Fluctuation of Clinical Signs With Near-Syncopal Episodes in a Dog With Gliomatosis Cerebri: A Diagnostic Challenge

Here we report on an EHV-1 outbreak investigation caused by a novel genotype H752 (histidine in amino acid position 752 of the ORF 30 gene). The outbreak involved 31 performance horses. Horses were monitored over a period of 35 days for clinical signs, therapeutic outcome and qPCR results of EHV-1 in blood and nasal secretions. The morbidity of the EHV-1 outbreak was 84% with 26 clinically infected horses displaying fever and less frequently anorexia and distal limb edema. Four horses showed mild transient neurological deficits. Clinically diseased horses experienced high viral load of EHV-1 in blood and/or nasal secretions via qPCR, while subclinically infected horses had detectable EHV-1 mainly in nasal secretions. The majority of infected horses showed a rise in antibody titers to EHV-1 during the outbreak. All 31 horses were treated with valacyclovir, while clinically infected horses further received flunixin meglumine and sodium heparin. This investigation highlights various relevant aspects of an EHV-1 outbreak caused by a new H752 genotype: (i) importance of early detection of EHV-1 infection; (ii) diagnostic challenge to assess H752 genotype; (iii) apparent benefit of valacyclovir use in the early stage of the outbreak; and (iv) weekly testing of blood and nasal secretions by qPCR in order to monitor individual infection status and lift quarantine.

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Granulomatous panuveitis associated with Hodgkin lymphoma: A case report with review of the literature

European Journal of Ophthalmology ◽

10.1177/1120672120969036 ◽

2020 ◽

pp. 112067212096903

Author(s):

Abdulaziz A Alshamrani ◽

Waleed K Alsarhani ◽

Abdulrahman A Aljasser ◽

Marcos J Rubio-Caso

Keyword(s):

Case Report ◽

Hodgkin Lymphoma ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Clinical Signs ◽

Cervical Lymphadenopathy ◽

Intraocular Lymphoma ◽

Review Of The Literature ◽

Diagnostic Challenge ◽

Non Hodgkin Lymphoma

Background: Intraocular lymphoma (IOL) is an uncommon ophthalmic malignancy and poses a diagnostic challenge. Uveitis associated with systemic lymphoma (USL) has been predominantly attributed to non-Hodgkin lymphoma (NHL) and rarely reported with Hodgkin lymphoma (HL) in the literature. Methods: Case report with review of the literature. Results: A 25-year-old healthy male presented with bilateral granulomatous panuveitis including vasculitis and discrete chorioretinal yellowish-white lesions. Macular optical coherence tomography (OCT) of both eyes revealed a disruption of ellipsoid and interdigitation zones over the areas of subretinal lesions as well as a small sub-retinal pigment epithelium (RPE) deposit in one eye. Thorough uveitis workup revealed clavicular, axillary and cervical lymphadenopathy, and biopsy of lymph nodes confirmed the diagnosis of nodular lymphocyte-predominant (NLP) HL. Six months later and after receiving chemotherapy, all symptoms and most of clinical signs resolved. Conclusions: Clinical features of USL do not differ between HL and NHL. However, the age of presentation may be much younger in HL. Ocular manifestations can precede systemic HL diagnosis, as shown in our patient. Therefore, USL should be part of the differential diagnosis of panuveitis. Paraneoplastic inflammation is thought be the cause of uveitis associated with HL. The sub-RPE deposit and disruption of ellipsoid and interdigitation zones on OCT have not been documented before as a manifestation of uveitis secondary to HL. In addition, the NLP subtype of HL was reported in only 1 case with uveitis in the literature.

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Evaluation of Tryptic Podocin Peptide in Urine Sediment Using LC-MS-MRM Method as a Potential Biomarker of Glomerular Injury in Dogs with Clinical Signs of Renal and Cardiac Disorders

Molecules ◽

10.3390/molecules24173088 ◽

2019 ◽

Vol 24 (17) ◽

pp. 3088 ◽

Cited By ~ 3

Author(s):

Barbara Szczepankiewicz ◽

Remigiusz Bąchor ◽

Robert Pasławski ◽

Natalia Siwińska ◽

Urszula Pasławska ◽

...

