Subtotal pericardectomy and epicardial excision for treatment of coccidioidomycosis-induced effusive-constrictive pericarditis in dogs: 17 cases (1999-2003)

Case report: Treatment of constrictive epicarditis using the waffle procedure in a dog that had previously undergone a subtotal pericardiectomy

A 10 year-old female spayed German Short-haired Pointer dog weighing 26.8 kg (59 lb) presented with a 2 week history of recurrent ascites. The dog had a 4 year history of idiopathic pericardial effusion causing sporadic episodes of cardiac tamponade and secondary ascites. A subtotal pericardiectomy was performed 3 months prior to presentation. The patient had done well for 2 months following this procedure, at which point the large-volume modified transudate ascites recurred, necessitating abdominocentesis every 10 days. Thoracic and abdominal computed tomography (CT) revealed no abdominal or vascular cause of ascites. Transthoracic echocardiography performed under general anesthesia showed constrictive epicarditis (visceral pericarditis) resulting in diastolic dysfunction and right-sided congestive heart failure. A sternotomy was performed for a pericardial waffle procedure or crosshatch pericardiotomy-scoring of crosshatched incisions into the thickened epicardium. Echocardiographic findings postoperatively were consistent with resolved constrictive epicarditis. At 8 months postoperatively, the dog was clinically normal and had only required one abdominocentesis one month after the waffle procedure. This case report describes the successful treatment of a dog with constrictive epicarditis using a novel surgical technique (waffle procedure) that has not yet been described in veterinary medicine.

The dog as a sentinel and animal model for coccidioidomycosis

Coccidioidomycosis is a potentially fatal fungal disease of humans and animals that follows inhalation of Coccidioides spp. arthroconidia in the environment. The disease in dogs resembles that in people, and because dogs may be at increased risk of exposure due to their proximity to the ground and digging behavior, they are valuable models for the disease in humans. Dogs have been sentinels for identification of new regions of endemicity in Washington and Texas. Canine serosurveillance has also been used to predict variables associated with environmental presence of Coccidioides spp. Expansion of the endemic region of coccidioidomycosis with climate change-along with predicted population increases and increased development in the southwest United States-may result in 45.4 million additional people at risk of infection by 2090. Here we provide an overview of the value of dogs as sentinels for the disease and encourage the routine reporting of coccidioidomycosis cases in dogs to public health agencies. We also highlight the value of dogs as naturally occurring models for studying novel treatment options and preventatives, such as a novel live avirulent coccidioidomycosis vaccine.

Subtotal Pericardiectomy and Epicardiectomy for Treatment of Septic Pericarditis and Constrictive Epicarditis in a Dog

A 1 yr old, 1.7 kg, spayed female Chihuahua was presented for respiratory distress and an enlarged cardiac silhouette as seen on thoracic radiographs. Echocardiogram revealed pericardial effusion and cardiac tamponade. Computed tomography revealed marked pleural and pericardial effusion, thickening of the pericardium caudally, and a mass along the mediastinum. Pericardial fluid obtained via pericardiocentesis showed suppurative inflammation with mixed anaerobic bacteria isolated on culture. Subtotal pericardiectomy and partial lung lobectomy was performed to treat septic pericarditis. Postoperative echocardiogram showed increased right-sided pressures consistent with constrictive epicarditis, and 10 days after surgery, the dog was re-presented for right-sided heart failure. An epicardectomy was performed. A definitive source of infection was not identified, although a penetrating foreign body (e.g., grass awn) was suspected. The dog recovered and 10 yr follow up revealed no evidence of constrictive pathology on echocardiogram. This case report demonstrates the successful treatment of septic pericarditis and constrictive epicarditis via subtotal pericardiectomy and epicardiectomy.

