This case report describes a 1.5 year old female Scottish Terrier that presented with severe bilateral necrotizing scleritis. Both eyes showed signs of severe inflammation, scleral melting, and hypotony. The left eye was enucleated and histopathology revealed pyogranulomatous infiltration of the sclera, cornea, uvea, and orbital tissues. The right eye also had to be enucleated a week later due to perforation. Blood tests and serology were unremarkable. Anti-myeloperoxidase antibody levels in the dog's serum were not statistically different from healthy controls, suggesting this case did not involve an ANCA-associated vascul
This document provides an overview of ocular parasites, including Toxocara canis, Cysticercus cellulosae, Gnathostoma spinigerum, and Histoplasma capsulatum. It discusses the organisms, clinical presentations, diagnosis, and treatment of each parasite. Key points include that Toxocara canis causes ocular inflammation and granulomas, Cysticercus cellulosae causes cysts in eye tissues leading to uveitis, and Gnathostoma spinigerum and Histoplasma capsulatum can spread from the lungs to the eyes and cause vision changes. Diagnosis involves clinical examination, imaging, and serology testing, while treatment consists of ant
1. Chronic osteomyelitis in children can result from untreated acute hematogenous osteomyelitis or spread of infection from neighboring tissues. Common causes include open fractures and puncture wounds.
2. Clinical findings include fever, bone pain, local tenderness, sinus discharge, and bone deformities. Pathological features include bone necrosis, new bone formation, and prostaglandin-induced bone resorption.
3. Treatment involves antibiotics, surgical debridement to remove dead tissue, and reconstruction if significant bone loss. The goal is to eradicate infection while preserving bone stock.
A puncture wound to the foot is presented. The patient often steps on a nail and presents with pain and swelling, seeking a tetanus shot. Examination of the wound reveals a linear or stellate tear in the cornified epithelium. Treatment involves cleaning the wound, inspecting for debris or foreign objects with x-rays if deep penetration is suspected. The wound is saucerized or trimmed to remove debris, and irrigated. Tetanus prophylaxis is provided, and follow up arranged to monitor for infection. Puncture wounds generally do well with simple treatment, but deep or contaminated wounds pose risk of osteomyelitis and require orthopedic consultation.
The document discusses fungal osteomyelitis and septic arthritis. It covers the common fungal pathogens including Candida, Aspergillus, Coccidioides, Histoplasma, Blastomyces, and Cryptococcus. It discusses risk factors, routes of spread, clinical presentation, diagnosis and treatment of different fungal infections affecting bone and joints. Prosthetic joint infections are also covered. Management involves antifungal therapy as well as surgical debridement and hardware removal in some cases. Outcomes depend on the causative organism, presence of hardware or concurrent bacterial infection.
This document discusses osteomyelitis, an infection of bone. It describes the classification systems of Waldvogel and Cierny-Mader, which categorize osteomyelitis based on duration, pathogenesis, anatomical involvement, and host physiology. Common types include hematogenous osteomyelitis from bacteremia and contiguous osteomyelitis from a nearby soft tissue infection. Diagnosis involves imaging, labs, and bone biopsy for culture and pathology. Staphylococcus aureus is a frequent pathogen.
This case report describes a 17-year-old male who presented with floaters in the right eye for 5 days. On examination, there was optic disc swelling and a white lesion in the right eye. Serological testing found elevated toxoplasma IgG antibodies. This is consistent with a diagnosis of ocular toxoplasmosis, which is caused by the protozoan Toxoplasma gondii. The patient was started on antibiotics and steroids to treat the infection and reduce inflammation. Ocular toxoplasmosis typically causes retinitis that can damage the retina and vision if left untreated.
This document provides an overview of ocular parasites, including Toxocara canis, Cysticercus cellulosae, Gnathostoma spinigerum, and Histoplasma capsulatum. It discusses the organisms, clinical presentations, diagnosis, and treatment of each parasite. Key points include that Toxocara canis causes ocular inflammation and granulomas, Cysticercus cellulosae causes cysts in eye tissues leading to uveitis, and Gnathostoma spinigerum and Histoplasma capsulatum can spread from the lungs to the eyes and cause vision changes. Diagnosis involves clinical examination, imaging, and serology testing, while treatment consists of ant
1. Chronic osteomyelitis in children can result from untreated acute hematogenous osteomyelitis or spread of infection from neighboring tissues. Common causes include open fractures and puncture wounds.
2. Clinical findings include fever, bone pain, local tenderness, sinus discharge, and bone deformities. Pathological features include bone necrosis, new bone formation, and prostaglandin-induced bone resorption.
3. Treatment involves antibiotics, surgical debridement to remove dead tissue, and reconstruction if significant bone loss. The goal is to eradicate infection while preserving bone stock.
A puncture wound to the foot is presented. The patient often steps on a nail and presents with pain and swelling, seeking a tetanus shot. Examination of the wound reveals a linear or stellate tear in the cornified epithelium. Treatment involves cleaning the wound, inspecting for debris or foreign objects with x-rays if deep penetration is suspected. The wound is saucerized or trimmed to remove debris, and irrigated. Tetanus prophylaxis is provided, and follow up arranged to monitor for infection. Puncture wounds generally do well with simple treatment, but deep or contaminated wounds pose risk of osteomyelitis and require orthopedic consultation.
The document discusses fungal osteomyelitis and septic arthritis. It covers the common fungal pathogens including Candida, Aspergillus, Coccidioides, Histoplasma, Blastomyces, and Cryptococcus. It discusses risk factors, routes of spread, clinical presentation, diagnosis and treatment of different fungal infections affecting bone and joints. Prosthetic joint infections are also covered. Management involves antifungal therapy as well as surgical debridement and hardware removal in some cases. Outcomes depend on the causative organism, presence of hardware or concurrent bacterial infection.
This document discusses osteomyelitis, an infection of bone. It describes the classification systems of Waldvogel and Cierny-Mader, which categorize osteomyelitis based on duration, pathogenesis, anatomical involvement, and host physiology. Common types include hematogenous osteomyelitis from bacteremia and contiguous osteomyelitis from a nearby soft tissue infection. Diagnosis involves imaging, labs, and bone biopsy for culture and pathology. Staphylococcus aureus is a frequent pathogen.
This case report describes a 17-year-old male who presented with floaters in the right eye for 5 days. On examination, there was optic disc swelling and a white lesion in the right eye. Serological testing found elevated toxoplasma IgG antibodies. This is consistent with a diagnosis of ocular toxoplasmosis, which is caused by the protozoan Toxoplasma gondii. The patient was started on antibiotics and steroids to treat the infection and reduce inflammation. Ocular toxoplasmosis typically causes retinitis that can damage the retina and vision if left untreated.
