Retrospective study of feline and canine cryptococcosis in Australia from 1981 to 2001: 195 cases

Natural disasters and the rise of zoonotic diseases: A case of post-earthquake disseminated cryptococcosis in a dog

Cryptococcosis is a systemic zoonotic disease that is challenging to diagnose based on clinical findings in cats and dogs due to the nonspecific nature of its clinical presentation. This case report aims to document the first confirmed case of disseminated cryptococcosis caused by Cryptococcus neoformans in a dog in Turkey and to highlight the potential link between natural disasters such as earthquakes and the emergence of zoonotic diseases in domestic animals. A two-and-a-half-year-old spayed female Cocker Spaniel presented with increased respiratory sounds, skin lesions, facial swelling and enlarged lymph nodes. These symptoms appear to be a complication of Demodex infestation due to the stress experienced by the dog following exposure to a severe earthquake. Diagnostic procedures including cytologic examination, fungal culture and DNA sequence analysis, which confirmed the infection was caused by C. neoformans. Due to the delay in the correct diagnosis of the disease, which, contrary to common data, started as an allergic reaction on the skin and was later diagnosed as a Demodex infestation, the dog died of severe respiratory failure during the treatment with itraconazole. The case highlights the critical role of veterinary emergency and critical care in the diagnosis and management of zoonotic diseases post-natural disasters. It also highlights the need for increased awareness and preparedness among veterinary professionals to address animal health challenges following such events.

First case of feline cryptococcosis in Bosnia and Herzegovina

Case summary

A 2-year-old domestic longhair crossbred female cat was referred for a second opinion on a non-healing surgical wound after left eye enucleation. In addition to the left orbital lesion, ulcerative granular masses protruding from the left nostril and on the base of the left ear were noted. A diagnosis of cryptococcosis was established using histopathological examination and a latex cryptococcal antigen agglutination test. The cat was successfully treated with itraconazole.

Relevance and novel information

Cryptococcosis, commonly reported in Australia, western Canada and the western USA, is rarely reported in companion animals in Europe. This marks the first report of cryptococcosis in cats in Bosnia and Herzegovina, emphasising the need to raise awareness within the veterinary community, both local and regional, about this disease.

A case of disseminated cryptococcosis with abdominal involvement due to Cryptococcus neoformans species complex in a Ragdoll cat and false-negative cryptococcal antigen lateral flow tests due to the postzone phenomenon

Although cryptococcosis is the most common systemic fungal disease of cats, abdominal involvement is rarely reported. The pathogenesis of cryptococcosis usually involves sinonasal colonisation, followed by tissue invasion and sinonasal infection, with possible subsequent spread to the lungs and/or direct extension into the central nervous system (CNS), for example, via the cribriform plate. Further haematogenous spread can occur to any tissue, including skin and the CNS. This report describes a case of disseminated cryptococcosis due to Cryptococcus neoformans species complex in a 13-year-old cat, the fourth documented Australian feline case with abdominal involvement. The cat presented with a chronic history of upper respiratory disease that progressed to severe lethargy and anorexia. An autopsy revealed striking peritonitis with multifocal abdominal involvement affecting the liver, spleen, adrenal glands, kidneys, pancreas and mesentery. Cryptococcal organisms were also observed in organs within the thoracic cavity, sinonasal tissues and the CNS. Testing of abdominal fluid and serum for cryptococcal antigen using a commercially available lateral flow assay using neat fluid specimen initially tested false-negative. However, after dilution of the sample to 1:64, a positive result was obtained, confirming a postzone phenomenon. Taken together, the collective findings were indicative of widely disseminated cryptococcosis due to Cryptococcus neoformans with atypical involvement of the abdominal cavity.

A severe case of disseminated cryptococcosis in a young French bulldog living in South-East Queensland caused by Cryptococcus gattii VGII

BACKGROUND

Cryptococcus is one of the most common systemic mycosis worldwide, infecting young adults of the large to giant breed dogs. Infection is commonly acquired from the environment via the sinonasal cavity as the main portal of entry. It either remains there, or spreads to the central nervous system (CNS) and the eye (optic nerve and retina) by penetration of the cribriform plate, or haematogenously to other viscera. Lung involvement is uncommon in cats and dogs in contrast to human and equine patients. Whilst there is a wide genetic diversity amongst Cryptococcus neoformans and Cryptococcus gattii isolates along the West Coast and Northern parts of Australia, the molecular diversity of C. gatti is considered very low on the East Coast of Australia, with a huge preponderance of VGI cases. We report on a young small breed brachycephalic dog that presented with extreme gastrointestinal and respiratory signs, but no CNS involvement. It is the first reported case of C. gattii VGII genotype in a companion animal from Queensland.

CASE REPORT

A 9-month old female entire French Bulldog presented initially for diarrhoea. Clinical progression was accompanied by the development of respiratory signs, so the patient was referred to a 24 h care facility. Following hospitalisation, the patient became hypoxemic requiring mechanical ventilation. A bronchoalveolar lavage performed antemortem confirmed abundant Cryptococcal spp. Further culturing and genotyping identified the species as Cryptococcus gattii VGII. Post-mortem findings indicated gross gastrointestinal and mesenteric involvement, with possible dissemination to the local mesenteric lymph node and lungs.

CONCLUSION

This case describes a rare example of a Cryptococcus spp suspected of disseminating from the gastrointestinal tract to the lungs, without involvement of the CNS. The observation of this finding in a small brachycephalic breed is unusual, and the finding of genotype VGII on the East Coast of Queensland is extremely unusual as there is no prior travel history of the dog or owners. The presence of a miliary lung pattern with primary gastrointestinal disease in a small breed dog warrants adding cryptococcosis to the differential diagnosis.

