Clinical presentation, outcome and prognostic factors in dogs with immune-mediated haemolytic anaemia: a retrospective single-centre study of 104 cases in Ireland (2002-2020).

BACKGROUND: Immune-mediated haemolytic anaemia (IMHA) has a high mortality rate within the first weeks to months of diagnosis. Identifying dogs at increased risk of death may help guide decision-making for owners and veterinarians. Prior studies have identified several but inconsistent prognostic factors. The objectives of the study were to describe the clinical presentation and outcome of canine immune-mediated haemolytic anaemia in Ireland and to assess for independent factors associated with survival including long-term survival. Medical records from a single centre were reviewed between 2002 and 2020 to identify dogs with immune-mediated haemolytic anaemia using the American College of Veterinary Internal Medicine (ACVIM) consensus statement algorithm. Survival analysis was performed using univariable Cox proportional hazards regression models with Breslow method for ties to identify prognostic factors. RESULTS: One hundred and four cases were included. The diagnosis of immune-mediated haemolytic anaemia was classified as definitive, supportive and suspicious in 42 (40%), 50 (48%), and 12 dogs (12%) respectively. Twenty-two dogs (21%) were diagnosed with associative IMHA and 82 dogs were diagnosed with non-associative IMHA (79%). 65% of the cases received more than one immunosuppressive medication during the course of treatment. The mortality rate at one and three months was 16% (95% confidence interval [CI] 9-26) and 31% (95% CI 21-43) respectively. Excluding dogs that died within three months, the median survival time was 2664 days. The relapse rate during the follow-up period was 7%. Survival did not improve over the course of the study period. Thrombocytopenia and hyperbilirubinaemia were identified as negative prognostic indicators (Hazard ratio 2.2 and 2.5, 95% CI 1.1-4.1 and 1.1-5.6, respectively). CONCLUSIONS: Excluding dogs that died within three months, the outcome was good in dogs with non-associative immune-mediated haemolytic anaemia in Ireland. The relapse rate was low regardless of the presence of associative causes. Thrombocytopenia and hyperbilirubinaemia were the only independent negative prognostic factors. The one-month and three-month mortality rates were similar compared to prior studies and survival did not improve over time during the study period: the mortality rate of canine immune-mediated haemolytic anaemia remains high in the acute phase.

Retrospective analysis of 131 feline uroliths from the Republic of Ireland and Northern Ireland (2010-2020).

BACKGROUND: The proportions of different urolith types have not been investigated in cats from the Republic of Ireland (ROI) and Northern Ireland (NI) previously. The objective of this study was to investigate the proportions of different feline urolith types submitted to Minnesota Urolith Center from the ROI and NI from 2010 to 2020. An additional aim of this study was to identify potential risk factors associated with each urolith type in cats in this geographic area. RESULTS: One hundred and thirty-one uroliths were submitted for the studied period with 44.3% being struvite, 43.5% calcium oxalate and 7.6% compound. Only 11 uroliths were submitted in the first 4 years. The number of submissions increased after 2015, peaking in 2019 with 25 submissions. Due to low numbers no conclusions could be made about changes in incidence of urolith types over time. Cats ≤7 years of age were significantly more likely to be diagnosed with struvite uroliths (OR, 2.87 [1.37-6.06]; p = 0.007) while cats ≥7 years of age with calcium oxalate uroliths (OR, 2.67, [1.29-5.37], p = 0.004). CONCLUSIONS: This is the first epidemiologic study of urolithiasis from cats in the ROI and NI. The most prevalent types of uroliths in our study population were struvite and calcium oxalate. Due to the low number of urolith submissions, changes in the incidence of different uroliths could not be accurately determined. Increasing age was associated with calcium oxalate formation while younger cats were more commonly diagnosed with struvite urolithiasis which can be medically dissolved. Therefore, urolith dissolution is more likely to be successful in young cats than older cats.

Congenital esophageal stenosis in a Labrador retriever.

