Abstract
Candida infections account for approximately 10% of hospital acquired infections in the United States.1,2 While Candida albicans has historically been the most commonly encountered species, Candida glabrata prevalence has increased over the past decade to comprise 29% of health care-associated Candida infections.1 The emergence of C. glabrata is complicated by its propensity towards resistance to traditional antifungal drugs.1,3 Caspofungin is an echinocandin which specifically targets the fungal cell wall and has proven effective in eliminating Candida spp. in murine and human trials.4-6 Despite established success in other species, no published data exist documenting trials involving marine mammals. In 2017, a 34-year-old, female bottlenose dolphin (Tursiops truncatus) weighing ∼370 lb underwent a 5-week course of once daily intravenous caspofungin to treat a persistent ventral cervical C. glabrata abscess.7 With dosing extrapolated from human trials,8 a loading dose of 140 mg was given intravenously on day 1, followed by a once daily maintenance dose of 90 mg. For each treatment, caspofungin was diluted in 250 ml of 0.9% sodium chloride solution and administered as a slow intravenous infusion over 30–60 minutes via the ventral peduncle and ventral/dorsal fluke vasculature. A target plasma concentration of 2 µg/ml was chosen based on abscess fluid fungal sensitivities and data from published in vitro and human clinical trials.4,9 During the course of therapy, no adverse effects were seen, and blood CBC and chemistry values remained normal. Abscess fluid samples submitted for culture and cytology were both negative by the end of the treatment period.
Acknowledgments
The authors thank the trainers, veterinary technicians, and veterinarians of the National Marine Mammal Foundation and the U.S. Navy Marine Mammal Program for their support of this case.
* Presenting author
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