Diagnosis of pneumocystis pneumonia in a 2‐year‐old King Charles Cavalier Spaniel using the polymerase chain reaction

A 2‐year‐old, female spayed, King Charles Cavalier Spaniel was presented for evaluation of dyspnea, inappetence, and lethargy. Thoracic radiographs revealed a moderate diffuse interstitial lung pattern affecting the perihilar and caudodorsal lung fields, and an echocardiogram revealed severe pulmonary hypertension. A bronchoalveolar lavage (BAL) was performed, and cytology revealed mixed inflammation with cysts and trophozoites consistent with Pneumocystis. Pneumocystis infection was later confirmed with PCR. To the author's knowledge, this report represents the first case of canine pneumocystis pneumonia diagnosed antemortem with PCR from a BAL sample. Pneumocystis represents an important, but uncommon cause of afebrile pneumonia in immunosuppressed dogs.     

Mitral valve and tricuspid valve dysplasia in a 9‐week‐old Standardbred colt

A 9‐week‐old Standardbred colt was presented for investigation of dull demeanour, exercise intolerance and heart murmurs. Cardiac auscultation revealed a grade 5/6 holosystolic murmur and a grade 5/6 pansystolic murmur over the left and right cardiac apex respectively, and an irregularly irregular cardiac rhythm. Electrocardiographic examination findings were consistent with atrial fibrillation and tachycardia. Echocardiographic examination identified marked atrioventricular regurgitation and atrial dilation bilaterally, thickening of the mitral and tricuspid valves and dilation of the pulmonary artery consistent with pulmonary hypertension. No ventricular or atrial septal defect was present. Cardiomegaly and diffuse pulmonary oedema were evident on examination of lateral thoracic radiographs. Dysplasia of the mitral and tricuspid valves, eccentric cardiomegaly and pulmonary oedema were confirmed by post mortem examination. Dysplasia of the atrioventricular valves represents a rare cause of biventricular failure in the horse.     

Pneumocystis Pneumonia in a Thoroughbred Racehorse

Pneumocystis pneumonia is an opportunistic respiratory infection that occurs in immunocompromised animals. In horses, pneumocystic pneumonia is observed mostly in foals and often progresses rapidly. Here, we report pneumocystic pneumonia in a Thoroughbred racehorse. A 3-year-old Thoroughbred racehorse colt had marked respiratory symptoms for 3 weeks and was unresponsive to antibiotic treatment. At necropsy, firm, tan, patchy lesions were scattered diffusely in the lungs. Microscopically, alveolar septa thickened by proliferation of collagen fibers and infiltration of inflammatory cells were observed. In the alveolar spaces, many brown-black yeast-like organisms similar to cystic forms of Pneumocystis carinii were recognized by staining with Gomori's methenamine silver. Bronchoalveolar lavage fluid (BALF) obtained before necropsy included macrophages engulfing the fungus bodies. Amplified products were obtained from BALF and lung tissue samples by Pneumocystis-specific nested PCR. Phylogenetic analysis based on the 18S rRNA gene sequence revealed that the P. carinii organism from BALF was related to the Pneumocystis spp. detected in other animals and was especially close to P. carinii derived from ferrets. This is a rare case of pneumocystic pneumonia in a colt with chronic pulmonary lesions.     

Cladosporium cladosporioides‐complex infection in a mixed‐breed dog

A 3‐year‐old female mixed‐breed dog was referred with a 2‐day history of serious dyspnea, coughing, lethargy, anorexia, and a low‐grade right anterior lameness. At presentation, the dog had an increased respiratory rate, dull heart and lung sounds, and cyanotic mucous membranes. It was hyperthermic and slightly dehydrated. Laboratory findings showed mild neutrophilia with a left shift, while serum biochemistry variables were in the normal range. However, urinalysis revealed mild proteinuria and rare erythrocytes and leukocytes on sediment examination. Thoracic radiographs showed a diffuse mixed interstitial and alveolar pattern with an air bronchogram, while appendicular radiographs showed a right humeral interrupted brush‐like periosteal reaction. Thoracic ultrasonography revealed mediastinal lymph node enlargement. Cytology from a fine‐needle aspirate of mediastinal lymph nodes revealed a pyogranulomatous lymphadenitis with numerous fungal hyphae. Culture on Sabouraud dextrose agar isolated dark fungal colonies with microscopic features consistent with Cladosporium spp. Sequencing of the internal transcribed spacer region identified the fungus as a species of the Cladosporium cladosporioides‐complex.     

