The results demonstrate that the transformations of their image, the changes in abilities, the uncertainty and stories of cancer are linked to suffering and must be addressed by practitioners and researchers. Le cancer rappelle aussi souvent la mort. Enfin, huit de ces femmes avaient des enfants. Toutefois, pour plusieurs, le cancer et ses traitements sont venus marquer leur corps. Je suis pas malade encore. Cette participante associe directement sa souffrance au fait de ne pas trouver son visage joli. On le camoufle! Tu ne peux plus rien faire. In that study involving 14 Persian cats, 10 of 14 were treated twice weekly with 0.
All 10 cats were culture negative at weeks five and eight, whereas only one of four controls was culture negative. All cats were culture negative at week 10; however, when cats were euthanized at weeks 10 or 12, all had focal lesions and evidence of dermatophyte infection was found in the skin of three cats on histological examination. By day 28, all cats had negative fungal cultures and clinical lesions appeared to have resolved; however, lesions started to recur at day 60, and by day all cats were culture positive for M.
Owner noncompliance with regard to adhering to treatment recommendations, limiting new additions to the cattery and suspending breeding was noted in the study. In a third study, cattery cats from two catteries received once weekly 0. All cats initially had partial clinical improvement and reduced fungal colony numbers on dermatophyte cultures after two to four weeks of treatment; however, no cat was culture negative and colony counts increased a month after treatment was finished.
Three of four studies involving a total of cats specifically mentioned adverse effects. No eye, mucous membrane or skin abnormalities were reported. There was a slight discolouration to the hair coat. One cat developed hind limb muscle weakness after four treatments but this resolved even with continued topical treatments. This study protocol was repeated but this time evaluated these agents against T. The mean MICs did not vary significantly between the three dermatophyte species tested, but the MICs of miconazole alone and in combination with chlorhexidine for T.
A synergistic or additive effect was seen in 15 of 23 isolates tested. Test solution dilutions ranged from to for both products. In an infected cat hair challenge model, M. The first field study compared the efficacy of oral griseofulvin alone to oral griseofulvin with adjunct shampoo treatment in 22 Persian cats. The combination shampoo was found to be superior to miconazole alone and chlorhexidene shampoo alone was no better than placebo.
Chlorhexidine is a biguanide compound. Low concentrations affect the cell membrane integrity and higher concentrations result in congealing of cytoplasm.
In this study, no concurrent systemic antifungal medication was administered. Miconazole as a sole shampoo formulation has been evaluated in two studies. In one study it was used as adjunct topical therapy for the treatment of M. The antifungal efficacy of systemic terbinafine is well established. There is only one published study on the use of this compound for topical therapy. In one small study, four of eight dogs with naturally occurring M.
After three baths, two of four dogs were culture negative and none of the control dogs were culture negative. In one study, isolated infected whole hairs were culture negative after eight treatments with a ketoconazole shampoo. A dilution of a 0. Of note, the product is currently supplied as a 3. An essential oil EO is the volatile oil derived from some part of a plant, for example a leaf, stem or flower and usually carries the odour or flavour of the plant. Essential oils are usually lipophilic compounds and therefore are not miscible in water. Some EO are pure compounds e. There is increased interest in EO as alternatives to synthetic drugs because of concerns regarding drug resistance.
In addition, there is interest in exploring the application of EO in skin products to order to treat or avoid skin infections. The reader is referred to reviews for summaries of research on the antimicrobial and antifungal properties of EO. There were no reported adverse effects. In the second study, 14 cats with confirmed M. When a herbal mixture composed of chemically defined EOs of Litsea cubeba, Illicium verum , Foeniculum vulgare and Pelargonium graveolens was sprayed on naturally M.
The organism obtains necessary growth nutrients by consuming target fungi. In this study, pathogen fungal colonies in contact with P. Currently there are two commercial formulations of this biological agent available in the Czech Republic. Compared with untreated controls, the clinical and mycological response to clotrimazole was significantly better from day 11 until the end of the study.
The response to clotrimazole equalled or occasionally exceeded that of miconazole. In an experimental infection model, guinea pigs were infected with either T. Topical treatment alone affected organisms in the stratum corneum but did not prevent invasion of fungi into the hair shafts. One study showed that the topical application either terbinafine or econazole was noninflammatory on the skin of cats or dogs.
