Granulomatous meningoencephalitis

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Granulomatous meningoencephalitis (GME) is an inflammatory disease of the central nervous system (CNS) of dogs and, rarely, cats. It is a form of meningoencephalitis. GME is likely second only to encephalitis caused by canine distemper virus as the most common cause of inflammatory disease of the canine CNS. [1] The disease is more common in female dogs of young and middle age. It has a rapid onset. The lesions of GME exist mainly in the white matter of the cerebrum, brainstem, cerebellum, and spinal cord. [2] The cause is only known to be noninfectious and is considered at this time to be idiopathic. Because lesions resemble those seen in allergic meningoencephalitis, GME is thought to have an immune-mediated cause, but it is also thought that the disease may be based on an abnormal response to an infectious agent. [3] One study searched for viral DNA from canine herpesvirus , canine adenovirus , and canine parvovirus in brain tissue from dogs with GME, necrotizing meningoencephalitis, and necrotizing leukoencephalitis (see below for the latter two conditions), but failed to find any. [4]

Contents

Types of GME

Diagnosis and treatment

Cerebrospinal fluid (CSF) analysis shows a large number of white blood cells. Typically small mature lymphocytes are the majority of cells seen, with monocytes and neutrophils making up the rest. [8] Definitive diagnosis is based on histopathology, either a brain biopsy or post-mortem evaluation (necropsy). A CT scan or MRI will show patchy, diffuse, or multifocal lesions. For a number of years, the basic treatment was some type of corticosteroid in combination with one or more immunosuppressive drugs, typically cytosine arabinoside and/or cyclosporine or other medications such as azathioprine, cyclophosphamide, [6] or procarbazine, of which were usually added one at a time to the corticosteroid until a successful combination was found. There is evidence that treatment with radiation therapy for focal GME provides the longest periods of remission. [1]

Pug dog encephalitis

Pug dog encephalitis (PDE) is an idiopathic inflammatory disease primarily affecting the prosencephalon (forebrain and thalamus). It is also known as necrotizing meningoencephalitis. The disease may be inherited in Pugs and Maltese and has been diagnosed in other breeds as well (Yorkies, Chihuahuas). [6] The prevalence of PDE in pugs is about 1%. [9] It differs in pathology from GME by more tissue breakdown and increased eosinophils (white blood cells). CSF analysis is also unique among inflammatory CNS diseases in dogs in that the cells are predominantly lymphocytes, instead of a mixed population of mononuclear cells. [10] In Maltese and Pugs, there is extensive necrosis and inflammation of the gray matter of the cerebrum and subcortical white matter. The most common early symptoms are related to forebrain disease and include seizures and dementia, and later circling, head tilt, and blindness with normal pupillary light reflexes may be seen. PDE has a poor prognosis.

Necrotizing leukoencephalitis

In Yorkshire Terriers there can be severe mononuclear inflammation of the brainstem and periventricular cerebral white matter. Because the condition in this breed frequently affects only the white matter, it has been called necrotizing leukoencephalitis. Symptoms of brainstem and central vestibular disease predominate. [11]

Other types of noninfectious meningoencephalitis

See also

Related Research Articles

Canine distemper viral disease affecting some mammals

Canine distemper is a viral disease that affects a wide variety of mammal families, including domestic and wild species of dogs, coyotes, foxes, pandas, wolves, ferrets, skunks, raccoons, and felines, as well as pinnipeds, some primates, and a variety of other species.

Viral meningitis Medical condition

Viral meningitis, also known as aseptic meningitis, is a type of meningitis due to a viral infection. It results in inflammation of the meninges. Symptoms commonly include headache, fever, sensitivity to light and neck stiffness.

Granuloma Medical condition

A granuloma is an aggregation of macrophages that forms in response to chronic inflammation. This occurs when the immune system attempts to isolate foreign substances that it is otherwise unable to eliminate. Such substances include infectious organisms including bacteria and fungi, as well as other materials such as foreign objects, keratin, and suture fragments.

Free-living amoebae in the Amoebozoa group are important causes of disease in humans and animals.

Naegleriasis Rare and usually fatal brain infection by a protist

Naegleriasis is an almost invariably fatal infection of the brain by the free-living unicellular eukaryote Naegleria fowleri. Symptoms are meningitis-like and include headache, fever, nausea, vomiting, a stiff neck, confusion, hallucinations and seizures. Symptoms progress rapidly over around five days, and death usually results within one to two weeks of symptoms.

Aseptic meningitis Medical condition

Aseptic meningitis is the inflammation of the meninges, a membrane covering the brain and spinal cord, in patients whose cerebral spinal fluid test result is negative with routine bacterial cultures. Aseptic meningitis is caused by viruses, mycobacteria, spirochetes, fungi, medications, and cancer malignancies. The testing for both meningitis and aseptic meningitis is mostly the same. A cerebrospinal fluid sample is taken by lumbar puncture and is tested for leukocyte levels to determine if there is an infection and goes on to further testing to see what the actual cause is. The symptoms are the same for both meningitis and aseptic meningitis but the severity of the symptoms and the treatment can depend on the certain cause.