This case report describes a 7-year-old mixed breed dog that presented with vision loss and presumptive glaucoma in the right eye. Examination revealed corneal edema, areflexive mydriasis, cataract, and elevated intraocular pressure in the right eye. Ultrasound showed total retinal detachment and a mass lesion at the posterior pole. The glaucoma worsened over two months despite treatment. Reexamination showed the mass had enlarged significantly. The eye was enucleated and pathology confirmed a benign choroidal melanoma. This represents a rare presentation of choroidal melanoma in dogs, which usually causes secondary ocular changes like retinal detachment or glaucoma.
This document discusses viral keratitis, specifically herpes simplex keratitis and herpes zoster ophthalmicus. It describes the etiology, pathogenesis, clinical features, and treatment for both conditions. For herpes simplex keratitis, it outlines the signs and symptoms of primary and recurrent infection, including punctate epithelial keratitis, dendritic ulcers, and stromal keratitis. For herpes zoster ophthalmicus, it discusses the acute and chronic phases, associated ocular and neurological complications, and recommended antiviral and supportive treatments.
Ceftriaxone: 1 g IM once
C16,47
Lavage of the infected eye
C16
Treatment to cover chlamydia is indicated
C16,50
Dual therapy
C16
1) Conjunctivitis is inflammation of the conjunctiva that covers the sclera and inside of the eyelids.
2) Causes of conjunctivitis include viral (most common), bacterial, allergic, toxic, autoimmune, and tumoral. The most common viruses are adenoviruses.
3) Treatment depends on the cause but may include antibiotics, antivirals, cold compresses
This document outlines acute osteomyelitis, including its classification, pathophysiology, clinical presentations, investigations, and treatment. It is an inflammatory condition of bone and bone marrow caused by infectious agents. Staphylococcus aureus is the most common causative organism. Clinical features include fever, pain, swelling, and tenderness over the affected bone. Investigations include blood tests, imaging like X-rays and MRI, and bone biopsy for culture and sensitivity. Treatment involves antibiotics targeting the likely organisms as well as surgical drainage if abscesses are present, with antibiotics continued after surgery.
This document discusses and classifies acute and subacute osteomyelitis. It begins by defining osteomyelitis as a bone or bone marrow infection. It then classifies osteomyelitis based on timing of onset (acute <2 weeks, subacute 2-6 weeks, chronic >6 weeks) and method of spread (exogenous or hematogenous). Key points include: acute osteomyelitis most commonly spreads hematogenously while staphylococcus aureus is the most common cause; subacute osteomyelitis has an indolent course and is often an incidental finding on imaging. Treatment involves antibiotics, surgery if abscess or lack of response, and immobilization.
This document provides information on puncture wounds and their management. It discusses the pathophysiology, risk factors, clinical features, diagnosis, and treatment of various types of puncture wounds including those from high pressure injection injuries, animal bites, needle sticks, and more. Complications are outlined along with prevention and management recommendations. Imaging, wound care, debridement, antibiotics, and tetanus prophylaxis are frequently recommended depending on the wound type and risk of infection.
1. Viral corneal ulcers have increased due to antibiotics reducing bacterial flora. Herpes simplex virus is a common cause, initially infecting epithelium and potentially becoming neurotropic. Primary infection involves non-immune individuals while recurrent infections reactivate dormant virus.
2. Herpes simplex keratitis manifestations include punctate epithelial keratitis, dendritic ulcers, and stromal keratitis treated with antivirals like acyclovir along with supportive measures. Herpes zoster ophthalmicus affects the trigeminal nerve causing vesicular skin lesions and ocular complications in 50% of cases like keratitis, treated with antivirals and steroids.
This presentation gives a brief idea of Acute osteomyelitis, its cause, predisposing factors, pathogenesis, signs and symptoms, investigation and its management. It also explain Nades principle.
This document discusses chronic osteomyelitis, including its causes, types, clinical features, investigations, staging, treatment, and differential diagnosis. Chronic osteomyelitis is caused by bacteria such as Staphylococcus aureus entering bone through breaks in the skin or surgery. It is characterized by destruction of bone tissue, formation of cavities containing pus and dead bone, and chronic inflammation. Diagnosis involves imaging like x-rays and biopsy. Treatment consists of long-term antibiotics, surgery to remove infected tissue, and management of any underlying risks or complications.
Acute osteomyelitis is a bacterial infection of bone that mainly affects children. It is classified based on duration (acute, subacute, chronic) and route of infection (primary/hematogenous, secondary). Staphylococci and streptococci are common causes. Clinical features include pain, fever and localized tenderness. Diagnosis involves imaging like bone scans and MRI. Treatment consists of supportive care, splinting, appropriate antibiotics based on patient factors, and surgical drainage if abscess is present. Complications can include impaired bone growth and chronic osteomyelitis if not treated properly.
This document provides an overview of osteomyelitis, including its history, causes, types, clinical presentation, diagnostic evaluation, treatment approaches, and adjunctive therapies. It discusses the typical bacteria involved, importance of biopsy for diagnosis, use of imaging studies like X-rays and MRIs, and treatment through a multimodal approach including antibiotics, surgical debridement, reconstruction, and optimization of patient comorbidities. Local antibiotic delivery methods like polymethylmethacrylate beads are also summarized.
1. Hematogenous osteomyelitis is a bacterial infection of the bone that most commonly affects the metaphysis of long bones in children. Staphylococcus aureus is the primary cause in 70-90% of cases.
2. Infection typically begins in the vascular metaphyseal region of bones and can spread to the joint space in young children. Symptoms include fever, bone pain, and local swelling. Diagnosis involves blood tests, imaging, and bone aspiration to confirm bacteria.
3. Treatment involves IV antibiotics targeting S. aureus for 2-4 weeks, followed by oral antibiotics if the child improves. Surgery to drain abscesses may be needed
Acute osteomyelitis is a bacterial bone infection, most commonly caused by Staphylococcus aureus. It typically presents in children as fever, pain and swelling near the metaphysis of long bones. Investigations like blood tests, X-rays and MRI can help with diagnosis. Treatment involves antibiotics, splinting and possible surgical drainage, with precautions taken to prevent complications like chronic osteomyelitis, pathological fractures or growth plate disturbances.
This document summarizes various viral causes of keratitis, including herpes simplex virus, varicella zoster virus, and adenovirus. It describes the pathogenesis, clinical manifestations, and characteristics of each viral infection. Herpes simplex virus can cause epithelial keratitis, stromal keratitis, endotheliitis, and recurrent ocular infections. Varicella zoster virus reactivation can result in herpes zoster ophthalmicus, with varied corneal involvement. Adenovirus commonly causes epidemic keratoconjunctivitis but can also lead to pharyngoconjunctival fever or non-specific conjunctivitis.
