Severity of Nasal Inflammatory Disease Questionnaire for Canine Idiopathic Rhinitis Control: Instrument Development and Initial Validity Evidence.

BACKGROUND: Effective treatments are needed for idiopathic chronic rhinitis in dogs, but assessment of efficacy requires a practical, quantifiable method for assessing severity of disease. OBJECTIVES: To develop and perform initial validity and reliability testing of an owner-completed questionnaire for assessing clinical signs and dog and owner quality of life (QOL) in canine chronic rhinitis. ANIMALS: Twenty-two dogs with histopathologically confirmed chronic rhinitis and 72 healthy dogs. METHODS: In this prospective study, an online questionnaire was created based on literature review and feedback from veterinarians, veterinary internists with respiratory expertise, and owners of dogs with rhinitis. Owners of affected dogs completed the questionnaire twice, 1 week apart, to test reliability. Healthy dogs were assessed once. Data were analyzed using the Rasch Rating Scale Model, and results were interpreted using Messick's framework for evaluating construct validity evidence. RESULTS: Initial item generation resulted in 5 domains: nasal signs, paranasal signs, global rhinitis severity, and dog's and owner's QOL. A 25-item questionnaire was developed using 5-point Likert-type scales. No respondent found the questionnaire difficult to complete. Strong psychometric evidence was available to support the substantive, generalizability, content, and structural aspects of construct validity. Statistical differences were found between responses for affected and control dogs for all but 2 items. These items were eliminated, resulting in the 23-item Severity of Nasal Inflammatory Disease (SNIFLD) questionnaire. CONCLUSIONS AND CLINICAL IMPORTANCE: The SNIFLD questionnaire provides a mechanism for repeated assessments of disease severity in dogs with chronic rhinitis.

Aspiration of barium-impregnated polyethylene spheres by a dog.

This case report describes an 11-year-old Belgian Malinois dog with acute onset of cough caused by aspiration of barium-impregnated polyethylene spheres (BIPS) and pneumonia following an episode of suspected gastric dilation. Although bronchoscopic retrieval of the BIPS was largely unsuccessful, the dog recovered uneventfully, with most of the BIPS being coughed out and swallowed over a 1-month period. Aspiration of BIPS should be considered a potential complication of their administration. Furthermore, endoscopic removal of aspirated BIPS is challenging and may not be indicated because of their inert nature and possible self-clearance.

Demographic and historical findings, including exposure to environmental tobacco smoke, in dogs with chronic cough.

BACKGROUND: Controlled studies investigating risk factors for the common presenting problem of chronic cough in dogs are lacking. HYPOTHESIS/OBJECTIVES: To identify demographic and historical factors associated with chronic cough in dogs, and associations between the characteristics of cough and diagnosis. ANIMALS: Dogs were patients of an academic internal medicine referral service. Coughing dogs had a duration of cough>or=2 months (n=115). Control dogs had presenting problems other than cough (n=104). METHODS: Owners completed written questionnaires. Demographic information and diagnoses were obtained from medical records. Demographic and historical data were compared between coughing and control dogs. Demographic data and exposure to environmental tobacco smoke (ETS) also were compared with hospital accessions and adult smoking rates, respectively. Characteristics of cough were compared among diagnoses. RESULTS: Most coughing dogs had a diagnosis of large airway disease (n=88; 77%). Tracheobronchomalacia (TBM) was diagnosed in 59 dogs (51%), including 79% of toy breed dogs. Demographic risk factors included older age, smaller body weight, and being toy breed (P<.001). No association was found between coughing and month (P=.239) or season (P=.414) of presentation. Exposure to ETS was not confirmed to be a risk factor (P=.243). No historical description of cough was unique to a particular diagnosis. CONCLUSIONS AND CLINICAL IMPORTANCE: Associations with age, size, and toy breeds were strong. TBM is frequent in dogs with chronic cough, but descriptions of cough should be used cautiously in prioritizing differential diagnoses. The association between exposure to ETS and chronic cough deserves additional study.

Frequency of pulmonary mineralization and hypoxemia in 21 dogs with pituitary-dependent hyperadrenocorticism.