Viral encephalitis is inflammation of the brain parenchyma, called encephalitis, by a virus. The different forms of viral encephalitis are called viral encephalitides. It is the most common type of encephalitis and often occurs with viral meningitis. Encephalitic viruses first cause infection and replicate outside of the central nervous system (CNS), most reaching the CNS through the circulatory system and a minority from nerve endings toward the CNS. Once in the brain, the virus and the host's inflammatory response disrupt neural function, leading to illness and complications, many of which frequently are neurological in nature, such as impaired motor skills and altered behavior.

Meningoencephalitis Medical condition

Meningoencephalitis, also known as herpes meningoencephalitis, is a medical condition that simultaneously resembles both meningitis, which is an infection or inflammation of the meninges, and encephalitis, which is an infection or inflammation of the brain.

Neurosyphilis Infection of the central nervous system in a patient with syphilis

Neurosyphilis refers to infection of the central nervous system in a patient with syphilis. In the era of modern antibiotics the majority of neurosyphilis cases have been reported in HIV-infected patients. Meningitis is the most common neurological presentation in early syphilis. Tertiary syphilis symptoms are exclusively neurosyphilis, though neurosyphilis may occur at any stage of infection.

Infectious canine hepatitis (ICH) is an acute liver infection in dogs caused by Canine mastadenovirus A, formerly called Canine adenovirus 1 (CAV-1). CAV-1 also causes disease in wolves, coyotes, and bears, and encephalitis in foxes. The virus is spread in the feces, urine, blood, saliva, and nasal discharge of infected dogs. It is contracted through the mouth or nose, where it replicates in the tonsils. The virus then infects the liver and kidneys. The incubation period is 4 to 7 days.

Necrotizing meningoencephalitis (NME) is a fatal inflammatory central nervous system (CNS) disorder, where an extensive cerebral necrosis is associated with a multifocal, non-suppurative meningoencephalitis of the neuro cortex. It was originally identified and recorded in the 1960s in pure breed pugs, with which this disease is nowadays mostly associated with, occurring essentially in small breed dogs ranging from six months to seven years of age. It causes intense necrotizing inflammatory lesions in the brain stem and Cerebellum. The etiopathology is still unclear. The pathogen that triggers the disease and contributes to its development has not yet been identified. It is presumed to have a multifactorial, heritable, autoimmune etiology. The process is rapidly progressive, culminating in status epilepticus and ending fatally for the dog.

<i>Balamuthia mandrillaris</i> Species of pathogenic Amoebozoa

Balamuthia mandrillaris is a free-living amoeba that is known to cause the rare but deadly neurological condition known as granulomatous amoebic encephalitis (GAE). B. mandrillaris is a soil dwelling amoeba and was first discovered in 1986 in the brain of a mandrill that died in the San Diego Wild Animal Park.

Granulomatous amoebic encephalitis Rare and usually fatal brain infection by certain amoebae

Granulomatous amoebic encephalitis (GAE) is a rare, usually fatal, subacute-to-chronic central nervous system disease caused by certain species of free-living amoebae of the genera Acanthamoeba, Balamuthia and Sappinia pedata. The term is most commonly used with Acanthamoeba. In more modern references, the term "balamuthia amoebic encephalitis" (BAE) is commonly used when Balamuthia mandrillaris is the cause.

Angiostrongyliasis is an infection by a roundworm of the Angiostrongylus type. Symptoms may vary from none, to mild, to meningitis.

Mollarets meningitis Medical condition

Mollaret's meningitis is a recurrent or chronic inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. Since Mollaret's meningitis is a recurrent, benign (non-cancerous), aseptic meningitis, it is also referred to as benign recurrent lymphocytic meningitis. It was named for Pierre Mollaret, the French neurologist who first described it in 1944.

The Central Nervous System controls most of the functions of the body and mind. It comprises the brain, spinal cord and the nerve fibers that branch off to all parts of the body. The Central Nervous System viral diseases are caused by viruses that attack the CNS. Existing and emerging viral CNS infections are major sources of human morbidity and mortality. Virus infections usually begin in the peripheral tissues, and can invade the mammalian system by spreading into the peripheral nervous system and more rarely the CNS. CNS is protected by effective immune responses and multi-layer barriers, but some viruses enter with high-efficiency through the bloodstream and some by directly infecting the nerves that innervate the tissues. Most viruses that enter can be opportunistic and accidental pathogens, but some like herpes viruses and rabies virus have evolved in time to enter the nervous system efficiently, by exploiting the neuronal cell biology. While acute viral diseases come on quickly, chronic viral conditions have long incubation periods inside the body. Their symptoms develop slowly and follow a progressive, fatal course.

