Prevalência da infecção do trato urinário e análise bacteriológica e antimicrobiana de uroculturas de gatos atendidos no HCV/UFRGS no período de 2009 a 2016

A infecção do trato urinário é a colonização bacteriana do epitélio estratificado dos variados locais do sistema urinário. É relativamente incomum em felinos domésticos, devido aos diversos mecanismos de defesa presentes nesta espécie. Possuir alterações anatômicas, idade avançada, ser fêmea castrada, ter baixo escore corporal, apresentar urólitos, ter sido submetido à procedimento de cateterização uretral ou ter passado por cirurgia de uretrostomia perineal são características que predispõem o indivíduo à infecção urinária. Além destes fatores, a presença de diabetes, doença renal crônica ou hipertireoidismo aumentam as chances de colonização bacteriana no trato urinário. O método padrão ouro para diagnóstico é a cultura de urina colhida através de cistocentese. A espécie bacteriana mais frequentemente encontrada nas uroculturas positivas é Escherichia coli e os sinais clínicos mais frequentes são hematúria, disúria, polaciúria e periúria. Neste trabalho, foi feito um estudo retrospectivo das uroculturas realizadas em gatos entre os meses de janeiro de 2009 e março de 2016, atendidos no Hospital de Clínicas Veterinárias da UFRGS. O objetivo foi a verificação da prevalência de infecção do trato e determinação de quais espécies de bactérias aparecem mais vezes nas culturas de urina positivas. O estudo também buscou estabelecer fatores associados à colonização bacteriana no trato urinário, além de identificar quais antimicrobianos são mais eficientes no combate aos microrganismos envolvidos. Entre os 60 animais com cultura de urina positiva, houve predomínio de machos castrados, entre três e seis anos de idade, alimentados com dieta exclusivamente composta por ração seca, creatinina sanguínea menor que 1,6 mg/dl e densidade urinária menor que 1,035. Os sinais clínicos mais frequentes foram hematúria, disúria e anúria. A bactéria mais frequentemente encontrada foi Staphylococcus spp. Quanto aos antimicrobianos testados, a combinação de amoxicilina com ácido clavulânico foi a mais eficaz contra gram-positivas, enquanto as bactérias gram-negativas apresentaram maior sensibilidade à norfloxacina. Esses dados obtidos auxiliarão no direcionamento do diagnóstico e tratamento dos gatos com suspeita de doenças do trato urinário atendidos no HCV/UFRGS.Urinary tract infection is the bacterial colonization of the stratified epithelium of any part of the urinary system. Is relatively uncommon in cats, due to the many defense mechanisms presents in this species. Cats that have anatomical abnormalities, old age, are a spayed female, have low body condition score, have uroliths, underwent a perineal urethrostomy surgery or underwent urinary catheterization are more prone to develop urinary tract infection. Furthermore, diabetes mellitus, chronic kidney disease and hyperthyroidism increase the risk of bacterial colonization in the urinary tract. The most frequently found bacterial species in positive cultures is Escherichia coli, and the most common clinical signs are hematuria, dysuria, pollakiuria and periuria. Culture of urine collected by cystocentesis is the gold standard method of diagnosis. In this study, we made a retrospective study of urine cultures performed in cats attended at the Veterinary Hospital of UFRGS, between the months of January 2009 and March 2016. The objective was to verify the prevalence of urinary tract infection and determining which species of bacteria appear more often in positive urine cultures. The study also sought to establish risk factors associated with bacterial colonization of the urinary tract, and identify which antimicrobials are more effective in combating microorganisms involved. Among the 60 animals that tested positive in urine culture, there was a predominance of 3 to 6 years old castrated males, fed a diet composed exclusively of dry food, with blood creatinine lower than 1.6 mg / dl and urinary density lower than 1,035 . The most common clinical signs were hematuria, dysuria and anuria. The most commonly found bacteria were Staphylococcus spp. The combination of amoxicillin with clavulanic acid was the most effective antibiotics against gram-positive bacteria and gram-negative bacteria showed higher sensitivity to norfloxacin. These data will assist in directing the diagnosis and treatment of cats with suspected urinary tract diseases seen in HCV / UFRGS

Mielinólise osmótica talâmica após manejo de crise de hipoadrenocorticismo primário

