Feline pyothorax: a retrospective study of 27 cases in Australia

Successful Management of Recurrent Pyothorax in a Cat: Clinical Findings with Medical and Surgical Approaches

Feline pyothorax or thoracic empyema is a condition characterized by the accumulation of purulent exudate within the thoracic cavity due to infection [...].

Fungal Empyema Thoracis Associated with Clavispora lusitaniae-First Report in a Domestic Cat

Invasive fungal infections are life-threatening conditions that always pose a challenge to veterinary practitioners. The diagnostic and therapeutic approaches in a case of pleural effusion in a domestic cat with a 7-day history of progressive tachypnea were described. Fungal pyothorax was diagnosed on the basis of the clinical signs, radiography findings, complete blood counts, and isolation of the pathogen from pleural effusion samples on two occasions. After three thoracenteses for evacuation of the pleural exudate and 15-day therapy with terbinafine, the general condition of the patient was very good; the complete blood count and respiratory and heart rates returned to normal; and no diagnostic imaging signs of pleural effusion were present. To the best of our knowledge, this is the first report of empyema thoracis caused by Clavispora lusitaniae in a domestic cat. The described case emphasises the primary importance of timely identification of pathogenic agent(s) of feline pyothorax and appropriately prescribed treatment for the prevention of severe complications and fatal outcomes.

Recommended recumbency to avoid insertional complications during small-bore wire-guided thoracostomy tube placement in cats-a cadaver study

BACKGROUND

Small-bore wire-guided thoracostomy tubes (SBWGTT) are commonly used in cats to manage pleural disease and generally have a low complication rate. Our study aimed to explore the correlation between recumbency of cats, placement method, and the occurrence of insertional complications to identify risk factors during SBWGTT placement. In this experimental cadaveric study, SBWGTT placement using a modified Seldinger technique was conducted in 24 feline cadavers. Cats, euthanized for reasons unrelated to the study, were randomly assigned to pleural effusion (EFF; n = 12) and pneumothorax (PNEU; n = 12) groups. Each cadaver was intubated and ventilated with a peak inspiratory pressure (PIP) of 10 mmHg, and sterile saline or air was instilled into the thorax over a 5 mm thoracoscopic trocar in the fourth intercostal space (ICS). Instillation was stopped when the lateral thoracic wall to lung distance (TWLD) reached 10 to 12 mm, measured with ultrasound in the favorable position. Sternal recumbency was the favorable position for the EFF group, and lateral recumbency for the PNEU group. Following the placement of the first SBWGTT in each group, the cadavers were positioned unfavorably (lateral recumbency for EFF group, sternal recumbency for PNEU group), and a second drain was introduced contralaterally. A bilateral 8th ICS thoracotomy was then performed to visually assess intrathoracic structures and drain integrity. A binary logistic regression mixed model was conducted to determine interaction between the induced condition and body position.

RESULTS

A total of 48 SBWGTTs were placed, with complications observed in 33.3% (8/24) of cases. Five of these were major complications consisting of lung lacerations. Complications were more common in the unfavorable position, accounting for 75% of cases, although this result was not statistically significant. The odds of complication rates were > 70% in the unfavorable position and decreased with an increase in TWLD (< 30%).

CONCLUSION

Complications associated with SBWGTT placement are influenced by recumbency, although the data did not reach statistical significance. Placing cats in lateral recumbency for pneumothorax treatment and sternal recumbency for pleural effusion treatment may reduce insertional complications.

Diagnosis of Septic Body Cavity Effusion in Dogs and Cats: Cytology vs. Bacterial Culture

The elective test for the determination of the effusions etiopathogenesis is represented by physico-chemical analysis and cytology. Nevertheless, the bacterial culture and antibiotic sensitivity tests are crucial for setting therapy and for the outcome. This study compared cytology with microbiology in the etiologic diagnosis of exudative body cavity effusions in dogs and cats collected from October 2018 to October 2022. All samples underwent aerobic and anaerobic culture and cytology examination. Bacterial identifications were confirmed using matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry, whereas cytological samples were blindly evaluated either in May Grunwald-Giemsa (MGG) or Gram-stained samples by two board-certified clinical pathologists. A moderate agreement (κ = 0.454) between cytology and bacterial culture was revealed. The sensitivity of the cytological evaluation in our study ranged from 38.5% to 67.9%, and the specificity ranged from 88.9% to 100%, depending on the type of the effusion, so cytology may not be representative of the etiopathogenesis, whereas bacterial culture can misidentify or fail to isolate the correct pathogen for difficult in vitro growing due to the presence of inhibitory substances or contamination. Cytology and bacterial culture results for exudative body cavity effusions in dogs and cats can be misleading if conducted separately, so these two tests should be performed together to increase diagnostic accuracy.

Successful surgical management of a pyothorax in a Guinea baboon (Papio papio)

A 16-year-old male Guinea baboon (Papio papio) was evaluated for weakness and focal wet fur of 1-week duration. A pyothorax caused by Streptococcus anginosus was diagnosed. A surgical approach was chosen, combined with a systemic antibiotic therapy. Medical imaging and C-reactive protein follow-up revealed the resolution of the pyothorax.

Salmonella enterica subspecies enterica serotype Typhimurium induced pyelonephritis and suspected multifocal myositis in a cat

Case summary

A 2-year-old male neutered domestic shorthair cat presented with an acute onset of muscular pain, ataxia and fever. Serological tests for Toxoplasma gondii IgM and IgG, cryptococcal antigen, feline immune deficiency virus antibody and feline leukaemia virus antigen were all negative. Brain and spinal MRI showed evidence of myositis and bilateral renal parenchymal abnormalities and pyelectasis. Salmonella enterica subspecies enterica serotype Typhimurium 1,4, [5],12:i:1,2 was isolated from urine and was susceptible to amoxycillin, amoxycillin-clavulanic acid, enrofloxacin and trimethoprim-sulfonamide. All clinical signs resolved after a 2-week treatment course with oral amoxycillin-clavulanate. A repeat urine culture 7 days after completing the antimicrobial course was negative.

Relevance and novel information

Infection with Salmonella species is uncommon in cats and has not previously been reported in association with pyelonephritis or generalised myositis. The importance of performing urine culture in the initial diagnostic investigation of cats with pyrexia is highlighted in this case report.

