The newSEE CE Schedule INSIDE & on a Referralremovable Contact postcard! Info Partners In Care Veterinary Referral News from Angell Animal Medical Center Fall 2015 π Volume 9:3 π angell.org π facebook.com/AngellReferringVeterinarians CARDIOVASCULAR HEALTHY INTERACTION BETWEEN CANINE CUTANEOUS FELINE TOOTH BARTONELLA LEPTOSPIROSIS EFFECTS OF SYSTEMIC JUVENILE PET BIRDS AND MAST CELL TUMOR RESORPTIONS HYPERTENSION IN CATS VETERINARY PROFESSIONALS PAGE 1 PAGE 1 PAGE 3 PAGE 6 PAGE 8 PAGE 10 INTERNAL MEDICINE ONCOLOGY Bartonella Canine Cutaneous Mast π Maureen C. Carroll DVM, DACVIM Cell Tumors: Updates angell.org/internalmedicine in Grading, Prognostic [email protected] 617-541-5186 Markers, and Therapy π Ivan Martinez, DVM, DACVIM (Internal Medicine and Medical Oncology) angell.org/oncology 617-541-5136 [email protected] s veterinarians, we are expected to be experts in the field of ast cell tumors (MCTs) are the most common cutaneous infectious disease. As a result, we must now become learned in tumor in dogs, representing around 16-21% of all skin more and more infectious organisms that not only tumors, and may occur as solitary nodules or multiple affect our veterinary patients but can also infect the human masses.1 Mast cell tumors may also present at non- Acounterparts with whom these animals are associated. Flea and Mcutaneous sites, including a visceral form affecting liver, spleen, tick-borne diseases are at the center of our attention as veterinarians, and abdominal lymph nodes, bone marrow, or the gastrointestinal tract. our knowledge of Bartonella is evolving rapidly. Although much Overall, MCTs have an extremely wide range of clinical appearances, with has been learned about this organism in the past two decades, years varied biologic behavior and prognosis, and therefore therapy is not of research are likely necessary to fully understand the spectrum of uniform for all and must be tailored to the specific situation of each its pathogenicity. individual patient. This can add to confusion when discussing the various treatment options with pet owners. Bartonella was originally isolated from an HIV-infected person, and was first diagnosed in a dog (1993) diagnosed with endocarditis. In general For the particular case of cutaneous MCTs, multiple factors can help us this organism is now known to be associated with cases of endocarditis predict biologic behavior and therefore guide our therapeutic and myocarditis, granulomatous disease, chronic intravascular infection, recommendations. The most consistent and reliable of such factors is the and vasoproliferative disorders in humans and animals. tumor grade, which only can be determined from histopathology (not cytology) and therefore requires removal or biopsy of the tumor. Historically Today there are 32 named and many other unnamed species of Bartonella. MCTs are divided into 3 different grades (I-II-III or low-intermediate-high Among the many species, we do know that B. henselae and B. clarridgeiae based on Bostock and Patnaik grading systems), where low-grade MCTs are can be pathogenic in cats; B. vinsonii (berkhoffi i) and B. clarridgeae in relatively non-aggressive with a low chance of metastasis (<10-20%), high- dogs. Exposure to these serovars can be found throughout most of the grade MCTs are aggressive and have a metastatic potential of 55-96%, and United States and the world. intermediate-grade (or grade II) MCTs are a “gray area,” where some behave (CONTINUED ON NEXT PAGE) (CONTINUED ON PAGE 4) 1. INTERNAL MEDICINE INTERNAL MEDICINE INTERNAL Bartonella is a very fastidious gram negative in dogs. B. vinsonii in dogs can cause chronic Sample submissions for all Bartonella testing rod that remains in a mammalian host as an intraerythrocytic and intraendothelial infections can go to Galaxy Laboratories or Colorado intraerythrocytic and interendothelial bacteria, that can result in vasoproliferative disease, in State University: and can remain so for a prolonged period of addition to endocarditis (Boxers over represented), time. Other cell targets for this organism myocarditis, peliosis hepatis, granulomatous www.galaxylaboratories.com include: microglial cells, macrophages, and disease, granulomatous hepatitis, lymphadenitis, csu-cvmbs.colostat.edu CD34 bone marrow progenitor cells, which rhinitis, epistaxis, encephalitis, skin lesions, may play a role in cytopenias we can observe vasculitis, panniculitis, polyarthritis, uveitis, TREATMENT with Bartonella (humans and dogs). and meningitis, among others. Sometimes Azithromycin is no longer recommended, as dogs can present with only fever of unknown TRANSMISSION Bartonella develops rapid resistance to this drug. origin and epistaxis. Bartonella spp is transmitted by more vectors The recommended