Proposal for rational antibacterial use in the diagnosis and treatment of dogs with chronic diarrhoea

Chronic diarrhoea is a frequent complaint in canine practice and the diagnostic path is often characterised by numerous diagnostic tests and stepwise empirical treatments, often applied before gastrointestinal endoscopy/mucosal biopsies. These include dietary interventions (novel protein, hydrolysed protein diet), parasiticides and still, in many cases, antibacterials. Indiscriminate use of antibacterial drugs risks detrimental consequences for both the individual patient (antimicrobial resistance, long‐term disruption of intestinal bacterial populations, potential worsening of gastrointestinal signs) and the general public. For that reason, in this Perspective essay we advocate use of antibacterials only after histopathologic evaluation of gastrointestinal biopsies or, for those cases in which endoscopy is not possible, after other therapeutic trials, such as diet/pre‐probiotics or anti‐inflammatory drugs have proven unsuccessful. They should be reserved, after appropriate dietary trials, for those canine chronic diarrhoeic patients with signs of true primary infection (i.e. signs of systemic inflammatory response syndrome or evidence of adherent‐invasive bacteria) that justify antibacterial use.

Effects of probiotic bacteria on mucosal polyamines levels in dogs with IBD and colonic polyps: a preliminary study

Spermine (SPM) and its precursor putrescine (PUT), regulated by ornithine decarboxylase (ODC) and diamino-oxidase (DAO), are polyamines required for cell growth and proliferation. Only a few studies have investigated the anti-inflammatory and tumour inhibitory properties of probiotics on mucosal polyamine levels. We investigated the effects of a high concentration multistrain probiotic for human use on colonic polyamine biosynthesis in dogs. Histological sections (inflammatory bowel disease, n=10; polyposis, n=5) were assessed after receiving 112 to 225×10⁹ lyophilised bacteria daily for 60 days at baseline (T0) and 30 days after treatment end (T90). Histology scores, expression of PUT, SPM, ODC and DAO, and a clinical activity index (CIBDAI) were compared at T0 and T90. In polyps, cellular proliferation (Ki-67 expression), and apoptosis (caspase-3 protein expression) were also evaluated. After treatment, in inflammatory bowel disease significant decreases were observed for CIBDAI (P=0.006) and histology scores (P<0.001); PUT, SPM and ODC expression increased (P<0.01). In polyps, a significant decrease in polyamine levels, ODC activity, and Ki-67, and a significant increase in caspase-3 positivity and DAO expression (P=0.005) was noted. Our results suggest potential anti-proliferative and anti-inflammatory effects of the probiotic mixture in polyps and inflammation, associated with reduced mucosal infiltration and up-regulation of PUT, SPM, and ODC levels.

Hypovitaminosis D is associated with negative outcome in dogs with protein losing enteropathy: a retrospective study of 43 cases

Background

Hypovitaminosis D has previously been shown to be prevalent amongst dogs with protein losing enteropathy (PLE).

The hypothesis of this study was that Low 25-hydroxyvitamin D (25(OH) D) serum concentrations could be a risk factor for negative outcome in dogs with PLE.

Forty-three dogs diagnosed with PLE (2005–2014) and which serum Vitamin D serum concentrations were collected and archived at −80 Degrees C were analyzed.

Post-diagnostic communication with referring veterinarians was made to determine outcome of PLE dogss: Dogs which died due to PLE within 4 months after diagnosis (negative outcome group, n = 22) and dogs alive or which died due to another disease at the end point of the study (1 year after diagnosis, good outcome group, n = 21). Serum samples taken at the time of diagnosis were analysed for ionized calcium (iCa) concentrations and serum 25(OH) D concentration.

Results

Clinical (CCECAI) scores, age at PLE diagnosis, and iCa concentrations were not significantly different between dog groups. A significantly greater (p < 0.001) number of PLE dogs treated with hydrolyzed or elimination diet alone showed good outcome as compared to the PLE negative outcome group. Median serum 25(OH) D concentration was significantly (p = 0.017) lower in dogs with negative outcome versus PLE dogs with good outcome. Using logistic regression analysis, 25(OH) D serum concentration was shown to be a statistically significant factor for outcome determination. Cox regression analysis yielded a hazard ratio of 0.974 (95% CI 0.949, 0.999) per each one nmol/l increase in serum 25(OH) D concentration.

Conclusions

Low serum 25(OH) D concentration in PLE dogs was significantly associated with poor outcome. Further studies are required to investigate the clinical efficacy of Vitamin D (cholecalciferol) as a potential therapeutic agent for dogs with PLE.

Endoscopic assessment of the duodenum in dogs with inflammatory bowel disease

BACKGROUND

Endoscopy is performed for direct inspection of the mucosa and acquisition of biopsies in dogs with inflammatory bowel disease (IBD).

AIM

To evaluate the interobserver agreement in the endoscopic assessment of duodenal mucosa in dogs with IBD.

METHODS

Thirty-five archived endoscopic images of grossly normal (n = 6) and inflamed (n = 29) duodenal mucosa were displayed to 3 expert and 5 trainee endoscopists. Each image was assessed independently by endoscopists for mucosal abnormalities using established indices (of hyperemia, granularity, friability, lymphatic dilatation, and erosions) or interpreted as normal mucosa (trial 1). A repeated trial (trial 2) was performed with the same images presented in random order 1 month later, and accompanied by a visual template.

