Uveal inflammation in septic newborn foals

Prevalence of anterior uveitis in cases of systemic inflammatory response syndrome in dogs and cats

OBJECTIVE

To determine the prevalence of anterior uveitis in dogs and cats hospitalized with a diagnosis of systemic inflammatory response syndrome (SIRS).

ANIMALS STUDIED

Dogs and cats hospitalized between May 2020 and January 2021 were prospectively included.

PROCEDURES

Patients were categorized into two different groups: The first group included patients diagnosed with SIRS, and the second group included patients hospitalized without SIRS as a control group. Daily physical and ophthalmological examinations were conducted during hospitalization. Diagnosis of anterior uveitis was made based on the presence of aqueous flare, low intraocular pressure, and other associated ocular signs such as episcleral injection and miosis. A multinomial logistic regression analysis was conducted to investigate factors associated with SIRS and anterior uveitis development.

RESULTS

The study comprised 42 patients with SIRS and 26 patients without SIRS. Among those with SIRS, 38% developed anterior uveitis, whereas only 7.7% of patients without SIRS showed signs of anterior uveitis. The prevalence of uveitis was significantly higher in animals with SIRS compared to those without SIRS (p < .05).

CONCLUSION

Anterior uveitis is more prevalent in patients with SIRS than patients without SIRS. Therefore, complete ophthalmic examination is recommended in all patients presenting with this syndrome.

Infectious Uveitis in Horses and New Insights in Its Leptospiral Biofilm-Related Pathogenesis

Uveitis is a sight-threatening eye disease in equids known worldwide that leads to considerable pain and suffering. By far the most common type of uveitis in Germany and neighboring countries is classical equine recurrent uveitis (ERU), which is caused by chronic intraocular leptospiral infection and is the main cause of infectious uveitis in horses. Other infectious causes are extremely rare and are usually clinically distinguishable from ERU. ERU can be treated very effectively by vitreous cavity lavage (vitrectomy). For proper indications of this demanding surgery, it is necessary to differentiate ERU from other types of uveitis in which vitrectomy is not helpful. This can be conducted on the basis of anamnesis in combination with ophthalmologic findings and by aqueous humor examination. During vitrectomy, vitreous material is obtained. These vitreous samples have historically been used for numerous etiologic studies. In this way, a chronic intraocular leptospiral infection has been shown to be the cause of typical ERU and, among other findings, ERU has also been recognized as a biofilm infection, providing new insights into the pathogenesis of ERU and explaining some thus far unexplainable phenomena of ERU. ERU may not only have transmissible aspects to some types of uveitis in humans but may also serve as a model for a spontaneously occurring biofilm infection. Vitreous material obtained during therapeutically indicated vitrectomy can be used for further studies on in vivo biofilm formation, biofilm composition and possible therapeutic approaches.

A retrospective histologic study of 140 cases of clinically significant equine ocular disorders

Ocular diseases are an important category in equine medicine; however, most articles regarding histologic ocular lesions in horses are exclusive to a specific condition and do not provide a complete review of clinically significant ocular disease frequency in a diagnostic laboratory. We reviewed sections of equine eyes from 140 cases (98 enucleations [biopsies] and 42 autopsies) with clinically relevant ocular alterations at 2 diagnostic centers in the United States. The most common primary conditions were non-traumatic keratitis (36), equine recurrent uveitis (ERU; 31), traumatic injuries (22), ocular and periocular neoplasms (19), and uveitis and/or endophthalmitis resulting from sepsis (18). Congenital anomalies (3) and retinal atrophy and detachment alone (3) were infrequent. Non-traumatic keratitis was frequently accompanied by anterior uveitis (22), corneal rupture (16), pre-iridal fibrovascular membrane formation (13), and secondary mycotic infection (11). ERU was the second and third most prevalent disease in autopsies and enucleations, respectively. This condition was commonly associated with glaucoma (15). Glaucoma (25) and cataract (20) were the most prevalent secondary alterations in the evaluated cases. Keratitis (20) and corneal rupture (16) were among the most prevalent consequences of trauma. Information presented herein may guide clinicians and pathologists, contributing to the early diagnosis of potentially vision-impairing conditions and raising the chances of successful treatment and cure.

Retrospective evaluation of blood culture isolates and sepsis survival rate in foals in the Czech Republic: 50 cases (2011-2013)

OBJECTIVE

To identify the specific pathogens causing sepsis in hospitalized foals in the Czech Republic and identify important factors associated with their survival.

DESIGN

A retrospective study from 2011 to 2013.

SETTING

University veterinary teaching hospital.

ANIMALS

Fifty compromised foals.

INTERVENTIONS

None.

MEASUREMENT AND MAIN RESULTS

Blood was aseptically collected for bacterial culture from compromised foals. The foals were classified as septic according to a positive blood culture result or sepsis score ≥11. Blood cultures were positive in 44% of the foals. In these positive cultures, 27.3% had only Gram-positive (G+) bacteria and 54.5% had only Gram-negative (G-) bacteria. A mixed bacterial population was presented in 18.2% of the positive cultures. Thirty-six foals were classified as septic on the basis of positive blood culture or a sepsis score ≥11. In the group of foals that did not survive, there were significantly more foals with low levels of immunoglobulin G (IgG) than foals with normal levels of IgG (P < 0.0001). We also found a significant difference in the proportion of foals with low levels of IgG and positive blood cultures when compared to negative blood cultures. Twenty-six of the 50 foals were discharged from the hospital. Survival was significantly lower in foals with a diagnosis of sepsis than in foals without sepsis. There was no statistically significant difference between foals that died as a result of infection caused by G- or G+ pathogens. There was no difference in the proportion of survivors that did or did not receive antimicrobials prior to admission.

