Consensus Statements of the American College of Veterinary Internal Medicine (ACVIM) provide the veterinary community with up-to-date information on the pathophysiology, diagnosis, and treatment of clinically important animal diseases. The ACVIM Board of Regents oversees selection of relevant topics, identification of panel members with the expertise to draft the statements, and other aspects of assuring the integrity of the process. The statements are derived from evidence-based medicine whenever possible and the panel offers interpretive comments when such evidence is inadequate or contradictory. A draft is prepared by the panel, followed by solicitation of input by the ACVIM membership which may be incorporated into the statement. It is then submitted to the Journal of Veterinary Internal Medicine, where it is edited prior to publication. The authors are solely responsible for the content of the statements. This report offers a consensus opinion on the diagnosis, epidemiology, treatment, and control of the primary enteropathogenic bacteria in dogs and cats, with an emphasis on Clostridium difficile, Clostridium perfringens, Campylobacter spp., Salmonella spp., and Escherichia coli associated with granulomatous colitis in Boxers. Veterinarians are challenged when attempting to diagnose animals with suspected bacterial-associated diarrhea because well-scrutinized practice guidelines that provide objective recommendations for implementing fecal testing are lacking. This problem is compounded by similar isolation rates for putative bacterial enteropathogens in animals with and without diarrhea, and by the lack of consensus among veterinary diagnostic laboratories as to which diagnostic assays should be utilized. Most bacterial enteropathogens are associated with self-limiting diarrhea, and injudicious administration of antimicrobials could be more harmful than beneficial. Salmonella and Campylobacter are well-documented zoonoses, but antimicrobial administration is not routinely advocated in uncomplicated cases and supportive therapy is recommended. Basic practices of isolation, use of appropriate protective equipment, and proper cleaning and disinfection are the mainstays of control. Handwashing with soap and water is preferred over use of alcohol-based hand sanitizers because spores of C. difficile and C. perfringens are alcohol-resistant, but susceptible to bleach (1:10 to 1:20 dilution of regular household bleach) and accelerated hydrogen peroxide. The implementation of practice guidelines in combination with the integration of validated molecular-based testing and conventional testing is pivotal if we are to optimize the identification and management of enteropathogenic bacteria in dogs and cats. Enteropathogenic Bacteria in Dogs and

This report presents the clinical, laboratory, imaging, and pathologic findings in 61 dogs with pheochromocytoma by retrospective evaluation of medical records. Pheochromocytomas were diagnosed by histopathologic examination of tissue specimens in all dogs. Special stains (chromogranin A and synaptophysin) also were used t o confirm the chromaffin cell origin of the tumors. Epidemiologic findings were in agreement with previous studies, indicating that pheochromocytomas affect middle-aged t o older dogs with no apparent gender or breed predilection. The tumor was considered clinical in 21 dogs (34%), was responsible for abnormalities related t o a space-occupying mass in 7 dogs (ll%), and was an incidental finding in 35 dogs (57%). The hematologic and biochemical findings were nonspecific. Hypertension was detected in 10 of 23 (43%) dogs tested, but all hypertensive dogs had concurrent diseases that may have heochromocytoma is a tumor of the chromaffin cells of P the adrenal medulla or sympathetic paraganglia'.2 that has been described in human beings, horses, cattle, dogs, cats, and laboratory rats.' Clinical diagnosis of pheochromocytoma is relatively rare.'.' A variety of vague and nonspecific clinical signs attributed to excessive secretion of catecholamines has been reported in dogs with pheochromo~y t o m a .~-* The mass effect or local invasion of structures by these tumors also can produce clinical signs. Approximately 50% of pheochromocytomas are discovered incidentally in dogs with no clinical signs or other problem caused by the tum0r.j Antemortem diagnosis of pheochromocytoma is difficult because of lack of specific clinical signs.' There are few comprehensive studies pertaining to pheochromocytomas in the veterinary literature and a paucity of information documenting the imaging diagnosis of this tumor.'.' The purpose of this study was to characterize the clinical, laboratory, imaging, and pathologic findings of pheochromocytoma in 61 dogs. findings, clinicopathologic data, imaging results, pathologic findings, and outcome for each dog. Signalment (breed and gender) of the 61 dogs was compared to that of the hospital population during the same period using chi square analysis. Hypotheses tested were accepted when P < .OS. Materials and MethodsMedical records were analyzed to determine if the tumor was clinical (group I), was responsible for abnormalities related to a space-occupying mass (group 2), or was an incidental finding (group 3). Criteria for including dogs in group 1 were selected from previous retrospective studies on pheochromocytoma'.' and included the presence of at least one of the following: weakness, lethargy; polyuria and polydipsia (PUPD); collapse, panting, dyspnea or tachypnea; vomiting, anorexia or inappetence; weight loss; seizures; tachyarrhythmias; pale mucous membranes; injected mucous membranes; fever; and cardiac arrest. Criteria for including dogs in group 2 were the presence of at least one of the following: ascites, limb edema, abdominal pain, abdominal distention, and ...