The purpose of this study was to determine the frequency of hypoxemia and pulmonary mineralization using 99mTc-methylene diphosphonate (99mTc-MDP) in dogs with pituitary-dependent hyperadrenocorticism (PDH). Twenty-one dogs with PDH were prospectively evaluated using thoracic radiography, arterial blood gas analysis, and bone phase and pulmonary perfusion scintigraphy (using 99mTc-macro-aggregated albumin [99mTc-MAA]). The radiographs and bone and perfusion studies were evaluated subjectively. An averaged quantitative count density ratio was calculated between the thorax and cranial thoraco-lumbar vertebrae from lateral thoracic 99mTc-MDP images. Thoracic:vertebral ratios were calculated using 99mTc-MDP studies from 21 control dogs. The thoracic:vertebral ratios were compared between the 2 groups (PDH and control). The mean age (+/-SD) of the 21 PDH dogs was 10.2 (+/-3) years, whereas the mean age of the control group was 9.8 (+/-3) years. Seven of the 21 dogs with PDH were hypoxemic (defined as an arterial partial pressure of oxygen [PaO2] < 80 mm Hg) with an average PaO2 (+/-SD) of 62 (+/-15) mm Hg. Of the 7 hypoxemic dogs, 2 were found to have pulmonary mineralization based on bone scintigraphic images. Pulmonary perfusion abnormalities were not identified using 99mTc-MAA in any of the 21 PDH dogs. Six PDH dogs had an abnormal interstitial pulmonary pattern and 5 of these dogs were hypoxemic. The average quantitative thoracic:vertebral ratio was not significantly different between the PDH and control dogs (0.5 +/- 0.4 versus 0.4 +/- 0.1, P = .16). Causes of hypoxemia other than pulmonary thromboembolism should be considered in dogs with PDH. Pulmonary mineralization may contribute to hypoxemia in dogs with PDH.

Tracheal rupture in cats: 16 cases (1983-1998).

OBJECTIVE: To determine causes of tracheal rupture in cats and the mechanism of injury. DESIGN: A retrospective study was conducted to identify cats with tracheal rupture. A second study was conducted to establish mechanism of injury, and a third study was conducted to determine volume of air needed to obtain an airtight seal when inflating the cuff of an endotracheal tube in a cat. ANIMALS: 16 cats with clinical signs of tracheal rupture, 10 cat cadavers, and 20 clinically normal cats that were undergoing anesthesia. PROCEDURES: Details were extracted from medical records of 16 cats with tracheal rupture (9 treated surgically and 7 treated conservatively). For the cadaver study, the trachea of each cat cadaver was intubated and observed during overinflation of the endotracheal tube cuff. For clinically normal cats, volume of air needed to obtain an airtight seal for the endotracheal tube was recorded. RESULTS: Most ruptures were associated with cats anesthetized for dental procedures. Clinical signs associated with tracheal rupture included subcutaneous emphysema, coughing, gagging, dyspnea, anorexia, and fever. Tracheoscopy was the method of choice for documenting tracheal rupture. Surgical and conservative management were successfully used, unless the injury extended to the carina. In the cadaver study, overinflation of the endotracheal tube cuff with > 6 ml of air resulted in tracheal rupture in 7 of 10 cadavers. For clinically normal cats, the volume of air (mean +/- SD) needed to obtain an airtight seal was 1.6 +/- 0.7 ml. CLINICAL IMPLICATIONS: Overinflation of an endotracheal tube cuff may result in tracheal rupture in cats.

Use of a modified stomach tube for bronchoalveolar lavage in dogs.

A technique that did not require use of a bronchoscope for bronchoalveolar lavage (BAL) in dogs was developed. An inexpensive, readily available 16-F Levin-type stomach tube was modified for the procedure. The technique was effective for collecting BAL fluid in 9 dogs that ranged from 9.3 to 26.2 kg (20.5 to 57.6 lb). Recovered fluid was consistent with fluid collected bronchoscopically. Mean recovery volume was 84/125 ml (67%), mean WBC counts were high (> 300 cells/microl), and > 70% of cells were macrophages. Complications from use of the technique were not detected on the basis of pulse oximetry, thoracic radiography, and clinical observation. This effective, simple, and safe technique for BAL can be readily performed in clinical settings that do not have bronchoscopic capabilities. It also provides a less costly alternative than bronchoscopic BAL.

