Septic feline due to pyothorax and associated complications: diagnostic and therapeutic challenge.
DOI:
https://doi.org/10.19137/cienvet202426205Keywords:
Pyothorax, Sepsis, Cardiomyopathy dysfunction due to sepsis, Thromboprophylaxis, Pulmonary hypertension, Pleuropulmonary ultrasoundAbstract
The case of a 2-year-old common European feline was admitted to the emergency room due to weakness, inactivity, and total anorexia of several days of evolution according to on-call veterinarians. Using emergency pleuropulmonary ultrasonography Veterinary Point of care ultrasound, pleural effusion with suspended particles is observed. Thoracentesis was performed, obtaining a fluid with characteristics of empyema, thoracic drains were placed for evacuation and pleural lavages. Upon admission, the patient presented severe myocardial contractile dysfunction with global dilation of the heart. In addition, there were signs of stasis or spontaneous ultrasound contrast, which correlates with prothrombotic events. Bacteriological cure was achieved with pharmacological management and drainage with daily washings after one month of treatment. Improvement is observed in cardiac function (with serial ultrasound monitoring) and thromboprophylaxis without evidence of alterations generated by thrombotic phenomena. Six months after the event occurred, the patient leads a normal life without requiring any support therapy.
Downloads
References
Troìa R, Mascalzoni G, Calipa S, Magagnoli I, Dondi F, Giunti M. Multiorgan dysfunction syndrome in feline sepsis: prevalence and prognostic implication. J Feline Med Surg. 2019 Jun;21(6):559-565. https://doi.org/10.1177/1098612X18792106
Flynn A., Chokkalingam Mani B, & Mather PJ. (2010). Sepsis-induced cardiomyopathy: a review of pathophysiologic mechanisms. Heart Failure Reviews, 15(6), 605–611. https://doi:10.1007/s10741-010-9176-4
Krämer F, Rainer J, Bali MS. Short- and long-term outcome in cats diagnosed with pyothorax: 47 cases (2009-2018). J Small Anim Pract. 2021 Aug;62(8):669-676. https://doi.org/10.1111/jsap.13327
Doyle RS, Bellenger CR, Campoy L, McAllister H. Pyothorax in a cat managed by intrathoracic debridement and postoperative ventilatory support. Ir Vet J. 2005 Apr 1;58(4):211-5. doi: 10.1186/2046-0481-58-4-211.
Sim JJ, Lau SF, Omar S, Watanabe M, Aslam MW. A Retrospective Study on Bacteriology, Clinicopathologic and Radiographic Features in 28 Cats Diagnosed with Pyothorax. Animals (Basel). 2021 Aug 3;11(8):2286. https://doi.org/10.3390/ani11082286
Barrs VR, Beatty JA. Feline pyothorax - new insights into an old problem: part 2. Treatment recommendations and prophylaxis. Vet J. 2009 Feb;179(2):171-8. https://doi.org/10.1016/j.tvjl.2008.03.019
Demetriou JL, Foale RD, Ladlow J, McGrotty Y, Faulkner J, Kirby BM. Canine and feline pyothorax: a retrospective study of 50 cases in the UK and Ireland. J Small Anim Pract. 2002 Sep;43(9):388-94. https://doi.org/10.1111/j.1748-5827.2002.tb00089.x
Demetriou JL, Foale RD, Ladlow J, McGrotty Y, Faulkner J, Kirby BM. Canine and feline pyothorax: a retrospective study of 50 cases in the UK and Ireland. J Small Anim Pract. 2002 Sep; 43(9):388-94. https://doi.org/10.1111/j.1748-5827.2002.tb00089.x
Colice GL, Curtis A, Deslauriers J, Heffner J, Light R, Littenberg B, Sahn S, Weinstein RA, Yusen RD. Medical and surgical treatment of parapneumonic effusions: an evidence-based guideline. Chest. 2000 Oct;118(4):1158-71. https://doi.org/10.1378/chest.118.4.1158
Shen KR, Bribriesco A, Crabtree T, Denlinger C, Eby J, Eiken P, Jones DR, Keshavjee S, Maldonado F, Paul S, Kozower B. The American Association for Thoracic Surgery consensus guidelines for the management of empyema. J Thorac Cardiovasc Surg. 2017 Jun;153(6):e129-e146. https://doi.org/10.1016/j.jtcvs.2017.01.030
Heier, E,; Wurtinger, G.; Hassdenteufel, E.; Schneider, M. Therapy of Pyothorax in Cats via Small-Bore Thoracostomy Tube in Terms of Efficacy, Complications and Outcomes. Animals 2022, 12, 107. https://doi.org/10.3390/ani12010107.
