Canine angiostrongylosis: an emerging disease in Europe

Objective – The aim of this article is to review Angiostrongylus vasorum infection in dogs, including the life cycle, signalment, clinical signs, diagnosis, and treatment. Apparent changes in the epidemiology of this unique parasite are considered, alongside information available regarding its recent geographic spread.
Etiology – A. vasorum is a metastrongyloid parasite capable of causing an array of clinical problems in dogs, including cardiorespiratory, coagulopathic, and neurologic signs. Currently, the parasite has a worldwide distribution; however, it usually arises in small pockets of enzootic foci. Recent reports suggest a changing distribution of this parasite, which has renewed interest in its epidemiology and in the risk of expansion to new areas including mainland North America.
Diagnosis – A definitive diagnosis of angiostrongylosis is usually made using the modified Baermann technique either using feces or tracheobronchial secretions; however, this review also discusses novel methods such as serologic and molecular techniques.
Therapy – Once a diagnosis of angiostrongylosis is made, prompt treatment should follow with anthelmintic drugs (such as moxidectin/imidacloprid, milbemycin oxime, or fenbendazole) and supportive care dependent upon the patient's clinical signs. Currently, there is no proven prophylactic regime.
Prognosis – The prognosis appears to be very dependent upon the severity of clinical signs at presentation. A. vasorum can be fatal and death may be sudden. However, if a prompt diagnosis is made and appropriate treatment is administered complete clinical resolution is possible.     

Feline babesiosis

Objective – To review and summarize current information regarding the etiology, clinical presentation, diagnosis, treatment, and prognosis of feline babesiosis, especially with regard to features distinct from canine babesiosis.
Etiology – Babesiosis is caused by hemoprotozoa of the genus Babesia . Numerous species of Babesia exist worldwide. The babesial organism spends the majority of its life cycle within the erythrocyte of the definitive host, resulting in hemolysis, with or without systemic complications.
Diagnosis – Definitive diagnosis depends on direct visualization of the organism on blood smear or a positive polymerase chain reaction. Positive serologic tests indicate only exposure, with or without active infection.
Therapy – Antiprotozoal drugs and supportive care are the mainstays of therapy. Primaquine phosphate is considered the treatment of choice in cats.
Prognosis – Prognosis depends on the severity of disease, which in turn depends on both organism and host factors. Mortality rates of 15–20% are reported.     

Clinical management of canine babesiosis

Objective – To review and summarize current information regarding epidemiology, pathogenesis, and pathophysiology leading to the various clinical syndromes associated with canine babesiosis. Diagnosis, treatment, preventative strategies, and zoonotic implications are discussed.
Etiology – Babesiosis is caused by hemoprotozoa of the genus Babesia . Numerous species of Babesia exist worldwide. An increased incidence of babesiosis is described, especially in North America. The babesial organism spends the majority of its life cycle within the erythrocyte of the definitive host, resulting in hemolysis, with or without systemic complications.
Diagnosis – Definitive diagnosis depends on direct visualization of the organism on blood smear or polymerase chain reaction. A positive serologic antibody test indicates exposure with or without active infection.
Therapy – Antiprotozoal drugs, antimicrobials, and supportive care are the mainstays of babesiosis therapy.
Prognosis – Prognosis depends on the severity of disease, which in turn depends on both organism and host factors. Clinical syndromes associated with a poorer prognosis include red biliary syndrome, acute renal failure, acute respiratory distress syndrome, neurologic dysfunction, acute pancreatitis, cardiac dysfunction, and hypoglycemia.     

Tetanus: pathophysiology, clinical signs, diagnosis, and update on new treatment modalities

Objective: To review the pathophysiology, clinical signs, diagnosis, and current treatment modalities used in treating tetanus in small animals and humans. Etiology: Tetanus is caused by the activity of a toxin released from the bacterial organism, Clostridium tetani. The disease has an incubation period of 3 days to 3 weeks and usually follows a deep penetrating wound. Diagnosis: The diagnosis of tetanus is usually based on history and clinical signs. Therapy: Therapy of tetanus consists of direct and supportive care and includes toxin neutralization via human or equine derived immunoglobulin, antimicrobial therapy to eliminate C. tetani, and central and peripheral muscle relaxants to control hypertonicity. Adjunctive care may include positive pressure ventilation, anticonvulsant medication, drugs to treat autonomic dysfunction, and nutritional support. Prognosis: Prognosis varies based on severity of clinical signs at the time of diagnosis and the availability of appropriate care.     