Clinicopathological and Radiological Features of Cats Presented with Infectious Respiratory Disease Signs: A Focus on Rhodococcus equi and Klebsiella pneumoniae

The objective of this study was to evaluate the prevalence of involvement of common viral organisms R. equi and K. pneumoniae and their clinicopathological and radiological features in respiratory disease of Malaysian domestic cats. A total of 34 feline cases with acute/chronic infectious respiratory disease signs were followed prospectively to investigate respiratory disease due to R. equi and K. pneumoniae and their relationship with concurrent viral infections in disease manifestation. All sampled cats (n = 27) were positive for FCoV antibodies and negative for FeLV. A significantly high antibody titer for FCV in n = 26 cases was also noticed. A single sample of pyothorax from a 3-months-old, non-vaccinated kitten was positive for R. equi. Bronchopneumonia with severe infiltration of the polymorphs and mononuclear inflammatory cells were prominent features of lungs histopathology from the kitten positive for R. equi. K. pneumoniae subsp. pneumoniae was confirmed from tracheal swabs of two cats. Histologically, the tracheal tissues of the two cats positive for K. pneumoniae were normal. In diagnostic imaging, epicenter of the infectious URT disease was nasal conchae rostrally and nasal turbinates caudally, however for infectious LRT disease was bronchial tree. Conclusively, infectious respiratory disease is a complex illness in cats, predominantly for unvaccinated kittens and young adult cats, especially those kept in multi-cat household or shelter environments because of the involvement of multiple bacterial and viral organisms as primary or secondary invaders. Clinicians should not preclude feline rhodococcosis from differentials, especially in kittens with pyothorax and less than one year of age. Unlike R. equi, K. pneumoniae has the potential to colonize URT of cats which might be disseminating further to cause LRT disease.

Pyothorax caused by Nocardia sp. in a cat - Case report

Nocardiosis is an infection caused by ubiquitous opportunistic bacteria and is rare in felines. In retrospective studies of the infection in the species, pyothorax was found in only about 5% of the cases described, with the most frequent forms being cutaneous and subcutaneous. This report describes Nocardia spp. as an etiologic agent of pyothorax in a feline leukemia virus (FeLV)-positive female cat. A 10-year-old female mixed-breed cat, positive for FeLV, with chronic kidney disease IRIS stage 2, was examined with a severe dyspneic onset, suspected of pleural effusion. It also had skin lesions in the interscapular region. The patient underwent thoracentesis, and a dense, creamy, fetid, and flocculated liquid was collected. Radiography was performed after draining the pleural fluid, which showed images suggestive of atelectasis of the left lung lobes and pneumonia. The collected material was sent for analysis, which found that it was a septic exudate. In addition, it was referred for bacterial culture in a special medium due to suspicion of nocardiosis. Long-term treatment with amoxicillin + clavulanic acid resolved the clinical case.

Retrospective Evaluation of the Use and Complications of Small-Bore Wire-Guided Thoracostomy Tubes in Dogs and Cats: 156 Cases (2007–2019)

Background

Small-bore wire-guided thoracostomy tubes (SBWGTT) are commonly used in small animals for management of pleural space disease. We aimed to evaluate the indications, placement locations, types of complications, and complication rate of small-bore wire-guided thoracostomy tube placements in dogs and cats in a university setting.

Methods

Electronic medical records of patients that underwent SBWGTT placement were reviewed. Signalment, disease, outcome, indication for thoracostomy tube, placement location, number of attempts, diagnostic imaging, number, and type (insertional, technical, and infectious) of complications were recorded. Logistic regression analysis was performed to determine risk factors for complications.

Results

A hundred fifty-six cases were identified between 2007 and 2019. Traumatic pneumothorax (33%), pyothorax (25%), and spontaneous pneumothorax (16%) were the most common indications for placement of a SBWGTT. Complications developed in 50 cases (32%). Technical and insertional complications accounted for 21.7% and 14.1% of all cases. Infectious complications were rare with 3.1% of all cases. Pneumothorax (19%), soft tissue swelling at insertion site (14%), and kinking of the chest tube (13%) were most common. Accidental lung perforation was reported in 5/50 complications (7%). Multiple chest tube placement attempts were associated with complications (OR = 6.01 CI: 2.13 to 16.93 p = 0.0007).

Conclusions

Complications of SBWGTT placement occurred in one third of cases. Serious complications such as accidental lung perforation was reported in two cases. Complications were associated with number of attempts.

Retrospective analysis of radiographic signs in feline pleural effusions to predict disease aetiology

Background

The objectives of the study were to determine the prevalence of underlying conditions causing pleural effusion in cats and to calculate the positive predictive values, negative predictive values, sensitivity and specificity of radiographic signs to predict aetiology of the pleural fluid.

Methods

Data from 148 cats with pleural effusion and diagnosed with known aetiologies were retrospectively analysed. Sixty one cats had thoracic radiographs evaluated by consensus through pre-defined radiographic signs by two radiologists blinded to the diagnoses.

Results

Congestive heart failure (53.4%) was the most common diagnosis, followed by neoplasia (20.3%), pyothorax (10.8%), idiopathic chylous effusion (5.4%), feline infectious peritonitis (1.4%) and "other" or cats with multiple diagnoses (total 8.8%). Cats with an enlarged cardiac silhouette had a high positive predictive value of congestive heart failure (90%). Mediastinal masses (100%)and pulmonary masses (100%) were highly predictive of neoplastic disease. Pulmonary nodules (50%) were poorly predictive of neoplastic disease. The remainder of the radiographic variables were not informative predictors of underlying disease.

Conclusions

In our sample of cats, congestive heart failure was the most common cause of pleural effusion. Radiographically enlarged cardiac silhouette and presence of a mediastinal mass may be useful predictors of aetiology, however there are limitations to the use of radiography alone as a diagnostic tool.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12917-022-03218-3.

Prevalence of Bacterial Species in Skin, Urine, Diarrheal Stool, and Respiratory Samples in Cats

Bacterial infections are a significant cause of illness and death in different animals. However, these bacterial infections could be a source of human disease or illness if these pathogenic bacteria are present in companion animals. This study aimed to investigate the prevalence of pathogenic bacteria associated with different site infections in cats in the Republic of Korea. For this purpose, samples were collected from the skin/ear, urine, respiratory, and diarrheal stool origins of cats obtained between 2018 and 2019 from seven different laboratories and centers participating in the Korean Veterinary Antimicrobial Resistance Monitoring System. These samples were subjected to analysis for the identification and isolation of associated bacterial species using a bacterial culture approach. A total of 609 isolates were identified in four different cat samples. Among them, 267, 184, 57, and 101 were extracted from diarrheal stool, skin, urine, and respiratory samples, respectively. The findings of this study showed that Escherichia coli was the most prevalent species among isolated bacterial species of diarrheal stool and urine origin. Staphylococcus felis and Pasteurella multocida were most prevalent in the skin and respiratory tract, respectively. However, there was no significant difference in bacterial distribution among the different age groups in all samples. This is the first nationwide surveillance report that associates bacterial prevalence with their site of origin and helps in the prevention of bacterial infections in cats. Moreover, the pattern of bacterial prevalence could provide sufficient guidance for the selection of empirical antimicrobial therapy against infections in cats.

