Clinical features, treatment and outcome of discospondylitis in cats

Objectives There is a paucity of information on feline discospondylitis. This study aimed to describe the signalment, clinical and laboratory findings, aetiological agents, treatment and outcome in cats affected by discospondylitis. Methods This was a retrospective review of the medical records of cats diagnosed with discospondylitis at four referral institutions. Results A total of 17 cats were identified. Most were domestic shorthair cats (76.5%) and male (58.8%), with a median age of 9 years (range 0.9–14) and a median duration of clinical signs of 3 weeks (range 0.3–16). All cats presented with spinal hyperaesthesia; 3/17 had pyrexia. Neurological dysfunction was found in 64.7% of cats, which was indicative of a T3–L3 or L4–S2 spinal segment, associated nerve root or associated nerve neurolocalisation. Haematology, serum biochemistry and urinalysis revealed occasional inconsistent non-specific changes. All cats underwent urine culture; 9/17 cats also had a distinct tissue cultured. Positive bacterial cultures were obtained in two cats (11.8%) for Staphylococcus species (urine, blood and intradiscal fine-needle aspirate) and Escherichia coli (urine); both presented with multifocal discospondylitis. Treatment was non-surgical in all cats, with sustained antibiotic therapy for a median of 3 months (range 1–9). Analgesia provided included non-steroidal anti-inflammatory drugs, alone or in combination with gabapentin. Restricted exercise was advised for a minimum of 4 weeks. Outcome information available in 12 cats was excellent in terms of pain control and neurological function in 10 cats (83.3%) at the time of stopping antibiotics. Recurrence occurred in one case, which had received a single antibiotic for 6 weeks, and relapsed 4 months after presentation. One other case failed to improve and was euthanased during the course of hospitalisation. Conclusions and relevance Feline discospondylitis is uncommon and no obvious signalment predisposition was found in this study. Spinal hyperaesthesia was universally present, with neurological dysfunction also highly prevalent. Bacterial culture was unrewarding in most cases. Amoxicillin–clavulanic acid or cephalosporins are reasonable choices for first-line antibiotics. Prognosis was favourable, with no long-term evidence of recurrence in cats on sustained antibiotic therapy, for a mean duration of 3 months.

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Brain Abscess Caused by Nocardia: Case Report and Literature Review

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0040-1719124 ◽

2020 ◽

Author(s):

Guilherme Finger ◽

Maria Eduarda Conte Gripa ◽

Tiago Paczko Bozko Cecchini ◽

Tobias Ludwig do Nascimento

Keyword(s):

Case Report ◽

Antibiotic Therapy ◽

Brain Abscess ◽

Clinical Signs ◽

Occipital Lobe ◽

High Morbidity ◽

Rare Clinical Entity ◽

Brain Abscesses

AbstractNocardia brain abscess is a rare clinical entity, accounting for 2% of all brain abscesses, associated with high morbidity and a mortality rate 3 times higher than brain abscesses caused by other bacteria. Proper investigation and treatment, characterized by a long-term antibiotic therapy, play an important role on the outcome of the patient. The authors describe a case of a patient without neurological comorbidities who developed clinical signs of right occipital lobe impairment and seizures, whose investigation demonstrated brain abscess caused by Nocardia spp. The patient was treated surgically followed by antibiotic therapy with a great outcome after 1 year of follow-up.

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Persistent Multispecies Actinomyces Mastitis Treated With Repeated Aspiration and Long-Term Oral Antibiotics

The American Surgeon ◽

10.1177/00031348211025748 ◽

2021 ◽

pp. 000313482110257

Author(s):

Colin Jenkins ◽

Anand Ganapathy ◽

Crystal Fancher ◽

Kazuhide Matsushima

Keyword(s):

Antibiotic Therapy ◽

Rare Condition ◽

Breast Abscess ◽

Amoxicillin Clavulanic Acid ◽

Recurrent Breast ◽

Causative Bacterium ◽

Repeated Aspiration ◽

Prolonged Antibiotic Therapy

Actinomycosis is an infection characterized by abscess formation, draining sinuses, and tissue fibrosis. The causative bacterium is a Gram-positive facultative anaerobe from the genus Actinomyces. Infections classically affect the cervicofacial, thoracic, or pelvic region and often require prolonged antibiotic therapy. Actinomycosis of the breast is a rare condition that may present as a recurrent breast abscess. We present a 33-year-old female with a recurrent breast abscess which grew A. radingae and A. israeli on aspirated fluid cultures. Treatment with surgical aspiration and a 6-week course of oral amoxicillin/clavulanic acid 875 mg twice daily resulted in clinical improvement. Our case demonstrates how recurrent breast abscesses caused by Actinomyces can be difficult to manage. Long-term antibiotic therapy with surgical aspiration and regular follow-up offer the best chance of clinical resolution.