A 1-year-old neutered male Labrador retriever was presented for investigation of chronic regurgitations that had started at weaning. Contrast radiographs and fluoroscopy of the thorax identified a focal narrowing of the proximal intrathoracic esophagus. Examination with CT-angiography excluded extraluminal causes for the narrowing, e.g., vascular ring anomaly. Esophagoscopy revealed the presence of a muscular stenosis with the appearance of a sphincter at the level of the proximal intrathoracic esophagus, without evidence of stricture. A diagnosis of congenital esophageal stenosis was made, suspected secondary to fibromuscular hypertrophy. Regurgitation resolved with conservative management and the dog was well at a 2-year follow-up examination. This case represents one of few small animal cases of congenital esophageal stenosis reported and apparently the only case successfully managed conservatively. Key clinical message: This report describes the clinical presentation, diagnostic imaging findings, and treatment of a rare case of congenital esophageal stenosis in a Labrador retriever. Medical and conservative therapies alone may be sufficient for treatment of congenital esophageal stenosis depending on presentation and suspected histopathological type. These therapies should be considered before initiating interventional procedures.

Sténose congénitale de l'oesophage chez un Labrador retriever. Un Labrador mâle castré âgé de 1 an a été présenté pour une investigation de régurgitations chroniques qui avaient commencé au sevrage. Les radiographies de contraste et la fluoroscopie du thorax ont identifié un rétrécissement focal de l'oesophage intrathoracique proximal. L'examen par tomodensitométrie-angiographie a exclu les causes extraluminales du rétrécissement, c'est-à-dire une anomalie de l'anneau vasculaire. L'oesophagoscopie a révélé la présence d'une sténose musculaire avec apparition d'un sphincter au niveau de l'oesophage intrathoracique proximal, sans signe de rétrécissement. Un diagnostic de sténose congénitale de l'oesophage a été posé, en raison d'une suspicion d'hypertrophie fibromusculaire. La régurgitation s'est résolue avec une gestion conservatrice et le chien allait bien lors d'un examen de suivi à 2 ans. Ce cas représente l'un des rares cas de sténose congénitale de l'oesophage rapportés chez les petits animaux et apparemment le seul cas traité avec succès de manière conservatrice.Message clinique clé :Ce rapport décrit la présentation clinique, les résultats de l'imagerie diagnostique et le traitement d'un cas rare de sténose congénitale de l'oesophage chez un Labrador. Les thérapies médicales et conservatrices seules peuvent être suffisantes pour le traitement de la sténose congénitale de l'oesophage en fonction de la présentation et du type histopathologique suspecté. Ces thérapies doivent être envisagées avant d'entreprendre des procédures interventionnelles.(Traduit par Dr Serge Messier).

Diagnostic performance of predicted ionized calcium in dogs with total hypercalcemia and total hypocalcemia.

BACKGROUND: Abnormal total calcium (tCa) values do not necessarily imply dysregulated ionized calcium. OBJECTIVES: We aimed to evaluate the diagnostic performance of predicted ionized calcium (piCa) regarding true calcium status in dogs with abnormal tCa. METHODS: This was a cross-sectional multicenter study. piCa and its prediction interval (PI) were calculated in 114 dogs, from three different hospitals, with either increased (62) or decreased tCa (52), All dogs also had ionized calcium and a biochemical profile available. The sensitivity, specificity, predictive values, and diagnostic discordance of piCa to confirm ionized hypercalcemia (iHyperCa) and ionized hypocalcemia (iHypoCa) were calculated using logistic regression analysis. RESULTS: iHyperCa was found in 28% and 66% of hyperphosphatemic and non-hyperphosphatemic dogs with tCa above the reference interval upper limit, respectively. The piCa correctly classified dogs with iHyperCa in 72.2% of those with hyperphosphatemia and 93.2% of those without hyperphosphatemia. Comparatively, elevating the tCa threshold to 12 mg/dL properly classified dogs 50% and 75% of the time in hyperphosphatemic and non-hyperphosphatemic dogs, respectively. iHypoCa was found in only 31/52 (60%) dogs with decreased tCa. The piCa correctly classified 55.2 to 100% of dogs with iHypoCa depending on the hospital. The PI demonstrated high sensitivity for iHyperCa (100%) and high specificity for both iHyperCa (100%) and iHypoCa (100%). CONCLUSIONS: Evaluating tCa alone does not reliably determine ionized calcium status. Even with hyperphosphatemia, piCa and its PI represent a reliable alternative to interpret abnormal tCa values when ionized calcium measurements are not available. However, if the tCa reference interval is notably different from 7.6 to 11.4 mg/dL, piCa values might be under/overestimated.

