Pyrexia and weakness in a four-month-old Holstein heifer calf

Alycia Kowalski Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI

Search for other papers by Alycia Kowalski in
Current site
Google Scholar
PubMed
Close
 DVM
,
Diego De Gasperi Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI

Search for other papers by Diego De Gasperi in
Current site
Google Scholar
PubMed
Close
 DVM, DACVS
,
Chelsea Holschbach Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI

Search for other papers by Chelsea Holschbach in
Current site
Google Scholar
PubMed
Close
 DVM, MS, DACVIM
,
Kelsey Jorge Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI

Search for other papers by Kelsey Jorge in
Current site
Google Scholar
PubMed
Close
 DVM
,
Samantha Loeber Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI

Search for other papers by Samantha Loeber in
Current site
Google Scholar
PubMed
Close
 DVM, DACVR
, and
Simon F. Peek Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI

Search for other papers by Simon F. Peek in
Current site
Google Scholar
PubMed
Close
 BVSc, PhD, DACVIM

History

A 4-month-old, approximately 150-kg Holstein heifer calf was referred because of pyrexia and weakness. On the farm, a 6-day history of intermittent pyrexia (40.6 °C to 41.1 °C; reference range, 37.8 °C to 38.6 °C) was reported, for which the calf had been administered tulathromycin, and IV flunixin meglumine.

Initial physical examination revealed persistent pyrexia (40.1 °C), mild tachypnea (40 breaths per minute; reference range, 20 to 40 breaths per minute), and occasional spontaneous coughing. Findings on cardiothoracic auscultation were clinically normal, but rumen contractions and borborygmi were absent. An approximately 6 cm soft, nonpainful subcutaneous swelling was present cranial to the right shoulder joint however no heat or effusion were present on palpation of the limb joints and no lameness was appreciated.

A CBC at the time of admission revealed mild hyperfibrinogenemia (700 mg/dL; reference range, 100 to 400 mg/dL) as well as mild leukocytosis (15.3 X 103 WBCs/µL; reference range, 4.7 X 103 to 11.1 X 103 WBCs/µL) characterized by a mature neutrophilia (segmented neutrophils, 7.3 X 103 cells/µL [1.6 X 103 to 6.1 X 103 cells/µL]) and left shift (band neutrophils, 4.5 X 103 cells/µL; reference limit ≤ 0.1 cells/µL) with toxic changes present on WBC morphology, supportive of an infectious process. Serum biochemical analysis and arterial blood gas analysis were consistent with a mild metabolic alkalosis and decreased gastrointestinal motility (hyponatremia [132 mmol/L; reference range, 133 to 141 mmol/L], hypokalemia [3.4 mmol/L; reference range, 4.0 to 5.3 mmol/L], hypochloremia [89 mmol/L; reference range, 95 to 103 mmol/L], bicarbonate [35.9 mmol/L; reference range, 23 to 32 mmol/L]). Thoracic radiography at admission revealed a diffuse, mild bronchointerstitial pattern consistent with mild bronchopneumonia, with no areas of lobar or lobular consolidation on radiography or thoracic ultrasonography. Abdominal ultrasonography revealed segments of both hyper-and hypomotile small intestines with wall thickening (up to 6 mm; reference limit < 3 mm), consistent with functional ileus and enteritis. A subjectively distended gall bladder was identified with an increased amount of hyperechogenic material, consistent with cholestasis and cholecystitis.

On the day of presentation, the heifer developed diarrhea, and fecal bacterial cultures confirmed the presence of Salmonella enterica serovar Dublin. Broad-spectrum antimicrobials (potassium penicillin G [22,000 IU/kg, IV, q 6 h] and ceftiofur sodium [2.2 mg/kg, SC, q 24 h]) were administered based on in vitro susceptibility testing.

