal plaques only in the frontal sinus had Aspergillus spp identified on culture of nasal biopsy specimens. These results, in conjunction with the finding of hyphae in nasal biopsy specimens from dogs with plaques only in the frontal sinus, suggest that infection was not isolated to the frontal sinus in these dogs, despite the lack of visual evidence of plaques in the nasal cavity. Infection might have spread from the nasal cavity into the frontal sinus, or the fungus could have been partially cleared by local defense mechanisms in the nasal cavity but not in the sinus.

Thirty of the 46 dogs (65%) in the present study had undergone nasal examination prior to referral, although specific details on the methods used were not always available from the medical records. It is possible that prior manipulation of the nasal cavity resulted in an inability to detect fungal plaques in the nasal cavity of some dogs or caused inoculation of the sinus with fungal plaques from the nasal cavity. However, the proportion of dogs in which a nasal examination had been performed prior to referral was not significantly different between dogs with fungal plaques in the nasal cavity (24/38) and dogs with fungal plaques only in the frontal sinus (6/8). Also, fungal plaques typically adhere tightly to the epithelium and require substantial debridement to become dislodged from the nasal cavity.8,9 Therefore, it is unlikely that hydrostatic flushing or biopsy of the nasal cavity resulted in the inability to detect plaques in the nasal cavity in some dogs in the present study.

Access to the frontal sinus is sometimes possible via endoscopy when substantial destruction of nasal turbinates results in widening of the nasofrontal duct. A rigid endoscope with a 30° viewing angle can allow examination of the sinus, or a flexible endoscope can be guided into the sinus. However, sinus trephination followed by sinuscopy allows more complete examination of the affected area and, in our experience, provides for more effective debridement of fungal plaques. It also permits placement of catheters directly in the frontal sinus for topical application of antifungal treatment,8,9 although a study15 of dye distribution in cadaver skulls indicated that frontal sinus distribution was satisfactory with nasal application alone. Potential complications of sinus trephination include SC emphysema, infection, and penetration of the calvarium, but no complications were seen in dogs in the present study.

In the present study, fungal hyphae were seen in all 3 frontal sinus biopsy specimens but in only 17 of 41 (41%) of the nasal biopsy specimens. This discrepancy might result from the method used to extract material from the sinus for histologic examination. In the sinus, a much smaller region is available for sampling, and this could increase the diagnostic yield of such samples. Owing to the retrospective nature of the present study, it could not be determined whether nasal biopsy specimens included plaques or were solely epithelial. Although histologic evidence of aspergillosis is often used as a diagnostic criterion,8 given the superficial nature of fungal hyphae in dogs with nasal aspergillosis,11 detection of fungal hyphae in the nasal cavity should not always be expected.

A previous report12 indicated that computed tomographic imaging has high sensitivity and specificity for the diagnosis of aspergillosis when interpreted by a qualified radiologist, and our data confirm this. Although recent publications9,13 have reported that bilateral evidence of disease was common in dogs with nasal aspergillosis, dogs included in the present study primarily had unilateral disease. This might reflect an earlier phase of disease in dogs examined in the present study or less aggressive fungal organisms.

Our data suggest that trephination of the frontal sinus and sinuscopy for identification of fungal plaques aid in the diagnosis of nasal aspergillus in dogs. Sinuscopy was particularly useful in dogs with computed tomographic findings suggestive of aspergillosis and rhinoscopic evidence of destructive rhinitis, in which fungal plaques were not detected during rhinoscopy. Subjectively, trephination also allowed better debridement of infected material in the frontal sinus prior to topical treatment. Further study is required to establish the role of trephination and sinuscopy in regard to response to treatment.

a.

General Electric Medical Instruments, Milwaukee, Wis.

b.

Olympus America, Melville, NY.

c.

Endoscopy Support Services, Brewster, NY.

d.

Sontec Instruments, Englewood, Colo.

e.

Graph Pad Prism, San Diego, Calif.

References

  • 1

    Sharp NJH. Aspergillosis and penicilliosis. In: Greene CE, ed. Infectious diseases of the dog and cat. Philadelphia: WB Saunders Co, 1998; 404413.

