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. 2023 May-Jun;37(3):998-1006.
doi: 10.1111/jvim.16725. Epub 2023 Apr 24.

Clinical utility of fungal culture and antifungal susceptibility in cats and dogs with histoplasmosis

Andrew S Hanzlicek  1   2 , Kate S KuKanich  3 , Audrey K Cook  4 , Steven Hodges  5 , John M Thomason  6 , Rupika DeSilva  7 , Akhilesh Ramachandran  7 , Michelle M Durkin  2
Affiliations

Clinical utility of fungal culture and antifungal susceptibility in cats and dogs with histoplasmosis

Andrew S Hanzlicek et al. J Vet Intern Med. 2023 May-Jun.

Abstract

Background: Culture can be used for diagnosis and antifungal susceptibility testing in animals with fungal infections. Limited information is available regarding the diagnostic performance of culture and the susceptibility patterns of Histoplasma spp. isolates.

Hypothesis/objectives: Describe the clinical utility of culture and the susceptibility patterns of Histoplasma spp. isolates causing histoplasmosis in cats and dogs.

Animals: Seventy-one client-owned animals, including 33 cats and 19 dogs with proven or probable histoplasmosis.

Methods: Culture was attempted from tissue or fluid samples. Diagnostic performance of culture, cytopathology, and antigen detection were compared with final diagnosis. Susceptibility to antifungal agents was determined for a subset (11 from dogs, 9 from cats) of culture isolates.

Results: Culture had a diagnostic sensitivity of 17/33 (52%; 95% confidence interval [CI], 34%-69%) and 15/19 (79%; 95% CI, 61%-97%) and specificity of 6/6 (100%; 95% CI, 54%-100%) and 10/10 (100%; 95% CI, 69%-100%) in cats and dogs, respectively. Culture was not positive in any animal in which cytopathology and antigen testing were negative. Target drug exposure (area under the concentration curve [AUC]/minimum inhibitory concentration [MIC] >25) should be easily achieved for all isolates for itraconazole, voriconazole, or posaconazole. Five of 20 (25%) isolates had fluconazole MIC ≥32 μg/mL and achieving target drug exposure is unlikely.

Conclusions and clinical importance: Fungal culture did not improve diagnostic sensitivity when used with cytopathology and antigen detection. Susceptibility testing might help identify isolates for which fluconazole is less likely to be effective.

Keywords: canine; feline; fungal infection; histoplasma; invasive fungal infection.

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Conflict of interest statement

Audrey K. Cook served as Associate Editor for the Journal of Veterinary Internal Medicine. She was not involved in review of this manuscript. Andrew Hanzlicek and Michelle Durkin are employed by MiraVista Diagnostics which offers commercially the antigen detection assay described in this manuscript. No other authors declare a conflict of interest.

Figures

FIGURE 1
FIGURE 1
Histoplasma spp. isolates from 9 cats and 11 dogs with histoplasmosis and the associated minimum inhibitory concentrations for select antifungal agents. Amp‐B, amphotericin‐b; Flu, fluconazole; Itra, itraconazole; Posa, posaconazole; Terb, terbinafine; Vori, voriconazole.
See this image and copyright information in PMC

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