Accidental infection of veterinary personnel with Mycobacterium tuberculosis at necropsy: a case study

Mycobacterium tuberculosis is the main cause of human tuberculosis. Infection in companion animals is mainly acquired from close contact to a diseased human patient and hence rarely diagnosed in countries with low tuberculosis incidence rates. Therefore the general awareness of the disease might be low. Here we report the potential risk of infection for veterinary personnel with M. tuberculosis during the clinical and pathological examination of a dog with unexpected disseminated tuberculosis. The dog had presented with symptoms of a central nervous system disease; rapid deterioration prevented a complete clinical workup, however. Post-mortem examination revealed systemic mycobacteriosis, and M. tuberculosis was identified by PCR amplification of DNA extracts from paraffin-embedded tissue sections and spoligotyping. Contact investigations among the owners and veterinary personnel using an IFN-γ release assay indicated that the index dog did not infect humans during its lifetime. Serological and IFN-γ release assay results of one of two cats in direct contact with the index dog, however, suggested that transmission of M. tuberculosis might have occurred. Importantly, all three pathologists performing the necropsy on the dog tested positive. Accidental infection was most likely due to inhalation of M. tuberculosis containing aerosols created by using an electric saw to open the brain cavity. As a consequence routine necropsy procedures have been adapted and a disease surveillance program, including tuberculosis, has been initiated. Our results highlight the importance of disease awareness and timely diagnosis of zoonotic infectious agents in optimizing work safety for veterinary personnel.     

The use of intravenous lipid emulsion as an antidote in veterinary toxicology

Objective – To review the use of IV lipid emulsion (ILE) for the treatment of toxicities related to fat‐soluble agents; evaluate current human and veterinary literature; and to provide proposed guidelines for the use of this emerging therapy in veterinary medicine and toxicology. Data Sources – Human and veterinary medical literature. Human Data Synthesis – Human data are composed mostly of case reports describing the response to treatment with ILE as variant from mild improvement to complete resolution of clinical signs, which is suspected to be due to the variability of lipid solubility of the drugs. The use of ILE therapy has been advocated as an antidote in cases of local anesthetic and other lipophilic drug toxicoses, particularly in the face of cardiopulmonary arrest and unsuccessful cardiopulmonary cerebral resuscitation. Veterinary Data Synthesis – The use of ILE therapy in veterinary medicine has recently been advocated by animal poison control centers for toxicoses associated with fat‐soluble agents, but there are only few clinical reports documenting successful use of this therapy. Evidence for the use of ILE in both human and veterinary medicine is composed primarily from experimental animal data. Conclusions – The use of ILE appears to be a safe therapy for the poisoned animal patient, but is warranted only with certain toxicoses. Adverse events associated with ILE in veterinary medicine are rare and anecdotal. Standard resuscitation protocols should be exhausted before considering this therapy and the potential side effects should be evaluated before administration of ILE as a potential antidote in cases of lipophilic drug toxicoses. Further research is waranted.     

Veterinary applications of cytokines

In the recent past a large variety of cytokines have been cloned for most important veterinary species and more is planned with development of a coordinated approach to cytokine reagents production. Application of these cytokines in veterinary species can be found in the development of effective diagnostics, with the IFN-gamma-based detection of tuberculosis as a prime example. In addition, cytokines have been used to determine which immune responses are essential for immune protection with flow-on effects for the development of novel ways to induce these specific immune responses. The realisation that the murine immune system is quite different from the human, together with the increased availability of cytokine reagents for many large animals plus unique experimental approaches only available in these animals, has lead to an explosion in the use of veterinary species as models for human diseases.     

Viral vectors for targeting the canine retina: a review

Clinical trials are currently underway using gene therapy to treat retinal disease such as Leber congenital amaurosis (LCA). Viral vectors that have been utilized to target retinal cells include adenoviruses, lentiviruses, and recombinant adeno-associated viruses (rAAV). Of the three classes, rAAV vectors show the greatest promise for retinal gene therapy. Recent developments in virus technology such as the development of hybrid and capsid mutant rAAV vectors mean that specific retinal cells can be targeted and faster stronger transgene expression is now possible compared to that achieved with the first generation of vectors. Gene therapy trials in dogs have been very important in the development of therapy for RPE65 LCA which is currently in phase I/II clinical trials in humans. Recent successes in using gene therapy to treat canine achromatopsia, X-linked progressive retinal atrophy (PRA) and the more severe rapid degenerations such as rod-cone dysplasia type 3 may lead also to the translation to human clinical trials. Dogs have played and continue to play an important role as animal models for proof-of-concept studies of retinal gene therapy. As modifications and improvements in gene therapy protocols are made from experience gathered from human clinical trials perhaps gene therapy for the treatment of canine clinical patients will become available to veterinary ophthalmologists.     

