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Cat with Cryptococcus

post #1 of 9
Thread Starter 

Hi,

My cat has had the terrible fungal infection cryptococcus, on his nose, for about 21 months now. 
We first tried Itrafungol for six months this did nothing and the lump on his nose grew larger.
He then gained an infection caused by this which  Amoxycare attended to.
We're currently using 50mg of Fluconazole. This appears to be keeping it at bay yet not fixing the problem. We've been using it since February.
We also turned to a homeopathic remdy called Thuja. This again did nothing.

It's hard to get him to eat due to his lack of smell and taste caused by the nasal infection.

Below are two pictures.




His eyes aren't effected at the moment, this picture was simply taken with him trying to get to sleep.



 


Any help is much appreciated.

Thanks.

post #2 of 9

First of all, I am SO SORRY to hear of your poor sweet kitty having this illness!!! I have not heard of it, and looking at his picture breaks my heart. It sounds as if maybe he is immuno-suppressed, maybe also has FIV or Felv?


I looked this up on the internet just because I have never heard of it before. You probably did the same research as me, so please forgive me if I am repeating something you have doubtless read. But this article says that Amphotericin B is the most effective agent for treatment when there is a chronic situation and other treatments have failed. And it certainly seems like your cat has a quality of life issue considering his poor situation :-( :-( :-(

 

http://veterinarycalendar.dvm360.com/avhc/Medicine/Treating-feline-cryptococcosis-Proceedings/ArticleStandard/Article/detail/598999

 

I also found this other article that discusses this in general, and compares the three treatments, again concluding that Amphotericin B is advised when the condition is severe. Please let me know what you think and whether this is an option for your kitty that you have discussed with your vet. Your boy looks so uncomfortable. I wonder if you can give him a softer e-collar to help him rest better? And am sending you vibes as this must be very hard on you to see him like this for so long and not getting better :-( vibes.gif vibes.gif vibes.gif vibes.gif vibes.gif vibes.gif vibes.gif

 

 

  • Treatment In-depth
     
  • Various antifungal drugs can be used for the treatment of cryptococcosis. 
     
  • Treatment outcome is influenced by FeLV and FIV status; cats seropositive for FeLV or FIV have a higher likelihood of treatment failure. 
     
  • Treatment outcome is not influenced by gender, location of the infection, or magnitude of pretreatment serum antigen titer. 
     
  • The cryptococcal antigen titers of cats successfully treated decreases over time during treatment.
     
  • For cats in which treatment is successful, antigen titers usually decrease significantly from pretreatment values at 2 months after initiation of treatment. By 10 months after initiating treatment, titers decrease by at least 2 orders of magnitude in cats successfully treated. 
     
  • Most patients require prolonged therapy. The average case requires treatment for 6 to 10 months depending on the severity and extent of the disease. 

    Treatments include
     
  • Ketoconazole (Nizoral®) at 10 to 20 mg/kg twice daily with food for 6 to 10 months. Response is not as good as it is with other drugs (e.g. itraconazole). In addition ketoconazole is not well tolerated by cats and frequently causes vomiting and diarrhea. It has the potential to cause hepatitis (liver inflammation).
     
  • Itraconazole is given orally at 10 mg/kg twice daily for 6 to 10 months. It comes in 100 mg capsules (Sporonox®) and in 10 mg/ml solution. The solution appears to have better absorption and bioavailability than the capsules. Adverse effects include vomiting, diarrhea and liver disease. 
     
  • Fluconazole (Diflucan®) orally at 5 to 15 mg/kg once to twice daily for 6 to 10 months. Fluconazole has excellent penetration in the brain and in the eyes. It has better bioavailability than itraconazole. Fewer adverse effects than both ketoconazole and itraconazole. It is not metabolized in the liver, thus it is safe in patients where there is concern regarding liver function. It is eliminated mostly unchanged in the urine. Dose may need to be adjusted in decreased kidney function exists.
     
  • Amphotericin B in cats at 0.1 to 0.5 mg/kg IV 3 times weekly until total cumulative dose of 4 to 10 mg/kg is reached. Kidney toxicity is the main adverse effect.

    Good prognosis is associated with decrease of serum antigen titers. 
     
  • If amphotericin B is used it is recommended to monitor kidney function. If ketoconazole or itraconazole are used then monitoring of liver enzymes is suggested. 
     
  • A simple, practical and inexpensive method of administering amphotericin B as a subcutaneous infusion has been developed. The calculated dose of amphotericin B (0.5 to 0.8 mg/kg) is added to 400 mL of 0.45 percent saline containing 2.5 percent dextrose. These amounts are given subcutaneously 2 or 3 times weekly over several months, to a total cumulative dose of 8 to 26 mg/kg of body weight. Subcutaneous infusions are well tolerated by the animals, although concentrations of amphotericin B in excess of 20 mg/L may result in local irritation. 
     