This document summarizes information about parasitic infections of the retina, including Toxoplasmosis, Toxocariasis, and Cysticercosis.
Toxoplasmosis is caused by the protozoan Toxoplasma gondii. It commonly presents as focal necrotizing retinitis with overlying vitritis. Diagnosis involves serologic testing for IgG and IgM antibodies. Treatment includes anti-parasitic medications like sulfadiazine and pyrimethamine.
Toxocariasis is caused by the roundworm Toxocara canis and presents as posterior pole or peripheral retinal granulomas. Diagnosis is made via serum ELISA detecting exo-ant
1) Osteomyelitis is an infection of bone tissue that can be acute or chronic. Acute osteomyelitis is commonly caused by Staphylococcus aureus and presents with pain, swelling, and fever.
2) If not treated adequately within 48 hours, surgical drainage and antibiotics are needed. Chronic osteomyelitis can develop if treatment is delayed and causes long-term bone changes seen on x-ray like sequestra and involucrum.
3) Specific types include Brodie's abscess, where infection is contained in the bone, and Garre's osteomyelitis, which is nonsuppurative. Surgical debridement is usually needed to treat chronic cases.
Fungal corneal ulcers are a significant cause of blindness worldwide, accounting for 36% of corneal ulcers in Bangladesh. Risk factors include agricultural work involving vegetable matter and trauma, as well as conditions like diabetes. Diagnosis involves corneal scraping and staining to identify fungal elements microscopically. Common fungi include Fusarium, Aspergillus, and Candida. Treatment involves natamycin or amphotericin B eye drops, sometimes with systemic antifungals. Surgery may be needed for severe cases. Prognosis depends on size, depth and organism involved.
Osteomyelitis is an inflammation of bone caused by a bacterial infection. It can be acute, subacute, or chronic depending on symptom duration. Classification is also based on infection mechanism (exogenous or hematogenous) and host response (pyogenic or nonpyogenic). Common causes include Staphylococcus aureus and various bacteria depending on patient factors. Diagnosis involves identifying symptoms, obtaining cultures from lesions, and imaging tests like MRI. Treatment involves antibiotics as well as surgical drainage of pus and dead tissue.
This document discusses septic arthritis, which is a joint infection caused by bacteria, viruses, or other microorganisms invading the joint space. Common causes include bloodstream dissemination from a distant infection, adjacent soft tissue infection, or trauma. Symptoms include intense joint pain, swelling, and inability to move the joint. Diagnosis involves joint fluid analysis showing inflammatory cells. Treatment requires appropriate antibiotics based on culture results as well as surgical drainage of the joint in some cases. Risk factors include diabetes, rheumatoid arthritis, or immunosuppression. Prompt diagnosis and treatment are important to prevent joint destruction and systemic infection.
This case report describes a 7-year-old mixed breed dog that presented with vision loss and presumptive glaucoma in the right eye. Examination revealed corneal edema, areflexive mydriasis, cataract, and elevated intraocular pressure in the right eye. Ultrasound showed total retinal detachment and a mass lesion at the posterior pole. The glaucoma worsened over two months despite treatment. Reexamination showed the mass had enlarged significantly. The eye was enucleated and pathology confirmed a benign choroidal melanoma. This represents a rare presentation of choroidal melanoma in dogs, which usually causes secondary ocular changes like retinal detachment or glaucoma.
This document discusses viral keratitis, specifically herpes simplex keratitis and herpes zoster ophthalmicus. It describes the etiology, pathogenesis, clinical features, and treatment for both conditions. For herpes simplex keratitis, it outlines the signs and symptoms of primary and recurrent infection, including punctate epithelial keratitis, dendritic ulcers, and stromal keratitis. For herpes zoster ophthalmicus, it discusses the acute and chronic phases, associated ocular and neurological complications, and recommended antiviral and supportive treatments.
Ceftriaxone: 1 g IM once
C16,47
Lavage of the infected eye
C16
Treatment to cover chlamydia is indicated
C16,50
Dual therapy
C16
1) Conjunctivitis is inflammation of the conjunctiva that covers the sclera and inside of the eyelids.
2) Causes of conjunctivitis include viral (most common), bacterial, allergic, toxic, autoimmune, and tumoral. The most common viruses are adenoviruses.
3) Treatment depends on the cause but may include antibiotics, antivirals, cold compresses
This document outlines acute osteomyelitis, including its classification, pathophysiology, clinical presentations, investigations, and treatment. It is an inflammatory condition of bone and bone marrow caused by infectious agents. Staphylococcus aureus is the most common causative organism. Clinical features include fever, pain, swelling, and tenderness over the affected bone. Investigations include blood tests, imaging like X-rays and MRI, and bone biopsy for culture and sensitivity. Treatment involves antibiotics targeting the likely organisms as well as surgical drainage if abscesses are present, with antibiotics continued after surgery.
This document discusses and classifies acute and subacute osteomyelitis. It begins by defining osteomyelitis as a bone or bone marrow infection. It then classifies osteomyelitis based on timing of onset (acute <2 weeks, subacute 2-6 weeks, chronic >6 weeks) and method of spread (exogenous or hematogenous). Key points include: acute osteomyelitis most commonly spreads hematogenously while staphylococcus aureus is the most common cause; subacute osteomyelitis has an indolent course and is often an incidental finding on imaging. Treatment involves antibiotics, surgery if abscess or lack of response, and immobilization.
This document provides information on puncture wounds and their management. It discusses the pathophysiology, risk factors, clinical features, diagnosis, and treatment of various types of puncture wounds including those from high pressure injection injuries, animal bites, needle sticks, and more. Complications are outlined along with prevention and management recommendations. Imaging, wound care, debridement, antibiotics, and tetanus prophylaxis are frequently recommended depending on the wound type and risk of infection.
1. Viral corneal ulcers have increased due to antibiotics reducing bacterial flora. Herpes simplex virus is a common cause, initially infecting epithelium and potentially becoming neurotropic. Primary infection involves non-immune individuals while recurrent infections reactivate dormant virus.
2. Herpes simplex keratitis manifestations include punctate epithelial keratitis, dendritic ulcers, and stromal keratitis treated with antivirals like acyclovir along with supportive measures. Herpes zoster ophthalmicus affects the trigeminal nerve causing vesicular skin lesions and ocular complications in 50% of cases like keratitis, treated with antivirals and steroids.
This presentation gives a brief idea of Acute osteomyelitis, its cause, predisposing factors, pathogenesis, signs and symptoms, investigation and its management. It also explain Nades principle.
