A field study of ovine listerial meningo-encephalitis with particular reference to cerebrospinal fluid analysis as an aid to diagnosis and prognosis

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Survival associated with cerebrospinal fluid analysis in downer adult dairy cows: A retrospective study (2006-2014)

Background

Threshold values for total nucleated cell count (TNCC) and protein concentration in cerebrospinal fluid (CSF) of downer dairy cows suggestive of a spinal cord lesion were recently published.

Objectives

Determine short‐ and long‐term survival of downer cows that underwent CSF analysis using the reported threshold values. Evaluate the prognostic value of these threshold values to predict short‐ and long‐term survival.

Animals

Two hundred and fourteen downer adult dairy cows that underwent CSF analysis during hospitalization at the Centre Hospitalier Universitaire Vétérinaire (CHUV) of the Université de Montréal.

Methods

Retrospective study. Medical records of downer adult dairy cows presented to the hospital between January 2006 and October 2014 for which CSF analysis results were available were studied. Short‐term (discharge from hospital) and long‐term (completion of lactation) survival were determined and compared in accordance with CSF TNCC and protein concentration, using a Chi‐square test.

Results

Cows with CSF TNCC and/or protein concentration above the threshold values had a significantly lower short‐term survival rate (P = .02). The odds of nonsurvival of cows with one or both CSF values above the threshold values was 2.16 times higher than the odds for cows with values under the threshold values. CSF TNCC >4.5 cells/μL had sensitivity and specificity of 17.3% (95% CI: 10.7%‐25.7%) and 92.3% (95% CI: 85.4%‐96.6%), respectively, for predicting short‐term nonsurvival. CSF protein concentration >0.39 g/L had sensitivity and specificity of 20.9% (95% CI: 13.7%‐29.7%) and 91.4% (95% CI: 84.2%‐96.0%), respectively.

Conclusions

CSF analysis above threshold values used in this study is associated with increased odds of short‐term nonsurvival.

Brainstem and Cranial Nerve Disorders of Ruminants

Asymmetrical signs of brainstem disease occur relatively infrequently in ruminants. The most common differential diagnoses include listeriosis, otitis media/interna, and pituitary abscess syndrome. Although these conditions produce signs of brainstem dysfunction, the diseases can usually be differentiated based on historical findings and subtle clinical differences. Basic laboratory diagnostic tests are often not specific in the definitive diagnosis but may be supportive. Advanced imaging techniques have proven to be useful in the diagnosis of otitis media/interna. Presumptive clinical diagnosis is confirmed at necropsy. Treatment involves a prolonged course of antibiotic therapy but is unrewarding in cases of pituitary abscess syndrome.

Cerebrospinal Fluid

This chapter discusses the anatomy, functions, and biochemistry of cerebrospinal fluid (CSF). CSF has four major functions: physical support of neural structures, excretion and “sink” action, intracerebral transport, and control of the chemical environment of the central nervous system. CSF provides a “water jacket” of physical support and buoyancy. The CSF is protective because its volume changes reciprocally with changes in the volume of intracranial contents, particularly blood. Thus, the CSF protects the brain from changes in arterial and central venous pressure associated with posture, respiration, and exertion. Acute or chronic pathological changes in intracranial contents can be accommodated, to a point, by changes in the CSF volume. The direct transfer of brain metabolites into the CSF provides excretory function. This capacity is important because the brain lacks a lymphatic system. The lymphatic function of the CSF is also manifested in the removal of large proteins and cells, such as bacteria or blood cells, by bulk CSF absorption. The “sink” action of the CSF arises from the restricted access of water-soluble substances to the CSF and the low concentration of these solutes in the CSF.

Diagnostic techniques and clinicopathologic findings in ruminant neurologic disease

In ruminant species, cerebrospinal fluid (CSF) collection and analysis provide rapid (in some situations, instant) information to the veterinary clinician investigating a disease problem in the living animal. CSF analysis is particularly useful with respect to confirming the presence of an inflammatory lesion involving the leptomeninges,such as bacterial meningoencephalitis, and in investigating potential compressive lesions of the spinal cord. When correctly performed under local anesthesia, lumbar CSF collection in ruminants is a safe procedure and there are no harmful sequelae. Familiarity with the technique aids high extradural injection of lidocaine or xylazine, which has many applications in farm practice. There are few indications for cisternal CSF collection in food animals.