Serum interleukin 17 concentrations in dogs with immune-mediated hemolytic anemia.

BACKGROUND: Increased serum interleukin 17 (IL-17) concentration has been associated with the immunopathogenesis of autoimmune hemolytic anemia in humans. No data are available about IL-17 in immune-mediated hemolytic anemia (IMHA) of dogs. OBJECTIVES: Monitor changes in serum IL-17 concentration during the acute stages of IMHA in dogs, compared with results in healthy dogs, and its relationship with outcome. ANIMALS: Thirty-one client-owned dogs with primary IMHA and 27 healthy dogs. METHODS: Quantification of serum IL-17 concentration using a commercially available ELISA kit at the time of admission (D0), after 48 hours (D2) and after 96 hours (D4) as compared to concentration in healthy dogs. The IMHA dogs were classified as survivors if discharged from hospital, or nonsurvivors for any cause of in-hospital mortality. RESULTS: Mean serum IL-17 concentration was higher in dogs with IMHA on admission compared with healthy dogs (D0), but this difference was not significant (mean, 19.52 pg/mL vs 10.52 pg/mL, respectively, P = .17). Throughout hospitalization, serum IL-17 concentration significantly decreased in survivors. Serum IL-17 concentration at D0 was not different between survivors and nonsurvivors, but surviving dogs had significantly lower serum IL-17 concentration at D2 and D4 (P = .04 and P = .004, respectively) compared with nonsurviving dogs. No correlation was found between serum IL-17 concentration and serum total bilirubin or lactate concentrations or CBC parameters. CONCLUSION AND CLINICAL IMPORTANCE: Serum IL-17 concentration remained significantly higher in nonsurviving IMHA dogs whereas it significantly decreased during hospitalization in survivors, making serum IL-17 concentration a potential biomarker for severity and response to treatment in IMHA.

Clinical significance of Proteus mirabilis bacteriuria in dogs, risk factors and antimicrobial susceptibility.

The objectives of this study were to describe the in vitro antimicrobial susceptibility and clinical significance of Proteus mirabilis in canine bacteriuria and to identify the risk factors associated with P. mirabilis urinary tract infections. This is a retrospective observational study of 48 P. mirabilis-positive canine urinary cultures. Only 22 of the 48 P. mirabilis isolates (45.8%) were non-susceptible to at least one tested antimicrobial. Most P. mirabilis isolates (98%) were susceptible to enrofloxacin, 93.7% to amoxicillin/clavulanic acid, and 85.4% to ampicillin, cephalothin, and trimethoprim-sulfamethoxazole. Five multidrug-resistant isolates were detected (10.4%). A significant increase in antimicrobial resistance was observed over the study period. Positive P. mirabilis cultures were associated with bacterial cystitis in 36 of 39 dogs (92.3%), pyelonephritis in 2 of 39 dogs (5.1%), and one dog had both bacterial cystitis and pyelonephritis (2.5%). There was no subclinical bacteriuria. Most urinary tract infections were complicated as risk factors were identified in 37 of 39 dogs (94.8%). The most commonly identified risk factors were the presence of a contaminated peri-vulvar area with urine/feces or a hypoplastic vulva. To conclude, P. mirabilis bacteriuria was associated with upper and lower urinary tract infections in this study and was found more frequently in complicated bacterial cystitis. Multidrug-resistant isolates and increased P. mirabilis antimicrobial resistance have been identified over the last 10 years, but most isolates remain susceptible to first-line antimicrobials such as amoxicillin and trimethoprim-sulfamethoxazole.