Evaluation of Host Constitutive and Ex Vivo Coccidioidal Antigen-Stimulated Immune Response in Dogs with Naturally Acquired Coccidioidomycosis

The early innate immune response to coccidioidomycosis has proven to be pivotal in directing the adaptive immune response and disease outcome in mice and humans but is unexplored in dogs. The objectives of this study were to evaluate the innate immune profile of dogs with coccidioidomycosis and determine if differences exist based on the extent of infection (i.e., pulmonary or disseminated). A total of 28 dogs with coccidioidomycosis (pulmonary, n = 16; disseminated, n = 12) and 10 seronegative healthy controls were enrolled. Immunologic testing was performed immediately, without ex vivo incubation (i.e., constitutive), and after coccidioidal antigen stimulation of whole blood cultures. Whole blood cultures were incubated with a phosphate-buffered solution (PBS) (negative control) or a coccidioidal antigen (rCTS1 (105-310); 10 µg/mL) for 24 h. A validated canine-specific multiplex bead-based assay was used to measure 12 cytokines in plasma and cell culture supernatant. Serum C-reactive protein (CRP) was measured with an ELISA assay. Leukocyte expression of toll-like receptors (TLRs)2 and TLR4 was measured using flow cytometry. Dogs with coccidioidomycosis had higher constitutive plasma keratinocyte chemotactic (KC)-like concentrations (p = 0.02) and serum CRP concentrations compared to controls (p < 0.001). Moreover, dogs with pulmonary coccidioidomycosis had higher serum CRP concentrations than those with dissemination (p = 0.001). Peripheral blood leukocytes from dogs with coccidioidomycosis produced higher concentrations of tumor necrosis factor (TNF)-α (p = 0.0003), interleukin (IL)-6 (p = 0.04), interferon (IFN)-γ (p = 0.03), monocyte chemoattractant protein (MCP)-1 (p = 0.02), IL-10 (p = 0.02), and lower IL-8 (p = 0.003) in supernatants following coccidioidal antigen stimulation when compared to those from control dogs. There was no detectable difference between dogs with pulmonary and disseminated disease. No differences in constitutive or stimulated leukocyte TLR2 and TLR4 expression were found. These results provide information about the constitutive and coccidioidal antigen-specific stimulated immune profile in dogs with naturally acquired coccidioidomycosis.

Serum 25-hydroxyvitamin D concentrations in dogs with coccidioidomycosis and variables associated with extent of clinically evident disease

BACKGROUND

Clinicopathologic variables predictive of disseminated coccidioidomycosis are known in humans but have not been explored in dogs. Serum 25-hydroxyvitamin (OH)D correlates with severity of disease of various etiologies in dogs but its role in coccidioidomycosis is unknown.

OBJECTIVE

Determine whether serum 25(OH)D concentrations are different in dogs with coccidioidomycosis compared with healthy controls and if clinicopathologic variables are associated with extent of disease.

ANIMALS

Thirty-five dogs with coccidioidomycosis (pulmonary, n = 13; disseminated, n = 15; uncharacterized, n = 7), and 25 healthy control dogs.

METHODS

Prospective cohort study. Serum 25(OH)D and C-reactive protein (CRP) concentrations were measured with modified-HPLC and a commercial ELISA kit, respectively.

RESULTS

There was no difference in 25(OH)D concentrations between dogs with coccidioidomycosis (median, interquartile range [IQR]; 31.9 ng/mL, 23.3-49.2) and controls (29.5 ng/mL, 25.6-40.8, P = .73). Serum 25(OH)D concentration was lower in dogs with coccidioidomycosis and IgG titers ≥1:32 than dogs with titers below this cut-off (P = .02). Dogs with IgG titers ≥1:32 were more likely to have disseminated disease (OR, 7.5; 95% CI: 1.1-68; P = .03). Serum CRP concentrations were higher in dogs with IgG titers ≥1:16 (median, IQR; 4474.8 ng/mL, 2885.8-8236.1) than in those below this cut-off (151.2 ng/mL, 30.4-2907.3; P = .02). There was a significant inverse association between serum 25(OH)D and CRP at 25(OH)D concentrations ≤33 ng/mL.

CONCLUSION AND CLINICAL IMPORTANCE

Serum 25(OH)D concentration was lower for dogs with IgG titers ≥1:32, indicating a potential association between semi-quantitative titers and 25(OH)D concentrations in dogs with coccidioidomycosis. IgG titers ≥1:32 yielded higher odds of disseminated disease, but was inadequate as a standalone test to determine form of disease.

Clinical performance of a point-of-care Coccidioides antibody test in dogs

Background

Point‐of‐care (POC) Coccidioides antibody assays may provide veterinarians with rapid and accurate diagnostic information.

