Fluconazole therapy for coccidioidomycosis in Japanese macaques

The South Texas Primate Observatory is the home of more than 200 Japanese snow macaque monkeys and of a small number of vervets. The colony was established to study social behavior in monkey families; consequently, animals range freely over more than 59 acres. During the past 6 years, there have been six documented cases of coccidioidomycosis. In addition, there have been six probable cases and five possible cases. Disease was progressive in all monkeys and was characterized by cough, wasting, and the appearance of draining cutaneous abscesses. Untreated, monkeys usually died within several months. Fourteen monkeys were treated with oral fluconazole; eight improved rapidly, and the others had no response. Four of the monkeys that improved relapsed quickly after fluconazole treatment was interrupted. Two monkeys showed initial improvement, relapsed when fluconazole treatment was interrupted, and again improved when fluconazole treatment was resumed. The present studies suggest that fluconazole may be effective treatment in primates with coccidioidomycosis and that euthanasia is no longer necessary. However, prolonged treatment is necessary, and relapses may occur.