The Canadian Veterinary Journal La Revue …...Equine sinonasal anaplastic sarcoma infected with multi-drug resistant Escherichia coli February/Février 2019 Volume 60, No. 02 February/Février

What is the evidence that bovine coronavirus is a biologically significant respiratory pathogen in cattle?

Distribution and abundance of Eimeria species in commercial turkey flocks across Canada

Comparison of carbon dioxide laser versus bipolar vessel device for staphylectomy for the treatment of brachycephalic obstructive airway syndrome

Evaluation of risk factors for mortality in dogs with lung lobe torsion: A retrospective study of 66 dogs (2000–2015)

Transient distal renal tubular acidosis in a dog with gastric-dilatation-volvulus

Use of slide scrape lysates for polymerase chain reaction confirmation of disseminated Mycobacterium avium infection in a cat

Feline infectious peritonitis in a cat presented because of papular skin lesions

Bilateral phacoemulsification and intraocular lens implantation in a young African lion (Panthera leo)

Plasma transfusions in horses with typhlocolitis/colitis

Congenital hydrocephalus in a Belgian draft horse associated with a nonsense mutation in B3GALNT2

Equine sinonasal anaplastic sarcoma infected with multi-drug resistant Escherichia coli

February/Février 2019 Volume 60, No. 02

February/Février 2019 Vol. 60, No. 02

The Canadian Veterinary Journal La Revue vétérinaire canadienne

The Canadian Veterinary Journal La R

evue vétérinaire canadienne

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CVJ / VOL 60 / FEBRUARY 2019 115

SCIENTIFIC RUBRIQUE SCIENTIFIQUE

REVIEW ARTICLE COMPTE RENDU

147 What is the evidence that bovine coronavirus is a biologically significant respiratory pathogen in cattle?John Ellis

ARTICLES

153 Distribution and abundance of Eimeria species in commercial turkey flocks across CanadaRachel K. Imai, John R. Barta

160 Comparison of carbon dioxide laser versus bipolar vessel device for staphylectomy for the treatment of brachycephalic obstructive airway syndromeMeghan S. Kirsch, Daniel Spector, Sarah R. Kalafut, George E. Moore, Renee McDougall

167 Evaluation of risk factors for mortality in dogs with lung lobe torsion: A retrospective study of 66 dogs (2000–2015)Shannon H. Wainberg, Brigitte A. Brisson, Stephanie N. Reabel, Jennifer Hay, Galina Hayes, Cindy L. Shmon, Kim Murphy, William Sears

CASE REPORTS RAPPORTS DE CAS

174 Transient distal renal tubular acidosis in a dog with gastric-dilatation-volvulusCarlos Torrente, Carla Molina, Luis Bosch, Cristina Costa-Farré

179 Use of slide scrape lysates for polymerase chain reaction confirmation of disseminated Mycobacterium avium infection in a catHilary J. Burgess, Betty P. Lockerbie, Tanya R. Marshall

183 Feline infectious peritonitis in a cat presented because of papular skin lesionsTony Redford, Ahmad N. Al-Dissi

186 Bilateral phacoemulsification and intraocular lens implantation in a young African lion (Panthera leo)Marta Viñas, Nunzio D’Anna, Adolfo Guandalini, Michele Capasso, Maurizio Nocerino, Alessandra Guerriero, John Sapienza

BRIEF COMMUNICATIONS COMMUNICATIONS BRÈVES

193 Plasma transfusions in horses with typhlocolitis/colitisLuis G. Arroyo, William Sears, Diego E. Gomez

197 Congenital hydrocephalus in a Belgian draft horse associated with a nonsense mutation in B3GALNT2David Scott Kolb, Claudia Klein

STUDENT PAPER COMMUNICATION ÉTUDIANTE

199 Equine sinonasal anaplastic sarcoma infected with multi-drug resistant Escherichia coliAlexandra Warren

127 QUIZ CORNER TEST ÉCLAIR

Contents Table des matières

FEBRUARY/FÉVRIER 2019


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Contents Table des matièresFEATURES RUBRIQUES

FEBRUARY/FÉVRIER 2019

EDITORIAL ÉDITORIAL

119 Veterinary telemedicine Télémédecine vétérinaireCarlton Gyles

123 VETERINARY MEDICAL ETHICS DÉONTOLOGIE VÉTÉRINAIRE

SPECIAL REPORT RAPPORT SPÉCIAL

145 The Pan-Canadian Approach to Wildlife HealthCraig Stephen

THE ART OF PRIVATE VETERINARY PRACTICE L’ART DE LA PRATIQUE VÉTÉRINAIRE PRIVÉE

203 Too much of a good thingMyrna Milani

Contributors

“Instructions for authors” are available online (www.canadianveterinarians.net).

Les «Directives à l’intention des auteurs» sont disponibles en ligne (www.veterinairesaucanada.net).

202 Index of Advertisers Index des annonceurs

205 Classifieds Petites annonces

NOTICES ANNONCES

131 NEWS NOUVELLESHeather Broughton, Isabelle Vallières

N E W S | N O U V E L L E S


118 CVJ / VOL 60 / FEBRUARY 2019

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Editorial policy: All published articles including editorials and letters reflect the opinions of the authors and do not necessarily reflect the opinion of the publisher.Publication of an advertisement does not necessarily imply that the publisher agrees with or supports the claims therein.The Canadian Veterinary Medical Association holds complete copyright of all articles within this issue.Politique de la Rédaction : Tous les articles publiés, y compris les éditoriaux et les lettres, représentent l’opinion de l’auteur et non pas nécessairement la position de l’éditeur.La publication d’une annonce ne signifie pas nécessairement que l’éditeur est d’accord avec son contenu ou qu’il l’appuie.L’Association canadienne des médecins vétérinaires détient le droit d’auteur complet sur tous les articles contenus dans le présent numéro.

Editor-in-Chief/Rédacteur en chef Carlton Gyles, Guelph, OntarioAssociate Editors/Rédacteurs associés Bruce Grahn, Saskatoon, Saskatchewan Wayne McDonell, Guelph, OntarioFeature Editors/Rédacteurs des chroniques Jangi Bajwa, Burnaby, British ColumbiaBruce Grahn, Saskatoon, SaskatchewanMyrna Milani, Charlestown, New HampshireDebbie Stoewen, Ayr, OntarioTim Blackwell, Fergus, OntarioAssistant Editors/Rédacteurs adjoints Robert Friendship, Guelph, Ontario Greg Harasen, Regina, Saskatchewan Jacob Thundathil, Calgary, Alberta Ron Johnson, Guelph, Ontario Richard Kennedy, Pincher Creek, Alberta Shawn McKenna, Charlottetown, P.E.I. Luis Gaitero, Guelph, OntarioManaging Editor/Directrice de la rédaction Heather Broughton, Ottawa, OntarioAssistant Managing Editor/Directrice adjointe de la rédaction Stella Wheatley, Ottawa, OntarioEditorial Coordinator/Coordonnatrice de la rédaction Kelly Gray-Sabourin, Ottawa, OntarioAdvertising and Sponsorship Consultant/Consultante, publicité et commandites Laima Laffitte, Wendover, Ontario

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Editorial Éditorial

«L a télémédecine se définit largement comme le recours aux technologies de télécommunication pour

fournir des renseignements et des services médicaux» (1). Les applications de la télémédecine moderne trouvent leur origine dans le transfert des électrocardiogrammes en Europe au début du 20e siècle. Peu de temps après, des consultations par radio ont été utilisées pour porter assistance aux patients à bord des navires ou dans des endroits éloignés. En Amérique du Nord, une vague de programmes, dont la transmission d’images radiographiques, s’est amorcée dans les années 1950. D’autre part, les besoins de la NASA pour fournir une capacité d’assistance médicale à distance aux astronautes ont suscité des progrès aux États-Unis. Plus tard, la télémédecine a été perçue comme une réponse partielle aux pénuries de médecins de famille et de spécialistes, particulièrement en région éloignée. La télémédecine est aussi perçue comme un moyen efficace et pratique d’accéder aux soins pour les travailleurs à court de temps.

Le développement de la nouvelle technologie permet de réduire graduellement son coût tandis que la pression sur l’infrastructure hospitalière et la prévalence des affections médicales chroniques continuent d’augmenter et, en conséquence, la télémédecine devient de plus en plus attrayante pour les prestataires de soins et les patients. Un système qui a commencé comme un simple transfert d’images s’est épanoui en un éventail complexe de technologies qui forment des réseaux médicaux électroniques afin de fournir de la chirurgie assistée, un diagnostic ou des consultations thérapeutiques, une gestion des cas et de l’éducation à distance.

Au Canada, plusieurs compagnies privées fournissent l’accès à la télémédecine pour les humains. Habituellement, les clients paient des frais de consultation ou achètent un abonnement. Un PDG d’entreprise a signalé que plus de la moitié des diagnostics posés n’exigent pas un accès en personne et a suggéré que la télémédecine représente une solution partielle au problème des

“T elemedicine can be broadly defined as the use of telecommunications technologies to provide medical

information and services” (1). Modern telemedicine applications originate with the transfer of electrocardiograms in Europe at the beginning of the 20th century. Not long after, consultations by radio were used to assist patients on ships and in remote places. In North America, a wave of programs including transmission of radiographic images began in the 1950s. NASA’s need to have the capacity to remotely provide medical assistance to astronauts spurred developments in the USA. Later, telemedicine was seen as a partial answer to shortages of family doctors and specialists, especially in remote areas. Telemedicine is also seen as providing efficient and convenient access for busy working people.

As newer technology is developed, the cost of the technology goes down, but pressure on hospital infrastructure continues to increase, as does the prevalence of chronic medical conditions, thereby making telemedicine increasing more attractive for pro-viders and patients. A system that started as a simple transfer of images has blossomed into a complex array of technologies that form electronic medical networks to provide remotely assisted surgery, diagnostic or therapeutic consultations, case manage-ment and education.

In Canada, a number of private companies provide access to telemedicine for humans. Typically, clients pay a consultation fee, or purchase a subscription. One company CEO noted that over half of the diagnoses that are made do not require in-person hands-on access and suggested that telemedicine is a partial answer to the problem of long wait times, as well as a time-saver for some patients (2). You pay for rapid and convenient access to a doctor who can provide advice, order prescriptions, and treat certain conditions (3). One advertisement promises instant connection to a doctor from your phone, tablet, or computer at any time. The patient opens the app, describes her/his symptoms and requests to see a doctor. You are connected to a doctor, with

Veterinary telemedicine

Télémédecine vétérinaire

Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.

L’usage du présent article se limite à un seul exemplaire pour étude personnelle. Les personnes intéressées à se procurer des réimpressions devraient communiquer avec le bureau de l’ACMV ([email protected]) pour obtenir des exemplaires additionnels ou la permission d’utiliser cet article ailleurs.



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longs délais d’attente ainsi qu’une façon d’économiser du temps pour certains patients (2). Les patients paient pour un accès rapide et pratique à un médecin qui peut fournir des conseils, commander des ordonnances et traiter certaines affections (3). Une publicité promet un accès instantané, en tout temps, à un médecin à partir de votre téléphone, tablette ou ordinateur. Le patient ouvre l’application, décrit ses symptômes et demande à voir un médecin. Le lien est établi avec un médecin et une consultation s’effectue par écrit ou en mode audio ou vidéo. Le médecin peut poser un diagnostic et, si nécessaire, fournir des ordonnances.

La télémédecine vétérinaire suit cette même évolution que la télémédecine humaine, mais il y a des défis associés à l’incapacité des patients de décrire leurs maux. Des organismes de réglementation, tels que le College of Veterinarians of Ontario (CVO), ont agi rapidement afin d’établir un cadre de travail pour la prestation de soins vétérinaires de cette manière. Les règlements du CVO appuient les progrès de la télémédecine pour les animaux, mais ils insistent sur la présence d’une relation vétérinaire-client-patient (RVCP). Dans beaucoup de cas, un examen physique est considéré comme étant essentiel pour un diagnostic approprié et des médicaments ne peuvent pas être prescrits en se basant uniquement sur la télémédecine.

Il existe maintenant plusieurs possibilités permettant aux clients d’accéder à des services de télésanté pour leurs animaux au Canada et aux États-Unis. L’entreprise Ontario Veterinary TeleHealth Services a été lancée en 2016 et affirme être la première dans ce domaine au Canada. Dirigée par le Dr Garth Graham de Guelph, en Ontario, cette entreprise a établi des plateformes de communication numérique qui permettent aux médecins vétérinaires d’entrer en contact avec les propriétaires d’animaux afin d’offrir une consultation sur des questions de santé. L’entreprise était d’abord simplement un numéro 1-800 où les propriétaires d’animaux pouvaient contacter le Dr Graham qui écoutait la description du propriétaire et offrait des conseils (4).

L’entreprise Healthy Pets a été fondée plus récemment mais elle a récolté une publicité considérable lors d’un épisode de l’émission de télévision Dragon’s Den, au cours de laquelle Emma Harris, PDG de l’entreprise, a reçu un investissement de 500 000 $ du fond de capital de risque d’Arlene Dickinson (5). Healthy Pets offre une plateforme vidéo et un réseau de médecins vétérinaires qui peuvent évaluer les signes cliniques et offrir des conseils mais n’ont pas le droit de poser un diagnostic ni de prescrire de médicaments. Les propriétaires d’animaux peuvent opter pour une seule consultation de 15 minutes ou ils peuvent acheter un abonnement mensuel. Les médecins vétérinaires du réseau paient 50 $/mois et gagnent 20 $ par consultation. La valeur du service consiste à guider les clients vers le niveau approprié d’intervention et il le fait d’une manière pratique et économique.

Healthy Pets s’apparente aux compagnies américaines, comme Whisker Docs, qui offre une ligne d’assistance 24 heures par jour et sept jours par semaine par téléphone, courriel ou clavardage. Ces compagnies facturent 39,99 $ pour un appel et 4,99 $ pour un courriel. L’abonnement annuel coûte 129,99 $ et l’abonnement mensuel est de 16,99 $. Fait intéressant,

whom you consult by text, audio, or video. The doctor can make a diagnosis and, if necessary, provide prescriptions.

Veterinary telemedicine is following along the same path as human telemedicine but has challenges associated with the inability of patients to describe their ailment. Regulatory bod-ies such as the College of Veterinarians of Ontario (CVO) have been quick to lay out the framework within which veterinar-ians can engage in this form of veterinary practice. The CVO regulations support developments in telemedicine for animals, but insist on a veterinarian-client-patient relationship (VCPR). In many cases a physical examination is considered essential for a proper diagnosis and drugs cannot be prescribed based on telemedicine alone.

There are now several opportunities for clients to access telehealth services for their pets in Canada and the US. Ontario Veterinary TeleHealth Services started in 2016 and claims to be the first in this field in Canada. Led by Dr. Garth Graham in Guelph, Ontario, this company has established digital commu-nication platforms that allow veterinarians to connect with pet owners to provide consultation on health issues. The business started as a simple one in which pet owners could call a 1-800 number and reach Dr. Graham who would listen to the owner’s description and offer advice (4).

Healthy Pets started more recently but garnered considerable publicity through an episode of the television show Dragon’s Den, on which Emma Harris, CEO of the company, received a $500 000 boost from Arlene Dickinson’s venture capital fund (5). Healthy Pets has a video platform and a network of vet-erinarians who are able to assess clinical signs and offer advice but are not permitted to diagnose or prescribe. Pet owners may opt for single 15-minute sessions or they may pay a monthly subscription. Veterinarians in the network pay $50/month and earn $20 per consultation. The value of the service is that it guides clients to the appropriate level of intervention and does so in a convenient and inexpensive manner.

Healthy Pets is similar to US companies, such as Whisker Docs, which offers a 24/7 pet helpline via phone, e-mail, or live chat. They charge $39.99 for a call-in or live chat and $4.99 for e-mail. Annual subscription is $129.99; monthly subscription is $16.99. An interesting expansion involves an arrangement with Embrace Pet Insurance, whereby pet owners with this company’s insurance have free access to Whisker Docs services.

Telemedicine for farm animals is somewhat different. Some rural farm animal practices are using smartphones and iPads in combination with FaceTime and Skype to gather and share patient information in order to get a head start on decision-making and to provide assistance to inexperienced colleagues in activities such as surgery. Also, researchers are investigating systems to monitor farm animal health at a distance. Challenges include cost-effectiveness, robustness and accuracy of equipment, effectiveness in predicting health status, and information security.

There appears to be a bright future for telemedicine for animals. It expands access to veterinary health care, provides an inexpensive triage service, provides payment for veterinary consultation, and is particularly effective in situations such as follow-up after an office or hospital visit or for inspection of surgical sites or mobility.


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References1. Perednia DA, Allen A. Telemedicine technology and clinical applications.

J Am Med Assoc 1995;273:483–488.2. Hughes M. How Maple brought on-demand telemedicine to Canada.

February 2018. Available from: https://thenextweb.com/ca/2018/03/08/maple-brought-demand-telemedicine-canada/ Last accessed December 9, 2018.

3. Online doctors, virtual health and prescriptions. $49/consultation. Available from: https://www.getmaple.ca/?utm_term=tele%20medicine&utm_content=59389545790&utm_campaign=1405004122&gclid=CjwKCAjwu5veBRBBEiwAFTqDwV1L7zlaqD3Z6-q3jnx1rPqN86b6pxkO1pndKbWW4Q_V6XdlkXNrcBoCZl0QAvD_BwE Last accessed December 9, 2018.

4. Roberts O. Urban Cowboy: Should you go to the vet? Ask Telehealth Pets. May 11, 2017. Available from: https://www.guelphtoday.com/columns/urban-cowboy-with-owen-roberts/urban-cowboy-should-you-go-to-the-vet-ask-telehealth-pets-610406 Last accessed December 9, 2018.

5. Carroza A. First Video-Based Canadian Veterinary Telehealth Company Launched. American Veterinarian, April 13, 2018. Available from: https://www.americanveterinarian.com/news/first-videobased-canadian-veterinary-telehealth-company-launched Last accessed December 9, 2018. ■

Carlton Gyles

Opinions expressed in this column are those of the Editor.

une entente conclue avec Embrace Pet Insurance permet aux propriétaires d’animaux inscrits aux services de cette compagnie d’assurance d’avoir accès gratuitement aux services de Whisker Docs.

La télémédecine pour les animaux d’élevage est quelque peu différente. Quelques établissements ruraux pour animaux d’élevage utilisent des téléphones intelligents et des iPad conjointement à FaceTime et Skype afin de recueillir et de partager les renseignements des patients pour prendre de l’avance sur la prise de décisions et fournir de l’assistance aux collègues non expérimentés dans des activités comme la chirurgie. De plus, des chercheurs étudient des systèmes permettant de surveiller à distance la santé des animaux d’élevage. Les défis liés à ces systèmes incluent l’abordabilité, la solidité et l’exactitude de l’équipement, l’efficacité dans la prédiction de l’état de santé et la sécurité de l’information.

La télémédecine pour les animaux semble vouée à un brillant avenir, car elle permet d’élargir l’accès aux soins vétérinaires, fournit un service de triage économique, offre une rémunération pour la consultation vétérinaire et est particulièrement efficace dans des situations comme un suivi après une visite au cabinet ou à la clinique ou pour l’inspection des sites chirurgicaux ou la mobilité.

Renvois1. PEREDNIA, D.A. et A. ALLEN. «Telemedicine Technology and Clinical

Applications», JAMA, 1995, vol. 273, p. 483–488.2. HUGHES, M. How Maple brought on-demand telemedicine to Canada.

Février 2018. Disponible au : https://thenextweb.com/ca/2018/03/08/maple-brought-demand-telemedicine-canada/ Dernière consultation le 9 décembre 2018.

3. Online doctors, virtual health and prescriptions. $49/consultation. Disponible au : https://www.getmaple.ca/?utm_term=tele%20medicine&utm_content=59389545790&utm_campaign=1405004122&gclid=CjwKCAjwu5veBRBBEiwAFTqDwV1L7zlaqD3Z6-q3jnx1rPqN86b6pxkO1pndKbWW4Q_V6XdlkXNrcBoCZl0QAvD_BwE Dernière consultation le 9 décembre 2018.

4. ROBERTS, O. Urban Cowboy: Should you go to the vet? Ask Telehealth Pets. Le 11 mai 2017. Disponible au : https://www.guelphtoday.com/columns/urban-cowboy-with-owen-roberts/urban-cowboy-should-you-go-to-the-vet-ask-telehealth-pets-610406 Dernière consultation le 9 décembre 2018.

5. CARROZA, A. «First Video-Based Canadian Veterinary Telehealth Company Launched», American Veterinarian, le 13 avril 2018. Disponible au : https://www.americanveterinarian.com/news/first-videobased-canadian-veterinary-telehealth-company-launched Dernière consultation le 9 décembre 2018. ■

Carlton Gyles

Les opinions exprimées dans cette rubrique sont celles du rédacteur en chef.



Veterinary Medical Ethics Déontologie vétérinaire

Ethical question of the month — February 2019When a pet shows signs of severe distress outside of regular business hours, clients are directed to an emergency clinic. It is common practice in such cases for the emergency clinic to request a down-payment or guarantee of payment for the initial examination and treatment. Emergency care can be very costly and some owners request the emergency clinic do whatever necessary to save their pet without appreciating the costs involved and without the ability to pay. Animals in severe distress have been refused admission at emergency clinics if the clients are unable to provide proof that they can afford the emergency work. Is refusing to treat an animal in severe distress compatible with the Canadian Veterinary Oath to relieve animal suffering? How should practitioners balance their business and professional responsibilities?

Question de déontologie du mois — Février 2019Lorsqu’un animal de compagnie manifeste des signes de détresse graves en dehors des heures d’ouverture habituelles, on demande aux clients de se rendre à une clinique d’urgence. Dans de tels cas, il est pratique courante pour la clinique d’urgence de demander un acompte ou une garantie de paiement pour l’examen initial et le traitement. Les soins d’urgence peuvent être très coûteux et certains propriétaires demandent à la clinique de faire tout ce qui est nécessaire pour sauver leur animal de compagnie sans apprécier les coûts qui sont impliqués et sans la capacité de payer. Des cliniques d’urgence ont refusé d’admettre des animaux en détresse grave si les clients sont incapables de fournir la preuve qu’ils ont les moyens de payer pour les soins d’urgence. Le refus de traiter un animal en détresse grave est-il compatible avec le Serment vétérinaire canadien selon lequel il faut soulager les souffrances animales? Comment les praticiens devraient-ils équilibrer les responsabilités de leur entreprise et leurs responsabilités professionnelles?

Comments/Commentaires :

Name/Nom :

Address/Adresse :

Responses to the case presented are welcome. Please limit your reply to approximately 50 words and forward along with your name and address to: Ethical Choices, c/o Dr. Tim Blackwell, 6486 E. Garafraxa, Townline, Belwood, Ontario N0B 1J0; telephone: (519) 846-3413; fax: (519) 846-8178; e-mail: [email protected] ethical questions of the month are also welcome! All ethical questions or scenarios in the ethics column are based on actual events, which are changed, including names, loca-tions, species, etc., to protect the confidentiality of the parties involved.

Les réponses au cas présenté sont les bienvenues. Veuillez limiter votre réponse à environ 50 mots et nous la faire parvenir par la poste avec vos nom et adresse à l’adresse suivante : Choix déontologiques, a/s du Dr Tim Blackwell, 6486, E. Garafraxa, Townline, Belwood (Ontario) N0B 1J0; téléphone : (519) 846-3413; télécopieur : (519) 846-8178; courriel : [email protected] propositions de questions déontologiques sont toujours bienvenues! Toutes les questions et situations présentées dans cette chronique s’inspirent d’événements réels dont nous modifions certains éléments, comme les noms, les endroits ou les espèces, pour protéger l’anonymat des personnes en cause.

Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.

L’usage du présent article se limite à un seul exemplaire pour étude personnelle. Les personnes intéressées à se procurer des réimpressions devraient communiquer avec le bureau de l’ACMV ([email protected]) pour obtenir des exemplaires additionnels ou la permission d’utiliser cet article ailleurs.



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Ethical question of the month — November 2018Your beef cattle clients know from experience that foot-rot responds well to antibiotic treatment. Recently, your clients have begun to treat their cattle with foot-rot using a dart gun. Producers find this approach time efficient compared with moving affected animals into a chute or treatment pen. You are aware of published research demonstrating that dart guns are not as effective as the standard syringe injection procedure when dose and injection site are compared (1,2). You prescribe and dispense medication with clear instructions regarding dose and injection technique while aware that your clients are using dart guns to treat their animals. New antibiotic prescription rules in Canada place a greater responsibility on you than previously to ensure appropriate antibiotic use in livestock. Should you continue to dispense antibiotics to your beef cattle clients, fully aware that these drugs will be used in an extra-label manner that you do not recommend?

References1. Coetzee JF, Kleinhenz MD, Magstadt DR, et al. Pneumatic dart delivery of tulathromycin in calves results in lower antimicrobial

concentrations and increased biomarkers of stress and injection site inflammation compared with subcutaneous injection. J Anim Sci 2018;96:3089–3101.

2. Hairgrove T, Gill R, Waters C, et al. Does dart gun delivery of antibiotics cause changes in drug disposition or meat quality? Proceedings of the American Association of Bovine Practitioners, Charlotte, North Carolina, 2016:167–168.

Question de déontologie du mois — Novembre 2018Vos clients éleveurs de bovins de boucherie savent d’expérience que la fièvre aphteuse répond bien au traitement antibiotique. Récemment, vos clients ont commencé à traiter leurs bovins atteints de piétin à l’aide d’un fusil à injection. Les éleveurs trouvent que cette approche est rapide et ils la préfèrent au déplacement des animaux affectés dans un couloir de contention ou un enclos de traitement. Vous êtes au courant que des études de recherche ont démontré que les fusils à injection ne sont pas aussi efficaces que les injections de seringue lorsque l’on compare la dose et le site d’injection (1, 2). Vous prescrivez et distribuez des médicaments en donnant des directives claires concernant la dose et la technique d’injection, tout en sachant que vos clients utilisent des fusils à injection pour traiter leurs animaux. Les nouvelles règles de prescription des antibiotiques au Canada vous imposent maintenant une responsabilité accrue afin d’assurer une utilisation appropriée des antibiotiques chez le bétail. Devriez-vous continuer à distribuer des antibiotiques à vos clients qui sont éleveurs de bovins de boucherie en sachant que ces médicaments seront utilisés d’une manière en dérogation des directives de l’étiquette que vous ne recommandez pas?

Renvois1. COETZEE, J.F., M.D. KLEINHENZ, D.R. MAGSTADT et al. «Pneumatic dart delivery of tulathromycin in calves results

in lower antimicrobial concentrations and increased biomarkers of stress and injection site inflammation compared with subcutaneous injection», J Anim Sci, 2018, vol. 96, p. 3089–3101.

2. HAIRGROVE, T., R. GILL, C. WATERS et al. «Does dart gun delivery of antibiotics cause changes in drug disposition or meat quality?», Proceedings of the American Association of Bovine Practitioners, Charlotte, Caroline du Nord, 2016, p. 167–168.

An ethicist’s commentary on dart gun used to deliver antibiotics for foot-rotFoot-rot is an extremely painful bacterial infection in cattle which, aside from resulting in extremely severe pain, can also cause loss of appetite, decreased weight gain, decreased milk production, great restriction on mobility, and refusal of bulls to mount. In fact, so painful and devastating is this disease that the drug used for pain control for foot-rot is the only FDA approved analgesic for cattle. Treatment of choice is antibiotic therapy delivered by injection. The disease can also easily spread to other animals in the herd.

In an effort to make delivery of antibiotics more efficient, some cattlemen utilize a dart gun, with darts containing the antibiotic. There is limited data on the effectiveness of this approach, but it is clearly less time-consuming than inject-ing each animal. Research results of dart use are inconclusive. Whereas some studies say that the proper use of darts is not very much different from injection, another study showed that 4 out of 15 darts failed to deliver the antibiotic to the area designated

appropriate by the BQA (Beef Quality Assurance) for antibi-otic injection (1). Failure of the dart can result in insufficient amounts of antibiotics delivered; injection into inappropriate tissue (intramuscular rather than subcutaneous); and food safety issues arising from accumulation of drugs in the incorrect locus.

To put it simply, use of a dart gun can result in failure of treatment and risk to animals and consumers. Using the dart gun as a “quick fix” is therefore bad husbandry and bad manage-ment. As John Maday, chief editor for Bovine Veterinarian and a good friend of the beef industry, wrote use of darts should be restricted to situations of necessity, not convenience (2). What then, should the role of the veterinarian be with regard to the practice of darting to save time? As the case presentation illus-trates, the veterinarian provides explicit directions for proper use when dispensing antibiotics, even though he or she may be aware that some clients will utilize dart guns. Not only is it morally questionable to ignore improper use, it is extremely



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imprudent. For one thing, if darting creates a food safety issue or an animal health issue, the veterinarian can end up being sued on the grounds that he or she knowingly permitted misuse.

Furthermore, and equally important, the credibility of the veterinary profession is at stake here. If journalists begin pro-mulgating the notion that veterinarians allow improper use of antibiotics, this can undoubtedly strengthen suspicion of veterinary medicine already extant by virtue of demonstrated development of antibiotic resistance. Such cases can be seen as bespeaking lack of veterinarian concern for the well-being of cattle and of people. And this in turn can lead to greater control by government of veterinary practice with correlative loss of professional autonomy.

How should veterinarians address this issue? Were I a veteri-narian dispensing antibiotics for foot-rot, suspecting that the client plans to dart the animals rather than using the proper but more labor-intensive injection technique, I would ask the client to sign a document promising to use the drug in accordance with the veterinarian’s instructions. In this document, I would delineate all the risks arising from improper use, not only to the animals and to human health, but also to the public image of the cattle business, to the societal respect for veterinary medicine, and to the status in society of the veterinarian himself or herself.

I would also remind my clients how far darting has moved from the pride cattlemen take in providing good care for their animals. To evidence my point, I would tell them about the statue that stands in front of the agriculture building at Colorado State University. Entitled “20% chance of flurries,” it depicts an elderly rancher on horseback carrying a lost calf home across the saddle in the middle of a snowstorm. Realistically rendered, even showing his windblown duster and white snow-drifts, it eloquently bespeaks the rancher ethic, with the cattle-man risking his life to bring home the baby animal. Clearly, his motivation is not financial. In an age where society demands good husbandry, the extra time spent avoiding shortcuts is more than justified by this unique image of the cattleman’s ethic.

Bernard E. Rollin, PhD

Reference1. Coetzee JF, Kleinhenz MD, Magstadt DR, et al. Pneumatic dart delivery

of tulathromycin in calves results in lower antimicrobial concentrations and increased biomarkers of stress and injection site inflammation com-pared with subcutaneous injection. J Anim Sci 2018;96:3089–3101.

2. Maday J. Dart Decisions. AgWeb. July 4, 2018. Available from: https://www.agweb.com/article/dart-decisions/ Last accessed December 17, 2018.

Members of the CVMA are entitled to receive the Canadian Journal of Veterinary Research (CJVR) at no additional charge. The CJVR, in the form of an interactive (portable document format) pdf, can be found on the CVMA member-only website (www.canadian veterinarians.net/publications-research-issue.aspx).

Published by the CVMA, this quarterly, peer-reviewed journal is Canada’s only national veterinary research publication.

Articles from the January 2019 issue of CJVR that might be of interest to practitioners include:

Evaluation of effects of radiation therapy combined with either pamidronate or zoledronate on canine osteosarcoma cells on page 3

Changes in antimicrobial susceptibility profiles of Mycoplasma bovis over time on page 34

Peripartum metabolic profiles in a Holstein dairy herd with alarm level prevalence of subclinical ketosis detected in early lactation on page 50

The CJVR, along with the monthly Canadian Veterinary Journal, is also archived on PubMed Central (www.pubmedcentral.com) 6 months after publication.

An interactive pdf of The CVJ is also available on the member-only section of the CVMA website.

Les membres de l’ACMV reçoivent un abonnement gratuit à la Revue canadienne de recherche vétérinaire. On peut consulter la RCRV, qui est présentée en format pdf interactif, sur le site Web de l’ACMV réservé aux membres (www.veterinairesaucanada.net/ publications-research-issue.aspx).

Publiée par l’ACMV, cette revue trimestrielle évaluée par les pairs est la seule publication nationale de recherche vétérinaire au Canada.

Les articles suivants du numéro de janvier 2019 de la RCRV pourraient intéresser les praticiens :

Evaluation of effects of radiation therapy combined with either pamidronate or zoledronate on canine osteosarcoma cells à la page 3

Changes in antimicrobial susceptibility profiles of Mycoplasma bovis over time à la page 34

Peripartum metabolic profiles in a Holstein dairy herd with alarm level prevalence of subclinical ketosis detected in early lactation à la page 50

La RCRV, avec La Revue vétérinaire canadienne qui est publiée mensuellement, est aussi archivée sur PubMed Central (www.pubmedcentral.com) six mois après la publication.

Un pdf interactif de La RVC est aussi disponible dans la section réservée aux membres du site Web de l’ACMV.

Have Another Look at CJVRAvez-vous consulté la RCRV dernièrement?


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1. A 3-year-old cat is presented with an acute onset of unilat-eral exophthalmos and pain on opening the mouth. Which of the following is/are recommended diagnostic tests? A. Orbital ultrasoundB. CT scanC. Dental examination and dental radiographsD. A and BE. A, B, and C

2. Cyanosis of the mucous membranes indicates which of the following?1. A high level of CO2

2. A problem with oxygen delivery3. A hemoglobin oxygen saturation of less than 75%4. An oxygen flow rate of 2 to 3 mL/kg/min A. 1 is correct. B. 1 and 2 are correct. C. 2 and 3 are correct. D. 2, 3, and 4 are correct.

3. A 6-month-old Labrador retriever presents for exercise intolerance. On physical examination, it has a systolic right heart murmur and normal femoral pulse quality. An elec-trocardiogram is performed, and the QRS complex is splin-tered. The most likely congenital heart defect is which of the following?A. Pulmonic stenosisB. PDAC. Ventricular septal defectD. Subaortic stenosisE. Tricuspid valve dysplasia

1. Un chat âgé de 3 ans présente un début soudain d’exophtalmie unilatérale et de douleur à l’ouverture de la gueule. Laquelle (lesquelles) des épreuves de diagnostic suivantes est (sont) recommandée (es)?A. échographie orbitaire;B. scanogramme;C. examen et radiographies des dents;D. A et B;E. A, B et C.

2. La cyanose des muqueuses indique lequel (lesquels) des problèmes suivants?1. Un taux élevé de CO2.2. Un problème de distribution d’oxygène.3. Une saturation de l’hémoglobine en oxygène de moins de

75 %.4. Un débit d’oxygène de 2 à 3 ml/kg/min. A. 1 est correct; B. 1 et 2 sont corrects; C. 2 et 3 sont corrects; D. 2, 3 et 4 sont corrects.

3. Un Labrador retriever âgé de 6 mois présente de l’intolérance à l’effort. À l’examen physique, le chien montre un souffle cardiaque droit systolique et un pouls fémoral normal. On réalise un électrocardiogramme et le complexe QRS est dentelé. Lequel des défauts cardiaques congénitaux suivants est le plus probable? A. sténose pulmonaire;B. persistance du canal artériel;C. communication interventriculaire;D. sténose subaortique;E. dysplasie de la valve tricuspide.

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– Dr. Louis Kwantes, Park Veterinary Centre. Sherwood Park, AB. NVA partner since 2016.

As you begin considering your opti ons for selling your pet hospital business, it’s important to fi nd a partner aligned with your values, respectf ul of the individuality of what you’ve built, and equipped to grow your business, while your team and culture remain intact.

Ask around to fi nd out which buyers have the best reputati on for caring for pets and the people who love them.

Is it the right culture fi t for your team?

01NO.

Because selling your pet hospital is such a personal decision, you’ll want to understand what types of opti ons are available, and to what level they can tailor the terms to meet your needs.

A S K I F T H E B U Y E R C A N :• Make all cash off ers with no

fi nance conti ngency

• Off er Joint Venture partnerships for growth and fl exibility

• Buy the real estate outright or lease from you

NO.

Are there fl exibledeal structures?

02

As you contemplate transiti oning your business, you’ll want to know every aspect is covered. Seek out a partner with a dedicated team seasoned in marketi ng (including digital adverti sing and social media strategy), web development and hosti ng, client sati sfacti on surveys, IT, HR, accounti ng, taxes, legal and more.

How comprehensive are the support services?

NO.03

3 Questions to ask as you enter discussions with potential partners.

What’s your vision for the future of your business?

We’re confi dent that we can care for and grow your practi ce like no one else. We’d be more than happy to talk through your questi ons. You can reach us at: 888.767.7755 | NVA.COM | [email protected]


– Dr. Louis Kwantes, Park Veterinary Centre. Sherwood Park, AB. NVA partner since 2016.

As you begin considering your opti ons for selling your pet hospital business, it’s important to fi nd a partner aligned with your values, respectf ul of the individuality of what you’ve built, and equipped to grow your business, while your team and culture remain intact.

Ask around to fi nd out which buyers have the best reputati on for caring for pets and the people who love them.

Is it the right culture fi t for your team?

01NO.

Because selling your pet hospital is such a personal decision, you’ll want to understand what types of opti ons are available, and to what level they can tailor the terms to meet your needs.

A S K I F T H E B U Y E R C A N :• Make all cash off ers with no

fi nance conti ngency

• Off er Joint Venture partnerships for growth and fl exibility

• Buy the real estate outright or lease from you

NO.

Are there fl exibledeal structures?

02

As you contemplate transiti oning your business, you’ll want to know every aspect is covered. Seek out a partner with a dedicated team seasoned in marketi ng (including digital adverti sing and social media strategy), web development and hosti ng, client sati sfacti on surveys, IT, HR, accounti ng, taxes, legal and more.

How comprehensive are the support services?

NO.03

3 Questions to ask as you enter discussions with potential partners.

What’s your vision for the future of your business?

We’re confi dent that we can care for and grow your practi ce like no one else. We’d be more than happy to talk through your questi ons. You can reach us at: 888.767.7755 | NVA.COM | [email protected]



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4. A 3-year-old male dachshund is presented for hair loss. Examination reveals complete hair loss affecting the entire ventrum. The skin in this area is completely normal in appearance the dog is not pruritic. What is the most appro-priate diagnostic test to confirm the presumed diagnosis?A. Skin scrapingsB. Serum allergy testingC. Intradermal allergy testingD. Skin biopsyE. Elimination diet trial

5. Manure should be spread on fields when which of the fol-lowing is true?A. Snow covers them.B. Rain is forecast.C. Crops are maturing.D. Tillage will occur.E. The farm is Cryptosporidia-free.

4. Un Dachshund âgé de 3 ans présente une perte de poils. L’examen révèle une perte totale de poils affectant le ventre tout entier. La peau de cette région a une apparence complètement normale et il n’y a pas de prurit. Laquelle des épreuves diagnostiques suivantes est la plus appropriée pour confirmer le diagnostic de présomption? A. raclages de la peau;B. épreuve allergique sérique;C. épreuve allergique intradermique;D. biopsies de la peau;E. épreuve de régime d’exclusion.

5. On doit épandre le fumier dans les champs lorsque laquelle des conditions suivantes est vraie?A. La neige recouvre les champs.B. Il y a prévision de pluie.C. Les cultures sont en croissance.D. Les travaux des champs sont en cours.E. La ferme est exempte de Cryptosporidia.

Questions and answers were derived from Review Questions and Answers for Veterinary Boards 2nd ed., a 5-volume series including Basic Sciences, Clinical Sciences, Small Animal Medicine and Surgery, Large Animal Medicine and Surgery, and Ancillary Topics, by kind permission of the publisher, Mosby–Year Book, Inc., St. Louis, Missouri.

Les questions et les réponses sont extraites de Review Questions and Answers for Veterinary Boards 2nd ed., une série de cinq volu mes qui comprend Basic Sciences, Clinical Sciences, Small Animal Medicine and Surgery, Large Animal Medicine and Surgery, et Ancillary Topics, avec l’aimable permission de l’éditeur, Mosby–Year Book, Inc. de St. Louis (Missouri).

(See p. 192 for answers./Voir les réponses à la page 192.)



N E W S | N O U V E L L E S

Mise à jour du Conseil

Le Conseil de l’Association canadienne des médecins vétérinaires (ACMV) s’est réuni afin d’évaluer le travail que l’ACMV a réalisé

en 2018 et d’approuver les plans de programme et le budget de 2019. Le Conseil a aussi pris des décisions sur les politiques. L’un des faits saillants de l’année 2018 a été le nombre record de 7399 membres inscrits à l’ACMV! De plus, l’ACMV comporte un effectif de 7851 techniciens vétérinaires affiliés de TTVAC.

En janvier 2019, le Conseil de l’ACMV se composait des membres suivants, représentant les associations provinciales de médecins vétérinaires, les écoles de médecine vétérinaire, les étudiants en médecine vétérinaire et les techniciens vétérinaires :

Council Update

The Canadian Veterinary Medical Association (CVMA) Council met to evaluate the work that the CVMA delivered

in 2018 and to approve the 2019 program plans and budget. Council also made policy decisions. One of the 2018 highlights was the record achieved in CVMA membership of 7399! In addition to that, the CVMA comprises 7851 affiliated RVTTC veterinary technicians.

As of January 2019, CVMA Council consists of the follow-ing members, representing provincial veterinary medical asso-ciations, veterinary colleges, veterinary students and veterinary technicians:

CVMA Council participants and guests.

Participants au Conseil de l’ACMV et invités.

• Dr. Terri Chotowetz, president• Dr. Troye McPherson, immediate past-president• Dr. Melanie Hicks, president-elect (New Brunswick)• Dr. Enid Stiles, vice-president (Quebec)• Dr. Louis Kwantes, executive member (Alberta)• Dr. Barry Stemshorn, treasurer (Ex officio)• Mr. Jost am Rhyn, CEO (Ex officio)• Dr. Christiane Armstrong (British Columbia)• Dr. Tracy Fisher (Saskatchewan)• Dr. Christopher Bell (Manitoba)• Dr. Timothy Arthur (Ontario)• Dr. Trevor Lawson (Nova Scotia)• Dr. Erin MacDonald (Prince Edward Island)• Ms. Kate Rundle, SCVMA president• Ms. Lois Ridgway, RVT (RVTTC) (Ex officio)

• Dre Terri Chotowetz, présidente• Dre Troye McPherson, présidente sortante• Dre Melanie Hicks, présidente désignée (Nouveau-Brunswick)• Dre Enid Stiles, vice-présidente (Québec)• Dr Louis Kwantes, membre de l’exécutif (Alberta)• Dr Barry Stemshorn, trésorier (membre d’office)• M. Jost am Rhyn, CEO (membre d’office)• Dre Christiane Armstrong (Colombie-Britannique)• Dre Tracy Fisher (Saskatchewan)• Dr Christopher Bell (Manitoba)• Dr Timothy Arthur (Ontario)• Dr Trevor Lawson (Nouvelle-Écosse)• Dre Erin MacDonald (Île-du-Prince-Édouard)• Mme Kate Rundle, présidente des ÉACMV• Mme Lois Ridgway, TVA (TTVAC) (membre d’office)



N Planification stratégique : L’ACMV a tenu deux groupes de discussion avec les participants à l’édition 2018 du Programme des futurs leaders de l’ACMV. Voici quelques-unes des constatations de ces ateliers intéressants :

Satisfaction générale :• Les médecins vétérinaires du groupe de discussion adorent leur

travail auprès des animaux et, pour la plupart, avec les clients. Parmi les défis mentionnés, citons la conciliation travail-famille, être propriétaire d’entreprise, les collègues et les employés.

• La conciliation travail-famille représente un enjeu pour presque tous les médecins vétérinaires du groupe de discussion, particulièrement les difficultés liées à l’épuisement et à la «fatigue décisionnelle» qui affectent leur vie personnelle.

• Les difficultés avec les employeurs et la direction représentent probablement le plus grand défi que doivent relever les personnes au sein des groupes. Il existe aussi certaines préoccupations au niveau des décisions d’affaires et de la qualité des soins.

Attentes et réalité :• La plupart des médecins vétérinaires des groupes adoraient

le côté de la pratique médicale de leur carrière. Par contre, la plupart n’étaient pas préparés pour la culture en milieu de travail, les communications et les défis liés à la gestion.

• Les participants ont signalé que leur formation vétérinaire n’incluait pas une formation sur la gestion de la clientèle, particulièrement les préoccupations financières des clients.

• Les clients ont représenté l’un des premiers défis pour beaucoup de médecins vétérinaires, particulièrement la capacité de concilier les soins pour les animaux et les exigences des clients ainsi que les clients qui n’avaient simplement pas les moyens de se payer les soins appropriés.En 2019, l’ACMV se concentrera en particulier sur a) les défis

liés à la communication des médecins vétérinaires récemment diplômés avec les clients et les membres de l’équipe et b) les besoins de formation «sur le tas» (en cours d’emploi) au sein des établissements vétérinaires.

Pour en apprendre davantage à propos des membres de l’ACMV et des besoins potentiels des membres, l’ACMV mènera des sondages quantitatifs et qualitatifs en 2019. Ils fourniront des renseignements utiles qui seront utilisés lors de la réunion de planification stratégique de mars 2019 avec le Conseil de l’ACMV, les présidents des comités et le personnel de direction.

Comité sur le bien-être animal (CBA)En 2019, le CBA examinera les énoncés de position sur l’euthanasie, le contrôle des animaux nuisibles et l’amputation de la queue des moutons. Le CBA élaborera aussi de nouveaux énoncés de position sur le bien-être animal et l’hébergement conjoint ainsi que sur les animaux d’assistance. De plus, l’ébauche d’un code de pratiques pour les petits mammifères de compagnie sera rédigée et on procédera aussi à l’examen et à la révision du Code de pratiques à l’intention des chatteries.

Quant aux activités de défense des intérêts, le comité effectuera un suivi sur la mise en œuvre des modifications proposées aux règlements fédéraux sur le transport. L’ACMV continuera aussi d’appuyer le projet de loi C-84 — Loi modifiant le Code criminel (bestialité et combat d’animaux).

Strategic Planning: The CVMA conducted 2 focus groups with participants of the CVMA’s 2018 Emerging Leaders Program. Here are just a few findings from these insightful workshops:

Overall satisfaction:• Focus group veterinarians love their work with animals, and,

for the most part, with clients. Challenges mentioned were work-life balance, business owners, colleagues and staff.

• Work-life balance is an issue for almost all focus group veterinarians, specifically the struggles with exhaustion and “decision fatigue” that affects their personal lives.

• Possibly the greatest challenge the groups face are difficulties with employers and management; there was also some con-cerns about business decisions and quality of care.

Expectations versus reality:• Most veterinarians in the groups enjoyed the medical prac-

tice side of their careers. On the other hand, most were not prepared for the workplace culture, communications and the management challenges.