This document discusses chronic osteomyelitis, including its causes, types, clinical features, investigations, staging, treatment, and differential diagnosis. Chronic osteomyelitis is caused by bacteria such as Staphylococcus aureus entering bone through breaks in the skin or surgery. It is characterized by destruction of bone tissue, formation of cavities containing pus and dead bone, and chronic inflammation. Diagnosis involves imaging like x-rays and biopsy. Treatment consists of long-term antibiotics, surgery to remove infected tissue, and management of any underlying risks or complications.
Acute osteomyelitis is a bacterial infection of bone that mainly affects children. It is classified based on duration (acute, subacute, chronic) and route of infection (primary/hematogenous, secondary). Staphylococci and streptococci are common causes. Clinical features include pain, fever and localized tenderness. Diagnosis involves imaging like bone scans and MRI. Treatment consists of supportive care, splinting, appropriate antibiotics based on patient factors, and surgical drainage if abscess is present. Complications can include impaired bone growth and chronic osteomyelitis if not treated properly.
This document provides an overview of osteomyelitis, including its history, causes, types, clinical presentation, diagnostic evaluation, treatment approaches, and adjunctive therapies. It discusses the typical bacteria involved, importance of biopsy for diagnosis, use of imaging studies like X-rays and MRIs, and treatment through a multimodal approach including antibiotics, surgical debridement, reconstruction, and optimization of patient comorbidities. Local antibiotic delivery methods like polymethylmethacrylate beads are also summarized.
1. Hematogenous osteomyelitis is a bacterial infection of the bone that most commonly affects the metaphysis of long bones in children. Staphylococcus aureus is the primary cause in 70-90% of cases.
2. Infection typically begins in the vascular metaphyseal region of bones and can spread to the joint space in young children. Symptoms include fever, bone pain, and local swelling. Diagnosis involves blood tests, imaging, and bone aspiration to confirm bacteria.
3. Treatment involves IV antibiotics targeting S. aureus for 2-4 weeks, followed by oral antibiotics if the child improves. Surgery to drain abscesses may be needed
Acute osteomyelitis is a bacterial bone infection, most commonly caused by Staphylococcus aureus. It typically presents in children as fever, pain and swelling near the metaphysis of long bones. Investigations like blood tests, X-rays and MRI can help with diagnosis. Treatment involves antibiotics, splinting and possible surgical drainage, with precautions taken to prevent complications like chronic osteomyelitis, pathological fractures or growth plate disturbances.
This document summarizes various viral causes of keratitis, including herpes simplex virus, varicella zoster virus, and adenovirus. It describes the pathogenesis, clinical manifestations, and characteristics of each viral infection. Herpes simplex virus can cause epithelial keratitis, stromal keratitis, endotheliitis, and recurrent ocular infections. Varicella zoster virus reactivation can result in herpes zoster ophthalmicus, with varied corneal involvement. Adenovirus commonly causes epidemic keratoconjunctivitis but can also lead to pharyngoconjunctival fever or non-specific conjunctivitis.
This document summarizes information about parasitic infections of the retina, including Toxoplasmosis, Toxocariasis, and Cysticercosis.
Toxoplasmosis is caused by the protozoan Toxoplasma gondii. It commonly presents as focal necrotizing retinitis with overlying vitritis. Diagnosis involves serologic testing for IgG and IgM antibodies. Treatment includes anti-parasitic medications like sulfadiazine and pyrimethamine.
Toxocariasis is caused by the roundworm Toxocara canis and presents as posterior pole or peripheral retinal granulomas. Diagnosis is made via serum ELISA detecting exo-ant
1) Osteomyelitis is an infection of bone tissue that can be acute or chronic. Acute osteomyelitis is commonly caused by Staphylococcus aureus and presents with pain, swelling, and fever.
2) If not treated adequately within 48 hours, surgical drainage and antibiotics are needed. Chronic osteomyelitis can develop if treatment is delayed and causes long-term bone changes seen on x-ray like sequestra and involucrum.
3) Specific types include Brodie's abscess, where infection is contained in the bone, and Garre's osteomyelitis, which is nonsuppurative. Surgical debridement is usually needed to treat chronic cases.
Fungal corneal ulcers are a significant cause of blindness worldwide, accounting for 36% of corneal ulcers in Bangladesh. Risk factors include agricultural work involving vegetable matter and trauma, as well as conditions like diabetes. Diagnosis involves corneal scraping and staining to identify fungal elements microscopically. Common fungi include Fusarium, Aspergillus, and Candida. Treatment involves natamycin or amphotericin B eye drops, sometimes with systemic antifungals. Surgery may be needed for severe cases. Prognosis depends on size, depth and organism involved.
Osteomyelitis is an inflammation of bone caused by a bacterial infection. It can be acute, subacute, or chronic depending on symptom duration. Classification is also based on infection mechanism (exogenous or hematogenous) and host response (pyogenic or nonpyogenic). Common causes include Staphylococcus aureus and various bacteria depending on patient factors. Diagnosis involves identifying symptoms, obtaining cultures from lesions, and imaging tests like MRI. Treatment involves antibiotics as well as surgical drainage of pus and dead tissue.
This document discusses septic arthritis, which is a joint infection caused by bacteria, viruses, or other microorganisms invading the joint space. Common causes include bloodstream dissemination from a distant infection, adjacent soft tissue infection, or trauma. Symptoms include intense joint pain, swelling, and inability to move the joint. Diagnosis involves joint fluid analysis showing inflammatory cells. Treatment requires appropriate antibiotics based on culture results as well as surgical drainage of the joint in some cases. Risk factors include diabetes, rheumatoid arthritis, or immunosuppression. Prompt diagnosis and treatment are important to prevent joint destruction and systemic infection.
The document outlines a 4-step strategic planning process for public relations: 1) Defining problems through situation analysis, 2) Planning and programming goals, target audiences, objectives, and strategies, 3) Taking action and communicating through implementation plans and communication strategies, 4) Evaluating the program and providing feedback. It also discusses important aspects of effective communication like respect, empathy, clarity, and humility according to the REACH model and tips for public relations officers to build credibility and solve problems.
A empresa de tecnologia anunciou um novo smartphone com câmera aprimorada, maior tela e bateria de longa duração. O dispositivo também possui processador mais rápido e armazenamento expansível. O novo modelo será lançado em outubro por um preço inicial de US$799.
A União Europeia está preocupada com o impacto ambiental do plástico descartável e planeja proibir itens como talheres, pratos, copos e canudos plásticos até 2021. A proibição visa reduzir a poluição plástica nos oceanos e promover alternativas mais sustentáveis. Os países da UE terão até 2021 para implementar as novas diretrizes.
A empresa anunciou um novo produto para competir no mercado de smartphones. O novo aparelho tem câmera de alta resolução, processador rápido e bateria de longa duração por preço acessível. A expectativa é que o lançamento ajude a empresa a aumentar sua participação no setor.