Clinical Features and Outcome of Heterobilharzia americana Infection in Dogs

Background: Heterobilharzia americana (HA), the causative agent of canine schistosomiasis, is a flatworm with a freshwater snail as an intermediate host. Only case reports or small case series evaluating naturally infected dogs have been published.
Objective: Describe clinical signs in dogs naturally infected with HA.
Animals: Twenty-two dogs naturally infected with HA from 1985 to 2009.
Methods: Retrospective study. All medical records were searched for HA and schistosomiasis. Only dogs with a diagnosis based on identification of ova on histopathology or fecal saline sedimentation were included.
Results: The median age was 3.1 years (1–12). The median duration of clinical signs before diagnosis was 0.63 months (0.03–12). The most common clinical signs were lethargy (91%), weight loss (77%), hyporexia (68%), vomiting (59%), and diarrhea (55%). Eleven of the 22 dogs were hypercalcemic. Hypercalcemia did not resolve without definitive treatment with praziquantel. HA infection was an incidental diagnosis in 7/22 dogs. Diagnosis was obtained via necropsy (4), histopathology (9), and fecal examination (9). Definitive treatment included praziquantel and fenbendazole. Eighteen dogs were diagnosed antemortem and 17 were treated. Twelve dogs were alive for 6 months to 3 years after diagnosis.
Conclusions and Clinical Importance: HA infection occurs in younger, larger breed, indoor dogs. Hypercalcemia does not resolve without praziquantel treatment. Prognosis is good and neither hypercalcemic-induced renal failure nor ascites appears to worsen prognosis. Dogs in affected areas or that have traveled to affected areas that present for weight loss, gastrointestinal or liver disease, and hypercalcemia, should be tested.     

Brown spider envenomation

The venom from spiders of the genus Loxosceles, the most famous being Loxosceles recluse (the most brown recluse spider) can cause serious poisoning. These spiders inhabit the south and south central states from Georgia through Texas and north to southern Wisconsin. They are commonly called violin spiders because of the violin-shaped marking on the dorsum of the cephalothorax. Many dermonecrotic lesions are incorrectly diagnosed as Brown recluse bites, as up to 50% of the diagnoses are in geographic regions of the country which do not have Loxosceles spiders. Sphingomyelinase D is the primary venom dermonecrotic factor. The toxin depletes serum hemolytic complement, prolongs the activated partial thromboplastin time and depletes clotting factors VIII, IX, XI, and XII. The venom induces rapid coagulation and occlusion of small capillaries, causing subsequent tissue necrosis. A classic "bulls eye" lesion develops, an erythematous area inside of which is a pale ischemic region that develops a dark necrotic center as the lesion matures. Healing is slow, and these ulcers may persist for months leaving a deep scar. Systemic signs occur less commonly but can be life threatening. The most prevalent sign is a hemolytic anemia with significant hemoglobinuria. There is no specific antidote. Dapsone a leukocyte inhibitor has been shown to be effective in treating dermal lesions in animal models. Conservative therapy includes several cleanings daily with Burrow's solution and hydrogen peroxide. Systemic signs of Loxosceles envenomation are potentially fatal and should be aggressively addressed. Hospitalization and intravenous fluid therapy may be needed to maintain adequate hydration and to protect renal function.     

Four cases of snake envenomation responsive to death adder antivenom

Death adder envenomation is rare in humans and there is only one brief report previously in dogs. This paper details three cases of canine common death adder (Acanthophis antarcticus) envenomation and one case of bardick (Echiopsis curta) envenomation which were responsive to death adder antivenom. The available literature on death adder envenomations is also reviewed. The main clinical sign in the four dogs was severe lower motor neuron paralysis. There was no clinical evidence of coagulopathy or myopathy. Use of a snake venom detection kit was essential for selection of appropriate antivenom. Death adder and bardick envenomation in dogs potentially has a good prognosis if sufficient antivenom is administered and intensive supportive care is available.     

Snake envenomation in cats and its detection by rapid immunoassay

Objective To determine the usefulness of a snake venom detection kit (SVDK) in the management of envenomed cats.
Design A clinical study.  

