Standard ACTH (aqueous solution) Stimulation Protocol
Depot ACTH (Synacthen® Depot) Stimulation Protocol
Following medical therapy for hyperadrenocorticism an ACTH stimulation test should be performed:
Trilostane
Mitotane
Reference
https://www.antechdiagnostics.com/laboratory-diagnostics/molecular-diagnostics/cadet-braf-plus
- less than 50% reduction in lesion extent after 2 weeks of treatment- emergence of new lesions during treatment
- presence of residual lesions after 6 weeks of treatment
The optimal collection technique varies with the type of skin lesion:
- skin biopsy with sterile technique, surface epidermis removed (most reliable)
- swab sampling after puncture with sterile needle and gentle squeezing (suitable for small lesions, e.g. papules)
- fine needle aspiration - most suitable for nodules with intact pockets of exudate.Immediately after collection:
1ml
Cultures are examined at 24 hrs, 48 hrs and 7 days.
Preferred blood culture bottle is BacT/ALERT PF Paediatric. These can be ordered using our Vet Supply Requisition Form. These bottles are suitable for aerobic and facultative anaerobic microorganisms (bacteria and yeast). Obligate anaerobes may require a dedicated BacT/ALERT Anaerobic blood culture bottle (which can also be ordered using our Vet Supply Requisition Form). Compared to traditional manual methods using glass bottles, the BacT/ALERT bottles have added benefits including:
Brucella suis in dogs:
Serology to screen for Brucella suis infection:
Dogs with suspected clinical signs and considered at risk should be tested for antibodies to B suis.
Dogs should be re-tested in a further 6 weeks if:
Bacterial culture to confirm Brucella suis infection:
Brucella suis infection can be confirmed by bacterial culture from fresh tissue or fluid (or swabs, though tissue is preferred):
Brucella suis in pigs:
The signs of infection with Brucella suis in pigs are variable as the bacteria may spread beyond the reproductive tract and localise in other parts of the body. The most significant clinical signs are:
Antibody testing for Brucella may be conducted but is not specific for Brucella suis (see Brucella suis in dogs).Brucella suis in cattle and horses:
Cattle and horses may be infected with Brucella suis if they share an environment with feral pigs (e.g. open waters frequented by feral pigs). There are no specific clinical signs but cattle and horses may be antibody-positive for Brucella due to infection with Brucella suis. A positive antibody test result in cattle, usually detected during a herd infertility investigation, must be investigated further to ensure that it has not been caused by Brucella abortus.
Brucella suis in humans:
Humans can become infected via inhalation, ingestion or through broken skin or conjunctiva. Brucella suis mainly affects abattoir workers, pig farmers and feral pig shooters. Conditions of slaughter and field preparation of feral pigs influences the risk of human infection and strict hygiene is essential. Human infection can also occur from contaminated feral pig meat during food preparation, cooking, serving and eating.Owners of dogs diagnosed with brucellosis should seek advice from a human infectious disease clinician if they have concerns about their own health. References:
NSW Department of Primary Industries (2017) Brucellosis (Brucella suis) in dogs - guidelines for veterinarians. Primefact 1421. Second edition. http://www.dpi.nsw.gov.au/__data/assets/pdf_file/0008/577376/Brucellosis-in-dogs-guidelines-for-veterinarians.pdfNational list of notifiable animal diseases (205) http://www.agriculture.gov.au/pests-diseases-weeds/animal/notifiable
James DR et al (2017) Clinical management of Brucella suis infection in dogs and implications for public health. Aust Vet J 95(1):19-25
- three 14 G Trucut biopsies (each 2 cm long) - 5 x 5 x 5 mm - Analysis can be attempted using smaller samples but is not as accurate. - If < 50 mg liver tissue, this will incur a surcharge (approximately 1.5X the price of routine assay)
- ‘O’ ring sealed 1-1.5 mL tubes are ideal (e.g. small pediatric red top non-EDTA Sarstedt blood tube). - Biopsy samples should not be submitted in large (e.g. 50 mL) containers.