O hipoadrenocorticismo primário (PHA) é uma condição pouco frequente na rotina clínica, e dentre suas manifestações clássicas, a deficiente função mineralocorticoide promove distúrbio eletrolítico associado a hiponatremia e hipercalemia. Na presença de hiponatremia, uma suplementação rápida de sódio oferece risco de indução de mielinólise osmótica, sendo a região pontina mais suscetível. Este trabalho tem como objetivo descrever um caso de provável síndrome de mielinólise osmótica talâmica após terapia em fêmea West White Highland Terrier de 2 anos em crise de PHA. A paciente foi atendida no HCV/UFRGS com diagnóstico presuntivo de hipoadrenocorticismo, e já estava recebendo terapia com prednisolona, ranitidina e omeprazol. A dose da prednisolona foi considerada elevada, sendo, portanto, iniciada redução gradual da mesma. Trinta e seis horas após redução da dose, a canina apresentou gastroenterite severa e foi internada em clínica particular, onde recebeu fluidoterapia com solução de NaCl à 0,9%, juntamente com gastroprotetores, prednisolona e fludrocortisona. Após três dias, recebeu alta e, depois de quatro dias em casa, iniciou quadro neurológico, caracterizado por tetraparesia pouco ambulatória, déficits proprioceptivos e redução de reflexos de nervos cranianos. No exame de ressonância magnética, foram documentadas duas lesões circulares intra axiais, distribuídas de forma extremamente simétrica, uma em tálamo esquerdo e outra em tálamo direito. A paciente voltou a ficar internada e apresentou melhora dos sinais neurológicos frente a manutenção da terapia com prednisolona e fludrocortisona. O trabalho evidencia a importância da confirmação hormonal do diagnóstico e da avaliação eletrolítica em pacientes com PHA, os riscos da suplementação excessiva de sódio, e que a terapia padrão de suplementação de glicocorticoides aparentemente é suficiente para auxiliar na recuperação neurológica dos pacientes que sofrem mielinólise osmótica.Primary hypoadrenocorticism (PHA) is a rare condition in small animal medicine. Among its classic manifestations, mineralocorticoid function deficiency leads to electrolytical disturbances associated with hyponatremia and hyperkalemia. In the presence of hyponatremia, a quick sodium supplementation offers a risk of osmotic myelinolysis syndrome, being central pontine region more susceptible. The aim of this work is to report a possible thalamic osmotic myelinolysis syndrome in a 3 years old female West White Highland Terrier in PHA crisis. The patient was brought to the HCV/UFRGS with a hypoadrenocorticism presumptive diagnosis already being treated with prednisolone, ranitidine, omeprazole. The prednisolone dose (1mg/kg, VO, bid) was considered too high, and then a gradual reduction scheme was started. However, after 36 hours the patient showed a severe gastroenteritis with hematoquesia, being then interned in a particular clinical facility. The patient received NaCl 0.9% intravenously and gastric protectors associated with dexamethasone initially followed by prednisolone and fludrocortisone. The animal was discharged from the facility after three days; however, after four days at home started to show neurologic abnormalities characterized by little ambulatory tetraparesis, proprioceptive deficits in the four legs and reduction in cranial nerves reflexes. At magnetic resonance imaging two symmetric and circular lesions within left and right thalamus were documented suggesting osmotic myelinolysis. The patient was kept admitted at the clinic until neurological recovery was documented while therapy with prednisolone and fludrocortisone was continued. This case report evidences the importance of a hormonal diagnostic confirmation and electrolytic evaluation before starting PHA therapy, as well as the risk of a quick serum sodium elevation. Moreover, emphasizes that probably standard glucocorticoid replacement therapy is enough to help neurologic recover of dogs that suffer osmotic myelinolysis syndrome

Osmotic Demyelination Syndrome after Primary Hypoadrenocorticism Crisis Management

