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Ostrager A, Bentley RT, Lewis MJ, Moore GE. Survival in dogs with meningoencephalomyelitis of unknown etiology with and without lesions detected by magnetic resonance imaging. J Vet Intern Med 2024. [PMID: 38804716 DOI: 10.1111/jvim.17109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 05/02/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The prognosis of individual dogs with meningoencephalomyelitis of unknown etiology (MUE) remains difficult to predict. MUE cases with no lesions detected by magnetic resonance imaging (MRI) occur, but it is unknown whether this finding is associated with prognosis. HYPOTHESIS MUE cases without detectable lesions on MRI have a better outcome than cases with detectable lesions. ANIMALS Study included 73 client-owned dogs with MUE presenting to Purdue University Veterinary Hospital from 2010 to 2020. METHODS Retrospective study. Dogs with a clinical diagnosis of MUE were identified by medical record search. MRI reports were reviewed for presence or absence of lesions consistent with MUE. Clinical findings at presentation, treatment, disease-specific survival, and outcomes including rates of remission and relapse were compared between cases with normal MRI or abnormal MRI. RESULTS Overall, 54 dogs (74%) were classified as abnormal MRI, and 19 dogs (26%) were classified as normal MRI cases. Death caused by MUE occurred in 1/19 (5%) normal MRI dogs and 18/54 (33%) abnormal MRI dogs (P = .016). Median survival was >107 months in both groups, but survival was significantly longer in the normal MRI group (P = .019). On multivariate analysis, abnormal MRI was significantly related to death (hazard ratio, 7.71; 95% confidence interval 1.03-58.00, P = .0470), whereas significant relationships with death were not identified for either the use of secondary immunosuppressive medications or cerebrospinal fluid nucleated cell count. CONCLUSIONS MUE dogs with no detectable lesions on MRI have reduced disease-related death compared with dogs with abnormal MRI. The presence or absence of MRI lesions in MUE dogs is prognostically relevant.
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Affiliation(s)
- Arielle Ostrager
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - R Timothy Bentley
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Melissa J Lewis
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - George E Moore
- Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
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Sung J, Chae Y, Yun T, Koo Y, Lee D, Kim H, Yang MP, Kang BT. Use of neurofilament light chain to identify structural brain diseases in dogs. J Vet Intern Med 2024. [PMID: 38778568 DOI: 10.1111/jvim.17110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Neurofilament light chain (NfL) is released into the peripheral circulation by damaged axons. OBJECTIVES To evaluate the diagnostic value of serum NfL concentration in dogs with intracranial diseases. ANIMALS Study included 37 healthy dogs, 31 dogs with idiopathic epilepsy (IE), 45 dogs with meningoencephalitis of unknown etiology (MUE), 20 dogs with hydrocephalus, and 19 dogs with brain tumors. METHODS Cohort study. Serum NfL concentrations were measured in all dogs using single-molecule array technology. RESULTS Serum NfL concentration in dogs with each structural disease was significantly higher than in healthy dogs and dogs with IE (P = .01). The area under the receiver operating characteristic curve of NfL for differentiating between dogs with structural diseases and IE was 0.868. An optimal cutoff value of the NfL 27.10 pg/mL had a sensitivity of 86.67% and a specificity of 74.19% to differentiate the dogs with IE from those with structural brain diseases. There were significant correlations between NfL concentrations and lesion size: (1) MUE, P = .01, r = 0.429; (2) hydrocephalus, P = .01, r = 0.563. CONCLUSIONS AND CLINICAL IMPORTANCE Serum NfL could be a useful biomarker for distinguishing IE from structural diseases in dogs and predicting the lesion sizes of MUE and hydrocephalus.
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Affiliation(s)
- Jookyung Sung
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Yeon Chae
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Taesik Yun
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Yoonhoi Koo
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Dohee Lee
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Hakhyun Kim
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Mhan-Pyo Yang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Byeong-Teck Kang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
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van Renen J, Kehl A, Buhmann G, Matiasek LA, Zablotski Y, Fischer A. Allele frequency of a genetic risk variant for necrotizing meningoencephalitis in pug dogs from Europe and association with the clinical phenotype. Front Vet Sci 2024; 11:1407288. [PMID: 38840637 PMCID: PMC11150678 DOI: 10.3389/fvets.2024.1407288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 04/30/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Necrotizing meningoencephalitis (NME) in pugs is a potentially fatal disease, which needs lifelong treatment with immunosuppressive or immunomodulatory drugs and shares parallels with acute fulminating multiple sclerosis. Genetic variants of the DLA class II gene are associated with an increased risk for NME. Genetic testing is recommended prior to breeding. The aim of this study was to describe the current allele frequency of a previously identified NME risk variant in the European pug population. A secondary aim was to investigate the association of the NME risk variant with the clinical phenotype in pugs. Methods Results of genetic testing for the CFA12:2605517delC variant in European pugs between 2012 and 2020 were retrieved (n = 5,974). A validated questionnaire was mailed to all submitters of samples for further information on neurological signs, diagnostic tests, and disease course. Results The allele frequency of the CFA12 NME risk variant was 25.7% in the European pug population dogs; 7.4% of the dogs were homozygous and 36.7% were heterozygous for the NME risk variant on CFA12. Completed questionnaires were available in 203 dogs including 25 dogs with epileptic seizures or other neurological signs. The clinical phenotype was consistent with NME in 3.9% with a median age of onset of 1.0 years, and indicative of idiopathic epilepsy in 2.9% with a median onset of 2.5 years. Eleven dogs remained unclassified. Pugs with the NME phenotype were significantly more frequently homozygous for the NME risk variant on CFA12 compared to pugs ≥6 years without neurological signs or seizures (p = 0.008). Discussion The CFA12:2605517delC genetic risk variant is widely distributed in the European pug population and frequently homozygous in pugs with a NME phenotype. The data support the clinical relevance of the CFA12:2605517delC genetic risk variant.
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Affiliation(s)
- Jana van Renen
- Small Animal Clinic, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Alexandra Kehl
- Laboklin, Bad Kissingen, Germany
- Comparative Experimental Pathology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Gesine Buhmann
- Small Animal Clinic, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Lara A. Matiasek
- Small Animal Clinic, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Yury Zablotski
- Small Animal Clinic, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Andrea Fischer
- Small Animal Clinic, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
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Kim SH, Oh YI, Park SM, An JH, Kim TH, Kim SS, Ah JG, Seo KW, Youn HY. Retrospective evaluation of prognosis and survival with various immunosuppressants in 82 dogs diagnosed with meningoencephalitis of unknown etiology (2010-2021). BMC Vet Res 2023; 19:269. [PMID: 38087262 PMCID: PMC10714563 DOI: 10.1186/s12917-023-03800-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Meningoencephalomyelitis of unknown etiology (MUE) is a comprehensive term for non-infectious inflammatory brain diseases of the central nervous system (CNS) caused by abnormal autoimmune responses. This study aims to compare the differences in survival and clinical response of MUE according to the adjuvant immunosuppressant use. Medical records of 82 dogs diagnosed with MUE were reviewed retrospectively. RESULTS The overall survival time was 769 days (range 14-2687 days). The median survival time for each adjunctive was: leflunomide 1035 days (range 126-2163 days), mycophenolate mofetil 865 days (range 39-2191 days), cyclosporin 441 days (range 11-2176 days), cytosine arabinoside 754 days (range 6-1898 days) and a combination of mycophenolate mofetil and cytosine arabinoside 132 days (range 23-1227 days). There was no significant difference in the incidence rate of adverse events according to the immunosuppressants, but moderate to severe anemia was confirmed in 3 patients (18.7%) in the leflunomide group. CONCLUSIONS The survival time and response rate of MUE dogs differed depending on which adjunctive immunosuppressants were used. Leflunomide showed a long survival time and a relatively good response rate in dogs with MUE. However, a large-scale further study with standardized doses of immunosuppressants and supportive treatment and constant monitoring interval is needed.
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Affiliation(s)
- So-Hee Kim
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, 00826, Republic of Korea
| | - Ye-In Oh
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Kyungpook National University, Daegu, 41566, Republic of Korea
| | - Su-Min Park
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, 00826, Republic of Korea
| | - Ju Hyun An
- Department of Veterinary Emergency and Critical Care Medicine and Institute of Veterinary Science, College of Veterinary Medicine, Kangwon National University, Chuncheon-si, 24341, Republic of Korea
| | - Tae-Hee Kim
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, 00826, Republic of Korea
| | - Sung-Soo Kim
- VIP Animal Medical Center KR, Seoul, 02830, Republic of Korea
| | - Jae-Gon Ah
- VIP Animal Medical Center KR, Seoul, 02830, Republic of Korea
| | - Kyoung-Won Seo
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, 00826, Republic of Korea
| | - Hwa-Young Youn
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, 00826, Republic of Korea.
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Bach FS, Cray C, Burgos AP, Junior JAV, Montiani-Ferreira F. A comparison between neurological clinical signs, cerebrospinal fluid analysis, cross-sectional CNS imaging, and infectious disease testing in 168 dogs with infectious or immune-mediated meningoencephalomyelitis from Brazil. Front Vet Sci 2023; 10:1239106. [PMID: 38026652 PMCID: PMC10630916 DOI: 10.3389/fvets.2023.1239106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/26/2023] [Indexed: 12/01/2023] Open
Abstract
This retrospective study evaluated canine patients with presumptively diagnosed meningoencephalomyelitis (ME) based on neurological clinical signs, cerebrospinal fluid (CSF) analysis, cross-sectional imaging, and infectious disease testing with a limited neurological-focused polymerase chain reaction (PCR) panel performed on blood and CSF. The first goal was to determine the proportion of dogs where the condition was caused by an infectious agent versus a probable immune-mediated etiology (i.e., meningoencephalomyelitis of unknown origin; MUO) in our geographic region. The secondary goals of this study were to examine and define associations between abnormal CSF test results and cross-sectional neuroimaging findings, in addition to defining the age and most common neurological clinical signs in each group of ME. A total of 168 dogs matched the inclusion criteria with magnetic resonance imaging (MRI) performed in 130 dogs and computed tomography (CT) performed in 38 dogs. Presumptive MUO was observed in 152/168 (90.5%) of dogs and infectious ME was identified in 16/168 (9.5%) of dogs (p < 0.0001). Canine distemper virus (CDV) was the most common cause of infectious ME in 10/16 dogs (62.5%). Of the total cases with a positive infectious disease result, 3/16 (18.7%) had normal CSF results and 13/16 (81.3%) had abnormal CSF results (p = 0.0078). MRI and CT abnormalities in the brain were detected in 74 and 39% of dogs with inflammatory CSF, respectively. MRI and CT abnormalities in the spinal cord were detected in 90 and 57% of dogs with inflammatory CSF results, respectively. Age was not significantly different between infectious ME and presumptive MUO groups (p = 0.15). Seizures were the most common clinical sign reported for both MUO (36.8% of cases) and infectious ME (31.2% of cases). In conclusion, presumptive MUO is significantly more common than infectious ME in this population of dogs. Furthermore, although normal CSF results were uncommon in dogs with infectious ME, this finding occurred in several patients (3/16), suggesting that infectious disease testing should be considered even in the face of normal CSF results. Finally, MRI was more sensitive than CT in the detection of abnormalities when dogs with ME had inflammatory CSF results but was not 100% sensitive, suggesting CSF analysis should be performed to rule out inflammation even when no abnormalities are detected on MRI or CT.
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Affiliation(s)
| | - Carolyn Cray
- Division of Comparative Pathology, Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Ana Paula Burgos
- Small Animal Surgery Service, Catholic University of Paraná, Curitiba, Brazil
| | | | - Fabiano Montiani-Ferreira
- Division of Comparative Pathology, Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
- Comparative Ophthalmology Lab (LABOCO), Federal University of Paraná, Curitiba, Brazil
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Fonte-Oliveira L, Pereira A, Gregório H, Ribeiro J, Correia-Gomes C, Marcos R, Santos M. Evaluation of a Manual Cytocentrifuge versus the Standard Automated Cytocentrifuge in the Analysis of Canine Cerebrospinal Fluid: A Case Series of 55 Dogs. Vet Sci 2023; 10:631. [PMID: 37999454 PMCID: PMC10674567 DOI: 10.3390/vetsci10110631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/22/2023] [Accepted: 10/19/2023] [Indexed: 11/25/2023] Open
Abstract
Cytospins are important for evaluating fluids with very low cellularity such as cerebrospinal fluid (CSF). The aim of this study was to compare the CSF cytospin preparations obtained from automated and manual cytocentrifugation methods. A prospective case series was performed to analyze canine CSF samples using both centrifugation methods. The cytospins were processed within 30-60 min and prepared simultaneously in a conventional automated cytocentrifuge and in an in-house manual cytocentrifuge, using a fixed volume of CSF fluid. The cellularity, differential cell count and the proportion of cell artifacts (pseudopods and vacuolization) were blindly assessed in the cytospin preparations obtained using the two methods. The agreement and correlation between both methods were analyzed. There were 55 dogs enrolled (48 prospectively and 7 retrospectively) in the study. 38 dogs had normal total nucleated cell counts, while 17 had pleocytosis. Automated and manual cytocentrifugation had similar cell yields, and no significant differences in differential cell counts or the presence of artifacts existed between both methods. In cases with pleocytosis, the cytologic diagnosis obtained using each method was similar. Manual cytocentrifugation of CSF is a reliable and economic method designed for routine clinical practice. Its use reduces the specimen deterioration related to processing and analysis delays when samples are transported to external laboratories for evaluation.
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Affiliation(s)
- Luísa Fonte-Oliveira
- Cytology and Hematology Diagnostic Services, Laboratory of Histology and Embryology, Department of Microscopy, ICBAS-UP, School of Medicine and Biomedical Sciences, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal (R.M.)
