Cyanotic Mucous Membranes Research Articles

Hérnia diafragmática traumática em cão

The term diaphragmatic hernia refers to rupture of the diaphragm, the muscle that separates the thoracic and abdominal cavities. The diaphragm plays an important role in ventilation, serving as an inspiratory muscle, in addition to helping transport lymphatic fluid. Most diaphragmatic hernias in dogs and cats are caused by trauma, particularly being run over by a car. They are frequently diagnosed in small animal clinics and there is no age or species predisposition for traumatic diaphragmatic hernias. Symptoms vary but include difficulty breathing, tachypnea, pale or cyanotic mucous membranes, tachycardia and oliguria. The definitive diagnosis is confirmed by the combination of a well performed anamnesis and imaging tests such as radiography and ultrasound. The recommended treatment is surgery, with diaphragm surgery, combines with follow-up and post-operative care to ensure a good recovery. This work reports the case of a female puppy, ran over by a vehicle. After imaging tests, she was diagnosed with a diaphragmatic hernia and subsequently underwent diaphragmatic herniorrhaphy, a diaphragm correction procedure. The surgical procedure and the patient's recovery went well, without complications.

Microfilaruria of Dirofilaria immitis in a dog from Italy

Dirofilaria immitis is a mosquito-borne nematode-causing canine heartworm disease, with adult worms localized in the pulmonary arteries and right heart. In rare cases, ectopic migration might occur, and adults and blood circulating microfilariae can be found in unusual organs or fluids (e.g., eyes, abdominal cavity, bone marrow, and urine). A 17-year-old mixed-breed female dog was presented in a private veterinary clinic in Italy for hematuria and dysuria. Physical examination showed cardiac mitral murmur with marked respiratory distress and cyanotic mucous membranes after handling. Abdominal ultrasounds revealed a non-specific chronic cystopathy, while the echocardiography showed enlargement of the right heart associated with tricuspid insufficiency and mitral regurgitation, with the presence of an adult filariae in the right ventricular chamber. Circulating microfilariae were observed in the blood smear and molecularly identified as D. immitis. Unusual microfilaruria was detected in the urine sediment. Data presented raise awareness about the occurrence of microfilariae in unusual locations, such as the bladder, suggesting the need of a thorough clinical and laboratory assessment where D. immitis is endemic.

Pathohistological features of mediastinal lymphoma in domestic cats

The article covers two clinical cases of domestic cats suffering from a mediastinal form of lymphoma and provides their cytological, immunohistochemical, and pathohistological verification. The lymphoma immunophenotyping method using the B-cell markers CD79a and CD3 was used to identify T-cells. The mediastinal type of lymphoma in cats is usually rarely registered and statistically, the number of cases does not exceed 20%, which is consistent with our observations. Shortness of breath, difficulty with swallowing, lack of appetite, cyanotic mucous membranes, lymphadenomegaly of the mediastinal lymph nodes and effusion in the chest cavity were found in the clinically ill cats. An X-ray examination of the chest cavity revealed an increased contrast in the mediastinal area and displacement of the lungs towards the spine. A complete blood count revealed lymphopenia. Cytological smears of the chest cavity transudates revealed mostly monomorphic lymphoblasts with large rounded hyperchromic nuclei and narrow cytoplasm stained in light blue. The karyoplasm was somewhat granular, the nucleoli were visible, and the mitoses were atypical and numerous. The cytological picture in biopsy samples of mediastinal lymph nodes was characterized by a monomorphic population of lymphoblasts with an eccentrically located nucleus and moderately basophilic karyoplasm. The cell cytoplasm was vacuolated in some places, with presence of atypical mitotic figures. Most of the cells had two nuclei. Diffuse tumoral lesions of the chest cavity tissues, focal tumorous lesions of the lung parenchyma, and lymphadenopathy of the mediastinal lymph nodes were found during the autopsy in the first case. The second clinical case demonstrated the massive lymphadenopathy of the mediastinal lymph nodes. Histologically, a diffuse lesion by a monomorphic population of lymphoblasts was revealed in preparations from the soft tissues of the chest wall. The lymphoblasts’ insignificant cytoplasm, with nuclei from round to elliptical shape, infiltrated the chest wall’s soft tissues. It was found immunohistochemically that the blast cells showed reactivity to CD79a, and were mostly negative to CD3. This indicates the development of a large diffuse B-cell lymphoma. The immunohistochemical picture of lymph node necropsies from another cat was somewhat similar. However, it was also characterized by lymphoblasts with eccentrically placed nuclei, increased number of cells with mitotic figures, somewhat intensive CD3 antibodies expression (especially in the paracortical area of lymph nodes), and significant CD79a marker expression.

