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Multisystemic infection with an Acanthamoeba sp in a dog

Marc Kent DVM, DACVIM1, Simon R. Platt BVM&S, DACVIM2, Raquel R. Rech DVM, PhD, DACVP3, Joseph S. Eagleson DVM4, Elizabeth W. Howerth DVM, PhD, DACVP5, Megan Shoff PhD6, Paul A. Fuerst PhD7, Greg Booton PhD8, Govinda S. Visvesvara PhD9, and Scott J. Schatzberg DVM, PhD, DACVIM10
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  • 1 Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602.
  • | 2 Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602.
  • | 3 Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, GA 30602.
  • | 4 Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602.
  • | 5 Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, GA 30602.
  • | 6 Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Biology, FDA, 10903 New Hampshire Ave, Silver Spring, MD 20993.
  • | 7 Department of Evolution, Ecology, and Organismal Biology, College of Biological Sciences, The Ohio State University, Columbus, OH 43210.
  • | 8 Department of Molecular Genetics, College of Biological Sciences, The Ohio State University, Columbus, OH 43210.
  • | 9 Division of Parasitic Diseases, National Center for Zoonotic, Vector-Borne and Enteric Diseases, CDC, 1600 Clifton Rd, Atlanta, GA 30333.
  • | 10 Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602.

Abstract

Case Description—A 10-month-old Boxer was evaluated for fever and signs of cervical pain.

Clinical Findings—Physical examination revealed lethargy, fever, and mucopurulent ocular and preputial discharge. On neurologic examination, the gait was characterized by a short stride. The dog kept its head flexed and resisted movement of the neck, consistent with cervical pain. Clinicopathologic findings included neutrophilic leukocytosis, a left shift, and monocytosis. Cervical radiographs were unremarkable. Cerebrospinal fluid analysis revealed neutrophilic pleocytosis and high total protein content. On the basis of signalment, history, and clinicopathologic data, a diagnosis of steroid-responsive meningitis-arteritis was made.

Treatment and Outcome—The dog was treated with prednisone (3.2 mg/kg [1.45 mg/lb], PO, q 24 h), for 3 weeks with limited response. Consequently, azathioprine (2 mg/kg [0.9 mg/lb], PO, q 24 h) was administered. Three weeks later, the dog was evaluated for tachypnea and lethargy. Complete blood count revealed leukopenia, neutropenia, and a left shift. Thoracic radiography revealed a diffuse bronchointerstitial pattern. The dog subsequently went into respiratory arrest and died. On histologic evaluation, amoebic organisms were observed in the lungs, kidneys, and meninges of the brain and spinal cord. A unique Acanthamoeba sp was identified by use of PCR assay.

Clinical Relevance—This dog developed systemic amoebic infection presumed to be secondary to immunosuppression. The development of secondary infection should be considered in animals undergoing immunosuppression for immune-mediated disease that develop clinical signs unrelated to the primary disease. Although uncommon, amoebic infection may develop in immunosuppressed animals. Use of a PCR assay for identification of Acanthamoeba spp may provide an antemortem diagnosis.

Abstract

Case Description—A 10-month-old Boxer was evaluated for fever and signs of cervical pain.

Clinical Findings—Physical examination revealed lethargy, fever, and mucopurulent ocular and preputial discharge. On neurologic examination, the gait was characterized by a short stride. The dog kept its head flexed and resisted movement of the neck, consistent with cervical pain. Clinicopathologic findings included neutrophilic leukocytosis, a left shift, and monocytosis. Cervical radiographs were unremarkable. Cerebrospinal fluid analysis revealed neutrophilic pleocytosis and high total protein content. On the basis of signalment, history, and clinicopathologic data, a diagnosis of steroid-responsive meningitis-arteritis was made.

Treatment and Outcome—The dog was treated with prednisone (3.2 mg/kg [1.45 mg/lb], PO, q 24 h), for 3 weeks with limited response. Consequently, azathioprine (2 mg/kg [0.9 mg/lb], PO, q 24 h) was administered. Three weeks later, the dog was evaluated for tachypnea and lethargy. Complete blood count revealed leukopenia, neutropenia, and a left shift. Thoracic radiography revealed a diffuse bronchointerstitial pattern. The dog subsequently went into respiratory arrest and died. On histologic evaluation, amoebic organisms were observed in the lungs, kidneys, and meninges of the brain and spinal cord. A unique Acanthamoeba sp was identified by use of PCR assay.

Clinical Relevance—This dog developed systemic amoebic infection presumed to be secondary to immunosuppression. The development of secondary infection should be considered in animals undergoing immunosuppression for immune-mediated disease that develop clinical signs unrelated to the primary disease. Although uncommon, amoebic infection may develop in immunosuppressed animals. Use of a PCR assay for identification of Acanthamoeba spp may provide an antemortem diagnosis.

Contributor Notes

Address correspondence to Dr. Kent (Mkentl@uga.edu).