Full text of DOI:10.1111/j.1751-0813.2000.tb10581.x

Clinical
Pulmonary cryptococcosis and
Capillaria aerophila infection in an
FIV-positive cat
Australian
VETERINARY
JOURNAL
a
a
a
a
VR BARRS , P MARTINb, RG NICOLL , JA BEATTY and R MALIK
Faculty of Veterinary Science, The University of Sydney, New South Wales 2006
C L I N I C A L S E C T I O N
EDITORS
DAVID WATSON
JENI HOOD
A 12-year-old, FIV-positive, domestic longhair cat was presented with a history of
sneezing and coughing during the previous seven months. On thoracic radio-
graphs, a prominent bronchial pattern and three focal, opacified nodules were
seen. Cytology of bronchoalveolar lavage fluid demonstrated spherical, capsulate,
narrow-necked, budding yeasts within macrophages. Culture of the fluid yielded a
heavy growth of Cryptococcus neoformans var neoformans. The serum latex cryp-
tococcal antigen agglutination test titre was 158. The cat was treated with itra-
conazole and the cough resolved over a 5-month period but then recurred. Repeat
thoracic radiographs showed resolution of the pulmonary nodules but a persistent
bronchial pattern. Adult nematodes and ova with morphology characteristic of
Capillaria aerophila were seen in bronchoalveolar lavage fluid and no yeasts were
cultured from the fluid. The cryptococcal titre was zero. The lungworm infection was
treated successfully with abamectin and the cough resolved. Immunosuppression
related to FIV infection may have predisposed this cat to sequential respiratory tract
infections.
ADVISORY COMMITTEE
AVIAN
LUCIO FILIPPICH
EQUINE
DAVID HODGSON
OPHTHALMOLOGY
JEFF SMITH
PRODUCTION ANIMALS
JAKOB MALMO
SMALL ANIMALS
JILL MADDISON
Aust Vet J 2000;78:154-158
SURGERY
Key words: Cryptococcus neoformans, Capillaria aerophila, FIV, cat, ivermectin.
GEOFF ROBINS
AIDS
ALP
ALT
BAL
FIV
Acquired immune deficiency syndrome
Alkaline phosphatase
Alanine transaminase
ZOO/EXOTIC ANIMALS
LARRY VOGELNEST
Bronchoalveolar lavage
EDITORIAL ASSISTANT AND
DESKTOP PUBLISHING
ANNA GALLO
Feline immunodeficiency virus
Latex cryptococcal antigen agglutination test
Orally
LCAT
PO
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On physical examination the cat was
Case Report
tachypnoeic (respiratory rate 54/min)
and mildly increased breath sounds were
auscultated during inspiration and expi-
ration. Heart rate (160/min) and rectal
temperature (38.1oC) were normal. No
murmur was audible and no nasal
discharge was detected. Lower respira-
tory tract disease was suspected and
ventrodorsal and bilateral thoracic radio-
graphs were taken. In the left lateral
projection there were two poorly defined
soft tissue opacities overlying the cardiac
silhouette in the region of the right
middle lung lobe (Figure 1). In the right
lateral projection a well-defined nodule
with soft tissue density was present over-
lying the cardiac silhouette in the region
of the caudal part of the left cranial lung
lobe (Figure 2). In addition, there was a
diffuse bronchial pattern throughout the
remainder of the lung fields.
A 12-year-old, castrated domestic
longhair cat (bodyweight 5.3 kg)
presented to a veterinarian with a 3-
month history of sneezing and coughing. The
cat had unlimited outdoor access. It was
treated with oral prednisolone and
bromhexine hydrochloride (doses un-
recorded) for 10 days for suspected allergic
containing
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bronchitis and rhinitis.The cat improved
initially but then began coughing again.
A short time later the cat was examined
by another veterinarian and found to
have tracheal hypersensitivity and
increased breath sounds on thoracic
auscultation. Referral was recommended
to further evaluate the cat’s respiratory
disease. Four months later the cat was
presented to the University Veterinary
Centre, Sydney. Coughing was now the
major presenting complaint as there had
been no recent history of sneezing.
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AVA House, 272 Brunswick Road,
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An unguided BAL was performed
under general anaesthesia induced with
ketamine, midazolam and atropine and
a
Department of Veterinary Clinical Sciences
b
Department of Veterinary Anatomy and Pathology
Aust Vet J Vol 78, No 3, March 2000
154

Clinical
flushed through the urinary catheter and
retrieved via negative syringe-pressure as
the cat coughed. Many clumps of floc-
culent material were collected for cyto-
logical examination and culture.