We characterized the complete genome of a novel dog circovirus (DogCV) from the liver of a dog with severe hemorrhagic gastroenteritis, vasculitis, and granulomatous lymphadenitis. DogCV was detected by PCR in fecal samples from 19/168 (11.3%) dogs with diarrhea and 14/204 (6.9%) healthy dogs and in blood from 19/409 (3.3%) of dogs with thrombocytopenia and neutropenia, fever of unknown origin, or past tick bite. Co-infection with other canine pathogens was detected for 13/19 (68%) DogCV-positive dogs with diarrhea. DogCV capsid proteins from different dogs varied by up to 8%. In situ hybridization and transmission electron microscopy detected DogCV in the lymph nodes and spleens of 4 dogs with vascular compromise and histiocytic inflammation. The detection of a circovirus in tissues of dogs expands the known tropism of these viruses to a second mammalian host. Our results indicate that circovirus, alone or in co-infection with other pathogens, might contribute to illness and death in dogs.

Background: Pancreas-specific lipase is reported to aid in diagnosing acute pancreatitis (AP) in dogs but has not been rigorously evaluated clinically.Hypothesis/Objectives: To describe variability of disease in dogs with suspected clinical AP, and to evaluate accuracy of 2 pancreatic-specific lipase immunoassays, Spec cPL (SPEC) and SNAP cPL (SNAP), in diagnosing clinical AP. We hypothesized that SPEC and SNAP provide better diagnostic accuracy than serum amylase or total lipase.Animals: A total of 84 dogs; 27 without AP and 57 with clinical signs associated with AP. Methods: Multicenter study. Dogs were prospectively enrolled based upon initial history and physical examination, then retrospectively classified into groups according to the likelihood of having clinical AP by a consensus of experts blinded to SPEC and SNAP results. Bayesian latent class analyses were used to estimate the diagnostic accuracy of SPEC and SNAP.Results: The estimates for test sensitivities and specificities, respectively, ranged between 91.5-94.1% and 71.1-77.5% for SNAP, 86.5-93.6% and 66.3-77.0% for SPEC (cutoff value of 200 lg/L), 71.7-77.8% and 80.5-88.0% for SPEC (cutoff value of 400 lg/L), and were 52.4-56. 0% and 76.7-80.6% for amylase, and 43.4-53.6% and 89.3-92.5% for lipase.Conclusions and Clinical Importance: SNAP and SPEC have higher sensitivity for diagnosing clinical AP than does measurement of serum amylase or lipase activity. A positive SPEC or SNAP has a good positive predictive value (PPV) in populations likely to have AP and a good negative predictive value (NPV) when there is low prevalence of disease.

Abstract. Despite the high prevalence of feline pancreatic disease, no detailed description on the histopathologic nature of this disease is currently available in the literature. In this study we characterize the distribution and histopathologic changes commonly found in feline pancreases, correlate the lesions with age and gastrointestinal GI and extra-gastrointestinal disease, and compare the pancreatic lesions in cats with those in humans. The entire pancreas was removed and examined from 115 cats presented for necropsy irrespective of the cause of death. Histologic sections from left limb, right limb, and body were scored for lesions of acute (AP) and chronic pancreatitis (CP) with a scoring system based on similar systems used in human and veterinary literature. The lesions of CP in cats resemble CP in humans, with fibrosis being more prominent than inflammatory changes. Cystic degeneration gradually increased as other lesions of CP were more prominent. A distinct nodular change of zymogen depletion and acinar cell dysplasia not associated with pancreatitis was prominent in 15.6% of the pancreases. Histologically, AP consisted of neutrophilic inflammation associated with interstitial edema and necrosis of mesenteric fat.An overall prevalence of 67%, and 45% in clinically normal animals, was identified. CP was found in 69 (60.0%) pancreases, and 58 (50.4%) had CP only, with a significant correlation between age and occurrence of CP. There was a statistically significant higher prevalence of CP in the left limb in animals with gastrointestinal disease. AP was present in 18 animals (15.7%) of which 7 animals had AP only (6.1%).

