Toxoplasmosis.

Toxoplasmosis in dogs and cats can cause chorioretinitis, anterior uveitis, or both. Ocular lesions are a common manifestation of generalized toxoplasmosis. The prevalence of toxoplasmosis as a cause of idiopathic anterior uveitis in cats is not clear, although there is a significant association between exposure to T. gondii and feline anterior uveitis. The pathogenesis of ocular toxoplasmosis may be different in humans and cats, and the anterior uveitis may represent a type of immune-mediated inflammation. A diagnosis is made by observing compatible clinical findings and obtaining supportive findings on serologic tests. Despite improved diagnostic techniques, including determination of IgM class antibodies and PCR testing, definitive diagnosis of ocular toxoplasmosis remains a challenge. Topical anti-inflammatory therapy should be used in cats with anterior uveitis, a positive serum titer, and no concurrent systemic signs. Systemic clindamycin should be given to cats with ocular and systemic signs and to cats with suggestive serology and idiopathic anterior uveitis that fails to respond to topical therapy alone.     

INSULINOMA IN THE DOG

Four clinical cases of insulinoma in the dog are described. In each, nervous signs increased in frequency and severity over a period of approximately 4 months. Diagnosis was made on clinical signs, blood glucose concentration, response to glucose therapy and, in the 2 cases in which an radioimmunoassay was performed, blood insulin levels. Differential diagnosis and management regimes for insulinomas are discussed. Neocropsy confirmed the diagnoses in 3 cases, with multiple pancreatic lesions being present in 2, and metastases in all 3.     

Dysautonomia in dogs: 65 cases (1993-2000)

OBJECTIVE: To determine signalment, history, clinical findings, results of autonomic function testing and other antemortem diagnostic tests, and pathologic findings in dogs with dysautonomia. DESIGN: Retrospective study. ANIMALS: 65 dogs with dysautonomia. PROCEDURE: Case records of 68 dogs with a diagnosis of dysautonomia were reviewed; inclusion criteria included histologic confirmation of dysautonomia or clinical signs and results of pharmacologic testing consistent with dysautonomia. RESULTS: 65 dogs fulfilled all criteria for dysautonomia. Dogs from rural environments were overrepresented, and cases of dysautonomia were reported for every month, although the highest number of cases was reported in February and March. Vomiting was the most common clinical sign, followed by diarrhea, signs of anorexia and depression, weight loss, and dysuria. The most common physical examination finding was decreased or absent anal tone, followed by absent pupillary light reflexes and elevated nictitating membrane. Results of pharmacologic testing were consistent with dysautonomia, although no single test was 100% sensitive. Histologic lesions consistent with dysautonomia were found in the autonomic ganglia, brainstem nuclei, and ventral horns of the spinal cord. CONCLUSIONS AND CLINICAL RELEVANCE: Dysautonomia is an endemic disease in Kansas, and a high index of suspicion of the disease can be made by combining clinical signs, physical examination findings, and results of pharmacologic testing.     

Yolk coelomitis in a white-throated monitor lizard (Varanus albigularis)

Yolk coelomitis as a result of pre-ovulatory follicular stasis is a common disorder in captive reptiles, especially in captive lizards of various genera. The clinical signs are generally fairly non-specific and diagnosis is based on clinical signs together with most of the common diagnostic modalities. The condition is most likely a husbandry and environment-related reproductive disorder. It has not been reported in wild free-living specimens. This report describes the clinical presentation and post mortem lesions in a white-throated monitor lizard that died during treatment for non-specific clinical signs related to a severe yolk coelomitis.     

Soft tissue- and bone-phase scintigraphy for diagnosis of navicular disease in horses

Radiography and soft tissue- and bone-phase scintigraphy were performed on 14 clinically normal horses and 35 horses in which definite, probable, or possible navicular disease had been diagnosed. The specificity of radiography and scintigraphy in revealing signs of navicular disease were nearly equal; however, the sensitivity of scintigraphy appeared to be greater than that of radiography. The greatest sensitivity and specificity were achieved when the results of radiography and scintigraphy were evaluated together. Differences in sensitivity were greatest when scintigraphy revealed lesions not detected by radiography. Although a diagnosis of navicular disease was sometimes made when only soft tissue-phase or only bone-phase scintigraphy revealed lesions, results obtained during the 2 phases generally were similar. It was concluded that scintigraphy can be a valuable aid in diagnosing navicular disease in horses, especially when radiographic findings do not support clinical findings.     