Septic pericarditis in a Yorkshire Terrier

Objective: To describe a novel case management strategy for a small breed dog diagnosed with septic pericarditis. Case summary: An 8‐year‐old spayed female Yorkshire Terrier presented for evaluation of pericardial effusion and persistent hypoglycemia. The dog had been hospitalized at a primary care facility for acute onset of vomiting, lethargy, inappetance, and painful abdominal distension. Pericardial effusion was detected and upon referral, cytologic examination revealed a suppurative exudate with Gram‐positive and Gram‐negative bacteria. The dog was treated with pericardiocentesis and placement of an indwelling pericardial catheter. Subtotal pericardiectomy was performed and a thoracotomy tube was utilized postoperatively. A penicillin‐susceptible Bacteroides species was cultured from the pericardial fluid and was treated with a 6‐week course of antibiotics. The dog was discharged from the hospital and clinical signs have not recurred in over 2 years. New or unique information provided: Septic pericarditis, an uncommon cause of canine pericardial effusion, has been described primarily in large breed dogs and in association with bacterial infection secondary to Hordeum grass (foxtail) awn migration. This case was unique in that the dog was a small breed with no evidence of foreign body penetration or other precipitating cause for the pericarditis. In a novel management plan, an indwelling pericardial catheter was employed to stabilize the dog before subtotal pericardiectomy.     

Presumptive iatrogenic hypoadrenocorticism induced by high‐dose ketoconazole administration in a dog

A 11‐year‐old male neutered Shih Tzu was referred to a tertiary facility with a history of weight loss, decreased appetite, polydipsia, and lethargy. The dog had a 10‐year history of nonspecific allergic dermatitis and was being treated with 16 mg/kg of ketoconazole q12h for Malassezia dermatitis. Vague gastrointestinal signs, hypocholesterolemia, and lack of a stress leukogram increased suspicion for hypoadrenocorticism (HA). An adrenocorticotropic hormone (ACTH) stimulation test identified hypocortisolemia on pre‐ and post‐ACTH samples and ketoconazole was discontinued. After a short course of corticosteroid treatment, an ACTH stimulation test was repeated and pre‐ACTH cortisol concentration was within the reference range, and the post‐ACTH cortisol concentration was mildly increased. The temporal association between return of adequate adrenocortical cortisol production and discontinuation of ketoconazole led to the conclusion that the dog had developed iatrogenic HA secondary to ketoconazole treatment.     

Presumed immune‐mediated hemolytic anemia in two foals with Rhodococcus equi infection

Objective – To describe the clinical presentation, case management, and outcome in 2 foals with Rhodococcus equi infection associated with presumptive severe immune‐mediated hemolytic anemia. Series Summary – Two foals diagnosed with R. equi pneumonia on the basis of tracheal wash cultures, thoracic radiographs, and thoracic ultrasonography were concurrently diagnosed with hemolytic anemia. Both foals required whole blood transfusions, and were treated with the antimicrobial combination of rifampin and a macrolide (eg, clarithromycin, erythromycin, or azithromycin). Dexamethasone was used to prevent further hemolysis in both foals, and to treat acute lung injury/acute respiratory distress syndrome in 1 of the foals. Both foals survived, and required prolonged antimicrobial therapy. New or Unique Information Provided – Although extra‐pulmonary disorders are commonly diagnosed in foals infected with R. equi, hemolytic anemia is rarely described. Dexamethasone is considered the treatment of choice for immune‐mediated hemolytic anemia, but may be contra‐indicated in foals with severe bacterial infections. In these foals, a relatively low dose and short duration of dexamethasone was utilized in an attempt to minimize immune suppression, although early discontinuation in 1 foal precipitated a second hemolytic crisis.     

