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Discospondylitis 267

• Myositis • Cerebrospinal fluid analysis (pp. 1080 and B) may be needed for the treatment of fungal
discospondylitis (p. 81).
• Polyarthritis 1323): findings generally are nonspecific; • B. canis: tetracyclines (doxycycline or
VetBooks.ir Initial Database • Echocardiogram and abdominal ultrasound: minocycline) for a minimum of 1-2 months Diseases and Disorders
elevated protein is most commonly reported
abnormality, and pleocytosis is rare.
• Complete blood count can reveal mild to
in combination with aminoglycosides
moderate neutrophilia; serum biochemistry
1-2 weeks of treatment. Recently, the use
abnormalities can include hypoalbuminemia used to evaluate for underlying/concurrent (streptomycin or gentamicin) for the first
systemic disease (e.g., endocarditis, abdomi-
and hyperglobulinemia. nal abscess or lymphadenomegaly) of enrofloxacin has been described.
• Urine culture: positive in roughly one-third • Percutaneous disc aspirates and culture or ○ Brucellosis cannot be cured, and zoonotic
of cases. Fungal hyphae may be seen in urine surgical biopsy: typically reserved for patients risk must be considered before opting for
sediment or identified on routine urine culture. that are not responding to medical therapy treatment.
• Blood cultures increase the likelihood of a or when a clear diagnosis cannot be reached • Surgical decompression may be warranted
positive culture result to two-thirds of cases. with imaging alone. if neurologic deficits are severe due to sig-
• B. canis testing should be performed in nificant spinal cord compression and signs
endemic areas, regardless of patient’s repro- TREATMENT do not resolve with appropriate antibiotic
ductive status (p. 1319). therapy. Spinal stabilization is often required
• Galactomannan antigen assay: very sensitive Treatment Overview if surgery is performed.
for diagnosis of disseminated aspergillosis. Treatment is initiated with broad-spectrum anti-
(p. 1309) biotics, ideally based on culture and sensitivity Chronic Treatment
• Radiographs remain the mainstay of diag- results (blood, aspirate from disc space, or less Physical rehabilitation therapy can help
nosis. A delay of up to 6 weeks between the ideally, urine). Antimicrobial therapy should maximize recovery for patients with severe
onset of signs and radiographic changes is be continued until clinical and radiographic neurologic deficits.
possible; serial radiographs may be of benefit resolution is documented, typically a minimum
if the index of suspicion for discospondylitis of 6 months. Behavior/Exercise
is high. Characteristic findings include Exercise restriction advised during the initial
○ Loss of definition/irregularity of endplate Acute General Treatment 4-6 weeks of therapy.
margins • If culture and sensitivity is not available, first-
○ Lysis and sclerosis of the adjacent endplates line therapy often involves first-generation Drug Interactions
and vertebral bodies cephalosporins or beta-lactamase–resistant Some of the drugs that may be considered
○ In early disease, the vertebral bodies can penicillins, as treatment for coagulase-positive are nephrotoxic (e.g., amphotericin B,
appear shorter and the disc spaces wider Staphylococcus. aminoglycosides).
as destruction occurs. In juvenile dogs, • Resolution of spinal hyperesthesia gener-
early signs more commonly include disc ally occurs within 3-5 days of appropriate Possible Complications
space narrowing and subluxation. antimicrobial therapy. Pain control can be • Secondary pathologic vertebral fracture and
○ With chronic disease, collapse of the disc achieved with nonsteroidal antiinflammatory subluxation
space and fusion of the adjacent vertebral drugs (NSAIDs). • Epidural abscessation/empyema
bodies can occur. • Antimicrobial therapy should be continued • If neurologic progression is documented,
○ Periosteal new bone formation on the for at least 4-6 weeks after radiographic advanced imaging is recommended.
ventral and lateral aspects of affected changes become static.
vertebrae • If no improvement after 1 week, consider Recommended Monitoring
○ The lumbosacral space is most commonly additional diagnostics or adding a second • Serial radiographs every 4-6 weeks or sooner
affected. Majority of dogs have lesions in antimicrobial agent (fluoroquinolone or if the clinical signs worsen.
the thoracolumbar spine. Cervical lesions aminoglycoside). • Treatment is continued until there is clinical
are present in < 20% of cases. • For patients with severe illness, initiate and radiographic evidence of disease resolu-
○ Up to 40% of cases have multifocal therapy with intravenous antimicrobials tion. In adult dogs, radiographic progression
disease; it is recommended that survey (24-48 hours). can occur for up to 9 weeks after the initia-
radiographs of the entire vertebral column • Aspergillus spp are intrinsically resistant tion of therapy, even in patients showing a
be obtained. to fluconazole; multiple antifungal drugs good clinical response. In dogs < 1 year of
• Radiographic changes must be distinguished (itraconazole or voriconazole ± amphotericin age, radiographic improvement correlates well
from spondylosis deformans and vertebral
neoplasia.
○ Spondylosis deformans is characterized
by smooth, regular new bone formation Organism Antimicrobial Agent Dosage
ventrally, and discospondylitis causes Staphylococcus spp Cefazolin 22 mg/kg IV q 8h
irregular bony lysis. Cephalexin 25-30 mg/kg PO q 8h
○ Bony lysis is centered over the vertebral Ampicillin-sulbactam 20 mg/kg IV q 8h
body and remains confined to one vertebra Amoxicillin-clavulanate 20-25 mg/kg PO q 12h
for most neoplastic diseases, but disco- Streptococcus spp Amoxicillin 22 mg/kg PO q 12h
spondylitis involves two adjacent vertebral Escherichia coli Enrofloxacin 5 mg/kg PO q 12h
endplates. Cephalexin 25-30 mg/kg PO q 8h
Amoxicillin-clavulanate 20-25 mg/kg PO q 12h
Advanced or Confirmatory Testing
• Ultrasonography can have clinical applicabil- Brucella canis Doxycycline 10-15 mg/kg PO q 12h
20 mg/kg IM q 24h
Streptomycin
ity early in the course of disease because Gentamicin sulfate 9-14 mg/kg IV, IM, SQ q 24h
characteristic sonographic findings can appear Enrofloxacin 5 mg/kg PO q 12h
before radiographic changes.
• CT and MRI (p. 1132): increase the diag- Aspergillus Itraconazole 5 mg/kg PO q 12-24h
5 mg/kg PO q 12h
Voriconazole
nostic yield and should be considered when Amphotericin B Formulations vary
neurologic signs are present.
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