Diseases associated with feline leukemia virus and feline immunodeficiency virus infection: A retrospective study of 1470 necropsied cats (2010-2020)

Feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) are retroviruses affecting cats worldwide, and the prevalence of infection varies considerably according to the geographic area. We retrospectively described FIV- and FeLV-associated diseases in a population of 1470 necropsied cats, of which 396 (26.9%) were infected with FeLV, 199 (13.5%) with FIV, and 134 (9.1%) with FeLV and FIV concomitantly. Cats infected with FeLV (OR 3.4) and co-infected with FeLV and FIV (OR 1.9) were more likely to have neoplasms. The diagnosis of lymphoma and leukemia was higher in cats infected with FeLV (OR 3.9 and 19.4, respectively) and coinfected with FeLV and FIV (OR 1.9 and 19.3, respectively). The odds of diagnosing bacterial diseases were higher in cats coinfected with FeLV and FIV (OR: 2.8), whereas the odds of viral diseases were higher in those infected with FeLV (OR: 2.8), with 2.2 times more diagnoses of feline infectious peritonitis. Neoplastic and infectious diseases in FIV-infected cats did not differ significantly from those in uninfected cats. According to our results, a high prevalence of retroviral infections was observed in southern Brazil, mainly in relation to FeLV. Infected cats were significantly younger than uninfected cats. The main causes of death associated with FeLV infection and FeLV and FIV coinfection were neoplastic and infectious diseases. In contrast, FIV infection was not associated with any specific condition.

Clinical features, outcomes, and long-term survival times of cats and dogs with central nervous system cryptococcosis in Australia: 50 cases (2000-2020)

OBJECTIVE

To describe the clinical findings and outcomes of Australian cats and dogs with CNS cryptococcosis.

ANIMALS

19 cats and 31 dogs with CNS cryptococcosis diagnosed between 2000 and 2020.

PROCEDURES

A case series and cohort study were performed using the same 50 animals. Both studies were multi-institutional and both retrospective and prospective. Disease features were compared between cats and dogs, and associations between putative risk factors and survival time (ST) were assessed.

RESULTS

Dogs were younger at initial presentation than cats and had lower latex cryptococcal antigen agglutination titers. Extraneurologic signs were common and frequently involved sinonasal and contiguous tissues. Neuroanatomic localization was predominantly forebrain, central vestibular (including cerebellum), multifocal, or diffuse. CSF analysis predominantly showed pleocytosis, with eosinophilic inflammation common in dogs. Seventy-eight percent (39/50) of patients received antifungal treatment. Median STs (from presentation) in treated patients were 1,678 days for cats and 679 days for dogs. Abnormal mentation at presentation (in dogs) and CSF collection (in cats) were associated with shorter STs. In treated dogs, those that received glucocorticoids prior to diagnosis, or single rather than multiple antifungal agents, had shorter STs.

CLINICAL RELEVANCE

The prognosis for feline and canine CNS cryptococcosis is guarded, yet long STs are possible with appropriate treatment. Presence of subtle upper respiratory tract signs may suggest cryptococcosis in patients with neurologic signs, while the absence of neurologic signs does not preclude CNS involvement.

Clinical performance of the IMMY cryptococcal antigen lateral flow assay in dogs and cats

BACKGROUND

Cryptococcal lateral flow antigen assays (CLFAs) have been assessed in comparison to the latex cryptococcal antigen agglutination test but their clinical performance is unknown.

OBJECTIVE

Determine clinical performance of IMMY CLFA (Immuno-Mycologics Inc, Oklahoma) using patients with and without cryptococcosis as the reference standard.

ANIMALS

One-hundred ninety-seven serum samples from client-owned dogs and cats.

METHODS

Review of medical records of a referral population of dogs and cats that had CLFA performed between 2012 and 2020. Animals were classified as cryptococcosis positive (Cr+) or negative (Cr-) based on clinical information. Clinical diagnosis was used to calculate positive and negative percent agreement of the CLFA.

RESULTS

Twelve specimens (4 canine, 8 feline) were obtained from Cr+ animals and had positive CLFA results. One-hundred eighty-five specimens (139 canine, 46 feline) were collected from Cr- animals. Negative CLFA results were recorded in 129 canine and 44 feline Cr- samples. Positive CLFA results were noted for 10 canine and 2 feline Cr- samples. Positive percent agreement of CLFA was 100% (confidence interval [CI], 39.8%-100% dogs; 63.1%-100% cats). Negative percent agreements were 92.8% (CI, 87.2%-96.5%) for dogs and 95.7% (CI, 85.2%-99.5%) for cats.

CONCLUSIONS AND CLINICAL IMPORTANCE

A negative IMMY CLFA result enables reliable exclusion of cryptococcal infection in dogs and cats. By contrast, a positive result must be interpreted cautiously and further testing should be performed to verify a diagnosis of cryptococcosis.

Important Mycoses of Wildlife: Emphasis on Etiology, Epidemiology, Diagnosis, and Pathology—A Review: PART 1

Simple Summary

The number of wild animals is steadily declining globally, so the early diagnosis and proper treatment of emerging diseases are vital. Fungal diseases are commonly encountered in practice and have a high zoonotic potential. This article describes aspergillosis, candidiasis, histoplasmosis, cryptococcosis, and penicilliosis, and is only the first part of a detailed review. The laboratory methods (fungal isolation, gross pathology, histopathology, histochemistry, cytology, immunohistochemistry, radiography, CT, PCR, or ELISA) used in the diagnosis and the clinical details that provide a complete view of the mycoses are presented.

Abstract

In the past few years, there has been a spurred tripling in the figures of fungal diseases leading to one of the most alarming rates of extinction ever reported in wild species. Some of these fungal diseases are capable of virulent infections and are now considered emerging diseases due to the extremely high number of cases diagnosed with fungal infections in the last few decades. Most of these mycotic diseases in wildlife are zoonotic, and with the emergence and re-emergence of viral and bacterial zoonotic diseases originating from wildlife, which are causing devastating effects on the human population, it is important to pay attention to these wildlife-borne mycotic diseases with zoonotic capabilities. Several diagnostic techniques such as fungal isolation, gross pathology, histopathology, histochemistry, cytology, immunohistochemistry, radiography, CT, and molecular methods such as PCR or ELISA have been invaluable in the diagnosis of wildlife mycoses. The most important data used in the diagnosis of these wildlife mycoses with a zoonotic potential have been re-emphasized. This will have implications for forestalling future epidemics of these potential zoonotic mycotic diseases originating from wildlife. In conclusion, this review will highlight the etiology, epidemiology, diagnosis, pathogenesis, pathogenicity, pathology, and hematological/serum biochemical findings of five important mycoses found in wild animals.

