A Study on Generalized Dermatitis Associated With Malassezia Over Growth in Five Cats

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   Indian Journal of Canine PracticeVolume5 Issue1,June, 2013  ASTUDY ON GENERALIZED DERMATITIS ASSOCIATEDWITH  MALASSEZIA  OVER GROWTH IN FIVE CATS A.K. Srivastava and B. Syed Faculty of Veterinary Medicine, Jigjiga University, Jigjiga, Ethiopia.The report deals with the five clinical cases of generalized dermatitis associated with Malasseziaovergrowth in cats presented to the Faculty of Veterinary Medicine, Jigjiga University,Ethiopia. Elevatednumbers of yeasts wereobserved in lesional skin by cytology and culture. Skin lesions occurred on the face,ventral neck, abdomen and ear canals and were characterized by some degree of alopecia, erythema and crusting.In most cases, pruritus was intense. The species M. pachydermatis was systematically isolated. Keywords:  Dermatitis, Malassezia, Cytological assessment, Dermatological signs, Predisposingfactor. Introduction  . M alassezia yeasts belong to normalcutaneous or mucosal microbiota of manywarm-blooded vertebrates (Sugita et al.  2010).These yeasts are now recognized asopportunistic pathogens that play a significantrole in the development of different human andanimal diseases such as otitis externa or seborrheic dermatitis. Malassezia yeasts havean affinity for lipids as substrates and the term“lipophilic yeasts” has frequently been used tocharacterize the genus. In fact, 13 out of the 14currently described Malassezia species show anabsolute requirement for long fatty acid chains(Gue´ho E.; 2010). These “lipid-dependent”yeasts are therefore seldom isolated in thelaboratory unless specific nutrients are provided in the medium. The species M. pachydermatis is the only lipophilic yeast thatmay be isolated in regular media likeSabouraud dextrose agar. In 1983, Dufait R. was the first one toreport Malassezia yeasts as a cause of generalized dermatitis in dogs. He described aseries of 50 dogs with pruritic dermatitis fromwhich the yeasts could be readily recovered bycytology or culture and which responded toantifungal therapy. Skin lesions consisted of erythema and hyperpigmentation that mostoften affected the ventral abdomen, althoughthe face, feet and perineal regions were alsocommonly affected. A few years later, similar cases were described in dogs from Brazil andUSA (Mason K.V. and Evans A.G.; 1991).These reports forced the veterinarydermatology community to consider the potential role of M. pachydermatis as a cause of canine skin diseases(Bond et al.  2010).Malassezia yeasts can also be isolated from theexternal ear canal and mucosae of healthy catsas well as cats with otitis externa anddermatitis. In healthy cats, reported percentagesof isolationof Malassezia yeasts range fromless than 10% to approximately 20% and up to40%(Sugita et al.  2010). In parallel, thespecies M. pachydermatis has been identified incats with otitis externa(Bond et al.  2010).Lipid-dependent species, identified as M.furfur, M. globosa, M. sympodialis and M.slooffiae have also been reported from the skinor the external auditory canal of healthy cats or other felids(Sugita et al.  2010)and(Crosaz et al. 2012). In 2004, a novel species M. nana wasdescribed from otic discharges of a cat in Japan(Hirai at al.  2004). Material and Methods All the cats were presented to theFaculty of Veterinary Medicine, JigjigaUniversity, Ethiopia. Elevated Malassezia populations were detected by cytologicalassessment of slides prepared using swabs or superficial scrapings. Contact plates filled withmodified Dixon’s medium were applied onlesional skin (Fig. 1). Plates were incubated at32°C for 5 days. Malassezia yeasts wereidentified by microscopic examination of thecells and by physiological tests according toGue´ho E., 2010. For all the cases, positivesubculture on Sabouraud dextrose agar confirmed that the colonies belonged to the nonlipid-dependent species M. pachydermatis. Case 1 was a 3-year-old neutered malePersian cat presented to the Faculty of Veterinary Medicine for a 2 month-old pruritusand a bilateral otitis externa associated withdiarrhea. Alopecia, erythema, crusts and greasyadherent brownish scales were observed on theventral part of the neck. Case 2 was a 5-year-old neuteredfemale short-haired cat presented with a 10month-old pruritus associated with anorexia,   Indian Journal of Canine PracticeVolume5 Issue1,June, 2013  diarrhea and weight loss. Dermatological signsincluded erythema, crusts, and alopecia on theface, the ventral neck and the abdomen (Fig.2a). In both cats, cytological examination of ear canals revealed the presence of a