Resumo
Background: The eosinophilic furunculosis is an uncommon skin disease that affects young dogs aged between two and five years. Sex predilections are not noted. Most reported cases have been in large breeds with abundant access to the outdoors like public gardens and parks. The exact pathogenesis remains unknown but the pattern of lesions development suggests involvement reaction to insect bites and arthropods. The time between contact with the agent and the appearance of lesions is short, often less than 24 h. The skin lesions appear suddenly in the face, usually on the dorsal muzzle and/ or periocular region, pinnae and lips. More rarely on the trunk, chest and legs and it is characterized by predominantly hemorrhagic ulcers with edema. Pustules, nodules and plaques rapidly fistulate and drain serosanguinous exudates. Pruritus is variable, but may be severe. Severely affected dogs may be febrile, lethargic and anoretic. Peripheral blood eosinophilia is seen in the majority of cases. Clinical differential diagnosis include demodicosis, dermatophytosis, nasal deep bacterial folliculitis and furunculosis, pemphigus foliaceus, pemphigus erythematosus and drug reactions. None of these diseases share the fulminant rapid onset of eosinophilic furunculosis. The diagnosis is based on history, clinical signs, cytology and skin biopsies. The treatment involves oral steroids until complete remission of lesions and the antibiotic therapy is indicated in cases of associated bacterial infection. Case: The patient was a 4-year-old, male Pit Bull dog attended in a small animal clinic in Niteroi-Rio de Janeiro, which presented ulcerated, exudative lesions on the dorsal muzzle and right leg. After sedation, clinical examination was performed and an exudate was collected from the ulcerated skin lesion for cytopathological analysis .The slide containing the lesion impression was stained by a quick panoptic method. In order to collect samples, the dog was sedated with a combination of ketamine hydrochloride and acepromazine and a skin fragment was collected from the nasal bridge lesion with a 6 mm punch after local anesthesia with 2% lidocaine hydrochloride. The specimen was fixed in 10% buffered formalin and sent for histopathological analysis. The cytopathological exam revealed a marked eosinophilic inflammation. Histopathological examination revealed ulcerated skin. The epidermis was moderately acanthotic with mild espongiosis and the dermis was characterized by intense eosinophilic folliculocentric inflammations. An extensive folicular rupture, eosinophilic mural foliculitis were presented and PAS staining did not identify fungal structures. Oral prednisone (2 mg/Kg) at 24h intervals was prescribed until complete remission of the lesions. After fifteen days of glucocorticoids therapy, involution of the skin lesions was observed by physical examination and was also reported by the owner. Discussion: The eosinophilic furunculosis is an acute, severe predominantly facial disease of outdoor dogs, which occurrence is rare. The diagnosis and treatment of this disease are frequently neglected because they are not included in the differential diagnosis of diverse cutaneous infections. In view of the scarcity of reports and to alert veterinarians that the disease should be included in the differential diagnosis with other bacterial diseases, this report described a case of canine eosinophilic furunculosis.
