Successful treatment of guttural pouch mycosis with itraconazole and topical enilconazole in a horse.

The study discusses a case of treating guttural pouch mycosis in a horse with a combination of itraconazole and topical enilconazole. The therapy showed improvement and recovery in the horse, suggesting the effectiveness of the combined treatment for this health condition in horses.

About Guttural Pouch Mycosis

• Guttural pouch mycosis (GPM) is a fungal infection affecting horses, mostly in eastern United States and the United Kingdom.
• The disease can lead to various symptoms such as unilateral and bilateral nose blood flow, one-sided nasal discharge, swallowing difficulty, and laryngeal paralysis.
• Aspergillus sp. are most commonly isolated fungi from GPM and the infection can lead to severe problems such as acute death due to hemorrhage, weight loss, aspiration pneumonia among others.

Treatment of GPM

• Both surgical and medical treatments have been employed to treat GPM. Mechanical removal of the fungal plaques and the use of different antifungal solutions have been used with a varying degree of success.
• The study mentions that benzimidazoles and their derivatives such as clotrimazole, econazole, miconazole, enilconazole, isoconazole, and itraconazole inhibit fungal growth and are effective in treating superficial and deep mycoses in humans and animals.
• All these agents inhibit ergosterol biosynthesis in the fungal cell membrane, leading to functional changes in the permeability of the membrane which eventually destroy the fungal cells.

Case Study of Treatment

• The case study discusses a 10-year-old horse weighing 510 kg, which was referred to the Veterinary Medical Teaching Hospital of the University of California due to symptoms of GPM.
• This horse was initially treated with miconazole and then with a mixture of thiabendazole and dimethyl sulfoxide, without any significant improvement.
• With the introduction of itraconazole and topical enilconazole therapy in the horse’s treatment, there was a reduction in the mycotic plaque and the horse’s dysphagia gradually improved over the next two weeks.
• Six weeks after the therapy, the horse had gained 15 kg, was no longer dysphagic, and showed no evidence of guttural pouch mycosis on endoscopic examination. Seven months after the end of therapy, the horse was able to perform normally.

Conclusion

• Guttural pouch mycosis with severe dysphagia usually has a poor prognosis regardless of therapy, but this study suggests that the combination of itraconazole and enilconazole therapy can be effective.
• The study concludes that enilconazole and itraconazole could be useful for treating refractory guttural pouch mycosis.