• Participants noted that their medical education didn’t include training in managing clients, particularly the clients’ financial concerns.

• Clients were an early challenge for many veterinarians, spe-cifically the ability to balance their care for the animals with the demands of clients, as well as clients who simply cannot afford the cost of appropriate care.In 2019, the CVMA will focus, in particular, on a) commu-

nication challenges of recent graduate veterinarians with clients and the staff team, and b) on-boarding (on-the-job training) needs in practice.

To learn more about CVMA members and the potential needs of members, the CVMA will conduct quantitative and qualitative surveys in 2019. This will provide valuable informa-tion for the March 2019 Strategic Planning meeting involving CVMA Council, Committee Chairs and management staff.

Animal Welfare Committee (AWC)In 2019, the AWC will review Position Statements on eutha-nasia, pest control, and tail docking in sheep. The AWC will also develop new Position Statements on animal welfare and co-sheltering, and service animals. A draft code of practice on Small Mammal Pets will be developed as well as a review and revision of the Cattery Code.

On the advocacy front, the Committee will follow up on the implementation of proposed amendments to the federal trans-portation regulations. The CVMA will also continue to support Bill C-84 — An Act to amend the Criminal Code (bestiality and animal fighting).

The CVMA will maintain and strengthen representation on the National Farm Animal Care Council (NFACC) Code development; the National Farm Animal Health and Welfare Council; the National Companion Animal Coalition; and the Canadian Violence Link Coalition.

Communications/educationIn 2019, the CVMA will realign web resources that focus on animal abuse; demonstrate the impact of CVMA’s Position



NL’ACMV poursuivra et renforcera sa représentation dans le cadre de l’élaboration des codes du Conseil national pour les soins aux animaux d’élevage (CNSAE); le Conseil national sur la santé et le bien-être des animaux d’élevage et la Canadian Violence Link Coalition.

Communication et formationEn 2019, l’ACMV réalignera ses ressources Web qui portent sur la violence envers les animaux, démontrera l’impact des énoncés de position de l’ACMV, publiera des articles sur le bien-être animal dans La RVC, invitera la participation des étudiants à l’égard des enjeux liés au bien-être animal et élaborera un cadre stratégique et un plan d’action pour la gestion de la douleur qui comprendra notamment des outils pour les praticiens et le public.

Comité sur les enjeux nationaux (CEN)En ce qui concerne l’utilisation des antimicrobiens en 2019, l’ACMV atteindra les objectifs suivants :• Elle participera aux tables rondes concernant l’élaboration du

Plan d’action fédéral pour le Cadre pancanadien sur la résistance aux antimicrobiens.

• Elle peaufinera les nouvelles lignes directrices en ligne sur l’utilisation prudente des antimicrobiens et ajoutera l’aquaculture et les équidés.

• Elle pilotera la surveillance de l’utilisation des antimicrobiens avec un groupe limité de praticiens des animaux destinés à l’alimentation.

• Elle rehaussera la sensibilisation et effectuera un transfert des connaissances et des meilleures pratiques sur l’antibio-gouvernance aux médecins vétérinaires et au public.

• Elle considérera et fera la promotion des solutions de remplacement à l’utilisation des antimicrobiens.Dans le domaine des produits cannabinoïdes chez les animaux de

compagnie, l’ACMV surveillera l’impact de la légalisation du cannabis sur les médecins vétérinaires et les patients et elle communiquera des renseignements pertinents aux membres et poursuivra le dialogue avec Santé Canada (SC).

Énoncés de positionEn 2019, l’ACMV élaborera un nouvel énoncé de position sur les animaux d’assistance, elle révisera un énoncé de position sur l’utilisation des antimicrobiens chez les animaux (déjà éliminé en raison de l’introduction de nouveaux règlements par SC), elle révisera l’énoncé de position sur les interventions chirurgicales, elle révisera l’énoncé de position sur la télémédecine et elle coordonnera le Forum mondial de l’ACMV qui se penchera sur l’énoncé de position de la télémédecine durant le congrès 2019.

Maladie de LymeEn 2019, l’ACMV présentera de nouveau le Mois national de la sensibilisation aux tiques et établira et maintiendra des liens entre l’ACMV et les entités médicales et les organismes de santé publique (Association médicale canadienne, Agence de la santé publique du Canada, Santé Canada).

Évaluation nationale de l’OIEL’ACMV représentera les intérêts des médecins vétérinaires canadiens et participera à un plan d’action découlant de cette évaluation.

Statements; feature animal welfare articles in The CVJ; engage students in animal welfare issues, and develop a Pain Management Framework and action plan including tools for practitioners and the public.

National Issues Committee (NIC)With regard to antimicrobial use (AMU), in 2019, the CVMA will achieve the following:• Participate in roundtables regarding the development of a

Federal Action Plan for the Pan Canadian Framework for Antimicrobial Resistance (AMR).

• Fine tune new online antimicrobial prudent use guidelines; add aquaculture and equine.

• Pilot antimicrobial use surveillance with a limited group of food animal practitioners.

• Increase awareness and transfer knowledge and best practices on antimicrobial stewardship with veterinarians and public.

• Consider and promote alternatives to AMU.In the area of cannabinoid products and in pets, the CVMA

will monitor the impact of legalization of cannabis on veterinar-ians and patients and provide pertinent information to members, and continue dialogue with Health Canada (HC).

Position StatementsIn 2019, the CVMA will develop a new Position Statement on service animals; renew a Position Statement on Antimicrobial Use in Animals (previously rescinded with introduction of HC rule changes); review Surgical Procedures Position Statement; review Telemedicine Position Statement; and coordinate CVMA Global Forum on Telemedicine Position Statement during the 2019 Convention.

Lyme diseaseIn 2019, the CVMA will again roll out National Tick Awareness Month; and build and maintain linkages between the CVMA and medical and public health entities (Canadian Medical Association, Public Health Agency of Canada, Health Canada).

OIE country assessmentThe CVMA will represent the interests of Canadian veterinarians and engage in the action plan resulting from this assessment.

Ownership and selection of petsThe CVMA will keep this public section of the CVMA website pertinent.

RepresentationsThe CVMA is represented on the Canadian Animal Health Products Regulatory Advisory Committee (CAHPRAC); the CAHPRAC Subcommittee on Communications; Health Canada’s Veterinary Natural Health Products Expert Advisory Committee; the Zoo-technical Products working group; the Centre for Emerging and Zoonotic Disease Integrated Intelligence and Response (CEZD IIR), the Canadian Animal Health Surveillance System (CAHSS), and the National Companion Animal Coalition.

Dr. Jaspinder Komal, vice-president, Science Branch, Canadian Food Inspection Agency (CFIA), Chief Veterinary Officer and Canada’s delegate to the World Organisation for Animal Health (OIE), met with Council to discuss veterinary



N Possession et choix d’un animal de compagnieL’ACMV mettra à jour cette section publique du site Web de l’ACMV.

ReprésentationsL’ACMV est représentée au sein du Comité consultatif canadien sur la réglementation des produits de santé animale (CCCRPSA), du sous-comité du CCCRPSA sur les communications, du comité consultatif d’experts sur produits de santé naturels vétérinaires, du groupe de travail sur les produits zootechniques, du Centre pour des renseignements et une intervention intégrés sur les maladies émergentes et zoonotiques (CEZD IIR), du système canadien de surveillance de la santé animale (SCSSA) et de la Coalition nationale sur les animaux de compagnie.

Le Dr Jaspinder Komal, vice-président, Science, à l’Agence canadienne d’inspection des aliments (ACIA), médecin vétérinaire en chef et délégué du Canada auprès de l’Organisation mondiale de la santé animale (OIE), a rencontré le Conseil afin de discuter de la capacité vétérinaire dans le secteur public, de la nouvelle politique fédérale sur la surveillance vétérinaire des antimicrobiens et de la façon dont l’ACMV peut porter assistance en lien avec les usines de fabrication des aliments pour animaux. Le Dr Komal a aussi informé le Conseil à propos du processus pour le plan d’action du gouvernement fédéral après l’évaluation de la performance des services vétérinaires au Canada par l’OIE et il a discuté de la participation de l’ACMV dans ce processus.

La Dre Mary-Jane Ireland, directrice générale, Direction des médicaments vétérinaires (DMV), et la Dre Manisha Mehrotra, directrice, Division de l’innocuité pour les humains, se sont jointes au Conseil pour une présentation et des discussions sur la situation en lien avec les modifications aux règlements et aux politiques ainsi que sur l’usage du cannabis et des opioïdes.

Élevage des chiensLe Conseil a approuvé l’énoncé de position révisé suivant :

«L’Association canadienne des médecins vétérinaires (ACMV) appuie l’élevage des chiens seulement lorsque l’élevage est entrepris par des personnes qui se sont engagées à fournir un niveau élevé de soins à leurs chiens et à assurer leur bien-être physique et psychologique.

De plus, l’ACMV appuie seulement l’élevage des chiens par ceux qui travaillent en vue de produire une progéniture qui est prédisposée à une bonne qualité de vie. Une bonne qualité de vie est une vie au cours de laquelle les chiens jouissent d’un bien-être physique, psychologique et social sans être atteints de maladies ni d’affections chroniques.

L’ACMV s’oppose à l’accouplement sélectif des chiens qui provoque des changements de la fonction et de la conformation physique, de la couleur du pelage ou du tempérament lorsqu’ils sont néfastes pour la santé ou la qualité de vie de la descendance.»

Normes pour l’hébergement conjointLe Conseil a approuvé l’élaboration d’un nouvel énoncé de position sur les soins aux animaux lors de l’hébergement conjoint d’urgence.

capacity in the public sector, the new federal policy on veterinary oversight of antimicrobials, and how the CVMA can assist with the implications on feed mills. Dr. Komal also informed Council about the process for the federal government’s action plan fol-lowing the OIE Performance of Veterinary Service Evaluation of Canada and discussed the involvement of the CVMA in this process.

Dr. Mary-Jane Ireland, director general, Veterinary Drugs Directorate (VDD), and Dr. Manisha Mehrotra, director, Human Safety Division, VDD, joined Council for a presentation and discussions on the status of the AMU regulatory and policy changes, as well as on cannabis and opioid use.

Dog breedingCouncil approved the following revised Position Statement:

“The Canadian Veterinary Medical Association (CVMA) sup-ports the breeding of dogs only when it is undertaken by those who are committed to providing a high level of care for their dogs and to supporting their dogs’ physical and psychological well-being.

“Likewise, the CVMA only supports the breeding of dogs by those who strive to produce offspring that are predisposed to a good quality of life. A good quality of life is one in which dogs normally experience a state of physical, psychological, and social well-being, without disease or chronic illness.

“The CVMA opposes the selective breeding of dogs resulting in changes in body form, function, coat color, or temperament, that are potentially detrimental to the quality of life of the resulting progeny.”

Co-sheltering standardsCouncil approved the development of a new Position Statement on Animal Care in Emergency Co-sheltering.

Small Mammal Code of PracticeCouncil approved the development of a Code of Practice for Small Mammal Pets that, by its structure, will mirror the recently developed Kennel and Cattery Codes of Practice.

Continuous monitoring of antimicrobialsCouncil approved a joint American Veterinary Medical Association-CVMA- Federation of Veterinarians of Europe Position Statement on Continuous Monitoring of Antimicrobial Use and Antimicrobial Resistance. The full text is posted on the CVMA’s website under the Policy & Advocacy tab, International Relations section.

Shortage of veterinariansThe CVMA has heard anecdotally from many veterinary prac-tices across Canada that they have a difficult time finding veteri-narians to fill positions. However, the CVMA has no work-force study data at this time to confirm the information. We can attest that the classified ads in The Canadian Veterinary Journal are at an all-time high. The CVMA will monitor the situation and consider whether to conduct a workforce study.



NCode de pratiques pour les petits mammifèresLe Conseil a approuvé la rédaction d’un Code de pratiques pour les petits mammifères de compagnie dont le format s’apparentera aux Codes de pratiques recommandées pour les chenils et les chatteries récemment publiés.

Surveillance continue des antimicrobiensLe Conseil a approuvé un énoncé de position conjoint de l’American Veterinary Medical Association-ACMV-Fédération des vétérinaires d’Europe sur la surveillance continue de l’utilisation des antimicrobiens et l’antibiorésistance. La version intégrale est affichée sur le site Web de l’ACMV sous l’onglet Politiques et défense des intérêts, dans la section des Relations internationales.

Pénurie de médecins vétérinairesL’ACMV a entendu des anecdotes de nombreux établissements vétérinaires au Canada mentionnant qu’ils ont de la difficulté à trouver des médecins vétérinaires pour combler les postes. L’ACMV ne possède pas actuellement de données provenant d’études sur la main-d’œuvre afin de confirmer ces renseignements, mais nous pouvons cependant confirmer que le nombre de petites annonces publiées dans La Revue vétérinaire canadienne se situe à un niveau record. L’ACMV surveillera la situation et décidera s’il vaut la peine de réaliser une étude sur la main-d’œuvre.

Agrément des programmes de techniques vétérinaires par l’ACMVLe Conseil a approuvé l’agrément du programme de technologie en santé animale d’Olds College à Olds, en Alberta; le programme de technologie vétérinaire du Maritime Business College à Sackville, en Nouvelle-Écosse; et le programme de technologie en santé animale de Lakeland College à Vermilion, en Alberta.

Symposium des ÉACMVLe Symposium des Étudiants de l’ACMV s’est déroulé les 18 et 19 janvier 2019 à la Faculté de médicine vétérinaire de l’Université de Montréal à Saint-Hyacinthe, au Québec. Au moment de mettre sous presse, 259 étudiants étaient inscrits à ce populaire événement annuel.

Atelier de leadership étudiantLes Étudiants de l’ACMV ont tenu la plus récente édition de cet atelier le 17 novembre 2018 au Western College of Veterinary Medicine. Cet atelier a été animé par le Dr Rick DeBowes. Tous les étudiants qui ont participé à ce cours d’une journée ont reçu un certificat de l’Atelier de leadership étudiant.

Congrès 2021 de l’ACMVLe Conseil a approuvé la ville de Calgary afin d’accueillir le congrès 2021, qui se déroulera du 9 au 12 juillet.

Congrès 2019 de l’ACMV-WSAVAC’est l’occasion pour l’ACMV d’inviter le monde vétérinaire au Canada. La World Small Animal Veterinary Association (dont l’ACMV est membre) et l’ACMV organiseront ce congrès conjoint du 16 au 19 juillet 2019 à Toronto, en Ontario. Le 16 juillet 2019, dans le cadre de cet événement, l’ACMV organisera un Sommet mondial sur «La norme d’excellence en matière de bien-être animal — impact positif et négatif sur les animaux et les médecins vétérinaires». Ce Sommet sera présidé par la présidente désignée de l’ACMV, la Dre Melanie Hicks. L’ACMV organisera aussi un Forum sur les enjeux mondiaux qui portera sur la télésanté et le bien-être animal et sera présidé par le Dr Serge Chalhoub, membre du Comité sur les enjeux nationaux de l’ACMV.

(par Jost am Rhyn, PDG, ACMV)

CVMA Veterinary Technician Program AccreditationCouncil approved CVMA accredita-tion of the Olds College, Animal Health Technology Program, Olds, Alberta; the Maritime Business College, Veterinary Technology Program, Sackville, Nova Scotia; and Lakeland College, Animal Health Technology, Vermilion, Alberta.

SCVMA SymposiumThe Symposium of the Students of the CVMA, which took place on January 18 and 19, 2019, was hosted by the Faculté de médicine vétérinaire de l’Université de Montréal in St. Hyacinthe, Quebec. At press time, 259 students had signed up for this popular annual event.

Student Leadership WorkshopThe Students of the CVMA hosted the latest Workshop at the Western College of Veterinary Medicine on November 17, 2018. This Workshop was facilitated by Dr. Rick DeBowes. All participating students of this 1-day course received a Student Leadership Workshop Certificate.

CVMA Convention 2021Council approved that Calgary be the host city for the 2021 Convention, which is scheduled to take place from July 9–12.

2019 CVMA-WSAVA ConferenceThis is an opportunity for the CVMA to bring the veterinary world to Canada. The World Small Animal Veterinary Association (of which the CVMA is a member) and the CVMA are hosting this joint Congress from July 16 to 19, 2019 in Toronto, Ontario. On July 16, 2019, as part of this event, the CVMA will be hosting a Global Summit on “The Gold Standard of Animal Welfare — Positive and Negative Impact on Animals and Veterinarians.” This Summit will be chaired by CVMA’s president-elect, Dr. Melanie Hicks. The CVMA will also host a Global Issues Forum on Telehealth and Animal Welfare, which will be chaired by Dr. Serge Chalhoub, member of the CVMA’s National Issues Committee.

(by Jost am Rhyn, CEO, CVMA)



N Rencontrez quelques-uns des futurs leaders vétérinaires du Canada!

Le Prix de leadership étudiant de l’ACMV, qui a été établi en 1966, se compose d’une plaque et d’une bourse et est décerné

annuellement à un étudiant en médecine vétérinaire de troisième année à chacune des écoles de médecine vétérinaire canadiennes. Le récipiendaire est choisi par ses camarades de classe en fonction de son leadership et de ses réalisations dans les affaires étudiantes. Un Prix de leadership étudiant de l’ACMV est aussi présenté annuellement à un étudiant inscrit à l’une des écoles de médecine vétérinaire affiliées et est choisi par le Jury de sélection de l’ACMV et les représentants sénior du Comité des Étudiants de l’ACMV (ÉACMV).

Voici les récipiendaires de l’édition 2018 du Prix de leadership étudiant de l’ACMV :

Katya Melnick, maintenant étudiante de quatrième année au Western College of Veterinary Medicine (WCVM), a grandi sur l’eau avec des chats et quelques poules à Pinawa, au Manitoba. Katya se passionne pour le ski nautique et le ski alpin et elle s’est récemment épris du vélo de montagne. Après avoir terminé son diplôme en agriculture animale à l’Université du Manitoba, Katya a été acceptée au WCVM. Elle occupe actuellement le poste de présidente de la promotion 2019 et elle aime être agente de liaison étudiante entre sa promotion et l’administration universitaire. Après la fin de ses études, Katya espère exercer en médecine générale des petits animaux et elle est très excitée d’être l’une des récipiendaires du Prix de leadership étudiant de l’ACMV!

Rae-Leigh Pederzolli, étudiante de troisième année à la Faculté de médecine vétérinaire de l’Université de Calgary (UCVM), est née et a grandi dans une exploitation commerciale de naissage-élevage à Medicine Hat, en Alberta. Elle a passé son enfance à travailler à l’exploitation familiale et à participer à des courses de barils, à des courses de bouvillons et à des parcours d’acrobaties dans les rodéos. Rae-Leigh a obtenu son baccalauréat en sciences avec spécialisation en sciences animales en 2014 ainsi qu’une maîtrise en sciences en 2016 auprès du Dr Gregory Penner, professeur agrégé et titulaire de la chaire Centennial en physiologie nutritionnelle, tous deux à l’Université de la Saskatchewan. Son projet a évalué la fonction barrière de l’appareil gastro-intestinal chez les bouvillons Holstein lorsqu’ils sont exposés à un faible apport alimentaire et à une acidose ruminale aiguë. Rae-Leigh a été choisie pour le Programme des jeunes leaders de la Canadian Cattlemen’s Association en 2014 et a été mentorée par Kajal Devani, leader de l’équipe de service aux membres à la Canadian Angus Association et elle a été membre à titre individuel du Conseil des jeunes de la Canadian Cattelmen’s Association pour l’année 2015–2016. Rae-Leigh a aussi été fortunée d’être choisie comme déléguée étudiante pour les congrès International Livestock Congress tenus aux États-Unis et au Canada ainsi que lors de l’International Livestock Forum. Pendant les deux premières années à l’UCVM, Rae-Leigh a été présidente de la promotion 2020 de l’UCVM et elle est actuellement présidente du Club de la santé des animaux d’élevage, ce qui inclut le poste de délégué junior de l’UCVM auprès de l’American Association of Bovine Practitioners. En dehors des études, elle aime voyager et faire de la plongée sous-marine, de l’entraînement en parcours et de l’équitation. À la fin de son cours,

Meet some of Canada’s Future Veterinary Leaders!

The CVMA Student Leadership Award, instituted in 1966, consists of a plaque and a monetary award presented annu-

ally to a 3rd-year veterinary student at each of the Canadian veterinary colleges. The recipient is selected by classmates on the basis of leadership and achievement in student affairs. One International CVMA Student Leadership Award recipient is also presented annually to a student studying at one of the CVMA’s international student affiliate schools and is chosen by the CVMA Awards Selection Committee and the Students of the CVMA (SCVMA) Committee senior representatives.

Below are the 2018 CVMA Student Leadership Award recipients:

Katya Melnick, now a 4th-year student at the Western College of Veterinary Medicine (WCVM), grew up near the water with cats and a few backyard laying hens in Pinawa, Manitoba. Katya has a passion for water and downhill ski-ing, as well as recently becoming excited about mountain biking. After completing her degree in Animal Agriculture at the University of

Manitoba, Katya was accepted into WCVM. She is currently serving as the Class of 2019 president and enjoys being a student liaison between her class and the college administration. After Katya graduates, she hopes to practice small animal general medicine and is excited to be one of the recipients of the CVMA Student Leadership Award!

Rae-Leigh Pederzolli, a 3rd-year student at the University of Calgary — Faculty of Veterinary Medicine (UCVM), was born and raised on a commercial cow calf operation in Medicine Hat, Alberta. She spent her childhood helping at her home operation and competing in rodeo arena barrel racing, steer riding, and trick riding. Rae-Leigh completed a Bachelor of Science degree with

honors majoring in Animal Science in 2014 as well as a Master of Science degree in 2016 with Dr. Gregory Penner, an associ-ate professor and Centennial Enhancement Chair in Nutritional Physiology, both at the University of Saskatchewan. Her project evaluated the barrier function of the gastrointestinal tract in Holstein steers when exposed to low feed intake and acute rumi-nal acidosis. Rae-Leigh was selected for the Cattlemen’s Young Leaders Program in 2014 and was mentored by Kajal Devani, member service team leader at the Canadian Angus Association and she was a member at large for the Young Cattlemen’s Council under the Canadian Cattlemen’s Association for the 2015–2016 year. Rae-Leigh was also fortunate to be selected as a student delegate for both the Canadian and American International Livestock Congress, as well as the International

Katya Melnick

Rae-Leigh Pederzolli



NLivestock Forum. For the first 2 years at UCVM, Rae-Leigh served as UCVM’s Class of 2020 president and she is currently the Production Animal Health Club president, which includes being the UCVM junior delegate for the American Association of Bovine Practitioners. Outside of academics, she enjoys travel-ling, scuba diving, crossfit, and horseback riding. After gradua-tion, Rae-Leigh’s main focus is to practice large animal medicine in her rural community while still being actively involved at her home operation.

Jolene Vermeulen, now a 4th-year student at the Atlantic Veterinary College (AVC), grew up on Nova Scotia’s southern shore. Jolene completed her Bachelor of Science degree at the Nova Scotia Agricultural College in Truro, Nova Scotia, majoring in Animal Science and her Master of Science degree in Animal Behavior and Welfare at the University of Guelph. During

all her post-secondary education, Jolene’s passion for large ani-mals continued to grow. In 2014, Jolene bought a dairy farm with her husband in Princeport, Nova Scotia where they milk 60 Holsteins. The year after purchasing the farm, Jolene was accepted to AVC where she has continued to develop her large animal knowledge. Jolene’s hope is that after graduation she will be able to practice large animal medicine in the Maritimes and have the opportunity to educate other young farmers.

Rachel Gauvin, now a 4th-year veterinary student at la Faculté de médecine vétérinaire (FMV) de l’Université de Montréal, has always been involved in her college. During her first 2 years pursuing her doctor-ate in veterinary medicine, Rachel was her Class of 2020 student rep-resentative and for the last 2 years, she served as the External Affairs coordinator for the Association des étudiants en médecine vétérinaire du

Québec (AEMVQ). Rachel was also one of the coordinators in charge of FMV’s small animal shelter for a year, and has taken an active part in many of her college’s projects and commit-tees including the Politics Committee, the Student Well-Being Committee, the Committee for the Reform of FMV’s DVM Program, and the Young Women’s Veterinary Association. Rachel is also proud of how she pushed for, and initiated, a change in the way the integrational activities for new students were done at FMV. Rachel helped make the activities more inclusive and respectful and she also encouraged the entire student body to adopt a healthier mindset when organizing them.

Eastman Welsford, now a 4th-year student at the Ontario Veterinary College (OVC), took every opportunity to get involved at OVC from the moment he walked through the doors. Eastman served as co-president of his class and feels fortunate for the opportunity to work alongside faculty and motivated students. Born in Montreal, Quebec and raised in

Rae-Leigh désire exercer la médecine des grands animaux dans sa collectivité rurale tout en demeurant active au sein de l’exploitation familiale.

Jolene Vermeulen, maintenant étudiante de quatrième année à l’Atlantic Veterinary College (AVC), a grandi sur la rive sud de la Nouvelle-Écosse. Jolene a terminé son baccalauréat en sciences au Nova Scotia Agricultural College à Truro, en Nouvelle-Écosse, avec une majeure en sciences animales, et sa maîtrise, qui a porté sur le comportement et le bien-être des animaux, à l’Université de Guelph. Durant son éducation postsecondaire, la passion de Jolene pour les grands animaux a continué de croître. En 2014, Jolene a acheté une ferme laitière avec son mari à Princeport, en Nouvelle-Écosse, où elle fait la traite de 60 vaches Holstein. L’année suivant l’achat de la ferme, Jolene a été acceptée à l’AVC où elle a continué de perfectionner ses connaissances sur les grands animaux. Jolene espère que, à la fin de ses études, elle pourra exercer la médecine des grands animaux dans les Maritimes et avoir l’occasion d’enseigner à d’autres jeunes éleveurs.

Rachel Gauvin, maintenant étudiante en médecine vétérinaire de quatrième année à la Faculté de médecine vétérinaire (FMV) de l’Université de Montréal, a toujours participé activement aux activités de son école. Durant ses deux premières années au programme de doctorat en médecine vétérinaire, Rachel a été représentante étudiante de la promotion 2020 et, pendant les deux dernières années, elle a occupé le poste de coordonnatrice des affaires externes pour l’Association des étudiants en médecine vétérinaire du Québec (AEMVQ). Rachel a aussi été coordonnatrice responsable du refuge pour petits animaux de la FMV pendant un an et elle a participé activement aux nombreux projets et comités de la faculté, dont le Comité des politiques, le Comité du bien-être des étudiants, le Comité pour la réforme du programme de D.M.V. de la FMV et l’Association des jeunes femmes médecins vétérinaires. Rachel est aussi fière de la façon dont elle a fait la promotion et mis en œuvre des changements liés aux activités d’intégration des nouveaux étudiants à la FMV. Rachel a contribué à rendre les activités plus inclusives et respectueuses et elle a aussi encouragé tous les étudiants à adopter un état d’esprit plus sain lors de l’organisation de ces activités.

Eastman Welsford, maintenant étudiant de quatrième année à l’Ontario Veterinary College (OVC), a profité de toutes les occasions pour s’impliquer à l’OVC dès le moment où il a franchi le seuil de la porte. Eastman a occupé le poste de coprésident de sa promotion et il s’estime fortuné d’avoir l’occasion de travailler aux côtés des professeurs et d’étudiants motivés. Né à Montréal, au Québec, Eastman a grandi à Oakville, en Ontario, et les animaux ont toujours fait partie de sa vie. Le chien familial était son premier meilleur ami et la maison comptait presque toujours un animal de compagnie. Il était clair qu’Eastman était destiné à une carrière auprès des animaux après avoir grandi aux côtés de poissons, de lézards, de chiens, d’oiseaux et d’un furet et avoir passé les fins de semaine dans des écuries. Avant d’être accepté à l’OVC, Eastman a obtenu un baccalauréat en arts et en sciences à l’Université McGill avec une majeure en biologie et en anthropologie. Pendant ce temps, Eastman a développé un vif intérêt pour l’agriculture, après avoir travaillé à la ferme laitière du Campus Macdonald. Il croit que la combinaison des arts et des sciences est importante en médecine vétérinaire, car ces deux domaines réunissent les

Jolene Vermeulen

Rachel Gauvin



N sciences appliquées de la biologie et de la médecine avec l’importance d’une communication efficace avec les clients et le travail au sein d’une équipe de soins de santé. Eastman désire travailler dans un établissement pour grands animaux et espère réaliser un internat d’un an.

Matthew Barnes, maintenant étudiant canadien en médecine vétérinaire de quatrième année à l’École de médecine vétérinaire de l’Université de Glasgow en Écosse, est né et a grandi à Toronto, en Ontario. Pendant son diplôme de premier cycle, Matthew a fait du travail bénévole auprès de nombreuses organisations : membre du Comité de l’équipe de collecte de sang de l’Université Queen’s qui organisait des cliniques de don de sang sur le campus; bénévole auprès du programme d’éducation Helen Tufts Child Outreach Program afin de mentorer des enfants défavorisés à Kingston, en Ontario; chargé de cours et instructeur d’un laboratoire sur l’anatomie humaine. Au cours de la première année de Matthew à l’école de médecine vétérinaire, il a poursuivi sa participation aux clubs et aux sociétés universitaires.

Matthew possède de solides compétences en relations interpersonnelles et en communications et il a présenté un discours à ses nouveaux collègues et a été élu représentant étudiant de la promotion 2020 afin de défendre les intérêts et les préoccupations des membres auprès du personnel et lors des réunions du gouvernement étudiant. Il a aussi été choisi comme coordonnateur du programme de mentorat étudiant «Big Vet Wee Vet», qui procède au jumelage d’étudiants sénior afin de faciliter la transition à la vie à Glasgow et de favoriser les amitiés.

Matthew est aussi représentant étudiant pour VetPrep, une compagnie de préparation à l’Examen nord-américain d’agrément en médecine vétérinaire (NAVLE). Matthew a été choisi en partie parce que, pendant quatre étés, il a travaillé pour Prep101, une entreprise de préparation aux examens qui enseigne la chimie organique de niveau universitaire aux étudiants qui se préparent au Medical College Admissions Test (MCAT) en vue de présenter une demande en médecine.

Matthew est aussi membre du Club d’escalade de l’Université de Glasgow, de la Société de zoologie, du Club de pathologie, du Club clinique, du Club de boxe de l’Université et, bien entendu, de la Section locale de l’ACMV à l’Université de Glasgow (affectueusement appelée «Club Canada»).

Sur son parcours de médecin vétérinaire, Matthew a reçu des appuis exceptionnels de sa famille, de ses professeurs et de ses mentors qui ont contribué à l’établissement des buts professionnels de Matthew : enseigner aux autres, continuellement apprendre, pousser la profession vers l’avant et promouvoir le bien-être animal. Après la fin de ses études, Matthew a l’intention d’atteindre ses buts en obtenant l’agrément en médecine interne afin qu’il puisse enseigner et transmettre ses connaissances aux futurs médecins vétérinaires du Canada, tout en exerçant une médecine vétérinaire compatissante.

Oakville, Ontario, animals were always in the picture for Eastman. The family dog was his first best friend and the house was almost never without pets. It was clear Eastman was destined for a career with animals after grow-ing up with pet fish, lizards, dogs, birds and a ferret and spending weekends at riding sta-bles. Before being accepted to OVC, Eastman completed a Bachelor of Arts and Science at McGill University majoring in Biology and Anthropology. It’s during this time Eastman

developed a keen interest in agriculture, having worked on the Macdonald Campus dairy farm. He believes the combination of arts and science is important in veterinary medicine, bringing together applied sciences in biology and medicine with the importance of communicating effectively with clients and working as part of a healthcare team. Eastman is looking forward to working in large animal practice after graduation and hopes to complete a one-year internship.

Born and raised in Toronto, Ontario, Matthew Barnes is now a 4th-year Canadian veterinary student studying abroad at the University of Glasgow — School of Veterinary Medicine in Scotland. While pursuing his undergraduate degree, Matthew volunteered in many organizations, includ-ing being a Queen’s University Blood Team Committee member; organizing campus blood donation clinics, volunteering for the Helen Tufts Child Outreach Program; mentoring

disadvantaged children in Kingston, Ontario, being a teaching assistant and a human anatomy course laboratory instructor. In Matthew’s 1st year of vet-erinary school, he continued his involvement in school clubs and societies.

With approachability and strong communications skills, Matthew delivered a speech to his new peers, and was elected as the Class of 2020 student representative, representing class members’ interests and concerns at staff and student government meetings, and selected as the “Big Vet Wee Vet” student mentorship program coordinator, matching 1st-year students with senior students who help them transition to life in Glasgow and foster friendships.

Matthew is also the VetPrep student representative, a North American Veterinary Licensing Exam (NAVLE) test preparation company. Matthew was selected, in part, because for 4 summers he worked for Prep101, a test preparation company teaching prospective medical students univer-sity level organic chemistry in preparation to write their Medical College Admissions Test (MCAT).

Matthew is also a member of the Glasgow University Mountaineering Club, the Zoological Society, the Pathology Club, the Clinical Club, the university boxing club and, of course, the University of Glasgow CVMA Chapter (affectionately dubbed the “Canada Club”).

On the road to becoming a veterinarian, Matthew received invaluable support from family, professors and mentors that helped form Matthew’s professional goals; teaching others, continuously learning, pushing the profession forward and promoting animal welfare. After graduation, Matthew intends to achieve his goals by pursuing board certification in Internal Medicine so he can teach and transfer his knowledge to future vet-erinarians in Canada, while practicing compassionate veterinary medicine.

Eastman Welsford

Matthew Barnes



NPleins feux sur une participante au Programme des futurs leadersEvy van Nobelen

J’ai obtenu mon diplôme à l’Université d’Utrecht, aux Pays-Bas, en 2013. Je suis déménagée ici pour travailler en tant que

vétérinaire pour petits animaux au Canada immédiatement après la fin des études. J’adore voyager, tricoter et faire des sketchs urbains.

Avant d’assister au Programme des futurs leaders (PFL), je me sentais désillusionnée face à la médecine vétérinaire. Je me sentais prise au piège émotionnel par les clients et les membres de l’équipe, je n’avais pas eu de mentorat et les compétitions entre collègues et des environnements toxiques au travail avaient finalement affecté mon bien-être. En même temps, j’avais perdu mon admiration pour le rôle de vétérinaire qui m’inspirait auparavant. J’ai décidé d’observer les vétérinaires et leurs équipes durant de petits ateliers locaux et dans leurs cliniques lors d’une activité de jumelage. Malheureusement, j’ai découvert qu’il y avait beaucoup de compétition et de peur, tant entre les cliniques et au sein des cliniques entre les divers postes. Quelques vétérinaires que j’ai rencontrés ont été francs à propos de leur réticence à m’offrir du mentorat, afin de partager leurs compétences et connaissances. Ils semblaient craindre de perdre leur clientèle et leur revenu. J’éprouvais du cynisme et de la déception envers les collectivités vétérinaires que je connaissais.

Fort heureusement, le PFL est arrivé juste à temps. Le Dr Rick DeBowes est un conférencier très motivant.

On nous a donné des tâches et des morceaux de casse-tête et il fallait travailler en équipe pour les terminer. Il s’agissait d’excellentes leçons en communication et en comportement humain. Les exercices m’ont montré une équipe saine et comment elle effectue son travail. Il faut qu’il y ait du respect, une bonne communication entre les membres de l’équipe et un bon leader. Durant les ateliers, nous avons aussi discuté ce en quoi consiste un bon leadership et les caractéristiques qui sont cruciales pour un leader efficace afin d’assurer le bon fonctionnement de l’équipe. Le Dr DeBowes a signalé que les bons leaders sont formés et ne sont pas nés comme tels. La responsabilité du leadership ne signifie pas automatiquement que nous sommes un bon leader. Le leadership ne signifie pas seulement la communication de directives aux autres, car il faut aussi être capable d’inspirer les gens à sortir des sentiers battus et de responsabiliser l’équipe. Un bon leader apprécie et reconnaît les contributions de chaque membre de l’équipe. Le leadership est une compétence qui peut s’apprendre par de la formation et que l’on doit exercer.

À titre de médecins vétérinaires, nous sommes tous des leaders. Nous dirigeons notre équipe et il est important aussi de nous comporter en leaders en étant conscients de notre comportement et le gérant de façon appropriée. En ce qui concerne le leadership en soi, le Dr DeBowes nous a enseigné qu’il fallait avoir des valeurs fondamentales et les respecter en milieu de travail afin de nous aider à créer des limites et à nous épanouir. Mes valeurs fondamentales me définissent moi et mon milieu choisi. Le Dr DeBowes nous a aussi encouragés à garder l’esprit ouvert, à rechercher des possibilités et à prendre des risques afin de nous améliorer. Il a expliqué que notre état d’esprit a un impact sur notre pensée et nos

Spotlight on an Emerging Leader Program ParticipantEvy van Nobelen

I graduated from the University of Utrecht, the Netherlands in 2013. I moved to live and work as a small animal veterinarian

in Canada right after graduation. I love traveling, knitting, and urban sketching.

Before attending the Emerging Leader Program (ELP), I felt disillusioned about veterinary medicine. Getting blackmailed emotionally by clients and team members, lacking mentorship from the start, case competitions, and toxic work environments had finally affected my well-being. At the same time, I lost my admiration for my veterinarian role model who used to inspire me. I decided to observe veterinarians and their teams during small local workshops and in their clinics through shadowing. Sadly, I discovered there is a lot of competition and fear out there, both between clinics and within clinics between various positions. A few veterinarians I met were candid about their reluctance in providing mentorship, sharing their skills and knowledge. They seem to fear that they would lose their niche and income. I became cynical and disappointed in the veterinary community I knew.

Thankfully ELP came in the nick of time. Dr. Rick DeBowes is a very motivating speaker.

We were given tasks and pieces of puzzles, which required teamwork in order to solve them. They were great lessons in communication and human behavior. The exercises showed me what a healthy team is and how it performs. The key is respect, good communication between each team member and a good leader. During the sessions, we also discussed what leadership is about and which characteristics of an effective leader are crucial for the team’s performance. Dr. DeBowes pointed out that good leaders are made and not born. Having the prerogative to lead does not mean one is automatically a good leader. Being a leader does not mean that one only gives directions to others, but one also needs to be able to inspire people to think outside the box and give the team accountability. A good leader appreciates and acknowledges the contribution of each team member. Leadership is a skill that can be learned through training and needs to be practiced.

As veterinarians, we are all leaders; we lead our team and it is important to also lead ourselves through practicing self-awareness and self-management. With regard to self-leadership, Dr. DeBowes taught us that having core values and sticking

Evy van Nobelen



N gestes. Vu que la plupart des personnes ont peur du changement, nos propres croyances peuvent limiter les possibilités. J’ai suivi ces conseils et j’ai pris des risques. Maintenant, je suis comblée dans un milieu de travail plus sain.

Le PFL 2018 à Vancouver a été une expérience incroyable pour moi et m’a offert des connaissances sur le leadership. Il a servi à renouvelé mon enthousiasme, ma motivation et mes aspirations en tant que vétérinaire. Selon moi, les vétérinaires de tous les niveaux et aussi les gestionnaires de clinique devraient participer à la formation au leadership afin de les aider à créer un milieu de travail sain et durable.

to them in the workplace will help us to create boundaries and find fulfillment. My core values define me and my chosen environment. Dr. DeBowes also encouraged us to keep an open mind, look for possibilities, and take risks in order to grow. He explained that our mindset impacts our thinking and action. As most people fear change, our own beliefs can limit possibilities. I took his advice to heart and took the risk. Now, I have found fulfillment in a healthier work environment.

The ELP 2018 in Vancouver provided an amazing experience and knowledge on leadership. It has renewed my enthusiasm, motivation, and aspirations as a veterinarian. In my opinion, veterinarians of all levels and also practice managers should par-ticipate in leadership training to help them build a productive, healthy, and sustainable workplace.

NécrologieDr Tom HullandLe Dr Thomas (Tom) Hulland, qui est décédé le 15 octobre 2018, manquera à sa famille, à ses collègues et à ses amis. Il leur manquera non seulement parce qu’il était un pathologiste universitaire exceptionnel et respecté à l’échelle internationale, mais aussi parce que c’était un homme doux et généreux qui s’était mérité l’admiration des étudiants, du personnel et de ses collègues professeurs.

Tom a obtenu son D.M.V. en 1954 à l’Ontario Veterinary College (OVC) et il a ensuite terminé son cours de chirurgie vétérinaire à l’OVC et un Ph.D. en pathologie à l’Université d’Édimbourg, en Écosse. C’était un diplomate de l’American College of Veterinary Pathology (ACVP) et il est devenu président de l’ACVP en 1973. C’était un enseignant et un conseiller de recherche exceptionnel qui adorait ses étudiants et prenait le temps d’expliquer la pathologie. Son leadership à l’OVC a inclus les postes de directeur du Département de pathologie, de doyen associé des affaires universitaires (pendant 12 ans) et de doyen intérimaire. Il a présidé plusieurs comités et groupes de travail de l’OVC et de l’université. On sollicitait fréquemment ses services pour ces rôles parce qu’il respectait l’institution, qu’il était juste et qu’il avait une capacité exceptionnelle pour l’écoute et un intérêt réel pour les propos de ses interlocuteurs.

Tom a occupé des postes ailleurs qu’à l’Université de Guelph. Il a été président de l’Association canadienne des médecins vétérinaires (ACMV) en 1971–1972 et a été membre du Conseil de l’ACMV pendant plusieurs années. C’était un Fellow de la Royal Society of Medicine de Londres en Angleterre. En 2002, il a reçu le titre d’ancien distingué de l’OVC en reconnaissance de son dévouement généreux envers ses étudiants et ses contributions exceptionnelles pendant tout sa vie à sa profession et à l’Université.

Tom est survécu par Eleanore, sa femme de 62 ans, quatre enfants et huit petits-enfants. Une célébration de sa vie a eu lieu le 1er décembre à l’Arboretum Center de l’Université de Guelph, à Guelph.

Carlton Gyles

ObituaryDr. Tom HullandFamily, colleagues, and friends will miss Dr. Thomas (Tom) Hulland, who passed away on October 15, 2018. He will be missed not only because he was an exceptional academic and internationally respected pathologist but also because he was a gentle, thoughtful man who earned the admiration of students, staff and faculty colleagues.

Tom was a 1954 DVM graduate of the Ontario Veterinary College (OVC) who later earned a Veterinary Surgery diploma from the OVC and a PhD in pathology from the University of Edinburgh, Scotland. He was a diplomate of the American College of Veterinary Pathology (ACVP) and became presi-dent of the ACVP in 1973. He was an exceptional teacher and research advisor who cared about his students and always took the time to explain pathology. His leadership at the OVC included roles of chair of the Department of Pathology, associate dean, Academic (for 12 years), and acting dean. He was chair of several college and university committees and task forces. He was sought after for these roles because of his caring for the institution, his fairmindedness, and his outstanding capacity to listen and be genuinely interested in what each person had to say.

Tom served the profession beyond the University of Guelph. He was president of the Canadian Veterinary Medical Association (CVMA) in 1971–1972 and a member of the CVMA Council for several years. He was a Fellow of the Royal Society of Medicine, London, England. In 2002 he was honored as OVC Distinguished Alumnus in recognition of his unselfish devotion to his students and his outstanding life-long contribu-tions to his profession and university.

Tom is survived by Eleanore, his wife of 62 years, 4 children, and 8 grandchildren. A Celebration of Life took place at the University of Guelph Arboretum Center, Guelph on Saturday, December 1st.

Carlton Gyles



NTTVAC annonce une nouvelle adhésion affiliée à la World Small Animal Veterinary Association

Le 24 septembre 2018, à l’Assemblée générale de la World Small Animal Veterinary Association (WSAVA) tenue à

Singapore, Technologues et techniciens vétérinaires agréés du Canada (TTVAC) a été accepté à titre de nouveau membre affilié de la collectivité vétérinaire mondiale de la WSAVA.

«La WSAVA est excitée d’accueillir TTVAC à titre de membre affilié et, à ce titre, tous ses membres au sein de la collectivité vétérinaire mondiale de la WSAVA», dit le Dr Walt Ingwersen, président sortant de la WSAVA. «Notre plan stratégique reconnaît la valeur des membres de l’équipe des animaux de compagnie pour la réalisation de la vision et de la mission de la WSAVA, dont les techniciens vétérinaires font partie intégrante. Nous nous réjouissons à la pensée de la participation accrue de TTVAC à la formation continue concertée et en tant que membres actifs au sein des groupes des lignes directrices.»

À l’échelle nationale, TTVAC et l’Association canadienne des médecins vétérinaires (ACMV) travaillent en étroite collaboration au sein de divers comités, dont le Conseil de l’ACMV, le Comité sur le bien-être animal de l’ACMV, le Comité pour l’agrément des programmes de TSA/TV de l’ACMV et le Comité de perfectionnement professionnel de l’ACMV. Ensemble, ils respectent le Protocole d’entente (signé en 2014) en travaillant en harmonie afin de soutenir et d’avancer la médecine vétérinaire au Canada.

«L’ACMV est ravie d’avoir contribué à l’intégration des technologues et des techniciens vétérinaires agréés canadiens dans la discussion sur la santé vétérinaire mondiale», dit la Dre Terri Chotowetz, présidente de l’ACMV. «La reconnaissance de TTVAC en tant que membre affilié de la WSAVA renforcera la relation qu’a le Canada avec la collectivité vétérinaire mondiale et contribuera assurément à l’avancement de la médecine vétérinaire à l’échelle mondiale.»

À l’échelle internationale, en 2016, TTVAC est devenu la première association de techniciens vétérinaires à se joindre à l’Association mondiale vétérinaire. Vu que la médecine des petits animaux représente un domaine d’expertise important au sein de l’effectif des techniciens et des technologues vétérinaires agréés (TVA), TTVAC désirait élargir ses relations mondiales afin de communiquer son expertise tout en offrant des occasions aux TVA de participer au sein de la collectivité vétérinaire mondiale de la WSAVA. À titre de membre affilié de la WSAVA, il sera mutuellement bénéfique de partager la voix des TVA tout en contribuant activement aux comités de la WSAVA.

Le conseil d’administration de TTVAC désire remercier le Dr Jim Berry qui a présenté la demande en son nom.

Technologues et techniciens vétérinaires agréés du Canada (TTVAC) est une organisation nationale sans but lucratif qui unit les associations de techniciens et de technologues vétérinaires canadiens. Fondé en 1989 sous le nom d’Association canadienne des technologues et techniciens en santé animale (ACTTSA), TTVAC a pour mission de promouvoir la profession de technologue vétérinaire, d’établir et de maintenir les normes nationales d’adhésion et est une ressource à l’égard des enjeux nationaux et internationaux.