IL‐12p40 gene expression in lung and hilar lymph nodes of MPS‐resistant pigs

Mycoplasma pneumonia of swine (MPS) is caused by Mycoplasma hyopneumoniae (M.hp) and is a common chronic respiratory disease of pigs. Recently, a genetically selected variant of the Landrace pig (Miyagino L2) has a lower incidence of pulmonary MPS lesions. We investigated the pathological and immunological characteristics of MPS resistance in these pigs (n = 24) by comparing with the normal landrace pig (control: n = 24). The pathological MPS lung lesion score in MPS‐selected landrace pigs was significantly lower than in the control. The gene expression of interleukin (IL)‐12p40, which acts as a chemoattractant and a component of the bioactive cytokines IL‐12 and IL‐23, was significantly higher at the hilar lymph nodes, lung, and spleen in MPS‐selected landrace pigs than in control landrace pigs, and these were negatively correlated with the macroscopic MPS lung lesion score. In summary, we demonstrate that resistance against MPS in Miyagino L2 pigs is associated with IL‐12p40 up‐regulation, in comparison with normal landrace pigs without the MPS vaccine. In addition, a comparative study of macroscopic MPS lung lesions and IL‐12p40 gene expression in lung and hilar lymph nodes may lead to beneficial selection traits for the genetic selection for MPS resistance in pigs.     

Adverse effects of a 10‐day course of ibuprofen in Holstein calves

Nonsteroidal anti‐inflammatory drugs (NSAIDs) are recommended for various conditions in cattle. Ibuprofen is an inexpensive short‐acting NSAID and is readily available in liquid formulation for administration to bottle‐fed calves. We compared the adverse effects of a 10‐day course of ibuprofen and placebo in 16 five‐ to six‐week‐old Holstein bull calves that were being treated for experimentally induced bovine respiratory syncytial virus infection. Ibuprofen was administered as a liquid in milk replacer at 30 mg/kg divided three times daily. We found an increased prevalence of abomasal ulceration 5 of 8 in the ibuprofen compared to placebo group 2 of 6 (P = NS). There was one (1 of 8) case of mild interstitial nephritis in the ibuprofen and none (0 of 8) in the placebo group (P = NS). Renal function as measured by serum BUN and creatinine levels was not different between groups; no animal demonstrated an increase in creatinine.     

Regional distribution of collagen and haemosiderin in the lungs of horses with exercise‐induced pulmonary haemorrhage

Reasons for performing study: Regional veno‐occlusive remodelling of pulmonary veins in EIPH‐affected horses, suggests that pulmonary veins may be central to pathogenesis. The current study quantified site‐specific changes in vein walls, collagen and haemosiderin accumulation, and pleural vascular profiles in the lungs of horses suffering EIPH. Hypothesis: In the caudodorsal lung regions of EIPH‐affected horses, there is veno‐occlusive remodelling with haemosiderosis, angiogenesis and fibrosis of the interstitium, interlobular septa and pleura. Methods: Morphometric methods were used to analyse the distribution and accumulation of pulmonary collagen and haemosiderin, and to count pleural vascular profiles in the lungs of 5 EIPH‐affected and 2 control horses. Results: Vein wall thickness was greatest in the dorsocaudal lung and significantly correlated with haemosiderin accumulation. Increased venous, interstitial, pleural and septal collagen; lung haemosiderin; and pleural vascular profiles occurred together and changes were most pronounced in the dorsocaudal lung. Further, haemosiderin accumulation colocalised with decreased pulmonary vein lumen size. Vein wall thickening, haemosiderin accumulation and histological score were highly correlated and these changes occurred only in the caudodorsal part of the lung. Conclusion: The colocalisation of these changes suggests that regional (caudodorsal) venous remodelling plays an important role in the pathogenesis of EIPH. Potential relevance: The results support the hypothesis that repeated bouts of venous hypertension during strenuous exercise cause regional vein wall remodelling and collagen accumulation, venous occlusion and pulmonary capillary hypertension. Subjected to these high pressures, there is capillary stress failure, bleeding, haemosiderin accumulation and, subsequently, lung fibrosis.     