Nasopharyngeal cryptococcosis in a cat: interlaboratory variation in cryptococcal antigen assay test results

Case summary

An indoor-only 6-year-old spayed female domestic cat was evaluated for a history of stertorous respiration. Skull radiographs revealed increased soft tissue density within the caudal aspect of the left nasal cavity. CT and rhinoscopy revealed a mass lesion in the choana, plus a smaller lesion, nearly completely occluding flow through the nasal passages. Rhinoscopy was used to collect a biopsy specimen from a fleshy, tan–yellow mass visualized in the caudal nasopharynx. Histopathology was diagnostic for Cryptococcus species infection and systemic antifungal therapy with fluconazole was initiated. Following a series of discordant results, serum samples were submitted to a veterinary diagnostic laboratory that utilized a cryptococcal antigen latex agglutination system with pretreatment of serum with pronase. Twenty-three months after the initial diagnosis, the cat’s serum cryptococcal antigen titer declined to 1:5 and the cat has responded well to continuing treatment.

Relevance and novel information

This case illustrates challenges associated with discordant test results for cryptococcal antigen among laboratories. Discordancies may be due to differences in assay design, or the underlying disease state itself, or whether serum is pre-treated with pronase; with some tests relying on the training and experience of the operator if the cryptococcal antigen detection test requires a subjective interpretation. It also resolves some confusion in the literature related to the assay types available and terminology used to describe them, and emphasizes the importance of considering cryptococcosis as an important differential for cats with upper respiratory signs, without nasal discharge, even if the cat is kept exclusively indoors.

CT findings of nasal cryptococcosis in cats and dogs: A case series

Cryptococcus spp. can cause chronic rhinitis in cats and dogs. Computed tomography (CT) descriptions of imaging features of nasal cryptococcosis are limited. This retrospective single-center consecutive case series aimed to describe the CT features of lesions in cats and dogs with nasal cryptococcosis. Ten cats and 12 dogs with a diagnosis of nasal cryptococcosis confirmed with cytology, histopathology, and/or serology that had undergone a head CT from 2010 and 2020 were included. Images were evaluated by a veterinary radiologist for the presence of a nasal or nasopharyngeal mass, regional destruction, intracranial extension, and lymphadenopathy. The majority of cats (8/10 [80%]) had nasal lesions with most cases described as non-destructive rhinitis (7/8 [88%]). Three cats (3/10 [30%]) had a nasal mass. All cats had a nasopharyngeal mass, and in most cases (8/10 [80%]) the nasopharyngeal mass was centered caudally near the temporomandibular joints. None of the cats had cribriform plate lysis or meningeal enhancement. All dogs had nasal lesions. Eleven dogs (11/12 [92%]) had destructive rhinitis with lysis of nasal conchae. Most dogs (8/12; 67%) had a nasal mass, of which in seven dogs the caudal nasal mass extended into the rostral nasopharynx. Most dogs had cribriform plate lysis (9/12 [75%]), of which four dogs (44%) had mass extension into the cranium. Our findings support potential differences in CT features between dogs and cats with nasal cryptococcosis. Nasal cryptococcosis should be considered a differential diagnosis in dogs and cats with nasal and nasopharyngeal masses.

Cryptococcus neoformans VNII as the Main Cause of Cryptococcosis in Domestic Cats from Rio de Janeiro, Brazil

Cryptococcosis is a systemic fungal disease acquired from contaminated environments with propagules of the basidiomycetous yeasts of the Cryptococcus neoformans and C. gattii species complexes. The C. neoformans species complex classically comprises four major molecular types (VNI, VNII, VNIII, and VNIV), and the C. gattii species complex comprises another four (VGI, VGII, VGIII, and VGIV) and the newly identified molecular type VGV. These major molecular types differ in their epidemiological and ecological features, clinical presentations, and therapeutic outcomes. Generally, the most common isolated types are VNI, VGI, and VGII. The epidemiological profile of cryptococcosis in domestic cats is poorly studied and cats can be the sentinels for human infections. Therefore, the present study aimed to determine the molecular characterization of Cryptococcus spp. isolated from domestic cats and their dwellings in the metropolitan area of Rio de Janeiro, Brazil. A total of 36 Cryptococcus spp. strains, both clinical and environmental, from 19 cats were subtyped using multilocus sequence typing (MLST). The ploidy was identified using flow cytometry and the mating type was determined through amplification with specific pheromone primers. All strains were mating type alpha and 6/36 were diploid (all VNII). Most isolates (63.88%) were identified as VNII, a rare molecular type, leading to the consideration that this genotype is more likely related to skin lesions, since there was a high percentage (68.75%) of cats with skin lesions, which is also considered rare. Further studies regarding the molecular epidemiology of cryptococcosis in felines are still needed to clarify the reason for the large proportion of the rare molecular type VNII causing infections in cats.

Acute cerebral compression caused by an epidural hematoma associated with cryptococcosis in a dog

OBJECTIVE

To describe acute cerebral compression caused by an epidural hematoma (EDH) in a dog with cryptococcal infection.

CASE SUMMARY

An 18-month-old neutered male Neapolitan Mastiff was found comatose with no preceding clinical signs apart from a mild forelimb lameness. A CT scan of the head revealed a lesion within the right caudal nasal cavity that traversed the cribriform plate in addition to a right epidural lesion resulting in compression of the right cerebrum. Assessment of brain death was made based on the presence of coma, apnea, and absence of brain stem reflexes and included assessment of the vestibulo-ocular reflex. Postmortem identified a large EDH causing marked compression of the right frontal lobe. A nasal biopsy cultured Cryptococcus gattii.

NEW OR UNIQUE INFORMATION PROVIDED

EDH formation in a dog secondary to cryptococcosis has not been previously reported. This is also the first time a caloric vestibulo-ocular reflex assessment has been reported in a dog.

Disseminated invasive aspergillosis caused by Aspergillus felis in a cat

A 2‐year‐old male desexed Ragdoll cat with a 1‐year history of sneezing and nasal discharge presented with a large subcutaneous cervical mass, identified as the right medial retropharyngeal lymph node on computed tomography (CT). A right orbital mass, destructive sino‐nasal cavity disease and multiple pulmonary nodules were also identified. Aspergillus felis was cultured from the lymph node. After treatment with posaconazole and liposomal amphotericin B the lymph node enlargement and orbital mass resolved but left frontal sinus involvement and pulmonary lesions persisted despite additional caspofungin therapy. The cat was euthanized 14 months after diagnosis with dysphagia and chronic progressive exophthalmos. A meningeal granuloma with intravascular fungal hyphae was identified at post‐mortem and A felis was cultured from the left frontal sinus and a right retrobulbar fungal granuloma. This case demonstrates that disseminated disease is a possible sequel to invasive fungal rhinosinusitis caused by A felis in cats.

