Modified rush venom immunotherapy in dogs with Hymenoptera hypersensitivity.

BACKGROUND: Hymenoptera envenomation occurs frequently in people and dogs and can trigger anaphylaxis. Venom immunotherapy (VIT) is the only preventive treatment for Hymenoptera hypersensitivity and is indicated for people with severe adverse reactions to insect stings. Rush VIT is an accelerated VIT protocol in people. This has not been reported in dogs. OBJECTIVES: The objective of the study was to evaluate the safety of modified rush VIT. ANIMALS: Twenty client-owned dogs with Hymenoptera hypersensitivity based on a history of adverse reactions to Hymenoptera envenomation and a positive intradermal test to honey bee and/or paper wasp venom. MATERIALS AND METHODS: Dogs received incremental doses of venom via subcutaneous injection one day per week for three consecutive weeks until the maintenance dose was achieved. Vital signs were recorded every 30 min prior to venom administration. Adverse reactions were categorised as localised or grade I-IV systemic reactions. RESULTS: Nineteen of 20 dogs (95%) completed rush VIT. One dog experienced a grade III systemic adverse reaction and was withdrawn from the study. No adverse reactions occurred in 10 of 20 dogs (50%). Localised and grade I-II systemic reactions occurred in nine of 20 dogs (45%), including nausea (n = 5), injection site pruritus (n = 3) and diarrhoea and lethargy (n = 1). CONCLUSIONS AND CLINICAL RELEVANCE: Modified rush VIT in dogs was well-tolerated and should be considered for dogs with Hymenoptera hypersensitivity. Larger studies are needed to evaluate the efficacy of VIT in dogs for preventing hypersensitivity reactions to insect stings.

Sensitivity of a Hymenoptera serological immunoglobulin (Ig)E assay for the diagnosis of venom hypersensitivity in dogs.

BACKGROUND: Hymenoptera envenomation with honey bee (Apis mellifera) and paper wasp (Polistes spp.) may cause life-threatening anaphylaxis in dogs. In human patients, clinical history, intradermal testing (IDT) and measurement of allergen-specific serological immunoglobulin (Ig)E (sIgE) are used to support a diagnosis of Hymenoptera venom hypersensitivity. The utility of venom allergen-specific sIgE has not yet been evaluated for this purpose in dogs. OBJECTIVES: The objective of the study was to investigate the sensitivity (sn), specificity (sp) and positive predictive value (PPV) of honey bee and paper wasp serological titres using a commercially available sIgE assay [VARL (Veterinary Allergen Reference Laboratory) Liquid Gold] against clinical history for a diagnosis of Hymenoptera hypersensitivity in dogs. MATERIALS AND METHODS: Honeybee and paper wasp IgE serum titres were measured in 15 client-owned dogs with a diagnosis of Hymenoptera venom hypersensitivity based on a history of anaphylaxis, owner observation of Hymenoptera, and positive IDT to bee and/or wasp; and in 10 client-owned dogs with no known history of anaphylaxis or Hymenoptera exposure and a negative IDT to bee and wasp. RESULTS: Analysis of receiver operating characteristic (ROC) curves demonstrate that a VARL score cut-off of one of six for honeybee yields Sn, Sp and PPV of 40%, 60% and 60%, respectively, and two of six for wasp yields Sn, Sp and PPV of 25%, 78% and 60%, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Owing to the poor sensitivity and PPV of sIgE assays for both bee and wasp hypersensitivity in dogs with known envenomation and anaphylaxis, the use of sIgE cannot be recommended as a tool for venom identification.

Fatal disseminated toxoplasmosis in a feline immunodeficiency virus-positive cat receiving oclacitinib for feline atopic skin syndrome.

Toxoplasma gondii is a ubiquitous protozoan, for which felids are the definitive host. Immunocompromised individuals are susceptible to recrudescent toxoplasmosis. This case describes a 6-year-old, feline immunodeficiency virus-positive domestic short hair cat with feline atopic skin syndrome that developed fatal toxoplasmosis after treatment with oclacitinib for five months.