Spontaneous pneumothorax in German Shorthair Pointer due to penetration of a grass awn

This case report describes an incident of pneumothorax in 4-month old male German Shorthaired Pointer caused by a grass awn. The patient was brought to the Small Animal Clinic of the Faculty of Veterinary Medicine at Trakia University, Stara Zagora, Bulgaria with respiratory distress and anxiety. Tachypnea, cyanotic mucous membranes and tachycardia were observed during physical examination. Abnormal collection of air in the pleural space between the lung and the chest was observed radiographically. A diagnosis of primary spontaneous closed pneumothorax was made based on these findings. Later pathoanatomical findings showed the presence of the grass awn that had penetrated through the skin.

Neonatal sepsis in dogs: Incidence, clinical aspects and mortality

The neonatal period in dogs remains associated with high mortality rates. Sepsis is the main cause of neonatal losses during the first three weeks of life. Additionally, failure in the clinical assessment and early diagnosis of sick newborns is still common, leading to inadequate care, which contributes to a high mortality rate. Thus, the objective of this study was to describe the incidence of sepsis in canine newborns, the clinical aspects involved, the main isolated bacterial agents and mortality rates to facilitate clinicians’ early recognition of this condition. Of the 152 litters and 762 neonates evaluated, 14.8% (113/762) had sepsis or septic shock, and the mortality rate among affected puppies was 25.6% (29/113). Among the puppies with sepsis that died, early mortality (0–2 days of age) occurred in 69% (20/29) of affected neonates, and late mortality (3–30 days of age) occurred in 31% (9/29) of affected neonates. Significant differences (p < 0.0001) in clinical parameters (heart and respiratory rates, blood glucose, body temperature, peripheral oxygen saturation and reflexes) were noted among healthy neonates and neonates with sepsis and septic shock. The main and most relevant clinical signs were apathy, a reduced sucking reflex, diarrhea, the neonatal triad, failure to gain weight, bradycardia, dyspnea, cyanotic mucous membranes, body erythema, reduced peripheral oxygen saturation, cyanosis and tissue necrosis in the extremities. The mother may have been the main source of infection for 87.6% (99/113) of neonates with sepsis. Most infections were transmitted during pregnancy (68%, 77/113) in cases of neonatal sepsis. The major source of infection for neonates was the uterus, followed by breast milk and maternal oropharyngeal secretions. The most frequently isolated bacterial agent was Escherichia coli, accounting for 25.6% (29/113) of sepsis cases. The morbidity and mortality of neonatal sepsis in dogs is high. The clinical evaluation and diagnosis of sepsis in neonates differ from those in adult animals. Thus, knowledge of the neonatal particularities of sepsis is essential for proper clinical management and greater survival of these patients.