Clinical pulmonary function testing in dogs and cats.

Pulmonary function testing is a relatively new area in clinical veterinary medicine, with few individuals currently obtaining TBFVL and pulmonary mechanics on a clinical cases of respiratory disease in dogs and cats. ABG analysis is a technique available to all veterinarians through commercial laboratories or local hospitals. Information obtained from these tests will allow for a better understanding of the pathophysiology of naturally occurring diseases as well as assisting in the determination of the efficacy of various therapeutic agents (such as bronchodilators), which to date has been lacking in veterinary medicine.     

Diagnostic alternatives used by veterinary surgeons for the recording of udder diseases in the Norwegian Health Card System for Cattle

A questionnaire, in which 7 cases of udder disease were described, was distributed to 890 veterinarians in Norway. They were requested to classify the cases according to the diagnostic alternatives listed in the Norwegian Health Card System for Cattle (NHCSC). The NHCSC recordings are used for progeny testing of bulls, for disease monitoring, and for research purposes. The aim of this study was to evaluate the quality of the recordings for udder diseases. The questionnaire was answered by 633 veterinary surgeons. Four cases of clinical mastitis (CM) with abnormal secretion as well as other clinical signs of inflammation were correctly classified as CM by almost 100% of the veterinary surgeons. A cow in the final stage of lactation, showing no clinical signs except for clots in the milk, was considered not to be a clinical case by more than 25% of the veterinary surgeons. A typical case of subclinical mastitis (SM) was reported as SM by 83% of the veterinary surgeons, and as CM by 16%. A subclinical case with a recent history of clots in the secretion was classified as SM by 66% of the veterinary surgeons, but almost 40% either reported CM as their sole diagnosis or considered the case to be CM in combination with SM. Of the clinical cases, those exhibiting marked local signs of inflammation and a systemic reaction were correctly classified as acute clinical mastitis (ACM) by 96%-98% of the veterinary surgeons. In the NHCSC, the diagnostic alternatives for cases of CM are ACM and chronic clinical mastitis (CCM). One case, for which the diagnosis subacute clinical mastitis was appropriate according to standard definitions, was classified as CCM by 66%, and as ACM by 6%. Based on the information given in the questionnaire, the diagnosis for 2 of the clinical cases could have been either ACM or CCM, and for both cases each of these 2 alternatives was reported by more than 43% of the veterinary surgeons. A teat lesion, which was present together with ACM in one cow, was reported by 91% of the veterinary surgeons.     

Distinctive histopathologic features of canine optic nerve hypoplasia and aplasia: a retrospective review of 13 cases

Canine optic nerve hypoplasia (ONH) and aplasia (ONA) are significant neuro-ophthalmologic disorders that have been reported in several species. The purpose of this study was to describe the distinctive histopathologic features of ONH and ONA in canine patients identified from a collection of 20 000 ocular submissions at the comparative ocular pathology laboratory of Wisconsin from 1989 to 2006. The following information about ONH and ONA cases was collected: signalment, and clinical and gross findings, including unilateral vs. bilateral involvement. Microscopic evaluation was performed, with attention to optic nerve malformation, retinal ganglion cell (RGC) and nerve fiber layer (NFL) loss, and retinal disorganization. The distribution of retinal vasculature was recorded and a search for unusual findings of ONH and ONA was performed. Information and histologic documentation was available for 13 cases. Eight cases of ONH and five cases of ONA were identified. The average group age was 20.2 months and 16.1 months, respectively. The most common breed was the Shih Tzu (3/13). ONH usually presented bilaterally (7/8); all ONA cases presented as a unilateral disease (5/5). The morphologic findings in the optic nerve (ON) in ONH included variable degrees of ON hypoplasia and gliosis, as well as ectopic vestigial ON remnants within orbital nerves and connective tissues. The NFL was detected in the majority of the ONH cases; however, RGCs were rare or absent. Mild retinal disorganization was seen occasionally. Most cases of ONH were associated with regional peripheral retinal blood vessel extension into the vitreous, leaving the peripheral retina avascular. In ONA cases the retinal blood vessels, NFL and RGCs were totally absent and retinal disorganization was severe. Distinctive microscopic features encountered in ONA included anterior segment dysgenesis in some cases. The retina in these cases was stretched across the posterior lens capsule, never making contact with the posterior pole of the globe. The current study reviews the human and veterinary literature pertaining to ONH and ONA, compares ONH and ONA in dogs, and presents related ophthalmic histopathologic findings that have not been reported previously.     

