Successful treatment of necrotizing fasciitis in the hind limb of a great dane

A 5-month-old, intact female Great Dane was presented for an acute onset of rapidly progressive lameness, severe pain, and diffuse swelling of the right hind limb. Ultrasound evaluation revealed echogenic fluid pockets extending along fascial planes of the right hind limb, from the proximal femur to the hock. Necrotic soft tissues were debrided, and closed-suction drains were placed. No foreign material was identified at surgery. Fluid culture identified a beta-hemolytic Streptococcus sp., and affected fascial histopathology was consistent with necrotizing fasciitis. Postoperatively, the puppy was managed with intravenous broad-spectrum antibiotics, local infusions of amikacin, and daily physical rehabilitation. Oral pentoxifylline was administered to treat bronchopneumonia and streptococcal toxic shock syndrome that developed secondary to necrotizing fasciitis. To our knowledge, this is the first report of a successfully managed case of beta-hemolytic, streptococcal, necrotizing fasciitis successfully managed after a single surgical debridement in combination with systemic broad-spectrum antibiotics, local amikacin infusion, active closed-suction drainage, daily cytology, massage, and passive range-of-motion exercises to maintain limb function.     

Pathology of Mycoplasma agalactiae induced granular vulvovaginitis (GVV) in goats.

Granular vulvovaginitis (GVV) was experimentally produced in female kids by topical application of M. agalactiae on the scarified vulvar mucosa. Grossly visible GVV lesions were seen in 25 out of 30 infected kids, yet all were positive for microscopic lesions. Microscope lesions that appeared by 7 days post infection (DPI) were comprised of stromal oedema, lymphocytic infiltration into the lamina propria and perivascular accumulation of a few lymphocytes. The lesions observed between 28 and 49 DPI were comparable to those of spontaneous cases (severe). The changes seen in kids euthanized between 56 to 70 DPI were suggestive of the chronic stage of the disease. M. agalactiae was reisolated from all the infected kids from 7 to 70 days after inoculation. The pathology and pathogenesis of this condition have been described and discussed.     

Staphylococcus pseudintermedius necrotizing fasciitis in a dog

Staphylococcus pseudintermedius was implicated as the cause of rapidly progressive and fatal necrotizing fasciitis in a dog. The isolate was methicillin-susceptible and did not contain genes encoding the Panton-Valentine leukocidin. While Streptococcus canis is typically considered to be the main cause of necrotizing fasciitis in dogs, staphylococci should also be considered.     

A case of necrotizing fasciitis with septic shock in a cat caused by Acinetobacter baumannii

A 4-year-old, neutered female, domestic shorthair cat admitted to the animal hospital for recurrent constipation presumed to be due to post-traumatic injuries, went into shock with signs including fever and ataxia followed by stupor. On the fifth day of hospitalization, the cat developed severe, diffuse oedema of the ventral abdomen with multifocal to coalescing erythematous areas and small vesicle formation. The results of bacteriological cultures of liver, spleen and kidney specimens led to the diagnosis of Acinetobacter baumannii sepsis. Histopathological findings of skin samples taken during necropsy showed an extensive epidermal and dermal necrosis with septic vasculitis and numerous intralesional gram-negative bacteria. Detection of the bla(OXA-51-like) gene specific for A. baumannii by PCR, performed retrospectively on samples of the deep layers of the skin, confirmed the presence of A. baumannii also in the cutaneous lesions. To our knowledge this is the first report of a necrotizing fasciitis with septic shock in a cat caused by A. baumannii.     

Lesions in broiler and layer chickens in an outbreak of highly pathogenic avian influenza virus infection

Fifteen chickens, five broilers and ten layers, from the Pennsylvania 1983 outbreak of highly pathogenic avian influenza virus infection, were examined. Gross lesions in the broilers were limited to serosal petechiae and dehydration. In the layers there was comb edema, vesiculation, and necrosis. Microscopic lesions were mild to severe diffuse nonsuppurative encephalitis, very mild to severe diffuse necrotizing pancreatitis, and very mild to severe subacute necrotizing myositis involving numerous skeletal muscles and most severe in the external ocular muscles and limbs. While many of these lesions have been seen in experimental infections of chickens with influenza viruses, the pattern of organs involved in this group of chickens is distinctive.     