Background: Primary hypoadrenocorticism is a rare condition resulting from immune-mediated destruction of the adrenal cortices. It can also occur due to necrosis, neoplasms, infarctions and granulomas. The clinical and laboratory changes are due to deficient secretion of glucocorticoids and mineralocorticoids, which leads to electrolyte disorders associated with hyponatremia and hyperkalemia. These disorders can cause hypotension, hypovolemia and shock, putting a patient's life at risk if inadequate hydroelectrolytic supplementation and hormone replacement is provided. Nevertheless, rapid sodium chloride supplementation is contraindicated due to the risk of central pontine myelinolysis induction. The present study aims to describe a thalamic osmotic demyelination syndrome after management of a primary hypoadrenocorticism crisis in a 2-year-old, female West White Highland Terrier. Case: The patient had a presumptive diagnosis of hypoadrenocorticism already receiving oral prednisolone and gastrointestinal protectants in the last 2 days. After prednisolone dose reduction the dog presented a severe primary hypoadrenocorticism crisis treated with intravenous sodium chloride 0.9% solution along with supportive therapy. Four days after being discharged from the hospital, the patient showed severe neurological impairment and went back to the clinic where a neurological examination revealed mental depression, drowsiness, ambulatory tetraparesis and proprioceptive deficit of the 4 limbs, postural deficits, and cranial nerves with decreased response. Due to these clinical signs, a magnetic resonance imaging was performed. It showed 2 intra-axial circular lesions, symmetrically distributed in both thalamus sides, with approximately 0.8 cm in diameter each without any other anatomical changes on magnetic resonance imaging. The images were compatible with metabolic lesions, suggesting demyelination. Furthermore, liquor analysis did not show relevant abnormalities, except for a slight increase in density and pH at the upper limit of the reference range. After treatment, the patient had a good neurological evolution secondary to standard primary hypoadrenocorticism treatment, without sequelae. Discussion: In the present case report, primary hypoadrenocorticism gastrointestinal signs seemed to be triggered by a food indiscretion episode, not responsive to the symptomatic therapies employed. The patient´s breed and age (young West White Highland Terrier bitch) is in accordance with the demographic profile of patients affected by the disease, where young females are frequently more affected. Regarding the probable thalamic osmotic demyelination syndrome documented in this case, is important to notice that myelinolysis or demyelination is an exceedingly rare noninflammatory neurological disorder, initially called central pontine myelinolysis, which can occur after rapid correction of hyponatremia. It has already been observed in dogs after correction of hyponatremia of different origins, including hypoadrenocorticism and parasitic gastrointestinal disorders. Currently, the terms "osmotic myelinolysis" or “osmotic demyelination syndrome" are considered more suitable when compared to the term "central pontine myelinolysis" since it has been demonstrated in dogs and humans the occurrence of demyelination secondary to the rapid correction of hyponatremia in distinct regions of the central nervous system including pons, basal nuclei, striatum, thalamus, cortex, hippocampus and cerebellum. The present case report emphasizes the difficulties for hormonal confirmation of primary hypoadrenocorticism in a patient already on corticosteroid treatment, as well as proposes that the current term osmotic demyelination syndrome replace the term “central pontine myelinolysis” in veterinary literature related to the management of hypoadrenocorticism crisis.Keywords: Addison Syndrome, hyponatremia, osmotic myelinolysis, magnetic resonance imaging

Osmotic demyelination syndrome after primary hypoadrenocorticism crisis management

Background: Primary hypoadrenocorticism is a rare condition resulting from immune-mediated destruction of the adrenal cortices. It can also occur due to necrosis, neoplasms, infarctions, and granulomas. The clinical and laboratory changes are due to deficient secretion of glucocorticoids and mineralocorticoids, which leads to electrolyte disorders associated with hyponatremia and hyperkalemia. These disorders can cause hypotension, hypovolemia and shock, putting a patient’s life at risk if inadequate hydroelectrolytic supplementation and hormone replacement is provided. Nevertheless, rapid sodium chloride supplementation is contraindicated due to the risk of central pontine myelinolysis induction. The present study aims to describe a thalamic osmotic demyelination syndrome after management of a primary hypoadrenocorticism crisis in a 2-year-old, female West White Highland Terrier. Case: The patient had a presumptive diagnosis of hypoadrenocorticism already receiving oral prednisolone and gastrointestinal protectants in the last 2 days. After prednisolone dose reduction the dog presented a severe primary hypoadrenocorticism crisis treated with intravenous sodium chloride 0.9% solution along with supportive therapy. Four days after being discharged from the hospital, the patient showed severe neurological impairment and went back to the clinic where a neurological examination revealed mental depression, drowsiness, ambulatory tetraparesis and proprioceptive deficit of the 4 limbs, postural deficits, and cranial nerves with decreased response. Due to these clinical signs, a magnetic resonance imaging was performed. It showed 2 intra-axial circular lesions, symmetrically distributed in both thalamus sides, with approximately 0.8 cm in diameter each without any other anatomical changes on magnetic resonance imaging. The images were compatible with metabolic lesions, suggesting demyelination. Furthermore, liquor analysis did not show relevant abnormalities, except for a slight increase in density and pH at the upper limit of the reference range. After treatment, the patient had a good neurological evolution secondary to standard primary hypoadrenocorticism treatment, without sequelae. Discussion: In the present case report, primary hypoadrenocorticism gastrointestinal signs seemed to be triggered by a food indiscretion episode, not responsive to the symptomatic therapies employed. The patient´s breed and age (young West White Highland Terrier bitch) is in accordance with the demographic profile of patients affected by the disease, where young females are frequently more affected. Regarding the probable thalamic osmotic demyelination syndrome documented in this case, is important to notice that myelinolysis or demyelination is an exceedingly rare noninflammatory neurological disorder, initially called central pontine myelinolysis, which can occur after rapid correction of hyponatremia. It has already been observed in dogs after correction of hyponatremia of different origins, including hypoadrenocorticism and parasitic gastrointestinal disorders. Currently, the terms “osmotic myelinolysis” or “osmotic demyelination syndrome” are considered more suitable when compared to the term “central pontine myelinolysis” since it has been demonstrated in dogs and humans the occurrence of demyelination secondary to the rapid correction of hyponatremia in distinct regions of the central nervous system including pons, basal nuclei, striatum, thalamus, cortex, hypoppocampus, and cerebelum. The present case report emphasizes the difficulties for hormonal confirmation of primary hypoadrenocorticism in a patient already on corticosteroid treatment, as well as proposes that the current term osmotic demyelination syndrome replace the term “central pontine myelinolysis” in veterinary literature related to the management of hypoadrenocorticism crisis

