Some aspects of the diagnosis and treatment of eosinophilic granuloma in cats

Introduction

Eosinophils represent the most active cells in mammals that show protective and assistive activity in the host immune defence against helminth parasites. These cells are also responsible for the reduction of allergic and inflammatory reactions. The eosinophils play a key role in allergic reactions by secretion of different chemical molecules leading to swelling, lesions and granuloma onset.

Material and Methods

The study was carried out on 30 cats with inflammatory skin lesions. The cats ranged in age from seven months to 13 years, and had an average age of three years. The research methodology included information on the disease, dermatological conclusions, concomitant disorders, medical and laboratory data and the treatment strategy.

Results

In total, 30 cats were diagnosed with eosinophilic granuloma complex. The distribution of lesions was 87.1% in the skin and 12.9% at the skin-mucosal junction. The lesions increased and decreased with the seasons of spring and summer, and the onset of the disease usually coincided with exposure to fleas.

Conclusion

Eosinophilic granuloma complex in cats is a serious pathology and frequently requires lifelong treatment, so it is important to diagnose it quickly and accurately to ensure optimal treatment of affected animals.

Staphylococci isolated from cats in Italy with superficial pyoderma and allergic dermatitis: Characterisation of isolates and their resistance to antimicrobials

BACKGROUND

In cats, superficial pyoderma traditionally is considered rare and few reports are available. There is a particular lack of studies concerning Staphylococcus species associated with pyoderma in subjects affected by allergic skin diseases.

HYPOTHESIS/OBJECTIVES

(i) To evaluate the association between Staphylococcus spp. and superficial pyoderma in allergic cats and (ii) to characterise isolated staphylococci and analyse their antimicrobial resistance patterns.

ANIMALS

Forty-one cats with allergic dermatitis and superficial pyoderma in Italy.

MATERIALS AND METHODS

Skin swabs were cultured for the isolation of Staphylococcus spp. Species identification was performed by matrix-assisted laser desorption/ionisation time of flight mass spectrometry and 16S-rRNA sequencing. Staphylococcus aureus isolates were further characterised by staphylococcal protein A gene-typing. Antimicrobial susceptibility was performed by the disk diffusion method.

RESULTS

Staphylococci were isolated from 36/41 cats sampled and 39 different isolates were identified. Uneven distribution of staphylococcal species was observed among different body locations. The 39 isolates were S. aureus (n = 15), S. felis (n = 10), S. pseudintermedius (n = 8) and other staphylococci (n = 6). Eight different S. aureus spa-types associated with human clonal complexes were identified. Antimicrobial resistance was observed to penicillin (56.4%), tetracycline (46.2%), enrofloxacin (33.3%), erythromycin (28.2%), amikacin (25.6%), clindamycin (23.1%), marbofloxacin (15.4%), gentamicin (12.8%), trimethoprim-sulfamethoxazole (10.3%), chloramphenicol (7.7%) and cefoxitin/oxacillin (5.1%). Fifteen isolates (38.4%) were multidrug-resistant while meticillin resistance was associated only with S. pseudintermedius.

CONCLUSIONS AND CLINICAL RELEVANCE

These results confirm that S. aureus, S. pseudintermedius, and S. felis are frequently associated with superficial pyoderma in allergic cats. Semi-synthetic penicillins remain a suitable first-line treatment in this study, yet the high prevalence of antimicrobial resistant isolates suggests that antimicrobial susceptibility testing should be performed routinely.

Occurrence of Antimicrobial Resistance Genes in the Oral Cavity of Cats with Chronic Gingivostomatitis

Simple Summary

Oral disease in cats is a significant concern in the small animal practice setting. The specific cause of this disease is inadequately understood; however, antibiotics are commonly used for the management, although many cats respond poorly to these treatments. Antibiotics have been overused and misused in the context of both human and veterinary medicine. Consequently, many antimicrobial drugs are becoming less effective in treating infections. This study aimed to evaluate the presence of antimicrobial resistance genes in swabs obtained from the mouth of cats. Moreover, the study looked at simultaneous occurrence between these genes and one type of oral fungi. We found that antimicrobial resistance genes are extremely common in both clinically healthy and sick cats. Furthermore, we established that Malassezia (a type of fungi) co-occurs with some resistance genes. The findings are important because antimicrobial resistance genes present in the mouth of cats have the potential to transfer to humans and thereby make certain antibiotics less effective.