Assuntos
Animais , Masculino , Cães , Dermatopatias/veterinária , Doenças do Cão/diagnóstico , Eosinófilos/citologia , Furunculose/diagnóstico , Furunculose/tratamento farmacológico , Neutrófilos/citologiaResumo
Background: The eosinophilic furunculosis is an uncommon skin disease that affects young dogs aged between two and five years. Sex predilections are not noted. Most reported cases have been in large breeds with abundant access to the outdoors like public gardens and parks. The exact pathogenesis remains unknown but the pattern of lesions development suggests involvement reaction to insect bites and arthropods. The time between contact with the agent and the appearance of lesions is short, often less than 24 h. The skin lesions appear suddenly in the face, usually on the dorsal muzzle and/ or periocular region, pinnae and lips. More rarely on the trunk, chest and legs and it is characterized by predominantly hemorrhagic ulcers with edema. Pustules, nodules and plaques rapidly fistulate and drain serosanguinous exudates. Pruritus is variable, but may be severe. Severely affected dogs may be febrile, lethargic and anoretic. Peripheral blood eosinophilia is seen in the majority of cases. Clinical differential diagnosis include demodicosis, dermatophytosis, nasal deep bacterial folliculitis and furunculosis, pemphigus foliaceus, pemphigus erythematosus and drug reactions. None of these diseases share the fulminant rapid onset of eosinophilic furunculosis. The diagnosis is based on history, clinical signs, cytology and skin biopsies. The treatment involves oral steroids until complet
Background: The eosinophilic furunculosis is an uncommon skin disease that affects young dogs aged between two and five years. Sex predilections are not noted. Most reported cases have been in large breeds with abundant access to the outdoors like public gardens and parks. The exact pathogenesis remains unknown but the pattern of lesions development suggests involvement reaction to insect bites and arthropods. The time between contact with the agent and the appearance of lesions is short, often less than 24 h. The skin lesions appear suddenly in the face, usually on the dorsal muzzle and/ or periocular region, pinnae and lips. More rarely on the trunk, chest and legs and it is characterized by predominantly hemorrhagic ulcers with edema. Pustules, nodules and plaques rapidly fistulate and drain serosanguinous exudates. Pruritus is variable, but may be severe. Severely affected dogs may be febrile, lethargic and anoretic. Peripheral blood eosinophilia is seen in the majority of cases. Clinical differential diagnosis include demodicosis, dermatophytosis, nasal deep bacterial folliculitis and furunculosis, pemphigus foliaceus, pemphigus erythematosus and drug reactions. None of these diseases share the fulminant rapid onset of eosinophilic furunculosis. The diagnosis is based on history, clinical signs, cytology and skin biopsies. The treatment involves oral steroids until complet
Resumo
A utilização do corticosteróide antenatal objetivando induzir artificialmente a maturação fetal e garantir a sobrevivência de neonatos críticos é bem estabelecido e rotineiramente utilizado em Medicina. Por outro lado, a utilização pós-natal de corticóide, como garantia de melhores condições clínicas do neonato, ainda figura como expressivo desafio tanto em neonatologia humana quanto veterinária. Deste modo, este estudo tem como objetivo avaliar a eficácia da corticoterapia pré ou pós-natal em cordeiros prematuros extremos na melhora da condição clínica, pulmonar, metabólica e hemodinâmica; necessidade de assistência ventilatória e na garantia de sobrevivência neonatal. Para tal, cordeiros prematuros, nascidos aos 135 dias de gestação, foram aleatoriamente alocados nos grupos: corticoterapia materna pré-natal (CORT PRÉ; n=8), corticoterapia pós-natal (CORT PÓS; n=9) e controle (CONT; n=5). A corticoterapia foi realizada com betametasona em dose única de 0,5 mg/Kg, por via de aplicação intra muscular, aos 133 dias de gestação ou aos 10 minutos após o nascimento para os grupos CORT PRÉ e CORT PÓS, respectivamente. O parto foi induzido utilizando-se o fármaco aglepristona às 49 horas prévias à data estimada para o parto. Os neonatos foram avaliados quanto ao escore Apgar, condição clínica geral (freqüência cardíaca, freqüência respiratória, tônus muscular e irritabilidade reflexa), temperatura corpórea, hemogasometria arterial, glicemia, lactatemia, concentrações séricas das enzimas antioxidantes (superoxido dismutase SOD e glutationa peroxidase GPx) e marcador do estresse oxidativo (TBARS) em 10 momentos pontuais durante os 