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Feline Ocular Histoplasmosis, Comparison With Human Presumed Ocular Histoplasmosis Syndrome
(POHS).
Leandro Teixeira COPLOW fellow
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Histoplasma Capsulatum
Sporothrixschenkii
Coccidioides Immitis
Aspergillus sp.
Blastomycesdermatitidis
Deep mycoticinfections
Cryptococcus neoformans
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Histoplasma Capsulatum
Sporothrixschenkii
Coccidioides Immitis
Aspergillus sp.
Blastomycesdermatitidis
Deep mycoticinfections
Cryptococcus neoformans
Davies & Troy, 1996
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Major mycotic infectionsAreas of high environmental concentration
Hi HistoplasmosisCoccidiomycosis
BlastomycosisAdapted Wolf & Troy 1990
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Deep Deep mycoticmycotic infectionsinfections
•• Variable association Variable association –– glucocorticoidsglucocorticoids administrationadministration
–– Feline leukemia virus (Feline leukemia virus (FeLVFeLV) ) (Davies and Troy 1996)(Davies and Troy 1996)
–– Feline immunodeficiency virus (FIV) Feline immunodeficiency virus (FIV)
–– Feline Feline panleukopeniapanleukopenia virus (virus (FePLVFePLV) )
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HistoplasmosisHistoplasmosis
•• Infectious and nonInfectious and non‐‐contagious systemic contagious systemic mycosismycosis
•• Cause:Cause:–– Dimorphic fungus Dimorphic fungus HistoplasmaHistoplasma capsulatumcapsulatum
•• Low morbidity and high mortalityLow morbidity and high mortality
•• Acute wasting, depression, fever, anorexia Acute wasting, depression, fever, anorexia and anemiaand anemia
•• Inhaled Inhaled mycelialmycelial forms and forms and macroconidiasmacroconidias
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HistoplasmosisHistoplasmosis
•*Ocular involvement more common in histoplasmosis than in other deep mycosis (24% of the cases). Davies & Troy 1996Davies & Troy 1996
•All 4 animals that that had ophthalmic examinations had ocular involvement. Wolf & Wolf & BeldemBeldem 19841984
LungsLungs SpleenSpleen
LiverLiver
*EyesEyes
Lymph nodesnodes
Bone marrowBone marrow
BoneBone
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HistoplasmosisHistoplasmosis
•• Ocular signs:Ocular signs:–– MucoidMucoid ocular dischargeocular discharge
–– BlepharospasmBlepharospasm
–– ConjunctivitisConjunctivitis
–– ChemosisChemosis
–– ChorioretinitisChorioretinitis
–– Retinal detachmentRetinal detachment
–– 22aryary glaucomaglaucoma
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Presumed ocular histoplasmosissyndrome (POHS)
•• Distinct clinical entity characterized by:Distinct clinical entity characterized by:–– Peripheral atrophic Peripheral atrophic chorioretinalchorioretinal scars,scars,–– PeripapillaryPeripapillary scarringscarring–– MaculopathyMaculopathy
•• Believed to be secondary to exposure to Believed to be secondary to exposure to HistoplasmaHistoplasma capsulatumcapsulatum..–– Fungus rarely isolated or cultured from an eye with the Fungus rarely isolated or cultured from an eye with the typically typically
associated clinical findings.associated clinical findings.
•• Epidemiologic findings link the fungus to this condition. Epidemiologic findings link the fungus to this condition. –– Similar geographic distribution of fungus and POHS +Similar geographic distribution of fungus and POHS +–– HistoplasminHistoplasmin skin testing may exacerbate the ocular condition.skin testing may exacerbate the ocular condition.
•• Visual loss in POHS is secondary to the development of macular Visual loss in POHS is secondary to the development of macular choroidalchoroidal neovascularizationneovascularization (CNV).(CNV).