A Cross‐Sectional Study Examining the Prevalence and Risk Factors for Anti‐Microbial‐Resistant Generic Escherichia coli in Domestic Dogs that Frequent Dog Parks in Three Cities in South‐Western Ontario,Canada

Anti‐microbial resistance can threaten health by limiting treatment options and increasing the risk of hospitalization and severity of infection. Companion animals can shed anti‐microbial‐resistant bacteria that may result in the exposure of other dogs and humans to anti‐microbial‐resistant genes. The prevalence of anti‐microbial‐resistant generic Escherichia coli in the faeces of dogs that visited dog parks in south‐western Ontario was examined and risk factors for shedding anti‐microbial‐resistant generic E. coli identified. From May to August 2009, canine faecal samples were collected at ten dog parks in three cities in south‐western Ontario, Canada. Owners completed a questionnaire related to pet characteristics and management factors including recent treatment with antibiotics. Faecal samples were collected from 251 dogs, and 189 surveys were completed. Generic E. coli was isolated from 237 of the faecal samples, and up to three isolates per sample were tested for anti‐microbial susceptibility. Eighty‐nine percent of isolates were pan‐susceptible; 82.3% of dogs shed isolates that were pan‐susceptible. Multiclass resistance was detected in 7.2% of the isolates from 10.1% of the dogs. Based on multilevel multivariable logistic regression, a risk factor for the shedding of generic E. coli resistant to ampicillin was attending dog day care. Risk factors for the shedding of E. coli resistant to at least one anti‐microbial included attending dog day care and being a large mixed breed dog, whereas consumption of commercial dry and home cooked diets was protective factor. In a multilevel multivariable model for the shedding of multiclass‐resistant E. coli, exposure to compost and being a large mixed breed dog were risk factors, while consumption of a commercial dry diet was a sparing factor. Pet dogs are a potential reservoir of anti‐microbial‐resistant generic E. coli; some dog characteristics and management factors are associated with the prevalence of anti‐microbial‐resistant generic E. coli in dogs.     

Dietary N,N‐dimethylglycine supplementation improves nutrient digestibility and attenuates pulmonary hypertension syndrome in broilers

N,N‐dimethylglycine (DMG) is an intermediary metabolite in cellular choline and betaine metabolism. The present trial aimed to evaluate the effect of dietary DMG on nutrient digestibility and development of pulmonary hypertension syndrome in broilers. A total of 64 14‐day‐old broiler hens (Ross‐308) were raised until age 40 days under cold environmental temperature conditions (15 °C) and were fed a high energy feed in order to incite pulmonary hypertension. Birds were randomly assigned to two groups of which each group had eight replicate pens of four birds each. Test diets contained 0 or 167 mg Na‐DMG (Taminizer^® D; Taminco N.V., Ghent, Belgium)/kg feed. N,N‐dimethylglycine supplementation resulted in a significant improvement in apparent faecal digestibility of crude protein and nitrogen‐free extract. Further, fulminant ascites was numerically lowered by DMG and incidence of pulmonary hypertension decreased significantly from 44.8% in the control group to 14.6% in the DMG group. Finally, fasted plasma level of non‐esterified fatty acids (NEFA) was twofold in the control group in relation to the DMG group. In conclusion, these data demonstrate beneficial effects of DMG on digestibility of non‐fat fractions, on fat metabolism and on progression towards broiler ascites syndrome.     

Bit‐induced asphyxia in the racehorse as a cause of sudden death

The prevention of sudden death requires removal of its cause and this is unknown. The author's hypothesis is that bit‐induced asphyxia, partial or complete, is a cause of sudden death. Antemortem data on bit‐induced asphyxia were compared with post mortem data on sudden deaths to explore a possible cause‐and‐effect relationship. Causal categories from sudden death necropsy data were reclassified. Those causing a horse to fall (cardiopulmonary failures) were considered primary effects and those resulting from a fall (CNS trauma and haemorrhagic shock) secondary effects. Cardiac failure from negative pressure pulmonary oedema caused by bit‐induced obstruction of the nasopharynx was consistent with the hypothesis. In 1988, asphyxia from recurrent laryngeal neuropathy was posited as a cause of exercise‐induced pulmonary haemorrhage (EIPH). It is now suggested that the bit is another cause of asphyxia; EIPH is a sign of negative pressure pulmonary oedema which, in turn, causes cardiac failure and sudden death. By breaking the airtight lip‐seal at exercise, a bit dissipates negative pressure in the oral compartments, destabilises the soft palate and obstructs the nasopharynx. Bitted rein pressure, kinking the airway and rendering parts of it flaccid, is a further cause of asphyxia. The data comparison supports a unifying hypothesis on 4 problems currently considered idiopathic; that the bit is an ultimate cause of palatal instability, dynamic collapse of the upper respiratory tract, EIPH and sudden death. Bitless training and racing trials are recommended as a means of demonstrating that bitless racing is possible, preferable and predicted to reduce the prevalence of all 4 problems.     

