- Email: [email protected]
Fungal diseases of rabbits
Vet Clin Exot Anim 6 (2003) 429–433
Fungal diseases of rabbits Carol J. Canny, DVM Diplomate ABVP-Aviana,*, Christopher S. Gamble, DVMb b
a 321 Chartridge Drive, Hagerstown, MD 21742, USA Small Animal Section, US Army Medical Research Institute for Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, MD 21702, USA
Dermatophytosis (ringworm, favus) Dermatophytosis is a superficial infection of the stratum corneum of the skin, hair, and nails. Dermatophytosis in rabbits most often is reported to be caused by Trichophyton mentagrophytes. Infection by Microsporum species is reported less commonly [1,2]. However, one exotic animal practitioner, however, feels that Microsporum species infection is most common, especially in house rabbits [3]. Microsporum canis and M gypseum are isolated most commonly, with rare reports of other Microsporum species [4–7]. Lesions often are observed on the nose, eyelids, pinna, and legs of the animal, with occasional spread to the nail bed. The lesions usually appear as areas of patchy alopecia with crusts and broken hairs, sometimes accompanied by erythema and pruritus. The typical ringworm sign of a red, raised, circular lesion with a clear center is uncommon. Young animals are at increased risk of infection, especially if there is some form of underlying stress such as poor nutrition, overcrowding, or other adverse environmental factors. Infection also can be caused by direct contact with other infected animals or contaminated fomites such as brushes. Some rabbits are asymptomatic carriers. In a recent study, 3.8% (4 of 104) of asymptomatic rabbits cultured positive for T mentagrophytes. All rabbits, except one, were under 6 months of age [8]. Carrier rates have been as high as 36% in other studies [9]. Infection can be self-limiting, but treatment is recommended for most rabbits because of the zoonotic potential. Differential diagnoses include ectoparasitism, trauma, overgrooming, barbering, and moist dermatitis.
* Corresponding author. E-mail address: [email protected] (C.J. Canny). 1094-9194/03/$ - see front matter Ó 2003, Elsevier Inc. All rights reserved. doi:10.1016/S1094-9194(03)00009-4
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C.J. Canny, C.S. Gamble / Vet Clin Exot Anim 6 (2003) 429–433
Diagnosis If ringworm is suspected, several methods of confirmation can be used. The most common test is to collect hair and place in a culture with dermatophyte medium (DTM). If a DTM is positive, the medium will change from yellow to red as soon as the dermatophyte mycelium growth is noticed. Saprophytic fungi growth also will cause a color change, but only after the mycelium has developed and has been present for several days. Examination of the lesion with a Wood’s lamp can be performed; however, only Microsporum species will fluoresce, and only 50% of M canis strains will fluoresce [10]. Some strains need to be irradiated for several minutes before a positive fluorescence becomes evident. A positive fluorescence will be an apple green color at the base of the hair follicle. False positives appear white or blue in color and may be caused by scales, debris, bacteria, or keratin plugs on the skin and hair. Macroscopic and microscopic examinations should be performed to identify the species of fungi growing. Macroscopically, M canis will appear as a whitish, cotton-like colony with a yellow-orange underside. M gypseum will be a flat, pale brown colony with a pale yellow underside, and T mentagrophytes has the appearance of a flat, white to gray powdery colony with a brown underside [10]. Saprophytic fungal colonies are often black, dark brown, or gray in appearance. A microscopic examination of the macroconidia should be performed not sooner than 5 to 7 days from the first observation of growth. To perform the examination, place a piece of tape against the colony and examine the colony on a microscope slide with a drop of cotton blue lactophenol. M canis macroconidia will be spindle shaped with thick walls and knob-like ends. The macroconidia of M gypseum will be spindle shaped with thin walls and no knob-like ends. T mentagrophytes will appear cigar shaped with thin walls; however, this organism is recognized best by the grape-like appearance of the microconidia and the presence of spiral hyphae [10]. Histology may show hyperkeratosis, acanthosis, and infiltration of the dermis with polymorphonuclear leukocytes [1]. Special stains, including periodic acid-Schiff and Gomori methenamine silver stain, can identify fungal elements.