ULTRASONOGRAPHIC FEATURES OF CANINE HEPATIC NODULAR HYPERPLASIA

Hepatic nodular hyperplasia is a benign, usually clinically inapparent, proliferative lesion commonly found at necropsy in older dogs. Three examples of hepatic nodular hyperplasia are described in dogs with clinical signs compatible with hepatic disease in which ultrasonography revealed a variety of echotextural changes in the liver similar to those reported in primary or secondary hepatic neoplasia. In subsequent in vitro ultrasonographic studies of hepatic nodular hyperplasia lesions detected at necropsy in dogs without clinical signs of hepatic disease, only subtle echotextural changes were seen. Hence, hepatic nodular hyperplasia may be inapparent in vivo in many dogs. Hepatic nodular hyperplasia is a potentially confusing sporadic finding which must be considered by ultrasonographers examining dogs with clinical signs of hepatic disease. The diagnosis of hepatic neoplasia should not be made on the basis of ultrasonographic findings alone.     

Diagnosis of Transmissible Gastroenteritis in Pigs by Means of Immunofluorescence

The fluorescent antibody (FA) test for the diagnosis of field outbreaks of transmissible gastroenteritis (TGE) in baby pigs was compared to other available means including: virus isolation by inoculation of test pigs, intestinal lesions especially villous atrophy, and clinical observations.

Immunofluorescent tests were done on frozen sections of the small intestine and it was possible to make a specific diagnosis within two hours after collecting samples. The results obtained with the FA test compared favorably with virus isolation from infected tissues. It was considered a more advantageous procedure as long as infected pigs were in a relatively early phase of the disease. Because of the variability of the lesions as related to the stage of infection, pathologic diagnoses were less satisfactory. Field diagnoses made on the basis of clinical signs were least reliable.

     

Inflammatory cerebrospinal fluid analysis in cats: clinical diagnosis and outcome

The medical records of 62 cats with clinical signs of central nervous system disease and accompanying inflammatory cerebrospinal fluid (CSF) analysis were examined retrospectively to determine if signalment, clinical signs, CSF analysis and ancillary testing could accurately predict the type of central nervous system disease that was present. An inflammatory CSF was defined as one in which a total nucleated cell count was greater than 5 cells/microl or one in which the total nucleated cell count was normal but the nucleated cell differential count was abnormal. Sex, degree of CSF inflammation, neuroanatomical location and systemic signs provided little contributory information to the final diagnosis. In 63% of the cases a presumptive diagnosis could be made based on a combination of clinical signs, clinicopathological data and ancillary diagnostic tests. CSF analysis alone was useful only in the diagnosis of cats with feline infectious peritonitis, Cryptococcus species infection, lymphoma and trauma. Overall, despite extensive diagnostic evaluation, a specific diagnosis could not be made in 37% of cats. The prognosis for cats with inflammatory CSF was poor with 77% of cats surviving less than 1 year.     

Clinicopathologic features of an unusual outbreak of cryptococcosis in dogs, cats, ferrets, and a bird: 38 cases (January to July 2003)

OBJECTIVE: To determine clinical and pathologic findings associated with an outbreak of cryptococcosis in an unusual geographic location (British Columbia, Canada). DESIGN: Retrospective study. ANIMALS: 1 pink-fronted cockatoo, 2 ferrets, 20 cats, and 15 dogs. PROCEDURE: A presumptive diagnosis of cryptococcosis was made on the basis of serologic, histopathologic, or cytologic findings, and a definitive diagnosis was made on the basis of culture or immunohistochemical staining. RESULTS: No breed or sex predilections were detected in affected dogs or cats. Eleven cats had neurologic signs, 7 had skin lesions, and 5 had respiratory tract signs. None of 17 cats tested serologically for FeLV yielded positive results; 1 of 17 cats yielded positive results for FIV (western blot). Nine of 15 dogs had neurologic signs, 2 had periorbital swellings, and only 3 had respiratory tract signs initially. Microbiologic culture in 15 cases yielded 2 isolates of Cryptococcus neoformans var grubii (serotype A) and 13 isolates of C. neoformans var gattii (serotype B); all organisms were susceptible to amphotericin B and ketoconazole. Serologic testing had sensitivity of 92% and specificity of 98%. CONCLUSIONS AND CLINICAL RELEVANCE: Serologic titers were beneficial in identifying infection in animals with nonspecific signs, but routine serum biochemical or hematologic parameters were of little value in diagnosis. Most animals had nonspecific CNS signs and represented a diagnostic challenge. Animals that travel to or live in this region and have nonspecific malaise or unusual neurologic signs should be evaluated for cryptococcosis.     

Sonography of the liver, gallbladder, and spleen

Focal hepatic and splenic lesions, vascular abnormalities, and disorders of the biliary system can readily be detected with ultrasonography. The sonographic diagnosis can be substantially narrowed when the presenting clinical signs are considered. Ultrasonography is less helpful when the liver or spleen is diffusely involved without parenchymal, abnormalities. However, certain diseases may also be eliminated from diagnostic consideration on the basis of this finding. Percutaneous ultrasound guided biopsy markedly improves the success and safety of obtaining a definitive diagnosis when either diffuse or focal lesions are present. Sonography has also been very beneficial for serially evaluating the response to therapy once focal lesions of the liver or spleen have been identified.     

