Transcript CASE #8 - Dr. Roberta Dev Anand

CASE #8
PATIENT PRESENTATION
PATIENT PRESENTATION
• SIGNALMENT: ~4-5yr old, intact, male, DMH
• PRESENTING COMPLAINT: inappetant,
hypersalivation, lethargy
• Hx: indoor/outdoor cat, has not had
vaccinations in over 3 years. Cat has had a few
fights with other neighborhood cats over the
years, but nothing serious.
PATIENT PRESENTATION
• PHYSICAL EXAM:
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Gingivitis, stomatitis
Wt. loss
Temp: 103.5, HR: 200, RR:36
Mm: pale , CRT: 2sec
• Other clinical signs may include:
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Gingivitis, stomatitis
Chronic fever
Vomiting
Diarrhea
Chronic URI
cachexia
Chronic, unresponsive skin/ear infections
DIAGNOSTIC TESTS
• CBC/SERUM CHEMISTRIES
• FeLV/FIV ELISA
– All unvaccinated outdoor cats should be tested for
these diseases as they are contagious and without
cure
DIAGNOSTIC TEST RESULTS
• CBC
– Anemia, lymphopenia
• ELISA positive
– THIS IS AN ANTIBODY TEST, not antigen – there
will be interference by maternal antibodies and
vaccination!
– Test result may be supported by other lab tests
such as IFA, Western blot, & PCR
TRANSMISSION
• TRANSMISSION
– Most infections are acquired through horizontal
transmission among adult male, sexually intact
cats
– Fight and bite wounds appear to be the major
route of transmission.
– It is possible to transmit the virus vertically to
neonatal kittens, but the virus is not easily
transmitted this way.
TREATMENT
• SEE FELINE LEUKEMIA VIRUS
• DENTAL SURGERY
– Whole mouth extraction of teeth may be
necessary in cats with chronic stomatitis and
gingivitis
CLIENT INFO & PROGNOSIS
• Although FIV is morphologically and
biochemically similar to HIV, it poses no threat to
humans
• Infected cats may survive for prolonged periods
before experiencing advanced stages of the
disease
– Some may be asymptomatic for 10+ yrs
• Keep FIV pos cats indoors
• Keep FIV pos cats free of stress and concurrent
disease
CASE #9
PATIENT PRESENTATION
PATIENT PRESENTATION
• SIGNALMENT: ~6mth old neutered, male DSH
• PRESENTING COMPLAINT: depression, feels “hot”,
looks yellow, painful abdomen, and difficulty
breathing. Cat began to act strange over the last
week. Poor appetite, soft stool
• Hx: indoor/outdoor cat, fully vaccinated, but not
against FeLV and FIV, microchipped, often brings
“gifts of mice” home
PATIENT PRESENTATION
• PHYSICAL EXAM
– Temp: 104.1, HR:220, RR:40, shallow
– Depression
– Labored breathing
– Icteric mm, CRT: difficult to assess, >2sec
– Painful on abdominal palpation
– OS: signs of inflammation/uveitis
PATIENT PRESENTATION
DIAGNOSTIC TESTS
• CBC/SERUM CHEMISTRIES
– Elevated ALT. ALP, total bilirubin
– CBC WNL
• FeLV/FIV Test
– Neg/Neg
• Thoracic radiographs
– pneumonia
• Paired titers
• ELISA
• FECAL
– See next slide
DIAGNOSTIC TESTS
PNEUMONIA IS MOST COMMON IN NEONATALLY
NEONATALLY OR TRANSPLACENTALLY INFECTED CATS
TOXOPLASMA OOCYTS
THESE OOCYTS
ARE DIFFICULT & RARE
TO FIND
TRANSMISSION & LIFE CYCLE
• TRANSMISSION:
– EATING CONTAMINATED MEAT
• Ingestion of uncooked or undercooked meat is most likely the
main route of infection in both cats and humans.
– Fecal – oral route
– Transplacental route
• Cats are the definitive host for Toxoplasma
gondii, but several animal can serve as
intermediate hosts
TRANSMISSION & LIFE CYCLE
CATS ONLY SHED OOCYTS
IN THE FECES FOR 1-2 WEEKS
THE OOCYTS BECOME INFECTIVE
AFTER 1-5 DAYS
TACHYZOITES ARE THE RAPIDLY
DIVIDING STAGE OF THIS PARASITE
THAT INFECTS THE TISSUES
TREATMENT & PROGNOSIS
• Clindamycin or Trimethoprim Sulfa for 2-3
weeks (may require 4 weeks treatment)
• Prognosis is poor for young patients with
hepatic or respiratory involvement, but good
for the older cat with minimal or no signs of
disease
TRANSMISSION & LIFE CYCLE
CLIENT INFORMATION
• Exposure to Toxoplasma is common – 30%-60%
of adult humans are seropositive
• Humans who are immunosuppressed should
avoid contact with infected cats
– Have someone else clean the litter box
• Avoid getting a new cat during pregnancy
• Have antibody titers checked before getting
pregnant
– Infection during the 1st or 2nd trimester can lead to
birth defects
• Cook all meat thoroughly
• DON’T PANIC
CASE # 10
PATIENT PRESENTATION
PATIENT PRESENTATION
• SIGNALMENT: 2yr old hound mix, intact male
• PRESENTING COMPLAINT: dog is reluctant to
move, has a stiff gait and seems painful,
possibly ataxic, lethargic for the last week.
