What Is Your Diagnosis? Esophageal and Gastric Washes in a Pet Moellendorff's Rat Snake

Veterinary Clinical Pathology · 2025-11-03

A 6-year-old female Moellendorff's rat snake (Orthriophis moellendorffi), weighing 0.8 kg, was presented to the Purdue University Veterinary Hospital for evaluation of open-mouth breathing, hypersalivation, and gurgling respiratory sounds. The owner reported that the snake had been quarantined in the serpentarium 1 week prior due to excessive oral mucus, though its appetite remained normal. The owner also disclosed maintaining approximately 50 snakes but provided no further husbandry details. On physical examination, the snake was alert and responsive but exhibited dyspnea. A laryngeal swab was collected for bacterial culture and sensitivity testing; after 5 days, aerobic culture yielded no growth. Ten days later, with no clinical improvement, the snake returned for reevaluation. Bloodwork was unremarkable, but radiographs revealed esophageal dilation with gas and increased soft tissue opacity caudal to the heart, suggestive of esophageal wall thickening or a mass. No radiographic evidence of respiratory disease was observed. Gastric and esophageal washes were obtained for cytologic analysis (Figure 1A,B). Both samples exhibited similar features. The samples were of low cellularity, consisting mainly of poorly preserved inflammatory cells and scant erythrocytes in the background. The leukocyte differential consisted of approximately 70% heterophils, 25% macrophages, and 5% lymphocytes. Rare basophils and plasma cells were identified on scanning, along with numerous unremarkable ciliated columnar cells and goblet cells. Notably, sparse thin-walled oval structures (25–35 μm wide × 45–50 μm long) were present. Frequently, a discernible, deeply basophilic granular material consistent with larval forms was seen inside these structures. The cytologic interpretation was mild heterophilic inflammation with larvated ova morphologically compatible with nematode eggs (likely Strongyloides /Rhabdias spp.). Smears of the esophageal and gastric washes underwent molecular testing at the University of Florida's Zoological Medicine and Wildlife Disease Laboratory. Genomic DNA was extracted and amplified via PCR using primers NC5 (5′-GTA GGT GAA CCT GCG GAA GGA TCA TT-3′) and NC2 (5′-TTA GTT TCT TTT CCT CCG CT-3′), which target conserved regions flanking the ITS1-5.8S-ITS2 ribosomal complex in nematodes [1]. The amplified PCR products were submitted for Sanger sequencing. Following quality trimming and assembly, a final consensus sequence of 581 bp was submitted to GenBank under accession number PQ303691. A comparison with the database revealed similarity to a previously described Strongyloides sp. (97.7%; GenBank entry: OQ107246.1) in a colony of captive colubrids [2]. Despite treatment with fenbendazole (for endoparasites) and metronidazole (for potential secondary bacterial infection), the snake's condition deteriorated, necessitating euthanasia. No postmortem examination or fecal analysis was conducted. Strongyloides are nematodes belonging to the family Strongyloididae [3]. At least 50 species have been described within this genus [4], infecting mammals, birds, reptiles, and amphibians [5]. Transmission occurs when larvae penetrate the host's skin or oral mucosa, enter systemic circulation, and migrate to the lungs [3]. They access the oral cavity through the trachea, where they can be ingested and subsequently enter the gastrointestinal tract [3]. However, both the Strongyloididae and Rhabdiasidae families have the potential to cause clinical signs associated with respiratory disease due to larval migration or adult parasites residing in the respiratory tissue, respectively [3]. Infected snakes often exhibit open-mouth breathing, mucous accumulation around the nares and glottis, and may develop severe pneumonia with secondary bacterial infection [3]. Because both families produce morphologically similar larvated eggs in feces [3], molecular analysis was critical for an accurate etiologic diagnosis in this case. The amplified sequence showed the highest similarity to a potential novel Strongyloides species recently identified in captive colubrids from central Florida, USA [2]. In that study, affected snakes frequently demonstrated esophageal thickening, with nematodes sometimes visible in the esophagus and stomach at various life stages [2]. The esophageal soft tissue opacity observed radiographically likely represented a helminth infection focus, though this couldn't be confirmed histologically. The snake's clinical signs may have reflected tracheal compression by the esophageal mass or dysphagia misinterpreted as respiratory distress. Although Strongyloides infections are common in snakes, this represents the first reported case in O. moellendorffi. While not contradictory, the diagnosis was unexpectedly achieved through cytologic examination of esophageal and gastric washes. The sequence's strong similarity to a potentially novel and highly pathogenic Strongyloides species [2] raises concerns about transmission risks in captive environments. This finding underscores the value of molecular methods for identifying emerging parasitic threats in reptile collections. The authors would like to acknowledge Dr. Robert J. Ossiboff for providing the sequences from the amplified material. The authors declare no conflicts of interest.