Conférence du Dr Bernard Charlin (Faculté de médecine, Université de Montréal) présentée le 16 mai 2016 dans le cadre de la 2e Journée de la recherche et de l’innovation en éducation des sciences de la santé à l'Université de Montréal.
Résumé:
En se basant sur des travaux de recherche menés à l’Université de Montréal, nous avons conçu un système de formation en ligne qui place les participants devant des situations complexes et leur demande de donner un sens aux informations complémentaires qui leur sont fournies. En répondant, les participants ont accès aux réponses et aux justifications données par un panel de praticiens expérimentés, suivies par des messages clés amenés par un expert du domaine. L’ensemble forme un système de formation interactif ancré sur la pratique qui donne un feedback automatisé permettant de former au raisonnement clinique et au jugement en matière de professionnalisme.
Conférence de Geneviève Dottini et Joannie Van Houtte St-Gelais (Faculté des sciences infirmières de l’Université de Montréal) présentée dans le cadre de la 2e Journée de la recherche et de l’innovation en éducation des sciences de la santé qui a eu lieu à l’Université de Montréal le 16 mai 2016.
Résumé:
Depuis plus de 10 ans, le programme de baccalauréat en sciences infirmières de l’Université de Montréal est basé sur l’approche par compétences (APC). Plusieurs cours, à différents moments du programme, comprennent des exercices de pratique réflexive, élément essentiel de l’APC, dont certains sont liés à l’élaboration d’un portfolio académique. L’arrivée d’un e-portfolio à l’UdeM a permis de formaliser et d’intégrer ces exercices. Le e-portfolio est présenté durant la première session et accompagne les étudiants jusqu’à la fin du programme. Nous présenterons l’utilisation du e-portfolio dans notre programme ainsi que les principaux défis qui y sont liés et les avenues d’amélioration possibles.
This document analyzes employment trends in India from 1993-2013 based on data from the National Sample Survey. It finds that the share of the workforce employed in agriculture has declined while employment has increased in the manufacturing, non-manufacturing and service sectors. Within services, employment has grown the most in trade, transport, education and health. The study aims to explain sectoral employment trends and factors affecting employment in India.
Coming back in Albania, based in the facts from the EU countries we should say that consumption will not be very sensitive to short-term fluctuations in income, because many consumers will add to or draw down their savings to smooth their consumption, and others may be able to repay or add to their debts in order to do so.
Public investments can boost economy more than private onesALTAX Consulting
The general idea is that if a critical mass of small investments is undertaken simultaneously the average social return will be much higher than the average private return, because they will create demand for each other, and overcome coordination failures that keep private market economies in a low-income equilibrium.
This document discusses the consumer decision making process. It outlines five factors that influence consumer decisions, as well as three levels of consumer decision making ranging from extensive problem solving to routine response behavior. The stages of the consumer decision making process are described, including need recognition, information search, evaluation of alternatives, purchase, and post-purchase behavior. An example consumer decision process for purchasing a new car is provided to illustrate these stages.
A case of odontogenic orbital cellulitis causing blindness in young maleDr Laltanpuia Chhangte
This document describes a case report of a 30-year-old male who presented with loss of vision in his right eye due to orbital cellulitis caused by an odontogenic (tooth-related) infection. He had a history of recurrent dental abscesses that he did not properly treat. Imaging showed abscesses in the right temporal muscle and orbit. Cultures grew Staphylococcus aureus. He was treated with IV antibiotics and tooth extraction but lost vision permanently in his right eye due to delayed treatment of the orbital infection. The report discusses how odontogenic infections can spread to the orbit through various pathways and cause vision loss if not promptly treated.
A 61-year-old man with a history of rheumatoid arthritis presented with redness, irritation, and blurred vision in his right eye. He was diagnosed with peripheral ulcerative keratopathy (PUK). His symptoms improved with oral steroids, topical steroids, ofloxacin drops, and bacitracin ointment. PUK is a rare inflammatory eye condition commonly associated with rheumatoid arthritis that involves breakdown of the cornea.
Background: Idiopathic Macular Telangiectasia type 2 (IMT2) is a relatively uncommon clinical condition with an estimated prevalence of 1% within the general population. This condition can be challenging to precisely identify in early stages but advancements in clinical imaging to include fl uorescein angiography and Optical Coherence Tomography Angiography (OCTA) can allow for timely diagnosis and prompt intervention that may leads to improved long-term clinical outcomes. Emerging literature has recognized the role of Macular
Pigment (MP) in IMT2 in terms of Henle fi ber layer deposition mechanisms and potential mitigation of infl ammatory and oxidative stress. Primary care optometrists are in a unique position to facilitate early detection and manage through close evaluation and individualized lutein supplementation
Diplopia Caused by Salmonella enteritidis Infectioniosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A 37-year-old woman presented with bilateral orbital cysts for 2 months. Examination found enlarged lacrimal and salivary glands with anterior uveitis in the right eye. Testing showed elevated ACE and lysozyme levels. A biopsy of the left lacrimal gland found granulomatous inflammation consistent with sarcoidosis. The patient was started on oral prednisone and topical steroids for treatment.
Histoplasmosis is a systemic mycosis present in an endemic state in many tropical or temperate regions. It is a pathology induced by Histoplasma capsulatum, dimorphic fungus thriving in wetlands and at moderate temperatures. In immunocompetent subjects, 95% of clinical forms are asymptomatic. The preferred sites for this dissemination are pulmonary, medullary, hepatic, splenic and ganglionic. Exceptionally, the fungus can reach the eye.
Bilateral Corneal Thinning Post-Photorefractive Keratectomy Secondary to Untr...semualkaira
Photorefractive keratectomy (PRK) has been shown to be an effective surgical treatment for ametropic conditions. However, PRK is
associated with potential side effects which include glare, halos,
dry eye, haze, and corneal infection. This report focused on the
continued management and documentation of an unusual presentation of infectious keratitis secondary to previously untreated
blepharitis in a 29-year-old healthy Caucasian male
Bilateral Corneal Thinning Post-Photorefractive Keratectomy Secondary to Untr...semualkaira
Photorefractive keratectomy (PRK) has been shown to be an effective surgical treatment for ametropic conditions. However, PRK is
associated with potential side effects which include glare, halos,
dry eye, haze, and corneal infection. This report focused on the
continued management and documentation of an unusual presentation of infectious keratitis secondary to previously untreated
blepharitis in a 29-year-old healthy Caucasian male. He underwent
bilateral PRK one month prior and was formally diagnosed with
non-resistant staphylococcus aureus keratitis in both eyes. His uncorrected visual acuity was in the normal range in both eyes (OU).
