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Análise e interpretação de líquido cefalorraquidiano em cães na prática clínica : estudo retrospetivo de 130 casos
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Resumo(s)
A análise de Líquido Cefalorraquidiano (LCR) é um exame complementar de diagnóstico extremamente útil, pois permite o acesso a informações relativas à saúde neurológica dos pacientes. Esta é frequentemente realizada com o propósito de auxiliar no processo diagnóstico ou para o controlo da evolução clínica dos doentes. Com o presente estudo procurou-se conhecer a realidade clínica associada a este exame, desde os sinais clínicos dos cães a que é colhido LCR, passando pelos resultados desta análise, até ao desfecho clínico dos episódios em estudo.
No presente estudo foram incluídos 130 cães, os seus LCR foram analisados, comparando-se os resultados obtidos nos exames citológicos e nos PCR realizados com o descrito na bibliografia. Foram ainda comparados os desfechos clínicos de 54 cães com diferentes resultados na avaliação citológica, procurando-se perceber se as conclusões extraídas da análise de LCR possuem valor como ferramenta de prognóstico.
A contagem de células nucleadas totais apresentou-se aumentada em 62 (47,7%) amostras, 55 (42,3%) com pleocitoses de células mistas e 7 (5,38%) neutrofílicas, tendo sido identificada a presença de bactérias numa amostra deste último grupo. Não foram identificadas pleocitoses mononucleares. Em 32 amostras foram realizadas técnica de PCR para deteção de agentes infeciosos, tendo sido, em 4 delas identificados os seguintes agentes: uma com Toxoplasma gondii, uma com Neospora caninum e duas com o vírus da esgana canina. A amostra com Neospora caninum não evidenciou qualquer alteração à citologia, enquanto que as restantes 3 amostras apresentaram pleocitoses moderadas de células mistas. Os cães de raça Beagle demonstraram uma associação com as pleocitoses neutrofílicas. A análise citológica e PCR de LCR demonstrou não possuir valor prognóstico.
Os dados obtidos reforçam a importância da análise do LCR em cães com doença neurológica, dada a frequência de pleocitoses e de agentes infeciosos no LCR neste estudo ter sido superior à descrita na bibliografia. Concluiu-se também que o recurso a técnicas moleculares é essencial, mesmo quando o LCR não apresenta as alterações analíticas esperadas, devendo os clínicos recorrer a estas técnicas sempre que suspeitem de qualquer agente infecioso como causa de meningite, não necessitando de o justificar na presença de uma pleocitose, mas sim nos sinais clínicos e diagnósticos diferenciais para cada caso.
ABSTRACT - CEREBROSPINAL FLUID ANALYSIS AND INTERPRETATION IN DOGS IN CLINICAL PRACTICE - RETROSPECTIVE STUDY OF 130 CASES - The analysis of cerebrospinal fluid (CSF) is an extremely useful complementary diagnostic exam, as it allows access to information regarding the patient’s neurological health. This test is often performed for the purpose of assisting the diagnosis process or for controlling the clinical evolution of patients. The present study aimed to understand the clinical reality of this exam, including the clinical signs of the dogs from which the CSF was collected, the results of this analysis and the clinical outcome of the episodes under study For this study, 130 dogs were included on which the CSF was analyzed, comparing the results obtained in the cytological tests and in the PCR with those described in the bibliography. The clinical outcomes of 54 dogs with different results in the cytological evaluation were also compared, in an attempt to understand whether the conclusions drawn from the CSF analysis were valuable as a prognostic tool. The total nucleated cell count was increased in 62 (47.7%) samples, 55 (42.3%) with mixed cell pleocytosis and 7 (5.38%) neutrophilic, with bacteria identified in a sample from last group. No mononuclear pleocytosis were identified. Infectious agents were identified in 4 of the 32 samples where the PCR technique was performed: one tested positive for Toxoplasma gondii, one for Neospora caninum and two for canine distemper virus. The sample with Neospora caninum showed no change in cytology, whilst the other 3 samples had moderate mixed cell pleocytosis. Beagle dogs showed an association with neutrophilic pleocytosis. CSF cytological and PCR analysis showed no prognostic value. The data obtained reinforced the importance of testing the CSF of dogs with neurological disease, given that the frequency of pleocytosis and infectious agents present in the CSF in this study was superior to that described in the literature. It can also be concluded that the use of molecular techniques is essential, even when the CSF does not present the expected analytical changes. The clinicians should resort to these techniques whenever they suspect an infectious agent as the cause of meningitis, without the need to justify it in the presence of pleocytosis, but in the clinical signs and the differencial diagnosis of each case.
ABSTRACT - CEREBROSPINAL FLUID ANALYSIS AND INTERPRETATION IN DOGS IN CLINICAL PRACTICE - RETROSPECTIVE STUDY OF 130 CASES - The analysis of cerebrospinal fluid (CSF) is an extremely useful complementary diagnostic exam, as it allows access to information regarding the patient’s neurological health. This test is often performed for the purpose of assisting the diagnosis process or for controlling the clinical evolution of patients. The present study aimed to understand the clinical reality of this exam, including the clinical signs of the dogs from which the CSF was collected, the results of this analysis and the clinical outcome of the episodes under study For this study, 130 dogs were included on which the CSF was analyzed, comparing the results obtained in the cytological tests and in the PCR with those described in the bibliography. The clinical outcomes of 54 dogs with different results in the cytological evaluation were also compared, in an attempt to understand whether the conclusions drawn from the CSF analysis were valuable as a prognostic tool. The total nucleated cell count was increased in 62 (47.7%) samples, 55 (42.3%) with mixed cell pleocytosis and 7 (5.38%) neutrophilic, with bacteria identified in a sample from last group. No mononuclear pleocytosis were identified. Infectious agents were identified in 4 of the 32 samples where the PCR technique was performed: one tested positive for Toxoplasma gondii, one for Neospora caninum and two for canine distemper virus. The sample with Neospora caninum showed no change in cytology, whilst the other 3 samples had moderate mixed cell pleocytosis. Beagle dogs showed an association with neutrophilic pleocytosis. CSF cytological and PCR analysis showed no prognostic value. The data obtained reinforced the importance of testing the CSF of dogs with neurological disease, given that the frequency of pleocytosis and infectious agents present in the CSF in this study was superior to that described in the literature. It can also be concluded that the use of molecular techniques is essential, even when the CSF does not present the expected analytical changes. The clinicians should resort to these techniques whenever they suspect an infectious agent as the cause of meningitis, without the need to justify it in the presence of pleocytosis, but in the clinical signs and the differencial diagnosis of each case.
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
Líquido cefalorraquidiano neurologia clínica cães pleocitose Cerebrospinal fluid clinical neurology dogs pleocytosis
Contexto Educativo
Citação
Pedro, A.C. (2018). Análise e interpretação de líquido cefalorraquidiano em cães na prática clínica : estudo retrospetivo de 130 casos. Dissertação de mestrado. Universidade de Lisboa, Faculdade de Medicina Veterinária, Lisboa.
Editora
Universidade de Lisboa, Faculdade de Medicina Veterinária