Toxoplasma gondii est un protozoaire ubiquitaire dont les félidés sont l'hôte définitif. Les personnes immunodéprimées sont sensibles à la toxoplasmose recrudescente. Ce cas décrit un chat domestique à poils courts de 6 ans, positif pour le virus de l'immunodéficience féline, atteint du syndrome atopique cutané félin, qui a développé une toxoplasmose mortelle après un traitement à l'oclacitinib pendant cinq mois.

Toxoplasma gondii es un protozoo ubicuo, cuyo huésped definitivo son los felinos. Las personas inmunocomprometidas son susceptibles a la toxoplasmosis recrudescente. Este caso describe un gato doméstico de pelo corto positivo para el virus de la inmunodeficiencia felina de 6 años de edad con síndrome de piel atópica felina, que desarrolló toxoplasmosis fatal después del tratamiento con oclacitinib durante cinco meses.

Toxoplasma gondii é um protozoário ubíquo para o qual os felídeos são o hospedeiro definitivo. Indivíduos imunocomprometidos são suscetíveis a toxoplasmose recrudescente. Este relato descreve um caso de um felino doméstico de pelo curto de seis anos de idade, positivo para o vírus da imunodeficiência felina, com síndrome atópica felina, que desenvolveu toxoplasmose fatal após tratamento com oclacitinib por cinco meses.

Sterile pyogranuloma syndrome in a dog successfully treated with immunosuppressive therapy and reconstructive seed grafting.

This report describes a case of sterile pyogranuloma syndrome managed with immunomodulatory therapy and seed skin grafting. Seed skin grafting can be considered as part of a multimodal treatment approach for cutaneous defects caused by ulcerative immune-mediated diseases where secondary intention healing is delayed or contraindicated, and other forms of wound reconstruction may be prohibitive.

Cet article décrit un cas de syndrome pyogranulome stérile géré avec un traitement immunomodulateur et une greffe de peau. La greffe de peau peut être considérée comme faisant partie d'une approche de traitement multimodal des défauts cutanés causés par des maladies ulcératives à médiation immunitaire où la cicatrisation secondaire est retardée ou contre-indiquée, et pour lesquelles d'autres formes de reconstruction de plaies peuvent être prohibitives.

Este artículo describe un caso de síndrome de piogranuloma estéril manejado con terapia inmunomoduladora e injerto de piel por ensemillado. El injerto de piel por ensemillado se puede considerar como parte de un enfoque de tratamiento multimodal para los defectos cutáneos causados por enfermedades ulcerativas inmunomediadas en las que la cicatrización por segunda intención se retrasa o está contraindicada, y otras formas de reconstrucción de heridas pueden ser prohibitivas.

Este relato descreve um caso de síndrome do piogranuloma estéril tratado com terapia imunomoduladora e enxerto de pele. Enxertia de pele pode ser considerada parte da terapia multimodal para defeitos cutâneos causados por doenças imunomediadas ulcerativas em que a cicatrização por segunda intenção é postergada ou contraindicada, e outras formas de reconstrução de feridas são proibitivas.

Determination of threshold concentrations of plant pollens in intradermal testing using fluorescein in clinically healthy nonallergic cats.

