Journal of Veterinary Internal Medicine

STANDARD ARTICLE OPEN ACCESS

Small Animal Internal Medicine Neurology

Clinical Signs, Advanced Diagnostic Imaging Findings,

Treatment, and Outcome of Mycotic Discospondylitis
in 11 Dogs
Samuel Okonji1 | Andrea Di Paola2 | Silvia Benini1 | Antonella Gallucci3 | Alberto Cauduro2 | Cristian Falzone4 |
Teresa Gagliardo | Gualtiero Gandini1
5

1Dipartimento di Scienze Mediche Veterinarie, Department of Veterinary Medical Sciences, Università degli Studi di Bologna, Ozzano dell'Emilia,
Italy | 2Neurovet, Milano, Italy | 3Centro Veterinario Professionale La Fenice, Assemini, Italy | 4Clinica Veterinaria Pedrani Diagnostica Piccoli Animali
Srl, Thiene, Italy | 5Diagnostic Center Palermovet, Palermo, Italy

Correspondence: Samuel Okonji (samuel.okonji@unibo.it)

Received: 10 November 2024 | Revised: 26 March 2025 | Accepted: 1 April 2025

Funding: The authors received no specific funding for this work.

Keywords: antimycotic treatment | aspergillosis | diskospondylitis | fungal | microbiology | systemic mycosis

ABSTRACT
Background: Discospondylitis refers to inflammation of the intervertebral disc and adjacent vertebral endplates. The literature
on mycotic discospondylitis (MD) in dogs is limited.
Objective: To describe clinical and advanced diagnostic imaging findings, therapeutic strategies, and outcomes in dogs with a
confirmed diagnosis of MD.
Animals: Eleven client-­owned dogs with a diagnosis of MD.
Materials and Methods: Medical records from five veterinary neurological referral centers were retrospectively reviewed be-
tween 2017 and 2024. The confirmed diagnosis of MD was based on clinical and magnetic resonance imaging (MRI) findings
and the detection of fungal hyphae in urine, intervertebral disc, or cerebrospinal fluid (CSF).
Results: German shepherd (GS) were the most prevalent breed (7/11). Pain was the main clinical sign reported in all dogs, as-
sociated with gait abnormalities in 9 dogs. T3-­L3 neuroanatomical localization was described in 10 dogs. MRI showed multiple
intervertebral disc involvement in 7 dogs. Fungal hyphae were identified in urine sediment in 5 dogs and by CT-­guided needle as-
piration of the affected disc in 2 dogs. Aspergillus spp. was the most common etiological agent being reported in 7 dogs. Ten dogs
were dead at the end of data analysis, with a median survival time of 30 days.
Conclusion and Clinical Importance: This case series demonstrates the necessity of accurate diagnosis to set an appropriate
treatment, despite the poor prognosis after antifungal therapy.

1   |   Introduction domestic animals, including dogs, cats, horses, cattle, and swine
[2–4]. The disease is considered common in dogs. Publications
Discospondylitis is an infection of the intervertebral disc and on discospondylitis include three studies of 513, 386, and 120
the adjacent vertebral endplates [1]. It is well recognized in dogs [5–7]. Discospondylitis is more frequently diagnosed in
human medicine and is described in the veterinary literature in medium-­to giant-­breed dogs of all ages, with the most common

Abbreviations: CNS, central nervous system; CRP, C-­reactive protein; CSF, cerebrospinal fluid; CT, computed tomography; GSs, German shepherds; MD, mycotic
discospondylitis; MRI, magnetic resonance image; T1W, T1-­weighted; T2W, T2-­weighted.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2025 The Author(s). Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.