One study described successful treatment of five dogs and four cats with focal application of enilconazole. The hair around the lesions was clipped and the lesions were treated every three days for four weeks. Eight of nine animals were culture negative after four weeks of treatment. One cat was clinically cured but culture positive. Systemic antifungal therapy targets the active site of fungal infection and proliferation on the infected animal. Until the infection is eliminated in this site, the infected animal is at risk for further spread of lesions on its body, continued seeding of the hair coat with infective spores, and being a source of infection for other animals and people.
The most commonly used systemic antifungal drugs for dermatophytosis in veterinary medicine are itraconazole, ketoconazole, terbinafine and griseofulvin. Itraconazole is a first generation triazole. At low doses it is fungistatic and at high doses it is fungicidal. Ergosterol is best suited for maintaining cell wall integrity and activity.
Itraconazole is insoluble and requires specific formulations to be absorbed in the gastrointestinal tract because it is highly lipophilic and a weak basic compound. The bioavailability is pH dependent with absorption being greater in an acidic environment. Capsules are recommended to be administered with food to decrease gastrointestinal adverse effects and to decrease gastric pH and enhance absorption. Levels in the stratum corneum of skin areas with a high density of sebaceous glands were up to 10 times higher than plasma levels. In people, the drug has been shown to persist in the epidermis for up to four weeks after discontinuation of treatment.
Concentrations were also dose dependent. After one week, the median itraconazole hair concentration increased to 1. During nontreatment weeks median values decreased to 0. Two weeks after the last dose, the mean hair itraconazole concentrations were still 1. In a manufacturer's toxicology study, dogs received placebo, 2. Information on adverse effects is extrapolated from studies reporting on its use in the treatment of intermediate or deep mycoses.
In dogs, the drug is well tolerated with the most common adverse being anorexia. No published cases of cutaneous vasculitis in dogs treated for dermatophytosis were identified. Three independent studies evaluated the pharmacokinetics of itraconazole in healthy cats, although none used the currently licensed formulation for cats. The original target animal safety studies for cats were not readily available for review; however, there is a summary of findings.
Upon postmortem examination the liver was pale; histopathological changes were not reported.
One cat developed clinical signs icterus, inappetence. Both cats recovered after discontinuation of the drug and supportive care. At doses used to treat feline dermatophytosis, studies report the drug is well tolerated and if adverse effects are observed they are mild and include decreased food consumption, depression and increased serum ALT concentration. Fatal liver toxicity has been reported in one cat being treated for cryptococcosis with itraconazole. In that study, cats were treated with large doses median In a study reporting on the fungicidal efficacy of itraconazole against M.
Efficacy against M. Twelve studies have described the treatment of cats with M. The studies span a treatment time from to , during which period a wide range of treatment schedules were used: low dose pulse therapy 1. In one study, seven of 15 cats did not reach mycological cure but itraconazole was used at 1. The number of days to mycological cure, when reported, ranged from 36 to Three studies reported Persian cats in the population and one of these studies had three cats that did not achieve mycological cure, and all had greater numbers of days to mycological cure.
Four studies involved shelter cats and it was reported that occasionally some cats did not eat well for the first few days of hospitalization in the treatment ward. No treatment study reported stopping the drug due to adverse effects and no deaths were reported. Ketoconazole was the first oral azole released in the s.
The drug is highly lipophilic and this leads to high concentrations in fatty tissues. Its absorption may be enhanced by administration with a small amount of food. The drug is dissolved by gastric acidity and any other drugs that decrease gastric secretions will decrease bioavailabilty. In dogs, ketoconazole has been shown to interfere with endogenous steroid synthesis, which is reversible. Obvious signs of depression or inappetence were not observed, but cats had a decrease in body weight and the hair coats of some cats became slightly dry and rough. Ketoconazole administration leads to increased plasma concentrations of ivermectin and midazolam in dogs and ciclosporin in dogs and cats.
It should be avoided in breeding animals because it can decrease production of testosterone. There are two likely explanations: first, at the time of its release, griseofulvin was still widely available and relatively inexpensive compared to ketoconazole; second, literature searches for descriptions of its use in animals reveals that the primary interest in ketoconazole was for the treatment of intermediate and deep mycoses.