Exogenous Tracheal Bone Structure in a Cat

Background: Acute dyspnea is a clinical emergency with a presentation similar to several etiologies. Cats are usually referred with complaints of anorexia, abdominal breathing, cyanosis, and open mouth breathing, and veterinarians should stabilize the animals as soon as possible. The incidence of aspiration of foreign bodies is low, particularly in this species. The diagnosis consists of observing the foreign structure in the lumen of the trachea, commonly performed using radiography or bronchoscopy. This report describes a case of a feline with a tracheal foreign body, with a detailed description of the clinical findings and successful treatment.Case: A 10-year-old female feline exhibited severe dyspnea and cyanosis. During the anamnesis, the owner stated that the clinical signs suddenly presented one day prior, after the animal ingested a piece of fish. Physical examination revealed changes in pulmonary auscultation, which was bilaterally muffled, and intense respiratory distress, as observed by the evident signs of exhaustion (sternal decubitus, reduced muscle tone), in addition to cyanotic mucous membranes. The animal was intubated and maintained under anesthesia with propofol infusion and respiratory support (ambu) for 1 h, during which complementary examinations were performed. Chest radiography showed the presence of a radiopaque structure (approximately 0.5 cm) in the tracheal region. Thus, we decided to remove the structure using bronchoscopy. The foreign body was located above the main bronchial bifurcation and was removed. There was an improvement in oxygenation after 20 min of maintenance of ventilatory support, followed by weaning of the animal's successful respiratory support. Antibiotic therapy and analgesia were prescribed at home, and the animal exhibited full recovery after 10 days.Discussion: Dyspnea is a clinical sign that should be treated as an emergency, as it is associated with high mortality. In these cases, positive pressure ventilation is indicated in three situations: persistent hypoventilation, severe hypoxemia unresponsive to oxygen therapy, and excessive respiratory effort or fatigue. Dyspnea may be due to impairment of the upper or lower airway or restrictive conditions. Clinically, felines with tracheal foreign bodies have a sudden onset of dyspnea, tachypnea, cough, and lethargy. In these patients, the reduction in lung sounds is a common finding, as observed in the present case. The occurrence of tracheal foreign bodies in cats is rare and, depending on the type of foreign body and its location in the airway, complete obstruction of the respiratory tract may occur. In the present case, it was possible to observe the foreign body in the trachea on radiographic images. Felines with tracheal foreign bodies generally present a structure located close to the carina, as observed in the present case. Bronchoscopy using a flexible or rigid tube is considered the gold-standard technique for removing foreign bodies from the respiratory tract, and the greatest difficulty during the removal procedure is ensuring that the airways are not obstructed by the instruments used. The use of these materials is not free of complications, as they may be responsible for the development of pneumothorax, pneumomediastinum, dyspnea, and respiratory failure. In the present case, there were no complications during or after the procedure, and the patient recovered completely.

Rift Valley fever virus live attenuated vaccine strain Smithburn can cause meningoencephalitis in alpacas

Rift Valley fever (RVF) is a zoonotic, viral, mosquito‐borne disease that causes considerable morbidity and mortality in ruminants during the rainy season in Africa. In June 2018, 4 alpaca inoculated subcutaneously with Rift Valley Fever (RVF) Smithburn live attenuated vaccine strain exhibited pyrexia, aberrant vocalization, anorexia, neurological signs (tremors, disorientation, overknuckling and ataxia leading to full recumbency), respiratory distress and sudden death (3 animals). One animal died the evening of inoculation, the other two at 2–3 weeks post inoculation. The fourth alpaca fully recovered. Due to significant concern that this was wildtype Rift Valley fever, vaccine strain reversion, or an atypical camelid response to Smithburn vaccination, a full necropsy and further workup were conducted on the latter 2 fatal cases including necropsy, histopathology, immunohistochemistry (IHC), RNAscope in situ hybridization (ISH), reverse transcription real‐time PCR (RT‐qPCR) and confirmatory sequencing.Necropsy and histopathology were conducted per standard procedures at the WCPVL. RT‐qPCR for RVFV L segment and sequencing of each of the three genome segments were conducted per standard procedures at the OVI. Anti‐RVFV glycoprotein IHC and ISH for RVFV L segment RNA were conducted per published methods in Ragan et al., 2019.Macroscopic lesions included cyanotic mucous membranes, severe pulmonary oedema and congestion and multifocal petechiae and ecchymoses throughout the left and right ventricular epi‐, endo‐ and myocardium. The most distinctive microscopic lesions were multifocal neuronal necrosis, gliosis and prominent histiocytic and lymphoplasmacytic perivascular cuffing of blood vessels in the cerebrum as well as a histiocytic and lymphoplasmacytic cerebral meningitis. Multifocally, in the cerebrum, viral antigen and RNA were present in the cytoplasm of neurons, including in the cell body, dendritic arborizations and axons (Figure 1) and brain samples tested positive for RVFV RNA by RT‐qPCR. The liver was negative for RVFV by both IHC and ISH. Additional genetic analysis of the brain tissue revealed that the virus clustered in Lineage K (100% sequence identity) with close association to published Smithburn vaccine sequences (sequence identity ranging from 99.1 – 100%).This is the first report of respiratory distress, neurological signs and sudden death in alpaca post inoculation with the Smithburn strain. It is also the first examination of RVF viral RNA distribution in alpaca tissues. RVF live attenuated Smithburn vaccine can cause meningoencephalitis in alpacas.Support or Funding InformationWCPVL and Laboratory of Investigative Pathology, Department of Diagnostic Medicine/Pathobiology, KSU CVMAlpaca Rift Valley fever virus RNA positive encephalitisCerebral encephalitis in an alpaca vaccinated with Smithburn live attenuated vaccine strain labeled with pan‐RVFV (L segment probe‐set) ISH (brown), counterstained with hematoxylin. Bar is 50 microns.Figure 1

Leptospirosis in Northern Sea Otters (Enhydra lutris kenyoni) from Washington, USA.