Ammar MA, Hilal A, Abdalla W. The role of lung ultrasound in procalcitonin-guided antibiotic discontinuation in ventilator-associated pneumonia. Indian J Anaesth. 2022 Jun;66(6):431-435. https://doi: 10.4103/ija.ija_98921.
Bessat C, Boillat-Blanco N, Albrich WC. The potential clinical value of pairing procalcitonin and lung ultrasonography to guide antibiotic therapy in patients with community-acquired pneumonia: a narrative review. Expert Rev Respir Med. 2023 Jul-Dec;17(10):919-927. https://doi.org/10.1080/17476348.2023.2254232
Declue AE, Delgado C, Chang CH, Sharp CR. Clinical and immunologic assessment of sepsis and the systemic inflammatory response syndrome in cats. J Am Vet Med Assoc. 2011 Apr 1;238(7):890-7. https://doi.org/10.2460/javma.238.7.890
Roberta Troìa, Giulia Mascalzoni, Stefano Calipa, Ilaria Magagnoli, Francesco Dondi and Massimo Giunti. Multiorgan dysfunction syndrome in feline sepsis: prevalence and prognostic implication. Journal of Feline Medicine and Surgery 2019, Vol. 21(6) 559–565. https://doi.org/10.1177/1098612X18792106
Reversible Myocardial Depression Associated with Sepsis in a Dog Amy E. Dickinson, Elizabeth A. Rozanski, and John E. Rush. J Vet Intern Med 2007;21:1117–1120.
Ince, M.E.; Turgut, K.; Naseri, A. Echocardiographic Assessment of Left Ventricular Systolic and Diastolic Functions in Dogs with Severe Sepsis and Septic Shock; Longitudinal Study. Animals 2021, 11, 2011. https://doi.org/10.3390/ani11072011.
Shvilkina T and Shapiro N Front. Sepsis-Induced myocardial dysfunction: heterogeneity of functional effects and clinical significance. Cardiovasc. Med. (2023) 10:1200441. https://doi.org/10.3389/fcvm.2023.1200441
Naseri A, Akyuz E, Turgut K, Guzelbektes H, Sen I. Sepsis-induced cardiomyopathy in animals: From experimental studies to echocardiography-based clinical research. Can Vet J. 2023 Sep;64(9):871-877. PMID: 37663026; PMCID: PMC10426250.
Pugliese, M.; Napoli, E.; La Maestra, R.; Or M.E.; Bilgiç, B.; Previti, A.; Biondi, V.; Passantino, A. Cardiac Troponin I and Electrocardiographic Evaluation in Hospitalized Cats with Systemic Inflammatory Response Syndrome. Vet. Sci. 2023, 10, 570. https://doi.org/10.3390/vetsci10090570
Simmons J, Pittet JF. The coagulopathy of acute sepsis. Curr Opin Anaesthesiol. 2015 Apr;28(2):227-36. https://doi: 10.1097/ACO.0000000000000163.
Disseminated Intravascular Coagulation in Cats Michael A. Estrin DVM, Conni E. Wehausen, Carl R. Lessen, Justine A. Lee. J Vet Intern Med2006;20:1334–1339
Takahide Ito and Michihiro Suwa. Left atrial spontaneous echo contrast: relationship with clinical and echocardiographic parameters. Echo research and practice. 6:2 R65–R73. https://doi.org/10.1530/ERP-18-0083.