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localization of infection being at the level of the lumbo-­sacral administration of paramagnetic contrast) and CT findings
junction [8]. The most common route of infection is hematog- include osteolytic changes at the level of the endplates and
enous spread from a primary site such as the genitourinary vertebral bodies with reduction of the affected interverte-
system, skin, and mouth. Less commonly, direct infection bral space, subchondral sclerosis, and osteoproliferative
secondary to a migrating foreign body or previous surgery is lesions;
­reported [9].
• Detection of fungal hyphae on cytological examination of
the urine sediment (collected by cystocentesis), interverte-
Bacterial etiology is by far the most common cause of discospon-
bral disc, or cerebrospinal fluid (CSF).
dylitis in dogs and is generally associated with a good prognosis
for recovery [1, 9], with a range from 76% to 86% of dogs achiev- • Information on the follow-­up is available on the clinical re-
ing complete resolution of clinical signs [6, 7, 10]. Rare reports cords or telephone call to the owner.
of mycotic infections are described in veterinary medicine, all
associated with a poor outcome [11–14]. Dogs were excluded if there was incomplete information on neu-
rological examination results and neuroanatomical localization,
German shepherds (GSs) appeared to be predisposed to my- if they had not undergone advanced diagnostic imaging, or if
cotic discospondylitis (MD) in one study [11]. Aspergillus spp., there was no information on the outcome.
a saprophytic and ubiquitous organism, is the most commonly
diagnosed fungus [8]. Other fungi reported as causative agents Data collected from the dogs records included age at presenta-
of discospondylitis in dogs include Pseudallescheria boydii, tion, sex, neuter status, breed, body weight, onset, progression,
Scedosporium apiospermum, Coccidioides immitis, Mucor, and duration of clinical signs before presentation, presence of
Fusarium, Paecilomyces, Penicillium, and Chrysosporium spp. systemic clinical signs, neurological status, and neuroanatom-
[9, 12, 14] Reported treatment consists of administration of anti- ical localization (C1-­C5, C6-­T2, T3-­L3, L4-­S3 or multifocal),
fungal drugs such as itraconazole and fluconazole, and despite blood test results (hematology and serum biochemistry including
prolonged treatment, sometimes for life, the prognosis is poor C-­reactive protein [CRP]), urinalysis, mycological culture, diag-
[9–12]. Aspergillus spp. is resistant to fluconazole. nostic imaging findings (MRI and/or CT and, in selected cases,
radiographs of the vertebral column, abdominal ultrasound, and
Currently, there is limited literature on MD. Except for rare case chest radiographs), treatment administered after diagnosis, sur-
reports [9–12, 15], the study with the largest cohort (10 dogs) was vival time (from the time of etiological diagnosis to death), and
published approximately 30 years ago and included limited in- outcome. Data on treatment protocols were recorded, including
formation on signs of neurological disease. It should be consid- type of antimycotic drug, dosage, duration of treatment, and any
ered that diagnostic imaging in this case series consisted only of other medication. The presence of elongated extradural material
plain radiography due to technological limitations. The aim of T1W iso-­hypointense with enhancement after administration of
this study is to contribute to the knowledge of MD in dogs by de- intravenous paramagnetic contrast was recorded as a concomi-
scribing the clinical and advanced diagnostic imaging findings, tant lesion indicative of spinal epidural empyema.
therapeutic approach, and outcome in a cohort of 11 dogs.
Cerebrospinal fluid (CSF) examination with assessment of protein
content and cell count, and cytology was included if performed.
2   |   Materials and Methods
Neurological status was defined according to the Modified Frankel
Cases were identified retrospectively by searching all parts of scale (MFS) as follows: 5 (paraplegic, deep pain negative); 4 (para-
the medical records of five veterinary referral centers using the plegic deep pain positive); 3 (non-­ambulatory paretic); 2 (ambula-
following terms: “MD”, “fungal discospondylitis,” and “systemic tory paretic); 1 (spinal pain only); 0 (neurologically normal) [16].
mycosis,” from 2017 to 2024.
The clinical course of discospondylitis was classified as acute if
< 2 days, subacute if between 2 and 7 days, and chronic if > 7 days,
Dogs were diagnosed by a board-­certified veterinary neurologist
based on the time from the onset of signs to the diagnosis of my-
(ECVN diplomate) or ECVN resident.
cotic infection. Progression was assessed by comparing the neu-
rological findings at the initial neurological examination with the
In order to be included in the study, dogs were required to
follow-­up neurological examination, including assessment of gait,
meet all of the following inclusion criteria:
postural reaction, and spinal pain, and categorized as static, wors-
ening, improving, or intermittent. Response to treatment was eval-
• Information on the neurological condition, including neu-
uated using the same timeline and variables as for progression and
roanatomical localization of the lesion.
was classified as positive if there was a clinical improvement (at
• Findings of advanced imaging diagnostic techniques least by 1 grade), stable if there was no improvement, or negative if
(Computed tomography [CT] or magnetic resonance imag- there was worsening of clinical signs.
ing [MRI]) compatible with discospondylitis. Specifically,
MRI findings include morphological and signal changes of Relapse was defined as a recurrence of clinical signs after the im-
the intervertebral disc, endplates, and vertebral body (hy- provement or the achievement of a normal neurological condition.
perintense signal on T2-­weighted [T2W] sequences, hyper-
intense on STIR sequences, iso-­hypointense on T1-­weighted The reason for the death of the dogs and whether it was related
[T1W] sequences, and enhancement after intravenous to the mycosis was recorded.

