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Abordagem ao Diagnóstico da Meningite-Arterite Responsiva a Corticosteróides em Cães: Atualidade e Perspetivas Futuras
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Advisor(s)
Abstract(s)
A síndrome de meningite-arterite responsiva aos corticosteróides (MARC) é uma das doenças mais
frequentemente diagnosticadas em cães que apresentam hiperestesia cervical. Nos últimos anos
foram investigados meios de diagnóstico específicos que permitem o diagnóstico definitivo da
doença. O objetivo do presente artigo de revisão é resumir a atualidade na abordagem diagnóstica e
apresentar novos biomarcadores com potencial de diagnóstico específico e com acesso não invasivo.
O exame de estado geral dos animais afetados é a primeira etapa do diagnóstico: queixa de
hiperestesia cervical, associada a pirexia e alterações hematológicas (leucocitose, neutrofilia e/ou
monocitose) são bons indicadores de MARC. Juntamente com os achados do exame físico, o nível da
concentração da proteína C reativa no sangue é um bom indicador de inflamação sistémica, que deve
ser relacionado com os achados de imagiologia. Na Ressonância Magnética (RM) observa-se realce
das meninges, assim como da membrana sinovial das facetas articulares vertebrais e dos músculos
paravertebrais. Este exame complementar permite ainda excluir outros diagnósticos diferenciais,
como extrusão do disco intervertebral, e detetar hemorragias intra ou extramedulares. A
identificação de um padrão de alteração na ressonância magnética, assim como alterações sugestivas
no líquido cefalorraquidiano, no soro e no hemograma, podem permitir distinguir a MARC de outras
meningites assépticas. No futuro, a utilização de novas técnicas de diagnóstico como o doseamento
da concentração de microRNA, o doseamento e a especificidade das imunoglobulinas e a
identificação de redes extracelulares de neutrófilos no líquido cefalorraquidiano e soro, podem
auxiliar o diagnóstico de MARC com recurso a métodos menos invasivos.
Steroid-responsive meningitis-arteritis (SRMA) syndrome is one of the most frequently diagnosed diseases in dogs presenting with cervical hyperesthesia. In recent years, specific diagnostic methods have been investigated to enable a definitive diagnosis of the disease. The aim of this review article is to summarize the current diagnostic approach and to present new biomarkers with specific diagnostic potential with non-invasive access. The general examination of affected animals is the first step of diagnosis: cervical hyperesthesia, associated with pyrexia and hematological changes (leukocytosis, neutrophilia, and/or monocytosis), are good indicators of SRMA. Along with physical examination findings, the concentration levels of C-reactive protein in the cerebrospinal fluid are good indicators of systemic inflammation, which must be correlated with imaging findings. In Magnetic Resonance Imaging (MRI), enhancement of the meninges, as well as the synovial membrane of the vertebral articular facets and the paravertebral muscles, can be observed. This imaging modality also allows for the exclusion of other differential diagnoses, such as intervertebral disc extrusion, or to detect intra- or extramedullary hemorrhages. The identification of changes in MRI, cerebrospinal fluid (CSF), serum and complete blood count, may help distinguish SRMA from other aseptic meningitis. In the future, the use of new diagnostic techniques, such as microRNA concentration, the measurement and specificity of immunoglobulins, and detection of extracellular traps of neutrophils in cerebrospinal fluid (CSF) and serum, may aid the diagnosis of SRMA using less invasive methods.
Steroid-responsive meningitis-arteritis (SRMA) syndrome is one of the most frequently diagnosed diseases in dogs presenting with cervical hyperesthesia. In recent years, specific diagnostic methods have been investigated to enable a definitive diagnosis of the disease. The aim of this review article is to summarize the current diagnostic approach and to present new biomarkers with specific diagnostic potential with non-invasive access. The general examination of affected animals is the first step of diagnosis: cervical hyperesthesia, associated with pyrexia and hematological changes (leukocytosis, neutrophilia, and/or monocytosis), are good indicators of SRMA. Along with physical examination findings, the concentration levels of C-reactive protein in the cerebrospinal fluid are good indicators of systemic inflammation, which must be correlated with imaging findings. In Magnetic Resonance Imaging (MRI), enhancement of the meninges, as well as the synovial membrane of the vertebral articular facets and the paravertebral muscles, can be observed. This imaging modality also allows for the exclusion of other differential diagnoses, such as intervertebral disc extrusion, or to detect intra- or extramedullary hemorrhages. The identification of changes in MRI, cerebrospinal fluid (CSF), serum and complete blood count, may help distinguish SRMA from other aseptic meningitis. In the future, the use of new diagnostic techniques, such as microRNA concentration, the measurement and specificity of immunoglobulins, and detection of extracellular traps of neutrophils in cerebrospinal fluid (CSF) and serum, may aid the diagnosis of SRMA using less invasive methods.
Description
Keywords
Biomarcadores Imagiologia MARC Meningite Sinais clínicos Teste diagnóstico Biomarker Clinical signs Diagnostic imaging Diagnostic test Meningitis SRMA