RESUMO
A 1-year-old mixed breed dog initially presented with marked ascites due to a low-protein transudate resulting from portal hypertension. Laboratory evaluation revealed non-regenerative anemia, lymphopenia, thrombocytopenia, evidence of hepatic insufficiency [hypoalbuminemia, decreased urea, increased post-prandial bile acids, prolonged activated partial thromboplastin time (aPTT)] and Ehrlichia canis infection. Approximately a week later, the dog was declining and was euthanized. On autopsy, multifocal hepatic granulomas and acquired portosystemic shunts (APSS) were seen. Imprint cytology revealed fungal hyphae and pyogranulomatous inflammation in the liver and brain. Disseminated Cladophialophora bantiana phaeohyphomycosis was diagnosed by histologic examination, culture and PCR. Immunosuppression due to ehrlichiosis is suspected to have predisposed this animal to fungal infection. To the authors' knowledge, this is the first report of C. bantiana in the West Indies.
RESUMO
BACKGROUND: Literature on the laboratory diagnosis of uroperitoneum is scarce, and it is mostly based on the biochemical findings of cavitary fluid and serum. Cell count and protein concentrations measurements are rarely used and available studies on this subject are based on a relatively small cohort of individuals. OBJECTIVES: We aimed to use a large sample pool of dogs to establish cutoff points for biochemical analytes in cavitary fluids and serum for the diagnosis of uroperitoneum. We also sought to evaluate the general classification of these cavitary fluids. METHODS: In a retrospective and prospective study, 180 canine abdominal effusion cases were evaluated, 30 of which were uroperitoneum (uroperitoneum group, UG) and 150 with other etiologies (non-uroperitoneum group, NUG). RESULTS: The results showed that 83.3% of UG and 12.7% of NUG abdominal fluid cases were not classified as transudates or exudates. The use of specific cutoffs for fluid creatinine concentrations (≥2.1 mg/dL) and fluid:serum creatinine ratios (Cf: Cs ≥ 1.25) in these unclassified effusions resulted in an accuracy of 99.0% for the laboratory diagnosis of uroperitoneum. CONCLUSIONS: The adoption of a new set of criteria and cutoffs based on the combination of parameters such as TP, TNCC, fluid creatinine and Cf: Cs improves the diagnosis of uroperitoneum in dogs.
Assuntos
Doenças do Cão , Derrame Pleural , Animais , Técnicas de Laboratório Clínico/veterinária , Doenças do Cão/diagnóstico , Cães , Exsudatos e Transudatos , Humanos , Derrame Pleural/veterinária , Estudos Prospectivos , Estudos RetrospectivosRESUMO
BACKGROUND: The classification of effusions in human medicine currently uses biochemical parameters of verified analytical accuracy, while veterinary medicine is traditionally guided by protein content (TP) and total nucleated cell count (TNCC) in the effusion, without solid scientific support. OBJECTIVE: We aimed to assess the accuracy of the current veterinary classification system to distinguish transudates from exudates and create new tools involving biochemical parameters that better classify canine cavitary effusions. METHODS: Clinical, laboratory, and imaging data from 250 canine pleural and peritoneal effusions were retrospectively and prospectively collected, organized, and statistically evaluated. Multiple logistic regression analysis was performed using biochemical and cellular parameters. RESULTS: For identifying exudates, the accuracy (87.7%, n = 204) of the best traditional classification system (TNCC > 3000 cells/µL) was similar to that of the individual biochemical cutoff values with the greatest accuracy in the abdominal cavity (eg, cholesterol, CHO-E > 40.1 mg/dL, 87.3%, n = 55). The accuracy of albumin (ALB-E > 0.8 g/dL) in the pleural cavity was nonetheless higher (100%, n = 23). The best multiple predictive models for any cavity used the percentage of neutrophils and CHO-E (n = 72), presenting an accuracy, sensitivity, and specificity for the diagnosis of exudate of 88%, 96%, and 67%, respectively. CONCLUSIONS: Biochemical classification of pleural effusions has a higher accuracy than the traditional system (based on TP and TNCC). Utility and cutoff of analytes are different for each cavity. Implementing a multiple regression model or establishing ratios or gradients with concurrent serum values adds no significant improvement in the diagnostic potential of distinguishing transudate and exudates in dogs.
Assuntos
Doenças do Cão , Derrame Pleural , Albuminas , Animais , Líquido Ascítico , Doenças do Cão/diagnóstico , Cães , Exsudatos e Transudatos , Derrame Pleural/diagnóstico , Derrame Pleural/veterinária , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: There is disagreement in the literature about the proportion of neutrophils expected in canine transudates. A cutoff of <30% neutrophils has been recommended for distinguishing transudates from exudates, but its validity has not been established. OBJECTIVE: The aim of this study was to evaluate differential cell counts in canine effusions and analyze the percentage and number of neutrophils in transudates and exudates. METHODS: Effusion data were obtained retrospectively from 263 dogs with pleural or peritoneal effusion. Low-protein transudates, high-protein transudates, and exudates were classified using the total protein (TP) concentration and total nucleated cell count (TNCC). Differential percentages and absolute neutrophil counts were compared by the effusion type and underlying etiology. RESULTS: Low-protein transudates (n = 63), high-protein transudates (n = 84), and exudates (n = 77) had a median (range) of 35% (0%-100%), 59% (0%-100%), and 90% (50%-98%) neutrophils (P < .0001). All effusions with <50% neutrophils were transudates, but 53% of transudates had ≥50% neutrophils, and 69% had ≥30%. Median neutrophil counts were 62/µL (0-892/µL), 538/µL (0-4550/µL), and 45 590/µL (5400-496 800/µL) in low-protein transudates, high-protein transudates, and exudates, respectively (P < .0001). Neutrophil counts correlated with TNCC (r2 = 0.99), such that using neutrophil cutoffs did not affect effusion classifications in most cases. Neutrophil percentages and counts were higher in effusions from dogs with uroabdomen and sepsis (P < .01); neutrophil counts were lower in dogs with hepatic insufficiency (P < .0001). Uroabdomen usually caused low-protein, high-neutrophil exudates. CONCLUSIONS: Although effusions with <50% neutrophils are transudates, most transudates and exudates have ≥50% neutrophils, limiting the diagnostic usefulness of % neutrophils for classifying effusions. Absolute neutrophil cutoffs did not notably improve effusion classification but could warrant future studies.