Animals

Twenty-two cats were investigated.
Procedure Cats injected subcutaneously with approximately 0.25 or 1.0 lethal dose (LD) of tiger snake venom or 1 or 4 LD of brown snake venom were observed for clinical symptoms of envenomation at intervals over the ensuring 24 to 48 hours(h). Blood and urine samples were taken at regular intervals and assayed in a quantitative laboratory assay for snake venoms. Selected samples were assayed in parallel in a rapid, semi-quantitative SVDK.
Results The studies showed that it was important to estimate the elapsed time from envenomation to presentation. If this time was less than 8 h, blood was the most appropriate sample and a negative result should exclude serious envenomation. If the elapsed time exceeded 8 h, it was essential that urine be sampled. Venom levels in urine were high at 8 h and approached the level of test sensitivity over 24 to 48 h; however by this time clinical signs were obvious in endangered cats.  

Conclusions

Careful use of the SVDK is a valuable aid in the management of a potentially envenomed cat.     

Suspected tick paralysis (Ixodes holocyclus) in a Miniature Horse

A 9‐year‐old Miniature Horse gelding infested with ticks (Ixodes holocyclus) was presented with flaccid motor paralysis causing recumbency. Neurological examination and other diagnostic tests did not identify an alternative aetiology, leading to a presumptive diagnosis of tick paralysis. The gelding was treated with tick antiserum and intensive supportive care. He made a gradual recovery over the 48 h following presentation and was discharged without further complications. This case report describes in detail the clinical signs and successful treatment of a Miniature Horse with flaccid paralysis caused by suspected envenomation by Ixodes holocyclus.     

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.     

Feline Degenerative Joint Disease

Objective: To critically review and collate published information on feline degenerative joint disease (DJD) and identify areas in which information is lacking.
Study Design: Critical literature review.
Methods: Literature search through Pub Med, Commonwealth Agricultural Bureau Abstracts published in the English Language, or translated into English (January 1940–August 2008).
Results: Although there are no prospective studies, the prevalence of radiographic DJD appears to be high and can be associated with clinical signs of decreased mobility. There appears to be a mismatch between radiographic and clinical examination findings (pain response). There is little information on the cause of DJD in different joints. There are no fully validated subjective or objective assessment systems for the measurement of chronic DJD-associated pain in the cat. Development of a feline model of chronic DJD-associated pain may speed the development and evaluation of candidate pain-alleviating compounds and treatments.
Conclusions: The high prevalence of feline DJD and lack of information about it, suggests further investigation is needed.
Clinical Relevance: Feline DJD occurs with high frequency, and yet there is little to guide the clinician on prevention or treatment.     

Ascites is a Negative Prognostic Indicator in Chronic Hepatitis in Dogs

Background: Chronic hepatitis (CH) in dogs is common but little is known about factors associated with survival. Ascites is a well-recognized negative prognostic indicator in humans.
Hypothesis: Ascites is a negative prognostic indicator in CH in dogs.
Animals: Thirty-four dogs with histologically confirmed CH presented to 1 institution between 1996 and 2005.
Methods: Retrospective observational study. CH was diagnosed by histopathology of liver tissue according to the WSAVA criteria. Ascites was diagnosed by abdominal ultrasound. The association of ascites with survival from diagnosis or onset of owner-reported clinical signs until death from any cause or from liver disease was analyzed. Ascitic and nonascitic groups were further analyzed for differences in treatment and sex.
Results: Fourteen of 34 dogs had ascites. Survival from diagnosis to death from liver disease was 0.4 months (95% confidence interval [CI], 0.2–0.6) for ascitic dogs and 24.3 months (CI 11.4–37.1) for nonascitic dogs ( P < .001), and from onset of signs to death from liver disease was 2.0 months (CI 0.0–5.6) for ascitic dogs and 33.0 months (CI 8.6–57.4) for nonascitic dogs ( P = .0020). Diet and spironolactone use differed between groups.
Conclusions and Clinical Importance: Ascites is a significant negative prognostic indicator in dogs with CH. Veterinarians and owners can use this information to aid clinical decision making in affected dogs.     

Hypothalamic-pituitary axis deficiency following traumatic brain injury in a dog

Objective – To describe endocrine dysfunction associated with traumatic brain injury in a dog.
Summary – A 12-week-old dog presented with traumatic brain injury and did not respond to traditional supportive care. Continued hypothermia, electrolyte derangements, hypotension, and hyposthenuria prompted screening for and detection of several hypothalamic-pituitary disorders including: hypoadrenocorticism, central diabetes insipidus, hypothyroidism, and growth hormone deficiency. Electrolyte abnormalities, urine osmolarity, and blood pressure improved with treatment for the associated disorders.
New or Unique Information Provided – This is the first report of generalized hypothalamic-pituitary dysfunction or panhypopituitarism following traumatic brain injury in a dog.     