- AniCura CHV Porto Hospital Veterinário, 4100-320 Porto, Portugal; (A.P.); (H.G.)
| | - André Pereira
- AniCura CHV Porto Hospital Veterinário, 4100-320 Porto, Portugal; (A.P.); (H.G.)
| | - Hugo Gregório
- AniCura CHV Porto Hospital Veterinário, 4100-320 Porto, Portugal; (A.P.); (H.G.)
| | - João Ribeiro
- Referência Veterinária, 2645-550 Alcabideche, Portugal;
- Faculdade de Medicina Veterinária, Universidade Lusófona de Humanidades e Tecnologias, 1749-024 Lisboa, Portugal
| | | | - Ricardo Marcos
- Cytology and Hematology Diagnostic Services, Laboratory of Histology and Embryology, Department of Microscopy, ICBAS-UP, School of Medicine and Biomedical Sciences, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal (R.M.)
| | - Marta Santos
- Cytology and Hematology Diagnostic Services, Laboratory of Histology and Embryology, Department of Microscopy, ICBAS-UP, School of Medicine and Biomedical Sciences, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal (R.M.)
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Heidemann PL, Erhald B, Koch BC, Gredal H. Investigation of side effects to treatment and cause of death in 63 Scandinavian dogs suffering from meningoencephalitis of unknown origin: a retrospective study. Acta Vet Scand 2023; 65:46. [PMID: 37858113 PMCID: PMC10588026 DOI: 10.1186/s13028-023-00709-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Meningoencephalitis of unknown origin is a common cause of severe neurological disease in dogs. The term covers a heterogeneous group of noninfectious inflammatory diseases, with immune dysregulation widely accepted as the underlying disease mechanism. Current treatment consists of immunosuppression, with corticosteroids being the mainstay of virtually all treatment regimens. However, side effects of corticosteroids can be severe, and might be the cause of death in some patients. This retrospective, multi-centric study aimed at describing a population of Scandinavian dogs with meningoencephalitis of unknown origin in regards to reported side effects and cause of death, and to highlight possible differences in survival, when comparing corticosteroid monotherapy with other treatment regimens. RESULTS Within the 5-year study period, 63 dogs were included. Of these, 35 (49.3%) died or were euthanized during the study period. Median survival time from time of diagnosis based on Kaplan-Meier curves for the overall population was 714 days (equivalent to around 25 months, range 0-1678 days). There was no statistically significant difference (P = 0.31) in survival between dogs treated with corticosteroid monotherapy (n = 26, median survival time 716 days, equivalent to around 25 months, range 5-911 days), dogs receiving a combination of corticosteroids and ciclosporin (n = 15, median survival time 916 days, equivalent to around 31 months, range 35-1678 days), and dogs receiving corticosteroids combined with either cytosine arabinoside, leflunomide, or a combination of 2 or more add-on drugs (n = 13, median survival time 1186 days, equivalent to around 40 months, range 121-1640 days). Side effects were registered for 47/63 dogs. Polyphagia (n = 37/47), polyuria/polydipsia (n = 37/47), diarrhea (n = 29/47) and lethargy (n = 28/47) were most frequently reported. The most common cause for euthanasia was relapse (n = 15/35, 42.9%), followed by insufficient or lack of treatment response (n = 9, 25.7%). Side effects were the direct cause of euthanasia in 2/35 dogs (5.7%). CONCLUSIONS A large proportion of dogs in the overall population were euthanized due to relapse, emphasizing a need for treatment regimens aimed at specifically preventing relapse for an improved long-term survival. Side effects in dogs receiving corticosteroid monotherapy were rarely a direct cause of death, but were reported for all dogs. No statistically significant difference in survival was found when corticosteroid monotherapy was compared to other treatment regimens.
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Affiliation(s)
- Pernille Lindholm Heidemann
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlaegevej 16, Frederiksberg, 1870, Denmark.
| | - Bolette Erhald
- Evidensia Södra Djursjukhuset Kungens Kurva, Månskärsvägen 13, 141 75 Kungens, Kurva, Sweden
| | - Bodil Cathrine Koch
- Fredrikstad Dyrehospital (Fredrikstad Small Animal Hospital), Wilbergjordet 2, Fredrikstad, 1605, Norway
| | - Hanne Gredal
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlaegevej 16, Frederiksberg, 1870, Denmark
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Yue J, Lin P, Lian C, Yao H, Jiang L, Liao S, Xu L, Zhang J, Tan J, Chen Z, Yang J, Gao C, Huang L, Yang X, Long Y. Brain radial enhancement pattern in patients with negative glial fibrillary acidic protein-IgG: A cases series study. J Neurol Sci 2023; 453:120782. [PMID: 37683309 DOI: 10.1016/j.jns.2023.120782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Brain radial enhancement pattern on magnetic resonance imaging (MRI) has been identified as typical lesions in autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A). However, the authors encountered several patients without GFAP-IgG showing that such specific imaging. In the present study, we reported the clinical pictures of 5 GFAP-IgG-negative patients with GFAP-A specific imaging pattern. METHODS Data was retrospectively obtained from June 2013 through April 2023, and five GFAP-IgG-negative patients with valid data were recruited. Clinical information was either obtained by the investigators or retrieved from the referring clinicians and included prodromal symptoms, neurologic manifestations, comorbidities, results of ancillary studies. RESULTS Altogether five GFAP-IgG-negative patients with "meningoencephalitis/encephalitis" manifestations and brain radial perivascular enhancement were confirmed. One patient had peripheral lymphoma. Four patients had other autoimmune antibody in serum and/or cerebrospinal fluid, of which one patient had positive aquaporin IgG. Clinical features of the five patients included headache, fever, epilepsy and abnormal behavioral symptoms. MRI of patients revealed radial perivascular gadolinium enhancement extending from the lateral ventricles to the white matter suggestive of autoimmune GFAP-A. CONCLUSION GFAP-A-like disorders with radial perivascular enhancement could be found in GFAP-IgG-negative patients with or without neoplasm, which could provide new insight into the differential diagnosis of GFAP-A.
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Affiliation(s)
- Jiajia Yue
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Peihao Lin
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Chun Lian
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Haiyan Yao
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Lihong Jiang
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Sha Liao
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Lufen Xu
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Jiayuan Zhang
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Jie Tan
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Zixuan Chen
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Jie Yang
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Cong Gao
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Li Huang
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Xinguang Yang
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Sun Yat-sen Memorial Hospital, the Second Affiliated Hospital of Sun Yat-sen University, 107#Yan Jiang West Road, Guangzhou, China
| | - Youming Long
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China.
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9
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Raposo M, de la Fuente C, Pumarola M, Ríos J, Añor S. Immunohistochemical evaluation of fibrin/fibrinogen, d-dimers, and intravascular thrombosis in brains of dogs with meningoencephalitis of unknown origin. Vet J 2023; 298-299:106018. [PMID: 37532174 DOI: 10.1016/j.tvjl.2023.106018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/17/2023] [Accepted: 07/30/2023] [Indexed: 08/04/2023]
Abstract
Granulomatous meningoencephalitis (GME) and necrotizing encephalitides (NE) are the most common immune-mediated inflammatory diseases of the central nervous system in dogs. Activation of the fibrinolytic system in multiple sclerosis, a similar immune-mediated disease affecting the central nervous system in humans, seems to be related to disease progression. The aim of this study was to identify fibrin/fibrinogen and D-dimer deposition, as well as presence of intravascular thrombosis (IVT) in brains of dogs with a diagnosis of GME or NE. Immunohistochemical studies using antibodies against fibrin/fibrinogen and D-dimers were performed. Statistical analyses were performed to determine whether there were differences in the presence and location of fibrin/fibrinogen, D-dimers deposits, and IVT between GME and NE. Samples from sixty-four dogs were included in the study: 32 with a diagnosis of GME and 32 with a diagnosis of NE. Fibrin/fibrinogen depositions were detected in all samples and d-dimers were detected in 43/64 samples. IVT was present in 29/64 samples, with a significantly higher score in samples from dogs with NE than in samples from dogs with GME (P = 0.001). These data support hemostatic system activation in both diseases, especially NE. This finding might be related to the origin of the necrotic lesions seen in NE, which could represent chronic ischemic lesions. Further studies are needed to investigate the association between vascular lesions and the histopathological differences between GME and NE and the hemostatic system as a potential therapeutic target.
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Affiliation(s)
- M Raposo
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain; Fundació Hospital Clínic Veterinari, Facultad de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - C de la Fuente
- Fundació Hospital Clínic Veterinari, Facultad de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - M Pumarola
- Unitat de Patologia Murina i Comparada (UPMiC) and Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - J Ríos
- Unitat de Bioestadística, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - S Añor
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain; Fundació Hospital Clínic Veterinari, Facultad de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain.
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10
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Lee S, Song WJ, Park J, Kim M, Choen S, Kim MC, Jeong H, Yun Y. Off-Label Use of Crisdesalazine (GedaCure) in Meningoencephalitis in Two Dogs. Vet Sci 2023; 10:438. [PMID: 37505843 PMCID: PMC10383347 DOI: 10.3390/vetsci10070438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/23/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023] Open
Abstract
An 8-year-old, castrated male Shih-tzu dog (Case 1) showing ataxia and gait disorder was referred for neurological examination and magnetic resonance imaging. Through comprehensive examinations, the patient was tentatively diagnosed with meningoencephalitis of unknown origin (MUO) and treatment with prednisolone and cytosine arabinoside was started. The symptoms were improving with immunosuppressive treatment. However, severe bacterial cystitis occurred and we could not avoid tapering off prednisolone. Then, neurological signs recurred. Therefore, we added crisdesalazine, which allowed us to reduce the daily dosage of immunosuppressants easily. In another case, a 4-year-old, spayed female Yorkshire terrier dog (Case 2) was referred to our hospital showing a head tilt, circling, and loss of the menace reflex. The patient was tentatively diagnosed with MUO and treatment with some immunosuppressants was attempted. The clinical symptoms improved, but the alleviation was inadequate. Thus, we added crisdesalazine. The neurological signs then markedly improved. Moreover, the drugs could be tapered off more easily than before. Crisdesalazine is a novel drug that has antioxidant and anti-inflammatory action in brain disease and is used particularly for dementia. In this paper, we tried an off-label use of this drug in canine MUO patients, and found that it had, in these two patients, additional therapeutic effects on the MUO.
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Affiliation(s)
- Saeyoung Lee
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Jeju National University, Jeju 63243, Republic of Korea
| | - Woo-Jin Song
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Jeju National University, Jeju 63243, Republic of Korea
- The Research Institute of Veterinary Science, College of Veterinary Medicine, Jeju National University, Jeju 63243, Republic of Korea
| | - Jongjin Park
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Jeju National University, Jeju 63243, Republic of Korea
| | - Minkun Kim
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Jeju National University, Jeju 63243, Republic of Korea
| | - Sangkyung Choen
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - Myung-Chul Kim
- The Research Institute of Veterinary Science, College of Veterinary Medicine, Jeju National University, Jeju 63243, Republic of Korea
- Diagnostic Laboratory Medicine, College of Veterinary Medicine, Jeju National University, Jeju 63243, Republic of Korea
| | - Hyohoon Jeong
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Jeju National University, Jeju 63243, Republic of Korea
- The Research Institute of Veterinary Science, College of Veterinary Medicine, Jeju National University, Jeju 63243, Republic of Korea
| | - Youngmin Yun
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Jeju National University, Jeju 63243, Republic of Korea
- The Research Institute of Veterinary Science, College of Veterinary Medicine, Jeju National University, Jeju 63243, Republic of Korea
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11
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Beasley MJ, Shores A. Perspectives on pharmacologic strategies in the management of meningoencephalomyelitis of unknown origin in dogs. Front Vet Sci 2023; 10:1167002. [PMID: 37234070 PMCID: PMC10205981 DOI: 10.3389/fvets.2023.1167002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023] Open
Abstract
There are many non-infectious inflammatory diseases, assumed to be immune-mediated in origin, recognized to affect the nervous system in canine patients. Concentrating on meningoencephalomyelitis of unknown origin, we will discuss the medications used to treat the underlying disease process, focusing on their adverse effects, therapeutic monitoring when necessary and effectiveness. The literature overwhelmingly supports the use of a steroid/ Cytosar® or steroid/ cyclosporine treatment protocol with the steroid tapered after the acute phase of the disease, leaving the secondary medication to control the disease long term. The decision on when and how quickly to taper the steroid is clinician dependent as a best practices has not been established in the literature. Also discussed will be the supportive care treatments often needed in the acute phase of these patients' diagnosis and treatment such as anti-edema and anti-epileptic agents.
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Affiliation(s)
- Michaela J. Beasley
- College of Veterinary Medicine, Mississippi State University, Starkville, MS, United States
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12
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Gonçalves R, Maddox TW, Phillipps S, Nagendran A, Cooper C, Orlandi R, Fentem R, Walmsley GL. Development of a reliable clinical assessment tool for meningoencephalitis in dogs: The neurodisability scale. J Vet Intern Med 2023; 37:1111-1118. [PMID: 37092590 DOI: 10.1111/jvim.16717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/06/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Meningoencephalitis of unknown origin (MUO) comprises a group of debilitating inflammatory diseases affecting the central nervous system of dogs. Currently, no validated clinical scale is available for the objective assessment of MUO severity. OBJECTIVES Design a neurodisability scale (NDS) to grade clinical severity and determine its reliability and whether or not the score at presentation correlates with outcome. ANIMALS One hundred dogs with MUO were included for retrospective review and 31 dogs were subsequently enrolled for prospective evaluation. METHODS Medical records were retrospectively reviewed for 100 dogs diagnosed with MUO to identify the most frequent neurological examination findings. The NDS was designed based on these results and evaluated for prospective and retrospective use in a new population of MUO patients (n = 31) by different groups of independent blinded assessors, including calculation of interobserver agreement and association with outcome. RESULTS The most common clinical signs in MUO patients were used to inform categories for scoring in the NDS: seizure activity, ambulatory status, posture and cerebral, cerebellar, brainstem, and visual functions. The intraclass correlation coefficient (ICC) for prospective use of the NDS was 0.83 (95% confidence interval [CI], 0.68-0.91) indicating good agreement, and moderate agreement was found between prospective and retrospective assessors (ICC, 0.71; 95% CI, 0.56-0.83). No association was found between NDS score and long-term outcome. CONCLUSIONS AND CLINICAL IMPORTANCE The NDS is a novel clinical measure for objective assessment of neurological dysfunction and showed good reliability when used prospectively in MUO patients but, in this small population, no association with outcome could be identified.
