Addiction LXXVII
03-04-20, 08:11 PM
#7226
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I just tried. I guess you need to log in on a computer to start a club. Couldn’t do it on my phone, and I don’t bring a computer with me to work.....
03-04-20, 08:15 PM
#7227
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Yes dogs get fungal infections in the nasal passages especially aspergillus and cryptococcus. German shepherds are known to fairly commonly have an immune “blind spot” to aspergillus. But because of this, they usually have diffuse disease if they get it in the CNS, rather than a fungal granuloma. They typically present with a snotty nose for nasal aspergillus (which happens without the immunodeficiency aspect of things). Anyway, I had considered fungal testing when I first saw him because his white count and his globulins were both elevated. But he also had a generalized skin infection likely associated with the hypothyroidism so I decided to treat that first before doing the fungal testing. His globulins have normalized with antibiotics for the skin, but his white count is still elevated. So it could be fungal, with an atypical presentation. But whatever this is will turn out to be atypical, if I can figure it out. The normal CSF white count also argues against a primary inflammatory disease although with a granuloma CSF could be normal.
Cats frequently present with CNS cryptococcus as a solitary granuloma but dogs usually have a more disseminated encephalitis, it would be atypical for CSF to be normal.
Side interesting note: I just had a case of CNS crypto in a cat two weeks ago. I do my own CSF cell counts because we don’t have an in-house lab. You know the case is a doozy whopper when you see numerous crypto organisms on an unstained hemocytometer sample! Just rechecked the cat who is doing fabulously well.
03-04-20, 08:35 PM
#7228
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Yes it could be paraneoplastic. Not a common syndrome in a dog to have a paraneoplastic coagulopathy but possible.
03-04-20, 08:38 PM
#7230
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I can see the cribiform plate and the causal (aka posterior) nasal passage and frontal sinus on the MRI. The temporal lobe mass is nowhere near the cribiform plate and there’s definitely not a nasal lesion extending into the brain. When I CT his nose, I will be looking at the more rostral aka anterior nasal passages.
Yes dogs get fungal infections in the nasal passages especially aspergillus and cryptococcus. German shepherds are known to fairly commonly have an immune “blind spot” to aspergillus. But because of this, they usually have diffuse disease if they get it in the CNS, rather than a fungal granuloma. They typically present with a snotty nose for nasal aspergillus (which happens without the immunodeficiency aspect of things). Anyway, I had considered fungal testing when I first saw him because his white count and his globulins were both elevated. But he also had a generalized skin infection likely associated with the hypothyroidism so I decided to treat that first before doing the fungal testing. His globulins have normalized with antibiotics for the skin, but his white count is still elevated. So it could be fungal, with an atypical presentation. But whatever this is will turn out to be atypical, if I can figure it out. The normal CSF white count also argues against a primary inflammatory disease although with a granuloma CSF could be normal.
Cats frequently present with CNS cryptococcus as a solitary granuloma but dogs usually have a more disseminated encephalitis, it would be atypical for CSF to be normal.
Side interesting note: I just had a case of CNS crypto in a cat two weeks ago. I do my own CSF cell counts because we don’t have an in-house lab. You know the case is a doozy whopper when you see numerous crypto organisms on an unstained hemocytometer sample! Just rechecked the cat who is doing fabulously well.
Yes dogs get fungal infections in the nasal passages especially aspergillus and cryptococcus. German shepherds are known to fairly commonly have an immune “blind spot” to aspergillus. But because of this, they usually have diffuse disease if they get it in the CNS, rather than a fungal granuloma. They typically present with a snotty nose for nasal aspergillus (which happens without the immunodeficiency aspect of things). Anyway, I had considered fungal testing when I first saw him because his white count and his globulins were both elevated. But he also had a generalized skin infection likely associated with the hypothyroidism so I decided to treat that first before doing the fungal testing. His globulins have normalized with antibiotics for the skin, but his white count is still elevated. So it could be fungal, with an atypical presentation. But whatever this is will turn out to be atypical, if I can figure it out. The normal CSF white count also argues against a primary inflammatory disease although with a granuloma CSF could be normal.
Cats frequently present with CNS cryptococcus as a solitary granuloma but dogs usually have a more disseminated encephalitis, it would be atypical for CSF to be normal.
Side interesting note: I just had a case of CNS crypto in a cat two weeks ago. I do my own CSF cell counts because we don’t have an in-house lab. You know the case is a doozy whopper when you see numerous crypto organisms on an unstained hemocytometer sample! Just rechecked the cat who is doing fabulously well.
At the old Boston City Hospital, we had to do our own CSF counts because the lab was too slow and unreliable and I saw crypto that way too. Of course, someone had to tell me what it was.
03-04-20, 08:55 PM
#7231
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What kind of role for the steroid? Coagulopathy? He’s just on your everyday anti inflammatory dose of pred to help with vasogenic edema (not that he had much on his MRI).
Yes it could be paraneoplastic. Not a common syndrome in a dog to have a paraneoplastic coagulopathy but possible.
Yes it could be paraneoplastic. Not a common syndrome in a dog to have a paraneoplastic coagulopathy but possible.
03-04-20, 09:01 PM
#7232
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The only infectious cases I rarely to never use steroids as part of the treatment is bacterial encephalitis which for me is almost always direct extension from otitis media interna. Those cases are superfragile and they just get mannitol as needed until they turn the corner.
03-04-20, 09:05 PM
#7233
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03-04-20, 09:09 PM
#7235
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03-04-20, 09:11 PM
#7236
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03-04-20, 09:30 PM
#7237
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03-04-20, 09:34 PM
#7238
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03-04-20, 09:38 PM
#7239
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Don't cough on me.
03-04-20, 09:44 PM
#7240
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03-04-20, 09:54 PM
#7241
VFL For Life
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When he had to take a daily drug we had it compounded and flavored. That worked (but was expensive).
Sadly he is no longer with us.
03-04-20, 10:14 PM
#7242
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03-04-20, 10:26 PM
#7243
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03-05-20, 12:22 AM
#7244
Super Modest
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I nominate WhyFi
__________________
Keep the chain tight!
03-05-20, 04:36 AM
#7245
smelling the roses
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No. He's from Virginia.
03-05-20, 04:47 AM
#7246
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03-05-20, 05:30 AM
#7247
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03-05-20, 05:37 AM
#7248
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You're heading back to the skies at an interesting time for airlines.
https://twitter.com/peterbakernyt/st...01845029449728
https://twitter.com/peterbakernyt/st...01845029449728
luckily i don’t fly for those guys. They typically do like 28 flights a day to china or something like that. We do 10 a month if that.
03-05-20, 05:40 AM
#7249
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Lol he’s on steroids. Like all my patients essentially. Even fungal encephalitis I’ll usually use a little steroid, because there’s so much inflammation in the brain and I can get away with it. Of course this dog is not on any antifungal medication so in the absence of that the steroids could be an issue.
The only infectious cases I rarely to never use steroids as part of the treatment is bacterial encephalitis which for me is almost always direct extension from otitis media interna. Those cases are superfragile and they just get mannitol as needed until they turn the corner.
The only infectious cases I rarely to never use steroids as part of the treatment is bacterial encephalitis which for me is almost always direct extension from otitis media interna. Those cases are superfragile and they just get mannitol as needed until they turn the corner.
03-05-20, 05:40 AM
#7250
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