The heifer improved systemically over the first week of hospitalization, and diarrhea resolved; however, progressive mild to moderate lameness was noted affecting the right forelimb. No distal limb swelling or effusion was appreciated nor could a positive response to palpation or hoof testers be elicited. The previously identified soft tissue swelling cranial to the right shoulder joint increased in firmness and became painful on palpation. The degree of lameness and swelling remained static between days 7 and 14 of hospitalization with no further changes on physical examination nor localization of the lameness. Standing orthogonal (right lateral) radiographic images of the proximal aspect of the humerus and the shoulder joint region were obtained on days 7 and 14 of hospitalization (Figure 1).

Figure 1
Figure 1

Right lateral radiographic views of the right shoulder of a 4-month-old Holstein heifer calf evaluated for moderate right forelimb lameness and firm swelling cranial to the shoulder joint 7 days (A) and 14 days (B) after identification of lameness.

Citation: Journal of the American Veterinary Medical Association 261, 8; 10.2460/javma.23.03.0128

Diagnostic Findings and Interpretation

Standing right lateral radiographic images revealed the development of an irregular margin and roughening to the greater tubercle of the right proximal humerus (Figure 2) over the 7-day period. Based upon the radiographic progression seen in the standard orthogonal view between day 7 and 14, a craniomedial-caudolateral oblique projection (Figure 3) and ultrasonographic examination of the right upper forelimb were also performed on day 14. Previous oblique craniomedial-caudolateral radiographic images of the right shoulder joint area and ultrasonographic examination performed on day 7 (images not shown) had not detected any substantial abnormalities. Figure 3 has been highlighted on the craniolateral aspect of the greater tubercle of the humerus to demonstrate an ovoid, well-defined, irregularly marginated, concave osteolucent region of geographic osteolysis and subchondral bone sclerosis. These findings were consistent with an osteomyelitic lesion, likely secondary to hematogenous spread of Salmonella Dublin. Right shoulder region ultrasonography (Figure 3) using a 12MHz linear array transducer (LOGIQ e Vet NextGEN; GE) with the heifer standing and weight bearing on the limb revealed an approximately 3.5 cm by 1.45 cm area of roughening alongside a concave defect along the craniolateral aspect of the greater tubercle, deep to the overlying incompletely ossified layer of the apophysis. A mild amount of increased anechoic fluid was present within the bicipital bursa, but the shoulder joint did not appear effusive.

Figure 2
Figure 2

Same radiographic projections as Figure 1. There is an irregular margin and roughening to the greater tubercle of the right proximal humerus (arrow) that is radiographically evident by day 14.

Citation: Journal of the American Veterinary Medical Association 261, 8; 10.2460/javma.23.03.0128

Figure 3
Figure 3
Figure 3

Additional imaging of the same calf on day 14. A—Craniomedial-caudolateral oblique radiographic view of the right shoulder joint illustrating a 3.5 X 1.45-cm ovoid, irregularly marginated, concave osteolucent region of geographic osteolysis with ill-defined sclerosis of the subchondral bone (oval). B—Longitudinal ultrasonographic image of the craniolateral aspect of the right proximal humerus illustrating marked roughening together with a concave defect along the greater tubercle (arrows).

Citation: Journal of the American Veterinary Medical Association 261, 8; 10.2460/javma.23.03.0128

Treatment and Outcome

The lytic lesion was initially injected with amikacin sulfate (500 mg [250 mg/mL]) via ultrasonographic guidance while awaiting client approval for surgical debridement under general anesthesia. Curettage and placement of amikacin-impregnated plaster of Paris beads was performed surgically (day 18 of hospitalization) and a sample of lytic bone submitted for culture and susceptibility, yielding an isolate with an identical in vitro susceptibility pattern to that originally obtained from feces. Gentamicin (6.6 mg/kg, IV, q24h) was administered based on culture and susceptibility of a sample of the lytic bone. Perioperative flunixin meglumine (1.1 mg/kg, IV) was administered, however this did not provide adequate analgesia postoperatively, therefore a morphine constant rate infusion (0.025 mg/kg/h) was administered for 8 days in addition to low-dose flunixin meglumine (0.5 mg/kg, IV, q 12 h). The heifer was transitioned to oral meloxicam (loading dose 1 mg/kg, PO, q 24 h for 3 days, then 1 mg/kg, PO, q 48 h) and remained comfortable with only a mild mechanical lameness, but was sound at the walk approximately 21 days following surgical debridement. Radiographic follow-up on days 26 and 33 of hospitalization demonstrated that the previously osteolytic area of the proximal humerus was progressively filling in with new bone. The heifer was discharged sound from the hospital 39 days after surgery.