First report of a subcutaneous infection by Cryptococcus neoformans (former Cryptococcus neoformans var. grubii) in a cat in Costa Rica

This is a case report of a feline animal that presented with a skin infection on the neck from which Cryptococcus neoformans (former C. neoformans var. grubii) was isolated and identified. The cat presented two nodular tumors, approximately 2 cm in diameter, raised, solid, with a slightly irregular surface and a reddish color with white areas. Histologically, these tumors corresponded to granulomatous dermatitis and panniculitis with the presence of a large number of intralesional yeasts. From identification with biochemical and spectroscopic techniques of these lesion samples, it was determined that the etiological agent was C. neoformans. There is little information on this variety of Cryptococcus causing subcutaneous infection without involvement of other organs, and the presence of this pathogen in the few reports available has not been reliably determined. This is the first report of a cat affected by C. neoformans in Costa Rica.

Abdominal cryptococcosis in dogs and cats: 38 cases (2000-2018)

INTRODUCTION

To report the clinical presentation, laboratory and imaging findings, treatment and outcome of abdominal cryptococcosis in dogs and cats in Australia.

MATERIALS AND METHODS

Canine and feline cases from Australia were retrospectively identified (2000 to 2018) via laboratory and referral centre searches for abdominal cryptococcosis diagnosed by cytology (needle aspirates) or histopathology (biopsy or necropsy) of abdominal organs/tissues. Signalment, presenting complaints, clinical signs, laboratory findings, medical imaging, latex cryptococcal antigen agglutination test (LCAT) titres, treatment and outcome data was collected.

RESULTS

Thirty-eight cases were included (35 dogs, three cats) in the study. Median age of presentation was 2 years for dogs and 6 years for cats. Common presenting complaints included vomiting (23/38), lethargy (19/38) and inappetence/anorexia (15/38). Abdominal ultrasound (25/38 cases) revealed mesenteric and intestinal lesions in most of the cases. On surgical exploration, seven cases had an intestinal lesion associated with an intussusception. Nineteen cases had a pre-treatment LCAT performed, with a median initial titre of 1:2048 (range 1:2 to 65,536). Twenty-four cases (23 dogs, one cat) received treatment, either medical, surgical or both. Median survival time for cases with combined medical and surgical treatment, surgical treatment alone or medical treatment alone was 730, 140 and 561 days, respectively. Eleven remain alive at the time of follow up.

CLINICAL SIGNIFICANCE

Abdominal cryptococcosis although rare should be a considered as a diagnostic possibility in an especially young dog presenting with gastro-intestinal signs. Older dogs can also present with this condition and should not be euthanised based on imaging alone due to the likenesses with neoplasia. With appropriate treatment and monitoring many dogs may have a prolonged survival period and some may be cured.

Survival time and relapse in dogs with meningoencephalomyelitis of unknown origin treated with prednisolone and ciclosporin: a retrospective study

OBJECTIVE

To analyse outcome in dogs with a presumptive diagnosis of meningoencephalomyelitis of unknown origin (MUO) treated with prednisolone and ciclosporin and to assess the effect of a number of patient variables on survival time and rate of relapse.

DESIGN

Retrospective case series.

METHODS

Medical records of 40 client-owned dogs with a diagnosis of MUO treated with prednisolone and ciclosporin at one institution between June 2010 and January 2018 were reviewed retrospectively to assess survival times and prognostic indicators for death and/or relapse. The minimum follow-up time was 11 months post-diagnosis.

RESULTS

Median survival was 1345 days (95% confidence interval: 487-∞). No associations with hazard of death or relapse were detected for the presence of multifocal magnetic resonance imaging (MRI) abnormalities, caudal fossa location of MRI abnormalities, value of cerebrospinal fluid total nucleated cell count or total protein at time of diagnosis, or suspected elevation in intracranial pressure at time of diagnosis.

CONCLUSION

Protracted survival time may be achieved with a treatment combination of prednisolone and ciclosporin. Suspected elevation in intracranial pressure at the time of diagnosis did not affect long-term outcome in this cohort.

Comparing immunochromatography with latex antigen agglutination testing for the diagnosis of cryptococcosis in cats, dogs and koalas

Although the point-of-care cryptococcal antigen lateral flow assay (LFA) has revolutionized the diagnosis of cryptococcosis in human patients, to date there has been no large-scale examination of this test in animals. We therefore assessed the LFA in cats, dogs and koalas suspected of having cryptococcosis. In sum, 528 serum specimens (129 from cats, 108 from dogs, 291 from koalas) were tested using the LFA and one of two commercially available latex cryptococcal antigen agglutination test (LCAT) kits. The LCAT is a proven and well-accepted method in veterinary patients and therefore taken as the "gold standard" against which the LFA was compared. The LFA achieved a sensitivity of 92%, 100%, and 98% in cats, dogs, and koalas, respectively, with corresponding negative predictive values of 94%, 100%, and 98%. The specificity of the LFA was 81%, 84%, and 62% for cats, dogs, and koalas, respectively, with corresponding positive predictive values of 76%, 48%, and 69%. These findings suggest the most appropriate role for the LFA is as a screening test to rule out a diagnosis of cryptococcosis in cats, dogs, and koalas. Point-of-care accessibility makes it equally suited for use in the field and as a cage-side test in veterinary hospitals. The suboptimal specificity of the LFA makes it less suited to definitive confirmation of cryptococcosis in animals; therefore, all LFA-positive test results should be confirmed by LCAT testing. The discrepancy between these observations and the high specificity of the LFA in humans may reflect differences in the host-pathogen interactions amongst the species.

First case of feline cryptococcosis in Hong Kong, caused by Cryptococcus neoformans

A nine-year-old domestic short hair cat was presented for a nasal planum mass, nasal discharge, hyporexia and weight loss. On physical examination nasal proliferative and ulcerative lesions and submandibular lymphadenopathy were identified. Cytology, histopathology, fungal culture, antigen serology and MALDI-TOF confirmed cryptococcal rhinitis with regional mandibular lymph node involvement due to Cryptococcus neoformans infection. This is the first reported case of cryptococcosis in a feline patient in Hong Kong.

