Abstract

Coccidioidomycosis in a bottlenose dolphin was first reported in 1998.¹ In 2009, a 26-year-old female bottlenose dolphin (Tursiops truncatus) was diagnosed with pulmonary coccidioidomycosis.² To date, the disease has been successfully managed with input from Coccidioides immitis experts at the University of California-Davis, the University of Arizona, and the University of Texas. Initial treatment of the 168-kg dolphin consisted of voriconazole (1000 mg PO once weekly) and terbinafine (1000 mg PO SID). Five months into treatment, the dolphin developed signs consistent with toxicity, including tremors, premature ventricular contractions, ventricular bigeminy, and elevated hepatic enzymes.³ After medications were discontinued and blood drug levels decreased, signs of toxicity resolved. Once clinically stable, voriconazole was reinitiated at 200 mg PO once weekly and gradually increased. The animal's ability to exercise, dive, and transport out of the water was examined. Exercise and diving intolerance was not observed, and the dolphin was consistently stable out of the water. The animal has since deployed and been transported by aircraft without complication. Clinical progression is regularly monitored with bloodwork, ultrasound, serology, blood drug levels, and serial CT scans. Currently, C. immitis titers are favorably low at 1:2 (originally 1:64). CT scan results from December 2014 showed static chronic pulmonary parenchymal disease and marginal lymphadenopathy with no evidence of progression or dissemination. Current management includes voriconazole (600 mg PO once weekly) with a target trough drug level of ~ 2–3 µg/mL and annual CT scans. Marginal lymph node sampling is being considered to rule out chronic active disease.

Acknowledgements

We would like to thank our colleagues at the U.S. Navy Marine Mammal Program and the National Marine Mammal Foundation. We are grateful for the numerous veterinarians, physicians, veterinary technicians, trainers and support staff that have aided with the diagnosis, treatment and care of this animal. We would like to especially thank Risa Daniels, Dr. Shawn Johnson, Dr. Laura Yates, Dr. Stephanie Venn-Watson and Dr. Sam Ridgway for their support of this case. Also, Dr. Steve Ferrara and Dr. Bud Hall from the interventional radiology team at Naval Medical Center San Diego, Dr. Pappagianis from the University of California-Davis, Dr. Mike Rinaldi at The University of Texas Health Science Center at San Antonio, and the Valley Fever Center for Excellence at the University of Arizona for their invaluable subject matter expertise.

* Presenting author

Literature Cited

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