CONCLUSIONS

In our study, we confirmed the increasing trend for G+ bacteria in blood cultures but G- still predominate. The percentage of nonsurviving septic foals was high.

Equine recurrent uveitis: Human and equine perspectives

Equine recurrent uveitis (ERU) is a spontaneous disease characterised by repeated episodes of intraocular inflammation. The epidemiology of ERU has not been fully elucidated, but the condition appears to be much more common in horses than is recurrent uveitis in humans, especially in certain breeds and geographical regions. Both humans and horses show a similarly altered immune response and a marked autoimmune response as the primary disease pathophysiology. However, an inciting cause is not always clear. Potential inciting factors in horses include microbial agents such as Leptospira spp. Microbial factors and genetic predisposition to the disease may provide clues as to why the horse appears so susceptible to this disease. The aim of this review is to discuss the immunology and genetics of ERU, compare the disease in horses with autoimmune anterior uveitis in humans, and discuss potential reasons for the increased prevalence in the horse.

Ocular abnormalities in healthy Standardbred foals

OBJECTIVE

To determine the prevalence and describe ocular abnormalities in healthy Standardbred foals within 48 h of birth.

ANIMALS

One hundred and two neonatal foals.

PROCEDURES

All foals had an unassisted delivery. On the basis of physical examination and the results of hematological and biochemical parameters, all foals were unaffected by systemic diseases. A complete ophthalmic examination was performed within 48 h of birth. Foals with ocular hemorrhages were re-examined weekly until the abnormalities were resolved.

RESULTS

65/102 (63.7%) foals did not show ocular abnormalities, while in 37/102 (36.3%) cases, ocular abnormalities were present. Retinal and subconjunctival hemorrhages were recorded in 19/102 (18.6%), and in 13/102 (12.7%), respectively. In 4/102 (3.9%) animals, an entropion of the lower eyelid was present. Only one foal (1%) showed a congenital nuclear unilateral cataract. No other ocular abnormalities were detected. However, all foals showed various degrees of remnants of hyaloid system. One week after the first ocular examination, retinal hemorrhages had resolved in 100% of the eyes, whereas subconjunctival hemorrhages had disappeared in all eyes by the second week following the first examination.

CONCLUSIONS

The acquired ocular lesions observed with relatively high frequency in the examined healthy Standardbred foals were ocular hemorrhages, which always showed a good outcome. Although these abnormalities were present at birth, they were not considered strictly congenital but likely acquired during parturition. Instead, congenital ocular abnormalities were rarely diagnosed, and the entropion of the lower eyelid was the most common disease in the breed.

Ophthalmic lesions in neonatal foals evaluated for nonophthalmic disease at referral hospitals

OBJECTIVE

To determine types and frequency of ophthalmic lesions detected in neonatal foals evaluated for nonophthalmic disease at 3 veterinary referral hospitals and to investigate associations between systemic and ophthalmic diseases in these foals.

DESIGN

Prospective cross-sectional study.

ANIMALS

70 foals < 30 days old.

PROCEDURES

Complete ophthalmic examinations were performed. Signalment, clinical signs, mentation during ophthalmic examination, results of clinicopathologic tests, and diagnosis of systemic disease were recorded. Descriptive data analysis including a χ(2) test for associations was performed.

RESULTS

Most foals (39/70 [55.7%]) with systemic disease had ≥ 1 ophthalmic lesion detected. Of the 39 foals with ophthalmic disease, 24 (61.5%) had potentially vision-threatening lesions. Clinically important abnormalities included conjunctival hyperemia or episcleral injection (30/70 [42.9%]), uveitis (18/70 [25.7%]), ulcerative keratitis (13/70 [18.6%]), nonulcerative keratitis (10/70 [14.3%]), entropion (8/70 [11.4%]), retinal hemorrhage (8/70 [11.4%]), and cataract (6/70 [8.6%]). Foals with sepsis were significantly more likely to have uveitis than were those without sepsis. Foals with sepsis and uveitis were also significantly less likely to survive to discharge than were foals that had sepsis without uveitis. Acquired ophthalmic disease (detected in 37/70 [52.9%] foals) was significantly more common than congenital ophthalmic disease (detected in 9/70 [12.9%]).

CONCLUSIONS AND CLINICAL RELEVANCE

Ophthalmic lesions were detected in 55.7% of neonatal foals with systemic disease. Acquired ophthalmic disease was more commonly detected than congenital ophthalmic disease. Foals with sepsis were more likely to have uveitis than were foals without sepsis. A complete ophthalmic examination is indicated in neonatal foals evaluated for systemic disease.

Uveitis associated with septic peritonitis in a cat

OBJECTIVE

To report a case of bilateral uveitis believed to be a consequence of septic peritonitis in a 19-month-old cat.

CASE SUMMARY

Bilateral anterior uveitis with suspicion of extension to the posterior segment was documented in a previously healthy young cat during hospitalization for severe septic peritonitis. Based on medical history and other findings uveitis was believed to result from concurrent abdominal sepsis, due either to metastatic seeding of bacterial organisms or to effects of bacterial toxins and inflammatory mediators on the blood-aqueous barrier. The cat was surgically and medically managed, and made a full recovery with respect to both his ocular and his abdominal disease.

NEW OR UNIQUE INFORMATION PROVIDED

Ocular complications secondary to systemic sepsis are well documented in people but seldom reported in the veterinary literature. To the authors' knowledge this is the first report of uveitis linked to septic peritonitis in any veterinary species and the first to report sepsis-related uveitis in a cat. Ocular inflammatory disease in the context of critical illness deserves attention as a potential significant source of morbidity. The development of ocular inflammatory disease may serve as a sentinel lesion for systemic sepsis and other life-threatening conditions.