Disseminated Cryptococcosis in a Dog Presented by: Paul G. Gallagher Co-Authors: Natalie Durrett Crawford, Farrah B. Horowitz, D. Phillip Sponenberg Virginia-Maryland Regional College of Veterinary Medicine Virginia Tech, Duck Pond Drive (0442) Blacksburg, VA Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Clinical History  “Phoebe”  Six year old spayed female mixed breed dog  Referred on suspicion of cervical disc disease  Past medical problems  History of chronic otitis, UTI, uroliths  One month history  Ataxia  Inability to lift head  Apparent cervical pain Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Clinical Evaluation  Physical / Neurologic Exam  Severe Respiratory distress  Distended abdomen  Neurologic deficits  No cervical pain  Laboratory data  Respiratory arrest - death Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Gross Lesions  Approximately 50 ml serosanguinous fluid in abdomen  Lungs – diffusely red, slightly firm, small off-white lesions  Pancreas – numerous off-white nodules, one limb dark red / friable  Spleen – numerous dark red/black nodules  Eyes, brain, cervical spinal cord – no gross lesions Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Histologic Lesions Spinal Cord Dorsal Horn Ventral Horn GM WM Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Histologic Lesions Spinal Cord Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Mucicarmine GMS (Grocott’s Methenamine Silver) Special Stains Spinal Cord Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Diagnosis  Morphologic: Spinal cord, granulomatous meningomyelitis with intralesional yeast  Additional Diagnoses  Brain, granulomatous meningoencephalitis  Liver, granulomatous hepatitis  Kidney, multifocal granulomatous interstitial nephritis and glomerulonephritis  Pancreas, diffuse granulomatous pancreatitis  Heart, granulomatous myocarditis  Lung, granulomatous interstitial pneumonia  Eye, granulomatous uveitis with retinal detachment  Disease Diagnosis: Disseminated Cryptococcosis Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Cryptococcus  Dimorphic fungus  C. neoformans  var. grubii  var. neoformans  C. gatti  Transmission  Pathogenesis  Zoonotic?  Humans vs. domestic animals  Dogs vs. cats Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Virulence Factors  Mucopolysaccharide capsule  Ability to replicate at body temperature  Phenoloxidase (laccase)  Serine protease Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Prognosis  Disseminated, CNS disease – guarded  Localized nasal or cutaneous disease – good if treated early and appropriately; guarded for severe or longstanding disease  Poor for resolution of neurologic deficits Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

References  Bovers M, Hagen F, Boekhout T. Diversity of the Cryptococcus neoformans-Cryptococcus gattii species complex. Rev Iberoam Micol 2008;25:S4-S12.  Bartlett KH, Kidd SE, Kronstad JW. The Emergence of Cryptococcus gattii in British Columbia and the Pacific Northwest. Curr Infect Dis Rep 2008;10:  Duncan CG, Stephen C, Campbell J. Evaluation of risk factors for Cryptococcus gattii infection in dogs and cats. J Am Vet Med Assoc 2006;228:  Greene CE. Infectious diseases of the dog and cat. 3rd ed. Philadelphia, Pa. ; London: Elsevier Saunders,  Kerl ME. Update on canine and feline fungal diseases. Vet Clin North Am Small Anim Pract 2003;33:  Maxie MG, Jubb KVF. Pathology of domestic animals. 5th ed. Edinburgh ; New York: Elsevier Saunders,  Nielsen K, De Obaldia AL, Heitman J. Cryptococcus neoformans mates on pigeon guano: implications for the realized ecological niche and globalization. Eukaryot Cell 2007;6: Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Thank You  Dr. Natalie Durrett Crawford  Dr. D. Phillip Sponenberg  Dr. Tanya LeRoith Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Questions?