Aspergillosis

RE: Aspergillosis

Andrew Kent — Thu, 12 May 2016 20:20:07 GMT

Everybody will give you different advice about aspergillosis and suggest different techniques - which goes to show that the evidence for any of them over the other is lacking.

My own view (which I believe is supported by the evidence both published and unpublished) is that the most significant factor in probability of success is completeness of debridement. In the cases I see most dogs have the bulk of disease within the nose which means (again in my view) that endoscopic management is often the best approach and is my first line treatment.

I do use enilconazole with the foley technique afterwards (which now only needs to be left dwelling for 15 mins as this has been shown to be equivalent to 1 hour) but I don't feel this is a significant factor in success.

There is a nice review in Veterinary Clinics of North America (Vol 37-5) if you are looking for more guidance.

Good luck!

Andy

RE: Aspergillosis

Hannah Wynne Richards — Thu, 12 May 2016 18:29:57 GMT

Make sure you've got blood available for transfusion before you start - noses bleed!

Wynne

RE: Aspergillosis

grumpyoldman — Thu, 12 May 2016 17:48:56 GMT

use a 4-5 mm orthopaedic drill , place it in a hand chuck so that the cutting edge only protrudes 5 mm , The bone is soft and thin over the sinus and is easy to drill through just with a few hand turns . Use a lateral head X-ray to locate the frontal sinuses in relation to the orbits . ID the midline and drill 10mm lateral to it over the middle of the sinus ,Make a cluster of holes ,then use Rongeurs to joint them up . Evacuate all the crud from the sinus. The ostia at the rostra-ventral aspect of the sinus is often small furred up and not draining properly so you need to scrape it out and widen it slightly to pass the cut off drip set or nasogastric tube your using to flush it with . Depending upon the dog I would use 20ml Imaverol tid for 1 week .

RE: Aspergillosis

ashvetenry — Thu, 12 May 2016 17:34:04 GMT

I know this is reviving a very old thread but can you advise how this is done please? Jamshidi needles are advised in the 2013 In Practice article but what gauge for eg a 25kg dog and what volume is flushed through each side and what volume of cream is instilled? What are the landmarks etc for the trephination- I have been unable to find a good description of the procedure anywhere.

Many thanks,

Ashley.

Re: Aspergillosis

karen jones — Wed, 24 Sep 2014 21:24:32 GMT

Thank you for your help , liquid canestan ordered, method using Foley catheters researched next need to find a slot to do And there we go. Malcolm we haven't got any pessaries from boots either .....

Re: Aspergillosis

karen jones — Wed, 24 Sep 2014 19:39:56 GMT

Ordered in canestan liquid from Henry schein, found some instructions on using Foley catheters etc and now to find a slot when we can do it. Thanks for all your help and no haven't bought pessaries from boots ....

Re: Aspergillosis

Tim Charlesworth — Wed, 24 Sep 2014 18:53:24 GMT

Forgot to say that our medic always treats them w/o trephination. Surgeon's don't mind drilling holes and don't have as much patience though and (as the Sharman review points out) there really isn't much in it,

Tim

Re: Aspergillosis

Tim Charlesworth — Wed, 24 Sep 2014 18:51:48 GMT

Most of the above (otomax? ) are reasonable options. We tend to use sinus trephination, flush through with clotrimazole solution and then place depot canesten cream into the sinuses. It does involve surgery but it's much faster then the 1hr soaks and doesn't require rhinoscopic debridement which is beyond my skill set.

Whatever you use, it's important to do follow up rhinoscopy to see if lesions are resolving (usually 4weeks or so at which point you can repeat the proceudre if needed). It's a really annoying disease to diagnose in the first place as there are multiple other causes of turbinate destruction that need to be considered. Also worth checking that the cribriform plate is intact before you put anything down that may be "irritant" to the meninges.

Tim

Re: Aspergillosis

Ceri Gruffudd Jones — Wed, 24 Sep 2014 17:39:20 GMT

I have also had success in one case with systemic itraconazole where the owner declined procedures that needed GA. They were aware of potential hepatic side effects (not seen) and prepared for the vast expense of a 10 week course of treatment with oral itrafungol. I know the published cure rates are lower wit systemic rather than topical but it's worth remembering there is another option.

