A case report of Budd-Chiari syndrome with cardiac complications and low SPO2 successfully managed by an integrated-approach

Budd-Chiari syndrome [BCS] is a rare, potentially life-threatening condition characterized by the triad of abdominal pain, ascites, and hepatomegaly (with or without jaundice). There will be an underlying disorder in most cases. The diagnosis, as well as management of the case, requires a multidisciplinary approach. The treatment should aim at reducing the presenting symptoms as well as removing the underlying pathology. Here we explain a case report of a 21-year-old male patient in the subacute stage of BCS with its complications and considered as a candidate for liver transplantation. His liver enzymes, PT/INR, D- dimer, and homocysteine values were above normal levels. The arterial oxygen saturation level was subnormal, and he was on supportive oxygen supplement. Inferior venacava [IVC] Doppler revealed a non-obstructive intrahepatic thrombus. The patient was treated with Homoeopathic medicine Arsenicum album and Arnica montana, given as an adjuvant to conventional treatment.

Internal parasitic burdens in brown rats (Rattus norvegicus) from Grenada, West Indies.

This study identified the endoparasites in Brown rat (Rattus norvegicus) during May to July 2017 in Grenada, West Indies. A total of 162 rats, 76 females and 86 males were trapped from St. George and St. David parishes in Grenada. The collected fecal samples were examined for parasitic eggs and/or oocysts using simple fecal flotation technique. Adult parasites found in the intestinal tract were examined for identification. The overall prevalence of intestinal parasites among rats was 79 %. Ten helminth species were recovered, several of which were reported for the first time in rodents in Grenada. The internal parasites consist of seven nematodes (Angiostrongylus spp., Nippostrongylus braziliensis, Heterakis spumosa, Strongyloides ratti, Aspiculuris tetraptera, Syphacia spp. and Protospirura spp.), one cestode (Hymenolepsis diminuta), one acanthocephalan (Moniliformis moniliformis) and one protozoa species (Eimeria spp.). The most prevalent zoonotic species were Angiostrongylus spp. (35.2%), Hymenolepsis diminuta (7.4%) and Moniliformis moniliformis (3.1%). Several nonzoonotic endoparasites; which included Nippostrongylus braziliensis (50.6%), Heterakis spumosa (15.4%), Strongyloides ratti (43.2%), Aspiculuris tetraptera (2.5%), Syphacia spp. (1.9%), Protospirura spp. (1.2%) and Eimeria spp. (4.7%) were also identified. The most prevalent parasites were Nippostrongylus brasiliensis (50.6%), Strongyloides ratti (43.2%) and Angiostrongylus spp. (35.2%). Co-infections occurred with up to six species per rat showing different combinations of parasitic infections.

Prevalence of Cryptosporidium spp. in asymptomatic small ruminants in Grenada, West Indies.

Cryptosporidium spp. is a protozoan parasite that causes enteric infection in a wide range of hosts, including livestock and humans. The aim of this cross-sectional study was to estimate the prevalence of Cryptosporidium spp. in small ruminants in Grenada, West Indies. Fecal samples were collected from 100 sheep and 202 goats from 32 farms. The fecal samples were tested using an Enzyme-linked immunosorbent assay (ELISA) for qualitative detection of antigens in feces (Diagnostic Automation Inc., USA). The overall prevalence of Cryptosporidium spp. was 19.5% [95% confidence interval (CI): 15.4% to 24.4%] in both sheep and goats. The prevalence of Cryptosporidium spp. in sheep and goats was 14% (95% CI: 8.4% to 22.3%) and 22.3% (95% CI: 17.1% to 28.5%), respectively. There was no significant difference in the prevalence of Cryptosporidium spp. infection between sheep and goats (p = .42, Fisher's exact test) in Grenada. Of the 32 farms visited, 19 (59.4%) had at least one Cryptosporidium spp. positive animal.

Retrospective study of canine heartworm disease with caval syndrome in Grenada, West Indies.