RESULTS

There was slight interobserver agreement in initial mucosal assessment for expert and trainee endoscopists in trial 1 (kappa ≤ 0.02, P > .05). Interobserver agreement improved in trial 2 for both expert and trainee endoscopists (kappa = 0.2, P > .05) for experts and (P < .05) for trainees. There was a significant (P < .01) improvement in trainee endoscopy scores of lesions from trial 1 to trial 2. Regression analysis showed a significant (P < .01) difference between expert versus trainee endoscopy scores in trial 1. Repeat lesion assessment aided by use of a visual template (trial 2) improved the overall scores of trainee endoscopists to near that of expert endoscopists (P = .06).

CONCLUSIONS AND CLINICAL IMPORTANCE

Interobserver agreement of IBD mucosal appearance from endoscopic findings benefitted from operator experience.

Design of a simplified histopathologic model for gastrointestinal inflammation in dogs

Significant interobserver variability in the diagnostic interpretation of endoscopic gastrointestinal (GI) specimens exists even with the use of World Small Animal Veterinary Association (WSAVA) standardization criteria. Chi-square analyses compared the extent of pathologists' agreement for microarchitectural features of inflammation in endoscopic specimens obtained from 253 animals of the original WSAVA study. Patterns of agreement between pathologists were classified as broad (3/4 pathologists agreed), dichotomous (2/4 pathologists agreed), or divergent (no agreement between pathologists). The simplified model for GI inflammation was based on those parameters for which the pathologists had either broad or minimally divergent opinions of histopathologic significance. In this model, the parameters chosen were as follows: gastric parameters (intraepithelial lymphocytes [IELs], lamina propria [LP] infiltrates, and mucosal fibrosis), duodenal parameters (villus atrophy, epithelial injury, IELs, crypt changes, and LP infiltrates), and colonic parameters (epithelial injury, crypt dilation, fibrosis, LP infiltrates, and goblet cell depletion). Preliminary data using this simplified model showed excellent correlation between pathologists in defining the presence and extent of GI inflammation in dogs.

Comparison of oral prednisone and prednisone combined with metronidazole for induction therapy of canine inflammatory bowel disease: a randomized-controlled trial

BACKGROUND

Although prednisone and metronidazole are commonly used to treat canine inflammatory bowel disease (IBD), no randomized-controlled trials have been performed.

HYPOTHESIS

Combination drug therapy with prednisone and metronidazole will be more effective than prednisone alone for treatment of canine IBD. Reduction in disease severity will be accompanied by decreased canine IBD activity index (CIBDAI) scores and serum C-reactive protein (CRP) concentrations.

ANIMALS

Fifty-four pet dogs diagnosed with IBD of varying severity.

METHODS

Dogs were randomized to receive oral prednisone (1 mg/kg; n = 25) or prednisone and metronidazole (10 mg/kg; n = 29) twice daily for 21 days. Clinical (CIBDAI) scores and serum CRP were determined at diagnosis and after 21 days of drug therapy. The primary efficacy measure was remission at 21 days, defined as a 75% or greater reduction in baseline CIBDAI score.

RESULTS

Differences between treatments in the rate of remission (both exceeding 80%) or the magnitude of its change over time were not observed. CRP concentrations in prednisone-treated dogs were increased because of many dogs having active disease. Both treatments reduced CRP in comparison with pretreatment concentrations. An interaction between CIBDAI and CRP was identified in 42 of 54 dogs (78%), whereas 8 of 54 dogs (15%) showed disagreement between these indices.

CONCLUSIONS AND CLINICAL IMPORTANCE

Prednisone is as effective as combined treatment with prednisone and metronidazole for induction therapy of canine IBD. CRP may be normal or increased in dogs with IBD and may be useful in assessing the response of individual dogs to treatment along with changes in the CIBDAI.

Fluorescence in situ hybridization confirms clearance of visible Helicobacter spp. associated with gastritis in dogs and cats

BACKGROUND

The results of studies examining the role of Helicobacter spp. in the pathogenesis of canine and feline gastritis are inconclusive. Furthermore, data evaluating the effectiveness of medical therapy for eradication of Helicobacter infection are limited.

AIM

To detect Helicobacter spp. in mucosal biopsies of dogs and cats diagnosed with gastritis, with fluorescence in situ hybridization (FISH).

ANIMALS

Three dogs and 2 cats with signs of chronic gastrointestinal disease.

METHODS

Dogs and cats infected with Helicobacter spp. were treated with triple antimicrobial therapy and fed an elimination diet for 21 days. Helicobacter spp. status in endoscopic (3 dogs, 1 cat) or surgical biopsies (1 cat) of gastric mucosa was compared pre- and posttreatment in each animal by histology, FISH analysis, and polymerase chain reaction (PCR).

RESULTS

Gastritis of varying severity with intraglandular spiral bacteria was observed in all animals. Pretreatment diagnostic tests confirmed the presence of mucosal Helicobacter spp. in all animals by FISH and histopathology and in 4/5 animals by PCR. Rapid resolution of vomiting episodes was observed in all animals. Gastric biopsies performed after triple therapy revealed clearance of visible Helicobacter spp. by histopathology and negative FISH analysis, as well as PCR in all animals.

CONCLUSIONS AND CLINICAL IMPORTANCE

Application of FISH to routine biopsy specimens enabled rapid and specific identification of Helicobacter spp. within the gastric mucosa of dogs and cats. Although medical therapy was useful in resolution of clinical signs and clearance of visible Helicobacter spp. in gastric biopsies, gastric inflammation persisted.