Abstract

Feline chronic gingivostomatitis (FCGS) is a severe immune-mediated inflammatory disease with concurrent oral dysbiosis (bacterial and fungal). Broad-spectrum antibiotics are used empirically in FCGS. Still, neither the occurrence of antimicrobial-resistant (AMR) bacteria nor potential patterns of co-occurrence between AMR genes and fungi have been documented in FCGS. This study explored the differential occurrence of AMR genes and the co-occurrence of AMR genes with oral fungal species. Briefly, 14 clinically healthy (CH) cats and 14 cats with FCGS were included. Using a sterile swab, oral tissue surfaces were sampled and submitted for 16S rRNA and ITS-2 next-generation DNA sequencing. Microbial DNA was analyzed using a proprietary curated database targeting AMR genes found in bacterial pathogens. The co-occurrence of AMR genes and fungi was tested using point biserial correlation. A total of 21 and 23 different AMR genes were detected in CH and FCGS cats, respectively. A comparison of AMR-gene frequencies between groups revealed statistically significant differences in the occurrence of genes conferring resistance to aminoglycosides (ant4Ib), beta-lactam (mecA), and macrolides (mphD and mphC). Two AMR genes (mecA and mphD) showed statistically significant co-occurrence with Malassezia restricta. In conclusion, resistance to clinically relevant antibiotics, such as beta-lactams and macrolides, is a significant cause for concern in the context of both feline and human medicine.

Management of Severe Oral Inflammatory Conditions in Dogs and Cats

Severe oral inflammatory disease is not uncommon in the mouths of canine and feline patients. An approach to oral diagnosis is offered. This article discusses a brief review of important points in the oral diagnosis and management of main canine (canine chronic ulcerative stomatitis (CCUS), eosinophilic stomatitis, and Wegener's granulomatosis (WG)) and feline diseases (feline gingivostomatitis/caudal stomatitis, oral eosinophilic lesions, pyogenic granuloma, and autoimmune diseases with oral manifestations), and-whereby possible-information about the current understanding of disease pathogenesis and treatment is offered.

Treatment of the feline atopic syndrome - a systematic review

BACKGROUND

Feline allergic skin disease and asthma occur regularly in small animal practice.

OBJECTIVES

To provide evidence-based recommendations for small animal practitioners on the treatment of feline atopic syndrome (FAS).

METHODS AND MATERIALS

The authors reviewed the literature available before February 2020, prepared a detailed evidence-based literature review and made recommendations based on the evaluated evidence.

RESULTS

Sixty-six papers and abstracts were identified describing treatment interventions for FAS and evaluated to establish treatment recommendations. For many treatment options, the papers were retrospective, open studies or case reports.

CONCLUSION AND CLINICAL RELEVANCE

In this review, there was good evidence for the efficacy of systemic glucocorticoids and ciclosporin, and limited evidence for the efficacy of topical glucocorticoids, oclacitinib and allergen-specific immunotherapy in feline atopic skin syndrome. Evidence pointed to low-to-moderate efficacy for antihistamines, fatty acids and palmitoyl ethanolamide. In feline asthma, there was good evidence for the efficacy of oral and inhaled glucocorticoids, and limited evidence of moderate efficacy for allergen-specific immunotherapy. Evidence supported low-to-moderate efficacy of mesenchymal stem cells, inhaled lidocaine and oclacitinib as treatments for feline asthma. For almost all therapeutic options (with the exception of glucocorticoids and ciclosporin), more randomised controlled trials are needed.

Clinicopathological Features, Risk Factors and Predispositions, and Response to Treatment of Eosinophilic Oral Disease in 24 Dogs (2000-2016)

The objectives of this study were to retrospectively describe clinicopathological features of eosinophilic oral disease in dogs, to identify possible risk factors or predispositions to the condition, and to report overall treatment response. Canine medical records from a veterinary teaching hospital and private referral practice over a 17-year period were reviewed for a diagnosis of eosinophilic oral disease. Twenty-four dogs with 26 lesions met the inclusion criteria. Patient mean age and body weight were 6.8 (3.8) years and 13.4 kg, respectively. Fifteen breeds were represented including Cavalier King Charles spaniel (16.7%), Labrador retriever (12.5%), and West Highland white terrier (12.5%). Eosinophilic lesions were found in the palate (65.4%), tongue (26.9%), and other oral locations (7.7%). Median follow-up time was 5 months. Analysis revealed statistically significant associations between lesion location and body weight (palatal and tongue lesions were more likely in smaller dogs, whereas lesions in the other category [lip or mucosa] were more likely in larger dogs). There was a correlation in lesion location and resolution (all dogs with palatal lesions became asymptomatic at their last recheck), and resolution and the use of antibiotics plus prednisone (greater likelihood of resolution without the use of this combination). Seventy percent of asymptomatic dogs resolved without medication or with allergen therapy alone, suggesting that asymptomatic dogs may respond well to conservative management. No associations were found between lesion location and breed, signalment and response to therapy, lesion resolution and the use of glucocorticoids, or significance of peripheral eosinophilia.

A cross-sectional study of show English bulldogs in the United States: evaluating paw lesions, cytological findings, pruritic behaviours and gastrointestinal signs

BACKGROUND

English bulldogs (EBDs) are considered to commonly show signs of pododermatitis and gastrointestinal (GI) disease.