3 dias subsequentes ao parto. Para os cordeiros destinados ao suporte ventilatório, avaliamos o tempo (em minutos) necessário para o início do protocolo ventilatório a partir do nascimento e o tempo de permanência na ventilação. Os dados foram analisados por meio de testes paramétricos e não-paramétricos, com nível de significância de 95%. As variáveis também foram submetidas ao teste de correlação de Spearman. Como resultados, observamos melhor condição de vitalidade e tônus muscular nos neonatos tratados em relação ao grupo controle. Quanto à avaliação cardiogênica, a betametasona pré-natal apresentou efeito bradicárdico, enquanto a administração pós-natal resultou em efeito taquicárdico. Tanto os resultados de frequência respiratória como temperatura corpórea foram estatisticamente superiores nos neonatos tratados em relação ao controle. Todos os cordeiros nasceram bradicárdicos e bradipneicos, com valores normais atingidos a partir de 10 minutos. Observamos hiperglicemia nos grupos tratados, com valor estatisticamente superior no grupo CORT PÓS. O valor de lactato foi estatisticamente superior no grupo CORT PÓS em relação ao controle. Quanto aos componentes do equilíbrio ácido-básico, os neonatos do grupo CORT PRÉ tiveram valores significativamente maiores de bicarbonato, enquanto menores pressões de CO2 foram observadas a partir de 60 minutos, embora sem diferença quanto ao pH e BE. Os tratamentos não determinaram alterações nos valores de PO2 e SO2. Entretanto, os diferentes protocolos corticoterápicos influenciaram no perfil hematológico neonatal, com valores significativamente maiores de hematócrito no grupo CORT PÓS, seguido pelo grupo CORT PRÉ. Observamos também atuação do tratamento pós-natal nos valores de SOD e correlação positiva com os valores de hematócrito e hemoglobina. Comparando-se o percentual de cordeiros submetidos à assistência ventilatória, verificou-se maior necessidade no grupo controle. Os neonatos do grupo CORT PRÉ permaneceram por tempo menor sob assistência ventilatória, em relação ao grupo controle Com base nos resultados obtidos, concluímos que a corticoterapia pós-natal ou pré-natal favorece a condição clínica neonatal (vitalidade, tônus muscular e funções vitais), a função pulmonar (trocas gasosas e compensação aos desequilíbrios ácido-básicos) e a atividade metabólica (controle glicêmico). O tratamento pós-natal aumentou a atividade da enzima SOD, reduzindo os riscos de danos pulmonares. Ainda, o tratamento com betametasona pós-natal ou materna pré-natal diminui a necessidade de assistência ventilatória em cordeiros prematuros extremos.
The use of corticosteroid aiming artificially fetal lung maturation and survival of critical neonates is used as a routine in medicine. On the other hand, the postnatal steroid therapy used to improve clinical conditions of the newborn, It's still a therapeutic challenge both in human as veterinary neonatology. Thus, the aims this study is to assess the effectiveness of corticosteroid, used in the pre or postnatal period, in extremely preterm lambs to improve clinical, pulmonary, metabolic and hemodynamic condition; the need for ventilatory support and neonatal survival rate. For it, preterm lambs, born with 135 days of gestation, were randomly allocated into three groups: prenatal maternal corticosteroid therapy (CORT PRE; n = 8), postnatal corticosteroid therapy (CORT POST; n = 9) and control (CONT; n = 5). The steroid therapy was performed with betamethasone in a single dose of 0.5 mg/ kg, by intramuscular route of administration, at 133 days of pregnancy our after 10 minutes from the birth in the groups CORT PRÉ and CORT PÓS, respectively. The labor was induced with aglepristone administrated 49 hours prior to the estimated date of birth. Newborns were assessed by Apgar score, general medical condition (heart rate, respiratory rate, muscle tone and reflex irritability), body temperature, blood gas analysis, blood glucose, blood lactate concentration, serum concentrations of antioxidant enzymes (superoxide dismutase - SOD and glutathione peroxidase - GPx) and marker of oxidative stress (TBARS). The assessments were performed in 10 moments during the three days from delivery. For ventilated newborns, we assessed the needed time (in minutes) between birth and the beginning of ventilatory protocol, as well as lenght of stay on ventilatory support. Data were analyzed using parametric and non-parametric tests, with 95% of significance level. The variables were assessed from Spearman correlation test. As results, we noted better condition of vitality and muscle tone in newborns treated when compared with control