What’s your diagnosis? Globular to amorphous material in peripheral blood smears

Veterinary Clinical Pathology · 2025-06-03

Three 8-week-old research dogs (two male intact Victorian Bulldogs and one female intact Shih Tzu) had peripheral blood submitted to the Purdue University Veterinary Hospital Clinical Pathology Laboratory (PUVHCPL) for a health screening. These dogs were enrolled in a study aimed at understanding the impact of ground transportation on puppy welfare. All research dogs were considered healthy and had no significant abnormalities observed on physical exam. The dogs were not currently being injected with any fluids or medications. However, as a form of pain management during blood draws, lidocaine cream was applied locally at the blood draw site five minutes before blood collection on each dog. The blood draw site was performed with a 22-, 23-, or 25-gauge needle and included either the jugular vein or cephalic vein. The medical technologist at PUVHCPL observed an unknown material observed at the feathered edge of all blood smears from these dogs, which triggered a review by the clinical pathologist for further evaluation. The peripheral blood of one Victorian Bulldog was analyzed using the Advia 2120i Hematology System (Siemens, Washington, DC). Additionally, all three research dogs had peripheral blood smears stained with Modified Wright stain and processed using the Siemens Hema-Tek 3000 system. Since the other two research dogs were only submitted for slide review, their blood was not analyzed by the Advia system. The scatterplots from the Victorian Bulldog only showed abnormalities in the “Baso” channel (Figure 1), where a continuous, linear abnormality is seen going through the mononuclear area of the scatterplot and into where basophils are typically located. This abnormality is presumed to be due to the lidocaine gel since no other abnormalities that could cause this change were noted in the dog's peripheral blood. The smears were evaluated by a clinical pathology resident (EA) and deemed to be of good diagnostic quality without evidence of any age-related changes. Leukocyte numbers and erythrocyte density of two dogs were within normal limits. One dog had minimal macrocytic hypochromic anemia. A few reactive lymphocytes, as well as a moderate amount of poikilocytes, rare polychromatophils, clumped platelets, and rare large platelets, were observed on all of the blood smears. Despite clumping and mild size variability, a manual estimate of platelet numbers was within normal limits. In addition, low to moderate amounts of amorphous to globular, purple to magenta, extracellular material was observed at the feathered edge and occasionally in the monolayer of the peripheral blood smears. Differentials for this material included an artifact of sampling or staining precipitate, a proteinaceous or mucinous material, or material associated with the use of lidocaine cream (Uber Numb 5% Lidocaine Numbing Cream, UberScientific, LLC, Lexington, KT)1 as part of pain management during blood draws. To verify that this material was associated with the use of lidocaine cream, the researchers provided the cream for further investigation. Whole blood in 3.0-mL K2-EDTA tubes from one dog and horse were obtained from excess samples. These samples were mixed gently and slowly warmed to ambient temperature. Four to five drops of each blood sample (dog and horse) were placed into two separate test tubes, and a small amount of the lidocaine cream (less than 0.5 g) was gently mixed with the blood. Another test tube not containing lidocaine cream was used as a control for each species. Peripheral blood smears were made from each test tube, stained with Modified Wright stain using the Siemens Hema-Tek 3000, and evaluated by the same clinical pathology resident (EA). As seen in Figures 2A and 3A, no globular to amorphous material is seen at the feathered edge. However, in Figures 2B and 3B, where the lidocaine cream was added to the peripheral blood, abundant amounts of globular to amorphous, purple to magenta material can be seen at the feathered edge. This material was morphologically indistinguishable from the unknown material identified on the blood smears from the research animals (Figure 4). Therefore, we concluded that the material at the feathered edge of the blood smears from these research dogs was consistent with the lidocaine cream used for pain management. Lidocaine cream Uber Numb 5% Lidocaine Numbing Cream, UberScientific, is a topical anesthetic commonly used to temporarily relieve pain, itching, or swelling associated with anorectal disorders as well as relieve pain during blood draws in humans.1 For the research dogs in this case, the cream was used for pain relief during the blood draw and to prevent negative behavioral reactions during future blood draws. The amorphous component of the material seen on the peripheral blood smear is somewhat similar to what is found on cytology samples having ultrasound gel contamination.2 This may be due to ultrasound gel and the lidocaine cream having similar ingredients (disodium EDTA, distilled water, and propylene glycol). However, the lidocaine cream has a more globular appearance than the granular, bright purple material associated with ultrasound gel. This article highlights the importance of knowing the characteristics of artifacts that can be seen in peripheral blood smears of animals. Different artifacts, such as lidocaine cream and ultrasound gel, will have different appearances on blood smears stained with Modified Wright stain, and knowing these characteristics will allow pathologists and technicians to identify these artifacts and relay findings to the clinicians. In conclusion, the globular to amorphous, purple to magenta material seen on the peripheral blood smears of the research dogs was due to lidocaine cream contamination of the blood sample during collection. The addition of lidocaine cream to blood samples, ex vivo, supports this conclusion. To the authors' knowledge, documentation of this finding has not been previously reported. The authors have no conflicts of interest.