  • This protocol enables the administration of larger, and thus more effective, quantities of amphotericin B without producing marked kidney impairment.
post #3 of 9
Thread Starter 
Quote:
Originally Posted by BarbB View Post

First of all, I am SO SORRY to hear of your poor sweet kitty having this illness!!! I have not heard of it, and looking at his picture breaks my heart. It sounds as if maybe he is immuno-suppressed, maybe also has FIV or Felv?


I looked this up on the internet just because I have never heard of it before. You probably did the same research as me, so please forgive me if I am repeating something you have doubtless read. But this article says that Amphotericin B is the most effective agent for treatment when there is a chronic situation and other treatments have failed. And it certainly seems like your cat has a quality of life issue considering his poor situation :-( :-( :-(

 

http://veterinarycalendar.dvm360.com/avhc/Medicine/Treating-feline-cryptococcosis-Proceedings/ArticleStandard/Article/detail/598999

 

I also found this other article that discusses this in general, and compares the three treatments, again concluding that Amphotericin B is advised when the condition is severe. Please let me know what you think and whether this is an option for your kitty that you have discussed with your vet. Your boy looks so uncomfortable. I wonder if you can give him a softer e-collar to help him rest better? And am sending you vibes as this must be very hard on you to see him like this for so long and not getting better :-( vibes.gif vibes.gif vibes.gif vibes.gif vibes.gif vibes.gif vibes.gif

 

 

  • Treatment In-depth
     
  • Various antifungal drugs can be used for the treatment of cryptococcosis. 
     
  • Treatment outcome is influenced by FeLV and FIV status; cats seropositive for FeLV or FIV have a higher likelihood of treatment failure. 
     
  • Treatment outcome is not influenced by gender, location of the infection, or magnitude of pretreatment serum antigen titer. 
     
  • The cryptococcal antigen titers of cats successfully treated decreases over time during treatment.
     
  • For cats in which treatment is successful, antigen titers usually decrease significantly from pretreatment values at 2 months after initiation of treatment. By 10 months after initiating treatment, titers decrease by at least 2 orders of magnitude in cats successfully treated. 
     
  • Most patients require prolonged therapy. The average case requires treatment for 6 to 10 months depending on the severity and extent of the disease. 

    Treatments include
     
  • Ketoconazole (Nizoral®) at 10 to 20 mg/kg twice daily with food for 6 to 10 months. Response is not as good as it is with other drugs (e.g. itraconazole). In addition ketoconazole is not well tolerated by cats and frequently causes vomiting and diarrhea. It has the potential to cause hepatitis (liver inflammation).
     
  • Itraconazole is given orally at 10 mg/kg twice daily for 6 to 10 months. It comes in 100 mg capsules (Sporonox®) and in 10 mg/ml solution. The solution appears to have better absorption and bioavailability than the capsules. Adverse effects include vomiting, diarrhea and liver disease. 
     
  • Fluconazole (Diflucan®) orally at 5 to 15 mg/kg once to twice daily for 6 to 10 months. Fluconazole has excellent penetration in the brain and in the eyes. It has better bioavailability than itraconazole. Fewer adverse effects than both ketoconazole and itraconazole. It is not metabolized in the liver, thus it is safe in patients where there is concern regarding liver function. It is eliminated mostly unchanged in the urine. Dose may need to be adjusted in decreased kidney function exists.
     
  • Amphotericin B in cats at 0.1 to 0.5 mg/kg IV 3 times weekly until total cumulative dose of 4 to 10 mg/kg is reached. Kidney toxicity is the main adverse effect.

    Good prognosis is associated with decrease of serum antigen titers. 
     
  • If amphotericin B is used it is recommended to monitor kidney function. If ketoconazole or itraconazole are used then monitoring of liver enzymes is suggested. 
     
  • A simple, practical and inexpensive method of administering amphotericin B as a subcutaneous infusion has been developed. The calculated dose of amphotericin B (0.5 to 0.8 mg/kg) is added to 400 mL of 0.45 percent saline containing 2.5 percent dextrose. These amounts are given subcutaneously 2 or 3 times weekly over several months, to a total cumulative dose of 8 to 26 mg/kg of body weight. Subcutaneous infusions are well tolerated by the animals, although concentrations of amphotericin B in excess of 20 mg/L may result in local irritation. 
     
  • This protocol enables the administration of larger, and thus more effective, quantities of amphotericin B without producing marked kidney impairment.

Thanks for the response. I'd heard of Amphotericin B, however I'd hard Fluconazole was the most effective elsewhere. 

