title: Invasive mould infections of the naso-orbital region of cats: a case involving Aspergillus fumigatus and an aetiological review.
abstract: CASE AND CONTEXT: This report describes a cat diagnosed with sinonasal-orbital Aspergillus fumigatus infection using advanced imaging, histopathology and culture. Aetiology, clinical aspects and treatment of this rare and devastating infection are discussed with reference to a literature review of invasive mould (ie, filamentous fungal) infections involving tissues of the naso-orbital region of cats.
  
  
  METHODS
  Invasive fungal infections can present with different localisations (nasal passages, sinuses, orbits, subcutaneous space, palate, etc) depending on the species involved and its means of introduction into the tissues. Localised subcutaneous lesions (swellings, ulcerations, masses, nodules, etc), without concomitant signs of nasal/orbital disease, generally result from traumatic injuries and subsequent inoculation of fungal spores into the subcutaneous space. In contrast, naso-ocular involvement and concurrent signs of nasal disease (nasal discharge, sneezing, masses protruding from the nostrils) generally result from inhalation of spores, with subsequent spread of infection into the nasal planum or penetration of overlying bone and invasion of the subcutaneous space. Aspergillus species typically show such an invasion mechanism and frequently affect orbital tissues. Dematiaceous fungi (ie, filamentous fungi with brown/black hyphae) are reported to cause solitary, less invasive, slowly developing lesions, probably as a result of traumatic injuries with inoculation of fungal propagules. Accordingly, the subcutaneous space is more frequently primarily involved.
  
  
  RESULTS
  Whatever the mould species, reported treatment options include surgery and a series of antifungal drugs. The outcome is frequently poor, especially for Aspergillus infections, although various measures can be taken to maximise the chances of success, as discussed in this report.
authors.affiliation: Studio Veterinario Oculistico, Torino, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Giordano
authors.forename: Paola
authors.initials: P
authors.lastname: Gianella
authors.forename: Stefano
authors.initials: S
authors.lastname: Bo
authors.forename: Antonella
authors.initials: A
authors.lastname: Vercelli
authors.forename: Chiara
authors.initials: C
authors.lastname: Giudice
authors.forename: Daniele
authors.initials: D
authors.lastname: Della Santa
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Tortorano
authors.forename: Claudio
authors.initials: C
authors.lastname: Peruccio
authors.forename: Andrea
authors.initials: A
authors.lastname: Peano
mesh_terms: D000818:Animals; D001228:Aspergillosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy / Q000662:veterinary*; D001232:Aspergillus fumigatus / Q000302:isolation & purification / Q000472:pathogenicity*; D002371:Cat Diseases / Q000382:microbiology* / Q000628:therapy; D002415:Cats; D008297:Male; D009668:Nose Diseases / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy / Q000662:veterinary*; D009916:Orbital Diseases / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy / Q000662:veterinary*
references.citation: Mycoses. 2006;49 Suppl 1:7-16
references.pmid: 16961576
references.citation: Aust Vet J. 2007 Mar;85(3):N23
references.pmid: 17385254
references.citation: J Feline Med Surg. 2009 Aug;11(8):720-3
references.pmid: 19553150
references.citation: Antimicrob Agents Chemother. 2008 Apr;52(4):1244-51
references.pmid: 18212093
references.citation: J Small Anim Pract. 2001 Feb;42(2):75-8
references.pmid: 11263702
references.citation: Med Mycol. 2009;47 Suppl 1:S315-23
references.pmid: 18608893
references.citation: Am J Otolaryngol. 2008 Jan-Feb;29(1):24-30
references.pmid: 18061828
references.citation: J Am Vet Med Assoc. 1988 Nov 1;193(9):1101-3
references.pmid: 3198465
references.citation: J Am Vet Med Assoc. 2003 May 15;222(10):1380-4, 1365
references.pmid: 12762382