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Affiliation(s)
- Rita Gonçalves
- Department of Veterinary Science, Small Animal Teaching Hospital, University of Liverpool, Leahurst, Neston, Cheshire, United Kingdom
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Thomas W Maddox
- Department of Veterinary Science, Small Animal Teaching Hospital, University of Liverpool, Leahurst, Neston, Cheshire, United Kingdom
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Stephanie Phillipps
- Department of Veterinary Science, Small Animal Teaching Hospital, University of Liverpool, Leahurst, Neston, Cheshire, United Kingdom
| | - Aran Nagendran
- Department of Veterinary Science, Small Animal Teaching Hospital, University of Liverpool, Leahurst, Neston, Cheshire, United Kingdom
| | - Camilla Cooper
- Department of Veterinary Science, Small Animal Teaching Hospital, University of Liverpool, Leahurst, Neston, Cheshire, United Kingdom
| | - Rocio Orlandi
- Department of Veterinary Science, Small Animal Teaching Hospital, University of Liverpool, Leahurst, Neston, Cheshire, United Kingdom
| | - Rory Fentem
- Department of Veterinary Science, Small Animal Teaching Hospital, University of Liverpool, Leahurst, Neston, Cheshire, United Kingdom
| | - Gemma L Walmsley
- Department of Veterinary Science, Small Animal Teaching Hospital, University of Liverpool, Leahurst, Neston, Cheshire, United Kingdom
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
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13
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Herzig R, Beckmann K, Körner M, Steffen F, Rohrer Bley C. A shortened whole brain radiation therapy protocol for meningoencephalitis of unknown origin in dogs. Front Vet Sci 2023; 10:1132736. [PMID: 37020978 PMCID: PMC10069678 DOI: 10.3389/fvets.2023.1132736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/28/2023] [Indexed: 04/07/2023] Open
Abstract
Introduction A variety of treatment options have been described for canine meningoencephalitis of unknown origin (MUO). Few studies focused on radiation therapy as a second line immunomodulating treatment, implicating its effective use. However, a standard radiation therapy protocol is lacking, and further research will help to evaluate the effect of different dose regimens. Methods Ten dogs diagnosed with MUO based on MRI and CSF findings were prospectively enrolled. The dogs were treated with a shortened whole brain radiation therapy protocol (5 × 4 Gy) in combination with prednisolone. Neurologic changes were quantified using an established scoring scheme. Follow-up MRI and CSF examination was scheduled three months after radiation therapy. Overall survival and time to progression were calculated. Histopathology of the brain was performed in case of death. Results Seven dogs were diagnosed de novo and three had a history of relapsing MUO. Neurological status improved in all 10 dogs during radiation therapy, with 4/10 returning to normal shortly after radiation therapy. Three dogs died within the first three months after radiation therapy. At follow-up MRI lesions completely resolved in two dogs, partially resolved in five dogs, and progressed in one dog. After follow-up MRI, dogs were further treated with prednisolone monotherapy (two dogs) and additional immunosuppressant drugs (five dogs). Overall, four dogs showed disease progression, with a mean time to progression of 691 days (95%CI: 396-987) and mean overall survival for all dogs was 723 days (95%CI: 436-1011) (both medians not reached). Histopathology confirmed MUO in three dogs but was suggestive for oligodendroglioma in one dog. Radiation induced side effects were not seen. Conclusion Shortened whole-brain radiation therapy could be an additional treatment option for MUO in conjunction to prednisolone, specifically for cases that require rapid relief of symptoms and with relapsing history.
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Affiliation(s)
- Robert Herzig
- Division of Neurology, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
- *Correspondence: Robert Herzig
| | - Katrin Beckmann
- Division of Neurology, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Maximilian Körner
- Division of Radiation Oncology, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Frank Steffen
- Division of Neurology, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Carla Rohrer Bley
- Division of Radiation Oncology, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
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14
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Greco A, Meomartino L, Gnudi G, Brunetti A, Di Giancamillo M. Imaging techniques in veterinary medicine . Part II: Computed tomography, magnetic resonance imaging, nuclear medicine. Eur J Radiol Open 2022; 10:100467. [PMID: 36570419 PMCID: PMC9768321 DOI: 10.1016/j.ejro.2022.100467] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
Radiography and ultrasonography are the most used techniques in veterinary clinical practice, due to organizational, managerial and, mostly, economic reasons. However, in the last decades, Computed tomography (CT), Magnetic Resonance Imaging (MRI) and, to a lesser extent, Nuclear Medicine (MN) are increasingly used. As we said in the previous article, all the Diagnostic Imaging techniques are actually "indispensable" in Veterinary Medicine, where many patients do not show any symptoms.This second part describes Computed Tomography (CT), Magnetic Resonance (MRI) and Nuclear Medicine techniques in Veterinary Medicine are described.
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Affiliation(s)
- Adelaide Greco
- Centro Interdipartimentale di Radiologia Veterinaria, Università degli Studi di Napoli “Federico II”, Via F. Delpino, 1, 80137 Napoli, Italy
| | - Leonardo Meomartino
- Centro Interdipartimentale di Radiologia Veterinaria, Università degli Studi di Napoli “Federico II”, Via F. Delpino, 1, 80137 Napoli, Italy,Corresponding author.
| | - Giacomo Gnudi
- Dipartimento di Scienze Mediche Veterinarie, Università di Parma, Via del Taglio, 10, 43126 Parma, Italy
| | - Arturo Brunetti
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli “Federico II”, Via Pansini, 5, 80131 Napoli, Italy
| | - Mauro Di Giancamillo
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milano, Italy
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15
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Nessler JN, Oevermann A, Schawacht M, Gerhauser I, Spitzbarth I, Bittermann S, Steffen F, Schmidt MJ, Tipold A. Concomitant necrotizing encephalitis and granulomatous meningoencephalitis in four toy breed dogs. Front Vet Sci 2022; 9:957285. [PMID: 36118343 PMCID: PMC9477003 DOI: 10.3389/fvets.2022.957285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/09/2022] [Indexed: 11/26/2022] Open
Abstract
The term “meningoencephalitis of unknown origin” (MUO) describes a group of different encephalitides in dogs in which no infectious agent can be identified and a multifactorial etiology is suspected. Among others, genetic factors and unknown triggers seem to be involved. Included are necrotizing leukoencephalitis (NLE), necrotizing meningoencephalitis (NME), and granulomatous meningoencephalitis (GME). In this case series, we describe the histopathological findings of four toy breed dogs with focal or multifocal necrotizing encephalitis and mainly lymphocytic perivascular infiltrates on histopathological examination. At the same time, however, in all dogs, focal or multifocal high-grade angiocentric granulomatous inflammatory lesions were evident with focal histiocytic perivascular infiltrates in the brain. The former changes are typical for NLE and NME. In contrast, the latter changes are indicative of GME. This case series shows that the boundaries between the necrotizing and granulomatous variants of MUO might be smooth and suggests that NLE, NME, and GME are not as distinct as previously described. This finding could be a crucial piece of the puzzle in the study of the pathogenesis of MUO as individual susceptibility and specific triggers could be responsible for the manifestation of the different MUO subtypes.
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Affiliation(s)
- Jasmin Nicole Nessler
- Department for Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
- *Correspondence: Jasmin Nicole Nessler
| | - Anna Oevermann
- Department of Clinical Research and Veterinary Public Health, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Marina Schawacht
- Department for Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Ingo Gerhauser
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Ingo Spitzbarth
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Sophie Bittermann
- Department of Clinical Research and Veterinary Public Health, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Frank Steffen
- Department of Clinical Neurology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Martin Jürgen Schmidt
- Clinic for Small Animal-Surgery, Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine, Justus-Liebig-University, Giessen, Germany
| | - Andrea Tipold
- Department for Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
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16
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Zdora I, Raue J, Söbbeler F, Tipold A, Baumgärtner W, Nessler JN. Case report: Lympho-histiocytic meningoencephalitis with central nervous system vasculitis of unknown origin in three dogs. Front Vet Sci 2022; 9:944867. [PMID: 36090171 PMCID: PMC9449415 DOI: 10.3389/fvets.2022.944867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022] Open
Abstract
Meningoencephalitis of unknown origin (MUO) is an umbrella term for a variety of subtypes of meningoencephalitis of dogs and cats with no identifiable infectious agent. In dogs, granulomatous meningoencephalitis (GME), necrotizing meningoencephalitis (NME), and necrotizing leukoencephalitis (NLE) are the most commonly reported subtypes. However, sporadically there are reports about other subtypes such as greyhound encephalitis or eosinophilic meningoencephalitis. The following case series presents three dogs with peracute to acute progressive signs of encephalopathy. The magnetic resonance imaging (MRI) of two dogs (post mortem n = 1/2) showed severe, diffuse swelling of the cortical gray matter with increased signal intensity in T2weighted (w) and fluid-attenuated inversion recovery (FLAIR) and decreased signal intensity in T1w. Additionally, focal to multifocal areas with signal void in both dogs and caudal transforaminal herniation of the cerebellum in one dog was observed. Post mortem histopathological examination revealed lympho-histiocytic encephalitis and central nervous system (CNS) vasculitis in all dogs. No infectious agents were detectable by histopathology (hematoxylin and eosin stain), periodic acid-Schiff reaction (PAS), Ziehl-Neelsen stain and immunohistochemistry for Canine adenovirus-1, Parvovirus, Listeria monocytogenes, Parainfluenzavirus, Toxoplasma gondii, Herpes-suis virus, Pan-Morbillivirus, Tick born encephalitis virus, Severe acute respiratory syndrome coronavirus (SARS-CoV) 2. Furthermore, two dogs were tested negative for rabies virus. To the best of the authors' knowledge, this is the first report of a lympho-histiocytic encephalitis with CNS vasculitis with no identifiable infectious agent. It is suggested to consider this as an additional subtype of MUO with severe clinical signs.
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Affiliation(s)
- Isabel Zdora
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
- Center of Systems Neuroscience, Hannover, Germany
| | - Jonathan Raue
- Department for Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Franz Söbbeler
- Department for Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Andrea Tipold
- Center of Systems Neuroscience, Hannover, Germany
- Department for Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Wolfgang Baumgärtner
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
- Center of Systems Neuroscience, Hannover, Germany
| | - Jasmin Nicole Nessler
- Department for Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
- *Correspondence: Jasmin Nicole Nessler
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17
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Lawn RW, Harcourt-Brown TR. Risk factors for early death or euthanasia within 100 days of diagnosis in dogs with meningoencephalitis of unknown origin. Vet J 2022; 287:105884. [PMID: 35987308 DOI: 10.1016/j.tvjl.2022.105884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/27/2022] [Accepted: 08/13/2022] [Indexed: 10/15/2022]
Abstract
Meningoencephalitis of unknown origin (MUO) in the dog is an inflammatory condition of the central nervous system with variable short- and long-term prognosis. Previous studies have attempted to identify risk factors for early death; however, the findings were inconsistent and prognostication and treatment selection remain difficult for cases of MUO. The aim of this study was to compare the influence of putative prognostic factors on early survival in dogs with MUO. Logistic regression was used to analyse the effect of clinical and magnetic resonance imaging (MRI) features at diagnosis and type of immune-suppressive treatment received on survival at three-time points; 7 days, 30 days, and 100 days post-diagnosis. Ninety eight dogs were included. Dogs that were obtunded at presentation had a 6.6 times increased odds of death in the first 7 days after diagnosis, a 2.1 times increased risk of death 8-30 days after diagnosis, and a 1.9 times increased risk of death 31-100 days after diagnosis. No other clinical, MRI feature, or treatment was found to have a significant influence on survival. Obtundation at presentation was found to increase risk of early euthanasia in dogs with MUO, while the addition of an IV infusion of cytarabine to immune-suppressive corticosteroid therapy (prednisolone and/or dexamethasone) at initial treatment did not improve the odds of survival at 7, 30, or 100 days after diagnosis.
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Affiliation(s)
- R W Lawn
- Langford Vets Small Animal Referral Hospital, Langford House, Langford, Bristol BS40 5DU, UK.
| | - T R Harcourt-Brown
- Langford Vets Small Animal Referral Hospital, Langford House, Langford, Bristol BS40 5DU, UK
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18
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Phillipps S, DeDecker S, Gutierrez-Quintana R, Alcoverro E, Gomes SA, Goncalves R. Idiopathic generalised tremor syndrome in dogs. Vet Rec 2022; 191:e1734. [PMID: 35700269 DOI: 10.1002/vetr.1734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 02/15/2022] [Accepted: 04/05/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Idiopathic generalised tremor syndrome (IGTS) causes tremor and often vestibulocerebellar signs. Previous publications on IGTS in dogs are restricted to case reports or lack exclusion of structural causes. METHODS Medical records of 75 dogs diagnosed with IGTS that had undergone magnetic resonance imaging (MRI) of the brain were collected retrospectively. RESULTS Crossbreeds were affected most commonly (41.3%), followed by West Highland white terriers (14.7%) and cocker spaniels (10.7%). A higher proportion of females were affected than males (68.0%). Median age of the affected dogs was 17 months (range 6-121 months), and median bodyweight was 9.15 kg (range 2.9-26 kg). All dogs presented with tremors and most experienced concomitant neurological signs (93.3%). Seventeen (22.7%) were hyperthermic and 31 (41.3%) had gastrointestinal signs. MRI of the brain was normal in most of the cases, and cerebrospinal fluid analysis frequently revealed mild pleocytosis. All animals were treated with prednisolone, and 39 (51.3%) also received diazepam. Median follow-up time was 13 months (range 0-134 months). The overall outcome was good, although 16 (21.3%) patients were reported to have relapsing clinical signs and 10 (13.2%) patients experienced persistent mild clinical signs. CONCLUSIONS IGTS should be suspected in any dog with generalised tremor and vestibulocerebellar signs with younger and smaller dogs more commonly affected.