Therapy of Pyothorax in Cats via Small-Bore Thoracostomy Tube in Terms of Efficacy, Complications and Outcomes

Simple Summary

With this study we present our therapeutic strategy for cats with purulent fluid accumulation in the thorax. In addition to the systemic administration of antibiotics, the aim of the therapy is always the drainage of the purulent fluid from the thorax. For this purpose, we use a particular small-bore chest drain. The first aim of our study is to assess the efficacy and complication rate of our drainage. The second objective is to evaluate two treatment groups regarding their disease outcomes. We were able to show that our small-bore chest drain is similarly effective to the traditionally used large-bore drains. At the same time, we had a very low drain-associated complication rate. We detected no difference between the treatment groups and, thus, no effect on survival by early placement of bilateral drains into the thoracic cavity or lavage of the thoracic cavity with a heparinised solution. Our study supports the theory that drainage of purulent fluid from the thoracic cavity in cats can be performed with small-bore drains with good results and minimal risk of complications.

Abstract

First-line therapy for cats with pyothorax consists of intravenous antibiotics, drainage of the septic pleural effusion and closed-chest lavage. Large-bore thoracostomy tubes are traditionally used for drainage, but case series indicate a comparable efficacy using small-bore tubes. In this retrospective study, we describe a new technique of sheath-guided small-bore (6 F) thoracostomy tubes in cats with pyothorax and evaluate their efficacy and complications. Additionally, we compare outcomes between two treatment groups. Placement and use of the small-bore thoracostomy tubes described here has a low complication rate of 4% (3/67 tubes), and 53% (24/45) of the cats could be treated with thoracostomy tubes and closed-chest lavage according to the protocol. The success rate is reduced by 18% (8/45) due to deaths caused mainly by sepsis, 16% (7/45) due to structural diseases requiring surgery and a further 14% (6/43) due to lavage failures that could only be cured after additive therapy (thoracotomy or fibrinolysis). The long-term prognosis was very good, with a survival rate one year after discharge of 94% (30/32). We detected no effect on survival by early placement of bilateral thoracostomy tubes or closed-chest lavage with a heparinised solution. In conclusion, therapy of pyothorax with small-bore thoracostomy tubes is as successful as therapy with large- or medium-bore tubes.

A Retrospective Study on Bacteriology, Clinicopathologic and Radiographic Features in 28 Cats Diagnosed with Pyothorax

This retrospective study aimed to determine the etiological, clinicopathological, and radiographic features and outcome of feline pyothorax cases. Medical records from twenty-eight cats with pyothorax aged from 4 months to 10 years (median 10 months) diagnosed between 2013 and 2020 were reviewed. Dyspnoea (75.0%), abnormal lung sounds (75.0%) and open-mouth breathing (64.3%) were the predominant respiratory signs. Leucocytosis (61.5%), particularly monocytosis (68.0%), and hyperglobulinaemia (65.4%) were among the most prominent findings in blood analysis. Bilateral pleural effusion was found in 67.9% of the thoracic radiographs. A total of 47.4% of the cytological samples revealed the presence of bacteria, while all had positive bacterial growth. Pasteurella multocida, E. coli, Streptococcus spp., and Staphylococcus spp. were the predominant aerobic bacteria isolated from pleural effusion samples. A chest tube was placed in 64.3% of the cats and 66.7% of cats with chest tubes survived. In total, 46.4% of cats with pyothorax recovered. Amoxicillin-clavulanate was the antimicrobial of choice against aerobic bacteria found in this study and should be given in combination with antimicrobials that cover anaerobic bacteria. Chest tube placement is crucial for treatment success. Cytological results and bacterial culture may not be consistent; thus, bacterial culture should be performed for every case.

CT findings, management and short-term outcome of dogs with pyothorax: 101 cases (2010 to 2019)

OBJECTIVES

To describe diagnosis, CT findings, management and short-term outcome of a large population of canine pyothorax cases.

METHODS

Retrospective analysis of 101 canine pyothorax cases at two UK referral centres. Medical records and CT images were reviewed. Dogs were included if pre- and post-contrast CT was performed within 48 hours of presentation.

RESULTS

CT abnormalities included pleural thickening (84.1%), pannus (67.3%), pneumothorax (61.4%), mediastinal effusion (28.7%), pulmonary (13.8%) and mediastinal (7.9%) abscessation, foreign body presence (7.9%), foreign body tracts (6.9%) and pneumonia (6.9%). Seventy-one percent of dogs were managed surgically, of which 90.2% survived, and 29% were managed medically, of which 72.4% survived. Overall mortality was 14.8% and 86.6% of these dogs died within 48 hours of admission. All dogs with evidence of a foreign body on CT underwent surgery.

CLINICAL SIGNIFICANCE

Mortality in our population was low and most dogs that died did so within 48 hours of hospitalisation, regardless of management type.

Use of a pleural access port for the treatment of pyothorax in a cat

Background:

Pyothorax in cats is treated with intravenous fluids and antibiotics, and while thoracotomy and debridement are less commonly necessary, thoracostomy tubes are the treatment of choice when repeated drainage of the pleural cavity is needed.

Case Description:

An 11-month-old British short-haired cat was presented for a sudden onset of lethargy, dyspnea, and tachypnea, following an ovariohysterectomy 10 days prior to the treatment process. Pyrexia and muffled cardiac sounds on the left hemithorax were noted. A hemogram indicated the development of anemia and neutrophilia with a left shift. Radiography and ultrasonography confirmed a pleural effusion, and a CT scan ruled out the presence of any masses or perforating foreign bodies. A PCR on the pleural effusion ruled out feline coronavirus infection, and fluid analysis was confirmed as a septic exudate with Pasteurella multocida infection. A pleural access port was used to treat the pyothorax that successfully reduced hospitalization time and lowered overall financial outlay despite surgical implantation.

Conclusion:

The present report describes the successful use of a pleural port to treat pyothorax in one cat. This is the first time such a device has been reported for the treatment of pyothorax.

Short- and long-term outcome in cats diagnosed with pyothorax: 47 cases (2009-2018)

OBJECTIVES

The aims of this retrospective study were to report the short- and long-term outcome in cats treated for pyothorax and to identify prognostic indicators as well as determine recurrence rate.

METHODS

Medical records from April 2009 to August 2018 were retrospectively reviewed. Cases were included if a diagnosis of pyothorax was confirmed via cytology and/or culture of pleural fluid. Cats diagnosed with or suspected of having other thoracic diseases and cats with no evidence of pleural effusion were excluded from the study.

