[music playing] Kelly:   Coming up on The Paw Report, we look  into a fungal disease that targets   dogs more than most species.

In the  US, blastomycosis is prevalent in the   Midwest and here in Illinois.

Join us for  a discussion with Dr. Jennifer Reinhart,   who'll talk about treatment and recovery for  our four-legged friends diagnosed with blasto.

[music playing] Male voice:   It's almost impossible to imagine life without  internet today.

It keeps us connected to work,   school and loved ones no matter where they are.

Fidium fiber internet now serves over a million   locations providing reliable, consistent service  that keeps these connections strong.

From vibrant   cities to quiet rural areas, fiber broadband is a  key driver of economic growth.

Fidium is dedicated   to supporting communities and enhancing lives  through this essential technology.

Learn more   at Fidiumfiber.com.

Olivia:   At Tender Touch Grooming, we groom dogs of all  sizes and breeds tenderly.

Our team pampers your   furry friend with care, because every pet  deserves a tender touch.

Appointments are   available via text at (217) 317-9489.

Rameen:   The Paw Report on WEIU is supported by Rural King,  America's farm and home store, livestock feed,   farm equipment, pet supplies and more.

You  can find your store and more information   regarding Rural King at ruralking.com.

Rob:   Dave's Decorating Center is a proud supporter  of The Paw Report on WEIU.

Dave's Decorating   Center features the Mohawk Smartstrand Silk  Forever Clean carpet.

Dave's Decorating Center,   authorized Mohawk color center in Charleston.

Kelly:   Thanks for joining us for this episode of The Paw  Report.

And on this episode, we have a first-time   guest.

We welcome from the University of  Illinois Veterinary Teaching Hospital, Dr.   Jennifer Reinhart.

Thank you so much for making  the trip South and joining us here at WEIU.

Jennifer: Absolutely.

I'm very happy to be here.

Kelly: Well, today we're talking about kind   of a difficult subject matter, but very important.

And that is about a fungal issue that you see in a   lot of pets that you treat, and that is something  called blastomycosis or blasto.

And so our viewers   will hear us call it blasto probably a lot through  this interview.

So let's start at the beginning.

What is blastomycosis?

Jennifer:   So blasto is, as you said, a fungal infection.

It  happens really commonly in our area in Illinois,   also Wisconsin, down into Kentucky,  Tennessee.

And as I think you alluded to,   it's very common in dogs, although it can't happen  in other species as well, like cats and people.

Kelly: I'm going to rewind it just   a little bit because you mentioned Wisconsin, and  that's where you come from.

That's where you did   some medical education.

Jennifer:   That's right.

I did my PhD in Wisconsin and  my husband's family is from there as well.

Kelly: So you do have some ties?

Jennifer: Absolutely.

Kelly: How could my pet be infected   with blastomycosis or blasto?

Jennifer:   So the fungal organisms actually live in the  soil, honestly everywhere in the Midwest,   but especially in proximity to large bodies  of water.

And most commonly, they get it by   inhaling it from the soil.

They're down there  sniffing or maybe there's been a big rainstorm,   and that aerosolizes some of the dust and it  just gets up into the air and they inhale it.

And not every animal that inhales or is  exposed to blasto actually gets the disease,   and we really don't exactly understand why some  animals get sick from it and other animals don't.

It's just at this point a random assortment  of animals that get it.

Maybe some animals   who have immunosuppression, they're on certain  drugs, they might be more likely to get it,   but most of our blasto patients are otherwise  healthy, usually young adult active animals.

Kelly: If I'm a pet owner and I'm noticing some weird   things about my animal, how does it show itself?

Jennifer:   So blasto can look like a lot of different  things because it's what we call a deep mycosis,   which means that it can affect  multiple different body systems.

So sometimes there's no specific signs, they're  just not feeling well, they're lethargic,   they're not eating.

Maybe they have a fever,  that's quite common.

But as I said before,   blasto, they get it via inhalation.

And so  the lungs is the most commonly affected body   systems.

So we may see things like coughing  or shortness of breath, things like that.

But then, like I said, it can go to other  places as well.

The skin is a really common   area.

So sometimes we'll see little nodules,  which sometimes will ulcerate.