Surveillance and risk management during the latter stages of eradication: experiences from Australia

The paper reviews the eradication of bovine tuberculosis from Australia with special reference to surveillance and managing the risk of animals exposed to tuberculosis infected animals during the latter stages of eradication. The successful eradication was based on a sound technical program with strong industry and government support. The model of joint industry and government funding and decision-making first used during the brucellosis and tuberculosis eradication campaign (BTEC) has been successfully incorporated within subsequent livestock disease control programs in Australia. An overview of the history of tuberculosis eradication in Australia provides a background to the surveillance approach. Australia was fortunate that there were no wildlife reservoir hosts. Feral animal reservoir hosts were removed during the eradication program. Surveillance to detect rare diseases is recognised to be statistically challenging with high resource requirements. Australian veterinary authorities have a high level of confidence that the combination of increasing sensitivity of abattoir surveillance systems by the submission of all granulomas detected at slaughter with increasing risk management of animals exposed to tuberculosis infected animals during the final stages of eradication provides a high level of assurance that Mycobacterium bovis has been eradicated.     

Emergency medicine clerkship: a joining of private-practice referral veterinary medicine with an academic institution

Novel approaches to the clinical training of veterinary students in many disciplines are being sought by veterinary colleges. In 2004, the University of Florida College of Veterinary Medicine approached the Small Animal Department and Florida Veterinary Specialists (FVS) in Tampa with a proposal to jointly design and run an elective clerkship in emergency medicine. The program would focus on providing increased emergency case exposure in a real-world environment to interested third- and fourth-year veterinary students. The purpose would be to better prepare these students for emergent cases while increasing their overall level of clinical confidence. This article reviews in detail the clerkship structure, its objectives, and the logistics of training and support at FVS. In this instance, the academic-private institution partnership has been successful in providing effective learning for veterinary students over the last three years. This clerkship structure may serve as a template for other institutions exploring alternatives to the traditional clinical training of veterinary students.     

Computerised decision support in veterinary medicine,exemplified in a canine idiopathic epilepsy care pathway

Computerised decision support is of emerging and increasing importance in human medicine, but as yet has not been thoroughly applied or evaluated in veterinary medicine. In this essay, the authors report on the first example of a veterinary care pathway, a specific form of computerised decision support, which guides clinicians through a clinical workflow and incorporates individual patient data to inform patient-specific decision recommendations. The veterinary care pathway was designed using consensus statements and specialist neurologist opinion to create a decision support tool concerning canine idiopathic epilepsy. The authors evaluated the care pathway by comparing 35 clinical decisions made by referral clinicians in historical cases of idiopathic epilepsy to decisions recommended by the care pathway when presented with the same clinical case. Their results show that in 77.1% (95% confidence interval [59.9, 89.6]) of cases the care pathway recommended a decision that was the same or similar to a specialist neurologist's decision. Whilst further studies are needed to explore the potential use of such technology in clinical practice, the authors believe this first application provides great promise of a new and alternative method of clinical decision support.     

西南部分地区中兽医验方收集分析与典型案例

中兽医是我国优秀的传统文化遗产,但随着近几年畜牧行业的发展和壮大,中兽医传统经方验方传承面临困境.为了改善这种困境,使中兽医更好应用于临床,服务于社会,传承并发扬中兽医学.研究选用问卷调查法,交流访谈法及文献资料法对西南片区中兽医验方进行收集,并对其进行归纳整理、分析,分析了验方来源地分布情况、验方使用时间情况、验方治...     