RESULTS

Fifty-five cats met the inclusion criteria. Eighty five percent (n=47) cats underwent medical management with thoracostomy tubes, pleural lavage and broad-spectrum antibiotics. Fifteen percent (n=5) cases failed medical treatment and underwent thoracotomy. Twenty eight percent (n=13) did not survive to hospital discharge. Short-term survival (14 days) was achieved in 72% (n=34). Long-term follow-up was available for 31 of 34 with a long-term survival rate of 68% (n=30). The recurrence rate was 6% (n=2).

CONCLUSION

For cats with pyothorax that survive to discharge the prognosis is excellent and the condition is associated with a low recurrence rate.

The use of small-bore wire-guided chest drains for the management of feline pyothorax: A retrospective case series

Background:

Pyothorax in cats is routinely managed, at least initially, with thoracic tube placement associated with systemic antimicrobial administration. Traditionally, large-bore trocar-type thoracostomy tubes have preferentially been used for the drainage of thick material from the pleural space. In recent years, the use of small-bore wire-guided thoracic drains has increased in both small animals and in humans. Few studies have highlighted the efficacy of small-bore wire-guided thoracostomy tubes.

Aim:

The purpose of this study was to describe the use of small-bore wire-guided thoracostomy tubes in feline pyothorax in terms of efficacy, safety, and outcome.

Methods:

Cats with pyothorax managed with small-bore thoracostomy tubes (SBTTs) (2015–2018) were retrospectively studied. The number of drains inserted, the need for anesthesia and analgesia for chest tube placement and maintenance, and related major and minor complications were reviewed. Clinical data, diagnostic results, treatment, and outcome were recorded.

Results:

Ten cats were enrolled. Thoracostomy tube placement was unilateral in 7/10 cats, despite the presence of bilateral effusion in 9/10 cats, and required sedation (8/10) or anesthesia (2/10). Three cats experienced minor complications during the chest tube insertion, including self-limiting pneumothorax (1/3) and malpositioning (2/3). One cat had a major complication (non-functional malposition) requiring reposition of the drain. Pain management was adequately achieved using opioids (8/10) or opioids plus nonsteroidal anti-inflammatory drugs (2/10). Partial chest tube occlusion occurred in three cases and it was resolved with lavage. In one case, the occlusion was complete, requiring drain removal. Three out of 10 cats were treated medically, combining thoracostomy tubes and antibiotics, while 7/10 cats underwent surgery. All the cats survived.

Conclusion:

SBTTs represent a safe and effective option for the initial management of feline pyothorax. In fact, mainly minor complications were reported during insertion and usage. The SBTTs were well tolerated by the cats with a satisfactory performance in terms of exudate drainage in most cases. The combined use of a small-bore thoracostomy drain together with the common practice of surgical treatment might have resulted in the successful management of the cases presented.

Antimicrobial susceptibility patterns of anaerobic bacteria identified from clinical specimens of diseased dogs and cats

We aimed to clarify antimicrobial susceptibility patterns of anaerobes from diseased companion animals. Bacterial identification was based on the Japanese 2012 guidelines for the testing of anaerobic bacteria. AST was performed using the broth microdilution method. The anaerobe-containing samples collected from 2014 to 2018 included blood (anaerobe recovery rate, 5.0%), bile (9.4%), joint fluids (0.6%), pleural effusions (42.6%), ascites (64.1%), cerebrospinal fluids (3.0%), and punctures (75.0%). The anaerobes identified included Bacteroides spp. (33.2%), Peptostreptococcus spp. (19.6%), Prevotella spp. (13.6%), Propionibacterium spp. (10.3%), Clostridium spp. (9.3%), and Fusobacterium spp. (7.5%). Bacteroides fragilis group isolates were resistant to penicillin G (100%), ampicillin (100%), cefmetazole (63.6%), ceftizoxime (90.0%), and clindamycin (40.0%). Our observations demonstrated antimicrobial susceptibility in anaerobes isolated from Japanese companion animals.

Canine and Feline Exudative Pleural Diseases

Exudative pleural diseases are a common cause of respiratory distress and systemic illness in dogs and cats. This article covers the pathophysiology, development, and classification of exudative pleural effusions. The most current diagnostic strategies, causes, imaging findings, and medical or surgical treatment options for select diseases are reviewed in detail.

Retrospective analysis of pleural effusion in cats

OBJECTIVES

Pleural effusion is a common presenting cause for feline patients in small animal practice. The objectives of this study were to identify possible correlations between the aetiology of effusion and clinical and laboratory findings.

METHODS

In this retrospective study of 306 cats diagnosed with pleural effusion of established aetiology, cats were divided into six major groups: cardiac disease (CD), feline infectious peritonitis (FIP), neoplasia, pyothorax, chylothorax and miscellaneous. Clinical, laboratory and radiographic parameters were compared between groups.

RESULTS

CD was the most common aetiology (35.3%), followed by neoplasia (30.7%), pyothorax (8.8%), FIP (8.5%), chylothorax (4.6%) and miscellaneous diseases (3.7%). In 26 (8.5%) cats, more than one underlying disease was diagnosed as a possible aetiology for pleural effusion. Cats with FIP were significantly younger than those with CD (P <0.001) and neoplasia (P <0.001). Cats with CD were presented with a significantly lower body temperature compared with cats with FIP (P = 0.022). Cats with CD had significantly higher serum alanine aminotransferase activity compared with all other cats (FIP and pyothorax, P <0.001; neoplasia and chylothorax, P = 0.02) and serum alkaline phosphatase activity compared with the pyothorax (P <0.001) and FIP groups (P = 0.04), and significantly lower protein concentrations (FIP, pyothorax and neoplasia, P <0.001; chylothorax, P = 0.04) and nucleated cell counts in the effusion than all other groups (pyothorax and neoplasia, P <0.001; chylothorax, P = 0.02; FIP, P = 0.04). The glucose level in the effusion of cats with pyothorax was significantly lower than glucose levels in patients with CD, neoplasia and chylothorax (P <0.001). Of 249 cats with a follow-up of at least 10 days, 55.8% died or were euthanased during that time.

CONCLUSIONS AND RELEVANCE

CD and neoplasia were the most common causes for feline pleural effusion. Age, liver enzymes, as well as cell count, protein and glucose levels in the effusion can aid in the investigation of underlying aetiologies.