Sonography of the liver, gallbladder, and spleen

Focal hepatic and splenic lesions, vascular abnormalities, and disorders of the biliary system can readily be detected with ultrasonography. The sonographic appearance in certain cases may be nonspecific, but the differential diagnosis can be substantially narrowed when the presenting clinical signs are considered. Ultrasonography is less helpful when the liver or spleen is diffusely involved without parenchymal abnormalities. However, certain diseases may also be eliminated from diagnostic consideration on the basis of this finding. Percutaneous ultrasound guided biopsy markedly improves the success and safety of obtaining a definitive diagnosis when either diffuse or focal lesions are present. Sonography has also been very beneficial for serially evaluating the response to therapy once focal lesions of the liver or spleen have been identified.     

Horner's syndrome in cats and dogs: a review

The literature was reviewed and reference made to a retrospective study of cases of Horner's syndrome seen at the Royal (Dick) School of Veterinary Studies. It was concluded that the cardinal diagnostic sign of Horner's syndrome is miosis. Ptosis, prolapse of the third eyelid and apparent enophthalmos are frequently presented but other signs of sympathetic deficit such as facial or aural vasodilatation are observed less consistently. The clinical diagnosis may be confirmed by pupillary response to cocaine. Horner's syndrome was frequently associated with trauma and less commonly with neoplasia. In a significant number of cases the cause was undetermined. Lesions of central neurons are reported infrequently while lesions of preganglionic and postganglionic neurons are described more often and appear to have a similar incidence. Preganglionic lesions most frequently involve the thoracic spinal cord and cervical sympathetic trunk while postganglionic lesions usually result from middle ear and retrobulbar disorders. The site of the lesion may be determined on the basis of clinical signs and pupillary response to phenyladrenalin or hydroxyamphetamine which both distinguish postganglionic lesions from preganglionic and central lesions.     

Assessment of clinical criteria to diagnose scrapie in Italy

A reliable ante-mortem test for the detection of scrapie in all genotypes has not yet been developed and clinical diagnosis remains a useful tool for surveillance purposes. This paper describes the results of a three-year study in which clinical signs consistent with scrapie were recorded according to standardized criteria in 245 sheep from 21 outbreaks in Italy in order to identify helpful criteria for the diagnosis of the disease. Thirty-seven sheep were scrapie-positive at post-mortem rapid testing, 23 showed weight loss, 20 had proprioceptive deficits, 17 demonstrated ataxia and nibble reflex, and some sheep had a combination of signs. Six scrapie-positive sheep were asymptomatic. The clinical protocol was easy to handle and appears to be a useful tool for improving passive surveillance. The data suggested that positive clinical history, nibble, and nibble combined with proprioceptive positioning deficit have a quite high negative predictive value. The protocol will be proposed as a tool for field inspection in passive surveillance in Italy.     

Malignant catarrhal fever in Switzerland: 2. Evaluation of the diagnosis]

Malignant catarrhal fever (MCF) is a mostly fatal lymphoproliferative disease of cattle. In 1995 a PCR based method was introduced for the detection of the ovine herpesvirus 2 (OvHV-2), which is regarded as the causative agent of the sheep-associated form of the disease. This PCR can be regarded as a gold standard for the in vivo diagnosis of sheep-associated MCF in cattle (Müller-Doblies et al., 1998). This semi-nested PCR was now used as a reference test for the reassessment of diagnostic criteria in the clinical and post mortem diagnosis that could previously not be quantitated. Based on 83 suspected cases with a complete clinical record the clinical signs were weighted and grouped according to their sensitivity and specificity into lead signs indicative of MCF and frequently accompanying signs supportive for the diagnosis of MCF and general clinical signs that were less reliable for the diagnosis. Differential diagnoses are discussed, which are of particular significance due to their status as OIE list A diseases e.g. foot-and-mouth disease or rinderpest. 38 PCR confirmed cattle with MCF served for the quantitative analysis of organ lesions. For the post mortem diagnosis an essential set of organ samples is defined to permit a reliable histological diagnosis, as the gross pathology often did not give any indication for the diagnosis. These criteria should help to improve the diagnostic efficiency and to select the appropriate laboratory diagnostic procedures for MCF-suspected cattle.     

Acute tularemia in three domestic cats.

