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Steroid responsive meningitis
Meningitis
also see Granulometous meningioencephalitis (GME)
also see Bacterial Infection
also see Fungal Infection
also see Distemper
also see Neurological problems
Steroid responsive meningitis not distemper in Mini SchnauzerQuestion: My question is regarding my nine-month-old minature schnauzer. We got
Heidi about five months ago. She has had all of her puppy shots and
has always been very hyper and very active, just as a puppy should be.About a month and a half ago, we noticed that Heidi was having trouble
keeping her eyes open. We took her to vet and were told that she had
allergies and to put some antibiotic ointment in them twice a day.
he also had a slight runny nose at that time and we were told that this
too was from allergies and we were told how much Benadry to give her when
she flared up.Time went on and her eyes cleared up. However, her nose continued to
be cracked and dry and would become crusted over with drainage. On
Sunday June 24, I noticed Heidi becoming unsteady on her feet (especially on
our ceramic tile). I trimmed her toe nails and the fur around her paws
but her clumsiness continued to worsen throughout the day. I returned to
our vet on Monday July 25th and was told that she most likely has
distemper. She did have a low-grade fever that day. The vet told me
(in front of my kids) that if she started developing seizures, she would
need to be put to sleep. I was so frustrated and angry. The vet would
hardly answer any of my questions at all. He gave her a shot of cortisone, a
prescription antibiotic pill, and some prednisone pills. He said she
would either get much better or much worse in the next ten days and to
let him know if we needed him. My daughters and I were so distraught at
this news. We are so attached to this dog - she is truly a member of our
family.I went home that night and found this website. In the meantime, I
decided to get a second opinion. I was able to see a different vet on
Wednesday June 27th. He was so sweet with Heidi. He checked her from head to
tail.
He watched her walk and agreed that there was definitely something
wrong with her neurologic system. He said he could not promise me that it
was not distemper but said that it would be very rare for her to have it
after being vaccinated. She did not have a fever on this day. He wants to
continue the prednisone and switched her to a stronger antibiotic
which will cover other diseases such as rocky mountain spotted fever, etc.
which could also interfere with the neurologic system. The vet also told me
that her teeth were in perfect condition which was a good sign because
dogs with distemper sometimes have rough and pitty teeth. He checked
her ears and told me that they were full of mites. He said that this too
could be part of her clumsiness.Today is Friday June 29th. Heidi is walking, even sometimes running,
so much better now. Her nose has not ran at all today or yesterday. The
vet did warn me that sometimes prednisone can "mask" the symptoms and they
may seem like they are doing better when maybe they really are not. She
has always acted like she feels pretty good, even when the first vet gave
her the death sentence. She wags her tail, she eats, drinks, goes outside
to play, her only problem seems to be her coordination.I just wanted your insight as to what you thought. She seems to be
getting so much better. We are going to do blood work later after she
finishes the prednsione (two weeks) to rule out other diseases. How
common do you think it is for a young vaccinated puppy (who is never
around any other dogs) to catch distemper and would a dog with
distemper act just the same as usual only with a lack of coordination? If it is
distemper, how progressive is the disease and how can I know for sure
that there is no hope for her?Thanks for your time.
P.S. I figured out a great way to give dogs medicine. Take a little
bit of extra crunchy peanut butter and hide the pill in that and let them
lick it off your finger. They can't tell the difference between the pill
and the peanuts! She gobbles it right up.
Thanks again. JenniferAnswer: Jennifer-
It is unusual for puppies who have been vaccinated against distemper
after they are twelve weeks of age to develop distemper. Some puppies do
develop vaccine induced encephalitis but this normally happens in very young
puppies or in puppies who are immune compromised for some reason. This
problem usually develops 1 to 2 weeks after vaccination when it occurs,
so I suspect that it is not likely in Heidi's case, because she was most
likely vaccinated several months ago. The only time we give up on
patients who we believe have distemper is when they can not get over the initial
clinicals signs (gastrointestinal problems or pneumonia) and reach a
point that it seems hopeless to keep going or when they develop severe
seizures after the initial signs that won't respond to anti-seizure medications.The most likely problem with the symptoms that you describe is steroid
responsive meningitis. Puppies with steroid responsive meningitis
usually have a fever, they have a stiff or uncoordinated gait, they often
resist having their head and neck touched or manipulated and may show signs of
severe pain. Paralysis, severe weakness or seizures may also occur.