I think we're going to have to go back to the vets to have a word and mention these other drugs.

post #4 of 9

OMG.  This is a bad looking sight.  I am so sorry for what you and your cat are going through.  I would be sitting on my vet's doorstep wanting something else done.  It looks like you have been given some good information by others who have researched this problem.  I hope you have good communication with your vet so you can work together and get this cat some relief.

 

Welcome to The Cat Site.  I am just sorry your first post had to be here with a problem.
 

post #5 of 9

OMG!  Im so sorry for you AND your baby!  I thought Sugar had a problem (well she does, but..).  I hope you can find something that works soon and your kitty his better...I imagine you have gone to more that one vet?  I highly recommend going to a vet that treats cats ONLY.  Sugar has had major over grooming, sores and hair loss issues since Jan. of this year...I took her to a regular vet and they misdiagnosed and medicated her improperly more than once before I took her to an all cats vet......she figured out the underlying problem that had to be dealt with before we could even get where we are now and Sugar is much better.....the regular vet was giving Sugar steroids to try to get the hair to grow back and misdiagnosed her with hyperthyroid (& medicated for it)...I spent a fortune and she only got worse.  My vet that only deals with cats did a simple, in office, inexpensive skin scrape and I knew in 10 mins that she has a bacterial skin infection that we had to get rid of before figuring out the trigger to the whole thing was/is.....which is where we are now......good vibes to you and your kitty!

 

Christy

post #6 of 9

In the UK the best thing for this cat would probably be a referal to one of the Vetinary Schools, but they are expensive.  There are 8 of them spread over the UK, so transport can be an issue for some people as well as cost, but a friend whose cat who kept blocking got a terrific result from his PUS at Glasgow.

post #7 of 9

I'm assuming that your poor cat has Cryptococcosis which is caused by the fungus called Cryptococcus? (I'm in Australia and it may have a different name here)

 

I also have a 14 Y.O. cat 'Pandi' who has this dreadful disease but fortunately for us she is well on her way to recovery.

 

Pandi's nose did not get as bad as your poor puss but she was covered in lesions over 80% of her body including inside her ears, her eyes and mouth. Her nose was far more swollen and lesions bigger than this at her worst, she sneezed bloody mucus continually.

 

 

 

 

We have been treating her with 30mg Fluconazole twice daily for four months now and she is responding extremely well. At first it got much worse and I questioned why I was putting her through this but after a couple of weeks I saw a change for the better. I have my phone alarm set and have been anal about giving her her tablets every 12 hours apart.

 

I would put a 'smorgasboard' of food out for her each day. Our vet told me to give her anything she liked just to get her to eat. Her food choices included fresh cooked salmon, prawns raw and cooked, ham, cheese, chicken breast cooked and raw, tinned sardines and cream. HUMAN FOOD, she has never liked cat food! I'd also warm the food in the microwave, this gives off a smell and makes it more appealing. I sat with her and 'played' with the food moving it around offering it up to her mouth tiny bits at a time. It was heartbreaking when she wouldn't eat a single mouthful.

 

I asked about an Elizabethan collar for Pandi as she continually scratched the scabs off her head and I thought they would never heal but was advised not to get one as it can cause added stress in cats. 

 

I have kept a diary on Pandi's journey with Cryptococcosis, my vet asked me to do it as there is only two known cases of cats suffering with this in Australia at this present time. I will post Pandi's story on this forum.

 

My heart goes out to you, don't give up. 

xxx

post #8 of 9

Hi, I too have a cat with horrible disease. Im on the mid north coast of NSW. he also had multiple lesions, trouble breathing, loss of appetite and constipation. he started on nizoral, but developed neuro probs...staggering etc, apparently from the dead organisms in his brain creating inflammation, lost heaps of weight and developed a urinary tract infection. I stopped all treatment for a month, then started on itraconazole (sporanox). The new lesions cleared quickly, the nasal ones are much slower. His sneezing has stopped, appetite is good, but not much weight gain. he is still constipated and appears confused, he also cries loudly!

 

If you need to try the more expensive meds, shop around and look online, there was hundreds of dollars difference in the price of sporanox.

 

It is a soul destroying , expensive and exhausting illness, but we'll keep trying!

 

Good luck to everyone. Joanie 

post #9 of 9

So sorry for you and your kitty.   :-(

 

As far as appetite is concerned, we are giving our cat mirtzapine, half of a 7.5 mg tab, every three days for appetite stimulation.  I believe this is a canine drug, but it working wonders to get our baby to eat as we treat the underlying causes of his lack of appetite.  At least it keeps him and alive while we keep trying to get him back to health.

 

Good luck.

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