Diff-Quik stained smears of the BAL
fluid demonstrated much mucus, some
inspissated Curschmann’s spirals and
scattered ciliated, columnar epithelial
cells. The sample was highly cellular,
consisting of 80% macrophages, 15%
neutrophils, 5% eosinophils and scat-
tered lymphocytes. Many macrophages
contained multiple intracellular, spher-
ical, capsulate, narrow-necked, budding
yeasts. The cytological diagnosis was
cryptococcal
bronchopneumonia.
Culture of the fluid on birdseed agar
yielded a heavy growth of non-mucoid
colonies of C neoformans demonstrating
the brown-colour-effect. The organism
was typed as C neoformans var neofor -
mans at a reference laboratory. The
serum LCAT titre was 128. An FIV
antibody test (Witness, Rhone Merieux)
was positive and a feline leukaemia virus
antigen test (ViraCHEK, Synbiotics)
was negative.
Figure 1. Left lateral thoracic radiograph, showing two poorly defined nodules of soft
tissue opacity (arrows) overlying the cardiac silhouette in the region of the right middle
lung lobe.
Treatment was commenced with itra-
conazole (100 mg PO once daily). Six
weeks later the cat became inappetent.
Serum ALP activity was mildly elevated
(52 U/L, reference range < 50), while
ALT activity was moderately elevated
(239 U/L, reference range < 60).
Thoracic radiographs showed some reso-
lution of the nodules, but the bronchial
pattern and a single focal pulmonary
opacity in the right middle lung lobe
persisted. The serum LCAT titre was
unchanged at 128. Itraconazole was
continued at 50 mg PO once daily then
increased gradually to 100mg PO once
daily with no adverse effects. The owner
declined adjunctive therapy with
amphotericin and/or 5-flucytosine.
Itraconazole therapy was continued
for a further 5 months and during this
time the cat’s cough resolved. The cat
then began to cough again. The owner
(a pharmacist) did not seek veterinary
attention for a further 3 months but
continued to administer itraconazole.
Two weeks prior to the third presenta-
tion, the cat began sneezing and devel-
oped an ocular discharge. On physical
examination the cat had a moist cough,
marked tracheal hypersensitivity and
increased breath sounds on auscultation
of the lung fields. Purulent ocular and
Figure 2. Right lateral thoracic radiograph, showing a well-defined nodule of soft tissue
opacity (arrow) overlying the cardiac silhouette in the region of the caudal part of the left
cranial lung lobe.
maintained using halothane in oxygen.
The cat was intubated with a sterile,
cuffed endotracheal tube (internal diam-
eter 4 mm). The plane of anaesthesia
was lightened until a cough reflex could
be elicited. A sterile urinary catheter
(size 8 French) was gently advanced
through the endotracheal tube until it
became wedged in a bronchus. Two 10
mL aliquots of sterile 0.9% saline were
Aust Vet J Vol 78, No 3, March 2000
155

Clinical
nasal discharges were present. Repeat
thoracic radiographs showed resolution
of the focal pulmonary nodules.
However, a bronchial pattern was
evident and more prominent than previ-
ously. An unguided BAL was repeated
and yielded abundant thick, mucoid
material. Diff-Quik stained smears of
the BAL fluid demonstrated moderate
numbers of inflammatory cells
comprising 67% macrophages, 20%
eosinophils, 11% neutrophils and 2%
lymphocytes. No yeasts were seen. Low-
power, light microscopic examination of
wet preparations of the lavage fluid
revealed three female nematodes,
containing and surrounded by bipolar
operculate ova, with morphological
features characteristic of Capillaria
aerophila (Figures 3 & 4). Culture of the
BAL fluid on birdseed agar, Sabaroud’s
dextrose agar and sheep blood agar
yielded no growth. The serum LCAT
titre was zero. No budding yeasts or C
aerophila ova were seen in cytological
preparations of nasal swabs. On a
routine biochemical and haematological
profile mildly increased ALT activity (81
U/L), a mature neutrophilia (15.6 x
109/L) and lymphocytopaenia (0.8 x
109/L) were detected. Circulating
numbers of eosinophils were within the
reference range (0.34 x 109/L).
prescribed for the upper-respiratory tract
infection (25 mg PO twice daily). At
recheck examination 2 weeks later the
oculonasal discharge and cough had
resolved and a faecal flotation test was
negative for parasitic ova; a second dose
of abamectin was administered (300
mg/kg subcutaneously).