We diagnosed leptospirosis in six northern sea otters (Enhydra lutris kenyoni) that stranded on beaches in Washington State, US in 2002. Significant gross findings included cyanotic oral mucous membranes, renal swelling, congestion or pale streaks on the cut surface of renal lobules, hematuria, dehydration, lymphadenopathy, pulmonary congestion, and rarely adrenal hemorrhage and congestion. Histopathology showed lymphoplasmacytic tubulointerstitial nephritis with intraluminal spirochetes and immunoreactivity to leptospiral antigens in the renal tubules and interstitium. A quantitative polymerase chain reaction (qPCR) using kidney or urine for the leptospiral lipL32 gene was positive with cycle threshold values indicative of abundant or moderate amounts of nucleic acid. A microscopic agglutination test showed the highest serum antibody titer to serovar Pomona and positive titers to serovars Autumnalis, Bratislava, Hebdomadis, Grippotyphosa, Icterohaemorrhagiae, Pyrogenes, Ballum, Canicola, and Hardjo. Although antibodies to Leptospira interrogans have been previously detected in sea otters, this report describes the pathology of leptospirosis in diseased free-ranging sea otters.

Nitrate and nitrite poisoning in sheep and goats caused by ingestion of Portulaca oleracea

ABSTRACT: Three outbreaks of poisoning by Portulaca oleracea were reported in sheep and goats in Northeast Brazil. In the first outbreak, 8 out of 20 sheep were affected and later died. In the second outbreak, three goats and one sheep died out of a flock of 30 animals that included both species. In the third outbreak, two out of 19 sheep were affected, and they recovered after a treatment of 2% methylene blue at a dose of 4 mg/kg body weight. In the first and second outbreaks, the animals ingested P. oleracea after it was cut and offered in feeders. In the third outbreak, the flock was grazing in an area that had been invaded by the plant. To determine the toxicity, P. oleracea was administered experimentally at a dose of 80g/kg of body weight to seven sheep, weighing 19-30 kg. One control sheep received green grass. One to four hours after P. oleracea ingestion, the animals showed clinical signs of poisoning characterized by cyanotic mucous membranes, bloat, ruminal pH of 8-9, pollakiuria, aerophagia, involuntary movements of the upper lip, apathy, tachypnea and tachycardia. Five animals recovered, including one that was treated with 1% methylene blue, and two animals died. During necropsy, the mucous membranes were brownish, and the blood was dark brown. Diphenylamine tests of the plant and of rumen contents were positive for nitrates. Positive results for nitrates were also found in 24 samples of P. oleracea that were collected in different places in the states of Pernambuco and Paraíba. We conclude that P. oleracea accumulates nitrates at toxic levels and may cause poisoning in sheep and goats.

Equine colitis Χ

Colitis Χ is an acute or peracute colitis of unknown origin, which is characterized by a sudden, watery diarrhea that is usually accompanied by symptoms of hypovolemic shock and leads to death in less than 24 hours. Although colitis X has been studied extensively, the causative factor has not been clarified yet and prognosis is average to poor, as mortality could reach 90-100%. Still, mortality rate could fall to 75%, if treatment is imminent and aggressive. Occasionally the disease has been attributed to viruses, parasites, bacteria, use of antibiotics and sulfonamides and heavy metal poisoning. Stress is considered as an aggravatingfactor for colitis X. The clinical signs are similar to those described for other forms of acute- peracute colitis. Diarrhea and abdominal pain constitute the main discoveries, but at the same time tachykardia, tachypnea, weak pulse, congested or cyanotic mucous membranes and increased capillary refill time are noted. In most cases, colitis X leads to death between 4 to 14 hours. As far as the laboratory findings are concerned, the most important finding is the leucopenia, initially characterized by neutropenia, which might evolve in neutrophilia. Moreover, haemoconcentration is noted with an increase in the packed cell volume, whilst thetotal proteins are initially increased, but changes into a lower than normal value. The most significant laboratory finding in colitis X is the increase of total Cortisol concentration in blood plasma.Histopathologically, the mucosa of the large colon is hemorrhagic, necrotic and covered with fibrohemorrhagic exudate, while the submucosa, the muscular tunic and the local lymphonodes are edematous. The treatment of colitis X should be dire and aggressive, including administration of fluids, electrolytes and blood plasma, anti-inflammatory and analgesic drugs and antibiotics. Preventing dehydration is of paramount importance. The applicationof nutritional measures is important. More specifically, parenteral or normal feeding could be used to address the exacerbated metabolism of the sick horse. Finally, the use of probiotics is considered beneficial in the restoration of the normal intestinal flora. The most common probiotics contain Lactobacillus spp. and Bifidobacterium spp.