Prevalência da infecção do trato urinário e análise bacteriológica e antimicrobiana de uroculturas de gatos atendidos no HCV/UFRGS no período de 2009 a 2016

A infecção do trato urinário é a colonização bacteriana do epitélio estratificado dos variados locais do sistema urinário. É relativamente incomum em felinos domésticos, devido aos diversos mecanismos de defesa presentes nesta espécie. Possuir alterações anatômicas, idade avançada, ser fêmea castrada, ter baixo escore corporal, apresentar urólitos, ter sido submetido à procedimento de cateterização uretral ou ter passado por cirurgia de uretrostomia perineal são características que predispõem o indivíduo à infecção urinária. Além destes fatores, a presença de diabetes, doença renal crônica ou hipertireoidismo aumentam as chances de colonização bacteriana no trato urinário. O método padrão ouro para diagnóstico é a cultura de urina colhida através de cistocentese. A espécie bacteriana mais frequentemente encontrada nas uroculturas positivas é Escherichia coli e os sinais clínicos mais frequentes são hematúria, disúria, polaciúria e periúria. Neste trabalho, foi feito um estudo retrospectivo das uroculturas realizadas em gatos entre os meses de janeiro de 2009 e março de 2016, atendidos no Hospital de Clínicas Veterinárias da UFRGS. O objetivo foi a verificação da prevalência de infecção do trato e determinação de quais espécies de bactérias aparecem mais vezes nas culturas de urina positivas. O estudo também buscou estabelecer fatores associados à colonização bacteriana no trato urinário, além de identificar quais antimicrobianos são mais eficientes no combate aos microrganismos envolvidos. Entre os 60 animais com cultura de urina positiva, houve predomínio de machos castrados, entre três e seis anos de idade, alimentados com dieta exclusivamente composta por ração seca, creatinina sanguínea menor que 1,6 mg/dl e densidade urinária menor que 1,035. Os sinais clínicos mais frequentes foram hematúria, disúria e anúria. A bactéria mais frequentemente encontrada foi Staphylococcus spp. Quanto aos antimicrobianos testados, a combinação de amoxicilina com ácido clavulânico foi a mais eficaz contra gram-positivas, enquanto as bactérias gram-negativas apresentaram maior sensibilidade à norfloxacina. Esses dados obtidos auxiliarão no direcionamento do diagnóstico e tratamento dos gatos com suspeita de doenças do trato urinário atendidos no HCV/UFRGS.Urinary tract infection is the bacterial colonization of the stratified epithelium of any part of the urinary system. Is relatively uncommon in cats, due to the many defense mechanisms presents in this species. Cats that have anatomical abnormalities, old age, are a spayed female, have low body condition score, have uroliths, underwent a perineal urethrostomy surgery or underwent urinary catheterization are more prone to develop urinary tract infection. Furthermore, diabetes mellitus, chronic kidney disease and hyperthyroidism increase the risk of bacterial colonization in the urinary tract. The most frequently found bacterial species in positive cultures is Escherichia coli, and the most common clinical signs are hematuria, dysuria, pollakiuria and periuria. Culture of urine collected by cystocentesis is the gold standard method of diagnosis. In this study, we made a retrospective study of urine cultures performed in cats attended at the Veterinary Hospital of UFRGS, between the months of January 2009 and March 2016. The objective was to verify the prevalence of urinary tract infection and determining which species of bacteria appear more often in positive urine cultures. The study also sought to establish risk factors associated with bacterial colonization of the urinary tract, and identify which antimicrobials are more effective in combating microorganisms involved. Among the 60 animals that tested positive in urine culture, there was a predominance of 3 to 6 years old castrated males, fed a diet composed exclusively of dry food, with blood creatinine lower than 1.6 mg / dl and urinary density lower than 1,035 . The most common clinical signs were hematuria, dysuria and anuria. The most commonly found bacteria were Staphylococcus spp. The combination of amoxicillin with clavulanic acid was the most effective antibiotics against gram-positive bacteria and gram-negative bacteria showed higher sensitivity to norfloxacin. These data will assist in directing the diagnosis and treatment of cats with suspected urinary tract diseases seen in HCV / UFRGS