disease process involved airways in addi-
tion to localised regions of pulmonary
parenchyma. Given that the pulmonary
nodules and the cough resolved
following itraconazole therapy, it would
seem most likely that these nodules were
cryptococcal granulomas. However, the
possibility exists that they were pneu-
monic foci surrounding C aerophila
adults or aspirated eggs.2
Infection of cats by C neoformans is
most commonly restricted to the nasal
cavity and adjacent or contiguous struc-
tures, including the nasopharynx. Two
variants (neoformans and gattii) occur, of
which C neoformans var neoformans
more commonly causes clinical disease
in cats in Sydney.3-4 Infectious propag-
ules presumably establish infection
following deposition in the upper respi-
ratory tract. In some cats (< 7%)
subclinical colonisation of the nasal
passages may occur.5 In contrast, in
humans, the lower respiratory tract is
thought to be the primary site of crypto-
coccal deposition and replication
following inhalation. In horses and
koalas, the upper and lower respiratory
tract can both be primary sites of infec-
tion. In this cat it was not possible to
determine if cryptococcal rhinitis
preceded pneumonia, or vice versa,
although the history of sneezing suggests
the former scenario.
Discussion
Solitary lung nodules are rare in the
cat and are most commonly associated
with mycotic pneumonia, primary or
metastatic neoplasia and parasitic granu-
lomas. Less common causes are toxo-
plasmosis, focal pneumonia including
infections caused by Mycobacterium spp,
Rhodococcus spp and Mycoplasma spp,
localised haemorrhage, cysts, infarcts,
feline allergic bronchitis and feline infec-
tious peritonitis.1
Although the initial physical and radi-
ological findings in this case were indica-
tive of lower respiratory tract disease, the
prior history of sneezing suggested the
possibility of an infectious disease
process starting in the nasal cavity with
subsequent extension into the lower
airways. Methods for obtaining a sample
from the lower respiratory tract for cyto-
logical examination and culture include
deep bronchial washing, unguided BAL,
bronchoscopically-guided brushing and
ultrasound-guided fine-needle aspiration
of a pulmonary nodule. Unguided BAL
was chosen in this case because the
diffuse bronchial pattern suggested the
Itraconazole was discontinued and the
cat was treated with abamectin (300
In cats, cryptococcal infection may
spread from the nasal cavity by direct
extension through the cribriform plate
mg/kg subcutaneously), terbutaline (0.6
mg
PO twice daily) and doxycycline was
Figure 3. Wet preparation of bronchoalveolar lavage fluid. Adult
Capillaria aerophila contain and are surrounded by ova. The nema-
todes were thin, had a uterine opening at the oesophageal
intestinal junction and a stichosome (13.2 x).
Figure 4. Wet preparation of bronchoalveolar lavage fluid.
Unembryonated and double-operculated Capillaria aerophila ova
with characteristically asymmetric bipolar plugs (132 x).
156
Aust Vet J Vol 78, No 3, March 2000

Clinical
or haematogenously to cause menin-
goencephalitis.4,6 The disease may also
disseminate via blood or lymphatics to
other tissues including lymph nodes,
skin, lung and kidney.6-7 Concurrent
upper and lower respiratory tract disease
without systemic dissemination, as seen
in this case, has rarely been described. 8
Cryptococcal infections in cats may be
treated with oral triazole drugs including
fluconazole and itraconazole, either
alone or in combination with ampho-
tericin B and flucytosine.4,5 Treatment
using azole drugs alone takes months to
years to effect a cure and concurrent FIV
infection may necessitate longer courses
of therapy.9 Itraconazole may cause
reversible, dose-related, hepatotoxicity
in cats10 as in the present case, although
a 50% reduction in the dosage usually
permits therapy to be continued.
Serology is a useful noninvasive method
of monitoring efficacy of therapy.
Ideally, antifungal therapy should be
continued until the LCAT titre declines
to less than 1.10,11
It is well established that immune
dysfunction, usually resulting from HIV
infection, is a major predisposing factor
for the development of cryptococcosis in
humans .12 Whether the same is true in
cats remains the subject of debate. The
prevalence of FIV infection in cats with
cryptococcosis in Australia has been
reported by Malik et al to be 28%.9
Since this prevalence approximated that
reported among healthy cats in
Australia13 it was interpreted as indi-
cating that FIV-positivity is not a signifi-
cant risk factor for the development of
cryptococcosis. However, subsequent
seroprevalence surveys from the same
region as cats studied by Malik et al
indicated that only 8% of healthy cats
are FIV-positive.14 Although FIV-
infection does not impart an
unfavourable prognosis, affected cats
tend to have advanced and/or dissemi-
nated disease.9,15 It is possible that FIV
infection in this cat was associated with
immune dysfunction manifested clini-
cally as sequential infections including
cryptococcosis, capillariasis and prob-
able viral upper respiratory tract disease.