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The collected data were recorded and analyzed in a spreadsheet other two cases, owners reported only pain without obvious gait
using Microsoft Excel for Mac version 16.74. Statistical analysis abnormalities.
was descriptive, and continuous variables such as age and body
weight were described using the median value. Regarding the presence of previous illness, two dogs had a uri-
nary tract infection (of which one treated with enrofloxacin for
1 week) and 1 dog had undergone ovariohysterectomy 2 weeks
3   |   Results before due to a pyometra. Further and more specific information
was not provided by the referring veterinarians.
3.1   |   Animals
The course of discospondylitis was chronic in 9 (81.8%) dogs,
Sixteen dogs with presumed MD were identified from the data- acute in 1, and subacute in another (9.1%) case. Nine dogs had
base search. One case was excluded due to a lack of information progressive signs, while in 2 dogs, signs were intermittent.
on neurological examination. In two dogs, no advanced imaging
was performed, and in two cases, no fungal hyphae were identi-
fied in the samples collected. A total of 11 dogs met the inclusion 3.3   |   Clinical Signs, Neuroanatomical Localization,
criteria (Figure 1). and Blood Test Results

Details data on signalment, onset, and progression of clinical signs, Information on general physical examination findings was
neurological status, and neuroanatomical localization of the study available for 10 dogs. Out of these, 4 dogs showed no abnormal-
cohort are provided in Table S1 of the Supporting Information. ities. Six (54.5%) dogs showed pyrexia with a mean temperature
of 39.8°C (range 39.5°C–40.1°C) and included 1 dog who also
The median age of the enrolled dogs was 5.1 years (range 3.2– presented with progressive weight loss and anorexia.
10.9 years), and the median weight was 32.5 kg (range 16–48 kg).
Six dogs were females (4 entire and 2 neutered), and 5 dogs were The most common clinical finding on neurological examination
males (4 entire and 1 neutered). was pain on palpation of the vertebral column, present in all dogs.

The most represented breed was the GS, with a total of seven Gait abnormalities were found in 9 dogs. Of these, three dogs
dogs. The other breeds represented were Siberian Husky (one had proprioceptive ataxia of the hind limbs and ambulatory
dog), Belgian Shepherd (one dog), Bull terrier (one dog), and paraparesis (grade 2), three dogs had non-­ambulatory parapa-
mixed breed dog (one dog). resis (grade 3), two dogs were paraplegic with intact nociception
(grade 4), and one case was paraplegic with absent nociception
(grade 5).
3.2   |   Anamnesis
Overall, postural reactions were absent in 6 dogs, with three
The main complaint of the owners was ambulatory deficits, re- dogs scoring grade 3 on the MFS, two dogs scoring grade 4, and
ported in nine dogs and associated with overt pain in 2. In the one dog scoring grade 5.

FIGURE 1    |    Study protocol for case selection. n, Number of dogs.