Acute Francisella tularensis infection in 3 domestic cats was presumptively diagnosed on the basis of clinical signs and lesions and confirmed by culturing or immunofluorescent demonstration of the organism. Clinical findings include marked signs of depression, oral/lingual ulceration, regional or generalized lymphadenomegaly, hepatosplenomegaly, panleukopenia with severe toxic change of neutrophils, and hyperbilirubinemia with bilirubinuria. Lesions found at necropsy included icterus, oropharyngeal and lingual ulceration, multiple foci of necrosis in lymph nodes, spleen, liver, and lung, and severe segmental or diffuse enterocolitis. Results of serologic testing for F tularensis was positive in only 1 of the 3 cats. The organism was cultured aerobically from several tissues, including aspirated bone marrow obtained before death in 1 cat. Results of an indirect fluorescent antibody test, performed on fresh and formalin-fixed tissues of all cats, were positive. Because of the severe clinical course, opportunity to evaluate therapeutic regimens was not possible. Until now, confirmed diagnosis of feline tularemia only has been made retrospectively, in instances when cats were suspected to have transmitted infection to human beings in whom the primary diagnosis was made. The findings in this report provide a basis for presumptive diagnosis that will help to minimize public health risk associated with this potentially fatal zoonotic disease.     

OSTEOMYELITIS

Osteomyelitis is bone infection which may be present in both the acute and chronic forms and may result from direct contamination of the bone or from the hematogenous spreading. The diagnosis of osteomyelitis should be based on clinical signs, radiographic studies, and culture of the causative organism. The treatment of osteomyelitis depends on the extent and duration of the disease and involves the use of: (1) proper supportive care, (2) appropriate surgical principles, and (3) selection of systemic antibiotics determined by bacterial culture and antibiotic susceptibility testing. The closed irrigation-suction technique may be of positive benefit in selected cases of chronic bacterial osteomyelitis.     

Hemithyroidectomy in a horse with confirmed hyperthyroidism

A 23-year-old Quarter Horse gelding was admitted to the hospital because of cachexia and hyperactive behavior of 1 year's duration. At admission the horse was severely emaciated, tachycardic with a grade V/VI diastolic murmur, pyrexic, polydipsic, enophthalmic, and alopecic. The right lobe of the thyroid gland was noticeably larger than typical. The horse was also hyperexcitable and had a ravenous appetite. A presumptive diagnosis of hyperthyroidism was made on the basis of clinical signs and high plasma thyroid hormone concentrations. Confirmation of the diagnosis was made on the basis of results of a triiodothyronine-suppression test. Following endocrine testing, the affected portion of the thyroid gland was removed and identified histologically as an adenoma. Return or plasma thyroid hormone concentrations to reference range values and resolution of the clinical signs of disease following hemithyroidectomy provided further conformation of the diagnosis. On the basis of finding in this horse, it appears that horses with hyperthyroidism may be successfully treated by hemithyroidectomy.     

Diagnosis of Borrelia‐associated uveitis in two horses

Borrelia burgdorferi, the etiologic agent of Lyme disease is a tick born spirochetal infection. Clinical signs of Lyme borreliosis are uncommon in horses, but when present they are often vague and nonspecific. In horses, Lyme borreliosis has been implicated in musculoskeletal, neurological, reproductive, and ocular disorders, including uveitis, but definitive diagnosis can be challenging as the causative agent is rarely isolated and serologic tests can be unreliable and do not confirm active disease. Here, we report two cases of equine uveitis associated with B. burgdorferi based on the identification of spirochetes within ocular fluids and confirmed with PCR testing. The two cases illustrate some of the challenges encountered in the recognition and diagnosis of equine Lyme borreliosis. Although only one of many possible causes of equine uveitis, Lyme disease should be considered a differential diagnosis, especially in endemic areas. Given the possibility for false negative results of serum tests during uveitis associated with B. burgdorferi and the failure of such tests to confirm active infection, a combination of cytologic assessment, antibody, and/or PCR testing of ocular fluids may be worthwhile if the clinical suspicion for Lyme uveitis is high.     

The ACVD task force on canine atopic dermatitis (XV): fundamental concepts in clinical diagnosis.

The clinical signs of atopic dermatitis (AD) in man and in dogs are variable, and there is no single physical or historical feature that, if present, indicates the presence of AD. The initial diagnosis of AD is made clinically with the fulfillment of a combination of criteria that are strongly associated with the disease. Several schemes have been proposed in an attempt to define uniform clinical criteria for diagnosing canine AD, but no system is perfect. Once AD is considered as a possible diagnosis, other important differential diagnoses must be methodically eliminated from consideration. As a final step, once the clinician is certain that AD is probable, "allergy" tests may be conducted to provide additional evidence to "substantiate" the diagnosis. It is important to understand that allergy testing, in whatever form, is not appropriately used early in the patient evaluation as a screening test. Rather, it should be reserved, after a firm clinical diagnosis of AD has been made, to implement allergen avoidance schemes or to select allergens to be incorporated in immunotherapy formulations.     

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.