Alimentary Tract Manifestations of Bovine Adenovirus Infections

Two calves and a feedlot steer with systemic bovine adenovirus infection had hemorrhagic and necrotizing lesions confined to the digestive tract. In one calf there was severe, multifocal, necrotizing, hemorrhagic rumenitis, omasitis, abomasitis, enteritis and colitis. Small intestinal lesions were predominantly in Peyer's patches. Multifocal necrotizing abomasitis was the principal change in the other calf. Large amphophilic intranuclear inclusions typical of bovine adenovirus were common in swollen vascular endothelial cells. Bovine adenovirus was isolated from the former calf.The steer had diffuse hemorrhagic enterocolitis and large numbers of BAV inclusions in vascular endothelial cells of the intestinal lamina propria. Serum-neutralization tests to bovine adenovirus type 3 on acute and convalescent samples from six clinically affected in-contact animals revealed fourfold elevations in two.     

Fournier's gangrene in a cat

Objective – To describe the clinical course of a cat diagnosed with Fournier's gangrene.
Case Summary – A 2-year-old castrated male cat was presented to an emergency hospital for evaluation of acute onset of lethargy, mucoid anal discharge, and fever. During hospitalization, with provision of supportive care, an area of necrotizing fasciitis around the prepuce and anus developed and surgical debridement was performed. Severe sepsis developed secondary to the necrotizing fasciitis and the cat was eventually euthanized.
New Information Provided – The purpose of this report is to document the first case of Fournier's gangrene in a cat that presented for mucoid anal discharge, lethargy, and mild ataxia, and to alert emergency clinicians to this disease process. Early detection of the disease with prompt, aggressive supportive care and surgical debridement is necessary for successful treatment.     

Necrotizing fasciitis: a review

Necrotizing fasciitis is a rapidly spreading, bacterial, soft-tissue infection reported in both humans and dogs. A review of the pathophysiology, clinical findings, diagnosis, and treatment of necrotizing fasciitis is presented, with the goal of familiarizing veterinarians with this uncommon but potentially fatal condition. A case report highlighting the fulminant course of this disease is also included.     

Pathology of maternal genital tract, placenta, and fetus in equine viral arteritis

Six pregnant mares were given equine viral arteritis virus intravenously. Tissues from genital tracts, placentae, and fetuses were examined by light and electron microscopy to study the mechanism of abortion. Four mares which died with acute disease had diffuse vacuolation of endometrial epithelium and systemic necrotizing vasculitis. Two of these mares had dead fetuses and two had live fetuses; virus was isolated from tissues of one live fetus. Placentae of mares dying from acute disease did not have lesions attributable to infection; virus was isolated from two of these placentae. One of the two mares which recovered from clinical disease aborted a dead fetus eight days after inoculation. The mare had severe necrotizing myometritis and virus was isolated from maternal ovaries and from fetal tissues. The fetus did not have lesions attributable to arteritis virus. These results suggest that although fetal death may occur in utero during acute equine viral arteritis, abortion probably is due to lesions in the uterus of the mare.     

Clostridium septicum myositis in a western lowland gorilla (Gorilla gorilla gorilla).

A 10-yr-old male gorilla (Gorilla gorilla gorilla) with a history of conspecific bite wounds was evaluated for acute onset of depression, anorexia, and right hemiparesis. The animal was immobilized for diagnostic examination and treatment for suspected toxic shock from a necrotizing, emphysematous wound infection, but was euthanized due to complications during recovery. Gross and histopathologic examination revealed acute necrotizing myositis, fasciitis, cellulitis, and emphysema in the affected wound area, with large numbers of large Gram-positive rods among necrotic muscle fibers. Severe pulmonary edema with airways containing fibrin, acute hemorrhage in multiple body sites, thrombosis in blood vessels in the skeletal muscle, liver, and lung, and lymph node hyperplasia with lymphoid necrosis and hemorrhage. Immunohistochemical fluorescent antibody staining of muscle from the wound site was positive for     

Magnetic resonance imaging findings in histologically confirmed Pug dog encephalitis

The purpose of the study was to describe magnetic resonance (MR) imaging features of histologically confirmed necrotizing encephalitis in four Pugs and to compare those findings with MR imaging characteristics of necrotizing encephalitis in other breeds. All dogs had the following common findings: lesions restricted to the forebrain, both cerebral hemispheres diffusely but asymmetrically affected, lesions affected gray and white matter resulting in loss of distinction between both, most severe lesions in occipital and parietal lobes, lesions were irregularly T2-hyperintense and T1-isointense to slightly T1-hypointense, and no cavitation. There were various degrees of contrast enhancement of brain and leptomeninges. Asymmetry of lateral ventricles and midline shift was seen in one dog each. Two dogs had brain herniation, which may have contributed to the progression of neurologic signs. Hyperintensity on T2-weighted and fluid attenuated inversion recovery images in the hippocampus and piriform lobe was consistent with excitotoxic edema, whereas similar imaging features in other forebrain areas corresponded to areas of inflammation or liquefaction on histopathology. In comparison with necrotizing encephalitis in other canine breeds, Pug dog encephalitis has some unique MR imaging features. Therefore, these characteristics cannot be applied to other breeds, nor should imaging features of necrotizing encephalitis of other canine breeds be used for interpretation of MR images in Pug dogs.     