Objectives

To determine the agreement of a POC lateral flow assay (LFA), sona Coccidioides (IMMY, Norman, Oklahoma) with the current diagnostic standard, the immunodiffusion assay (agar gel immunodiffusion [AGID]; Coccidioidomycosis Serology Laboratory, University of California, Davis, California).

Animals

Forty‐eight sera specimens from 48 dogs.

Methods

Sera specimens were collected from client‐owned dogs that had a clinical suspicion for coccidioidomycosis. Animals were classified as Coccidioides antibody‐positive (n = 36) based on a positive AGID or Coccidioides antibody‐negative (n = 12) based on a negative AGID. The performance of the LFA assay was determined by comparing results to AGID results.

Results

The LFA assay demonstrated agreement in 32 of 36 Coccidioides antibody‐positive specimens and 12 of 12 Coccidioides antibody‐negative specimens, resulting in a positive percentage agreement of 88.9% (95% confidence interval [CI], 74.7‐95.6%) and negative percentage agreement of 100% (95% CI, 75.8‐100%) as compared to AGID. A receiver operator characteristic curve was constructed, and the area under the curve was 0.944 (CI, 0.880‐1.000).

Conclusion and Clinical importance

This LFA is a rapid alternative to the traditional AGID. The LFA provides excellent predictive value for positive results. Positive agreement was lower in dogs with low AGID titers; therefore, confirmatory testing is recommended if a high index of suspicion exists.

Systematic review of the treatment options for pericardial effusions in dogs

OBJECTIVE

To evaluate the evidence for the conservative and surgical management of pericardial effusions for neoplastic and idiopathic etiologies in dogs.

STUDY DESIGN

Systematic review.

SAMPLE POPULATION

Peer-reviewed English-language articles describing the treatment and outcome of naturally occurring pericardial effusion in domestic dogs.

METHODS

A literature search was performed with PubMed, Cab Abstracts, Scopus, and Agricola in August 2019 for articles describing pericardial effusion treatment in dogs. Inclusion criteria were applied, and articles were evaluated for reported outcome and level of evidence by using The Oxford 2011 Levels of Evidence, a previously described hierarchical system, and GRADE (Grading of Recommendations, Assessment, Development and Evaluation).

RESULTS

One hundred eight of the 641 unique articles that were identified and evaluated met inclusion criteria. Most articles included were case studies (68.2%) or retrospective case series (25.2%), with all articles providing a low level of evidence. The articles had inconsistent inclusion criteria, outcome measures, and follow-up, making comparison of outcomes difficult.

CONCLUSION

Because of the low quality of evidence of the studies included in this systematic review and the variability of the outcomes, there is not sufficient evidence to recommend one treatment option rather than another.

CLINICAL SIGNIFICANCE

There is a requirement for higher quality evidence such as randomized controlled trials and prospective comparative cohort studies. Standardization of outcome measures reported for each treatment option and disease process studied will allow for better comparison of outcomes between studies.

Bicavitary eosinophilic effusion in a dog with coccidioidomycosis

This is a case of coccidioidomycosis in a dog, examined for vomiting and labored breathing. Physical examination and thoracic and abdominal imaging revealed pleural and peritoneal effusions, both of which exhibited neutrophilic inflammation with a substantial eosinophilic component. The dog had positive IgM and IgG coccidioidomycosis titers at initial evaluation. The eosinophilic component of the inflammation was attributed to coccidioidomycosis. The dog underwent approximately 6 months of fluconazole treatment, with both effusions and clinical signs improving after 6 weeks. Three months after cessation of antifungal treatment, the dog developed a mid‐diaphyseal lytic and proliferative lesion in the left radius caused by Coccidioides spp. This case illustrates the importance of consideration of coccidioidomycosis when an eosinophilic cavitary effusion is present in dogs that live in or have traveled to endemic regions.