• Hx: dog goes hunting with the owner about
once month for the last 3 months. Dog is
current on HW and flea preventive.
PATIENT PRESENTATION
• PHYSICAL EXAM
– Temp: 103.5, HR: 116, RR:24
– Mild mucopurulent ocular discharge
– Mm:pale pk, CRT: 2sec
– Animal is somewhat painful and ataxic
– Technician finds several ticks on the head and
neck region
PATIENT PRESENTATION
DIAGNOSTIC TESTS
• CBC/SERUM CHEMISTRIES
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Anemia
Leukocytosis w/left shift
Thrombocytopenia
Increased liver enzymes (ALT, ALP)
Hypoproteinemia
• SERUM TITERS – 4-fold increase between titers
• TISSUE BIOPSY & FLUORESCENT STAINING
DIAGNOSTICS & TREATMENT
• DIAGNOSIS: TICK-BORNE DISEASE
– ROCKY MOUNTAIN SPOTTED FEVER – caused by
Rickettsia rickettsii, a gram- obligate intracellular
bacterial organism.
– This organism is carried in the saliva of the tick
– Clinical signs occur secondary to vasculitis of small
blood vessels throughout the body. Other clinical
signs include: edema, hemorrhage, seizures,
coughing, vomiting, diarrhea, and more…
DERMACENTOR VARIABILIS
TICKS MUST BE ATTACHED TO HOST FOR 5-20
HOURS BEFORE TRANSMITTING INFECTIOUS ORGANISM
DERMACENTOR ANDERSONI
DIAGNOSIS & TREATMENT
• TREATMENT
– Doxycycline
– Tetracycline
– Antibiotics only reduce the number of organisms,
the animal must have a good immune system to
eliminate them.
CLIENT INFORMATION
• Blood from infectious patients and from the
tick can be infectious
• Client should watch for signs of myalgia,
headache, fever, or abdominal pain
• Keep pets out of heavily infested tick areas
and remove ticks quickly. Add tick prevention
to the pet’s health regimen.
• Incubation period is ~7days
CASE #11
PATIENT PRESENTATION
PATIENT PRESENTATION
PATIENT PRESENTATION
• SIGNALMENT: 2yr old mixed breed, castrated
male
• PRESENTING COMPLAINT: lethargy, labored
breathing, swollen neck, and swollen rt rear leg
for about a week that seemed to resolve. About 6
weeks later developed bleeding from the nose,
dyspnea, weakness, and “red spots” on the skin
• Hx: outdoor dog, vaccinations current, on HW
and flea preventive.
PATIENT PRESENTATION
• PHYSICAL EXAM
– Temp: 103.8, HR: 120, RR: 28
– Mild epistaxis
– Petechial hemorrhages
– Edema of the extremities
– Ticks found in the coat
DIAGNOSTIC TESTS
• CBC/SERUM CHEMISTRY
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25% have pancytopenia
Anemia
Thrombocytopenia
Hyperglobulinemia
• Blood smear
• Observe morula in
mononuclear cells
• IFA
DIAGNOSIS
• DIAGNOSIS: TICK-BORNE DISEASE
– CANINE MONOCYTIC EHRLICHIOSIS, caused by
Ehrlichia canis transmitted by the tick Rhipicephalus
sanguineus
– After infection, E. canis causes acute, subclinical, and
chronic stages of the disease
– ACUTE: lasts 2-4 weeks
• Organisms multiplies in mononuclear cells
• Mononuclear cells carry the organism to other organs
including the lungs, kidneys, and meninges.
• Vasculitis develops
– SUBCLINICAL PHASE
• Few clinical signs if any
– CHRONIC PHASE
• Bone marrow suppression
• Bleeding tendencies
RHIPICEPHALUS SANGUINEUS
TREATMENT
• ANTIBIOTICS
– Doxycycline
– Tetracycline
– +/- blood transfusions
CASE #12
PATIENT PRESENTATION
PATIENT PRESENTATION
• SIGNALMENT: 3yr old castrated male, English
Setter
• Hx: Moved from the northeast about 3 weeks
ago. Prior to moving, owner pulled off a few
ticks . Some of the areas have a red rash. In
the last few days, the dogs is showing some
lameness in the rear legs
PATIENT PRESENTATION
• PHYSICAL EXAM
– Temp:103.5, HR: 100, RR: 24
– Lethargic
– Wt. bearing lameness on the rt. Rear limb that
seems to come and go.
PATIENT PRESENTATION
DIAGNOSTIC TESTS
• Radiographs
– Would be normal
• ELISA TEST
– Lyme Positive
• SYNOVIAL FLUID ANALYSIS
– Increased nucleated cells
PATIENT PRESENTATION
LYME DISEASE
• LYME DISEASE is caused by the spirochete
Borrelia Burgodorferi, passed by an Ixodes tick
– The tick must be attached to the host for more than
48 hours
• Other clinical signs:
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Fever
Anorexia
Lymphadenopathy
Chronic flare-ups
Myocardial abnormalities
Nephritis, esp in Labs
TREATMENT & PREVENTION
• ANTIBIOTICS
– Doxycycline
– Anti-inflammatory drugs for pain
• NSAIDs OR
• Steroids
– VACCINATION
• For animals in endemic areas, northeast U.S.
• CLIENT INFO
• Infected animals may have relapses even after treatment
because the antibiotic does not completely eliminate the
organism
• Use tick prevention