Necrotizing pneumonia in cats associated with infection by EF-4a bacteria

Two cases of severe necrotizing pneumonia in cats caused by Gram-negative bacteria called "Eugonic Fermenter 4a" (EF-4a) are described. The gross lesions resembled to those commonly seen with lung tuberculosis in other animal species.     

Experimental reproduction of severe disease in CD/CD pigs concurrently infected with type 2 porcine circovirus and porcine reproductive and respiratory syndrome virus

Three-week-old cesarean-derived colostrum-deprived (CD/CD) pigs were inoculated with porcine circovirus type 2 (PCV2, n = 19), porcine reproductive and respiratory syndrome virus (PRRSV, n = 13), concurrent PCV2 and PRRSV (PCV2/PRRSV, n = 17), or a sham inoculum (n = 12) to compare the independent and combined effects of these agents. Necropsies were performed at 7, 10, 14, 21, 35, and 49 days postinoculation (dpi) or when pigs became moribund. By 10 dpi, PCV2/PRRSV-inoculated pigs had severe dyspnea, lethargy, and occasional icterus; after 10 dpi, mortality in this group was 10/11 (91%), and all PCV2/ PRRSV-inoculated pigs were dead by 20 dpi. PCV2-inoculated pigs developed lethargy and sporadic icterus, and 8/19 (42%) developed exudative epidermitis; mortality was 5/19 (26%). PRRSV-inoculated pigs developed dyspnea and mild lethargy that resolved by 28 dpi. Microscopic lesions consistent with postweaning multisystemic wasting syndrome (PMWS) were present in both PCV2- and PCV2/PRRSV-inoculated pigs and included lymphoid depletion, necrotizing hepatitis, mild necrotizing bronchiolitis, and infiltrates of macrophages that occasionally contained basophilic intracytoplasmic inclusion bodies in lymphoid and other tissues. PCV2/ PRRSV-inoculated pigs also had severe proliferative interstitial pneumonia and more consistent hepatic lesions. The most severe lesions contained the greatest number of PCV2 antigen-containing cells. PRRSV-inoculated pigs had moderate proliferative interstitial pneumonia but did not develop bronchiolar or hepatic lesions or lymphoid depletion. All groups remained seronegative to porcine parvovirus. The results indicate that 1) PCV2 coinfection increases the severity of PRRSV-induced interstitial pneumonia in CD/CD pigs and 2) PCV2 but not PRRSV induces the lymphoid depletion, granulomatous inflammation, and necrotizing hepatitis characteristic of PMWS.     

Paramyxovirus infection in pigs with interstitial pneumonia and encephalitis in the United States.

In the last few years, newly recognized paramyxoviruses have been associated with severe disease in several animal species, including swine, as well as in human beings. Recently, a paramyxovirus was isolated from a swine herd in the northcentral United States that experienced an epizootic of respiratory and central nervous system disease. Affected pigs had interstitial pneumonia with necrotizing bronchiolitis and encephalitis characterized by lymphocytic perivasculitis and diffuse gliosis. Germ-free pigs inoculated with this isolate developed mild clinical illness and similar but less severe histopathologic lesions in lungs and brain.     

Relationship between morphological characteristics of the teat duct and prevalence of intramammary infections with Streptococcus agalactiae in dairy cows

The objective of the study was to determine the relationship between morphological findings of the surface of teat duct particularly the level of ceratosis and the prevalence of intramammary infections (IMI). The study was conducted on a commercial dairy herd housing about 3000 lactating dairy cows. We examined 891 quarters in the middle of lactation. Duplicate samples of quarter foremilk were collected monthly. The bacteriological status of quarters was determined according to the recommendations of IDF. At the same time teats were evaluated by clinical examinations. The appearance of teat skin lesions and the status of the teat duct especially the existence of hyperceratosis (HC) was documented. Four classes of teat duct hyperceratosis were defined: without, slight, medium and severe HC. The rate of IMI in different classes of hyperceratosis of teat duct was compared by Chi-square analysis. Prevalences of intramammary infections were determined three times (P1, P2 and P3) during the study period. Prevalence of infection was high for S. aureus (P1: 5.6% vs. P2: 4.5% vs. P3: 4.3%), Sc. agalactiae (P1: 2.7% vs. P2: 2.6% vs. P3: 2.8%) and CNS (P1: 10.7% vs. P2: 8.8% vs. P3: 9.6%). Furthermore we detected IMI caused by other streptococci, yeast, E. coli and mixed infections. A positive correlation between status of HC and prevalence of IMI for Sc. agalactiae was found. At the second and third sampling time the rate of intramammary infection with Sc. agalactiae in quarters with medium HC (P2: 9.21% and P3: 13.73%) differed significantly (p < 0.05) compared to groups without (P2: 1.56% and P3: 1.91%) and slight hyperceratosis (P2: 2.33% and P3: 2.56%). The results of our study indicate a correlation between morphology of teat duct surface, especially regarding to Sc. agalactiae. On one hand HC can cause high intramammary infection rate with Sc. agalactiae. On the other hand it is possible that HC is the consequence of a quarter infection with Sc. agalactiae. Further research is required.     

