INTRODUCTION
Neurological
manifestations
01 canine
distemper virus
infect&
F
ABSTRACT
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Virus replication starts in the lymphoid tissues. When lymphatic tissue infection becomes
widespread, viraemia develops and an initial rise
in body temperature and leucopenia is observed.
Viral antigen can be found in buffy coat preparations during this time. Ten to 14 days after inoculation the virus invades various epithelial tissues
and the central nervous system. CDV enters the
brain parenchyma through the cerebrospinal
fluid pathways (Higgins and others 1982) or
crosses the blood-brain barrier by way of infected
lymphoid cells (Summers and others 1979). In
the central nervous system it replicates in neurons and in glial cells, resulting in grey matter
and white matter lesions with demyelination. In
many cases demyelination is the most important
finding.
The initial lesions in the white matter are not
inflammatory and are the result of viral replication in glial cells (Vandevelde and others 1985).
These lesions are characterised by demyelination
and occur in predilection sites such as the cerebellum, optic system and spinal cord. A chronic
course can result from a late or insufficient
immune response against CDV (Krakowka and
others 1975, Appel and others 1982). Inflammation in the demyelinating lesions during
the chronic disease may lead to further damage
of the white matter (Vandevelde and others
1982).
CLINICAL SIGNS
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LABORATORY FINDINGS
A frequent haematological finding is lymphopenia, sometimes combined with leucopenia
or leucocytosis with left shift, anaemia, monocytosis and rarely thrombocytopenia (Greene and
Appel 1990). Lymphopenia, a sign of immunosuppression in CDV infection, is also combined
with a decrease of lymphocyte responsiveness to
lectin stimulation (Cerruti-Sola and others 1983).
Serum biochemical findings including electrophoresis are non-specific and rarely useful for
diagnosis in this disease.
Examination of the cerebrospinal fluid can be a
very useful diagnostic procedure in distemper.
However, during the acute demyelinating stage of
the disease, inflammatory reactions are lacking
and protein and cell content of the cerebrospinal
fluid may be normal (Vandevelde and others
1986). In the chronic stage of the disease, inflammation occurs with invasion of mononuclear
cells in the lesions and the cerebrospinal fluid. In
such cases pleocytosis is frequently but not
always found (Bichsel and others 1984).
Many of the invaded cells are immunoglobulin-producing lymphocytes. By measuring the
IgG content in cerebrospinal fluid and serum and
using the corresponding albumin values as a reference, the so called IgG index can be determined (Bichsel and others 1984, Tipold and
others 1992). The IgG index is elevated in most
cases with inflammatory distemper, even in
those cases in which no significant pleocytosis
can be found. However, the index is normal in
most dogs with acute non-inflammatory distemper. The demonstration of an elevated IgG index
468
is very helpful to detect the presence of inflammation of the central nervous system but is not
specific for distemper (Tipold and others 1992).
DIAGNOSIS
A clinical diagnosis of distemper is often difficult when the typical presentation of the disease
with neurological signs developing after systemic
symptoms is lacking. Likewise, myoclonus,
which is highly suggestive of nervous distemper,
is lacking in more than half of the cases. When
multifocal neurological signs are found, an
inflammatory disease of the central nervous systtem is suspected and can be confirmed by cerebrospinal fluid examination.
CDV infection should be considered in the differential diagnosis in such cases. As described
above, frequently only one localisation is found.
Such cases of distemper with focal signs and in
which other typical findings such as extraneural
signs or myoclonus are lacking, are a diagnostic
challenge for the veterinary surgeon. Other focal
lesions have to be excluded by a variety of imaging techniques. Careful cerebrospinal fluid examination in such animals may reveal the presence
of inflammation suggesting the possibility of
CDV infection.