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POHS
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POHS
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StudyStudy
•• COPLOW data base COPLOW data base ‐‐ 24 cases24 cases–– 18 cases of feline ocular 18 cases of feline ocular histoplasmosishistoplasmosis
–– 6 suspected cases of 6 suspected cases of histoplasmosishistoplasmosis where no where no organisms were found.organisms were found.•• Criteria of inclusion:Criteria of inclusion:
–– Clinical suspicion and/or Clinical suspicion and/or ChoroidalChoroidal neovascularizationneovascularization with with no history or signs of trauma/no history or signs of trauma/scleralscleral rupturerupture
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StudyStudy
•• Ages Ages –– 1.5 to 16 years1.5 to 16 years‐‐old (7.2 yearsold (7.2 years‐‐old old average)average)
•• No breed or sex predilectionNo breed or sex predilection
OS OD OU Conjunctiva
HistoplasmaHistoplasma ++ 1 12 4 1
POHSPOHS‐‐likelike 6 ‐‐ ‐‐ ‐‐
Affected eyeAffected eye
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Clinical SignsClinical Signs
UnspecificAnorexia, lethargy and weight loss
SpecificGeneralized lymphadenopathy, splenomegaly, tachypnea, pulmonary lesions
Histoplasma+
83%(10/12)
75%(9/12)
POHS‐like 50%(3/6)
33.3%(2/6)
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Most commonly Most commonly Clinical ophthalmic findingsClinical ophthalmic findings
Histoplasma + POHS‐like
Glaucoma Glaucoma
Panuveitis Uveitis
Retinal detachment Retinal detachment
Retinitis Chorioretinitis
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•• HistoplasmaHistoplasma positive grouppositive group–– 12/18 performed some ancillary diagnostic12/18 performed some ancillary diagnostic–– 50% were positive50% were positive
•• 4 FNA4 FNA•• 1 Serologic test1 Serologic test•• 1 PCR from lymph node aspirate1 PCR from lymph node aspirate
•• POHS POHS ––like grouplike group–– 3/6 performed some ancillary diagnostic3/6 performed some ancillary diagnostic–– All negativeAll negative
Ancillary examsAncillary exams
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HistopathologyHistopathology
•• HistoplasmaHistoplasma positive grouppositive group
1* *
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HistopathologyHistopathology•• HistoplasmaHistoplasma positive grouppositive group
GMS 60X
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HistopathologyHistopathology•• POHSPOHS‐‐like grouplike group
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HistopathologyHistopathology•• POHSPOHS‐‐like grouplike group
*
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Distribution of the casesDistribution of the cases
HistoplasmaHistoplasma positivepositive POHSPOHS‐‐like like
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Distribution of the casesDistribution of the cases
HistoplasmaHistoplasma positivepositive POHSPOHS‐‐like like
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Follow up informationFollow up information
•• HistoplasmaHistoplasma positive grouppositive group–– 8/188/18
•• 5 euthanized due to complication related to the 5 euthanized due to complication related to the diseasedisease
•• 3 still alive and well3 still alive and well
•• POHSPOHS‐‐like grouplike group–– All cases lost for follow up informationAll cases lost for follow up information
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ConclusionsConclusions
•• Feline ocular Feline ocular HistoplasmosisHistoplasmosis: : –– lymphoplasmacyticlymphoplasmacytic and and granulomatousgranulomatous panuveitispanuveitis and and
pyogranulomatouspyogranulomatous endophthalmitisendophthalmitis with intrawith intra‐‐histiocytic histiocytic retinal and retinal and choroidalchoroidal yeasts affecting midyeasts affecting mid‐‐age animals in age animals in endemic areas. endemic areas.
•• Suspected Suspected histoplasmosishistoplasmosis cases: cases: –– Presented no organismsPresented no organisms–– Histological lesions that are similar to cats with organisms andHistological lesions that are similar to cats with organisms and
human POHS human POHS •• choroidalchoroidal neovascularizationneovascularization and moderate and moderate lymphoplasmacyticlymphoplasmacyticinfiltrateinfiltrate
•• We speculate that the cat is a useful model to study the We speculate that the cat is a useful model to study the mechanisms involved in the development of POHS. mechanisms involved in the development of POHS.
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ThanksThanks
•• Dr. Dr. DubielzigDubielzig
•• Dr. Dr. SchobertSchobert
•• COPLOW staffCOPLOW staff
•• COPLOW studentsCOPLOW students