Activation of Meiotic Genes Mediates Ploidy Reduction during Cryptococcal Infection

Cryptococcus neoformans is a global human fungal pathogen that causes fatal meningoencephalitis in mostly immunocompromised individuals. During pulmonary infection, cryptococcal cells form large polyploid cells that exhibit increased resistance to host immune attack and are proposed to contribute to the latency of cryptococcal infection. These polyploid titan cells can generate haploid and aneuploid progeny that may result in systemic infection. What triggers cryptococcal polyploidization and how ploidy reduction is achieved remain open questions. Here, we discovered that Cryptococcus cells polyploidize in response to genotoxic stresses that cause DNA double-strand breaks. Intriguingly, meiosis-specific genes are activated in C. neoformans and contribute to ploidy reduction, both in vitro and during infection in mice. Cryptococcal cells that activated their meiotic genes in mice were resistant to specific genotoxic stress compared to sister cells recovered from the same host tissue but without activation of meiotic genes. Our findings support the idea that meiotic genes, in addition to their conventional roles in classic sexual reproduction, contribute to adaptation of eukaryotic cells that undergo dramatic genome changes in response to genotoxic stress. The discovery has additional implications for evolution of sexual reproduction and the paradox of the presence of meiotic machinery in asexual species. Finally, our findings in this eukaryotic microbe mirror the revolutionary discoveries of the polyploidization and meiosis-like ploidy reduction process in cancer cells, suggesting that the reversible ploidy change itself could provide a general mechanism for rejuvenation to promote individual survival in response to stress.

First case of a dog infected with Aspergillus (Phialosimplex) caninus in Australasia

Case history: A 2-year-old Rottweiler dog from Perth (WA, Australia) was referred for assessment of a chronic productive cough and weight loss.Clinical findings: Severely enlarged bilateral superficial cervical lymph nodes and severely enlarged abdominal organs were present. The body condition score was poor and there was moderate muscle wasting. Thoracic and abdominal computed tomography images revealed severe diffuse enlargement of thoracic and abdominal lymph nodes, hepatomegaly and diffuse splenomegaly. A diffuse bronchial pattern with severe multifocal saccular bronchiectasis was identified in the lungs.Diagnostic findings: Fungal organisms were seen within macrophages on cytological preparations and on histopathological sections of biopsies of the superficial cervical lymph node. Macrophages contained intracytoplasmic, non-filamentous round-to-ovoid organisms, which varied in size from 5-30 µm in diameter with variable morphology. Budding was not observed, and no hyphae were present. Fungal culture of lymph node tissue resulted in growth of Aspergillus (Phialosimplex) caninus which was confirmed by amplification and sequencing of a segment of the 16S-23S rRNA internal transcribed spacer. Concurrent bacterial bronchitis was diagnosed on culture of broncho-alveolar fluid.Diagnosis: Disseminated aspergillosis caused by Aspergillus caninus.Clinical relevance: This is believed to be the first report of infection caused by A. caninus in a dog in Australasia. The dog was treated with itraconazole for 7 months and was still alive 7 months after the start of treatment.

The Evolution of Sexual Reproduction and the Mating-Type Locus: Links to Pathogenesis of Cryptococcus Human Pathogenic Fungi

Cryptococcus species utilize a variety of sexual reproduction mechanisms, which generate genetic diversity, purge deleterious mutations, and contribute to their ability to occupy myriad environmental niches and exhibit a range of pathogenic potential. The bisexual and unisexual cycles of pathogenic Cryptococcus species are stimulated by properties associated with their environmental niches and proceed through well-characterized signaling pathways and corresponding morphological changes. Genes governing mating are encoded by the mating-type (MAT) loci and influence pathogenesis, population dynamics, and lineage divergence in Cryptococcus. MAT has undergone significant evolutionary changes within the Cryptococcus genus, including transition from the ancestral tetrapolar state in nonpathogenic species to a bipolar mating system in pathogenic species, as well as several internal reconfigurations. Owing to the variety of established sexual reproduction mechanisms and the robust characterization of the evolution of mating and MAT in this genus, Cryptococcus species provide key insights into the evolution of sexual reproduction.

Cryptococcosis with ocular and central nervous system involvement in a 3-year-old dog

To date, cryptococcosis remains sporadic in Europe, and this is a case of canine cryptococcosis with ocular and CNS involvement in continental Europe with identification of the organism on cerebral spinal fluid (CSF) cytology and description of the clinical and MRI features, and outcome.

CT identifies pulmonary cryptococcosis in a domestic feline

A domestic cat was presented for lethargy and coughing. Thoracic radiographs identified a mass within the right cranial lung lobe and a nodule in the left cranial lung lobe. Cryptococcus spp. was diagnosed via ultrasound-guided fine needle aspirate cytology. Despite fluconazole and prednisolone treatment, clinical signs progressed and suggested airway obstruction. Computed tomography revealed mass invasion into the trachea and other areas of the lower airway resulting in obstruction. Bronchoscopy was performed to debulk the tracheal mass and obtain biopsies. Histopathology confirmed Cryptococcus spp. At the time of this report, the patient remained clinically stable with daily itraconazole (5 mg/kg) treatment.

Evaluation of the clinical performance of 2 point-of-care cryptococcal antigen tests in dogs and cats

Background

Point‐of‐care (POC) Cryptococcus antigen assays may provide veterinarians with a more rapid, patient‐side diagnosis when compared with traditional laboratory‐based latex agglutination tests.

Objective

To determine the sensitivity and specificity of 2 POC lateral flow cryptococcal serum antigen tests, CrAg LFA (Immy, Norman, OK) and the CryptoPS (Biosynex, Strasbourg, France) for diagnosis of cryptococcosis in dogs and cats, using the cryptococcal antigen latex agglutination system (CALAS) as the reference standard.

Animals

102 serum samples from 51 dogs and 40 cats.

Methods

Specimens were classified as CALAS‐positive (n = 25) or CALAS‐negative (n = 77). The sensitivity and specificity of each POC assay was calculated by comparing the results to the serologic reference standard results.

Results

The CrAg LFA assay correctly classified 23/25 CALAS‐positive specimens and 69/74 CALAS‐negative specimens resulting in a sensitivity of 92.0% (confidence interval [CI], 75.0%‐98.6%) and specificity of 93.2% (CI, 85.1%‐97.1%). The CryptoPS assay correctly classified 8/10 tested CALAS‐positive specimens and 56/59 tested CALAS‐negative specimens resulting in a sensitivity of 80.0% (CI, 49.0%‐96.5%) and specificity of 94.9% (CI, 86.1%‐98.6%).

Conclusion and Clinical Importance

The POC assays appear to be a sensitive and specific alternative to the traditional CALAS assay with more rapid turnaround times, which may result in earlier diagnosis and treatment.

