Clinical and Histopathologic Characterization of Canine Chronic Ulcerative Stomatitis

Medical Management of Canine Chronic Ulcerative Stomatitis Using Cyclosporine and Metronidazole

Canine chronic ulcerative stomatitis (CCUS) is a spontaneously occurring, painful, and often debilitating condition of the oral cavity, with a suspected immune-mediated component. The response to pharmacological treatment is generally poor, thus the need to identify more effective medical therapies for this condition. This article describes a prospective clinical trial that was designed to evaluate the efficiency of a combination of cyclosporine and metronidazole in managing CCUS. The hypothesis was that a combination of cyclosporine and metronidazole would effectively minimize clinical signs associated with CCUS. Ten client-owned dogs with a biopsy-confirmed diagnosis consistent with CCUS were prescribed cyclosporine (5 mg/kg) for 1 week, followed by the addition of metronidazole (15-20 mg/kg), both administered orally once daily. The cyclosporine dosage interval was lengthened over time. Dogs were observed for a 6-month period and evaluated using a 32-point Canine Ulcerative Stomatitis Disease Activity Index (CUSDAI). Regular cyclosporine therapeutic drug monitoring was also conducted by the measurement of whole blood cyclosporine levels and the pharmacodynamic assessment of the T-cell expression of IL-2. The results demonstrated that a combination of cyclosporine and metronidazole was effective in minimizing the clinical signs of CCUS and in reducing CUSDAI scores. Neither blood cyclosporine levels nor the T-cell expression of IL-2 predicted improvement in clinical signs and CUSDAI scores, although there was a correlation between blood drug concentrations and the suppression of T-cell IL-2 expression. The evaluation of clinical signs and CUSDAI scores appears to be the most effective means of assessing response to therapy, and therapeutic drug level monitoring does not appear to be routinely indicated.

Lesions of the oral cavity of dogs: 720 cases

ABSTRACT: Seven hundred twenty cases of oral cavity lesions in dogs were diagnosed from 2015 to 2020 in Distrito Federal, Brazil. Four hundred thirty-two (60%) lesions were neoplastic, and 288 (40%) were non-neoplastic. Of the neoplasms, 229 (53%) were considered malignant and 203 (47%) benign, affecting mainly males, of 43 different breeds, with an average age of 9.4 years, mainly the gum and lip. Melanoma was the most (96/432, 22.2%) commonly diagnosed neoplasm, followed by peripheral odontogenic fibroma (68/432, 15.7%), papilloma (63/432, 14.5%) and squamous cell carcinoma (SCC) (56/432, 12.9%). Non-neoplastic lesions also affected males predominantly, from 41 different breeds, with an average age of 8.9 years, mainly in the gums, lip, and tongue. These lesions were diagnosed as inflammatory (230/288, 79.8%), hyperplastic (47/288, 16.3%) and other lesions (11/288, 3.8%).

Histopathological Results of Mouth Lesions in Dogs and Cats from Colombia

Mouth-related neoplastic and non-neoplastic lesions are commonly found in dogs and cats, and their diagnosis and classification are important for treatment planning and prognosis. This retrospective study analyzed mouth-related lesions in dogs and cats between 2000-2019 from the animal pathology laboratory of the Universidad de Antioquia, Medellín, Colombia. A total of 640 mouth-related lesions affecting 572 dogs (89.4%) and 68 cats (10.6%) were reviewed. Lesions were classified as neoplastic or non-neoplastic. The average age for neoplastic lesions was 8.6 years in dogs and 6.4 years in cats, while for non-neoplastic lesions the average age was 7.7 years for dogs and 5 years for cats. Data was analyzed using descriptive statistical methods according to year and source of report, demographic information for the animal, location of the lesion, and diagnosis. Tissue origin and behavior were variables considered for neoplastic lesions. Melanoma was the most common neoplasia in dogs and squamous cell carcinoma was most common in cats. The most frequent non-neoplastic lesion in dogs was gingival hyperplasia, while in cats the inflammatory lesions showed a wide range of morphological diagnoses. This study described many pathological lesions affecting the oral cavity for both dogs and cats and provides useful epidemiological data for both pathologists and clinicians.

Management of Severe Oral Inflammatory Conditions in Dogs and Cats

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

Immunopathogenesis of canine chronic ulcerative stomatitis

Canine Chronic Ulcerative Stomatitis is a spontaneously occurring inflammatory disease of the oral mucosa. An immune-mediated pathogenesis is suspected though not yet proven. We have recently reported on the clinical and histologic features, and identification of select leukocyte cell populations within the lesion. A clinical and histologic similarity to oral lichen planus of people was proposed. In the present study, these initial observations are extended by examining lesions from 24 dogs with clinical evidence of chronic ulcerative stomatitis. Because dogs with chronic ulcerative stomatitis often have concurrent periodontal disease, we wondered if dental plaque/biofilm may be a common instigator of inflammation in both lesions. We hypothesized that dogs with chronic ulcerative stomatitis would exhibit a spectrum of pathologic changes and phenotype of infiltrating leukocytes that would inform lesion pathogenesis and that these changes would differ from inflammatory phenotypes in periodontitis. Previously we identified chronic ulcerative stomatitis lesions to be rich in FoxP3+ and IL17+ cells. As such, we suspect that these leukocytes play an important role in lesion pathogenesis. The current study confirms the presence of moderate to large numbers of FoxP3+ T cells and IL17+ cells in all ulcerative stomatitis lesions using confocal immunofluorescence. Interestingly, the majority of IL17+ cells were determined to be non-T cells and IL17+ cell frequencies were negatively correlated with severity on the clinical scoring system. Three histologic subtypes of ulcerative stomatitis were determined; lichenoid, deep stomatitis and granulomatous. Periodontitis lesions, like stomatitis lesions, were B cell and plasma cell rich, but otherwise differed from the stomatitis lesions. Direct immunofluorescence results did not support an autoantibody-mediated autoimmune disease process. This investigation contributes to the body of literature regarding leukocyte involvement in canine idiopathic inflammatory disease pathogenesis.