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Affiliation(s)
- Stephanie Phillipps
- Institute of Infection, Veterinary and Ecological Sciences, Small Animal Teaching Hospital, University of Liverpool, Neston, UK
| | - Steven DeDecker
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
| | | | | | | | - Rita Goncalves
- Institute of Infection, Veterinary and Ecological Sciences, Small Animal Teaching Hospital, University of Liverpool, Neston, UK
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19
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Höche J, House RV, Heinrich A, Schliephake A, Albrecht K, Pfeffer M, Ellenberger C. Pathogen Screening for Possible Causes of Meningitis/Encephalitis in Wild Carnivores From Saxony-Anhalt. Front Vet Sci 2022; 9:826355. [PMID: 35464387 PMCID: PMC9021439 DOI: 10.3389/fvets.2022.826355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Inflammation in meninges and/or brain is regularly noticed in red foxes and other wild carnivores during rabies control programs. Despite negative rabies virus (RABV) results, the etiologies of these cases remain unknown. Thus, the aim of this study was to provide an overview of the occurrence of pathogens that may cause diseases in the brains of wild carnivores and pose a risk to humans and other animals. In addition to RABV and canine distemper virus (CDV), a variety of pathogens, including members of Flaviviridae, Bornaviridae, Herpesviridae, Circoviridae, as well as bacteria and parasites can also cause brain lesions. In 2016 and 2017, brain samples of 1,124 wild carnivores were examined by direct fluorescent antibody test for RABV as well as (reverse-transcriptase) quantitative polymerase chain reaction (PCR) for the presence of CDV as part of a monitoring program in Saxony-Anhalt, Germany. Here, we applied similar methods to specifically detect suid herpesvirus 1 (SuHV-1), West Nile virus (WNV), Borna disease virus 1 (BoDV-1), canid alphaherpesvirus 1 (CaHV-1), canine parvovirus type 2 (CPV-2), fox circovirus (FoxCV), and Neospora caninum (N. caninum). Further, bacteriogical examination for the existence of Listeria monocytogenes (L. monocytogenes) and immunohistochemistry of selected cases to detect Toxoplasma gondii (T. gondii) antigen were performed. Of all pathogens studied, CDV was found most frequently (31.05%), followed by FoxCV (6.80%), CPV-2 (6.41%), T. gondii (4/15; 26.67%), nematode larvae (1.51%), L. monocytogenes (0.3%), and various other bacterial pathogens (1.42%). In 68 of these cases (6.05%), multiple pathogen combinations were present simultaneously. However, RABV, WNV, BoDV-1, SuHV-1, CaHV-1, and N. caninum were not detected. The majority of the histopathological changes in 440 animals were inflammation (320/440; 72.73%), predominantly non-suppurative in character (280/320; 87.50%), and in many cases in combination with gliosis, satellitosis, neuronophagia, neuronal necrosis, and/or vacuolization/demyelination, or in single cases with malacia. Thus, it could be shown that wild carnivores in Saxony-Anhalt are carriers mainly for CDV and sometimes also for other, partly zoonotic pathogens. Therefore, the existing monitoring program should be expanded to assess the spill-over risk from wild carnivores to humans and other animals and to demonstrate the role of wild carnivores in the epidemiology of these zoonotic pathogens.
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Affiliation(s)
- Jennifer Höche
- Department of Veterinary Medicine, State Office for Consumer Protection Saxony-Anhalt, Stendal, Germany
- *Correspondence: Jennifer Höche
| | - Robert Valerio House
- Department of Veterinary Medicine, State Office for Consumer Protection Saxony-Anhalt, Stendal, Germany
| | - Anja Heinrich
- Department of Veterinary Medicine, State Office for Consumer Protection Saxony-Anhalt, Stendal, Germany
| | - Annette Schliephake
- Department of Veterinary Medicine, State Office for Consumer Protection Saxony-Anhalt, Stendal, Germany
| | - Kerstin Albrecht
- Department of Veterinary Medicine, State Office for Consumer Protection Saxony-Anhalt, Stendal, Germany
| | - Martin Pfeffer
- Centre of Veterinary Public Health, Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, Leipzig, Germany
| | - Christin Ellenberger
- Department of Veterinary Medicine, State Office for Consumer Protection Saxony-Anhalt, Stendal, Germany
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Hanael E, Baruch S, Chai O, Nir Z, Rapoport K, Ruggeri M, Eizenberg I, Peery D, Friedman A, Shamir MH. Detection of blood‐brain barrier dysfunction using advanced imaging methods to predict seizures in dogs with meningoencephalitis of unknown origin. J Vet Intern Med 2022; 36:702-712. [PMID: 35285550 PMCID: PMC8965229 DOI: 10.1111/jvim.16396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 12/01/2022] Open
Abstract
Background The blood‐brain barrier (BBB), which separates the intravascular and neuropil compartments, characterizes the vascular bed of the brain and is essential for its proper function. Recent advances in imaging techniques have driven the development of methods for quantitative assessment of BBB permeability. Hypothesis/Objectives Permeability of the BBB can be assessed quantitatively in dogs with meningoencephalitis of unknown origin (MUO) and its status is associated with the occurrence of seizures. Animals Forty dogs with MUO and 12 dogs without MUO. Methods Retrospective, prospective cohort study. Both dynamic contrast enhancement (DCE) and subtraction enhancement analysis (SEA) methods were used to evaluate of BBB permeability in affected (DCE, n = 8; SEA, n = 32) and control dogs (DCE, n = 6; SEA, n = 6). Association between BBB dysfunction (BBBD) score and clinical characteristics was examined. In brain regions where BBBD was identified by DCE or SEA magnetic resonance imaging (MRI) analysis, immunofluorescent staining for albumin, glial fibrillary acidic protein, ionized calcium binding adaptor molecule, and phosphorylated mothers against decapentaplegic homolog 2 were performed to detect albumin extravasation, reactive astrocytes, activated microglia, and transforming growth factor beta signaling, respectively. Results Dogs with BBBD had significantly higher seizure prevalence (72% vs 19%; P = .01) when compared to MUO dogs with no BBBD. The addition of SEA to routine MRI evaluation increased the identification rate of brain pathology in dogs with MUO from 50% to 72%. Conclusions and Clinical Importance Imaging‐based assessment of BBB integrity has the potential to predict risk of seizures in dogs with MUO.
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Affiliation(s)
- Erez Hanael
- Hebrew University Koret School of Veterinary Medicine‐Veterinary Teaching Hospital Rehovot Israel
| | - Shelly Baruch
- Hebrew University Koret School of Veterinary Medicine‐Veterinary Teaching Hospital Rehovot Israel
| | - Orit Chai
- Hebrew University Koret School of Veterinary Medicine‐Veterinary Teaching Hospital Rehovot Israel
| | - Zohar Nir
- Hebrew University Koret School of Veterinary Medicine‐Veterinary Teaching Hospital Rehovot Israel
| | - Kira Rapoport
- Hebrew University Koret School of Veterinary Medicine‐Veterinary Teaching Hospital Rehovot Israel
| | - Marco Ruggeri
- Hebrew University Koret School of Veterinary Medicine‐Veterinary Teaching Hospital Rehovot Israel
| | - Itzhak Eizenberg
- Hebrew University Koret School of Veterinary Medicine‐Veterinary Teaching Hospital Rehovot Israel
| | - Dana Peery
- Hebrew University Koret School of Veterinary Medicine‐Veterinary Teaching Hospital Rehovot Israel
| | - Alon Friedman
- Departments of Physiology and Cell Biology, Brain, and Cognitive Sciences, Zlotowski Center for Neuroscience Ben‐Gurion University of the Negev Beer Sheva Israel
- Department of Medical Neuroscience, Faculty of Medicine Dalhousie University Halifax NS Canada
| | - Merav H. Shamir
- Hebrew University Koret School of Veterinary Medicine‐Veterinary Teaching Hospital Rehovot Israel
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21
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Benito MB, Fuentes MP, Manso‐Diaz G, Madonado BS, Diaz CP. Clinical signs, diagnostic imaging and histopathology in a dog with granulomatous meningoencephalitis manifested as a polyneuropathy. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Miguel Benito Benito
- Small Animal Medicine and Surgery Department Complutense University of Madrid Madrid Spain
- Neurology and Neurosurgery Service Hamilton Specialists Referrals High Wycombe UK
| | - Miriam Portero Fuentes
- Small Animal Medicine and Surgery Department Complutense University of Madrid Madrid Spain
| | - Gabriel Manso‐Diaz
- Small Animal Medicine and Surgery Department Complutense University of Madrid Madrid Spain
| | - Belén Sánchez Madonado
- Small Animal Medicine and Surgery Department Complutense University of Madrid Madrid Spain
| | - Carmen Pérez Diaz
- Small Animal Medicine and Surgery Department Complutense University of Madrid Madrid Spain
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Gonçalves R, De Decker S, Walmsley G, Butterfield S, Maddox TW. Inflammatory Disease Affecting the Central Nervous System in Dogs: A Retrospective Study in England (2010–2019). Front Vet Sci 2022; 8:819945. [PMID: 35155652 PMCID: PMC8829331 DOI: 10.3389/fvets.2021.819945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/15/2021] [Indexed: 11/29/2022] Open
Abstract
The epidemiology of inflammatory diseases affecting the central nervous system (CNS) in dogs is largely unknown. We aimed to report the relative proportion of different causes of inflammatory disease affecting the CNS in dogs and identify predictors for infectious vs. immune-mediated conditions and predictors for the most common diseases affecting the brain and the spinal cord. This was a retrospective cohort study over a 10-year period in 2 referral institutions using multivariable and multinomial logistic regression for identification of risk factors. In total, 1,140 client-owned dogs diagnosed with inflammatory disease affecting the CNS were included. Fifteen different diagnoses were identified, with immune-mediated (83.6%) disease being more common than infectious conditions (16.4%). The most common immune-mediated conditions diagnosed were meningoencephalitis of unknown origin (47.5%) and steroid-responsive meningitis–arteritis (30.7%), and the most common infectious conditions were discospondylitis (9.3%) and otogenic intracranial infection (2.2%). Older age (p < 0.001, OR = 1.019, 95% CI: 1.014–1.024), higher body weight (p < 0.001, OR = 1.049, 95% CI: 1.025–1.074), male sex (p = 0.009, OR = 1.685, 95% CI: 1.141–2.488), longer duration of the clinical signs before presentation (p < 0.001, OR = 1.011, 95% CI: 1.006–1.017), progressive nature of the clinical signs (p < 0.001, OR = 2.295, 95% CI: 1.463–3.599), identification of a possibly associated preceding event (p = 0.0012, OR = 1.93, 95% CI: 1.159–3.213), and hyperesthesia on presentation (p < 0.001, OR = 2.303, 95% CI: 1.528–3.473) were associated with a diagnosis of infectious diseases. Our data shows that immune-mediated diseases are more common than infectious conditions as a cause for inflammatory CNS disease in dogs. The risk factors for the most common diagnoses were identified from signalment, history, and findings of the physical and neurological examinations to give valuable information that can guide clinicians with their investigations.
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Affiliation(s)
- Rita Gonçalves
- Department of Small Animal Clinical Science, Small Animal Teaching Hospital, University of Liverpool, Liverpool, United Kingdom
- Department of Musculoskeletal and Ageing Science, Institute of Lifecourse and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- *Correspondence: Rita Gonçalves
| | - Steven De Decker
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, United Kingdom
| | - Gemma Walmsley
- Department of Small Animal Clinical Science, Small Animal Teaching Hospital, University of Liverpool, Liverpool, United Kingdom
- Department of Musculoskeletal and Ageing Science, Institute of Lifecourse and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Sarah Butterfield
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, United Kingdom
| | - Thomas W. Maddox
- Department of Small Animal Clinical Science, Small Animal Teaching Hospital, University of Liverpool, Liverpool, United Kingdom
- Department of Musculoskeletal and Ageing Science, Institute of Lifecourse and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
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Nessler JN, Jo WK, Osterhaus ADME, Ludlow M, Tipold A. Canine Meningoencephalitis of Unknown Origin-The Search for Infectious Agents in the Cerebrospinal Fluid via Deep Sequencing. Front Vet Sci 2021; 8:645517. [PMID: 34950723 PMCID: PMC8688736 DOI: 10.3389/fvets.2021.645517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 11/15/2021] [Indexed: 01/02/2023] Open
Abstract
Meningoencephalitis of unknown origin (MUO) describes a group of meningoencephalitides in dogs with a hitherto unknown trigger. An infectious agent has been suggested as one possible trigger of MUO but has not been proven so far. A relatively new method to screen for viral RNA or DNA is next-generation sequencing (NGS) or deep sequencing. In this study, a metagenomics analysis of the virome in a sample is analyzed and scanned for known or unknown viruses. We examined fresh-frozen CSF of 6 dogs with MUO via NGS using a modified sequence-independent, single-primer amplification protocol to detect a possible infectious trigger. Analysis of sequencing reads obtained from the six CSF samples showed no evidence of a virus infection. The inability to detect a viral trigger which could be implicated in the development of MUO in the examined population of European dogs, suggests that the current techniques are not sufficiently sensitive to identify a possible virus infection, that the virus is already eliminated at the time-point of disease outbreak, the trigger might be non-infectious or that there is no external trigger responsible for initiating MUO in dogs.
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Affiliation(s)
- Jasmin Nicole Nessler
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Foundation, Hannover, Germany
| | - Wendy Karen Jo
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Foundation, Hannover, Germany
| | - Albert D M E Osterhaus
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Foundation, Hannover, Germany
| | - Martin Ludlow
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Foundation, Hannover, Germany
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Foundation, Hannover, Germany
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Zilli J, Olszewska A, Farke D, Schmidt MJ. Successful surgical and medical treatment of a severe, acute epidural bleed in a young dog due to steroid responsive meningitis-arteritis. Acta Vet Scand 2021; 63:27. [PMID: 34246290 PMCID: PMC8272355 DOI: 10.1186/s13028-021-00593-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/05/2021] [Indexed: 12/13/2022] Open
Abstract
Background Steroid responsive meningitis-arteritis (SRMA) is an immune-mediated disease of the leptomeninges and its associated blood vessels, typically responsive to corticosteroids. Clinically relevant haemorrhage is a rare finding in such patients and for this reason surgical decompression of the spinal cord is normally not considered. The diagnosis of SRMA is supported by serum C-reactive protein (CRP) increase, cerebrospinal fluid (CSF) examination, including cytology (polymorphonuclear pleocytosis in the acute form), nucleated cell-, red blood cell- and protein count, as well as by evaluating CSF and serum IgA concentrations. D-dimer concentrations in serum and CSF should be elevated as well and therefore can be also evaluated as a further diagnostic tool. Case presentation A 1.5-year-old mixed breed dog was presented with pyrexia, cervical pain and acute tetraparesis. Magnetic resonance imaging revealed an extradural mass lesion at the level of the sixth cervical vertebra, consistent with a subacute epidural haemorrhage, causing severe compression of the spinal cord. Based on the dog’s signalment, clinical history and results of the blood and CSF analyses (incl. D-dimer determination), SRMA with secondary epidural haemorrhage was suspected. Decompressive surgery was performed through a right sided partial dorsal laminectomy. Post-surgical immunosuppressive treatment was started with cytarabine and then continued with prednisolone after completion of wound healing. Conclusions This is the first report in which medical and surgical treatment were combined in a patient with SRMA and it highlights the possibility of performing a successful surgical intervention despite the need for immunosuppressive therapy. Moreover, while SRMA diagnosis is normally based on CSF analysis and CSF and serum IgA concentrations, D-dimer concentrations in serum and CSF were also useful in this patient.
