Nasopharyngeal eosinophilic sclerosing fibroplasia in a 15-year-old cat: expanding the anatomical and age spectrum of the disease

Treating acute rhinosinusitis requires assessing severity and selecting appropriate antimicrobial agents. In 2006, we developed clinical scoring system for diagnosing and treating acute rhinosinusitis based on three clinical symptoms of rhinorrhea, fever, and facial pain and three nasal findings of characteristics and nasal discharge amount, nasal mucosal swelling and nasal mucosal redness. To verify and update scoring, we studied score-based diagnosis of adult acute rhinosinusitis severity. Prevalence of symptoms such as fever and serous nasal discharge in 95 subjects was low as 8.4% and 3% indicating less useful as evaluation items on the diagnosis. Mucopurulent nasal discharge (r = 0.67), facial pain (r = 0.51), rhinorrhea (r = 0.47), and swelling (r = 0.45) correlated significantly with severity evaluated by attending otolaryngological specialists. Nasal mucosal swelling caused discrepancy between clinical scoring and specialists' assess- ment. Evaluated by multivaliate analysis, factors affecting severity assessment were mucopurulent nasal discharge, facial pain, and rhinorrhea (p < 0.0001), but not swelling (p = 0.49). We concluded that mucopurulent nasal discharge scored 0, 2, or 4, facial pain scored 0, 1, or 2, and rhinorrhea scored 0, 1, or 2 should be used in evaluation in new clinical scoring, classified by severity as mild scored 1-3, moderate scored 4-6, and severe scored 7-8 by evaluating consistency with specialist assessment.

Respiratory tract infection (ISP) is a disease that often occurs in cats kept in crowded environments. This condition is the main cause of high morbidity and mortality in cats. The purpose of writing this article is to diagnose respiratory tract infections (ISP). An 8-month-old male cat named Ruby was brought by his owner to the Veterinary Internal Medicine Laboratory, Faculty of Veterinary Medicine, Udayana University with complaints of sneezing and mucopurulent discharge from the nose for approximately two months and accompanied by coughing for the past month. On physical examination, the case cat had tachypnea, mucopurulent nasal discharge, and gingivitis. The mandibular lymph nodes are symmetrically swollen. X-ray examination results showed increased opacity in the lungs. Routine hematological examination showed that the case cat had neutrophilia. The cat was diagnosed with a respiratory tract infection (ISP) in the form of chronic rhinitis and bronchopneumonia. The treatment given was the antibiotic doxycycline hyclate as causative therapy, the anti-inflammatory methylprednisolone orally and the antihistamine chlorpheniramine maleate orally as symptomatic therapy, and fish oil as supportive therapy. The results of two weeks of therapy showed that the animal in the case had experienced changes, namely that the nasal discharge had disappeared, the frequency of sneezing and coughing had decreased and the cat's gums were no longer inflamed.

Transnasal endoscopy of the pharyngeal orifice of the eustachian tube was performed on 155 ears with otitis media with effusion (77 ears of children, 78 ears of adults). In children, blockage of the orifice by mucopurulent nasal discharge was the most frequent finding (72.7%), followed by compression of the orifice by the adenoid tissue (52.0%), hypertrophy of the peritubal tonsil (16.9%), and edema around the orifice, especially at its posterior lip (10.4%). In adults, the most frequent abnormal finding was edema of the orifice (26.9%), followed by blockage of the orifice by mucopurulent nasal discharge (23.1%), and atrophy of the orifice (10.3%). In 39.7% of cases findings were normal. Thus, main pathological findings associated with tubal dysfunction involved inflammation in the nasopharynx.