Endemic disease control and regulation in Australia 1901-2010

At Federation in 1901, Australia retained separate State veterinary services responsible for the control of endemic animal diseases. By 2010 the Commonwealth, State and Territory Governments and the livestock industries had coordinated a structure with supporting activities and shared finances that provides Australia's veterinary services and its livestock industries with preparedness and control programs for nominated exotic and endemic animal diseases. Animal Health Australia operates as the coordinating body for these programs. Since 1901, contagious bovine pleuropneumonia, bovine brucellosis and bovine tuberculosis have been eradicated, providing considerable industry benefits. While the entry of exotic diseases has been restricted, tick fevers, tick infestation, bluetongue infection, avirulent and velogenic Newcastle disease, Hendra virus, lyssavirus infection and Menagle virus infection have arisen from either hosts within Australia or from insect incursion from neighbouring countries. The control of endemic livestock diseases has been accompanied by the development of veterinary laboratory services by the Commonwealth, State and Territory Governments. The Australian Animal Health Laboratory operating since 1985 in Geelong has ensured Australia remains at the forefront of technological advances in veterinary diagnostic techniques. From the 1970s animal welfare has become an important component of national initiatives that remain focussed on satisfying community and international expectations.     

Proximal isovelocity surface area variability during systole in dogs with mitral valve prolapse

The proximal isovelocity surface area (PISA) principles and methodology have been described in human and veterinary medicine with special emphasis given to the ease and speed for the quantification of mitral regurgitation. Although limitations have been described in both human and veterinary medicine, in the case of veterinary medicine, clinical examples have not been well defined and in some cases have not been individually presented. The objective of this paper is to illustrate in a qualitative manner the echocardiographic existence of the dynamic behavior and variability of mitral regurgitation in dogs with mitral valve prolapse, a factor to be taken into consideration as a limitation inherent to the PISA technique.     

Regionalization: a strategy that will assist with bovine tuberculosis control and facilitate trade

It is expected that the revised chapter on bovine tuberculosis in the Terrestrial Animal Health Code of the Office Internationale des Epizooties (OIE) will embrace regionalization as a functional means of assisting countries, states or regions to meet the requirements for freedom from tuberculosis and to facilitate trade. The benefits and applications of regionalization, which comprises zoning and compartmentalisation, are discussed. Regionalization requires that a country's veterinary administration is able to implement transparent and auditable biosecurity measures that will ensure that the tuberculosis-free status of a subpopulation of cattle is maintained despite the presence of infection in another cattle subpopulation, or in other domestic or wild animal species. Zoning, which requires cattle subpopulations to be separated by geographic boundaries, provides a practical basis whereby countries, states or regions, can progress towards freedom from tuberculosis, regardless of the source of infection for defined cattle subpopulations. Compartmentalisation however, requires that husbandry or management practices will be used to prevent a tuberculosis-free cattle subpopulation from contacting interspecific and intraspecific sources of infection. This will be difficult to achieve except for specialised cases such as artificial breeding centers.     

The pathology of Mycobacterium tuberculosis infection

Mycobacterium tuberculosis is an old enemy of the human race, with evidence of infection observed as early as 5000 years ago. Although more host-restricted than Mycobacterium bovis, which can infect all warm-blooded vertebrates, M. tuberculosis can infect, and cause morbidity and mortality in, several veterinary species as well. As M. tuberculosis is one of the earliest described bacterial pathogens, the literature describing this organism is vast and overwhelming. This review strives to distill what is currently known about this bacterium and the disease it causes for the veterinary pathologist.     

The role of albumin replacement in the critically ill veterinary patient

Objective: To review the human and veterinary literature on the physiological role and effects of therapeutic albumin supplementation. Data sources: Data from human and veterinary literature was reviewed. Human data synthesis: Hypoalbuminemia often occurs in a variety of critical illnesses, and contributes to the development of life‐threatening complications, including pulmonary edema, delayed wound healing, feeding intolerance, hypercoaguability, and multiple organ dysfunction. Serum albumin concentration has been used as a prognostic indicator in cases of chronic hypoalbuminemia. The use of albumin replacement therapy in humans is sometimes controversial, but may be associated with improved morbidity and decreased mortality. Veterinary data synthesis: Unlike human literature, there is a paucity of controlled clinical studies in the literature regarding albumin supplementation in veterinary patients. Rather, the majority of published studies were performed in experimental animals or via retrospective analyses. One recent study evaluated the use of plasma to improve albumin concentration in dogs with hypoalbuminemia. Other older studies investigated wound healing in dogs with experimentally induced hypoalbuminemia. As in human medicine, serum albumin concentration may be helpful as a prognostic indicator in critically ill dogs. Conclusion: Albumin is one of the most important proteins in the body because of its role in maintenance of colloid oncotic pressure, substrate transport, buffering capacity, as a mediator of coagulation and wound healing, and free‐radical scavenging. Albumin replacement in veterinary medicine is difficult, but until prospective clinical trials determine the efficacy of albumin replacement are conducted, a suggested clinical guideline would be to maintain albumin concentration at or above 2.0 g/dl utilizing fresh frozen plasma.     

