Berlin Dena, Jaffey Jared A, Bolch Charlotte, Zhou Tian, Rayhel Laura H, Hanzlicek Andrew S
Department of Specialty Medicine, Midwestern University College of Veterinary Medicine, Glendale, AZ, United States.
Office of Research and Sponsored Programs, Midwestern University, Glendale, AZ, United States.
Front Vet Sci. 2024 Jul 3;11:1402572. doi: 10.3389/fvets.2024.1402572. eCollection 2024.
Pulmonary coccidioidomycosis is a relatively common fungal disorder in dogs that have lived in or traveled to endemic regions and fluconazole is a common antifungal treatment. Liver enzymopathy can occur with fluconazole administration, but the frequency of occurrence nor potentially associative factors have been explored in dogs with pulmonary coccidioidomycosis. Therefore, our objectives were to describe the occurrence and magnitude of liver enzyme activity (LEA) elevation in dogs with pulmonary coccidioidomycosis during treatment with fluconazole and identify variables associated with liver enzymopathy. This was a retrospective observational study that analyzed serum biochemical data obtained from a separate prospective study that included 32 client-owned dogs with newly diagnosed pulmonary coccidioidomycosis from October 2020 to February 2021. fluconazole administration (median dosage: 16.2 mg/kg/day) was initiated after diagnosis and dogs were evaluated once every 3 months thereafter until remission or for a maximum of 12 months. Recorded biochemical parameters at each visit (including baseline) included alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT). Magnitude of increased LEA was based on the fold increase above the upper limit of the reference interval and defined as mild (<5×), moderate (5-10×) or severe (>10×). Forty-seven percent (15/32) of dogs were documented to have elevations in one or more LEAs after initiation of fluconazole administration during the study period. Thirty-four percent and 25% of dogs had elevated ALP and ALT activities, respectively, at some point during treatment. Elevations in AST and GGT activities were rare. The magnitude of LEA elevation was mild in all cases. Logistic regression models did not identify associations between age, weight, sex, neutered status, prednisone administration, fluconazole dose or duration of treatment with the occurrence of liver enzymopathy. Approximately half of dogs with pulmonary coccidioidomycosis are expected to develop mild increases in activities of ALP and/or ALT with rare involvement of AST or GGT at some point during treatment with fluconazole up to 12 months.
肺球孢子菌病在曾生活于或前往过流行地区的犬类中是一种相对常见的真菌性疾病，氟康唑是常用的抗真菌治疗药物。使用氟康唑时可能会出现肝脏酶病，但在患有肺球孢子菌病的犬类中，其发生率以及潜在的相关因素尚未得到研究。因此，我们旨在描述患有肺球孢子菌病的犬类在接受氟康唑治疗期间肝脏酶活性（LEA）升高的发生率和程度，并确定与肝脏酶病相关的变量。这是一项回顾性观察研究，分析了从一项单独的前瞻性研究中获得的血清生化数据，该前瞻性研究纳入了2020年10月至2021年2月期间32只新诊断为肺球孢子菌病的客户拥有的犬只。诊断后开始使用氟康唑（中位剂量：16.2mg/kg/天），此后每3个月对犬只进行一次评估，直至缓解或最长评估12个月。每次就诊（包括基线）记录的生化参数包括丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、碱性磷酸酶（ALP）和γ-谷氨酰转移酶（GGT）。LEA升高的程度基于高于参考区间上限的倍数增加，定义为轻度（<5倍）、中度（5 - 10倍）或重度（>10倍）。在研究期间，47%（15/32）的犬只在开始使用氟康唑后被记录有一项或多项LEA升高。在治疗的某些阶段，分别有34%和25%的犬只出现ALP和ALT活性升高。AST和GGT活性升高的情况很少见。所有病例中LEA升高的程度均为轻度。逻辑回归模型未发现年龄、体重、性别、绝育状态、泼尼松使用、氟康唑剂量或治疗持续时间与肝脏酶病的发生之间存在关联。预计约一半患有肺球孢子菌病的犬只在使用氟康唑治疗长达12个月的某些阶段会出现ALP和/或ALT活性轻度升高，而AST或GGT很少受累。