Comments

In this case, hematogenous spread of Salmonella Dublin from a primary systemic infection was considered likely. As there was not any heat, signs of pain on palpation, or evidence of lameness associated with the soft tissue swelling over the shoulder joint at the time of admission, initial differential diagnoses included a traumatic injury or less likely an enlarged prescapular lymph node. However, no osseous abnormalities were initially identified on either standard orthogonal or oblique radiographic projections or via ultrasonography. As signs of pain on palpation and evidence of lameness progressed, serial radiographic and ultrasonographic imaging were invaluable in identifying the development of an osseous lesion that became apparent 14 days after identification of lameness. Identification of the osteomyelitic lesion over the craniolateral aspect of the proximal humerus supported suspected translocation of Salmonella Dublin, which was later confirmed by culture and susceptibility testing of a sample of lytic bone, identifying it as the same isolate as that obtained from the feces. While hematogenous spread of this host adapted serovar to the skeleton leading to septic arthritis and physitis is well documented,1,2 clinical identification in the absence of joint effusion, swelling, heat, or signs of pain on physical examination makes the diagnosis much more challenging, especially when involving the upper limbs or axial skeleton. As the prognosis for calves with Salmonella Dublin infection markedly deteriorates when secondary boney involvement occurs,3 diligent use of diagnostic imaging can be especially valuable.

The identification and localization of the osteomyelitic lesion was eventually best characterized through oblique radiographic views and high frequency musculoskeletal ultrasonography. It is reasonable to predict that CT would have been a highly sensitive imaging modality for early boney changes perhaps prior to the radiographic diagnosis being made. Anatomically, the soft tissues of the shoulder region and the superimposition of the air-filled trachea can make radiographic interpretation of the greater humeral tubercle difficult; however, of note, was the improved diagnostic value of the oblique view on day 14 (Figure 3) compared to the standard orthogonal view (Figures 1 and 2). This emphasizes the value of oblique radiographic views, in this case the uncommonly obtained craniomedial-caudolateral projection in a standing calf, to highlight a lesion suspected from either the physical examination, and/or from orthogonal images. The presence of soft tissue swelling with lameness many days prior to the identification of lytic changes radiographically, highlights the challenges with this modality in early bone infection and emphasizes the need for repeated assessment. The radiographic detection of a focal area of ill-defined osteolucency with subchondral bone sclerosis in a juvenile calf should always raise suspicion of septic process, however hematogenous spread of infection at this age is more common to joints and physes than to bone.4 An important differential diagnosis for the observed radiographic changes might include neoplastic bone disease, but this was considered extremely unlikely in this case due to the signalment; reports of primary or metastatic bone tumors being exceptionally uncommon in cattle at any age.5 However, given the high index of suspicion of a septic osteomyelitis secondary to Salmonella Dublin translocation, the recommendation for the most successful outcome was surgical exploration with debridement along with local and systemic antimicrobial treatment. This approach would also have allowed for investigation of other differential diagnoses for the observed imaging changes to include biopsy.

Extralabel drug use was performed with owner consent and complied with provisions of AMDUCA and 21 CFR §530. Following consultation with the Food Animal Residue Avoidance Bank (FARAD) and the owners of the heifer relating to the use of an aminoglycoside in the treatment of this case, prior written consent that the heifer would never enter the human food chain was first obtained. Because she was not lactating, and would not be for many months, no guidance regarding milk withdrawal was given; readers are advised to obtain guidance from FARAD regarding milk withdrawals for aminoglycoside use in lactating dairy cattle prior to their administration.