Canine heartworm disease caused by Dirofilaria immitis is an important disease of dogs. The aim of this retrospective study was to estimate the prevalence of canine heartworm disease and evaluate cases of caval syndrome in dogs submitted for necropsy in Grenada. Out of 1617 dogs necropsied over a period of 13 years (2001-2013), 249 were found to be infected with D. immitis; giving an overall prevalence of 15.4% (95% confidence interval, 13.6% to 17.1%). There was no significant difference between male and female dogs with respect to canine heartworm infection (p = 0.3). During this period, the annual prevalence of canine heartworm disease was 22% in 2001 before slightly declining to an average of 18% in 2002-2003 and peaking at 26.8% in 2004-2005. From 2006 onwards, annual prevalence rates have steadily been decreasing; reaching the lowest (9%) in 2013. Among the 249 positive cases, 33 (13.2%) of the dogs had caval syndrome. Caval syndrome cases presented with concurrent clinical signs and were associated with cardio-pulmonary and hepatic gross lesions at necropsy. Aberrant migration of D. immitis was also noted in 2 dogs with caval syndrome. This is the first report which presents the findings of canine heartworm disease with caval syndrome in Grenada.

Seroprevalence of Trypanosoma cruzi in stray and pet dogs in Grenada, West Indies.

American trypanosomiasis (Chagas disease) caused by the protozoan parasite Trypanosoma cruzi is endemic to parts of South America and the Caribbean. Infected dogs are important in the epidemiology of the parasite as they can play a role in the transmission of the parasite to humans. A total of 399 dog sera (242 stray and 157 pet dogs) were examined for T. cruzi infection; using a qualitative immunochromatographic dipstick test, based on recombinant antigens specific for American trypanosomiasis (Trypanosoma detect rapid test; InBios international, Inc., Seattle, Washington). Overall seroprevalence for T. cruzi was estimated at 10.5% (95% confidence interval: 7.5% to 13.5%); with stray dogs being significantly more affected (p<0.05, χ2). Results from this study indicate that dogs in Grenada are moderately exposed to T. cruzi compared to other areas in the region.

Spirocercosis in owned and stray dogs in Grenada.

The aim of this retrospective study was to estimate the prevalence of Spirocerca lupi and its associated lesions in owned and stray dogs in Grenada. During 2001-2011 necropsies were carried out on 1022 owned and 450 stray dogs at the pathology diagnostic laboratory, School of Veterinary Medicine, St. George's University, Grenada. Lesions due to S. lupi characterized by focal to multifocal granulomatous esophagitis with aneurysms, mineralized plaques and nodules in the adjacent thoracic aorta were found in 90 (8.8%; 95% confidence interval, 7.1-10.5%) of owned dogs and 64 (14.2%; 95% CI, 11.2-17.6%) of stray dogs. Stray dogs were significantly more affected by spirocercosis than owned dogs (p=0.0022). Of the 90 owned dogs with spirocercosis, 3 dogs had aberrant migration to the thoracic vertebral column with resultant spondylitis; 1 dog each had aberrant migration involving the stomach and the lung. Two dogs had ruptured aorta with hemothorax. Among the 64 stray dogs with spirocercosis, one dog had an esophageal granuloma that transformed into a fibroblastic osteosarcoma; spondylitis due to aberrant migration of S. lupi and hypertrophic osteopathy. We report spirocercosis for the first time in the dogs from a tropical island of Grenada.

Seroprevalence of Toxoplasma gondii in pigs, sheep, goats, and cattle from Grenada and Carriacou, West Indies.

Prevalence of Toxoplasma gondii infection in pregnant women in Grenada is considered high. Little is known of the epidemiology of T. gondii infection in Caribbean Islands. Serum samples of 750 food animals in Grenada and Carriacou were tested for antibodies to T. gondii by the modified agglutination test (MAT). Antibodies to T. gondii (MAT, 1∶25 or higher) were found in 23.1% of 247 pigs, 44.1% of 204 sheep, 42.8% of 180 goats, and 8.4% of 119 cattle. Seroprevalence increased with age, indicating postnatal acquisition of T. gondii. Antibody titers of 1∶200 or higher were present in 65 of 90 seropositive sheep, 61 of 77 seropositive goats, and 23 of 57 seropositive pigs. However, none of the cattle had a MAT titer of 1∶200, suggesting that bovines are a poor host for T. gondii. Results indicate that pigs, sheep, and goats could be important sources of T. gondii infection if their meat is consumed undercooked.

Neoplastic and nonneoplastic cutaneous tumors of dogs in grenada, west indies.

