{"title":"犬多骨性椎体骨髓炎和肌炎伴琥珀酸厌氧菌菌血症。","authors":"T. Liatis, A. Skarbek, C. Jones, S. Wyatt","doi":"10.1111/jsap.13814","DOIUrl":null,"url":null,"abstract":"<p>A 12-year-old male neutered Dachshund presented following a 3-week history of lethargy, hyporexia, pyrexia and spinal pain, which acutely progressed to non-ambulatory paraparesis. Amoxicillin-clavulanate 20 mg/kg intravenously was administered once 1 day prior. The dog was diagnosed with sterile panniculitis 4-years prior and has since been maintained on oral prednisolone (currently 0.8 mg/kg once on alternate days). Physical examination revealed pyrexia and generalised poor muscling. Neuroanatomical localisation was consistent with a T3-L3 myelopathy. Haematology revealed inflammatory leukogram, and anaemia (28.5%, reference intervals [RI]: 37% to 55%), whilst serum biochemistry revealed increased C-reactive protein (167.6 mg/L, RI <10 mg/L). CT revealed polyostotic osteolytic lesions affecting multiple vertebrae (Fig 1), the right eleventh rib, iliac wings and left scapula. Additionally, there were thickened heterogeneously hyperattenuating and moderately enhancing paraspinal soft tissues and a cranial mediastinal lymphadenomegaly. Differential diagnoses included vertebral osteomyelitis (bacterial/fungal) or neoplasia (multiple myeloma/multifocal osteosarcoma). Urinalysis was unremarkable including negative Bence-Jones proteins. CT-guided cytology of T5 and L3 vertebrae and paraspinal muscles suggested neutrophilic inflammation, whilst hepatic and splenic cytology were unremarkable. Bone marrow cytology and biopsy from the right ilium revealed myeloid hyperplasia without evidence of microorganisms or neoplastic cells. Bacterial and fungal cultures from urine and bone marrow were negative. Blood culture was positive to <i>Anaerobiospirillum succiniciproducens</i> and a diagnosis of suspected bacterial vertebral osteomyelitis and myositis was made. Concurrent meningomyelitis cannot be excluded as cerebrospinal fluid analysis was not performed. Treatment with amoxicillin-clavulanate for 12 weeks and multimodal analgesia was initiated, and prednisolone was discontinued. At 8-weeks, the dog was comfortable but remained non-ambulatory, and subsequently had a relapse of clinical signs (pyrexia, anorexia and marked spinal hyperaesthesia) 4 weeks after discontinuation of antibiotics. <i>A. succiniciproducens</i> is a rare anaerobic bacterium considered part of the normal gastrointestinal microbiota in dogs and it has been implicated in sporadic cases of bacteraemia, usually in immunocompromised human patients. In this case, chronic immunosuppression was proposed as a cause for opportunistic bacterial infection with a commensal species. Urine and bone marrow cultures may be negative due to prior use of antibiotics or their low sensitivity in regions with mild lesions and low microbial burden (e.g., iliac bone).</p>","PeriodicalId":17062,"journal":{"name":"Journal of Small Animal Practice","volume":"66 3","pages":"215"},"PeriodicalIF":1.7000,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jsap.13814","citationCount":"0","resultStr":"{\"title\":\"Polyostotic vertebral osteomyelitis and myositis in a dog with Anaerobiospirillum succiniciproducens bacteraemia\",\"authors\":\"T. Liatis, A. Skarbek, C. Jones, S. Wyatt\",\"doi\":\"10.1111/jsap.13814\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>A 12-year-old male neutered Dachshund presented following a 3-week history of lethargy, hyporexia, pyrexia and spinal pain, which acutely progressed to non-ambulatory paraparesis. Amoxicillin-clavulanate 20 mg/kg intravenously was administered once 1 day prior. The dog was diagnosed with sterile panniculitis 4-years