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Opções terapêuticas na resolução da micose das bolsas guturrais por Aspergillus em equinos
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Advisor(s)
Abstract(s)
A micose das bolsas guturais é uma infeção pouco frequente. É a terceira infeção mais encontrada
nas bolsas guturais no cavalo após empiema e timpanismo. O agente patogénico mais comumente
encontrado é o Aspergillus fumigatus) geralmente em hospedeiros imunologicamente comprometidos.
A micose das bolsas guturais é mais frequentemente unilateralmente, mas pode envolver ambas as
bolsas guturais. A localização preferencial da placa fúngica é no bordo dorsal do compartimento
medial da bolsa gutural. Esta afeção envolve preferencialmente a artéria carótida interna (ACI),
podendo também envolver a artéria carótida externa e a artéria maxilar.
O diagnóstico da doença em equinos é realizado pelo exame clínico associado a exames
complementares de diagnóstico como endoscopia, radiologia, histopatologia e cultura microbiana. O
diagnóstico pode também ser complementado com exames hematológicos variando segundo o
estado geral do animal. Os sinais mais comuns associados a esta infeção são epistaxisis, disfagia,
síndrome de Horner e sinais neurológicos tais como a paralisia faríngea e hemiplegia laríngea. O
tratamento médico pode ser local ou sistémico, pela administração de antifúngicos. A micose das
bolsas guturais pode adquirir condições fatais, perante a existência de hemorragia ativa, devendo
nestes casos ser abordada como uma emergência. O tratamento cirúrgico é amplamente
aconselhado, associado ao tratamento médico. A resolução cirúrgica passa pela oclusão da artéria
acometida, por diferentes métodos, tais como ligadura da artéria, oclusão com balão desmontável ou
não desmontável, embolização trans arterial com coils ou plugs, utilizando a fluoroscopia. Em casos
onde a avaliação prévia apresenta fortes riscos anestésicos, estão descritos novos métodos de
resolução com o animal em estação. O prognóstico para esta doença é favorável quando os animais
são tratados cirurgicamente, não obstante, devem ser tidos em conta outros fatores tais como sinais
neurológicos associados.
Mycosis of the guttural pouches is an infrequent infection. It is the third infection of the guttural pouches found in the horse after empyema and tympanic disease. The pathogen most commonly found is Aspergillus fumigatus, usually in immunocompromised individuals. mycosis of the guttural pouches is most often unilateral but may involve both guttural pouches. The preferential location of the fungal plaque is on the dorsal edge of the medial compartment of the guttural pouche. This affection preferentially involves the internal carotid artery but may also involve the external carotid artery and the maxillary artery. The diagnosis of the disease is made by clinical examination associated with complementary diagnostic tests such as endoscopy, radiology, histopathology and fungal culture. The diagnosis may also be complemented with hematological tests which vary according to the general state of the animal. The most common signs associated with this infection is epistaxis, dysphagia, Horner's syndrome and neurological signs such as, pharyngeal paralysis and laryngeal hemiplegia. Medical treatment may be local or systemic with the administration of antifungals. Mycosis of the guttural pouches can acquire fatal conditions if active bleeding is present and should in these cases be treated as emergency. Surgical treatment is widely advised, associated with medical treatment. The surgical resolution involves occlusion of the affected artery by different methods, such as artery ligature, occlusion with a detachable or non-detachable balloon and fluoroscopy trans arterial embolization with coils or with plugs. In cases that present high anesthetic risk, new methods of resolution with the animal standing are described. The prognosis for this disease is positive when animals are treated surgically, but other factors such neurological signs should be taken into account.
Mycosis of the guttural pouches is an infrequent infection. It is the third infection of the guttural pouches found in the horse after empyema and tympanic disease. The pathogen most commonly found is Aspergillus fumigatus, usually in immunocompromised individuals. mycosis of the guttural pouches is most often unilateral but may involve both guttural pouches. The preferential location of the fungal plaque is on the dorsal edge of the medial compartment of the guttural pouche. This affection preferentially involves the internal carotid artery but may also involve the external carotid artery and the maxillary artery. The diagnosis of the disease is made by clinical examination associated with complementary diagnostic tests such as endoscopy, radiology, histopathology and fungal culture. The diagnosis may also be complemented with hematological tests which vary according to the general state of the animal. The most common signs associated with this infection is epistaxis, dysphagia, Horner's syndrome and neurological signs such as, pharyngeal paralysis and laryngeal hemiplegia. Medical treatment may be local or systemic with the administration of antifungals. Mycosis of the guttural pouches can acquire fatal conditions if active bleeding is present and should in these cases be treated as emergency. Surgical treatment is widely advised, associated with medical treatment. The surgical resolution involves occlusion of the affected artery by different methods, such as artery ligature, occlusion with a detachable or non-detachable balloon and fluoroscopy trans arterial embolization with coils or with plugs. In cases that present high anesthetic risk, new methods of resolution with the animal standing are described. The prognosis for this disease is positive when animals are treated surgically, but other factors such neurological signs should be taken into account.
Description
Keywords
Aspergillus Disfagia Endoscopia Epistaxis Embolização trans arterial com coils Micose das bolsas guturais Síndroma de Horner Aspergillus Dysphagia Endoscopy and arterial embolization with coils Epistaxis Guttural pouch mycosis Horner’s syndrome