Examination revealed inferior arc-shaped corneal thinning. Anterior segment photography and corneal topography were performed
on both eyes, and he was diagnosed with resolving staphylococcus
keratitis with persistent inferior thinning OU. The present report
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Anti mpo in dog with necrotizing scleritis - cazalot- vet sciences 2015
1. Vet. Sci. 2015, 2, 259-269; doi:10.3390/vetsci2030259
veterinary sciences
ISSN 2306-7381
www.mdpi.com/journal/vetsci
Case Report
Investigation of Anti-Myeloperoxidase Antibodies in a Dog with
Bilateral Necrotizing Scleritis
Guillaume Cazalot 1,
* and Sidonie N. Lavergne 2
1
Clinique de la La Borde Rouge, 150 rue Edmond Rostand, Toulouse 31200, France
2
Department of Comparative Biosciences, College of Veterinary Medicine,
University of Illinois-Urbana-Champaign, Urbana, IL 61802, USA; E-Mail: slavergn@illinois.edu
* Author to whom correspondence should be addressed; E-Mail: laborderouge@yahoo.fr.
Academic Editor: Anthony Blikslager
Received: 30 March 2015 / Accepted: 8 September 2015 / Published: 18 September 2015
Abstract: Necrotizing scleritis is uncommon in dogs and presumed to be immune-mediated.
Its clinical pattern and histopathology are similar to ocular lesions observed in humans suffering
from granulomatosis with polyangiitis (GPA), formerly named Wegener’s granulomatosis,
where the pathogenesis revolves around anti-neutrophil antibodies (e.g., anti-myeloperoxidase).
These antibodies are used to diagnose and follow-up the disease in humans, but variants
that only affect the eyes often test negative. Here, we present the first case of canine
necrotizing scleritis where measurement of anti-myeloperoxidase antibodies was attempted.
A 1.5 year-old female Scottish Terrier was presented with bilateral deep multifocal
scleromalacia, severe inflammation of corneal/uveal/retrobulbar tissues, perilimbal corneal
oedema and neovascularization, hypotony, and mild exophthalmos. Corticosteroids and
antibiotics had been administrated (topically and orally) without success. Due to painful
multifocal scleral perforation with vitreal haemorrhage, the left eye underwent enucleation,
so did the right eye one week later. The histopathology of the left eye revealed a neutrophilic
and histiocytic scleral infiltration with extension of pyogranulomatous inflammation to
the cornea, choroid, ciliary body, and orbital fat. Levels of plasma anti-myeloperoxidase
antibodies were not statistically significant to those of 13 healthy dogs. Further research is
warranted to investigate the presence and role of anti-neutrophil antibodies in canine
necrotizing scleritis.
Keywords: eye; canine; wegener; ANCA; granulomatous
OPEN ACCESS
2. Vet. Sci. 2015, 2 260
1. Introduction
The veterinary literature contains only few published cases of canine necrotizing scleritis (NS) [1–5].
This syndrome seemingly affects young adults without gender or breed predisposition. Severe
inflammation extends to intraocular and periocular structures and often leads to enucleation [2,4–6].
NS is better described in humans, mostly in patients suffering from granulomatosis with polyangiitis
(GPA) (formerly named Wegener’s granulomatosis) that is a systemic immune-mediated vasculitis
syndrome [7,8]. However, some “limited GPA” can only come with ocular lesions of NS, without any
systemic signs [8–10]. The pathogenesis of systemic GPA is associated with Anti-Neutrophil Cytoplasmic
Antibodies (ANCA), such as anti-myeloperoxidase (MPO) and anti-PR3 antibodies [11–14]. Interestingly,
the clinical signs and the ocular histopathology in patients with the ocular form of GPA closely
resemble those described in canine NS. However, nobody has ever explored the presence or role of
ANCAs in canine NS.
The present report describes a case of severe bilateral necrotizing scleritis in a Scottish Terrier,
that quickly led to a bilateral enucleation. In addition to traditional clinical blood tests, we ran some
serological tests and a histopathology analysis of the first enucleated eye, and we investigated the
presence of anti-MPO antibodies in the patient’s serum.
2. Case
2.1. Anamnesis
A 1.5 year-old female Scottish Terrier was referred for severe acute bilateral kerato-uveitis. About
15 days prior to referral, the dog had developed a mild corneal perikeratic edema with perilimbal
episcleral diffuse hyperemia. The complete blood cell count was normal and serological tests
(Leishmania infantum; Toxoplasma gondii; Ehrlichia canis; Leptospira spp.; Borrelia burgdorferi)
came back negative. For two weeks, topical neomycin and dexamethasone were prescribed three times
a day in addition to oral amoxicillin/clavulanic acid (12.5 mg/kg bid) and prednisolone (1 mg/kg sid)
for two weeks. Despite these treatments the lesions were strongly worsening with the onset of visual
impairment, so the dog was referred to our clinic.
2.2. Clinical Examination
At presentation, the dog was in good general condition and the physical examination did not
show any abnormalities. The mid-distance examination revealed an overall inflammation of both eyes
with a slight exophthalmos, without strabismus, in the left one and a bilateral moderate epiphora
(Figure 1A). In addition, the menace response was negative in the left side and decreased in the right
one. The dazzling reflex was also diminished in both eyes. Direct and indirect pupillary light responses
were adequate. The Schirmer tear test (Schirmer Plus®
GECIS inc., Neung sur Beuvron, France) was
within the normal range (19 mm per minute in the left eye and 15 mm per minute on the right one).
In both eyes, a severe conjunctival and episcleral hyperhemia was associated with brown melting areas
of scleromalacia (3 on the left eye and 1 on the right one; Figures 1B,C respectively). The perilimbal
edema had reached the central cornea and was associated with perilimbal neovascularization.
3. Vet. Sci. 2015, 2 261
The pupillary diameter was normal, but uveal inflammation had led to a hypotony so severe that the
ocular pressure could not be measured in either eye (Tonopen®
MENTOR, Reichert inc., New York,
NY, USA). In addition, after pharmacologically induced mydriasis (tropicamide and phenylephrine,
alternatively, every 5 min for 20 min), the vitreous appeared cloudy in both eyes, with hemorrhages in
the left one, which prevented the ophthalmoscopic examination.
Figure 1. Gross ocular lesions. Panel A shows a bilateral keratouveitis. Note the
perilimbic oedema in both eyes and the slight exophthalmos with nictitating membrane
elevation OD. A close-up OS is presented in the Panel B; note the neovascularization
infiltrating the deep corneal stroma and the brown melting area of scleromalacia. Finally,
Panel C shows a slightly elevated pyogranuloma of the sclera OD.
An ophthalmic ultrasound (10 MHz probe; AU3 Partner ESAOTE BIOMEDICA) was performed to
better examine the posterior segment of both eyes. On the left eye, strong hemorrhages were observed
in the vitreous whereas a severe hyalitis with vitreous deposits was present in the right one. There was
no evidence of retinal detachment. In the left eye, dense retrobulbar tissue was observed, probably
responsible of the slight exophthalmos.