The data in this study are difficult to interpret because it is unclear if all of the treated animals were truly infected. Wood's lamp examinations were positive in 49 of 50 examinations but it is not stated if fungal cultures were also performed in the same animals. The authors reported no adverse effects in any of the 95 treated cats, but that two puppies vomited immediately after ingestion of the drug. The owner reported intermittent constipation during drug administration.
One cat did not achieve clinical cure. Two dogs were reported to show signs of depression, diarrhoea and vomiting. After two weeks oral ketoconazole treatment was stopped and the dogs were treated topically with enilconazole for four weeks. Mycological cure was not documented in this study.
In the final study, 12 cats with confirmed M. Treatment was stopped in three of 12 cats due to gastrointestinal adverse effects.
It was stopped in one cat after two weeks of treatment due to diarrhoea. In the third cat, ketoconazole was stopped due to diarrhoea that developed after an increase in dose due to lack of response to treatment. Nine of 12 cats had a documented mycological cure. Fluconazole is a first generation triazole that was first released in Its mechanism of action is similar to that of other azoles.
It is water soluble and minimally protein bound. Absorption is not affected by concurrent use of antacids and does not require food for optimal absorption. The drug is used primarily for the treatment of systemic mycoses. Fluconazole has poor antifungal efficacy against dermatophytes; it has the highest MIC compared to itraconazole, terbinafine, ketoconazole and griseofulvin for both Microsporum spp.
Terbinafine is a synthetic allylamine which was developed by chemical modification of naftitine. Compared to itraconazole, fluconazole, ketoconazole and griseofulvin, terbinafine has the lowest MIC for Microsporum sp. Ten of 10 guinea pigs infected with either T. In the study with veterinary isolates, terbinafine MICs ranged from 0. There are four studies evaluating the pharmacokinetics of terbinafine in dogs that are pertinent to its use in the treatment of dermatophytosis.
The mean terbinafine concentrations in paw stratum corneum, skin on the thorax and sebum did not reach the MIC 90 of 0. There are four pertinent studies evaluating the pharmacokinetics of terbinafine in cats. Given that this drug is not licensed for use in small animals, there are no published target animal safety studies for review. Published reports of its use either as treatment for dermatophytosis or pharmacokinetic studies were reviewed for mention of adverse effects.
One study reported that treatment was stopped for one of 12 cats due to three episodes of vomiting. Histological findings were suggestive of an allergic reaction. Translated review of the entire original paper reported that postmortem examination of cats did not reveal renal or liver changes; the abstract does not reflect the content of the translated study Chen C, personal communication. Griseofulvin was first isolated from the homogenized mycelium of Penicillium griseofulvin in and it was first successfully used to treat dermatophytosis in people in It causes morphological changes in fungal cells and may antagonize chitin synthesis in the fungal cell wall.
The drug is weakly water soluble and is poorly absorbed from the gastrointestinal tract. Absorption is affected by dietary fat, drug formulation, and particle size and dissolution rate. Absorption in dogs improved when polyethylene glycol PEG was used as a dispersal carrier in the ultramicrosized formulations. Griseofulvin's spectrum of antifungal activity is limited to that of the dermatophytes. In one study, the mean MIC against isolates was 1.
In the same study, the mean MIC for griseofulvin was 0. The MIC of ketoconazole for Microsporum was 1. In the first description of the use of griseofulvin to treat small animal dermatophytosis involved the treatment of 22 cats, 20 of which were Persian cats. Negative mycological status was finally accomplished after the use of topical therapy captan dip or napthlane soap. In , the same authors published a study describing the use and response to griseofulvin treatment in 31 cats; however, 22 cats were from the original paper.
Three papers describe the use of griseofulvin, clipping of infected hairs, topical therapy and environmental cleaning as recommended protocols to treat feline dermatophytosis in catteries. Clipping of Wood's lamp positive hairs, topical therapy and systemic therapy resulted in the fastest time to mycological cure. Potential adverse drug reactions to griseofulvin have been studied since its release. The first toxicity study on griseofulvin was published in There were no detectable changes in cat growth or abnormalities on postmortem examination.
Griseofulvin is a known teratogen in experimental rat studies. Studies in dogs are limited; therapeutic doses of griseofulvin had no effect on semen quality. In the 14 studies describing the use of griseofulvin to treat clinical dermatophytosis, no deaths were reported. Adverse reactions were noted in four cats. Pruritus was the only adverse effect noted in one cat. However, in five papers serious adverse reactions have been reported in animals receiving griseofulvin. In one report, seven cats developed lethargy, pyrexia, anorexia, depression, ataxia, upper respiratory infections, and in five of seven cases leukopenia or pancytopenia.