Keyword(s):

Clinical Signs ◽

Cardiorenal Syndrome ◽

Specific Protein ◽

Glomerular Injury ◽

Model Peptide ◽

Diagnostic Challenge ◽

Urine Sediment ◽

Heart Insufficiency ◽

Potential Biomarker ◽

Potential Applicability

The early asymptomatic stage of glomerular injury is a diagnostic challenge in the course of renal and extra-renal disease, e.g., heart insufficiency. It was found that podocin, a podocyte-specific protein present in the urine, may serve as a biomarker in the diagnosis of glomerular disease in humans and animals including glomerulonephritis, glomerulosclerosis, amyloidosis, or nephropathy. Therefore, there is a need of development of the sensitive and straightforward method of urinary podocin identification. In this work, we report our extended research under the glomerular injury investigation in dogs by application of clinical examination and LC-MS-MRM method in the identification of canine podocin in urine samples. The LC-MS-MRM method is based on the identification of podocin tryptic peptide with the 218H-AAEILAATPAAVQLR-OH232 sequence. The model peptide was characterized by the highest ionization efficiency of all the proposed model podocin tryptic peptides in a canine urine sediment according to the LC-MS/MS analysis. The obtained results revealed the presence of the model peptide in 40.9% of dogs with MMVD (active glomerular injury secondary to heart disease = cardiorenal syndrome-CRS) and 33.3% dogs with chronic kidney disease. The potential applicability of the developed methodology in the analysis of podocin in canine urine sediments was confirmed.

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Early detection and treatment for bovine respiratory disease

Livestock ◽

10.12968/live.2020.25.6.254 ◽

2020 ◽

Vol 25 (6) ◽

pp. 254-260

Author(s):

Tim Potter

Keyword(s):

Respiratory Disease ◽

Bovine Respiratory Disease ◽

Clinical Signs ◽

Scoring Systems ◽

Diagnostic Challenge ◽

Risk Of Mortality ◽

Increased Risk ◽

Costs Of Treatment ◽

Anti Inflammatory ◽

On Farm

Bovine respiratory disease (BRD) is a complex syndrome that can cause significant economic impact on farm through the immediate costs of treatment as well as long-term production losses, and increased risk of mortality or premature departure from the herd. The clinical signs and pathology are due in part to the host's response to inflammatory mediators that are produced in reaction to the presence of the pathogens. Variation in individual animals' responses to the sepsis associated with BRD result in the spectrum of clinical signs and disease severity observed on farm. The variation in clinical picture presents a diagnostic challenge for farmers and can negatively impact disease detection. The use of objective scoring systems for BRD can facilitate the detection and provide a means of monitoring disease at a herd or group level. While antimicrobials remain the mainstay of BRD treatment on farm, the use of a non-steroidal anti-inflammatory drugs (NSAID) alongside them has become commonplace, with the aim of promoting more rapid recovery via their analgesic, anti-inflammatory and antipyretic actions.

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Diagnostic features in 10 naturally occurring cases of acute fatal canine leptospirosis

Journal of Veterinary Diagnostic Investigation ◽

10.1177/1040638714553293 ◽

2014 ◽

Vol 26 (6) ◽

pp. 799-804 ◽

Cited By ~ 6

Author(s):

Daniel R. Rissi ◽

Cathy A. Brown

Keyword(s):