Managing the refractory case of feline IBD

Feline inflammatory bowel disease (FIBD) is characterized by persistent gastrointestinal signs, histologic evidence of mucosal inflammation, and responsiveness to immunotherapeutic intervention. Since a concise and comprehensive review of IBD has been recently presented ( Jergens 1999 ), the purpose of this overview is to provide current perspectives on FIBD, and strategies for dealing with patients that fail to respond to routine medical management.

Gastric emptying as assessed by barium-impregnated polyethylene spheres in healthy dogs consuming a commercial kibble ration

Barium-impregnated polyethylene spheres (BIPS) were used to assess gastric emptying in medium-sized dogs consuming a commercial kibble ration. Two sizes of spheres were used: 1.5 mm and 5.0 mm in diameter. Ventrodorsal and right lateral recumbent radiographs were taken immediately before and after consumption of the test meal, and then hourly. The lag phase and the time to 25% (GET25), 50% (GET50), and 75% (GET75) gastric emptying of each sized marker were calculated. There was no significant difference between the lag phases of the small and large BIPS. There was a significant difference between the 1.5 and 5.0 markers at GET25, GET50, and GET75 in these medium-sized dogs. In a majority (70%) of the dogs in this study, GET25 of the 1.5-mm marker occurred at 4.73+/-1.44 hours; GET50 (1.5 mm) occurred at 8.29+/-1.62 hours, and GET75 (1.5 mm) occurred at 10.82+/-1.35 hours. The 5.0-mm markers tended to empty erratically and slowly. Four of the eight dogs retained some of the large markers in their stomachs at the end of the study period (24 hours).

Immunomodulation therapy for feline leukemia virus infection

Clinically ill feline leukemia virus (FeLV)-infected cats, treated with Staphylococcus protein A (SPA) or oral interferon alpha (IFN), or both, were compared with cats treated with saline (SAL). Nine cats received SPA/SAL, nine received SPA/IFN, 10 received SAL/IFN, and eight received SAL/SAL. Twelve cats survived and completed the 100-week therapy. Significantly more owners of cats treated with SPA/SAL thought their cat's health improved during treatment compared to owners of cats treated with SAL/SAL (P=0.05, pair-wise comparison) or SPA/IFN (P=0.05, pair-wise comparison). No significant differences in body weight, temperature, hematocrit, red blood cell counts, mean corpuscular hemoglobin concentration, reticulocyte counts, white blood cell or neutrophil numbers, lymphocyte concentrations, bone-marrow cytopathology, FeLV status, survival time, activity, or appetite scores were observed. No significant differences in the owners' subjective assessment of their cat's health following treatment with SAL/IFN, SPA/IFN, or SAL/SAL were seen. Therapy with SPA as a single agent results in the owners' subjective impression of improved health of their FeLV-infected cats.

Possible causal association of idiopathic inflammatory bowel disease with thrombocytopenia in the dog

Extraintestinal manifestations of inflammatory bowel disease (IBD) are commonly observed in humans but are poorly documented in companion animals. Thrombocytopenia is an uncommon but well-documented extraintestinal hematological abnormality in humans; however, there are no previous reports of IBD and concurrent thrombocytopenia in the veterinary literature. Seven dogs having idiopathic IBD and concurrent thrombocytopenia were identified and evaluated retrospectively (this represents an incidence of 2.5% in the authors' IBD population). Obvious known causes for thrombocytopenia were eliminated by diagnostic testing as deemed appropriate by the clinician of record. Thrombocytopenia resolved with treatment for the IBD in some but not all patients. This is similar to reports in humans. Thrombocytopenia typically appears to be subclinical, and the severity does not correlate with the degree of intestinal inflammation defined histopathologically. However, quantitative platelet counts should be monitored during IBD therapy, as additional immunosuppression may be required to treat thrombocytopenia, despite resolution of gastrointestinal signs. It is speculated that thrombocytopenia may be causally associated with canine IBD, possibly secondary to immune stimulation from lumenal bacterial antigens, altered immunological regulation, or both.

Flow cytometric analysis of colonic and small intestinal mucosal lymphocytes obtained by endoscopic biopsy in the healthy dog

Flow cytometric analysis of the lymphocyte population of the gut could provide useful information on the immune cells present in the gut that would not be easily obtained in tissue sections. However, little is known of the normal lymphocyte population in the canine gut as determined by flow cytometry, which allows for simultaneous staining of multiple cell surface antigens and identification of specific lymphocytic subsets. Therefore, intraepithelial lymphocytes were obtained from biopsies of the healthy canine proximal small intestine and colon taken with an endoscope, and flow cytometric analysis was used to characterize the lymphocyte subsets present. Endoscopic biopsy of the intestine is a minimally invasive technique commonly used for diagnostic purposes. Although CD3+ lymphocytes were the most abundant subset in both colon and small intestine, CD3+/CD8- lymphocytes predominated in the proximal small intestine, whereas CD3+/CD8+ lymphocytes did in the colon. Canine CD8+ intraepithelial lymphocytes were predominantly CD8alphabeta+ in both small intestine and colon. CD4+ intraepithelial lymphocytes were always much less numerous than CD8+ intraepithelial lymphocytes. As in man, a majority of intraepithelial lymphocytes expressed the T-cell receptor, TCRalphabeta, but TCRgammadelta was expressed by a third of intraepithelial T-cells in the proximal small intestine, and approximately 15% of those in the colon. Very few CD21+ lymphocytes were detected in samples of healthy canine colon and small intestinal intraepithelial cells. We have showed that canine intraepithelial lymphocytes are regionally specialized, and that those from the small intestine are unique in comparison to those of other species such as man and rodents due to the large numbers of CD3+/CD8- intraepithelial lymphocytes. This study provides a baseline for comparison with intraepithelial lymphocytes obtained from canine patients with intestinal disease.