prior and has since been maintained on oral prednisolone (currently 0.8 mg/kg once on alternate days). Physical examination revealed pyrexia and generalised poor muscling. Neuroanatomical localisation was consistent with a T3-L3 myelopathy. Haematology revealed inflammatory leukogram, and anaemia (28.5%, reference intervals [RI]: 37% to 55%), whilst serum biochemistry revealed increased C-reactive protein (167.6 mg/L, RI <10 mg/L). CT revealed polyostotic osteolytic lesions affecting multiple vertebrae (Fig 1), the right eleventh rib, iliac wings and left scapula. Additionally, there were thickened heterogeneously hyperattenuating and moderately enhancing paraspinal soft tissues and a cranial mediastinal lymphadenomegaly. Differential diagnoses included vertebral osteomyelitis (bacterial/fungal) or neoplasia (multiple myeloma/multifocal osteosarcoma). Urinalysis was unremarkable including negative Bence-Jones proteins. CT-guided cytology of T5 and L3 vertebrae and paraspinal muscles suggested neutrophilic inflammation, whilst hepatic and splenic cytology were unremarkable. Bone marrow cytology and biopsy from the right ilium revealed myeloid hyperplasia without evidence of microorganisms or neoplastic cells. Bacterial and fungal cultures from urine and bone marrow were negative. Blood culture was positive to <i>Anaerobiospirillum succiniciproducens</i> and a diagnosis of suspected bacterial vertebral osteomyelitis and myositis was made. Concurrent meningomyelitis cannot be excluded as cerebrospinal fluid analysis was not performed. Treatment with amoxicillin-clavulanate for 12 weeks and multimodal analgesia was initiated, and prednisolone was discontinued. At 8-weeks, the dog was comfortable but remained non-ambulatory, and subsequently had a relapse of clinical signs (pyrexia, anorexia and marked spinal hyperaesthesia) 4 weeks after discontinuation of antibiotics. <i>A. succiniciproducens</i> is a rare anaerobic bacterium considered part of the normal gastrointestinal microbiota in dogs and it has been implicated in sporadic cases of bacteraemia, usually in immunocompromised human patients. In this case, chronic immunosuppression was proposed as a cause for opportunistic bacterial infection with a commensal species. 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引用次数: 0
摘要
一只12岁的雄性绝育腊肠犬在3周后出现嗜睡、缺氧、发热和脊柱疼痛,并急性发展为非行动性麻痹。阿莫西林-克拉维酸酯20 mg/kg静脉滴注,1天前1次。这只狗4年前被诊断为无菌性膜炎,此后一直口服强的松龙(目前为0.8 mg/kg,隔天一次)。体格检查显示发热和全身肌肉无力。神经解剖定位符合T3-L3脊髓病变。血液学显示炎症性白象和贫血(28.5%,参考区间[RI]: 37%至55%),而血清生化显示c反应蛋白升高(167.6 mg/L, RI <10 mg/L)。CT显示多发性骨性溶解病变累及多节椎骨(图1)、右第11根肋骨、髂翼和左肩胛骨。此外,椎旁软组织和颅纵隔淋巴结均增厚,呈非均匀高衰减和中度增强。鉴别诊断包括椎体骨髓炎(细菌性/真菌性)或肿瘤(多发性骨髓瘤/多灶性骨肉瘤)。尿液分析无显著差异,包括Bence-Jones蛋白阴性。ct引导下T5、L3椎体及棘旁肌的细胞学检查提示中性粒细胞炎症,而肝脏和脾脏细胞学检查未见明显变化。骨髓细胞学和右髂骨活检显示骨髓增生,没有微生物或肿瘤细胞的证据。尿液和骨髓的细菌和真菌培养呈阴性。血培养对产琥珀酸厌氧菌呈阳性,诊断为疑似细菌性椎体骨髓炎和肌炎。由于没有进行脑脊液分析,不能排除并发脑脊膜炎。阿莫西林-克拉维酸治疗12周,开始多模式镇痛,停用强的松龙。8周时,狗很舒服,但仍然不能走动,随后在停用抗生素4周后,临床症状(发热、厌食和明显的脊髓过敏)复发。琥珀酸甲杆菌是一种罕见的厌氧细菌,被认为是狗正常胃肠道微生物群的一部分,它与散发的菌血症病例有关,通常发生在免疫功能低下的人类患者中。在这种情况下,慢性免疫抑制被认为是与共生物种的机会性细菌感染的原因。尿液和骨髓培养可能是阴性的,因为以前使用过抗生素,或者在轻度病变和微生物负荷低的区域(如髂骨)抗生素敏感性低。
Polyostotic vertebral osteomyelitis and myositis in a dog with Anaerobiospirillum succiniciproducens bacteraemia