Clinical Findings and Outcome in 30 Dogs with Presumptive or Confirmed Nerve Sheath Tumors

Veterinary Sciences · 2024-04-28 · 6 citations

Nerve sheath tumors (NSTs) are well-recognized primary nervous system tumors, but there is relatively limited information in dogs including comparison of NSTs in different anatomical locations. This retrospective study describes the clinical features and outcomes in a group of dogs with NSTs affecting the cranial nerves or spinal nerves. Thirty dogs were included, 25 with a presumptive diagnosis and five confirmed by histopathologic analysis. Seven dogs also had cytology of tumor samples, which were supportive of the NST diagnosis in four. Eight dogs had cranial nerve-associated NSTs, with six involving the trigeminal nerve. Twenty-two dogs had spinal nerve-associated NSTs including 13 invading the spinal canal and nine peripheral to the spinal canal, with the majority affecting nerves or nerve roots of the brachial plexus. The prognosis was poor, with dogs being euthanized eventually because of disease progression. Among dogs alive 1 week after diagnosis, the median survival time was 4 months but ranged from 2 weeks to >2 years. While there was a broad overlap between NST locations, survival was generally longer for dogs without spinal canal or intracranial involvement. The results expand available information on NSTs in dogs but should be interpreted with caution given the small number of dogs with a definitive diagnosis. Further investigation is warranted to determine how tumor location, invasiveness, and treatments pursued impact outcome.

Pathology in Practice

Journal of the American Veterinary Medical Association · 2022-04-08 · 1 citations

In collaboration with the American College of Veterinary Pathologists.

Ejection Fraction Improvement Following Contemporary High-Risk Percutaneous Coronary Intervention: RESTORE EF Study Results

Journal of the Society for Cardiovascular Angiography & Interventions · 2022-08-13 · 23 citations

BackgroundDespite many reports of clinical outcomes in patients undergoing high-risk percutaneous coronary intervention (HRPCI) with hemodynamic support, little is known about whether this approach improves left ventricular ejection fraction (LVEF). The purpose of the present observational study was to examine, in an ideal patient population with Impella-supported HRPCI, whether there is an impact on left ventricular function at midterm follow-up.MethodsRESTORE EF is a multicenter, retrospective analysis of a prospectively collected observational data set that aimed to assess 90-day LVEF in patients undergoing Impella-supported nonemergent HRPCI (NCT04648306), who survived with no intervening cardiac procedures prior to the primary endpoint follow-up window (90-day LVEF assessment). Secondary endpoints included change in New York Heart Association Functional Classification and Canadian Cardiovascular Society Angina Grade at the last follow-up.ResultsFrom August 2019 to May 2021, 406 patients were enrolled at 22 US sites. Age was 70.2 ​​± ​​11.4 ​​years; 26% were female. In paired assessment at 90-day follow-up, baseline LVEF improved from 35 ​​± ​​15% to 45 ​​± ​​14% (N = 251, P < .0001), with significantly greater improvement in patients with residual SYNTAX score I of 0. Percentage classified as New York Heart Association class III/IV decreased from 62% at baseline to 15% at last follow-up (P < .001), and percentage with Canadian Cardiovascular Society grade III/IV symptoms decreased from 72% to 2% (P < .0001).ConclusionsIn an ideal cohort of HRPCI patients, there is a signal that hemodynamically supported HRPCI affords significant improvement in 90-day LVEF, with complete revascularization associated with greater LVEF improvement. These hypothesis-generating findings merit further assessment in large, all-comer studies and randomized trials.