RVTTC Announces New Affiliate Membership of World Small Animal Veterinary Association

On September 24, 2018, at the World Small Animal Veterinary Association (WSAVA) General Assembly

in Singapore, the Registered Veterinary Technologists and Technicians of Canada (RVTTC) was accepted as a new affiliate member of the WSAVA Global Veterinary Community.

“The WSAVA is excited to welcome the RVTTC as an affili-ate member and as such, all of their members to the WSAVA Global Veterinary Community,” says Dr. Walt Ingwersen, WSAVA immediate past-president. “Our strategic plan rec-ognizes the value of all companion animal team members in achieving the WSAVA Vision and Mission, of which veterinary technicians are integral members. We look forward to further involvement from the RVTTC in both collaborative continuing education delivery, as well as active members in our guideline groups”.

Nationally, the RVTTC and the Canadian Veterinary Medical Association (CVMA) work closely together on a variety of com-mittees including CVMA Council, CVMA Animal Welfare Committee, CVMA AHT/VT Program Accreditation Committee, and the CVMA Professional Development Committee. Together, they honor the Memorandum of Understanding (signed in 2014) by working in harmony to support and advance veterinary medi-cine in Canada.

“The CVMA is thrilled to have helped bring Canadian reg-istered veterinary technologists and technicians into the global veterinary health discussion,” says Dr. Terri Chotowetz, CVMA president. “Recognizing the RVTTC as an affiliate member of WSAVA will strengthen the relationship Canada has with the global veterinary community and undoubtedly contribute to the advancement of veterinary medicine worldwide.”

Internationally, 2016 marked the RVTTC becoming the 1st veterinary technician association to join the World Veterinary Association. As small animal medicine is a significant area of expertise within the registered veterinary technician and tech-nologist (RVTs) membership, the RVTTC wished to expand its global connections to share this expertise, while providing an opportunity for RVTs to engage within the WSAVA global veterinary community. As an affiliate member of WSAVA it will be mutually beneficial to share the RVT voice while actively contributing within the WSAVA committees.

The RVTTC Board of Directors wishes to thank Dr. Jim Berry for presenting the application on its behalf.

The Registered Veterinary Technologists and Technicians of Canada (RVTTC) is a not-for-profit national organization unit-ing Canadian veterinary technician and technologist associations. Founded in 1989 as the Canadian Association of Animal Health Technologists and Technicians (CAAHTT), RVTTC is tasked with promoting the veterinary technology profession, establish-ing and maintaining national standards of membership, and is a resource regarding national and international issues.



N

L’Association canadienne des médecins vétérinaires (ACMV) a créé, de concert avec des intervenants clés, une nouvelle

plateforme en ligne conçue pour aider les vétérinaires du pays à prendre des décisions favorisant une utilisation responsable et appropriée des antimicrobiens chez les animaux.

La plateforme des Lignes directrices de l’ACMV sur l’utilisation des antimicrobiens intègre une interface électronique interrogeable et des capacités de filtrage afin d’accéder plus rapidement à l’information sur l’utilisation des antimicrobiens. De plus, elle permet de mettre les renseignements à jour plus fréquemment et d’ajouter de nouvelles ressources. On peut aussi la consulter sur différents appareils (ordinateur portable, tablette, téléphone intelligent, etc.). La plateforme est actuellement en anglais, mais la version française sera disponible dans les prochains mois.

«En tant que médecins vétérinaires, nous surveillons l’utilisation responsable et appropriée des antimicrobiens chez les animaux et nous aidons ainsi à prévenir le plus possible l’émergence et la propagation de l’antibiorésistance, une menace au Canada et ailleurs dans le monde», déclare la Dre Terri Chotowetz, présidente de l’ACMV. «La nouvelle plateforme des lignes directrices sur l’utilisation des antimicrobiens permet à notre profession d’appuyer la stratégie mondiale du Canada en matière de résistance et de recours aux antimicrobiens.»

La version en ligne remplace les lignes directrices datant de 2008 offertes uniquement sous forme imprimée. La portée des lignes directrices initiales (quatre groupes d’espèces : bovins de boucherie, bovins laitiers, volaille et porcs) a été élargie et comprend maintenant les petits ruminants (moutons) et les animaux de compagnie (chiens et chats). Les recommandations sur l’utilisation des antimicrobiens ont été élaborées et vérifiées par six groupes vétérinaires particuliers aux espèces, composés d’experts en la matière et de leurs équipes de soutien.

La nouvelle version des lignes directrices de l’ACMV sur l’utilisation des antimicrobiens a été élaborée en 2017 et en 2018 grâce au soutien financier de l’Agence canadienne d’inspection des aliments et du programme Agri-assurance d’Agriculture et Agroalimentaire Canada.

Tous les médecins vétérinaires agréés par un organisme compétent canadien disposeront d’un accès sans restriction au contenu de la nouvelle plateforme d’information en ligne hébergée

The Canadian Veterinary Medical Association (CVMA), with the input of key stakeholders, has created a new online

platform for Canada’s veterinarians to support decision-making on appropriate and responsible use of antimicrobials in animals.

The CVMA Guidelines for Veterinary Antimicrobial Use is an electronic searchable interface with filtering capabilities for quicker access to information on antimicrobial use. It also allows for more frequent updating of information and the addition of new resources, and it is accessible from a variety of devices (e.g., laptop, tablet, smartphone).

“As veterinarians, we oversee the appropriate and responsible use of antimicrobials in animals, thereby helping minimize the emergence and spread of antimicrobial resistance; a threat in Canada and around the world,” says CVMA president Dr. Terri Chotowetz. “The new online platform of veterinary guidelines for antimicrobial use allows our profession to support Canada’s overarching strategy on antimicrobial resistance and use.”

The updated format replaces the CVMA’s original print-only guidelines from 2008. The scope of the original guidelines (4 species groups: beef, dairy, poultry, and swine) was expanded to include small ruminants and companion animals (canine, feline). Recommendations on antimicrobial use were developed and tested by key subject matter experts and their supporting teams, representing 6 veterinary species groups.

Development of the updated veterinary guidelines for anti-microbial use was supported during 2017 and 2018 by fund-ing from Agriculture and Agri-Food Canada’s AgriAssurance Program, and the Canadian Food Inspection Agency.

All licensed veterinarians in Canada will be granted full access to content on the new information platform hosted on the CVMA website (www.canadianveterinarians.net/AMU-UAM) until April 1, 2019, when only active CVMA members will have full access.

The new online platform is intended to host documentation and information to be reviewed and updated regularly to ensure it represents the latest in guidance and science-based knowledge. Future platform development will include integrated links to other key resources, veterinary guidelines for additional animal species, information on alternatives to antimicrobial use. The guidelines will be available in both official languages.

Taking it Online New online platform supports Canada’s veterinarians in overseeing responsible use of veterinary antimicrobials

Transposition en ligneUne nouvelle plateforme aide les médecins vétérinaires canadiens à surveiller l’utilisation responsable des antimicrobiens.



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sur le site Web de l’ACMV (veterinairesaucanada.net/AMU-UAM) jusqu’au 1er avril 2019. Après cette date, l’accès sans restriction sera réservé aux membres en règle de l’ACMV.

La plateforme sert à héberger des documents et de l’information et son contenu sera révisé et mis à jour régulièrement afin de refléter les dernières recommandations et connaissances scientifiques. La prochaine phase de développement de la plateforme comprend l’ajout de liens renvoyant à d’autres ressources importantes, à des lignes directrices sur d’autres espèces animales et à des renseignements sur les méthodes en vue de remplacer l’administration des antimicrobiens. Les lignes directrices seront disponibles dans les deux langues officielles.

Le travail de l’Association canadienne des médecins vétérinaires appuiera l’engagement du Canada en vue de préserver l’efficacité des antimicrobiens maintenant et à l’avenir, chez les animaux et les humains, comme le décrit le document Lutter contre la résistance aux antimicrobiens et optimiser leur utilisation : un cadre d’action pancanadien.

The work by the CVMA will help Canada’s commitment to conserve the effectiveness of antimicrobials now and into the future, in animals and humans, as described in Tackling Antimicrobial Resistance and Antimicrobial Use: A Pan-Canadian Framework for Action.

You may not have the time, facilities, or experience to write scientific articles for review by experts.

But you have interesting and valuable experiences that are worth sharing. We encourage you to share by submitting articles to Practitioners’

Corner, The Canadian Veterinary Journal. Simply e-mail your article to Ms. Heather Broughton ([email protected]). We will edit to ensure the format is correct then we will

publish your article in The CVJ.

Attention Practitioners


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Special Report Rapport spécial

The Pan-Canadian Approach to Wildlife Health

Craig Stephen

W ildlife diseases and their effects are expected to increase with climate change, urbanization, and increased natural

resource development (1). Growing demands for cumulative effects management are creating new expectations to measure, monitor, and maintain wildlife population health (2). A new approach is needed to: i) harmonize capacity across Canada; ii) more efficiently use shared platforms, infrastructure, and expertise; and iii) bolster the ability to quickly detect emerging threats while promoting new partnerships to anticipate prob-lems and sustain healthy populations in advance of harm. The current approach to wildlife health problems is often reactive and follows a “disease-by-disease” sequence. As a consequence, problems are rarely addressed in their early stages and response options may be few. There is a need for greater focus on early warning, prevention, and preparedness, which will depend on improved knowledge of risks, better surveillance for early warning, improved coordination, and integrated response capability. In the Spring of 2018, all federal, provincial, and territorial Ministers responsible for biodiversity and conser-vation approved a new Pan-Canadian Approach to Wildlife Health. The Approach presents a vision for wildlife health to protect the socioeconomic, cultural, and ecological value of healthy wildlife. The Canadian Wildlife Health Cooperative has championed this modernization of wildlife health over the past 4 years, working closely with government and non-governmental partners to advocate for an approach to effectively respond to up-and-coming threats to conservation, public health, and economies from climate change, emerging diseases, globalization and changes to organizational capacities.

The Approach addresses 4 challenges. First, is the challenge of crossing boundaries. Unlike public health and domestic animal health, which are the mandates of specific government agencies with direct budget allocations, wildlife health falls across multi-ple agencies at several levels of government. Problems at human-animal-environmental interfaces require an all-of-government approach, but the gulf between departmental and jurisdictional mandates seems exceptionally wide for wildlife health. While federal, provincial, and territorial governments implement a

wide variety of wildlife health programs within their mandates, many wildlife health issues fall across multiple departments and levels of government. The success of past collaborations (e.g., avian influenza, white nose syndrome of bats) is driving demand for more regular and systematic mechanisms to share capacity and information across programs and personnel. For this reason, partnerships and coordinated networks of expertise are essential for achieving the goals of the Pan-Canadian Approach. The Approach outlines an innovative public management model with the flexibility to deliver and integrate roles across Ministries, governments, and private sectors.

The second challenge arises from our rapidly changing social and environmental conditions. With changing landscapes and climates, and global transport of humans and goods, new avenues are being created for the movement of pathogens and pollutants into and within the Canadian environment. These changes are creating new risks for conservation, public health, and economic activities. Wildlife health continues to be a “canary in the coal mine” that helps us to identify environ-mental threats in advance of human illness, ecological effects, or economic impacts. Demands for wildlife health services and expertise are growing beyond current capacity because of the needs for assurances for trading partners, the expectation to manage for uncertainty, and the increase in emerging diseases threatening public health, conservation, and agriculture.

Thirdly, we are challenged in providing assurances throughout the second biggest country in the world that human activities are not negatively affecting wildlife health, or that wildlife health is not a risk. Efforts and investment vary throughout the country and few formal mechanisms exist to share and make best use of wildlife health observations. Canada must be able to make credible and verifiable wildlife health claims to meet its inter-national and national obligations. The World Organisation for Animal Health (OIE) and World Health Organization (WHO), for example, both require that Canada maintain capabilities that can immediately detect and respond to unusual or unforeseen events that may become a significant human or animal health threat. The Convention on Biological Diversity and the Rio Declaration on Environment and Development similarly require that signatories be able to identify and monitor circumstances likely to adversely impact conservation and sustainable use of biological diversity. Canada’s Constitution affirms the rights of First Nations, Métis, and Inuit peoples to hunt, fish, and consume wild foods. The implementation of the Pan-Canadian Approach to Wildlife Health contributes to the fiduciary obli-gations owed to First Nations, Métis, and Inuit peoples and provides a strong response to our international obligations.

Canadian Wildlife Health Cooperative, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan.Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.



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The fourth challenge is our increasing reliance on ad hoc pro-grams without sustainable or predictable resource. This situation is creating a deficit that is diminishing services and capabilities which, in turn, threatens the ability to anticipate emerging needs, provide nationally representative situational awareness, allow for prevention and preparedness, harmonize an equitable program across Canada, and plan beyond an annual cycle.

The 4 strategic goals of the Approach are to: i) strengthen Canada’s capacity to identify and reduce wild animal health threats and determinants that put conservation, public health, and cultural or economic opportunities at risk; ii) develop, implement, and assess programs and policies intended to sustain healthy wild animals and the positive contributions they make to Canada by reducing disparities and differences in capacity and information across the country; iii) encourage strategies that improve anticipation of wildlife health policy and practice needs in the face of rapidly changing social and environmental conditions; and iv) improve efficiency and effectiveness of public services by working together towards the goal of sustainable wildlife health.

The approach focusses on 4 pillars of activity to achieve its goals. The first is health intelligence; the process of generating, collecting, and analyzing a variety of information to foster col-laboration and consultation through innovation in surveillance, information exchange, research, and response. Health intelli-gence activities will link information to document the wildlife health situation in Canada, including signals of emerging risks and changes in vulnerability. This will be achieved, in part, by working towards equitable access to diagnostic and investiga-tive capacity to track wildlife health trends and assess their significance and by developing coordinated analytical capacity to interpret and communicate health intelligence outputs.

The second pillar develops and supports coordinated and responsible management of expertise and capacity across Canada, providing independent advice, and helping achieve policy goals through wildlife health stewardship. A national secretariat will be responsible for planning and managing capaci-ties and functions needed to provide a national perspective on wildlife health, regularly assemble a pan-Canadian perspective of the state of wildlife health and ensure timely sharing of policy-relevant knowledge arising from the network.

Innovation is the third pillar of the Approach. Wildlife health innovation involves research and knowledge transfer that lead to new public policy and practices to forecast ways to prevent adverse wildlife health outcomes and sustain confidence and access to the services wildlife provide Canadians. The fourth pillar promotes openness, transparency, and integrity through integrated governance to facilitate effective collaboration and promotes performance orientation in program delivery. A recently created forum for leadership, strategy, policy develop-ment and inter-jurisdictional cooperation will help translate wildlife health policy goals and social expectations into positive health outcomes.

The Pan-Canadian Approach to Wildlife Health will ensure fair and secure marketplace access and public use of natural resources, collectively worth billions of dollars to the Canadian economy. The resulting wildlife health intelligence network will strive to: i) be nationally representative; ii) identify needs for adaptive management of endemic problems; iii) provide early warning of emerging threats; iv) detect infectious, non-infectious, or environmental threats; and v) support a sentinel system to monitor environmental safety. The improved situ-ational awareness will help identify, triage, and prioritize threats across Canada to support risk prioritization and evidence-based risk management across public health, conservation, agriculture, natural resource management, and other economic and social sectors. The Approach ensures no single agency bears the full burden of a national program and that investment of any one agency is leveraged by the capacity, infrastructure, and expertise secured through the total investment of all partners. A health protection focus supports more cost-effective and proactive responses against threats compared to investing only in reactions to problems after they emerge.

Canada’s approach to wildlife health is internationally well-respected, serving as a model for many other countries. The essential structures and arrangements necessary to implement the Pan-Canadian Approach to Wildlife Health are in place; however, they require coordination, resources, and dedicated leadership. Environmental and Climate Change Canada is leading the government’s charge to implement the Approach. It is supported by the advice and cooperation of a commit-tee of federal, provincial, territorial, First Nations, Inuit, and academic and non-governmental partners. This committee will help identify 5-year priorities for action and create the busi-ness case to secure the funds needed to see that the goals of the Approach are fully realized. The Pan-Canadian Approach builds on the foundations created by the Canadian Wildlife Health Cooperative by sustaining and supplementing core stewardships and health intelligence capacities and creates new opportunities to expand the network of skills and expertise to meet modern demands for a national wildlife health program. Interacting with knowledge users, knowledge producers, partners in Canada and abroad will allow for more effective mobilization of information to decision-makers. By networking wildlife health expertise and knowledge found in existing provincial, territorial, federal, and academic partners, a more resilient, better informed, and better prepared network will be created.

References1. Stephen C, Wittrock J, Wade J. Using a harm reduction approach in an

environmental case study of fish and wildlife health. EcoHealth 2018;15: 4–7.

2. Wittrock J, Duncan C, Stephen C. A determinants of health conceptual model for fish and wildlife health. J Wildl Dis 2018 Oct 5. doi: 10.7589/ 2018-05-118.



Review Article Compte rendu

What is the evidence that bovine coronavirus is a biologically significant respiratory pathogen in cattle?

John Ellis

Abstract — Coronaviruses, including bovine coronavirus (BCoV), are etiologically associated with enteric and respiratory disease across a wide range of mammalian and avian species. The role of BCoV in calfhood diarrhea is well-established, but its role in the bovine respiratory disease complex (BRDC) has been controversial. This review re-examines the evidence that BCoV is a significant pathogen in the BRDC.

Résumé — Quelle est la preuve que le coronavirus bovin est un agent pathogène biologiquement important chez le bétail? Les coronavirus, y compris les coronavirus bovins (BCoV), sont étiologiquement associés à des maladies entériques et respiratoires chez un vaste éventail d’espèces mammifères et aviaires. Le rôle du BCoV dans la diarrhée des veaux est bien établi, mais son rôle dans le complexe de la maladie respiratoire bovine est controversé. Cet examen se penche de nouveau sur les preuves indiquant que le BCoV est un agent pathogène important pour le complexe de la maladie respiratoire bovine.

(Traduit par Isabelle Vallières)

Can Vet J 2019;60:147–152

Introduction

B ovine coronavirus (BCoV) belongs to a family of microbes that is etiologically associated with enteric and respiratory

disease across a wide range of mammalian and avian species (1). The role of BCoV in calfhood diarrhea is well-established, and it continues to be a problem in calf-rearing operations (1). The role of BCoV in the bovine respiratory disease complex (BRDC) has been controversial, and, if anything, the recent increased application of molecular diagnostics to BRDC cases has further muddied the waters. Over the years since its discovery there have been several reviews on BCoV, including some focusing on “respiratory” BCoV (2–5). Beyond the biological precedents linking coronaviruses to respiratory diseases, recent information concerning BCoV is reviewed herein, and the evidence that implicates BCoV in the BRDC is re-addressed.

A brief history of bovine coronavirusExemplifying Pasteur’s aphorism, “Chance only favors the prepared mind,” BCoV was accidently discovered by Mebus et al (6) at the University of Nebraska in 1972. These authors

were conducting efficacy studies on a vaccine for the then newly discovered bovine reovirus-like virus (rotavirus) and astutely observed that while the vaccine was apparently effec-tive in reducing diarrhea due to the rotavirus, there were several herds in which vaccinated calves developed diarrhea later than expected with rotavirus, and their feces were free of that microbe. Mebus et al (6) observed a corona-like virus in diarrheic feces and conducted transmission experiments in gnotobiotic calves. They then cultured the virus, determined which cell types would support growth, attenuated the virus, and performed initial protection experiments (7). In the next decade BCoV was recognized as a common cause of calfhood diarrhea (8). In 1982 Thomas et al (9) working in England in a search for new microorganisms in calf pneumonia first impli-cated BCoV as a respiratory pathogen by inoculating material from nasopharyngeal swabs and lung washes from calves with naturally occurring respiratory disease into gnotobiotic calves. Coronaviruses were then observed using electron microscopy in respiratory samples and supernatants from organ cultures that were inoculated with respiratory samples from the experi-mentally infected calves (9). The studies by Thomas et al (9) also provided the first indication that the 2 BCoVs associated with enteric and respiratory disease were the same, or at least belonged to the same serotype, by noting that serum raised against enteric isolates of BCoV immunoagglutinated the “respiratory” BCoV. Shortly thereafter, workers in the same laboratory extended investigations of the relatedness of BCoVs in 1985, and demonstrated immunity to heterologous infection and cross-neutralization of BCoVs by porcine antisera to enteric and respiratory isolates (10). Subsequently, numerous investiga-tors have confirmed, using various techniques, that enteric and

Department of Veterinary Microbiology, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan S7N 5B4.Address all correspondence to Dr. John Ellis; e-mail: [email protected] of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.



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respiratory BCoVs are members of the same quasispecies (11), notwithstanding predictable genotypic and phenotypic differ-ences amongst isolates (1–5).

A primer on coronavirologyThe family Coronaviridae was originally named in the 1960s in the heyday of electron microscopy based on morphologic features (12). Coronaviruses are spherical to pleomorphic enveloped RNA viruses (1–5). They have distinctive club-shaped 20-nm peplomers or “spikes” protruding uniformly, circumferentially from the envelope. Some coronaviruses, including BCoV, have a secondary fringe of smaller 5-nm spikes (1–5). In electron micrographs the overall appearance of the viral particles was reminiscent of the solar corona to virologists, hence the name “corona” (12). The lipid-containing envelope makes these viruses susceptible to conventional disinfectants and the extra-corporal environment (1). The larger spike is a heterodimeric glycoprotein comprising 2 subunits, S1 and S2 (1,2,5). This spike protein has several important biological features: it interacts with sialic acid-containing receptors on the target cell membrane, prob-ably largely determining tissue tropism and species specificity of different coronaviruses; it is involved in fusing infected cells; it contains, mostly conformational, epitopes that are the major targets for antibody responses and less well- characterized cell-mediated immune responses; and it is the major site of immuno-logically important antigenic variation amongst BCoV isolates, which likely contributes to vaccines working, or not (1,2,5). The smaller spike is a second envelope glycoprotein, which is also a heterodimer comprising a host membrane (class I) protein and a hemagglutinin-esterase (HE). This spike also interacts with cellular receptors and contains epitopes that are targets for neu-tralizing antibodies (1,2,5). There are 3 other structural proteins; 2 transmembrane proteins: M and E, that assist in viral assembly, and an internal N or nuclear protein that is associated with the genome to form a helical nucleocapsid. The amino acid structure of N protein is relatively conserved amongst BCoV isolates and is therefore targeted in diagnostic testing such as polymerase chain reactions (PCRs) (1,2,5). Less glamorous, but no less biologically significant, is a group of 4 to 8 (depending on the particular coronavirus) nonstructural “accessory” proteins. These proteins have been best characterized in the emergent bat coronaviruses, notably SARS virus, but have not been thoroughly examined in BCoV. Nevertheless, a major function of these proteins is to inhibit innate (interferon) responses (1,13). Inter-isolate dif-ferences in this immunosuppressive function could contribute to differences in virulence amongst BCoV isolates (13); time will tell.

Coronaviruses are in the Order Nidovirales (from the Latin nidus, nest), which refers to their complex replicative scheme, involving “nests” of subgenomic RNAs (1). Essentially, this involves 3 major steps. First, part of the 1stranded RNA genome acts as messenger RNA for the synthesis of an RNA-dependent RNA polymerase. Then, this enzyme guides cellular machinery in the cytoplasm of the infected cell to transcribe a full length negative (complementary) RNA from which a new copy of the 1strand genome is transcribed. The RNA polymerase also directs the transcription of a set, or “nests” of

subgenomic messenger RNAs from the complementary RNA strand, which the cell uses to translate individual viral proteins (1). Molecular details aside, this highly error-prone replicative scheme, together with the possibility of recombination between isolates, results in high mutability, making BCoV and other coronaviruses rapidly moving targets.

Historically, coronaviruses were divided into 3 groups based on genetic and serologic properties: Group 1 included feline infectious peritonitis virus and transmissible gastroenteritis virus, and lacked the hemaglutinin-esterase (HE); Group 2 included BCoV and the human “cold” virus, HCoV-043, and had the HE; and Group 3 included avian viruses, notably infec-tious bronchitis virus (2,5). More recently, the relative ease and low cost of sequencing, together with the discovery of more coronaviruses, have complicated the taxonomy of coronaviruses (1). These viruses are currently divided into 4 genera based on the partial nucleotide sequences of the RNA-dependent RNA polymerase: alpha, beta (contains 4 subgroups A to D), gamma, and delta, with BCoV in the beta A grouping, with its close relationship to the human (and canine) “respiratory” coronavi-ruses preserved. Genotyping of BCoV isolates is in its infancy (14). However, despite the confusion more cladistics analyses may bring, it is likely that the current bottom line will not change; BCoV exists as a quasispecies with 1 serotype, but with significant variation, including antigenic spectrum, tropism, and virulence, amongst isolates that does not necessarily relate to their clinical origin (enteric versus respiratory) (1,5).

Circumstantial evidence that BCoV is a respiratory pathogenAssociations with ex vivo and postmortem samplingAs indicated in the first report implicating BCoV as a respira-tory pathogen in the early 1980s (9), the presence of a microbe in nasal secretions and other respiratory samples has long been taken as evidence of pathogenicity/causality in BRD cases. Historically, detection was accomplished using electron micro-scopy and/or virus isolation. Isolation of BCoV in cell culture can be problematic because, as first reported in the seminal studies (7), it is fastidious, especially in the case of field isolates (15,16). The latter usually preferentially grow in primary or very low passage cell cultures, and, for some undetermined reason, in the human rectal adenocarcinoma cell line, HRT-18 (17), which is the cell of choice in most diagnostic settings when culture of BCoV is attempted (1). Currently, as throughout veterinary diagnostic medicine, reverse transcriptase (RT)-PCR-based methods (18–25), and most recently metagenomic analysis (26) have largely supplanted culture in identifying BCoV in clinical samples. The increased sensitivity, however, could lead to false positives with regard to biological significance in the likely case that a certain threshold of viral growth is necessary to cause clinical disease. Attesting to this caveat emptor, as is the case with many (all?) endemic pathogens in host populations, BCoV has been identified in respiratory samples from healthy (16,21,26–28) as well as sick cattle (16,18–25). In the latter case, BCoV shedding has been documented in the absence of other recognized, or tested for, respiratory pathogens (27,28), and, more frequently as an apparent co-conspirator with other



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respiratory pathogens in clinical specimens (18,22,27–31). Even if it is not consistent with Evan’s postulates (29) the presence of BCoV in the nasal secretions of healthy cattle is not exculpatory of pathogenicity; however, it does make the indictment of BCoV as a significant respiratory pathogen, based on presence alone, more tenuous. Simply because a microbe is present in a sick animal does not necessarily mean it is a pathogen. Quantitative PCR (qPCR) has been used experimentally in a small number of calves to correlate amount of nasal shedding with transmis-sibility (32). No direct link was found, but this study suffered the confounding variable of developing immunity (32). Beyond Evans postulates (29), more data correlating BCoV load with disease would be an obvious theoretical and practical advance-ment to more definitively establish the conditions of causality with regard to the detection of BCoV in clinical samples.

Associations with immune responses to BCoVLike a fingerprint at the scene of a crime, traditionally and currently, post-disease seroconversion is often used as evi-dence of causality. From its initial discovery and indictment in respiratory disease to the present day, numerous serological studies have implicated BCoV; but not without reasonable doubt (28,31,33–37). Conversely, an association between an immune response to BCoV, a priori to exposure/challenge, and disease-sparing has also been taken as circumstantial evidence of causality. Several epidemiologic studies have reported that high antibody titers to BCoV, most likely resulting from expo-sure prior to weaning, can have a respiratory disease-sparing effect. Cattle with high antibody titers on entry to a feedlot or other situations of exposure are less likely than those with low antibody titers to develop the BRDC and/or require treatment (28,31,34,38–40). In addition, in the 1 and only prospective study that examined the effect of (intranasal) vaccination for BCoV it was reported that vaccination before entry to the feed-lot and/or antibody titers . 20 were associated with decreased risk of treatment for BRDC; whereas vaccination on arrival was associated with increased risk (41). However, in the absence of specific etiologic diagnosis, preferably visualization of BCoV in lesions, these data may indicate an association and not a causal relationship. The data do not rule out that calves with a broad range of immunological experience may have less BRD simply because they also have antibody and other immune responses to the pathogen(s) which is the true the cause of the observed disease; bovine respiratory syncytial virus (BRSV), for instance. Moreover, at the individual calf level, data are conflicting as to the predictive value of BCoV antibody titers regarding which calves require treatment for BRDC after entry to a feedlot (25,28,34).

Physical evidence that BCoV is a respiratory pathogenIn contrast to the relative plethora of circumstantial evidence in the form of epidemiologic data and routine diagnostic testing of clinical specimens that are often used to indict BCoV as a respiratory pathogen, there is a dearth of physical evidence of its criminality in that organ system. Quite simply, there are very few images demonstrating BCoV in lesions in the respiratory

tract in naturally or experimentally infected cattle in the peer-reviewed literature or textbooks, which would arguably consti-tute a “smoking gun” of direct evidence, at least for pathologists. From the standpoint of naturally occurring disease, this could be due, at least in part, to the timing of sampling. Cattle that die of respiratory disease often present little physical (immuno-histochemical) evidence of viral infection in affected organs simply because the acutely infecting respiratory viruses have come and gone by the time an animal succumbs to secondary, more readily demonstrable, bacterial infections (5,42). In the last decade, 1 investigation of outbreaks of acute respiratory disease in intensively reared beef calves showed a series of good quality gross and histological lesions. These included tracheal petechia-tion together with mucopurulent discharge and bronchointer-stitial pneumonia with intra-bronchiolar syncytial cells in an affected airway that could have been compatible with BCoV infection (43). Bovine coronaviral RNA was detected by qRT-PCR in 2 of 15 lesional lungs tested; however, unfortunately, there was no apparent attempt to directly associate BCoV with the histological lesions.

From the perspective of attempting to demonstrate Koch’s postulates by experimentally reproducing disease, convincing evidence convicting BCoV in a causal relationship with respira-tory disease is scant. Four studies reported a failure to produce clinical respiratory disease using various BCoV-containing inocula (10,44–46). The first was a complicated cross-protection study and used feces from diarrheic calves administered orally or material from nasopharyngeal swabs administered intranasally and intratracheally as inoculum. Bovine coronavirus-positive epithelial cells were demonstrable in nasal turbinates and/or tracheas of 11 of 12 infected calves; however, there was no associated inflammation reported or evident in pictures of immunohistochemically stained tissues (10). No BCoV was similarly identified in lungs of any calf. In a second study, 18 (3- to 50-day-old) gnotobiotic calves and 7 (25- to 63-day-old) colostrum-deprived calves were inoculated intranasally, orally, or by both routes with a suspension of BCoV-containing intestinal contents that had been derived from the 5th passage of similar material in gnotobiotic calves and was “bacteriologically sterile” (44). All the calves developed diarrhea by 2 to 4 d after infec-tion, but none had clinical signs of respiratory disease. Bovine coronavirus-infected nasal and/or tracheal epithelial cells were detected in 16 of the 18 calves, and in the “lung tissue” (impres-sion smears) of 4/18 calves by immunofluorescent staining. Two of the latter calves had “focal interstitial emphysema”; however, assessment of histological changes was not performed, or at least not presented. In the third study, 5 (1- to 10-day-old) colos-trum-deprived calves and 2 (5- to 27-day-old) gnotobiotic calves were administered either 40 mL of a HRT-18 cultured (passage level and dose not given) “respiratory” strain (BC930), or “a winter dysentery strain” or “a calf diarrhea strain,” “oronasally” (passage levels and doses not given) (45). All calves developed diarrhea of variable severity and duration. No calves developed signs of respiratory disease, and aside from monitoring nasal (and fecal) shedding of BCoV, there was no examination of any tissues from the respiratory tract to determine sites of infection. Arguably the most convincing experimental physical evidence of



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the pathogenicity of BCoV in the respiratory tract was obtained with a winter dysentery isolate of the virus, the Korean strain “KWD3” that had been passaged 6 times in HRT-18 cells (46). Six 2- to 4-day-old colostrum-deprived (CD) Holstein calves were inoculated orally with 40 mL of HRT-18 cell culture super-natant containing 1.5 3 108 focus (plaque) forming units/mL; 1 CD calf was mock infected with 40 mL of uninfected HRT-18 cell culture supernatant, and 1 CD calf received 40 mL of inactivated infected HRT-18 supernatant. All of the infected calves developed diarrhea and elevated body temperatures; the mock infected controls did not. Despite the report of no clinical signs of respiratory disease in the infected calves, there were significant lesions described throughout the respiratory tract, including infection and necrosis of epithelia in the nasal turbinates, trachea, bronchioles, and pulmonary parenchyma. There was associated interstitial pneumonia and hyperplasia of type II pneumocytes, and BCoV antigens were demonstrated immunohistochemically in the cytoplasm of degenerate epithe-lial cells. Unfortunately, these changes were illustrated in figures of only moderate quality, somewhat limiting interpretation. Although the authors did not exclude the possibility of some inhalation of the inocula during administration, they made the point of discussing a probable role for viremia, including cell-free and infection of cells of monocyte macrophage lineage, resulting from transenteric transmission in the pathogenesis of respiratory infection.

Two studies reported reproduction of some level of respira-tory disease (47–49). In the first published attempt to produce respiratory disease with BCoV, 7 (, 7-day-old) calves, 5 CD, 2 colostrum fed, were infected with a tracheal-organ culture supernatant containing BCoV (derived from a field case) as inoculum (47). Mild signs of respiratory disease, including cough and nasal discharge, as well as diarrhea, were produced. A few scattered areas of atelectasis were observed in lungs of 3 calves; changes in tracheas and nasal turbinates were not reported. Bovine coronavirus positive cells were visualized by immunofluorescence in the lungs of 2 calves, but no histologi-cal examination of respiratory organs was reported. However, this was the result of a draconian, unnatural challenge method involving both intranasal and transtracheal inoculation of 10 mL of supernatant given twice daily for 4 consecutive days. In another study published as 2 brief communications (48,49), 5-day-old CD Holstein calves were infected orally with dif-ferent doses of an attenuated BCoV (2 calves; Mebus strain; 41 passages in vitro) or a “virulent pneumoenteric strain,” the “Minnesota strain” in the form of suspended filtered fecal material containing BCoV from a field case (3 calves). All 3 calves that received the field isolate developed diarrhea; 2 had “pneumonia,” including respiratory distress, and 1 of these died. The investigators reported fluorescence using BCoV conjugates [but not with conjugates for bovine respiratory syncytial virus (BRSV), bovine parainfluenza virus-3 (BPIV-3), or bovine herpes virus-1 (BHV-1)] of variable intensity in lung sections and “disrupted nasal cells.” There were no images of lesions or immunological staining.

Some degree of diarrhea resulted during the attempts to reproduce respiratory disease with inocula containing BCoV,

even when “respiratory” isolates were used and some respira-tory disease was observed. Ironically, this unintended outcome provides some of the best evidence of the still-debated idea that the BCoVs that cause enteric and respiratory disease in cattle are essentially the same (5). Excluding the possibility that BCoV is not a significant respiratory pathogen, it is not known why respiratory disease caused by BCoV has been so difficult to reproduce. It could involve strain differences, host factors, or environmental co-factors to name a few, but it may be as conceptually and practically simple as how the BCoV inoculum is propagated. As demonstrated in the first paper reporting the in vitro culturing of BCoV nearly 50 y ago (7), and confirmed subsequently (2,5), upon repeated passage in cell culture, BCoV isolates become more promiscuous in their ability to grow in a broader range of cell types, and in higher passage cell cultures. This could simply reflect the de facto selec-tion of variants within the quasispecies that are more flexible in their growth requirements. Again, the seminal studies indicated that this “adaptation to culture” is associated with attenuation (7); good for vaccine development, not so good for producing inocula to study pathogenesis. Still, the details as to how, and to what extent this promiscuity concerning target cell permissivity to infection in vitro is associated with changes in pathogenicity and/or virulence in vivo remains to be more fully examined. It has been more than a decade since there has been a publication related to the experimental reproduction of respiratory disease with BCoV in calves.

In conclusion, the answer to the rhetorical question that is the title of this review ultimately turns on one’s definition of “biologically significant.” Certainly, from the standpoint of pulmonary infection and pathology, in contrast to, for example, BRSV (50), available evidence indicates that BCoV has been associated with neither substantial infection of the lower airways or pulmonary parenchyma, nor substantial pulmonary pathol-ogy. In this it is different from the avian infectious bronchitis virus (IBV), the prototype virus of the Coronaviridae (12); severe respiratory disease and pulmonary (airway) pathology can be sequel to infection with virulent strains of that virus (1,12). With regard to the trachea, BCoV infection has been associated with mild clinical signs consistent with tracheal disease, and BCoV infection has been documented immunohistochemically in situ in that organ. However, this infection has apparently not been associated with the severe clinical tracheitis and extensive necrotizing, so-called “stove-pipe” lesions, typical of many cases of bovine herpesvirus-1 infection (50) or IBV (1). Examination of the nasal turbinates and sinuses is generally not a common practice in cases of bovine respiratory disease outside academia. BCoV has been identified, in situ, in those parts of the upper respiratory tract, which is consistent with the “cold-like” signs that are associated with BCoV infection in cattle, as well as in humans infected with another prototypical coronavirus respon-sible for the “common cold” (12).

Although it is certainly cliché to discuss the synergy between various pathogens in the development of the BRDC, it is prob-ably in the case of mixed infections, generally the rule, that BCoV achieves significance as a respiratory pathogen. Certainly, infection and some level of damage to epithelium and resultant



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inflammation, relatively innocuous in itself (witness the com-mon cold), could and often probably does serve as a preamble to “secondary infections.” Indeed, the first study implicating BCoV as a respiratory pathogen (10) provided evidence of this probable necessity and alluded to the problem of reproducing disease with a monoculture of BCoV (or other recognized respi-ratory pathogens), proving that Koch’s postulates are a limited way of thinking about a syndromic, etiologically complicated, disease. This difficulty in reproducing dramatic respiratory disease, or at least something that can be measured beyond shedding of virus, with BCoV (alone) is also an impediment to having a BCoV vaccine with a label claim for respiratory disease from a regulatory perspective. In the context of this apparent constraint of disease production, it is both interesting and inconsistent that vaccines for the 2 recognized paramyxoviral respiratory pathogens of cattle, BRSV and bovine parainfluenza virus-3 (BPIV-3), were in the case of BRSV (51), and are in the case of BPIV-3 (52), licensed on the basis, essentially, of reduced nasal shedding (of the viruses) alone, with no requirement for producing typical clinical respiratory disease in the experimental models traditionally employed. Perhaps the best way forward is to place more emphasis on studying BCoV in the context of mixed infections, and relatedly, evaluate the efficacy of BCoV-containing vaccines in the context of disease reduction overall, rather than in the traditional regulatory approach to licensure: 1 agent, 1 disease.

Acknowledgments/DisclosuresThe author has conducted and conducts vaccine efficacy studies for Pfizer Animal Health, Zoetis, Merial, Merck Animal Health, Fort Dodge Animal Health, Boehringer Ingelheim Vetmedica, Elanco. CVJ

References 1. Brownlie J. Coronaviridae. In: MacLachlan NJ, Dubovi EJ, eds. Fenner’s

Veterinary Virology. 5th ed. San Diego, California: Elsevier, 2017: 435–459.

2. Clark MA. Bovine coronavirus. Br Vet J, 1993;149:51–70. 3. Kapil S, Basaraba RJ. Infectious bovine rhinotracheitis, parainfluenza-3,

and respiratory coronavirus. Vet Clin North Am Food Anim Pract 1997; 13:455–469.

4. Bolieau MJ, Kapil S. Bovine coronavirus associated syndromes. Vet Clin North Am Food Anim Prac 2010;26:123–146.

5. Saif LJ. Bovine respiratory coronavirus. Vet Clin North Am Food Anim Pract 2010;26:349–364.

6. Mebus CA, White RG, Stair EL, Rhodes MB, Twiehaus MJ. Neonatal calf diarrhea: Results of a field trial using a reo-like virus vaccine. Vet Med Small Anim Clin 1972;67:173–178.

7. Mebus CA, Stair EL, Rhodes MB, Twiehaus MJ. Neonatal calf diarrhea: Propagation, attenuation and characteristics of a coronavirus-like agent. Am J Vet Res 1973;34:145–150.

8. Woode GN, Bridger JC, Meyling A. Significance of bovine coronavirus infection. Vet Rec 1978;102:15–16.

9. Thomas LH, Gourlay RN, Stott EJ, Howard CJ, Bridger JC. A search for new microorganisms in calf pneumonia by the inoculation of gno-tobiotic calves. Res Vet Sci 1982;33:170–182.

10. Reynolds DJ, Debney TG, Hall GA, Thomas LH, Parsons KR. Studies on the relationship between coronaviruses from the intestinal and respiratory tract of calves. Arch Virol 1985;85:71–83.

11. Domingo E, Martinez-Salas E, Sobrino F, et al. The quasispecies (extremely heterogenous) nature of viral RNA genome populations: Biological relevance — A review. Gene 1985;40:1–9.

12. Estola T. Coronaviruses, a new group of animal RNA viruses. Avian Dis 1970;14:330–336.

13. Perlman S, Netland J. Coronavirues post-SARS: Update on replication and pathogenesis. Nat Rev Microbiol 2009;7:439–450.

14. Kin N, Miszczak F, Diancourt L, et al. Comparative molecular epidemi-ology of two closely related coronaviruses, bovine coronavirus (BCoV) and human coronavirus OC43 (HCoV-OC43), reveals a different evolutionary pattern. Infect Genet Evol 2016;40:186–191.

15. Benfield DA, Saif LJ. Cell propagation of a coronavirus isolated from cows with winter dysentery. J Clin Microbiol 1990;28:1454–1457.

16. Hasoksuz M, Lathrop SL, Gadfield KL, Saif LJ. Isolation of bovine respiratory coronaviruses from feedlot cattle and comparison of their biological and antigenic properties with bovine enteric coronaviruses. Am J Vet Res 1999;60:1227–1233.

17. Hogue BG, King B, Brian DA. Antigenic relationships among proteins of bovine coronavirus, human respiratory coronavirus OC43, and mouse hepatitis coronavirus A59. J. Virol 1984;51:384–388.

18. Fulton RW, Blood KS, Panciera RJ, et al. Lung pathology and infec-tious agents in fatal feedlot pneumonias and relationship with mortality, disease onset, and treatments. J Vet Diagn Invest 2009;21:464–477.

19. Moore SJ, O’Dea MA, Perkins N, Barnes A, O’Hara AJ. Mortality of live export cattle on long-haul voyages: Pathologic changes and patho-gens. J Vet Diagn Invest 2014;26:252–265.

20. O’Neill R, Mooney J, Connaghan E, Furphy C, Graham DA. Patterns of detection of respiratory viruses in nasal swabs from calves in Ireland: A retrospective study. Vet Rec 2014;175:351–357.

21. Francoz D, Buczinski S, Belanger G, et al. Respiratory pathogens in Quebec dairy calves and their relationship with clinical status, lung con-solidation, and average daily gain. J Vet Intern Med 2015;29:381–387.

22. Fulton RW, d’Offay JM, Landis C, et al. Detection and characterization of viruses as field and vaccine strains. Vaccine 2016;34:3478–3492.

23. Doyle D, Credille B, Lehenbauer TW, et al. Agreement among 4 sam-pling methods to identify respiratory pathogens in dairy calves with acute bovine respiratory disease. J Vet Intern Med 2017;31:954–959.

24. Kishimoto M, Tsuchiaka S, Rahpaya SS, et al. Development of a one-run real time PCR detection system for pathogens associated with bovine respiratory disease complex. J Vet Med Sci 2017;79:517–523.

25. Workman AM, Kuehn LA, McDonald TG, Clawson ML, Chitko-Mckowen CG, Loy JD. Evaluation of the effect of serum antibody abundance against bovine coronavirus on bovine coronavirus shedding and risk of respiratory tract disease in beef calves from birth through the first five weeks in a feedlot. Am J Vet Res 2017;78:1065–1076.

26 Mitra N, Cernicchiaro N, Torres S, Li F, Hause BM. Metagenomic characterization of the virome associated with bovine respiratory disease in feedlot cattle identified novel viruses and suggests an etiologic role for influenza D virus. J Gen Virol 2016;97:1771–1784.

27. Storz J, Purdy CW, Lin X, et al. Isolation of respiratory bovine corona-virus, other cytocydal viruses, and Pasteurella spp. from cattle involved in two natural outbreaks of shipping fever. J Am Vet Med Assoc 2000; 216:1599–1604.

28. Fulton RW, Step DL, Wahrmund J, et al. Bovine coronavirus (BCV) infections in transported commingled beef cattle and sole-source ranch calves. Can J Vet Res 2011;75:191–199.

29. Storz J, Lin X, Purdy CW, et al. Coronavirus and Pasteurella infections in bovine shipping fever pneumonia and Evan’s criteria for causation. J Clin Microbiol 2000;38:3291–3298.

30. Gagea MI, Bateman KG, van Dreumel T, et al. Diseases and pathogens associated with mortality in Ontario beef feedlots. J Vet Diag Invest 2006;18:18–28.

31. Cho KO, Hoet AE, Loerch SC, Wittum TE, Saif LJ. Evaluation of concurrent shedding of bovine coronavirus via the respiratory tract and enteric route in feedlot cattle. Am J Vet Res 2001;62:1436–1441.

32. Oma VS, Traven M, Alenius S, Myrmel M, Stokstad M. Bovine coro-navirus in naturally and experimentally exposed calves; viral shedding and the potential for transmission. Vet J 2016;13:100–111.

33. Storz J, Stine L, Liem A, Anderson GA. Coronavirus isolation from nasal swab samples in cattle with signs of respiratory tract disease after shipping. J Am Vet Med Assoc 1996;208:1452–1455.

34. Marten SW, Nagy E, Shewen PE, Harland RJ. The association of titers to bovine coronavirus with treatment for bovine respiratory disease and weight gain in feedlot cattle. Can J Vet Res 1998;62:257–261.

35. Lathrop SL, Wittum TE, Loerch SC, Perino LJ, Saif LJ. Antibody titers against bovine coronavirus and shedding of the virus via the respiratory tracat in feedlot cattle. Am J Vet Res 2000;61:1057–1061.

36. Hasoksuz M, Hoet AE, Loerch SC, Wittum TE, Nielsen PR, Saif LJ. Detection of respiratory and enteric shedding of bovine coronaviruses in cattle in Ohio feedlot. J Vet Diagn Invest 2002;14:308–313.



CO

MP

TE

RE

ND

U

37. Lin XO, O’Reilly KL, Storz J, Purdy CW, Loan RW. Antibody responses to respiratory coronavirus infections of cattle during shipping fever pathogenesis. Arch Virol 2000;145:2345–2349.