largenumber of Malassezia yeasts. Contact plates onthe face, the neck and the abdomen yieldedmany (more than 50) colonies of Malassezia. Incase 2, complete blood cell count (CBC)indicated leukocytosis with markedeosinophillia (24eosinophils/μL). In cats,hyper-eosinophilic syndrome can be associatedwith allergic diseases, parasitic diseases or some neoplastic syndromes. Bone marrowaspiration showed no abnormalities. Because cutaneous adverse food reactionwas suspected in both cats, a homemade dietwith a novel source of protein (camel meat)associated with boiled potatoes and colza oilwas prescribed. To control Malasseziaovergrowth a 2% miconazole/ 2%chlorhexidineshampoo was prescribed at 3 days interval for 4weeks. One month later, a significant clinicalimprovement was noticed(Fig.2b). At thattime, cytology and cultures were negative. Incase 2, the re-introduction of the srcinal foodlead to a clinical relapse. Case 3 was a 12-year-old neuteredfemale short-haired cat presented with a 4month-old pruritus associated with anorexia,depression and vomiting. Dermatological signsincluded erythema, crusts, and alopecia on theface, the ventral and dorsal parts of the neck,the forelimbs and the tail (Fig.3) Case 4 was a 6-year-old neutered maleshort-haired cat presented with a 1year twomonths-old pruritus and otitis externaassociated with episodic diarrhea.Dermatological signs included erythema,crusts, and alopecia on the face, the ventral partof the neck, and a brown, greasy material in thenail folds (Fig. 4). Fig. 1. Numerous colonies of MalasseziaFig. 2. (a) Erythema,crusts,andalopecia on the abdomenafter 5days of incubation at 32 0 Cof Cat and (b)the same cat after therecoveryFig.3. Erythema, crusts, and alopecia on theFig. 4. Brown and greasy materialwith Malasseziaface of a Cat (Case-3).overgrowthobservedin the nail folds of a cat(Case 4) Case 5 was a 4-year-old neutered maleChartreux cat presented with a 3-month-old pruritus associated with fever, conjunctivitisand cough. Dermatological signs includederythema, crusts, and alopecia on the ears, theabdomen and the inner face of thighs.Cytological examination of both ear canals andnail folds(for Case4) revealed the presence of Malassezia yeasts. Contact plates on the faceand the neck yielded many (morethan50)colonies of Malassezia. The presence of anti-feline corona virus (FCoV) antibodies(41:800)confirmed that two cats (Cases3 and 4) wereinfected by the virus responsible for Feline   Indian Journal of Canine PracticeVolume5 Issue1,June, 2013  Infectious Peritonitis(FIP). Serum RT-PCR wasalso positive for the FIP virus. In Case 5,thelesions appeared 6days after the cat wasvaccinated. Feline herpes virus (FelHV-1) wasidentified in conjunctival swabs by PCR. In Cases 3 and 4, pads containing 0.5%climbazole and 3% chlorhexadine (DouxosPyo pads, Sogeval) were applied every day onthe lesions (for4weeks). In Case 4, ear dropscontaining miconazole (20mg/mL) (SurolansElanco) were also applied twice a day(for2weeks). A dermatological improvementwas noticed after antifungal therapy, but catsconditions finally declined, probably due tokidney failure, and the animals died. In Case 5, no antifungal treatment wasapplied. The cat condition rapidly declined andthe animal was sacrificed. Results and Discussion  In cats, generalized Malassezia dermatitisremains extremely rare. A causal relationship between the overgrowth of Malasseziaorganisms and the development of seborrheicdermatitis was first proposed during the1994American College of VeterinaryDermatology meeting. The two cats hadgeneralized exfoliative and greasyerythroderma, which responded to antifungaltherapy. However, relapses were frequent andrequired repeated therapy. No predisposingdisorders were identified and thehistopathological changes were nonspecific. Incats, Malassezia overgrowth has since beenassociated with retroviral infections (Sierra et al.  2000 and Reche Jr. et al.  2010), paraneoplastic syndromes (Godfrey D.R.; 1998and Maudlin et al.  2010), thymoma (Maudlin et al.  2010 and Forster-Van Hijfte et al.  1997),and diabetes mellitus (Perrins et al.  2007 andBensignor E.; 2010). In a retrospective study,Maudlin et al. evaluated the presence andimportance of Malassezia yeasts in feline skin biopsy specimens submitted for histopathological examination between January1999 and November 2000 (Maudlin et al. 2010). Fifteen (2.7%) submissions containedMalassezia yeasts in the stratum corneum of theepidermis or follicular in fundibulum. Elevenof the 15cats presented with an acute onset of multifocal to generalized skin lesions. All 11cats were sacrificed or died within 2months of the onset of clinical signs. Based