Antibiotic resistance: an overview

The results of large scale surveys have indicated that in general terms antibiotic resistance in bacteria has not increased, especially in Europe and North America. When the prevalence of resistance in specific bacteria has increased the increase has usually been associated with the introduction of a novel antimicrobial agent, whether in human or veterinary clinical practice, but the prevalence of resistance that is recognised may be very small. It would appear that the use of antibiotics in livestock farming during the past 20 years has not compromised public health. Any problems in human medicine which are due to bacterial resistance have resulted from the use of antibiotics in man and not from their use in agriculture. Similarly, any problems in veterinary medicine which are due to bacterial resistance have resulted from the use of antibiotics in animals and not from their use in man.     

The First 25 Years of the American College of Veterinary Internal Medicine

In a brief period of 25 years the ACVIM has developed from an idea into one of the leading specialties in veterinary medicine. The varied training, experience, and backgrounds of the specialists who designed the College were the necessary basis from which high but attainable standards were established. The continued involvement and interactions of the diplomates with organized veterinary medicine, species and client groups, allied specialty groups, and research organizations have enabled the College to remain at the cutting edge of the clinical sciences. The contacts that undergraduate veterinary students have with diplomates in veterinary teaching hospitals, along with attendance at the ACVIM Forum and the Journal, encourage many to undertake careers in one of the specialties of the College. The collegial atmosphere within the ACVIM that began in its formative years is a hallmark of the College. That atmosphere continues to be fostered by acquaintances that interns and residents establish during their training programs, during examinations, and while presenting and attending papers at the Forum. Many collaborative educational and research projects have emerged from these networks. In many cases, diplomates have decided to accept positions or pay visits because of these friendships. The ACVIM is a caring organization that treasures the creation of new knowledge and its ability to share that knowledge with its main public—the veterinary profession and others responsible for the care of animals. May it always be so.     

Light at the end of the tunnel? Advances in the understanding and treatment of glaucoma and inherited retinal degeneration

Glaucoma and inherited retinal degeneration/dystrophy are leading causes of blindness in veterinary patients. Currently, there is no treatment for the loss of vision that characterizes both groups of diseases. However, this reality may soon change as recent advances in understanding of the disease processes allow researchers to develop new therapies aimed at preventing blindness and restoring vision to blind patients. Elucidating the molecular mechanisms of retinal ganglion cell death in glaucoma patients has led to the development of neuroprotective drugs which protect retinal cells and their function from the disastrous effects of elevated pressure. Identification of the genetic mutation responsible for inherited degenerations and dystrophies of the outer retina has enabled researchers using gene therapy to restore vision to blind dogs. Other patients may benefit from retinal transplantation, stem cell therapy, neuroprotective drugs, nutritional supplementation and even retinal prostheses. It is possible that soon it will be possible to restore sight to some blind patients.     

Why measuring outcomes is important in health care

A new strategy has been introduced in human health care, namely, achieving the best outcomes for the lowest cost and thus maximizing value for patients. In value‐based care, the only true measures of quality are the outcomes that matter to patients. When outcomes are measured and reported, it fosters improvement and adoption of best practices, thus further improving outcomes. Understanding outcomes is central in providing value and represents an opportunity for redefining veterinary patient care. Value is created by improving the outcomes of patients with a particular clinical condition over the full cycle of care, which normally involves multiple specialties and care sites. To be successful, a key aspect of value based care is working as teams (integrated practice units) centered around the patient's clinical condition. As veterinary medicine has become more specialized and more complex, multidisciplinary communication and trust among the care team are paramount in providing value to patients (and clients). Use of patient‐reported outcomes is an essential aspect for improving clinical care, because it enhances the connections among doctors and with patients. Designing and implementing owner‐reported outcomes in veterinary clinical practice will lead to an understanding of the effects of treatments on outcomes and quality of life (QOL) of our patients from the owner's perspective, a key way to assess a veterinary patient's QOL.