Single Cell ◽

Immunohistochemical Staining ◽

Fluorescent Antibody ◽

Clinical Signs ◽

Antibody Test ◽

Cell Necrosis ◽

Antibody Testing ◽

Diagnostic Challenge ◽

Diagnostic Features ◽

Multiple Organs

The current report describes the diagnostic features in 10 cases of acute fatal canine leptospirosis with minimal renal and hepatic changes that may present a diagnostic challenge for the pathologist. Most affected dogs were less than 6 months of age and had a biochemical profile consistent with hepatorenal dysfunction. Clinical signs consisted of vomiting, depression, icterus, dehydration, diarrhea, and anorexia. All dogs died or were humanely euthanized within 3–7 days after the onset of clinical disease. Necropsy findings included pulmonary edema with hemorrhages, icterus, renal and hepatic pallor and swelling, and gastric edema with hemorrhage. Despite severe azotemia, histological changes in the kidneys were subtle in all dogs, and included mild renal tubular simplification, with single-cell necrosis and attenuation, along with minimal interstitial lymphoplasmacytic inflammation, edema, and hemorrhage. Hepatic lesions included scattered hepatocellular single-cell necrosis and hepatocellular dissociation. Prominent extrarenal lesions typically associated with uremia including vascular fibrinoid necrosis in multiple organs, pulmonary mineralization with occasional fibrinosuppurative exudation, and gastric mineralization were also present. Postmortem diagnostic confirmation was based on the detection of leptospiral antigen on fresh renal samples by fluorescent antibody test and on the demonstration of intact spirochetes in sections of kidneys using immunohistochemical staining. Acute fatal canine leptospirosis occurred as a fulminant hepatorenal disease affecting mainly young dogs, and the diagnosis was dependent on the recognition of the subtle renal changes with confirmation via fluorescent antibody testing or immunohistochemical staining.

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Bovine Babesiosis Diagnosed in Formalin-Fixed, Paraffin-Embedded Tissues by Using In Situ Hybridization

Veterinary Pathology ◽

10.1177/0300985820948816 ◽

2020 ◽

Vol 57 (6) ◽

pp. 812-820 ◽

Cited By ~ 1

Author(s):

Kirsten Hülskötter ◽

Vanessa M. Pfankuche ◽

Lydia van Dyck ◽

Martin Höltershinken ◽

Andrea Springer ◽

...

Keyword(s):

In Situ Hybridization ◽

Clinical Signs ◽

Economic Damage ◽

Bovine Babesiosis ◽

Diagnostic Challenge ◽

Postmortem Diagnosis ◽

Formalin Fixed Paraffin ◽

Formalin Fixed Paraffin Embedded ◽

Formalin Fixed

Bovine babesiosis, caused by Babesia divergens, is in general a rare disease in Europe. Nonetheless, local outbreaks can cause severe economic damage, and postmortem identification represents a diagnostic challenge. During a recent outbreak in May 2018 in northern Germany, 21 animals of a herd of 150 cattle died within 40 days having had clinical signs of fever and hemoglobinuria. Gross examination of 4 of the 21 deceased animals revealed a tick infestation, jaundice, and dark brown staining of urine and kidneys. Histologically, there were iron-positive deposits, hyperplasia of the red pulp of the spleen, and centrilobular necrosis of hepatocytes. In several locations, small basophilic granules suggestive of intraerythrocytic parasites were visible in hematoxylin-eosin- and Giemsa-stained sections. Peripheral blood smears from a living cow from the herd and polymerase chain reaction (PCR) of feeding ticks revealed B. divergens infection. In situ hybridization (ISH) was applied on formalin-fixed, paraffin-embedded (FFPE) tissue of the necropsied cattle to confirm babesiosis in these animals postmortem. Digoxigenin-labeled DNA probes were generated based on a specific nucleotide sequence for B. divergens, obtained by PCR and sequencing of DNA isolates from infected Ixodes ricinus ticks from deceased cattle. ISH using these probes allowed postmortem diagnosis of B. divergens infection in routinely fixed FFPE tissues.

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Acute binocular diplopia: peripheral or central?