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Treatment: NSAIDs

10.1093/med/9780198734444.003.0020 ◽

2016 ◽

Author(s):

Jonathan Chan ◽

Nigil Haroon

Keyword(s):

Symptom Control ◽

Pharmacological Therapy ◽

First Line ◽

Safety Concerns ◽

Randomized Controlled ◽

Equivalent Effect ◽

Inhibit Prostaglandin Synthesis ◽

Inflammatory Drugs ◽

Disease Modifying

Non-steroidal anti-inflammatory drugs (NSAIDs) constitute a diverse group of medications that inhibit prostaglandin synthesis. NSAIDs form the first-line pharmacological therapy in ankylosing spondylitis (AS). A number of randomized controlled trials (RCTs) support the efficacy of NSAIDs in reducing pain and improving patient function. Head-to-head comparisons have demonstrated equivalent effect of different NSAIDs in symptom control. The proposed disease-modifying potential of regular NSAID therapy is debatable and recent literature provides evidence to the contrary. Several safety concerns have been raised regarding long-term use of NSAIDs, especially an increase in cardiovascular risk. This chapter discusses the pharmacology, efficacy in treatment of AS, disease-modifying potential, and safety concerns of NSAIDs.

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A Patient on Long-Term Proton Pump Inhibitors Develops Sudden Seizures and Encephalopathy: An Unusual Presentation of Hypomagnesaemia

Case Reports in Gastrointestinal Medicine ◽

10.1155/2012/632721 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Nirav Y. Gandhi ◽

Walid K. Sharif ◽

Sumeet Chadha ◽

Jayadave Shakher

Keyword(s):

Magnesium Deficiency ◽

Clinical Signs ◽

Normal Range ◽

Total Vitamin ◽

Laboratory Findings ◽

Treatment Focus ◽

Calcium And Magnesium ◽

Underlying Mechanisms ◽

Biochemical Abnormalities

Objective. To present an unusual but known cause of hypomagnesaemia induced-hypocalcaemia in a chronic GORD patient with severe symptoms with a review of the current literature.Methods. Analysis of the clinical and laboratory findings of the patient and discussion of the multi-factorial nature of his disease and the underlying mechanisms.Results. Our patient described features of magnesium deficiency such as weakness, muscle twitches, and fits with clinical signs of hypocalcaemia: a carpal pedal spasm and paraesthesia. Preadmission blood results revealed low calcium and magnesium levels. He was admitted to ITU, when he presented with seizures and developed encephalopathy. The total vitamin D level was 52.4 nmol/L (>49.9). His U&Es and LFTs were within the normal range with the exception of potassium. He was on Omeprazole for his GORD. With omission of the PPI 1 day after admission and replacement therapy, his ion levels normalised.Conclusion. Hypomagnesaemia is often undiagnosed and is associated with multiple biochemical abnormalities. Treatment focus should be aimed at stopping the PPI and replacing the magnesium. Over use of PPIs is a problem in practice, with the FDA issuing a warning over long-term use. Continued monitoring and decision making on dose reduction/withdrawal is essential to avoid complications.

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Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis Syndrome – A Pictorial Review

10.25259/ijmsr_16_2019 ◽

2019 ◽

Vol 1 ◽

pp. 41-46

Author(s):

Moomal Haris ◽

Harun Gupta

Keyword(s):

Inflammatory Process ◽

Clinical Presentation ◽

Symptom Control ◽

Clinical Syndrome ◽

First Line ◽

Pictorial Review ◽

Inflammatory Arthropathy ◽

Inflammatory Drugs ◽

Long Term Prognosis

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) is an acronym which encompasses SAPHO. SAPHO is a distinct clinical syndrome which involves the musculoskeletal and dermatological systems. The clinical presentation can be variable, and therefore, patients may present to non-specialists who are not familiar with the disease. It is, therefore, important for the radiologist to be aware of the imaging manifestations of SAPHO; as often, it is them who are the first to propose the diagnosis. Imaging allows differentiation of SAPHO from other disease processes such as inflammatory arthropathy, infection, and malignancy which can share similar features and also to demonstrate potentially subclinical areas of disease involvement. Treatment is empirical and aimed at symptom control and modifying the inflammatory process. Nonsteroidal anti-inflammatory drugs are the first-line agents. The disease has a good long-term prognosis, despite the challenges in diagnosis and treatment.

