Locality: Danville, IL
Medical Diagnosis of Blastomycosis?: Yes
Where Caught: Not sure, but definitely in the Danville, IL area. He had been in the west Chicago suburbs for a few days at Christmas time, but with snow on the ground it's highly unlikely he caught Blasto there. This spring was very wet in our area & the ground didn't dry out very often. Harley was taken to a pet event at a local park that has a river thru it, but he'd been there dozens of times the previous year. We moved to a new house in the same neighborhood as the old one & Harley had been in the front yard but not the back yard or inside the new one. He accompanied us back to the old house while we did yard work there.
Symptoms: He had a swollen toe that we thought was due to getting stepped on while playing ball in the yard. The toe started to drain around the nail so he was taken to his vet. The vet put him on antibiotics thinking his toe was infected & made follow-up appt for 2 weeks later. By the follow up appt besides his toe being more swollen swelling down the front of that leg, he had developed several swollen glands, 1 skin lesion, diarrhea, wasn't eating well and had lost some weight. The vet aspirated some fluid from one of the swollen glands & also did a smear of the fluid from the lesion & both showed blasto. X-rays showed lung involvement & he didn't want to play much, he has not had any coughing or labored breathing commonly seen in dogs with lung involvement.
In hindsight, Harley had been favoring his foot approx. 3 weeks prior to being stepped on. He did not show signs of pain when moving his leg but there was a small cut on one of his pads so I treated it with topical antibiotic & he stopped favoring that leg. The cut was not on the same toe that become swollen.
Treatment: Harley was put on Spornox & Rimadyl. He is being treated at the University of Illinois small animal clinic. He was only on Rimadyl for 4 weeks & as of 9/26/08 still on 150 mg of Sporonox (Itraconozole) daily. Last check up 9/9/08 showed much improvement in his toe & lymph nodes no longer swollen but not much change in lung x-rays.
Check up on 10/7/08 & 11/4/08 were same. MiraVista test result of 10/27/08 was 15 (high positive). His toe & lymph nodes are back to normal. Still little change in the lung x-ray and the vet thinks Blasto has caused permanent damage which may slow him down but should not be life-threatening.
Harley developed slight cough 11/9/08 which worsened so he was taken to the vet 11/12/08. He was diagnosed with Megaesophagus (enlarged esophagus). The cause is undetermined at this time, but is not thought to be related to Blasto. Because of the new problem & the high positive MiraVista result, the vet has doubled the Sporonox until at least the next visit 12/9/08. Because the enlarged esophagus can cause aspiration of food into the lungs causing a form of pneumonia/infection he is on Clavamox (antibiotic) for 2 weeks.
Harley was in for a follow up appt 12/9 & showed no signs of enlarged esophagus. Tests for physical imbalances that can cause Megaesophagus came up negative, so vets don't know what caused it or why it apparently went away. He had developed several sores and elevated liver enzymes. The dermatologist thought the sores could be a side effect of Itraconozole & with the elevated liver test, he's been switched to Fluconozole.
Harley had his January 09 follow-up appt. All of the sores are almost gone, the radiograph of his affected foot had no abnormalities and he seemed to be doing fine. X-ray showed no sign of Megaesophagus. Liver enzymes still at the same slightly elevated level but Flucon is supposed to be easier on the liver than Itra and there had been so little change in his MiraVista antigen tests, vet decided to up the Flucon from 100mg/day to 300mg/day. He goes back for bloodwork in Feb, & another MiraVista test in March. Vet is hopeful for negative result in March.
Harley was in for his Feb follow-up. His elevated liver enzymes have come back down & he's doing great. Will do the MiraVista urine test the last week of March & he's set to go back for another follow-up visit April 10. It's Good Friday & we're hoping for good news on the MiraVista test.
Sent sample for MiraVista test end of March, result was 2, just barely positive - very good news!
Harley had a follow up visit 4/10/09. His liver enzymes were slightly elevated so with his MiraVista test being so low, it was decided to discontinue the antifungal treatment & have another MiraVista test done in 6-8 weeks. If his results are above 2, he may have to go back on medication.
Had another MiraVista test done late Aug 2009 with results just under 1. Will continue testing every 6 months or so. Test is not expensive & collecting urine is not invasive.
Cost of Treatment: Sporonox was approx $500 for the first 28 days (150 mg daily).
Rimadyl is approx $15 for 14 days (100 mg daily).
The original emergency room visit recommended by his regular vet included x-rays, radiographs & a bunch of tests was approx $600.
The first follow-up visit with variety of tests & X-rays was approx $170.
Second follow-up visit was approx $60 with no x-rays, 3rd was approx $100 with x-rays. Located pharmacy in Canada for Sporonox so now approximately $150 for 45 day supply but takes 3 weeks to arrive. Got 3 weeks supply from Wal-Mart for approx $250.
Follow up visits in Oct & Nov approx $180 each. Visit to diagnose Megaesophagus + antibiotics $530. He's also had 2 MiraVista antigen tests at $98 each
December's follow-up visit was approx $230 & approximately $40 for a month's supply of Fluconozole
January's follow-up visit included chest & leg x-rays along with bloodwork for approx $340 - Dosage of Flucon was tripled so the price per month tripled also to approx $120 per month. Third MiraVista test, only $65, must be getting the repeat customer discount:)
Another follow-up visit, $79. Will do another MiraVista test & depending on the outcome of it, that may be the last of his treatments.
Additional Comments: Harley was diagnosed July 14, 2008 and so far (9/26/08) is tolerating the medication well, his appetite is back to normal, he's put on some weight, hasn't had any respiratory distress, and is back to playing & walks as normal. His toe is no longer swollen but the nail did break off just past the toe. He had developed 3 additional skin lesions within 3 weeks of diagnosis. The original & 3 additional lesions are almost completely healed.
Harley's been on Itra for 4 & 1/2 months and is doing great. His cough from Megaesophagus is gone & he finished the Clavamox Thanksgiving morning.
After 5 months meds were switched from Itra to Flucon-seems to be doing well with the switch.
January and Harley seems to be doing very well. Will go in for follow-up blood work again in Feb. Even with tripled dosage, is doing well.
Feb bloodwork came back fine. Sent urine sample to MiraVist & result was still in the barely positive range, which is quite an improvement from the high positive range he was in back in December. Will still be on meds a while longer. Discontinued meds in April 2009. As of November 2015, Harley's slowed down a lot, but he's around 14 -15 years old so not a big surprise. Still Blasto free since 2009!