# Aspergillosis, or other fungal infections in the nose?



## BellaVT (12 mo ago)

Does anyone here have experience with fungal infections in your dog's nose? 

Our Bella (11 month old unspayed female) has had congestion and mucus dripping from one nostril for about a month. She also has had significant swelling of the lymph node in her neck on the same side for a couple weeks. Given her outdoor habits of snuffling at everything she can find, we suspected she might have a stick or some other foreign body stuck in that side of her nose. 

We took her to our regular vet a week and a half ago. The weren't really able to look inside her nose, but prescribed an antibiotic (enrofloxacin). We gave it to her for a week, then went back because she wasn't showing any signs of improvement. She seemed more lethargic (relative to a very high energy baseline) and we were starting to see more (but still not much) blood in her mucus. 

The regular vet inspected again, agreed that it looked a little worse, and suggested we take her as an emergency walk-in to a regional clinic with better imaging capabilities. We took her the next day. They agreed she should be checked further, and kept her overnight. The next day they did full anesthesia, a CT scan, and a rhinoscopy, and determined that she was already missing a significant amount of the turbinate bones in her nose on the affected side. Infections like this are apparently rare in young dogs, although possibly elevated in likelihood in Vizslas. 

They did see what they thought might be a small amount of fungal plaques, but didn't find anything definitive. The thought the loss (lysis) of bone in the nose was strongly indicative of fungal infection, but didn't want to begin treatment until they were more sure. Aspergillis (which causes apergillosis) would be the most common, but there are other less common species as well. The current best treatment apparently involves flooding the nasal cavities with antifungal while under general anesthesia, but the treatment details might depend on which fungus is present. 

As of today, after 10 hours of driving back and forth, she's home again with a somewhat bloody nose from the rhinoscopy. She's in fairly good spirits (possibly residual from the painkillers she was given) and we struggle to keep her calm so she doesn't sneeze and spray blood everywhere. We picked her up on the early side to try to avoid the snowstorms currently happening in the are. Our goal is to wait at least another day before we let her run free in the woods, but she's rapidly goes crazy without exercise. 

We're now waiting for them to have the results from the fungal culture and biopsy, which they say might take a week or two. The presumption is that we'll take her back for treatment once we have a clearer diagnosis. Happily, it sounds like they've eliminated cancer or anything worse as a likely suspect. Other than cost, the prognosis once treated seems pretty good. I'm hoping this means there won't be permanent damage to the functionality of her nose, but I haven't found much data on this. 

Anyone happen to have prior experience with this or anything similar?


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## BellaVT (12 mo ago)

Doing a self-update, after two weeks the biopsy and fungal culture came back somewhere between "negative" and "inconclusive". Apparently this isn't that surprising --- fungal cultures apparently aren't very reliable. The next step was going to be a series (of also not very reliable) blood tests. So we drove her back to the clinic yesterday (2.5 hr) and were a little surprised that their new recommendation was that we skip the blood tests and go straight to a fairly invasive treatment: drill holes into her frontal sinuses, pack them with antifungal cream, while also flooding the nasal cavity with liquid antifungal and leaving it there for an hour.

Their fear was that if the infection was aggressive enough to destroy the nasal turbinate bones within a month of showing symptoms, unless treated quickly it might continue to progress quickly to destroy the "cribriform plate" between the nose and the brain, leading to bad consequences. The odd part was that Bella had responded unexpectedly well to to the initial diagnostic rhinoscopy: minor nasal congestion remained, but no more blood in mucous, no more lethargy, full energy, and full appetite. So the question was whether to do an aggressive procedure on an apparently healthy young dog without any definitive tests showing the problem.

Our vet was clearly uncertain, and apologized for being unable to give us better guidance. As a teaching hospital, they have access to people who concentrate on answering such questions, and the advice of the two experts who were consulted was to treat as if it was aspergillosis. We talked with one of them for a while, and he indeed seemed as knowledgeable as one could hope. From seeing only the CT scans, his advice was a definite "treat", but examining the apparently healthy and happy dog, he agreed it was a conundrum. He seemed certain that the turbinate bone destruction was aspergillosis, said that he'd never seen a case where it resolved itself without treatment, but granted the saline flushing from the earlier inspection could have improved things.

So they left it up to us to decide how to proceed, with the advice that if it was their own dog (all of them were dog owners) they would probably do the surgery. So after taking Bella on a walk and run around the back of their snowy cow pastures and solar panel arrays, we decided to go ahead with it. After one more run on a snowy golf course (figuring she wouldn't get much exercise for the next couple days), we left her in their care and drove back dog-less to Vermont. We're expecting a call later today to tell us how the surgery went, and hoping to go back to pick her up tomorrow. They warned us she would look rather scary, with a shaved face and two new exposed holes in her head.

Wish us luck!


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## sandiegov (May 31, 2016)

Sending positive energy and prayers to Miss Bella for a successful surgery.


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## Gabica (Jan 20, 2018)

sending lots of ESP. it must feel devastating.


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## texasred (Jan 29, 2012)

Prayers


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## BellaVT (12 mo ago)

Thanks for your encouragement!

We picked her up yesterday after her surgery. No particular complications, although they decided to keep her for an extra day to monitor her breathing in case she had inhaled too much liquid or fungicide during the anesthesia. They warned us that she'd look particularly "gruesome", but she doesn't actually look that bad. The holes in the top of her head are very small, and not particular visible, although they do leak small amounts of of bloody fungicide cream. I wouldn't recommend the shaved forehead look for Vizsla's, though. 

Diagnostically, no one is sure what's going on. Looking inside her sinuses, they found evidence of lesions and tissue destruction on both sides, but not in a way that matched their expectations for Aspergillus. They did a cytology smear from a sample in her nose, and found no "hyphae" (which would have been clear signs of fungus) but did find microscopic green balls of something (which might be fungal spores, or might be unrelated pollen). We're awaiting the results of some blood tests and another biopsy sample. 

Their best guess at this point is that either it's typical Aspergillus presenting in an atypical manner, some rarer variety of Aspergillus, or some possibly clinically unknown fungus. If it's Aspergillus, the fungicide treatment will presumably be effective at stopping it. If it's something else, maybe we'll fallback on an expensive new broad-spectrum oral antifungal (Voriconazole) that's sometimes effective and sometimes had bad side effects. We'll get some test results early next week, but might be two weeks for the rest of them. 

She seems content staying curled up in her crate today. Sometimes she's eager to eat, and sometimes she's ignoring even our best treats (little bits of Smoky Link sausage). Hopefully she'll be able to go back out in the woods in a few days. We're alternating between full winter and early spring here in Vermont. We put out our maple syrup taps a couple days ago during a melt, and got a few gallons of sap that we've been slowly boiling down the woodstove. It's snowing hard again now, with the temperature heading back to single digits for tonight.


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