The Causes of Canine Myocarditis and Myocardial Fibrosis Are Elusive by Targeted Molecular Testing: Retrospective Analysis and Literature Review

Myocarditis can cause death or permanent heart damage. As epidemiologic and etiopathologic data for canine myocarditis are lacking, we performed a retrospective study using nucleic acid extracted from archived (2007 to 2015) tissues from myocarditis cases and control dogs without myocardial lesions. Heart tissue from pediatric/juvenile and adult dogs was tested with a comprehensive panel of conventional and real-time polymerase chain reaction (PCR) assays targeting recognized agents of canine myocarditis based on a literature review and informed by the comparative epidemiology of human myocarditis. The PCR screen, which included canine parvovirus 2 (CPV-2), canine distemper virus, canine herpesvirus, Borrelia spp, West Nile virus, adenovirus, parainfluenza virus, pneumovirus, respiratory coronavirus, influenza virus, Bartonella spp, Rickettsia spp, Mycoplasma spp, and Neospora caninum, did not detect agents in 35 of 66 cases (53%; 95% confidence interval [CI], 41%-65%) and was frequently negative in adults (21/26); by comparison, agents were not detected in 27 of 57 controls (47%; 95% CI, 35%-60%). Canine distemper virus, herpesvirus, adenovirus, coronavirus, parainfluenza virus, Mycoplasma haemocanis, and N. caninum were occasionally detected in both cases and controls; thus, PCR detection was not considered to indicate causation. We previously reported that CPV-2 continues to be associated with myocarditis in young dogs despite widespread vaccination; in adults, CPV-2 was detected in 2 of 26 cases and 4 of 22 controls. As several agents were similarly detected in cases and controls, it is unclear if these are cardiopathogenic, incidental, or latent. West Nile virus was detected at the analytic limit in 1 adult case. We did not detect Borrelia spp, Bartonella spp, Rickettsia spp, or influenza A virus in the myocarditis cases. These data demonstrate the limitations of current targeted diagnostic tests and the need for additional research to identify unknown agents and develop testing strategies for canine myocarditis.

Selected Clinical Features of Coccidioidomycosis in Dogs

Canine coccidioidomycosis, a systemic fungal infection endemic to arid and semiarid regions of North, Central, and South America, is commonly diagnosed in dogs living in or traveling through lower Sonoran life zones in the states of California and Arizona. Canine and human cases have geographic overlap. Similarities between clinical coccidioidomycosis in dogs and humans include asymptomatic infection, primary respiratory disease and disseminated disease. Differences include a high rate of dissemination in dogs, differences in predilection of dissemination sites, and a granulomatous or diffuse meningoencephalopathic form in the canine central nervous system (CNS) without the obstructive component seen in humans. Dogs presenting with CNS coccidioidomycosis most commonly experience seizures. Prior disease history and serology are unreliable indicators of CNS coccidioidomycosis. Magnetic resonance imaging (MRI) is advantageous for diagnosis of CNS coccidioidomycosis in dogs. Long-term administration of antifungal medication is promoted for treatment of both primary and disseminated coccidioidomycosis in dogs. Supportive treatment addressing pain, fever, inappetance, coughing, and other clinical signs improves patient care. Glucocorticoids and or anticonvulsants are also recommended for canine disseminated CNS disease. Protracted treatment times, lack of owner compliance, failure of the disease to respond to the first antifungal drug selected, and high cost are challenges of successfully treating dogs.

Pericardial Effusion in a Dog with Pericardial Hemangiosarcoma

An adult Jack Russel terrier dog presented for evaluation of large-volume peritoneal and pleural effusion. Echocardiography revealed scant pericardial effusion and abnormally thickened pericardium. Electrocardiography revealed complete atrioventricular block with junctional and ventricular escape beats and occasional ventricular premature complexes. Computed tomography of the thorax confirmed diffuse abnormal thickening of the pericardium, and a tentative diagnosis of constrictive-effusive pericarditis was made. The dog underwent subtotal pericardiectomy to remove the parietal pericardium and permanent epicardial pacemaker implantation to manage bradycardia. Based on pericardial histopathology and immunohistochemistry, a diagnosis of pericardial hemangiosarcoma was made. Systemic chemotherapy was initiated with doxorubicin 1 month after surgery. Despite initial improvement with chemotherapy, the dog was euthanized 4 months after surgery because of development of recurrent pleural effusion. To the author's knowledge, this is the first case report in dogs to describe isolated pericardial location of hemangiosarcoma resulting in constrictive-effusive pericarditis.