A 27-year-old Hispanic man from Central America presented to his primary care physician with an 8-year history of chronic sinusitis, mucopurulent nasal discharge, progressive hoarseness, and exertional dyspnea. Laboratory workup, including a complete blood count and electrolyte levels, was normal. Nasal cultures were negative for mycobacteria and fungus. A computed tomographic scan revealed a deviated nasal septum, bilateral enlarged jugulodigastric lymph nodes, mild irregularity of the free margin of the right vocal cord, mucosal thickening in the subglottic larynx (Figure 1), and calcifications in the proximal trachea. The patient was subsequently referred to an otolaryngologist.A laryngoscopy was performed and the subglottis was found to be stenotic; the supraglottis appeared granular. Multiple biopsies were taken from the granular areas. Microscopically, the fragments were covered by stratified nonkeratinizing squamous mucosa containing a dense subepithelial infiltrate of plasma cells with numerous Russell bodies, occasional neutrophils, and large foamy histiocytes (Figures 2 and 3). In view of the density of the plasma cells, immunohistochemical studies for κ and λ light chains were performed and showed a polyclonal plasma cell population. The most noteworthy finding was the presence of large foamy histiocytes, which were found to contain small rodlike bacteria. These organisms were gram-negative and highlighted by Warthin-Starry (Figure 4) and periodic acid–Schiff stains. Acid-fast bacilli and Gomori methenamine silver stains were negative for microorganisms.Rhinoscleroma is an unusual chronic granulomatous disease of the upper airways that is caused by Klebsiella rhinoscleromatis. Von Hebra first described this disease in 1870. Mikulicz noted its characteristic histologic features in 1877 (hence, the foamy histiocytes are named Mikulicz cells). In 1882, Von Frisch identified the causative organism, a gram-negative diplobacillus, now known as K rhinoscleromatis.1,2 The disease is rarely seen in the United States, but is endemic to North and Central Africa, Central and South America, Eastern and Southern Europe, India, Egypt, and Indonesia.3 Rhinoscleroma is not highly contagious. Poor hygiene, crowded living conditions, and malnutrition increase the potential for infection and transmission.4 It affects primarily young persons in the second and third decades of life, and there is a slight female predominance.2 Rhinoscleroma has been reported in patients with acquired immunodeficiency syndrome, and experimental evidence has shown an association with altered T-cell function.5Rhinoscleroma can involve any part of the respiratory tract. The histologic characteristics of the lesions depend on the clinical stage of the disease. Both clinically and pathologically, rhinoscleroma has been divided into 3 or 4 stages: the catarrhal/atrophic, granulomatous, and sclerotic stages.2 Microscopically, the catarrhal/atrophic stage exhibits squamous metaplasia and a nonspecific subepithelial infiltrate of polymorphonuclear leukocytes with granulation tissue. The diagnostic features are found in the granulomatous stage. In addition to chronic inflammatory cells, Russell bodies, and pseudoepitheliomatous hyperplasia, groups of large vacuolated histiocytes are present. Klebsiella rhinoscleromatis resides in these histiocytes. If numerous, they can be seen with hematoxylin-eosin stains, but may require periodic acid–Schiff, silver impregnation, or immunohistochemical stains for identification. The sclerotic stage displays extensive fibrosis, which may lead to stenosis and disfiguration.The differential diagnosis includes several infectious granulomatous processes, including bacterial (tuberculosis, actinomycosis, syphilis, and leprosy), fungal (histoplasmosis, blastomycosis, paracoccidioidomycosis, and sporotrichosis), and parasitic (mucocutaneous leishmaniasis) diseases. Sarcoidosis, vasculitis (especially Wegener granulomatosis), and neoplastic diseases can mimic rhinoscleroma and should be considered in the differential diagnosis.2An accurate history, a thorough physical examination, and a high index of suspicion6 facilitate the diagnosis of rhinoscleroma. Klebsiella rhinoscleromatis is not found in normal secretions. A positive culture is diagnostic of rhinoscleroma, but cultures are positive in only 50% to 60% of cases.Rhinoscleroma is a slowly progressive disease characterized by periods of remission and relapse. It is rarely lethal, unless it obstructs the airways. Antibiotics (especially ciprofloxacin and rifampin) are the mainstays of treatment, whereas surgery and laser therapy are required to treat airway compromise and tissue deformity. Owing to a high incidence of recurrence, prolonged antibiotic therapy over months to years is necessary.1,2,7

This case report documents the diagnosis and successful treatment of cryptococcosis caused by Cryptococcus gattii VGII in a 20‐month‐old male domestic shorthair cat from Manaus, Brazil, which was concurrently infected with feline immunodeficiency virus (FIV) and diagnosed with demodicosis. The cat presented with mucopurulent nasal discharge, cutaneous lesions on the neck, and a subcutaneous mass between the shoulder blades. Laboratory investigations, including fine‐needle aspiration cytology, fungal culture, and PCR‐RFLP genotyping, confirmed the presence of C. gattii VGII. The cat was treated with fluconazole (10 mg/kg/day) and topical fluralaner–moxidectin, resulting in complete clinical resolution of all lesions and associated symptoms. This report underscores the significance of considering cryptococcosis as a differential diagnosis in immunocompromised cats presenting with cutaneous or respiratory symptoms. Additionally, it highlights the importance of recognizing the Amazon region as an area of environmental prevalence of C. gattii VGII, reinforcing the need for awareness regarding its impact on animal health.