Osmotic Demyelination Syndrome after Primary Hypoadrenocorticism Crisis Management

Background: Primary hypoadrenocorticism is a rare condition resulting from immune-mediated destruction of the adrenal cortices. It can also occur due to necrosis, neoplasms, infarctions and granulomas. The clinical and laboratory changes are due to deficient secretion of glucocorticoids and mineralocorticoids, which leads to electrolyte disorders associated with hyponatremia and hyperkalemia. These disorders can cause hypotension, hypovolemia and shock, putting a patient's life at risk if inadequate hydroelectrolytic supplementation and hormone replacement is provided. Nevertheless, rapid sodium chloride supplementation is contraindicated due to the risk of central pontine myelinolysis induction. The present study aims to describe a thalamic osmotic demyelination syndrome after management of a primary hypoadrenocorticism crisis in a 2-year-old, female West White Highland Terrier. Case: The patient had a presumptive diagnosis of hypoadrenocorticism already receiving oral prednisolone and gastrointestinal protectants in the last 2 days. After prednisolone dose reduction the dog presented a severe primary hypoadrenocorticism crisis treated with intravenous sodium chloride 0.9% solution along with supportive therapy. Four days after being discharged from the hospital, the patient showed severe neurological impairment and went back to the clinic where a neurological examination revealed mental depression, drowsiness, ambulatory tetraparesis and proprioceptive deficit of the 4 limbs, postural deficits, and cranial nerves with decreased response. Due to these clinical signs, a magnetic resonance imaging was performed. It showed 2 intra-axial circular lesions, symmetrically distributed in both thalamus sides, with approximately 0.8 cm in diameter each without any other anatomical changes on magnetic resonance imaging. The images were compatible with metabolic lesions, suggesting demyelination. Furthermore, liquor analysis did not show relevant abnormalities, except for a slight increase in density and pH at the upper limit of the reference range. After treatment, the patient had a good neurological evolution secondary to standard primary hypoadrenocorticism treatment, without sequelae. Discussion: In the present case report, primary hypoadrenocorticism gastrointestinal signs seemed to be triggered by a food indiscretion episode, not responsive to the symptomatic therapies employed. The patient´s breed and age (young West White Highland Terrier bitch) is in accordance with the demographic profile of patients affected by the disease, where young females are frequently more affected. Regarding the probable thalamic osmotic demyelination syndrome documented in this case, is important to notice that myelinolysis or demyelination is an exceedingly rare noninflammatory neurological disorder, initially called central pontine myelinolysis, which can occur after rapid correction of hyponatremia. It has already been observed in dogs after correction of hyponatremia of different origins, including hypoadrenocorticism and parasitic gastrointestinal disorders. Currently, the terms "osmotic myelinolysis" or “osmotic demyelination syndrome" are considered more suitable when compared to the term "central pontine myelinolysis" since it has been demonstrated in dogs and humans the occurrence of demyelination secondary to the rapid correction of hyponatremia in distinct regions of the central nervous system including pons, basal nuclei, striatum, thalamus, cortex, hippocampus and cerebellum. The present case report emphasizes the difficulties for hormonal confirmation of primary hypoadrenocorticism in a patient already on corticosteroid treatment, as well as proposes that the current term osmotic demyelination syndrome replace the term “central pontine myelinolysis” in veterinary literature related to the management of hypoadrenocorticism crisis.Keywords: Addison Syndrome, hyponatremia, osmotic myelinolysis, magnetic resonance imaging