Reversed patent ductus arteriosus and multiple congenital malformations in an 8‐day‐old Arabo‐Friesian foal

SummaryAn 8‐day‐old Arabo‐Friesian filly was presented with signs of severe dyspnoea, tachypnoea, coughing and cyanotic mucous membranes. On auscultation, a bilateral grade V/VI continuous heart murmur and heart rate of 155 beats/min (sinus tachycardia) were detected. Lung ultrasonography revealed pronounced comet tail artefacts indicating lung oedema. Echocardiography showed right ventricular hypertrophy, a 1.2 cm muscular ventricular septal defect with a left‐to‐right shunt, a stenotic bicuspid pulmonary valve and severe mitral and tricuspid valve regurgitation. Tricuspid regurgitation peak velocity indicated a right ventricular systolic pressure of 119 mmHg. The pulmonary artery was severely dilated and a 1 cm diameter patent ductus arteriosus was found. Colour flow Doppler showed systolic ductal flow reversal with right‐to‐left shunting through the ductus. Arterial partial oxygen pressure and saturation were lower in the metatarsal artery (25 mmHg, saturation 52.6%) than in the carotid artery (31 mmHg, saturation 64.3%). Due to the poor prognosis, the foal was subjected to euthanasia and necropsy confirmed the ultrasonographic findings. Patent ductus arteriosus is a rare condition and occurs most frequently in combination with tetralogy and pentalogy of Fallot. A genetic basis for congenital cardiac disease, especially for ventricular septal defects, in Arabians and for aortic rupture and aorto‐pulmonary fistulation in Friesians has been reported. Whether cross‐breeding leads to an increased prevalence is unknown. This is the first case report with echocardiographic visualisation of reversed ductal flow in a neonatal Arabo‐Friesian foal.

Acetaminophen Toxicosis in a Cat

Acetaminophen causes serious problems as toxication in cats in spite of being an effective and reliable analgesic and antipyretic in humans. A six months-old female cat suffering from cough was presented to examination to International Pet Hospital/Tirana/Albania when no result was obtained after one acetaminophen tablet had been administered in order to heal the disease. Depression, grey and cyanotic mucous membranes and tongue, tachypnea, tachycardia, hypothermia were primary clinical signs. The color of blood and urine were darkened. On the basis of anamnesis and clinical findings, a definitive diagnosis of acetaminophen toxicosis was made. Therapeutic protocol contained blood transfusion, N-Acetylcysteine, ascorbic acid, cimeditine and IV fluid therapy. Patient's blood samples were collected for haemogram and serum analyses with regular intervals was cured with appropriate treatment.

Timpanismo em bovinos, secundário à obstrução esofágica por Citrus limon (limão siciliano)

Resumo: Timpanismo ruminal consiste na distensão acentuada do rúmen e retículo, devido a incapacidade do animal em expulsar gases produzidos durante o processo fisiológico da fermentação. O timpanismo pode ser ocasionado de forma primária, por formação de espuma estável, ou secundária, devido a anormalidades funcionais e/ou físicas que interferem na eructação. Nesse trabalho, são descritos os aspectos epidemiológicos, clínicos e anatomopatológicos da ocorrência de timpanismo secundário em bovinos, decorrente da obstrução esofágica aguda por limões sicilianos. Cinco bovinos, de um lote de 210, foram afetados. Os bovinos eram suplementados com resíduo de tangerina (Citrus reticulata) no cocho e na última carga desse subproduto, havia limões sicilianos inteiros misturados ao resíduo. Os cinco animais afetados eram da raça Aberdeen Angus e tinham entre 12-24 meses de idade. Todos apresentaram sinais clínicos caracterizados principalmente por mucosas cianóticas, grave timpanismo, desconforto abdominal, acentuada dispneia e taquicardia, atonia ruminal, desidratação, decúbito e morte. O curso clínico variou entre 24 a 48 horas. Na necropsia, os cinco bovinos apresentavam grave obstrução esofágica por limões nas porções: cranial (logo após a laringe [1/5]), porção medial (entrada do tórax [1/5]) e final (próximo ao cárdia [3/5]). Nas áreas de oclusão, observou-se extensa necrose e ulceração da mucosa esofágica. O conteúdo ruminal dos bovinos estava seco e misturado com limões inteiros. No esôfago de dois animais havia linha de timpanismo. As lesões histológicas eram visualizadas principalmente no esôfago, na região da obstrução, onde se evidenciaram alterações degenerativas, necróticas e ulcerativas acentuadas no revestimento epitelial.