    • Search Google Scholar
    • Export Citation
  • 2

    Stanzani M, Orciuolo E, Lewis R, et al. Aspergillus fumigatus suppresses the human cellular immune response via gliotoxin-mediated apoptosis of monocytes. Blood 2005; 105: 22582265.

    • Search Google Scholar
    • Export Citation
  • 3

    Youngchim S, Morris-Jones R, Hay RJ, et al. Production of melanin by Aspergillus fumigatus. J Med Microbiol 2004; 53: 175181.

  • 4

    Panda NK, Balaji P, Chakrabarti A, et al. Paranasal sinus aspergillosis: its categorization to develop a treatment protocol. Mycoses 2004; 47: 277283.

    • Search Google Scholar
    • Export Citation
  • 5

    Harvey CE. Nasal aspergillosis and penicilliosis in dogs: results of treatment with thiabendazole. J Am Vet Med Assoc 1984; 184: 4850.

    • Search Google Scholar
    • Export Citation
  • 6

    Sharp NJH, Harvey CE, O'Brien JA. Treatment of canine nasal aspergillosis/penicilliosis with fluconazole (UK-49,858). J Small Anim Pract 1991; 32: 513516.

    • Search Google Scholar
    • Export Citation
  • 7

    Mathews KG, Koblik PD, Richardson EF, et al. Computed tomographic assessment of noninvasive intranasal infusions in dogs with fungal rhinitis. Vet Surg 1996; 25: 309319.

    • Search Google Scholar
    • Export Citation
  • 8

    Mathews KG, Davidson AP, Koblik PD, et al. Comparison of topical administration of clotrimazole through surgically placed versus nonsurgically placed catheters for treatment of nasal aspergillosis in dogs: 60 cases (1990–1996). J Am Vet Med Assoc 1998; 213: 501506.

    • Search Google Scholar
    • Export Citation
  • 9

    Zonderland JL, Stork CK, Saunders JH, et al. Intranasal infusion of enilconazole for treatment of sinonasal aspergillosis in dogs. J Am Vet Med Assoc 2002; 221: 14211425.

    • Search Google Scholar
    • Export Citation
  • 10

    Saunders JH, Clercx C, Snaps FR, et al. Radiographic, magnetic resonance imaging, computed tomographic, and rhinoscopic features of nasal aspergillosis in dogs. J Am Vet Med Assoc 2004; 225: 17031712.

    • Search Google Scholar
    • Export Citation
  • 11

    Peeters D, Day MJ, Clercx C. An immunohistochemical study of canine nasal aspergillosis. J Comp Pathol 2005; 132: 283288.

  • 12

    Saunders JH, van Bree H. Comparison of radiography and computed tomography for the diagnosis of canine nasal aspergillosis. Vet Radiol Ultrasound 2003; 44: 414419.

    • Search Google Scholar
    • Export Citation
  • 13

    Saunders JH, Zonderland LJ, Clercx C, et al. Computed tomographic findings in 35 dogs with nasal aspergillosis. Vet Radiol Ultrasound 2002; 43: 59.

    • Search Google Scholar
    • Export Citation
  • 14

    Harvey CE, O'Brien JA. Nasal aspergillosis-penicilliosis. In: Kirk RW, ed. Current veterinary therapy VIII. Philadelphia: WB Saunders Co, 1983; 236240.

    • Search Google Scholar
    • Export Citation
  • 15

    Richardson EF, Mathews KG. Distribution of topical agents in the frontal sinuses and nasal cavity of dogs: comparison between current protocols for treatment of nasal aspergillosis and a new noninvasive technique. Vet Surg 1995; 24: 476483.

    • Search Google Scholar
    • Export Citation
  • Figure 1—

    Computed tomographic images of the nasal cavity (A) and frontal sinuses (B) of a dog with unilateral (left-sided) nasal aspergillosis. Notice that in the left side of the nasal cavity, destruction and atrophy of the turbinates have resulted in cavitation of that side of the nasal cavity. A mixed soft tissue and gas density is irregularly adhered to the interior of the left frontal sinus and may represent a fungal plaque in the frontal sinus.

