Range of Clinical Manifestations Caused by Invasive Meningococcal Disease Due to Serogroup W: A Systematic Review.

INTRODUCTION: Invasive meningococcal disease (IMD) due to serogroup W meningococci (MenW) is consistently reported with atypical clinical manifestations, including gastrointestinal symptoms, bacteremic pneumonia, and septic arthritis. We undertook a systematic review of the literature for a comprehensive assessment of the clinical presentation of IMD caused by MenW. METHODS: PubMed and Embase databases were searched from inception to June 2022 using a combination of MeSH terms and free text for articles that reported symptoms and signs of MenW IMD, and associated manifestations. RESULTS: The most commonly reported symptoms identified included: fever (range 36-100% of cases), nausea and/or vomiting (range 38-47%), vomiting (range 14-68%), cough (range 7-57%), sore throat (range 13-34%), headache (range 7-50%), diarrhea (range 8-47%), altered consciousness/mental status (range 7-38%), stiff neck (range 7-54%), and nausea (range 7-20%). Sepsis (range 15-83% of cases) was the most commonly reported manifestation followed by meningitis (range 5-72%), sepsis and meningitis (range 6-74%), bacteremic pneumonia (range 4-24%), arthritis (range 1-15%), and other manifestations (e.g., pharyngitis/epiglottitis/supraglottitis/tonsillitis/conjunctivitis; range 1-24%). The case fatality rates ranged from 8-40%, and among the survivors 4-14% had long-term sequelae. CONCLUSIONS: Clinicians need to be aware of the nonspecific symptoms and signs of IMD, as well as of the atypical manifestations in regions where MenW is known to circulate to ensure timely diagnoses and treatment.

Habituation of healthy dogs to treadmill trotting: repeatability assessment of vertical ground reaction force.

To assess the repeatability of kinetic gait analysis with a treadmill, 28 sound adult dogs were made to trot on an instrumented system. Vertical ground reaction force variables (Peak PFz and Impulse IFz) were collected by 10-s recordings, once a week, 4 weeks in succession. Data were analysed using a repeated-measures two-way ANOVA to investigate habituation to treadmill locomotion. Recorded data were stabilized from the end of the first and second sessions for IFz and PFz, respectively. The percentages of variance attributable to dogs, weeks, minutes and repetitions were, respectively, 72%, 10%, 7%, and 11% for PFz and 84%, 7%, 3%, and 6% for IFz. Habituation occurred after a single training session. Good repeatability was determined by a low coefficient of variation (3.4-4.7%). Adding a treadmill to kinetic gait analysis deserves consideration: reliable data are easily recorded using appropriate habituation and statistical model.

Progressive myelopathy due to a spontaneous intramedullary hematoma in a dog: pre- and postoperative clinical and magnetic resonance imaging follow-up.

A 4-year-old, male Jack Russell terrier was presented for a 6-month history of progressive right hemiparesis with episodic cervical hyperesthesia. The neurological examination showed a right-sided, upper motoneuron syndrome and partial Horner's syndrome. Two magnetic resonance imaging (MRI) examinations were performed 3 months apart and revealed a persistent cervical intramedullary hematoma. A dorsal myelotomy was performed. A subacute hematoma was confirmed histologically without underlying lesions. Eighteen months later, the dog's clinical signs were minimal. Two MRI examinations were performed 2 weeks and 5 months after surgery and revealed regressing signal abnormalities at the surgical site, consistent with a surgical scar.

Accuracy of asymmetry indices of ground reaction forces for diagnosis of hind limb lameness in dogs.

OBJECTIVE: To determine the accuracy of asymmetry indices of ground reaction forces (GRF) for diagnosis of hind limb lameness in dogs. ANIMALS: 36 healthy dogs and 13 dogs with naturally acquired cranial cruciate ligament rupture or hip dysplasia. PROCEDURES: Lameness for affected dogs ranged from not detectable to minor and constant. While dogs trotted on an instrumented treadmill, GRF variables were recorded and analyzed with asymmetry indices. Each index was tested for its ability to discriminate between healthy and affected dogs. Combinations of several indices were also assessed. RESULTS: Vertical force variables had better accuracy than craniocaudal force variables. Peak vertical force was the most accurate variable. Partial asymmetry during trotting was detected in healthy dogs. A multivariate approach that used peak vertical force and maximal rising slope yielded the optimum combination to distinguish between healthy and affected dogs. In addition, sensitivity of 92% or specificity of 95% may be achieved with 2 cutoff values while simultaneously maintaining specificity or sensitivity, respectively, at > 85%. CONCLUSIONS AND CLINICAL RELEVANCE: Asymmetry indices of GRFs were accurate for detection of hind limb lameness in dogs. This is particularly relevant for study designs in which only a single gait evaluation is possible.

Cutaneous saphenous nerve graft for the treatment of sciatic neurotmesis in a dog.

CASE DESCRIPTION: A 2-year-old Griffon Vendéen was examined because of a 1-month history of right hind limb lameness after a traumatic injury. CLINICAL FINDINGS: Neurologic examination revealed monoplegia and anesthesia of the right hind limb distal to the stifle (femorotibial) joint except for the area supplied by the cutaneous saphenous nerve. Results of electromyographic testing were consistent with a severe lesion of the tibial and peroneal nerves at the level of the stifle joint. TREATMENT AND OUTCOME: Exploratory surgery revealed an 80-mm-long gap in both the peroneal and tibial branches of the right sciatic nerve. A section of the left cutaneous saphenous nerve was interposed to graft the nerve defects. The dog received joint mechanotherapy and electrophysiologic therapy during the reinnervation process. Ten months after surgery, the dog had recovered almost completely. Neurologic examination revealed diminished flexion of the tarsal and digital joints. Repeat electromyographic testing revealed no abnormal spontaneous electrical activity in the right hind limb musculature, and small compound muscle action potentials were recorded in the right interosseous and cranial tibial muscles. CLINICAL RELEVANCE: Without surgical treatment, neurotmesis injury results in poor recovery of motor and sensory functions and may result in amputation. If a nerve defect exists, nerve grafting should be considered, even if the procedure is delayed until well after the injury. The sensory portion of the cutaneous saphenous nerve is a potential source of peripheral nerve for grafting in dogs. Reinnervation is a long-term process and physiologic support and owner involvement are necessary, but nearly complete functional recovery is possible.