Inflammatory Myeloradiculitis Secondary to Pembrolizumab: A Case Report and Literature Review.

Immune checkpoint inhibitors are the most important new medications in oncology and include inhibitors of programmed cell death protein-1 (PD-1) such as Pembrolizumab, Nivolumab, and Cemiplimab. These anticancer agents prevent tumour immune evasion and have been associated with a range of immune-related adverse events (irAEs) including those involving the nervous system. In this case report and literature review, we present the first case of inflammatory myeloradiculitis secondary to Pembrolizumab. We also summarise the characteristics, treatment, and outcomes of other cases reported in the literature which include a component of myelitis. Finally, we make general recommendations on management.

Dermatophilus congolensis-associated placentitis, funisitis and abortion in a horse.

Placentitis, funisitis and fetal bronchopneumonia were diagnosed in an aborted full-term Thoroughbred fetus and its placenta by histopathological examination. Dermatophilus congolensis organisms were isolated from placenta, lung and stomach content. The genotypic identification of aerobic culture was confirmed by sequential analysis of the entire 16S rDNA gene. This is the first report of Dermatophilus congolensis-associated abortion in any species.

Pathological, entomological, avian and meteorological investigation of a West Nile virus epidemic in a horse farm.

Pathological, entomological and avian investigations were conducted during the summer of 2002, in a horse farm that had four cases of West Nile virus (WNV) infection in horses. All the four horses had encephalitis and WNV infection was confirmed by RT-PCR and in situ hybridization procedure. Forty-seven per cent of house sparrows that resided on the farm were tested positive for WNV infection. Mosquitoes (98%Culex pipiens) collected by trapping at the farm, during this period were positive for WNV. The meteorological data for year 2002 were compared to previous 16 years. The precipitation and atmospheric temperature were found to be reduced and higher respectively, indicating a drier summer than the prior 16 years, which may have been a contributing factor for the outbreak. None of the horses on these premises had been vaccinated for WNV disease.

Intestinal lesions in a horse associated with eastern equine encephalomyelitis virus infection.

The primary lesions of eastern equine encephalomyelitis (EEE) virus infection in the horse are limited to the brain and spinal cord. Intestinal lesions in addition to the changes in the central nervous system were found in a 6-month-old male Tennessee Walking Horse. One week prior to death, this colt was vaccinated for EEE virus, western equine encephalomyelitis virus, influenza virus, equine rhinopneumonitis virus, and tetanus. The clinical signs consisted of ataxia and rear-end weakness, with a body temperature of 102.8 F. Gross lesions consisted of yellowish discoloration, swelling, edema, and hemorrhage of the brain stem and dark discoloration of the gray matter of the spinal cord. Microscopic lesions in the small intestine were mainly in the muscular layer and consisted of multifocal areas of myonecrosis and lymphomonocytic infiltration with a few focal areas of mild fibrous connective tissue proliferation. Occasional focal mild perivascular lymphocytic infiltration was observed in the submucosa. Lesions in the brain and spinal cord consisted of widespread areas of perivascular lymphomonocytic cuffing, focal areas of necrosis, neutrophilic infiltration, hemorrhage, neuronal degeneration, and gliosis. Hepatic changes consisted of periportal lymphocytic infiltration and mild vacuolar degeneration of hepatocytes. EEE virus was isolated from the intestine and detected by DNA in situ hybridization.

Multiple abortions associated with caprine herpesvirus infection in a goat herd.

Herpesvirus infection of pregnant goats may result in abortion of fetuses without other signs of infection in does. Fetuses aborted as a result of caprine herpesvirus infection have tissue necrosis and intranuclear inclusion bodies in multiple organs.

Diagnosis of bovine viral diarrhea virus infection using monoclonal antibodies.