The lymph nodes   can get big.

It can get in their eyes, so they  can have difficulty seeing or have pain.

It can   get in the bones, so they might be limping.

And  it can actually get in the brain as well, so they   can have behavioral abnormalities from it.

And so sometimes it can be really difficult   as a veterinarian and certainly as a pet owner to  say, yes, my dog has blasto because you have to   put the pieces together.

And the more organs  that are affected, the more we're like, "Hmm,   that's starting to look like blasto."

But we  don't know until we run the tests for it.

Kelly: I'm just   using the common term hot spots.

I know pets get  that, dogs get that.

Does that have any sort-   Jennifer: No.

Kelly: Does blasto show itself   in something like a hot spot?

Jennifer:   I think that to a pet owner, a hot spot and  a blasto lesion might look similar, but to a   veterinarian, it looks a little bit different.

There can definitely be some oozing and some   draining from both of them, but the blasto lesions  oftentimes are nodular, more swollen.

But again,   if you have concerns about any lesions, any skin  abnormalities on your pet, take them to your vet.

Kelly: Absolutely.

It's prevalent in the Midwest and   here in Illinois.

Why is it in Illinois or why in  the Midwest?

Is it our environmental conditions?

Jennifer: I don't think we exactly know   other than we know that this organism really likes  the waterways that are in the Midwest.

It follows   the Mississippi River, the Ohio River, up into  the St. Lawrence.

They get it in Southern Canada   too.

And for whatever reason, this is a real hot  spot for it.

And the disease exists in other parts   of the world as well, but it's much, much more  prevalent, endemic in this area of the world.

Kelly: How does blasto differ from other   fungal infections that we hear about, read about,  maybe like ringworm or something like that?

Jennifer: Sure.

So the two most common   fungal infections in animals are, as you said,  ringworm, which is a skin infection.

And also   the other one is malassezia, which is another skin  infection.

And they're generally pretty easy to   identify and treat.

They can be managed with just  oftentimes topical medications, and they don't go,   as you say, deep into the body, that they stay  on the skin.

Whereas blasto, although we know   it can affect the skin, that's one of the organs  it likes, it's systemic, it's throughout the body   affecting multiple organs.

Kelly:   How do you go about diagnosing?

So you come  in and I'm sure there's a series of tests,   maybe skin tests.

How does that go?

Jennifer:   So I mean obviously the first step is that the  veterinarian has to recognize that there are   these organs affected in an animal living in  this area.

And I'd say most veterinarians in   Illinois are very comfortable diagnosing blasto  because we see it so commonly.

So then the next   step would be to run tests.

The best way  to diagnose blasto is actually to see it   on a microscope.

And there's lots of different  ways that we can collect samples to do that.

If the animal has a skin lesion that's open,  then a very simple thing we can do is called   an impression smear where we take just a little  slide, press it on the oozy lesion and look at it   under a microscope.

And usually when you look at  a lesion or a sample from an animal with blasto,   the organisms are very apparent on the  slide.

It's usually pretty easy to find.

But there may be other ways.

Depending on  what organs are involved, we might need to do   different kinds of sampling techniques.

So maybe  doing what's called a fine needle aspiration,   putting a small needle into a lesion, like say a  big lymph node, sucking out some cells, and again,   looking at it under the microscope.

If we can't find it on the microscope,   or if we think the blasto is in a place that's  much more difficult to sample, like say the brain,   then there is actually a urine test that can be  performed as well that looks for little pieces   of the fungus in the urine.

And that's a  send-out test.

It's usually pretty good,   but really the best, most concrete way to say yes,  this dog has blasto is to actually see the little   microscopic fungi on a sample.

Kelly:   Do you see a lot of cases?

I know it's  prevalent in the Midwest here in Illinois,   but I guess when you look at all the different  reasons why pets come into the vet's office,   do you see a lot of cases of this?

Jennifer:   I mean more so than a lot of other infectious  diseases, but it's certainly not the main   thing that we see because animals come  to their vet for all sorts of reasons.

Kelly: Sure.

Jennifer: I'd say at my   hospital at the University Veterinary Teaching  Hospital, we probably see 20 to 30 cases a year.