38. O’Connor A, Marten SW, Nagy E, Menzies P, Harland R. The rela-tionship between the occurrence of undifferentiated bovine respiratory disease and titer changes to bovine coronavirus and bovine viral diarrhea virus in 3 Ontario feedlots. Can J Vet Res 2001;65:137–142.

39. Thomas CJ, Hoet AE, Sreevatsan S, et al. Transmission of bovine coro-navirus and serologic responses in feedlot calves under field conditions. Am J Vet Res 2006;67:1412–1420.

40. Pardon B, Alliet J, Boone R, Roelandt S, Valgaeren B, Deprez P. Prediction of respiratory disease and diarrhea in veal calves based on immunoglobulin levels and the serostatus for respiratory pathogens measured at arrival. Prevent Vet Med 2015;120:169–176.

41. Plummer PJ, Rohrbach BW, Daugherty RA, et al. Effect of intranasal vaccination against bovine enteric coronavirus on the occurrence of respiratory tract disease in a commercial backgounding feedlot. J Am Vet Med Assoc 2004;225:726–731.

42. Booker CW, Abutarbush SM, Morley PS, et al. Microbiological and histopathological findings in cases of fatal bovine respiratory disease of feedlot cattle in Western Canada. Can Vet J 2008;49:473–481.

43. Hick PM, Read AJ, Lugton I, et al. Coronavirus infection in intensively managed cattle with respiratory disease. Aust Vet J 2012:381–386.

44. Saif LJ, Redman DR, Moorhead PD, Theil KW. Experimentally induced coronavirus infections in calves: Viral replication in the respiratory and intestinal tracts. Am J Vet Res 1986;47:1426–1432.

45. Cho K-O, Hasoksuz M, Nielsen PR, Chang K-O, Lathrop S, Saif LJ. Cross-protection studies between respiratory and calf diarrhea and winter dysentery coronavirus strains in calves and RT-PCR and nested PCR for their detection. Arch Virol 2001;146:2401–2409.

46. Park SJ, Kim GY, Choy HE, et al. Dual enteric and respiratory tropisms of winter dysentery bovine coronavirus in calves. Arch Virol 2007;152: 1885–1900.

47. McNulty MS, Bryson DG, Allan GM, Logan EF. Coronavirus infection of the bovine respiratory tract. Vet Microbiol 1984;9:425–434.

48. Kapil S, Trent AM, Goyal SM. Excretion and persistence of bovine coronavirus in neonatal calves. Arch Virol 1990;115:127–132.

49. Kapil S, Pomeroy KA, Goyal PG, Trent AM. Experimental infection with a virulent pneumoenteric isolate of bovine coronavirus. J Vet Diagn Invest 1991;3:88–89.

50. Ellis JA. Update on viral pathogenesis in BRD. Anim Health Res Rev 2009;10:149–153.

51. Ellis JA. How efficacious are vaccines against bovine respiratory syncytial virus in cattle? Vet Microbiol 2017;206:59–68.

52. Ellis JA. Bovine parainfluenza virus-3. Vet Clin Food Anim 2010;26: 575–593.



Article

Distribution and abundance of Eimeria species in commercial turkey flocks across Canada

Rachel K. Imai, John R. Barta

Abstract — Diversity and regional abundance of Eimeria species infecting Canadian commercial turkey flocks are largely unknown. To address this paucity of data regarding coccidiosis and its distribution in Canada, fecal samples from turkey flocks (N = 39) representing 27 commercial farms [ON (n = 20), SK (n = 2), BC (n = 3), AB (n = 1), NS (n = 1)] were screened for coccidia. Identification of all Eimeria species present in each sample was accomplished using a nested-polymerase chain reaction (PCR) assay targeting the mitochondrial cytochrome C oxidase subunit I gene. Most samples (33/39) were Eimeria-positive with 6 Eimeria species identified by the nested-PCR assay (1 to 6 species/sample, average 3.2); 4 samples (4/39, . 10% of samples) contained all 6 species. Eimeria species were common and distributed widely in Canadian commercial turkey flocks. Turkeys reared using in-feed medication or live vaccination for coccidiosis control had similar Eimeria species diversity within individual flocks. These preliminary observations highlight that coccidiosis remains a concern for Canadian turkey producers.

Résumé — Distribution et abondance d’espèces d’Eimeria infectant des troupeaux de dindes commerciaux à travers le Canada. La diversité et l’abondance régionale d’espèces d’Eimeria infectants des troupeaux de dindes commerciaux canadiens sont pour la plupart inconnues. Pour adresser cette pénurie de données concernant les coccidies et leurs distributions au Canada, des échantillons fécaux provenant de 39 troupeaux de dindes, représentants 27 fermes commerciales [ON (n = 20), SK (n = 2), BC (n = 3), AB (n = 1), NS (n = 1)] étaient cribler pour la coccidie. L’identification de toutes les espèces d’Eimeria trouvées dans chaque échantillon était accomplie en utilisant une PCR nichée pour cibler la sous-unité I mitochondriale du cytochrome C oxydase. La plupart des échantillons (33/39) était positif pour l’Eimeria avec six espèces d’Eimeria identifiées par la PCR nichée (1 à 6 espèces/échantillon, moyenne 3,2); quatre échantillons (4/39, . 10 % d’échantillons) contenaient toutes les six espèces. Les espèces d’Eimeria sont communes et sont largement distribuées dans les troupeaux de dindes commerciaux canadiens. Les dindes élevées en utilisant des anticoccidiens en additifs alimentaire ou vaccinées avec des vaccins vivants pour la coccidie avaient une diversité d’espèces d’Eimeria similaire entre les troupeaux individuels. Ces observations préliminaires indiquent que la coccidie demeure toujours une préocculation pour les éleveurs de dindons.

(Traduit par Alex Léveillé et Lisa Gordon)

Can Vet J 2019;60:153–159

Introduction

T here are 6 well-described Eimeria spp. that have been characterized through molecular genotyping methods;

additional Eimeria spp. from turkeys have been named but their taxonomic validity remains uncertain. The Eimeria spp. widely accepted to be valid are: E. adenoeides, E. dispersa, E. gal-

lopavonis, E. innocua, E. meleagrimitis, and E. meleagridis. Few species are believed to cause clinical coccidiosis in turkeys and information on the degree of pathogenicity for certain species is lacking (1,2). Although over 183 million kg of meat turkeys are produced annually in Canada (3), information on the distribu-tion and identities of Eimeria spp. infecting turkeys in Canada has not been examined systematically. Identifying species of Eimeria based on morphological features alone has been shown to be unreliable because of the significant overlap in shapes and sizes of oocysts (4,5). Chapman (6) highlighted the importance of combining phenotypic characteristics as outlined by Joyner (7), such as site of development, characteristic lesions, cross-immunity, and pathogenicity, with molecular methods includ-ing DNA extraction and polymerase chain reaction (PCR) (8). Understanding the distribution and diversity of Eimeria spp. within Canadian turkey operations is essential for making ratio-nal decisions regarding the economic and health importance of

Department of Pathobiology, Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1.Address all correspondence to Dr. John R. Barta; e-mail: [email protected] of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.



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these parasites and the need for their inclusion in live coccidiosis vaccines for use in turkeys.

In the present study, field samples were solicited from geo-graphically distant locations across Canada in order to determine the number of oocysts shed in commercial turkey flocks. The diversity of Eimeria spp. parasites found in positive samples was further characterized using a modification of a species-specific, nested PCR assay (8).

Materials and methodsObtaining samples and detecting Eimeria oocystsA detailed letter was sent to turkey farmers across Canada requesting turkey fecal samples. Farmers were sent specific instructions outlining how the fecal samples were to be col-lected as well as all required collection materials and packaging for shipment to the University of Guelph. The samples were collected from the top of the litter and the freshest of drop-pings were to be collected. The samples were mixed with a 1:50 diluted bleach solution (provided) and sent overnight (at room temperature). Upon arrival samples were stored at 4°C until processing. Each participating farmer was asked to identify the coccidiosis control program being used (either live vaccination or in-feed anticoccidial medication) for each submitted sample; no further information regarding anticoccidial use or manage-ment was requested or obtained.

Initial detection of oocysts was made using light microscopy directly from the sample. If negative, 5 g of the original sample was mixed to homogeneity with saturated NaCl (aqueous) to a total volume of 50 mL; an aliquot of the homogenate was loaded into a McMaster counting chamber. The chamber was examined for the presence/absence of oocysts and recorded as oocyst-positive or oocyst-negative. No further processing was done on oocyst-negative samples with the exception of 2 samples that were included in the DNA extraction procedure outlined below as oocyst-negative control DNA.

Oocyst-positive fecal samples were processed for sporula-tion by mixing 30 g fecal sample with approximately 60 mL 2.5% potassium dichromate (w/v aqueous) and passing the homogenate through a sieve with 1 mm2 openings. The filtrate (, 100 mL) was transferred to a 250-mL Erlenmeyer flask capped with aluminum foil perforated to permit air exchange and then placed on a rotary platform shaker operating at 100 rpm at room temperature for 5 d to permit sporula-tion of viable oocysts. Following sporulation, the filtrate of sporulated/unsporulated oocysts mixed with fine fecal debris in 2.5% potassium dichromate was the source of material for DNA extraction.

DNA extractionThe DNA was extracted from all oocyst-positive samples fol-lowing crude filtration and sporulation. Briefly, post-sporulation oocysts and fecal debris suspended in 2.5% potassium dichro-mate (w/v aqueous) were collected by centrifugation (1500 3 g for 10 min). The supernatant was decanted from the pelleted oocysts and debris; a 23 volume of 0.9% saline (0.9% NaCl, w/v aqueous) was added to the pelleted material and mixed to

homogeneity. The resulting washed, sporulated oocysts mixed with fine fecal debris were held at 4°C until DNA isolation.

The DNA was isolated using DNAzol (Life Technologies, Burlington, Ontario) following the manufacturer’s instruc-tions modified by the addition of 0.5 mm glass beads (Ferro Micro beads; Cataphote Division, Jackson, Mississippi, USA) to improve oocyst disruption as described previously (8). A sample (1.5 mL) of the washed, sporulated oocysts mixed with fine fecal debris was pelleted by centrifugation (1200 3 g for 2 min). After decanting and discarding the supernatant, 100 mL DNAzol reagent was added to the pellet and mixed, and approx-imately 0.3 g of 0.5 mm glass beads was added until a few dry beads were at the surface of the sample. This lysis mixture was processed in a horizontal bead beater fitted with a rack holder for 1.5 mL centrifuge tubes (Mickle Disintegrator l; Mickle Laboratory Engineering, Gomshall, Surrey, UK) for 60 s. Oocyst breakage was confirmed microscopically, and additional rounds of disruption were used until most of the oocysts had been lysed. Once sufficient oocyst breakage was confirmed microscopically, an additional 900 mL of DNAzol was added to the sample plus beads and the entire tube rotated at room temperature for at least 1 h and up to 14 h (overnight) to ensure complete disrup-tion of the sample. After this process, the sample was centri-fuged at 13 000 3 g for 15 min at 4°C; the supernatant was transferred to a new 1.5 mL centrifuge tube to remove insoluble debris and glass beads; the remainder of the DNAzol extraction procedure was completed as described by the manufacturer. At the conclusion of the isolation protocol, the pelleted DNA was dissolved in 100 mL of EB Buffer provided in the QIAquick PCR purification kit (QIAGEN, Venlo, The Netherlands). Half (50 mL) of each sample was further purified using QIAquick column purification following the manufacturer’s instructions. The DNA concentration was estimated spectrophotometrically both before and after column purification using a NanoDrop 2000 instrument (NanoDrop, Wilmington, Delaware, USA).

Nested PCR assay for Eimeria species identificationPrimary PCR. A PCR-based assay based on Hafeez et al (8) was used to identify the various Eimeria spp. in each DNA sample. A nested PCR approach was taken to improve the sensitivity of this PCR-based assay for low abundance Eimeria spp. present in a mixed sample. In the first round of PCR, genus-specific primers (COI_UNI_199F — 59-ATGATYTT CTTTGTAGTTATGCC-39; mtRNA20_UNI_R — 59-GTAT GGATTTCACGGTCAA-39) that amplify a 1272 base pair (bp) fragment spanning the region from nucleotide 199 of the COI coding region to 27 nucleotides (nt) past its end were used. This covers nearly the complete cytochrome C oxidase subunit I region of the mitochondrial genomes of all Eimeria spp. Each primary PCR tube contained 500 nM of each primer, 50 mM MgCl2, 1 mM dNTPs, 13 PCR buffer and 0.4 U Platinum Taq polymerase (Life Technologies). For the primary PCR, samples were run at 95°C for 180 s, followed by 35 cycles of denaturation at 94°C for 30 s, annealing at 58°C for 30 s and extension at 72°C for 75 s, followed by a final extension at 72°C for 5 min. Using a portion from each tube, PCR products



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were electrophoresed on a 1.5% agarose submarine gel in Tris-Acetate-EDTA (TAE) buffer (40 mM Tris, 20 mM acetic acid, 1 mM EDTA) at 95 V for 30 min. The resulting gel was stained with ethidium bromide and the product size was esti-mated by comparison with a 1-Kb Plus DNA Ladder (Bio Basic, Mississauga, Ontario) visualized using UV transillumination. If a primary amplicon was not visualized, a second PCR run was completed on the sample using an annealing temperature of 54°C instead of 58°C.

After electrophoresis, the intensity of each positive band was compared to the 1500 bp band of the DNA ladder to estimate amplicon abundance. If the band was estimated at # 250 ng, a 1:100 dilution of the primary PCR tube contents was made using nuclease-free water; if the band was estimated to be . 250 ng, a 1:1000 dilution was made using nuclease-free water. A 2.5-mL aliquot of the appropriately diluted primary reaction solution was then used as template for each subsequent species-specific PCR reaction.

Secondary PCR. The species-specific PCR-based assay using diluted primary PCR amplicons (as described) as templates was completed as described by Hafeez et al (8) with minor modifica-tions to the annealing conditions for each primer pair (Table 1).

AnimalsTurkey poults (hens) used to propagate some field samples were received as a donation from Hendrix Genetics Hybrid Turkeys (Kitchener, Ontario). All studies were performed in the CAF (Central Animal Facilities) Isolation Unit at the University of Guelph, Guelph, Ontario, in compliance with the Canadian Council on Animal Care’s “Guide to the Care and Use of Experimental Animals,” 2nd edition (2017; www.ccac.ca). All experiments were approved by the University of Guelph’s Animal Care Committee in compliance with all institutional and national guidelines. All birds were provided feed and water ad libitum.

Propagation for samples negative on PCR assayIf an oocyst-positive sample tested negative in the primary PCR assay, oocysts in the sample were propagated through birds to

provide fresh oocysts for characterization. Coccidia-free turkey poults (2 to 3 per cage) were inoculated with a small number of oocysts (, 2000 per bird) suspended in 1 mL 0.9% saline from a single PCR-negative sample via oral gavage. Inoculations via oral gavage were accomplished using a 1-mL Luer Slip tuber-culin syringe without a needle or feeding tube fitted. Oocysts collected from such propagations were sporulated, isolated, and had DNA extracted as previously described. The DNAs isolated from such propagated samples were then used as templates for primary PCR in the same manner as DNA isolated directly from a field sample. Samples that were propagated in vivo before species- specific PCR were designated “PS” (i.e., Passaged Sample) whereas oocysts isolated directly from a submitted sample were designated “S” (i.e., Sample).

ResultsSample locationsA total of 39 fecal samples representing unique flocks or barns located on 27 farms were obtained from farmers who collected and sent samples to the laboratory from various locations across Canada (Table 2). Of the 27 farms, 20 farms were from numer-ous locations across Ontario, 2 farms were from Saskatchewan (Farms 17 and 27), 3 farms were from British Columbia (Farms 11, 12, 13), 1 farm was from Alberta (Farm 18), and 1 from Nova Scotia (Farm 14). Live coccidiosis vaccination was being used in almost half of the sampled flocks (18 samples) and anticoccidial medications were being used in the remaining flocks (21 samples).

Geographic distribution and diversity of Eimeria speciesOocysts of various Eimeria spp. were detected microscopically in 33 of 39 samples (85% prevalence) and oocyst-positive samples were recorded in samples from all provinces.

Primary and subsequent secondary nested PCR assays were performed on oocyst-positive samples as outlined in Table 2. Of the 33 oocyst-positive samples, 26 samples were positive follow-ing the primary PCR reaction and the primary product could be used for secondary nested species-specific PCR reactions.

Table 1. PCR annealing temperatures used with the Eimeria species-specific PCR primers.

Annealing temperature Revised Amplicon of Hafeez annealing size Species Primer name et al (8) temperature (base pairs)

Eimeria adenoeides E.ad.CO1_427F E.ad.CO1_1186R

62°C 64°C 713

Eimeria dispersa E.disp.CO1_577F E.disp.CO1_1028R

55°C 59°C 451

Eimeria gallopavonis E.gal.CO1_292F E.gal.CO1_1153R

62°C 60°C 861

Eimeria meleagridis E.md.CO1_431F E.md.CO1_1443R

58°C 55°C 1012

Eimeria meleagrimitis E.mel.CO1_474F E.mel.CO1_1028R

52°C 62°C 554

Eimeria innocua E.inn.COI.396F E.inn.COI.604R

50°C 59°C 209



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There was considerable diversity in the number and specific species detected in the samples using the nested PCR assay; 1 to 6 different Eimeria spp. were detected in oocyst-positive samples. One location from Ontario had all known Eimeria spp. in turkeys (i.e., E. adenoeides, E. dispersa, E. gallopavonis, E. innocua, E. meleagridis, and E. meleagrimitis) present in each of 4 submitted samples. The 1 positive sample received from 1 farm in Nova Scotia contained E. adenoeides, E. meleagridis, and E. meleagrimitis. The 1 sample received from the single sampled farm in Alberta contained only E. adenoeides. Of the 2 samples from 2 farms in Saskatchewan, only 1 sample was positive and it contained E. meleagrimitis. Of the 3 samples from 3 different farms in British Columbia, 2 samples contained 3 or 4 Eimeria spp. each representing 5 unique Eimeria spp.; only E. dispersa was not detected in the BC samples.

Overall, the species diversity (Table 3) of Eimeria present in samples coming from flocks using live coccidiosis vaccination (14 PCR-positive samples with 3.6 species/sample) was higher than the species diversity found in samples from medicated flocks (12 PCR-positive samples with 2.8 species/sample). However, exclusion of the 2 Eimeria spp. expected to be pres-ent in all flocks administered the live coccidiosis vaccine (i.e., E. adenoeides and E. meleagrimitis) resulted in remarkably similar mean parasite species diversity in vaccinated and medicated flocks at 2.4 and 2.8 Eimeria species/sample, respectively.

DiscussionPrior to the present study, the diversity of Eimeria spp. infecting turkeys on Canadian commercial farms was largely unknown because suitable fecal sampling and analyses from various

Table 2. Summary of farm, fecal sample number, and province for samples received. Oocyst detection, polymerase chain reaction (PCR) result, and Eimeria species present within each turkey fecal sample are summarized.

Coccidiosis Primary control Oocyst PCR

Secondary species-specific PCR (1/2)c

Farm ID Samplesa in useb Province presence (1/2) AD MEL DISP GALL INN MD

F1 PS1 M ON 1 1 1 1 2 1 2 2F1 S2 M ON 1 2 n/a n/a n/a n/a n/a n/aF1 S3 M ON 1 2 n/a n/a n/a n/a n/a n/aF2 PS1 V ON 1 1 1 2 2 1 2 2F2 PS2 V ON 1 1 2 2 2 2 2 1F3 PS1 V ON 1 1 2 1 2 2 2 1F3 PS2 V ON 1 1 2 1 2 2 2 1F4 PS1 M ON 1 1 1 1 2 1 2 1F4 S2 M ON 1 2 n/a n/a n/a n/a n/a n/aF4 S3 M ON 1 1 1 1 2 1 2 2F4 S4 M ON 1 1 1 1 2 1 2 1F5 PS1 M ON 1 1 2 1 2 1 2 2F6 PS1 V ON 1 1 2 1 1 1 2 2F7 S1 M ON 1 1 2 1 2 2 2 2F8 PS1 M ON 1 1 2 1 2 2 2 2F9 PS1 V ON 1 1 2 1 2 2 2 1F10 S1 M ON 1 1 1 1 2 1 2 1F11 PS1 M BC 1 1 1 1 2 2 1 1F12 PS1 M BC 1d 2 n/a n/a n/a n/a n/a n/aF13 PS1 M BC 1 1 2 1 2 1 2 1F14 S1 M NS 1 1 1 1 2 2 2 1F15 S1 V ON 1 2 n/a n/a n/a n/a n/a n/aF16 PS1 V ON 1 1 2 1 1 1 2 2F17 S1 M SK 1 1 2 1 2 2 2 2F18 S1 V AB 1 1 1 2 2 2 2 2F19 S1 V ON 1 2 n/a n/a n/a n/a n/a n/aF20 S1 V ON 1 1 2 1 1 1 1 1F20 S2 V ON 1 2 n/a n/a n/a n/a n/a n/aF20 S3 V ON 1 1 2 1 1 1 1 1F21 S1 V ON 1 1 1 1 1 1 1 1F21 S2 V ON 1 1 1 1 1 1 1 1F21 S3 V ON 1 1 1 1 1 1 1 1F21 S4 V ON 1 1 1 1 1 1 1 1F22 S1 M ON 2 n/a n/a n/a n/a n/a n/a n/aF23 S1 V ON 2 n/a n/a n/a n/a n/a n/a n/aF24 S1 M ON 2 n/a n/a n/a n/a n/a n/a n/aF25 S1 M ON 2 n/a n/a n/a n/a n/a n/a n/aF26 S1 M ON 2 n/a n/a n/a n/a n/a n/a n/aF27 S1 M SK 2 n/a n/a n/a n/a n/a n/a n/a

Total positive 33 26 13 23 8 16 7 16a Samples designated “S” were identified as oocyst-positive or negative and DNA extraction for PCR was done on oocyst-positive samples; samples designated “PS” had

detectable oocysts in the original sample but primary PCR was negative. ‘PS’ samples were passaged in coccidia-free poults before DNA extraction and primary PCR.b V — vaccinated; M — medicated with anticoccidial drugs.c Species-specific PCR test for AD — Eimeria adenoeides; DISP — Eimeria dispersa; GALL — Eimeria gallopavonis; INN — Eimeria innocua; MD — Eimeria meleagridis;

MEL — Eimeria meleagrimitis.d Fecal sample was oocyst-positive when received but when the oocysts were passaged through poults, the poults did not shed oocysts.n/a — Not available.



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geographic locales had not been attempted systematically. With few exceptions (9), there was a paucity of information regarding Eimeria spp. on farms in Canada. Furthermore, the available data were based universally on morphological diagno-ses. Molecular and biological data (2,5,8,10–14) have become available for turkey Eimeria species only recently, permitting detailed studies that were previously challenging to undertake because of the difficulty in differentiating these parasites in field samples (1).

The preliminary prevalence data obtained in this study sug-gest that the 6 generally recognized Eimeria spp. capable of infecting turkeys are distributed widely within Canadian com-mercial turkey flocks. At least some Eimeria spp. are common, abundant, and widespread in these flocks. The composition and diversity of parasites in individual samples varied widely and, despite the relative paucity of samples from outside of Ontario in the survey, a diverse parasite fauna was found across the country. Previous reports based on morphological identification of Eimeria spp. from the USA (15–17) and the UK (18,19) had suggested that Eimeria spp. of turkeys were common and dis-tributed widely in commercial turkey flocks. Direct comparisons between previous studies and the present work are complicated by the limitations of such morphological identifications (5). Nonetheless, the 85% (33/39) prevalence of the highly patho-genic parasite, E. meleagrimitis, in US samples detected by Edgar (16) was remarkably similar to the 88% prevalence (23/26) of the same parasite in the present study.

Most samples (85%) herein had detectable oocysts and the number of detectable Eimeria spp. in the positive samples ranged from 1 to 6 with an average of 3.2 species/sample detected among all PCR-positive samples. Flocks that were vaccinated had more species diversity (average of 3.6 Eimeria species/sample) compared to samples from medicated flocks but this greater species diversity was largely the result of including the vaccine constituents found in Immucox-T in the species count. The species diversity was essentially identical after correcting for the species found in the vaccine. Generally, oocyst-positive samples obtained from vaccinated and medicated flocks that

were successfully amplified using the nested PCR assay had 2 to 3 Eimeria spp. present.

The diversity of Eimeria spp. circulating in Canadian com-mercial turkey flocks was remarkably similar to the prevalence and diversity of Eimeria spp. found in hunter-harvested wild turkeys in Ontario. As in the commercial flocks, most of the sampled hunter-harvested wild turkeys were infected (77% Eimeria oocyst-positive, n = 107) (20). Earlier investigations using morphometric data to differentiate parasites (9,21–23) had shown that Eimeria spp. were common and relatively diverse in wild turkeys in the southern USA; more recently, MacDonald et al (20) used molecular methods similar to those used in the present work to demonstrate that Eimeria spp. were common and diverse in Ontario wild turkeys. Interestingly, 4 of the 6 species found within commercial flocks in the present study (i.e., all except E. dispersa and E. innocua) were also found in wild turkeys in Ontario, Canada, with an average of 2.6 Eimeria species per oocyst-positive bird. In the present study, the 26 oocyst-positive samples that were PCR positive had similar species diversity (2.8 and 2.4 species/samples for medicated and vaccinated flocks, respectively) to the hunter-harvested wild turkeys even though additional Eimeria spp. were detected in the commercial birds. It is probable that all Eimeria spp. would be detected in both wild and domestic turkeys across their dis-tributions in Canada given sufficient sampling effort; it is likely that any geographic restriction of particular Eimeria spp. (e.g., E. dispersa found only in Ontario samples) reflects the limited sampling more than restricted geographic range.

With similar prevalence and diversity of Eimeria spp., wild turkeys may be potential reservoirs for Eimeria spp. infecting commercial poultry; there is no physiological or other impedi-ment against Eimeria spp. that infect commercial turkeys infect-ing wild turkeys or vice versa (1,20). Commercial turkey farms are widespread across Canada and may be in close association with wild turkey habitats that may provide opportunity for transfer of pathogens from wild to domestic flocks and vice versa. The opportunity for such cross infections in Canada was negli-gible until the reintroduction of wild turkeys during the 1980’s

Table 3. Summary of oocyst positive samples from each province, Eimeria species found in each province, number of samples from vaccinated and medicated flocks and average species diversity per province.

Average species Oocyst PCR diversity Location positive positive AD DISP GALL INN MD MEL (species/sample)

AB 1 1 1 0 0 0 0 0 1BC 3 2 1 0 1 1 2 2 3.5NS 1 1 1 0 0 0 1 1 3ON 27 21 10 8 15 6 13 19 3.4SK 1 1 0 0 0 0 0 1 1All of Canada 33 26 13 8 16 7 16 23 3.2

Summary of PCR positive samples PCR 1 ve Average species diversity

Vaccinated flocks (Immucox-T) 3.6Vaccinated flocks (excluding Immucox-T constituents)a 14 2.4

Medicated flocks (Anticoccidials) 12 2.8a Immucox-T contains Eimeria adenoeides and Eimeria meleagrimitis.AB — Alberta; BC — British Columbia; NS — Nova Scotia; ON — Ontario; SK — Saskatchewan. AD — Eimeria adenoeides; DISP — Eimeria dispersa; GALL — Eimeria gallopavonis; INN — Eimeria innocua; MD — Eimeria meleagridis; MEL — Eimeria meleagrimitis.



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was undertaken to reverse the extirpation (local extinction) of Meleagris gallopavo during the early 20th century through wide-spread hunting and loss of habitat. In 1984, captive-bred wild turkeys from the United States were released to initiate their re-establishment (24); that has resulted in a flourishing wild turkey population in Canada (Eastern and Western) (25). Wild turkeys have been shown to shed Eimeria spp. oocysts into the environment in Ontario (20) and these parasites may be carried into commercial operations. Eimeria spp. apparently overwinter within infected wild turkeys or within the environment sug-gesting that they may have adapted to the harsh local climatic conditions. Such hardy parasites may be important reservoirs of infection for turkey barns that are typically “all-in-all-out” operations; brooder barns, in particular, are typically cleaned thoroughly between each flock (26). Conversely, commercial turkey operations must compost, dispose of, or spread their manure depending on the farm’s nutrient management plan. This spreading of manure into the environment may provide a source of Eimeria spp. for wild turkeys and an alternate way that commercial turkeys could be infecting wild populations. With this potential cycle of infection between wild and domestic animals and increased potential of spreading infection within the higher stocking density of commercial farms, eliminating Eimeria spp. from commercial or wild populations seems chal-lenging. As a result, preventing this condition may be the best option to reduce the economic burden on the industry.

Although many Eimeria spp. of turkeys are considered only mildly pathogenic (1,2,10) there may be more numerous pathogenic species than previously assumed (i.e., not only E. adenoeides and E. meleagrimitis). The diversity of species iden-tified across Canada begs the question as to whether or not the existing Immucox-T vaccine can protect against all pathogenic Eimeria spp. present in a turkey flock. A recent well-controlled in vivo cross-species challenge study (27) confirmed that no significant adaptive cross-immunity was detected among any of the 6 Eimeria species found in turkeys despite robust protec-tion against homologous challenge. However, some limited, non-specific (innate) protection was conferred by 1 Eimeria sp. against other Eimeria spp. residing in the same region of the intestinal tract (27). Cross-challenged birds immunized with 1 “cecal” species challenged with a different cecal species (i.e., “same-zone” challenge) had numerically decreased oocyst output compared to birds challenged similarly but immunized with an Eimeria sp. inhabiting a different region of the intestine (i.e., “cross-zone” challenge). For example, a bird immunized with E. adenoeides (a cecal species) challenged with E. meleagridis or E. gallopavonis (also cecal species), had a 48% decrease in oocyst output compared with cross-zone challenges (i.e., an “intestinal” species challenged with a cecal species) (27). Consequently, it was suggested (27) that Immucox-T vaccine may provide limited, non-specific protection against Eimeria spp. that inhabit the same regions of the intestinal tract as the parasites in the vaccine. The 2 constitutive Eimeria spp. in the vaccine that inhabit both the intestinal and cecal regions should provide robust, immune-mediated protection against homologous challenge (i.e., E. meleagrimitis and E. adenoeides vaccine constituents) with proper vaccine management and at

least limited, non-specific protection against all other Eimeria spp. that infect turkeys.

The present study identified common Eimeria spp. found on a limited number of commercial farms in Canada sampled in a consistent manner and analyzed using newly available molecular diagnostic methods (8) for determining the preva-lence of the various Eimeria spp. However, further research is needed to gain a more detailed understanding of the geographic and seasonal distribution of Eimeria spp. in more regions of Canada. Establishing the diversity and distribution of the vari-ous Eimeria spp. in Canadian commercial flocks may be useful for managing the use of the single licensed live coccidiosis vac-cine currently registered for use in turkey (Immucox-T contain-ing E. adenoeides and E. meleagrimitis), as well as prophylactic anticoccidial use.

AcknowledgmentsWe thank Julia Whale and Julie Cobean for their technical assis-tance and support. Perryn Kruth, Alex Léveillé, Evelin Rejman, and Ryan Snyder are thanked for their contributions. The French translation of the fecal sample request letter to turkey farmers in Quebec and abstract were provided by Alex Léveillé and Lisa Gordon. The staff of the CAF Isolation Unit, University of Guelph, are thanked for their ongoing superior care and assistance with experimental animals. This research was funded through grants from the Natural Sciences and Engineering Research Council of Canada (NSERC — Discovery Grant #400566) and the Ontario Ministry of Agriculture, Food and Rural Affairs (OMAFRA — Tier II #200331) to JRB. RKI was supported, in part, by an Ontario Veterinary College Scholarship (MSc). The donation of turkey poults by Hendrix Genetics, Kitchener Ontario, Canada is acknowledged with thanks. CVJ

References 1. Chapman HD. Coccidiosis in the turkey. Avian Pathol 2008;37:

205–223. 2. El-Sherry S, Ogedengbe ME, Hafeez MA, Al-Din S, Gad N,

Barta JR. Re-description of a genetically-typed, single oocyst line of the turkey coccidium, Eimeria dispersa Tyzzer, 1929. Parasitol Res 2017;116:2661–2670.

3. Government of Canada — Agriculture and Agri-Food Canada [home-page on the Internet] c2017. Canada’s Turkey Industry. Available from: http://www.agr.gc.ca/eng/industry-markets-and-trade/market-informa-tion-by-sector/poultry-and-eggs/poultry-and-egg-market-information/turkey/?id=1384971854398 Last accessed November 9, 2018.

4. Reid WM. Anticoccidials used in the poultry industry: Time of action against the coccidial life cycle. Folia Vet 1972;2:641–667.

5. El-Sherry S, Ogedengbe ME, Hafeez MA, Sayf-Al-Din M, Gad N, Barta JR. Sequence-based genotyping clarifies conflicting historical morpho-metric and biological data for 5 Eimeria species infecting turkeys. Poult Sci 2015;94:262–272.

6. Chapman HD. Milestones in avian coccidiosis research: A review. Poult Sci 2014;93:501–511.

7. Joyner LP. The identification and diagnosis of avian coccidiosis. In: Long PL, Boorman KN, Freeman BM, eds. Avian Coccidiosis. Edinburgh, UK: British Poultry Science, 1978:29–49.

8. Hafeez MA, Shivaramaiah S, Dorsey KM, et al. Simultaneous identi-fication and DNA barcoding of six Eimeria species infecting turkeys using PCR primers targeting the mitochondrial cytochrome c oxidase subunit I (mtCOI) locus. Parasitol Res 2015;114:1761–1768.

9. Jeffers TK, Bentley EJ. Monensin sensitivity of recent field isolates of turkey coccidia. Poult Sci 1980;59:1722–1730.

10. El-Sherry S, Ogedengbe ME, Hafeez MA, Sayf-Al-Din M, Gad N, Barta JR. Re-description of a genetically typed, single oocyst line of the



AR

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turkey coccidium, Eimeria adenoeides Moore and Brown, 1951. Parasitol Res 2014;113:3993–4004.

11. El-Sherry S, Rathinam T, Hafeez MA. Biological re-description of a genetically typed, single oocyst line of the turkey coccidium, Eimeria meleagrimitis Tyzzer 1929. Parasitol Res 2014;113:1135–1146.

12. El-Sherry S, Ogedengbe ME, Hafeez MA, Barta JR. Cecal coccidiosis in turkeys: Comparative biology of three Eimeria species in the lower intestinal tract of turkeys using genetically-typed, single oocyst lines. Parasitol Res 2018. In press.

13. Ogedengbe ME, El-Sherry S, Whale J, Barta JR. Complete mito-chondrial genome sequences from five Eimeria species (Apicomplexa; Coccidia; Eimeriidae) infecting domestic turkeys. Parasit Vectors 2014; 7:335.

14. Hafeez MA, Vrba V, Barta JR. The complete mitochondrial genome sequence of Eimeria innocua (Eimeriidae, Coccidia, Apicomplexa). Mitochondr DNA 2016;27:2805–2806.

15. Edgar SA, Bond DS. Turkey coccidia widely distributed in United States. Highlights of Agricultural Research. Auburn University, AL: Agricultural Experiment Station 1965;12:13.

16. Edgar SA. Practical immunization of chickens and turkeys against coc-cidia. In: McDougald LR, Joyner LP, Long PL, eds. Research in avian coccidiosis. University of Georgia, Athens, Georgia, 1986:617.

17. Rathinam T, Chapman HD. Sensitivity of isolates of Eimeria from turkey flocks to the anticoccidial drugs amprolium, clopidol, diclazuril, and monensin. Avian Dis 2009;53:405–408.

18. Clarkson MJ, Gentles MA. Coccidiosis in turkeys. Vet Rec 1958; 70:211–214.

19. Long PL, Millard BJ. Studies on Eimeria dispersa Tyzzer 1929 in turkeys. Parasitology 1979;78:41–51.

20. MacDonald AM, Jardine CM, Rejman E, et al. J Wildl Dis 2018. In press.

21. Prestwood AK, Kellogg FE, Doster GL, Edgar SA. Coccidia in east-ern wild turkeys of the southeastern United States. J Parasitol 1971; 57:189–190.

22. Hopkins B, Skeeles JK, Houghten GE, Slagle D, Gardner K. A survey of infectious diseases in wild turkeys (Meleagridis gallopavo silvestris) from Arkansas. J Wildl Dis 1990;26:466–472.

23. Oates DW, Wallner-Pendleton EA, Kanev I, Sterner MC, Cerny HE. A survey of infectious diseases and parasites in wild turkeys from Nebraska. Trans Nebr Acad Sci Affil Soc 2005;30:25–31.

24. Ontario Federation of Anglers and Hunters (OFAH) [homepage on the Internet] c2018. Wild Turkey. Available from: https://www.ofah.org/fishing-hunting/hunting/wild-turkey Last accessed November 9, 2018.

25. Ontario Ministry of Natural Resources (OMNR). Wild turkey manage-ment plan for Ontario. Ministry of Natural Resources, Ottawa, Ontario. 2007, 44 pp.

26. Turkey Farmers of Canada [homepage on the Internet] c2018 Canada’s Turkey Industry by the numbers. Available from: https://www.turkeyfarmersofcanada.ca/industry-information/industry-statistics/ Last accessed November 9, 2018.

27. Imai RK. Diversity and cross-immunity of Eimeria species infecting turkeys in commercial flocks in Canada [MSc dissertation]. Guelph, Ontario: University of Guelph, 2018.

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Article

Comparison of carbon dioxide laser versus bipolar vessel device for staphylectomy for the treatment of brachycephalic obstructive airway syndrome

Meghan S. Kirsch, Daniel Spector, Sarah R. Kalafut, George E. Moore, Renee McDougall

Abstract — Carbon dioxide (CO2) laser and bipolar vessel sealing device (BSD) are industry standards for soft palate resection. No studies exist to directly compare these 2 techniques in a clinical setting. The purpose of this study was to describe and compare clinical outcomes for dogs that underwent CO2 laser versus BSD staphylectomy. Medical records of brachycephalic dogs that underwent CO2 laser (Group-L) or BSD staphylectomies (Group-B) between September 2013 and September 2017 were reviewed retrospectively. Of 60 dogs that met the inclusion criteria, 26 dogs (43%) were designated Group-L and 34 (57%) Group-B. Techniques did not differ in procedure or anesthetic time (P = 0.52 and P = 0.19, respectively) or major complication rates [intraoperative (P = 1.00), post-operative (P = 0.72), short-term (P = 1.00), and long-term (P = 0.68)]. This study suggests that patient outcomes are similar for dogs undergoing staphylectomy performed by CO2 laser and BSD.

Résumé — Comparaison du laser au gaz carbonique par rapport au dispositif de coagulation bipolaire lors de la staphylectomie pour le traitement du syndrome de brachycéphalie d’obstruction des voies respiratoires. Le laser au gaz carbonique (CO2) et le dispositif de coagulation bipolaire sont des normes de l’industrie pour la résection du palais mou. Aucune étude n’existe afin de comparer ces deux techniques dans un milieu clinique. Le but de cette étude consistait à décrire et à comparer les résultats cliniques pour les chiens qui ont subi une opération au laser CO2 par rapport à une staphylectomie à l’aide d’un dispositif de coagulation bipolaire. Les dossiers médicaux de chiens brachycéphales qui ont subi des staphylectomies au laser CO2 (Groupe-L) ou à l’aide d’un dispositif de coagulation bipolaire (Groupe-B) entre septembre 2013 et septembre 2017 ont été examinés rétrospectivement. Parmi les 60 chiens qui satisfaisaient aux critères d’inclusion, 26 chiens (43 %) ont été désignés dans le Groupe-L et 34 (57 %) dans le Groupe-B. Les techniques n’ont pas différé pour la durée de l’intervention ou de l’anesthésie (P = 0,52 et P = 0,19, respectivement) ou les taux de complications majeures [intra-opératoires (P = 1,00), post-opératoires (P = 0,72), à court terme (P = 1,00) et à long terme (P = 0,68)]. Cette étude suggère que les résultats des patients sont semblables pour les chiens subissant une staphylectomie réalisée par laser au CO2 et à l’aide d’un dispositif de coagulation bipolaire.

(Traduit par Isabelle Vallières)Can Vet J 2019;60:160–166

Introduction

E longated soft palate (ESP) is a common abnormality among dogs with brachycephalic syndrome (BS); a syn-

drome which is composed of primary and secondary compo-nents. The primary components of stenotic nares, elongated soft palate, and hypoplastic trachea often lead to secondary components of everted laryngeal saccules or tonsils, tonsillar enlargement, as well as laryngeal collapse and edema due to increased airway pressure (1–4). Brachycephalic syndrome is

commonly diagnosed in breeds such as the English bulldog, pug, Boston terrier, and Cavalier King Charles spaniel (2,3). Treatment for BS is primarily surgical and performed to decrease airway resistance and prevent the development of a secondary BS component (3,5).

Described surgical techniques include wedge resection of the ala nasi, staphylectomy, partial tonsillectomy and ventriculec-tomy, and more advanced techniques such as folded flap pala-toplasty, nasal vestibuloplasty, and laser-assisted turbinectomy

Animal Medical Center, New York, New York, USA (Kirsch, Spector, Kalafut, McDougall); Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA (Moore).Address all correspondence to Dr. Meghan Kirsch; e-mail: [email protected] grant or financial support was provided. There are no financial or other conflicts of interest of any authors related to a company or product used in the report. This study was presented at the American College of Veterinary Surgeons Surgery Summit 2017 meeting poster session and the Society of Veterinary Soft Tissue Surgery annual meeting 2018.Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.



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(5–7). Staphylectomy to correct an ESP has traditionally been performed by sharp excision followed by primary closure by suturing (5,8). Complications associated with this procedure include pharyngeal edema, dyspnea, nasal regurgitation, aspira-tion pneumonia, airway obstruction, and the need for temporary or permanent tracheostomy (9,10). Alternative procedures for ES have been described in an effort to reduce the incidence of postoperative complications and include the use of carbon diox-ide (CO2) and diode lasers, and electrosurgical devices such as monopoloar and bipolar cautery, bipolar vessel sealing devices, and ultrasonic energy systems (11–16).

Two of the most frequently used modalities are the CO2 laser and bipolar vessel sealing device (BSD) (5,10). There are fundamental differences in the ways CO2 laser and BSD generate thermal energy. The CO2 laser works by producing focused infrared light (wavelength: 10 600 nm) that is highly absorbed by water resulting in ablation and vaporization of the tissues (11,13). The LigaSure (Covidien Energy-Based Devices, Boulder, Colorado, USA) is a commonly used bipolar vessel sealing device that uses electrothermal energy to denature col-lagen and elastin in blood vessel walls and seal the vessels (7,17). This device automatically adjusts the current and output volt-age according to tissue impedance. To the authors’ knowledge, only 1 study has compared CO2 laser and BSD techniques for staphylectomy in dogs (7). Neither technique resulted in significant complications in a small number of normocephalic dogs; however, postoperative evaluation was limited to 96 h (7). Several studies investigating CO2 laser and BSD techniques have reported faster procedure times and decreased hemorrhage, swelling, and postoperative pain compared to sharp dissection (2,6,7,14). However, studies comparing clinical outcome are lacking. The purpose of the study herein was to compare clinical outcomes following staphylectomy using CO2 laser and BSD techniques in brachycephalic dogs with elongated soft palate. We hypothesized that there would be no difference in short- or long-term complications between the 2 procedures.

Materials and methodsMedical records from the Animal Medical Center from September 2013 to September 2017 were reviewed to identify dogs that underwent staphylectomy with CO2 laser or BSD. Dogs with complete medical records and documented upper airway examination findings consistent with an ESP were included in the study. Information retrieved from the medical records included signalment, presenting complaint, clinical signs, preoperative thoracic radiographic findings, nasal and upper airway examination findings including presence and grade of laryngeal collapse, perioperative protocol, surgical methods, and outcome at follow-up appointments. Concurrent medical conditions and surgical procedures were also recorded. Dogs were excluded from the study if they had concurrent upper air-way disease unrelated to BS such as laryngeal paralysis, tracheal collapse or epiglottic retroversion, had previous upper airway surgery, or if they had a concurrent illness that would signifi-cantly impact prognosis. Primary changes associated with BS included stenotic nares and elongated soft palate. A hypoplastic trachea, though independent of BS anatomic conditions, was

included as a primary component as commonly described in the literature. Secondary changes included eversion of the laryngeal saccules (grade I laryngeal collapse), moderate to severe laryngeal collapse (grades II and III laryngeal collapse), enlarged tonsils, and palatine or laryngeal edema (18).

Dogs were categorized based on method of staphylectomy into 2 groups; Group-L and Group-B. Group-L dogs had the palate resected by use of a CO2 laser as described by Clark and Sinibaldi (11). Group-B dogs had the palate resected using a BSD in a technique similar to that described by Brdecka et al (7). However, different from the technique used in that study, the dogs in Group-B underwent the procedure in sternal recumbency and the elongated soft palate was excised to the level of the caudal aspect of the tonsillar crypts. The BSD used in our study, LigaSure Small Jaw (LSJ; Covidien Energy-Based Devices) had the ability to seal and transect the tissue simultane-ously, and therefore the additional step of transecting the tissue with Metzenbaum scissors as previously described (7) was not required. The device (LSJ), had the benefit of a small, curved jaw, minimal thermal spread, and a low temperature profile (17). The total and median numbers of airway procedures in addition to staphylectomy were recorded, and included wedge resection alaplasty, laryngeal sacculectomy, tonsillectomy, and procedures unrelated to the airway. Due to the retrospective nature of the study, procedure times for the staphylectomy alone were not available for comparison, and instead, a composite of all multilevel BAS surgical procedures and total anesthesia times were used as a surrogate measurement.

Intra-operative and post-operative complications following anesthesia for staphylectomy surgery were evaluated and com-pared between the 2 treatment groups. Complications were defined as intra-operative if they occurred from the time of sedation for upper airway examination, inclusive of the surgical procedure, to the time of extubation. Postoperative complica-tions occurred from the time of extubation to discharge from the hospital. Short-term follow-up information was retrieved from medical records from re-examination visits 2 wk following surgery and any additional visits documented before 14 d after discharge. Long-term follow-up information was recorded as the last documented examination. Complications were further divided into major and minor complications with major compli-cations necessitating surgical treatment (tracheostomy, revision surgery), prolonged hospitalization (aspiration pneumonia, non-cardiac pulmonary edema, hypoxia, respiratory crisis, and reintubation), or resulting in death or euthanasia. Minor com-plications included cough, stertor, nasal discharge, incisional infection, and regurgitation. The number of complications as well as type were compared between groups.