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25
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Little A, Olivier A, Lee AM, Moore T. What Is Your Neurologic Diagnosis? J Am Vet Med Assoc 2021; 258:1075-1078. [PMID: 33944592 DOI: 10.2460/javma.258.10.1075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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26
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Andersen-Ranberg E, Berendt M, Gredal H. Biomarkers of non-infectious inflammatory CNS diseases in dogs: Where are we now? Part 2 - Steroid responsive meningitis-arteritis. Vet J 2021; 273:105692. [PMID: 34148607 DOI: 10.1016/j.tvjl.2021.105692] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 12/24/2022]
Abstract
Steroid responsive meningitis-arteritis (SRMA) in dogs causes severe inflammation of meningeal arteries leading to generalized meningitis with possible neurological signs, as well as a systemic inflammatory response. The etiology and exact pathogenesis are unknown, but an immune-mediated origin has been suggested and is supported by a positive response to immunosuppressive treatment with corticosteroids. A collection of clinical and paraclinical characteristics may be highly indicative of SRMA, but a single and conclusive diagnostic test or biomarker is currently not available. The aim of this review is to provide an overview of the current understanding and knowledge on SRMA, with special emphasis on potential biomarkers and their applicability in the diagnostic work-up. Though no specific markers for SRMA currently exist, clinically useful markers include IgA and several acute phase proteins e.g. C-reactive protein. A frequent problem of both acknowledged and proposed biomarkers, is, however, their inability to effectively differentiate SRMA from other systemic inflammatory conditions. Other proposed diagnostic markers include genetic markers, acute phase proteins such as serum amyloid A, cytokines such as interleukin-17 and CC-motif ligand 19, endocannabinoid receptors and heat shock protein 70; these suggestions however either lack specificity or need further investigation.
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Affiliation(s)
- Emilie Andersen-Ranberg
- Copenhagen University, Department of Veterinary Clinical Sciences, Dyrlægevej 16, DK-1870 Frederiksberg C, Denmark
| | - Mette Berendt
- Copenhagen University, Department of Veterinary Clinical Sciences, Dyrlægevej 16, DK-1870 Frederiksberg C, Denmark
| | - Hanne Gredal
- Copenhagen University, Department of Veterinary Clinical Sciences, Dyrlægevej 16, DK-1870 Frederiksberg C, Denmark.
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Clinical Presentation, Diagnostic Findings, and Long-term Survival Time in 182 Dogs With Meningoencephalitis of Unknown Origin From Central Europe That Were Administered Glucocorticosteroid Monotherapy. Top Companion Anim Med 2021; 44:100539. [PMID: 33964477 DOI: 10.1016/j.tcam.2021.100539] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/23/2022]
Abstract
Canine non-infectious inflammatory meningoencephalomyelitis is termed meningoencephalomyelitis of unknown origin (MUO) and may affect dogs of every breed at any age. Treatment with immunosuppressive medication, the survival time based on MRI, and cerebrospinal fluid (CSF) findings has been widely reported; however, these studies only included a small number of patients, or they are summaries from the literature. Therefore, the aim of this study was to compare the clinical presentation, diagnostic findings, treatment protocol and long-term survival time in many dogs diagnosed with MUO in one clinic with previously published studies. One hundred eighty-two dogs met the inclusion criteria. Age, sex, duration of clinical signs before diagnosis, presence of neurological signs, MRI and CSF analysis were similar to those in previous reports. Our study revealed that dogs with a brainstem lesion have a 60% lower chance of death before 1 year than dogs with multifocal brain lesions. A total of 55.56% of treated dogs survived for more than 1 year, and 10.55% survived for more than 5 years since diagnosis. The median survival time for all dogs was 540 days. Our findings support glucocorticosteroid monotherapy as a viable treatment option for dogs with MUO.
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Stephen AA, Kent M, Barber RM. What Is Your Neurologic Diagnosis? J Am Vet Med Assoc 2021; 258:141-145. [PMID: 33405982 DOI: 10.2460/javma.258.2.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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29
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Andersen-Ranberg E, Berendt M, Gredal H. Biomarkers of non-infectious inflammatory CNS diseases in dogs - Where are we now? Part I: Meningoencephalitis of unknown origin. Vet J 2021; 273:105678. [PMID: 34148601 DOI: 10.1016/j.tvjl.2021.105678] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
Meningoencephalitides of Unknown Origin (MUO) comprises a group of non-infectious inflammatory brain conditions, which frequently cause severe neurological disease and death in dogs. Although multiple diagnostic markers have been investigated, a conclusive diagnosis, at present, essentially relies on postmortem histopathology. However, different groups of biomarkers, e.g. acute phase proteins, antibodies, cytokines, and neuro-imaging markers may prove useful in the diagnostic investigation of dogs with MUO. It appears from the current literature that acute phase proteins such as C-reactive protein are often normal in MUO, but may be useful to rule out steroid responsive meningitis-arteritis as well as other systemic inflammatory conditions. In antibody research, anti-glial fibrillary acidic protein (GFAP) may play a role, but further research is needed to establish this as a consistent marker of particularly Pug dog encephalitis. The proposed diagnostic markers often lack specificity to distinguish between the subtypes of MUO, but an increased expression of interferon-γ (IFN-γ) in necrotizing meningoencephalitis (NME) and interleukin-17 (IL-17) in granulomatous meningoencephalitis (GME) in tissue biopsies may indicate their potential as specific markers of NME and GME, respectively, suggesting further investigations of these in serum and CSF. While neuro-imaging is already an important part of the diagnostic work-up in MUO, further promising results have been shown with Positron Emission Tomography (PET) as well as proton resonance spectroscopy (1H MRS), which may be able to detect areas of necrosis and granulomas, respectively, with relatively high specificity. This review presents different groups of established and potential diagnostic markers of MUO assessing current results and future potential.
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Affiliation(s)
- Emilie Andersen-Ranberg
- Copenhagen University, Department of Veterinary Clinical Sciences, Dyrlægevej 16, DK-1870 Frederiksberg C, Denmark
| | - Mette Berendt
- Copenhagen University, Department of Veterinary Clinical Sciences, Dyrlægevej 16, DK-1870 Frederiksberg C, Denmark
| | - Hanne Gredal
- Copenhagen University, Department of Veterinary Clinical Sciences, Dyrlægevej 16, DK-1870 Frederiksberg C, Denmark.
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Portero M, Miró G, Checa R, Martínez de Merlo E, Fragío C, Benito M, Sainz Á, Pérez C. Role of Leishmania infantum in Meningoencephalitis of Unknown Origin in Dogs from a Canine Leishmaniosis Endemic Area. Microorganisms 2021; 9:microorganisms9030571. [PMID: 33802179 PMCID: PMC7998340 DOI: 10.3390/microorganisms9030571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/06/2021] [Accepted: 03/07/2021] [Indexed: 11/17/2022] Open
Abstract
The main hypothesis for the aetiology of meningoencephalitis of unknown origin (MUO) in dogs is an autoimmune or genetic cause that is associated with a triggering event (environmental factors/infectious agents). The aim of this ambispective cohort study was to test for Leishmania infantum infection in the blood and cerebrospinal fluid (CSF) of dogs with MUO in an endemic area of canine leishmaniosis. Dogs with MUO were selected amongst all dogs undergoing blood anti-L. infantum antibody testing (control group). The blood plasma or serum samples from all dogs were analysed for anti- L. infantum antibodies by a quantitative indirect fluorescent assay (IFAT). In dogs with MUO, CSF samples were obtained for analysed by PCR detection of L. infantum DNA. Forty-four percent and 22% of the dogs in the MUO group featured magnetic resonance imaging (MRI) findings and CSF cytology respectively, consistent with L. infantum infection. IFAT, PCR, and histological findings were negative for L. infantum. A significant difference in L. infantum infection prevalence was found between the control and MUO group (p = 0.0022). While it seems unlikely that L. infantum plays a role in the aetiology of MUO, in endemic areas, this pathogen should be included in the differential diagnosis of this neurological disorder.
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Affiliation(s)
- Miriam Portero
- Department of Small Animal Medicine and Surgery, Hospital Clinico Veterinario Complutense, Veterinary Faculty, Universidad Complutense de Madrid, 28040 Madrid, Spain; (E.M.d.M.); (C.F.); (M.B.); (Á.S.); (C.P.)
- Correspondence: (M.P.); (G.M.)
| | - Guadalupe Miró
- Department of Animal Health, Veterinary Faculty, Universidad Complutense de Madrid, 28040 Madrid, Spain;
- Correspondence: (M.P.); (G.M.)
| | - Rocío Checa
- Department of Animal Health, Veterinary Faculty, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Elena Martínez de Merlo
- Department of Small Animal Medicine and Surgery, Hospital Clinico Veterinario Complutense, Veterinary Faculty, Universidad Complutense de Madrid, 28040 Madrid, Spain; (E.M.d.M.); (C.F.); (M.B.); (Á.S.); (C.P.)
| | - Cristina Fragío
- Department of Small Animal Medicine and Surgery, Hospital Clinico Veterinario Complutense, Veterinary Faculty, Universidad Complutense de Madrid, 28040 Madrid, Spain; (E.M.d.M.); (C.F.); (M.B.); (Á.S.); (C.P.)
| | - Miguel Benito
- Department of Small Animal Medicine and Surgery, Hospital Clinico Veterinario Complutense, Veterinary Faculty, Universidad Complutense de Madrid, 28040 Madrid, Spain; (E.M.d.M.); (C.F.); (M.B.); (Á.S.); (C.P.)
| | - Ángel Sainz
- Department of Small Animal Medicine and Surgery, Hospital Clinico Veterinario Complutense, Veterinary Faculty, Universidad Complutense de Madrid, 28040 Madrid, Spain; (E.M.d.M.); (C.F.); (M.B.); (Á.S.); (C.P.)
| | - Carmen Pérez
- Department of Small Animal Medicine and Surgery, Hospital Clinico Veterinario Complutense, Veterinary Faculty, Universidad Complutense de Madrid, 28040 Madrid, Spain; (E.M.d.M.); (C.F.); (M.B.); (Á.S.); (C.P.)
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Rozental AJ, McGrath S, Mooney AP, Hinson SR, McKeon A, Pittock SJ, Gross CC, Tyler KL. Evaluation of cell-based and tissue-based immunofluorescent assays for detection of glial fibrillary acidic protein autoantibodies in the cerebrospinal fluid of dogs with meningoencephalitis of unknown origin and other central nervous system disorders. Am J Vet Res 2021; 82:132-137. [PMID: 33480282 DOI: 10.2460/ajvr.82.2.132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate whether cell-based and tissue-based immunofluorescent assays (IFAs) run in parallel could be used to detect glial fibrillary acidic protein (GFAP) autoantibodies in the CSF of dogs with meningoencephalitis of unknown origin (MUO) and other CNS disorders. ANIMALS 15 CSF samples obtained from dogs with presumed MUO (n = 5), CNS disease other than MUO (5), and idiopathic epilepsy (5). PROCEDURES All CSF samples underwent parallel analysis with a cell-based IFA that targeted the α isoform of human GFAP and a tissue-based IFA that involved mouse brain cryosections. Descriptive data were generated. RESULTS Only 1 CSF sample yielded mildly positive results on the cell-based IFA; that sample was from 1 of the dogs with presumed MUO. The remaining 14 CSF samples tested negative on the cell-based IFA. All 15 CSF samples yielded negative results on the tissue-based IFA. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that concurrent use of a cell-based IFA designed to target the human GFAP-α isoform and a tissue-based IFA that involved mouse tissue cryosections was inadequate for detection of GFAP autoantibodies in canine CSF samples. Given that GFAP autoantibodies were likely present in the CSF samples analyzed, these findings suggested that epitopes differ substantially between canine and human GFAP and that canine GFAP autoantibody does not bind to mouse GFAP. Without a positive control, absence of GFAP autoantibody in this cohort cannot be ruled out. Further research is necessary to develop a noninvasive and sensitive method for diagnosis of MUO in dogs.
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Muñiz Moris L, Cherubini GB, Caine A. Low-Field Magnetic Resonance Imaging Findings in 18 Dogs With Presumed Optic Neuritis. Front Vet Sci 2021; 7:585828. [PMID: 33490127 PMCID: PMC7817917 DOI: 10.3389/fvets.2020.585828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 12/10/2020] [Indexed: 11/23/2022] Open
Abstract
Canine optic neuritis has been attributed to a focal or disseminated form of granulomatous meningoencephalitis (GME) amongst other etiologies. Magnetic resonance imaging (MRI) has been proven to help differentiate the structures within the optic nerve sheath and therefore could aid the diagnosis of optic neuritis in dogs. The objectives of this study were to describe and compare the MRI abnormalities affecting the optic nerve sheath complex and optic chiasm in dogs with clinically suspected optic neuritis as a component of meningoencephalitis of unknown etiology (MUE) or as an isolated form (I-ON). Retrospective evaluation of patient details, clinical signs, cerebrospinal fluid (CSF) analysis, and MRI findings of dogs with clinically suspected optic neuritis between January 2011 and May 2018 was performed. Eighteen dogs met the inclusion criteria. MRI findings included contrast enhancement of both optic nerves (11/18) and optic chiasm (6/18), changes within the CSF volume surrounding the optic nerve (10/18), changes to the optic disc (10/18), changes of size or signal affecting the optic chiasm (10/18), changes in the Short TI inversion recovery (STIR) signal of the optic nerve (7/15), retrobulbar changes (3/18), and concurrent brain lesions (13/18). A variety of subtle MRI features may indicate optic nerve involvement and low-field MRI is a sensitive method to detect changes within the optic nerve sheath complex in dogs with optic neuritis as an isolated form (I-ON) or as an extension of MUE.
