A challenging case: Progressive, generalized pain in a young English bulldog - Veterinary Medicine
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A challenging case: Progressive, generalized pain in a young English bulldog
These clinicians identify the cause of a dog's extreme, difficult-to-localize pain and successfully alleviate it.


VETERINARY MEDICINE


Microorganisms involved

The most frequently isolated microorganisms in discospondylitis are coagulase-positive Staphylococcus species (Staphylococcus aureus, Staphylococcus intermedius).38 Brucella canis is another possible cause of discospondylitis, likely from hematogenous spread from a genital infection.6 Fungal infections are less common, with Aspergillus species being the most frequent fungal cause of discospondylitis. German shepherds are overrepresented in cases of disseminated aspergillosis.39,40

Overall, physitis is less common than discospondylitis and, thus, information in the literature is limited. Escherichia coli, Serratia species, and Streptococcus species were identified in the urine in three dogs with vertebral physitis.2 One dog with concurrent vertebral physitis and discospondylitis was seropositive for Brucella canis infection. Three other dogs with vertebral physitis revealed two positive biopsy culture samples for Actinobacter species and Enterococci species.2 Bacterial culture of the blood in one dog with vertebral physitis revealed Staphylococcus intermedius.41

Treatment

Treatment of vertebral physitis consists of exercise restriction, long-term antibiotic therapy, and analgesics. Bacterial and fungal cultures of urine, blood, or infected tissue are indicated to establish a definitive diagnosis and to aid in the choice of appropriate antibiotic or antifungal treatment.3,5 Additionally, Brucella canis serology should always be performed if a vertebral infection is identified or suspected because of the zoonotic potential and guarded prognosis.6 Since vertebral physitis and discospondylitis are both vertebral infections thought to arise from an infection elsewhere in the body, it may be assumed that the same organisms identified with discospondylitis may also cause vertebral physitis. Thus, in patients with discospondylitis or physitis, empirical therapy with an antibiotic effective against coagulase-positive Staphylococcus species such as a first-generation cephalosporin or a beta-
lactamase-resistant penicillin is a logical choice while awaiting culture results or when aerobic cultures fail to identify a causative bacterial agent.38 Treat dogs with neurologic deficits or severe pain more aggressively with broad-spectrum antibiotics such as a combination of a beta-lactam antibiotic as well as an aminoglycoside or fluoroquinolone.18

Reassess patients that fail to improve within five days of starting antibiotic treatment. Continue antibiotic treatment for at least eight weeks to treat the infection and prevent relapse.4 In a retrospective study on the clinical features of discospondylitis, antibiotic therapy was continued for a median of 53 weeks and, because of the study results, the authors recommended treatment with antibiotic therapy until complete resolution of radiographic evidence of active disease.18

SUMMARY

Vertebral physitis is a vertebral infection that should be suspected in cases of lameness and back pain in young dogs. Bacterial cultures of urine and blood with sensitivity testing plus serologic testing for Brucella canis should be performed in all dogs suspected of having a vertebral infection.4 Vertebral physitis is diagnosed based on clinical signs; the results of radiography, computed tomography, or MRI; bacteriologic studies; and response to antibiotic treatment.

ACKNOWLEDGMENTS

The authors thank Dr. Sheldon Steinberg and Dr. Charles Vite for their collective expertise and clinical input with this patient, Dr. H. Daniel Cantwell for his interpretation of the radiograph in Figure 1, and Dr. Justin Goggin for his interpretation of the MRI in Figure 5.

Laura C. Tepper, DVM
Department of Clinical Sciences
College of Veterinary Medicine
Mississippi State University
Mississippi State, MS 39762-6100
Eric N. Glass, MS, DVM, DACVIM (neurology)
Red Bank Veterinary Hospital
197 Hance Ave.
Tinton Falls, NJ 07724
Marc Kent, DVM, DACVIM (neurology and internal medicine)
Department of Small Animal Medicine and Surgery
College of Veterinary Medicine
University of Georgia
Athens, GA 30602-7390


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Source: VETERINARY MEDICINE,
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