Statistical analysisNumerical data were assessed for normality by the Shapiro-Wilk test. Normally distributed data in independent groups were compared using Student’s t-test, and nonparametric data of 2 groups were compared with the Wilcoxon rank sum test. Summary statistics for parametric data are presented as mean 6 standard deviation (SD), and for nonparametric data are pre-sented as median (range). Proportions of categorical data were



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compared using the Chi-squared test of independence, unless expected frequencies were , 5 in which case Fisher’s exact test was used. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated from 2 3 2 contingency tables. A P-value , 0.05 was considered statistically significant.

ResultsA review of the medical records identified 69 dogs that underwent staphylectomy between September 2013 and September 2017. Nine dogs were excluded from the study as they had additional upper airway procedures unrelated to the primary BAS under the same anesthesia including tracheal stent placement, temporary epiglottopexy and upper airway endoscopy due to bronchopneumonia. Of the 60 dogs that met the inclusion criteria, 26 dogs (43%) comprised Group-L and 34 dogs (57%) comprised Group-B. Breeds represented included French bulldog (31/60, 52%), English bulldog (19/60, 32%), pug (8/60, 13%), bulldog mix (1/60, 2%), and shih tsu (1/60, 2%). The average age at the time of surgery was 4.3 y (range: 0.4 to 10.8 y). There was equal distribution of males and females: castrated males (n = 20), intact males (n = 10), spayed females (n = 23), and intact females (n = 7). Median body weight (BW) was 11.4 kg (range: 5.1 to 31.1 kg). There was no significant difference between Group-L and Group-B in breeds represented, mean age at the time of surgery, gender, or median body weight (P $ 0.13).

Nineteen dogs (32%) were presented for elective surgery, and at the time of presentation had no to mild stertor. Twenty-six dogs (43%) were presented for elective surgery (not currently in respiratory crisis) with a history of moderate to severe clinical signs (dyspnea, exercise intolerance, collapse, cyanosis, hyper-thermia). Nine dogs (15%) were presented in acute respiratory crisis and 6 dogs (10%) were hospitalized for other reasons not attributed to the upper airway but had an acute respiratory crisis necessitating upper airway surgery for extubation. Nineteen dogs (32%) had a history of chronic vomiting and regurgitation and 9 dogs (15%) had a history of aspiration pneumonia. There were no statistically significant differences between groups concerning presenting complaint, history of vomiting or regurgitation, or incidence of aspiration pneumonia (P $ 0.67).

Preoperative thoracic radiography was performed for 57 (95%) of the dogs. Five (9%) dogs were diagnosed with aspiration pneumonia and 7 (12%) dogs had radiographic evidence of hiatal hernia. Radiographs were also evaluated by a Board-certified radiologist for the presence of a hypoplastic trachea. There was no significant difference between the groups in preoperative aspiration pneumonia (P = 0.07) or hiatal hernia (P = 1.00).

Of the 60 dogs, the median number of primary components for BAS was 2 (range: 1 to 3) with ESP noted in all dogs, ste-notic nares in 50 dogs (83%) and hypoplastic trachea in 7 dogs (12%). The median number of secondary components of BAS was 1 (range: 0 to 4). Secondary components included everted laryngeal saccules in 53 dogs (88%), moderate to severe laryn-geal collapse in 11 dogs (18%), enlarged tonsils in 7 dogs (12%), and palatine or laryngeal edema in 9 dogs (15%). There was no significant difference between the groups in median number of primary or secondary (P $ 0.14) components of BAS.

All dogs received perioperative gastrointestinal protectants (proton pump inhibitor) and an anti-emetic. Forty-eight dogs (80%) received 1 or more doses of dexamethasone (DexaJet SP; Biomeda-MTC Animal Health, Cambridge, Ontario), median dose: 0.1 mg/kg BW, range: 0.01 to 0.5 mg/kg BW, during the peri-operative period for the prophylactic treatment of upper air-way inflammation. There was no significant difference between the groups (P = 0.33). Fifty-five (92%) dogs underwent multi-level surgery to address additional components of BAS including wedge resection alaplasty in 46 (77%), laryngeal sacculectomy in 47 (78%), and tonsillectomy in 8 dogs (13%). The median number of upper airway BS-related surgeries for both groups was 3 (range: 1 to 4); however, in total Group-L underwent significantly more multilevel surgical procedures than Group-B (P = 0.01). Additional procedures unrelated to the respiratory tract performed under the same anesthetic event were recorded in 23 dogs (38%), and included laparoscopic ovariectomy, open ovariohysterectomy, prescrotal castration, episioplasty, hiatal hernia repair, upper gastrointestinal endoscopy and biopsies, subcutaneous mass removal, combined laparoscopic ovariectomy and renal biopsy, tail amputation, head and bulla computed tomography, tracheobronchoscopy, and pacemaker placement. There was no statistical significance between the groups in terms of additional procedures unrelated to the upper airway (P = 0.10).

For Group-L, the median procedure time was 32.5 min (range: 10 to 80 min) and anesthesia time was 67.5 min (35 to 295 min). For Group-B, the mean procedure time was 27.5 min (range: 10 to 60 min) and anesthesia time was 58.5 min (range: 20 to 210 min). There was no significant difference in procedure or anesthesia time between the groups (P = 0.52 and P = 0.19, respectively). The median length of hospitalization was 2 d (range: 1 to 11 d) with no significant difference between the groups (P = 0.67). The final cost of surgery and hospitalization was not significantly different between the groups (P = 0.01) with a median of $3131 US$ (range: $850 to $19 640 US$) for Group-B and $3475 US$ (range: $1430 to $11 645 US$) for Group-L.

The overall major complication rate was 14/60 (23%) includ-ing 5 dogs (5/26, 19%) from Group-L and 9 dogs (9/34, 26%) from Group-B. There was no significant difference between the groups in major or minor complications in the intraoperative, post-operative, short-term, or long-term periods (P $ 0.68). No significant difference was demonstrated between the groups in major complications necessitating additional surgical inter-ventions (P = 1.00), prolonged hospitalization (P = 0.51), or resultant death or euthanasia (P = 0.22). Patients that underwent major complications throughout the study period are further described in Tables 1 and 2.

The entire population was further assessed for variables associated with the development of major complications. Two preoperative variables were associated with an increased risk of major complications; English bulldog breed [odds ratio (OR): 5.83; 95% confidence interval (CI): 1.3 to 26.1; P = 0.03] and the development of respiratory distress following hospitalization for a concurrent disease process (OR: 8.8; 95% CI: 1.4 to 54.9; P = 0.02). There was no significant difference between Group-L



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and Group-B in preoperative variables associated with major complications (P , 0.13) (Table 3). The overall mortality rate for the study was 6/60 (10%) with all cases of death/euthanasia occurring within the post-operative and long-term periods. Two major complications were negatively associated with an increased risk of death/euthanasia throughout the study period; aspiration pneumonia (OR:17; 95% CI: 2.3 to 123.02; P = 0.01) and placement of a temporary tracheostomy (OR: 26.5; 95% CI: 1.9 to 359.2; P = 0.02). Of the 3 dogs that underwent placement of a temporary tracheostomy tube, all 3 had aspiration pneu-monia and 2 subsequently died or were euthanized. There was no difference between Group-L and Group-B in complications associated with death/euthanasia (P , 0.17) (Table 4). Though not associated with an increased risk of death/euthanasia, revi-sion surgery was performed in 3/60 (5%) dogs including 2 from Group-L and 1 from Group-B. Two of the revision surgeries were performed secondary to a respiratory crisis and the third case of revision surgery was performed secondary to owner reported exercise intolerance in the short-term period. There was no significant difference between the groups in the performance of revision surgery (P = 0.57).

DiscussionThe results of this study indicate that the clinical outcome and procedure time for staphylectomy in dogs are similar between CO2 laser and the LigaSure. To the authors’ knowledge this is the first study to provide a direct clinical comparison between CO2 laser and BSD-assisted staphylectomy in a population of brachycephalic dogs. While the results demonstrate no statisti-

cal difference between the 2 groups in total procedure times and anesthesia times (P = 0.52 and P = 19, respectively), there were more multilevel surgical procedures performed in Group-L (P = 0.01) even with the exclusion of patients that received staphylectomy alone (P = 0.01). It may be inferred that sur-geries in Group-L were faster, given a greater total number of multilevel procedures and similar total procedure and anesthesia times; however, further prospective studies are necessary for a direct comparison. Surgical times for staphylectomy performed by CO2 laser in the literature have been variable. Davidson et al (19) reported a mean staphylectomy procedure time of 309 s (range: 210 to 450 s). Dunie-Merigot (12) reported surgical times of 510 s when combined staphylectomy and extended palatoplasty techniques were used in brachycephalic dogs with upper airway obstructive syndrome. Brdecka et al (7) reported shorter surgical times for staphylectomy performed by a bipolar sealing device (mean 67.5 1/2 14.1 s, range: 45 to 90 s) com-pared with the CO2 laser (mean: 174.5 1/2 76.5 s, range: 90 to 313 s) in normal dogs. The medical records used for the current study reported only total surgical time and did not differenti-ate between individual procedure times in multilevel surgeries.

The second goal of the current study was to compare the 2 procedures in terms of complication rates. The intraoperative, post-operative, short-term, and long-term complication rates were similar between the 2 groups. While Group-B had more major complications at each time point, the difference was not significant. During the intraoperative period, Group-L had no major complications. Group-B had a single patient that became hypoxemic during surgery and required reintubation and

Table 1. Patient variables and major complications for Group-L.

Patient number

1 2 3 4 5

Signalment 4-year-old 2-year-old 11-year-old 10-year-old 5-year-old French bulldog French bulldog French bulldog French bulldog French bulldog

Preoperative variables Presenting complaint Elective Elective, history of Hospitalized, other Hospitalized, other Elective, history of respiratory crisis respiratory crisis Vomiting/regurgitation None None None Chronic None Aspiration pneumonia None None None Historical, not current None Laryngeal collapse None None None Grade II None

Procedure variables Upper airway related Staphylectomy Staphylectomy Staphylectomy Staphylectomy Staphylectomy Rhinoplasty Rhinoplasty Rhinoplasty Rhinoplasty Rhinoplasty Sacculectomy Tonsillectomy Sacculectomy Sacculectomy Additional None None Transjugular pacemaker Tracheobronchoscopy Episioplasty placement BAS time (min) 29 19 13 26 43 Anesthesia time (min) 64 49 295 160 160

Major complications Intraoperative None None None None None Postoperative None None Asp. Pneumonia Hypoxemia Hypoxemia Hypoxemia Aspiration pneumonia Reintubation Reintubation Reintubation Tracheostomy Short-term Revision None None None None Long-term None Respiratory crisis None Respiratory crisis None Revision Death/euthanasia



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Table 2. Patient variables and major complications for Group-B.

Patient number

1 2 3 4 5

Signalment 6-year-old 1-year-old 11-year-old 4-year-old 9-year-old Pug French bulldog English bulldog French bulldog Pug

Preoperative variables Presenting complaint Hospitalized, Elective Elective, history of Elective, history of Hospitalized, other respiratory crisis respiratory crisis other Vomiting/regurgitation Chronic None None Chronic None Aspiration pneumonia Historical and None None None Historical concurrent Laryngeal collapse Grade III Grade III None None None

Procedure variables Upper airway related Staphylectomy Staphylectomy Staphylectomy Staphylectomy Staphylectomy Sacculectomy Rhinoplasty Rhinoplasty Rhinoplasty Rhinoplasty Sacculectomy Sacculectomy Sacculectomy Sacculectomy Tonsillectomy Additional None None Endoscopy and biopsies Endoscopy and biopsies None BAS time (min) 14 26 20 20 24 Anesthesia time (min) 57 125 68 55 60

Major complications Intraoperative None None Hypoxemia None None Postoperative Hypoxemia None Reintubation Hypoxemia Hypoxemia Death/euthanasia Tracheostomy Reintubation Aspiration pneumonia Death Short-term n/a None Hypoxemia Hypoxemia n/a Respiratory crisis Aspiration pneumonia Aspiration pneumonia Revision Tracheostomy Long term n/a Respiratory crisis Hypoxemia n/a NCPE Death/euthanasia Laryngeal collapse progression

Patient number

6 7 8 9

Signalment 10-year-old 6-year-old 11-year-old 7-year-old English bulldog English bulldog English bulldog English bulldog

Preoperative variables Presenting complaint Respiratory crisis Respiratory crisis Respiratory crisis Respiratory crisis Vomiting/regurgitation None None None Chronic Aspiration pneumonia None None Historical and concurrent None Laryngeal collapse None Grade IV None None

Procedure variables Upper airway related Staphylectomy Staphylectomy Staphylectomy Staphylectomy Rhinoplasty Rhinoplasty Rhinoplasty Sacculectomy Sacculectomy Sacculectomy Additional None None None None BAS time (min) 40 10 30 20 Anesthesia time (min) 45 130 50 20

Major complications Intraoperative None None None None Postoperative Hypoxemia Respiratory crisis Hypoxemia None Death/euthanasia Death/euthanasia Reintubation Short-term n/a n/a None None Long-term n/a n/a None Hypoxemia Respiratory crisis Laryngeal collapse Aspiration pneumonia Tracheostomy

BAS — Brachycephalic airway syndrome; NCPE — Noncardiogenic pulmonary edema.n/a — Not available.



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placement of a temporary tracheostomy tube in the post-opera-tive period. Of the 10 patients that experienced major compli-cations during the postoperative period, 3 were from Group-L (3/26, 12%) and 7 from Group-B (7/34, 21%). In further comparing complications between the groups, 1 patient from Group-L (1/26, 4%) and 2 patients from Group-B (2/30, 7%) experienced major short-term complications. Long-term com-plications occurred in 2 patients from Group-L (2/26, 8%) and 3 from Group-B (3/30, 10%). Mortality rates follow a similar trend as postoperative rates were lower for Group-L (0/26, 0%) compared with Group-B (4/34, 12%), although these differences were not significant.

The ideal procedure for staphylectomy would provide consis-tent hemostasis with minimal local inflammation, edema, and complications. The current study failed to demonstrate superior-ity when comparing the CO2 laser with LigaSure and it appears that each method should be evaluated for its potential advantage and disadvantages specific to the patient, surgeon, and facility.

Post-operative dyspnea can occur in up to 20% of patients following upper airway surgery that is related to pharyngeal and laryngeal inflammation and edema, which can further contribute to airway resistance (9,10). In comparing the CO2 laser with LigaSure there is no clear advantage of one modality over the other in post-operative inflammation evaluated histologically in one study (7). In the current study, severe post-operative dys-pnea (reported as hypoxia) occurred in 9 patients, and of these patients, 4 ultimately died or were euthanized. Our study failed to demonstrate a statistically significant difference between the groups in terms of post-operative complications.

Another possible contributing factor to the perioperative complication rate is the high rate of aspiration pneumonia in the study (6/60, 10%). In a study by Ree et al (9), both perioperative metoclopramide use (OR: 16; P = 0.0172) and postoperative radiographic evidence of pneumonia reported in 5% of dogs (OR: 49.99; P = 0.0059) were associated with development of major complications (euthanasia/death and need for temporary tracheostomy tube placement). At our institution, metoclopramide has been routinely administered in the perioperative period. The current study showed, simi-

larly, that patients which developed aspiration pneumonia alone (OR: 17; P = 0.0103) or in addition to placement of a temporary tracheostomy tube (OR: 26.5; P = 0.0243) were at much greater risk for mortality. Lorinson et al (20) also reported aspiration pneumonia as a significant risk factor for the development of major complications in the postoperative period. In that study, postoperative aspiration pneumonia was reported in 11% of dogs with the overall mortality rate associated with aspiration pneumonia being 6.25%; however, in bulldogs aspiration pneumonia appeared to be more severe with a 12.5% mortality rate (20). In our study, English bulldogs were significantly more likely than any other brachycephalic breed to develop a major complication (OR: 5.83; P = 0.03). Brachycephalic breeds have increased negative intrathoracic pres-sure as a result of increased respiratory effort which predisposes them to gastroesophageal reflux and subsequently aspiration pneumonia (6,20,21).

Limitations of the current study include those associated with retrospective studies including a lack of standardization in the amount of soft palate resected and anatomic landmarks used for staphylectomy. The goal of staphylectomy is to shorten the soft palate by resection of the caudal portion to prevent obstruction to the rima glottidis during inspiration (2,10,11). A reported complication of excessive staphylectomy is pharyngonasal regur-gitation secondary to over-shortening the soft palate (9,10). Future studies should be conducted to determine if there are differences between ease of use and precision in performing staphylectomy with the CO2 laser versus LigaSure. In addition, staphylectomy is used to shorten the soft palate but does not address underlying soft palate hyperplasia that may contribute to the upper airway obstruction. A recent study determined a correlation between the thickness of the soft palate and severity of brachycephalic obstructive clinical signs (6). This study also demonstrated that the soft palate of French bulldogs is signifi-cantly thicker than that of pugs (6).

The current study showed similar outcomes and safety for CO2 laser and BSD-assisted staphylectomy. Both procedures were equally effective in speed of the procedure, minimal intra-operative complications and favorable clinical outcomes. CVJ

Table 3. Preoperative variables significantly associated with major complications for Group-L and Group-B.

Preoperative variable Total (N = 60) Group-L (N = 26) Group-B (N = 34)

Bulldog breed (n = 19) 19/60 (32%) 6/26 (23%) 13/34 (38%) Major complication (n = 5) 5/19 (26%) 0/6 (0%) 5/13 (38%)

Hospitalized, other (n = 6) 6/60 (10%) 2/26 (7.7%) 4/34 (12%) Major complication (n = 4) 4/6 (67%) 2/2 (100%) 2/4 (50%)

Table 4. Major complications significantly associated with death/euthanasia for Group-L and Group-B.

Major complication Total (N = 60) Group-L (N = 26) Group-B (N = 34)

Aspiration pneumonia (n = 6) 6/60 (10%) 2/26 (7.7%) 4/34 (12%) Tracheostomy (n = 3) 3/6 (50%) 1/2 (50%) 2/4 (50%) Death/euthanasia (n = 3) 3/6 (50%) 1/2 (50%) 2/4 (50%)

Tracheostomy (n = 3) 3/60 (5%) 1/26 (4%) 2/34 (6%) Death/euthanasia (n = 2) 2/3 (67%) 1/1 (100%) 1/2 (50%)



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References 1. Fasanella FJ, Shivley JM, Wardlaw JL, Givaruangsawat S. Brachycephalic

airway obstructive syndrome in dogs: 90 cases (1991–2008). J Am Vet Med Assoc 2010;237:1048–1051.

2. Riecks TW, Birchard SJ, Stephens JA. Surgical correction of brachyce-phalic syndrome in dogs: 62 cases (1991–2004). J Am Vet Med Assoc 2007;230:1324–1328.

3. Baker GJ. Surgery of the canine pharynx and larynx. J Small Anim Pract 1972;13:505–513.

4. Torrez CV, Hunt GB. Results of surgical correction of abnormalities associated with brachycephalic airway obstruction syndrome in dogs in Australia. J Small Anim Pract 2006;47:150–154.

5. Harvey CE. Review of results of airway obstruction surgery in the dog. J Small Anim Pract 2008;24:555–559.

6. Haimel G, Dupré G. Brachycephalic airway syndrome: A compara-tive study between pugs and French bulldogs. J Small Anim Pract 2015;56:714–719.

7. Brdecka D, Rawlings C, Howerth E, Cornell K, Stiffler K. A histo-pathological comparison of two techniques for soft palate resection in normal dogs. J Am Anim Hosp Assoc 2007;43:39–44.

8. Dupré G, Heidenreich D. Brachycephalic syndrome. Vet Clin North Am Small Anim Pract 2016;46:691–707.

9. Ree JJ, Milovancev M, MacIntyre LA, Townsend KL. Factors associ-ated with major complications in the short-term postoperative period in dogs undergoing surgery for brachycephalic airway syndrome. Can Vet J 2016;57:976–980.

10. Mercurio A. Complications of upper airway surgery in companion animals. Vet Clin North Am Small Anim Pract 2011;41:969–980.

11. Clark GN, Sinibaldi KR. Use of a carbon dioxide laser for treatment of elongated soft palate in dogs. J Am Vet Med Assoc 1994;204: 1779–1781.

12. Dunie-Merigot A, Bouvy B, Poncet C. Comparative use of CO2 laser, diode laser and monopolar electrocautery for resection of the soft pal-ate in dogs with brachycephalic airway obstructive syndrome. Vet Rec 2010;167:700–704.

13. Lauretano AM, Khosla RK, Richardson G, et al. Efficacy of laser-assisted uvulopalatoplasty. Lasers Surg Med 1998;21:109–116.

14. Tambella AM, Vullo C, Dini F, Palumbo Piccionello A, Attili AR. Carbon dioxide laser-assisted staphylectomy in brachycephalic and nonbrachycephalic dogs. Turk J Vet Anim Sci 2013;37:734–742.

15. Oechtering GU, Pohl S, Schlueter C, Schuenemann R. A novel approach to brachycephalic syndrome. 2. Laser-assisted turbinectomy (LATE). Vet Surg 2016;45:173–181.

16. Cook D, Moses P, Mackie J. Clinical effects of the use of a bipolar vessel sealing device for soft palate resection and tonsillectomy in dogs, with histological assessment of resected tonsillar tissue. Aust Vet J 2015; 93:445–451.

17. Belch A, Matiasovic M, Rasotto R, Demetriou J. Comparison of the use of LigaSure versus a standard technique for tonsillectomy in dogs. Vet Rec 2017;180:196.

18. White RN. Surgical management of laryngeal collapse associated with brachycephalic airway obstruction syndrome in dogs. J Small Anim Pract. 2012;53:44–50.

19. Davidson EB, Davis MS, Campbell GA, et al. Evaluation of carbon dioxide laser and conventional incisional techniques for resection of soft palates in brachycephalic dogs. J Am Vet Med Assoc 2001;219:776–781.

20. Lorinson D, Bright R. Brachycephalic airway obstruction syndrome: A review of 118 cases. Canine Pract 1997;22:18–21.

21. Liu N-C, Sargan DR, Adams VJ, Ladlow JF. Characterisation of brachycephalic obstructive airway syndrome in French bulldogs using whole-body barometric plethysmography. PloS One. 2015;10:e0130741.

Below is a list of several links to Canadian sources of information on animal health and disease. Our goal is to provide current information while not duplicating existing efforts. We hope that this contact information will be of assistance to veterinarians across the country.

Canadian Animal Health Coalition (CAHC/CCSA) newsletter http://service.meltwaternews.com/mnews-ws/resources/pastnewsletter/latestHtml?n=MTUwNTUz&r=MTUyNzQz

Alberta Animal Health Source (ABVMA) site: http://www.albertaanimalhealthsource.ca/

Animal Health Laboratory — University of Guelph http://www.guelphlabservices.com/ahl/

British Columbia — Animal Health Monitor http://www2.gov.bc.ca/gov/content/industry/agriculture-seafood/animals-and-crops/animal-health/animal-health-centre/newsletter

Prairie Diagnostic Services Inc. (Animal Health Perspectives newsletter) http://pdsinc.ca/

Ministry of Agriculture, Food and Rural Affairs (Ceptor — Animal Health News) http://www.omafra.gov.on.ca/english/livestock/ceptor/news.html

University of PEI — Diagnostic Services (Newsletter) http://www.upei.ca/avc/diagnostic-services/newsletters

Animal Health Information Sources

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Article

Evaluation of risk factors for mortality in dogs with lung lobe torsion: A retrospective study of 66 dogs (2000–2015)

Shannon H. Wainberg, Brigitte A. Brisson, Stephanie N. Reabel, Jennifer Hay, Galina Hayes, Cindy L. Shmon, Kim Murphy, William Sears

Abstract — The objectives of this retrospective case series study were to describe a group of 66 dogs with lung lobe torsion (LLT) and to investigate the incidence of complications and risk factors for mortality and overall outcome in this population. Sixty-six dogs with LLT from 3 independent academic institutions were investigated. Information on signalment, history, clinical findings, and interventions was obtained. Associations with mortality outcome were examined via logistic regression. Dogs with a depressed mentation at presentation were 21 times more likely to die than dogs with normal mentation [P = 0.008, 95% confidence interval (CI) = 1.949 to 579.904]. The overall odds of mortality were increased by 18% for each unit change in Acute Patient Physiologic and Laboratory Evaluation (APPLEfast) score (P = 0.04, 95% CI = 0.998 to 1.44). No other clinical abnormalities correlated with outcome.

Résumé — Évaluation des facteurs de risque pour la mortalité chez les chiens souffrant d’une torsion du lobe pulmonaire : étude rétrospective de 66 chiens (2000–2015). Les objectifs de cette étude rétrospective d’une série de cas consistaient à décrire un groupe de 66 chiens ayant une torsion du lobe pulmonaire (TLP) et d’investiguer l’incidence de complications et les facteurs de risque pour la mortalité et les résultats généraux chez cette population. Soixante-six chiens atteints de TLP provenant de trois établissements universitaires indépendants ont été étudiés. Des données ont été obtenues sur le signalement, les résultats cliniques et les interventions. Les associations avec les résultats de mortalité ont été examinées via la régression logistique. Il était 21 fois plus probable que les chiens ayant un état mental déprimé à la présentation meurent que les chiens ayant un état mental normal (P = 0,008, intervalle de confiance [IC] de 95 % = de 1,949 à 579,904). Les probabilités globales de mortalité augmentaient de 18 % pour chaque unité de changement selon la note Acute Patient Physiologic and Laboratory Evaluation (APPLEfast) (P = 0,04, IC de 95 % = de 0,998 à 1,44). Aucune autre anomalie clinique n’offrait de corrélation avec les résultats.


Can Vet J 2019;60:167–173

Introduction

L ung lobe torsion (LLT) is a rare life-threatening condition that results from the rotation of a lung lobe along its lon-

gitudinal axis with twisting of the bronchovascular pedicle at the hilus, causing pulmonary arterial and venous obstruction, thrombosis, and necrosis of the lung lobe (1). Lung lobe torsion is typically an acute condition of dogs that can be fatal without surgical intervention. Pathophysiology is typically described

as spontaneous or secondary to underlying thoracic disease or trauma. Diagnosis is most commonly made based on the detec-tion of dyspnea or tachypnea and evidence of pleural effusion with pulmonary consolidation and twisted/truncated bronchi on radiographs. In many cases a more definitive diagnosis can be made based on the results of a thoracic ultrasound examina-tion, computed tomography (CT), or bronchoscopy (2–5), but some cases cannot be confirmed without surgery or necropsy.

Departments of Clinical Studies (Wainberg, Brisson, Reabel) and Population Medicine (Sears), Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1; Department of Clinical Sciences (Hay, Shmon), Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5A2; Department of Clinical Sciences (Hayes), College of Veterinary Medicine, Cornell University, Ithaca, New York 14853, USA (Murphy).Address all correspondence to Dr. Shannon Wainberg; e-mail: [email protected]. Murphy’s current address is Murphy Veterinary Surgery, Guelph, Ontario N1L 1C8.Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.



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Various large and small breed dogs have been reported to develop LLT. Previous studies have found Afghan hounds and pug breeds overrepresented (2,6,7), with Afghan hounds being 133 times more likely to develop LLT than other large breed dogs (6), and male pugs being prone to spontaneous torsion of the left cranial lung lobe (7). Few studies have reported on LLT and the largest study to date included only 22 dogs (6). This study found an overall fair to guarded prognosis with only 68% (n = 15) of dogs surviving to discharge and 33% (n = 5) of these 15 dogs dying of thoracic-related disease within the study period (6). This study was mostly descriptive and to the authors’ knowledge, no risk factors other than breed predisposi-tion were studied or identified against patient outcome. More recent studies found the overall prognosis for LLT to be good to excellent with survival rates to discharge ranging from 86% to 100%; however, these studies included small numbers of dogs and focused on 1 specific breed: notably pugs (7,8). This discrepancy in patient outcome and lack in information on predisposing patient factors prompted this study.

The Acute Patient Physiologic and Laboratory Evaluation (APPLEfast) model is a scoring system for illness severity based on several clinical variables that predict mortality risk and help to provide an objective basis for risk stratification (9–11). Lung lobe torsion does not currently have a diagnosis-specific scoring system and so this diagnosis-independent model was chosen to provide a level of objective standardization among patients’ groups and to determine if the APPLEfast model could be applied to a group of patients with LLT to predict prob-ability of death.

The main objectives of this study were to describe a large group of dogs with LLT and to investigate the incidence of complications and risk factors for mortality and overall outcome in this population.

Materials and methodsInclusion criteriaMedical records of all dogs with LLT examined at the Ontario Veterinary College (OVC), Western College of Veterinary Medicine (WCVM), and Cornell University College of Veterinary Medicine from January 2000 to 2015 were reviewed. Cases were included if a complete medical record (history, clini-cal signs, imaging, and surgical report, including outcome) was available and if LLT was confirmed at the time of surgery, or necropsy for dogs that were euthanized. Long-term follow-up was obtained when recorded in the medical record.

Data collectionData retrieved from medical records included age, gender, breed, history, clinical signs, complete blood (cell) count (CBC) and serum biochemistry, pleural fluid cytology, APPLEfast parameters if available (mentation at admission, lactate, glucose, platelets, albumin), diagnostic modalities and results, surgical procedures performed, lung lobe(s) affected, histopathology results, nec-ropsy reports, pleural fluid and/or lung bacterial culture and susceptibility, duration of hospitalization, anesthesia and surgery times, intra- and post-operative complications, and outcome (euthanasia, death, or discharge).

MentationMedical records were evaluated and patient mentation at admis-sion was ranked as bright, alert, responsive (BAR), quiet, alert, and responsive (QAR), and depressed (dull, depressed, laterally recumbent, or non-responsive).

APPLEfast score calculationThe APPLEfast score is used to stratify illness severity and risk of mortality in hospitalized animals (8). A number is assigned to each parameter collected from the medical record (menta-tion at admission, lactate, glucose, platelets, albumin) based on the degree of abnormality, previously established by logistic regression model construction of 598 critically ill dogs, and the sum of these numbers is referred to as the APPLEfast score. For this purpose, separate mentation scores were assigned using the previously published scoring system: 0 = normal; 1 = able to stand unassisted, responsive but dull; 2 = can stand when assisted, responsive but dull; 3 = unable to stand, responsive; and 4 = unable to stand, unresponsive (9). Mentation status was collected at admission before sedation or administration of analgesic, while the lowest abnormal parameter within 24 h of admission and before surgery was collected for all values other than lactate. When available, the highest abnormal parameter within 24 h of admission and prior to surgery was collected for lactate. Each numerical increment or reduction in APPLEfast score is referred to as a unit. Total scores were calculated based on procedures described by Hayes et al (9) (Figure 1).

Statistical analysesStatistical analysis was done using a commercial software (SAS/STAT 9.4; SAS Institute, Cary, North Carolina, USA) and descriptive statistics were calculated for many data. Data were assessed for normality and means 1/2 SD were reported where data were normal, and medians (range) were reported where data were not normal. Differences between means were assessed using Student’s t-test. Fischer’s exact Chi-squared test was used to compare breed prevalence in the study to hospital popula-tions. Differences between medians were assessed using the Mann-Whitney test. Survival data were calculated on dogs that underwent surgery. Dogs euthanized prior to planned surgery were not included in the outcome analysis as a clear reason for euthanasia could not be determined from the records. This was done to prevent confounding variables affecting the statistical analysis since it was unclear whether this decision was due to patient variables (poor condition or prognosis) or non-patient variables (financial, not wanting surgery). Dogs euthanized dur-ing or after surgery were included in outcome analyses as eutha-nasia was elected due to poor clinical progression in all cases. Survival was related to the APPLEfast score via logistic regression. Odds ratios and 95% CIs were calculated for prevalence data. A P-value # 0.05 was considered significant.

OutcomeOutcome was divided into death or discharge. Death was classified as preoperative, intraoperative, or postoperative and cause of death (cardiopulmonary arrest or euthanasia) was recorded. Reason for euthanasia was recorded when possible.



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Dogs discharged were further categorized as being alive or dead at the time of follow-up. If dogs had died, further classification into disease and non-disease related death was made. All postop-erative complications were recorded. If the complication devel-oped post-discharge, it was considered a long-term complication.

ResultsSixty-six cases of LLT met the criteria for inclusion in the study (OVC = 33, WCVM = 22, and Cornell University College of Veterinary Medicine = 11). Mean age was 5.85 y 1/2 3.239 (range: 0.25 to 12.6 y). Fifty-five dogs were purebred, represent-ing 28 breeds, the major ones being 21 pugs, 3 Afghan hounds, 3 Labrador retrievers, 2 borzois, 2 golden retrievers, 2 shih-tzus. The remaining 11 (17%) were mixed-breed. Median weight was 13 kg (range: 1.13 to 60 kg, mean = 19.57 kg). Thirty-five (53%) dogs were small breed (, 15 kg). Twenty-one (60%) small breed dogs were pugs, which were significantly overrep-resented (P = 0.001) compared with the hospital population. There was no significant difference in outcome based on breed or dog weight in this study (P = 0.31).

Clinical abnormalitiesClinical signs at presentation included dyspnea (n = 28, 42%), anorexia (n = 53, 80%), cough (n = 28, 42%), lethargy (n = 57, 86%), and vomiting (n = 6, 9%). Median duration of clin-ical signs before presentation at the teaching hospital was 5 d (range: 1 to 22 d, mean = 7.7 d). Four dogs (6%) had a reported history of trauma. Abnormal physical examination findings included dull cardiopulmonary auscultation (n = 60, 91%), tachypnea (n = 40, 61%), pyrexia (n = 19, 29%) and a depressed mentation (n = 11, 17%). One dog with depressed mentation was euthanized before planned surgery (no clear rea-son was noted in the medical record) and was therefore omitted from analysis. Of the remaining 10 dogs, 3 died before surgery or immediately after surgery from cardiopulmonary arrest and 5 were successfully discharged. The remaining 2 dogs were eutha-nized after surgery and before discharge due to clinical deteriora-tion associated with a chylothorax (n = 1) and pneumothorax (1). There was an association between abnormal mentation (depressed versus normal) and disease-related euthanasia or death (Figure 2). Dogs with a depressed mentation were 21 times more likely to die than dogs with a normal mentation (P = 0.008; 95% CI = 1.95 to 579.90). No other clinical abnormalities were associated with outcome.

Clinicopathologic findingsA CBC and biochemistry profile performed within 24 h of admission was available for 59 of 66 dogs. Abnormalities included neutrophilia (n = 50), anemia (n = 30), hypoalbumin-emia (n = 28), elevated alkaline phosphatase (n = 22), bilirubi-nemia (n = 16), hyperglycemia (n = 10), hypercholesterolemia (10), elevated alanine aminotransferase (n = 7), thrombocyto-penia (n = 4), and hemorrhage (n = 1). Hyperlactatemia was not evaluated in previous studies and lactate concentration was found to be elevated (. 2 mmol/L) in 35% of cases before surgery. High lactate was not associated with death (P = 0.06; OR = 8.34; 95% CI = 0.92 to 229.59).

Pleural fluid was obtained before surgery by thoracocentesis in 37 dogs. Examination of the pleural fluid revealed non-degenerate neutrophils, mild to moderate hemorrhage with macrophages, lymphocytes, and small reactive mesothelial cells in 36 dogs. Chylothorax was diagnosed in 6 dogs based on tri-glyceride levels. Cytology inconsistent with a LLT was noted in 1 dog in which coccoid bacteria and large hyperplastic mesothe-lial cells were identified. Pleural fluid and/or lung samples from 31 dogs were submitted for culture, and 2 had bacterial growth; organisms identified were Streptococcus canis and Staphylococcus pseudintermedius.

APPLEfastAPPLEfast was performed for all dogs for which required data were available, but several patients did not have a recorded lactate value. Mentation was available in 66 of 66 dogs, while lactate was available in only 37 of 66 dogs. As such, a total of 37 APPLEfast scores were calculated in this study (Table 1). Three cases were excluded from analysis as cause for euthanasia could not be determined, resulting in a total of 34 APPLEfast scores. Median APPLEfast score was 20 (range = 12 to 34; mean = 21.5). Overall, the odds of disease related death increased by 18% for each unit increase in APPLEfast score (P = 0.04; 95% CI = 1.03 to 1.44) (Figure 3).

Diagnostic imagingThoracic radiographs were taken in all dogs. Radiographs revealed pleural effusion in 54 dogs and were considered diag-nostic for LLT according to the imaging reports in 16 (24%) dogs. Ultrasound was performed in 28 dogs and was considered diagnostic for LLT in 5 (18%) dogs. Computed tomography (CT) scan was performed in 17 dogs and was considered

Figure 1. Canine Acute Patient Physiologic and Laboratory Evaluation (APPLEfast) score. The score was calculated by summing the value in the upper left corner of the appropriate cell for each of the 5 parameters listed, with a maximum potential score of 50.

APPLEfast Score SI units

7, 4.6

84.6–5.6

95.7–9.0

109.1–15.0

glucose (mmol/L). 15.0

albumin (g/L)33–35

8, 26

726–30

631–32

2. 35

lactate (mmol/L), 2

42–8

1. 420

12. 10

88–10

platelet count261–420 000

5, 151

6151–200

3201–260

mentation score0

41

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diagnostic for LLT in 13 (76%) dogs. Six dogs had all 3 imag-ing modalities performed prior to surgery. Bronchoscopy was performed in 12 dogs and was considered diagnostic in 6 (50%).

TreatmentSeven (10.6%) dogs died (n = 2) or were euthanized (n = 5) before surgery due to poor prognosis, poor condition, and/or financial reasons. The remaining 59 (89.4%) dogs were treated surgically. Surgical approach for these dogs included an intercos-tal thoracotomy (n = 56, 84.9%) or median sternotomy (n = 3, 4.5%). Lung lobectomy was performed with a thoracoabdomi-nal (TA) stapler (n = 44), ligatures (n = 4), hand sewn (n = 4), TA stapler and ligatures (n = 5), and TA stapler and hand sewn (n = 2). The lobes affected and removed at the time of surgery included the left cranial lung lobe (n = 30), the right middle lung lobe (n = 22), the right cranial lung lobe (n = 4), and the left caudal lung lobe (n = 3). Pugs more frequently had the left cranial lung lobe affected (n = 18, 90%) compared to the right middle lung lobe (n = 2, 10%). Median anesthesia time for diagnostic and surgical procedures, including other surgical pro-cedures such as thoracic duct ligation and diaphragmatic hernia repair where required, was 180 min (range: 75 to 570 min) and median surgery time was 90 min (range: 45 to 480 min).

HistologyLung lobes from 57 dogs were submitted for histopathology. Findings, including hemorrhage, thrombosis, and necrosis, were consistent with LLT in 56 dogs. No histological diagnosis was recorded in the remaining report, but medical records includ-ing the surgery report and discharge statement confirmed the diagnosis of LLT.

OutcomeOf the 59 (89.4%) dogs that underwent treatment following diagnosis, 8 (13.6%) died during surgery (n = 3) or after sur-gery (5). Of these, 3 dogs suffered cardiopulmonary arrest and 5 were euthanized at the owner’s request due to complications or secondary to other thoracic disease (chylothorax = 2, pneu-mothorax = 1, bronchoalveolar carcinoma = 1, sepsis due to pyothorax = 1) resulting in a perceived poor prognosis.

Postoperative complications occurred before discharge in 14/59 (24%) dogs. These included chylothorax (n = 3, 21%), pneumothorax (n = 6, 43%), and non-chylous pleural effusion (n = 4, 29%). Chylous effusion was diagnosed based on a high triglyceride ratio between the thoracic effusion and serum. One dog with persistent severe hypotension presumably caused by a septic pyothorax failed to recover from anesthesia and was eutha-nized at the owner’s request due to a poor prognosis. Patients were excluded from outcome calculations if any complications were identified before surgery or if complications developed after discharge.

Of the 6 dogs with preoperative chylothorax, 1 was eutha-nized before planned surgery and 2 were euthanized after sur-gery because of a perceived poor prognosis. One dog that had persistent chylothorax after surgery underwent thoracic duct ligation 8 d later and was successfully discharged. One dog had no evidence of persistent chylothorax immediately after surgery, but it recurred 2 wk later. This dog was not treated and was clinically normal at the time of follow-up 3 mo later. One dog underwent thoracic duct ligation at the time of surgery and was discharged without recurrence.

Three dogs without a previous diagnosis of chylothorax devel-oped it after surgery. Two developed chylothorax immediately

Figure 2. Outcome of dogs (n = 60) based on mentation at time of presentation.

% P

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Outcome of patients (n = 60) based on mentation at time of presentation (P = 0.003)

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P = 0.056

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after surgery and were euthanized without treatment and the third was euthanized 1 month after due to congestive heart failure and renal failure.

Pneumothorax was identified in 6 dogs after surgery with no confirmed cause noted in the medical record. Five of these dogs were successfully discharged following management in hospital with a chest tube for 3 to 6 d before discharge from hospital. The 6th dog was euthanized after surgery due to persistent pneumothorax and a perceived poor prognosis.

Four dogs developed non-chylous pleural effusion after surgery. One resolved 10 d after diagnosis without further treatment. Two dogs were euthanized due to failure to respond to treatment and 1 was managed for 2 mo until it was lost to follow-up. One dog underwent cardiac arrest 1 mo after surgery and was diagnosed on postmortem histopathology with granu-lomatous blastomycosis.

Long-term complications developed in 5 dogs following dis-charge from the hospital and included chylothorax (n = 2) and LLT recurrence (n = 3). One dog developed chylothorax 5 mo after surgery, underwent no further treatment, and was doing well at follow-up 2 y later. The other dog was diagnosed with chylothorax by thoracocentesis 3 y after LLT and was discharged without any report of recurrence in 10 y after thoracocentesis. One dog underwent thoracotomy for a second lung lobe tor-sion (left cranial) 6 mo following right cranial lung lobectomy.

Two dogs had radiographs suspicious for recurrent LLT 8 wk and 6 mo after surgery, but were euthanized due to a perceived poor prognosis associated with the need for a second surgery. A postmortem examination was not permitted in either case. Both dogs were suspected to have had a right middle lung lobe torsion following a previous left cranial lung lobectomy.

Fifty-one of the 59 dogs (86%) dogs survived until discharge, 10 of which were alive at the time of data collection and 15 of which had died from causes unrelated to LLT. Of the 8 dogs that did not survive to discharge, 5 were euthanized for reasons that could have been addressed medically or surgically. The remaining cases (n = 26) were lost to follow-up.

DiscussionOverall outcome of LLT with timely and appropriate surgical treatment was found to be very good in this study. Eighty-six percent of dogs that underwent treatment in this study were discharged. Clinicopathologic findings reported herein were consistent with previous reports (6–8,12–14,17), none of which individually were associated with patient outcome. Mentation status was found to have a significant association with outcome in this study, whereby dogs with a depressed mentation were 21 times more likely to die or be euthanized for poor doing than dogs that had normal mentation (P = 0.004; 95% CI = 1.95 to 579.90) (Figure 2). Although mentation is a subjective measure

Table 1. Data retrieved for calculation of APPLEfast scores.

Case Mentation Lactate Lactate Glucose Glucose Platelet Platelet Albumin Albumin APPLEfast number score (mmol/L) score (mmol/L) score (3109/L) score (g/L) score (max = 50)

1 6 9.6 8 6.5 9 446 1 23 8 32 2 7 8.5 8 2.6 7 271 0 33 0 22 3 4 4.4 4 3.9 7 658 1 20 8 24 4 4 4.1 4 7.1 9 428 1 26 7 25 5 6 3.9 4 8.8 9 223 3 32 6 28 6 4 3.2 4 9.2 10 5 5 25 8 31 7 4 3.2 4 4.7 8 282 0 29 7 23 8 14 2.6 4 5.7 9 167 6 33 0 33 9 0 2.56 4 5.3 8 112 5 31 6 2310 7 2.4 4 5.8 9 198 6 21 8 3411 0 2.3 4 6.8 9 299 0 33 0 1312 4 2.2 4 5.6 8 130 5 23 8 2913 0 2.2 4 9.1 10 291 0 25 8 2214 7 1.9 0 5.1 8 427 1 24 8 2415 0 1.8 0 5.2 8 472 1 29 7 1616 4 1.8 0 6.5 9 260 3 32 6 2217 4 1.7 0 4.5 7 298 0 28 7 1818 4 1.64 0 4.5 7 151 6 27 7 2419 0 1.5 0 5.4 8 437 1 30 7 1620 4 1.5 0 6.8 9 271 0 31 6 1921 4 1.4 0 5.1 8 470 1 28 7 2022 0 1.3 0 7 9 93 5 18 8 2223 4 1.2 0 5.1 8 356 0 24 8 2024 0 1.2 0 8.3 9 381 0 27 7 1625 4 1.15 0 4.3 7 299 0 20 8 1926 0 1.1 0 5.7 8 794 1 31 6 1527 4 1.05 0 4.8 8 368 0 WNL 0 1228 4 1 0 5 8 362 0 25 8 2029 4 0.95 0 6.6 9 WNL 0 36 2 1530 4 0.9 0 5.7 9 269 0 32 6 1931 4 0.62 0 4.9 8 236 3 33 0 1532 0 0.6 4 5 8 376 0 30 7 1933 4 0.57 0 6.1 9 191 6 27 7 2634 0 0 0 6.8 9 351 0 32 6 15

WNL — within normal limits.



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in veterinary medicine, the APPLEfast model provided more objective criteria, including ability to ambulate and respond to the surrounding environment, to help eliminate clinician vari-ability in assessment of this non-numerical parameter.

The APPLEfast model is a scoring system that predicts the probability of death based on a combination of clinical findings that have been previously identified as factors associated with survival prediction index (9–12). The APPLEfast can provide the researcher with an objective illness severity measure (9). Only 37 APPLEfast scores were obtained for dogs in this study because several dogs did not have a recorded lactate level. Most of the missing lactate data was from one institution in which lactate levels were unfortunately not included in the paper record dur-ing the study period. The absence of this data is therefore less likely to have been related to the severity of illness and is less likely to have biased the results.

Our results revealed that the odds of mortality were increased by 18% for each unit change in APPLEfast score (P = 0.04, 95%; CI = 1.03 to 1.44) (Figure 2). Dogs with an elevated lactate concentration (. 2 mmol/L) tended to die more frequently (Table 1); however, this difference was not significant (P = 0.06), likely due to lack of power resulting in a type II error. None of the other variables studied were associated with outcome.

Thoracic radiographs revealed pleural effusion in most of the dogs (83%) but were only considered to be diagnostic for LLT in 30%. Thoracic CT resulted in the greatest frequency of a positive diagnosis for LLT (76%) but was not used as much as ultrasound due to its less frequent availability, relatively higher cost, and need for sedation or general anesthesia. Compared to previous studies (6), ultrasound was not often considered diagnostic for LLT in this study (5/28 cases). This can be attributed to selection criteria whereby a definitive diagnosis of LLT recorded in the radiology report was required in this study to confirm an LLT. Despite the lack of formal diagnosis obtained using these imaging modalities, many dogs had surgery following radiographs and ultrasound with a suspicion for LTT.