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Postural reactions were reduced in 3 dogs (scoring grade 2 on findings compatible with discospondylitis (one with multiple
MFS) and normal in 2 dogs that had no gait abnormalities but discs involved, and the other dog with a single site of discospon-
only pain on palpation of the vertebral column. dylitis), whereas two of the four dogs with radiographic findings
consistent with a single lesion had multiple discs affected on
A T3-­L3 neuroanatomical localization was detected in most of MRI. Comparison between the localization of discospondylitis
the cases (10 dogs). In 1 dog, neurological clinical signs consis- between MRI, CT, and radiographs is provided in Table S2 in the
tent with multiple localizations were found. They included am- Supporting Information.
bulatory changes due to a T3-­L3 spinal cord lesion and pain at
the level of the lumbo-­sacral junction. One dog had a CSF sample collected. In this dog, fungal hyphae
were present. Information regarding total cell count and total
Blood test results were available for all dogs. The complete protein was not available.
blood cell count showed neutrophilic leukocytosis in six dogs,
two of which occurred with monocytosis. Serum biochemistry
was normal in 5 dogs. Six dogs showed higher CRP, occurring 3.5   |   Diagnosis of Mycotic Infection
in all cases with neutrophilic leukocytosis. In one dog, ab-
normal CRP was associated with an elevation in total protein The diagnosis of mycotic infection was made in five dogs by the
and globulins, and in one case with an abnormally high level detection of fungal hyphae in the urine sediment. Figure S2 in
of creatinine. In one dog, there was only an abnormally high the Supporting Information shows the presence of fungal hy-
level of alkaline phosphatase (ALP) activity and blood urea phae in a urine sample. In 2 cases, the diagnosis was made by
concentration. cytological examination of material obtained by CT-­guided nee-
dle aspiration of the affected disc. In 3 dogs, the diagnosis was
made by biopsy obtained by surgical curettage of the infected
3.4   |   Diagnostic Imaging disc, while in 1 case, fungal hyphae were found on cytological
examination of the CSF.
Two imaging modalities were performed in 7 cases (six dogs un-
derwent radiographs of the vertebral column prior to advanced Mycological culture was performed in all dogs from the same
diagnostic imaging, and one dog underwent a CT of the entire samples in which fungal hyphae were found cytologically and
vertebral column after the MRI) while 1 dog underwent three the etiological agent was identified in 10 dogs. Specifically,
diagnostic imaging modalities (radiographs prior to MRI, and 7 belonged to Aspergillus spp. (of which four detected from
CT of the vertebral column). Three dogs had only MRI. urine, two by surgical curettage and one by CT-­guided needle
aspiration), 1 to Candida albicans (identified from urine), 1 to
MRI was performed in all dogs, and information on the localiza- Saccaromyces spp. (detected by CT-­guided needle aspiration),
tion of the affected area was recorded in all cases. MRI showed and 1 to Penicillium spp. (identified by surgical curettage). In
lesions involving only one disc in 4 cases, all at the T3-­L3 level, one case (the one in which fungal hyphae were found on cy-
and more than one disc in 7 dogs, four of which involved only tological examination of the CSF), the fungus was confirmed
the thoracolumbar vertebral column and three with localization but not identified due to a laboratory issue. Of those belong-
at both the T3-­L3 and L4-­S3 levels (Table S2). In the whole popu- ing to Aspergillus spp., it was possible to identify the species
lation, the median number of affected intervertebral disc spaces (Aspergillus fumigatus) in two cases. Detailed information is
was 2.5 (range 1–10). When considering only dogs with multiple provided in Table S3 in the Supporting Information.
sites of discospondylitis, the median number of discs affected
was 4.5 (range 2–10).
3.6   |   Treatment
Lesions compatible with spinal epidural empyema were de-
scribed in 5 cases, four at the level of T3-­L3 and one at L4-­S3 Information regarding treatment was available for 10 dogs. Of
spinal cord segments. Paravertebral muscle involvement, these, one dog was not treated because of the onset of acute renal
likely secondary to the infection, was detected in all dogs. MRI failure shortly after diagnosis and the owner's decision to euth-
findings of a MD associated with an empyema are shown in anize the dog. Therefore, 9 dogs received specific antimycotic
Figure S1 in the Supporting Information. therapy.