references.citation: Vet Ophthalmol. 2009 May-Jun;12(3):176-82
references.pmid: 19392877
references.citation: Mycoses. 2008 Jul;51(4):360-1
references.pmid: 18855848
references.citation: J Feline Med Surg. 2002 Sep;4(3):157-63
references.pmid: 12360955
references.citation: Aust Vet J. 1996 Apr;73(4):124-8
references.pmid: 8660225
references.citation: Hautarzt. 1981 Nov;32(11):567-70
references.pmid: 7309510
references.citation: Antimicrob Agents Chemother. 2002 Feb;46(2):556-7
references.pmid: 11796377
references.citation: Vet Rec. 2004 Sep 18;155(12):368-70
references.pmid: 15493606
references.citation: J Am Anim Hosp Assoc. 2006 Jul-Aug;42(4):302-7
references.pmid: 16822770
references.citation: J Am Vet Med Assoc. 1998 Aug 15;213(4):507-9
references.pmid: 9713533
references.citation: J Am Vet Med Assoc. 2009 Nov 15;235(10):1188-93
references.pmid: 19912040
references.citation: J Feline Med Surg. 2009 Aug;11(8):621-3
references.pmid: 19574075
references.citation: Curr Med Res Opin. 2004 Apr;20(4):485-504
references.pmid: 15119986
references.citation: N Z Vet J. 1990 Sep;38(3):123
references.pmid: 16031596
references.citation: Clin Ther. 2007 Sep;29(9):1862-86
references.pmid: 18035188
references.citation: Med Mycol. 2004 Oct;42(5):449-60
references.pmid: 15552647
references.citation: J Feline Med Surg. 2004 Dec;6(6):383-90
references.pmid: 15546771
references.citation: Vector Borne Zoonotic Dis. 2010 Mar;10(2):135-41
references.pmid: 19514808
references.citation: J Am Vet Med Assoc. 1984 Jan 1;184(1):93-4
references.pmid: 6321414
references.citation: Can Vet J. 1984 Mar;25(3):130-4
references.pmid: 17422372
references.citation: J Comp Pathol. 1982 Jul;92(3):479
references.pmid: 6890562
references.citation: Mycoses. 1993 Nov-Dec;36(11-12):451-4
references.pmid: 7935583
references.citation: Jpn J Ophthalmol. 2007 Jul-Aug;51(4):309-11
references.pmid: 17660997
references.citation: Clin Infect Dis. 1996 May;22 Suppl 2:S148-53
references.pmid: 8722843
references.citation: Clin Infect Dis. 2008 Feb 1;46(3):327-60
references.pmid: 18177225
references.citation: Vet Clin North Am Small Anim Pract. 2000 Sep;30(5):1029-50
references.pmid: 11033873
references.citation: Future Microbiol. 2009 Nov;4(9):1185-222
references.pmid: 19895220
references.citation: J Vet Intern Med. 2008 Jul-Aug;22(4):851-9
references.pmid: 18647155
references.citation: Br J Ophthalmol. 2004 May;88(5):681-7
references.pmid: 15090423
references.citation: Can Vet J. 1982 Feb;23(2):48-9
references.pmid: 17422109
references.citation: Stud Mycol. 2007;59:147-203
references.pmid: 18490953
references.citation: Vet Radiol Ultrasound. 1997 May-Jun;38(3):208-10
references.pmid: 9238792
references.citation: J Med Vet Mycol. 1989;27(4):257-64
references.pmid: 2795405
references.citation: Eukaryot Cell. 2006 Oct;5(10):1705-12
references.pmid: 17030996
references.citation: J Am Anim Hosp Assoc. 2000 Jul-Aug;36(4):343-7
references.pmid: 10914535
references.citation: Surv Ophthalmol. 1996 Sep-Oct;41(2):142-54
references.pmid: 8890440
references.citation: Can J Infect Dis Med Microbiol. 2008 Jul;19(4):297-305
references.pmid: 19436511
references.citation: J Feline Med Surg. 2005 Feb;7(1):53-8
references.pmid: 15686974
references.citation: Vet Dermatol. 2001 Oct;12(5):297-301
references.pmid: 11906656
references.citation: Med Mycol. 2009;47(6):625-39
references.pmid: 19306217
references.citation: J Vet Intern Med. 2008 Jul-Aug;22(4):839-43
references.pmid: 18482276
references.citation: J Clin Microbiol. 2007 Feb;45(2):380-5
references.pmid: 17122000
references.citation: J Feline Med Surg. 2009 Apr;11(4):332-6
references.pmid: 18848796
references.citation: Vet Ophthalmol. 2010 May;13(3):190-203
references.pmid: 20500720
references.citation: Vet Rec. 2008 Mar 29;162(13):415-6
references.pmid: 18375987
references.citation: J Vet Intern Med. 1994 Nov-Dec;8(6):409-13
references.pmid: 7884727
references.citation: J Med Vet Mycol. 1994;32 Suppl 1:329-49
references.pmid: 7722796
references.citation: J Am Vet Med Assoc. 1980 Mar 1;176(5):449-51
references.pmid: 7358563