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Affiliation(s)
| | | | - Abby Caine
- Dick White Referrals, Cambridgeshire, United Kingdom
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Kang MH, Park HM. Challenges of stem cell therapies in companion animal practice. J Vet Sci 2020; 21:e42. [PMID: 32476316 PMCID: PMC7263915 DOI: 10.4142/jvs.2020.21.e42] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 12/13/2022] Open
Abstract
Regenerative medicine using stem cells from various sources are emerging treatment modality in several refractory diseases in veterinary medicine. It is well-known that stem cells can differentiate into specific cell types, self-renew, and regenerate. In addition, the unique immunomodulatory effects of stem cells have made stem cell transplantation a promising option for treating a wide range of disease and injuries. Recently, the medical demands for companion animals have been rapidly increasing, and certain disease conditions require alternative treatment options. In this review, we focused on stem cell application research in companion animals including experimental models, case reports and clinical trials in dogs and cats. The clinical studies and therapeutic protocols were categorized, evaluated and summarized according to the organ systems involved. The results indicate that evidence for the effectiveness of cell-based treatment in specific diseases or organ systems is not yet conclusive. Nonetheless, stem cell therapy may be a realistic treatment option in the near future, therefore, considerable efforts are needed to find optimized cell sources, cell numbers and delivery methods in order to standardize treatment methods and evaluation processes.
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Affiliation(s)
- Min Hee Kang
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea
| | - Hee Myung Park
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea.
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Farke D, Kolecka M, Czerwik A, Wrzosek M, Schaub S, Kramer M, Failing K, Schmidt MJ. Prevalence of seizures in dogs and cats with idiopathic internal hydrocephalus and seizure prevalence after implantation of a ventriculo-peritoneal shunt. J Vet Intern Med 2020; 34:1986-1992. [PMID: 32918850 PMCID: PMC7517859 DOI: 10.1111/jvim.15890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 08/07/2020] [Accepted: 08/18/2020] [Indexed: 01/30/2023] Open
Abstract
Background Seizures are considered a clinical sign in dogs with internal hydrocephalus but are not found in recent studies. Seizure prevalence due to ventricular enlargement and the prevalence of postoperative seizures in animals is not known. Objectives To determine seizure prevalence in dogs and cats with idiopathic internal hydrocephalus, to identify risk factors for seizure development, and to determine seizure prevalence in a 2‐year period after ventriculo‐peritoneal shunting (VPS). Animals Records and MRIs of 197 animals from 2001 to December 2019 were investigated. A total of 121 animals (98 dogs and 23 cats) were included in the study. Methods A retrospective multicenter case cohort study was conducted. Databases were searched for dogs and cats with internal hydrocephalus. MRI and CSF examinations were evaluated for signs of additional underlying disorders. Prevalence of seizures was estimated for animals showing only hydrocephalus internus. Risk factors were evaluated according to age, morphometric and morphological findings in the brain. All animals that underwent surgery were reexamined 2 years after surgery. Results One hundred twenty‐one animals (98 dogs and 23 cats) with internal hydrocephalus met the inclusion criteria. Seizure prevalence in dogs and cats with internal hydrocephalus was low (1.7%; <5.8% CI 95%). Seizures were not observed in the 2‐year period after surgery. Conclusion and Clinical Importance Seizure prevalence in dogs and cats diagnosed with hydrocephalus internus is low. Seizures in association with VPS do not seem to be a complication of the procedure.
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Affiliation(s)
- Daniela Farke
- Department of Veterinary Clinical Sciences, Small Animal Clinic, Justus-Liebig-University, Giessen, Germany
| | - Malgorzata Kolecka
- Department of Veterinary Clinical Sciences, Small Animal Clinic, Justus-Liebig-University, Giessen, Germany
| | - Adriana Czerwik
- Department of Veterinary Clinical Sciences, Small Animal Clinic, Justus-Liebig-University, Giessen, Germany
| | - Marcin Wrzosek
- Department of Internal Medicine and Clinic for Horses, Dogs and Cats, The Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences, Wrocław, Poland
| | - Sebastian Schaub
- Department of Veterinary Clinical Sciences, Small Animal Clinic, Justus-Liebig-University, Giessen, Germany
| | - Martin Kramer
- Department of Veterinary Clinical Sciences, Small Animal Clinic, Justus-Liebig-University, Giessen, Germany
| | - Klaus Failing
- Unit for Biomathematics and Data Processing, Faculty of Veterinary Medicine, Justus Liebig-University-Giessen, Giessen, Germany
| | - Martin Jürgen Schmidt
- Department of Veterinary Clinical Sciences, Small Animal Clinic, Justus-Liebig-University, Giessen, Germany
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Buhmann G, Wielaender F, Rosati M, Matiasek K, Hartmann K, Fischer A. [Canine meningoencephalitis and meningitis: retrospective analysis of a veterinary hospital population]. TIERAERZTLICHE PRAXIS AUSGABE KLEINTIERE HEIMTIERE 2020; 48:233-244. [PMID: 32823346 DOI: 10.1055/a-1186-8051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Characterization of the etiology of meningoencephalitis and meningitis in dogs through an analysis of a veterinary hospital population. MATERIAL AND METHODS Retrospective study (2011-2016) with evaluation of clinical and diagnostic data of dogs with cerebrospinal fluid (CSF) pleocytosis (> 5/µl). Only dogs with cytological evaluation of CSF or pathological examination of CNS were included. Results of CSF cytology and examination for infectious diseases were reviewed. RESULTS A total of 62 dogs met the inclusion criteria. 14.5 % (n = 9) were classified as reactive CSF pleocytosis due to other structural CNS disease, such as neoplasia or infarct. Meningoencephalitis or meningitis of unknown origin was diagnosed in 56.5 % (n = 35). In 29.0 % (n = 18), investigations for infectious diseases or presence of bacteria in CSF cytology (n = 5) indicated an infectious etiology. This infectious etiology appeared reliable in 6 dogs (9.7 %) based on the examination findings, in 9 dogs (14.5 %), there was only a suspicion of infectious meningoencephalitis or meningitis and in 3 dogs (4.8 %), the findings were of uncertain significance. CONCLUSION The most common cause of CSF pleocytosis was meningoencephalitis or meningitis of unknown origin. Nevertheless, there was evidence of a possible infectious etiology in 29 % of the dogs. For a reliable diagnosis, it is important to assess the CSF cytology and to conduct investigations for infectious diseases. CLINICAL RELEVANCE Meningoencephalitis or meningitis of unknown origin requires immunosuppressive therapy. Therefore, CSF cytology and investigations for infectious diseases are important for an exclusion of infectious meningoencephalitis or meningitis.
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Affiliation(s)
- Gesine Buhmann
- Medizinische Kleintierklinik, Zentrum für Klinische Tiermedizin der Ludwig-Maximilians-Universität München
| | - Franziska Wielaender
- Medizinische Kleintierklinik, Zentrum für Klinische Tiermedizin der Ludwig-Maximilians-Universität München
| | - Marco Rosati
- Sektion für Klinische und Vergleichende Neuropathologie, Zentrum für Klinische Tiermedizin der Ludwig-Maximilians-Universität München
| | - Kaspar Matiasek
- Sektion für Klinische und Vergleichende Neuropathologie, Zentrum für Klinische Tiermedizin der Ludwig-Maximilians-Universität München
| | - Katrin Hartmann
- Medizinische Kleintierklinik, Zentrum für Klinische Tiermedizin der Ludwig-Maximilians-Universität München
| | - Andrea Fischer
- Medizinische Kleintierklinik, Zentrum für Klinische Tiermedizin der Ludwig-Maximilians-Universität München
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Brady SL, Woodward AP, le Chevoir M. Survival time and relapse in dogs with meningoencephalomyelitis of unknown origin treated with prednisolone and ciclosporin: a retrospective study. Aust Vet J 2020; 98:491-498. [PMID: 32794230 DOI: 10.1111/avj.12994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To analyse outcome in dogs with a presumptive diagnosis of meningoencephalomyelitis of unknown origin (MUO) treated with prednisolone and ciclosporin and to assess the effect of a number of patient variables on survival time and rate of relapse. DESIGN Retrospective case series. METHODS Medical records of 40 client-owned dogs with a diagnosis of MUO treated with prednisolone and ciclosporin at one institution between June 2010 and January 2018 were reviewed retrospectively to assess survival times and prognostic indicators for death and/or relapse. The minimum follow-up time was 11 months post-diagnosis. RESULTS Median survival was 1345 days (95% confidence interval: 487-∞). No associations with hazard of death or relapse were detected for the presence of multifocal magnetic resonance imaging (MRI) abnormalities, caudal fossa location of MRI abnormalities, value of cerebrospinal fluid total nucleated cell count or total protein at time of diagnosis, or suspected elevation in intracranial pressure at time of diagnosis. CONCLUSION Protracted survival time may be achieved with a treatment combination of prednisolone and ciclosporin. Suspected elevation in intracranial pressure at the time of diagnosis did not affect long-term outcome in this cohort.
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Affiliation(s)
- S L Brady
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia.,The Queen's Veterinary School Hospital, University of Cambridge, Cambridge, United Kingdom
| | - A P Woodward
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia
| | - Mar le Chevoir
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia.,Veterinary Emergency and Specialty Hospital, Singapore
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Stark AC, McGrath S, Karn M, Thomson CE. Evaluation of cell-free DNA as a diagnostic marker in cerebrospinal fluid of dogs. Am J Vet Res 2020; 81:416-421. [PMID: 32343180 DOI: 10.2460/ajvr.81.5.416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether cell-free DNA (cfDNA) was detectable in CSF samples from dogs, whether CSF sample volume impacted CSF cfDNA concentration measurement, and whether CSF cfDNA concentration was associated with CNS disease category or CSF RBC count (RBCC), nucleated cell count (NCC), or protein concentration, which could aid in the diagnosis of neurologic diseases in dogs. SAMPLE 80 CSF samples collected from dogs with (n = 60) and without (20) clinical neurologic disease between February 2017 and May 2018. PROCEDURES Results for CSF RBCC, NCC, protein concentration, and cfDNA concentration were compared across CSF groups established on the basis of whether they were obtained from dogs with (case groups) or without (control group) clinical signs of neurologic disease In addition, 5 paired CSF samples representing large (3.0-mL) and small (0.5-mL) volumes, were used to evaluate whether sample volume impacted measurement of CSF cfDNA concentration. RESULTS cfDNA was detected in 76 of the 80 (95%) CSF samples used to evaluate parameters across disease categories and in all 5 of the paired samples used to evaluate whether sample volume impacted cfDNA quantification. There were no substantial differences in cfDNA concentrations identified between groups (on the basis of disease category or sample volume), and the CSF cfDNA concentration did not meaningfully correlate with CSF RBCC, NCC, or protein concentration. CONCLUSIONS AND CLINICAL RELEVANCE Although results indicated that the CSF cfDNA concentration could not be used to differentiate between categories of neurologic disease in dogs of the the present study, further investigation is warranted regarding the use of CSF analysis, including sequencing specific cfDNA mutations, for diagnosing and monitoring neurologic disease in dogs.
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Barnes Heller HL, Granick MN, Pinkerton ME, Keuler NS. Case-control study of risk factors for granulomatous meningoencephalomyelitis in dogs. J Am Vet Med Assoc 2020; 254:822-825. [PMID: 30888272 DOI: 10.2460/javma.254.7.822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify environmental and other variables associated with a diagnosis of granulomatous meningoencephalomyelitis (GME) in dogs. DESIGN Case-control study. ANIMALS 31 dogs that received a histologic diagnosis of GME (case dogs) from January 2003 to January 2014 and 91 age- and breed-matched dogs. PROCEDURES Data were obtained from each dog's medical records regarding home address, signalment, body weight, body condition score (BCS), vaccination history, and date of diagnosis (case dogs) or visit (control dogs). Home address data were used to determine the human population density in each dog's geographic region. Seasonal distributions of GME diagnoses in the case group were evaluated for differences. Case and control dogs were compared with respect to the remaining variables. RESULTS For case dogs, no significant difference was identified among seasons in the distribution of GME diagnoses; however, such diagnoses were more common in the spring than in other seasons. No significant differences were identified between case and control dogs in age, body weight, BCS, human population density, season of diagnosis or visit, or time of last vaccination. Although females appeared more likely than males to have a GME diagnosis, this association was not significant and did not change when BCS, time since last vaccination, or human population density was considered. CONCLUSIONS AND CLINICAL RELEVANCE None of the evaluated factors, including investigated environmental triggers, were associated with a GME diagnosis in the dogs of this study. Additional research is warranted involving dogs from a broader geographic area.
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Song JH, Yu DH, Hwang TS, Seung BJ, Sur JH, Kim YJ, Jung DI. Expression of platelet-derived growth factor receptor-α/ß, vascular endothelial growth factor receptor-2, c-Abl, and c-Kit in canine granulomatous meningoencephalitis and necrotizing encephalitis. Vet Med Sci 2020; 6:965-974. [PMID: 32585777 PMCID: PMC7738704 DOI: 10.1002/vms3.314] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/11/2020] [Accepted: 05/27/2020] [Indexed: 01/21/2023] Open
Abstract
Background Given the active research on targeted therapy using tyrosine kinase (TK) inhibitors (TKIs) in the field of oncology, further studies have recently been conducted to evaluate their use in autoimmune disorders. Based on immunological investigations, previous studies have suggested that granulomatous meningoencephalomyelitis (GME) and necrotizing encephalomyelitis (NE) are similar to multiple sclerosis (MS), which is a human autoimmune demyelinating central nervous system disease. Objectives Considering this perspective, we hypothesized that canine GME and NE have significant expression of one or more TKs, which are associated with human MS pathogenesis. Methods To determine the possible use of conventional multi‐targeted TKIs as a treatment for canine GME and NE, we characterized the immunohistochemical expression of platelet‐derived growth factor receptor (PDGFR)‐α, PDGFR‐ß, vascular endothelial growth factor receptor (VEGFR)‐2, c‐Abl and c‐Kit in GME and NE samples. Results Histological samples from four dogs with GME and three with NE were retrieved. All samples stained positive for PDGFR‐ß (7/7 [100%]). PDGFR‐α and c‐Kit were expressed in 3/7 (42.8%) samples each. c‐Abl was identified in 2/7 (28.5%) samples; no sample showed VEGFR‐2 (0%) expression. Co‐expression of TKs was identified in 6/7 (85.7%) dogs. Conclusions All samples were positive for at least one or more of PDGFR‐α, PDGFR‐ß, c‐Kit and c‐Abl, which are known as the target TKs of conventional multi‐targeted TKIs. Their presence does suggest that these TKs may play a role in the pathogenesis of GME and NE. Therefore, multi‐targeted TKIs may provide benefits in the treatment of canine GME and NE by suppressing the activity of these TKs.