Deep and systemic mycoses Reports of deep or systemic mycoses in rabbits are very rare. In domestic rabbits, Aspergillus fumigatus is isolated most commonly, but A niger and A flavus also have been reported [11–13]. The lesions usually are confined to the lungs. In one rabbitry, pulmonary aspergillosis was discovered in apparently healthy rabbits and appeared only in kits under 5 weeks of age [12]. Gross lesions were 1 mm to 3 mm in size and granulomatous in nature. Histopathology revealed fungal hyphae with ‘‘asteroid’’ bodies present.
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One case of spontaneous abortion in late pregnancy caused by A fumigatus also has been reported. Infection was presumed to be from contaminated flooring [11]. Contaminated commercial bedding in an animal care research facility was also the cause of an aspergillosis outbreak in mice, and this possibility should be considered as a potential source of infection when investigating a fungal outbreak in rabbits [14].
Clinical management Although identification of the dermatophyte in question is important, treatment regimes will be similar regardless of the species isolated. If a lesion is small or superficial, a variety of topical antifungal agents can be used daily until resolution. These include clotrimazole (Lotrimin) cream or lotion and miconazole (Conofite) cream. The use of lime sulfur (LymDip) as a bath or dip also is recommended weekly for at least 4 weeks. Additionally, local lesions should not be clipped, in order to reduce the possibility of iatrogenic skin abrasions, which may cause the infection to become generalized. Clipping also may increase environmental contamination. If dealing with a long-haired breed, clip only the hair surrounding the lesion and dispose of the hair properly. The process of giving a bath or dip to a rabbit can be extremely stressful, and there are anecdotal reports of rabbits dying after this process. Therefore, the benefits of this protocol should be considered carefully before treatment [15]. If a lesion is widespread or not responsive to topical treatment systemic therapy should be initiated. Griseofulvin (Fulvicin) at 25 mg/kg orally once daily or divided twice daily is recommended. If using an ultramicrosized form of griseofulvin, decrease the dose by 50% and give with a high fat meal. Griseofulvin is a teratogen and should not be given during pregnancy. Griseofulvin is only effective against dermatophyte infections. In dogs and cats, griseofulvin can cause gastrointestinal signs such as anorexia, or in severe cases, bone marrow suppression. Although these adverse effects are not reported in rabbits, if rabbits develop adverse reactions to griseofulvin, ketoconazole at 10 mg to 40 mg per kg orally once daily can be used as an alternative. Newer drugs, such as itraconazole and terbenafine, have limited pharmacokinetic data and clinical usage in rabbits. Therefore, their use cannot be recommended, until further studies have been performed. The use of lufenuron (Program) in treating superficial fungal infections in dogs and cats has been successful [16]. Lufenuron acts as an insect growth regulator and is used for the treatment of fleas. It inhibits chitin synthesis, polymerization and deposition. Because fungal cells also are surrounded by cell walls composed of chitin and other complex polysaccharides, fungal infections are responsive to lufenuron therapy.