Characterization of and factors associated with causes of pleural effusion in cats

OBJECTIVE To characterize and investigate potential associations between causes of pleural effusion and various clinical factors in a large cohort of affected cats. DESIGN Retrospective case series with nested cross-sectional study. ANIMALS 380 client-owned cats with a diagnosis of pleural effusion from January 1, 2009, through July 14, 2014, for which the cause of pleural effusion had been fully investigated. PROCEDURES Electronic medical records were reviewed and data collected regarding cat characteristics, clinical signs, cause of pleural effusion, treatment, and survival status at discharge from the hospital. Variables were examined for associations with causes of pleural effusion. RESULTS 87 (22.9%) cats died or were euthanized before discharge from the hospital. Congestive heart failure (CHF) was the most common cause (155 [40.8%]) of pleural effusion, followed by neoplasia (98 [25.8%]). Other causes included pyothorax, idiopathic chylothorax, trauma, feline infectious peritonitis, and nontraumatic diaphragmatic hernia. Cats with trauma or feline infectious peritonitis were significantly younger than those with CHF or neoplasia. Cats with lymphoma were significantly younger than those with carcinoma. Cats with CHF had a significantly lower rectal temperature at hospital admission (mean ± SD, 36.9 ± 1.2°C [98.4 ± 2.2°F]) than did cats with pleural effusion from other causes (37.9 ± 1.2°C [100.2 ± 2.2°F]). CONCLUSIONS AND CLINICAL RELEVANCE Cats with pleural effusion in this study had a poor prognosis; CHF and neoplasia were common causes. Age and hypothermia may be helpful to raise the index of suspicion for certain underlying causes of pleural effusion in cats.

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.

Pericardial flap to repair a pulmonary laceration in a cat with pyothorax

Case summary

A 2-year-old female neutered domestic shorthair cat was presented for investigation of acute onset tachypnoea and dyspnoea. Pyothorax was diagnosed based on thoracic radiographs and fluid analysis. Medical treatment consisted of bilateral thoracostomy tube placement, antibiotic therapy and thoracic lavage. After 12 days of medical management infection was still present, warranting exploratory thoracotomy. At surgery, encapsulated abscesses were found in the left lung, right cranial and right middle lobes. The right caudal lobe was the only macroscopically non-abscessated lobe, and appeared to have a parenchymal laceration 8 mm long over the dorsolateral surface. Following partial pericardiectomy, mediastinectomy and debridement of abscesses, a pericardial flap was reflected caudolaterally and apposed over the laceration to seal the affected lung lobe. This flap was sutured to a rim of fibrinous adhesion that was partially covering this lobe. After 8 days the cat was discharged with antibiotic therapy for 3 more weeks. Follow-up assessment at 19 and 38 weeks postoperatively confirmed the cat to have good exercise tolerance. Thoracic radiographs at 19 weeks revealed good bilateral aeration of the pulmonary parenchyma without pleural effusion.

Relevance and novel information

Lung lobe laceration can be treated by lung lobectomy or direct suturing of the lung parenchyma. This is the first report using a pericardial flap to repair a lung laceration. Pericardial flap was successfully used to treat this lung laceration where lobectomy was contraindicated. Encouraging results were present at 8 months postoperatively.

Fluoroscopically guided wide-bore thoracostomy tube placement: Description of the technique and comparison to blind placement

OBJECTIVE

To describe and compare fluoroscopic guidance for placement of wide-bore thoracostomy tubes (FGTT) to traditional, blind placement of thoracostomy tubes (BPTT).

STUDY DESIGN

Prospective clinical trial.

ANIMALS

Twenty client-owned dogs.

METHODS

Dogs requiring medical management of pleural effusion received a BPTT, whereas dogs undergoing postoperative management of pneumothorax and/or pleural fluid after lateral thoracotomy received an FGTT. Time of placement, accuracy of positioning, radiation exposure, and complications were compared between groups.

RESULTS

Initial placement of BPTT took a mean of 168 seconds (range, 89-197), whereas adequate placement was radiographically confirmed at 20 minutes and 38 seconds (range, 7 minutes and 57 seconds to 39 min). Initial placement of FGTT took a mean time of 108 seconds (range, 50-341, P = .17), and adequate placement was confirmed at 125 seconds (range, 50-341, P < .001). Major errors in placement requiring removal and replacement occurred in 2 dogs for BPTT and in none for FGTT. Procedural complications did not differ between groups, and no postoperative complication occurred within the first 12 hours after placement. Radiation entrance surface dose was lower in the BPTT group (P = .004), but stochastic radiation doses did not differ.

CONCLUSION

Fluoroscopic guidance of wide-bore thoracostomy tubes accelerated the time to accurate tube placement and alleviated the requirement for removal and replacement in this population. Although use of fluoroscopy increased radiation entrance surface dose, the dose was not clinically significant.

CLINICAL SIGNIFICANCE

Fluoroscopic guidance of wide-bore thoracostomy tubes should be considered as an alternative to traditional, blind placement.

Clinical, laboratory, and hemostatic findings in cats with naturally occurring sepsis

OBJECTIVE To characterize clinical and laboratory findings in cats with naturally occurring sepsis, emphasizing hemostasis-related findings, and evaluate these variables for associations with patient outcomes. DESIGN Prospective, observational, clinical study. ANIMALS 31 cats with sepsis and 33 healthy control cats. PROCEDURES Data collected included history; clinical signs; results of hematologic, serum biochemical, and hemostatic tests; diagnosis; and outcome (survival vs death during hospitalization or ≤ 30 days after hospital discharge). Differences between cats with and without sepsis and associations between variables of interest and death were analyzed statistically. RESULTS The sepsis group included cats with pyothorax (n = 10), septic peritonitis (7), panleukopenia virus infection (5), bite wounds (5), abscesses and diffuse cellulitis (3), and pyometra (1). Common clinical abnormalities included dehydration (21 cats), lethargy (21), anorexia (18), pale mucous membranes (15), and dullness (15). Numerous clinicopathologic abnormalities were identified in cats with sepsis; novel findings included metarubricytosis, hypertriglyceridemia, and high circulating muscle enzyme activities. Median activated partial thromboplastin time and plasma D-dimer concentrations were significantly higher, and total protein C and antithrombin activities were significantly lower, in the sepsis group than in healthy control cats. Disseminated intravascular coagulopathy was uncommon (4/22 [18%] cats with sepsis). None of the clinicopathologic abnormalities were significantly associated with death on multivariate analysis. CONCLUSIONS AND CLINICAL RELEVANCE Cats with sepsis had multiple hematologic, biochemical, and hemostatic abnormalities on hospital admission, including several findings suggestive of hemostatic derangement. Additional research including larger numbers of cats is needed to further investigate these findings and explore associations with outcome.

Diagnosis and management of pyothorax in a domestic ferret (Mustela putorius furo)

OBJECTIVE

To describe the diagnosis, management, and outcome of pyothorax in a domestic ferret (Mustela putorius furo).