This retrospective survey was undertaken between 2002 and 2007 on samples from dogs residing in Grenada. The objectives of the study were to identify the most common histologic types of canine cutaneous tumors, determine the relative frequency of each tumor type, and compare results to reports from other regions. In a series of 225 skin masses examined, the proportion of neoplasms was 72% whereas nonneoplastic tumors accounted for 15.6%, and inflammatory conditions constituted 12.4%. There were 10 types of nonneoplastic tumors with hamartomas being the most common (28.5%), followed by sebaceous hyperplasia (25.7%) and fibroepithelial polyps (22.8%). The 10 most common cutaneous neoplasms were hemangiosarcomas (19.1%), histiocytomas (8.6%), melanocytomas (8%), mast cell tumors (6.8%), lipomas (6.8%), hemangiopericytomas (6.2%), papillomas (5.6%), fibrosarcomas (5.6%), hemangiomas (4.9%), and squamous cell carcinomas (4.3%). Tumors of vascular origin and transmissible venereal tumors were more common in dogs in our study than reported from other regions.

Preliminary molecular characterization of a fowl poxvirus isolate in Grenada.

Two 1-mo-old local breed chickens, with gross lesions in the skin of the head region suspected to be fowl poxvirus infection, were submitted to the Diagnostic Laboratory of the School of Veterinary Medicine, Grenada, West Indies. Cutaneous lesions were collected from these birds for virus isolation, histopathologic diagnosis, and molecular analysis. Fowl poxvirus infection was confirmed by virus isolation in chicken embryo and by histopathology. Molecular characterization of the fowl poxvirus was conducted by PCR amplification of selected genomic fragments and by nucleotide sequencing. Integration of reticuloendotheliosis virus fragments into the fowl poxvirus genome was confirmed by PCR and DNA sequencing. This is the first report from the Caribbean region on the preliminary molecular characterization of a fowl poxvirus isolate.

A serological study of Dirofilaria immitis in feral cats in Grenada, West Indies.

A study to determine the seroprevalence of Dirofilaria immitis was carried out in feral cats in Grenada. Of the 137 feral cats tested for circulating antibodies (IgG; lateral-flow immunoassay) and circulating antigens (Ag; enzyme-linked immunosorbent assay), 8% (95% confidence interval (CI) 3.5-12.5%) were antibody positive and 5.1% (95% CI 1.4-8.8%) were antigen positive. No significant difference between cats aged>1 to 4 years and cats less than 1 year of age was found (P>0.05, χ²). There was also no significant difference (P>0.05, χ²) between male and female cats. Dirofilaria immitis prevalence is relatively high in the feral cat population of Grenada. Evidence of D. immitis infection in feral cats coupled with the endemic nature of heartworm disease in dogs in Grenada leads us to suggest the introduction of heartworm prophylaxis in cats. To the authors' knowledge, this serological evidence of heartworm infection in feral cats in Grenada is the first report from the Caribbean region.

Seroprevalence of canine leishmaniasis and American trypanosomiasis in dogs from Grenada, West Indies.

Canine leishmaniasis and American trypanosomiasis (AT) are caused by related hemoflagellated parasites, Leishmania spp. and Trypanosoma cruzi, which share several common host species. Dogs are reservoirs for human infections by both pathogens. We determined the prevalence of antibodies to Leishmania spp. and T. cruzi in dogs from Grenada, West Indies. We examined 70 dog sera using the qualitative immunochromatographic dipstick tests (ICTs) based on recombinant antigens specific for visceral leishmaniasis and AT. Antibodies to visceral Leishmania were not detected in Grenadian dogs by ICT. Using the canine dipsticks for AT, antibodies to T. cruzi were determined in 3 (4.3%) of the 70 dogs. Results from this study indicate that dogs in Grenada are exposed in low levels to T. cruzi , but not to visceral Leishmania spp. at all.

Seroprevalence of Toxoplasma gondii and concurrent Bartonella spp., feline immunodeficiency virus, and feline leukemia virus infections in cats from Grenada, West Indies.

