Short communication: Diagnostic accuracy of focused lung ultrasonography as a rapid method for the diagnosis of respiratory disease in dairy calves

Development of a classification system for lung ultrasonographic findings in calves based on the association with cure and production outcomes

The primary objective of this study was to determine associations between ultrasound-based classification systems (using maximum consolidations depth, number of quadrants with consolidation, and consolidation location), clinical indicators, and performance outcomes (ultrasonographic cure, ADG, and cold carcass weight [CCW]) in veal calves following oral metaphylaxis. A retrospective cohort study was conducted on 1,090 white veal calves originating from 3 Belgian veal herds. Clinical scoring and quick thoracic ultrasound (qTUS) follow-up were done by 4 experienced operators at arrival (wk 0), at the start of the first metaphylactic treatment with doxycycline (treatment initiation, wk 1), at the end of this metaphylactic treatment (short-term evaluation, wk 3) and on a long-term evaluation point (wk 10-12). Cure was defined as complete reaeration of previously consolidated lung tissue. Pathogens were identified using culture and nanopore sequencing. One week after arrival, healthy lungs (no consolidation), mild pneumonia (consolidation <1 cm), moderate pneumonia (consolidation 1-2.5 cm), and severe pneumonia (consolidation ≥3 cm) were identified in 46.9%, 12.4%, 21.4%, and 19.4% of calves, respectively. Short-term cure was 59.3% for calves with mild pneumonia, 50.2% for calves with moderate pneumonia, and 32.7% for calves with severe pneumonia, resulting in a total short-term cure of 45.9%. Coronavirus, respiratory syncytial virus, influenza D virus, and Mycoplasmopsis bovis were circulating during treatment. At the long-term evaluation point (wk 10-12), final cure was 59.3%, 55.8%, and 40.3% for calves with mild, moderate, and severe pneumonia at treatment initiation, respectively. Multivariable regression models indicated that different interactions between qTUS categories and number of affected quadrants were associated with short- and long-term odds of cure. Generated models resulted in 3 classification methods, either based on maximum consolidation depth, number of affected quadrants, or an integrated system of both. Calves with clinical pneumonia (Wisconsin score ≥5 and lung consolidation ≥1 cm) had decreased short-term odds to be cured after metaphylaxis compared with calves with subclinical pneumonia (Wisconsin score <5 and lung consolidation ≥1 cm; odds ratio = 0.43; 95% CI: 0.27-0.67). For calves with severe pneumonia in wk 10-12, when compared with calves in a lower qTUS category, ADG and CCW were reduced by 104 g/day (SD = 13; 95% CI: 78-130) and 7.1kg (SD = 1.9; 95% CI: 3.4-10.9), respectively. Categorization based on maximum consolidation depth, the number of affected quadrants, or an integrated system of both has the potential to be included in an ultrasound scoring system. However, based on the practicality for recording, reporting, and follow-up, the authors recommend categorizing calves into mild, moderate, and severe pneumonia based on maximum consolidation depth measurement, referred to as qTUS score, as a practical classification system for ultrasonographic lung assessment in calves.

Genomic analysis of bovine respiratory disease resistance in preweaned dairy calves diagnosed by a combination of clinical signs and thoracic ultrasonography

Bovine respiratory disease (BRD) poses a significant risk of morbidity and mortality in preweaned dairy calves. Research indicates that this multifactorial disorder can be attributed to the involvement of various pathogens. Currently, there is little information from genome-wide association studies (GWAS) for BRD resistance in young calves based on objective measures and classification of the disease. In this study, we moved forward in phenotyping BRD by coupling two diagnostic tests, the thoracic ultrasonography (TUS) and Wisconsin respiratory score (WISC), in order to assess susceptible and resistant animals to BRD. A total of 240 individuals were scored for BRD using TUS and WISC. A GWAS was performed using a selective genotyping approach to identify Quantitative Trait Loci (QTL) for BRD resistance. A total of 47 calves classified as BRD resistant (TUS ≤  1/ WISC ≤  4) and 47 as BRD susceptible (TUS =  5/ any WISC) were genotyped with the NEOGEN's GGP Bovine 100K SNP chip. QTL were then identified comparing the SNPs allelic frequencies between the two groups. A total of 28 QTL regions (QTLRs) were defined according to significative SNPs, 141 genes were annotated in the defined QTLRs. The genes were functionally classified into 4 main categories, i.e., i) regulation of systemic arterial blood pressure, ii) fertility, iii) immune function, and iv) filament cytoskeleton. Furthermore, 61 out of 141 genes identified here can be considered promising candidate genes since they were already associated with BRD resistance in published GWAS studies in dairy cattle. The ASB9, BMX, EPSTI1, and OLFM4 genes were identified in 4 of the 6 considered studies. This study paves the way for further research to mine the genome for resistance to respiratory diseases, utilizing an accurate classification process.