Therefore, although CT was more useful in obtaining a defini-tive diagnosis of lung lobe torsion in this study (13/17 cases), combined thoracic radiographs and ultrasound provided suffi-cient information to warrant thoracic exploration with definitive diagnosis obtained at the time of surgery.

Pleural fluid or samples from the affected lung lobes were obtained and submitted for culture in 31 dogs. Only 6% of the submitted cultures were positive for bacterial growth. This is markedly different from a previous study in which 60% of cul-tures submitted yielded bacterial growth (6). These differences may be attributed to a different study population, differences in duration of torsion, or variation in sample collection or culture techniques. Although the exact pathophysiology of LLT is not understood, this study supports that underlying infection is not a common risk factor for the development of LLT.

Pugs, which have been previously identified as a predisposed breed (7,8,15), were significantly overrepresented as a small breed in this study. Previous studies have identified an associa-tion between breed and the torsed lobe, with the right middle lung lobe most commonly affected in large breed dogs (16), and the left cranial lung lobe more commonly affected in pugs (7,8,15). This was also true in the current study. However, breed or dog size (large versus small) had no association with outcome in this study (P = 0.31).

Four dogs (6%) in this study had a history of thoracic trauma and 14 had identified concurrent thoracic disease (chylothorax = 6, spontaneous pneumothorax, and aspiration pneumonia = 2 each, traumatic pneumothorax bronchoalveolar carcinoma, pyothorax, and smoke inhalation = 1 each). The remaining 47 (71%) cases were classified as spontaneous LLT because no histologic evidence of underlying disease was pres-ent. These percentages are similar to previously reported cases of spontaneous lung lobe torsion (6,7).

Acute or persistent chylothorax has been identified as a com-mon concurrent thoracic condition with LLT (6,14). Although several causes have been identified including neoplasia, trauma, and heart disease, in many cases chylothorax is considered idiopathic (18). In the present study, 3 cases not documented to have chylothorax before surgery developed chylothorax after surgery. In these cases, it is possible that the pleural effusion was not consistent with chylous effusion pre-surgery and led to an incorrect diagnosis due to the LLT confounding the cytologic characteristics of the pleural effusion. It is difficult to assess whether LLT caused disruption to the thoracic duct resulting in chylothorax, or vice versa without knowing whether chylothorax was in fact present pre-surgery. Of 9 cases with chylothorax in this study, 8 had surgery for lung lobectomy. Chylothorax resolved in 75% of dogs and thoracic duct ligation was only performed in 25% (2 of 8 dogs). The remaining 4 dog owners elected no further treatment and no recurrence of chylothorax was reported. Previous literature found an association between chylothorax and outcome; however, more recent studies, includ-ing the present study, have found this not to be true (6). One must, however, consider that some dogs with chylothorax were euthanized due to non-patient factors (financial, emotional) and therefore an actual overall outcome is unknown. No signifi-cant correlation was found between trauma, previous thoracic

Figure 3. Logistic regression of survival versus APPLEfast.

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Logistic regression of survival versus APPLEfast

0 5 10 15 20 25 30 35 40 45 50

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surgery, concurrent thoracic conditions, and overall patient outcome in this study.

Limitations of this study are related to its retrospective nature in that clinical data collected (specifically lactate levels), imaging interpretation, surgeon technique, postoperative man-agement, and follow-up were not uniform among institutions. Multiple institutions were involved in this study in order to obtain a larger sample size, which resulted in greater variability in methods of diagnosis, treatment, and management of cases. Despite including 3 times more cases than the largest previously published report, lack of power to detect associations between other risk factors and outcome was likely a limitation given so few dogs had a negative (death or complication) outcome after surgery in this study which limits the precision of estimation of effect and could be misleading. This is supported by the wide confidence intervals reported for the odds ratios in this study.

To date, no study has reported on a large number of dogs with LLT. This study confirmed the ability of the APPLEfast score, which is a diagnosis-independent illness severity score, to predict outcome in this population when required data were available in the medical record. The APPLEfast score is currently meant for assessment of populations and is not considered an accurate predictor of individual cases. This study also identi-fied depressed mentation as a risk factor for poor outcome in dogs with LLT; however, caution should be exercised regard-ing the use of this parameter to guide prognosis and client decision-making in clinical practice since depression can be subjective, and may be affected by factors other than LLT itself. CVJ

References 1. Moon M, Fossum TW. Lung lobe torsion. In: Bonagura JD, ed. Kirk’s

Current Veterinary Therapy XII: Small Animal Practice. Philadelphia, Pennsylvania: WB Saunders, 1995:919–921.

2. D’Anjou A, Tidwell AS, Hecht S. Radiographic diagnosis of lung lobe torsion. Vet Radiol Ultrasound 2005;46:478–484.

3. Seiler G, Schwarz T, Vignoli M, Rodriguez D. Computed tomographic features of lung lobe torsion. Vet Radiol Ultrasound 2008;49:504–508.

4. Shultz RM, Peters J, Zwingenberger A. Radiography, computed tomog-raphy and virtual bronchoscopy in four dogs and cats with lung lobe torsion. J Small Anim Pract 2009;50:360–363.

5. Moses BL. Fiberoptic bronschoscopy for diagnosis of lung lobe torsion in a dog. J Am Vet Med Assoc 1980;176:44–47.

6. Neath PJ, Brockman DJ, King LG. Lung lobe torsion in dogs: 22 cases (1981–1999). J Am Vet Med Assoc 2000;217:1041–1044.

7. Murphy KA, Brisson BA. Evaluation of lung lobe torsion in Pugs: 7 cases (1991–2004). J Am Vet Med Assoc 2006;228:86–90.

8. Rooney MB, Lanz O, Monnet E. Spontaneous lung lobe torsion in two pugs. J Am Anim Hosp Assoc 2001;37:128–130.

9. Hayes G, Mathews K, Doig G, et al. The acute patient physiologic and laboratory evaluation (APPLE) score: A severity of illness stratification system for hospitalized dogs. J Vet Intern Med 2010;24:1034–1047.

10. King LG, Stevens MT, Ostro EN. A model for prediction of survival in critically ill dogs. J Vet Emerg Crit Care 1994;4:85–99.

11. King LG, Wohl JS, Manning AM, Hackner SG, Raffe MR, Maislin G. Evaluation of the survival prediction index as a model of risk stratifi-cation for clinical research in dogs admitted to intensive care units at 4 locations. Am J Vet Res 2001;62:948–954.

12. Lord PF, Greiner TP, Greene RW, DeHoff WD. Lung lobe torsion in the dog. J Am Anim Hosp Assoc 1973;9:473–482.

13. Williams JH, Duncan NM. Chylothorax with concurrent right cardiac lung lobe torsion in an Afghan Hound. J S Afr Vet Assoc 1986;57: 35–37.

14. Johnston GR, Feeney DA, O’Brien TD, et al. Recurring lung lobe tor-sion in three Afghan Hounds. J Am Vet Med Assoc 1984;184:842–845.

15. Gelzer AR, Downs MO, Newell SM, Mahaffey MB, Fletcher J, Latimer KS. Accessory lung lobe torsion and chylothorax in an Afghan hound. J Am Anim Hosp Assoc 1997;33:171–176.

16. Spranklin DB, Gulikers KP, Lanz OI. Recurrence of spontaneous lung lobe torsion in a pug. J Am Anim Hosp Assoc 2003;39:446–451.

17. Gallanger LA. Lung lobe torsion. In: Bojrab MJ, ed. Disease Mechanisms in Small Animal Surgery. 2nd ed. Philadelphia, Pennsylvania: Lea & Febiger, 1993:386–387.

18. Birchard SJ, McLoughlin MA, Smeak DD. Chylothorax in the dog and cat: A review. Lymphology 1995;28:64–72.



Case Report Rapport de cas

Transient distal renal tubular acidosis in a dog with gastric-dilatation-volvulus

Carlos Torrente, Carla Molina, Luis Bosch, Cristina Costa-Farré

Abstract — A case of distal renal tubular acidosis occurring as a transient complication in a 13-year-old female greyhound dog with gastric-dilatation-volvulus was diagnosed. The acute renal ischemia and inflammatory condition associated with this syndrome could be considered the main underlying mechanisms responsible for the acute, severe, and complicating renal tubular dysfunction.

Résumé — Acidose tubulaire rénale distale transitoire chez un chien atteint de volvulus et de dilatation gastrique. Un cas d’acidose rénale distale se manifestant comme une complication transitoire chez une chienne Lévrier anglais âgée de 13 ans atteinte de dilatation gastrique-volvulus a été diagnostiqué. L’ischémie rénale aiguë et l’affection inflammatoire associées à ce syndrome pourrait être considérées comme les principaux mécanismes sous-jacents responsables de la dysfonction tubulaire rénale grave et complexe.


Can Vet J 2019;60:174–178

R enal tubular acidosis refers to an unusual group of kidney disorders characterized by the presence of normal anion

gap hyperchloremic metabolic acidosis associated with reduced bicarbonate reabsorption in the renal proximal tubule or fail-ure of the renal distal tubule to synthesize new bicarbonate in the absence of substantial renal insufficiency (1–4). Distal renal tubular acidosis (DRTA) can be a transient or permanent disorder and can occur either as a primary disease (congenital DRTA) or as a complication (acquired DRTA) of other diseases, both of renal and non-renal origin. Acquired DRTA has been described infrequently in the veterinary literature, mainly in association with some drugs and nephrotoxins, infectious dis-eases, autoimmune disorders, chronic hypocalcemic conditions, and neoplastic disorders (1,5–8).

The diagnostic criteria and clinical management of transient but severe DRTA in a geriatric dog presenting with a gastric-dilatation-volvulus syndrome (GDV) is described. The authors hypothesize about the underlying mechanisms responsible for this disorder.

Case descriptionA 13-year-old, spayed female, 23-kg greyhound dog was pre-sented to the Fundació Hospital Clínic Veterinari-UAB for evaluation of acute abdominal distention and non-productive retching. The clinical history included a previous diagnosis of hypothyroidism under treatment with levothyroxine.

Physical examination revealed dull mentation, tachypnea (60 breaths/min) with increased respiratory effort, congested and dry mucous membranes, capillary refill time , 2 s, tachy-cardia (176 beats/min), left side apical systolic heart murmur (grade 3/6), synchronous and bounding pulses, body tem-perature of 39.2°C, painful abdomen, and tympanic abdomi-nal distention. On admission, a mean arterial blood pres-sure (MAP) of 136 mmHg was obtained by oscillometric method (Vet20; B. Braun Medical S.A., Barcelona, Spain) and the electrocardiogram (ECG) showed ventricular tachycar-dia without hemodynamic consequences. Initial blood tests revealed a packed cell volume (PCV) of 65% [reference range (RR): 37% to 55%], total plasma protein concentration of 72 g/L (RR: 52 to 82 g/L), plasma glucose concentration of 8.32 mmol/L (RR: 3.89 to 7.94 mmol/L), and plasma lactate of 4.7 mmol/L (RR: , 2.0 mmol/L). Emergency treatment upon admission included flow-by oxygen at 4 to 5 L/min, per-cutaneous gastrocentesis, and intravenous fluid therapy with an isotonic crystalloid solution; a bolus of Lactated Ringer’s solution (B. Braun Medical S.A.), 20 mL/kg body weight (BW) was initially administered in 15 min, followed by a fluid rate of 10 mL/kg BW per hour. It should be noted that in spite of the moderate hyperlactatemia, use of this solution is not contraindicated in patients with type A hyperlactatemia (tissue hypoperfusion). At the normal dosages, use of this balanced

Departament de Medicina i Cirurgia Animal, Facultat de Veterinària de la UAB, Campus UAB Universitat Autònoma de Barcelona Bellaterra (Cerdanyola del Vallès), Barcelona 08193, Spain.Address all correspondence to Dr. Carlos Torrente; e-mail: [email protected] of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.



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replacement solution is not associated with an increase in blood lactate concentration if clearance mechanisms are not impaired (i.e., liver failure, lymphoma).

Pain control was achieved by administration of a bolus of fentanyl (Fentanest; Kern Pharma S.A., Madrid, Spain), 5 mg/kg BW, IV, and lidocaine (Lidocaina; B. Braun Medical S.A.), 2 mg/kg BW, IV, followed by a constant rate infusion (CRI) of both drugs (5 mg/kg BW per hour and 60 mg/kg BW per min, respectively). Treatment with cefazolin (Cefazolin; Laboratorios Normon SA, Madrid, Spain), 25 mg/kg BW, IV, was also initiated before surgery. Cefazolin was added to the pre-operative treatment plan following the surgical protocols of the FHCV-UAB for gastrointestinal surgery, in patients at risk for splanchnic hypoperfusion and gastrointestinal compromise.

Throughout the emergency stabilization period, moni-toring was carried out by continuous ECG, pulse- oximetry, non-invasive oscillometric blood pressure measurements and body temperature measurements. Blood samples were obtained for complete blood (cell) count (CBC), serum bio-chemistry, and electrolyte and coagulation profiles. Results of the blood analysis revealed a leukogram showing slight neutrophilia (12.45 3 109/L; RR: 2.95 to 11.64 3 109/L), marginal eosinopenia (0.05 3 109/L; RR: 0.06 to 1.23 3 109/L) and mild lymphopenia (0.83 3 109/L; RR: 1.05 to 5.1 3 109/L). Serum biochemistry showed mild hyperglyce-mia (8.32 mmol/L; RR: 3.89 to 7.94 mmol/L) and elevated alanine- aminotransferase (287 U/L; RR: 10 to 125 U/L). After stabilization, abdominal X-rays were taken and confirmed the final diagnosis of gastric dilatation volvulus (GDV).

The dog was premedicated with methadone (Semfortan; Laboratorios Esteve, Barcelona, Spain), 0.4 mg/kg BW, IM, and midazolam (Midazolam; Normon EFG, Madrid, Spain), 0.25 mg/kg BW, IV. No induction agent was necessary, and the patient was endotracheally intubated and connected to an anesthetic circuit. Intermittent mandatory positive-pressure ventilation with 100% oxygen was provided. Anesthesia was maintained using a CRI of a combination of fentanyl and lido-caine (5 mg/kg BW per hour and 60 mg/kg BW per minute, respectively), plus isofluorane (IsoFlo, Laboratorios Esteve). Intravenous fluid therapy was continued, using the same crystal-loid solution given on admission, at a rate of 10 to 20 mL/kg BW per hour depending on the patient’s blood pressure.

During anesthesia the patient was monitored by continuous ECG, invasive blood pressure, pulse-oximetry, end-tidal carbon dioxide (ETCO2), and body temperature. All parameters were registered in the anesthesia flowsheet every 10 min throughout the anesthetic procedure. Exploratory laparotomy and gastro-pexy were performed routinely. After 20 min of the surgical procedure, a sudden episode of hypotension secondary to a sustained supraventricular tachycardia (190 to 220 beats/min) was detected. A single dose of esmolol (Brevibloc; Baxter SA, Lessines, Belgium), 0.05 mg/kg BW, IV, was administered with a positive response and normal sinus rhythm and arterial blood pressure were re-established during the rest of the procedure. The patient recovered uneventfully from anesthesia.

Postoperative therapy included intravenous balanced iso-tonic crystalloid solution (Lactated Ringer’s solution; B. Braun

Medical S.A.) supplemented with potassium chloride (potassium chloride 2 M; B. Braun Medical S.A.), 30 mEq/L, to provide rehydration (5%) and maintenance needs. Dehydration percent-age was estimated based on dry mucous membranes and slightly increased body temperature. Additionally, broad-spectrum antibiotics including cefazolin (Cefazolin; Laboratorios Normon SA), 25 mg/kg BW, IV, q8h, and enrofloxacin (Enrofloxacin; Bayer AG), 10 mg/kg BW, IV, q24h; oxygen therapy by nasal prongs; omeprazole (Omeprazol; Laboratorios Cinfa SA, Pamplona, Spain), 1 mg/kg BW, IV, q12h; maropitant (Cerenia; Zoetis-España, Madrid, Spain), 1 mg/kg BW, IV, q24h, and levothyroxine (Leventa; Merck Sharp & Dohme Animal Health SL, Salamanca, Spain), 20 mg/kg BW, PO, q12h, were also started. Fentanyl and lidocaine CRI were continued after sur-gery, plus methadone as needed (0.2 to 0.4 mg/kg BW, SQ, q6h) for pain control. Packed cell volume, plasma concentration of total proteins, and glucose and lactate concentrations were recorded every 4 to 6 h during the first 24 h after surgery; body weight, hydration status, perfusion and respiratory parameters were also monitored 1, 2, and 4 times per day, respectively. An indwelling urinary catheter connected to a closed collection system was also placed immediately after surgery to monitor urinary output. Assessment of urinary specific gravity and urinary sediment was performed every 48 h during hospitaliza-tion. Early enteral nutritional support was initiated by placing a nasogastric feeding tube.

Despite the initial positive recovery over the first 24 h, pro-gressive mental depression, anorexia, non-ambulatory weakness, and polyuria/polydipsia were observed throughout the following 48 to 72 h. On the third day, blood samples were submitted for analysis, including a CBC, complete biochemical profile, and venous blood gas analysis. Urinalysis, thoracic radiographs and abdominal ultrasound were also performed. Laboratory abnormalities revealed a moderate hypernatremia, severe hyper-chloremia, and metabolic acidosis (Table 1). Analysis of urine obtained by cystocentesis revealed isostenuria (USG: 1.010), a pH of 7.0, ketonuria (21), bilirubinuria (21) and proteinuria (21), with an inactive urinary sediment and increased urine protein/creatinine (UPC) ratio (0.9; reference value: , 0.5). The urinary anion gap (UAG) was also abnormal (UAG 29.8; RR: 210 to 110 mEq/L). Thoracic radiographs and abdominal ultrasound did not show abnormalities.

Results of the laboratory tests confirmed a severe hyper-chloremic metabolic acidosis with normal anion gap (absence of unmeasured organic anions) and inappropriately alkaline urine and concomitant increased UAG and DRTA was strongly suspected. Because the patient’s blood pH was less than 7.2 (Table 1), acidosis was considered severe and at risk to cause life-threatening cardiovascular complications. Therefore, infusion of an alkalizing HCO3 solution (sodium bicarbonate 1/6 M; B. Braun Medical S.A.) was started according to the calculated patient’s base deficit. The total amount of HCO3 to be infused was estimated based on formulas described in the veterinary literature (9). A third (43 mmol of NaHCO3) of the total dose was administered over 30 min and venous blood gas was re-evaluated. The rest of the dose (86 mmol of NaHCO3) was administered over 6 h at a rate of 0.6 mmol/kg BW per hour.



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Immediately after infusion, the plasma HCO3 concentration was within normal limits and the metabolic acidosis was almost cor-rected (Table 1). The urine fractional excretion (FE) of HCO3 (0.34%; RR: 0.04% to 0.13%) was measured once the infusion of NaHCO3 was completed and the results were consistent with a diagnosis of DRTA (7).

After alkalinizing therapy, acid-base and electrolyte distur-bances were corrected progressively showing normalization of the anomalies on day 4 after admission. The dog remained in the ICU for 5 more days and during that period fluid therapy was adjusted according to the daily fluid balance assessment and blood analysis (Table 1). During those days, the dog remained bright and alert, her appetite was normal, and she showed no abnormal clinical signs.

The patient was discharged 13 d after admission. Three days later, the dog was re-evaluated, and the owner reported good attitude, appetite, and normal water intake. The patient was scheduled for follow-up 1 mo later. The dog continued to have a good attitude, normal appetite, and absence of clinical signs. Re-check blood analysis did not show abnormalities (Table 1) and urinalysis performed following cystocentesis revealed per-sistent isosthenuria (USG: 1.018; RR: 1.015 to 1.045) and increased UPC ratio (1; reference value: , 0.5). At that time a renal diet was prescribed.

The dog was scheduled for re-evaluation monthly, but the owner decided to continue follow-up with his own veterinar-ian and additional information was, therefore, unavailable. However, 6 mo after discharge telephone contact was resumed, and the owner reported a good condition with no changes in attitude, appetite, body weight, or daily water consumption. Recheck blood analysis and urinalysis were offered but the owner declined.

DiscussionDistal renal tubular acidosis refers to a group of disorders characterized by normal anion gap hyperchloremic metabolic acidosis that occurs as a result of failure of the distal tubules to synthesize bicarbonate or acidify the urine by H1 excretion, despite normal or only mildly reduced glomerular filtration rate (GFR) (1,2). Patients with DRTA show a decreased FE

of HCO3 and an impaired capacity to excrete H1 at the distal tubule. As a result, the patient’s urine pH was . 5.5 in the pres-ence of acidemia, characterized by a severe decrease in HCO3 plasma concentration (, 10 to 12 mmol/L) (1,2,10,11). Human patients with DRTA typically show a urine FE-HCO3 less than 3% after plasma HCO3 has been restored with an alkalizing solution. In this dog, urine FE-HCO3 was above the reference range but below the percentage previously described for this tubular disorder in dogs (7). In any case, the dog in this report met the main diagnostic criteria previously described for humans but also accepted for canine species.

Other tests have been described to confirm the diagnosis of DRTA, such as the ammonium chloride loading test (1) which is considered the gold standard in human medicine. This test consists of repeated measurements of urine pH and UAG (before and hourly), during 6 h after oral administration of NH4Cl, 0.1 g/kg BW. In clinically normal dogs, the kidneys excrete excess H1 in the urine, and pH should decrease to a minimum value of 5.5 at 4 h post-administration. Failure to acidify urine 6 to 8 h after NH4Cl administration confirms the diagnosis of DRTA. The UAG represents an indirect index of urinary NH4

1 that under normal circumstances is positive and ranges from 20 to 90 mEq/L. Patients with normal urinary acidification capacity should be expected to produce a negative UAG follow-ing NH4Cl administration. An inappropriately positive UAG suggests the possibility of DRTA resulting in lower amounts of NH4

1 and chloride in the urine. That test was not performed in our patient for several reasons: i) it is commonly associated with dysrhythmia and gastrointestinal side effects such as nau-sea and vomiting associated with the NH4Cl administration; ii) the test is considered unnecessary in patients with obvious hyperchloremic metabolic acidosis with inappropriately high urine pH; and iii) the test could be unsafe in patients which are already acidemic, as in the dog in the present report. In these cases, a single positive UAG measurement may be sufficient to verify the diagnosis of DRTA, such as the case described in this report (3,10–12).

Distal renal tubular acidosis involves failure of the renal distal tubule to synthesize new bicarbonate and to acidify the urine due to impaired secretion of the H1 load in the collecting

Table 1. Results of biochemistry and venous blood gas measurements during hospitalization in the ICU and subsequent follow-up.

Parameters Reference Units T0 T1 T2 T3 T4 T5 T6 T7 T8

pH 7.28 to 7.40 — 7.12 7.20 7.31 7.35 7.31 7.36 7.41 7.38 7.33pvCO2 32.7 to 44.7 mmHg 31.9 33.3 40.2 39.3 45 43.4 39.2 36 38pvO2 32 to 74 mmHg — 44 38 39 45 33 34 45 43SBE 24 to 4 mmol/L 219 215 26 24 23 21 1 22 21AGAP 12 to 25 mmol/L 22 — — 18 20.2 16.9 — 14 18HCO3

2 17 to 24 mmol/L 10.5 13.1 20.5 21.4 27.8 24.7 25.2 23 22Na1 144 to 163 mmol/L 169 168 167 166 163 162 154 156 150K1 3.5 to 5.8 mmol/L 5.1 4.5 3.6 3.4 3.5 3.6 4 4.1 3.8Cl2 109 to 122 mmol/L 142 — — 130 118 124 — 111 110Ca21 1.25 to 1.5 mmol/L 1.54 1.5 1.44 1.48 1.5 1.43 1.35 1.34 1.26Glucose 3.89 to 7.94 mmol/L 7.66 7.38 7.71 6.49 7.22 6.83 6.22 4.56 6.2Lactate , 2.5 mmol/L 1.4 0.9 1.6 2.6 — 1.3 1.3 1.4 1.1Creatinine 44.2 to 132.6 mmol/L 100.78 — — 68.95 — 63.65 — 61 61.9

pvCO2 — partial venous pressure of CO2; pvO2 — partial venous pressure of O2; SBE — standardized base excess.T0 — 72 h post-admission; T1 — post-administration of 1/3 total dose of NaHCO3; T2 — post-administration of a total dose of NaHCO3; T3 — 24 h post-T0; T4 — 36 h post-T0; T5 — 48 h post-T0; T6 — 72 h post-T0; T7 — 120 h post-T0; T8 — 1 month later.



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ducts. However, bicarbonate production failure may be due to: i) disabled voltage-dependent sodium reabsorption mechanism, with H1 and K1 retained inside the tubular cell causing meta-bolic acidosis and hyperkalemia; ii) a dysfunctional H1-ATPase pump mechanism, which impairs active secretion of H1 out of the cell but enhances losses of K1 into the tubular lumen because of increased electronegativity, triggering metabolic aci-dosis and hypokalemia; and iii) abnormal increased membrane permeability of distal tubular cells, which facilitates the exchange of H1 into the cell and potassium into the tubular lumen, also causing metabolic acidosis and concurrent hypokalemia in the affected patient (1,2,4,6). In the absence of abnormalities in plasma levels of potassium, to better characterize distal tubular dysfunction as either a defect in the H1-ATPase or voltage-dependent mechanism in patients with metabolic acidosis, a furosemide response test could be performed (5,7). This test assumes that furosemide increases distal tubular sodium delivery and enhances urine acidification by stimulation of Na1/H1 exchangers. In the present case, that test was not performed due to the dog’s clinical condition and the risks associated with furosemide administration in a dehydrated, polyuric, and polydipsic patient.

Although the present case fulfilled the main diagnostic crite-ria, other differential diagnoses such as urinary tract infection with urease-producing microorganisms or severe diarrhea had to be excluded before confirmation of a DRTA diagnosis. Based on the clinical history, symptoms, results of urinary sediment and culture, both diseases were ruled out. Underlying advanced chronic kidney disease was also excluded because of the absence of azotemia, hypertension, or evidence of chronic renal changes on abdominal ultrasound. Although patients with advanced stages of kidney disease frequently show acid-base disturbances and those metabolic disorders are commonly associated with normal anion gap metabolic acidosis too, this is not a common clinical finding in early stages of kidney disease in which capabil-ity of excretion of the H1 load is often preserved (1,5,10,13).

Isosthenuria was detected in our patient, 72 h after surgery. It should be noted that isosthenuria may be difficult to interpret in patients receiving intravenous fluid support. Therefore, it could be difficult to link that finding to an acute kidney injury instead of a previous asymptomatic chronic kidney disorder. Considering the patient’s age and other analytical findings, such as persistently increased UPC ratio during the first month of follow-up, an early stage of chronic kidney disease was strongly suspected. Although urinalysis on admission could have detected such abnormality, in the authors’ opinion information from that analysis would not have prevented the sudden and unexpected kidney injury and/or modified clinical management over the clinical course. Similarly, analytical determination of plasma or urinary biomarkers in early chronic kidney disease, such as symmetric dimethylarginine (SDMA) or neutrophil gelatinase-associated lipocalin (NGAL) could be considered. However, tak-ing into consideration availability of these tests on an emergency basis and clinical findings obtained by the diagnostic work-up performed on the patient, additional information offered by these tests would not have modified the clinical management during the ICU stay nor the initial follow-up.

In humans, common causes of acquired DRTA are autoim-mune disorders (i.e., systemic lupus erythematosus), nephro-toxins, pyelonephritis, chronic kidney disease from any cause, disorder in calcium metabolism (i.e., primary hyperparathy-roidism), and marked volume depletion (3,10,11). Similarly, in animals, acquired DRTA has been associated with drugs and nephrotoxins (i.e., amphotericin B, tetracycline, heavy metal toxicity, zonisamide), pyelonephritis, immune-mediated hemolytic anemia, leptospirosis, multiple myeloma, and chronic hypocalcemic conditions (1,5,7,8). However, in the present case, no specific cause of DRTA could be found despite a complete analytical, acid-base, imaging, and relevant diagnostic work-up.

Gastric-dilatation-volvulus syndrome is a common condi-tion, associated with high morbidity and potential mortality in emergency patients, that may result in a systemic inflammatory response and potentially multiple organ dysfunction syndrome (MODS). Organ dysfunction documented as part of MODS in canine species may include the heart, lung, gastrointestinal tract, hemostatic system, and kidney (14). Acute kidney injury (AKI) has been reported in dogs as a common (8%) complication associated with GDV. Predisposing factors include: sustained poor perfusion, exposure to endotoxins, thromboembolic events, and ischemic-reperfusion injury (IRI) itself (15). In human medicine, several reports document that despite the causal event, AKI is characterized by a lower capacity to decrease urinary pH in the presence of systemic acidosis, which is intensified by the acute decrease in functioning nephrons. In veterinary medicine, there is only 1 experimental study in dogs that evaluated the impaired renal acidification capacity of the kidney following an acute ischemic event. This study demonstrated that acute renal ischemia in dogs could be associated with a tubular defect in H1 ion secretion, predominantly in the distal tubules (16). Considering these arguments and the fact that during the recovery phase, the re-establishment of the urine acid excretion capacity can be prolonged much more than the normalization of the GFR, both mechanisms could explain the clinical and laboratory findings in the reported case. Finally, according to the exclusion of other potential causes of DRTA and because of the well-known pathogenesis of GDV, the authors hypothesize that the associated intravascular volume depletion, distributive shock and the IRI syndrome could have generated an acute and reversible kidney injury affecting the renal tubules resulting in the development of a transient but severe DRTA.

In canines, DRTA can be asymptomatic or symptomatic. In symptomatic patients, most clinical signs are associated with the acidemic state itself and include lethargy, anorexia, nausea, vomiting, weight loss, muscle weakness, and neurologic signs such as paralysis (1). In humans, polyuria and polydipsia are mainly associated with enhanced kaliuresis and calciuresis. Although urinary FE of these electrolytes was not measured, and the dog did not show hypokalemia, both mechanisms in addition to the increased natriuresis associated with the disease could explain findings such as polyuria/polydipsia in the dog herein. In the authors’ opinion, the early supplementation of intravenous fluids with potassium chloride could have masked the hypokalemic nephropathy frequently associated with this tubular disorder.



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In humans, chronic or prolonged DRTA may induce persis-tent metabolic acidosis that can lead to osteomalacia, urolithia-sis, bone demineralization, and nephrocalcinosis, which may evolve into chronic renal failure (11). According to the acute onset, short period of disease process, and limited follow-up those signs could not be identified in the present case.

Treatment for DRTA is directed at identifying the underlying disease process and providing adequate alkali base to balance H1 production (2,13). In veterinary medicine, the recommended initial dose is 1.0 to 1.5 mEq/kg BW per day of sodium bicar-bonate in divided doses, but higher doses (up to 4 mEq/kg BW per day) may be required to maintain normal pH (1,2). In this patient, an initial dose of 1.8 mEq/kg was administered. Due to the persistence of metabolic acidosis, a dose of 3.7 mEq/kg BW was administered to correct acid/base balance. The total dose of 5.5 mEq/kg BW per day is still considered moderate and compatible with a diagnosis of DRTA (1). Repeated evalua-tions after bicarbonate administration revealed resolution of the acidosis and alkali administration was discontinued.

Prognostic information about DRTA in canine species has not been reported in the veterinary literature. Human medi-cine reports describe a worse prognosis for DRTA compared to proximal RTA. This is due to the risk of complications such as urolithiasis and bone demineralization (1). In our patient, the tubular disorder appeared to have been transient in nature, a phenomenon that is rarely seen in human or veterinary medi-cine (17,18).

In the authors’ opinion, although DRTA is an uncommon disorder in veterinary patients, its incidence may be underesti-mated in the critical care setting. Despite a potential transient nature, this disorder might be associated with increased mor-bidity and mortality in affected individuals. Rapid detection of biochemical and electrolyte changes associated with DRTA in patients at risk of acute kidney injury and a careful correction of the associated acid-base and electrolyte disturbances should improve significantly the management of these critically ill patients. CVJ

References 1. Riordan L, Schaer M. Renal tubular acidosis. Comp Cont Ed Pract Vet

2005;27:513–529. 2. Di Bartola SP. Metabolic acid-base disorders. In: Di Bartola SP, ed.

Fluid, Electrolyte and Acid-Base Disorders in Small Animal Practice. 4th ed. St. Louis, Missouri: Saunders, 2012:253–286.

3. Yaxley J, Pirrone C. Review of the diagnostic evaluation of renal tubular acidosis. Ochsner J 2016;16:525–530.

4. Corey HE, Vallo A, Rodríguez-Soriano J. An analysis of renal tubular acidosis by the Stewart method. Pediatr Nephrol 2006;21:206–211.

5. Martinez SA, Hostutler RA. Distal renal tubular acidosis associated with concurrent leptospirosis in a dog. J Am Anim Hosp Assoc 2014;50: 203–208.

6. Torrente C, Silvestrini P, Ruiz de Gopegui R. Severe life-threatening hypokalemia in a cat with suspected distal renal tubular acidosis. J Vet Emerg Crit Care 2010;20:250–257.

7. Shearer LR, Boudreau AE, Holowaychuk MK. Distal renal tubular aci-dosis and immune-mediated hemolytic anemia in 3 Dogs. J Vet Intern Med 2009;23:1284–1288.

8. Cook AK, Allen AK, Espinosa D, Barr J. Renal tubular acidosis associ-ated with zonisamide therapy in a Dog. J Vet Intern Med 2011;25: 1454–1457.

9. Hooper K. Traditional acid-base analysis. In: Silverstein D, Hopper K. eds. Small Animal Critical Care Medicine. 2nd ed. St. Louis. Missouri: Saunders, 2015:298–295.

10. Reddy P. Clinical approach to renal tubular acidosis in adult patients. Int J Clin Pract 2011;65:350–360.

11. Rodríguez J. Renal tubular acidosis: The clinical entity. J Am Soc Nephrol 2002;13:2160–2170.

12. Mohebbi N, Wagner CA. Pathophysiology, diagnosis and treatment of inherited distal renal tubular acidosis. J Nephrol 2018;4:511–522.

13. Morris CG, Low J. Metabolic acidosis in the critically ill: Part 2. Causes and treatment. Anaesthesia 2008;63:396–411.

14. Sharp CR, Rozanski EA. Cardiovascular and systemic effects of gastric dilatation and volvulus in dogs. Top Companion Anim Med 2014;29: 67–70.

15. Bruchim Y, Itay S, Shira BH, et al. Evaluation of lidocaine treatment on frequency of cardiac arrhythmias, acute kidney injury, and hospitaliza-tion time in dogs with gastric dilatation volvulus. J Vet Emerg Crit Care 2012;22:419–427.

16. Winaver J, Agmon D, Harari R, Better OS. Impaired renal acidification following acute renal ischemia in the dog. Kidney Int 1986;30:906–913.

17. Jamieson PM, Chandler ML. Transient renal tubulopathy in a Labrador retriever. J Small Anim Pract 2001;42:546–549.

18. Leumann EP, Steinmann B. Persistent and transient distal renal tubular acidosis with bicarbonate wasting. Pediatr Res 1975;9:767–773.




Use of slide scrape lysates for polymerase chain reaction confirmation of disseminated Mycobacterium avium infection in a cat

Hilary J. Burgess, Betty P. Lockerbie, Tanya R. Marshall

Abstract — Disseminated mycobacteriosis in a 3-year-old domestic medium-haired cat was diagnosed on lymph node cytology. Slide scrape lysates from the cytology submission were used to confirm Mycobacterium avium by polymerase chain reaction (PCR) and sequencing and proved a simple technique that could be a valuable tool in veterinary diagnostics and research.

Résumé —Utilisation d’un lysat de grattage de lame pour la confirmation par amplification en chaîne par la polymérase d’une infection disséminée à Mycobacterium avium chez un chat. Une mycobactériose disséminée chez un chat domestique à poil moyen âgé de 3 ans a été diagnostiquée à l’aide d’une cytologie des ganglions lymphatiques. La soumission d’un lysat de grattage d’une lame provenant de la soumission de cytologie a été utilisé pour confirmer Mycobacterium avium par amplification en chaîne par la (PCR) et séquençage et elle s’est avérée une technique simple qui pourrait être un outil utile dans les diagnostics et la recherche vétérinaires.


Can Vet J 2019;60:179–182

Case description

A 3-year-old domestic medium-haired cat was presented for lack of appetite, weight loss, significant lethargy, hiding,

and increased shedding of the hair coat. The patient had been treated 3 wk earlier for bilateral keratitis, and the ocular abnor-malities had completely resolved.

On physical examination the patient was pyrexic, had gen-eralized lymphadenopathy, appeared unkempt, and had hair loss around the ears and on the left forelimb. A complete blood (cell) count (CBC) and serum chemistry were performed using automated bench top analyzers (VetScan HM5 and VS2; Abaxis, Union City, California, USA). There was a mild leukopenia [5.32 3 109/L; reference interval (RI): 5.50 to 19.50 3 109/L] characterized by a mild lymphopenia (1.08 3 109/L; RI: 1.50 to 7.00 3 109/L); likely as part of a cortisol response. While the analyzer detected a mild to moderate thrombocytopenia (91.00 3 109/L; RI: 300.00 to 800.00 3 109/L), a blood smear was not evaluated to rule out platelet clumping as a

likely cause. Abnormalities on serum chemistry were limited to a mild hypoalbuminemia (20.0 g/L; RI: 22.0 to 44.0 g/L) which was likely due to a negative acute phase response, but losses or malabsorption could not be ruled out with the available data; and mild decrease in blood urea nitrogen (2.86 mmol/L; RI: 3.57 to 10.71 mmol/L), which could have resulted from decreased protein intake. A SNAP FeLV/FIV combo test (IDEXX Laboratories, Westbrook, Maine, USA) was negative.

Fine-needle aspirates of the right and left submandibu-lar, prescapular, and popliteal lymph nodes were carried out and submitted to Prairie Diagnostic Services, Saskatoon, Saskatchewan, for cytological evaluation (Figure 1). The slides were stained with modified Wright-Giemsa stain (Fisher Scientific, Pittsburgh, Pennsylvania, USA) and coverslipped. All aspirates were similar in appearance, with a heterogeneous popu-lation of lymphocytes variably effaced by a moderate to marked increase in macrophages and a mild increase in non-degenerate neutrophils. On some slides the macrophages were arranged in sheets, and in all samples the macrophages were laden with negatively staining rods. These rods were also numerous in the dense basophilic background. Based on the characteristic cyto-logical appearance, and involvement of numerous lymph nodes, disseminated mycobacteriosis was diagnosed, and Mycobacterium avium was suspected.

At this point the patient was lost to follow-up, excluding the possibility of additional sampling for polymerase chain reaction (PCR) confirmation. However, as numerous cytology smears had been submitted, DNA isolation for PCR was attempted on slide scrape lysates (SSL). Coverslips were removed via immersion in xylene and material was scraped from 2 slides into separate Eppendorf tubes using single-edged razor blades. Each tube had 500 mL lysis buffer containing 500 mM Tris-HCl, 100 mM NaCl, and 10% sodium dodecyl sulfate. Proteinase K (5 mL of

Department of Veterinary Pathology, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan (Burgess, Lockerbie) and TM’z Veterinary Clinic PC Ltd., PO Box 1173, Lumsden, Saskatchewan S0G 3C0 (Marshall).Address all correspondence to Dr. Hilary J. Burgess; e-mail: [email protected] disclaimers or funding for the work presented in this manuscript.Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.



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a 10 mg/mL stock solution) was added, the samples were heated overnight at 56°C, DNA was extracted with phenol-chloroform and precipitated with ethanol. Pellets were resuspended in 50 mL Tris-EDTA buffer.

Before PCR, adequate DNA concentration (50 to 1000 ng) was confirmed for each sample using a spectrophotometer (NanoDrop spectrophotometer; Thermo Fisher Scientific, Wilmington, Delaware, USA). Polymerase chain reaction ampli-fication using 16S rRNA universal primers (16S For 59GAG TTT GAT CCT GGC TCA G39 and 16S Rev 59GWA TTA CCG CGG CKG CTG39) was performed in a 50-mL PCR reac-tion which included 100 ng of DNA, 0.20 mM dNTP, 2.5 mM MgCl2, 1 3 PCR Buffer, 0.4 mM of each primer and 2 units of Taq DNA polymerase. The following conditions were used to amplify the DNA: 30 s at 94°C, 60 s at 57°C, and 60 s at 72°C for 30 cycles. The no-template control sample was negative, whereas a band of the expected size (500 bp) was produced in the patient samples. This amplified DNA was purified using a commercial kit (EZ-10 Spin Column PCR Purification kit; Bio Basic, Markham, Ontario), pooled, and submitted for sequenc-ing at Macrogen, Seoul, Korea. Sequence analysis, using Staden Package programs Pregap4 and Gap4 (1), confirmed a 100% sequence identity between the patient sample and GenBank accession numbers LT558822.1, LC020093.1, JN899580.1, HM056092.1, GU142929.1, NR 117219.1, GQ184167.1 (Mycobacterium avium partial 16S rRNA gene, strains: Marseille, JCM 15429, E6, IEC14, M214, ATCC 25291 and M88, respectively), and NR 102855 (Mycobacterium avium 104 strain 104 16S ribosomal RNA, complete sequence) over a 501-bp region of high quality sequence.

Polymerase chain reaction for feline leukemia virus (FeLV) was also performed using the SSL, as previously described (2), and a faint band was produced in the patient sample but was considered equivocal with respect to the expected 166 bp size.

As a positive status could not be confidently confirmed visually, further amplification was performed, and DNA was purified and submitted for sequencing at Macrogen, as described. However, confirmation of the FeLV status on sequencing was not pos-sible due to insufficient material, and the diagnosis remained equivocal.

DiscussionMycobacterium avium complex refers to a group of closely related, ubiquitous, saprophytic, slow growing strains of myco-bacteria (3). It is divided into 2 main species M. avium and M. intracellulare, with M. avium being subdivided into 4 sub-species (avium, hominissuis, paratuberculosis, and silvaticum). Feces from birds infected with Mycobacterium avium complex (MAC) contain large numbers of bacilli (3). Infection of dogs and cats occurs from ingestion of infected meat or contact with infected soil or with fomites contaminated by poultry carcasses or feces (3). Among the opportunistic mycobacteria in animals, MAC organisms are the most likely to produce bacteremia and multiple-organ disseminated disease (3).

Despite the widespread environmental distribution of this organism, to the authors’ knowledge, there have only been 26 reports of disseminated disease in cats (4–16). As in the cur-rent case, most of these cats were young, but up to 13 y of age has been reported (5,14). There is a marked overrepresentation of Siamese and Abyssinian cats in the literature, suggesting the possibility of underlying familial immune defects (8,14). Feline leukemia virus and FIV are alternate causes of immunosup-pression in feline patients. The patient of the current report was a domestic medium-haired cat with no known Siamese or Abyssinian influence. The status of FeLV/FIV was nega-tive on initial testing test sensitivity is 98.6% and 93.5% for FeLV and FIV, respectively, and specificity 98.2% and 100%, respectively (IDEXX Laboratories). Of the previous 26 reports of disseminated disease, 24 cats were tested for FeLV antigen and 21 for FIV antibody. Except for 1 indeterminate IHC FeLV result (12), all cats were negative on initial FeLV/FIV testing (5–8,10,11,13–16). In 2 cases, follow-up FeLV testing was performed: real-time polymerase chain reaction on a mes-enteric lymph node biopsy in an 18-month-old cat, which was negative (16), and immunofluorescent antibody testing of bone marrow in a 4-year-old cat, which was positive (11). Although discrepant results between FeLV antigen testing and PCR are more likely in cats $ 7 y old, follow-up PCR on lymph node SSL was performed in the current case to rule out latent FeLV infection (2). Previous studies suggest that latent infections can involve a minor subset of nodal lymphocytes as well as bone marrow (2,17). If FeLV was truly present in the current case, the minor subset of lymphocytes that contain the virus may have been diluted by the inflammatory infiltrate and abundant intralesional organisms in the sample, resulting in the faint suspicious band, but insufficient material for sequencing. In the report by Rivière et al (16), follow-up molecular testing for latent FeLV infection was performed on mesenteric lymph node described on histopathology to contain a granulomatous and severely necrotic inflammatory reaction. While the FeLV status may have truly been negative in that case, it may be that bone

Figure 1. Fine-needle aspirate of the right submandibular lymph node showing numerous negatively staining rods within macrophages as well as in the background. Modified Wright’s stain.



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marrow would be a more appropriate sample, not only because it more consistently harbors latent infection, but also because the composition of the lymph node can be dramatically altered in cases of disseminated mycobacteriosis.

As in the current case, clinical signs of mycobacteriosis are typically non-specific with weight loss and ill thrift being com-mon, but can reflect specific organ involvement (3,14). Slow progression of this disease is typical, with signs being present in some cases for weeks to months before diagnosis (14). In the current case, it is unclear if the recent keratitis was related to the mycobacteriosis, but the more systemic signs developed over the following 3 wk. Diagnosis can be challenging because of the non-specific presentation of these patients, and mycobacte-rial infections should therefore be included in the differential diagnoses for wasting, multisystemic, or otherwise nonspecific disease in young cats (7).

Presumptive diagnosis often results from visualization of negative staining or acid-fast, uniform slender rods on cytology or histopathology samples; however, visualization within neu-trophils and monocytes in peripheral blood has also provided evidence of disseminated disease (8,11,12). Definitive diagnosis has historically required culture, which can take several weeks, but as PCR becomes more accessible, it offers a faster method to confirm the diagnosis and identify the species of Mycobacterium present. More recently, targeting specific gene sequences or using species and subspecies-specific PCR assays have allowed efficient discrimination of subspecies within the MAC complex, which cannot be achieved with 16S rRNA sequencing alone (18,19). Previous reports of disseminated mycobacteriosis in cats have typically identified the mycobacterial organism to the level of species (M. avium). Further investigation into subspecies would have been ideal but was not pursued in the current case due to financial restrictions. Although transmission of MAC from pets to humans has not been reported, animal infections should be regarded as potentially zoonotic, particularly for immunocom-promised individuals (8). The clinical relevance of the MAC in humans has been amplified in recent decades with the increasing population of immunocompromised individuals resulting from longer life expectancy, immunosuppressive chemotherapy, and the AIDS pandemic (19,20). Discriminating among closely related, yet pathogenetically diverse, members of the MAC would further our understanding of the epidemiology of these pathogens and the potential sources of infection (19).