Toxoplasma gondii and Bartonella spp. are zoonotic pathogens of cats. Feline immunodeficiency virus (FIV) and feline leukemia virus (FeLv) are related to human immunodeficiency virus, and human leukemia virus, respectively; all of these viruses are immunosuppressive. In the present study, the prevalence of antibodies to T. gondi, Bartonella spp., FIV, as well as FeLv antigen were determined in sera from 75 domestic and 101 feral cats (Felis catus) from the Caribbean island of Grenada, West Indies. Using a modified agglutination test, antibodies to T. gondii were found in 23 (30.6%) of the 75 pet cats with titers of 1:25 in 1, 1:50 in 3, 1:400 in 4, 1:500 in 12, 1:800 in 2, and 1:1,600 in 1, and 28 (27.7%) of 101 feral cats with titers of 1:25 in 4, 1:50 in 7, 1:200 in 4, 1:400 in 1, 1:500 in 3, 1:800 in 2, 1:1,600 in 3, and 1:3,200 in 4. Overall, in both pet and feral cats, the seroprevalence increased with age. Antibodies to Bartonella spp. were found in 38 (50.6%) of the 75 pet cats and 52.4% of 101 feral cats. Antibodies to FIV were found in 6 domestic and 22 feral cats. None of the 176 cats was positive for FeLv antigen. There was no correlation among T. gondii, Bartonella spp., and FIV seropositivity.

Existence of Angiostrongylus cantonensis in rats (Rattus norvegicus) in Grenada, West Indies.

The zoonotic rat lung worm, Angiostrongylus cantonensis is endemic to Asia, North America, Africa and Australia. The parasite is expanding geographically and has recently been recorded in some of the Greater Antilles in the northern part of the Caribbean. In this study A. cantonensis is reported for the first time in the Lesser Antilles in one of the southernmost islands, Grenada. Between September 2005 and September 2006, 192 rats (Rattus norvegicus) were trapped throughout the island. The rats were anesthetized, exsanguinated, necropsied and the lungs were fixed whole in 10% buffered formalin, trimmed, processed, cut at 3microm, stained with hematoxylin and eosin and examined microscopically. A total of 45 (23.4%) of the 192 rats examined were found to be infected with A. cantonensis and adult worms were found in the cardiopulmonary system of one of the rats. Microscopically, pulmonic lesions, consisting of pulmonary thrombosis, hypertrophy of pulmonary arteries and granulomatous pneumonia were associated with intralesional adults, larvae and embryonated eggs of A. cantonensis. An incidental finding of variably sized (2-7mm) solitary to multiple cysts containing larvae of Taenia taeniaformis were seen in the livers of 57 rats. This report of A. cantonensis in Grenada provides evidence of the further global expansion of this important zoonotic parasite and the public health implications of this discovery is discussed.

Seroprevalence of Leptospira in dogs in Grenada, West Indies.

Leptospira bacteria infect numerous species of animals and cause serious disease in both dogs and humans. Leptospirosis is caused by many different serovars and canine vaccine protection is serovar-specific. The objective of this study was to determine the seroprevalence and serovars of Leptospira in dogs in the island of Grenada, West Indies. Serum samples from 105 dogs were evaluated by the microscopic agglutination test (MAT) and by Enzyme Linked Immunosorbent Assay (ELISA) method adapted for canine Immunoglobulin M(IgM). Sera from 20 dogs were positive by MAT (195) and 67 were positive by ELISA (64.0%). All MAT-positive sera were also ELISA-positive. Percent seropositive did not differ significantly by age, sex or health score of dog or among the 6 parishes of Grenada. Fourteen of the MAT positive samples had anitbodies for multiple Leptospira serovars. All but one of the identified serovars were from the Icterohaemorrhagiae serogroup and included in decreasing order of frequency copenhagen, mankarso and icterohaemorrhagiae RGA. One dog was identified with antibodies for sergroup Pyrogenes serovar pyrogenes. Identification of the Leptospira serovars responsible for canine exposure in Grenada will facilitate appropriate recommendations for canine vacccination on the island.

Seroprevalence of Hantavirus in Rattus norvegicus in Grenada, West Indies.

Hantavirus is an emerging zoonotic virus with potential for significant human disease and mortality. Rodents are the natural reservoir for the virus. This study reports the seroprevalence of hantavirus in brown rats (Rattus norvigicus) in Grenada. Serum samples from 198 brown rats were tested for the immunoglobulin G (IgG) antibody to hantavirus using an enzyme-linked immunosorbant assay (ELISA). A seroprevalence rate of 29.3% was found. This is the first report of hantavirus exposure in any species on the island of Grenada and documents the brown rat as a reservoir host on the island.