Systemic Scedosporium prolificans infection in an 11‐month‐old Border collie with cobalamin deficiency secondary to selective cobalamin malabsorption (canine Imerslund‐Gräsbeck syndrome)

An 11‐month‐old Border collie presented collapsed and continued to deteriorate rapidly despite supportive treatment. The dog had a history of failure to thrive and recurring respiratory infection. Laboratory abnormalities included neutrophilic leucocytosis, Heinz body anaemia, hyperammonaemia, hyperbilirubinaemia, proteinuria and hypocobalaminaemia. Post‐mortem examination revealed multi‐focal necrosis within the heart, kidneys, pancreas, liver, meninges and cerebral cortex. Fungal hyphae in lesions were identified as Scedosporium prolificans following culture. Subsequent genotyping confirmed that the dog carried the CUBN:c.8392delC mutation in a homozygous state, verifying hereditary cobalamin deficiency (a.k.a. Imerslund‐Gräsbeck syndrome). Cobalamin deficiency may have been a predisposing factor for the development of systemic fungal infection in this dog.     

Pulmonary vasculature in dogs assessed by three‐dimensional fractal analysis and chemometrics

Fractal analysis of canine pulmonary vessels could allow quantification of their space‐filling properties. Aims of this prospective, analytical, cross‐sectional study were to describe methods for reconstructing three dimensional pulmonary arterial vascular trees from computed tomographic pulmonary angiogram, applying fractal analyses of these vascular trees in dogs with and without diseases that are known to predispose to thromboembolism, and testing the hypothesis that diseased dogs would have a different fractal dimension than healthy dogs. A total of 34 dogs were sampled. Based on computed tomographic pulmonary angiograms findings, dogs were divided in three groups: diseased with pulmonary thromboembolism (n = 7), diseased but without pulmonary thromboembolism (n = 21), and healthy (n = 6). An observer who was aware of group status created three‐dimensional pulmonary artery vascular trees for each dog using a semiautomated segmentation technique. Vascular three‐dimensional reconstructions were then evaluated using fractal analysis. Fractal dimensions were analyzed, by group, using analysis of variance and principal component analysis. Fractal dimensions were significantly different among the three groups taken together (P = 0.001), but not between the diseased dogs alone (P = 0.203). The principal component analysis showed a tendency of separation between healthy control and diseased groups, but not between groups of dogs with and without pulmonary thromboembolism. Findings indicated that computed tomographic pulmonary angiogram images can be used to reconstruct three‐dimensional pulmonary arterial vascular trees in dogs and that fractal analysis of these three‐dimensional vascular trees is a feasible method for quantifying the spatial relationships of pulmonary arteries. These methods could be applied in further research studies on pulmonary and vascular diseases in dogs.     

IMAGING DIAGNOSIS—SPONTANEOUS PNEUMOMEDIASTINUM SECONDARY TO PRIMARY PULMONARY PATHOLOGY IN A DALMATIAN DOG

A 1.5‐year‐old, 23 kg intact male Dalmatian dog was evaluated for acute respiratory insufficiency without a previous history of trauma or toxic exposition. Imaging revealed pneumomediastinum, pneumothorax, diffuse unstructured interstitial pulmonary pattern, pulmonary interstitial emphysema, and pneumoretroperitoneum. Histopathological evaluation of the lungs revealed perivascular and peribronchial emphysema, mild lymphocytic interstitial pneumonia with atypical proliferation of type II pneumocytes in bronchioles and alveoli. A lung disease resembling fibrosing interstitial pneumonia in man and cats has been previously reported in Dalmatians and should be included as a differential diagnosis for Dalmatians with this combination of clinical and imaging characteristics.     