Canine leishmaniasis associated with pericardial effusion in a 4-year-old dog

A 4-year-old crossbreed dog presented with a two-day history of lethargy and abdominal effusion. Physical examination and echocardiography revealed pericardial effusion with cardiac tamponade. Pericardiocentesis was performed. Intracytoplasmic Leishmania amastigotes were found on cytological examination of the pericardial fluid. The animal was treated with N-methylglucamine antimoniate and allopurinol. After an initial favorable response, cardiac tamponade reoccurred one month later. The dog died during a pericardiectomy four months after the initial diagnosis. Histology confirmed the presence of chronic pericarditis. The presence of Leishmania amastigotes on cytological examination of pericardial effusion suggests a possible association between canine leishmaniasis and chronic pericarditis. This finding also supports the importance of cytological examination of pericardial fluid in areas endemic for canine leishmaniasis.

Pericardial effusion associated with systemic inflammatory disease in seven dogs (January 2006 - January 2012)

Pericardial effusion (PE) is reported in dogs as a consequence of neoplasia, primary cardiac disease or as an idiopathic condition. We describe seven dogs with systemic inflammatory disease, PE without tamponade and increased cardiac troponin I concentrations. Echocardiographic findings and adjunctive testing did not identify other known causes of PE. Resolution of the PE was documented in five of seven dogs in which follow-up echocardiography was performed, often after anti-inflammatory therapy. Resolution of PE was associated with normalisation of cardiac troponin I levels. Clinical signs had not recurred in six dogs with follow-up for more than 12 months and up to 7 years. These findings suggest an association between systemic inflammation and PE in dogs.

Fibrinous pericarditis secondary to bacterial infection in a cat

A three-year-old spayed domestic short-haired cat presented for evaluation of weight loss, cardiomegaly and pleural effusion. Echocardiographic examination demonstrated a thickened pericardium with mild pericardial effusion and a large volume of pleural effusion characterized by exudate. Although the cat was treated with antibiotics, the clinical symptoms did not improve. The cat developed dyspnea and died on day 7. Necropsy revealed a large amount of modified transudates ascites, pleural effusion and markedly dilated pericardium. Histopathological examination revealed severe exudation of fibrin and granulation tissue in a thick layer of the epicardium. The cat was diagnosed with fibrinous pericarditis secondary to bacterial infection.

Septic pericarditis and pneumopericardium in a dog with an oesophageal foreign body

A 5-year-old, intact, male Yorkshire Terrier presented with a 6-day history of lethargy and anorexia. Clinical examination revealed dental plaque accumulation, abdominal effort during respiration and muffled heart sounds. Thoracic radiographs revealed an enlarged globoid cardiac silhouette and mild pneumopericardium, transthoracic ultrasonography revealed a pericardial effusion after which pericardiocentesis, cytology and culture diagnosed septic pericarditis. Three multidrug-resistant bacteria were isolated, two of which have been implicated in gas-producing infections before. Medical management failed to resolve the pericarditis and euthanasia was opted for. A chronic osseocartilaginous oesophageal foreign body cranial to the heart base was found on necropsy. Septic pericarditis and pneumopericardium are rare conditions in dogs. This is the first case to describe a multidrug-resistant polybacterial aetiology causing mild pneumopericardium and only the second case to describe septic pericarditis associated with an oesophageal foreign body.

Fungal myocarditis and pericardial effusion secondary to Inonotus tropicalis (phylum Basidiomycota) in a dog

Fungal disease is a rare cause of pericardial effusion in dogs. This report describes the first case of fungal pericardial effusion and myocarditis secondary to the fungal organism Inonotus tropicalis. A 9-year-old female spayed French bulldog with a multi-year history of treatment with glucocorticoids for management of atopy was presented for exercise intolerance, ascites and weight loss. Physical examination and thoracic imaging revealed enlarged peripheral and cranial mediastinal lymph nodes, left ventricular thickening and cardiac tamponade secondary to pericardial effusion. Fine needle aspiration of the cranial mediastinal lymph node showed pyogranulomatous inflammation with short, thin and poorly septated hyphae. Culture of the aspirate yielded a fungal isolate identified as Inonotus tropicalis based on morphologic features and rRNA gene sequencing. Postmortem examination showed myocardial thickening with multifocal to coalescing, firm, white, ill-defined nodules. Histology confirmed the presence of disseminated fungal infection with extensive myocardial involvement. Inonotus tropicalis is an opportunistic poroid wood-decaying basidiomycete. Infection in this dog was likely the result of chronic immunosuppressive therapy.

