Lindemann Dana M, Allender Matthew C, Rzadkowska Marta, Archer Grace, Kane Lauren, Baitchman Eric, Driskell Elizabeth A, Chu Caroline T, Singh Kuldeep, Hsiao Shih-Hsuan, Sykes John M, Cox Sherry
J Zoo Wildl Med. 2017 Sep;48(3):757-766. doi: 10.1638/2016-0179.1.
Snake fungal disease (SFD; Ophidiomyces ophiodiicola) is posing a significant threat to several free-ranging populations of pitvipers. Triazole antifungals have been proposed for the treatment of mycoses in reptiles; however, data are lacking about their safety and efficacy in snakes with SFD. Study 1 investigated in vitro susceptibility, and identified that plasma concentrations >250 ng/ml (voriconazole) and >1,000 ng/ml (itraconazole) may be effective in vivo for SFD. In Study 2, the pharmacokinetics after a single subcutaneous voriconazole injection were assessed in apparently healthy free-ranging cottonmouths (Agkistrodon piscivorus). Based on pilot-study results, four snakes were administered a single injection of voriconazole (5 mg/kg). One pilot snake and three full-study snakes died within 12 hr of voriconazole administration. All surviving snakes maintained plasma concentrations >250 ng/ml for 12-24 hr. In Study 3, two Eastern massasaugas (Sistrurus catenatus) and a timber rattlesnake (Crotalus horridus horridus) diagnosed with SFD were treated with voriconazole delivered by subcutaneous osmotic pumps. The timber rattlesnake (12.1-17.5 mg/kg/hr) reached therapeutic concentrations, whereas the massasaugas (1.02-1.6 mg/kg/hr) did not. In Study 4, the pharmacokinetics of a single 10-mg/kg per-cloaca dose of itraconazole (Sporanox®) was evaluated in seven apparently healthy free-ranging cottonmouths. Similarly, the plasma and tissue concentrations did not meet therapeutic concentrations based on in vitro data. The data presented in this report serve as an initial step toward understanding the pharmacokinetics, efficacy, and safety of triazole antifungals in pitviper species with SFD. Further study is needed to determine the appropriate dose and route of administration of triazole antifungals in pitviper species.
蛇类真菌病(SFD;ophidiomyces ophiodiicola)对几种自由放养的蝰蛇种群构成了重大威胁。三唑类抗真菌药已被提议用于治疗爬行动物的霉菌感染;然而,关于它们对患有SFD的蛇的安全性和有效性的数据却很缺乏。研究1调查了体外药敏性,并确定血浆浓度>250 ng/ml(伏立康唑)和>1000 ng/ml(伊曲康唑)在体内可能对SFD有效。在研究2中,对明显健康的自由放养水腹蛇(食鱼蝮,Agkistrodon piscivorus)进行单次皮下注射伏立康唑后的药代动力学进行了评估。根据前期研究结果,给四条蛇单次注射伏立康唑(5 mg/kg)。一条前期研究蛇和三条完整研究蛇在注射伏立康唑后12小时内死亡。所有存活的蛇血浆浓度>250 ng/ml维持了12至24小时。在研究3中,对两条被诊断患有SFD的东部马萨索加响尾蛇(Sistrurus catenatus)和一条东部菱斑响尾蛇(Crotalus horridus horridus)用皮下渗透泵给予伏立康唑进行治疗。东部菱斑响尾蛇(12.1 - 17.5 mg/kg/小时)达到了治疗浓度,而马萨索加响尾蛇(1.02 - 1.6 mg/kg/小时)则未达到。在研究4中,对七条明显健康的自由放养水腹蛇评估了每泄殖腔单次剂量10 mg/kg伊曲康唑(斯皮仁诺®)的药代动力学。同样,根据体外数据,血浆和组织浓度未达到治疗浓度。本报告中呈现的数据是朝着了解三唑类抗真菌药在患有SFD的蝰蛇物种中的药代动力学、疗效和安全性迈出的第一步。需要进一步研究以确定三唑类抗真菌药在蝰蛇物种中的合适剂量和给药途径。