Acknowledgments

The authors have nothing to declare.

References

  • 1.

    Healy AM, Doherty ML, Monaghan ML, McAllister H. Cervico-thoracic vertebral osteomyelitis in 14 calves. Vet J. 1997;154(3):227-232. doi:10.1016/S1090-0233(97)80027-5

    • Search Google Scholar
    • Export Citation
  • 2.

    Verschooten F, Vermeiren D, Devriese L. Bone infection in the bovine appendicular skeleton: a clinical, radiographic, and experimental study. Vet Radiol Ultrasound. 2000;41(3):250-260. doi:10.1111/j.1740-8261.2000.tb01488.x

    • Search Google Scholar
    • Export Citation
  • 3.

    McDonough PL, Fogelman D, Shin SJ, Brunner MA, Lein DH. Salmonella enterica serotype Dublin infection: an emerging infectious disease for the northeastern United States. J Clin Microbiol. 1999;37(8):2418-2427. doi:10.1128/jcm.37.8.2418-2427.1999

    • Search Google Scholar
    • Export Citation
  • 4.

    Constant C, Masseau I, Babkine M, et al. Radiographic study of hematogenous septic arthritis in dairy calves. Vet Comp Orthop Traumatol. 2018;31:252-260.

    • Search Google Scholar
    • Export Citation
  • 5.

    Verschooten F, De Moor A, Desmet P, Stenhaut T. Neoplasms associated with bone changes in cows. Vet Radiol. 1975;16:6-10.

  • Figure 1

    Right lateral radiographic views of the right shoulder of a 4-month-old Holstein heifer calf evaluated for moderate right forelimb lameness and firm swelling cranial to the shoulder joint 7 days (A) and 14 days (B) after identification of lameness.

  • Figure 2

    Same radiographic projections as Figure 1. There is an irregular margin and roughening to the greater tubercle of the right proximal humerus (arrow) that is radiographically evident by day 14.

  • Figure 3

    Additional imaging of the same calf on day 14. A—Craniomedial-caudolateral oblique radiographic view of the right shoulder joint illustrating a 3.5 X 1.45-cm ovoid, irregularly marginated, concave osteolucent region of geographic osteolysis with ill-defined sclerosis of the subchondral bone (oval). B—Longitudinal ultrasonographic image of the craniolateral aspect of the right proximal humerus illustrating marked roughening together with a concave defect along the greater tubercle (arrows).

  • 1.

    Healy AM, Doherty ML, Monaghan ML, McAllister H. Cervico-thoracic vertebral osteomyelitis in 14 calves. Vet J. 1997;154(3):227-232. doi:10.1016/S1090-0233(97)80027-5

    • Search Google Scholar
    • Export Citation
  • 2.

    Verschooten F, Vermeiren D, Devriese L. Bone infection in the bovine appendicular skeleton: a clinical, radiographic, and experimental study. Vet Radiol Ultrasound. 2000;41(3):250-260. doi:10.1111/j.1740-8261.2000.tb01488.x

    • Search Google Scholar
    • Export Citation
  • 3.

    McDonough PL, Fogelman D, Shin SJ, Brunner MA, Lein DH. Salmonella enterica serotype Dublin infection: an emerging infectious disease for the northeastern United States. J Clin Microbiol. 1999;37(8):2418-2427. doi:10.1128/jcm.37.8.2418-2427.1999

    • Search Google Scholar
    • Export Citation
  • 4.

    Constant C, Masseau I, Babkine M, et al. Radiographic study of hematogenous septic arthritis in dairy calves. Vet Comp Orthop Traumatol. 2018;31:252-260.

    • Search Google Scholar
    • Export Citation
  • 5.

    Verschooten F, De Moor A, Desmet P, Stenhaut T. Neoplasms associated with bone changes in cows. Vet Radiol. 1975;16:6-10.

Advertisement