And the cases that we see tend to be the more  severely affected animals because we can provide   specialty care, like say if an animal's having  difficulty breathing because of their blasto.

So those kinds of cases get referred to us.

But I think maybe in the veterinary literature,   in the published papers and such, probably maybe  1 in 1,000 to 1 in 10,000.

So it's not overall   a common disease, but it's much more common  here than it is say in California.

And so it's   something that people should know about.

Kelly:   So the magic question, it's a big word  for an awful fungus and issue, pet owners   want to know what can I do?

I mean, once you  diagnose it, what are the treatment options?

Jennifer: So the best chances of having a positive outcome   are when there's early diagnosis that we recognize  it before the animal gets too severely affected,   gets to the point where they're having trouble  breathing from the disease.

But absolutely,   there are medications that can be used  to treat blasto, antifungal medications,   which are basically like antibiotics meant  specifically for fungus instead of for bacteria.

But animals who are treated for blasto, unlike  say you get a bladder infection, they go on   antibiotics for a few days.

Treatment of blasto  takes several months, and we have to monitor them   closely, making sure that they're showing  improvement in their symptoms.

Improvements   say like if we're monitoring X-rays of their  chest, if they have disease in their chest,   making sure all the skin lesions go away.

And we really want to treat, honestly always   err on the side of treating longer than might  be necessary because there is always the chance   of relapse that if you don't treat long enough  that the disease could come back.

And even in   animals who look like they're completely resolved,  even about one in five of them will still have a   relapse and have to go back on medications.

Kelly:   That was going to be my next question, A, is it  curable?

And B, I guess there is a chance that it   could come back if it's an airborne ... Jennifer:   Well, yeah.

I mean that's the thing is that we see  animals if they are treated and then they relapse   just within a few months, we say, okay, well, we  probably never actually cleared it from the body,   that we just didn't treat long enough or with good  enough antifungals and we need to go longer.

But   then there are rare cases of dogs who get it when  they're two and then get it again when they're 10.

And that's probably reinfection that they just  live in an area where the fungus is so prevalent   that they get re-exposed.

Kelly:   So it is curable?

Jennifer:   It is curable, absolutely.

I'd say it really  depends on what organs are involved and how   severely affected they are.

But most animals  with mild to moderate disease, where again,   their lungs aren't severely compromised, their  brain is okay, do okay with treatment.

Again,   intensive treatment, but treatment.

Kelly:   Yeah, absolutely.

And intensive treatment,  but what if that intensive treatment isn't   done?

What if it doesn't show itself and a  pet owner doesn't really know it?

It'll be   fine.

It'll clear up.

I know what ultimately the  outcome could be, but I mean if it's prolonged.

Jennifer: I mean the earlier we identify the disease,   the sooner we can get treatment started, the  better the chance of having a positive outcome.

And honestly, probably the shorter duration of  treatment because if they just have a little bit   in their body, they may not need to be treated  for as long.

Compared to an animal who has   multiple organs affected, it's everywhere, those  animals need treatment for a very long time.

Kelly: Each client's obviously   going to be definitely different.

But when you  look at those cases that you say that maybe the   veterinary teaching hospital looks at per year,  recovery and prognosis, how does that fare?

Jennifer: So it's been my experience that   most animals who succumb to their disease, succumb  to blastomycosis, do so relatively soon within the   first couple of weeks of diagnosis.

And that's  because their disease is just so overwhelming.

They can't breathe or their brain is so inflamed  that they can't function.

And so those animals   usually pass away from their disease.

But even if they're severely affected,   if they come in and they show a response to  treatment, they start improving and we're   able to get them discharged, able to get them go  home, most of those animals do okay.

Does that   answer your question?

Kelly:   Oh, absolutely it does.

Now, can this disease,  this question's kind of two-fold, can it be   spread to let's say a multi-pet home?

You've  got maybe other dogs, maybe you have other cats,   maybe you have other animals besides the two  most popular, dogs and cats.

And what about   to humans?

What about to pet owners?

If I'm  like, "I'm afraid that I could get this."

Jennifer: Right, that's an excellent question.

And the answer hopefully is a positive one, makes  you feel better.