Four of seven cats developed severe neutropenia and one of these died. The neutropenia recurred in two FIV positive cats upon rechallenge with griseofulvin. Lufenuron is a benzoylphenylurea drug that disrupts chitin synthesis. Chitin is a critical component of the exoskeleton of arthropods, and is also an important component of the outer cell wall of fungi.
Interest in lufenuron as a possible antifungal treatment was triggered by a retrospective computer review of medical records which found that animals receiving lufenuron as a flea preventative were not treated for dermatophytosis. In an initial study, the authors used lufenuron to treat a total of 14 dogs The authors also reported that microscopic examination of fungal cultures revealed damaged and distorted macroconidia, missing septa and distorted fungal cell walls. Subsequent to these reports, a number of field studies reported on the efficacy of lufenuron with conflicting findings.
A French study compared two groups of cats with M. Lesions resolved but all of the cats were still culture positive; routine environmental decontamination was carried out. Except for two cats, all were culture negative at the end of treatment. The drug was reported to be more effective in dogs than cats. Persian cats and Yorkshire terrier dogs had the highest rate of treatment failure. A German study involving 39 cats receiving either oral or injectable lufenuron found that clinical cure occurred in treated cats but not mycological cure.
The results of this study are difficult to interpret because of the five different treatment groups, but lufenuron was found to be ineffective as a sole treatment with six of 13 cats still culture positive at day The ability of lufenuron to enhance the effects of terbinafine, enilconazole or griseofulvin has also been investigated.
The results demonstrated that both itraconazole and terbinafine performed equally well with regard to time to cure. There are three controlled studies evaluating the efficacy of lufenuron on the course of M. There are two blinded controlled studies on the efficacy of lufenuron to prevent or alter the course of experimental infection with M.
All cats became infected and the infection progressed and regressed in a similar manner in all three groups. In the second, 0. This was done to examine the possibility that the efficacy of lufenuron occurs only after it has passed metabolic changes. This was done because lufenuron is reported to concentrate in skin and subcutaneous tissue. Three studies described protective efficacy against experimental dermatophyte infections in dogs.
This was in contrast to dogs vaccinated against T. Investigators from both studies concluded that vaccination against M. In the last study, there was no clinical response to a commercial vaccine used as a sole therapy. There are seven studies describing various aspects of the use of fungal vaccines in cats. In the first, vaccination of M. Untreated cats remained lesional and culture positive. Itraconazole noncompounded and terbinafine are the most effective and safe treatments for dermatophytosis. Griseofulvin is effective but also has more potential adverse effects compared to itraconazole and terbinafine.
Ketoconazole and fluconazole are less effective treatment options and ketoconazole has more potential for adverse effects. Our literature searches showed that contact with a contaminated environment alone in the absence of concurrent microtrauma is an exceedingly rare source of infection in both people and animals. One publication was found documenting a child with no history of any animal contact contracting M.
The environment became readily contaminated as did the hair coat of cats, but lesions in cats were slow to develop and lacked a clear pattern. The most social cats developed lesions first and the shy cats were the last to develop lesions. The first place that lesions developed was on cat to cat contact sites. If casual exposure to spores in the environment is a high risk factor for contracting the disease, it is reasonable to assume that infection should have developed in all of the 24 cats within the same time period.
After removal of these cats and decontamination of the room, fungal cultures from all cats were negative.
In other studies, persistent exposure to spores in the environment did not result in reinfection in cats that were cured of infection. The infective propagule of dermatophyte fungi is called an arthroconidium and it forms as a result of segmentation and fragmentation of existing hyphae. Contamination was found on soft surfaces carpets, quilts and hard surfaces furniture and floors.
In most cases, positive air samples correlated with positive surface samples and were most likely the result of natural air currents in the home. There are two common misconceptions in the lay literature regarding environmental dermatophyte contamination. Dermatophytosis is a skin infection and does not cause fungal respiratory disease. Fungal respiratory infections are caused by the deep mycoses or organisms or moulds commonly found in the environment, such as Aspergillus , Cladosporium , Mucor and Rhizopus , which are commonly found in home environments.
