Successful Treatment of Nannizziopsis guarroi Infection using Systemic Terbinafine in a Central Bearded Dragon (Pogona vitticeps)

Abstract

Nannizziopsis guarroi infection in lizards presents therapeutic challenges as reports of poor clinical outcomes, including antifungal toxicity, incomplete clearance of infection and recrudescence of infection are common. The case presented here describes the successful treatment of a N. guarroi infection using systemic terbinafine and environmental disinfection in a captive-bred central bearded dragon (Pogona vitticeps). The lizard presented with darkly colored cutaneous lesions and mycologic culture samples were identified as N. guarroi using Matrix-Assisted Laser Desorption/Ionization – Time Of Flight (MALDI-TOF). Based upon the lack of clinical resolution of cutaneous lesions, weight loss, and reduced appetite, initial treatment with voriconazole was discontinued. Terbinafine was prescribed and weekly environmental disinfection with sodium hypochlorite was initiated until cutaneous clearance of the fungus was confirmed by negative culture, histopathology, and N. guarroi qPCR from cutaneous swab. Terbinafine treatment was discontinued after 80 days. There were no clinical signs of toxicity associated with the prolonged treatment and the lizard has not developed any cutaneous lesions or illness in more than two years of clinical follow up. While the most ideal treatment of N. guarroi is still being investigated, this case demonstrates a promising and safe treatment option for an increasingly common and devastating disease.