Epidural Idiopathic Sterile Pyogranulomatous Inflammation Causing Spinal Cord Compressive Injury in Five Miniature Dachshunds

Objective— To characterize the clinical signs, diagnostic and surgical findings, and outcome of dogs with idiopathic sterile pyogranulomatous inflammation (ISP) of epidural fat causing spinal cord compression.
Study Design— Retrospective study.
Animals— Dogs (n=5).
Methods— Dogs with epidural ISP (2002–2006) were identified retrospectively. Inclusion criteria were neurologic examination, myelography, and definitive diagnosis of ISP confirmed by surgery and histopathologic examination of epidural spinal cord compressive tissue.
Results— The most common clinical sign was paraparesis/paraplegia. No abnormalities were detected by laboratory testing or survey spine radiographs. On myelography, extradural spinal cord compressions were focal (dogs 1, 3, and 5) or multifocal (dogs 2 and 4). Surgical decompression of the spinal cord was completed by hemilaminectomy. Epidural fat collected surgically had pyogranulomatous inflammation of unknown cause and was histologically similar to subcutaneous ISP. All dogs had good long-term neurologic outcome (10–45 months follow-up). Some dogs had episodes of ISP at other sites before or after surgical treatment of epidural ISP, suggesting there may be a systemic form of ISP.
Conclusion— Epidural ISP may cause a spinal cord compressive lesion in Miniature Dachshunds, which can be treated by surgical decompression of the spinal cord with or without administration of adjunctive steroids.
Clinical Relevance— Epidural ISP should be considered as a possible cause of thoracolumbar myelopathy for Miniature Dachshunds.     

Prevalence of malignancy when solitary versus multiple lesions are detected during abdominal ultrasonographic examination of dogs with spontaneous hemoperitoneum: 31 cases (2003–2008)

Objective – To compare the histopathologic diagnosis in dogs with spontaneous hemoperitoneum when abdominal ultrasonographic examination detects a solitary versus multiple lesions.
Design – Retrospective cross-sectional study.
Setting – Private veterinary hospital.
Animals – Client-owned dogs presented with spontaneous hemoperitoneum between March 1, 2003 and June 1, 2008.
Interventions – Dogs were divided into 2 groups based on presence of a solitary or multiple abdominal ultrasonographic lesions. Prevalences were compared between groups for malignancy and specifically hemangiosarcoma.
Measurements and Main Results – Ten of 31 (32%) dogs had a solitary abdominal ultrasonographic lesion and 21 of 31 (68%) had more than 1 lesion. The bleeding tissue was characterized as malignant in 8 of 10 (80%) dogs with solitary lesions and 17 of 21 (81%) dogs with multiple lesions; there was no significant difference ( P =1.0) between groups. In this study no association ( P =0.26) was found between the number of abdominal ultrasonographic lesions observed and subsequent diagnosis of hemangiosarcoma.
Conclusions – Solitary abdominal ultrasonographic lesions in dogs with spontaneous hemoperitoneum do not necessarily indicate a lower prevalence of malignancy.     

Diagnosis and management of pancreatitis

While there is no single diagnostic approach, other than direct examination of the pancreas, that is completely reliable for the diagnosis of pancreatitis, a presumptive diagnosis of acute pancreatitis can be made with a good degree of confidence by careful evaluation of the entire clinical picture - history and clinical signs, results of physical examination, abdominal imaging and laboratory testing. The approach to treatment is to rest the pancreas, by withholding food, while providing general supportive care by fluid therapy including, in severe cases, plasma transfusion to replace plasma protease inhibitors and albumin. Additional specific interventions in an effort to halt the progression of spontaneous pancreatitis have not yet been shown to be effective, but control of obesity and avoidance of high fat diets may help prevent pancreatitis or lessen its severity when it occurs. Pancreatitis is an unpredictable disease of widely varying severity. While many patients with uncomplicated pancreatitis recover spontaneously following several days of supportive care, other patients die in spite of prolonged intensive care.     