Of the 2 dogs that underwent CT, multiple lesions were de- The most commonly used antimycotic drug was itraconazole
scribed in one case. Neither case had lesions compatible with (Itraconazole, EG S.p.a., Milan, Italy) administered to 7 dogs at a
spinal epidural empyema. In these two dogs, the MRI and CT dose of 5 mg/kg per os (PO) q12 h. The other antimycotic agents
findings were consistent, including the absence of spinal epi- used were fluconazole (EG S.p.a., Milan, Italy) at 5 mg/kg PO q12h
dural empyema. in 1 dog, and amphotericin B (Fungizone, AVAS Pharmaceuticals
S.r.l., Milan, Italy) in combination with flucytosine (Ancotil, Meda
Radiographic findings were recorded in 7 dogs. Five dogs had Pharma S.p.a., Milan, Italy) in another dog. In this latter case, the
features compatible with discospondylitis, including four with dose used was not detailed in the clinical record.
focal lesions and one with multiple discs affected. Abnormalities
were not detected on radiographs in 2 dogs. Of these seven dogs Six dogs had a good initial temporary response to the therapy. One
with radiographs, all underwent MRI, and one also underwent dog showed a sustained good response over time and was alive
CT. Two dogs with no radiographic abnormalities had MRI at the moment of the data collection. Two dogs had no response.

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Additional therapies used in combination with antifungals were This case series systematically addresses the clinical, advanced
analgesics such as gabapentin (Gabapentin, Teva Italia S.r.l., imaging, therapeutic, and outcome aspects of dogs with MD.
Milano, Italy) and tramadol (Altadol, Formevet S.r.l., Milan, The largest case series on the topic, published when advanced
Italy) in 9 (100%) cases, antibiotics (amoxicillin-­clavulanic acid diagnostic imaging was not available in veterinary medicine,
[Synulox, Zoetis Italy S.r.l., Modena] and marbofloxacin [Aristos, lacks detailed information on the diagnosis and treatment [17].
Fatro S.p.a., Bolonia]) in 7 (77.8%) dogs, nonsteroidal anti-­
inflammatory (NSAIDs) drugs in 4 dogs, and antiepileptic drugs In the English language literature on peer-­reviewed journals,
such as phenobarbital (Soliphen, Dechra Veterinary Products, a total number of fewer than 50 dogs with MD as the primary
Turin, Italy), levetiracetam (Keppra, GlaxoSmithKline, Jedda, site of infection or because of disseminated disease is described
Kingdom of Saudi Arabia or Matever, Pharmathen, Attica, [7, 11, 14, 15, 17–26]. MRI findings are described in one paper,
Greece) and midazolam (Midazolam, Hameln Pharmaceuticals, which included seven cases of central nervous system (CNS) as-
Hamelin, Germany) in 1 dog due to the development of status pergillosis [20].
epilepticus.
In agreement with what is reported in the literature, our data
Surgical curettage of the affected disc was performed in 3 cases. showed that the majority (7 of 11) of dogs were GSs. A predis-
posing factor for aspergillosis in GS is reported by some authors
and might include a defect in mucosal immunity, which could
3.7   |   Outcome have a genetic basis [17, 18]. An inherited immune disorder as-
sociated with abnormalities in IgA function is reported in GSs
At the end of data analysis, 10 dogs had died. The median sur- with low IgA serum levels, a finding described in this breed
vival time was 30 days (range 5–365). One dog was still alive and [26]. However, not all GSs with systemic fungal disease have
receiving antimycotic therapy 1210 days after diagnosis. The lower IgA levels [27]; therefore, a possible multifactorial etiology
blood test changes, etiological agent, antifungal therapy, out- should be considered, including immunosuppressive conditions
come, and survival time in our study cohort are summarized such as diabetes mellitus, chemotherapy treatment, glucocorti-
in Table S3. coid treatment, or concurrent infection [28]. In our study, the
presence of pre-­existing disease in two GSs (one dog with a his-
The cause of death was euthanasia in 8 dogs, four due to se- tory of urinary tract infection and one that underwent ovario-
vere worsening of ambulatory deficits, three due to develop- hysterectomy for the presence of pyometra) suggested possible
ment of systemic signs (diffuse pneumonia in one dog, signs conditions causing immunosuppression.
of systemic mycosis in one case, and acute nephropathy in the
other dog), and one dog due to refractory status epilepticus While previous literature shows an overrepresentation of males
occurring soon after the neurological examination and diag- for bacterial discospondylitis [5, 29], females are more reported
nosis of MD. An unrelated cause (hit by car) was recorded in 1 in MD [17, 18]. Despite the small number of dogs in our study, a
dog, while death related to an unknown cause was described slight majority of females was found (6 of 11).
in another dog.
On general physical examination, pyrexia was the most fre-
Follow-­up MRI was performed in 2 cases. One dog underwent quent finding, described in six cases. A recent retrospective
a first follow-­up MRI 270 days after diagnosis. MRI showed no study involving 120 dogs diagnosed with bacterial disco-
contrast enhancement of the previously affected intervertebral spondylitis confirmed pyrexia in 23% of the dogs [7]. In the
discs. After an acute worsening of the clinical signs, a second published reports on MD, although detailed information re-
follow-­up MRI was performed 110 days after the first follow-­up garding the measurement of body temperature is not pres-
MRI, which showed a severe recurrence of the discospondyli- ent in all papers, pyrexia was reported in 11 out of 26 dogs
tis in the same intervertebral spaces. The dog was euthanized [11, 14, 15, 17, 18, 21, 23, 25, 30, 31].
5 days later due to the gait deterioration.
Neurological examination showed pain on palpation of the
In the only dog still alive, a follow-­up MRI was performed vertebral column in all dogs. Nine dogs had gait abnormalities
510 days after the diagnosis of MD to assess the disease pro- associated with abnormal postural reactions in the hind limbs,
gression. The MRI showed substantial improvement of the suggesting direct spinal cord involvement.
previously affected intervertebral discs and endplates without
contrast enhancement. In the presence of discospondylitis, spinal cord damage can be
the consequence of compression due to an empyema [32] or, ac-
cording to the human literature, vertebral instability possibly
4   |   Discussion related to subluxation or pathologic fracture [33].

