Use of a liposomal formulation of amphotericin B for treating wound aspergillosis in a goliath heron (Ardea goliath)

Most effective treatment regimens for invasive fungal infections in birds have included parenteral amphotericin B or oral itraconazole. However, the nephrotoxicity of conventional amphotericin B and the necessity of administering it twice daily intravenously have limited its use. During routine physical examination, a 1-year-old male goliath heron (Ardea goliath) was found to have a deep infection with Aspergillus species of its pectoral muscle. Treatment with surgical debridement followed by topical povidone-iodine in conjunction with oral itraconazole for 50 days and then also topical miconazole for 19 days failed to resolve the infection. A novel preparation of liposomally encapsulated amphotericin B was made by combining the drug with sterile, water-soluble lubricating gel. Liposomal amphotericin B was administered topically at a dosage of 1.35 mg/kg once daily for 30 days, discontinued for 15 days (when it became unavailable), and then administered again once daily for 14 days, every 3 or 4 days for 16 days, and every 5-7 days for 60 days. Treatment of the wound with this antifungal medication, combined with antibiotics and vigorous surgical debridement, led to full resolution of wound aspergillosis in this goliath heron. We chose the liposomal formulation of amphotericin B because of its reduced nephrotoxicity and longer duration of activity relative to conventional amphotericin B. Liposomal amphotericin B is an intravenous preparation that can be given via nebulization as well and has a much longer residence time than conventional amphotericin. B in murine models, making it a potentially more practical drug also for treating respiratory tract aspergillosis in birds.