Colonic lymphocyte and plasma cell populations in dogs with lymphocytic-plasmacytic colitis

OBJECTIVES

To quantitate immunoglobulin-containing cells (IgA, IgG, and IgM) and CD3+ T cells in colonic biopsy specimens obtained from dogs with lymphocytic-plasmacytic colitis (LPC), and to compare lymphocyte and plasma cell populations in dogs with LPC with those in healthy dogs.

ANIMALS

10 healthy dogs and 11 dogs with LPC.

PROCEDURE

Colonic mucosal specimens obtained from healthy dogs and dogs with LPC were stained specifically for IgA-, IgG-, and IgM-containing cells and CD3+ T cells by use of immunoperoxidase techniques. Morphometric analyses were done to quantitate lymphocytes and plasma cells in standardized areas of colonic mucosa. Data analyses allowed determination of mean cell numbers in each dog group, and comparison of mean numbers of lymphocytes and plasma cells between dog groups.

RESULTS

CD3+ T cells predominated in healthy dogs, whereas CD3+ T cells and IgA-containing cells were most numerous in dogs with LPC. In both dog groups, the IgG- and IgM-containing cells were considerably less numerous than the other 2 cell types. Comparison of cell populations between dog groups indicated that IgA- and IgG-containing cells and CD3+ T cells were significantly more numerous in the colonic mucosa of dogs with LPC.

CONCLUSIONS

Dogs with LPC have significantly increased numbers of IgA- and IgG-containing cells and CD3+ T cells. These lymphocyte and plasma cell distributions indicate similarities to and differences from such distributions in human beings with inflammatory bowel disease. Results provide a basis for future correlation between histologic stage of disease activity and immunologic findings in dogs with LPC.

Inflammatory bowel disease. Current perspectives

This review provides current perspectives on canine and feline (IBD) as documented in the literature. As can be seen, the scientific database on this clinical syndrome is minute. Empirical clinical observations and experiences are valuable but do not replace the "good science" that can be achieved by performance of basic science research studies and controlled therapeutic trials. Continued advances in immunobiology, particularly molecular biology, should facilitate a greater understanding of IBD in both humans and animals. Indeed, preliminary investigations using these research tools have provided new insights into the immunopathology of canine IBD.

Flow cytometric analysis of canine colonic mucosal lymphocytes from endoscopically obtained biopsy specimens

OBJECTIVE

To validate use of canine colonic biopsy specimens obtained via endoscopy as a source of mucosal lymphocytes (ML) for flow cytometric analysis.

SAMPLE POPULATION

Mucosal biopsy specimens from 10 adult dogs.

PROCEDURE

Mucosal lymphocyte subsets obtained from excised colon were compared with ML subsets obtained from biopsy specimens obtained by use of an endoscopic forceps (6 dogs). Endoscopic colonic biopsy specimens from 4 other dogs were used to define whether obtained ML were predominantly of intraepithelial or lamina propria origin. Mucosal lymphocytes were isolated and labeled, using commercially available monoclonal antibodies directed against canine cell surface antigens. Lymphocyte subsets (cytotoxic or helper T cells; B cells) were determined by use of flow cytometric analysis.

RESULTS

A large number of viable ML was obtained after dissociation of the colonic epithelium from excised colon (45.5 + 21.5 X 10(6)) and endoscopic (7.2+/-3.4 X 10(6)) biopsy specimens. Lymphocyte subsets obtained with both methods were identical for each dog and consisted predominantly of intraepithelial lymphocytes, with some lymphocytes from the lamina propria. Collagenase digestion of excised colon also yielded a large number of viable lymphocytes from the lamina propria (56.7+/-20.4 X 10(6)), but collagenase digestion of endoscopic biopsy specimens was less rewarding.

CONCLUSION AND CLINICAL RELEVANCE

A representative sample of viable intraepithelial ML is obtainable from endoscopic biopsy specimens. Flow cytometric analysis, a minimally invasive technique, can be used to study ML of client-owned animals.

Cytologic examination of exfoliative specimens obtained during endoscopy for diagnosis of gastrointestinal tract disease in dogs and cats

OBJECTIVE

To determine whether cytologic examination of exfoliative specimens obtained during endoscopy was as useful as histologic examination of mucosal biopsy specimens for the diagnosis of gastrointestinal tract disease in dogs and cats and to compare the diagnostic accuracy of 2 techniques (brush or touch) in preparing specimens for cytologic examination.

DESIGN

Prospective case series.

ANIMALS

85 dogs and 23 cats.

PROCEDURE

Specimens for cytologic and histologic examination were obtained during routine endoscopic examination of the stomach, small intestine, and colon. A diagnosis was made on the basis of cytologic findings (graded objectively) and compared with the diagnosis on the basis of histologic findings.