Isolation of Cryptococcus gattii from feline chronic stage lipoid pneumonia

We hereby report a unique manifestation of feline cryptococcosis in the form of extensively consolidated lipoid pneumonia resulting in an isolated space-occupying lung lobe mass. Lung lobectomy was performed and a diagnosis of severe lipoid pneumonia with intra-lesional Cryptococcus gattii was made. The patient was asymptomatic for respiratory disease and no abnormalities of the upper respiratory tract were identified. Anti-fungal therapy was initiated following the diagnosis and the patient recovered without complication.

Cryptococcosis in the koala (Phascolarctos cinereus): pathogenesis and treatment in the context of two atypical cases

Disseminated cryptococcosis caused by Cryptococcus gattii (molecular type VGI) was diagnosed in an adult free-ranging female koala (Phascolarctos cinereus). Subclinical cryptococcosis was later diagnosed in this koala's joey. In the adult koala, a pathological fracture of the tibia was associated with the bone lysis of marked focal cryptococcal osteomyelitis. Limb-sparing orthopedic intervention, in the setting of disseminated cryptococcosis, was judged to have a poor prognosis, and the adult koala was euthanized. The joey was removed and hand-reared. Serological testing revealed persistent and increasing cryptococcal capsular antigenemia in the absence of clinical signs of disease and it was subsequently treated with oral fluconazole for approximately 16 months, rehabilitated and released into the wild. It was sighted 3 months post-release in a good state of health and again at 18 months post-release but was not recaptured on either occasion. This is the first published report of cryptococcal appendicular osteomyelitis in a koala. It is also the first report of concurrent disease in a dependent juvenile and the successful treatment of subclinical cryptococcosis to full resolution of the cryptococcal antigenemia in a free-ranging koala. This paper provides a discussion of cryptococcal osteomyelitis in animals, host-pathogen-environment interactions and treatment and monitoring protocols for cryptococcosis in koalas. Published reports describing the treatment of cryptococcosis in koalas are also collated and summarised.

An Overview of Sex Bias in C. neoformans Infections

Cryptococcosis, a fungal disease arising from the etiologic agent Cryptococcus neoformans, sickens a quarter of a million people annually, resulting in over 180,000 deaths. Interestingly, males are affected by cryptococcosis more frequently than females, a phenomenon observed for more than a half century. This disparity is seen in both HIV− (~3M:1F) and HIV⁺ (~8M:2F) populations of cryptococcal patients. In humans, male sex is considered a pre-disposing risk factor for cryptococcosis and males suffering from the disease have more severe symptoms and poorer outcomes. There are numerous observational, clinical and epidemiological studies documenting the male disadvantage in C. neoformans but with no further explanation of cause or mechanism. Despite being commonly acknowledged, little primary research has been conducted elucidating the reasons for these differences. The research that has been conducted, however, suggests sex hormones are a likely cause. Given that the sex difference is both prevalent and accepted by many researchers in the field, it is surprising that more is not known. This review highlights the data regarding differences in sexual dimorphism in C. neoformans infections and suggests future directions to close the research gap in this area.

Doenças micóticas em gatos no Rio Grande do Sul

RESUMO: As enfermidades fúngicas são diagnósticos diferenciais de diversas morbidades de caráter infeccioso, degenerativo ou proliferativo neoplásico, principalmente em gatos, que é a espécie mais suscetível a estas. Este trabalho descreve os achados anatomopatológicos de doenças fúngicas em gatos no período de janeiro de 2005 a dezembro de 2015 pelo SPV-UFRGS. Foram revisados 1.274 protocolos de necropsia e encontrou-se 17 casos de micoses, correspondendo a 1,33% dos diagnósticos. Quanto às amostras provenientes de biopsias, foram verificados 2.615 protocolos e detectou-se 59 casos de doenças fúngicas, totalizando 2,25% dos diagnósticos, sendo revisados seus achados macroscópicos, microscópicos, colorações especiais e cultivo micológico. O principal diagnóstico encontrado foi esporotricose com 34 casos de biópsia e cinco de necropsia. Criptococose obteve seis diagnósticos na necropsia e 13 na biópsia. O pseudomicetoma dermatofítico possui cinco casos de biópsia e dois de necropsia. Histoplasmose obteve um diagnóstico na necropsia e dois na biópsia. Aspergilose teve dois casos diagnosticados na necropsia. Candidíase e feo-hifomicose obtiveram um caso cada. Em quatro ocasiões, não se pode identificar o agente envolvido na lesão e foram classificados conforme a alteração morfológica em: dermatite fúngica, enterite fúngica, rinite micótica e dermatite e osteomielite fúngica. Através deste trabalho, pode-se identificar que a esporotricose foi o diagnóstico de doença fúngica mais frequente em felinos, seguido da criptococose e pseudomicetoma dermatofítico.

Skin as a marker of general feline health: Cutaneous manifestations of infectious disease

Practical relevance: Infectious disease in feline patients often presents a diagnostic challenge. This article reviews the most relevant viral, bacterial and protozoal diseases and their cutaneous manifestations. Many of the diseases discussed have overlapping presentations or may mimic more common noninfectious disease processes. The purpose of the article is to reinforce knowledge of common and uncommon infectious diseases, help practitioners identify possible infectious dermatoses, create a comprehensive and prioritized differential list, and provide guidance for the diagnosis of these diseases. A working knowledge of these clinical syndromes is important if what is thought to be a case of a common disease does not respond to conventional management.

AUDIENCE

This review is aimed at veterinarians who treat cats and especially those with an interest in feline dermatology. Tables are included to allow the reader to formulate a concise list of differential diagnoses for clinically similar presentations. The diagnostic approach to a case of ulcerative facial dermatitis is reviewed in a Case Notes quiz. Evidence base: This article includes up-to-date information regarding dermatologic manifestations of less commonly encountered feline cutaneous infectious diseases. Information has been drawn from the published, peer-reviewed literature and the most recent textbook chapters with a particular aim of describing and differentiating clinical lesions and the diagnostic approach to cutaneous disease, especially in unusual cases.

Atypical cutaneous cryptococcosis in four cats in the USA

BACKGROUND

Cryptococcosis is an uncommon fungal infection in humans and mammals. Occasionally, cryptococcosis manifests as cutaneous lesions, either as an extension of nasal disease or as stand alone lesions unassociated with the nose. Histologically, these lesions are typically characterized by abundant organisms with mild granulomatous dermatitis. Herein, four feline cases of atypical cutaneous cryptococcal infections are described.