The present retrospective study described 11 dogs with MD, pri- In our study, out of the nine dogs that showed gait deficits and
marily affecting GSs, and found that spinal pain and gait abnor- abnormal postural reactions, none had MRI findings of com-
malities were the most commonly reported clinical signs (100% pressive myelopathy secondary to vertebral instability or patho-
and 82% of dogs, respectively). Despite treatment, the median logic fracture. Among these nine dogs, five had MRI findings
survival was 30 days. At the time of writing, only one dog was suggestive of compressive myelitis due to empyema. The four
still alive, highlighting the poor prognosis of the disease. remaining dogs had no signs of myelopathy on MRI.

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In addition, the MRI of one of the two dogs that presented only vertebral column. Although these data seem to confirm what has
with pain showed a mild compressive myelopathy in the absence been reported by other authors [11, 17], it is difficult to compare
of obvious gait abnormalities. our findings with the existing literature. In particular, most of
the previous papers, especially the less recent ones, describe only
Direct compression of neural tissue in the vertebral canal and the radiographic findings with a possible underestimation of the
formation of ischemic injuries secondary to thrombosis or vas- number and location of affected intervertebral discs. However,
culitis have been proposed to explain the pathophysiology un- our results are consistent with what is reported in the current vet-
derlying the sign of neurological disease observed in dogs with erinary literature that MD is more often multifocal than bacterial
spinal epidural empyema [32, 33]. discospondylitis, for which multifocal localization is reported in
20%–37% of cases based on different studies [6, 7, 11, 15, 17, 18].
The reason for the gait abnormalities and altered postural re- Of note, three dogs in our case series had a single lesion.
actions in the absence of relevant spinal cord lesions on MRI
is not yet completely understood. In a study examining spinal Additional imaging features to help differentiate between bacte-
cord compression associated with bacterial discospondylitis, the rial and MD are not currently available in veterinary medicine. In
degree of spinal cord compression did not correlate with the se- human medicine, the presence of a focal paravertebral soft tissue
verity of neurologic signs [29]. abnormality on MRI is most commonly associated with MD [37].
In our study cohort, we found the presence of paravertebral soft
Twenty-­four hours after the neurological examination, one dog tissue abnormalities in 100% of dogs. In a previous study, report-
presented with forebrain clinical signs with the onset of a refrac- ing MRI features of 13 dogs with confirmed bacterial discospon-
tory status epilepticus. Although brain MRI and necropsy were dylitis, paravertebral muscle involvement was described in all
not performed, the primary suspicion was for mycotic extension cases [36]. These results do not appear to support the hypothesis
of MD to the intracranial nervous system. Although intracranial that paravertebral soft tissue involvement might help differentiate
spread of nasal aspergillosis through the cribriform plate of the mycotic from bacterial discospondylitis as in humans.
ethmoid is the most likely form of diffusion of this microorgan-
ism into the intracranial CNS [24], there are reports of hema- In our case series, the diagnosis of MD was obtained by cytolog-
togenous diffusion from primary sites of discospondylitis [20], as ical identification of the fungal hyphae and, in all but one case,
suspected in this dog. Considering the direction of CSF flow and by mycological culture. The use of enzyme immunoassay tests
the lack of progression of signs in the cranial part of the spinal for the diagnosis of systemic aspergillosis is reported in litera-