BACKGROUND: Currently the same allergen concentrations for canine intradermal testing (IDT) are recommended for feline IDT. Feline skin reactions are subtle and more difficult to read than canine reactions. This difference may be due to suboptimal allergen concentrations used for IDT in cats. HYPOTHESIS/OBJECTIVES: To determine the irritant threshold concentration (ITC) of 16 pollen allergens using serial dilutions of allergen and intravenous fluorescein. The hypothesis tested was that feline IDT currently is performed at suboptimal allergen concentrations for pollens. ANIMALS: Twenty privately owned healthy clinically nonallergic cats. METHODS: IDT was performed in duplicate using 16 pollen allergens (weeds, grasses and trees) at a dilution of 8000 PNU/mL. Two blinded investigators graded the test reactions independently using subjective and objective criteria. Intravenous fluorescein was then administered and the test reactions were re-evaluated. IDT was repeated for any allergen that was positive, using serial dilutions of allergen at a concentration of 6000 and 4000 PNU/mL. RESULTS: The ITC for 2 of 16 of the allergens was determined. The ITC of Cynodon dactylon (Bermuda grass) and Schinus spp. (Peppercorn) was determined to be between 6000 and 8000 PNU/mL. The ITC of all other allergens tested in this study was >8000 PNU/mL. CONCLUSIONS AND CLINICAL IMPORTANCE: This study confirms that suboptimal allergen concentrations currently are used for feline IDT as the ITC is >8000 PNU/mL for 14 of 16 of the grass, weed and tree pollens evaluated. The ITC of Cynodon dactylon and Schinus spp. was determined to be between 6000 and 8000 PNU/mL.

First report of angio-oedema subsequent to the administration of allergen specific sublingual immunotherapy for the management of equine hypersensitivity dermatitis.

BACKGROUND: Sublingual immunotherapy (SLIT) offers an alternative mode of allergen delivery to subcutaneous immunotherapy (SCIT) with the aim of inducing immunological tolerance. Currently, there are no published reports regarding the efficacy or safety of SLIT in horses. HYPOTHESIS/OBJECTIVE: To describe the first case of several adverse events occurring in a horse subsequent to the repeat administration of SLIT. ANIMAL: A seven-year-old, warmblood mare with a confirmed diagnosis of equine hypersensitivity dermatitis (EHD). METHODS AND RESULTS: Immunotherapy was recommended for management of EHD. Due to the temperament of the horse, the owner elected to proceed with SLIT. Thirty six hours after commencing SLIT, the mare developed scleral oedema, moderate dyspnoea and abdominal discomfort. SLIT was withdrawn for 10 days and re instituted using a ten-fold dilution of the original vaccine. Localized oedema and swelling of the tongue developed within 12 h of administration. At this juncture, SLIT was withdrawn. The horse was rechallenged with the SLIT allergen vehicle, 50% glycerine and no adverse reactions occurred. SCIT was commenced using the same allergens and no adverse events occurred with repeated administration. CONCLUSIONS AND CLINICAL IMPORTANCE: To the best of the authors' knowledge, this is the first reported case of adverse reactions developing subsequent to the administration of SLIT for the management of EHD.

Cutaneous asthenia (Ehlers-Danlos-like syndrome) of Burmese cats.

OF CASES: A 6-month-old Burmese kitten developed focal skin lesions following a routine ovariohysterectomy. These were eventually attributed to the patient struggling during catheter placement and induction of anaesthesia. The lesions were caused by fluid extravasation in the subcutis and ischaemic necrosis of the overlying dermis, giving rise to an eschar-like appearance. Such lesions have been seen previously in Burmese cats with cutaneous asthenia and it is thought that they arise due to poor collagenous support for dermal blood vessels. An increased skin extensibility index (>23%) supported a diagnosis of cutaneous asthenia (Ehlers-Danlos-like syndrome), which has been reported as an inherited condition of Burmese cats in Australia, New Zealand and Europe. An additional Burmese cat with cutaneous asthenia is presented in detail, with lifetime follow-up and further salient observations by the owner, a veterinarian. Photographs of three other affected Burmese cats are provided to illustrate the range of presentations encountered with this condition. All five affected cats were presented with eschars, atrophic alopecia and increased skin extensibility, while one cat also had skin ulcers. Routine histopathological examination, including use of special stains such as trichrome, was unhelpful in establishing the diagnosis. CLINICAL REVIEW: The clinical features of this genetic disease of Burmese cats are reviewed, especially in relation to the postulated 'vasculopathy' that gives rise to characteristic skin lesions. Long term management of this condition is discussed briefly.