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Affiliation(s)
- Joong-Hyun Song
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, Republic of Korea
| | - Do-Hyeon Yu
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, Republic of Korea
| | - Tae-Sung Hwang
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, Republic of Korea
| | - Byung-Joon Seung
- Department of Pathobiology, Small Animal Tumor Diagnostic Center, College of Veterinary Medicine, Konkuk University, Seoul, 05029, Republic of Korea
| | - Jung-Hyang Sur
- Department of Pathobiology, Small Animal Tumor Diagnostic Center, College of Veterinary Medicine, Konkuk University, Seoul, 05029, Republic of Korea
| | - Young Joo Kim
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, CA, 91766-1854, USA
| | - Dong-In Jung
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, Republic of Korea
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Song JH, Yu DH, Lee HC, Hwang TS, Kim YJ, An SJ, Jung DI. Evaluation of treatment with a combination of mycophenolate mofetil and prednisolone in dogs with meningoencephalomyelitis of unknown etiology: a retrospective study of 86 cases (2009-2017). BMC Vet Res 2020; 16:192. [PMID: 32532259 PMCID: PMC7291637 DOI: 10.1186/s12917-020-02414-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Combination therapy with glucocorticoids and adjunctive immunomodulating drugs has been generally accepted as a standard treatment regimen for meningoencephalomyelitis of unknown etiology (MUE). We hypothesized that treatment with MMF as an adjunctive agent along with glucocorticoids would be effective and well-tolerated protocol in dogs with MUE. Eighty-six dogs with MUE between May 2009 and June 2017 were included (59 females and 27 males; mean age of 5.93 years; mean body weight of 3.83 kg). The medical records of dogs with MUE treated with prednisolone and MMF were retrospectively evaluated to determine the therapeutic response, survival time, and treatment-related adverse effects. RESULTS A partial or complete response (CR) was recorded for 75 dogs. The overall median survival time from the initiation of treatment was 558 days. Dogs that showed CR with no relapse over the treatment period (from diagnosis to death) had significantly longer median survival times. A significantly higher mortality hazard ratio of 4.546 was recorded in dogs that failed to achieve CR. The interval between the onset of clinical signs and the clinical presentation was not significantly associated with CR, relapse rate, and survival time. Adverse effects included gastrointestinal upsets in 26 dogs (30.23%), sporadic infections in 17 dogs (19.77%), and pancreatitis in seven dogs (8.14%). CONCLUSIONS The results suggest that adjunctive MMF treatment for MUE is safe and comparable to other immunosuppressive protocols. The treatment should focus on the achievement of CR and preventing relapse for successful management.
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Affiliation(s)
- Joong-Hyun Song
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, South Korea
| | - Do-Hyeon Yu
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, South Korea
| | - Hee-Chun Lee
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, South Korea
| | - Tae-Sung Hwang
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, South Korea
| | - Young Joo Kim
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, California, 91766-1854, USA
| | - Su-Jin An
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, South Korea
| | - Dong-In Jung
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, South Korea.
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Vazquez Fuster IB, Taylor AR, Smith AN, Duran SH, Ravis WR, Jasper SL, Arnold RD. Pharmacokinetics of multivesicular liposomal encapsulated cytarabine when administered subcutaneously in dogs. J Vet Intern Med 2020; 34:1563-1569. [PMID: 32442344 PMCID: PMC7379012 DOI: 10.1111/jvim.15809] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 04/23/2020] [Accepted: 05/06/2020] [Indexed: 01/02/2023] Open
Abstract
Background Prolonged cytotoxic concentrations of cytarabine (CA) are required for maximum cytotoxicity. DepoCyt is a human liposomal cytarabine (LC) product that lasts longer in plasma and CSF compared with free CA (FC). The use of LC has not been evaluated in dogs. Objectives To perform a LC pharmacokinetic (PK) study when administered SC in dogs. Animals Five healthy female beagles. Methods Three‐period, 3‐treatment, nonblinded, randomized, and crossover design, including a pilot study. LC was administered at 50 mg/m2 SC and FC was administered at 25 and 50 mg/m2 SC and IV. Plasma CA concentrations were measured until 240, 72, and 8 hours after SC LC, SC FC, and IV FC administration, respectively. CA plasma concentrations were quantitated by ultra‐high‐performance liquid chromatography with mass spectrometry (MS/MS) detection and concentration‐time profiles were evaluated by noncompartmental analysis. Results Subcutaneous LC administration resulted in a maximum plasma concentration of 26.3 to 59.78 ng/mL, time to reach maximum plasma concentration of 2 hours, area under the concentration‐time curve to last measurable concentration of 669.3 to 1126 h × ng/mL, and plasma bioavailability (%F) of 19.6% to 31.3%. The PK profiles of FC after SC and IV administration differed when compared with LC. Conclusions and Clinical Importance In healthy dogs, SC LC administration at 50 mg/m2 results in measurable plasma CA concentrations, is apparently safe and well tolerated, but does not result in prolonged cytotoxic plasma concentrations. Poor absorption of LC prevented establishment of a complete LC PK profile.
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Affiliation(s)
| | - Amanda R Taylor
- Department of Neurology, MedVet Columbus, Worthington, Ohio, USA
| | - Annette N Smith
- Department of Clinical Sciences, Wilford and Kate Bailey Small Animal Teaching Hospital, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
| | - Sue H Duran
- J.T. Vaughan Large Animal Teaching Hospital, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
| | - William R Ravis
- Harrison School of Pharmacy, Auburn University, Auburn, Alabama, USA
| | - Shanese L Jasper
- Harrison School of Pharmacy, Auburn University, Auburn, Alabama, USA
| | - Robert D Arnold
- Harrison School of Pharmacy, Auburn University, Auburn, Alabama, USA
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Nessler J, Wohlsein P, Junginger J, Hansmann F, Erath J, Söbbeler F, Dziallas P, Tipold A. Meningoencephalomyelitis of Unknown Origin in Cats: A Case Series Describing Clinical and Pathological Findings. Front Vet Sci 2020; 7:291. [PMID: 32671104 PMCID: PMC7326087 DOI: 10.3389/fvets.2020.00291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/29/2020] [Indexed: 12/02/2022] Open
Abstract
Meningoencephalomyelitis of unknown origin (MUO) is an umbrella term describing inflammatory changes of the central nervous system (CNS) with suspected non-infectious etiology. Diagnosis of MUO mostly remains presumed in a clinical setting. Histopathological and immunohistochemical examination of CNS tissue represent additional tools for detection of inflammation and the exclusion of specific infectious agents. While MUO is well-described in canine patients, only little is known about MUO in cats. Previous reports of feline MUO involve either clinical findings or histopathological examination but not both. The present case series is the first report describing both clinical and histopathological findings of feline MUO: Four cats (age: 1.7–17.8 years) showed acute to chronic progressive neurological signs of encephalopathy or myelopathy. Three cats had extraneural signs (hyperthermia, weight loss, hyporexia, leukocytosis). Magnetic resonance imaging (MRI) showed multifocal intraparenchymal lesions in forebrain, brainstem or spinal cord with homogenous contrast enhancement (2/2). Cerebrospinal fluid (CSF) examination was normal or displayed albuminocytologic dissociation. Histopathology revealed a multifocal, lympho-histiocytic meningoencephalitis in three cases and a lympho-histiocytic myelitis in one case. Immunohistochemistry for feline parvovirus, feline coronavirus, feline herpesvirus, tick borne encephalitis virus, Borna disease virus, morbillivirus, rabies virus, suid herpesvirus-1, and Toxoplasma gondii were negative in all cases.
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Affiliation(s)
- Jasmin Nessler
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Foundation, Hanover, Germany
| | - Peter Wohlsein
- Department of Pathology, University of Veterinary Medicine Foundation, Hanover, Germany
| | - Johannes Junginger
- Department of Pathology, University of Veterinary Medicine Foundation, Hanover, Germany
| | - Florian Hansmann
- Department of Pathology, University of Veterinary Medicine Foundation, Hanover, Germany
| | - Johannes Erath
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Foundation, Hanover, Germany
| | - Franz Söbbeler
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Foundation, Hanover, Germany
| | - Peter Dziallas
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Foundation, Hanover, Germany
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Foundation, Hanover, Germany
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Kaczmarska A, José-López R, Czopowicz M, Lazzerini K, Leblond G, Stalin C, Gutierrez-Quintana R. Postencephalitic epilepsy in dogs with meningoencephalitis of unknown origin: Clinical features, risk factors, and long-term outcome. J Vet Intern Med 2020; 34:808-820. [PMID: 31990104 PMCID: PMC7096646 DOI: 10.1111/jvim.15687] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/10/2019] [Indexed: 12/27/2022] Open
Abstract
Background Although the presence of seizures in dogs with meningoencephalitis of unknown origin (MUO) has been associated with shorter survival times, data regarding the prevalence and risk factors for postencephalitic epilepsy (PEE) is lacking. Objectives To describe the clinical features, prevalence, risk factors, and long‐term outcome of PEE in dogs with MUO. Animals Sixty‐one dogs with presumptive diagnosis of MUO based on the clinicopathological and diagnostic imaging findings. Methods Retrospective study. Cases were identified by search of hospital medical records for dogs with suspected or confirmed MUO. Medical records of dogs meeting inclusion criteria were reviewed. Signalment, seizure history, clinicopathologic, and magnetic resonance imaging (MRI) findings were recorded. Results Among 61 dogs at risk of PEE, 14 (23%) dogs developed PEE. Three of 14 dogs with PEE (21%) developed drug‐resistant epilepsy. Dogs with PEE were younger (P = .03; ORadjusted = 0.75; 95% confidence interval [CI], 0.58‐0.98) and had significantly shorter survival times (log‐rank test P = .04) when compared to dogs that did not develop epilepsy. The risk factors associated with the development of PEE were the presence of acute symptomatic seizures (ASS; P = .04; ORadjusted = 4.76; 95% CI, 1.11‐20.4) and MRI lesions in the hippocampus (P = .04; ORadjusted = 4.75; 95% CI, 1.07‐21.0). Conclusions and Clinical Importance Dogs with MUO and seizures at the early stage of the disease (ASS) seem to be at a higher risk of developing PEE.
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Affiliation(s)
- Adriana Kaczmarska
- Small Animal Hospital, School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Roberto José-López
- Small Animal Hospital, School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Michał Czopowicz
- Laboratory of Veterinary Epidemiology and Economics, Faculty of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| | - Kali Lazzerini
- Small Animal Hospital, School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Guillaume Leblond
- Small Animal Hospital, School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Catherine Stalin
- Small Animal Hospital, School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
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Collinet A, Garcia G, Wellehan J, Childress A, Carrera-Justiz S. Investigation of astrovirus and bornavirus in the cerebrospinal fluid of dogs clinically diagnosed with meningoencephalitis of unknown etiology. J Vet Intern Med 2019; 34:232-236. [PMID: 31785029 PMCID: PMC6979266 DOI: 10.1111/jvim.15677] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 11/20/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Non-suppurative encephalitides in a variety of species, including humans and dogs, have been linked to infection by astroviruses and bornaviruses. HYPOTHESIS/OBJECTIVES To determine whether or not ribonucleic acid of astroviruses or bornaviruses was present in the cerebrospinal fluid (CSF) of dogs with clinically diagnosed meningoencephalomyelitis of unknown etiology (MUE). ANIMALS Twenty-five client-owned dogs evaluated by CSF analysis at a single university referral hospital. METHODS Prospective case-control study. Cerebrospinal fluid was collected from clinically diagnosed MUE and control cases and evaluated by reverse-transcriptase polymerase chain reaction for the presence of astrovirus and bornavirus. RESULTS Neither astrovirus nor bornavirus nucleic acids were identified in CSF collected from 20 clinically diagnosed MUE and 5 control cases. CONCLUSIONS AND CLINICAL IMPORTANCE The negative results of this investigation suggest that astrovirus and bornavirus are not commonly detectable in CSF of dogs with MUE.
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Affiliation(s)
- Audrey Collinet
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Gabriel Garcia
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Jim Wellehan
- Department of Comparative Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - April Childress
- Department of Comparative Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Sheila Carrera-Justiz
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
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45
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Posporis C, Beltran E, Dunning M, Espadas I, Gillespie S, Barry AT, Wessmann A. Prognostic Factors for Recovery of Vision in Canine Optic Neuritis of Unknown Etiology: 26 Dogs (2003-2018). Front Vet Sci 2019; 6:415. [PMID: 31824972 PMCID: PMC6882734 DOI: 10.3389/fvets.2019.00415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 11/07/2019] [Indexed: 12/03/2022] Open
Abstract
Optic neuritis (ON) is a recognized condition, yet factors influencing recovery of vision are currently unknown. The purpose of this study was to identify prognostic factors for recovery of vision in canine ON of unknown etiology. Clinical databases of three referral hospitals were searched for dogs with presumptive ON based on clinicopathologic, MRI/CT, and fundoscopic findings. Twenty-six dogs diagnosed with presumptive ON of unknown etiology, isolated (I-ON) and MUE-associated (MUE-ON), were included in the study. Their medical records were reviewed retrospectively, and the association of complete recovery of vision with signalment, clinicopathologic findings, and treatment was investigated. Datasets were tested for normality using the D'Agostino and Shapiro-Wilk tests. Individual datasets were compared using the Chi-squared test, Fisher's exact test, and the Mann-Whitney U-test. For multiple comparisons with parametric datasets, the one-way analysis of variance (ANOVA) was performed, and for non-parametric datasets, the Kruskal-Wallis test was performed to test for independence. For all data, averages are expressed as median with interquartile range and significance set at p < 0.05. Twenty-six dogs met the inclusion criteria. Median follow-up was 230 days (range 21–1901 days, mean 496 days). Six dogs (23%) achieved complete recovery and 20 dogs (77%) incomplete or no recovery of vision. The presence of a reactive pupillary light reflex (p = 0.013), the absence of fundoscopic lesions (p = 0.0006), a younger age (p = 0.038), and a lower cerebrospinal fluid (CSF) total nucleated cell count (TNCC) (p = 0.022) were statistically associated with complete recovery of vision. Dogs with I-ON were significantly younger (p = 0.046) and had lower CSF TNCC (p = 0.030) compared to the MUE-ON group. This study identified prognostic factors that may influence complete recovery of vision in dogs with ON. A larger cohort of dogs is required to determine whether these findings are robust and whether additional parameters aid accurate prognosis for recovery of vision in canine ON.