2.3. Surgical Procedure
As the three melting areas of the sclera were about to perforate and because of the pain they caused,
we elected to surgically remove the left eye under general anesthesia. The extreme weakness of the
flabby sclera was too hazardous to make a biopsy with collagen grafts, rendering the firm anchor of
4. Vet. Sci. 2015, 2 262
the sutures in this eye impossible. Furthermore, for financial reasons, the owner opted for enucleation
with histopathology of the left eye and a pharmacological approach in the right eye. While performing
a cautious enucleation, the traction of surgical pliers partially shred the sclera leading to news holes of
torn tissues, further supporting the limited potential of scleral grafts in this case.
2.4. Histological Diagnosis
The histopathology of the enucleated eye revealed a severe chronic suppurated to pyogranulomatous
infiltration of the sclera, with severe fibrinous congestion and numerous hemorrhages, extending to the
cornea, choroid, ciliary body, peri-ocular muscles, and orbital fat (Figure 2A). Lesions of scleromalacia
also demonstrated suppurative inflammation and multiple areas of necrosis. A highly concentrated
neutrophilic infiltrate was observed mainly in the sclera, sometimes associated with histiocytes in
small multifocal pyogranulomas (Figure 2B). Many of these histiocytes presented active macrophagic
characteristics with widely vacuolar cytoplasm. Numerous lymphocytes and plasmocytes were also
observed (Figure 2C). The perilimbal zone and the choroid also showed severe edema as well as
congestive and fibrinous hemorrhage associated with a lymphoplasmocytic infiltrate, extending to the
ciliary body and iris (Figure 2D). No organisms were identified with Periodic Acid Schiff (PAS) and
Fite Faraco reactions excluding fungal infestation and infection by acido-alcoholo-resistant
mycobacterium respectively. Onchocerca spp. was not present in sections. The final histopathology
conclusion was a severe idiopathic pyogranulomatous and necrotizing scleritis.
Fig.2
A. B.
C. D.
Figure 2. Histopathology of the left eye. Panel A shows a section of the entire globe.
Note the severe infiltration of the sclera, perilimbal cornea, uveal tract, and retrobulbar cone.
The following panel B is a 40×close-up, highlighting the infiltration of the sclera extending
to the choroid. Note the degenerating collagen mesh with pyogranulomas; Panel C shows the
pyogranuloma even closer (400×) where neutrophils and macrophages can be observed in the
5. Vet. Sci. 2015, 2 263
necrotic collagen mesh. Finally; panel D shows the perilimbal zone where the pyogranuloma is
noticeable with hemorrhages and neutrophilic infiltration of the corneal stroma.
2.5. Differential Diagnosis and Ancillary Tests
In dogs, scleral diseases can be clinically divided into superficial forms, called episcleritis, which are
usually benign and slowly evolving, and deep forms, called scleritis, which are often severe and
quickly worsening. In our case, the antero-posterior extension of the scleral inflammation to the
cornea, the uvea and the peri-ocular tissues was highly compatible with a diagnosis of scleritis.
The differential diagnosis of scleritis then includes traumatic injury, subconjunctival foreign body,
idiopathic scleritis, bacterial infection, fungal and parasitic infestation. In the literature, only infestations
with Ehrlichia canis, Leishmania infantum [15], or Onchocerca spp. [16] have been associated with
scleritis in dogs but infestations by Toxoplasma, Toxocara and Borrelia have been also reported in
humans with scleritis [17,18].
In our dog, there was no history or sign of a trauma. In addition, the unlikely presence of a bilateral
foreign body had been ruled out. Furthermore, multiple blood tests (complete blood count,
biochemiistry profile, serologies) and bacteriological stains (see histopathology) decreased the likelihood
of an infection.
2.6. Treatment
After the enucleation of the left eye, immunosuppressive doses of oral prednisolone (2 mg/kg/day)
were prescribed for one week in addition to oral amoxicillin/clavulanic acid (12.5 mg/kg bid) for
prophylactic purposes. A topical ointment (dexamethasone 0.1%, neomycin 350,000 UI%,
and polymyxin B 600,000 UI% was applied 3 times a day on the right eye for one week.
Unfortunately, the eye spontaneously perforated one week later and had to be removed in emergency
by the referring veterinarian. This eye was not submitted for histopathology. Oral antibiotherapy was
continued for one more week while oral corticotherapy was gradually decreased for two weeks before
complete discontinuation. We were able to follow-up on the dog for over a year, and she remained
healthy during this period.
2.7. Investigation of anti-MPO Antibodies
Two months after prednisolone discontinuation, serum samples from this dog and 13 healthy
dogs were analyzed using a commercial anti-human myeloperoxidase (MPO) detection ELISA kit
(Diamedix Inc., Miami Lakes, FL, USA). The kit anti-human secondary antibody was substituted with
an anti-dog secondary antibody (Santa Cruz Inc., Dallas, TX, USA) to match our patient’s species.
The plate was then read using a multi-function plate reader (Synergy 2, BioTek inc., Winooski, VT,
USA). We blanked all the absorbance results with the absorbance from the no serum control well.
Using the values established in the control dogs (“OD average + 2 or 3 SD”, with or without the outlier
dog #5), the patient’s serum was negative for anti-MPO antibodies (Figure 3). Curiously, the outlier
“control” dog #5 was borderline positive with a 3SD cut cut-off and fully positive with a 2SD cut-off.
We therefore explored its recent medical history into more details, and learned that the dog had had
6. Vet. Sci. 2015, 2 264
some diarrhea the week prior to the blood collection. Interestingly, anti-MPO antibodies have been
already detected in intestinal diseases in both humans and dogs [19–21].
Figure 3. Results of the anti-MPO ELISA. A commercial kit developed to detect anti-MPO
antibodies in human sera, was used to test our samples. We followed the manufacturer’s
instructions, but used an HRP anti-dog IgG secondary antibody rather than the anti-human
secondary provided with the kit. Absorbance values were obtained using a multi-function
plate reader. Using the “average + 2 or 3 standard deviations” cut-off, our patient was not
positive for anti-MPO antibodies, but one of the control dogs was.
3. Discussion
Only eight cases of canine idiopathic necrotizing scleritis have been reported in the literature:
4/8 were English Springer Spaniels and 1/8 was an English Cocker Spaniel [1–5]. Interestingly,
nodular and diffuse episcleritis are also most commonly observed in Spaniels.