Seroprevalence of Leptospira in dogs in Grenada, West Indies.

Leptospira bacteria infect numerous species of animals and cause serious disease in both dogs and humans. Leptospirosis is caused by many different serovars and canine vaccine protection is serovar-specific. The objective of this study was to determine the seroprevalence and serovars of Leptospira in dogs in the island of Grenada, West Indies. Serum samples from 105 dogs were evaluated by the microscopic agglutination test (MAT) and by Enzyme Linked Immunosorbent Assay (ELISA) method adapted for canine Immunoglobulin M(IgM). Sera from 20 dogs were positive by MAT (195) and 67 were positive by ELISA (64.0%). All MAT-positive sera were also ELISA-positive. Percent seropositive did not differ significantly by age, sex or health score of dog or among the 6 parishes of Grenada. Fourteen of the MAT positive samples had anitbodies for multiple Leptospira serovars. All but one of the identified serovars were from the Icterohaemorrhagiae serogroup and included in decreasing order of frequency copenhagen, mankarso and icterohaemorrhagiae RGA. One dog was identified with antibodies for sergroup Pyrogenes serovar pyrogenes. Identification of the Leptospira serovars responsible for canine exposure in Grenada will facilitate appropriate recommendations for canine vacccination on the island.

Seroprevalence of Hantavirus in Rattus norvegicus in Grenada, West Indies.

Hantavirus is an emerging zoonotic virus with potential for significant human disease and mortality. Rodents are the natural reservoir for the virus. This study reports the seroprevalence of hantavirus in brown rats (Rattus norvigicus) in Grenada. Serum samples from 198 brown rats were tested for the immunoglobulin G (IgG) antibody to hantavirus using an enzyme-linked immunosorbant assay (ELISA). A seroprevalence rate of 29.3% was found. This is the first report of hantavirus exposure in any species on the island of Grenada and documents the brown rat as a reservoir host on the island.

Toxoplasma gondii and Neospora caninum antibodies in dogs from Grenada, West Indies.

Toxoplasma gondii and Neospora caninum are structurally similar parasites with many common hosts. The prevalence of antibodies to T. gondii and N. caninum was determined in sera from dogs in Grenada, West Indies. Using a modified agglutination test, antibodies to T. gondii were found in 52 (48.5%) of the 107 dogs, with titers of 1:25 in 17, 1:50 in 19, 1:100 in 7, 1:1,600 in 5, and 1:3,200 or higher in 4. Seroprevalence increased with age from 2.2% in dogs <6 mo old to 18.9% in dogs older than 2 yr, indicating postnatal transmission of T. gondii in this population of canines. There was no correlation between the health of the dogs and the seroprevalence or magnitude of the T. gondii titer. Antibodies to N. caninum were determined by the indirect immunofluorescent antibody test (IFAT). Two of the 107 dogs had N. caninum antibodies (IFAT titers 1:100 and 1:400); these dogs had T. gondii titers of 1:1,600 and 1:50, respectively. Results indicate that these 2 structurally similar protozoa are antigenically different.

Seroepidemiology of feline leukaemia and feline immunodeficiency virus in domestic and feral cats in Grenada.

The serological prevalence of feline leukaemia virus (FeLV) and feline immunodeficiency virus (FIV) infections in domestic and feral cats in Grenada was studied using serum samples collected from 237 cats. The serum samples were tested for antibodies to the two viruses with the IDEXX ninety-six well micro assay plate ELISA kits. For confirmation, positive samples were further tested with the IDEXX comb FIV and FeLV snap tests. The overall prevalence of FeLV and FIV in cats in this study was 0% (n=237) and 19% (45/237), respectively. The seroplrevalence of FIV was 6.7% (7/104) in domestic cats and 28.6% (38/133) in feral cats. Feral cats had a significantly (p<0.05) higher FIV seroprevalence than domestic cats, and there was a significantly greater FIV seroprevalence in males compared to females as well as in cats 1 year of age and older compared to cats under one year. This study establishes the prevalence of FIV infection in Grenada. The negative FeLV results in our study are probably a reflection of Grenada's relative isolation and lack of numerous amicable contacts that occur when many cats share a close living space.