Concentration of enrofloxacin and its active metabolite in alveolar macrophages and pulmonary epithelial lining fluid of dogs.

The purpose of this study was to determine the concentration of enrofloxacin and its active metabolite, ciprofloxacin, in alveolar macrophages (AM) and epithelial lining fluid (ELF) of the lungs in comparison to plasma concentrations in healthy dogs. Eleven dogs were given a single oral dose (5 mg/kg) of enrofloxacin. Four hours later, plasma and bronchoalveolar lavage (BAL) fluid were collected. Cells were separated from the BAL fluid and lysed for determination of drug concentrations within AM. Supernatant was used to determine concentrations of drugs in ELF. Drug assays were performed by high-performance liquid chromatography. The concentration of enrofloxacin (mean +/- SD) was 0.33 +/- 0.14 microgram/mL in plasma, 3.34 +/- 2.4 micrograms/mL in AM and 4.79 +/- 5.0 micrograms/mL in ELF. The concentration of ciprofloxacin was 0.42 +/- 0.26 microgram/mL in plasma, 1.15 +/- 1.03 micrograms/mL in AM and 0.26 +/- 0.26 microgram/mL in ELF. Mean concentrations of both drugs in AM were greater than in plasma (AM to plasma ratio, 10.3 for enrofloxacin and 4.7 for ciprofloxacin). Mean concentrations of enrofloxacin, but not ciprofloxacin, in ELF were greater than in plasma (ELF to plasma ratio, 13.5 for enrofloxacin and 0.52 for ciprofloxacin). Enrofloxacin concentrations in AM and ELF largely exceeded the MICs of the major bacterial pathogens and surpassed by about two times the breakpoint MIC of that drug, and ciprofloxacin concentrations in AM surpassed the MIC of many susceptible organisms. These results suggest that sufficient antimicrobial activity is present in AM and ELF of dogs following oral administration of enrofloxacin to be effective in the treatment of lower respiratory tract infections involving susceptible organisms.

Effects of valacyclovir in cats infected with feline herpesvirus 1.

OBJECTIVE: To determine whether orally administered valacyclovir can be used safely and effectively to treat cats with primary, feline herpesvirus 1 (FHV-1) infection. ANIMALS: 14 specific-pathogen-free adult cats. PROCEDURE: Cats were infected with FHV-1 strain 87-727 (300 microliters, 10(7) plaque-forming units/ml) by ocular and nasal inoculations, and were treated every 6 hours with dextrose (controls) or valacyclovir (60 mg/kg of body weight, PO). Virus shedding from both eyes and the oropharynx was monitored every 2 days by virus isolation, and subjective clinical scores were assigned daily for ocular and nasal discharge and conjunctival hyperemia. Urinalysis, CBC, and serum biochemical analysis were done prior to inoculation, and on days 2, 5, 7, 9, and 12 of infection. Differences in CBC and serum biochemical indices between groups were compared, as were differences between preinfection values and maximal postinfection values, rectal temperature, and scores for disease severity. RESULTS: All cats developed acute conjunctivitis and rhinitis typical of FHV-1 infection. Beginning between days 6 and 9, valacyclovir-treated cats became noticeably more lethargic and dehydrated than did cats of the control group. Total WBC and neutrophil counts were significantly lower in cats of the valacyclovir group. The experiment was terminated on day 12 for humane reasons. Histologic changes attributable to FHV-1 infection were similar in all cats. Additional histologic abnormalities seen only in the valacyclovir-treated cats were coagulative necrosis of the renal tubular epithelium, centrilobular atrophy and hepatic necrosis, and severe bone marrow depression. CONCLUSIONS: Cats appear to be uniquely sensitive to the toxic effects of valacyclovir, and even high doses appear not to suppress FHV-1 replication in acutely infected cats. CLINICAL RELEVANCE: Use of valacyclovir is of questionable value in cats with acute FHV-1 infection and, at high doses, the drug may be toxic.