Brainstem and cranial nerve abnormalities: listeriosis, otitis media/interna, and pituitary abscess syndrome

This article reviews three disorders associated with multiple asymmetric cranial nerve deficits in ruminants: encephalitic listeriosis,otitis media/interna, and pituitary abscess syndrome. Emphasis is placed on encephalitic listeriosis, an infectious disease of the brainstem and cranial nerves caused by Listeria monocytogenes. The epidemiology, pathophysiology, clinical manifestations, diagnosis,and treatment of encephalitic listeriosis are reviewed, and differences between cattle and small ruminants are noted. Physical and neurologic examination findings that distinguish otitis media/interna and pituitary abscess syndrome from encephalitic listeriosis are highlighted.

Experimental murine hyalohyphomycosis with soil-derived isolates of Fusarium solani

Two strains of soil-borne Fusarium solani, both characterized for their ability to produce cyclosporin A and C, were examined for their pathogenicity in severe combined immunodeficiency (SCID) and BALB/c male mice. Intravenous (i.v.) infections with F. solani conidia were performed. No mortality was observed after infection with 0.3-1.6 x 10(7) cfu per mouse in SCID and BALB/c mice. When mice were infected with 0.8-1.5 x 10(6) cfu per mouse and 2 days later with 1.2-1.9 x 10(6) cfu per mouse, 28.6-85.7% survival occurred over a 25-day period, depending on the F. solani strain and the inbred mouse line used. Death was preceded by renal insufficiency affecting both kidneys. Furthermore, i.v. injection with heat-killed conidia followed 2 days later by injecting viable conidia resulted in renal infection in both breeds of mice. F. solani isolated from infected organs was more virulent than the original isolate, and 3/8 (37.5%) of BALB/c and 4/7 (57.1%) of SCID mice died after receiving a single dose. Dissemination to the brain was found only in SCID mice, but torticollis was observed in both mouse breeds. Soil-borne F. solani isolates possess poor pathogenic potential for mice, but either two successive infective doses or a primary injection with heat-killed conidia followed by a single infective dose breaks through host defenses in normal and immunoincompetent mice. Mouse passage increased the pathogenicity of two soil-derived F. solani strains.

Listeric infections in humans and animals in the Indian subcontinent: a review

Listeriosis is an important bacterial zoonosis caused by the intracellular pathogen Listeria monocytogenes. The disease has been reported in animals from the Indian subcontinent, usually in the form of sporadic cases but occasionally as outbreaks. Cases of listeriosis arise mainly from the ingestion of contaminated food. Listeriosis has been reported to cause encephalitis, abortion, mastitis, repeat breeding and endometriosis in animals. Listeric infections occur in children and women with a poor obstetric history. The epidemiological aspects and pathogenesis of listeriosis in animals and humans are not yet fully understood. This review offers comprehensive information on experimental studies and field cases in animals and on cases of human listeriosis. There are also sections on isolation from foods, diagnosis and treatment in humans and animals.

A case report of sporadic ovine listerial menigoencephalitis in Iowa with an overview of livestock and human cases

A case of ovine listeriosis was examined in a flock of sheep. The index case was a male lamb, which was part of a flock of 85 sheep located in central Iowa. Because the sheep were raised on a premise where soybean sprouts were also cultivated for the organic foods market, the potential of a public health concern was addressed. To identify the source of contaminations, clinical and environmental samples were cultured for Listeria monocytogenes. Isolates were serotyped and analyzed using pulsed-field gel electrophoresis (PFGE). Listeria monocytogenes (serotype 1) was recovered from the brain of a male lamb with clinical signs of listerial encephalitis. Isolates of serotypes 1 and 4 were also cultured from feces of clinically healthy lambs, compost piles, and soybean cleanings. By PFGE, the clinical isolate was distinctly different from the other isolates. Environmental isolates were identified as L. monocytogenes serotypes 1 and 4. However, by PFGE, none matched the profile of the single clinical isolate. Thus, the ultimate source of contamination is unknown.