Journal of Neurology ◽

10.1007/s00415-020-10088-y ◽

2020 ◽

Vol 267 (S1) ◽

pp. 136-142

Author(s):

Olympia Kremmyda ◽

Claudia Frenzel ◽

Katharina Hüfner ◽

Nicolina Goldschagg ◽

Christian Brem ◽

...

Keyword(s):

Emergency Department ◽

Motor Nerve ◽

Clinical Signs ◽

Signs And Symptoms ◽

Screen Test ◽

Ocular Motor ◽

Diagnostic Challenge ◽

Ocular Motor Disorders ◽

Visual Vertical ◽

Binocular Diplopia

Abstract Objectives Acute diplopia is a diagnostic challenge for clinicians, in particular in the emergency department. The most common cause of acute diplopia are ocular motor nerve palsies (OMP). In this prospective study, we focused on identifying the most crucial signs and symptoms for differentiating between peripheral and central OMP. Methods We prospectively evaluated 56 non-consecutive patients who presented at our emergency department with acute binocular diplopia (≤ 10 days). The patient history was taken using a standardized questionnaire and patients underwent a neurological, neuro-ophthalmological and neuro-otological examination, including measurement of the subjective visual vertical (SVV), Harms tangent screen test, and cranial MRI. Results Forty-six out of 56 patients were diagnosed with an ocular motor cranial nerve palsy (OMP), 21 of peripheral and 23 of central origin; in two patients, the etiology remained unknown. The following features were different in peripheral and central OMP: (1) the presence of vertigo/dizziness was more frequent in central (43.5%) than in peripheral (9.5%) OMP. (2) Central ocular motor signs, such as saccadic smooth pursuit, additional internuclear ophthalmoplegia, skew deviation, and saccade palsies, were also found more frequently in the central than in the peripheral group (86.7% vs. 33.3%). (3) Further, a pathological SVV deviation by monocular testing of the non-affected eye was also more common in central (77.3%) than in peripheral OMP (38.9%). The presence of all three factors has a positive predictive value of 100% (CI 50–100%) for the presence of a central lesion. Conclusions In acute diplopia due to central OMP, the most important accompanying symptom is vertigo/dizziness, and the most important clinical signs are central ocular motor disorders (which require examination of the non-paretic eye) and an SVV deviation in the non-paretic eye.

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Feline glioma: a retrospective study and review of the literature

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x16689506 ◽

2017 ◽

Vol 19 (12) ◽

pp. 1307-1314 ◽

Cited By ~ 10

Author(s):

Daniel R Rissi ◽

Andrew D Miller

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Clinical Signs ◽

Case Series ◽

Final Diagnosis ◽

Gliomatosis Cerebri ◽

Acute Onset ◽

World Health ◽

Diagnostic Features ◽

Central Nervous System Neoplasms

Case series summary This study aimed to evaluate the pathologic and diagnostic features of 13 cases of feline glioma diagnosed at two veterinary diagnostic institutions over 16 years. A retrospective search was conducted using the laboratory information system. Selected cases were reviewed, tumors were classified according to the 2007 World Health Organization Classification of Tumours of the Central Nervous System, and tissue sections were submitted to an immunohistochemistry panel for further characterization. Affected cats were adults (average age 8 years), and male neutered (9/13) domestic shorthair cats (12/13) were over-represented. Clinical signs had acute onset and were progressive, lasting from 1–60 days (average course 20.7 days). Euthanasia was elected in all but one case, owing to a poor prognosis or because of a suspicion of rabies. Tumors occurred in the telencephalon (8/13), spinal cord (3/13) and brainstem (2/13). Gross changes in seven cases consisted of well- or poorly demarcated, gray-to-brown, soft, gelatinous masses that often caused secondary changes to the brain. The final diagnosis and classification were made based on histopathology and immunohistochemistry. Diagnoses consisted of oligodendroglioma (six cases), anaplastic astrocytoma (two cases), oligoastrocytoma, anaplastic ependymoma, gliomatosis cerebri, glioblastoma and anaplastic oligodendroglioma (one case each). Relevance and novel information This article confirms the need for a full neurologic and neuropathologic examination in cats with clinical neurologic disease. In addition, it highlights and proposes a complete routine immunohistochemical panel for diagnostic confirmation and differentiation between glioma and other morphologically similar central nervous system neoplasms in cats.