HYPOTHESIS/OBJECTIVES

To describe a population of presumed healthy EBDs: (i) evaluate dogs according to published criteria for health, (ii) describe paw lesions, if present, (iii) report pruritic behaviours and GI signs and compare to normal values, (iv) report pedal cytological findings, and (v) determine correlation between lesions, cytological results and pruritic behaviours.

ANIMALS

Thirty four EBDs participating in a dog show.

METHODS AND MATERIALS

Dogs were examined, and pedal cytological samples were collected. Pruritic behaviours, GI signs and medical history were assessed. Owners completed questionnaires regarding history and assessed pruritus.

RESULTS

No dog met criteria for being healthy. All dogs had an abnormal dermatological examination, 22 of 34 had a history of recent drug administration and 16 of 34 had a history of dermatological disease. Every dog had at least one erythematous paw. Compared to values for a healthy dog population, facial rubbing was the only increased pruritic behaviour, and GI signs differed in belching, flatulence and regurgitation. Mean cytological evaluation values were within normal ranges except for inflammation. Lesions did not correlate with cytological findings or pruritic behaviours, with the exception of white coloured exudation with inflammation and cocci.

CONCLUSIONS AND CLINICAL IMPORTANCE

This study supports that show EBDs have frequent pedal lesions and history of dermatological disease, with over half receiving medication, as well as increased frequency of belching, flatulence and facial rubbing. Pedal cytological findings were not predictive of lesions, with the exception of white coloured exudation.

Dose tapering for ciclosporin in cats with nonflea-induced hypersensitivity dermatitis

BACKGROUND

Little information is available on the ciclosporin dose-tapering regimen and clinical response in the treatment of feline hypersensitivity dermatitis.

HYPOTHESIS/OBJECTIVES

To test a dose-tapering regimen and assess efficacy and clinical safety for up to 18 weeks.

ANIMALS

Eighty-eight client-owned cats with feline hypersensitivity dermatitis.

METHODS

Cats that received either a placebo or ciclosporin at 2.5 mg/kg or 7 mg/kg daily for 6 weeks were given 7 mg/kg ciclosporin daily for 4 weeks. Depending on the clinical response, the dose was tapered from daily to every other day over the next 4 weeks and further to twice a week for an additional 4 weeks.

RESULTS

After all cats received 7 mg/kg for 4 weeks, the dose could be tapered to every other day for the next 4 weeks in 70% of cats remaining in the study. During the next 4 weeks, 57, 15 and 22% of cats remaining in the study could be treated at twice a week, every other day or daily, respectively. After the first 4 weeks, the mean lesion score and owner-assessed pruritus improved over baseline by 69 and 61%, respectively, and remained stable during the following 8 weeks. Approximately 65% of the cats in the study were reported to have an adverse event (AE), very often mild and resolving spontaneously. The most frequent AEs were gastrointestinal and included primarily vomiting and diarrhoea. Eighty per cent of AEs occurred when cats were on daily treatment.

CONCLUSIONS AND CLINICAL IMPORTANCE

Results suggest that the induction dose of 7 mg/kg ciclosporin can be tapered as soon as 4 weeks without deterioration of the clinical response. Establishment of the lowest effective dosing regimen of ciclosporin reduced the frequency of AEs.

Feline eosinophilic granuloma complex(ities): some clinical clarification

PRACTICAL RELEVANCE

The feline eosinophilic granuloma complex (EGC) comprises a group of clinically well recognised but poorly understood dermatoses that are common in cats. In many cases, lesions are severe and can be accompanied by varying degrees of (and sometimes considerable) pruritus and/or pain. In addition, lesions can be chronic and recurrent. It is, therefore, important to achieve a prompt and accurate diagnosis in order to provide optimal, often life-long, treatment for affected cats.

PATIENT GROUP

There is no age predisposition or well documented breed predilection for the development of EGC lesions in cats. Some studies have reported a possible female predisposition, but this has not been consistently documented.

CLINICAL CHALLENGES

The clinical diagnosis of EGC lesions is usually straightforward, but investigation of the potential underlying aetiology can pose a challenge for the clinician. Information on the indication for various diagnostic tests and their interpretation is lacking, and the tendency for these cases to be managed with chronic medical intervention prior to achieving a definitive diagnosis can further complicate the interpretation of any diagnostic investigation. In addition, successful therapeutic management of these cases can be challenging. Some cats suffer only a single episode of disease that resolves with treatment, while others have recurrent lesions and some of these can be refractory to treatment. The individual variation in both the clinical nature of the disease and the response to therapy could be related to disease severity, but could also be explained by differences in the underlying aetiopathogenesis.

EVIDENCE BASE

This article reviews the published literature to discuss the complex aetiology of the EGC and present an overview of the different clinical presentations and diagnosis. A further and particular aim has been to provide some evidence-based recommendations for the management of this unusual group of dermatoses.