Sinonasal Aspergillosis - It Does Exist in Nebraska!
Christopher G. Byers, DVM, DACVECC, DACVIM (SAIM)
1. Performing frontal sinus trephination in a dog with sinonasal aspergillosis
2. Performing frontal sinus curettage in a dog with sinonasal aspergillosis
Aspergillus fumigatus is a saprophytic fungus that affects dogs in many geographic locations throughout the United States, including Nebraska. Sinonasal aspergillosis typically occurs in dolichocephalic breeds, affecting both nasal passages and paranasal sinuses. Infection routinely causes atrophic rhinitis and subsequent mucopurulent-to-hemorrhagic nasal discharge. Infection commonly manifests initially as unilateral disease, but without proper identification and treatment, bilateral disease frequently occurs. Dogs with nasal aspergillosis frequently have depigmentation of the nares, pain on palpation of the nasal cavity and may be systemically ill with varying degrees of lethargy, and weight loss.
Diagnosis of sinonasal aspergillus is made based on a combination of clinical signs, evidence of turbinate lysis, culture and/or histopathology from fungal colonies or effected turbinates visualized on rhinoscopy. Nasal computed tomography (CT) and rigid rhinoscopy are the preferred imaging modalities, as radiography is not as sensitive.
Currently the recommended intervention of choice for nasal aspergillosis is topical infusion with either enilconazole or clotrimazole. This treatment readily results in approximately 80-90% cure rates. If the frontal sinus(es) is/are involved, trephination to perform sinus curettage, infuse clotrimazole liquid, and instill clotrimazole cream (as depot therapy) are recommended. Oral anti-fungal therapy with ketoconazole and itraconazole are also treatment options, but success rates are 50% and 60%, respectively. There are a few reports of complimentary therapy with Aurum metallicum, but further research is needed before this form of treatment can be recommended.