ISSN 2398-2969      

Meningitis

icanis
Contributor(s):

Kyle Braund

Laurent Garosi

Synonym(s): Beagle pain syndrome, bacterial meningitis, steroid-responsive suppurative meningitis, meningitis and vasculitis, miscellaneous meningitis, meningitis and encephalitis; pyogranulomatous meningoencephalomyelitis (PME; granulomatous meningoencephalomyelitis (GME; eosinophilic meningoencephalitis; meningitis and polyarteritis. Steroid-responsive meningitis-arteritis.


Introduction

  • See also granulomatous meningoencephalomyelitis (GME) Granulomatous meningoencephalomyelitis , aseptic suppurative meningo-arteritis (= steroid responsive meningitis Steroid-responsive meningitis-arteritis (SRMA) ), breed specific meningitis.
  • Inflammation of the meninges. Associated with necrotizing fibrinoid arteritis in the context of aseptic suppurative meningo-arteritis.
  • Cause: infectious, eg bacterial, immune-mediated, idiopathic, eg aseptic suppurative meningo-arteritis → specific syndromes (Beagle, Bernese Mountain dog, Boxer, Weimaraner, Nova Scotia Duck Tolling Retriever, German Short-haired Pointer).
  • Signs: Hyperesthesia, fever, cervical pain, cervical rigidity.
  • Diagnosis: signs, CSF tap.
  • Treatment: antimicrobial agent for infectious cause (rare), immune-suppressive treatment for aseptic suppurative meningo-arteritis.
  • Prognosis: poor long-term.

Pathogenesis

Etiology

Predisposing factors

General

  • Trauma, eg bite wound.
  • Contaminated surgical instruments.
  • Previous infection with canine distemper virus.
  • Dog originating from USA or mainland Europe.
  • Exposure to ticks, Rocky Mountain spotted fever, ehrlichiosis.

Specific

  • Ticks - European tick-borne meningoencephalitis (TBE).

Pathophysiology

  • Bacterial invasion of the CNS usually → both meningitis and encephalitis. Such infections occur via hematogenous spread from distant foci within the body: direct extension from sinuses/ears/eyes; as a result of trauma, eg bite wound; and from contaminated instruments, eg spinal needle.
  • Note that one important source of bacterial infection of meninges/CNS parenchyma in dogs is bacterial endocarditis.
  • Organisms usually disseminate via CSF pathways and → cerebrospinal meningitis, often associated with micro abcess formation in brain/spinal cord.
  • Aseptic suppurative meningo-arteritis is a systemic immune disorder.
  • Meningitis and vasculitis - partial/complete vessel occlusion as a result of fibrinoid necrosis of vessel walls and periarteritis in meninges often leads to ischemia/thrombi.
  • Vasculitis is more common in the leptomeninges of the spinal cord than around the brain.
  • Lesion occasionally present in the thyroid, heart and mediastinum.
  • Pyrexia is thought to be secondary to bacterial invasion of the blood stream and CSF, accompanied by the release of leukocytic pyrogens and hypothalamic stimulation.
  • In humans, inflammation of the subarachnoid space activates protective reflexes, which result in nuchal rigidity and hyperextension of the neck and vertebral column.
  • A similar mechanism probably exists in dogs showing signs of cervical rigidity and occasionally seen opisthotonus and thoracic limb hyperextension.
  • Seizures may be caused by high fever, hypoglycemia, brain edema or inflammation.
  • Vomiting may result from increased intracranial pressure or from direct effects on the vomiting center.
  • In some animals, chemical signs may suggest CNS parenchymal involvement.

Timecourse

  • Often acute/hours/days.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Robson K, Smith P M (2011) Cryptococcal meningoencephalitis in a dog. Vet Rec 168 (20), 538 PubMed.
  • Lowrie M, Penderis J, McLaughlin M, Eckersall P D, Anderson T J (2009) Steroid responsive meningitis-arteritis: a prospective study of potential disease markers, prednisolone treatment, and long-term outcome in 20 dogs (2006-2008). JVIM 23 (4), 862-870 PubMed.
  • Tipold A, Schatzberg S J (2009) An update on steroid responsive meningitis arteritis. JSAP 51 (3), 150-154 PubMed.
  • Bathen-Noethen A, Carlson R, Menzel D, Mischke R & Tipold A (2008) Concentrations of acute-phase proteins in dogs with steroid responsive meningitis-arteritis. JVIM 22 (5), 1149-1156 PubMed.
  • Behr A, Cauzinille L (2006) Aseptic suppurative meninigitis in juvenile boxer dogs: retrospective study of 12 cases. JAAHA 42 (4), 277-282 PubMed.
  • Redman J (2002) Steroid-responsive meningitis-arteritis in the Nova Scotia duck tolling retriever. Vet Rec 151 (23), 712 PubMed.
  • Tatum L M et al (1999) Canine LaCrosse viral meningoencephalomyelitis​ with possible public health implications. J Vet Diag Invest 11 (2), 184-188 PubMed.
  • Tipold A et al (1999) Lymphocyte subset distribution in steroid responsive meningitis-arteritis in comparison to different canine encephalitides. Zentralbl Veterinarmed A​ 46 (2), 75-85 PubMed.
  • Bennett P F et al (1997) Idiopathic eosinophilic meningoencephalitis in Rottweiler dogs - three cases (1992-1997). Aus Vet J 75 (11), 786-789 PubMed.
  • Muñana K R (1996) Encephalitis and meningitis. Vet Clin North Am Small Anim Pract 26 (4), 857-874 PubMed
  • Brass D A (1994) Pathophysiology and neuroimmunology of bacterial meningitis. Comp Cont Educ Pract Vet 16 (1), 45-53 VetMedResource.
  • Tipold A & Jaggy A (1994) Steroid responsive meningitis-arteritis in dogs - long-term study of 32 cases. JSAP 35 (6), 311-316 VetMedResource.

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