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Natural History of Primary Autoimmune Neutropenia in Infancy

PEDIATRICS ◽

10.1542/peds.79.5.728 ◽

1987 ◽

Vol 79 (5) ◽

pp. 728-733

Author(s):

Lars T. Conway ◽

Mary E. Clay ◽

William E. Kline ◽

Norma K. C. Ramsay ◽

William Krivit ◽

...

Keyword(s):

Natural History ◽

Tract Infection ◽

Respiratory Tract ◽

Antibiotic Therapy ◽

Upper Respiratory Tract ◽

Autoimmune Neutropenia ◽

Laboratory Findings ◽

History Of ◽

Upper Respiratory

Five patients with primary autoimmune neutropenia were evaluated during their first 2 years of life. Their illness resolved spontaneously after 6 to 41 months (median 13 months), and the patients were subsequently followed for 13 to 73 months (median 28 months). None required immunosuppressive therapy to induce remission, and routine antibiotic therapy adequately controlled all infectious episodes. An increased rate of infection, particularly otitis media and upper respiratory tract infection, occurred during the neutropenic period. No other noninfectious illnesses, particularly no other autoimmune diseases, were reported in any of these patients at any time. In each case, resolution of neutropenia paralleled the disappearance of neutrophil autoantibodies which were specific for the NA1 antigen. This report describes the clinical and laboratory findings and the long-term history of primary autoimmune neutropenia in these five patients.

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Gallbladder mucocoele: A review

Journal of the South African Veterinary Association ◽

10.4102/jsava.v86i1.1318 ◽

2015 ◽

Vol 86 (1) ◽

Cited By ~ 7

Author(s):

Tesh M. Smalle ◽

Alane K. Cahalane ◽

Liza S. Köster

Keyword(s):

Current Literature ◽

Complete Blood Count ◽

Clinical Signs ◽

Serum Biochemistry ◽

Biliary Disease ◽

Biliary Surgery ◽

Term Survival ◽

Short And Long Term

Gallbladder mucocoele (GBM) is an abnormal, intraluminal accumulation of inspissated bile and/or mucous within the gallbladder. Older, small- to medium-breed dogs seem to be predisposed, but no sex predilection has been identified. Clinical signs are often non-specific and include vomiting, lethargy, anorexia, abdominal pain, icterus and polyuria–polydipsia. Results of a complete blood count may be unremarkable, but serum biochemistry usually reveals increased liver enzymes. The ultrasonographic appearance is diagnostic and well described in the literature. Surgical intervention for the treatment of GBM remains the therapeutic gold standard, with short- and long-term survival for biliary surgery being 66%. The worst outcome is seen in those dogs requiring cholecystoenterostomy. With GBM becoming an apparently increasingly common cause of extrahepatic biliary disease in canines, it is essential that clinicians become familiar with the current literature pertaining to this condition. Numerous predisposing factors are highlighted in this review article and the role of certain endocrinopathies (e.g. hyperadrenocorticism and hypothyroidism) in the development of GBM is touched upon. Furthermore, the aetiopathogenesis of this disease is discussed with reference to the latest literature. Cholecystectomy remains the treatment of choice, but other options are considered based on a current literature review.