The ability to perform PCR on material harvested from a cytology preparation was integral to confirming mycobacte-riosis in the current case in which additional samples were not available for routine PCR or culture. An advantage of PCR in its use on archived cytologic samples is the extremely small amount of material required. While fresh samples are preferred for PCR analysis, recent studies have demonstrated that there is no statistically significant difference in the ability to amplify DNA between fresh and archival cytology specimens (21). Specifically, when evaluating samples for amplification through primers directed to the housekeeping gene glyceraldehyde phosphate dehydrogenase (GAPDH) of human origin, 85% of SSL samples showed a positive reaction, compared to 91% of the fresh samples (21). In addition, there was no statistically

significant difference found in the yield of amplifiable DNA when different sample types were compared between SSLs and fresh samples (21). Similarly, cytologic samples were amenable to RT-PCR as long as the target gene fragment was restricted to 150 bp or less, and neither staining nor prolonged storage up to 15 y had major negative effects (22).

The use of SSL for PCR has rarely been described in the lit-erature (21–23). Preparation of SSLs varies somewhat between reports, with some destaining archival slides and others washing in ethanol or adding digestion buffer to the slide before removal of the cytologic material with a razor blade (21–23). In the cur-rent report, after removal of the coverslip, no special preparation was performed before scraping the slide. The procedure was no more technically demanding than a routine PCR and yielded a 501 bp high quality sequence. Without the ability to perform PCR on SSL in the current case, it would not have been possible to definitively confirm disseminated Mycobacterium avium infec-tion in this cat. This case provides a good example of the use of SSL for PCR diagnosis in a clinical case. While mycobacteriosis and FeLV were the focus of our investigation, the same sample retrieval technique could be used for PCR diagnosis of countless other diseases. Use of SSL for PCR could play an important role in veterinary pathology where fresh tissue is unavailable, as in the current case, in which morphologic review may help focus molecular diagnostics on certain areas or populations on a slide, or for retrospective studies. CVJ

References 1. Staden R, Beal KF, Bonfield JK. The Staden package. Methods Mol Biol

2000;132:115–130. 2. Jackson ML, Haines DM, Meric SM, Misra V. Feline leukemia virus

detection by immunohistochemistry and polymerase chain reaction in formalin-fixed, paraffin-embedded tumor tissue from cats with lym-phosarcoma. Can J Vet Res 1993;57:269–276.

3. Greene CE, Gunn-Moore DA. Mycobacterial infections. In: Greene CE, ed. Infectious Diseases of the Dog and Cat. 4th ed. St. Louis, Missouri: Saunders Elsevier, 2012:495–521.

4. Hix JW, Jones TC, Karlson AG. Avian tubercle bacillus infection in the cat. J Am Vet Med Assoc 1961;138:641–647.

5. Buergelt CD, Fowler JL, Wright PJ. Disseminated avian tuberculosis in a cat. Calif Vet 1982;10:13–15.

6. Drolet R. Disseminated tuberculosis caused by Mycobacterium avium in a cat. J Am Vet Med Assoc 1986;189:1336–1337.

7. Morfitt DC, Matthews JA, Thoen CO, Kluge JP. Disseminated Mycobacterium avium serotype 1 infection in a seven-month-old cat. J Vet Diagn Invest 1989;1:354–356.

8. Jordan HL, Cohn LA, Armstrong PJ. Disseminated Mycobacterium avium complex infection in three Siamese cats. J Am Vet Med Assoc 1994;204:90–93.

9. Perkins PC, Grindem CB, Levy JK. What is your diagnosis? An 11-year-old domestic longhaired cat with anaemia. Vet Clin Pathol 1995;24: 97–98.

10. van Dongen AM, Wagenaar JA, Kraus HS, Noordhoek GT, Eger A, Ottenschot TRF. Atypical mycobacteriosis in a cat. Vet Q 1996;18:47.

11. Latimer KS, Jameson PH, Crowell WA, Duncan JR, Currin KP. Disseminated Mycobacterium avium complex infection in a cat: Presumptive diagnosis by blood smear examination. Vet Clin Pathol 1997;26:85–89.

12. Barry M, Taylor J, Woods JP. Disseminated Mycobacterium avium infec-tion in a cat. Can Vet J 2002;43:369–371.

13. Griffin A, Newton AL, Aronson LR, Brown DC, Hess RS. Disseminated Mycobacterium avium complex infection following renal transplantation in a cat. J Am Vet Med Assoc 2003;222:1097–1101.

14. Baral RM, Metcalfe SS, Krockenberger MB, et al. Disseminated Mycobacterium avium infection in young cats: Overrepresentation of Abyssinian cats. J Feline Med Surg 2006;8:23–44.



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15. Sieber-Ruckstuhl NS, Sessions JK, Sanchez S, Latimer KS, Greene CE. Long-term cure of disseminated Mycobacterium avium infection in a cat. Vet Rec 2007;160:131–132.

16. Rivière D, Pingret JL, Etievant M, et al. Disseminated Mycobac terium avium subspecies infection in a cat. J Feline Med Surg 2011;13: 125–128.

17. Rojko JL, Hoover EA, Quacken-Bush SL, Olsen RG. Reactivation of latent feline leukemia virus infection. Nature 1982;298:385–388.

18. Higgins J, Camp P, Farrell D, Bravo D, Pate M, Robbe-Austerman S. Identification of Mycobacterium spp. of veterinary importance using rpoB gene sequencing. BMC Vet Res 2011; 7:77 doi: 10.1186/1746- 6148-7-77.

19. Shin SJ, Lee BS, Koh WJ, et al. Efficient differentiation of Mycobac-terium avium Complex species and subspecies by use of five-target multiplex PCR. J Clin Microbiol 2010;48:4057–4062.

20. Miguez-Burbano MJ, Flores M, Ashkin D, et al. Non-tuberculous myco-bacteria disease as a cause of hospitalization in HIV-infected subjects. Int J Infect Dis 2006;10:47–55.

21. Mattu R, Sorbara L, Filie AC, et al. Utilization of polymerase chain reaction on archival cytologic material: A comparison with fresh material with special emphasis on cerebrospinal fluids. Mod Pathol 2004;17:1295–1301.

22. Liu H, Huang X, Zhang Y, et al. Archival fixed histologic and cytologic specimens including stained and unstained materials are amenable to RT-PCR. Diagn Mol Pathol 2002;11:222–227.

23. Gupta N, Sharma K, Barwad A, et al. Thyroid tuberculosis — Role of PCR in diagnosis of a rare entity. Cytopathology 2011;22:392–396.




Feline infectious peritonitis in a cat presented because of papular skin lesions

Tony Redford, Ahmad N. Al-Dissi

Abstract — A 19-week-old neutered male domestic shorthair cat was examined because of multiple raised pruritic skin lesions along the dorsal head and back. Histopathology of biopsies of the lesions detected nodular pyogranulomatous dermatitis with vasculitis and necrosis, leading to a suspicion of feline infectious peritonitis (FIP). Postmortem examination revealed gross lesions consistent with FIP. Histopathologic lesions and positive immunohistochemical staining for feline coronavirus in multiple tissues, including the skin, confirmed the diagnosis of FIP. The current case was similar to previous cases, except for the initial presentation with cutaneous lesions and no other clinical signs, which had not been reported previously.

Résumé — Péritonite infectieuse féline chez un chat présenté pour des lésions cutanées papuleuses. Un chat domestique commun mâle stérilisé âgé de 19 semaines a été examiné en raison de multiples lésions cutanées prurigineuses épaisses le long de la tête dorsale et du dos. L’histopathologie des biopsies des lésions a détecté une dermatite pyogranulomateuse nodulaire avec vasculite et nécrose, ce qui a soulevé des soupçons de péritonite infectieuse féline (PIF). L’examen post mortem a révélé des lésions macroscopiques conformes à la PIF. Les lésions histopathologiques et la coloration immunohistochimique positive pour le coronavirus félin dans plusieurs tissus, y compris la peau, ont confirmé le diagnostic de PIF. Le cas actuel est semblable aux cas antérieurs, sauf pour la présentation initiale avec des lésions cutanées et aucun autre signe clinique, ce qui n’avait pas été signalé précédemment.


Can Vet J 2019;60:183–185

Introduction

F eline infectious peritonitis (FIP) is a chronic disease of cats that is caused by a mutated form of feline coronavirus

(FCoV) (1). This disease is characterized by gross lesions that may include pyogranulomas in multiple organs, polyserositis, and high protein cavitary effusions. Histologic lesions include pyogranulomatous inflammation and vasculitis in affected organs (2–4). Presence of FIP virus in lesions suggestive of FIP is often confirmed through immunohistochemistry (5).

Although FIP is a relatively common disease that has been reported since the 1950’s, cutaneous lesions associated with this disease are rare (2,5–11). Clinical and gross skin lesions have included papular nodules, pitting edema, or skin fragility with papular nodules being the most common (5 of 7 reported cases)

(5,7,8,11). All cats with papular lesions displayed multisystemic signs of FIP suggesting that these skin lesions appear later in the course of the disease.

In this report, we describe a unique case of FIP in which papular skin lesions were the cause for the cat’s initial presenta-tion to the referring veterinarian and were found before other multisystemic signs of infection were identified.

Case descriptionA 19-week-old neutered male domestic shorthair cat was first presented to its veterinarian on August 15, 2015, for multiple raised pruritic skin lesions along the dorsal head and back. The cat was febrile at this time, so therapy was initiated with cepha-lexin and diphenhydramine. The cat was again presented 5 d later with poor appetite and spreading of the skin lesions, and treatment was modified to consist of prednisone and methyl-prednisolone acetate. Biopsies were taken and submitted to the dermatopathology service of Prairie Diagnostic Services (PDS) at the Western College of Veterinary Medicine (WCVM), Saskatoon, Saskatchewan. Histopathology revealed nodular pyogranulomatous dermatitis with vasculitis and necrosis, and there was a strong suspicion of FIP. The cat’s health continued to decline, with progression to seizures. Euthanasia was performed on August 24, 2015 and the cat was received for necropsy at PDS a day later.

Department of Veterinary Pathology, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan S7N 5B4.Address all correspondence to Dr. Ahmad Al-Dissi; e-mail: [email protected] of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.



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The cat was in good body condition and there were multiple 3- to 5-mm diameter skin nodules along the dorsal surface of the head and neck, as well as the lateral aspects of the cranial thorax, similar to those described in the clinical history (Figure 1A). The abdomen, thorax, and pericardium contained abundant viscous serofibrinous effusions. The lungs, liver, and kidney contained multiple white nodules ranging from 3 to 7 mm in diameter. Multiple mesenteric lymph nodes were enlarged and firm. There were no other significant findings on gross examina-tion. A variety of tissues were fixed in 10% buffered formalin, routinely processed and stained with hematoxylin and eosin (H&E) for histopathology.

Histologically, the liver, lungs, kidneys, and mesenteric lymph nodes featured multifocal to coalescing areas of pyogranulo-matous inflammation composed of lymphocytes, plasma cells, macrophages, and neutrophils that were often surrounding and

infiltrating the wall of veins (phlebitis). Many larger foci had a central core of necrosis. Similar inflammatory cells often infil-trated the wall of veins in the meninges and extended into the meninges and, occasionally, the neuropil. Histologic examina-tion of the eye revealed pyogranulomatous inflammation and phlebitis in the periocular tissue, as well as pyogranulomatous optic neuritis. Sections of the skin also featured multiple vessels with walls infiltrated by mixed inflammatory cells and surround-ing large pale areas of dermal necrosis characterized by loss of collagen fibers and replacement with karyorrhectic and necrotic debris and surrounded by low numbers of lymphocytes, plasma cells and macrophages (Figure 1B).

Microscopic sections of the duodenum, jejunum, ileum, and colon featured multifocal crypt necrosis and mild lymphoplas-macytic infiltrates within the lamina propria.

Immunohistochemical staining for intracellular feline coro-navirus N protein (FIPV3-70, 1:500; Custom Monoclonals, West Sacramento, California, USA) was performed and showed positive staining within the cytoplasm of macrophages in the lung, kidney, skin, and brain (Figure 1C).

Immunohistochemistry of the colon, ileum, and spleen for feline parvovirus and feline leukemia virus yielded nega-tive results. A cause of the crypt necrosis was not determined. Feline infectious peritonitis with associated cutaneous lesions was diagnosed in this cat based on gross and histologic lesions along with immunohistochemistry results.

DiscussionThis report presents a case of systemic feline coronavirus infec-tion in a cat causing cutaneous lesions along with classic lesions of feline infectious peritonitis (FIP). While FIP is a common disease in domestic cats, cutaneous lesions associated with this disease are rare; there have only been 7 previous reports (2,5–9,11). The most common cutaneous manifestation is formation of papular nodules, as observed in the current case, but there are also single reports of swollen limbs with pitting edema and development of skin fragility syndrome in separate cases related to FIP virus infection (2,5–9,11). The current case is of particular interest because the cutaneous lesions were the primary reason for initial presentation, while all other cases, save for the case of pitting edema, were presented because of other systemic signs.

Examination of previous reports of FIP cases with skin involvement revealed interesting patterns that fit with many of the findings in the current case (Table 1). Younger animals seemed to be at higher risk for cutaneous lesions, as 4 of the 7 previous cases were less than 3 y old and the cat in the current case was only 19 wk old. There was no gender predilection, as 3 of the cats in previous cases were intact males, 3 were spayed females, 1 was of unspecified gender, and the cat in the current case was a neutered male. Domestic shorthair (4/7 previous and the current case) and sphinx cats (2/7 previous cases) were over-represented in FIP cases with cutaneous lesions, but conclusions cannot be drawn based on the low number of cases. Finally, all cases included some gross evidence of granuloma formation.

Despite the variety of gross manifestations of cutaneous dis-ease in previous reports, histologically, all cats in the 7 reported

Figure 1. A — Multiple round raised skin nodules along the dorsal surface of the head and neck. B — Histological section from an affected area of the skin displaying a locally extensive area of necrosis and few inflammatory infiltrates; H&E. C —Immunohistochemical staining of the skin displaying positive brown staining for feline infectious peritonitis virus within an affected area.

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cases had similar pyogranulomatous vasculitis and necrosis within the dermis. All cases also showed positive immunostain-ing for FCoV antigen in macrophages in the dermis and other affected tissues (2,5–9,11). It appears that histologic examina-tion of skin lesions related to FIP yields consistent findings and should raise suspicion for FIP, with IHC needed for definitive diagnosis.

There has yet to be an explanation for the development of cutaneous lesions in few cases of FIP with absence in most cases. The reason may be host-specific; one proposed explanation is the selectiveness of endothelial cell reactivity to systemic cyto-kines. There may be individual variability in the cellular adhe-sion molecules and integrins expressed on endothelial cells of different tissues and on leukocytes (2). Alternatively, tissue speci-ficity may be related to viral variability. While this has not been investigated thoroughly, the gene for the surface glycoprotein S of feline coronavirus differs between non-mutated coronavirus and the mutated FIP virus and may also take part in determin-ing the tissues to which virus particles may disseminate (12,13).

Regardless of the mechanism of tissue specificity of FIP viral infection, cutaneous lesions do occur occasionally. The reason

for rarity of dermal involvement needs further exploration, and pathologists should keep FIP on their differential diagnosis list when considering biopsies from cats with skin lesions. CVJ

References 1. Vennema H, Poland A, Foley J, Pedersen NC. Feline infectious peritoni-

tis viruses arise by mutation from endemic feline enteric coronaviruses. Virology 1998;243:150–157.

2. Cannon MJ, Silkstone MA, Kipar AM. Cutaneous lesions associated with coronavirus-induced vasculitis in a cat with feline infectious peri-tonitis and concurrent feline immunodeficiency virus infection. J Feline Med Surg 2005;7:233–236.

3. Kipar A, May H, Menger S, Weber M, Leukert W, Reinacher M. Morphologic features and 182 development of granulomatous vasculitis in feline infectious peritonitis. Vet Pathol 2005;42:321–330.

4. Kipar A, Meli ML. Feline infectious peritonitis: Still an enigma? Vet Pathol 2014;51:505–526.

5. Bauer BS, Kerr ME, Sandmeyer LS, Grahn BH. Positive immunostain-ing for feline infectious peritonitis (FIP) in a Sphinx cat with cutaneous lesions and bilateral panuveitis. Vet Ophthalmol 2013;16:160–163.

6. Declercq J, De Bosschere H, Schwarzkopf I, Declercq L. Papular cuta-neous lesions in a cat associated with feline infectious peritonitis. Vet Dermatol 2008;19:255–258.

7. Foster RA, Caswell JL, Rinkardt N. Chronic fibrinous and necrotic orchitis in a cat. Can Vet J 1996;37:681–682.

8. Gaisbauer S, Vandenabeele S, Daminet S, Paepe D. Immunological deep dermal vasculitis in a cat. Vlaams Diergeneeskundig Tijdschrift 2014;83:184–192.

9. Gross T. Pyogranulomatous vasculitis and mural folliculitis associated with feline infectious peritonitis in a Sphinx cat. Vet Pathol 1999;36: 507.

10. Holzworth J. Some important disorders of cats. Cornell Vet 1963;53: 157–160.

11. Trotman TK, Mauldin E, Hoffmann V, Del Piero F, Hess RS. Skin fragility syndrome in a cat with feline infectious peritonitis and hepatic lipidosis. Vet Dermatol 2007;18:365–369.

12. Pedersen NC. A review of feline infectious peritonitis virus infection: 1963–2008. J Feline Med Surg 2009;11:225–258.

13. Lewis CS, Porter E, Matthews D, et al. Genotyping coronaviruses associ-ated with feline infectious peritonitis. J Gen Virol 2015;96:1358–1368.

Table 1. Data summary of feline infectious peritonitis cases with cutaneous involvement.

Reference Breed Signalment Age

(7) DSH Male intact Adult(9) Sphinx Male intact 1 y(2) DSH Not specified 1 y(11) DSH Female spayed 6 y(6) DSH Male intact 7 m(5) Sphinx Female spayed 2 y(8) DSH Female spayed 13.5 yCurrent case DSH Male neutered 5 mo

DSH — Domestic shorthair.

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Bilateral phacoemulsification and intraocular lens implantation in a young African lion (Panthera leo)

Marta Viñas, Nunzio D’Anna, Adolfo Guandalini, Michele Capasso, Maurizio Nocerino, Alessandra Guerriero, John Sapienza

Abstract — An 18-month-old intact female lioness (Panthera leo) was referred to the Clinica Veterinaria Roma Sud for evaluation of bilateral cataracts. Phacoemulsification and implantation of 130 diopter intraocular lens (IOL) were performed bilaterally. Seven years after surgery, the IOL remained centrally positioned and the patient had normal activity.

Résumé — Phaco-émulsification bilatérale et implantation d’une lentille intra-oculaire chez une jeune lionne africaine (Panthera leo). Une lionne entière âgée de 18 mois (Panthera leo) a été dirigée à la Clinica Veterinaria Roma Sud pour l’évaluation de cataractes bilatérales. La phaco-émulsification et l’implantation de lentilles intra-oculaires dioptriques 130 (LID) ont été réalisées bilatéralement. Sept années après la chirurgie, les LID sont demeurées en position centrale et la patiente s’adonnait à des activités normales.


C ataract is defined as any opacity of the lens or its capsule (1). In young animals, cataract formation may result from

nutritional imbalance, congenital malformation, trauma, genetic factors, or as a sequel to other ocular diseases such as uveitis or retinal degeneration. Congenital cataracts have been described in Persian, Birman, and Himalayan kittens, and a 3-month-old clouded leopard (2–4). In 1 study, milk replacement was the cause of cataracts, suggesting that the milk replacer used may have contained inadequate levels of arginine (5). Low levels of dietary histidine have also been implicated in the pathogenesis of cataract formation in kittens (6). Primary and inherited cataracts are rare in domestic cats. Most feline cataracts are secondary and are commonly due to uveitis (2–4).

Cataracts are common in zoo animals (7–13). An inherited basis was proposed in a 3-month-old clouded leopard with bilat-eral cataract, as nutritional etiology was unlikely (2). In 2003, one lioness was diagnosed with cataracts; hence all lions from

the same group intended for the breeding program underwent complete ophthalmic examinations. A diagnosis of cataracts was made in 5 of these lions. Subsequently in 2010, candidate genes were evaluated for their potential role in cataract formation in these Angolan lions. The study concluded that the 14 candidate genes investigated were not involved in the cataracts observed (14). Encephalitozoon cuniculi has been described as a causative agent of cataract and uveitis in cats (15) and has also been iden-tified as a cause of cataract in a snow leopard (11).

Phacoemulsification with intraocular lens implantation is routine surgical treatment for cataracts in dogs and cats. A few reports have described treatment of cataracts in exotic ani-mals including a clouded leopard (Neofelis nebulosa) without intraocular lens implantation (2,7,8,12,13). The objective of the report herein was to describe, for the first time, bilateral phacoemulsification with intraocular implantation of lenses specifically manufactured for an African lion in order to achieve emmetropia.

Case descriptionAn 18-month-old, 96-kg intact female lioness (Panthera leo) was referred to the Clinica Veterinaria Roma Sud with a history of aggressive behavior since birth and visual dysfunction.

The lioness came from a circus in France. She was weaned from her mother at the age of 5 mo. Her diet had been based on chicken, rabbit, and beef supplemented with taurine 5 mg twice a week.

The general examination performed by the referral veterinarian revealed bilateral cataracts. Results of hematology, biochemistry, and electrolyte analyses were within normal limits (16). Serological tests for feline leukemia virus (FeLV), feline immune deficiency virus (FIV), and feline coronavirus (FCoV) were negative.

Policlinico Veterinario Roma sud, Ophthalmology, Via Pilade Mazza 24, Rome, Lazio 00173 Italy (Viñas, D’Anna); CVS-Centro Veterinario Specialistico, Ophthalmology, Rome, Lazio Italy (Guandalini); Naples, Italy (Capasso, Guerriero); Clinica Veterinaria Villa Felice, Anesthesiology, Naples, Italy (Nocerino); Long Island Veterinary Specialist, Ophthalmology, Plainview, New York, USA (Sapienza).Address all correspondence to Dr. Marta Viñas; e-mail: [email protected] of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.



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Ten days after initial presentation, the lioness was sedated intramuscularly using a blowpipe with medetomidine (Domitor; Elanco, Eli Lilly, FI, Italia), 30 mg/kg body weight (BW), ket-amine (Ketavet 100; Intervet Production, Aprilia, LT, Italy), 2 mg/kg BW, and butorphanol (Dolorex; MSD-Animal Health Italia, Segrate, MI, Italy), 0.1 mg/kg BW. Examination by a Board-certified ophthalmologist included slit-lamp biomicro-scopy, applanation tonometry (TonoPen Vet; Mentor, Norwell, Massachusetts, USA) and indirect ophthalmoscopy (Omega 2000; Heine, Herrsching, Germany). Bilaterally dazzle reflex was present; direct, and consensual pupillary light reflexes were present but incomplete. Slit-lamp biomicroscopy showed a late-immature cataract in the right eye and an early-immature cataract in the left eye (Figures 1a, b). Mild lens induced uveitis was present in the right eye, evidenced by a slight miosis. No signs of uveitis were present in the left eye. Intraocular pressure (IOP) readings after instillation of oxybuprocaine chloride 0.4% (Novesina; Novertis, Origgio, VA, Italy) were 20 mmHg OD and 25 mmHg OS. The IOP in both eyes was within normal limits (normal range: 23.9 1/2 4.1 mmHg) (17). A bilateral examination of the posterior segment was performed 10 min after topical application of tropicamide 1% (Visumidriatic; Visufarma S.p.A. RM, Italy). The examination, although lim-

ited, was unremarkable but showed mild resistance to complete dilatation of the right eye.

Physical examination was unremarkable. Phacoemulsification with intraocular lens implantation was discussed and recom-mended. In order to achieve emmetropic vision, the lens power was calculated using Retzlaff ’s formula (Figure 2). A and B mode ultrasounds and keratometry were performed.

B-mode ultrasound (MyLab, Esaote Pie Medical, Italy) revealed normal posterior segments in both eyes, and lenses that were 8.6 mm thick and 22 mm in diameter. The A-mode ultrasound (BioLine; Optikon 2000, RM, Italy) showed that the axial length was 27.92 mm (1/2 1.41 mm) OD and 28.31 mm (1/2 1.02 mm) OS, and the preoperative anterior chamber depth (ACD) was 5.76 mm (1/2 1.89 mm) OD and 7.36 mm (1/2 1.41 mm) OS. Keratometry (Keratron Piccolo; Optikon 2000, RM, Italy), using the Retzlaff theoretical formula, rep-resented by K, revealed a corneal curvature of 26.8 D 1/2 1.96 SD OD and 28.48 D 1/2 6.55 SD OS (Figure 3). The postoperative ACD (PACD) was calculated as the distance between the corneal epithelium and the center of the lens (equal to the preoperative ACD plus half lens thickness). Using mean axial length, K-value and estimated PACD, an IOL dioptric strength of 30.08 D for the left and 32.69 D for the right eye

Figure 1. On ophthalmic examination, the right eye (OD) had a late-immature cataract and the left eye (OS) had an early-immature cataract present.

Figure 2. Retzlaff theoretical formula used to calculate IOL power.



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was calculated. An IOL with a diopter power of 30 D was manufactured for both eyes.

Surgical procedureThe lioness was sedated with medetomidine (Domitor; Elanco), 30 mg/kg BW, ketamine (Ketavet 100; Intervet), 2 mg/kg BW, and butorphanol (Dolorex; MSD-Animal Health), 0.1 mg/kg BW. Anesthesia was induced with propofol (Vetofol; Esteve, MI, Italy), 1 mg/kg BW, followed by endotracheal intubation, and maintained with isoflurane (IsoFlo; Esteve) and oxygen. Meloxicam (Metacam; Boehringer, S.p.A, MI, Italy), 10 mg, and ceftriazone (Rocefin; Roche, MI, Italy), 2 g, were administered systemically before surgery.

Both eyes received 4 cycles of topical dexamethasone 0.2% (Luxazone; Allergan S.p.A. RM, Italy), ofloxacin 0.3% (Exocin; Allergan) and tropicamide 0.5% with phenylephrine 20 min apart. Electroretinography (ERG) (HMsERG, RetVetCorp, Columbia, Missouri, USA) in both dim light and dark adapta-tion was performed before surgery. The ERG showed apparent normal A and B wave amplitudes when compared to other cats’ recordings in our database. After 20 min of dark adapta-tion ERG was recorded with light intensities of 10 millican-dela/m2 (mcd.s/m2); 3000 mcd.s/m2; 10 000 mcd.s/m2. For photopic ERG study, there was a 10 min light adaptation. Electroretinography was recorded at 3 cd (32) std/cone bk 30 cd (Figure 4).

The lioness was positioned in dorsal recumbency. The ocular surface was prepared with povidone iodine solution, diluted with saline 1:50, and the eyelids were prepared with a dilution of 1:10 of the same povidine iodine (18). Rocuronium (Rocuronio; Fresenius Kabi, VE, Italy), 0.3 mg/kg BW, a neuromuscular blocking agent, was injected intravenously. The lioness was ventilated with a standard animal ventilator. The left eye was operated on first. As the pupil failed to dilate fully, the cornea was irrigated with 1.0 mL of diluted epinephrine 1:10 000 (A.I.C; Teva Italia, MI, Italy). Mydriasis improved allowing us to perform the surgery. A 2-step corneal incision using a microsur-gical blade n.64 (Swann-Morton, Sheffield, UK) and a keratome with a blade width of 2.8 mm (Surgical Specialties Corporation, Tijuana, Mexico) was made 1 mm from the limbal margin at the 1 o’clock position. A second incision of 1.0 mm width was made at the 10 o’clock position as a side-port incision. The anterior chamber was filled with hyaluronic acid (Viscoelastic 1.8% I-MED Animal Health, Dollard-des-Ormeaux, Quebec). A 9-mm anterior capsulotomy was made with a 25-gauge 1-inch needle and Vannas scissors. A continuous tear curvilinear capsu-lorrhexis (CCC) was carried out using Utrata forceps.

Phacoemulsification of the nucleus was conducted with a 30° phacoemulsification needle (Pulsar; Optikon 2000, RM, Italy). Total phacoemulsification time was 4 min and 42 s. The ultrasonic power used was 80%. The remaining cortical debris was aspirated with a 0.5-mm irrigation/aspiration (I/A) tip.

Figure 3. Keratometry revealed a corneal curvature of 26.8 D 1/2 1.96 SD in the OD and 28.48 D 1/2 6.55 SD in the OS.



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The posterior capsule was vacuum-polished. An enlargement of the corneal incision up to 5 mm was made in order to intro-duce the lens into the capsular bag. A 130.0 diopter acrylic foldable lens with a 22-mm diameter haptic was placed (S&V Technologies; AG Acrivet, Hennigsdorf, Germany). The visco-elastic was removed by irrigation/aspiration. The wound was closed routinely with a 9-0 Polyglactin 910 suture in a simple interrupted pattern (Vicryl; Ethicon, Johnson & Johnson, St. Stevens-Woluwe, BXL, Belgium). A subconjunctival injec-tion of triamcinolone (Kenacort; Bristol-Myers Squibb S.r.l, Italy), 20 mg, was performed. At that point, the lion became unstable and for safety reasons the surgery of the second eye was postponed. The recovery was uneventful.

After the surgery, the left eye was treated with topical antibi-otic ofloxacin 0.3% (Exocin; Allergan RM, Italy) 4 times daily for 15 d. Systemic antibiotic, ceftriazone (Rocefin; Roche), 2 g, q24h, for 14 d and meloxicam (Metacam; Boehringer),

0.1 mg/kg BW, q24h for 5 d were given. The patient was moved to a 2 m2 cage to apply topical medication, which was prepared in a 1-mL syringe. The needle of the syringe was manually bro-ken off and the content was sprayed into the eye.

One week after surgery, the lioness was sedated and anesthe-tized following the same protocol as previously described for performing the surgery on the right eye. The left eye showed an extrusion of one of the haptics. Under general anesthesia, both eyes were prepared following the same protocol. The corneal wound incision of the left eye was opened and the anterior chamber was filled with hyaluronic acid (Viscoelastic 1.8%, I-MED Animal Health). After the haptic was trimmed, the lens was consecutively reinserted into the capsular bag. The corneal incision was sutured as previously described.

A conventional one-handed phacoemulsification was per-formed on the right eye. The rest of the procedure was similar to that described for the previously operated left eye. Time for

Figure 4. Electroretinography (ERG) showed apparently normal A- and B-waves amplitudes when compared with other mammals.



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the phacoemulsification was 2 min and 52 s. In order to avoid the complication encountered with the left eye, shortening of the haptics (about 1 mm each side) was performed before the insertion.

This eye received 20 mg of triamcinolone as a subconjunc-tival injection. The anesthesia and recovery were uneventful. The postoperative treatment was the same as described for the right eye.

One week later, the lioness was sedated with the previously described drugs. A complete ophthalmic examination was per-formed including slit-lamp biomicroscopy, tonometry, indirect ophthalmoscopy, and fluorescein staining. The only abnormal finding was moderate intraocular inflammation, presenting as a grade 2 aqueous flare. Triamcinolone injection (20 mg) was repeated in both eyes.

Eight weeks after the second surgery, the patient was sedated as previously described. Both eyes appeared quiet with no active intraocular inflammation clinically detectable (Figures 5a, b). Without dilatation, retinoscopy (Heine Beta 200 Ophthalmoscope; Heine Ophthalmic Instruments, Herrsching, Germany) performed at this time revealed both eyes to be within 1.5 D of emmetropia.

The last complete ophthalmological evaluation was done 7 y after surgery. No signs of ocular discomfort or active intraocular inflammation were seen. The lioness showed quiet, normoten-sive eyes with good vision (Figures 6a, b).

DiscussionThere are several reports of surgical removal of cataracts in exotic species (2,7,8,10,13). Intracapsular lens extraction has been performed previously in an African lion with anterior lens luxation (19). This case report presents a successful phacoemul-

sification with intraocular lens implantation in an African lion. Systemic, metabolic, or infectious diseases were not detected by hematology or serology, and clinical signs were not consistent with a systemic cause. Encephalitozoon cuniculi infection cannot be ruled out, as a test for its presence was not performed.

The patient came from a circus in France, but further infor-mation about the parents’ origin was not available. With the frequent movement of animals in a circus environment, a relationship with a group of Angolan lions in Germany cannot be totally excluded. Congenital cataracts have been described in Persian, Birman, and Himalayan kittens (3). Taking into consideration that the lioness had exhibited aggressive behavior since birth, a congenital etiology would be most likely. Surgical removal associated with post-operative medical therapy is the gold standard treatment of cataracts. If surgery is not performed, the patient must be monitored and if necessary treated medically for complications such as lens-induced uveitis (LIU), secondary glaucoma, retinal detachment, and lens luxation (3). Surgical intervention of cataracts in exotic animals may be required if limited vision becomes an obstacle to normal function (12). Phacoemulsification with intraocular lens implantation was appropriate in this case.

A diopter lens power measurement was performed in order to achieve the most correct IOL for emmetropic vision. The proper lens power was determined to be 130.0 diopters, as derived from the Retzlaff equation. At the time of the second surgery, the left eye showed an extrusion from the capsular bag of one of the haptics. The intraocular lens was too big for the capsular bag, and 1 haptic was then trimmed and reinserted into the capsular bag. The amplitude and intensity of ERG were considered to be adequate for surgical intervention, compared to those from domestic cats in our database. In small animal

Figure 5. Left and right eyes, respectively, at 8 and 9 wk after surgery, showed a well-centered intraocular lens with no signs of anterior uveitis. Emmetropic vision within 1.5 D.

Figure 6. Left and right eyes, respectively, 7-year post-surgery follow-up.



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practice, all the patients that undergo a planned cataract surgery usually receive pre-surgical treatment. The goals are to reduce intraocular inflammation using topical anti-inflammatories and to minimize ocular microbial flora with broad-spectrum bactericidal topical antibiotics, started at least 12 to 24 h before surgery, and longer if LIU is present (3,20,21). Due to the extremely aggressive behavior of the patient, topical therapy before surgery could not be considered; therefore, it was reduced to just 4 cycles of treatment before surgery.

Bilateral phacoemulsification in dogs and cats is usually performed in a single surgery, as this has the advantage of restoring sight in both eyes with a single anesthetic episode as well as reducing the convalescent period, lowering overall cost when compared with 2 unilateral surgeries, and providing a higher percentage of patients which can regain vision from 1 or both eyes (22). In our case, due to the unstable anesthesia, we postponed the surgery in the second eye.

Small animal patients that undergo phacoemulsification receive intensive post-operative treatment with topical and systemic antibiotic and anti-inflammatory drugs, Elizabethan collar, and IOP measurements every 2 h for the first 12 h. In the present case, the treatment was reduced to topical application of ofloxacin 0.3% 4 times a day for 14 d. As sedation was required for examination, 2 postoperative evaluations were performed at 2 and 8 wk after the second surgery.

Complications following cataract surgery include corneal endothelial decompensation, uveitis, hyphema, fibrin forma-tion, glaucoma, and retinal detachment. Moderate uveitis was observed in our patient during the first 2 wk post-surgery, gradually resolving over 8 wk. Transitory ocular hypertension occurs in 22.9% to 50% of canine cases within 72 h following cataract surgery (3,23–25).

A study on African lions (Pantera leo) compared the effect on IOP using 2 different protocols for sedation. The use of IM xylazine (1 mg/kg BW), atropine (0.02 mg/kg BW), and ketamine (10 mg/kg BW) or IM ketamine (20 mg/kg BW) fol-lowed by IV ketamine (5 mg/kg BW) and diazepam (0.5 mg/kg BW), showed an insignificant effect on IOP (26).

To the authors’ knowledge, there are no studies in veterinary medicine documenting the effects on IOP using a medeto-midine, ketamine, and butorphanol combination via the IM route. A low IOP value secondary to the sedation cannot be completely ruled out.

In the last examination, all ophthalmic findings were within normal limits, and the patient showed correct visual behav-ior and clinical appearance. Good vision was achieved after surgery, as retinoscopy revealed both eyes being within 1.5 D of emmetropia and there was a dramatic improvement in the lioness behavior.

The data presented in this case report support the premise that 130 D IOL was an appropriate choice following lens extrac-tion in this African lion. The haptics of the lens needed to be shortened, as the IOL was too long for this patient. Manual error during the measurement of the lens dimensions by ocular ultra-sound was the most likely reason. Fortunately, shortening of the haptic was sufficient to provide excellent centration of the IOL.

To the authors’ knowledge, this is first case report of a bilat-eral phacoemulsification followed by intraocular lens implan-tation using a 130 D IOL in an African lion. A good clinical outcome is reported up to 7 y post-surgery.

AcknowledgmentsWe gratefully acknowledge Mrs. Ingeborg Fromberg from An-Vision, Mr. Andrea Francia and Mr. Roberto Federici from OPTIKON 2000, and Dr. Marco Russo, ultrasonographer, for their technical support. They all helped to produce the appropriate IOLs. Thanks to Mr. Daniel Berquiny, who gave hospitality to the lioness in his private zoo “Zoo delle Star” in Aprilia, Latina, Italy. CVJ

References 1. Glover TD, Constantinescu GN. Surgery for cataracts. Vet Clin North

Am Small Anim Pract 1997;27:1143–1173. 2. Cooley PL. Phacoemulsification in a clouded leopard (Neofelis nebulosa).

Vet Ophthalmol 2001;4:113–117. 3. Stiles J. Feline ophthalmology. In: Gelatt KN, ed. Veterinary Ophthal-

mology. 5th ed. Ames, Iowa: Wiley-Blackwell, 2013:1528–1519. 4. Sapienza JS. Feline lens disorders. Clin Tech Small Anim Pract 2005;

20:102–107. 5. Frankel DJ. Malnutrition-induced cataracts in an orphaned kitten. Can

Vet J 2001;42:653–654. 6. Quam DD, Morris JG, Rogers QR. Histidine requirement of kittens for

growth, haematopoiesis and prevention of cataracts. Br J Nutr 1987;58: 521–532.

7. Carter RT, Murphy CJ, Stuhr CM, Diehl KA. Bilateral phacoemulsifica-tion and intraocular lens implantation in a great horned owl. J Am Vet Med Assoc 2007;230:559–561.

8. Montiani-Ferreira F, Lima L, Bacellar M, D’Otaviano Vilani RG, Fedullo JD, Lange RR. Bilateral phacoemulsification in an orangutan (Pongo pygmaeus). Vet Ophthalmol 2010;13Suppl:91–99.

9. Gionfriddo JR. Cataracts in New World camelids (llamas, alpacas, vicuñas, and guanacos). Vet Clin North Am Exot Anim Pract 2002;5: 357–369.

10. Bakal RS, Hickson BH, Gilger BC, Levy MG, Flowers JR, Khoo L. Surgical removal of cataracts due to diplostomum species in Gulf Sturgeon (Acipenser oxyrinchus desotoi). J Zoo Wildl Med 2005;36: 504–508.

11. Scurrell EJ, Holding E, Hopper J, et al. Bilateral lenticular Encepha-litozoon cuniculi infection in a snow leopard (Panthera uncia). Vet Ophthalmol 2015;18:143–147.

12. De Faber JT, Pameijer JH, Schaftenaar W. Cataract surgery with fold-able intraocular lens implants in captive lowland gorillas (Gorilla gorilla gorilla). J Zoo Wildl Med 2004;35:520–524.

13. Kelly TR, Walton W, Nadelstein B, Lewbart GA. Phacoemulsification of bilateral cataracts in a loggerhead sea turtle (Caretta caretta). Vet Rec 2005;156:774–777.

14. Steinmetz A, Eulenberger K, Thielebein J, et al. Lens-anomalies and other ophthalmic findings in a group of closely-related angola lions (Panthera leo bleyenberghi). Zoo Biol 2006;25:433–439.

15. Benz P, Maa G, Csokai J, et al. Detection of Encephalitozoon cuniculi in the feline cataractous lens. Vet Ophthalmol 2011;14:37–47.

16. Kennedy-Stoskopf S. Canidae. In: Fowler ME, Miller RE, eds. Zoo and Wild Animal Medicine. 5th ed. Philadelphia, Pennsylvania: WB Saunders, 2003:494–495.

17. Ofri R, Steinmetz A, Thielebein J, Horowitz IH, Oechtering G, Kass PH. Factors affecting intraocular pressure in lions. Vet J 2008;177: 124–129.

18. Roberts SM, Severin GA, Lavach JD. Antibacterial activity of dilute povidone-iodine solutions used for ocular surface disinfection in dogs. Am J Vet Res 1986;47:1207–1210.

19. Sardari K, Emami MR, Tabatabaee AA, Ashkiani A. Cataract surgery in an African lion (Panthera leo) with anterior lens luxation. Comp Clin Pathol 2007;16:65–67.

20. Wilkie DA, Gemensky-Metzler AJ. Agents for intraocular surgery. Vet Clin North Am Small Anim Pract 2004;34:801–823.



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21. Yu-Speight AW, Kern TJ, Erb HN. Ciprofloxacin and ofloxacin aqueous humor concentrations after topical administration in dogs undergoing cataract surgery. Vet Ophthalmol 2005;8:181–187.

22. Davidson MG, Nasisse MP, Rusnak IM, Corbett WT, English RV. Success rates of unilateral vs. bilateral cataract extraction in dogs. Vet Surg 1990;19:232–236.

23. Crasta M, Clode AB, McMullen RJ, Pate DO, Gilger BC. Effect of three treatment protocols on acute ocular hypertension after phaco-emulsification and aspiration of cataracts in dogs. Vet Ophthalmol 2010; 13:14–19.

24. Klein HE, Krohne SG, Moore GE, Stiles J. Postoperative complications and visual outcomes of phacoemulsification in 103 dogs (179 eyes): 2006–2008. Vet Ophthalmol 2011;14:114–120.

25. Chahory S, Clerc B, Guez J, Sanaa M. Intraocular pressure development after cataract surgery: A prospective study in 50 dogs (1998–2000). Vet Ophthalmol 2003;6:105–112.

26. Ofri R, Horowitz I, Jacobson S, Kass PH. The effects of anesthesia and gender on intraocular pressure in lions (Panthera leo). J Zoo Wildl Med 1998;29:307–310.

1. E) All are recommended diagnostic tests. E) Ce sont toutes des épreuves de diagnostic recommandées.

2. C) The CO2 level does not cause cyanosis. Cyanosis is due to desaturated hemoglobin, which may occur with low oxygen delivery and oxygen saturations less than 90%. A hemoglo-bin saturation level of 75% is similar to venous blood and will be cyanotic. An oxygen flow rate of 2 to 3 mg/kg/min (4–6 mL/kg/min) is considered to be the metabolic require-ment for oxygen and will not cause cyanosis.

C) Le taux de CO2 ne cause pas de cyanose. La cyanose est due à l’hémoglobine insaturée qui peut avoir lieu avec une distribution d’oxygène basse et une saturation en oxygène de moins de 90 %. Un taux de saturation d’hémoglobine de 75 % est semblable au sang veineux et sera cyanosé. Un débit d’oxygène de 2 à 3 mg/kg/min (4 à 6 ml/kg/min) est considéré comme étant le besoin métabolique en oxygène et ne causera pas de cyanose.

3. E) A systolic right heart murmur and splintered QRS complexes are consistent with tricuspid valve dysplasia. Labrador retriev-ers are predisposed to tricuspid valve dysplasia.

E) Un souffle du cœur droit systolique et des complexes QRS dentelés sont compatibles avec la dysplasie de la valve tricuspide. Le Labrador est prédisposé à la dysplasie tricuspide.

4. D) Pattern baldness is diagnosed by ruling out endocrinopathies and with skin biopsy. It is a nonpruritic condition; the other choices are diagnostic tests for pruritic conditions.

D) On établit un diagnostic d’absence de poils par élimination des endocrinopathies et par biopsies cutanées. C’est une affection non prurigineuse. Les autres choix sont des épreuves diagnostiques pour des affections prurigineuses.

5. D) Manure discharge on snow or when rain is forecast is irre-sponsible because of the potential run-off into waterways. Risk of run-off can be avoided if tillage occurs soon after manure application. Application when plants are maturing would have little nutritive value. It is not currently possible to eradicate Cryptosporidia from dairy farms, but if the pre-vious precautions are taken, risk of zoonosis is reduced to safe levels.

D) L’épandage de fumier sur la neige ou lors de prévision de pluie est irresponsable à cause de l’écoulement potentiel dans les cours d’eau. Les risques d’écoulement peuvent être évités si les travaux des champs ont lieu tôt après l’épandage du fumier. L’application de fumier lorsque les cultures sont en croissance aura peu de valeur nutritive. Il n’est pas actuellement possible d’éradiquer Cryptosporidia des fermes laitières, mais si des précautions sont prises, les risques de zoonose sont réduits à des niveaux sécuritaires.

Answers to Quiz Corner Les réponses du test éclair

quiz corner is generously sponsored by le test éclair est généreusement commandité par

– Prolonged release mineralocorticoid replacement therapy with a non-mercury-based preservative– Subcutaneous (SC) injection for easier administration and client compliance – Easy to start in treatment-naïve dogs, and easy to switch in existing cases



Brief Communication Communication brève

Plasma transfusions in horses with typhlocolitis/colitis

Luis G. Arroyo, William Sears, Diego E. Gomez

Abstract — The outcome of treatment of horses with plasma for typhlocolitis/colitis at the Ontario Veterinary College-Health Sciences Centre was evaluated. Horses with typhlocolitis/colitis that received a plasma transfusion had higher odds of dying than did non-transfused horses. The clinical usefulness of transfusing plasma to hospitalized hypoproteinemic horses is questioned.

Résumé — Transfusions de plasma chez les chevaux atteints de typhlocolite/colite. Les résultats du traitement des chevaux à l’aide de plasma pour la typhlocolite/colite au Health Sciences Centre de l’Ontario Veterinary College ont été évalués. Les chevaux atteints de typhlocolite/colite qui avaient reçu une transfusion de plasma présentaient une probabilité accrue de décès par rapport aux chevaux qui n’avaient pas reçu une transfusion. L’utilité clinique de la transfusion de plasma aux chevaux hypoprotéinémiques hospitalisés est remise en question.


P lasma transfusions are frequently used in equine medicine for various medical conditions (1). Patients with chronic

or acute hypoproteinemia as a result of protein-losing enteropa-thies, strangulating lesions of the intestine, and enterocolitis, for example, are common candidates to receive plasma (1). Plasma transfusions have been advocated for one or more of the follow-ing: to restore or improve colloid osmotic pressure (COP) with the aim of preventing edema; to provide a source of protein for nutritional support; to counteract endotoxemia; and to supple-ment immunoregulatory factors such as opsonins, complement system, and immunoglobulins (1).

In equine medicine, clinical studies measuring the benefit or outcomes of such intervention in hypoproteinemic horses are lacking. Whilst guidelines for use of plasma transfusion are clearly defined in many texts (total protein , 40 g/L, albumin , 20 g/L, and COP , 12 mmHg), and transfusing plasma to hypoproteinemic horses appears intuitive, the rationale for its use is not evidence-based (1–3). Some prospective studies investigating the use of plasma for the treatment of endotoxemia in horses do exist, but the evidence for any benefit is conflict-ing (1).