Focal metatarsal fistulae syndrome affecting a greyhound dog successfully treated with topical 0.1% tacrolimus ointment.

Metatarsal fistulation is an uncommon cutaneous condition reported almost exclusively in German shepherd dogs and their cross-breeds. To the best of the authors' knowledge this is the first reported case of focal metatarsal fistulae syndrome affecting a greyhound. Remission was obtained within 6 weeks of commencing treatment using compounded 0.1% tacrolimus ointment twice daily and the dog remained stable for another 6 months with twice weekly application before treatment was discontinued. The dog remained in remission at the time of writing, which is 1 year after treatment withdrawal.

Otogenic meningoencephalomyelitis due to Cryptococcus gattii (VGII) infection in a cat from Western Australia.

CASE SUMMARY: A 7-year-old spayed domestic longhair cat from Perth, Western Australia, presented with left-sided head tilt, dysphonia, head shaking, inappetence and weight loss. A polypoid lesion had previously been removed from the external ear canal. Otitis media with extension into the external ear canal was suspected and investigated using video-otoscopy and computed tomography examination. Invasive disease with extension from the middle ear to the base of the skull, and intracranial extension into the caudal fossa and cranial cervical vertebral canal was detected. Cytology of external ear canal exudate showed capsulated budding yeasts and Cryptococcus gattii VGII was cultured. Treatment with amphotericin B infusions and oral fluconazole was prescribed, with nutritional support via oesophagostomy tube. The cat clinically recovered 12 months after treatment commenced. RELEVANCE AND NOVEL INFORMATION: This case report describes the successful medical treatment of otogenic meningoencephalomyelitis due to C gattii (VGII) infection in a cat.

Characterization of meticillin-resistant and meticillin-susceptible isolates of Staphylococcus pseudintermedius from cases of canine pyoderma in Australia.

Meticillin-resistant Staphylococcus pseudintermedius (MRSP) has recently emerged as a worldwide cause of canine pyoderma. In this study, we characterized 22 S. pseudintermedius isolates cultured from 19 dogs with pyoderma that attended a veterinary dermatology referral clinic in Australia in 2011 and 2012. Twelve isolates were identified as MRSP by mecA real-time PCR and phenotypic resistance to oxacillin. In addition to ß-lactam resistance, MRSP isolates were resistant to erythromycin (91.6 %), gentamicin (83.3 %), ciprofloxacin (83.3 %), chloramphenicol (75 %), clindamycin (66 %), oxytetracycline (66 %) and tetracycline (50 %), as shown by disc-diffusion susceptibility testing. Meticillin-susceptible S. pseudintermedius isolates only showed resistance to penicillin/ampicillin (90 %) and tetracycline (10 %). PFGE using the SmaI restriction enzyme was unable to type nine of the 12 MRSP isolates. However the nine isolates provided the same PFGE pulsotype using the Cfr91 restriction enzyme. Application of the mec-associated direct repeat unit (dru) typing method identified the nine SmaI PFGE-untypable isolates as dt11cb, a dru type that has only previously been associated with MRSP sequence type (ST)45 isolates that possess a unique SCCmec element. The dt11cb isolates shared a similar multidrug-resistant antibiogram phenotype profile, whereas the other MRSP isolates, dt11a, dt11af (dt11a-associated) and dt10h, were resistant to fewer antibiotic classes and had distinct PFGE profiles. This is the first report of MRSP causing pyoderma in dogs from Australia. The rapid intercontinental emergence and spread of multidrug-resistant MRSP strains confirms the urgent need for new treatment modalities for recurrent canine pyoderma in veterinary practice.

Cutaneous nocardiosis in two dogs receiving ciclosporin therapy for the management of canine atopic dermatitis.