therapy includes Doxycycline than any other infectious agent: ticks, Hematologically, monocytosis and eosinophilia 10 mg/kg po/12-24 combined with a sandflies, human lice, cat fleas, rodent fleas, can be observed in ~1/3 of dogs; thrombocytopenia fluoroquinolone for 4-6 weeks. and horn flies. In cats Bartonella is found most in ~50%, and anemia is also common. As in cats, frequently in flea-infested animals; in dogs biochemical abnormalities are uncommon. Doxycycline as a sole therapeutic will not clear the tick is the usual vector of transmission, most Bartonella infections. although fleas are also a vector. In flea endemic DIAGNOSIS areas, seroprevalence in cats can be as high as PUBLIC HEALTH As a rule of thumb for the diagnosis for any 90%; bacteremia rates 50% and greater. As this disease: A “positive” result on a blood test or a Bartonella spp can be transmitted to dogs, cats, organism can live in flea dirt for >9 days, culture does not necessarily prove causation for and humans via flea or tick bites, or via the year-round flea control is very important. bite, lick, or scratch from a bacteremic animal. Transmission between animals and humans disease. We can observe false positive and false negative results in both bacteremic and non- Infected flea dirt in the mouths, fur, or nails of can occur via scratch with a claw contaminated animals are also risk factors to humans. Flea with flea dirt, or via open wounds in contact bacteremic patients. and tick control is therefore imperative in with flea dirt, or from biting or licking from preventing transmission of this organism to infected animals. Dogs: Serology for antibodies to B. vinsonii (berkoffii) is a very specific test, as <4% of sick humans. As mentioned earlier, the human BARTONELLA IN CATS dogs are seropositive. Therefore, a positive is disease manifestations are very similar to the canine, and therefore can result in significant Although controlled studies in cats are limited, indication of exposure and/or active disease and should be treated. Because the sensitivity morbidity to the human population, veterinarians our knowledge continues to evolve. Bartonella most importantly! Any fluid—blood, body of antibody detection is so low, combined henselae lives in the cat flea. Cats infested with cavity, joint, cerebrospinal fluid, etc.—from an testing is recommended for dogs. The tests of fleas are 40% more likely to be Bartonella infected animal can harbor live organisms. choice are a combination of 1. and 2. below: positive on serology or PCR than cats without Proper and safe specimen handling at all times fleas. Alternatively, there is a high prevalence 1. PCR (blood) is of paramount importance among those in rate in non-clinical carriers in the general cat the veterinary community. population, thereby hindering our ability 2. BAPGM culture (insect medium) to establish disease causation, regardless of on blood flea status. Cats: Testing should be reserved for cats with For more information, please contact Angell’s Although we often associate Bartonella with suspected clinical disease due to prevalence of Internal Medicine service at 617-541-5186 or [email protected]. endocarditis and myocarditis, these manifestations subclinical carrier state in this species. are usually observed in research settings in cats. Cats who present with clinical signs associated Serology for antibody detection in cats can be with naturally acquired Bartonella usually suffer useful for determining exposure; however, due from fever and lymphadenopathy, lethargy, to the carrier state, its usefulness as a sole test uveitis, gingivitis, and sometimes neurological is questionable. PCR on whole blood for DNA symptoms. If one examines a patient with these detection, however, is often positive before symptoms that is flea-infested, Bartonella should seroconversion occurs, so using this diagnostic be on the list of differentials. in addition to serology will be of better Interestingly, Bartonella in cats usually does diagnostic utility in sick cats. Culture on blood not result in any biochemical or hematological can also be performed in lieu of PCR. abnormalities. Therefore, testing of choice in cats is a combination BARTONELLA IN DOGS of 1. and 2. below: Although the full spectrum of disease 1. PCR or BAPGM culture on blood manifestations in dogs is unclear, we do know that human bartonellosis mimics what we see 2. Serology for antibody detection (blood) 2. Partners In Care π Fall 2015 π Volume 9:3 DENTISTRY DENTISTRY Feline Tooth FIGURE 1 FIGURE 2 Resorptions π William Rosenblad, DVM angell.org/dentistry [email protected] 617-524-5643 eline tooth resorptions are a progressively destructive disease of cat teeth. They have been previously known as resorptive lesions,