Canine sinonasal mycosis
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This study reviews treatment outcome of five commonly used topical treatment techniques of dogs with Sinonasal Mycosis (SNM). Influence of different variables on treatment failure will be examined. Variables considered are: age, gender, ipsilateral versus bilateral affection, affection of the frontal sinus, severity of the infection and enlargement of the mandibular lymph node. Furthermore, a prospective case control study was done on 4 new patients with SNM in order to determine specific changes in blood values, signs of underlying disease and specific properties of the fungus itself. Study design: Retrospective (n = 51) and prospective study (n=4). Methods: Retrospective study: Medical reports of 51 dogs treated for sinonasal mycosis were obtained via research of the clinical database of the Faculty of Veterinary Science, Medicine of Companion Animals at Utrecht University for the time period March 2005 to March 2013. First treatment outcome and influence of variables described above were evaluated. Prospective case control study: Clinical examination, blood analyses, CT, rhinoscopy and biopsies were performed at 4 new patients with SNM at Department of Clinical Sience of Companion Animals, Faculty of Veterinary Medicine, Utrecht University. Mycotic plaques were collected, pH was measured, samples were cultured and DNA was isolated and typed. Determination of a resistance profile was started. Results: Retrospective study: When all topical treatment options were combined together, treatment success was 52.9% after first treatment and 78.4% after two treatments. No statistical difference was found in treatment outcome (recurrence of infection) over the entire follow-up between the different treatment groups 1-5. Treatment failure was not associated with age, gender, SNM in the frontal sinus, ipsilateral versus bilateral SNM infection, severity of the infection or enlargement of the mandibular lymph node. Significant proof that recurrence of SNM will not occur within 6 weeks after being treated with treatment option 4 (p= 0.049) was found. Recurrence rates of a combined group consisting of treatment 2 and 5 (to enlarge the sample size) showed a significant (p= 0.039) reduction in recurrence rate within 6 weeks when compared with other treatments. Relative risks and odds ratios calculated in this study to compare treatment outcomes and influence of different variables are not reliable. This indicates that the results are unreliable. Prospective case control study: Mycotic plaques collected in 4 patients were all typed as Aspergillus fumigatus. The pH of fresh collected fungus was between 7.9 and 8.2. Histological evaluation of biopsies shows that the fungus grows only superficially on the mucosa. The lamina propria was not infiltrated. Determination of a resistance profile was not completed while writing this report. Three patients were treated with treatment option 3 and one patient was treated with treatment option 5. One patient was euthanized because of clinical deterioration. Recurrence of clinical signs of SNM was seen in two dogs (patient 3 and 4, 50% of total). However, recurrence of SNM in patient 4 was not proven after he was euthanized. Slight hypo-hypoalbuminemia was seen in three out of four patients.