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Short Communications
Coccidioidomycosis in a
cat imported from the
USA to Portugal
I. Amorim, M. J. Colimão, P. P. Cortez,
P. Dias Pereira
COCCIDIOIDOMYCOSIS is a mycotic infection caused by the
dimorphic fungus Coccidioides species (C immitis and C posadasii) that
affects both human beings and domestic animals (Gross and others
2005, Barker and others 2007, Caswell and Williams 2007, Parish
and Blair 2008). Inhalation of airborne arthroconidia is responsible
for a systemic disease in animals characterised by fever, anorexia,
depression, cough and dyspnoea (Gross and others 2005, Caswell and
Williams 2007). Neurological, ophthalmological, cardiac and osseous
manifestations have also been reported (Caswell and Williams 2007,
Shubitz 2007, Graupmann-Kuzma and others 2008). Less commonly,
local inoculation of Coccidioides species may produce a solitary cutane-
ous lesion, usually without systemic involvement (Plotnick and oth-
ers 1997, Gross and others 2005). Coccidioidomycosis is an endemic
zoonosis in the south-western USA, northern Mexico and some
areas of Central and South America, and remains very rare outside
endemic regions (Caswell and Williams 2007, Parish and Blair 2008).
However, at a time when the movement of people and their com-
panion animals is increasingly common, it is important to be aware
that they can carry a variety of infectious agents from endemic to
disease-free regions, thus contributing to the emergence of imported
diseases. In fact, during the past decade, some cases of coccidioidomy-
cosis have been reported in European and Asian citizens who had trav-
elled to endemic areas (Chandesris and others 2008, Hombach and
others 2008, Indhirajanti and others 2009, Kwok and others 2009).
However, to date there are no documented cases of coccidioidal infec-
tion in animals outside endemic regions.
This short communication describes a case of coccidioidomycosis
in Europe, imported by a cat travelling from the south-western USA.
A four-year-old male domestic shorthair cat, born and resident
in the state of Texas, was brought to Portugal by its owners. A few
months after arriving in Europe, the animal was presented for clini-
cal evaluation. The cat had previously been neutered, vaccinated and
treated for both internal and external parasites in the USA. Serological
tests demonstrated that the animal was negative for feline leukaemia
virus and feline immunodeficiency virus. The cat had a cutaneous
nodular swelling 1 cm in diameter, that was centrally ulcerated with a
fistulous draining tract associated with seropurulent discharge, in the
Veterinary Record (2011) 169, 232a doi: 10.1136/vr.d4225
I. Amorim, DVM, Correspondence to Dr Dias Pereira,
P. P. Cortez, DVM, MSc, e-mail: pdiaspereira@yahoo.com.br
P. Dias Pereira, DVM, PhD,
Instituto de Ciências Biomédicas Abel Provenance: not commissioned;
Salazar, Universidade do Porto, Largo externally peer reviewed
Prof Abel Salazar 2, 4099-003 Porto,
Portugal Published Online First: 16 July 2011
M. J. Colimão, DVM,
Clínica Veterinária do Ferrel, Quinta
dos Areões, Espiche, 8600-109 Lagos,
Portugal
Short Communications
left thoracic area. The animal did not show any clinical signs other
than the dermatological lesion. A presumptive diagnosis of cutaneous
abscess, probably resulting from infection of a penetrating wound,
was established on the basis of the clinical characteristics of the lesion
and the absence of further clinical signs. The lesion was surgically
drained and systemic antibiotic (25 mg/kg enrofloxacin administered
orally once daily for 10 days) and corticosteroid (2.5 mg/kg pred-
nisolone administered orally once daily for four days, followed by
1.25 mg/kg once daily for a further four days) treatment was started.
The animal was re-evaluated three weeks later; although smaller,
the lesion had not resolved completely, and two further cutaneous
draining nodules were observed in the axillary and inguinal areas,
measuring 1 cm and 2 cm in diameter, respectively. The lesions were
surgically removed, fixed in 10 per cent formalin and submitted for
histological examination. Samples were processed routinely and sec-
tions were stained with haematoxylin and eosin and periodic acid-
Schiff (PAS) stains. Histological examination revealed an exuberant
pyogranulomatous inflammatory reaction, mainly consisting of mac-
rophages, neutrophils and fewer plasma cells, located in the subcuta-
neous adipose tissue and extending to subjacent muscular bundles.
Several large, spherical, PAS-positive double-walled organisms, whose
morphological features were consistent with Coccidioides spherules,
were found immersed in the inflammatory infiltrate (Fig 1). On the
basis of the morphological and histochemical findings, a diagnosis of
coccidioidomycosis was made.
The animal’s physical condition worsened and signs of systemic
disease became evident, including depression, anorexia and weight
loss. A systemic antifungal treatment (5 mg/kg itraconazole admin-
istered orally once daily) was started immediately after the diagno-
sis of coccidioidomycosis; however, the animal died one week later.
Postmortem examination was not allowed.
The cat lived with a dog that did not show signs of systemic or
dermatological disease. Neither the owners nor the veterinary staff
exhibited symptoms of the disease. Serological analyses (immunodif-
fusion and haemagglutination tests) were performed in people who
were in close contact with the cat, because of the epidemiological
importance of the disease and its possible impact on community
health. Although no clinical symptoms were apparent, some of the
veterinary staff (namely, the veterinary clinician and a nurse) showed