Systemic, oral characteristics and dental management of pediatric patient with Tetralogy of Fallot. A case report.

Introduction. Tetralogy of Fallot is a congenital heart disease and the most common cyanotic heart defect in children. It is clinically characterized by a ventricular septal defect, pulmonary stenosis, overriding aorta over ventricular septal defect and right ventricular hypertrophy. There is little or no information about the oral manifestations in patients with this pathology. A report and discussion of a pediatric patient diagnosed with Tetralogy of Fallot, its clinical manifestations, oral findings and dental management are presented. Case Report. A four-year-old male patient diagnosed with Tetralogy of Fallot and epileptic attacks. The patient has deciduous teeth with many severe early childhood caries, stomatitis and cyanotic mucous, radicular remains, periapical abscess and noticeable enamel hypoplasia. Conclusions. In agreement with other authors, children with systemic diseases such as Tetralogy of Fallot have a higher rate of caries, poor oral hygiene, high susceptibility to other infections and bacterial endocarditis, cyanotic mucous membranes and enamel hypoplasia. Primary prevention is critical, proper dental hygiene, regular dental check-ups and the use of antibiotic prophylaxis are particularly important, especially in high-risk patients.

Intoxicação aguda por triclorfon em caprinos tratados com a dose terapêutica

O presente estudo descreve um surto de intoxicação por triclorfon em caprinos, que receberam pela via oral, a dosagem terapêutica do princípio ativo em questão (100mg/kg), provenientes da Universidade Estadual de Maringá, campus de Umuarama, PR. Cinquenta e três ovinos foram tratados com a mesma formulação/solução e não se observou nenhum efeito colateral nos animais referente ao tratamento com triclorfon. Das 20 cabras medicadas, cerca de 40 minutos após a administração do triclorfon, oito apresentaram os clássicos sinais clínicos de ataxia, decúbito externo-lateral, sialorreia, tremores, constrição das pupilas, dispneia com ruídos, micção e defecação involuntária, paresia espástica, timpanismo e lacrimejamento. Quase que imediatamente após a detecção destes sinais, as oito cabras foram medicadas com sulfato de atropina 1% 0,5mg/kg mais fluidoterapia. Cinco destes animais tiveram de receber nova dosagem de sulfato de atropina uma hora após a primeira aplicação, em função de alguns sinais clínicos, como tremores musculares, ainda estarem presentes. De 48 a 72 horas após a administração do triclorfon, três destes cinco animais vieram a óbito. Na necropsia, foi possível observar mucosas cianóticas, congestão de fígado, baço e rins, vasos mesentéricos congestos, vesícula biliar repleta, enfisema pulmonar, parênquima pulmonar avermelhado. Os resultados encontrados neste trabalho chamam atenção que o surto aconteceu em cabras adultas, que apresentavam boas condições clínicas e acima de tudo, receberam a dosagem terapêutica recomendada em bula pelo fabricante. Talvez isso possa indicar alguma sensibilidade mais elevada desta espécie animal à dosagem recomendada em bula do triclorfon (100mg/kg) para caprinos.

Acute methemoglobinemia with hemolytic anemia following bio-organic plant nutrient compound exposure: Two case reports

Two young women, were reffered to our hospital on two different occasions with history of breathlessness and mental confusion, following consumption of two different bio-organic plant nutrient compounds with a suicidal intent. On examination, they had cyanotic mucous membranes, and their blood samples showed the classic ‘dark chocolate brown’ appearance. Work up revealed cyanosis unresponsive to oxygen supplementation and absence of cardiopulmonary abnormality. Pulse oximetry revealed saturation of 75% in case 1 and 80% in case 2, on 8 liters oxygen supplementation via face masks, although their arterial blood gas analysis was normal, suggestive of “saturation gap”. Methemoglobinemia was suspected based on these findings and was confirmed by Carbon monoxide-oximetry (CO-oximetry). Methylene blue was administered and the patients showed dramatic improvement. Both the patients developed evidence of hemolysis approximately 72 hours following admission which improved with blood transfusion and supportive treatment. The patients were eventually discharged without any neurological sequalae.