Constrictive pericarditis following surgical repair of a peritoneopericardial diaphragmatic hernia in a cat

A 4-year-old female spayed domestic longhair cat was referred for dyspnea. Further diagnostics revealed severe pleural effusion and a peritoneopericardial diaphragmatic hernia (PPDH). Following surgical correction of the PPDH the pleural effusion persisted. Re-check echocardiogram 4 weeks after initial evaluation revealed leftward deviation of the interventricular septum and interatrial septum occurring with inspiration. There were also exaggerated phasic changes in trans-tricuspid flow velocities suggestive of constrictive pericardial disease. Cardiac catheterization was performed and revealed elevated pressures in the right atrium and right ventricle. Constrictive pericarditis (CP) and epicarditis was confirmed at surgery, where subtotal pericardiectomy was performed with epicardial decortication. The cat continued to develop recurrent pleural effusion after surgery, although the volume and frequency of recurrence slowed over time. This is the first reported case of CP following PPDH repair in a cat.

Thoracoscopic pericardial window for management of pericardial effusion in 15 dogs

OBJECTIVES

To report short-term complications and long-term outcomes of thoracoscopic pericardial window for management of pericardial effusion in dogs.

METHODS

Retrospective study of dogs in which thoracoscopic pericardial window was performed using a three-cannula technique. Surgery time, complications, postoperative management, area of resected pericardium, histopathology results and outcome were evaluated.

RESULTS

Diagnoses included dogs with idiopathic pericardial effusion (n = 10), cardiac mass (n = 4) and mesothelioma (n = 1). One case required conversion to sternotomy. Median thoracoscopic surgery time was 52 · 5 (range, 45-80) minutes. Complications occurred in four (26%) cases. Median time to discharge was one (range, 1-6) day. Of dogs with idiopathic pericardial effusion, one is alive at 150 days, one was lost to follow-up at 180 days while eight were euthanased of which five were for unrelated reasons. All dogs with neoplastic causes died or were euthanased because of their illness. Median survival time for dogs with idiopathic pericardial effusion (635 days; range, 70-1165) was significantly longer than that for dogs with neoplasia (30 days; range, 1-107).

CLINICAL SIGNIFICANCE

Thoracoscopic pericardial window is of low morbidity with short surgery and hospitalisation times. It provides good long-term control of idiopathic pericardial effusion but short-term palliation of clinical signs in dogs with neoplastic disease.

Meeting report: Emerging respiratory viral infections and nonhuman primate case reports

A workshop on Emerging Respiratory Viral Infections and Spontaneous Diseases in nonhuman primates was sponsored by the concurrent Annual Meetings of the American College of Veterinary Pathologists and the American Society for Veterinary Clinical Pathology, held December 1-5, 2012, in Seattle, Washington. The session had platform presentations from Drs Karen Terio, Thijs Kuiken, Guy Boivin, and Robert Palermo that focused on naturally occurring influenza, human respiratory syncytial virus, and metapneumovirus in wild and zoo-housed great apes; the molecular biology and pathology of these viral respiratory diseases in nonhuman primate (NHP) models; and the therapeutic and vaccine approaches to prevention and control of these emerging respiratory viral infections. These formal presentations were followed by presentations of 14 unique case studies of rare or newly observed spontaneous lesions in NHPs (see online files for access to digital whole-slide images corresponding to each case report at http://scanscope.com/ACVP%20Slide%20Seminars/2012/Primate%20Pathology/view.apml). The session was attended by meeting participants that included students, pathology trainees, and experienced pathologists from academia and industry with an interest in respiratory and spontaneous diseases of NHPs.