It is not impossible, but very,   very, very rare for this disease to be passed  between individuals, so for the infected dog to   give it to their owner or to another animal.

And  that's because of the biology of the organism that   it's actually the infective form is in the soil is  different than what we harbor in our body, that it   actually changes.

So it's actually, if you have  a dog with blasto, they're not breathing it out.

Kelly: I was going to say, if   it's in their lungs and they're coughing, and you  get up in the dog's face and it coughs on you.

Jennifer: No, absolutely not.

The very rare reports of it   getting transmitted from a dog to a human is via  bites, bite wounds, so very, very uncommon.

But we   do see situations where there are multiple animals  or animals and humans affected in the same home,   and it's not because they're passing it between  each other, it's because they have a common source   of exposure.

They went hunting together.

Kelly:   Exactly.

They went in the woods together.

Jennifer:   Right, exactly.

Kelly:   They went by the water together.

Jennifer:   Exactly.

Kelly:   Is it possible, and pets are rambunctious, but  is it possible that you can prevent them from   getting this?

I mean, what's the magic theory of I  don't want my dog to get this, so what can I do?

Jennifer: Move to California.

No, so seriously,   I think about this too, and certainly there  are certain activities that increase exposure,   like you said, going out into the woods.

But other  things, like I said, it happens, say we have a big   rainstorm like we did yesterday, and a lot of  it gets aerosolized, you can't keep your dog or   pet from getting exposed by keeping him in the  house.

It's everywhere and in our environment.

And again, I don't want people to be scared  by that because most of us have been exposed   and almost none of us get the disease and that's  true for dogs as well.

But because the exposure   is so ubiquitous, there's really nothing  at this point, I think to be done to really   significantly ...

There's certainly nothing that  we can do to guarantee an animal won't get it in   this animal.

I do know that there's a company  that's actually working on vaccines for fungal   diseases, and so that might be something that we  see in the future, but that's at least several   years down the line.

Kelly:   Are there certain breeds that you see more  of than others that get this disease?

Jennifer: Yeah, that's a good question.

So definitely large sporting breeds and working  dogs tend to be overrepresented for blasto.

Kelly: So those would be your labs,   your retrievers, your hounds.

Jennifer:   The pointers.

But we think it's honestly probably  not something specific about those breeds.

It's   that those breeds tend to engage in behaviors,  activities that are going to put them at higher   risk.

Those are the dogs who are going to be  out running around on the farm or going to be   hunting or going fishing with the family, not the  mini poodle sitting on the couch next to you.

Kelly: Or the toy dog that's   in the purse over there.

Jennifer:   Right, and I definitely have seen blasto in those  little breeds too and in cats.

So it absolutely   can happen.

Kelly:   Going back to once they get the prognosis and  then there's a treatment plan, you said that   that treatment plan, there is some longevity  to it.

What does that look like?

Is it pills,   injections, topicals?

And then specifically, and  I know each client is different, but if you had   to give an average is long six months, is it two  years?

Is it how long?

What does that look like?

Jennifer: I'd say six months is probably about average,   but we can see it anywhere from just a couple of  months to extending over a year.

And as far as   the medications, the first line medications are  all oral medications given once or twice daily,   depending on the drug that's chosen.

In really  severe or refractory cases, there's a drug called   amphotericin that is given injectably that you'd  actually have to go into the hospital several   times a week to have an infusion given.

And that's  usually done over a three or four week period.

But   the mainstay are the oral antifungal medications.

And so in those situations, we definitely do want   to keep an eye on them.

Most of the time you'd  be coming into the vet for monitoring every month   or two.

We watch blood values because there  can be some side effects with the medications   that we want to make sure we catch.

And then  again, we want to make sure that we're seeing   steady improvement in how the skin lesions are  doing, repeating chest X-rays to make sure that   the lesions in the chest are getting smaller.

Keeping a close eye on the eyes because that's a   common site of infection, and like I said, can be  quite painful.

They can actually develop glaucoma   secondary to the infection, and in some cases,  they actually have to have their eyes removed   to keep them comfortable.

So there's really  a lot of stuff that goes into it.

And again,   it really comes down to which organs are affected  and that determines how we manage the disease.