BACKGROUND: Ciclosporin is a calcineurin inhibitor that is currently registered for the treatment of canine atopic dermatitis. The most common adverse effects include mild, transient gastrointestinal disturbances. Single case reports of opportunistic infections due to Nocardia spp., Neospora spp. and papillomaviruses have also been reported. HYPOTHESIS/OBJECTIVES: Clinicians should be aware of the potential risk of systemic immunosuppression and subsequent infection with Nocardia spp. in dogs receiving ciclosporin. ANIMALS: Cutaneous nocardiosis in two dogs receiving ciclosporin therapy for management of canine atopic dermatitis. METHODS: Histopathology, PCR for Nocardia spp. and computed tomography. RESULTS: One dog developed disseminated nocardiosis due to Nocardia brasiliensis and a second dog developed localized cutaneous nocardiosis due to a novel Nocardia species subsequent to ciclosporin administration at the recommended dose rate for the management of canine atopic dermatitis. The second case was receiving a combination of ciclosporin and ketoconazole, and serum trough ciclosporin levels were elevated. CONCLUSIONS AND CLINICAL IMPORTANCE: Clinicians should be aware of the potential risk of systemic immunosuppression and subsequent infection with Nocardia spp. in dogs receiving ciclosporin. Measurement of serum ciclosporin levels may be useful in identifying those individuals which are at risk of opportunistic infections.

Clinical, histopathological and immunological characteristics of exfoliative cutaneous lupus erythematosus in 25 German short-haired pointers.

Clinical, histopathological and immunological features of exfoliative cutaneous lupus erythematosus, an uncommon generalized exfoliative dermatitis occurring exclusively in German short-haired pointers, were characterized in 25 dogs. The disease affects young adult dogs and its familial incidence strongly suggests a hereditary origin. Lesions were characterized by scaling and alopecia affecting 100 (25/25) and 76% (19/25) of dogs, respectively. Follicular casts were present in 28% (7/25) of dogs. The muzzle, pinnae and dorsum were typically affected. Generalized skin lesions were described in 52% (13/25) of dogs. Systemic signs of pain and lameness affected several dogs. Anaemia and thrombocytopenia were detected in several dogs with a more severe clinical phenotype. The most common histopathological features were hyperkeratosis and a lymphocytic interface dermatitis. Direct immunostaining revealed IgG deposition in the epidermal and follicular basement membrane of 100 (19/19) and 41% (7/17) of dogs, respectively. Circulating antifollicular and antisebaceous gland IgG antibodies were demonstrated by indirect immunostaining in 57% (4/7) of dogs. This disease usually responds poorly to immunosuppressive therapy and it has a guarded prognosis. Where outcome was recorded, 85% (10/12) of dogs were euthanased due to either a failure to respond to, or complications associated with, immunomodulatory therapy. Two affected dogs are in remission and maintained on immunomodulatory dosages of prednisolone. This study demonstrates the existence of a cellular and humoral immune response directed against the epidermal basement membrane of dogs with exfoliative cutaneous lupus erythematosus. Additional studies are required to further characterize the immunological pathogenesis of this disease.

Mycobacterium goodii infection in a dog with concurrent hyperadrenocorticism.

Abstract A 9-year-old Boston terrier was diagnosed with multifocal, nodular panniculitis caused by an organism belonging to the Mycobacterium smegmatis group by histological evaluation and bacteriological identification. The mycobacterial species was identified by direct gene sequence analysis and confirmed to be Mycobacterium goodii. Treatment using doxycycline and ciprofloxacin was successfully implemented for the mycobacterial panniculitis over a period of 9 months. Concurrent pituitary-dependent hyperadrenocorticism (Cushing's disease) was also identified using routine diagnostic methods and mitotane therapy was implemented. There was follow-up for 14 months after cessation of antimicrobial therapy with no recurrence of mycobacterial infection. Although cutaneous infections are frequently recognized as complications of canine pituitary-dependent hyperadrenocorticism, concurrent mycobacterial panniculitis due to any rapidly growing mycobacterium has not previously been reported. This is the first confirmed case of mycobacterial panniculitis due to M. goodii infection in a dog and also the first of any rapidly growing mycobacterial infection in a dog with concurrent endogenous Cushing's disease.