Bronchoalveolar lavage in a dolphin.

Bronchoalveolar lavage (BAL) was performed twice to evaluate a stranded Atlantic bottle-nosed dolphin for pulmonary disease. A pediatric gastroscope with a working length of 1,090 mm and an outer diameter of 9.8 mm was of appropriate size for BAL in this dolphin. Fifty milliliters of sterile saline (0.9% NaCl) solution was used in each of 2 sites for the first lavage. Fluid recovery was 58 and 66% from the 2 sites; however, results of cytologic analyses were typical of a bronchial wash rather than BAL. Larger volumes of saline solution (85 to 100 ml/site) were used in the second lavage. Although fluid recovery was only 25 and 30% from the 2 sites, results of cytologic analyses were consistent with BAL. Mononuclear cells accounted for 72 and 90% of total WBC. Although the dolphin of this report did not appear to have pulmonary disease, experience obtained by performing BAL provided valuable information for the practical application of this technique in dolphins.

Fluconazole in cats: pharmacokinetics following intravenous and oral administration and penetration into cerebrospinal fluid, aqueous humour and pulmonary epithelial lining fluid.

The pharmacokinetics of fluconazole following intravenous (i.v.) and oral (p.o.) administration and the penetration of fluconazole into cerebrospinal fluid, aqueous humour and epithelial lining fluid (ELF) of the lungs were evaluated in adult male cats. Pharmacokinetic parameters were calculated from serum concentration-time data obtained following i.v. and p.o. administration of 50 mg per cat using a cross-over study design. Fluconazole concentrations were measured using a high-performance liquid chromatography assay. Mean total body clearance of fluconazole was 37.7 mL/h.kg, mean volume of distribution at steady state was 1.14 L/kg, mean residence time was 31.0 h and mean half-life of elimination was 25 h as derived by non-compartmental analysis of data. Absorption was complete. Mean ratios of fluid:serum fluconazole concentrations following administration of 50 mg fluconazole per day for 8 days were as follows: cerebrospinal fluid, 0.88; aqueous humour 0.79; ELF, 1.20. Fluconazole concentrations in cerebrospinal fluid, aqueous humour and ELF exceeded reported minimum inhibitory concentrations of fluconazole for pathogenic fungi. Results of this study suggest fluconazole can effectively be administered to cats at 50 mg per cat per day.

Cytologic identification of Toxoplasma gondii in bronchoalveolar lavage fluid of experimentally infected cats.

OBJECTIVE: To determine whether it was possible to retrieve organisms, by means of bronchoalveolar lavage (BAL), from cats inoculated with Toxoplasma gondii. DESIGN: Experimental study. ANIMALS: 27 cats. Sixteen of the 27 were experimentally infected with feline immunodeficiency virus. PROCEDURE: All cats were inoculated with T gondii tachyzoites. Cats were grouped on the basis of feline immunodeficiency virus status and route (IV or intra-arterial) and number of tachyzoites administered. Bronchoalveolar lavage was performed by means of a standard technique. Lavage fluid was evaluated cytologically for tachyzoites. RESULTS: Clinical signs of toxoplasmosis varied widely among individual cats, but were generally most pronounced in group-1 and -2 cats (n = 5 each) and less pronounced in group-3 (n = 5) cats. Group-4 and -5 cats (n = 6 each) did not have clinical signs of toxoplasmosis. In 14 of the 15 cats in groups 1, 2, and 3, tachyzoites were detected in BAL fluid collected 7 days after inoculation. Tachyzoites were detected 14 days after inoculation in the single cat without tachyzoites 7 days after inoculation. A necropsy was performed on 9 of these cats, and tachyzoites were identified histologically in 4 of the 9. Tachyzoites were not detected in BAL fluid collected 3 days (n = 6) or 7 days (n = 6) after inoculation from the 12 cats in groups 4 and 5. Tachyzoites were not identified histologically in any of these 12 cats. CLINICAL IMPLICATIONS: BAL may be useful in the diagnosis of toxoplasmosis, particularly in cats with signs of pulmonary involvement.

Effect of FIV infection on lung inflammatory cell populations recovered by bronchoalveolar lavage.