Neurovirology is an interdisciplinary field which represents a melding of clinical neuroscience, virology, immunology, and molecular biology. The main focus of the field is to study viruses capable of infecting the nervous system. In addition to this, the field studies the use of viruses to trace neuroanatomical pathways, for gene therapy, and to eliminate detrimental populations of neural cells.

Histiocytic diseases in dogs are a group of diseases in dogs which may involve the skin, and which can be difficult to differentiate from granulomatous, reactive inflammatory or lymphoproliferative diseases. The clinical presentation and behaviour as well as response to therapy vary greatly among the syndromes.

Head pressing is a veterinary condition characterized by pressing the head against a wall or pushing the face into a corner for no apparent reason. This condition is seen in dogs, cats, cows, horses, and goats. Head pressing is usually a sign of a neurological disorder, especially of the forebrain, or of toxicity due to liver damage, such as portosystemic shunt and hepatic encephalopathy.

References

  1. 1 2 Adamo F, O'Brien R (2004). "Use of cyclosporine to treat granulomatous meningoencephalitis in three dogs". J Am Vet Med Assoc. 225 (8): 1211–6, 1196. doi:10.2460/javma.2004.225.1211. PMID   15521442.
  2. ↑ Suzuki M, Uchida K, Morozumi M, Yanai T, Nakayama H, Yamaguchi R, Tateyama S (2003). "A comparative pathological study on granulomatous meningoencephalomyelitis and central malignant histiocytosis in dogs". J Vet Med Sci. 65 (12): 1319–24. doi: 10.1292/jvms.65.1319 . PMID   14709820.
  3. 1 2 3 Vite, C.H. (2005). "Inflammatory Diseases of the Central Nervous System". Braund's Clinical Neurology in Small Animals: Localization, Diagnosis and Treatment. Retrieved 2007-02-15.
  4. ↑ Schatzberg S, Haley N, Barr S, de Lahunta A, Sharp N (2005). "Polymerase chain reaction screening for DNA viruses in paraffin-embedded brains from dogs with necrotizing meningoencephalitis, necrotizing leukoencephalitis, and granulomatous meningoencephalitis". J Vet Intern Med. 19 (4): 553–9. doi: 10.1892/0891-6640(2005)19[553:PCRSFD]2.0.CO;2 . PMID   16095173.
  5. 1 2 "Idiopathic Inflammatory Diseases". The Merck Veterinary Manual. 2006. Retrieved 2007-02-15.
  6. 1 2 3 Ettinger, Stephen J.; Feldman, Edward C. (1995). Textbook of Veterinary Internal Medicine (4th ed.). W.B. Saunders Company. ISBN   0-7216-6795-3.
  7. ↑ Gelatt, Kirk N. (ed.) (1999). Veterinary Ophthalmology (3rd ed.). Lippincott, Williams & Wilkins. ISBN   0-683-30076-8.CS1 maint: extra text: authors list (link)
  8. ↑ Vernau, William (2005). "Cerebrospinal Fluid Analysis in Dogs and Cats" (PDF). Proceedings of the 50° Congresso Nazionale Multisala SCIVAC. Retrieved 2007-02-18.
  9. ↑ Greer, K. A.; Wong, A. K.; Liu, H.; Famula, T. R.; Pedersen, N. C.; Ruhe, A.; Wallace, M.; Neff, M. W. (April 2010). "Necrotizing meningoencephalitis of Pug Dogs associates with dog leukocyte antigen class II and resembles acute variant forms of multiple sclerosis". Tissue Antigens. 76 (2): 110–8. doi:10.1111/j.1399-0039.2010.01484.x. PMID   20403140.
  10. ↑ Higginbotham, Michael J.; Kent, Marc; Glass, Eric N. (August 2007). "Noninfectious Inflammatory Central Nervous System Diseases in Dogs". Compendium on Continuing Education for the Practicing Veterinarian. Veterinary Learning Systems. 29 (8): 488–497. PMID   17849703.
  11. ↑ Garosi, Laurent S. (2006). "CNS inflammatory (UK) problems: The neurologist's viewpoint, clinical approach and treatment" (PDF). Proceedings of the 53° Congresso Nazionale Multisala SCIVAC. Retrieved 2007-02-18.
  12. 1 2 Chrisman, Cheryl; Clemmons, Roger; Mariani, Christopher; Platt, Simon (2003). Neurology for the Small Animal Practitioner (1st ed.). Teton New Media. ISBN   1-893441-82-2.
  13. ↑ "Meningitis and Encephalitis: Introduction". The Merck Veterinary Manual. 2006. Retrieved 2007-02-15.
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