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C.J. Canny, C.S. Gamble / Vet Clin Exot Anim 6 (2003) 429–433
In rabbits, anecdotal reports of lufenuron usage at 135 mg per kg orally every 4 weeks until resolution has been reported [17]. The drug should be given with a high fat meal. The use of lufenuron for the treatment of dermatophytosis is considered off-label usage, and appropriate client notification is recommended. The length of treatment will vary with all protocols, and treatment should last for at least 2 weeks past clinical resolution or until two fungal cultures are negative with a 4-week interval in between [18,19]. Environmental control is also an important part of the treatment regime. Affected animals should be isolated from nonaffected animals, and the animal area should be cleaned thoroughly. Dispose of any bedding, rugs, or brushes. Nonporous surfaces should be cleaned or vacuumed routinely during the treatment period, with proper disposal of the vacuum bag after each use. Diluted household bleach (1:10) is recommended, although is not 100% effective in killing fungal spores. A commercial enilconazole fogger or spray (Clinafarm) is approved for use in poultry houses and may be of use in rabbitries or household settings. Steam cleaning is not an effective method of disinfection, as the water temperature needed to kill fungal spores is not reached with machines designed for consumer use [20]. Other treatments for use in rabbitries have been used. In one rabbitry, the number of carriers of T mentagrophytes was reduced after using one of two treatments. A 1% solution of copper sulfate was applied as a dip, and a spray with metastabilized chlorous acid/chlorine dioxide (MECA) was diluted as one part base compound to one part activator compound to 10 parts water. Treatments were given six times over a 26-day period [21]. Griseofulvin can be added to the feed at 0.75 g per kg feed for 14 days; however, this may be cost prohibitive [22]. Owners should be advised to wear gloves when treating their pets to minimize the potential for zoonotic transmission of the dermatophyte.
Saccharomycopsis Saccharomycopsis gutulatus, a yeast, is a normal finding in the gastrointestinal system of rabbits and may be classified as a pseudoparasite [23]. It does not cause clinical disease, but it may be seen on routine fecal examinations or in rabbits on a lower fiber diet.
References [1] Bergdall VK, Syskos RC. Metabolic, traumatic, mycotic, and miscellaneous diseases. In: Manning PJ, Ringler DH, Newcomer CE, editors. The biology of the laboratory rabbit. 2nd edition. San Diego: Academic Press; 1994. p. 335–53. [2] Harkness JE, Wagner JE. The biology and medicine of rabbits and rodents. 3rd edition. Philadelphia: Lea and Febinger; 1989. p. 131–2. [3] Jenkins J. Skin disorders of the rabbit. Vet Clin North Am Exot Anim Pract 2001;4:543–63.
C.J. Canny, C.S. Gamble / Vet Clin Exot Anim 6 (2003) 429–433
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[4] Simaljakova M, Buchvald J, Olexova B. Microsporum canis infection in rabbits and its transmission to humans. Mycoses 1989;32:93–6. [5] Sinha BK, Prasad CB, Sinha MN, et al. Dermatophytosis due to Microsporum gypseum in a pet rabbit—a case report. Mykosen 1982;25:332–4. [6] Vogtsberger LM, Hanroff HH, Pierce GE, et al. Spontaneous dermatophytosis due to Microsporum canis in rabbits. Lab Anim Sci 1986;36:294–7. [7] Weisbroth SH, Scher S. Microsporum gypseum dermatophytosis in a rabbit. J Am Vet Med Assoc 1971;159:629–34. [8] Vangeel I, Pasmans F, Vanrobaeys M, et al. Prevalence of dermatophytes in asymptomatic guinea pigs and rabbits. Vet Rec 2000;146(15):440–1. [9] Lopez-Martinez R, Mier T, Quirarte M. Dermatophytes isolated from laboratory animals. Mycopathologia 1984;88:111–3. [10] Noli C. Practical laboratory methods for the diagnosis of dermatologic diseases. In: Bonagura JD, editors. Kirk’s