Choosing the optimal combination of lung lobe evaluation during focused pulmonary ultrasonography in calves

Bovine respiratory disease (BRD) poses significant challenges on beef and dairy farms, affecting mortality rates, animal welfare, and production efficiency. Although pulmonary ultrasonography is highly sensitive and specific for monitoring lung lesions and diagnosing BRD, its practical application could be optimized by focusing on the most commonly affected lung lobes. This study first evaluated the efficacy of focused lung ultrasonography for diagnosing BRD in calves, examining individual lung lobes and their associations versus the extensive lung scanning under various disease prevalence scenarios. Then, the relationship between individual and combined clinical respiratory signs versus lung consolidation was analyzed. In a combined analysis, 193 Holstein calves from a longitudinal study and 112 Angus calves from a cross-sectional study underwent a total of 1,265 complete bilateral thoracic ultrasonographic evaluations from 1 to 6 mo of age. Then, the agreement and sensitivity (Se) of specific lung lobe combinations compared with the findings from total lung ultrasonography was assessed. The classification and regression tree (CART) algorithm was used to suggest an optimal examination sequence, and logistic regression was applied to associate specific clinical signs with the presence of lung consolidation, adjusting for breed and calf age. Findings revealed that the most sensitive areas are the cranial (kappa value [κ] = 0.867; Se = 84.7%) and caudal portion of the right cranial lobe (κ = 0.433; Se = 40.3%), the caudal portion (κ = 0.235; Se = 20.6%) of the left cranial lobe, and the middle lobe (κ = 0.25; Se = 22%). The optimal lobe combinations for focused lung ultrasonography were identified as the right cranial lobe paired with either the left cranial lobe or the middle lobe. Focused techniques achieved Se greater than 94% and maintained good agreement. These focused techniques were relatively robust to various true lung consolidation scenarios. The CART analysis recommended initiating examinations with the right cranial lobe, proceeding to the left cranial lobe, and concluding with the middle lobe. Although spontaneous cough was linked to pneumonia presence, reliance on a single clinical sign is not advised due to low Se (26.8%) and high specificity (85.4%); it should merely prompt further ultrasound assessment. In conclusion, focused lung ultrasonography, especially utilizing the right cranial lobe in conjunction with the left cranial lobe or the middle lobe, emerged as an effective strategy for focused pulmonary ultrasonography, preserving the accuracy of the results.

Cross-sectional study: can endogenous procalcitonin differentiate between healthy and bovine respiratory disease-affected preweaned dairy calves?

Bovine respiratory disease (BRD) represents a significant challenge in cattle management due to its multifactorial nature and lack of a gold standard diagnostic method. Procalcitonin (PCT) has emerged as a potential biomarker for bacterial infections in various species, including cattle. This study aimed to investigate plasma PCT concentration variations in pre-weaned dairy calves categorized as BRD-positive using clinical scores (WRSC; BRD-positive ≥5), thoracic ultrasonography with two cut-off (TUS; BRD-positive ≥1 or ≥3), or a combination of both methods (WRSC/TUS1cm or WRSC/TUS3cm). Additionally, the accuracy of PCT in diagnosing BRD was evaluated. A cross-sectional study was conducted on a convenience sample of 226 pre-weaned Italian-Friesian female calves. Clinical scoring, TUS, and plasma PCT analysis were performed. Calves were categorized based on TUS findings, clinical scores, or a combination of both methods. Statistical analyses were conducted to assess the differences in PCT concentrations among different groups and to determine the diagnostic accuracy of PCT. Results showed a significant increase in PCT levels in calves with lung consolidation detected by TUS using a 1 cm cutoff. However, the diagnostic accuracy of PCT in discriminating BRD-positive cases was poor (area under the curve 0.62). The optimal cutoff value for PCT was determined to be 86.63 pg/mL, with sensitivity of 49.7%, specificity of 71.8%, positive predictive value of 79.4% and negative predictive value of 39.5%. In conclusion, while PCT showed potential as a biomarker for BRD, its diagnostic accuracy was limited in this study. Future research should focus on integrating PCT measurements with other diagnostic methods and conducting longitudinal cohort studies to better understand its role in BRD diagnosis and management.