24 hours
0.75 mL whole blood (minimum 250 uL serum)
5 days
Footnotes:
a One VHT panel per invesigation (i.e. one charge per investigation)
b One VTO panel per sample tested (i.e. charge is per dry swab/tissue tested)
c One VSP (tissue) or VS (swab) panel per sample tested (i.e. charge is per tissue/swab tested)
d 5-10 tissues
e Suggested sample is single dry swab of multiple sites across the placenta (amnion, umbilical cord between amnion and chorioallantois, chorioallantois near umbilical cord insertion) (see diagram below). Alternative sample is fresh tissue (chorioallantois or pool of each of those sites).
f Amnion, umbilical cord between amnion and chorioallantois, chorioallantois near umbilical cord insertion, chorioallantois at cervical pole.
PCR (EHV-1, Chlamydia)
Bacterial culture (panel code VSP or VS)
Histopathology (panel code VMH)
SUMMARY
Fresh lung, liver, spleen, thymus (+/- placenta) EHV-1 PCR
Single dry swab (multiple sites across placenta) Chlamydia PCR
Fresh stomach contents, lung (or swabs) (+/- placenta) Bacterial culture
Formalin-fixed placenta, lung, liver, spleen, thymus Histopathology
Standard histology jars (70, 250 mL) containing formalin are available (free of charge):
Larger plastic buckets (1, 2, 5 or 10 litre) can also be obtained from QML:
As a general rule, each specimen is set up and allocated a separate panel (which generates a separate bill for each specimen).
This includes:
EXCEPTIONS to the “number of specimens = number of panels” rule include:
PTH in cats is performed in combination with 25-OHVitamin D and ionised calcium. Please refer to Vitamin D Profile – Feline for collection guidelines.
This test is not currently available
Please contact the QML Pathology Referred Tests Department (Ph: 07 3121 4045) in the Brisbane central laboratory to order the special EDTA tubes containing additive required for this assay
1ml whole blood
24 hours
This includes stimulants, depressants and tranquillisers.For the complete list of substances routinely tested, click here
Note:
Strychnine can only be tested in urine using this screen
To test for strychnine in stomach contents or bait, see Strychnine
Specimen:
The following tests are available:
These tests answer different questions:
LIVE BIRD specimens:
- Blood spot on filter paper (minimum 6 mm diameter circle of blood, which must penetrate the filter paper) (FTA cards are not suitable for HI). Allow to dry at room temperature for 12-24 hours in a vertical position. Then store in a ziplock bag at 4°C until shipment. Does not have to be refrigerated during shipment (preferably ship within 48 hours of collection). OR
- EDTA whole blood (minimum 0.2 mL). Refrigerate during shipment.
If only serum, plasma or lithium heparin whole blood is available (rather than - EDTA whole blood), this can be used for HI and PCR but is not the preferred sample.
- New growth feather or dystrophic feathers with a blood-filled quill (minimum 2 feathers). A good site is over the thigh (under wings). Store in a ziplock bag at 4°C until shipment. Does not have to be refrigerated during shipment (preferably ship within 48 hours of collection).
DEAD BIRD specimens:
- spleen, liver, affected dystrophic feathers
Panel code BFD:Each test (HI, HA and PCR) will generate a separate charge.
If blood and feathers are submitted, all three tests (HI, HA and PCR) will be done unless the request form indicates otherwise.
If blood only is submitted, two tests (HI and PCR) will be done unless the request form indicates otherwise.
If feathers only are submitted, two tests (HA and PCR) will be done unless the request form indicates otherwise.
Acute disease
Recommended samples to collect before development of abscesses are:
Pus (aspirated) from an unopened abscess is also suitable for testing.
Pus or exudate from a ruptured abscess is not recommended for bacterial culture, as any S equi subsp equi may be overgrown by other bacteria (including potentially S equi subsp zooepidemicus).Carrier horses
Recommended samples to collect are:
Collect washes/lavages into a sterile container (10 mL sterile yellow screw top centrifuge tube, Stores code 682574). A 10 mL specimen volume is preferred.To perform nasal wash, instil 50 mL warm sterile saline via a 50 cm length of sterile soft tubing (5-6 cm diameter). Insert into the nasal cavity via the ventral nasal meatus. All samples should be refrigerated and kept cool during transport to the laboratory.
50 mL stomach contents frozen
6 - 8 weeks
Urine:Minimum 3-5 mL
3 ml (at least 1ml plasma is required)
3 weeks
This Profile includes Feline PTH, Vitamin D (25-OH) and Ionised Calcium.
Background
For background, click here.