group. Regarding cardiogenic values, antenatal betamethasone resulted in bradycardic effect, while its posnatal administration was related with tachycardia. Both results of respiratory and body temperature rates were significantly higher in newborns treated compared to the control. All lambs born whith bradycardia and bradypnea, reached normal values from 10 minutes of life. Hyperglycemia was observed in the treated groups, with statistically higher values in CORT PÓS group. The lactate value was statistically higher in CORT PÓST group compared to the control. Concerning the components of the acid-base balance, the CORT PRÉ showed significantly higher values of bicarbonate, while lower pressures of CO2 were observed from 60 minutes, although there were no differences in pH and BE values. The treatments did not determine changes in PO2 and SO2 values. However, the different protocols of steroid therapy influenced on neonatal blood profile, with significantly higher hematocrit values in CORT POST group, followed by CORT PRÉ. We also observed influence of postnatal treatment in SOD values as well as positive correlation between SOD and the hematocrit and hemoglobin values. Comparing the percentage of lambs submitted to mechanical ventilation, there were most ventilated neonates in the control group. Lower ventilation time was observed in the CORT PRÉ group. Then we conclude that, the postnatal or antenatal steroids improve neonatal clinical condition (vitality, muscle tone and vital functions), lung function (gas exchange and compensation to acid-base imbalances) and metabolic activity (glycemic control). The postnatal treatment increased the activity of SOD by reducing the risks of pulmonary damage. Moreover, treatment with postnatal betamethasone or prenatal maternal reduces the need for mechanical ventilation in extremely preterm lambs.
Resumo
Background: The eosinophilic furunculosis is an uncommon skin disease that affects young dogs aged between two and five years. Sex predilections are not noted. Most reported cases have been in large breeds with abundant access to the outdoors like public gardens and parks. The exact pathogenesis remains unknown but the pattern of lesions development suggests involvement reaction to insect bites and arthropods. The time between contact with the agent and the appearance of lesions is short, often less than 24 h. The skin lesions appear suddenly in the face, usually on the dorsal muzzle and/ or periocular region, pinnae and lips. More rarely on the trunk, chest and legs and it is characterized by predominantly hemorrhagic ulcers with edema. Pustules, nodules and plaques rapidly fistulate and drain serosanguinous exudates. Pruritus is variable, but may be severe. Severely affected dogs may be febrile, lethargic and anoretic. Peripheral blood eosinophilia is seen in the majority of cases. Clinical differential diagnosis include demodicosis, dermatophytosis, nasal deep bacterial folliculitis and furunculosis, pemphigus foliaceus, pemphigus erythematosus and drug reactions. None of these diseases share the fulminant rapid onset of eosinophilic furunculosis. The diagnosis is based on history, clinical signs, cytology and skin biopsies. The treatment involves oral steroids until complet
Background: The eosinophilic furunculosis is an uncommon skin disease that affects young dogs aged between two and five years. Sex predilections are not noted. Most reported cases have been in large breeds with abundant access to the outdoors like public gardens and parks. The exact pathogenesis remains unknown but the pattern of lesions development suggests involvement reaction to insect bites and arthropods. The time between contact with the agent and the appearance of lesions is short, often less than 24 h. The skin lesions appear suddenly in the face, usually on the dorsal muzzle and/ or periocular region, pinnae and lips. More rarely on the trunk, chest and legs and it is characterized by predominantly hemorrhagic ulcers with edema. Pustules, nodules and plaques rapidly fistulate and drain serosanguinous exudates. Pruritus is variable, but may be severe. Severely affected dogs may be febrile, lethargic and anoretic. Peripheral blood eosinophilia is seen in the majority of cases. Clinical differential diagnosis include demodicosis, dermatophytosis, nasal deep bacterial folliculitis and furunculosis, pemphigus foliaceus, pemphigus erythematosus and drug reactions. None of these diseases share the fulminant rapid onset of eosinophilic furunculosis. The diagnosis is based on history, clinical signs, cytology and skin biopsies. The treatment involves oral steroids until complet