Seven cases of evident odontogenic sinusitis were studied retrospectively. Women were affected more than men, with an average age of 34. All of them has only one maxillary sinus involved. The most common origins were apical periodontitis or abscess at the maxillary first molar, followed by the same pathology at the second molar. One case appeared to be caused by osteomyelitis secondary to a combined apical and periodontal lesion at tooth#13 in a patient with diabetes mellitus. Common symptoms and signs presented were toothache, gingival swelling, large dental cavities, mucopurulent nasal discharge, nasal obstruction, postnasal drip, cheek swelling and cheek tenderness or paresthesia. One patient had a postextraction oro-antral fistula of one week old. Three cases presented concomitant cellulites on cheek which required incision and drainage. All causative teeth were removed and in only one occasion was a small opening to the sinus detected in the socket during the extraction. Two cases were known to have had persistent or recurrent symptoms of sinusitis two years after then.

Background: Methicillin-resistant Staphylococcus (MRSA) is a highly virulent bacterium which is difficult to eradicate. It has become a common nosocomail pathogen. However, it is relatively less emphasized in outpatient settings. Moreover, although Staphylococcus aureus is a common pathogen of the head and neck, MRSA infection in the sinonasal area rarely reported. Methods: Charts were reviewed to find MRSA rhinosinusitis patients who were diagnosed in the Outpatient Clinic of the Department of Otolaryngology, Taichung Veterans General Hospital. When rhinosinusitis patients were not responsive to empiric antibiotic treatment in the Outpatient Clinic, specimens were taken from the middle meatus with cotton-tipped sticks. The specimens were sent for aerobic and anaerobic cultures to determine the appropriate antibiotics to be used for treatment. After MRSA was cultured, several treatments, including antibiotics and nasal irrigation, were used for these patients. Results: Twenty-eight patients with MRSA rhinosinusitis were identified in our Outpatient Clinic between July 1995 and August 1997. Among them, 16 patients were male, and 12 were female. Their ages ranged from 7 to 71 years old. The mean age was 36.1 years. Six of these MRSA-infected patients were chronic sinusitis patients without any history of prior sinonasal surgery. Three were chronic hypertrophic rhinitis patients who had undergone a partial turbinectomy. The remaining 19 patients had undergone functional endoscopic sinus surgery (FESS). The indication for FESS chronic sinusitis in 17 patients, noninvasive fungal sinusitis in another, and atrophic rhinitis in the last. Mucopurulent nasal discharge and nasal crusting were the most common clinical manifestations. No responsible predisposing factor was found in these MRSA-infected patients. After treatment, 21 patients improved. Conclusions: MRSA infection may constitute a new problem in the management of rhinosinusitis patients.

Pathological changes associated with equine arteritis virus infection of the reproductive tract in prepubertal and peripubertal colts

Inflammatory polyps of the nasal turbinates of cats: an argument for designation as feline mesenchymal nasal hamartoma

Influence of Serum Antibody on Occurrence of Streptococcus zooepidemicus in the Nasopharynx of Weanling Foals

Influence of serum antibody on occurrence of Streptococcus zooepidemicus in the nasopharynx of weanling foals

Background: Guttural pouch empyema in horses is a disease described by the accumulation of purulent/mucopurulent exudate, which with chronification of the disease can become chondroids, affecting horses of any age and not presenting breed predisposition. The main cause of empyema is upper respiratory infection, associated or not with failure in the defense mechanisms, as well as drainage to the guttural pouch of retropharyngeal lymph node abscesses; the main pathogen related to this condition is Streptococcus equi. This paper aims to describes a case of a filly that presented a mucopurulent nasal discharge, five months of evolution, and irresponsive to antibiotic therapy.Case: A 2.5-year-old quarter filly was referred to the veterinary hospital presenting a five months evolution mucopurulent nasal discharge, irresponsive to gentamicin and ceftiofur, and later doxycycline, acetylcysteine and clenbuterol that were instituted on the farm. Throw the endoscopic examination of the upper respiratory tract, was observed the presence of mucopurulent content and chondroids inside the right guttural pouch. This material was collected and sent for culture and antibiogram tests. Streptococcus equi was isolated, and was only sensitive to ceftiofur. The treatment included the guttural pouches flushes with warm saline solution (0.9%) associated with Lauryl Dietylene Glycol Ether Sulfate Sodium (28%) and acetylcysteine (10%). In addition to topical treatment, 5 mg/kg of ceftiofur was administered intramuscularly daily for 7 days. After 10 flushes of the guttural pouch, was observed a total absence of chondroid and mucopurulent contents.Discussion: The treatment of the guttural pouch empyema can be performed either by conservative methods or by the surgical drainage. Among the benefits of the conservative treatment are the absence of the risks related to the surgical procedure and the possibility of doing the treatment without a surgical facility. On the other hand, it usually presents a longer time to the remission of the clinical signs compared with the surgical drainage, since the mucopurulent content and the chondroids have to be disassembled and dissolved before being able to be drained from the guttural pouch. Even though, the conservative treatment is effective to a large number of cases, and with the utilization of agents to dissolve the chondroids can be performed with success in cases with a large number and size of chondroids. The surgical treatment is considered the gold standard in chronic cases, due to the difficult of removal of the chondroids with the conservative methods. The main complications related with the method are the iatrogenic lesions to noble structures present inside the guttural pouches, as cranial nerves and arteries. The decision of the treatment, surgical or conservative, must consider the risks to the patient, the facilities, and the costs of the procedure. The present study demonstrates that agents as lauryl-diethylene-glycol-ether sodium sulfate (28%) and acetyl cysteine can be effective as diluents for thick secretions and organic contents, and for that reason, increase the success of the conservative treatment of guttural pouch empyema. Consequently, improving the outcome and the rate of remission in cases of guttural pouch empyema that have a large number of chondroids, and are located remotely from referring veterinary hospitals or that cannot afford the surgical procedure.