Quantification of lymphocyte subsets or
viral load may have clarified whether the
cat had an AIDS-like status associated
with long-standing FIV infection.
However, lymphocyte subset numbers
may not be useful as a marker of
immune-dysfunction in FIV-infected
cats since impaired lymphocyte respon-
siveness precedes the decline in CD4 cell
counts and some chronically infected
cats have very low CD4 counts without
obvious clinical immunodeficiency.16-17
In this cat, impaired T-cell immunity
due to FIV infection may have been
associated with an increased propensity
to heavy parasitism by C aerophila and
subsequent development of bronchitis.
The role of T-cell mediated immunity in
nematode infections is well documented
and involves a strong T-helper2 cell-
mediated response.18
Capillaria aerophila and Aeluro-
strongylus abstrusus are nematode lung-
worms that may infect cats. A similar
prevalence (3-5%) has been reported
for both in surveys of Australian cats.19-21
C aerophila, a parasite of foxes, dogs and
cats, most commonly causes subclinical
infections. Clinical disease was common
in foxes farmed for fur where it was asso-
ciated with poor husbandry practices.22
In cats, clinical infections are reportedly
rare but, like A abstrusus, heavy worm
burdens may result in severe bronchitis
sometimes with secondary broncho-
pneumonia.23-27
C aerophila belongs to the family
Trichuridae. The double-operculated
ova of C aerophila may be mistaken for
Trichuris spp when found in faecal
preparations from cats, although they
are smaller (usually less than 70 mm
long), have radial striations and their
asymmetric bipolar plugs are less protru-
berant.23 The life cycle of C aerophila is
direct, although earthworms and
rodents may act as paratenic hosts. Adult
worms reside beneath the epithelium of
trachea, bronchi and bronchioles. In
dogs, C aerophila has been reported to
occur also in the frontal sinuses and
nasal cavity, although, in retrospect
these nematodes were likely mistaken for
C böhmi, a parasite of the frontal sinus
mucosae of the fox, that can be distin-
guished from C aerophila by their ova
which have pitted rather than striated
surfaces.22,28-30
C aerophila ova are shed into the
airways, coughed up, swallowed and
passed in faeces. Infective larvae develop
within the egg and may survive harsh
environments for up to 1 year. Ingested
ova hatch in the intestine and larvae
migrate haematogenously to the lungs
within a week. The prepatent period is 6
weeks and infections remain patent for 8
to 11 months.23 Specific treatment
protocols have not been evaluated but
fenbendazole, levamisole and ivermectin
have been used successfully. Avermectins
are effective for treatment of A abstrusus
infections and appear to be effective in
the treatment of C aerophila infections
in cats at a dose of 300 mg/kg. 30
Allergic bronchitis is the most
common cause of chronic coughing in
cats.31 This case shows that therapeutic
trials with corticosteroids for this condi-
tion should be undertaken with caution
since infectious agents or parasites may
occasionally cause similar signs and
radiographic findings. Unguided BAL
followed by cytological examination and
culture is a simple, cost-effective proce-
dure to facilitate differentiation of these
different disorders.
Acknowledgments
JA Beatty is supported by a Research
Career
Development
Fellowship
awarded by the Wellcome Trust, UK.
Richard Malik is supported by the
Valentine Charlton Bequest adminis-
tered by the Post Graduate Foundation
in Veterinary science of The University
of Sydney.
References:
1.Farrow CS. The thorax. In: Farrow CS, Green R,
Shively M, editors. Radiology of the cat. Mosby, St
Louis, 1994;74.
2. Lautenslager JP. Internal helminths of cats. Vet
Clin North Am 1976;6:353-362.
3. Malik R, Martin P, Wigney DI et al.
Nasopharyngeal cryptococcosis. Aust Vet
J
1997;75:483-488.
4. Malik R, Martin P, Wigney DI, Love DN.
Cryptococcosis in cats: diagnosis and treatment.
In: Feline practice. University of Sydney
Postgraduate Committee in Veterinary Science
Proceedings No 243 1995;49-54.