Cytological evaluation of pleural effusion with cell block technique in a dog

Bu olguda, 3,5 yaşlı, dişi Setter İspanyol ırkı bir köpekte plevral efüzyonun tanısında hücre bloğu tekniğinin kullanım olanağı araştırıldı. Bir haftadan beri akut solunum güçlüğü, halsizlik, hızlı solunum öyküsü olan bir köpek Ankara Üniversitesi Veteriner Fakültesi Küçük Hayvan Hastanesine kabul edildi. Kan testleri dahil rutin klinik incelemeleri yapıldı. Yapılan fiziksel incelemede karın şişkinliği, plevral efüzyon ve kranial müköz membranlarda siyanoz dikkati çekti. Torakosentez ile alınan plevra sıvısı kahverengimsi renkte, bulanık ve granüler materyal içermekteydi. Alınan plevra sıvısı örnekleri üç kısıma ayrıldı. Bir kısmı santrifuj teknikleriyle çalışıldı, diğer kısımlar ise hücre bloğu ve bakteriyolojik izolasyon için kullanıldı. Mikrobiyolojik yoklamada Escherichia coli ve Klebsiella spp. izole edildi. Plevral sıvının sitolojisinde septik efüzyona rastlandı. Hücre bloğunda sitosantrifüj tekniğine göre hücrelerin morfolojik detayları daha belirgin olarak görüldü. Sonuç olarak, bu olguda plevral efüzyonlu bir köpeğe sitolojik, bakteriyolojik, abdominal radyografi, ekokardiyografi, rutin kan testleriyle şiddetli triküspid yetmezliğine bağlı pyotoraks tanısı konuldu

Methemoglobinemia In Rhesus Monkeys Due To M-Hemoglobinopathy

M-hemoglobinopathies in humans are usually due to amino acid changes, which tend to stabilize the heme iron in ferric state and inaccessible to methemoglobin reductase. Consequently, blood methemoglobin concentrations are elevated despite normal methemoglobin reductase activity. No naturally-occurring animal models for M-hemoglobinopathies have been described. In contrast to humans where thousands of hereditary disorders and genetic predispositions to disease have been described, inborn errors of metabolism in non-human primates have been very rarely documented (e.g. globoid cell leukodystrophy). As part of an NIH-supported National Referral Center for Animal Models of Human Genetic Disease, which focuses on homologous hereditary diseases in dogs and cats, we present here the discovery and characterization of an M-hemogobinopathy in rhesus monkeys (Macaca mulatta). Adult rhesus monkeys of Chinese origin with persistent cyanotic mucous membranes and healthy controls were studied from two institutions. Despite the apparent cyanosis, these primates did clinically not show any other overt signs. Routine complete blood cell counts, chemistry screens and urinalyses as well as cardiopulmonary examinations did not reveal any abnormalities. Fresh EDTA blood samples were analyzed to determine the degree and cause of methemoglobinemia and results were compared to healthy rhesus monkeys from the same institutions. Blood methemoglobin concentrations were persistently increased to 15-30% in affected monkeys, while control animals had &lt;1% methemoglobin levels. Methemoglobin (cytochrome b5) reductase activities in erythrocytes were repeatedly measured in vitro and found to be normal compared to controls. Based upon the hemoglobin-oxygen dissociation curves and p50 values (14.8 mmHg; compared to 14.5 and 14.6 mmHg for controls) the oxygen transport function was normal. Both cation-exchange as well as reversed-phase and high performance liquid chromatography analyses revealed normal elution patterns of hemoglobin isotype and globin chains. DNA studies identified a disease-associated polymorphism in the alpha globin gene (CAC → CAA) in the affected animals. This change in the alpha globin protein was confirmed by mass spectrometry (α78 His → Gln). Our findings indicate an electrophoretically silent α-globin polymorphism is associated with methemoglobinemia in these rhesus monkeys. This is the first description of methemoglobinemia in a non-human primate and represents the first animal model of an M-hemoglobinopathy. While clinical signs were relatively mild in these rhesus monkeys, our findings represent one of the first inborn errors of metabolism described in non-human primates, thus emphasizing how unusual disorders caused by “experiments of nature” provide rare opportunities to gain a better understanding of both medicine and biology. Rhesus monkeys represent unique, valuable animal models for developing and testing new treatment options for hemoglobinopathies. Disclosures: No relevant conflicts of interest to declare.