current veterinary therapy XIII small animal practice. Philadelphia: WB Saunders; 2000. p. 526–30. [11] Boro BR, Sarmah AK, Goswami JN, et al. A case of abortion in rabbit due to Aspergillus fumigatus infection. Vet Rec 1978;103:287–8. [12] Matsui T, Taguchi-Ochi S, Takano M, et al. Pulmonary aspergillosis in apparently healthy rabbits. Vet Pathol 1985;22:200–5. [13] Patton NM. Cutaneous and pulmonary aspergillosis in rabbits. Lab Anim Sci 1975; 25(3):347–50. [14] Mayeux P, Dupepe L, Dunn K, et al. Massive fungal contamination in animal care facilities traced to bedding supply. Appl Environ Microbiol 1995;61(6):2297–301. [15] Harvey C. Rabbit and rodent skin diseases. Seminars in Avian and Exotic Pet Medicine 1995;4:195–204. [16] Ben-Ziony Y, Arzi B. Use of lufenuron for treating fungal infections of dogs and cats: 297 cases (1997–1999). J Am Vet Med Assoc 2000;217(10):1510–3. [17] Chlebecek T. Selected drugs for ectoparasite control in exotic species. Exotic DVM Veterinary Magazine 2002;4(1):19–21. [18] Donnelly TM, Rush EM, Lackner PA. Ringworm in small exotic pets. Seminars in Avian and Exotic Pet Medicine 2000;9:82–93. [19] Hillyer EV. Dermatologic Diseases. In: Hillyer EV, Quesenberry KE, editors. Ferrets, rabbits, and rodents. Philadelphia: WB Saunders; 1997. p. 212–9. [20] Scott DW, Miller WH, Griffin CE. Fungal skin diseases. In: Scott DW, Miller WH, Griffin CE, editors. Muller & Kirk’s Small Animal Dermatology. Philadelphia: WB Saunders; 1995. p. 329–91. [21] Franklin CL, Gibson SV, Caffrey CJ, et al. Treatment of Trichophyton mentagrophytes in rabbits. J Am Vet Med Assoc 1991;198:1625–30. [22] Okerman L. Diseases of skin. In: Price CJ, Bedford PGC, Sutton JB, editors. Diseases of domestic rabbits. Oxford: Blackwell Scientific Publications; 1994. p. 48–62. [23] Bowman DD, Lynn RC. Diagnostic parasitology. In: Bowman DD, editor. Georgis’ parasitology for veterinarians. Philadelphia: WB Saunders; 1995. p. 293–405.
Fungal diseases of rabbits Carol J. Canny, DVM Diplomate ABVP-Aviana,*, Christopher S. Gamble, DVMb b
a 321 Chartridge Drive, Hagerstown, MD 21742, USA Small Animal Section, US Army Medical Research Institute for Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, MD 21702, USA
Dermatophytosis (ringworm, favus) Dermatophytosis is a superficial infection of the stratum corneum of the skin, hair, and nails. Dermatophytosis in rabbits most often is reported to be caused by Trichophyton mentagrophytes. Infection by Microsporum species is reported less commonly [1,2]. However, one exotic animal practitioner, however, feels that Microsporum species infection is most common, especially in house rabbits [3]. Microsporum canis and M gypseum are isolated most commonly, with rare reports of other Microsporum species [4–7]. Lesions often are observed on the nose, eyelids, pinna, and legs of the animal, with occasional spread to the nail bed. The lesions usually appear as areas of patchy alopecia with crusts and broken hairs, sometimes accompanied by erythema and pruritus. The typical ringworm sign of a red, raised, circular lesion with a clear center is uncommon. Young animals are at increased risk of infection, especially if there is some form of underlying stress such as poor nutrition, overcrowding, or other adverse environmental factors. Infection also can be caused by direct contact with other infected animals or contaminated fomites such as brushes. Some rabbits are asymptomatic carriers. In a recent study, 3.8% (4 of 104) of asymptomatic rabbits cultured positive for T mentagrophytes. All rabbits, except one, were under 6 months of age [8]. Carrier rates have been as high as 36% in other studies [9]. Infection can be self-limiting, but treatment is recommended for most rabbits because of the zoonotic potential. Differential diagnoses include ectoparasitism, trauma, overgrooming, barbering, and moist dermatitis.