A 12-year-old male neutered Dachshund presented following a 3-week history of lethargy, hyporexia, pyrexia and spinal pain, which acutely progressed to non-ambulatory paraparesis. Amoxicillin-clavulanate 20 mg/kg intravenously was administered once 1 day prior. The dog was diagnosed with sterile panniculitis 4-years prior and has since been maintained on oral prednisolone (currently 0.8 mg/kg once on alternate days). Physical examination revealed pyrexia and generalised poor muscling. Neuroanatomical localisation was consistent with a T3-L3 myelopathy. Haematology revealed inflammatory leukogram, and anaemia (28.5%, reference intervals [RI]: 37% to 55%), whilst serum biochemistry revealed increased C-reactive protein (167.6 mg/L, RI <10 mg/L). CT revealed polyostotic osteolytic lesions affecting multiple vertebrae (Fig 1), the right eleventh rib, iliac wings and left scapula. Additionally, there were thickened heterogeneously hyperattenuating and moderately enhancing paraspinal soft tissues and a cranial mediastinal lymphadenomegaly. Differential diagnoses included vertebral osteomyelitis (bacterial/fungal) or neoplasia (multiple myeloma/multifocal osteosarcoma). Urinalysis was unremarkable including negative Bence-Jones proteins. CT-guided cytology of T5 and L3 vertebrae and paraspinal muscles suggested neutrophilic inflammation, whilst hepatic and splenic cytology were unremarkable. Bone marrow cytology and biopsy from the right ilium revealed myeloid hyperplasia without evidence of microorganisms or neoplastic cells. Bacterial and fungal cultures from urine and bone marrow were negative. Blood culture was positive to Anaerobiospirillum succiniciproducens and a diagnosis of suspected bacterial vertebral osteomyelitis and myositis was made. Concurrent meningomyelitis cannot be excluded as cerebrospinal fluid analysis was not performed. Treatment with amoxicillin-clavulanate for 12 weeks and multimodal analgesia was initiated, and prednisolone was discontinued. At 8-weeks, the dog was comfortable but remained non-ambulatory, and subsequently had a relapse of clinical signs (pyrexia, anorexia and marked spinal hyperaesthesia) 4 weeks after discontinuation of antibiotics. A. succiniciproducens is a rare anaerobic bacterium considered part of the normal gastrointestinal microbiota in dogs and it has been implicated in sporadic cases of bacteraemia, usually in immunocompromised human patients. In this case, chronic immunosuppression was proposed as a cause for opportunistic bacterial infection with a commensal species. Urine and bone marrow cultures may be negative due to prior use of antibiotics or their low sensitivity in regions with mild lesions and low microbial burden (e.g., iliac bone).
期刊介绍:
Journal of Small Animal Practice (JSAP) is a monthly peer-reviewed publication integrating clinical research papers and case reports from international sources, covering all aspects of medicine and surgery relating to dogs, cats and other small animals. These papers facilitate the dissemination and implementation of new ideas and techniques relating to clinical veterinary practice, with the ultimate aim of promoting best practice. JSAP publishes high quality original articles, as well as other scientific and educational information. New developments are placed in perspective, encompassing new concepts and peer commentary. The target audience is veterinarians primarily engaged in the practise of small animal medicine and surgery.
In addition to original articles, JSAP will publish invited editorials (relating to a manuscript in the same issue or a topic of current interest), review articles, which provide in-depth discussion of important clinical issues, and other scientific and educational information from around the world.
The final decision on publication of a manuscript rests with the Editorial Board and ultimately with the Editor. All papers, regardless of type, represent the opinion of the authors and not necessarily that of the Editor, the Association or the Publisher.
The Journal of Small Animal Practice is published on behalf of the British Small Animal Veterinary Association and is also the official scientific journal of the World Small Animal Veterinary Association