Moxidectin toxicosis in a puppy successfully treated with intravenous lipids

Objective – To describe successful treatment of canine moxidectin toxicosis with the novel therapy of IV lipid administration.
Case Summary – A 16-week-old female Jack Russell Terrier was presented with acute onset of seizures followed by paralysis and coma shortly following suspected exposure to an equine formulation of moxidectin. Moxidectin toxicity was later confirmed. Initial therapy consisted of diazepam, glycopyrrolate, and IV fluids. Mechanical ventilation and supportive nursing care were provided as needed. An emulsion of 20% soybean oil in water, commonly used as the fat component of parenteral nutrition, was administered intravenously as a bolus of 2 mL/kg followed by 4 mL/kg/h for 4 hours beginning 10 hours after exposure and was administered again at a rate of 0.5 mL/kg/min for 30 minutes beginning 25.5 hours post-exposure. Mild improvement was seen after the first dose, and dramatic improvement was noted within 30 minutes of the second dose. The puppy's neurologic status returned to normal within 6 hours of the second administration, with no relapses.
Unique Information Provided – IV lipid therapy is a novel treatment approach for moxidectin toxicity. Its use is supported by recent research and case studies involving IV lipid administration for bupivacaine and other fat-soluble toxins. Lipid administration appeared to reverse the signs of toxicity and may prove to be a highly effective therapy for moxidectin and other fat-soluble toxins.     

A Retrospective Analysis of Renal Carcinoma in the Horse

Background: Renal carcinoma is a rare tumor of horses.
Hypothesis: Presenting complaints and clinical signs of this disease are vague and early diagnosis increases survival time.
Animals: Data were collected from the medical records of 4 horses presented to Washington State University as well as the 23 previously published case reports of horses with renal carcinoma.
Methods: Retrospective study.
Results: Renal carcinoma affects horses of all ages with most cases observed in geldings and Thoroughbreds. The most common presenting complaints are nonspecific and usually do not occur until late in the course of the disease. Routine laboratory results generally are unremarkable with no evidence of renal dysfunction. Urine and peritoneal fluid analyses are consistently abnormal, but the changes usually are nonspecific. Rectal palpation often allows detection of an abnormal kidney or a mass in the area of the kidney. Renal ultrasound examination is the most rewarding imaging procedure, and when combined with renal biopsy, antemortem diagnosis can be achieved. Renal carcinoma is both locally invasive and metastatic, necessitating careful staging for metastasis using thoracic radiography and abdominal ultrasound examination. If the tumor is localized to 1 kidney, nephrectomy is the treatment of choice. No chemotherapy or radiation treatment for renal carcinoma has been reported in the horse. Median survival for this series of cases was 11 days (0 days–1 year).
Conclusions and Clinical Importance: Prognosis is poor to grave.     

A Prospective, Randomized, Double-Blinded, Placebo-Controlled Study of Human Intravenous Immunoglobulin for the Acute Management of Presumptive Primary Immune-Mediated Thrombocytopenia in Dogs

Background: Immune-mediated thrombocytopenia (IMT) is a common hematologic disorder in dogs. Human intravenous immunoglobulin (hIVIG) may have a beneficial effect in canine IMT.
Hypothesis: A single hIVIG infusion (0.5 g/kg) in dogs with presumed primary IMT (pIMT) is a safe adjunctive emergency treatment to accelerate platelet count recovery and shorten hospitalization time without increasing the cost of patient care.
Animals: Eighteen client-owned dogs with a presumptive diagnosis of pIMT.
Methods: Prospective, randomized, double-blinded, placebo-controlled clinical trial.
Results: There were no identifiable immediate or delayed adverse reactions associated with hIVIG administration over a 6-month period. The median platelet count recovery time for the hIVIG group was 3.5 days (mean ± SD: 3.7 ± 1.3 days; range, 2–7 days) and 7.5 days (mean ± SD: 7.8 ± 3.9 days; range, 3–12 days) for the placebo group. The median duration of hospitalization for hIVIG group was 4 days (mean ± SD: 4.2 ± 0.4 days; range, 2–8 days) and 8 days (mean ± SD: 8.3 ± 0.6 days; range, 4–12 days) for the placebo group. There was no significant difference between groups with respect to expense of initial patient care, whereas significant reduction in platelet count recovery time ( P = .018) and duration of hospitalization ( P = .027) were detected in the hIVIG group.
Conclusions and Clinical Importance: Compared with corticosteroids alone, adjunctive emergency therapy of a single hIVIG infusion was safe and associated with a significant reduction in platelet count recovery time and duration of hospitalization without increasing the expense of medical care in a small group of dogs with presumed pIMT.