Long-term survival in a dog with meningoencephalitis and epidural abscessation due toActinomycesspecies

Abstract

A 2-year-old, female spayed Golden Retriever dog was presented to The Ohio State University Veterinary Medical Center for evaluation of ataxia, cervical pain, 1 episode of acute collapse, dull mentation, and inappetence. Physical examination revealed an elevated temperature of 39.7°C and severe cervical pain. Blood work revealed a mature neutrophilia. Cerebrospinal fluid (CSF) analysis revealed nondegenerative neutrophilic pleocytosis with no infectious agents. A presumptive diagnosis of steroid-responsive meningitis-arteritis was made, and corticosteroid therapy was started. The patient improved initially but experienced a vestibular episode characterized by falling and vertical nystagmus. A magnetic resonance imaging of the brain revealed an epidural abscess in the cervical vertebral canal and diffuse meningeal enhancement in the brain and cranial cervical spine. Abscess drainage revealed degenerate neutrophils and several filamentous, branching organisms. Culture of the initial CSF using an enrichment broth revealed growth of a Gram-positive organism 5 days after fluid collection. The isolate was identified by partial 16S ribosomal DNA sequencing as Actinomyces spp. The patient was successfully treated with long-term antibiotics. Our study reports the long-term survival after medical treatment of bacterial meningoencephalitis and epidural abscessation due to Actinomyces sp. infection in a dog. Bacterial meningoencephalitis should be included as a differential diagnosis in patients with cervical pain and fever, even when a nondegenerative neutrophilic pleocytosis is found on CSF analysis. Culture of the CSF with use of an enrichment broth should be considered in all cases of neutrophilic pleocytosis to rule out infections of the central nervous system.

Successful medical management of an epidural abscess in a dog

“…MRI has recently been reported as the imaging test of choice for the diagnosis of SEA (Nykamp and others 2003, Schmiedt and Thomas 2005, Song and others 2015). In the present case, a lesion consistent with SEA was identified by MRI, in addition to positive blood cultures with a pathogen commonly involved in this type of lesion ( Staphylococcus species).…”

“…Successful medical management has been recently described in veterinary medicine suggesting that non-surgical treatment should also be considered (Granger and others 2007, Escriou and others 2011, Song and others 2015, Monteiro and others 2016). …”

“…Epidural infections can present as a diffuse purulent exudate in a natural cavity without a capsule (empyema) or in a newly formed cavity (abscess) (Lavely and others 2006, Remedios and others 1996). The former is uncommonly reported in the veterinary literature and the latter has only rarely been described (Cherrone and others 2002, Linon and others 2014, Nykamp and others 2003, Schmiedt and Thomas 2005, Lavely and others 2006, De Stefani and others 2007, Granger and others 2007, Escriou and others 2011, Linon and others 2014, Song and others 2015, Monteiro and others 2016). Although both terms are distinct, they are usually used interchangeably in the literature.…”

“…Spinal epidural abscesses (SEAs) are rarely reported in veterinary medicine (Cherrone and others 2002, Schmiedt and Thomas 2005, Linon and others 2014). Infection results from haematogenous bacterial spread or direct local extension (Cherrone and others 2002, Lavely and others 2006, Song and others 2015, Monteiro and others 2016). The most common bacteriae isolated as the causative agent for spinal epidural infections in human beings and dogs are Staphylococcus and Streptococcus species (Linon and others 2014, Cherrone and others 2002, Monteiro and others 2016, Schmiedt and Thomas 2005).…”

“…Although historically myelography has been the most widely used diagnostic tool (Schmiedt and Thomas 2005). The current treatment of choice is surgical drainage and decompression (Lavely and others 2006, Granger and others 2007), although medical management has recently been described (Escriou and others 2011, Song and others 2015, Song and others 2015, Monteiro and others 2016) suggesting non‐surgical treatment should also be considered an option.…”