Cat with Cryptococcus

• 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[emoji]174[/emoji]) 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[emoji]174[/emoji]) 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[emoji]174[/emoji]) 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.

BarbB said:

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.co...eedings/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 :-( 

 

 

 

 

 

 

• 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[emoji]174[/emoji]) 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[emoji]174[/emoji]) 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[emoji]174[/emoji]) 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.

Click to expand...

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.

Pandi 21.05.JPG

• ruby6689
• Oct 4, 2012
• 5

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