RESULTS

The diagnostic accuracy of cytologic examination was high for all 3 organs. Sensitivities, specificities, and predictive values of positive and negative results were > 90% in most instances. The diagnostic accuracy of the brush technique was equal or superior to that of the touch technique for 84% of specimens. The brush technique was most useful in detecting cellular infiltrates in the lamina propria, whereas the touch technique was more likely to detect acute mucosal inflammation. Percentages of false-positive (3.2%) and false-negative (6.9%) cytologic interpretations were low.

CLINICAL IMPLICATIONS

Endoscopy is safe and requires little time to procure specimens for cytologic examination, which can be obtained concurrently with mucosal biopsy specimens. Cytologic examination of exfoliative specimens obtained during endoscopy is a useful and reliable adjunct to histologic examination of biopsy specimens in the diagnosis of gastrointestinal tract disease in dogs and cats.

Immunohistochemical characterization of immunoglobulin-containing cells and T cells in the colonic mucosa of healthy dogs

OBJECTIVES

To quantitate numbers of immunoglobulin (Ig)-containing cells (IgA, IgG, and IgM) and T cells (CD3+, CD4+, and CD8+) in the colonic mucosa of healthy dogs, and to determine whether mean cell numbers differ among colonic regions.

ANIMALS

10 clinically normal young adult mixed-breed dogs.

PROCEDURE

Endoscopically obtained specimens of ascending, transverse, and descending colonic mucosa were stained specifically for IgA, IgG, and IgM heavy chains and T-cell antigens, CD3+, CD4+, and CD8+, using immunoperoxidase techniques. Morphometric analysis, performed by light microscopy, was used to quantitate numbers in these standardized areas of colonic mucosa. Data analysis allowed determination of mean cell numbers in each colonic region, as well as comparison of mean cell numbers among colonic regions.

RESULTS

The CD3+ and CD8+ T cells were the predominant immune cell types in all colonic regions. In the mucosa, CD3+ T cells were significantly (P < 0.05) more numerous than CD8+ T cells, and CD8+ T cells were significantly (P < 0.05) more numerous than CD4+ T cells. The IgA-containing cells were significantly (P < 0.05) more numerous than IgG-containing cells, whereas IgM-containing cells were least numerous (P < 0.05). Differences in mean cell counts among colonic regions were not significant for Ig-containing cells or T cells.

CONCLUSIONS

Mean numbers of immune cells did not differ significantly among colonic regions in healthy dogs, although differences existed in mean populations of T cells and Ig-containing cells. The CD3+ and CD8+ T cells were the most numerous immune cell types in colonic mucosa.

CLINICAL RELEVANCE

These quantitative data provide a basis for study of alterations in populations of mucosal immune cells and their possible contribution to the pathogenesis of gastrointestinal tract disease.

Gastrointestinal disease and its management

Gastrointestinal (GI) diseases involving the alimentary tract and hepatobiliary system are common in geriatric dogs and cats. Inflammatory disorders predominate, but motility disturbances and degenerative lesions may also cause GI signs in affected animals. Treatment is directed at correction of the underlying cause and often requires tissue biopsy. The prognosis is good in many diseases with appropriate drug nutritional, and/or surgical therapy.

Colonic nitrite and immunoglobulin G concentrations in dogs with inflammatory bowel disease

OBJECTIVE

To evaluate lavage analytes as markers of mucosal inflammation in healthy dogs and dogs with inflammatory bowel disease (IBD).

DESIGN

Case control study.

ANIMALS

9 healthy dogs and 10 dogs with IBD.

PROCEDURE

A polyethylene glycol electrolyte solution was administered into the dogs colons via a rectal balloon catheter prior to colonoscopy. Lavage solution was allowed to remain intraluminally for 30 minutes and then was withdrawn. Lavage supernatant samples were immediately analyzed for total protein, IgG, and nitrite concentrations and myeloperoxidase activity. Mucosal biopsy specimens were obtained from the descending colon and histologically reviewed.

RESULTS

All dogs with IBD had mild to severe lymphocytic-plasmacytic colitis, whereas 8 of 9 healthy dogs did not have substantial mucosal inflammation. Myeloperoxidase activity was not detected in lavage samples from healthy dogs or dogs with IBD. Total protein concentration was not significantly different between groups. Mean nitrite and IgG concentrations were significantly higher in samples from dogs with IBD (1.83 nmol/ml and 46 mg/dl, respectively), compared with samples from healthy dogs (0.245 nmol/ml and undetectable concentrations, respectively). Severity of lesions was not correlated with nitrite or IgG concentration.

CLINICAL IMPLICATIONS

Assay of nitrite and IgG concentrations in colonic lavage fluid is a simple, objective means of evaluating mucosal inflammation in dogs with IBD. Potential uses include monitoring response to treatment and evaluation of complex cases of chronic intestinal inflammation.

Morphometric evaluation of immunoglobulin A-containing and immunoglobulin G-containing cells and T cells in duodenal mucosa from healthy dogs and from dogs with inflammatory bowel disease or nonspecific gastroenteritis

OBJECTIVE

To investigate the distribution of IgA- and IgG-containing cells and T cells in the villi of duodenal mucosa from healthy dogs and from dogs with inflammatory bowel disease (IBD) of gastroenteritis.

DESIGN

Case-control study.

ANIMALS

28 dogs, grouped according to clinical and histologic criteria: 11 dogs with IBD, 8 dogs with non-specific gastroenteritis, and 9 healthy dogs.