Human immunodeficiency virus (HIV) and ovine progressive pneumonia virus have been associated with lymphocytic pneumonitis. Pulmonary cell populations in cats infected with feline immunodeficiency virus (FIV) were evaluated by bronchoalveolar lavage (BAL) to identify changes associated with lentivirus infection in this species. Bronchoalveolar lavage was performed through an endotracheal tube using 15 ml kg-1 body weight of sterile 0.9% sodium chloride solution. Results of BAL fluid cytologic analysis from 19 cats experimentally infected with FIV for at least 8 months were compared with results from 34 uninfected cats. Infected cats had significantly higher total cell counts and relative neutrophil counts (P < 0.01). Lymphocytosis did not occur. Bronchoalveolar lavage fluid was collected from nine additional cats prior to, and 2, 6, and 17-18 weeks following infection with FIV. Neither neutrophilia nor lymphocytosis was associated with FIV infection in these cats.

Cytological analysis of bronchoalveolar lavage fluid in the diagnosis of spontaneous respiratory tract disease in dogs: a retrospective study.

Results of cytological analysis of bronchoalveolar lavage (BAL) fluid were compared with clinical diagnoses in dogs that presented with signs of respiratory disease to referral hospitals. Of 68 dogs in which a clinical diagnosis was possible, BAL cytological findings were considered definitive for the diagnosis in 17 cases (25%), supportive of the diagnosis in 34 cases (50%), and not helpful in 17 cases (25%). Findings were most often considered supportive of or definitive for the clinical diagnosis in dogs with alveolar or bronchial radiographic patterns, or the presence of pulmonary masses. BAL results among lung lobes differed in 23 of 63 dogs (37%) with diffuse radiographic patterns. Tracheal wash cytology differed from BAL fluid cytology in 45 of 66 dogs (68%). Bronchoalveolar lavage was a clinically useful procedure for the diagnostic evaluation of dogs with signs of respiratory disease.

Tumor necrosis factor-alpha responses are depressed and interleukin-6 responses unaltered in feline immunodeficiency virus infected cats.

Feline immunodeficiency virus (FIV), a lentivirus similar to HIV, causes an acquired immunodeficiency syndrome in cats. Similar to human immunodeficiency virus (HIV), the pathogenesis of FIV is associated with dysregulation of the cytokine network. While alterations in tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) expression have been reported in HIV-infected patients, changes attributable to HIV and those caused by cofactors such as secondary infections cannot always be readily distinguished. This study evaluated the effect of FIV infection on TNF-alpha and IL-6 production in cats not exposed to other potential cofactors such as secondary infections. TNF-alpha and IL-6 activities were evaluated in bronchoalveolar lavage (BAL) cells from FIV-infected and uninfected specific pathogen free (SPF) cats. Supernatants from lipopolysaccharide (LPS)-stimulated BAL cells from uninfected SPF cats had high levels of TNF-alpha and IL-6 activity, while stimulated BAL cell supernatants from FIV-infected SPF cats had significantly lower levels of TNF-alpha but unaltered IL-6 activity. Similarly, Con A/phorbol myristate acetate (PMA) stimulated non-adherent (NA-) peripheral blood mononuclear cells (PBMC) from FIV infected cats synthesized less TNF-alpha than similarly treated NA-PBMC from uninfected cats. Feline immunodeficiency virus could be recovered from the culture supernatants of BAL cells from infected cats by co-cultivation with susceptible lymphocytes. In situ hybridization identified FIV mRNA in a small fraction of alveolar macrophages in the BAL cell cultures.(ABSTRACT TRUNCATED AT 250 WORDS)

Cytologic characterization of bronchoalveolar lavage fluid collected through an endotracheal tube in cats.

