A treatment monitoring protocol to determine clinical remission in dogs with pulmonary coccidioidomycosis.

Abstract

BACKGROUND: Pulmonary coccidioidomycosis (PC) is a common cause of respiratory tract disease in dogs from endemic regions, but evidence-based guidelines for monitoring treatment and determining remission are lacking. HYPOTHESIS/OBJECTIVES: Describe temporal changes in clinical signs, antibody serology, and thoracic radiographs in dogs with PC, and evaluate the performance of a treatment monitoring protocol to determine clinical remission. ANIMALS: Thirty-one client-owned dogs with newly diagnosed PC. METHODS: A prospective, cohort study. Dogs were examined at diagnosis (T0) and once every 3&#xa0;months (T1-T4) until remission or for a maximum of 12&#xa0;months. Clinical status was assessed using an owner-completed visual analog scale (VAS) representative of the 24&#xa0;hours and 7&#xa0;days that preceded the visit. RESULTS: The 24-hour and 7-day VAS scores increased (ie, clinical signs improved) from T0 (24-hour: mean, 95% confidence interval [CI]; 42.3&#xa0;mm, 35.0-50.2; 7-day: 39.6&#xa0;mm, 31.9-47.3) to T1 (24-hour, 85.7&#xa0;mm, 78.1-93.3, 7-day, 84.4&#xa0;mm, 76.8-92.1, P&#xa0;<&#xa0;.001) with minimal change thereafter. Immunoglobulin G titers decreased from T0 (median, interquartile range [IQR]; 1:16, 1:4-1:32) to T1 (1:2, 1:1-1:8, P&#xa0;<&#xa0;.001) without significant changes thereafter. Eighty-four percent (26/31) of dogs achieved remission in a mean of 258.9&#xa0;days (SD, 108.9), which occurred at T1 (13%, 4/31), T2 (23%, 7/31), T3 (32%, 10/31), and T4 (16%, 5/31). Relapse occurred in 15% (4/26) of dogs. CONCLUSIONS AND CLINICAL IMPORTANCE: Most dogs with PC are expected to achieve remission within 6-9&#xa0;months of starting antifungal treatment, and relapse is not uncommon.