Successful Treatment of Intracardiac and Intraocular Blastomycosis in a Dog with Combination Azole Therapy

A 4 yr old spayed female Labrador retriever with clinical signs of blindness, cutaneous lesions, coughing, inappetence, and lethargy was diagnosed with disseminated blastomycosis based on cytologic (skin and lymph node aspirates) and histopathologic (skin biopsy) examinations of tissue samples. The dog deteriorated clinically during hospitalization and developed sustained ventricular tachycardia. Echocardiography revealed pericardial effusion, a nodule associated with the left ventricular papillary muscle, and a right atrial mural lesion. Therapy for myocardial performance and glaucoma was initiated. A combination of itraconazole and fluconazole successfully treated the dog. The dog regained vision in the left eye (oculus sinister [OS]) and had no residual cardiac disease detectable by either electrocardiography or echocardiography. This report is unique in documenting survival from intracardiac blastomycosis and in the use of combination azole therapy for treating disseminated disease with intraocular involvement.

Doppler echocardiographic diagnosis and surgical therapy of constrictive pericarditis in a cat

A 4-year-old Ragdoll cat presented for dyspnea secondary to chylous pleural effusion to the University of Georgia Veterinary Teaching Hospital. Physical examination, complete blood count, serum chemistries, urinalysis, thoracic radiographs, abdominal radiographs, and thoracic fluid cytology and culture failed to identify an etiology for the chylous effusion. The patient tested negative for feline leukemia virus, feline immunodeficiency virus and heartworm disease. Respiration phasic influences on early diastolic trans-mitral, trans-tricuspid and pulmonary vein blood flow velocities during Doppler echocardiography were consistent with constrictive pericarditis. The cat underwent subtotal pericardectomy. The patient recovered without complication and is overtly healthy without radiographic or echocardiographic abnormalities 6-months post-surgery. Constrictive pericarditis should be considered in cats with idiopathic pleural effusion, with or without ascites, in which standard echocardiographic assessment is not suggestive of structural heart disease. If constrictive pericarditis is present, the Doppler characteristics outlined here may allow for this diagnosis to be made. Pericardectomy may be highly rewarding, although the specific etiology of the constrictive pericarditis may remain unknown.

Coccidioidomycosis presenting as a heart base mass in two dogs

Two atypical cases of canine coccidioidomycosis presenting as heart base masses are described. An echocardiogram performed in one of the two dogs revealed a large mass at the base of the heart and a computed tomography scan showed that the mass compressed the bronchi, left atrium, aorta and pulmonary arteries. A firm, white or pale yellow mass was found at the base of the heart at necropsy examination in both cases. Microscopical examination of the masses revealed severe, chronic, locally extensive granulomatous or pyogranulomatous inflammation with intralesional spherules consistent with Coccidioides spp. The diagnosis was further confirmed by immunohistochemistry and in-situ hybridization. Coccidioides spp. have been reported to cause pericarditis in dogs, but this is the first description of coccidioidomycosis mimicking a heart-based tumour in dogs.

Coccidioidomycosis in dogs and cats: a review

The dimorphic fungi Coccidioides immitis and Coccidioides posadasii are the causative agents of coccidioidomycosis. Dogs and cats residing in and visiting endemic areas are at risk of exposure to infectious arthrospores. The primary infection is pulmonary and frequently results in chronic cough. Disseminated disease is common and causes cutaneous, osseous, cardiac, ocular, nervous system, or other organ disease. Radiographic changes include a variable degree of interstitial pulmonary infiltration, hilar lymphadenopathy, and osseous lesions. Serological titers support the diagnosis, but definitive diagnosis relies on identification of Coccidioides in cytological or tissue samples. Coccidioidomycosis should be considered in any dog or cat that has been potentially exposed during the previous 3 years and is presented with chronic illness, respiratory signs, lameness, lymphadenopathy, nonhealing cutaneous lesions, or neurological, ocular, or cardiac abnormalities.

Comparative aspects of coccidioidomycosis in animals and humans

Coccidioides spp. appear capable of infecting all mammals and at least some reptiles. Development of disease as a result of infection is species-dependent. Dogs seem to have a susceptibility similar to that of humans, with subclinical infections, mild-to-severe primary pulmonary disease, and disseminated disease. Whereas central nervous system disease in humans is typically meningitis, brain disease in dogs and cats takes the form of granulomatous parenchymal masses. Osteomyelitis is the most common form of disseminated disease in the dog, while skin lesions predominate in the cat. Orally administered azole antifungal agents are the backbone of therapy in animals as they are in humans.