Bronchoalveolar lavage was performed through an endotracheal tube in 34 specific-pathogen-free cats to determine expected values for bronchoalveolar lavage fluid cytologic analysis, using this method of collection. Saline solution for lavage was instilled in 3 separate aliquots at a volume of 5 ml/kg of body weight each. Analysis of sequential aliquots was performed to investigate the differences in cell counts among the 3 fractions. The effect of combining aliquots, including or omitting the first fraction, was evaluated to determine whether all aliquots could be combined for analysis without substantially affecting results. The total number of nucleated cells retrieved from each cat ranged from 0.9 to 31.1 x 10(6). Most of these cells were macrophages (78 +/- 15%, mean +/- SD) and eosinophils (16 +/- 14%). The first aliquot had the greatest number of epithelial cells, and the lowest total nucleated cell count and relative and absolute eosinophil counts. Differences among aliquots also were identified for relative and absolute macrophage counts, relative and absolute neutrophil counts, and absolute lymphocyte count. Statistically significant differences were found for many of the cell counts when values from the combination of the second and third aliquots were compared with values from the combination of all 3 aliquots. Magnitude of the differences was small, and these differences were not believed to be of practical consequence.

Confirmation of a pulmonary component of multicentric lymphosarcoma with bronchoalveolar lavage in two dogs.

Histologic examination of lung tissue has been the only definitive diagnostic procedure used to confirm pulmonary involvement with lymphosarcoma (LSA) in dogs. Lung involvement with LSA was diagnosed by cytologic examination of bronchoalveolar lavage fluid in 2 dogs with multicentric LSA. Both dogs had cough or dyspnea, in addition to peripheral lymphadenopathy or visceral organomegaly. Both dogs had nonspecific, abnormal thoracic radiographic findings, including diffuse pulmonary interstitial pattern, hydrothorax, and mediastinal and retrosternal lymphadenopathy. In these 2 dogs, postmortem lung histologic examination, performed immediately after bronchoalveolar lavage, confirmed the cytologic diagnosis of pulmonary infiltration with LSA.

Cytologic analysis of bronchoalveolar lavage fluid from 47 dogs with multicentric malignant lymphoma.

Bronchoalveolar lavage (BAL) was performed in 47 dogs with multicentric malignant lymphoma (ML). Cytologic results were evaluated, and ability to detect pulmonary involvement with ML, using BAL, was compared with ability to detect pulmonary involvement, using thoracic radiography and tracheal wash. Lung lobes were considered to be involved with ML on the basis of BAL fluid findings if morphologically abnormal lymphocytes were present in the fluid. Total nucleated cell count, relative lymphocyte count, and absolute lymphocyte count were greater (P < 0.001) in BAL fluid from dogs with multicentric ML than in BAL fluid from histologically normal dogs. Pulmonary involvement with ML was detected by BAL fluid cytologic examination in 89 of 135 lung lobes lavaged (66%). Lung lobes involved with ML were from 31 of the 47 dogs with multicentric ML (66%). Radiographic abnormalities supportive of pulmonary parenchymal involvement with ML were detected in 16 of the 47 dogs (34%). Of these 16 dogs, 15 (94%) had pulmonary involvement with ML on the basis of BAL fluid cytologic findings. Tracheal wash fluid contained abnormal lymphocytes in 4 of 41 dogs (10%). In all 4 dogs, BAL fluid also contained abnormal lymphocytes. Cytologic evaluation of BAL fluid was more sensitive in detecting pulmonary involvement with ML, compared with radiographic evaluation of the lungs or tracheal wash.

Identification of Histoplasma capsulatum organisms in the pleural and peritoneal effusions of a dog.

Histoplasma capsulatum organisms were identified by cytologic evaluation in the thoracic and abdominal effusions of a 5-year-old sexually intact male Cocker Spaniel that was referred because of anorexia and lethargy. Treatment with amphotericin B and ketoconazole was instituted. The dog developed respiratory arrest, a complication of the disseminated disease, and died. Necropsy findings included pleural effusion, hepatomegaly, and enlarged tracheobronchial, hilar, mediastinal, and mesenteric lymph nodes. Granulomas containing periodic acid-Schiff (PAS)-positive yeast-like organisms identified as H capsulatum were seen in the lungs, liver, and lymph nodes. The lymphatic vessels were dilated, and fibrosis of the portal and periportal regions of the liver was noticed. Identification of Histoplasma organisms by cytologic examination of pleural and abdominal effusions is a rare laboratory finding and can provide a minimally invasive and inexpensive definitive diagnosis of histoplasmosis.