5. Malik R, Wigney DI, Muir DB et al.
Asymptomatic carriage of Cryptococcus neofor -
mans in the nasal cavity of dogs and cats. J Med
Vet Mycol 1997:35;27-31.
6. Jacobs GJ, Medleau L. Cryptococcosis. In:
Greene CE, editor. Infectious diseases of the dog
and cat. 2nd edn, Saunders, Philadelphia,
1998;383-390.
7. Hamilton TA, Hawkins EC, DeNicoa DB.
Bronchoalveolar lavage and tracheal wash to
determine lung involvement in a cat with crypto-
coccosis. J Am Vet Med Assoc 1991;198:655-656.
8. Jacobs GJ, Greene CE, Medleau L. Feline and
canine cryptococcosis. Waltham Focus 1998;8:21-
27.
9. Malik R, Wigney DI, Muir DB, Gregory DJ, Love
DN. Cryptococcosis in cats:clinical and mycolog-
ical assessment of 29 cases and evaluation of
treatment using orally administered fluconazole. J
Med Mycol 1992;30:133-44.
10. Medleau L, Jacobs GJ, Marks MA.
Itraconazole for the treatment of cryptococcosis in
cats. J Vet Intern Med 1995;9:39-42.
11. Malik R, McPetrie R, Wigney DI, Craig AJ,
Love DN. A latex cryptococcal antigen agglutina-
tion test for diagnosis and monitoring of therapy for
cryptococcosis. Aust Vet J 1996;74:358-364.
12. Mitchell TG, Perfect JR. Cryptococcosis in the
era of AIDS - 100 years after the discovery of
Cryptococcus neoformans. Clin Microbiol Rev
1995;8:515-548.
Aust Vet J Vol 78, No 3, March 2000
157

Clinical
13. Robertson ID, Robinson WF, Alexander R,
Shaw SE, Sutherland RJ. Feline immunodefi-
ciency virus and feline leukaemia virus in cats.
Aust Vet Pract 1990;20:66-69.
London
1997:352:1377-1384.
19. Holmes PR, Kelly JD. Capillaria aerophila in
the domestic cat in Australia. Aust Vet
-
Series B: Biological Sciences.
25. Herman LH. Capillaria aerophila infection in a
cat. Vet Med Sm An Clin 1967;62:466-468.
26. Norsworthy GD. Feline lungworm treatment
case report. Feline Practice 1975;5:3,14.
J
14. Malik R, Kendall K, Cridland
J
et al.
1973;49:472-473.
27. Endres WA. Capillaria aerophila infection in a
cat. Vet Med Sm An Clin 1976;71:1553.
Prevalences of feline leukaemia virus and feline
immunodeficiency virus infections in cats in
Sydney. Aust Vet J 1997;75:323-327.
15. Walker C, Malik R, Canfield PJ. Analysis of
leucocytes and lymphocyte subsets in cats with
naturally occurring cryptococcosis but differing
feline immunodeficiency virus status. Aust Vet J
1995;72:93-96.
16. Hartmann K. Feline immunodeficiency virus
infection: an overview. The Vet J 1998;155:123-137.
17. Burkhard MJ, Hoover EA. Feline immunodefi-
ciency virus (FIV): immunopathogenesis. Part 1.
Feline Practice 1998;26:10-13.
18. Grencis RK. Th2-mediated host protective
immunity to intestinal nematode infections.
Philosophical Transactions of the Royal Society of
20. Wilson-Hanson SL, Prescott CW. A survey for
parasites in cats. Aust Vet J 1982;59:194-195.
21. Milstein TC, Goldsmid JM. Parasites of feral
cats from southern Tasmania and their potential
significance. Aust Vet J 1997;75:218-219.
22. Bowman DB. Nematodes. In: Bowman, DB,
editor. Georgi’s parasitology for veterinarians. 7th
edn, Saunders, Philadelphia, 1999;144-221.
23. Pechman RD. Respiratory parasites. In:
Sherding RD, editor. The cat:disease and clinical
management. 2nd edn. Churchill Livingstone, New
York, 1994:613-622.
28. Evinger JV, Kazacos KR, Cantwell HD.
Ivermectin for treatment of nasal capillariasis in a
dog. J Am Vet Med Assoc 1985;186:174-175.
29. King RR, Greiner EC, Ackerman N, Woodard
JC. Nasal capillariasis in a dog. J Am An Hosp
Assoc 1990:26:381-385.
