Bentley R Timothy, Heng Hock Gan, Thompson Craig, Lee Chun-Sheng, Kroll Robert A, Roy Michael E, Marini Lauren, Heo Jin, Wigle William L
Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, 47907.
Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, IN, 47907.
Vet Radiol Ultrasound. 2015 Sep-Oct;56(5):520-30. doi: 10.1111/vru.12258. Epub 2015 Apr 7.
Little published information is available to guide therapy for canine and feline patients with Coccidioides infections involving the central nervous system (CNS). The purpose of this cross-sectional retrospective study was to describe magnetic resonance imaging (MRI) features and outcome for a group of dogs and cats with solitary CNS Coccidiodes granulomas. Nine canine and two feline cases met inclusion criteria; four diagnosed and treated with surgery and fluconazole and seven diagnosed by serology or cytology and treated medically. Three cases had left Coccidioides endemic areas long before developing neurological disease. The MRI lesions shared many features with neoplastic masses. The extra-axial granulomas often had a lack of a distinct border between the mass and neural parenchyma. Four cases were extra-axial and seven were intra-axial, but distinguishing between extra-axial and intra-axial locations was sometimes challenging. The surgical cases had good outcomes and histology allowed definitive diagnosis. Medically managed patients also had generally good outcomes, with resolution of clinical signs in most cases. Findings indicated that distinction between neoplasia and focal Coccidioides granulomas based on MRI features is likely to be imprecise. Demonstration of the organism by cytology or histology is required for definitive diagnosis. The role of surgery for improving the outcome of brain or spinal coccidioidomycosis granulomas warrants further study.
关于患有累及中枢神经系统（CNS）的球孢子菌感染的犬猫患者的治疗，可供参考的已发表信息很少。这项横断面回顾性研究的目的是描述一组患有孤立性中枢神经系统球孢子菌肉芽肿的犬猫的磁共振成像（MRI）特征及预后。九例犬和两例猫的病例符合纳入标准；四例通过手术及氟康唑进行诊断和治疗，七例通过血清学或细胞学进行诊断并接受药物治疗。三例在出现神经系统疾病很久以前就离开了球孢子菌流行地区。MRI病变与肿瘤性肿块有许多共同特征。轴外肉芽肿在肿块与神经实质之间往往缺乏明显边界。四例为轴外病变，七例为轴内病变，但区分轴外和轴内位置有时具有挑战性。手术治疗的病例预后良好，组织学检查可明确诊断。药物治疗的患者总体预后也较好，大多数病例的临床症状得到缓解。研究结果表明，基于MRI特征区分肿瘤与局灶性球孢子菌肉芽肿可能不准确。明确诊断需要通过细胞学或组织学证明该病原体的存在。手术对改善脑或脊髓球孢子菌病肉芽肿预后的作用值得进一步研究。