* Corresponding author. E-mail address: [email protected] (C.J. Canny). 1094-9194/03/$ - see front matter Ó 2003, Elsevier Inc. All rights reserved. doi:10.1016/S1094-9194(03)00009-4
430
C.J. Canny, C.S. Gamble / Vet Clin Exot Anim 6 (2003) 429–433
Diagnosis If ringworm is suspected, several methods of confirmation can be used. The most common test is to collect hair and place in a culture with dermatophyte medium (DTM). If a DTM is positive, the medium will change from yellow to red as soon as the dermatophyte mycelium growth is noticed. Saprophytic fungi growth also will cause a color change, but only after the mycelium has developed and has been present for several days. Examination of the lesion with a Wood’s lamp can be performed; however, only Microsporum species will fluoresce, and only 50% of M canis strains will fluoresce [10]. Some strains need to be irradiated for several minutes before a positive fluorescence becomes evident. A positive fluorescence will be an apple green color at the base of the hair follicle. False positives appear white or blue in color and may be caused by scales, debris, bacteria, or keratin plugs on the skin and hair. Macroscopic and microscopic examinations should be performed to identify the species of fungi growing. Macroscopically, M canis will appear as a whitish, cotton-like colony with a yellow-orange underside. M gypseum will be a flat, pale brown colony with a pale yellow underside, and T mentagrophytes has the appearance of a flat, white to gray powdery colony with a brown underside [10]. Saprophytic fungal colonies are often black, dark brown, or gray in appearance. A microscopic examination of the macroconidia should be performed not sooner than 5 to 7 days from the first observation of growth. To perform the examination, place a piece of tape against the colony and examine the colony on a microscope slide with a drop of cotton blue lactophenol. M canis macroconidia will be spindle shaped with thick walls and knob-like ends. The macroconidia of M gypseum will be spindle shaped with thin walls and no knob-like ends. T mentagrophytes will appear cigar shaped with thin walls; however, this organism is recognized best by the grape-like appearance of the microconidia and the presence of spiral hyphae [10]. Histology may show hyperkeratosis, acanthosis, and infiltration of the dermis with polymorphonuclear leukocytes [1]. Special stains, including periodic acid-Schiff and Gomori methenamine silver stain, can identify fungal elements.
Deep and systemic mycoses Reports of deep or systemic mycoses in rabbits are very rare. In domestic rabbits, Aspergillus fumigatus is isolated most commonly, but A niger and A flavus also have been reported [11–13]. The lesions usually are confined to the lungs. In one rabbitry, pulmonary aspergillosis was discovered in apparently healthy rabbits and appeared only in kits under 5 weeks of age [12]. Gross lesions were 1 mm to 3 mm in size and granulomatous in nature. Histopathology revealed fungal hyphae with ‘‘asteroid’’ bodies present.
C.J. Canny, C.S. Gamble / Vet Clin Exot Anim 6 (2003) 429–433
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One case of spontaneous abortion in late pregnancy caused by A fumigatus also has been reported. Infection was presumed to be from contaminated flooring [11]. Contaminated commercial bedding in an animal care research facility was also the cause of an aspergillosis outbreak in mice, and this possibility should be considered as a potential source of infection when investigating a fungal outbreak in rabbits [14].