PROCEDURE

Endoscopic biopsy specimens of duodenal mucosa from each dog were stained specifically for IgA and IgG heavy chains and pan T-cell (CD3) antigen, using immunoperoxidase techniques. Morphometric analysis, performed via an image-analysis system, was used to count IgA- and IgG-containing cells and T cells within paired contiguous villi from each dog.

RESULTS

cells were the predominant immune cell type in all groups of dogs. Significant differences in the villus distribution of IgA- and IgG-containing cells and T cells were not observed. Healthy dogs had significantly higher T-cell counts than had dogs with IBD or gastroenteritis. Dogs with nonspecific gastroenteritis had a significantly higher concentration of IgA-containing cells than the other groups of dogs had. Significant group differences for IgG-containing cells also were evident, with dogs with IBD having the lowest cell counts.

CONCLUSIONS AND CLINICAL RELEVANCE

High concentrations of IgA- and IgG-containing cells and T cells in the villus lamina propria cannot be reliably used to distinguish IBD from other intestinal disorders in dogs. Evaluation of T cells may be the most discriminatory method for differentiating dogs with IBD from clinically normal dogs via examination of intestinal biopsy specimens.

Cardiopulmonary responses in healthy dogs during endoscopic examination of the gastrointestinal tract

Cardiopulmonary responses were evaluated in 12 dogs undergoing endoscopy (gastroscopy and enteroscopy). Constant endoscopic insufflation was used to distend the stomach and small intestine for 30 minutes in groups of small (< 10 kg; n = 4), medium (10 to 20 kg; n = 4), and large (> 20 kg; n = 4) dogs. Cardiopulmonary measurements within groups prior to gastric distention (preendoscopy) were compared with postendoscopy measurements and with those made during endoscopy. After distending the stomach and small intestine, increased luminal pressure within the body of the stomach and in the descending duodenum (P < 0.05) and increased abdominal girth (P < 0.05) were observed, with the greatest changes in small dogs. Caudal vena cava pressures and mean arterial and pulmonary artery pressures increased (P < 0.05) during endoscopy. Cardiac index varied, with small dogs having greater cardiac index (P < 0.05) during endoscopy, compared with that in medium and large dogs. Minute volume remained unchanged during insufflation, despite a decrease in tidal volume (P < 0.05), because of an increase in respiratory rate (P < 0.05). Arterial blood gas analysis revealed a mild, mixed metabolic/respiratory acidosis in all groups. Although cardiopulmonary changes associated with gastrointestinal tract endoscopy were common, the changes were often small and of little clinical significance.

Idiopathic inflammatory bowel disease in dogs and cats: 84 cases (1987-1990)

Idiopathic inflammatory bowel disease was the diagnosis for 58 dogs and 26 cats, with signs of persistent gastroenteritis, failed responses to dietary trials, and histologic evidence of cellular infiltrates unrelated to other causes of gastrointestinal tract inflammation. Clinical signs of large intestinal dysfunction, watery diarrhea, vomiting, and anorexia with weight loss were common. Nonspecific hematologic, biochemical, and radiographic abnormalities frequently were observed. Mucosal biopsy specimens, obtained endoscopically, were histologically evaluated for severity of mucosal epithelial damage. Mucosal erythema, friability, enhanced granularity, and ulceration or erosion were the predominant endoscopic lesions. Inflammatory bowel disease lesions of moderate severity predominated in the stomach, duodenum, and colon. Lymphocytic/plasmacytic infiltrates were limited to the lamina propria in biopsy specimens from all regions of the gastrointestinal tract. Inflammatory bowel disease commonly is associated with chronic gastroenteritis in dogs and cats.

Evaluation of hemostatic analytes after use of hypertonic saline solution combined with colloids for resuscitation of dogs with hypovolemia

The effects of hypertonic saline solution (HTSS) combined with colloids on hemostatic analytes were studied in 15 dogs. The analytes evaluated included platelet counts, one-stage prothrombin time, activated partial thromboplastin time, von Willebrand's factor antigen (vWf:Ag), and buccal mucosa bleeding times. The dogs were anesthetized, and jugular phlebotomy was used to induced hypovolemia (mean arterial blood pressure = 50 mm of Hg). Treatment dogs (n = 12) were resuscitated by infusion (6 ml/kg of body weight) of 1 of 3 solutions: HTSS combined with 6% dextran 70, 6% hetastarch, or 10% pentastarch. The control dogs (n = 3) were autotransfused. Hemostatic analytes were evaluated prior to induction of hypovolemia (baseline) and then after resuscitation (after 30 minutes of sustained hypovolemia) at 0.25, 0.5, 1, 6 and 24 hours. All treatment dogs responded rapidly and dramatically to resuscitation with hypertonic solutions. Clinically apparent hemostatic defects (epistaxis, petechiae, hematoma) were not observed in any dog. All coagulation variables evaluated, with the exception of vWf:Ag, remained within reference ranges over the 24-hour period. The vWf:Ag values were not statistically different than values from control dogs, and actual values were only slightly lower than reference ranges. Significant (P < or = 0.04) differences were detected for one-stage prothrombin time, but did not exceed reference ranges. The results of this study suggested that small volume HTSS/colloid solutions do not cause significant alterations in hemostatic analytes and should be considered for initial treatment of hypovolemic or hemorrhagic shock.

