Saturday, April 14, 2012

943. Maltese with seizure goes home on Day 2 - acute bacterial meningitis

The owner came for the Maltese in the morning. She accepted my advice to let the 5-year-old dog stay overnight at Toa Payoh Vets for observation. No fits. As good as gold. The active dog just jumped and pawed her legs as she settled the bill. Tongue pinkish as normal.

"Most likely a bacterial infection based on increase in total white cell count and a very high neutrophil count. Neutrophils are produced in large numbers by the dog's body to fight against bacterial infection. Did the dog go outdoors last few days?"

"No," she said. "This dog stays indoors and if he goes out, is not allowed to sniff the grass."

It was a surprising finding in the blood test. Evidence-based medicine is the best way as the owner wants answers and in this case, the blood test had been taken before treatment and provided some answers.

"There is a possibility of low blood gluocse which can lead to (hypoglycaemic) fits in your Maltese," I said. "The lab report mentioned a possible glycolysis and a repeat test. A blood test 2-4 weeks later is needed."

This is one of the cases where the owner got the vet to treat the seizure dog promptly and the blood test was taken. All dogs with fits must have blood tested unless the owner objects to them. Practise evidence-based medicine.

In this case, bacterial meningitis was likely to be present in the dog. As the owner had not delayed treatment, the antibiotics given had got rid of the bacteria and the dog recovered the next day.

NOTES ON ACUTE BACTERIAL MENINGITIS

1. Bacterial meningitis is an infection of the meninges which are the membranes surrounding the brain and spinal cord.

2. Causes: viral, bacterial and fungal infections.
3. Most common bacteria in people meningitis include

3.1 Streptoocccus pneumoniae (pneumonococcus),
3.2 Neisseria meningitidis (meningococcus)- upper respiratory infection bacteria enters bloodstream
3.3 Haemophilus influenzae (haemophilus) - upper respiratory infection, ear infection (otitis media) or sinus infections.
3.4 Listeria monocytogenes (listeria) - soil, dust, contaminated food.

When I was studying vet medicine in Glasgow in 1969-1974, I still remember my lectures about listeria in British pigs causing brain diseases. Antibiotics erythromycin were very effective.

Probably this dog had got listeria (blood test - total white cell count and neutrophils increase). The inflammation and swelling of the meninges caused "headache" (collapse suddenly according to the owner and vomiting), fever (not present in this case), neck stiffness (see image of the dog looking skywards I took) and abnormal mental state (eye-staring, salivation due to fits).

SPINAL FLUID TEST will confirm what type of bacteria is involved. Due to economic reasons, this was not done.

Bacterial meningitis can occur over a few hours or in 2 to 3 days. Delays in treatment can lead to permanent brain damage (coma, fits) or death.

Prompt antibiotic treatment enabled him to recover fully. Where the dog got infected (contaminated food, sniffing soil etc) is a mystery. This dog seldom goes out and therefore may not have the resistance to the bacteria. I had treated him for an ear infection two months ago but his ears had only a bit of yellow wax.

P.S. Reference to human acute bacterial meningitis.
There is an interesting case of a woman who contacted acute bacterial meningitis while holidaying in Bangkok and became unconscious for 3 months.
(Straits Times, Apr 18, 2012, Home, Pg B3, ex-coma patient in flap over lease)

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