All idiopathic scleritis clinically look very similar. In 1982, Fischer used histological examinations
to categorize them into non-necrotizing (NNS) or necrotizing scleritis (NS), based on the presence
or the absence of a necrotic meshwork of collagen. In fact, both entities can be histologically easily
confused. Furthermore, the sensibility of the diagnosis depends on the size of the section: the risk
to find necrosis increases in the examination of a whole enucleated globe compared to a scleral
biopsy [2,6]. Therefore, we could arise the hypothesis that idiopathic NS and NNS are different
variants or different stages of the same disease. In our case, we observed the same histological features
than reported in NS, that is a marked scleral inflammation, with granulomatous infiltrate and necrotic
7. Vet. Sci. 2015, 2 265
collagen alterations [2,3,22]. These chronic lesions of the sclera are thought to induce perilimbal,
periocular and uveal inflammation.[1,23] The congested fibrino-hemorrhagic uveal tract is usually
widely infiltrated by lymphocytes and plasma cells, extending to the peripheral cornea, periocular
muscles and orbital fat [22]. According to Denk and colleagues, the lesions of granulomatous scleritis
reported in three dogs were characterized by vasculitis, collagenolysis, granulomatous inflammation
and perivascular lymphoplasmacytic aggregation [3]. As described in episcleritis [24], there was
evidence of vascular immune complex deposition, and the inflammatory aggregates mostly contained
B lymphocytes with IgG plasma cells, compared to macrophages and T lymphocytes [2,3]. One of the
dogs subsequently developed cutaneous vascular disease consistent with a systemic immune-mediated
disorder [24]. The inability to identify an etiologic agent in any cases presumes an immune-mediated
response in canine NS. Based on immunohistochemical findings in three cases, the pathogenesis seems
to involve the immune system, likely via a primary type IV hypersensitivity (cytotoxic T cells) with an
underlying type III involvement (IgG antibodies) [3].
It is important to note that similar granulomatous and necrotic lesions of the sclera exist in humans.
Like in dogs, human NS shows a rapidly extending, painful, and vision-threatening behavior [18].
They represent about 25% of human scleritis [7,8] and often occur in systemic autoimmune disease
like granulomatosis with polyangiitis (GPA) [7,8,18], rheumatoid arthritis, systemic lupus erythematosus…
However some GPA variants have been reported more recently in patients who presented only ocular
lesions (e.g., dacryoadenitis, scleritis, episcleritis, orbitopathy or panuveitis) [9,11,23,25–27].
In this report, we decided to compare NS in our dog to NS observed in GPA. In the pathogenesis of
this disease, ANCAs have been shown to play a central [11–14]. Anti-proteinase 3 and anti-MPO
antibodies are these commonly used to diagnose and follow-up these diseases in human medicine.
It appears that ANCAs activate neutrophils when binding to them, leading to oxidative outburst,
increased tissue translocation, increased release of pro-inflammatory cytokines, and decreasing
removal of neutrophils by macrophages [28]. All these events lead to the vasculitis and surrounding
tissue damages seen in this syndrome.
In our case, ocular histopathological findings were highly suggestive of the human GPA,
with granulomatous foci, collagen necrosis, degeneration and mummification, neutrophils/nuclear
dust, plasma cells, epithelioid cells and multi nucleated giant cells along with eosinophils [11].
Because the clinical pattern also resembled the ocular lesions observed in GPA, we wanted to
investigate the presence of ANCA in this patient. Interestingly, anti-neutrophil antibodies, including
anti-MPO antibodies, have already been reported in dogs with immune-mediated diseases:
inflammatory bowel disease, blood dyscrasia, or drug hypersensitivity [21,28,29]. Canine PR3 cannot be
found as a gene or a protein in the National Center for Biotechnology Information databases;
PR3 is believed not to exist in dogs [28]. Thus, we decided to focus on anti-MPO antibodies because,
even if anti-PR3 GPA is more multi-organic than anti-MPO GPA, eye involvement has been described
in both conditions [30].
Our patient’s plasma was negative for anti-MPO antibodies using our ELISA kit. We hypothesized
some explanations. First, the dog could have been a representative of the ANCA-negative “limited”
ophthalmic GPA seen in humans [9]. Indeed, ANCA is more closely linked to the capillaritis in the
kidney and the lung that occur during the systemic vasculitis. Secondly, it is possible that antibody
titers decreased below detection levels because of the laps of time before plasma collection, period that
8. Vet. Sci. 2015, 2 266
included one week of immunosuppressive doses of steroids, gradually decreased for two weeks more.
Indeed, a decrease in ANCA levels correlate with clinical improvement in human patients responding
to immunosuppressive therapy [16]. Removal of the immune target organ by enucleation could also
have participated in decreased humoral immune response. Thus, destruction or removal of others
organs targeted by autoimmune diseases (e.g., thyroid) has been associated with reduced humoral
antibody levels [9]. Thirdly, our results could be explained by the fact that we used a human kit.
However, the amino acid sequence of MPO in humans and dogs matches at 96.3% for short chains
A and B%, and at 99.8% for the long chains C and D (www.blast.ncbi.nlm.nih.gov). In addition,
we have successfully used human kits to detect anti-MPO antibodies in dogs, including a similar
ELISA kit [28]. Finally, we would like to emphasize the fact that even if this dog truly was negative
for anti-MPO antibodies, this does not mean that other ANCAs were not present. Indeed, ANCAs can also
target neutrophil proteins such as lactoferrin, elastase, or cathepsins [31,32]. For instance, antibodies
targeting cathepsin-G have been identified in certain dogs with a history of drug allergy [28].
Interestingly, multiple ANCAs can be identified at the same time using approaches such as indirect
immunofluorescence [33].
4. Conclusions
In dogs, the prognosis of NS seems to be poorer than in humans, and complications often lead to
blindness or scleral staphylomas. For our patient and in all case reports presently available in the
literature, enucleation remained the treatment of choice. Despite its shortcomings, we hope that the
present case report will help raise awareness about canine NS and the potential role of ANCA in its
pathogenesis. Hopefully, future studies will be engaged to explore the presence of ANCAs in general
(not just those targeting MPO) in canine NS, using ELISA and/or other technical approaches.
Acknowledgments
The authors wish to thank the owner of the dog presented in this clinical case, and all the owners
who have let us collect blood samples for the control group. Thanks are also extended to the referring
veterinarian Maurou and the histopathology staff of LAPVSO (Toulouse, France). Finally, we would
like to thank Hamor for reviewing our manuscript before its submission.
Author Contributions
Guillaume Cazalot was the referring ophthalmologist who diagnosed the case, decided to investigate
the presence of ANCA in this patient, and collected the tested samples. Sidonie N. Lavergne was the
veterinary researcher who selected and conducted the assays, and analyzed the results. Guillaume Cazalot
and Sidonie N. Lavergne wrote the manuscript together.
Conflicts of Interest
The authors declare no conflict of interest.
9. Vet. Sci. 2015, 2 267
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