Black IW. Spontaneous echo contrast: where there's smoke there's fire. Echocardiography. 2000 May;17(4):373-82. https://doi.org/10.1111/j.1540-8175.2000.tb01153.x
Armelle de La forcade, Lenore Bacek, Marie-Claude Blais, Corrin Boyd, Benjamin M Brainard, Daniel L. Chan, Stefano Cortellini, Robert Goggs, Guillaume L Hoareau, Amy Koenigshof, Ron Li, Alex Lynch, Alan Ralph, Elizabeth Rozanski, Claire R Sharp. 2022 Update of the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) Domain 1- Defining populations at risk.. J Vet Emerg Crit Care. 2022;32:289–314. https://doi.org/10.1111/vec.13204
Jeremy P.T. Ward and Ivan F. McMurtry. Mechanisms of hypoxic pulmonary vasoconstriction and their roles in pulmonary hypertension: new findings for an old problem. Curr Opin Pharmacol. 2009 June; 9(3): 287–296. https://doi.org/10.1016/j.coph.2009.02.006
Jian Shi, Yuhong Chen, Haijun Zhi, Hui An4, Zhenjie Hu. Ann Transl. Levosimendan protects from sepsis-inducing cardiac dysfunction by suppressing inflammation, oxidative stress and regulating cardiac mitophagy via the PINK-1-Parkin pathway in mice. Med 2022;10(4):212 | https://dx.doi.org/10.21037/atm-22-483.
Carol Reinero, Lance C. Visser, Heidi B. Kellihan, Isabelle Masseau, Elizabeth Rozanski, Cécile Clercx, Kurt Williams, Jonathan Abbott, Michele Borgarelli, Brian A. Scansen. ACVIM consensus statement guidelines for the diagnosis, classification treatment, and monitoring of pulmonary hypertension in dogs. J Vet Intern Med. 2020;34:549–573. https://doi.org/10.1111/jvim.15725
L. Zhao NA, Mason NW, Morrell et al. Sildenafil Inhibits Hypoxia-Induced PulmonaryHypertension.Circulation.2001;104:424-428.https://doi.org/10.1161/hc2901.093117
Lindsay K. Harris and Andrew J. Crannage. Corticosteroids in Community-Acquired Pneumonia: A Review of Current Literature. Journal of Pharmacy Technology. 2021, Vol. 37(3) 152–160. https://doi.org/10.1177/8755122521995587
Rand JS, Kinnaird E, Baglioni A, Blackshaw J, Priest J. Acute Stress Hyperglycemia in Cats Is Associated with Struggling and Increased Concentrations of Lactate and Norepinephrine. J Vet Intern Med 2002;16:123–132. https://doi.org/10.1111/j.1939-1676.2002.tb02343.x
Torre DM, de Laforcade AM, Chan DL. Incidence and Clinical Relevance of Hyperglycemia in Critically Ill Dogs. J Vet Intern Med 2007;21:971–975. https://doi.org/10.1111/j.1939-1676.2007.tb03051.x
Contribuciones de los/as autores/as: Todos los autores/as contribuyeron a la concepción y el diseño del reporte. La preparación del material, la recopilación y el análisis de bibliografía fueron realizados por Juan Manuel Guevara, Celeste Maistruarena y Emiliano Canizzo. El primer borrador del manuscrito fue escrito por Juan Manuel Guevara y todos/as los/as autores/as comentaron las versiones anteriores del manuscrito. Todos/as los/as autores/as leyeron y aprobaron el manuscrito final. Agradecimiento: A mi compañera de vida María, a mis dos hijas Emilia y Amanda. Celeste y a Emiliano. A la tutora del paciente que no dudo un segundo en seguir adelante y confiar en nuestras indicaciones. Y a todo el equipo del Hospital Veterinario de Gualeguaychú, Entre Ríos.
Financiamiento: Sin financiamiento.
![imagen ilustrativa](https://cerac.unlpam.edu.ar/public/journals/8/submission_8470_8426_coverImage_es_ES.jpg)
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Bibiana Allende
![Creative Commons License](http://i.creativecommons.org/l/by-nc-sa/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Al momento de enviar sus contribuciones, los colaboradores deberán declarar , de manera fehaciente, que poseen el permiso del archivo o repositorio donde se obtuvieron los documentos que se anexan al trabajo, cualquiera sea su formato (manuscritos inéditos, imágenes, archivos audiovisuales, etc.), permiso que los autoriza a publicarlos y reproducirlos, liberando a la revista y sus editores de toda responsabilidad o reclamo de terceros , los autores deben adherir a la licencia Creative Commons denominada “Atribución - No Comercial CC BY-NC-SA”, mediante la cual el autor permite copiar, reproducir, distribuir, comunicar públicamente la obra y generar obras derivadas, siempre y cuando se cite y reconozca al autor original. No se permite, sin embargo, utilizar la obra con fines comerciales.