The monoclonal antibody (MAb) D89 against bovine viral diarrhea virus (BVDV) was used in conjunction with fluorescein-conjugated anti-mouse immunoglobulin in an indirect fluorescent antibody (IFA) procedure on frozen tissue sections and cell culture. During the 2-year study, BVDV was isolated from specimens submitted in 460 cases. The D89 Mab detected all but 2 BVDV isolates, both cytopathic. In 316 of the cases in which BVD virus was detected by IFA, specimens were inoculated on bovine turbinate cells and examined for BVDV antigens at 3-5, 10, and 20 days postinoculation. The BVDV was detected in 238/316 cases (75%) after 3-5 days incubation. The remainder were not detected until 10 or 20 days postinoculation. Virus isolation was enhanced in the early test if plates were centrifuged at the time of inoculation. Results suggest that D89 monoclonal antibody is a suitable diagnostic reagent for the detection of BVDV isolated from diagnostic specimens. The D89 MAb can be used for the detection of BVDV in both cell culture and tissues. Combination of D89 with another BVDV MAb (C17) did not improve the ability to detect BVDV in tissues compared to using D89 only, and the combined Mab's resulted in an increase in nonspecific fluorescence when used on tissues. Although pooling of different BVDV monoclonal antibodies may be necessary to detect all strains of BVDV in cell culture, pooling should be used with caution on tissues. Early detection of BVDV in cell culture by this IFA procedure permits faster confirmation of BVDV diagnosis when compared to the usual routine testing for noncytopathic BVDV at termination of first passage in cell culture.

Newcastle disease virus in waterfowl in wisconsin.

Newcastle disease virus was isolated from the cloaca of 1-5% of live-trapped waterfowl in Wisconsin in the fall from 1978-1980. Antibody to NDV was detected in 8% of the birds tested, with no apparent difference between sex and age classes. Experimental infection resulted in persistence of virus shedding for months after exposure. Lack of detectable antibody in some of the experimentally infected birds suggests that reported antibody prevalence may not be indicative of the true prevalence of the infection. Isolation of NDV for the last 9 years as well as the detection of antibody in waterfowl over 25 years ago, suggests a well-adapted host-parasite relationship. Experimental evidence of virus persistence in individual mallards (Anas platyrhynchos) provides a mechanism for maintenance of the virus in the wild population.

Characterization of isolates of Newcastle disease virus from migratory birds and turkeys.

The susceptibility of wild birds to infection with Newcastle disease virus (NDV) has resulted in speculation about the role of these free-flying birds in the origin and transmission of the virus infection. Since several NDV isolates from free-flying waterfowl and turkey flocks in the Midwest were avirulent for chickens and had thermostable hemagglutinins, isolates were collected from both waterfowl and turkeys over a seven-year period, 1974-1980, for comparison. Strains from both waterfowl and turkeys were avirulent, based on mean death times in chicken embryos, and could be differentiated from licensed vaccine strains with similar mean death times by in vitro markers. Waterfowl strains were generally thermostable, were slow to elute from chicken red blood cells, and produced plaques in chicken embryo fibroblasts. Some of the turkey isolates were similar to the waterfowl strains in thermostability, elution, and production of plaques in chick embryo fibroblasts. However, in the latter years of the study, there was a tendency toward isolation from turkey flocks of vaccine-like strains that did not produce plaques without additives and whose hemagglutinin was thermolabile. The appearance of these strains reflects either a selection for this virus type by the host or replacement of field strains by vaccine strains as the result of an increased usage of vaccines by producers.

Experimental infection and serologic survey for selected paramyxoviruses in red-winged blackbirds (Agelaius phoeniceus).

Red-winged blackbirds (Agelaius phoeniceus) were experimentally exposed to three avian paramyxoviruses: turkey parainfluenza virus, Yucaipa virus, and two strains of Newcastle disease virus. Aerosol exposure resulted in infection but exposure in food or drinking water rarely or never did. Tracheal swabs contained virus for up to eight days post exposure, cloacal swabs were negative. Transmission to contact birds occurred infrequently. Antibody response was of low titer and short duration. No hemagglutination inhibition activity against these viruses was found in 387 sera collected from red-winged blackbirds and tricolored blackbirds (Agelaius tricolor) trapped in six states.

Experimental Newcastle disease virus infections in three species of wild birds.

Three species of wild birds--the red-winged blackbird (Agelaius phoeniceus), an African weaver finch (Quelea quelea), and the sandhill crane (Grus canadensis)--were exposed to Newcastle disease virus (NDV) to determine susceptibility and host response. The NDV used were a vaccine strain (LaSota) and a viscerotropic velogenic strain (New York Parrot). Host response was monitored by virus isolation, signs of disease, and serologic response. Both the red-winged blackbirds and the quelea shed little virus and developed low antibody titers. A low mortality in the blackbirds did not appear to be due to ND alone. Vaccinated cranes were well protected against velogenic challenge, whereas unvaccinated cranes shed the velogenic virus from the cloaca for weeks. The ramifications of the low antibody titers produced in birds of two species are discussed, as well as the potential involvement of each species in transmission of the virus.