Journal of Feline Medicine and Surgery http://jfm.sagepub.com/ Dermatophytosis in Cats: ABCD guidelines on prevention and management Tadeusz Frymus, Tim Gruffydd-Jones, Maria Grazia Pennisi, Diane Addie, Sándor Belák, Corine Boucraut-Baralon, Herman Egberink, Katrin Hartmann, Margaret J Hosie, Albert Lloret, Hans Lutz, Fulvio Marsilio, Karin Möstl, Alan D Radford, Etienne Thiry, Uwe Truyen and Marian C Horzinek Journal of Feline Medicine and Surgery 2013 15: 598 DOI: 10.1177/1098612X13489222 The online version of this article can be found at: http://jfm.sagepub.com/content/15/7/598 Disclaimer The Journal of Feline Medicine and Surgery is an international journal and authors may discuss products and formulations that are not available or licensed in the individual reader's own country. Furthermore, drugs may be mentioned that are licensed for human use, and not for veterinary use. Readers need to bear this in mind and be aware of the prescribing laws pertaining to their own country. 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Downloaded from jfm.sagepub.com at Universite de Liege on September 3, 2013 Journal of Feline Medicine and Surgery (2013) 15, 598–604 CLINICAL REVIEW DERMATOPHYTOSIS IN CATS ABCD guidelines on prevention and management Tadeusz Frymus, Tim Gruffydd-Jones, Maria Grazia Pennisi, Diane Addie, Sándor Belák, Corine Boucraut-Baralon, Herman Egberink, Katrin Hartmann, Margaret J Hosie, Albert Lloret, Hans Lutz, Fulvio Marsilio, Karin Möstl, Alan D Radford, Etienne Thiry, Uwe Truyen and Marian C Horzinek Overview: Dermatophytosis, usually caused by Agent properties Microsporum canis, is the most common fungal infection in cats worldwide, and one of the most important infectious skin diseases in this species. In contrast to single-celled yeasts, dermatophytes (‘skin plants’) are Many adult cats are asymptomatic carriers. complex fungi growing as hyphae and forming a mycelium. About Severe clinical signs are seen mostly in kittens 40 species belonging to the genera Microsporum, Trichophyton and Epidermophyton are considered as dermatophytes. Over 90% of feline or immunosuppressed adults. Poor hygiene is a 1 predisposing factor, and the disease may be dermatophytosis cases worldwide are caused by Microsporum canis. endemic in shelters or catteries. Humans may be Others are caused by M gypseum, T mentagrophytes, T quinckeanum, easily infected and develop a similar skin disease. T verrucosum or other agents. With the exception of M gypseum, all of Infection: Infectious arthrospores produced by these agents produce proteolytic and keratolytic enzymes that enable dermatophytes may survive in the environment for them to utilise keratin as the sole source of nutrition after colonisation about a year. They are transmitted through contact of the dead, keratinised portion of epidermal tissue (mostly stratum with sick cats or healthy carriers, but also on dust corneum and hairs, sometimes nails). particles, brushes, clothes and other fomites. Dermatophytes produce arthro spores, which are highly resistant, surviving in a dry environment for 12 months or more [EBM grade Disease signs: Circular alopecia, desquamation 2 and sometimes an erythematous margin around III]. In a humid environment, however, arthro spores are short-lived. central healing (‘ringworm’) are typical. In many cats High temperatures (100°C) destroy them quickly. Arthrospores adhere this is a self-limiting disease with hair loss and scaling very strongly to keratin. only. In immunosuppressed animals, the outcome Depending on the source of infection and reservoirs, dermatophyte may be a multifocal or generalised skin disease. species are classified into zoophilic, sylvatic, geophilic and anthro- Diagnosis: Wood’s lamp examination and pophilic fungi. microscopic detection of arthrospores on hairs are Epidemiology simple methods to confirm M canis infection, but their sensitivity is relatively low. The gold standard for detection is culture on Sabouraud agar of hairs Dermatophytosis is worldwide the most common fungal infection of and scales collected from new lesions. cats and one of the most important infectious skin diseases in this Disease management: In shelters and catteries species. It may be transmitted to other animal species, and is also an eradication is difficult. Essential is a combination important zoonosis. M canis is a typical zoophilic dermatophyte. of systemic and topical treatments, maintained for Zoonosis several weeks. For systemic therapy itraconazole It was generally thought that subclinical M canis is the causative is the drug of choice, terbinafine an alternative. infections are very common in cats, espe- agent of ringworm. Recommended topical treatment is repeated body cially in longhaired animals over 2 years of rinse with an enilconazole solution or miconazole age. However, in many groups the preva- with or without chlorhexidine. In catteries/shelters lence is relatively low. Therefore, M canis medication must be accompanied by intensive decontamination of the environment. Vaccination: Few efficacy studies on anti-M canis vaccines (prophylactic or therapeutic) for cats have European Advisory Board been published, and a safe and efficient vaccine is on Cat Diseases not available. www.abcd-vets.org Corresponding author: Tadeusz Frymus Email: [email protected] JFMS CLINICAL PRACTICE DOI: 10.1177/1098612X13489222 598 Downloaded from jfm.sagepub.com at Universite de Liege on ©September Published 3, 2013 by SAGE on behalf of ISFM and AAFP 2013 REVIEW / ABCD guidelines on dermatophytosis should not be considered part of the normal EBM grades immunodeficiency virus (FIV) and feline fungal flora of cats and its isolation from a The ranking system leukaemia virus (FeLV) on the prevalence of healthy animal indicates either subclinical fungal infection has been investigated. The 1 for grading the level infection or fomite carriage. of evidence of higher prevalence of M canis in FIV-infected Arthrospores are transmitted through con- animals compared with normal cats reported various statements 3 tact with sick or subclinically infected ani- in one survey was not observed by another within this article is 4 mals, mainly cats, but also dogs or other described on group. It has been suggested that any associ- species. In sick animals, the infected hair page 533 of this ation may be related to differences in the envi- shafts are fragile and hair fragments contain- ronment rather than to the retroviral status of Special Issue. 5 ing arthrospores are very efficient in spread- the cats. ing infection. In addition, uninfected cats can The incubation period of ringworm caused passively transport arthrospores on their hair, by M canis is 1–3 weeks. During this time, thereby acting as a source of infection. Risk hyphae grow along the hair shafts through the factors include: introducing new animals into stratum corneum to the follicles where they a cattery, cat shows, shelters, mating, etc. produce spores that form a thick layer around Indirect contact is very important too; Dermatophytes the hair shafts. As dermatophytes are suscep- transmission may occur via contaminated tible to high temperatures, they cannot collars, brushes, toys, environments, etc. (‘skin plants’) colonise deeper parts of the skin or the follicle Arthrospores are easily spread on dust parti- are complex itself. Therefore, the hair grows normally but cles, even to rooms without access for cats. breaks easily near the skin surface, resulting Outdoor cats, especially in rural areas, can fungi growing in hair loss. Several metabolic products of the be exposed by digging to M gypseum, a fungus may induce an inflammatory response geophilic fungus living in soil. Cats may be as hyphae and in the skin, and may be observed mainly infected with T mentagrophytes or T quinck- forming a around the infected area, forming sometimes eanum through contact with small rodents, ring-like lesions with central areas of healing and with T verrucosum through contact with mycelium. Over and papules on the periphery (‘ringworm’). cattle. 90% of feline In many immunocompetent cats living in Pathogenesis hygienic conditions these lesions are limited dermatophytosis (eg, to the head) and disappear after several weeks. In immunosuppressed animals, the Healthy skin acts as an effective barrier cases outcome may be a multifocal or generalised against