In contrast to horses, humans most commonly receive plasma transfusions to provide coagulation factors for the prevention or treatment of bleeding disorders (4). However, even within a narrow scope of use, a lack of evidence-based medicine dem-onstrating any clinical benefit for such practice has generated heated discussion between protagonists and antagonists in human medicine (5). The use of plasma in equine patients has not undergone similar scrutiny. As a result, the authors of this study have questioned the clinical usefulness of transfusing plasma to hypoproteinemic horses hospitalized at our institu-tion. In recent years, some clinicians have discontinued this practice in cases of typhlocolitis/colitis. These are the cases that typically present with hypoproteinemia. The objective of this retrospective study was to compare the clinical outcome, defined as survival to discharge, of horses with typhlocolitis/colitis that received plasma transfusion during their hospitalization at our institution, with those that did not.

The medical records of adult horses (. 1 y old) with a final diagnosis of typhlocolitis or colitis admitted to our institution between January 2000 and April 2011 were reviewed. Final diagnosis was achieved through a combination of some or all of the following: physical examination including presence of diarrhea, rectal palpation, nasogastric intubation, ultrasound examination, abdominocentesis, and necropsy. Case information retrieved for the analysis included signalment, total plasma pro-tein (TPP) as measured by quantitative chemistry analysis, and whether plasma was administered or not. The plasma product administered was categorized as home harvest (blood collected from horses of the teaching herd), commercial, or unknown (origin of the plasma transfused not recorded). Outcome was recorded as survival to discharge from the hospital or not (euthanasia or death).

Data were statistically analyzed using a standard Fisher’s exact test to calculate the conditional maximal likelihood of the odds ratio (OR) of euthanasia/dying following not receiving plasma

Departments of Clinical Studies (Arroyo) and Population Medicine (Sears), Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1; Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA (Gomez).Address all correspondence to Dr. Luis Arroyo; e-mail: [email protected] of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.



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as opposed to receiving plasma. The exact Sterne confidence intervals (CI) on the OR were computed.

For horses that were transfused, TPP concentration (g/L) before and after (12 to 24 h) transfusion was recorded, and the change in TPP was calculated.

The total volume of plasma administered to horses that survived and to those that did not were compared using a Wilcoxon signed-rank test. To determine whether the type of plasma administered had any effect on outcome, a Chi-squared analysis was carried out to compare the use of home harvest and commercial plasma between horses that survived and those that did not survive.

A total of 465 horses met the inclusion criteria for the typh-locolitis/colitis cases during the study period. All horses had diarrhea, which was either present at the time of admission (n = 317) or became evident while in hospital (n = 148). There were 238 male and 227 female horses.

The ages ranged from 1 to 23.5 y, with a median of 12.1 y. The most common breeds represented were Thoroughbreds (n = 149), Standardbreds (n = 117), Quarter Horses (n = 47), mixed breed (n = 39), Warmblood breeds (n = 12), ponies (n = 10), Miniature horses (n = 7), and the remaining horses (n = 84), which included other breeds such as Friesian, Belgian, Haflinger, Andalusian, Tennessee Walker, and Hanoverian.

A total of 189 horses with typhlocolitis/colitis received plasma transfusion while 276 did not. Out of 189 transfused horses, 118 (62%) survived to discharge and 71 (38%) died or were euthanized during hospitalization. Out of 276 non-transfused horses, 206 (75%) survived and 70 (25%) died or were euthana-tized during hospitalization. Horses with typhlocolitis/colitis that received plasma transfusion had higher odds (OR: 1.77; 95% CI: 1.17 to 2.65; P = 0.05) of dying, or euthanasia, than did non-transfused horses.

The volume of plasma transfused ranged from 1 to 25.4 L (median: 4 L), in the group of horses that survived, and 1.2 to 16 L in the non-surviving group (median: 4 L). Of the horses that were administered plasma and survived, 83 (70%) horses received home harvest plasma, 31 (26%) received commercial plasma, and in 4 (3.4%) horses the type of plasma was not recorded. In the group of horses that did not survive, 50 (70%) received home harvest plasma, 20 (28%) received commercial plasma, and in 1 (1.4%) horse the type of plasma administered was not recorded. There were no significant differences in the volume (P = 0.68) or type (P = 0.82) of plasma administered in horses that survived compared with those that did not.

In total, there were 6 (3%) mild adverse reactions at the beginning of the first transfusion. Clinical signs of a reaction included hives and increased respiratory rate and rectal tempera-ture. Five horses with reactions were in the group that survived, and 1 horse was in the group that did not survive.

The TPP concentrations before and 24 h after transfusion were available for 115/189 (61%) and 64/71 (90%) surviving and non-surviving horses, respectively. The median TPP con-centrations of survivors and non-survivors before transfusion were 42 g/L (range: 28 to 78 g/L) and 45 g/L (range: 15 to 86 g/L), respectively (Figure 1). The TPP of surviving horses increased significantly after transfusion (before: 42 g/L; range:

28 to 78 and after: 46 g/L; range: 30 to 74; P = 0.001). The TPP of non-surviving horses after transfusion was not significantly different compared with the TPP before transfusion (before: 45 g/L; range: 15 to 86 g/L, and after: 46 g/L; range: 18 to 80 g/L; P = 0.647).

This study aimed to compare the clinical outcome, defined as survival to discharge, of horses with typhlocolitis/colitis that received plasma transfusion during hospitalization at our institution, with those that did not. Our results suggest that the administration of a plasma transfusion has a minimal associa-tion with survival. In fact, horses with typhlocolitis/colitis that received a plasma transfusion were 1.77 times more likely to die than horses that did not receive a plasma transfusion. The retrospective nature of the data collection means that a bias may exist whereby the more severely affected horses received plasma, and the severity of their disease made them more likely to die. However, notwithstanding this limitation, the data do not reveal a negative association with the lack of use of plasma. Moreover, based on recent publications, it can be argued that patients with a low TPP are not necessarily the ones most severely affected, because TPP alone has been shown to lack any prognostic value in horses presenting with acute colitis (6).

The median TPP of surviving and non-surviving horses before transfusion was consistent with hypoproteinemia. However, the range of TPP values before transfusion was wide in both groups of horses, which raises the question of whether some of the horses received plasma for reasons other than hypoproteinemia (e.g., coagulation, nutritional support, or to provide anti-endotoxin antibodies). The question of indication for plasma administration is fundamental and a cornerstone of this study. As mentioned, the rationale for the use of plasma is not evidence-based. The precise reason as to why it was admin-istered was frequently not stated in the medical record, and therefore could not be included in the data analysis.

In the opinion of the authors, administration of plasma for coagulation was unlikely to be the rationale for treatment in this study: the efficacy of plasma transfusion in horses with identified, or suspected, coagulation abnormalities has not been proven in clinical experimental settings. Furthermore, the authors believe that the provision of anti-endotoxin antibodies was unlikely to be the reason for administration of plasma: most horses in the study received the home harvest plasma, which was obtained from horses not immunized to produce hyperim-mune plasma. The practice of producing home harvest plasma was discontinued part way through the period from which the cases in this study were drawn, most likely explaining the use of commercial plasma in the remaining horses. Our results reveal that neither the type nor volume of plasma administered had any association with outcome.

Our results demonstrated a minimal increase (4 g/L) in TPP following transfusion in surviving (n = 115) horses, and a reduc-tion (21.5 g/L) in non-surviving (n = 64) horses. While it is tempting to make a statistical comparison of TPP among horses that survived and horses that did not survive, before and after plasma transfusion, the necessary information on the hydra-tion status of each horse was not available through the records, rendering such comparison insignificant.



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Nevertheless, the minimal increase in TPP, or lack thereof, in non-surviving and surviving horses is an interesting finding because it is comparable to findings in horses with hypoalbu-minemia, in which the total plasma levels of albumin usually only increase slightly or not at all, following plasma transfu-sion (7). Furthermore, even when an increase in TTP has occurred after transfusion, the TPP levels tend to decrease to pre- transfusion levels within 24 h of the transfusion (7).

This observation is not unexpected if the amount of plasma usually administered and fate of the product after transfusion are considered. For example, in a 450-kg adult horse, with severe acute diarrhea, a TPP of 36 g/L, and a serum albumin concen-tration of 18 g/L, the calculated total intravascular albumin content would be 810 g [blood volume of 100 mL/kg body weight (BW) 3 450 kg = 45 L]. Transfusion of 5 L of com-mercial plasma with a TPP of 62 g/L and an albumin content of 38 g/L would contribute 190 g of albumin (5 L 3 38 g/L). Assuming that the transfused proteins remain in the intravascu-lar space, and the blood volume increases by 5 L, the albumin concentration will increase from 18 g/L to 20 g/L. However, in disease states, the normal constant exchange rate of plasma constituents, such as albumin, between the intra- and extravas-cular compartments (trans-capillary escape rate), is increased, lowering the albumin concentration in plasma at a faster rate (8). In albumin therapy in humans, approximately 10% of the infused albumin leaves the intravascular space within 2 h, and by 2 d as much as 75% is distributed into the extravascular space (9). This distribution process can occur more rapidly if there is disruption of endothelial integrity, as occurs in colitis, leading to a significant increase in the rate of capillary albumin leakage (10,11). It is therefore possible that the increase in TPP follow-ing administration of plasma in surviving horses in this study is a reflection of a healthier state of the cecum and colon, and importantly in these horses the TPP may have increased even without a plasma transfusion.

The association between low COP in horses, and clinical outcome is not known. In humans, a relationship between death and COP could not be established in hypoproteinemic

patients, and the association between serum albumin and COP in critically ill patients was found to be insignificant (12). In horses, Bellezzo et al (10) reported a discrete increase (from 11 to 13 mmHg) in the oncotic pressure after synthetic col-loid administration in hypoproteinemic horses suffering from naturally occurring gastrointestinal disease. Atherton et al (11) treated colitis in horses with hyperimmunized plasma, control (regular) plasma, or no plasma. They reported that the mean val-ues for duration of diarrhea (6 standard error) were 41 6 10 h, 119 6 56 h, and 72 6 25 h for the hyperimmune plasma, nor-mal plasma, and control groups, respectively, but none of the treatments influenced the overall survival rate. Diarrhea resolved in 70% to 90% of the horses within 72 h regardless of the treat-ment group. The use of plasma as a source of colloidal support in horses, therefore, has a questionable impact. Large volumes may be required if plasma is used as a source of albumin. For example, approximately 25 mL/kg BW (12 L per 500 kg BW) is required to increase serum albumin by 5 g/L. It may be difficult, therefore, to justify its use with seemingly little evidence of an impact, the potential limitations of donor availability, and the economic constraints with such a large volume required.

In recent years, horses that were presented to our institution with conditions such as colitis, with TPP levels as low as 20 g/L [reference range (RR): 57 to 75 g/L], and albumin levels as low as 7 g/L (RR: 30 to 37 g/L) have been managed by addressing their primary disease and providing supportive care, without including plasma transfusions. Clinical signs traditionally associ-ated with severe hypoproteinemia such as edema have not been observed or were only mild and transient, and considered clini-cally not significant. However, the change in clinical decision-making regarding the use of plasma transfusion by the authors of this study requires scientific scrutiny and further interventional studies are necessary to validate this clinical rational.

In summary, the results of this study reveal that the admin-istration of plasma to horses with typhlocolitis/colitis did not improve the survival rate when compared to horses that did not receive a plasma transfusion. The lack of any negative association of forgoing the administration of plasma highlights the need for

Figure 1. Total plasma protein concentrations of surviving (A) and non-surviving (B) diarrheic horses before and after plasma transfusion.

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inquiry of current plasma transfusion recommendations, and for targeted research. The need for evidence-based medicine to support plasma transfusion is irrefutable. To provide high quality evidence supporting whether plasma has a positive effect on outcome in horses with typhlocolitis/colitis, a randomized blinded prospective multicenter clinical study would need to be conducted (13).

AcknowledgmentThe authors acknowledge Dr. Nicola Cribb for assistance in the preparation of this manuscript. CVJ

References 1. Tennent-Brown B. Plasma therapy in foals and adult horses. Compend

Contin Educ Vet 2011;33:E1-4. 2. Constable PD, Hinchcliff KW, Done S, Gruenber W. Diseases of the

alimentary tract — horses, pigs, and neonatal ruminants. In: Constable PD, Hinchcliff KW, Done S, Gruenber W, eds. Veterinary Medicine. A Textbook of the Diseases of Cattle, Horses, Sheep, Pigs and Goats. 11th ed. Philadelphia, Pennsylvania: WB Saunders, 2017.

3. McConnico RS. Acute colitis in horses. In: Sprayberry KA, Robinson NE, eds. Current Therapy in Equine Medicine. 7th ed. St. Louis, Missouri: Elsevier, 2015.

4. Yang L, Stanworth S, Hopewell S, Doree C, Murphy M. Is fresh-frozen plasma clinically effective? An update of a systematic review of random-ized controlled trials. Transfusion 2012;52:1673–1686.

5. Boldt J. The good, the bad, and the ugly: Should we completely banish human albumin from our intensive care units? Anesth Analg 2000;91:887–895.

6. Kovac M, Huskamp B, Scheidemann W, Toth J, Tambur Z. Survival and evaluation of clinical and laboratory variables as prognostic indicators in horses hospitalized with acute diarrhea: 342 cases (1995–2015). Acta Veterinaria-Beograd 2017;67:356–365.

7. Durham AE. Blood and plasma transfusion in the horse. Equine Vet Educ 1996;8:8–12.

8. Fleck A, Raines G, Hawker F, et al. Increased vascular permeability: A major cause of hypoalbuminaemia in disease and injury. Lancet 1985;1:781–784.

9. Boldt J. Use of albumin: An update. Br J Anaesth 2010;104:276–284.10. Bellezzo F, Kuhnmuench T, Hackett ES. The effect of colloid formula-

tion on colloid osmotic pressure in horses with naturally occurring gastrointestinal disease. BMC Vet Research 2014;10:S8.

11. Atherton RP. Efficacy of hyperimmunised plasma in the treatment of horses with acute diarrhoea. MSc Thesis, Virginia Polytechnic Institute and State University, 2007.

12. Blunt MC, Nicholson JP, Park GR. Serum albumin and colloid osmotic pressure in survivors and nonsurvivors of prolonged critical illness. Anaesthesia 1998;53:755–761.

13. CEBM Oxford Centre for Evidence-based Medicine — Levels of Evidence (March 2009) — CEBM. [Homepage on the Internet]. Available from: https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009 Last accessed November 28, 2018.



Brief Communication Communication brève

Congenital hydrocephalus in a Belgian draft horse associated with a nonsense mutation in B3GALNT2

David Scott Kolb, Claudia Klein

Abstract — Congenital hydrocephalus has been reported for a number of horse breeds, and for Friesian horses this condition has been associated with a nonsense mutation of B3GALNT2. We report the first case of congenital hydrocephalus associated with the said mutation in a Belgian draft horse. Genetic testing and consideration of the testing results in breeding programs are warranted.

Résumé — Hydrocéphalie congénitale chez un cheval de trait Belge associée à une mutation non-sens de B3GALNT2. L’hydrocéphalie congénitale a été signalée pour plusieurs races de chevaux et, pour les chevaux Frisons, cette affection a été associée à une mutation non-sens de B3GALNT2. Nous signalons le premier cas d’hydrocéphalie congénitale associée à cette mutation chez un cheval de trait Belge. Les tests génétiques et la considération des résultats des tests sont justifiés dans le cadre des programmes d’élevage.


C ongenital hydrocephalus (CH) is a birth defect charac-terized by the accumulation of cerebrospinal fluid in the

ventricles of the brain, which results in a marked increase in cranial cavity volume (1). While CH in horses is not a com-mon occurrence, 0.6 foals per 1000 births are estimated to be affected (2); it does result in the abortion or stillbirth of affected foals and can be a cause of dystocia. Congenital hydrocephalus has been reported for a number of horse breeds including the American Quarter Horse (3), American Miniature Horse (4), Friesian horse (1), Standardbred (5), Hanoverian Warmblood (6), and Thoroughbred (7). In Friesian horses, CH has an auto-somal recessive mode of inheritance which is associated with a nonsense mutation in the B3GALNT2 gene (8). Interestingly, the same nonsense mutation of the B3GALNT2 gene has been reported in a human patient with muscular dystrophy suffer-ing from hydrocephalus (9). Eight of 83 (9.6%) randomly selected Friesian stallions in Mexico were heterozygous for the nonsense mutation of the B3GALNT2 gene (10), while 8 of 60 (13.3%) Friesian stallions, and 139 of 805 (17.3%) Friesian broodmares screened in the Netherlands were carriers of the mutated allele (8).

We report here the first case of congenital hydrocephalus associated with the aforementioned mutation of B3GALNT2 in a Belgian draft horse. In the fall of 2016, a Belgian draft mare aborted a fetus during the 7th month of gestation. Upon visual inspection, the fetus had an enlarged and abnormally shaped skull (Figure 1). The dam’s daughter, which had been bred to the same stallion, also aborted a fetus with hydrocephalus dur-ing the third trimester around day 300 of gestation. Samples, including those of the dam and sire, were submitted to a com-mercial laboratory to determine the presence and zygosity of the B3GALNT2 nonsense mutation (Animal Genetics, Tallahassee, Florida, USA). Both parents were revealed to be carriers, i.e., heterozygous, for the mutation. Following the Mendelian laws of inheritance, the mating of heterozygous carriers results in a 25%

Lodi Veterinary Care, 705 North Main Street, Lodi, Wisconsin 53555, USA (Kolb); University of Calgary, Faculty of Veterinary Medicine, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6 (Klein).Address all correspondence to Dr. Claudia Klein; e-mail: [email protected] of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.

Figure 1. Enlarged and abnormally shaped skull of the aborted fetus.



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chance of obtaining a foal that is homozygous for the mutation and will be affected by hydrocephalus (Figure 2).

The seemingly high prevalence rate for heterozygosity in the Friesian horse population of greater than 10% (8) is likely attributable to the high inbreeding rate which was computed to be 1.5% using pedigree data (11), and exceeds the limit of 1% as recommended by the Food and Agriculture Organization (FAO) (12). Inbreeding data are not available for the Belgian draft breed, but given that it is a small population, a higher than average inbreeding rate can be expected.

The identification of the nonsense mutation of B3GALNT2 in a breed other than the Friesian horse emphasizes the impor-tance of genetic testing in cases of CH and the consideration of results for future matings. Ideally, only individuals not carrying the mutated allele should be paired. Realizing that this is not always practical, it is strongly recommended to have only one of the parents be a heterozygous carrier for the mutated allele to avoid the risk of CH in the resulting offspring. Should the mating of 2 heterozygous carriers be pursued, preimplanta-

tion genetic testing is a viable solution to manage the risk of CH in the resulting foal. Following breeding, the blastocyst is recovered and a trophectoderm biopsy is obtained after which the embryo is cryopreserved. Following genetic testing of the biopsied material confirming the absence of the B3GALNT2 mutation, the cryopreserved embryo can be transferred to a recipient mare (13,14). CVJ

References 1. Sipma KD, Cornillie P, Saulez MN, Stout TA, Voorhout G, Back W.

Phenotypic characteristics of hydrocephalus in stillborn Friesian foals. Vet Pathol 2013;50:1037–1042.

2. Ricketts SW, Barrelet A, Whitwell KE. Equine abortion. Equine Vet Educ 2003;15:18–21.

3. Foreman JH, Reed SM, Rantanen NW, DeBowes RM, Wagner PC. Congenital internal hydrocephalus in a quarter horse foal. J Equine Vet Sci 1983;3:154–164.

4. Ferris RA, Sonnis J, Webb B, Lindholm A, Hassel D. Hydrocephalus in an American Miniature Horse foal: A case report and review. J Equine Vet Sci 2011;31:611–614.

5. Ojala M, Ala-Huikku J. Inheritance of hydrocephalus in horses. Equine Vet J 1992;24:140–143.

6. Oey L, Müller JM, von Klopmann T, Jacobsen B, Beineke A, Feige K. Diagnosis of internal and external hydrocephalus in a warmblood foal using magnetic resonance imaging. Tierarztliche Praxis Ausgabe G, Grosstiere/Nutztiere 2011;39:41–45.

7. Bowman RW. Congenital hydrocephalus in 2 foals. Mod Vet Pract 1980;61:862–864.

8. Ducro BJ, Schurink A, Bastiaansen JW, et al. A nonsense mutation in B3GALNT2 is concordant with hydrocephalus in Friesian horses. BMC Genomics 2015;16:761.

9. Stevens E, Carss KJ, Cirak S, et al. Mutations in B3GALNT2 cause con-genital muscular dystrophy and hypoglycosylation of alpha-dystroglycan. Am J Hum Genet 2013;92:354–365.

10. Ayala-Valdovinos MA, Galindo-Garcia J, Sanchez-Chipres D, Duifhuis-Rivera T. Genotyping of friesian horses to detect a hydrocephalus-associated c.1423C>T mutation in B3GALNT2 using PCR-RFLP and PCR-PIRA methods: Frequency in stallion horses in Mexico. Mol Cell Probes 2017;32:69–71.

11. Ducro BJ. Relevance of test information in horse breeding. PhD Thesis 2001. Wageningen University. Available from: http://library.wur.nl/WebQuery/clc/1963624 Last accessed March 15, 2015.

12. FAO. Secondary guidelines for development of national farm animal genetic resources management plans: Management of small populations at risk. Rome, Italy 1998. Available from: http://www.fao.org/3/a-w9361e.pdf Last accessed March 15, 2018.

13. Herrera C. Clinical applications of preimplantation genetic testing in equine, bovine, and human embryos. J Equine Vet Sci 2016;41:29–34.

14. Hinrichs K, Choi Y-H. Equine embryo biopsy, genetic testing, and cryopreservation. J Equine Vet Sci 2012;32:390–396.

Figure 2. Diagram depicting Mendel’s laws of inheritance when mating 2 heterozygous carriers. B — unmutated allele; b — mutated allele.

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Student Paper Communication étudiante

Equine sinonasal anaplastic sarcoma infected with multi-drug resistant Escherichia coli

Alexandra Warren

Abstract — A 5-year-old Hanoverian horse was presented for a palpable and visible mass over the frontal and maxillary sinuses. Following endoscopy and radiography surgical excision was attempted. The horse was euthanized during surgery and samples of the mass were identified as malignant anaplastic sarcoma, a seldom reported sinonasal tumor in equids.

Résumé — Sarcome anaplasique naso-sinusien équin infecté par Escherichia coli multirésistant aux antibiotiques. Un cheval Hanovrien âgé de 5 ans a été présenté pour une masse palpable et visible sur les sinus frontal et maxillaire. Après une endoscopie et la radiographie, une excision chirurgicale a été tentée. Le cheval a été euthanasié durant la chirurgie et des échantillons de la masse ont été identifiés comme un sarcome anaplasique malin, une tumeur naso-sinusienne rarement signalée chez les équidés.


S inonasal tumors in horses are rare and generally present as maxillary sinus cysts, progressive ethmoid hematomas, or

inflammatory nasal polyps (1,2). Neoplasms are most commonly found in the caudal maxillary sinus, unlike in humans, in whom tumors are more likely to develop in the nasal passages (2). In equids, neoplasms usually present as squamous cell carcinomas (1); adenocarcinoma, osteomas, dental tumors, fibrosarcomas, and hemangiosarcomas are also found (1,3). One case report details an anaplastic sarcoma in the right caudal maxillary sinus of a 10-year-old horse (3). Anaplastic neoplasms are solid masses of undifferentiated cells that are commonly round or pleomor-phic epithelial cells, making them most commonly carcinomas.

Communication between the paranasal sinuses, nasal pas-sages, and nasopharynx allows for easy spread of tumor cells throughout the region by invasion or expansion (1). Tumors most commonly develop in the caudal maxillary sinus from which neoplastic cells are able to pass into the frontoconchal sinus through the frontomaxillary opening (1,4) and invade the rostral maxillary sinus by eroding the maxillary septum (1,4). The rostral maxillary sinus is divided into lateral and medial compartments by the infraorbital canal; from the medial portion a neoplasm could invade the ventrochonchal sinus, which com-

municates with the dorsochoncal sinus, through the conchomax-illary opening (4). The rostral maxillary sinus also communicates with the middle meatus via the nasomaxillary opening which allows neoplasms to expand into the nasopharynx (4). The close anatomic location of the nasal cavity and paranasal sinus to vital structures, such as the meninges, great vessels, and skull base, results in sinonasal tumors having a poor prognosis (5).

Growth of a tumor puts pressure on the surrounding tissues and blood vessels, resulting in increased rate of bone resorption, while surrounding unaffected areas with intact blood vessels lay down excessive new bone, causing facial swelling (1). In expans-ile growth, thinner bones, such as the concha and ethmoids, are destroyed as the tumor expands into them, while more flexible tissues, such as cartilage, are distorted (1). With invasive growth there is increased pressure on tissues as the tumor cells invade between layers of calcaneous bone (1). This allows for further spread of the neoplasia into regions such as the cribriform plate and orbit. The neoplasm can also occlude the blood and lymphatic vessels which exacerbates swelling of the head (1).

Metastasis of sinonasal tumors is infrequently reported (1,6,7) but can occur to local lymph nodes and other areas of the head (1,3). Clinical signs of sinonasal neoplasia are similar to those of non-neoplastic tumors, trauma, and infectious lesions (6). Nasal and ocular discharge, facial deformities and swelling, mastication problems, and neurologic signs have all been reported (1,3,6). Treatment is difficult because diagnosis often occurs in the late stages of disease (2).

Case descriptionA 5-year-old Hanoverian mare was presented with a 3-week his-tory of facial swelling and the owners had noticed blood on the stall walls. The horse appeared normal before presentation. The referring veterinarian had treated the horse with IM ceftiofur

Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan S7N 5B4.Address all correspondence to Ms. Alexandra Warren; e-mail: [email protected] of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.



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and penicillin G. Radiographs showed fluid in the frontal and right caudal maxillary sinuses. Nasal discharge began on the left side and progressed to bilateral discharge. A week before referral the horse was started on 2 g of phenylbutazone once a day. The horse was being treated with omeprazole before initial presentation to the referring veterinarian.

On examination, the horse had persistent left-sided muco-purulent nasal discharge and the left frontoconchal and caudal maxillary sinuses were swollen. External palpation found the swelling to be firm and boney. Percussion of the left maxillary and frontal sinuses was dull. Epiphora was observed in the left eye. There was swelling in the mid-neck near the trachea, attributed to the IM injections of ceftiofur.

The horse was sedated for upper airway endoscopy using xylazine (Rompun; Bayer Animal Health, Mississauga, Ontario), 0.3 mg/kg body weight (BW), IV, and butorphanol (Torbugesic; Mérial Canada, Baie d’Urfé, Québec), 0.01 mg/kg BW, IV. Endoscopy showed occlusion of the left nasomaxillary open-ing and mucopurulent discharge with hemorrhagic mucous membranes. The region’s normal anatomy was distorted, includ-ing the left dorsal meatus and conchae. The right side of the nasomaxillary opening was within normal limits as well as both guttural pouches, larynx, epiglottis, and dorsal pharynx.

Radiographs of the skull were taken (Figure 1). The left lateral view showed fluid lines in the rostral and caudal maxillary sinus and the dorsochoncal and frontoconchal sinuses, along with a mass of soft tissue with rounded margins in what was assumed to be the left frontoconchal and central maxillary sinuses. The nasal septum was deviated to the right in the ventral-dorsal view; an area of soft tissue or fluid opacity was observed on the left.

The coronal view showed boney deformities in the left frontal sinus and a soft tissue mass in the left caudal maxillary sinus. The tooth roots were within normal limits. Based on the initial examination a differential list included neoplasia, paranasal sinus cyst, or an ethmoid hematoma. The owner elected a sinus lavage and surgery to explore the sinus to determine the cause of the mass. The horse was admitted to hospital for surgery.

A standing sedated exploratory surgery was attempted, but the mare became fractious. It was decided that general anesthe-sia would be safer and less stressful for the horse and surgical team. The horse was in the hospital for 8 d before surgery under general anesthesia. During this time the horse was given a basic examination and treated with flunixin meglumine (Banamine; Intervet Canada, Kirkland, Quebec), 1 mg/kg BW, IV, and trim-ethoprim and sulfadiazine (TMS) (Tribrissen; Intervet Canada), 3.2 mg/kg BW trimethoprim and 16 mg/kg BW sulfadiazine, IV, q24h. The mare’s heart and respiration rates remained within normal limits for the first 5 d of hospitalization. At 8 am on day 5 the mare had copious white, frothy nasal discharge from the right nostril and increased swelling of the head and neck. The following day her heart rate was elevated at 60 beats/min (bpm), swelling was still present, ventral edema was noted, and she was having difficulty eating and drinking. The morning of surgery the mare’ s heart rate was 48 bpm and her respiration rate was 20 breaths/min. She was still having difficulty eating and there was some nasal discharge.

A frontoconchal sinusotomy flap procedure was performed. The horse was anesthetized with romifidine hydrochlo-ride (Sedivet; Boehringer Ingelheim, Burlington, Ontario), 0.05 mg/kg BW, IV, butorphanol (Torbugesic; Mérial Canada),

Figure 1. Radiographs of the head, showing the sinonasal tumor. A, B — left lateral view shows the mass (arrow) in the left rostral and caudal maxillary sinus, frontoconchal sinus, and the dorsoconchal and ventroconchal sinuses. C, D — Ventral-dorsal view shows the deviation of the nasal septum (arrow), to the right; there is a possibility of the mass extending into the right maxillary sinus (arrowhead). E, F — Coronal view shows that the right frontal sinus is unaffected (arrowhead), there are boney deformities in the left frontal sinus (large arrow). In the left maxillary sinus there is a soft tissue mass (thin arrow).



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0.02 mg/kg BW, IV, diazepam (Diazepam; Sandoz, Boucherville, Quebec), 0.04 mg/kg, IV, ketamine (Narketan; Vétoquinol, Lavaltrie, Québec), 2.4 mg/kg BW, IV, and guaifenesin (Trutina Pharmacy, Ancaster, Ontario) 5% in lactated ringers solution (Baxter, Mississauga, Ontario) IV and maintained on isoflurane inhalation anesthesia. The horse was placed in right lateral recumbency and then the forehead over the left maxillary and frontal sinuses was clipped and aseptically prepared. The horse was draped to expose the left frontoconchal sinus.

The rostral incision was 4 cm long and perpendicular to the midline at the level of the infraorbital foramen. The lateral incision was made along the axial aspect of the facial crest and the caudal incision extended from the axial to medial canthus to the midline. This created a 3-sided box with midline uninter-rupted. The skin was then reflected 2 cm from the edges of the incisions, as was the periosteum. To access the left frontoconchal sinus, an oscillating saw was used to create a frontoconchal sinus bone flap. The flap was elevated using blunt dissection and force to hinge the flap on the axial portion of the flap. An irregular cartilaginous, friable mass was discovered in the left frontal conchal sinus. The mass extended into the left rostral and caudal maxillary, ventrochonchal and dorsochoncal sinuses, and invaded the nasopharynx ventrally. A lavage with 500 mL lactated Ringer’s solution impregnated with 10 million IU of sodium penicillin was carried out and the mass was resected to the point of invasion into the nasopharynx but could not be resected further. The owner opted to have the mare euthanized during surgery.

A necropsy was not performed. Samples of the mass were sent to Prairie Diagnostic Services for histology, cytology, and culture. The mass was a malignant anaplastic sarcoma. The neoplasia was composed of interlacing and irregularly arranged polygonal to spindle-shaped cells with oval to slender nuclei. The cells were highly pleomorphic with marked anisocytosis and anisokaryosis. Mitosis was marked, and multinucleated neoplastic cells were observed.

Bacterial culture from a swab of the sinus mass revealed the presence of Escherichia coli as the predominant microbe. Staphylococcus and Streptococcus species were also identified. The E. coli was multi-drug resistant, susceptible to amikacin and enrofloxacin, intermediately resistant to gentamicin, and resistant to all other antimicrobials tested.

DiscussionAnaplastic sarcomas of the sinonasal region are rare in equids and other species (1–3,5,7). In horses only about 1% of all head and neck neoplasms are sarcomas (5). This neoplasm has clinical signs that are similar to those caused by neoplastic and non-neoplastic tumors, making definitive diagnosis difficult. Sinonasal tumors are most often diagnosed in the late stages of disease, once the tumor has infiltrated surrounding tissues, leading to clinical signs (2,5,6,8–10). As reported by Dixon et al (11), even after clinical signs are present 75% of patients with sinonasal tumors are initially treated with antibiotics. Nasal and ocular discharge and facial deformities are common clinical signs of sinonasal tumors (1,3,5), as are mastication problems (6). These clinical signs, however, are also all associated with

traumatic or infectious lesions which are more common than neoplasia (6,8).

In the present case the horse had an infection with multi-drug resistant E. coli, Streptococcus spp., and Staphylococcus spp. The referring veterinarian initially treated the horse with ceftiofur and penicillin, which were ineffective. Considering the resistance reported, these antimicrobials would not have been effective in treating the E. coli infection. The bacterial infection was most likely secondary to the anaplastic sarcoma and had treatment of this secondary infection been successful it would not have resolved the clinical signs attributed to the growing neoplasm.

The neoplasm was present in the ventrochonchal, dorsochon-cal, frontoconchal, and left caudal and rostral maxillary sinuses and extended into the nasopharynx. Sinonasal tumors most commonly originate in the caudal maxillary sinus (1); this is also seen in humans with sinonasal sarcomas (5). In the pres-ent case the mass most likely developed in the caudal maxillary sinus or the ventrochonchal sinus. From either location the mass would have been able to expand into all the affected structures. During surgery involvement of the sphenopalatine sinus was not detected, but this sinus could not be fully assessed. The mass did not appear to cross the nasal septum into the right side of the head, but this could not be confirmed.

Radiographs and endoscopy were used to identify the mass in the sinuses; however, the definitive diagnosis was reached fol-lowing surgery, histopathology, and cytology. Another option for diagnosis was using the endoscope to biopsy the mass for pathol-ogy before surgery. This would have provided the definitive diag-nosis of an anaplastic sarcoma and secondary bacterial infection. Had this approach been taken initially, it is likely that surgery would have still been performed to try to excise the sarcoma. Radiographs are currently the most common form of imaging used to diagnosis sinonasal tumors; however, radiographs do not provide as much information on location and extent of the lesion as computed tomography (CT) (6,8). The use of CT can improve surgical treatment of sinonasal tumors as better surgi-cal plans can be devised (6,8) to obtain good excisional margins (2). However, good margins are difficult to obtain unless the neoplasm is caught very early on (2). In advanced cases, like this one in which the sarcoma spread extensively, surgical treatment yields poor outcomes (6,8,9). Computed tomography can be used to diagnose these more extensive lesions, such as cribriform plate erosion, invasion of the cranium, and aggressive osteolysis, before surgery or other forms of treatment (8). Cissell et al (8) also reported that radiographs do not allow for assessment of the retrobulbar region, sphenopalatine sinus, or intracranial involvement, whereas CT does. Had CT been done on this mare the outcome, euthanasia, would likely be the same as removing the sarcoma would have left the nasopharynx communicating with the sinuses.

In humans it is more common to use radiotherapy rather than surgery as treatment for sinonasal tumors (2). Combinations of surgery, radiation, and chemotherapy had the most success in reducing the rate of recurrence and increasing survival time in humans (5,9). In dogs, radiation has been found to be more effective than surgical excision, whereas surgical excision fol-lowing radiotherapy yields similar survival times compared to



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using only radiotherapy to treat sinonasal neoplasia (10); there is evidence that this holds true for horses (9). Radiotherapy is not a prevalent treatment in horses, but there is a growing number of facilities offering radiotherapy (2). It is likely that radiotherapy would be more successful than surgical excision in treating sinonasal tumors in horses (2,10). However, had the sarcoma been treated with radiotherapy and/or complete surgical excision or any other multimodal form of treatment, a fistula would have been made connecting the ventral conchal sinus to the nasopharynx, allowing for passage of food and other ingesta into the sinuses which could then pass into the airways. Euthanasia, therefore, was the only viable option at this stage of the disease.

The present case is similar to the one other report of equine sinonasal anaplastic sarcoma (3). Clinical signs included facial swelling, unilateral nasal and ocular discharge, exophthalmos, blindness, lateral headshaking, facial pruritis, and self mutilation of the face (3). Endoscopy showed a distention of the right max-illary sinus and the mass was identified in the caudal maxillary sinus. Surgery was preformed to excise the mass, which extended from the caudal maxillary, ventrochonchal, and sphenopalatine sinuses. The horse was euthanized a few days after surgery due to increased neurologic signs. At necropsy, sclerosis and necrosis of the sinus walls, and loss of the bone separating the optic and trigeminal nerves at the optic chiasm were discovered. Histopathology showed plump spindle cells with pale ovoid nuclei such that the mass was deemed an anaplastic sarcoma. In the present case there were no neurologic signs, and the sarcoma did not infiltrate the optic chiasm or any other cranial nerves.

In the one other reported case of anaplastic sarcoma in the sinonasal region, the mare also had a secondary infection with E. coli that had a high level of antibiotic resistance. Both cases highlight the difficulty in treating sarcomas of the sinonasal region in horses.

AcknowledgmentsThe author thanks Drs. Chris Bell and Kris Torske at Elders Equine Veterinary Service for their skill, guidance, and support; the clinic staff for their help and dedication to patient care; and Dr. Yanyun Huang, the pathologist at Prairie Diagnostic Services, for his interpretation and report. CVJ

References 1. Head KW, Dixon PM. Equine nasal and paranasal sinus tumours.

Part 1: Review of the literature and tumour classification. Vet J 1999; 157:261–278.

2. Dixon PM. Equine sinonasal tumors: Does reporting of single case series still advance the neglected field of equine clinical oncology. Equine Vet Educ 2015;27:592–594.

3. Dixon PM, Head KW. Equine nasal and paranasal sinus tumors. Part 2: A contribution of 28 case reports. Vet J 1999;157:279–294.

4. Nickels FA. Nasal passages and paranasal sinuses. In: Auer JA, Stick JA, eds. Equine Surgery. 4th ed. St. Louis, Missouri: Elsevier, 2012: 557–568.

5. Kauke M, Safi AF, Grandoch A, Nickenig HJN, Zoller J, Kreppel M. Sarcomas of the sinonasal tract. Head Neck 2018;40:1279–1286.

6. Veraa S, Dijkman R, Klein WR, van den Belt AJM. Computed tomog-raphy in the diagnosis of malignant sinonasal tumours in three horses. Equine Vet Educ 2010;21:284–288.

7. Hanna A, Stieger-Vanegas SM, Heidel JR, Esser M, Schlipf J, Mecham J. Nasal adenocarcinoma in a horse with metastasis to lung, liver and bone and review of metastasis in nine horses with sinonasal tumors. Case Reports Vet Med 2015;Vol 2015; article ID 845870.

8. Cissell DD, Wisner ER, Textor JF, Mohr C, Scrivani PV, Theon AP. Computed tomographic appearance of equine sinonasal neoplasia. Vet Radiol Ultrasound 2011;53:245–221.

9. Gore MR. Treatment, outcomes, and demographics in sinonasal sar-coma: A systematic review of the literature. BMC Ear Nose Throat Disord 2018;18:4 doi: 10.1186/s12901-018-0052-5.

10. Bowles K, DeSandre-Robinson D, Kubicek L, Lurie D, Milner R, Boston SE. Outcome of definitive fractionated radiation followed by exenteration of the nasal cavity in dogs with sinonasal neoplasia: 16 cases. Vet Comp Oncol 2014;14:350–360.

11. Dixon PM, Parkin TD, Collins N, et al. Historical and clinical features of 200 cases of equine sinus disease. Vet Rec 2011;169:439.

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The Art of Private Veterinary Practice L’art de la pratique vétérinaire privée

W hen former veterinary college classmates Drs. Casale and Marchetti run into each other at a veterinary confer-

ence, they immediately agree to have dinner together to catch up. During that meal they discover that they both had become practice owners and that their practice philosophies were quite similar.

“But there’s one aspect of my philosophy that I felt so sure about when I became a practice owner that I’m not nearly so sure about now,” Dr. Casale says thoughtfully during a lull in the conversation. “I believed everyone in the practice always should put concern for the animals first and said this to every new employee. I’d worked in a practice where this wasn’t the case and it was awful. But something that happened last year reminded me of the gap between conversation and communication.”

On one hand, it did not surprise Dr. Marchetti that Dr. Casale changed her mind because a recurrent theme as they updated each other about their activities was how many of their ideas had changed over the years. On the other hand, he remembered how passionately she felt as a student about eventu-ally owning a practice in which every staff member would love animals and every animal and client would know this. Although he knew that his more practical as well as reserved food animal clients valued his and his staff ’s competence more highly than public displays of their inner feelings, he could see the benefits of such a positive-emotion-based orientation in a companion animal practice such as Dr. Casale’s. Naturally he asked her what caused her to rethink her orientation.

“It began when Josie, one of the young women who does kennel work, discovered a large, scruffy-looking dog lurking behind the clinic when she arrived for work one day,” Dr. Casale began to describe the event that changed more than her practice philosophy. “The dog was highly aggressive, but also very thin and she felt confident that all he needed was food and love.”

At that time, Dr. Casale saw no reason to question her employee’s reasoning. Within a matter of hours, the dog would accept treats from Josie and even allowed her to lure him into the clinic and into a run. Within a matter of days, the dog would allow her to pet him. However, this generated 2 conse-quences that almost destroyed the trust and rapport between Dr. Casale and her staff that the practitioner had worked so hard to cultivate. The more tolerant the dog became of Josie, the less tolerant he became of all other people and animals, and the more Josie became convinced that all he needed was someone who loved him as much as she did.

“Of course, as is often the case in these situations, that ‘someone’ wasn’t her,” Dr. Casale continued. “Josie already had a rescue who hated other dogs and only accepted a handful of people. There was no way she could keep the dog. None of the rest of the staff wanted to take the dog either. But unlike Josie, they suspected the same thing I did — that the dog most likely was a transport with strong street rather than pet dog roots that somebody dumped when he hurt someone. None of us had the time and energy, let alone the desire to take on such a canine project. I can’t tell you how many shelters and behavioral profes-sionals I contacted, and they all said the same thing: If the dog could be helped — and that was a big if — it would take time and commitment. And one of those professionals cautioned me about liability issues related to placing a dog like that as well as having the animal in the clinic — as if I didn’t think about that every day!”

At the same time, other staff members gradually adopted 1 of 3 orientations. Josie’s closest co-workers saw saving the dog at all costs as the perfect solution. Others saw this as a laudable, but impractical solution for many reasons. A third group opted to stay out of the discussion completely. These differing orienta-tions periodically became personal and disrupted the harmony in which the staff previously had worked.

Ultimately several circumstances brought the problem to a head. Some were practical. The dog required resources Dr. Casale and the staff needed for other patients. They could not place other animals in cages or runs near the dog because his aggressive displays stressed them. Whatever else this may have communicated to the practice’s clients, subjecting their animals to such canine harassment would not communicate

Too much of a good thing

Myrna Milani

Dr. Milani is a behavior and bond practitioner, teacher, and author of several books on the interaction of animal behavior, health, and the human-animal relationship.Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.



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that the practice put their patients first. And even though Josie bloomed in her role as the dog’s sole caregiver, it wreaked havoc with her ability to fulfill her work-related obligations. Initially other staff members pitched in to take up the slack, but over time most grew weary of the demands Josie and her canine “soul mate” placed on them.

Although Dr. Casale had mentioned the possibility of eutha-nasia several times as the number of viable options regarding the dog’s future decreased, no one wanted to upset the young woman who loved the dog so much. However, when the dog yanked the leash out of Josie’s hand and lunged at a technician and shredded his lab coat (but fortunately did only minor dam-age to his arm), Dr. Casale euthanized the dog.

“What a horrible situation!” exclaimed Dr. Marchetti. “What happened next?”

“After things calmed down, I realized that, for as much as I thought I communicated well with my staff and vice versa, that wasn’t true regarding this issue,” replied Dr. Casale. “Superficially we all agreed that concern for the well-being of our patients should play a central role in our practice philoso-phy. But Josie interpreted this to mean I agreed with her love-will-conquer-all philosophy. When she discovered I didn’t, she felt angry and betrayed.

Dr. Casale concluded the tale by noting she had 2 regrets regarding the incident, one about which she could do nothing and another that she could and did address. Her relationship with Josie was ruined and the practitioner eventually accepted that this was the way the young woman wanted to keep it. Fortunately, Josie agreed that she would be happier working somewhere else.

The practice owner’s other regret was that she had not spe-cifically addressed this issue in material given to prospective employees along with the employment application and reiter-ated it upon hiring. Instead she imparted this information informally during the job interview. In retrospect, Dr. Casale realized this denigrated the importance of the material to the employee’s success.

To correct this oversight, the veterinarian composed such a document so that there could be no misunderstanding regard-ing: a) the value the practice placed on concern for all their

patients’ well-being, and b) what this entailed. She stressed that this referred to all the animals which were hospitalized and all those seen at the veterinary clinic on any given day. It also acknowledged that, although it was normal for staff members to like certain animals compared to others, this should not interfere with every team member’s obligation to ensure that every animal received the same quality care.

Dr. Casale also provided more precise information regarding the reality of euthanasia in a veterinary practice. This included acknowledging that sometimes situations would arise when euthanasia constituted a caring response when the owner and veterinarian consider all the factors contributing to the animal’s condition. Some of these factors may be known only to the cli-ent and the veterinarian. Clients were under no obligation to justify their choice to staff members; respect for client confiden-tiality obligated the veterinarian not to share such information without the consent of the client.

Other times, the veterinarian may need to euthanize unowned animals for which no suitable homes can be found due to the severity of the animal’s problems and/or the threat these pose to others. These sad situations may be especially difficult for individuals prone to gravitate toward and develop stronger emotional ties with animals having such problems. The infor-mation Dr. Casale would provide to prospective employees acknowledged that such strong emotional ties can be beneficial with our own animals. However, all of those working in the veterinary practice must provide quality care for all the animals in their care, not just those who appeal to them for some reason. Once Dr. Casale completed her document, she shared it with her staff and practiced verbally communicating its key points, so she could provide the information naturally during the next potential employee interview.

Sometimes it is easy for busy practitioners to provide less information to lower level employees compared to those whose work is perceived as more important and more complex. But as this case demonstrates, failure to communicate in a meaningful way with those whose contribution may appear to be minimal may have maximum negative consequences. Moreover, these consequences may affect the entire staff plus all the animals in their care and the clients to whom those animals belong.



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The Canadian Veterinary Journal La Revue …...Equine sinonasal anaplastic sarcoma infected with multi-drug resistant Escherichia coli February/Février 2019 Volume 60, No. 02 February/Février