Cette étude a pour but d'évaluer la sensibilité in vitro aux antibiotiques de Proteus mirabilis lors de bactériurie chez le chien, son importance clinique et les facteurs de risques d'infection urinaire associée à Proteus mirabilis. Il s'agit d'une étude rétrospective, observationnelle reposant sur 48 cultures urinaires positives à Proteus mirabilis chez le chien. Seuls 22 des 48 isolats (45,8 %) n'étaient pas sensibles à au moins un des antibiotiques testés. La majorité des isolats (98 %) étaient sensibles à l'enrofloxacine, 93,7 % à l'amoxicilline/acide clavulanique et 85,4 % à l'ampicilline, céphalothine et trimethoprime-sulfamethoxazole. Cinq isolats multi-résistants ont été détectés (10,4 %). Une augmentation significative de la résistance a été observée sur la période étudiée. Une cystite bactérienne a été diagnostiquée chez 36 des 39 chiens inclus (92,3 %), une pyélonéphrite chez deux chiens (5,1 %) et un chien présentait des signes de cystite bactérienne et de pyélonéphrite (2,5 %). Aucune bactériurie subclinique n'a été identifiée; la plupart des infections urinaires étaient compliquées (94,8 %). Les facteurs de risque les plus rencontrés sont la contamination de la région péri-vulvaire ou la présence d'une vulve hypoplasique. En conclusion, Proteus mirabilis doit être suspecté en cas de cystite bactérienne compliquée. Des isolats multi-résistants ont été identifiés et une hausse de la résistance a été observée au cours des dix dernières années. La plupart reste sensible aux antibiotiques de premières lignes que sont l'amoxicilline et trimethoprime-sulfamethoxazole.(Traduit par les auteurs).

The multivariate predictive model to estimate ionized calcium concentration from serum biochemical results in dogs: External validation.

BACKGROUND: Predicted ionized calcium (piCa) can be calculated from routine biochemistry variables using a recently developed predictive model in dogs. However, it has not been evaluated with variables measured from multiple laboratories. OBJECTIVES: We aimed to (a) externally validate piCa in dogs where biochemistry results were obtained from different analyzers, and (b) compare the diagnostic performances of piCa and total calcium (tCa). METHODS: A cross-sectional multicentric study on 138 dogs from three different hospitals was performed. The sensitivity (Sen), specificity (Spe), positive (PPV) and negative predictive values (NPV), and diagnostic discordance of piCa and tCa were calculated using logistic regression for ionized hypercalcemia and hypocalcemia. Diagnostic performance fluctuations across hospitals were also assessed. RESULTS: For ionized hypercalcemia, the Sen (81.8%), Spe (96.1%), PPV (69.2%), NPV (97.7%), and diagnostic discordance (5.1%) of piCa were not significantly different among hospitals or from those of tCa. For ionized hypocalcemia, the Sen (range: 9.7%-53.8%) and Spe (range: 95.6%-99.6%) of piCa and tCa (Sen range: 16.2%-87.8%; Spe range: 58.3%-98.1%) varied across hospitals, although to a lesser extent for piCa. The diagnostic discordances of piCa (20.3%) and tCa (25.4%) were close. The prediction interval (PI) of piCa demonstrated high Sen to screen for ionized hypercalcemia (100%) and hypocalcemia (range: 75%-93.3%), and high Spe to diagnose ionized hypercalcemia and hypocalcemia (100% for both). CONCLUSIONS: These results support the external validation of piCa in dogs. Its PI represents a notable advantage over tCa to help clinicians explore calcium-related disorders when ionized calcium cannot be readily measured.