CASE SUMMARY

A domestic ferret was evaluated for a history of lethargy, anorexia, and pyrexia. Pleural effusion was detected with radiography and ultrasonography, and a diagnosis of pyothorax was made following cytologic evaluation of pleural fluid. Bilateral thoracostomy tubes were placed for thoracic drainage and lavage, and the ferret was treated with intravenous crystalloid fluids, antimicrobials, and analgesics. Bacterial culture of the pleural fluid yielded Fusobacterium spp. and Actinomyces hordeovulneris. This treatment protocol resulted in resolution of pyothorax, and a positive clinical outcome.

NEW OR UNIQUE INFORMATION PROVIDED

This is the first reported case of successful management of pyothorax caused by Fusobacterium spp. and A. hordeovulneris in a ferret.

Epidemiology of systemic inflammatory response syndrome and sepsis in cats hospitalized in a veterinary teaching hospital

OBJECTIVE To describe the epidemiology of the systemic inflammatory response syndrome (SIRS) and sepsis in cats hospitalized in a veterinary teaching hospital. DESIGN Observational study. ANIMALS 246 client-owned cats. PROCEDURES During a 3-month period, daily treatment records were evaluated for all hospitalized cats. Information extracted included signalment, temperature, heart rate, respiratory rate, diagnostic test results, diagnosis, duration of hospitalization, and outcome (survival or death). Cats were classified into 1 of 4 disease categories (sepsis [confirmed infection and SIRS], infection [confirmed infection without SIRS], noninfectious SIRS [SIRS without a confirmed infection], and no SIRS [no SIRS or infection]). RESULTS Of the 246 cats, 26 and 3 were hospitalized 2 and 3 times, respectively; thus, 275 hospitalizations were evaluated. When SIRS was defined as the presence of ≥ 2 of 4 SIRS criteria, 17 cats had sepsis, 16 had infections, 81 had noninfectious SIRS, and 161 were classified in the no SIRS category at hospital admission. The prevalence of sepsis at hospital admission was 6.2 cases/100 admissions. Four cats developed sepsis while hospitalized, resulting in a sepsis incidence rate of 1.5 cases/100 hospital admissions. Four of 17 cats with sepsis at hospital admission and 3 of 4 cats that developed sepsis while hospitalized died or were euthanized, resulting in a mortality rate of 33.3% for septic cats; 239 hospitalizations resulted in survival, 28 resulted in euthanasia, and 8 resulted in death. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that many hospitalized cats have evidence of SIRS and some have sepsis. In cats, sepsis is an important clinical entity with a high mortality rate.

Antimicrobial use Guidelines for Treatment of Respiratory Tract Disease in Dogs and Cats: Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases

Respiratory tract disease can be associated with primary or secondary bacterial infections in dogs and cats and is a common reason for use and potential misuse, improper use, and overuse of antimicrobials. There is a lack of comprehensive treatment guidelines such as those that are available for human medicine. Accordingly, the International Society for Companion Animal Infectious Diseases convened a Working Group of clinical microbiologists, pharmacologists, and internists to share experiences, examine scientific data, review clinical trials, and develop these guidelines to assist veterinarians in making antimicrobial treatment choices for use in the management of bacterial respiratory diseases in dogs and cats.

CT findings in two cats with broncholithiasis

Case series summary

Chronic inflammatory airway disease with secondary broncholithiasis was diagnosed in two cats from CT and bronchoalveolar lavage cytological findings. In one cat with progressively worsening lower respiratory tract signs, more than 80 discrete, highly attenuating endobronchial opacities were detected on thoracic CT. The broncholiths were distributed throughout the right middle, and left and right caudal lung lobes, and the caudal part of the left cranial and accessory lobes. In the other cat broncholithiasis was an incidental finding on thoracic radiographs taken during diagnostic investigation of inappetence. On thoracic CT, 25 calcified endobronchial opacities were detected in the left caudal lung lobe in secondary and tertiary bronchi. CT features of chronic inflammatory airway disease were present in both cases, including bronchiectasis, atelectasis, flattening of the diaphragm and bronchial wall thickening.

Relevance and novel information

This is the first report to document CT features of broncholithiasis in cats. Feline broncholithiasis should be considered as a differential diagnosis in any case where calcified endobronchial material is evident on thoracic radiographs or CT.

The effects of omeprazole therapy on bacterial colonization of the pharynx in healthy dogs

OBJECTIVE

To identify the relative abundance of commensal pharyngeal flora in healthy dogs and determine if abundance of pharyngeal flora is altered during omeprazole administration.

ANIMALS

Eight adult Beagles.

PROCEDURES

A total of 3 baseline pharyngeal swabs, collected 48 hours apart, were obtained from each dog. Omeprazole (1 mg/kg PO q 24 h) was administered for a total of 12 days. During omeprazole administration, pharyngeal swabs were obtained on Days 8, 10, and 12. All swabs were submitted for semiquantitative aerobic and anaerobic culture. Growth of bacterial isolates, as well as genus of isolates, was compared between the pretreatment (n = 24) and treatment (n = 24) swabs.

RESULTS

A greater abundance of several bacterial species was identified during the treatment period, including coagulase-negative Staphylococcus (P < 0.01), Bacillus (P < 0.01), and Pasteurella (P = 0.05). The abundance of bacterial species in samples collected during the treatment period was unchanged for Escherichia coli (P = 0.16), Provotella (P = 0.40), hemolytic Streptococcus (P = 0.34), and nonhemolytic Streptococcus (P = 0.14).

CONCLUSIONS AND CLINICAL RELEVANCE

This small study indicates that shifts in canine pharyngeal flora may occur during omeprazole therapy. Further studies are warranted to determine the clinical significance of gastric acid suppressants on pharyngeal flora in dogs.

Cryptococcus gattii infections

Understanding of the taxonomy and phylogeny of Cryptococcus gattii has been advanced by modern molecular techniques. C. gattii probably diverged from Cryptococcus neoformans between 16 million and 160 million years ago, depending on the dating methods applied, and maintains diversity by recombining in nature. South America is the likely source of the virulent C. gattii VGII molecular types that have emerged in North America. C. gattii shares major virulence determinants with C. neoformans, although genomic and transcriptomic studies revealed that despite similar genomes, the VGIIa and VGIIb subtypes employ very different transcriptional circuits and manifest differences in virulence phenotypes. Preliminary evidence suggests that C. gattii VGII causes severe lung disease and death without dissemination, whereas C. neoformans disseminates readily to the central nervous system (CNS) and causes death from meningoencephalitis. Overall, currently available data indicate that the C. gattii VGI, VGII, and VGIII molecular types more commonly affect nonimmunocompromised hosts, in contrast to VGIV. New, rapid, cheap diagnostic tests and imaging modalities are assisting early diagnosis and enabling better outcomes of cerebral cryptococcosis. Complications of CNS infection include increased intracranial pressure, severe neurological sequelae, and development of immune reconstitution syndrome, although the mortality rate is low. C. gattii VGII isolates may exhibit higher fluconazole MICs than other genotypes. Optimal therapeutic regimens are yet to be determined; in most cases, initial therapy with amphotericin B and 5-flucytosine is recommended.