Trema micrantha como causa de pneumopatia tóxica em ovinos: reprodução experimental

A intoxicação experimental por Trema micrantha em cinco ovinos é descrita. Quatro ovinos apresentaram sinais clínicos respiratórios acentuados e morte após ingestão da terceira dose de folhas da planta. As manifestações clínicas mais frequentes nesses casos foram taquipneia, dispneia, retração ritmada das narinas, mucosas cianóticas, corrimento nasal mucoso, hipertermia, aumento de volume abdominal bilateral e na região parotídea, incluindo crepitação à palpação, membros lateralmente afastados ao caminhar e decúbito esternal. T. micrantha mostrou-se tóxica para ovinos na dose de 20-50g/kg de peso animal. Na necropsia desses ovinos foram observados, além das mucosas cianóticas, enfisema subcutâneo em região cervical ventral ou porção mediastinal dorsal, pulmões não colabados, pesados, com impressão das costelas na superfície e conteúdo espumoso vermelho em traqueia e brônquios, além de múltiplas petéquias subpleurais. Na avaliação histológica predominaram alterações pulmonares, com espessamento de septos alveolares por proliferação difusa de pneumócitos tipo II, conferindo aspecto adenomatoso a algumas áreas. Os pneumócitos apresentavam núcleo volumoso, hipercromático, ora bizarro ou eram multinucleados, com nucléolos evidentes e, em algumas áreas, os pneumócitos estavam descamados para a luz alveolar, ora formando sincícios. Havia também proliferação do epitélio bronquiolar, com formação de mais de uma camada celular, núcleos hipercromáticos e volumosos e redução na quantidade de cílios. As alterações proliferativas dos pneumócitos e do epitélio bronquiolar foram evidenciadas pela imunomarcação anti-citoqueratina e anti-Ki-67 e, para a diferenciação entre pneumócitos e macrófagos alveolares, foi empregada imuno-histoquímica anti-mieloide/histiócitos (MAC387). Um ovino apresentou quadro clinico-patológico de insuficiência hepática aguda, com necrose hepatocelular acentuada após ingestão de 25g/kg de T. micrantha. A intoxicação experimental por T. micrantha em ovinos resultou em quadro clinico-patológico, predominantemente, respiratório na maioria dos casos, confirmando os resultados observados em casos de intoxicação espontânea.

Pathogenesis, laboratory diagnosis, and clinical implications of erythrocyte enzyme deficiencies in dogs, cats, and horses

Deficiencies of enzymes involved in erythrocyte metabolism can have significant effects on erythrocyte function and survival. Animals with pyruvate kinase (PK) or phosphofructokinase (PFK) deficiencies have shortened erythrocyte life spans and regenerative anemia. PK-deficient dogs (but not PK-deficient cats) develop progressive myelofibrosis and osteosclerosis of bone marrow and hemochromatosis and cirrhosis of the liver. PFK-deficient dogs have sporadic episodes of hyperventilation-induced intravascular hemolysis and hemoglobinuria. Cytochrome b5 reductase (Cb5R) deficiency in dogs and cats results in persistent methemoglobinemia and cyanotic mucous membranes. Severe deficiency of glucose-6-phosphate dehydrogenase, the rate-controlling enzyme in the pentose phosphate pathway, resulted in anemia with eccentrocytosis in an American saddlebred colt. Horses with erythrocyte flavin adenine dinucleotide (FAD) deficiency have both eccentrocytosis (attributable to severe deficiency in glutathione reductase activity) and methemoglobinemia (attributable to Cb5R deficiency); the dual enzyme deficiency occurs because FAD is a required cofactor for both enzymes. Erythrocyte enzyme deficiencies do not usually shorten life expectancy, except for PK-deficient dogs and potentially PFK-deficient dogs during a hemolytic crisis. Although enzyme deficiencies are rare causes of anemia and methemoglobinemia, the ability to diagnose deficient animals allows for the possibility of eliminating these undesirable traits in future breeding. DNA-based assays are available for PK and PFK deficiencies; whereas, biochemical tests of enzyme activity are required for other deficiencies. Continued research is needed to document additional enzyme deficiencies that likely occur and to develop additional DNA-based assays to detect heterozygous animals.