cord, diffusion from the spinal cord to the intracranial structures ture [38]. Although it was not used in our case series and there
via CSF seems very unlikely. Although this is a rare condition, a are no reports of its use in the previous MD literature, it may be
careful evaluation of the mental status and cranial nerves during of interest to evaluate its usefulness both in refining the diagno-
the neurological examination in dogs with MD is warranted to sis and in assessing the response to therapy.
provide information on possible intracranial involvement, to be
confirmed with brain MRI and CSF examination. The most commonly used antifungal drug in this study was
itraconazole, administered in seven dogs. Itraconazole is a
Signs of systemic inflammation in blood exams, such as neu- synthetic broad-­spectrum azole derivative with more effective
trophilic leukocytosis associated with CRP increase, were in vitro activity than ketoconazole against Candida species,
found in 50% of our cohort. A retrospective study on 16 dogs Aspergillus species, and dermatophytes [28]. Specific guidelines
diagnosed with bacterial discospondylitis showed that CRP for antifungal therapy in dogs with MD are not available, but
assessment might be clinically more useful to screen this dis- given the intrinsic resistance of Aspergillus spp. to fluconazole,
ease than pyrexia or leukocytosis alone [34]. As the findings it should not be recommended to treat MD in the absence of
of physical and neurological examination can often be non-­ clear indications from the antimycogram [28].
specific, CRP evaluation can be considered in the diagnostic
work-­up of dogs with suspected MD. Further studies, includ- In human beings, a randomized clinical trial in humans with
ing a larger number of dogs, are needed to evaluate whether aspergillosis showed that voriconazole improves survival and is
CRP may be a useful biomarker in the diagnosis of canine MD. well tolerated compared to amphotericin B [39]. In our country,
MRI is the gold standard in the diagnosis of discospondylitis the prohibitive cost of voriconazole for long-­term administration
because it provides more detailed information and can detect and the difficulty in obtaining this drug were the reasons for not
lesions earlier than radiographs [35]. In our study, the com- using this antifungal in our case series.
parison of the number of sites affected by MD between the
different imaging modalities showed that MRI, as in the case The results of our study are consistent with the reported poor
of bacterial discospondylitis, is more precise in detecting in- prognosis associated with this disease [11, 18] despite early di-
tervertebral disc infections at an earlier stage even in the pres- agnosis and treatment. At the end of the data analysis, only one
ence of mycotic etiologies [36]. In fact, two cases with normal dog was alive 1210 days after the diagnosis of MD and the overall
radiographs had lesions compatible with discospondylitis on median survival time was 30 days. It is difficult to make a com-
MRI, and two out of four dogs with radiographic findings con- parison with previous literature as many studies include MD in a
sistent with single lesions had multiple discs involved on MRI. broader cohort of dogs affected by systemic mycoses.

On diagnostic imaging, lesions in affected dogs were predomi- The present study has a few minor limitations, mainly due to its
nantly multifocal with a median number of affected discs of 2.5. retrospective nature and the rarity of the disease. Limitations
All dogs had discospondylitis affecting at least the thoracolumbar include the small number of dogs and, considering the

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retrospective analysis, the lack of a precise timeline for progres- References
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