To evaluate predictor variables for and complications associated with Streptococcus equi subsp equi infection (strangles) in horses. Retrospective case-control study. 108 horses with strangles (cases) and 215 horses without strangles (controls). Medical records from January 2005 through July 2012 were reviewed. Cases were defined as horses with clinical signs of strangles (pyrexia, retropharyngeal lymphadenopathy, and mucopurulent nasal discharge) that were associated with a confirmed strangles outbreak or had positive results for S equi on PCR assay or bacteriologic culture. Controls were defined as horses with pyrexia that did not meet the other criteria for cases. Data compared between cases and controls included signalment, clinical signs, diagnostic test results, and disease complications and outcome. Logistic regression was used to identify variables associated with strangles and its complications. Clinical signs of strangles were not evident in 12 of 25 cases classified as S equi carriers (infected > 40 days). Predictor variables associated with strangles included mucopurulent nasal discharge and external abscesses in the pharyngeal region. Strangles was more likely to be diagnosed in the spring than in the summer. Cases with anemia were more likely to develop purpura hemorrhagica than were cases without anemia. No risk factors were identified for the development of guttural pouch empyema or metastatic abscesses. Results indicated that not all horses infected with S equi develop clinical signs of strangles. We recommend that guttural pouch endoscopy and lavage with PCR assay of lavage fluid samples be performed to identify S equi carrier horses.

An outbreak of peste des petits ruminants (PPR) among recently vaccinated West African Dwarf male goats (buck) was investigated and managed at the Teaching and Research Farm University of Ibadan, Ibadan, Nigeria. The average age of the animals was ranged between 1½- 2years old. The morbidity rate of 87% and mortality rate of 28% was recorded on the flock, giving a case fatality rate of 32%. Sneezing, coughing, anorexia, mucopurulent nasal discharges, dyspnea and diarrhea with pungent characteristic odor were observed clinically. Clinical examination of clinically infected animals on the average revealed the followings: Temperature: 40.5°C, Heart rate: 76 beats per min, Respiratory rate: 44 breathes per min. 13 mortalities were recorded within a week post vaccination. Post mortem findings revealed mucopurulent oculonasal discharges, crust on the lips, erosive lesions on the gums, fecal soiled perineum, frothy mucoid tracheal fluid, copious hydroperitoneum, hyperemia, congestion and lungs hepatization with large intestine seemed congested. A rapid diagnostic kit for goat Peste des Petits Ruminants Virus Antibody was used to detect the positivity and correlated antibody titer in four of the goats; two from the apparently healthy group and two from the group still manifesting the clinical symptoms. Results of the two apparently healthy revealed some positivity which correlated to 1:160 antibody titer while the two animals from the group showing clinical signs revealed complete invalidation. Clinically infected animals were isolated and treated symptomatically for five consecutive days with Tylosin, Sulphadimidine and Multivitamins at recommended dosages To the best of the authors knowledge, this case will be the first confirmed PPR outbreak among West African Dwarf goats linked with vaccination using PPR rapid diagnostic kit outcome combined with clinico-pathological findings in the South-Western Nigeria.

Characterization of a Streptococcus equi ssp. equi Isolate From a Strangles Outbreak in Thailand