Peer-reviewed veterinary case report
Cryptococcus bone infection and itraconazole failure in Pesquet's
By Molter, Christine M et al.·Published in Journal of zoo and wildlife medicine : official publication of the American Association of Zoo Veterinarians·2014·View original on PubMed →
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Original publication title: Cryptococcus gattii osteomyelitis and compounded itraconazole treatment failure in a Pesquet's parrot (Psittrichas fulgidus).
- Species:
- bird
Plain-English summary
A 14-year-old female Pesquet's parrot was brought in because she was lethargic and having trouble flying. Blood tests showed a high white blood cell count, and further tests revealed a bone infection caused by a fungus called Cryptococcus gattii. The bird was initially treated with a compounded version of itraconazole, but after two months, she developed new breathing and swallowing problems. The treatment was switched to fluconazole, and after two years, her symptoms improved, although some lesions remained unchanged. The initial treatment failure was likely due to the compounded itraconazole not being absorbed well enough.
People also search for: parrot lethargy treatment · Cryptococcus gattii in birds · itraconazole for bird infections
Abstract
A 14-yr-old female Pesquet's parrot (Psittrichas fulgidus) presented for lethargy and decreased ability to fly. Physical exam was unremarkable. Blood work showed an elevated white blood cell count and a strong positive Aspergillus galactomannan titer. Empirical Aspergillus treatment was initiated with compounded generic itraconazole. Radiographs revealed an irregular osteolytic lesion isolated to the distal right humerus. Bone biopsy of the lesion, cytology, and histopathology were diagnostic for osteomyelitis with intralesional yeasts confirmed to be Cryptococcus gattii on fungal culture. After 2 mo of compounded itraconazole treatment, the bird developed dyspnea and dysphagia due to new Cryptococcus lesions in the proximal trachea and glottis. Plasma itraconazole levels were measured and found to be undetectable; therefore, treatment was changed to fluconazole. Twenty-four months after initial presentation, clinical signs improved, but radiographic and histopathology lesions were static. Initial treatment failure was believed to be due to the use of compounded generic itraconazole, which lacks cyclodextrin, a carrier agent used to improve oral absorption, found in commercial itraconazole.
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Search related cases →Original publication on PubMed: https://pubmed.ncbi.nlm.nih.gov/24712171/