Kelly: I don't want to sugar coat it,   but it sure sounds like this could be a costly  disease too.

I mean just given all the treatments,   the diagnosis and what can happen for six months,  I think that's something that pet owners just need   to be aware of.

Jennifer:   Yeah, I mean, the medications, the nice thing  is that there are a couple different options   for medication, some of which are cheaper  than others.

So I think that can help make   things more affordable.

But we're probably  looking at a couple hundred dollars a month   at least between the medications and the  tests that need to be done for monitoring.

Kelly: Are there any trials or studies,   anything that you're involved with or researchers  at the University of Illinois that are involved in   looking at this fungal disease and how changes  could be made to treatment or diagnosis down   the line?

Jennifer:   Yeah, so I'm actually running a study right now.

We're looking at whether or not measuring levels   of the antifungal drugs in the body can actually  help us improve treatment.

Basically adjusting   the dose every month to make sure that the blood  levels are correct, basically to prevent toxicity,   because if the drug levels get too high, they're  more likely to have side effects from the drug.

And if the drug levels get too low, then  the drug may not be effective.

So we're   basically looking to see whether or not taking  those measurements, watching the blood levels   will help improve treatment, help dogs get to  clinical resolution more quickly and more safely.

That's a study that we've actually completed  enrollment on right now, so we're not accepting   any new patients.

Five of our dogs have already  gone into remission, have successfully completed   treatment, and our other guys are well on their  way.

So it's been a really good experience.

We're   learning a lot from them.

And I certainly  plan on doing some other research projects   in the future.

And I also know that there's  some work being done at Wisconsin as well.

Kelly: A couple seconds left.

I find this topic   fascinating and it's definitely one we've never  dived into here on The Paw Report.

What was your   drive to go in this direction of medicine?

Jennifer:   So I'm a pharmacologist by training.

I'm  also an internist, so I treat animals,   but I also study drugs basically.

And so it's my  goal to optimize therapies, to try to find either   new drugs or ways to make drugs work better and  more safely, like I was just saying.

And coming   from Illinois, I did my vet school at Illinois and  then came back as faculty.

Blasto is, as I said,   it's big here.

It's something that is really an  important disease in this area.

And so knowing   that I had the skills to help, maybe, help improve  treatment for this disease, it really just seemed   to click for me.

Kelly:   Definitely an important topic and one that you're  definitely an expert at.

And we appreciate you   sharing a wealth of knowledge about this fungal  disease that I hope that clients out there,   pet owners out there may take a second look  if they notice something a little out of whack   with their pets.

So Dr. Jennifer Reinhart from  the University of Illinois Veterinary Teaching   Hospital, thank you for being a first-time guest,  hopefully a returning guest to The Paw Report.

Jennifer: Thank you for having me, and I hope   everyone's learned a little something today.

Kelly:   They did, I'm sure of it.

Jennifer:   Fantastic.

Kelly:   And thank you our viewers of The Paw Report for  joining us for this episode.

Until next time,   we'll see you then.

Rob:   Dave's Decorating Center is a proud supporter  of The Paw Report on WEIU.

Dave's Decorating   Center features the Mohawk Smartstrand Silk  Forever Clean carpet.

Dave's Decorating Center,   authorized Mohawk color center in Charleston.

Rameen:   The Paw Report on WEIU is supported by Rural King,  America's farm and home store, livestock feed,   farm equipment, pet supplies and more.

You can  find your store and more information regarding   Rural King at ruralking.com.

Olivia:   At Tender Touch Grooming, we groom dogs of all  sizes and breeds tenderly.

Our team pampers your   furry friend with care, because every pet deserves  a tender touch.

Appointments are available via   text at (217) 317-9489.

Male voice:   It's almost impossible to imagine life without  internet today.

It keeps us connected to work,   school and loved ones no matter where they are.

Fidium fiber internet now serves over a million   locations providing reliable, consistent service  that keeps these connections strong.

From vibrant   cities to quiet rural areas, fiber broadband is a  key driver of economic growth.

Fidium is dedicated   to supporting communities and enhancing lives  through this essential technology.

Learn more   at Fidiumfiber.com.

[music playing]