on thesefindings and the descriptions of the presentstudy, Malassezia overgrowth should beconsidered as a marker of life-threatening,underlying diseases in cats. Malassezia yeasts have also beenassociated with feline acne (White et al.  1997and Jazic et al.  2006) and idiopathic facialdermatitis (Bond et al.  2000). Atopic dermatitishas been described as a common predisposingfactor for Malassezia dermatitis in dogs, whereas this association has been reported lessfrequently in cats (Bensignor E.; 2010 andOrdeix et al.  2007). In a series of 18 allergiccats with Malassezia spp. overgrowth (Ordeix et al.  2007), atopic dermatitis was diagnosed in16 animals. All the cats were otherwise healthyand those tested (16outof18) were free fromretroviral infections. The beneficial effects of azole antifungal therapy alone in five out of seven of these cats led the authors to concludethat Malassezia yeasts can exacerbate theclinical signs of allergy in cats as well as indogs. Two out of six cases of the present reportwere associated with cutaneous food adversereaction, and topical antifungal therapy wasuseful. Inatopic animals, cutaneous lesionsrelated to Malassezia overgrowth commonlyoccur on the face, ventral neck, abdomen andear canals. The factors involved in thetransition, from commensalisms to parasitism, by Malassezia yeasts in cats are not fullyunderstood. The criteria required for the diagnosis of Malassezia dermatitis have not been definitelyestablished in pet carnivores. However, it may be proposed that such a diagnosis is appropriatewhen a cat with elevated numbers of Malassezia yeasts on lesional skin shows goodclinical and mycological responses toantifungal therapy. Cytological examination isconsidered as the most useful technique for assessment of Malassezia density on the skinsurface in animals. Several cytological criteriahave been proposed to diagnose canineMalassezia dermatitis, including theobservation of more than two yeasts per high power field in skin specimens. However, noreport has been published that provided detailsof yeast density on the surface of normal felineskin and the use of threshold values is notrecommended in cats. Contact-plate culturaltechniques provide a rapid and convenientmethod for isolation of Malassezia yeasts fromthe skin surface. Because of the presence of lipid-dependent yeasts on the skin of cats, theuse of lipid-supplemente-d media, especiallythe modified Dixon’s medium, is required.   Indian Journal of Canine PracticeVolume5 Issue1,June, 2013  However, in the present study, all the caseswere attributed to M. pachydermatis and wemay imagine that the use of regular media (notsupplemented withlipids) would have beenappropriate for the isolation of Malasseziayeasts. In cats, histo- pathological examinationof skin biopsy specimens typically showshyperkeratosis and irregular epidermalhyperplasia. As in dogs, Malassezia yeasts arenot always visible in the epidermal stratumcorneum, even in cases where large numbersare seen cytologically; this probably reflectsdisruption of this layer during processing. Arecent systematic review evaluated the efficacyof antifungal treatments for Malasseziadermatitis in dogs (N-egre et al.  2009). Thisreview allowed the recommendation, with goodevidence, of the use of only one topicaltreatment: a shampoo containing 2%miconazole and 2%chlorhexidine, twice a week for 3weeks. A similar review has not beenmade for cats, but we observe that the 2%miconazole/ 2% chlorhexadine shampoo had a beneficial effect in cats with adverse foodreaction. References Bensignor E. 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(1998).A case of feline paraneoplastic alopecia with secondaryMalassezia-associated dermatitis. Journal of Small Animal Practice; 39 : 394–6.Gue´ho E. (2010). Biodiversity, phylogeny andultrastructure In: Velegraki A., Mayzer P.,Gue´ho E., Boekhout T, editors. Malassezia and the skin.lsted.Berlin:Springer;.p.17–63.Hirai A., Kano R., Makimura K., et al.  (2004).Malassezia nana sp. nov., anovellipid-dependent yeast species isolated fromanimals. International Journal of Systematicand Evolutionary Microbiology; 54 :623–7.Jazic E., Coyner K.S., Loeffler D.G., et al. (2006).An evaluation of the clinical,cytological, infectious andhistopathological features of feline acne.Veterinary Dermatology; 17 :134–40.Maudlin E.A., Morris D.O. and GoldschmidtM.H. (2002). Retrospective study: the presence of Malassezia in feline skin biopsies. A clinico-pathological study.Veterinary Dermatology; 13 :7–14.Mason K.V. and Evans A.G.(1991).Dermatitisassociated with Malassezia pachydermatisin 11 dogs. 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