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Affiliation(s)
| | - Elsa Beltran
- Queen Mother Hospital for Animals, Royal Veterinary College, Hatfield, United Kingdom
| | - Mark Dunning
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, United Kingdom.,Willows Veterinary Centre and Referral Service, Shirley, United Kingdom
| | - Irene Espadas
- Neurology/Neurosurgery Service, Pride Veterinary Centre, Derby, United Kingdom.,Small Animal Teaching Hospital, School of Veterinary Sciences, University of Liverpool, Neston, United Kingdom
| | - Sabrina Gillespie
- Queen Mother Hospital for Animals, Royal Veterinary College, Hatfield, United Kingdom
| | - Amy Teresa Barry
- Queen Mother Hospital for Animals, Royal Veterinary College, Hatfield, United Kingdom
| | - Annette Wessmann
- Neurology/Neurosurgery Service, Pride Veterinary Centre, Derby, United Kingdom
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46
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Portero M, Martínez de Merlo E, Pérez C, Benito M, Daza MA, Fragio C. Cerebrospinal fluid and blood lactate concentrations as prognostic biomarkers in dogs with meningoencephalitis of unknown origin. Vet J 2019; 254:105395. [PMID: 31836169 DOI: 10.1016/j.tvjl.2019.105395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/22/2022]
Abstract
Meningoencephalitis of unknown origin (MUO) is a common inflammatory disease of the central nervous system. Several studies investigated finding prognostic factors, but results are contradictory. The aim of this study was to determine the concentrations of blood lactate (Blood-L) and cerebrospinal fluid lactate (CSF-L) in dogs with MUO for prognostic purposes. A total of 45 dogs with MUO (MUO group) and 11 with idiopathic epilepsy (IE group) were included. In the MUO group, 22 dogs were treated with prednisolone + cytosine arabinoside, 17 with prednisolone ± cyclosporine, and six received no treatment. In the MUO group, there was a strong-moderate positive correlation between Blood-L and CSF-L (ρ = 0.63557; P < 0.0001), a strong-moderate negative correlation between survival and CSF-L (ρ= -0.50210; P < 0.0004), and a weak negative correlation between survival and Blood-L (ρ= -0.35685; P < 0.0220). Dogs with a favourable response to treatment at 1 month had lower initial concentrations of Blood-L and CSF-L (P < 0.0010; P < 0.0037), and those with a worse response had higher values (P < 0.0497; P < 0.0004). Dogs that remained stable with treatment showed lower CSF-L concentrations (P < 0.0013). Dogs with Blood-L>4 mmol/L (P < 0.03) and/or CSF-L> 4 mmol/L (P < 0.009) had lower survival rates with the latter also showing more severe signs, probably indicating severe neuronal damage. These findings suggest that concentrations of CSF-L and Blood-L in dogs with MUO could be used as prognostic indicators.
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Affiliation(s)
- M Portero
- Department of Small Animal Medicine and Surgery, Hospital Clinico Veterinario Complutense, Universidad Complutense, Madrid, Avenida Puerta de Hierro s/n, 28040, Spain.
| | - E Martínez de Merlo
- Department of Small Animal Medicine and Surgery, Hospital Clinico Veterinario Complutense, Universidad Complutense, Madrid, Avenida Puerta de Hierro s/n, 28040, Spain
| | - C Pérez
- Department of Small Animal Medicine and Surgery, Hospital Clinico Veterinario Complutense, Universidad Complutense, Madrid, Avenida Puerta de Hierro s/n, 28040, Spain
| | - M Benito
- Department of Small Animal Medicine and Surgery, Hospital Clinico Veterinario Complutense, Universidad Complutense, Madrid, Avenida Puerta de Hierro s/n, 28040, Spain
| | - M A Daza
- Department of Small Animal Medicine and Surgery, Hospital Clinico Veterinario Complutense, Universidad Complutense, Madrid, Avenida Puerta de Hierro s/n, 28040, Spain
| | - C Fragio
- Department of Small Animal Medicine and Surgery, Hospital Clinico Veterinario Complutense, Universidad Complutense, Madrid, Avenida Puerta de Hierro s/n, 28040, Spain
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47
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Meyerhoff N, Rohn K, Carlson R, Tipold A. Measurement of Neutrophil Gelatinase-Associated Lipocalin Concentration in Canine Cerebrospinal Fluid and Serum and Its Involvement in Neuroinflammation. Front Vet Sci 2019; 6:315. [PMID: 31620456 PMCID: PMC6759468 DOI: 10.3389/fvets.2019.00315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/04/2019] [Indexed: 11/28/2022] Open
Abstract
Neutrophil gelatinase-associated Lipocalin (NGAL) is a glycoprotein involved in inflammation acting as an acute phase protein and chemokine as well as a regulator of iron homeostasis. NGAL has been shown to be upregulated in experimental autoimmune encephalomyelitis (EAE) in mice. Increased NGAL concentration in cerebrospinal fluid (CSF) and expression in central nervous system (CNS) has been described in human neuroinflammatory disease such as multiple sclerosis and neuropsychiatric lupus as well as in bacterial meningitis. We aimed to investigate involvement of NGAL in spontaneous canine neuroinflammation as a potential large animal model for immune- mediated neurological disorders. A commercially available Enzyme-linked Immunosorbent Assay (ELISA) for detection of canine NGAL was validated for use in canine CSF. Concentration in CSF and serum of canine patients suffering from steroid- responsive meningitis- arteriitis (SRMA), Meningoencephalitis of unknown origin (MUO), different non- inflammatory CNS disease and control dogs were compared. Relationship between NGAL concentration in CSF and serum and inflammatory parameters in CSF and blood (IgA concentration, total nucleated cell count (TNCC), protein content) as well as association with erythrocytes in CSF, duration of illness, plasma creatinine and urinary leucocytes were evaluated. In dogs with SRMA and MUO, CSF concentration of NGAL was significantly higher than in dogs with idiopathic epilepsy, compressive myelopathy, intracranial neoplasia and SRMA in remission (p < 0.0001). Patients with acute SRMA had significantly higher levels of NGAL in CSF than neurologically normal controls (p < 0.0001). Serum NGAL concentrations were significantly higher in dogs with SRMA than in patients with myelopathy and intracranial neoplasia (p < 0.0001). NGAL levels in CSF were strongly positively associated with IgA concentration (rSpear= 0.60116, p < 0.0001), TNCC (rSpear= 0.65746, p < 0.0001) and protein content (rSpear= 0.73353, p < 0.0001) in CSF. It can be measured in CSF of healthy and diseased dogs. Higher concentrations in canine patients with SRMA as well as positive association with TNCC in CSF suggest an involvement in pro-inflammatory pathways and chemotaxis in SRMA. High serum levels of NGAL in serum of SRMA patients in different stages of disease might reflect the systemic character of the disease.
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Affiliation(s)
- Nina Meyerhoff
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Karl Rohn
- Institute for Biometry, Epidemiology and Information Processing, University of Veterinary Medicine, Hanover, Germany
| | - Regina Carlson
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hanover, Germany
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48
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Bongartz U, Nessler J, Maiolini A, Stein VM, Tipold A, Bathen-Nöthen A. Vestibular disease in dogs: association between neurological examination, MRI lesion localisation and outcome. J Small Anim Pract 2019; 61:57-63. [PMID: 31515806 DOI: 10.1111/jsap.13070] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/26/2019] [Accepted: 08/19/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To determine whether the neurological examination correctly distinguishes between central and peripheral vestibular lesions in dogs. MATERIALS AND METHODS Retrospective study on dogs with vestibular disease presenting to two referral clinics in Germany. RESULTS Ninety-three dogs were included; neurological examination suggested central vestibular disease in 62 and a peripheral lesion in 31. MRI diagnosis was central vestibular disease in 68 dogs and peripheral in 25. Of the 62 dogs with a lesion localisation diagnosed as central vestibular by neurological exam, 61 were correctly identified (98.4%). Twenty-four of the 31 dogs diagnosed with a peripheral lesion by neurological exam had a consistent lesion on MRI (77.4%). CLINICAL SIGNIFICANCE The neurological examination is efficient at identifying lesions in the central vestibular system but less so for peripheral lesions. Therefore it is prudent to recommend imaging in dogs that show signs of peripheral vestibular syndrome but do not rapidly respond to treatment.
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Affiliation(s)
- U Bongartz
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany.,Veterinary Practice A. Bathen-Nöthen, Hatzfeldstraße 6, 51069, Köln, Germany
| | - J Nessler
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany
| | - A Maiolini
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany
| | - V M Stein
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany
| | - A Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany
| | - A Bathen-Nöthen
- Veterinary Practice A. Bathen-Nöthen, Hatzfeldstraße 6, 51069, Köln, Germany
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49
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Stafford EG, Kortum A, Castel A, Green L, Lau J, Early PJ, Muñana KR, Mariani CL, Yoder JA, Olby NJ. Presence of cerebrospinal fluid antibodies associated with autoimmune encephalitis of humans in dogs with neurologic disease. J Vet Intern Med 2019; 33:2175-2182. [PMID: 31495976 PMCID: PMC6766506 DOI: 10.1111/jvim.15616] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/22/2019] [Indexed: 12/12/2022] Open
Abstract
Background Presumed autoimmune diseases affecting the central nervous system (CNS) of dogs are common. In people, antibodies against neuronal cell surface antigens that are associated with a wide variety of neurological syndromes have been identified. The presence of cerebrospinal fluid (CSF) autoantibodies that target neuronal cell surface proteins has not been reported in dogs with neurologic disorders. Objectives Autoantibodies to neuronal cell surface antigens can be found in the CSF of dogs with inflammatory CNS disease. Our aim was to determine whether 6 neuronal cell surface autoantibodies were present in the CSF of dogs diagnosed with inflammatory and noninflammatory CNS disease. Animals Client‐owned dogs with CNS disease and complete diagnostic evaluation including magnetic resonance imaging and CSF analysis were included. One healthy dog was included as a negative control. Methods Cerebrospinal fluid was tested for 6 antigenic targets with a commercially available indirect immunofluorescence assay test kit. Results There were 32 dogs with neurological disease, 19 diagnosed with inflammatory disease (encephalitis and meningitis), 10 with noninflammatory disease (neoplasia, intervertebral disk disease, degenerative myelopathy, and epilepsy), 2 with no diagnosis, and 1 with neoplasia and meningoencephalitis. Anti‐N‐methyl‐d‐aspartate receptor 1 (NMDAR1) antibodies were detected in 3 dogs (3/32; 9.38%). All 3 dogs responded to treatment of meningoencephalomyelitis of unknown etiology (MUE). Conclusions and Clinical Importance Further evaluation of the prevalence and clinical relevance of CSF and serum antibodies to neuronal cell surface antigens is warranted. Defining antigenic targets associated with encephalitis in dogs might allow diagnostic categorization of MUE antemortem.
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Affiliation(s)
- Emma G Stafford
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina.,Clinical Veterinary Pharmacy, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Amanda Kortum
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Aude Castel
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina.,Department of Small Animal Clinical Sciences, University of Tennessee Veterinary Teaching Hospital, College of Veterinary Medicine, Knoxville, Tennessee
| | - Lauren Green
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina.,Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Jeanie Lau
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina.,Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Peter J Early
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina.,Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Karen R Muñana
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina.,Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Christopher L Mariani
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina.,Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Jeffrey A Yoder
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina.,Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Natasha J Olby
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina.,Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
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50
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Huang Q, Yang H, Liu T, Xu H, Chen B, Liu S, Li W, Long Y, Gao C. Patients with suspected benign tumors and glial fibrillary acidic protein autoantibody: an analysis of five cases. Int J Neurosci 2019; 129:1183-1188. [PMID: 31327295 DOI: 10.1080/00207454.2019.1645140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aim: To investigate the clinical features of five glial fibrillary acidic protein (GFAP) antibody positive patients with suspected benign tumors and explore its underlying pathogenesis. Materials and methods: Overall, 1018 serum and cerebrospinal fluid (CSF) samples were tested by indirect immunofluorescence assay and data from five patients with suspected tumors and positive for GFAP autoantibody in the CSF were analyzed retrospectively. Results: The positive rate of GFAP antibody in the serum and CSF was 3.93% by indirect immunofluorescence assay. Tumors were diagnosed before or after neurologic onset in 5 of 40 patients (12.5%) and no deterioration of the tumors was found during the long-term follow-up. Of the five patients, one patient suffered a thyroid nodule, one patient had a small nodule in the left lung, two patients suffered meningiomas, and one patient had a suspicious eosinophilic granuloma. Conclusion: GFAP autoimmunity may be a paraneoplastic immune response with a low frequency of tumor in Chinese patients with GFAP astrocytopathy.
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Affiliation(s)
- Qingmei Huang
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong Province , China.,Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong Province , China
| | - Huacai Yang
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong Province , China.,Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong Province , China
| | - Tianni Liu
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong Province , China.,Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong Province , China
| | - Huiming Xu
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong Province , China.,Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong Province , China
| | - Baikeng Chen
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong Province , China.,Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong Province , China
| | - Si Liu
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong Province , China.,Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong Province , China
| | - Wenfeng Li
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong Province , China.,Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong Province , China
| | - Youming Long
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong Province , China.,Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong Province , China
| | - Cong Gao
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong Province , China.,Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong Province , China
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