Adherent gram-positive cocci on the intestinal villi of two dogs with gastrointestinal disease

Two dogs were examined for clinical signs of chronic gastrointestinal disease. Duodenal mucosal biopsy specimens, obtained endoscopically, revealed histologic lesions of adherent gram-positive cocci on the villus epithelium of both dogs. The positive gram stain and morphologic features of the adherent cocci were suggestive of Streptococcus organisms. Indirect tests for intestinal bacterial overgrowth were not diagnostic, suggesting that the adherent cocci were a primary lesion. Rapid clinical response following dietary manipulation and the initiation of medical management was observed in both dogs. The dogs of this report draw similarities to Streptococcus durans infection previously reported in pigs, foals, and a single pup. The pathogenesis of enteric disease associated with adherent gram-positive cocci in dogs remains ill-defined.

Effect of desmopressin acetate on bleeding times and plasma von Willebrand factor in Doberman pinscher dogs with von Willebrand's disease

Effects of desmopressin acetate (1-desamino-8-D-arginine vasopressin [DDAVP]) on plasma von Willebrand factor (vWf) were studied in 12 purebred Doberman pinschers confirmed to have von Willebrand's disease (vWd) (plasma vWf antigen [vWf:Ag] concentrations, less than 30 U/dl). Twelve dogs had subnormal plasma botrocetin cofactor (BCf) activity and 11 dogs had prolonged buccal mucosa bleeding times. Tranquilization of three dogs with lenperone and three dogs with xylazine did not induce significant changes in mean plasma vWf:Ag concentrations or mean BCf activities. Thirty and 120 minutes after administration of DDAVP (1 micrograms/kg subcutaneously), there was significant shortening of the mean buccal mucosa bleeding time. Ten dogs responded to DDAVP with increases in BCf activity which exceeded 10 U/dl at 30 or 120 minutes, or both, after the drug was administered. At the same time, increases in plasma vWf:Ag concentrations were smaller than the increases in BCf activity. It was shown by multimeric analysis that primarily the higher molecular weight forms of vWf increased in plasma in response to DDAVP.

Hyperinsulinism and hypoglycemia associated with pancreatic islet cell tumor in a ferret

Pancreatic islet cell tumor causing hypoglycemia and hyperinsulinism was diagnosed in a ferret with a history of progressive neurologic dysfunction. The diagnosis was suspected by the findings of hypoglycemia when the ferret was not fed, hyperinsulinism, and an amended insulin/glucose ratio approaching infinity. A focal pancreatic mass was removed by partial pancreatectomy, resulting in euglycemia and the resolution of clinical signs. Histologic diagnosis of the pancreatic mass was consistent with islet cell tumor (insulinoma). The ferret remained clinically normal for 8 months, but died after recurring episodes of hyperglycemia and glucosuria. Necropsy revealed no evidence of islet cell neoplasia involving the pancreas or other structures.

Paraesophageal hiatal hernia and pyloric obstruction in a dog

Paraesophageal hiatal herniation and pyloric obstruction were diagnosed in a pup with a history of vomiting. Findings of contrast radiography included esophageal reflux, delayed gastric emptying time, and paraesophageal herniation. Exploratory celiotomy revealed increased firmness of the pylorus and a primary defect in the esophageal hiatus, which allowed gastric herniation. Nissen fundoplication was performed following reconstruction of the esophageal hiatus, and pyloroplasty was performed to relieve the gastric outlet obstruction. Pyloric biopsy findings were consistent with a diagnosis of chronic gastritis. Recovery from surgery was initially unremarkable; however, the dog died suddenly 3 weeks after surgery. Necropsy revealed a large diaphragmatic hernia adjacent to the esophageal hiatus; the hernia had resulted in incarceration of the abdominal organs. The hiatal hernia reconstruction remained intact and was not the cause of the diaphragmatic disruption.

Psittacine beak and feather disease syndrome in a cockatoo

Psittacine beak and feather disease syndrome was diagnosed in an adult sulfur-crested cockatoo with a history of chronic, progressive feather loss and beak necrosis. A definitive diagnosis was made on the basis of clinical signs and the observation of intracytoplasmic and intranuclear inclusions in involved feather follicular epithelium. Psittacine beak and feather disease syndrome develops in a variety of psittacine species and usually has a progressive and irreversible clinical course. Symmetric feather loss with replacement by severely dystrophic plumage is the salient clinical finding. Beak elongation and breakage also may be found. Treatment of diseased birds remains palliative and consists of a controlled environment, balanced nutrition, antibiotics, and autogenous vaccines. Avian practitioners should include psittacine beak and feather disease syndrome as a potential cause for pathologic feather loss in caged birds.

Bilateral pyelonephritis and hydroureter associated with metastatic adenocarcinoma in a dog

Metastatic adenocarcinoma, involving the trigone of the urinary bladder, resulted in bilateral pyelonephritis and hydroureter in an aged dog. Salient physical examination and clinicopathologic findings included bacterial urinary tract infection, renal pain response to abdominal palpation, and the observation of WBC casts in urine sediment. A good response to antimicrobial drug administration was observed initially; however, the dog later was euthanatized because of progressive renal disease. Necropsy revealed extensive peritoneal carcinomatosis with metastatic lesions causing occlusion of both ureters. Ostensibly, metastatic carcinoma involving the trigone resulted in urine stasis and enhanced the development of renal infection and hydroureter.