Clinical Evaluation of a Peptide‐ELISA based upon N‐terminal B‐cell Epitope of the VapA Protein for Diagnosis of Rhodococcus equi Pneumonia in Foals

A total of 227 field samples from naturally exposed foals aged between 3 weeks and 6 months were used in an evaluation of a peptide‐based enzyme‐linked immunosorbent assay (ELISA) for diagnosis of Rhodococcus equi infection. A biotinylated peptide derived from the virulence‐associated protein A (VapA) of R. equi, a horse pathogen, was synthesized and designated as PN11‐14. The peptide corresponds to the N‐terminal B‐cell epitope TSLNLQKDEPNGRASDTAGQ of the VapA protein. Based upon a serum immunoglobulin (Ig)G titre of 512 as a positive cut‐off value for the R. equi infection, the ELISA provided the overall sensitivity of 47.62%, specificity of 69.67% and an accuracy of 59.47% with a positive predictive value of 57.47% for true R. equi pneumonia. The assay was improved by detecting VapA‐specific IgGb antibodies against N‐terminal B‐cell epitope of the VapA protein rather than IgG antibodies. The VapA‐IgGb ELISA showed the overall sensitivity of 70.47%, specificity of 72.13% and accuracy of 71.36% with a positive predictive value of 68.52%. Diagnosis of R. equi disease in 6‐week‐old foals showed that the VapA‐IgGb ELISA provided an increasing trend (P = 0.0572) in sensitivity of 82.4% in comparison with the VapA‐IgG ELISA which showed the sensitivity of 58.8%. However, differences in specificity of both tests were statistically insignificant (P = 0.357) as analysed by the McNemar test. These results indicated that detection of VapA‐specific IgGb antibodies may be a better predictor of R. equi disease in foals.     

Suspected Phenobarbital‐Induced Pseudolymphoma in a Dog

Pseudolymphoma is a drug reaction to anti‐epileptics that is well recognized in humans; it has been reported in one cat but not dogs. In this report, lymphoma‐like clinical signs are suspected to be secondary to phenobarbital administration in a dog. A 2.5‐year‐old male, neutered Shepherd mix presented for a 3‐day history of progressive ataxia, dazed mentation, pyrexia, and lethargy. While hospitalized, the dog developed generalized lymphadenopathy and sustained pyrexia. The dog was receiving levetiracetam and phenobarbital for epilepsy, and serum concentrations of both were within standard therapeutic ranges. Abdominal ultrasound revealed hepatomegaly, splenomegaly, and generalized lymphadenopathy. Cytology of the peripheral lymph nodes was consistent with reactive lymph nodes, and aspirates of the liver and spleen revealed histiocytic‐neutrophilic inflammation. Phenobarbital was discontinued and replaced with zonisamide. Within 24 hours, the dog was normothermic, and other clinical signs resolved within a week. This case highlights a potentially serious yet reversible adverse reaction to phenobarbital in a dog. This idiosyncratic reaction could be mistaken for neoplasia and is an important differential for lymphoma‐like signs in any dog administered phenobarbital.     

An end‐to‐end urethral anastomosis after inguinal tunnelization: a new technique in a dog

An 8‐year‐old male dog was presented with a peri‐urethral intrapelvic mass with the characteristics of a sarcoma on computed tomography and cytology evaluation. A two‐step procedure leading to a permanent urinary diversion was performed. During the same procedure, the caudal pelvic urethra and mass were resected and an extrapelvic anastomosis of the pelvic portion of the urethra to its penile portion was performed after passage of the pelvic urethra through the inguinal canal. The procedure successfully produced a tension‐free end‐to‐end urethral anastomosis and no complications were observed during the postoperative period. Histologically, the lesion was reported as a narrowly excised liposarcoma. A 4‐week course of curative intent of radiotherapy was initiated 2 weeks after surgery. Eight months later, the dog was free of clinical signs.