Clinical findings and treatment of listeriosis in 67 sheep and goats

This paper describes the clinical findings and treatment of 67 sheep and goats with listeriosis. In 55 of them the diagnosis was made on the basis of the typical signs, which included vestibular ataxia, circling, head tilt and unilateral cranial nerve deficits, but in 12 animals a definitive diagnosis was made only after postmortem examination. The most significant haematological and biochemical findings were a high haematocrit in 16 animals, a high concentration of total protein in 33, a high concentration of bilirubin in 39 and a high concentration of urea nitrogen in 28 animals. Twenty-eight of the animals had a metabolic acidosis. Thirty-nine animals were treated with antibiotics, intravenous sodium chloride and glucose solutions and sodium bicarbonate. Ten of them survived and the others were euthanased because their condition deteriorated. Of the 10 that survived, nine were able to stand when they were first examined and one was in lateral recumbency. Of 15 animals treated with chloramphenicol, one survived; of 11 animals treated with oxytetracycline, two survived; and of nine animals treated with gentamicin and ampicillin, six survived.

A review of Listeria monocytogenes and listeriosis

Following the initial isolation and description in 1926 Listeria monocytogenes has been shown to be of world-wide prevalence and is associated with serious disease in a wide variety of animals, including man. Our knowledge of this bacterial pathogen and the various forms of listeriosis that it causes has until recently been extremely limited, but recent advances in taxonomy, isolation methods, bacterial typing, molecular biology and cell biology have extended our knowledge. It is an exquisitely adaptable environmental bacterium capable of existing both as an animal pathogen and plant saprophyte with a powerful array of regulated virulence factors. Most cases of listeriosis arise from the ingestion of contaminated food and in the UK the disease is particularly common in ruminants fed on silage. Although a number of forms of listeriosis are easily recognized, such as encephalitis, abortion and septicaemia, the epidemiological aspects and pathogenesis of infection in ruminants remain poorly understood. The invasion of peripheral nerve cells and rapid entry into the brain is postulated as a unique characteristic of its virulence, but relevant and practical disease models are still required to investigate this phenomenon. This review offers an up to date introduction to the organism with a description of virulence determinants, typing systems and a detailed account of listeriosis in animals. Experimental and field papers are reviewed and further sections deal with the diagnosis, treatment and control of listeriosis in animals. A final part gives an overview of listeriosis in man.

The collection and analysis of cerebrospinal fluid as an aid to diagnosis in ruminant neurological disease

In ruminant species cerebrospinal fluid (CSF) collection and analysis provides rapid and, in some situations, instant information to the veterinary clinician investigating a disease problem in the living animal. CSF analysis is particularly useful with respect to confirming the presence of an inflammatory lesion involving the leptomeninges such as bacterial meningoencephalitis. When correctly performed under local anaesthesia, lumbosacral CSF collection in ruminants is a safe procedure and there are no harmful sequelae. There are few indications for cisternal CSF collection in food animal practice.

Studies of the detection of Listeria monocytogenes by culture and PCR in cerebrospinal fluid samples from ruminants with listeric encephalitis

A total of 14 cerebrospinal fluid (CSF) samples from ruminants clinically suspected of suffering from listeric encephalitis were examined by polymerase chain reaction (PCR) for the detection of Listeria monocytogenes (L. m.). Of these samples, 11 were examined bacteriologically. Although the clinical diagnosis was confirmed in eight of 11 ruminants by histological and/or bacteriological examination of the brains, L. m. was only detected in one of the CSF samples using PCR, and in none by culture. The PCR-positive CSF sample was obtained from a sheep which had been treated with antibiotics prior to CSF sampling. From these findings, it was concluded that L. m. only occasionally gains access to the meningoventricular system in the course of listeric encephalitis of ruminants and that a reliable aetiological in vivo diagnosis of listeric encephalitis generally cannot be based on the detection of L. m. in the CSF of affected ruminants.

Cerebrospinal fluid and plasma glucose concentrations of ovine pregnancy toxaemia cases, inappetant ewes and normal ewes during late gestation

Cerebrospinal fluid (CSF) and plasma glucose concentrations of spontaneous ovine pregnancy toxaemia cases, determined within 24 h of the onset of clinical signs, were significantly lower (P < 0.01) compared to inappetant ewes and healthy ewes at a similar stage of gestation. A highly significant correlation (P < 0.001, r = 0.91) was present between the plasma and CSF glucose concentrations when the data from the three groups were combined. The data suggest that plasma glucose concentration accurately reflects CSF glucose concentration across the range of energy states in pregnant ewes and may provide support for the postulate that the neurological signs of ovine pregnancy toxaemia result from cerebral hypoglycaemia, as reflected by CSF glucose concentration. No cerebral glucose estimations were undertaken in this series.