Pathology in Practice

Journal of the American Veterinary Medical Association · 2022-02-25

In collaboration with the American College of Veterinary Pathologists.

Application of magnetically actuated self-clearing catheter for rapid in situ blood clot clearance in hemorrhagic stroke treatment

Nature Communications · 2022-01-26 · 24 citations

Maintaining the patency of indwelling drainage devices is critical in preventing further complications following an intraventricular hemorrhage (IVH) and other chronic disease management. Surgeons often use drainage devices to remove blood and cerebrospinal fluid but these catheters frequently become occluded with hematoma. Using an implantable magnetic microactuator, we created a self-clearing catheter that can generate large enough forces to break down obstructive blood clots by applying time-varying magnetic fields. In a blood-circulating model, our self-clearing catheters demonstrated a > 7x longer functionality than traditional catheters (211 vs. 27 min) and maintained a low pressure for longer periods (239 vs. 79 min). Using a porcine IVH model, the self-clearing catheters showed a greater survival rate than control catheters (86% vs. 0%) over the course of 6 weeks. The treated animals also had significantly smaller ventricle sizes 1 week after implantation compared to the control animals with traditional catheters. Our results suggest that these magnetic microactuator-embedded smart catheters can expedite the removal of blood from the ventricles and potentially improve the outcomes of critical patients suffering from often deadly IVH.

Development of an In Vitro Hemorrhagic Hydrocephalus Model for Functional Evaluation of Magnetic Microactuators Against Shunt Obstructions

World Neurosurgery · 2021 · 10 citations

• Medicine
• Surgery
• Cardiology

Safety and efficacy of dedicated guidewire, microcatheter, and guide catheter extension technologies for chronic total coronary occlusion revascularization: Primary results of the Teleflex Chronic Total Occlusion Study

Catheterization and Cardiovascular Interventions · 2021-09-28 · 3 citations

BACKGROUND: Description of procedural outcomes using contemporary techniques that apply specialized coronary guidewires, microcatheters, and guide catheter extensions designed for chronic total occlusion (CTO) percutaneous revascularization is limited. METHODS: A prospective, multicenter, single-arm study was conducted to evaluate procedural and in-hospital outcomes among 150 patients undergoing attempted CTO revascularization utilizing specialized guidewires, microcatheters and guide extensions. The primary endpoint was defined as successful guidewire recanalization and absence of in-hospital cardiac death, myocardial infarction (MI), or repeat target lesion revascularization (major adverse cardiac events, MACE). RESULTS: The prevalence of diabetes was 32.7%; prior MI, 48.0%; and previous bypass surgery, 32.7%. Average (mean ± standard deviation) CTO length was 46.9 ± 20.5 mm, and mean J-CTO score was 1.9 ± 0.9. Combined radial and femoral arterial access was performed in 50.0% of cases. Device utilization included: support microcatheter, 100%; guide catheter extension, 64.0%; and mean number of study guidewires/procedure was 4.8 ± 2.6. Overall, procedural success was achieved in 75.3% of patients. The rate of successful guidewire recanalization was 94.7%, and in-hospital MACE was 19.3%. Achievement of TIMI grade 2 or 3 flow was observed in 93.3% of patients. Crossing strategies included antegrade (54.0%), retrograde (1.3%) and combined antegrade/retrograde techniques (44.7%). Clinically significant perforation resulting in hemodynamic instability and/or requiring intervention occurred in 16 (10.7%) patients. CONCLUSIONS: In a multicenter, prospective registration study, favorable procedural success was achieved despite high lesion complexity using antegrade and retrograde guidewire maneuvers and with acceptable safety, yet with comparably higher risk than conventional non-CTO PCI.

ST-Segment Elevation Myocardial Infarction in the Morbidly Obese

JACC: Cardiovascular Interventions · 2021-03-18