Unfortunately, these are also the signs of most other forms of
meningitis, so bacterial meningitis, distemper induced meningitis, vasculitis and
fungal infections can cause similar signs.Examination of a cerebrospinal fluid (CSF) sample is helpful in
confirming that this condition is probably the cause of the symptoms seen. The
number and type of cells seen in the sample and the composition of the fluid
varies from one disorder to the next. It may not be possible to
absolutely confirm the presence of steroid responsive meningitis from the CSF
sample but it can be helpful in guiding how long to use corticosteroids and
whether other therapy, such as antibiotics, is necessary.Many general practitioners are not comfortable obtaining a CSF sample
or in interpreting the sample once it is drawn, so there is some resistance
to this diagnositc procedure among veterinarians. However, response to
therapy with corticosteroids is a pretty good sign that this condition is
present and in ruling out other causes. Its biggest drawback is the need to use
high doses of corticosteroids for some time if a patient doesn't
actually have this problem and the small risk of suppressing the immune system
in the face of a fungal or bacterial meningitis that might get worse with
this therapy.I am going to go on the assumption that steroid responsive meningitis
is present for the rest of this note, even though I hope that you
understand that is something that your vet should determine, based on eliminating
the other possibilities.Steroid responsive meningitis is named that because it is unclear why
it occurs, so naming it for the underlying cause isn't possible. It
responds well to the use of corticosteroids, so for now, that name seems best.
It is usually necessary to use corticosteroids daily for a couple of weeks to
a month or more to resolve the initial signs. Once the patient seems to
be back to normal, the dosage of corticosteroids can be tapered off,
slowly, to try to keep the illness from recurring. It is not unusual to have to
go back to the starting dosage of corticosteroids if a relapse occurs when
the corticosteroid is being reduced, at least for a short period of time.
Most dogs with this condition can be weaned completely off of steroids after
a few months but a few seem to need long term corticosteroid therapy. It
is possible that these patients may have a vasculitis disorder affecting
the central nervous system or something other than the typical steroid
responsive meningitis. The overall prognosis for this condition is
usually good, with most dogs either recovering completely or at least having
manageable disease.The most common corticosteroid used in treating this condition is
prednisone, usually used at a dosage of about 1 to 2mg/kg daily for the
first weeks of treatment and then going to an every other day dosing
scheme and finally tapering the dosage down slowly to stop the medication
after several months. If a relapse occurs while the prednisone is being
tapered, going back to the original dosage for a few days and then going back to
the last alternate day dosage that was working seems to control the problem
again in most cases.I am hoping that Heidi has continued to do well.
Mike Richards, DVM
8/2/2001
Q: Dr. Mike,
I wrote you last week about our dog which we were told had distemper. Now
it turns out that the autopsy shows that many things wrong with the dog but not
necessarily distemper. Our dog had menigitis, congenital liver problems,
pneumonia etc... I did not know that dogs got menigitis? What can you tell
us about this? Also, we are now about to get a new puppy. We have
throughly cleaned like you said, with bleach. Is there anything else we need to worry
about? Is menigitis also carried through the air?We really appreciate your answers. We are getting our money's worth, for
sure!Shirleen
A: Shirleen-
The definition of meningitis is inflammation of the meninges, the layer of
tissue that covers the brain and spinal cord. It can happen for a number of
reasons. Encephalitis is inflammation of the brain itself.In dogs, the most common form of meningitis is known as "steroid
responsive" meningitis. The name is derived from the fact that the
inflammation can be treated by using corticosteroids and because the reason
it occurs is not known. This form of meningitis may seem more common than
it is due to the infrequency of complete necropsy (autopsy) examinations in
veterinary medicine, but even when pretty intensive effort is made to
determine an underlying cause for meningitis it is impossible to find one
in many cases. In one study published in 1995 (the Journal of Veterinary
Internal Medicine, Tipold), the author could not find a specific cause for
meningitis in about 33% of the cases. This problem normally occurs in young
dogs but they are usually older than four months of age.There are a bunch of other causes of meningitis, including viral
infections, bacterial infections, fungal infections and parasites. There
are several meningitis syndromes that are not clearly understood, other
than steroid responsive meningitis. Granulometous meningoenephalitis of
older dogs is an example of one of these conditions.The two viral diseases in dogs that are known to cause meningitis are
distemper and parvovirus, with distemper being much more likely to be the
culprit in viral meningitis. The findings on the necropsy exam that you
have mentioned do not rule out distemper, which can sometimes be hard to
definitively identify. Most of the pathologists we have dealt with will at
least mention it as a strong possibility unless they think something else
is going on.Bacterial infections that can lead to meningitis include staphylococcal
infections, pasteurellosis and sometimes other bacteria. The biggest
problem with bacterial meningitis is that it is hard for antibiotics to
penetrate the blood/brain barrier so it is sometimes necessary to use
antibiotics for a really long time in order to control these infections.Most (possibly all) of the systemic fungal infections such as
histoplasmosis and blastomycosis can cause meningitis.Congenital liver diseases often lead to encephalitis. This is different
than meningitis but close enough that it seems reasonable to include the
congenital liver diseases in the differential diagnosis for your puppy,
since there is evidence of liver disease.Fortunately, in dogs, there does not seem to be a highly contagious
meningitis (other than distemper virus, which doesn't survive well in the
environment). It still seems very likely that there is very little risk to
a new puppy you might adopt after even this much time.Mike Richards, DVM
4/27/99
Last edited 06/19/04