Clinical management Although identification of the dermatophyte in question is important, treatment regimes will be similar regardless of the species isolated. If a lesion is small or superficial, a variety of topical antifungal agents can be used daily until resolution. These include clotrimazole (Lotrimin) cream or lotion and miconazole (Conofite) cream. The use of lime sulfur (LymDip) as a bath or dip also is recommended weekly for at least 4 weeks. Additionally, local lesions should not be clipped, in order to reduce the possibility of iatrogenic skin abrasions, which may cause the infection to become generalized. Clipping also may increase environmental contamination. If dealing with a long-haired breed, clip only the hair surrounding the lesion and dispose of the hair properly. The process of giving a bath or dip to a rabbit can be extremely stressful, and there are anecdotal reports of rabbits dying after this process. Therefore, the benefits of this protocol should be considered carefully before treatment [15]. If a lesion is widespread or not responsive to topical treatment systemic therapy should be initiated. Griseofulvin (Fulvicin) at 25 mg/kg orally once daily or divided twice daily is recommended. If using an ultramicrosized form of griseofulvin, decrease the dose by 50% and give with a high fat meal. Griseofulvin is a teratogen and should not be given during pregnancy. Griseofulvin is only effective against dermatophyte infections. In dogs and cats, griseofulvin can cause gastrointestinal signs such as anorexia, or in severe cases, bone marrow suppression. Although these adverse effects are not reported in rabbits, if rabbits develop adverse reactions to griseofulvin, ketoconazole at 10 mg to 40 mg per kg orally once daily can be used as an alternative. Newer drugs, such as itraconazole and terbenafine, have limited pharmacokinetic data and clinical usage in rabbits. Therefore, their use cannot be recommended, until further studies have been performed. The use of lufenuron (Program) in treating superficial fungal infections in dogs and cats has been successful [16]. Lufenuron acts as an insect growth regulator and is used for the treatment of fleas. It inhibits chitin synthesis, polymerization and deposition. Because fungal cells also are surrounded by cell walls composed of chitin and other complex polysaccharides, fungal infections are responsive to lufenuron therapy.
432
C.J. Canny, C.S. Gamble / Vet Clin Exot Anim 6 (2003) 429–433
In rabbits, anecdotal reports of lufenuron usage at 135 mg per kg orally every 4 weeks until resolution has been reported [17]. The drug should be given with a high fat meal. The use of lufenuron for the treatment of dermatophytosis is considered off-label usage, and appropriate client notification is recommended. The length of treatment will vary with all protocols, and treatment should last for at least 2 weeks past clinical resolution or until two fungal cultures are negative with a 4-week interval in between [18,19]. Environmental control is also an important part of the treatment regime. Affected animals should be isolated from nonaffected animals, and the animal area should be cleaned thoroughly. Dispose of any bedding, rugs, or brushes. Nonporous surfaces should be cleaned or vacuumed routinely during the treatment period, with proper disposal of the vacuum bag after each use. Diluted household bleach (1:10) is recommended, although is not 100% effective in killing fungal spores. A commercial enilconazole fogger or spray (Clinafarm) is approved for use in poultry houses and may be of use in rabbitries or household settings. Steam cleaning is not an effective method of disinfection, as the water temperature needed to kill fungal spores is not reached with machines designed for consumer use [20]. Other treatments for use in rabbitries have been used. In one rabbitry, the number of carriers of T mentagrophytes was reduced after using one of two treatments. A 1% solution of copper sulfate was applied as a dip, and a spray with metastabilized chlorous acid/chlorine dioxide (MECA) was diluted as one part base compound to one part activator compound to 10 parts water. Treatments were given six times over a 26-day period [21]. Griseofulvin can be added to the feed at 0.75 g per kg feed for 14 days; however, this may be cost prohibitive [22]. Owners should be advised to wear gloves when treating their pets to minimize the potential for zoonotic transmission of the dermatophyte.
Saccharomycopsis Saccharomycopsis gutulatus, a yeast, is a normal finding in the gastrointestinal system of rabbits and may be classified as a pseudoparasite [23]. It does not cause clinical disease, but it may be seen on routine fecal examinations or in rabbits on a lower fiber diet.
References [1] Bergdall VK, Syskos RC. Metabolic, traumatic, mycotic, and miscellaneous diseases. In: Manning PJ, Ringler DH, Newcomer CE, editors. The biology of the laboratory rabbit. 2nd edition. San Diego: Academic Press; 1994. p. 335–53. [2] Harkness JE, Wagner JE. The biology and medicine of rabbits and rodents. 3rd edition. Philadelphia: Lea and Febinger; 1989. p. 131–2. [3] Jenkins J. Skin disorders of the rabbit. Vet Clin North Am Exot Anim Pract 2001;4:543–63.