Buccal mucosa bleeding times of healthy dogs and of dogs in various pathologic states, including thrombocytopenia, uremia, and von Willebrand's disease

The buccal mucosa bleeding time (BMBT; duration of hemorrhage from standardized cuts made with a spring-loaded disposable device in the mucosal surface of the upper lip) was used to evaluate the hemostatic competence of dogs. The mean (+/- SD) BMBT for 34 healthy dogs was 2.62 +/- 0.49 minutes. The BMBT of healthy dogs anesthetized with halothane or tranquilized with xylazine were not significantly different from the BMBT of healthy dogs evaluated without chemical restraint. The BMBT was significantly (P less than 0.01) prolonged 21 hours after aspirin (10 mg/kg of body weight) was administered orally to 10 healthy dogs; however, the mean aspirin-induced increase in BMBT was only 0.40 minutes. The BMBT of 28 of 30 dogs with various diseases not traditionally associated with hemostatic deficiencies were near or within the range of BMBT for healthy dogs; however, 2 dogs had BMBT of greater than 8 minutes. In contrast, BMBT were prolonged in most dogs with diseases known to induce deficient primary hemostasis; the 3 dogs with thrombocytopenia (less than or equal to 20,000 platelets/microliter), the 7 Doberman Pinschers with von Willebrand's disease (von Willebrand factor antigen; less than or equal to 18 U/dl), and 5 of the 6 dogs with severe azotemia (serum urea nitrogen; greater than or equal to 124 mg/dl) had prolonged BMBT. The BMBT of 16 dogs were determined immediately before they were subjected to various surgical procedures, and the severity of the hemorrhage encountered during these procedures was subjectively evaluated; the amount of hemorrhage from 12 of the 16 dogs was considered to be appropriate for the corresponding surgical procedures, but the remaining 4 dogs bled excessively during surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Ovarian teratoma in a bitch

An ovarian teratoma in a 5-year-old bitch with a history of vaginal discharge was removed successfully by ovariohysterectomy. The mass was discovered on abdominal palpation and contained multiple mineralized densities that were visualized radiographically. Histologic examination of the mass confirmed the presence of tissues originating from multiple germ-cell layers, characteristic of a teratoma. Clinical findings in dogs with teratomas include abdominal distention, a palpable abdominal mass, and rarely, evidence of reproductive hormonal activity. These neoplasms are uncommon in the dog, and they may exhibit malignant tendencies, with metastasis developing in approximately 33% of the reported cases. Ovariohysterectomy is the preferred treatment for ovarian teratomas, and this procedure was curative in the dog of this report.

Effects of collection time and food consumption on the urine protein/creatinine ratio in the dog

Effects of collection time and food consumption on the variability of the urine protein/creatinine ratio were determined in 10 healthy dogs. In trial 1, dogs were fasted for 12 hours, and urine specimens were obtained by bladder catheterization every 2 hours over an 8-hour collection period during the day. After a 1-week rest, the dogs were entered into trial 2. Dogs were fed at least 60 kcal of a high protein meal/kg of body weight, and urine specimens were obtained every 2 hours over an 8-hour period during the day. Urine total protein and urine creatinine concentrations and the urine protein/creatinine ratio were determined for each urine specimen obtained. Friedman's 2-way analysis by ranks was used to determine the constancy of this ratio over the 4 periods in the 2 trials (fasted and fed). There was no significant variability (P greater than 0.05) in ratios over the 8-hour collection periods in the fasted or fed trial. Feeding did not significantly alter this ratio, because there was no significant difference (P greater than 0.05) in the urine protein/creatinine ratios of the dogs when they were fasted, compared with those of the dogs when they were fed. Seemingly, urine specimens obtained anytime during the day from dogs in both trials (fasted and fed) reflected the urine protein/creatinine ratio.

Cryptococcosis involving the eye and central nervous system of a dog

Cryptococcus neoformans meningoencephalitis was diagnosed as the cause of stupor and generalized seizures in a 2-year-old Cocker Spaniel. Unilateral granulomatous chorioretinitis was observed ophthalmoscopically, and isolation of C neoformans from CSF confirmed the antemortem diagnosis. The dog was euthanatized and necropsied. Multifocal lesions were seen throughout the lungs, nasal turbinates, cerebral cortex, and the optic nerve of each eye. Microscopically, the multifocal lesions were granulomas consisting of lymphocytes, macrophages, plasma cells, and cryptococcal organisms. Infection may have originated in the nasal passages and extended directly through the ethmoid plate into the meninges of the CNS and optic nerves. Although the prognosis is poor in dogs with CNS involvement, various chemotherapeutic agents are available for use by clinicians.

Effect of internal hemorrhage on fibrin(ogen) degradation products in canine blood

To determine effects of internal hemorrhage on fibrin(ogen) degradation products, blood was pumped from catheters in the jugular veins of 7 anesthetized dogs into extravascular sites in the same dogs. Blood (25 ml/kg of body weight) was transported into their peritoneal cavities (3 dogs) or into the muscle of the pelvic limbs (4 dogs). Blood samples were obtained periodically from these dogs for 4 days after the injections were given. Fibrin(ogen) degradation products (FDP) could not be detected in any of these samples by standard procedures with a commonly used clinical assay, based on the agglutination of antibody-coated latex beads. Even when the assay was modified to make it 2.5 times as sensitive, FDP was not detected. Seemingly, extravascular blood from internal hemorrhage is unlikely to supply enough FDP to the circulating blood to produce clinically important increases in FDP concentrations.