A clinical review of the pathophysiology, diagnosis, and treatment of pyothorax in dogs and cats

OBJECTIVE

To review the current literature in reference to the pathophysiology, diagnosis, and treatment of pyothorax in dogs and cats.

ETIOLOGY

Pyothorax, also known as thoracic empyema, is characterized by the accumulation of septic purulent fluid within the pleural space. While the actual route of pleural infection often remains unknown, the oral cavity and upper respiratory tract appear to be the most common source of microorganisms causing pyothorax in dogs and cats. In human medicine, pyothorax is a common clinical entity associated with bacterial pneumonia and progressive parapneumonic effusion.

DIAGNOSIS

Thoracic imaging can be used to support a diagnosis of pleural effusion, but cytologic examination or bacterial culture of pleural fluid are necessary for a definitive diagnosis of pyothorax.

THERAPY

The approach to treatment for pyothorax varies greatly in both human and veterinary medicine and remains controversial. Treatment of pyothorax has classically been divided into medical or surgical therapy and may include administration of antimicrobials, intermittent or continuous thoracic drainage, thoracic lavage, intrapleural fibrinolytic therapy, video-assisted thoracic surgery, and traditional thoracostomy. Despite all of the available options, the optimal treatment to ensure successful short- and long-term outcome, including the avoidance of recurrence, remains unknown.

PROGNOSIS

The prognosis for canine and feline pyothorax is variable but can be good with appropriate treatment. A review of the current veterinary literature revealed an overall reported survival rate of 83% in dogs and 62% in cats. As the clinical presentation of pyothorax in small animals is often delayed and nonspecific, rapid diagnosis and treatment are required to ensure successful outcome.

Gastric inflammatory pseudotumour secondary to Actinomyces hordeovulneris infection in a cat

Background

The authors report the first case of feline gastric actinomycosis associated with infection by Actinomyces hordeovulneris.

Case presentation

A 4-year-old, neutered male, semi-feral European cat, with a 1 year history of chronic vomiting, was referred to the clinic. Abdominal ultrasound examination identified a hypoechoic focal transmural thickening with loss of normal wall layering and hyperechoic speckles at the gastric body. Initial gastroscopic examination showed a tumour-like gastric mass with an ulcerated depression at the level of the greater curvature. Histologic examination of endoscopic biopsy specimens was consistent with a severe lymphoplasmacytic gastritis. After 2 months, due to persistence of abdominal discomfort, surgical exploration and intraoperative sampling of gross abnormalities was recommended. Full thickness gastric wall biopsies, and fine needle aspiration of the gastric thickening and gastric lymph node, were performed. Histopathological examination identified a transmural pyogranulomatous gastritis. Aspirate samples of the gastric wall cultured positive, with colony morphology, biochemical testing and PCR of the 16 s rRNA gene compatible with Actinomyces hordeovulneris. After 4 months of treatment with cefovecin (8 mg/kg subcutaneously every 14 days), the vomiting completely resolved, as well as the ultrasonographic gastric alteration.

Conclusion

This case report of feline gastric actinomycosis, caused by Actinomyces hordeovulneris, suggests that gastric bacterial infection should be considered in cases of focal gastric wall thickening associated with chronic vomiting in the cat, which may otherwise closely resemble neoplastic disease. Once a diagnosis of actinomycosis was obtained, a correct treatment with antibiotic therapy can resolve it.

Pleural Space Disease

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Abnormalities within the pleural space may include pleural effusion, pneumothorax, or space-occupying soft tissue structures (diaphragmatic hernia, neoplasia).

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A diagnostic thoracocentesis may also prove therapeutic in severely affected patients.

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Fluid analysis and cytologic evaluation should always be performed on aspirates from a patient with newly diagnosed pleural effusion of unconfirmed etiology.

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Aerobic and anaerobic culture and susceptibility testing of suppurative effusions are imperative.

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Comparison of pleural fluid and serum triglyceride levels and cholesterol concentrations are necessary to confirm the diagnosis of chylothorax.

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Clinical evidence of cardiovascular shock often precedes dyspnea in patients with hemothorax.

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Tension pneumothorax, regardless of its origin, rapidly may be fatal. Immediate drainage via thoracocentesis or thoracostomy tube placement is required before taking thoracic radiographs.

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Clinical signs of a traumatic diaphragmatic hernia may be delayed; however, early detection and correction are important because perioperative outcome is worse in chronically affected patients.

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Tools such as ultrasonography, computed tomography (CT), and thoracoscopy are becoming increasingly available to aid in the diagnostic evaluation and treatment of pleural space disease.

Feline respiratory disease: what is the role of Mycoplasma species?

PRACTICAL RELEVANCE

Non-hemotropic Mycoplasma species are frequently implicated in cases of respiratory disease, and also conjunctivitis, in cats.

CLINICAL CHALLENGES

Mycoplasma species are considered commensal bacteria of the conjunctiva and the upper respiratory tract of cats, and hence their role as a primary pathogen is difficult to determine. These organisms certainly appear to play a significant role as a secondary pathogen in the upper airways, and there is increasing evidence that in some animals they may represent a primary infection. However, mycoplasmas have not been found in the lower airways of clinically healthy cats - suggesting that, when present, they likely represent a pathologic process. Diagnostic challenges exist as well; Mycoplasma species are not typically identified via cytology due to their small size, and culture of these organisms requires special media and handling. Although PCR has improved identification and allowed for speciation, conflicting culture and PCR results can create a dilemma regarding the clinical relevance of infection.

EVIDENCE BASE

This article draws on original research and case reports to provide information about the role of Mycoplasma species in the feline upper and lower respiratory tract, diagnostic methods and associated challenges, and treatment options.

AUDIENCE

The goal is to provide small animal practitioners with a current and organized review of the often-conflicting literature regarding the role of Mycoplasma species in feline respiratory infections.

Pasteurella multocida infection in cats: ABCD guidelines on prevention and management

OVERVIEW

Pasteurella species are part of the normal oral flora of cats. They are also a common cause of infection in this species and an important zoonotic agent. INFECTION IN CATS: Pasteurella species are commonly isolated from subcutaneous abscesses and pyothorax in cats. They may also cause secondary lower respiratory tract infection and have been associated with spinal empyema and meningoencephalomyelitis. INFECTION IN HUMANS: Disease in humans mainly occurs after a cat bite or scratch, but may also be transmitted via respiratory secretions from cats in close contact with a person. Signs of local infection after a cat bite appear in a few hours (3-6 h). Severe disease and a fatal outcome mostly occur in immunocompromised people, but have also been reported in immunocompetent healthy individuals. Cat ownership by immunocompromised people may carry a risk.