METHODS

Skin punch biopsies from four client owned cats were submitted for histological evaluation between 2006 and 2015. Histological examination, including histochemical stains, was performed in all cases. Immunohistochemical stains and PCR were performed in three of four cases. Fungal culture was performed in two cases and transmission electron microscopy was performed in one case.

RESULTS

Grossly, the cutaneous lesions were papular to nodular with occasional ulceration and were located predominantly on the trunk. Histological examination revealed severe granulomatous to pyogranulomatous and eosinophilic dermatitis with rare, capsule-deficient yeasts. Immunohistochemistry, PCR and fungal culture confirmed Cryptococcus spp. to be the aetiological agent in these cases.

CONCLUSIONS AND CLINICAL IMPORTANCE

In cutaneous lesions, capsule-deficient strains of Cryptococcus spp. may induce a severe inflammatory response with rare intralesional organisms that may not be readily identified on routine haematoxylin and eosin stained slides. Special stains with careful examination and ancillary tests (PCR, immunohistochemistry, fungal culture or antigen testing) should be performed when pyogranulomatous and eosinophilic dermatitis is encountered without an identifiable cause.

Invasive Microsporum canis causing rhinitis and stomatitis in a cat

Microsporum canis is a pathogenic fungus that typically causes dermatophytosis in cats. This report describes a cat with a Microsporum canis infection causing invasive fungal rhinitis that extended through the hard palate, resulting in adjacent stomatitis. Treatment with itraconazole and terbinafine resolved the infection.

Cutaneous Disease as Sole Clinical Manifestation of Protothecosis in a Boxer Dog

Prototheca wickerhamii is ubiquitous, saprophytic achlorophyllous algae that cause opportunistic infections in the dog and cat and disseminated disease usually in immunocompromised animals. In this report an uncommon case of canine cutaneous protothecosis is presented. A 6-year-old female boxer was brought in with skin lesions that consisted of nodules and generalized footpad hyperkeratosis, depigmentation, and erosion. Cytology and histopathology showed pyogranulomatous inflammation along with organisms containing round sporangia with spherical sporangiospores. PCR and sequencing identified the causal organism as Prototheca wickerhamii. Therapy applied in this patient with either fluconazole alone or combination of amphotericin B and itraconazole proved effective only for footpad lesions but not for skin nodules. Systemic therapy seems to be ineffective for skin nodules, at least in chronic cases of canine cutaneous protothecosis. Although canine protothecosis usually presents with the disseminated form, cutaneous disease as sole clinical manifestation of the infection may also be witnessed.

Occurrence and susceptibilities to disinfectants of Cryptococcus neoformans in fecal droppings from pigeons in Bangkok, Thailand

Cryptococcus neoformans is an opportunistic pathogenic yeast that causes meningoencephalitis and deep skin dermatitis in humans and animals. A hygienic strategy using disinfectants on environmental samples can reduce the risk to the public. The objectives were to survey the distribution of C. neoformans in pigeon fecal droppings collected in 11 districts in Bangkok during 2011–2012 and to evaluate the efficacy of three commercial disinfectant products (based on potassium monopersulfate, sodium hypochlorite and quaternary ammonium compounds, respectively). These were evaluated against pure C. neoformans and yeasts resuspended in sterile pigeon feces using the dilution-neutralization method [Europäische NORM (EN) 1656]. In total, 18 of 164 (11%) samples were positive for C. neoformans. These came from only three of the 11 districts, with a prevalence of between 13–56%. Using multiplex PCR, serotype A was the sole group found. For all disinfectants, C. neoformans mixed in feces was tolerated at a higher dose and time exposure than pure isolates. The most effective disinfectant in this study was a 0.12% quaternary ammonium compound that could rapidly eradicate the yeasts mixed in feces. This finding highlights the occurrence and distribution of C. neoformans in the capital city of Thailand and the need to prolong the duration of exposure to disinfectants with pigeon feces.

Cryptococcus gattii-Induced Infections in Dogs from Southern Brazil

Cryptococcus gattii-induced cryptococcosis is an emerging infectious disease of humans and animals worldwide, with rare descriptions of this infection in domestic animals from Brazil. This study presents the findings associated with C. gattii in dogs from Londrina, Paraná, Southern Brazil. Two dogs, a 3-year-old, female German shepherd and a 6-year-old, male Boxer, were evaluated by a combination of pathological, mycological, and molecular diagnostic techniques. Significant pathological alterations included cryptococcal lymphadenitis, meningoencephalitis, tonsillitis, and rhinitis with nasal cryptococcomas in the German shepherd dog, while cryptococcal lymphadenitis and pneumonia were observed in the Boxer; both dogs had pseudocystic cryptococcosis. The mucicarmine histochemical stain readily identified the intralesional cryptococcal budding organisms in all affected tissues. Mycological culture and isolation confirmed the yeasts as C. gattii due to positive reaction with the L-canavanine glycine bromothymol blue agar. A PCR assay using the internal transcribed spacers (ITS)1 and ITS2 primers, which target the ITS1 and 2 regions including the 5.8S rRNA gene, amplified the desired amplicons; direct sequencing confirmed the isolate as C. gattii. ITS nucleotide differentiation demonstrated that the isolate forms part of the ITS type 4 Cryptococcus organisms which corresponds to the C. gattii VGII molecular subtype or the RAPD type 2 Cryptococcus organisms. Collectively, these findings confirmed the participation of C. gattii in the etiopathogenesis of the lesions observed in these dogs and expanded the epidemiological niche of this important mycotic agent to include Southern Brazil. It is noteworthy to mention that previous epidemiological studies have suggested that C. gattii-induced cryptococcosis is more frequently diagnosed in Northern relative to Southern Brazil, so these findings might suggest an expansion of the distribution of this agent within continental Brazil.

Cryptococcal nasopharyngeal polypoid mass in a cat

Case summary

An indoor 9-year-old castrated male domestic cat was referred with a 4 month history of increased upper airway noise. Computed tomography revealed a nasopharyngeal polypoid mass, which was removed endoscopically with basket forceps. Histopathology was compatible with a polypoid granulomatous pharyngitis with Cryptococcus-like organisms. This was supported by a positive serum latex cryptococcal antigen agglutination test (LCAT). Minimal inflammation of the nasal tissue was noted on histopathology, with no evidence of fungus. Following endoscopic removal of the mass, the patient was treated with systemic antifungal medication (itraconazole). One year after diagnosis, the LCAT titer was negative and the cat remained free of clinical signs.

