Treatment of intestinal pythiosis in a dog with a combination of marginal excision, chemotherapy, and immunotherapy.

Abstract

CASE DESCRIPTION:

A 1.5-year-old mixed-breed dog was examined because of a 1-month history of anorexia, vomiting, diarrhea, and weight loss.

CLINICAL FINDINGS:

The dog was very thin on physical examination (body condition score, 3/9). Results of all diagnostic tests were within reference limits except intestinal thickening and lymphadenopathy were identified on abdominal ultrasound examination. During exploratory laparotomy, thickening at the ileocecal-colic junction and within the transverse colon and mesenteric lymphadenopathy were identified, and the ileocecal-colic junction was resected. Histopathologic evaluation of the ileocecal-colic junction and full-thickness biopsy specimens from other sites as well as results of a serum ELISA were diagnostic for gastrointestinal Pythium insidiosum infection.

TREATMENT AND OUTCOME:

Pythiosis was initially treated medically with administration of itraconazole and terbinafine by mouth, but the colonic lesion was progressive with this regimen. Two months after diagnosis, a subtotal colectomy was performed; marginal excision (0.6 cm) was obtained at the aboral margin. The dog was treated with 3 doses of a pythiosis vaccine beginning approximately 2 weeks after surgery and was continued on itraconazole and terbinafine for 5 months. Parenteral and enteral nutrition as well as considerable general supportive care were required postoperatively. Six months after treatment, the dog had a normal serum ELISA titer. Two years after treatment, the dog had returned to preoperative weight and was clinically normal.

CLINICAL RELEVANCE:

This patient had an unusually positive therapeutic response to chronic, extensive, marginally excised gastrointestinal pythiosis.

• Authors: Chad W Schmiedt, Meri Stratton-Phelps, Bryan T Torres, Dennis Bell, Elizabeth W Uhl, Shawn Zimmerman, Jason Epstein, Karen K Cornell
• Journal: Journal of the American Veterinary Medical Association (J Am Vet Med Assoc) Vol. 241 Issue 3 Pg. 358-63 (Aug 01 2012) ISSN: 1943-569X [Electronic] United States
• PMID: 22812473 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Infective Agents
• Fluoroquinolones
• Naphthalenes
• Vaccines
• Itraconazole
• Enrofloxacin
• Terbinafine

Topics

• Animals
• Anti-Infective Agents (administration & dosage, therapeutic use)
• Dog Diseases (microbiology, pathology, therapy)
• Dogs
• Enrofloxacin
• Fluoroquinolones (therapeutic use)
• Intestinal Diseases (microbiology, therapy, veterinary)
• Itraconazole (administration & dosage, therapeutic use)
• Male
• Naphthalenes (administration & dosage, therapeutic use)
• Pythiosis (therapy, veterinary)
• Pythium (immunology)
• Terbinafine
• Vaccines (immunology)