elevated anti-Coccidioides antibody titres, indicating a previous con-
tact with the agent. Neither of these personnel had recently travelled
to regions where Coccidioides species is endemic, suggesting that the
contact with the fungus had occurred as a consequence of the clini-
cal management of the cat. Coccidioidomycosis is most commonly
acquired by the inhalation of aerosolised arthroconidia or by traumatic
percutaneous implantation; in addition, although not common, the
transmission of coccidioidomycosis from a cat to a human being,
attributed to a cat bite, has been described (Gaidici and Saubolle 2009).
Additional serological tests carried out on the veterinary staff to inves-
tigate the presence of Coccidioides antigens were negative.
Coccidioidomycosis is an endemic zoonotic mycosis in the
south-western USA (especially in California and Arizona) and in
some regions of Central and South America (Gross and others 2005,
Caswell and Williams 2007, Sunenshine and others 2007, Parish and
Blair 2008). The incidence of the disease in people in the USA has
greatly increased during the past decades; in Arizona, the incidence of
coccidioidomycosis increased from 12 new cases per 100,000 popula-
tion in 1995 to 58.2 new cases per 100,000 population in 2005 (Parish
and Blair 2008). Coccidioidal infection has also been extensively
documented in several animal species in endemic areas, including
domestic livestock, some wildlife species, primates, marine mammals,
and domestic dogs and cats (Shubitz 2007). Shubitz and others (2005)
estimated that coccidioidomycosis affects approximately 4 per cent
of the population of dogs in counties in Arizona where the infection
is endemic, with a higher risk observed in dogs that spend more time
outdoors (Butkiewicz and others 2005).
August 27, 2011 | Veterinary Record
 Downloaded from http://veterinaryrecord.bmj.com/ on September 15, 2016 - Published by group.bmj.com
Short Communications
(a)
(b)
FIG 1: (a) Coccidioides organisms surrounded by large
macrophages and neutrophils in a cutaneous lesion from a cat.
Haematoxylin and eosin. x 400. (b) The causative organisms are
large, spherical and periodic acid-Schiff (PAS)-positive. PAS. x 400
Recently, some cases of coccidioidomycosis in human beings
were reported in Europe and Asia; in each case there was a history of
travel to endemic regions (Chandesris and others 2008, Hombach and
others 2008, Indhirajanti and others 2009, Kwok and others 2009).
However, to the best of the authors’ knowledge, no cases of coccidi-
oidal infection in animals from outside endemic areas have been previ-
ously reported.
In recent years, it has become increasingly common for com-
panion animals to be brought by their owners to foreign countries.
Travellers and their pets are potential sources of a large number of
infectious pathogens, contributing to the emergence of several import-
ed diseases (Miyaji and Kamei 2003). As more people and animals
travel around the world, many diseases will not remain truly endemic
in nature, but will increase their geographical boundaries, extending to
non-endemic areas.
To face this serious, increasing global-scale problem, careful sur-
veillance efforts should be made. Obtaining an animal’s travel history
is essential in all new consultations, especially when considering pets
imported from or travelling to tropical regions; this will allow the vet-
erinarian to consider unexpected and exotic diseases in the differential
diagnosis for the presenting complaint. This will also constitute a
valuable tool in the selection of the most appropriate complementary
diagnostic examinations in order to reach a definitive diagnosis and
Veterinary Record | August 27, 2011
timely institution of adequate treatment. Furthermore, this informa-
tion is crucial for the development of epidemiological surveillance
strategies and to establish prophylactic programmes in order to control
and limit the spread of exotic diseases.
This short communication illustrates the challenge in making a
diagnosis of coccidioidomycosis in non-endemic areas. In cats, ulcer-
ated non-healing cutaneous lesions, which may mimic a wound infec-
tion, constitute a common clinical presentation of the disease. Both
conditions can easily be mistaken for each other, as occurred at the
initial stage in the present case. Therefore, the cat initially received
treatment with the antibiotic enrofloxacin. Despite the previously
reported risk of retinal degeneration associated with the administra-
tion of enrofloxacin to cats (Gelatt and others 2001, Ford and others
2007), the cat showed no signs of ophthalmic pathology in the course
of the treatment. The cat was also treated with the corticosteroid pred-
nisolone at the time of initial presentation of the cutaneous lesion,
which could have contributed to the dissemination of infection due
to the immunosuppressive effects of this drug. This short commu-
nication is intended to alert veterinary clinicians and pathologists in
Europe to the emergence of unexpected exotic diseases, and specifi-
cally coccidioidomycosis, which must be considered as differential
diagnoses when examining animals with a history of travel.
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 Downloaded from http://veterinaryrecord.bmj.com/ on September 15, 2016 - Published by group.bmj.com

Coccidioidomycosis in a cat imported from

the USA to Portugal
I. Amorim, M. J. Colimão, P. P. Cortez and P. Dias Pereira

Veterinary Record 2011 169: 232 originally published online July 16, 2011
doi: 10.1136/vr.d4225

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References This article cites 16 articles, 3 of which you can access for free at:
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