Dermatophytes have evolved to survive on human and animal hosts and require keratin as a source of nutrients. There are two studies evaluating the presence of dermatophytosis in the environment. Dermatophytes were isolated from the floors in 15 of 50 clinics. The most commonly isolated dermatophyte was M. Positive samples were most commonly isolated from the dermatology examination room 10 of During this time period there were no reports of outbreaks. There were no changes in cleaning routines. There are many published studies in both the human and veterinary literature on the dormancy of dermatophyte spores.
The ability to remain dormant and then sporulate under appropriate circumstances is a property of both human and animal pathogens. The remaining hairs were unable to infect susceptible kittens in an experimental infection model. Dermatophyte colonies from stored samples may have abnormal gross and microscopic characteristics and be poorly sporulating.
Although viable when nurtured under laboratory conditions for several weeks, their infectivity to a healthy host under natural infection conditions is likely to be doubtful. In addition to having good antifungal efficacy, a product should be nontoxic with a low irritancy to the animals and users.
In addition, it should be affordable, easy to apply, preferably ready to use out of the container to minimize dilution errors, and compatible with surfaces it is to be used upon. Sodium hypochlorite household bleach has been consistently shown to be an effective disinfectant when used at concentrations ranging from to even with short contact times. One study showed that if a 5.
There are many reasons not to use bleach and these include: lack of detergency which is a critical factor for disinfection, potential to react with other chemicals to create toxic gases, unpleasant odour, damage to hard surfaces, discolouration of fibres and coloured surfaces, damage to floor finishes, rapid loss of efficacy once diluted and human health concerns. The product is an irritant to both animals and people.
It is one of the newer broad spectrum disinfectants that have gained widespread use in many medical and veterinary environments. The Materials and Data Safety Sheet US states that it should not be mixed with a concentrated sodium hypochlorite product. Its antifungal efficacy against M. There is preliminary data supporting their use as environmental disinfectants limonene, geranial, neral. Disinfection of nonporous surfaces involves three steps.
The first is the mechanical removal of all debris via vacuuming or sweeping. Disinfectants will not work in the presence of organic debris. The second is the washing of the target surface with a detergent until the area is visibly clean. The use of a detergent is important because it will lift debris from surfaces.
Detergents must be rinsed from the target surface because some may inactivate disinfectants. These two steps are the most important and in many cases alone will decontaminate a surface as has been shown in shelter situations. Two washings on the longest wash cycle were effective. It was important not to overload the machine to allow for maximum agitation. The washing machine and the dryer were minimally contaminated and this was easily eliminated by spraying the surface with accelerated hydrogen peroxide.
A study investigated methods to decontaminate carpets exposed to infective M. Exposed carpeting could be decontaminated by washing twice with a carpet shampooer with detergent or via hot water extraction. Hot water extraction was associated with the fastest drying time and no discolouration. Disinfectants were found to discolour carpets. Household cleaners with label efficacy against Trichophyton spp.
There are no safe surface disinfectants for wood floors; however, one author KAM has successfully decontaminated wood floors via daily removal of hair and dust using commercial disposable cleaning clothes designed for dry mopping floors Moriello , unpublished data. Floors were then washed twice weekly with a wood oil soap. Arthrospores are shed into the environment from the hair coat. No studies were identified that specifically addressed the question of whether or not to clip the hair coat. In the 57 reviewed treatment studies, clipping of the hair coat was mentioned in nine of 57 studies.
In many of the older studies it was noted that clipping of the glowing hair tips or plucking of infected hairs was necessary to reach mycological cure. This is the experience in one author's KAM shelter experience and in collaborative studies. The major owner actions that can minimize confinement and decrease risk of infection to susceptible people are compliance with oral antifungal therapy and use of topical therapy twice weekly.
A recent literature review on the welfare implications of socialization has provided guidelines for socialization of puppies and kittens. Owners should provide deliberate social and environmental exposure for all puppies and kittens. Confinement of infected animals is an important part of disease containment in outbreaks of dermatophytosis. It allows more effective decontamination of the environment and also reduces the risk of transmission of dermatophytosis to other animals and people, especially children.
The ages of cats that are most susceptible to developing dermatophytosis are the ones that are the most difficult to confine. This includes kittens that usually contract the disease at a time when socialization is important and older immunosuppressed cats that may have concurrent disease and need additional medical therapy.