A final diagnosis is based on the demonstration of viral antigens in scrapings and body
fluids such as conjunctival smears, tracheal
washing, urine sediment and cerebrospinal fluid
cells. Viral antigen can be hard to find in the
extraneural tissues in cases with neurological
distemper without systemic signs. Viral antigen
can be detected in cerebrospinal fluid cells with
an indirect fluorescent antibody test using antiCDV antibodies. For this technique the cerebrospinal fluid cells have to be concentrated first
by sedimentation or centrifugation (Vandevelde
and Spano 1977). Frequently, only small numbers of cells can be obtained. The demonstration
of anti-CDV antibodies in serum is of limited
diagnostic value. Comparing serum antibody
titres with intrathecally produced anti-CDV IgG
may help diagnostically, however, severely
immunosuppressed animals may not have any
detectable antibody at all.
PROGNOSIS
The prognosis of CDV-infection with neurological signs is generally guarded, especially in
cases with severe immunosuppression and rapidly progressing clinical signs. Seizures in CDVinfection are an unfavourable prognostic sign
because they are generally difficult to control
TREATMENT
The lack of an effective antiviral treatment for
canine distemper vaccine. In most pups, the concentration of maternal antibodies reaches low
levels at six to eight weeks of age, but they may
be found until 14 weeks of age. As it is usually
not practical to determine the concentration of
maternal antibody, vaccination against CDV
every three to four weeks between six to 16
weeks of age is recommended, followed by
periodic boosters (Greene and Appel 1990).However, vaccination breakthroughs may occur. More
than half of the current dogs with neurological
distemper had been vaccinated against CDV. In
addition, post vaccinal encephalitis has been
reported after distemper vaccination (Hartley
1974).
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Antibody-induced generation of reactive oxygen radicals by
brain macrophages in canine distemper encephalitis: a
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STOCKER,
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HARTLEY,
W. J. (1974) A post-vaccinal inclusion body
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HIGGINS,
R. J.,KRAKOWKA,S. G., METZLER,
A. E. & KOESTNER,
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(1982) Primary demyelination in experimental canine distemper virus induced encephalomyelitis in gnotobiotic
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S., OLSEN,R., CONFER,
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A., PFISTER,H. & VANDEVELDE,
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VIDEO REVIEW
gnosis of this condition is only achieved by biopsy (unless one has seen it before). The four difficult cases which are discussed are atopy, drug
eruption, pemphigus foliaceus and vasculitis.
This last case nicely illustrates the point that
although the pathological process may be identified the underlying cause may still be elusive. In
both of these videos the authors talk the viewer
through their thought processes, and with a fair
degree of success. One must accept that videos
can never capture the essence of a diagnosis;
only being in the consulting room can achieve
that.
On the whole the format is successful and the
productions are useful. The photography is good
and the close-ups of the lesions particularly so.
The use of overlays to summarise the case history
or laboratory tests, for example, is very effective.
Some aspects of the production are less pleasing.
In particular the cutting between besuited clinician in the office to clinicians in consulting
tunic. This gives a somewhat disjointed feel to
the flow of the material and this reviewer and
one suspects the clinicians, would have felt more
comfortable with the discussions taking place in
the consulting room.
The tapes are supplied with a small booklet
which contains a few questions and seven summarised case histories. The presumption is that
the viewer will be in a position to answer these if
the information in the video productions has
been understood.
These two video productions will prove useful
to clinicians who require guidance on how to
apply investigative dermatological techniques to
clinical case material and the production is to be
commended.
RICHARD HARVEY
1-8
VANDEVELDE,
M., ZURBRIGGEN,
A., HIGGINS,
R. J. & PALMER,
D.
(1985) Spread and distribution of viral antigen in
nervous canine distemper. Acta Neuropathologica 67,
211-218
VANDEVELDE,
M., ZURBRIGGEN,
A., STECK,
A. & BICHSEL,
P. (1986)
Studies on the intrathecal humoral immune response in
canine distemper encephalitis. Journal of NeuroimmunolOgy11, 41-51
WOLF, M., CACHIN,
M., VANDEVELDE, M., TIPOLD, A. & DUBEY,
J. P. (1991) Zur klinischen diagnostik des protozoaren
myositissyndroms (Neospora caninum) des welpen.
Tierh'rztliche Praxis 19, 302-306