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.     

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.     

Relative adrenal insufficiency in critical illness

Objective: To review the effects of critical illness on hypothalamic–pituitary–adrenal (HPA) function in human and veterinary medicine. Data sources: Data from human and veterinary literature was reviewed. Human data synthesis: Relative adrenal insufficiency (RAI) appears to be common in critically ill human patients with sepsis or septic shock. Hypotension that is refractory to fluid therapy and requires vasopressors is the most common presentation of RAI in the human intensive care unit (ICU). Many investigators now advocate the use of a low‐dose adrenocorticotropin hormone stimulation test to diagnose RAI. It is important to evaluate for the presence of adrenal dysfunction, because current data suggest that treatment with ‘stress’ or low doses of glucocorticoids (200–300 mg hydrocortisone daily) may improve patient outcome in humans. Veterinary data synthesis: There is a paucity of controlled studies in the veterinary literature regarding the effects of critical illness on HPA function. The results of these studies are varied. However, research models of sepsis and hemorrhagic shock suggest the existence of RAI in animals. Prospective clinical studies are needed to further examine pituitary–adrenal response to severe illness in veterinary patients, and to determine if there are therapeutic options, including glucocorticoid administration, which will improve patient outcome in animals. Conclusions: RAI is well documented in critically ill human patients, yet little is known about adrenal dysfunction in veterinary critically ill patients. A small number of studies suggest that RAI may exist in certain subpopulations of veterinary patients. The syndrome of RAI could be considered as a differential diagnosis in seriously ill veterinary patients that fail to respond to appropriate therapy, especially when hypotension refractory to fluid and vasopressor therapy is encountered. This disorder may represent a previously unidentified syndrome in critically ill veterinary patients with important therapeutic implications.     

C-reactive protein, tumor necrosis factor α, and interleukin-6 in dogs with pyometra and SIRS

Objective: To determine the frequency of the systemic inflammatory response syndrome (SIRS) in canine pyometra and to evaluate the relationship between C‐reactive protein (CRP), tumor necrosis factor α (TNFα), interleukin‐6 (IL‐6), and SIRS. Design: Prospective clinical study. Setting: Veterinary teaching hospital. Animals: Fifty‐three clinical cases of canine pyometra and 19 healthy control bitches. Interventions: Upon admission to the veterinary hospital, history and physical examination findings, including previously defined clinical SIRS parameters, were documented. Blood samples were obtained for hematology and biochemical tests and for CRP, TNFα, and IL‐6 analysis. The diagnosis of pyometra was confirmed by histopathology of the uterus after ovariohysterectomy. After surgery, clinical SIRS parameters, length of hospitalization, and mortality were recorded. Measurements and main results: Pyometra dogs were grouped as SIRS positive (30/53; 57%) or SIRS negative (23/53; 43%). Logistic regression showed that CRP was the only parameter that significantly related to SIRS apart from the clinical criteria that define this syndrome. The mortality rate was low (2/53; 3.8%), and conclusions regarding association with SIRS could not be drawn. A positive SIRS status, high plasma CRP concentration, and high body temperature were variables that related to increased morbidity reflected by the length of hospitalization. Conclusions: SIRS was seen in 57% of canine pyometra cases and a positive SIRS status showed a positive association with prolonged hospitalization. The mortality rate was low (3.3%) among SIRS positive dogs, indicating that progression to multiple organ dysfunction syndrome (MODS) rarely occurs in surgically treated cases of pyometra. CRP was associated with SIRS and with prolonged hospitalization. Further studies of plasma CRP may be warranted in canine intensive care cases susceptible to development of SIRS and MODS.     

Serum α-1-acid glycoprotein concentrations in 26 dogs with pyometra

Background: The acute phase protein, α‐1‐acid glycoprotein (AGP), has been proposed to have a role in immunomodulation and to be a nonspecific antimicrobial agent. We suggest that AGP may be increased in dogs with pyometra and possibly to a greater extent in dogs also manifesting signs of systemic inflammatory response syndrome (SIRS). Objectives: Our objectives were to evaluate serum AGP concentrations in dogs diagnosed with pyometra compared with clinically healthy female dogs and to determine if AGP concentrations were correlated with severity of disease. Methods: Twenty‐six dogs with pyometra and 18 clinically healthy intact female dogs were included in this prospective study. A diagnosis of pyometra was verified by histopathologic examination after ovariohysterectomy in the pyometra group. A commercially available single radial immunodiffusion test was used for AGP analysis. Clinical findings, laboratory variables, and hospitalization times were compared. Results: Mean AGP concentration in dogs with pyometra (1943 ± 913 mg/L, mean ± SD), was significantly higher (P<.001) than in healthy dogs (495 ± 204 mg/L). Mean AGP concentration in dogs in the pyometra group with (n=18) or without (n=8) SIRS did not differ. Animals with a prolonged hospital stay had higher AGP concentrations. Conclusions: Pyometra was associated with increased serum concentrations of the acute phase protein AGP. AGP concentrations were associated with severity of disease as measured by duration of hospitalization. As AGP binds basic drugs, further studies of its pharmacokinetic and pharmacodynamic propreties in cases of pyometra may be of clinical interest.