Emphysematous pyonephrosis associated with extrahepatic portosystemic shunt in a dog

Clinical features, outcome, and illness severity scoring in 32 dogs with urosepsis (2017-2018)

OBJECTIVE

To describe the clinical features, outcome, and utility of illness severity scoring in dogs diagnosed with urosepsis.

DESIGN

Retrospective study (2017-2018).

SETTING

University teaching hospital.

ANIMALS

Thirty-two dogs diagnosed with urosepsis secondary to pyometra, prostatitis, or pyelonephritis.

INTERVENTIONS

 None.

MEASUREMENTS AND MAIN RESULTS

Urosepsis was identified in 32 dogs, consisting of 9 of 32 (28.1%) with pyometra, 7 of 32 (21.8%) with prostatitis, and 16 of 32 (50%) with pyelonephritis. In total, 28 (87.5%) dogs survived to discharge, with the following group-specific survival rates: pyometra, 9 of 9 (100%); prostatitis, 5 of 7 (71.4%); and pyelonephritis, 14 of 16 (87.5%). Positive bacterial cultures were obtained in 27 of 32 (84.1%) dogs. The most commonly implicated pathogens were Escherichia coli (14/37 [37.8%]), Klebsiella pneumoniae (8/37 [21.6%]), and Staphylococcus pseudintermedius (6/37 [16.2%]). Multiple organ dysfunction syndrome (MODS) was identified in 21 of 32 dogs (65.6%). Although the presence of MODS was not different between survivors and nonsurvivors (P = 0.6), nonsurvivors had more dysfunctional organs (P = 0.04). Nonsurvivors also had higher Acute Patient Physiology and Laboratory Evaluation (APPLE_FAST ) scores compared to survivors (P = 0.01).

CONCLUSIONS

Survival of dogs with urosepsis was good and may be higher than for other sources of sepsis. Compared to survivors, nonsurvivors had more dysfunctional organs and higher illness severity scores, which may be helpful in the assessment and management of dogs with urosepsis.

Emphysematous cystitis: review of current literature, diagnosis and management challenges

Emphysematous cystitis (EC) is a rare disease in human as well as in veterinary medicine; in both it is defined as an uncommon form of complicated urinary tract infection (UTI), characterized by the presence of gas within the bladder wall and lumen. While female dogs are at increased risk of developing an UTI, patients with EC are not subject to gender or age predisposition and may present with variable clinical manifestations. Diabetes mellitus (DM) appears as the most common risk factor for the development of EC, but many other underlying conditions have been mentioned in literature and should be taken into consideration. In case of EC, Escherichia coli appears to be the most common pathogen isolated from urine cultures. A conclusive diagnosis of EC requires necessarily the recourse to imaging methods, such as abdominal radiography and ultrasonography. An early diagnosis and appropriate medical therapy, consisting in protracted antibiotic treatment associated with control over underlying diseases, could lead to avoid surgical intervention.

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