  • Figure 2—

    Sinuscopic view of a fungal plaque in the frontal sinus of a dog with aspergillosis.

  • 1

    Sharp NJH. Aspergillosis and penicilliosis. In: Greene CE, ed. Infectious diseases of the dog and cat. Philadelphia: WB Saunders Co, 1998; 404413.

    • Search Google Scholar
    • Export Citation
  • 2

    Stanzani M, Orciuolo E, Lewis R, et al. Aspergillus fumigatus suppresses the human cellular immune response via gliotoxin-mediated apoptosis of monocytes. Blood 2005; 105: 22582265.

    • Search Google Scholar
    • Export Citation
  • 3

    Youngchim S, Morris-Jones R, Hay RJ, et al. Production of melanin by Aspergillus fumigatus. J Med Microbiol 2004; 53: 175181.

  • 4

    Panda NK, Balaji P, Chakrabarti A, et al. Paranasal sinus aspergillosis: its categorization to develop a treatment protocol. Mycoses 2004; 47: 277283.

    • Search Google Scholar
    • Export Citation
  • 5

    Harvey CE. Nasal aspergillosis and penicilliosis in dogs: results of treatment with thiabendazole. J Am Vet Med Assoc 1984; 184: 4850.

    • Search Google Scholar
    • Export Citation
  • 6

    Sharp NJH, Harvey CE, O'Brien JA. Treatment of canine nasal aspergillosis/penicilliosis with fluconazole (UK-49,858). J Small Anim Pract 1991; 32: 513516.

    • Search Google Scholar
    • Export Citation
  • 7

    Mathews KG, Koblik PD, Richardson EF, et al. Computed tomographic assessment of noninvasive intranasal infusions in dogs with fungal rhinitis. Vet Surg 1996; 25: 309319.

    • Search Google Scholar
    • Export Citation
  • 8

    Mathews KG, Davidson AP, Koblik PD, et al. Comparison of topical administration of clotrimazole through surgically placed versus nonsurgically placed catheters for treatment of nasal aspergillosis in dogs: 60 cases (1990–1996). J Am Vet Med Assoc 1998; 213: 501506.

    • Search Google Scholar
    • Export Citation
  • 9

    Zonderland JL, Stork CK, Saunders JH, et al. Intranasal infusion of enilconazole for treatment of sinonasal aspergillosis in dogs. J Am Vet Med Assoc 2002; 221: 14211425.

    • Search Google Scholar
    • Export Citation
  • 10

    Saunders JH, Clercx C, Snaps FR, et al. Radiographic, magnetic resonance imaging, computed tomographic, and rhinoscopic features of nasal aspergillosis in dogs. J Am Vet Med Assoc 2004; 225: 17031712.

    • Search Google Scholar
    • Export Citation
  • 11

    Peeters D, Day MJ, Clercx C. An immunohistochemical study of canine nasal aspergillosis. J Comp Pathol 2005; 132: 283288.

  • 12

    Saunders JH, van Bree H. Comparison of radiography and computed tomography for the diagnosis of canine nasal aspergillosis. Vet Radiol Ultrasound 2003; 44: 414419.

    • Search Google Scholar
    • Export Citation
  • 13

    Saunders JH, Zonderland LJ, Clercx C, et al. Computed tomographic findings in 35 dogs with nasal aspergillosis. Vet Radiol Ultrasound 2002; 43: 59.

    • Search Google Scholar
    • Export Citation
  • 14

    Harvey CE, O'Brien JA. Nasal aspergillosis-penicilliosis. In: Kirk RW, ed. Current veterinary therapy VIII. Philadelphia: WB Saunders Co, 1983; 236240.

    • Search Google Scholar
    • Export Citation
  • 15

    Richardson EF, Mathews KG. Distribution of topical agents in the frontal sinuses and nasal cavity of dogs: comparison between current protocols for treatment of nasal aspergillosis and a new noninvasive technique. Vet Surg 1995; 24: 476483.

    • Search Google Scholar
    • Export Citation

Advertisement