Relevance and novel information

This case report emphasizes the importance of considering Cryptococcus species as a potential etiology in cats presented with signs of nasopharyngeal obstruction with an isolated nasopharyngeal polypoid mass, even if kept indoors.

Cryptococcus gattii infections

Understanding of the taxonomy and phylogeny of Cryptococcus gattii has been advanced by modern molecular techniques. C. gattii probably diverged from Cryptococcus neoformans between 16 million and 160 million years ago, depending on the dating methods applied, and maintains diversity by recombining in nature. South America is the likely source of the virulent C. gattii VGII molecular types that have emerged in North America. C. gattii shares major virulence determinants with C. neoformans, although genomic and transcriptomic studies revealed that despite similar genomes, the VGIIa and VGIIb subtypes employ very different transcriptional circuits and manifest differences in virulence phenotypes. Preliminary evidence suggests that C. gattii VGII causes severe lung disease and death without dissemination, whereas C. neoformans disseminates readily to the central nervous system (CNS) and causes death from meningoencephalitis. Overall, currently available data indicate that the C. gattii VGI, VGII, and VGIII molecular types more commonly affect nonimmunocompromised hosts, in contrast to VGIV. New, rapid, cheap diagnostic tests and imaging modalities are assisting early diagnosis and enabling better outcomes of cerebral cryptococcosis. Complications of CNS infection include increased intracranial pressure, severe neurological sequelae, and development of immune reconstitution syndrome, although the mortality rate is low. C. gattii VGII isolates may exhibit higher fluconazole MICs than other genotypes. Optimal therapeutic regimens are yet to be determined; in most cases, initial therapy with amphotericin B and 5-flucytosine is recommended.

Abdominal Cryptococcosis in Two Dogs: Diagnosis and Medical Management

Canine cryptococcosis cases are typically reported as neurologic, disseminated, or both. There have been few reports of other parenchymal organ involvement. Dogs infected with Cryptococcus spp. are likely to develop central nervous system involvement, and those that are severely affected are treated aggressively with surgery and/or amphotericin B. This report describes two cases of canine abdominal cryptococcosis: one boxer with primary alimentary cryptococcosis alone and one miniature schnauzer with pancreatic and disseminated cryptococcosis. The boxer is unique in that the dog suffered from primary alimentary cryptococcosis without dissemination, secondary anemia due to gastrointestinal losses, and is the second case to have Cryptococcus spp. identified on fecal examination as part of the diagnostic workup. Unlike previous reports, surgery was not performed in either case, and both dogs were treated with fluconazole alone. Currently, both dogs are free from clinical signs, and Cryptococcus spp. antigen titers are negative at 17 and 15 mo after initial presentation. These cases suggest fluconazole may be effective therapy alone for canine abdominal cryptococcosis, negating the need for high-risk therapy options such as surgery and/or amphotericin B in some cases.

Recognition of seven species in the Cryptococcus gattii/Cryptococcus neoformans species complex

Phylogenetic analysis of 11 genetic loci and results from many genotyping studies revealed significant genetic diversity with the pathogenic Cryptococcus gattii/Cryptococcus neoformans species complex. Genealogical concordance, coalescence-based, and species tree approaches supported the presence of distinct and concordant lineages within the complex. Consequently, we propose to recognize the current C. neoformans var. grubii and C. neoformans var. neoformans as separate species, and five species within C. gattii. The type strain of C. neoformans CBS132 represents a serotype AD hybrid and is replaced. The newly delimited species differ in aspects of pathogenicity, prevalence for patient groups, as well as biochemical and physiological aspects, such as susceptibility to antifungals. MALDI-TOF mass spectrometry readily distinguishes the newly recognized species.

Otogenic meningoencephalomyelitis due toCryptococcus gattii(VGII) infection in a cat from Western Australia

Case summary

A 7-year-old spayed domestic longhair cat from Perth, Western Australia, presented with left-sided head tilt, dysphonia, head shaking, inappetence and weight loss. A polypoid lesion had previously been removed from the external ear canal. Otitis media with extension into the external ear canal was suspected and investigated using video-otoscopy and computed tomography examination. Invasive disease with extension from the middle ear to the base of the skull, and intracranial extension into the caudal fossa and cranial cervical vertebral canal was detected. Cytology of external ear canal exudate showed capsulated budding yeasts and Cryptococcus gattii VGII was cultured. Treatment with amphotericin B infusions and oral fluconazole was prescribed, with nutritional support via oesophagostomy tube. The cat clinically recovered 12 months after treatment commenced.

Relevance and novel information

This case report describes the successful medical treatment of otogenic meningoencephalomyelitis due to C gattii (VGII) infection in a cat.

Antifungal drug susceptibility and phylogenetic diversity among Cryptococcus isolates from dogs and cats in North America

Molecular types of the Cryptococcus neoformans/Cryptococcus gattii species complex that infect dogs and cats differ regionally and with host species. Antifungal drug susceptibility can vary with molecular type, but the susceptibility of Cryptococcus isolates from dogs and cats is largely unknown. Cryptococcus isolates from 15 dogs and 27 cats were typed using URA5 restriction fragment length polymorphism analysis (RFLP), PCR fingerprinting, and multilocus sequence typing (MLST). Susceptibility was determined using a microdilution assay (Sensititre YeastOne; Trek Diagnostic Systems). MICs were compared among groups. The 42 isolates studied comprised molecular types VGI (7%), VGIIa (7%), VGIIb (5%), VGIIc (5%), VGIII (38%), VGIV (2%), VNI (33%), and VNII (2%), as determined by URA5 RFLP. The VGIV isolate was more closely related to VGIII according to MLST. All VGIII isolates were from cats. All sequence types identified from veterinary isolates clustered with isolates from humans. VGIII isolates showed considerable genetic diversity compared with other Cryptococcus molecular types and could be divided into two major subgroups. Compared with C. neoformans MICs, C. gattii MICs were lower for flucytosine, and VGIII MICs were lower for flucytosine and itraconazole. For all drugs except itraconazole, C. gattii isolates exhibited a wider range of MICs than C. neoformans. MICs varied with Cryptococcus species and molecular type in dogs and cats, and MICs of VGIII isolates were most variable and may reflect phylogenetic diversity in this group. Because sequence types of dogs and cats reflect those infecting humans, these observations may also have implications for treatment of human cryptococcosis.