Alveolar echinococcosis in an Ontario dog resembling an hepatic abscess.

A boxer dog was evaluated because of lethargy, vomiting, and abdominal pain. Ultrasonography revealed multiple cystic structures in the abdomen. Exploratory laparotomy revealed 3 well-encapsulated hepatic masses and abdominal effusion with suppurative inflammation. Collectively, these findings suggested the hepatic masses were most likely abscesses. However, histologic examination of the hepatic masses revealed multi-cystic structures, consistent with alveolar echinococcosis. The diagnosis was confirmed by DNA sequencing. The dog was treated with daily albendazole, but within a few weeks exhibited adverse side effects. After 6 months, the dog's condition deteriorated, and it was euthanized.

Échinococcose alvéolaire ressemblant à un abcès hépatique chez un chien en Ontario. Un chien de race boxer fut évalué à cause de léthargie, vomissements, et douleur abdominale. Une échographie révéla de multiples structures kystiques dans l'abdomen. Une laparotomie exploratoire révéla trois masses hépatiques bien encapsulées et une effusion abdominale avec inflammation suppurative. Collectivement, ces données suggéraient que les masses hépatiques étaient fort probablement des abcès. Toutefois, l'examen histologique des masses hépatiques révéla des structures multi-kystiques, compatibles avec une échinococcose alvéolaire. Le diagnostic fut confirmé par séquençage d'ADN. Le chien fut traité avec de l'albendazole quotidiennement, mais en quelques semaines il montra des signes d'effets adverses. Après 6 mois la condition du chien se détériora et il fut euthanasié.(Traduit par Dr Serge Messier).

Gallbladder leiomyoma treated by laparoscopic cholecystectomy in a dog.

CASE DESCRIPTION: A 12-year-old spayed female Chinese Crested was referred because of a mass detected in the gallbladder during ultrasonographic evaluation of the abdomen, which had been prompted by a history of high serum liver enzyme activities. CLINICAL FINDINGS: Serum biochemical analysis revealed mild hypoglobulinemia and high alkaline phosphatase, γ-glutamyltransferase, and alanine aminotransferase activities. Abdominal ultrasonography revealed diffuse hepatopathy and multiple pedunculated mucosal structures within the gallbladder. TREATMENT AND OUTCOME: Following initial treatment with ursodiol (11.4 mg/kg [5.18 mg/lb], PO, q 12 h) and S-adenosylmethionine (30 mg/kg [13.6 mg/lb], PO, q 24 h) for 1 month to address possible cholestasis, no change was noted in ultrasonographic or serum biochemical findings. Consequently, laparoscopic cholecystectomy was performed concurrently with laparoscopic liver biopsy. Histologic evaluation of resected gallbladder tissue and the liver biopsy specimen revealed evidence of multifocal to coalescing leiomyomas of the gallbladder and multifocal lipogranulomas of the liver. Eleven days after the dog was discharged from the hospital, it was taken to an emergency clinic because of anorexia, vomiting, and diarrhea. Mild pancreatitis or gastroenteritis was suspected, supportive treatment was provided, and ursodiol and S-adenosylmethionine administration was reinitiated. At the time of follow-up telephone contact with the owner 234 days after surgery, the dog continued to receive ursodiol and S-adenosylmethionine and had no clinical signs associated with hepatobiliary disease. CLINICAL RELEVANCE: Leiomyomas, although rare, can develop in dogs and should be considered as a differential diagnosis for intramural gallbladder lesions. Laparoscopic cholecystectomy served as a minimally invasive surgical treatment for this benign neoplasia.

Spontaneous cholecystopleural fistula leading to biliothorax and sepsis in a cat.