When cats are in a home environment especially where there are other pets, family members, especially children, need to be advised about handling and the risk of infection. Items in the confinement area should be limited to those that can be washed daily e. This can be done with any number of mechanical means dust clothes, flat mops, sweeping etc. This ward was thoroughly cleaned and disinfected twice weekly with routine cleaning on other days.
Environmental sampling is not recommended unless there is concern about false positive fungal cultures confounding determination of mycological cure. Environmental decontamination's primary purpose is to prevent fomite contamination and false positive fungal culture results. HIV , metabolic diseases e. The greatest public health concern associated with pet ownership is an animal bite. The disease is primarily transmitted from contact with the hair coat or skin lesions of an infected animal.
Contact with accumulated scales and hair in the environment are possible sources. Microsporum canis was not isolated from the hair coat of dogs whose owners did not have dermatophyte lesions. In cats, M. In looking at the data from another perspective, M. This study showed that the pet may or may not be the source of a human infection.
Dermatophytosis is a common skin disease in immunocompromised people; however, literature review found that the primary pathogen of concern was Trichophyton rubrum , not M. Reports of M.
In another extensive review of the literature on severe dermatophytosis and acquired or innate immunodeficiency in 84 patients, occurrence was rare, and the most common pathogen was T. Dermatophytosis is a known zoonosis and causes skin lesions which are treatable and curable. Supporting Information S1. References on the incidence and prevalence of small animal dermatophytosis.
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries other than missing content should be directed to the corresponding author for the article. Volume 28 , Issue 3. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account. If the address matches an existing account you will receive an email with instructions to retrieve your username. Veterinary Dermatology Volume 28, Issue 3.
Review Open Access. Karen A. Moriello Corresponding Author E-mail address: karen. WAVD cannot be held responsible for errors or any consequences arising from the use of information contained in this article. Readers need to bear this in mind and be aware of the prescribing laws pertaining to their own countries. Tools Request permission Export citation Add to favorites Track citation. Share Give access Share full text access. Share full text access.
Please review our Terms and Conditions of Use and check box below to share full-text version of article. Abstract en Background Dermatophytosis is a superficial fungal skin disease of cats and dogs. Objectives The objective of this document is to review the existing literature and provide consensus recommendations for veterinary clinicians and lay people on the diagnosis and treatment of dermatophytosis in cats and dogs.
Conclusions No one diagnostic test was identified as the gold standard. Contexte La dermatophytose est une dermatose fongique superficielle du chat et du chien. Schlussfolgerungen Es wurde kein einzelner Test als Goldstandard identifiziert. Clinical Consensus Guidelines Clinical Consensus Guidelines CCGs provide the veterinary community with current information on the pathophysiology, diagnosis and treatment of commonly encountered dermatological conditions.
Current species classification Teleomorph a Sexual form of the fungus. Anamorph b Asexual or conidial form of the fungus. Former species classification Arthroderma benhamiae Trichophyton sp. Trichophyton mentagrophytes var. Historical note The earliest report in the English literature of positive fluorescence in a M. True or false? Sampling techniques Three sampling techniques for small animals have been described in the literature: hair coat brushings, hair plucking and sticky tape sampling. Fungal culture and monitoring of infections For decades, clinical cure and Wood's lamp examinations M.
Box 2. Disinfection of nonporous surfaces Disinfection of nonporous surfaces involves three steps. Disinfection of carpets A study investigated methods to decontaminate carpets exposed to infective M. Disinfection of wood floors There are no safe surface disinfectants for wood floors; however, one author KAM has successfully decontaminated wood floors via daily removal of hair and dust using commercial disposable cleaning clothes designed for dry mopping floors Moriello , unpublished data. Clipping of the hair coat No studies were identified that specifically addressed the question of whether or not to clip the hair coat.
Use of topical therapy The major owner actions that can minimize confinement and decrease risk of infection to susceptible people are compliance with oral antifungal therapy and use of topical therapy twice weekly. Confinement to an easily cleaned area A recent literature review on the welfare implications of socialization has provided guidelines for socialization of puppies and kittens. Environmental sampling Environmental sampling is not recommended unless there is concern about false positive fungal cultures confounding determination of mycological cure.