30. Blagburn BL, Hendrix CM, Lindsay DS,
Vaughan JL. Anthelmintic efficacy of ivermectin in
naturally parasitized cats. Am
J Vet Res
1987;48:670-672.
31. Gruffyd-Jones TJ. Investigation of the
coughing cat. In:Feline Practice. The University of
Sydney Post Graduate Foundation Proceedings
1995;243:171-173.
24. Barrs VR, Swinney GR, Martin P, Nicoll RG.
Concurrent Aelurostrongylus abstrusus infection
and salmonellosis in a kitten. Aust Vet J 1999;
77:11-14.
(Accepted for publication 7 September 1999)
Successful treatment of invasive nasal cryptococcosis in
a ferret
a
c
R MALIK , P MARTINb, J McGILL , A MARTINd and DN LOVEb
Invasive cryptococcal rhinitis due to Cryptococcus neoformans var gattii was diagnosed in a castrated, 5-year-old, albino
ferret with subcutaneous swelling of the nasal bridge. The diagnosis was based on histology, needle aspirate cytology and
positive culture on Sabouraud’s dextrose agar and birdseed agar. The ferret was successfully treated using a long course
of itraconazole (25 to 33 mg orally once daily with food) subsequent to surgical debulking of the lesion, using sequential
cryptococcal antigen titre determinations to guide therapy.
Aust Vet J 2000;78:158-159
LCAT
MIC
Latex cryptococcal antigen agglutination test
Minimum inhibitory concentration
swelling of the bridge of the nose and a
dry unkempt coat. The carer who had
taken over responsibility for the patient
neoformans. The strain was identified as
C neoformans var gattii,2,3 and showed in
vitro susceptibility to amphotericin B,
flucytosine, itraconazole (Etest MIC
0.023 mg/L) and fluconazole (Etest
MIC 0.5 mg/L).
5-year-old castrated albino ferret
from the Central Coast of New
South Wales was surrendered to
A
observed lethargy, coughing and sneezing.
the NSW Ferret Welfare Society because
it had developed a lump on its nose. The
lump had been present for several
months and the ferret was otherwise
well. A subcutaneous swelling on the
nasal bridge immediately caudal to the
nasal plane was excised surgically and
submitted for histological examination.
Cryptococcosis was diagnosed on the
basis of characteristic organism
morphology in tissue sections.1,2 The
ferret was referred to the University
Veterinary Centre, Sydney, for treatment.
Physical findings included residual
Appetite, body weight (1.2 kg) and
neurological function appeared normal.
The ferret was anaesthetised using
isoflurane in a 2:1 mixture of nitrous
The ferret was treated using orally
administered itraconazole (Sporanox,
Janssen Cilag)5 initially at 25 mg once
daily. Dosing was facilitated by mixing a
quarter of the contents of a 100 mg
capsule with a palatable nutritional
supplement gel (Energel, Veterinary
Companies of Australia). After 3 weeks
of therapy the itraconazole dose was
increased to 33 mg daily. The ferret did
well during treatment: appetite was
unchanged or increased, nasal cavity
signs improved and then resolved, and
overall physical status improved concur-
rently. At 171 days after starting itra-
conazole, there was no sign of nasal
cavity disease, swelling of the nasal
bridge was absent, the LCAT titre had
declined (128) and serum alanine
oxide and oxygen delivered using a tight
-
fitting face mask connected to a coaxial
non-rebreathing (Bain) system. Blood
was collected to determine the baseline
LCAT titre (1024) and a fine needle
aspirate was obtained from the nasal
swelling for cytology and fungal culture.
Diff-Quik stained smears from the
aspirates demonstrated numerous spher-
ical capsulate yeasts, many macrophages
and fewer neutrophils and lymphocytes.
a
Department of Veterinary Clinical Sciences, The
University of Sydney, New South Wales 2006
Department of Veterinary Anatomy and
Pathology, The University of Sydney, New South
Wales 2006
New South Wales Ferret Welfare Society, 56
Percival Street, Lilyfield, New South Wales 2040
Hornsby Veterinary Hospital, 11 Leonard Street,
Hornsby, Sydney, New South Wales 2077
A
moderately heavy growth of
b
Cryptococcus neoformans was observed
on Sabouraud’s dextrose agar and bird-
seed agar at 28oC. Colonies on birdseed
agar were mucoid and demonstrated the
brown-colour-effect characteristic of C
c
d
158
Aust Vet J Vol 78, No 3, March 2000