Re: Aspergillosis

Amy Lam — Wed, 24 Sep 2014 13:28:20 GMT

[quote user="karen jones"]What are people using to treat aspergillosis in a dogs nose? The books say clotimazole but are having difficulty sourcing some.[/quote]

I would do the following

ensure you remove (nasal - scope or trephine sinus - scope) all fungal plaques
solution enconazole or clotrimazole ( if no erosion through the cribiform plate on ct)
pack sinuses with canasten or put in catheters into the frontal sinuses for twice daily eniconazole application

These methods have the best success, but many dogs need 2-3 treatments. There's about 90% cure rate with aggressive therapy

It's a messy and reasonably expensive disease to treat properly, but very good response for a serious fungal infection

Good luck!

Amy Lam
Registrar in Small Animal Medicine

Re: Aspergillosis

Evelyn Barbour-Hill — Wed, 24 Sep 2014 12:35:33 GMT

[quote user="karen jones"]We have canestan cream on shelf but where are people getting the flush version from?

[/quote]

Centaur have Canesten liquid. I use it straight out of the bottle.

I think of it as more of a soak or bath than as a flush. Anyway, it seems to me that the problem is getting it into all the nooks and crannies and keeping it in contact with the fungus for long enough.

Re: Aspergillosis

Rob Reid — Wed, 24 Sep 2014 11:18:11 GMT

I've had good success using topical canesten solution instilled non-surgically via the nostril. I use Foley catheters to occlude the nostrils and a large Foley placed orally behind the soft palate and packed with swabs and instil Canesten mixed in propylene glycol into each sinus via a polypropylene catheter placed alongside the Foley in each nostril. The procedure takes an hour and I turn the patient every 15 minutes to try and get maximum coverage.

The procedure is described in more detail (exact doses etc) in a paper somewhere - I have it at work, but I'm off this week so I'm afraid I don't have the reference to hand. It's very easy to perform, but make sure the patient gets good pain relief afterwards. In one case I had to repeat the procedure 1 month later for resolution, but in the others I've done (5 in total) I've not needed to.

Re: Aspergillosis

Hannah Wynne Richards — Wed, 24 Sep 2014 10:38:39 GMT

The problem with flushing is it doesn't always treat the depths of the sinuses. The "old-fashioned " treatment was thibendazole tabs for 6 weeks. I'm not sure if mebendazole would work, but it's theoretically reasonable.

Wynne

PS Don't give a scrip for this one - if owners take it to the chemist, they tend to get acutely embarrassed if the chemist jumps to the (reasonable) conclusion that their childen have worms!

Re: Aspergillosis

karen jones — Wed, 24 Sep 2014 07:50:30 GMT

We have canestan cream on shelf but where are people getting the flush version from?

Re: Aspergillosis

Malcolm Ness — Tue, 23 Sep 2014 22:41:59 GMT

[quote user="Evelyn Barbour-Hill"]Now who will dare to try pessaries in the sinuses....? [/quote]

It's a very, very long way up!

Re: Aspergillosis

Evelyn Barbour-Hill — Tue, 23 Sep 2014 22:34:20 GMT

I've just checked, clotrimazole as Canesten seems to be readily available as both liquid and cream (also pessaries!)

Kudos to the bloke who first dared to try filling the sinuses with cream. Personally, I'd still do the liquid sloshing as well.

Anecdote: I did once, several years ago, in despair, use Otomax in the sinuses. It worked. But I'm not suggesting that as a good idea.

Now who will dare to try pessaries in the sinuses....?

Re: Aspergillosis

Nicola Lawlor — Tue, 23 Sep 2014 22:19:50 GMT

Last time I had one of these I used Canestan cream which I filled into the sinuses. Did the job brilliantly and was so much easier than the nasal flushing with the solution.

Re: Aspergillosis

Louise6732 — Tue, 23 Sep 2014 22:10:33 GMT

The JSAP article from 2012 is free access, an interesting read:

Sinonasal aspergillosis in dogs: a review

Journal of Small Animal Practice Volume 53, Issue 8, August 2012, Pages: 434–444,

M. J. Sharman and C. S. Mansfield

Louise

Re: Aspergillosis

Rob Loxley — Tue, 23 Sep 2014 20:43:37 GMT

canesten flush from the frontal sinus and depot canesten cream in sinus?