Evaluation of intra- and inter-rater agreement on ultrasound measurements of dairy cow teats by operators with different experience levels

Ultrasound is a valuable, non-invasive technique. It allows for detailed examination, precise measurement, and effective monitoring of teats in dairy cows. This study aimed to evaluate the reliability of ultrasound measurements of teats in dairy cows, specifically focusing on intra- and inter-rater agreement between operators with different levels of experience. The study included 51 healthy Holstein cows, with two operators (experienced and inexperienced) performing measurements on ultrasound images obtained before and after milking. The parameters analyzed were teat-canal length (TCL), teat-end width (TEW), teat-wall thickness (TWT), and teat-cistern width (TCW). Differences in teat measurements before and after milking, as well as between operators, were assessed using the Wilcoxon Signed Rank test and the Mann-Whitney U test, respectively. Intra- and inter-rater agreement was calculated using the intra-class correlation coefficient (ICC). Statistical significance was set at p < 0.05. A total of 402 ultrasound images were analyzed. Significant differences were found in TCL, TWT, and TCW before and after milking, while TEW remained unaffected. Statistically significant differences in TWT and TCW were observed between the two operators, while TCL and TEW did not show significant differences. Intra-rater agreement for the experienced operator was excellent, and for the inexperienced operator, it was good. Inter-rater agreement ranged from good to excellent for most parameters, except for TWT, where it was poor. The study confirms that both milking and operator experience influence teat measurements. However, with proper training, ultrasonography can be a reliable tool for assessing udder health in dairy cows, supporting its use in field conditions.

Assessing lung consolidation in goats using different ultrasonographic techniques

Goats are often affected by respiratory diseases and, despite ultrasonography can assess lung consolidations in several species, it is rarely used in these animals. So, this study evaluated the effectiveness of on-farm lung ultrasonography in detecting lung consolidations on 27 goats. The goats, scheduled for slaughter, underwent complete clinical examinations and lung ultrasonography. For the latter, both sides of the thorax were divided in four quadrants and examined using convex and linear probes before and after shaving the hair. Each quadrant was classified based on presence/absence of lung consolidation and maximum consolidation's depth (4-point scale: 0 healthy; 1 depth < 1 cm; 2 depth < 3 cm; 3 depth > 3 cm). The lungs were examined at necropsy, 66% of goats exhibited lung consolidations and sensitivity (83%-89%), specificity (100%), and κ coefficient values (0.67-0.72) were high with all techniques. An higher (p ≤ 0.01) percentage of class 1 lesions were found at necropsy compared to all the ultrasonographic techniques. All the ultrasonographic techniques effectively detected lung consolidation deeper than 1 cm. So, ultrasonography seems an effective tool for lung examination in goats with chronic pneumonia. The examination using the linear or the convex probes without shaving the hair could be a promising tool for the on-field diagnosis of pneumonia, although further research on larger sample sizes are necessary to validate these findings.

The role of endoscopy in bovine internal medicine - A review of current indication fields

Endoscopy in bovine internal medicine has come a long way from the first profound research papers in the 1980s to its present-day use. This paper reviews the progress in the 2000s and identifies the main application fields for diagnostic and therapeutic use. Inclusion criteria for scientific papers and reports encompassed focus on endoscopic examination techniques in cattle in the field of internal medicine and publication in a peer reviewed journal (case report/review/original research paper/short communication). Only papers written in English or German language were considered. Studies on laparoscopy, theloscopy, and bronchoscopy show that endoscopic approaches often enable more rapid and accurate diagnosis and treatment options for single diseased animals as well as on a herd level. Oesophagoscopy, rumenoscopy, cystoscopy and thoracoscopy have also been increasingly studied and proven to be safe and effective tools with some limitations in diagnosing and/or treating various diseases in cattle. Scientific approaches explored the epidural space in cattle and comparison of different endoscope systems lead to recommendations for sinuscopy. Yet, this narrative literature review clearly shows that unlike in human medicine, where endoscopy as a minimally invasive technique is used for countless routine procedures every day, there is still some catching up to do in bovine medicine even though the potential of endoscopy in this field has been documented.

Accuracy and inter-rater agreement among practitioners using quick thoracic ultrasonography to diagnose calf pneumonia

BACKGROUND

Thoracic ultrasonography (TUS) is a commonly used tool for on-farm detection of pneumonia in calves. Different scanning methods have been described, but the performance of novice practitioners after training has not been documented.

