Cryptococcosis as an emerging systemic mycosis in dogs.

OBJECTIVE: To review the etiology, pathogenesis, and clinical presentations of canine cryptococcosis that are of relevance to veterinary emergency and critical care veterinarians. Diagnosis, treatment, and public health considerations of the disease will also be discussed. ETIOLOGY: Cryptococcosis is a multisystemic disease of dogs, with a predilection for the CNS, caused by encapsulated yeast species of the genus Cryptococcus. The 2 main pathogenic species are Cryptococcus neoformans and Cryptococcus gattii (previously known as C. neoformans var. gattii). Cryptococcosis is an emerging disease in North America, with C. gattii gaining prominence as a cause of serious veterinary and human disease. DIAGNOSIS: Definitive diagnosis is made by serologic (antigen) testing, culture, and identification of the organism using light microscopy. False negatives and false positives, while uncommon, can occur in dogs using commercially available antigen tests. Cytological examination demonstrates the organism in a majority of cases, although culture is more sensitive. Specific media are required to differentiate between C. neoformans and C. gattii. THERAPY: The most commonly used antifungal drugs to treat canine cryptococcosis are azole antifungals and amphotericin B. Some strains of Cryptococcus are resistant to antifungal drugs, especially fluconazole. Cautious use of glucocorticoids in critically affected dogs with CNS presentations can improve outcome. PROGNOSIS: Prognosis is variable and depends on the severity of disease, underlying host immunocompetence, and financial constraints of the owner. Altered mental status in dogs with CNS cryptococcosis is a negative prognostic indicator. © Veterinary Emergency and Critical Care Society 2013.