CASE SUMMARY: A 13-year-old spayed female domestic shorthair cat presented with pleural effusion and suspected triaditis. Intake vitals and leukocytosis were consistent with a diagnosis of systemic inflammatory response syndrome. Biochemical analysis confirmed a pleural fluid-to-serum bile ratio consistent with a diagnosis of biliothorax. Abdominal ultrasound failed to identify a definitive gall bladder but noted a hypoechoic tubular structure ventral to the liver and contacting the diaphragm. Thoracic ultrasound identified a hyperechoic structure contacting the diaphragm at the same location. Thoracoabdominal CT scan identified a fluid-dense tubular structure extending from ventral to the liver, through a diaphragmatic defect and directly communicating with the pleural space, suspected to be an abnormal gall bladder. The cat was humanely euthanized, and post-mortem analysis confirmed a cholecystopleural fistula arising from the gall bladder with multifocal abscesses, mixed inflammatory hepatic infiltrates and small-cell gastrointestinal lymphoma. Culture of the abscess isolated Parabacteroides merdae, meeting the reported feline criteria for sepsis. RELEVANCE AND NOVEL INFORMATION: To our knowledge, spontaneous cholecystopleural fistula formation leading to biliothorax and sepsis has not been previously reported in the cat. This case highlights a novel sequela of gall bladder disease in this species, and biliothorax should be a differential diagnosis for pleural effusion in cats with evidence of cholecystitis or triaditis.

Reproducibility, stability, and biological variability of thrombin generation using calibrated automated thrombography in healthy dogs.

BACKGROUND: Thrombin plays a central role in hemostasis and thrombosis. Calibrated automated thrombography (CAT), a thrombin generation assay, may be a useful test for hemostatic disorders in dogs. OBJECTIVES: To describe CAT results in a group of healthy dogs, and assess preanalytical variables and biological variability. ANIMALS: Forty healthy dogs were enrolled. METHODS: Lag time (Lag), time to peak (ttpeak), peak thrombin generation (peak), and endogenous thrombin potential (ETP) were measured. Direct jugular venipuncture and winged-needle catheter-assisted saphenous venipuncture were used to collect samples from each dog, and results were compared between methods. Sample stability at -80°C was assessed over 12 months in a subset of samples. Biological variability of CAT was assessed via nested ANOVA using samples obtained weekly from a subset of 9 dogs for 4 consecutive weeks. RESULTS: Samples for CAT were stable at -80°C over 12 months of storage. Samples collected via winged-needle catheter venipuncture showed poor repeatability compared to direct venipuncture samples; there was also poor agreement between the 2 sampling methods. Intra-individual variability of CAT parameters was below 25%; inter-individual variability ranged from 36.9% to 78.5%. CONCLUSIONS: Measurement of thrombin generation using CAT appears to be repeatable in healthy dogs, and samples are stable for at least 12 months when stored at -80°C. Direct venipuncture sampling is recommended for CAT. Low indices of individuality suggest that subject-based reference intervals are more suitable when interpreting CAT results.

Heparinase-modified thromboelastography in cats.

BACKGROUND: Evaluation of underlying hemostatic function is challenging when feline patients are receiving an anticoagulant medication. Discontinuing the anticoagulant to obtain accurate results for hemostatic testing may lead to thrombotic complications. The addition of heparinase to blood samples may mitigate the effects of exogenous heparin and allow hemostatic testing. METHODS: Tissue factor (TF)-activated thromboelastography (TEG) was performed using citrated whole blood from 19 cats. Assays were performed using citrated whole blood, with and without addition of unfractionated heparin to a concentration of 0.2 U/mL. For each blood sample, TEG assays were performed using a standard cup and a heparinase-coated cup. KEY FINDINGS: For TEG variables R, k, α-angle, and MA, mean values were not statistically different when citrated blood was used with standard or heparinase-coated cups. Heparinized blood assayed in standard cups displayed a significantly increased R and k, and significantly decreased α-angle and MA when compared to heparinized blood assayed in heparinase-coated cups. TEG variables for heparinized blood assayed in heparinase cups was not statistically different from those of the citrated whole blood without added heparin. SIGNIFICANCE: Heparinase modified, TF-activated, TEG reverses heparin effects in feline-citrated blood.