Successful treatment of a severe case of fusariomycosis in a beluga whale (Delphinapterus leucas leucas).
An adult male beluga whale (Delphinapterus leucas leucas) was presented with a 4-cm-diameter, raised, firm nodule on the medial aspect of the left pectoral fin. A fissure developed within the center of the nodule, which formed an ulcerated cyst-like lesion. The lesion rapidly progressed in size, and, with peeling of material present within the cyst, the lesion flattened to a 36 x 25-cm cutaneous ulcer that extended into the axilla. Histopathologic features were consistent with lymphocytic and suppurative dermatitis with intralesional fungi. Fusarium solani was diagnosed by polymerase chain reaction (PCR). Fungal susceptibility testing was performed and revealed drug resistance to multiple antifungal medications tested individually and in combination therapies. Treatments used included serial surgical debridement of affected and surrounding tissue, topical application and regional infusion of various azole, and allylamine antifungals combined with either dimethyl sulfoxide or Tricide for absorption potentiation, and oral voriconazole administration. Although susceptibility testing revealed resistance to voriconazole, visible improvement of the lesion was noted after 6 weeks of oral voriconazole therapy. The voriconazole dosage was tapered based on serum levels and was administered over a 12-mo period. No local recurrence or new lesions were visible by 14 mo from first presentation.
John G. Shedd Aquarium, 1200 S. Lake Shore Drive, Chicago IL 60605, USA. Inaples@sheddaquarium.org
Lisa M
LM
Naples
Caryn P
CP
Poll
Ilze K
IK
Berzins
D000818:Animals; D000836:Animals, Zoo; D000935:Antifungal Agents / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005121:Extremities / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D005670:Fusarium / Q000302:isolation & purification*; D008297:Male; D009181:Mycoses / Q000188:drug therapy / Q000473:pathology / Q000601:surgery / Q000662:veterinary*; D011743:Pyrimidines / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D014230:Triazoles / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D065819:Voriconazole; D014907:Whales
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole