Manifestations of hypertensive encephalopathy in cats.

OBJECTIVES: Hypertensive encephalopathy in cats is an important entity but is underestimated in clinical practice. This could be explained, in part, by non-specific clinical signs. The objective of this study was to characterise the clinical manifestations of hypertensive encephalopathy in cats. METHODS: Cats with systemic hypertension (SHT) recognised by routine screening, associated with underlying predisposing disease or a clinical presentation suggestive of SHT (neurological or non-neurological), were prospectively enrolled over a 2-year period. Confirmation of SHT was based on at least two sets of measurements of systolic blood pressure >160 mmHg by Doppler sphygmomanometry. RESULTS: Fifty-six hypertensive cats with a median age of 16.5 years were identified; 31 had neurological signs. In 16/31 cats, neurological abnormalities were the primary complaint. The other 15 cats were first presented to the medicine or ophthalmology service, and neurological disease was recognised based on the cat's history. The most common neurological signs were ataxia, various manifestations of seizures and altered behaviour. Individual cats also showed paresis, pleurothotonus, cervical ventroflexion, stupor and facial nerve paralysis. In 28/30 cats, retinal lesions were detected. Of these 28 cats, six presented with a primary complaint of visual deficits, and neurological signs were not the primary complaint; nine presented with non-specific medical issues, without suspicion of SHT-induced organ damage; in 13 cats, neurological issues were the primary complaint and fundic abnormalities were detected subsequently. CONCLUSIONS AND RELEVANCE: SHT is common in older cats and the brain is an important target organ; however, neurological deficits are commonly ignored in cats with SHT. Gait abnormalities, (partial) seizures and even mild behavioural changes should prompt clinicians to consider the presence of SHT. A fundic examination in cats with suspected hypertensive encephalopathy is a sensitive test to support the diagnosis.

The bactericidal effect of two photoactivated chromophore for keratitis-corneal crosslinking protocols (standard vs. accelerated) on bacterial isolates associated with infectious keratitis in companion animals.

BACKGROUND: Bacterial corneal infections are common and potentially blinding diseases in all species. As antibiotic resistance is a growing concern, alternative treatment methods are an important focus of research. Photoactivated chromophore for keratitis-corneal crosslinking (PACK-CXL) is a promising oxygen radical-mediated alternative to antibiotic treatment. The main goal of this study was to assess the anti-bactericidal efficacy on clinical bacterial isolates of the current standard and an accelerated PACK-CXL treatment protocol delivering the same energy dose (5.4 J/cm2). METHODS: Clinical bacterial isolates from 11 dogs, five horses, one cat and one guinea pig were cultured, brought into suspension with 0.1% riboflavin and subsequently irradiated. Irradiation was performed with a 365 nm UVA light source for 30 min at 3mW/cm2 (standard protocol) or for 5 min at 18mW/cm2 (accelerated protocol), respectively. After treatment, the samples were cultured and colony forming units (CFU's) were counted and the weighted average mean of CFU's per µl was calculated. Results were statistically compared between treated and control samples using a linear mixed effects model. RESULTS: Both PACK-CXL protocols demonstrated a significant bactericidal effect on all tested isolates when compared to untreated controls. No efficacy difference between the two PACK-CXL protocols was observed. CONCLUSION: The accelerated PACK-CXL protocol can be recommended for empirical use in the treatment of bacterial corneal infections in veterinary patients while awaiting culture results. This will facilitate immediate treatment, the delivery of higher fluence PACK-CXL treatment within a reasonable time, and minimize the required anesthetic time or even obviate the need for general anesthesia.

Reliability of detecting fundus abnormalities associated with systemic hypertension in cats assessed by veterinarians with and without ophthalmology specialty training.

OBJECTIVES: Systemic hypertension (SHT) causes severe target organ damage (TOD) and blood pressure (BP) measurement should be routine in at-risk populations. Fundoscopy is a tool to corroborate acute clinical relevance of high BP results and to decide on immediate therapy. Not every cat with a high BP result can be examined by an ophthalmologist. The study objective was to determine the reliability of fundoscopy in cats with SHT performed by a veterinarian without ophthalmology specialty training. METHODS: Cats with suspicion of hypertensive TOD or belonging to an at-risk population for SHT with a first measurement of elevated BP >160 mmHg were enrolled. Indirect ophthalmoscopy was performed by a recent graduate veterinarian followed by a veterinary ophthalmologist. Confirmation of SHT was based on two additional sets of systolic BP measurements >160 mmHg by Doppler sphygmomanometry. RESULTS: Thirty-three cats were included. SHT was confirmed in 27 cats. SHT was detected on routine examinations in 12/27 cats; fundoscopic lesions were observed in 9/12 by the non-trained veterinarian and in 11/12 by an ophthalmologist. Nine of 27 cats were neurological patients; fundoscopic lesions were detected in 4/9 by the non-trained veterinarian and in 7/9 by an ophthalmologist. Six of 27 cats were presented for acute blindness; fundus lesions were detected in all six cats by the non-trained veterinarian and ophthalmologist. SHT was not confirmed and fundoscopic lesions were not detected by either examiner in 6/33 cats. Compared with a veterinary ophthalmologist, reliability of detecting fundus abnormalities by the non-trained veterinarian was 72% (13/18) for cats with, and 100% (6/6) for cats without, vision. CONCLUSIONS AND RELEVANCE: Fundus examination by a non-specialty trained veterinarian has reasonably high reliability for the detection of ocular TOD. Private practice veterinarians are encouraged to perform an initial fundic examination in suspected hypertensive cats.

Septic keratitis in dogs, cats, and horses in Switzerland: associated bacteria and antibiotic susceptibility.

OBJECTIVE: To evaluate the most common bacterial pathogens associated with septic keratitis in veterinary patients from Switzerland. The second objective was to analyze antibiotic susceptibility test results of the identified bacterial pathogens. The third objective was to evaluate potential breed predispositions to septic keratitis. PROCEDURES: Two hundred and fifty-five cultures and antibiotic susceptibility reports from dogs, cats, and horses with septic keratitis that were presented to the University of Zurich Veterinary Medical Teaching Hospital between 2009 and 2013 were reviewed. Odds ratios for the risk of having a septic keratitis were estimated for all dog and cat breeds compared to the general nonbrachycephalic hospital population. RESULTS: Ninety-six, 29, and 31 positive cultures were obtained from 89 canine, 28 feline, and 29 equine eyes, respectively. Repeat sampling accounted for the differences in numbers. Negative culture results were obtained in 50, 31, and 18 cases. Staphylococci and streptococci accounted for 66% of the isolates in dogs and 80% of the isolates in cats and horses. Staphylococcus spp. had a higher percentage of fluoroquinolone-resistant isolates compared to previous reports. Brachycephalic breeds had elevated odds ratios for the presence of septic keratitis. CONCLUSION: Identified bacterial pathogens and their prevalence as well as the elevated odds ratios for septic keratitis in brachycephalics are roughly consistent with previous studies. Based on systemic breakpoint data, resistance to commonly used topical antibiotics, including the second-generation fluoroquinolones, was found.