C.J. Canny, C.S. Gamble / Vet Clin Exot Anim 6 (2003) 429–433
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[4] Simaljakova M, Buchvald J, Olexova B. Microsporum canis infection in rabbits and its transmission to humans. Mycoses 1989;32:93–6. [5] Sinha BK, Prasad CB, Sinha MN, et al. Dermatophytosis due to Microsporum gypseum in a pet rabbit—a case report. Mykosen 1982;25:332–4. [6] Vogtsberger LM, Hanroff HH, Pierce GE, et al. Spontaneous dermatophytosis due to Microsporum canis in rabbits. Lab Anim Sci 1986;36:294–7. [7] Weisbroth SH, Scher S. Microsporum gypseum dermatophytosis in a rabbit. J Am Vet Med Assoc 1971;159:629–34. [8] Vangeel I, Pasmans F, Vanrobaeys M, et al. Prevalence of dermatophytes in asymptomatic guinea pigs and rabbits. Vet Rec 2000;146(15):440–1. [9] Lopez-Martinez R, Mier T, Quirarte M. Dermatophytes isolated from laboratory animals. Mycopathologia 1984;88:111–3. [10] Noli C. Practical laboratory methods for the diagnosis of dermatologic diseases. In: Bonagura JD, editors. Kirk’s current veterinary therapy XIII small animal practice. Philadelphia: WB Saunders; 2000. p. 526–30. [11] Boro BR, Sarmah AK, Goswami JN, et al. A case of abortion in rabbit due to Aspergillus fumigatus infection. Vet Rec 1978;103:287–8. [12] Matsui T, Taguchi-Ochi S, Takano M, et al. Pulmonary aspergillosis in apparently healthy rabbits. Vet Pathol 1985;22:200–5. [13] Patton NM. Cutaneous and pulmonary aspergillosis in rabbits. Lab Anim Sci 1975; 25(3):347–50. [14] Mayeux P, Dupepe L, Dunn K, et al. Massive fungal contamination in animal care facilities traced to bedding supply. Appl Environ Microbiol 1995;61(6):2297–301. [15] Harvey C. Rabbit and rodent skin diseases. Seminars in Avian and Exotic Pet Medicine 1995;4:195–204. [16] Ben-Ziony Y, Arzi B. Use of lufenuron for treating fungal infections of dogs and cats: 297 cases (1997–1999). J Am Vet Med Assoc 2000;217(10):1510–3. [17] Chlebecek T. Selected drugs for ectoparasite control in exotic species. Exotic DVM Veterinary Magazine 2002;4(1):19–21. [18] Donnelly TM, Rush EM, Lackner PA. Ringworm in small exotic pets. Seminars in Avian and Exotic Pet Medicine 2000;9:82–93. [19] Hillyer EV. Dermatologic Diseases. In: Hillyer EV, Quesenberry KE, editors. Ferrets, rabbits, and rodents. Philadelphia: WB Saunders; 1997. p. 212–9. [20] Scott DW, Miller WH, Griffin CE. Fungal skin diseases. In: Scott DW, Miller WH, Griffin CE, editors. Muller & Kirk’s Small Animal Dermatology. Philadelphia: WB Saunders; 1995. p. 329–91. [21] Franklin CL, Gibson SV, Caffrey CJ, et al. Treatment of Trichophyton mentagrophytes in rabbits. J Am Vet Med Assoc 1991;198:1625–30. [22] Okerman L. Diseases of skin. In: Price CJ, Bedford PGC, Sutton JB, editors. Diseases of domestic rabbits. Oxford: Blackwell Scientific Publications; 1994. p. 48–62. [23] Bowman DD, Lynn RC. Diagnostic parasitology. In: Bowman DD, editor. Georgis’ parasitology for veterinarians. Philadelphia: WB Saunders; 1995. p. 293–405.