Today's Veterinary Practice

MAR-APR 2018

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PEER REVIEWED 84 AVIAN ASPERGILLOSIS toxic because it binds to cholesterol. 3 Because of poor bioavailability, it must be given via the IV route. A variety of dosages can be given ( BOX 2 ). Amphotericin B is the drug of choice that can be administered directly into the granuloma during endoscopic evaluation. Itraconazole can be administered alone ( BOX 2 ); however, its effectiveness increases when it is combined with nebulized clotrimazole and/or IV or nebulized amphotericin B. 1 African grey parrots are very sensitive to itraconazole, and toxicosis has occurred at higher doses in this species. In this species, the dose should not exceed 5 mg/kg q24 h. 1 Inappetence and depression are the most common adverse effects associated with itraconazole in African grey parrots. 3 Fluconazole is typically less effective than itraconazole. 1 It is fungistatic and typically used for ocular or central nervous system mycosis. 1,3 It is the only antimycotic that can be administered via the SC route, but its therapeutic effect is limited. 3 Clotrimazole, a fungicidal and fungistatic, and terbinafine hydrochloride, known to penetrate mycotic granulomas, may also be good therapeutic choices ( BOX 2 ). Other medications that can be considered include the following: ■ Ketoconazole, a fungistatic with known resistance in the population. ■ Enilconazole, a fungistatic and fungicidal that can be used as a prophylactic or aerosolized treatment at a dose of 2 mg of medication per 1 mL of saline q12h for 30 minutes or an intratracheal dosage diluted and administered at 0.5 mL. ■ Voriconazole, which has been reported to be more effective than amphotericin B and itraconazole, but is hepatotoxic. 3 ■ F10, a newer medication available in the United States that can be used at a dilution of 1:250 to 1:50 for nebulization and as a sinus flush. 6,7 F10 contains the active ingredients benzalkonium chloride (0.22 mg/mL) and polyhexanide (0.02 mg/mL), which have not been shown to have adverse reactions at the recommended solution. 7 F10 super concentrate has been useful in treating secondary infection of respiratory aspergillosis. 8 No current antifungal has been developed for nebulization, but terbinafine, amphotericin B, enilconazole, and clotrimazole have been diluted and used. Systemic side effects are rare. This route of administration is useful because of the minimal stress it causes and its ability to provide both prophylactic and prolonged treatment. Oral administration is common and preferred due to potential organ toxicity associated with IV administration. Absorption, however, varies by species. Topical applications, including natamycin, enilconazole, and clotrimazole, can be formulated as ointments and are used more often for dermal or ocular infections. 3 Treatment of granulomas typically involves debulking and/or excision through surgery or endoscopy. 1 Surgical removal of granulomas can be an option to improve the treatment response. 3,4 Vaccination (eg, killed, whole cell) has been attempted through various routes (intramuscular, transcutaneous, subcutaneous), but results were variable and inconclusive. 4,9 No vaccine has yet been developed for immunization. PROGNOSIS Prognosis depends on the severity of each case (based on such factors as chronicity, immune status, and species). 1 An uncomplicated case typically has a good prognosis. Months- long treatment is not uncommon. If the underlying source is not identified, a bird can be reinfected after successful treatment. Prognosis depends on the severity of each case (based on such factors as chronicity, immune status, and species). 1

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