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Neopterin plasma concentrations in patients with aneurysmal subarachnoid hemorrhage: correlation with infection and long-term outcome

Journal of Neurosurgery ◽

10.3171/2015.3.jns142212 ◽

2016 ◽

Vol 124 (5) ◽

pp. 1287-1299 ◽

Cited By ~ 4

Author(s):

Leire Azurmendi ◽

Vincent Degos ◽

Natalia Tiberti ◽

Natacha Kapandji ◽

Paola Sanchez-Peña ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Antibiotic Therapy ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Plasma Concentrations ◽

Clinical Signs ◽

World Federation ◽

Long Term Outcome ◽

Poor Outcome ◽

Positive Bacterial Culture

OBJECT Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high rates of mortality and morbidity. The main predictor for the poor outcome is the World Federation of Neurosurgical Societies (WFNS) scale. However, this scale does not take into account proinflammatory events, such as infection occurring after the aSAH, which could modify the long-term status of patients. The aim of this study was to evaluate neopterin as an inflammatory biomarker for outcome and infection prediction in aSAH patients. METHODS Plasma concentrations of neopterin were measured in 61 aSAH patients (22 male and 39 female; mean age [± SD] 52.8 ± 11.8 years) using a commercial ELISA kit. Samples were collected daily for 10 days. Outcome at 12 months was determined using the Glasgow Outcome Scale (GOS) and dichotomized as poor (GOS score 1, 2, or 3) or good (GOS score 4 or 5). Infection was determined by the presence of a positive bacterial culture. RESULTS Patients with poor outcome at 12 months had higher concentrations of neopterin than patients with good outcome. In the same way, patients who had an infection during the hospitalization had significantly higher concentrations of neopterin than patients without infection (p = 0.001). Moreover, neopterin concentrations were significantly (p < 0.008) elevated in infected patients 2 days before infection detection and antibiotic therapy. CONCLUSIONS Neopterin is an efficient outcome predictor after aSAH. Furthermore, it is able to differentiate between infected and uninfected patients as early as 2 days before clinical signs of infection, facilitating earlier antibiotic therapy and better management.

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“Ow, doc, it hurts”

University of Western Ontario Medical Journal ◽

10.5206/uwomj.v85i1.4209 ◽

2016 ◽

Vol 85 (1) ◽

pp. 14-16

Author(s):

Brandon Chau ◽

Robert Bobotsis

Keyword(s):

Chronic Pain ◽

Multidisciplinary Approach ◽

Tricyclic Antidepressants ◽

Long Term Results ◽

First Line ◽

Second Line Therapy ◽

Line Therapy ◽

Topical Lidocaine ◽

Inflammatory Drugs

In a world where medical conditions are increasingly understood, chronic pain remains among the most difficult to diagnose and treat. Current first-line treatment of nonmalignant chronic pain include tricyclic antidepressants and physiotherapy, while topical lidocaine, nonsteroidal anti-inflammatory drugs and other antidepressants serve as appropriate second-line therapy. Opioids, though highly effective analgesics, remain medical options of last resort due to their highly addictive properties. Surgical implantation of nerve stimulators and/or spinal decompression may also be considered for treatment of chronic pain. As a parallel course of treatment, complementary and alternative medicine such as acupuncture may also be considered. Unfortunately, people with pain are among the least anticipated patients that doctors will see, and lack of both patience and expertise often result in cookie-cutter prescriptions and standardized healthcare that do not benefit individual patients. In the ever-evolving field of pain management, recent evidence has shown that a multidisciplinary approach, rather than traditional physician-based management, offers the best long-term results to patients.

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Disease-Modifying Effects of Long-Term and Continuous Use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in Spondyloarthritis

Advances in Pharmacological Sciences ◽

10.1155/2019/5324170 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Rebecca S. Y. Wong

Keyword(s):

Pain Relief ◽

Adverse Effects ◽

Musculoskeletal System ◽

First Line ◽

Disease Research ◽

Inflammatory Drugs ◽

Disease Modifying ◽

Anti Inflammatory ◽

Continuous Use

Spondyloarthritis or spondyloarthropathy (SpA) is a group of related rheumatic disorders, which presents with axial and nonaxial features, affecting structures within the musculoskeletal system, as well as other bodily systems. Both pharmacological and nonpharmacological therapeutic options are available for SpA. For decades, nonsteroidal anti-inflammatory drugs (NSAIDs) have been used as the first-line drugs to treat the disease. Research has shown that other than pain relief, NSAIDs have disease-modifying effects in SpA. However, to achieve these effects, continuous and/or long-term NSAID use is usually required. This review will give an overview of SpA, discuss NSAIDs and their disease-modifying effects in SpA, and highlight some of the important adverse effects of long-term and continuous NSAID use, particularly those related to the gastrointestinal, renal, and cardiovascular systems.

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