METHODS

In this study, 38 practitioners performed quick TUS (qTUS) on 18-23 calves each. Pneumonia was defined as lung consolidation 1 cm or more in depth. Diagnostic parameters (accuracy [Acc], sensitivity [Se] and specificity [Sp]) were compared to those of an experienced operator. Cohen's kappa and Krippendorff's alpha (Kalpha) were determined. The potential effects of training and exam sessions on performance were evaluated.

RESULTS

The average relative Se and Sp were 0.66 (standard deviation [SD] = 0.26; minimum [Min.]-Maximum [Max.] = 0-1) and 0.71 (SD = 0.19; Min.-Max. = 0.25-1), respectively. The average relative Acc was 0.73 (SD = 0.11; Min.-Max. = 0.52-0.96). Over all sessions, Cohen's kappa averaged 0.40 (SD = 0.24; Min.-Max. = 0.014-0.90) and Kalpha was 0.24 (95% confidence interval [CI]: 0.20-0.27), indicating 'fair' agreement. Calf age and housing influenced Se and Sp. Supervised practical training improved Se by 17.5% (95% CI: 0.01-0.34).

LIMITATIONS

The separate effects of calf age and housing could not be determined.

CONCLUSION

This study showed that qTUS, like any other clinical skill, has a learning curve, and variability in performance can be substantial. Adequate training and certification of one's skill are recommended to assure good diagnostic accuracy.

Strategies for Bovine Respiratory Disease (BRD) Diagnosis and Prognosis: A Comprehensive Overview

Despite significant advances in vaccination strategies and antibiotic therapy, bovine respiratory disease (BRD) continues to be the leading disease affecting the global cattle industry. The etiology of BRD is complex, often involving multiple microbial agents, which lead to intricate interactions between the host immune system and pathogens during various beef production stages. These interactions present environmental, social, and geographical challenges. Accurate diagnosis is essential for effective disease management. Nevertheless, correct identification of BRD cases remains a daunting challenge for animal health technicians in feedlots. In response to current regulations, there is a growing interest in refining clinical diagnoses of BRD to curb the overuse of antimicrobials. This shift marks a pivotal first step toward establishing a structured diagnostic framework for this disease. This review article provides an update on recent developments and future perspectives in clinical diagnostics and prognostic techniques for BRD, assessing their benefits and limitations. The methods discussed include the evaluation of clinical signs and animal behavior, biomarker analysis, molecular diagnostics, ultrasound imaging, and prognostic modeling. While some techniques show promise as standalone diagnostics, it is likely that a multifaceted approach-leveraging a combination of these methods-will yield the most accurate diagnosis of BRD.

Literature Review of the Principal Diagnostic Tests to Detect Bovine Respiratory Disease in Pre-Weaned Dairy and Veal Calves

Bovine respiratory disease (BRD) is an infection of the upper and lower respiratory tract, characterized by an inflammation of the lung. Different diagnostic tests can be used to detect BRD, including clinical respiratory scoring systems, thoracic auscultation, and imaging tests like thoracic ultrasonography and thoracic radiography. Although commonly used, none of these diagnostic tests are perfect for detecting BRD. This article reviews the advantages and drawbacks of these techniques and their performance in detecting BRD in pre-weaned dairy and veal calves.

Short communication: Circadian variations and day-to-day variability of clinical signs used for the early diagnosis of pneumonia within and between calves

For rational antimicrobial use, a timely and correct diagnosis of bovine respiratory disease, especially pneumonia, in calves is required. Current approaches often rely on clinical signs observed at a single time point, and do not take potential diurnal patterns in the manifestation of these clinical signs into account. Therefore, the aim of this pilot study was to investigate how clinical signs utilized for the (early) detection of pneumonia vary both within and between calves, throughout the day and across days. A longitudinal study was conducted in which 36 pre-weaned Holstein-Friesian calves were clinically examined eight times over the course of 48 h. The following parameters were considered: respiratory rate, type of respiration, dyspnea, stridor, induced cough (trachea reflex), spontaneous cough, eye and nasal discharge, ear positions, head tilt, rectal temperature, diarrhea, milk residue, body posture, Wisconsin and Davis BRD scorecard. The advent of thoracic ultrasonography (TUS) enables detection of (sub)clinical pneumonia in a more reliable way, compared to the diagnosis based solely on clinical signs. In this study, 14% (5/36) of the calves had an ultrasound confirmed pneumonia (consolidation ≥1 cm in depth). No variations were observed in the prevalence of clinical signs at the various time points of the day. However, we did observe a difference in the manifestation of clinical signs in individual calves (intra) and between (inter) them. Due to the significant intra-calf variability, diagnosing pneumonia based solely on a single observation of clinical signs, is likely to be insufficient. Hence, misdiagnosis might lead to incorrect use of antimicrobials.