Suspected parvovirus infection in porcupines

During a 142-day period, 6 porcupines died or were killed after becoming moribund. Three had severe acute necrotizing enteritis; two had acute necrotizing myocarditis, one with concurrent lymphocytic-plasmacytic enteritis; and one had chronic enteritis. Histologically, the acute necrotizing enteritis was characterized by villous fusion, blunting, and crypt dilatation. Many dilated crypts contained necrotic debris and were lined by flattened enterocytes. Acidophilic intranuclear inclusions were in colonic epithelial cells in one of these animals. The myocardial lesions consisted of degenerating shrunken myofibers, with infiltrating neutrophils and lymphocytes. Myofiber mineralization was evident in one animal. Though the histologic findings were indicative of parvovirus infection, electron microscopic, serologic, and virologic studies failed to demonstrate parvovirus as the etiologic agent.     

Necrotizing meningoencephalitis associated with cortical hippocampal hamartia in a Pekingese dog

A 4-year-old male Pekingese dog was referred to the clinic with a history of recurrent seizures and progressive abnormal gait and behavior, which did not respond to treatment. At necropsy, a large cortical defect in the right temporo-parietal cortex, malacia of subcortical white matter, right basal nuclei, and capsula interna, as well as abnormalities of the right hippocampus were observed. Histological examination of the brain revealed moderate to severe nonsuppurative meningoencephalitis in the left cerebral hemisphere and extensive infarction-like lesions with milder inflammation in the right hemisphere. In the right hippocampus, the pyramidal cells were arranged in a gyrus-like pattern and intermingled with gemistocytic and fibrillary astrocytes. The histopathological features of the inflammatory lesions were consistent with necrotizing meningoencephalitis and resembled those described in so-called Pug dog encephalitis. The hippocampal changes were interpreted as dysplasia (monolateral hippocampal cortical hamartia), unrelated to clinical signs and necrotizing inflammatory lesions.     

A necrotizing pneumonia in lambs caused by pseudorabies virus (Aujesky''s disease virus).

An outbreak of pseudorabies occurred in sheep housed with swine in the same building. Although the sheep and swine were not in physical contact, the lambs and ewes were exposed to air from the sows' section. Three dead lambs were submitted to the Iowa State University Veterinary Diagnostic Laboratory for necropsy. Grossly there were pulmonary congestion and multifocal pulmonary hemorrhages. Microscopic lesions were severe acute multifocal necrotizing bronchopneumonia with necrotizing vasculitis and intranuclear inclusion bodies within the neurons of the parabronchial ganglia. Bacterial cultures were negative for pathogenic agents; pseudorabies virus was isolated from ovine brain tissue. Viral antigen was demonstrated in the neurons of the parabronchial ganglia by immunoperoxidase staining. Electron microscopy revealed nucleocapsids in the parabronchial ganglionic neurons which contained basophilic intranuclear inclusion bodies. Viral DNA prepared from the ovine pseudorabies virus isolate was found by restriction endonuclease analysis to be related to the Indiana Funkhauser strain of pseudorabies virus.     

Fatal Streptococcus canis infections in intensively housed shelter cats

Three independent, fatal outbreaks of Streptococcus canis infection occurred in a 2-year period in shelter cats. The outbreaks occurred in Northern California (Yolo County), Southern California (Kern County), and North Carolina (Guilford County). An estimation of the affected population is >150 cats among 3 affected shelters, with a mortality rate of up to 30%. Among 20 cats submitted for necropsy there were 2 distinct pathologic presentations. The first (shelters 1 and 2) was skin ulceration and chronic respiratory infection that progressed, in some cats, to necrotizing sinusitis and meningitis. The second (shelter 3) was rapid progression from necrotizing fasciitis with skin ulceration to toxic shock-like syndrome, sepsis, and death. S canis was the sole pathogen identified in most cases. Whether hypervirulent S canis strains exist is unknown; there is little understanding of how these bacteria cause invasive disease in cats.