Mechanisms, causes, investigation and management of vomiting disorders in cats: a literature review

Vomiting is a common presenting complaint in feline practice. This article differs from previous reviews in that it is an evidence-based review of the mechanisms, causes, investigation and management of vomiting in the domestic cat. Published evidence was reviewed, and then used to make recommendations for clinical assessment, diagnosis, antiemetic drug treatment, dietary management and monitoring of cats presenting with vomiting. The strength of the evidence on which recommendations are made (and areas where evidence is lacking for cats) has been highlighted throughout.

Cryptococcus gattii: an emerging fungal pathogen infecting humans and animals

Infectious fungi are among a broad group of microbial pathogens that has and continues to emerge concomitantly due to the global AIDS pandemic as well as an overall increase of patients with compromised immune systems. In addition, many pathogens have been emerging and re-emerging, causing disease in both individuals who have an identifiable immune defect and those who do not. The fungal pathogen Cryptococcus gattii can infect individuals with and without an identifiable immune defect, with a broad geographic range including both endemic areas and emerging outbreak regions. Infections in patients and animals can be severe and often fatal if untreated. We review the molecular epidemiology, population structure, clinical manifestations, and ecological niche of this emerging pathogen.

Clinical outcome following pneumonectomy for management of chronic pyothorax in four cats

Pneumonectomy is the resection of all lung lobes from one side of the thorax. The clinical findings, treatment and outcome of four cases of feline chronic pyothorax managed with exploratory thoracotomy and pneumonectomy are reported. All cases were initially medically managed with thoracic drain placement and antibiosis. However, resolution was not achieved with medical therapy and diagnostic imaging findings consistent with an area of abscessation or marked lung lobe consolidation were identified, supporting a decision for surgical management. Surgical exploration was performed via median sternotomy and, on the basis of gross inspection, non-functional lung was removed. A left-sided pneumonectomy was performed in three cats and a right-sided pneumonectomy in one. All cases survived to discharge and an excellent quality of life was reported on long-term follow-up. Pneumonectomy appears to be well tolerated in the cat.

Clinical and immunologic assessment of sepsis and the systemic inflammatory response syndrome in cats

OBJECTIVE

To compare clinical findings and inflammatory mediator production among cats with sepsis, cats with noninfectious systemic inflammatory response syndrome (SIRS), and healthy cats.

DESIGN

Case-control study.

ANIMALS

Cats with sepsis (n = 16) or SIRS (19) and 8 healthy control cats.

PROCEDURES

Clinical variables were recorded for each cat, and plasma tumor necrosis factor (TNF) and interleukin (IL)-1β activities and IL-6 and CXC chemokine ligand (CXCL)-8 concentrations were determined at initial evaluation.

RESULTS

Clinicopathologic abnormalities associated with sepsis in cats included a high band neutrophil percentage, eosinopenia, hyponatremia, hypochloremia, hypoalbuminemia, hypocalcemia, and hyperbilirubinemia. When the sepsis and SIRS groups were compared, the only significant differences in the CBC and plasma biochemical findings were band neutrophil percentage and albumin concentration. Cats with sepsis had significantly greater plasma TNF activity than did healthy cats and were more likely to have detectable concentrations of IL-6 than were cats with SIRS or healthy cats. Plasma IL-1β activity did not differ among groups, and CXCL-8 was not detectable in most (32/43) cats. Mortality rate was not significantly greater for cats with sepsis (7/16) than for cats with SIRS (5/19). Plasma IL-1β activity and IL-6 and chloride concentrations were the only variables correlated with nonsurvival in the sepsis group.

CONCLUSIONS AND CLINICAL RELEVANCE

Cats with sepsis may have various clinicopathologic abnormalities but are more likely to have a high band neutrophil percentage and hypoalbuminemia than cats with noninfectious SIRS. Plasma interleukin-1β activity and plasma IL-6 and chloride concentrations may be useful prognostic biomarkers for septic cats.

Pleural effusion in the cat: a practical approach to determining aetiology

PRACTICAL RELEVANCE

Diverse disease processes result in sufficient fluid accumulation within the pleural space to cause respiratory compromise. Determining the underlying aetiology is key to appropriate management. This review outlines a practical approach to cases of pleural effusion, focusing on early recognition and confirmation of pleural space disease, stabilisation of the patient and logical diagnostic investigation. It emphasises the importance of a holistic approach, incorporating fluid analysis with other clinical data to determine the underlying aetiology.

CLINICAL CHALLENGES

Cats with pleural effusion often have severe respiratory compromise at presentation. Careful handling and prompt and adequate stabilisation, incorporating supplemental oxygen and therapeutic thoracocentesis, is essential to avoid respiratory failure. The typical, stepwise approach to the case must be adapted and the clinician may have to proceed, at least initially, without the luxury of information gained from a full history and physical examination. The challenge is to juggle stabilisation, localisation and confirmation of pleural effusion, owner communication and minimally invasive examination while remaining vigilant for clues that allow ranking of the differentials to formulate a diagnostic plan.

EVIDENCE BASE

Appropriately designed studies to determine the utility of diagnostic techniques in cases with confirmed aetiology are limited. The evidence supporting this review is grade II, III and IV, comprising a small number of prospective studies, several case series, reviews, extrapolation from other species, pathophysiological justification and combined clinical experience of those working in the field.

Pathogen associated molecular pattern-induced TNF, IL-1β, IL-6 and CXCL-8 production from feline whole blood culture

Whole blood culture (C(wb)) is a method to evaluate leukocyte response to stimuli. We used C(wb) to evaluate the inflammatory response to pathogen associated molecular patterns (PAMPs) in cats. Blood was collected from diluted with RPMI and stimulated with various concentrations of lipopolysaccharide (LPS), lipoteichoic acid (LTA), peptidoglycan (PG) or control (PBS). Multiple concentrations of LPS, LTA and PG significantly stimulated tumor necrosis factor (TNF), interleukin (IL)-1β and CXC chemokine ligand (CXCL)-8 in feline C(wb). All PAMPs failed to stimulate IL-6 production and PG failed to stimulate CXCL-8 production. Lipopolysaccharide was a more potent inducer of IL-1β and CXCL-8 than LTA or PG and LTA is a more potent inducer of CXCL-8 than PG. Based on these data, PAMPs from gram positive and negative bacteria induce TNF, IL-1β and CXCL-8 production in feline whole blood. Cats appear to be relatively more sensitive to gram negative compared to gram positive bacteria.