Clinical Scoring Systems in the Newborn Calf: An Overview

Simple Summary

Clinical scores are gaining increasing popularity in veterinary medicine thanks to their multiple advantages, which include quickness, ease, and convenience of use. This review discusses the applications of some already-known clinical scores in newborn calf management at birth and during the first weeks of age. Clinical scores are employed to assess newborn calf viability and to diagnose and monitor neonatal calf diarrhea and respiratory diseases, helping the clinician promptly recognize calves needing medical assistance. This review discusses limitations pertaining to their use and encourages efforts towards a greater consistency in definition and validation.

Abstract

A scoring system is an instrument that enables the scorers, including farmers, technicians, and veterinarians, to adopt a systematic approach for diagnosis or monitoring, as it decreases bias and confounding and increases objectivity. Practically, it is a number assigned to a patient that correlates with a probability that a diagnosis can be confirmed or that a specific outcome will follow. This article examines the clinical scores designed or adapted to bovine medicine that aim to assess newborn calf viability and to diagnose and monitor neonatal calf diarrhea and respiratory diseases, helping the clinician promptly recognize calves needing medical assistance. Despite the large number of clinical scores described in the literature, these are still barely used in farm animal practice; possibly, the complexity of the scores and missing recommendations for intervention are reasons for their lack of popularity as well as the crosswise lack of consistency among scores designed for the same purpose. Further research is needed in this regard to increase scores validation and encourage their application in bovine calf neonatology.

Ultrasonography of the cranial part of the thorax is a quick and sensitive technique to detect lung consolidation in veal calves

BACKGROUND

In the veal calf industry, bovine respiratory disease is the main cause of morbidity and mortality. Lung ultrasonography (LUS) is an accurate technique to diagnose bronchopneumonia in calves. Due to the economic constraints faced by the industry, a screening technique able to rapidly examine large numbers of calves is required.

OBJECTIVE

To determine if lung ultrasonography focusing on the cranial part of the thorax (1st to 2nd intercostal space (ICS) on the right and 2nd to 3rd on the left) and/or on the middle part of the thorax (3rd to 5th ICS on the right and 4th to 5th on the left) (alternative techniques) are rapid screening techniques as sensitive as LUS of the entire lung (reference technique) to identify calves with lung consolidation lesions.

METHODS

Data on 300 veal calves aged 33.1 ± 8.0 days and weighing on average 67.5 ± 4.0 kg at LUS from two farms were analysed. Systematic LUS of the entire lung was performed on all calves and a lung consolidation score was given to different parts of the thorax. Agreements between the alternative and the reference techniques were measured by Cohen's κ, McNemar's test and weighted κ.

RESULTS

Agreement between LUS focusing on the cranial + middle part or on the cranial part only of the thorax and the reference technique were almost perfect with a cutoff of 1 cm. The relative sensitivity of these two alternative techniques was high (> 93%).

CONCLUSION

Lung ultrasonography of the cranial + middle part or on the cranial part only of the thorax are quick and sensitive techniques to identify veal calves with lung consolidation lesions shortly after arrival at the facility.

Use of Thoracic Ultrasonography to Improve Disease Detection in Experimental BRD Infection

Bovine respiratory disease (BRD) is caused by complex interactions between viral and bacterial pathogens, host immune status, and environmental stressors. In both clinical and research settings, current methods for detecting BRD in calves commonly focus on visual indicators such as attitude, nasal discharge, and cough, in addition to vital signs such as rectal temperature and respiration rate. Recently, thoracic ultrasonography (TUS) has become more commonly used in clinical settings, in addition to physical examination to diagnose BRD. To assess the value of performing TUS during experimental BRD infection, 32 calves were challenged with bovine respiratory syncytial virus, to mimic a viral infection, and 30 calves were infected with Mannheimia haemolytica, to mimic a bacterial infection. TUS was performed at regular intervals using a standardized method and scoring system in addition to daily clinical scoring. Although overall correlations between clinical scores and TUS scores were generally weak (maximum R2 = 0.3212), TUS identified calves with abnormal lung pathology that would have otherwise been misclassified on the basis of clinical scoring alone, both on arrival and throughout the studies. In addition, TUS had an increased correlation with gross lung pathology on necropsy (maximum R2 = 0.5903), as compared to clinical scoring (maximum R2 = 0.3352). Our results suggest that TUS can provide additional information on calf health at enrollment and throughout a study and may provide an alternative to terminal studies, due to the high correlation with lung pathology at necropsy.