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Osteoid Osteoma of the Distal Humerus Mimicking Sequela of Pediatric Supracondylar Fracture: Arthroscopic Resection—Case Report and A Literature Review

Case Reports in Medicine ◽

10.1155/2013/247328 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Jordi Font Segura ◽

Sergi Barrera-Ochoa ◽

Albert Gargallo-Margarit ◽

Eva Correa-Vázquez ◽

Anna Isart-Torruella ◽

...

Keyword(s):

Osteoid Osteoma ◽

Confounding Factor ◽

Clinical Signs ◽

Distal Humerus ◽

Supracondylar Fracture ◽

Lower Limbs ◽

Long Bones ◽

Diagnostic Challenge ◽

Difficult Diagnosis ◽

Uncommon Location

Osteoid osteoma (OO) is a small and painful benign osteoblastic tumour located preferentially in the shaft of long bones near the metaphyseal junctions, with a predilection for the lower limbs. Juxta- and intra-articular OOs are rare and even though hip, elbow, and talus are the most commonly reported locations, they may be found in any joint accounting for approximately 13% of all osteoid osteomas. There is usually a significant time delay between symptom initiation and diagnosis when the lesion is present in an uncommon location due to the diagnostic challenge it presents due to the lack of classical clinical signs and/or radiographic features found in the extra-articular lesions. A case of a distal humerus OO of a 15-year-old girl is presented to point out that a confounding factor, such as a previous paediatric supracondylar fracture, may further delay the already difficult diagnosis of a juxta- or intra-articular osteoid osteoma and also to emphasize the possibility of arthroscopic treatment of such lesions.

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A Stratified Approach for Cushing’s Syndrome Diagnosis

Global Journal of Health Science ◽

10.5539/gjhs.v11n10p55 ◽

2019 ◽

Vol 11 (10) ◽

pp. 55

Author(s):

Mervin Chavez ◽

Joselyn Rojas ◽

Miguel Aguirre ◽

Marjorie Villalobos ◽

Juan Salazar ◽

...

Keyword(s):

Clinical Presentation ◽

Clinical Signs ◽

Signs And Symptoms ◽

Proximal Muscle ◽

Diagnostic Challenge ◽

Adequate Treatment ◽

Primary Origin ◽

Cutaneous Atrophy ◽

Buffalo Hump

Cushing’s syndrome is an endocrine disorder broadly renowned as a diagnostic challenge. From the initial clinical presentation up to the identification of the underlying etiology, it is necessary to adhere to a logical and stratified plan of action, directed to the correlation of signs and symptoms to the physiopathology of the syndrome, in order to accurately establish a diagnosis and adequate treatment. From stages as early as the patient’s first clinical evaluation, the physician should be specially attentive of a constellation of clinical signs which strongly suggest the diagnosis of Cushing’s syndrome, such as the presence of a “moon face”, a “buffalo hump”, cutaneous atrophy, proximal muscle weakness and purplish cutaneous striae, among others. Based off these findings, laboratory analyses are necessary for the detection of hypercortisolism. According to these results, and if physiologic causes are ruled out, pathologic hypercortisolism is confirmed. Lastly, a complex array of diagnostic tests must be navigated to identify the primary origin of the disorder. Thus, the diagnosis of Cushing’s syndrome requires a logically structured algorithm of action, constructed off its pathophysiologic implications, in order to optimize time, resources and the interdisciplinary workgroup required for its consecution, and offer patients the possibility of a better quality of life. It is also important to highlight the need for a stratified approach in patients with metabolic disturbance given that medical professionals may simply treat the patient for obesity not recognizing the presence of the complicating condition Cushing’s syndrome.

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