Background: Pancreatitis is a common disorder in dogs for which the antemortem diagnosis remains challenging. Objectives: To compare the sensitivity and specificity of serum markers for pancreatitis in dogs with histopathologic evidence of pancreatitis or lack thereof.Animals: Seventy dogs necropsied for a variety of reasons in which the pancreas was removed within 4 hours of euthanasia and serological markers were evaluated within 24 hours of death.Methods: Prospective study: Serum was analyzed for amylase and lipase activities, and concentrations of canine trypsin-like immunoreactivity (cTLI) and canine pancreas-specific lipase (cPL). Serial transverse sections of the pancreas were made every 2 cm throughout the entire pancreas and reviewed using a semiquantitative histopathologic grading scheme.Results: The sensitivity for the Spec cPL (cutoff value 400 lg/L) was 21 and 71% in dogs with mild (n = 56) or moderate-severe pancreatitis (n = 7), and 43 and 71% (cutoff value 200 lg/L), respectively. The sensitivity for the cTLI, serum amylase, and lipase in dogs with mild or moderate-severe pancreatitis was 30 and 29%; 7 and 14%; and 54 and 71%, respectively. The specificity for the Spec cPL based on 7 normal pancreata was 100 and 86% (cutoff value 400 and 200 lg/ L, respectively), whereas the specificity for the cTLI, serum amylase, and lipase activity was 100, 100, and 43%, respectively.Conclusion and Clinical Importance: The Spec cPL demonstrated the best overall performance characteristics (sensitivity and specificity) compared to other serum markers for diagnosing histopathologic lesions of pancreatitis in dogs.

Serum feline trypsinogen-like immunoreactivity (fTLI) concentrations and abdominal ultrasound have facilitated the noninvasive diagnosis of pancreatitis in cats, but low sensitivities (33% and 20-35%, respectively) have been reported. A radioimmunoassay has been validated to measure feline pancreatic lipase immunoreactivity (fPLI), but the assay's sensitivity and specificity have not been established. In human beings, the sensitivity of computed tomography (CT) is high (75-90%), but in a study of 10 cats, only 2 had CT changes suggestive of pancreatitis. We prospectively evaluated these diagnostic tests in cats with and without pancreatitis. In all cats, serum was obtained for fTLI and fPLI concentrations, and pancreatic ultrasound images and biopsies were acquired. Serum fPLI concentrations (P< .0001) and ultrasound findings (P = .0073) were significantly different between healthy cats and cats with pancreatitis. Serum fTLI concentrations (P = .15) and CT measurements (P = .18) were not significantly different between the groups. The sensitivity of fTLI in cats with moderate to severe pancreatitis was 80%, and the specificity in healthy cats was 75%. Feline PLI concentrations were both sensitive in cats with moderate to severe pancreatitis (100%) and specific in the healthy cats (100%). Abdominal ultrasound was both sensitive in cats with moderate to severe pancreatitis (80%) and specific in healthy cats (88%). The high sensitivities of fPLI and abdominal ultrasound suggest that these tests should play an important role in the noninvasive diagnosis of feline pancreatitis. As suggested by a previous study, pancreatic CT is not a useful diagnostic test for feline pancreatitis.

Background: An ultrasonographic pattern of thickened muscularis propria in the small intestine and lymphadenopathy have been associated with gastrointestinal lymphoma and inflammatory bowel disease (IBD) in cats.Objectives: To investigate the association of these imaging biomarkers with IBD and lymphoma in cats. Animals: One hundred and forty-two cats with a histologic diagnosis of normal small intestine (SI) (n 5 56), lymphoma (n 5 62), or IBD (n 5 24).Methods: Retrospective case review. Pathology records from 1998-2006 were searched for cats with a diagnosis of normal, IBD, or lymphoma, an ultrasonographic examination o28 days before surgery, and without ultrasonographic evidence of a mass. Multinomial regression analysis was used to determine the association of imaging biomarkers with disease status.Results: Cats with thickening of the muscularis propria detected by ultrasonographic examination were more likely to have lymphoma compared with normal SI cats (odds ratio [OR] 5 4.0, 95% confidence interval [95% CI] 1.2-13.1, P 5 .021) and those with IBD (OR 5 18.8, 95% CI 2.2-162.7, P 5 .008). Histologic samples of cats with muscularis propria thickening were more likely to have disease infiltrates in both the mucosal and submucosal layers (OR 5 8.1, 95% CI 1.7-38.4, P 5 .008) than cats with normal SI. Cats with ultrasonographic evidence of lymphadenopathy were more likely to have a diagnosis of lymphoma (OR 5 44.9, 95% CI 5.1-393.0, P 5 .001) or IBD (OR 5 10.8, 95% CI 1.1-106.3, P 5 .041) than normal SI. Fifty-six of 62 cats had confirmed or presumptive diagnosis of diffuse T-cell lymphoma.Conclusions and Clinical Relevance: Older cats with muscularis layer thickening are more likely to have T-cell lymphoma than IBD. The ultrasonographic pattern is associated with histologic infiltrates in the mucosal and submucosal layers of small intestine. Lymphadenopathy is associated with lymphoma or IBD.