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DO YOUR BEST!. “A creative man is motivated by the desire to achieve, not by the desire to beat others.” - Ayn Rand. PANSYTEMIC DISEASES. These diseases are covered predominantly in chapter 9 of your textbook. CASE #1. PATIENT PRESENTATION. PATIENT PRESENTATION. - PowerPoint PPT PresentationTRANSCRIPT
DO YOUR BEST!
“A creative man is motivated by the desire to achieve, not by the desire
to beat others.”-Ayn Rand
PANSYTEMIC DISEASES
These diseases are covered predominantly in chapter 9 of your textbook
CASE #1
PATIENT PRESENTATION
• SIGNALMENT: 12 week old, male/neutered, mixed breed puppy
• PRESENTING COMPLAINT: lethargy, ocular and nasal discharge for the past 3 days; mild cough, appetite is poor; puppy had diarrhea last night and vomiting/diarrhea this morning– Diet: Science diet puppy dry
• Hx: puppy adopted from local shelter 2 weeks ago; has received one set of vaccinations – owner was planning to schedule booster shots in one week
PATIENT PRESENTATION
• Hx: Puppy received his first doses of Heartworm and flea prevention 2 weeks ago at time of adoption.
• Other Info: Client has 1 other dog who is 1 year old and fully vaccinated; and 2 cats who are 2 and 5 yrs old that are fully vaccinated
PATIENT PRESENTATION
• PHYSICAL EXAM FINDINGS:– Lethargy– ~8% dehydrated– Temp: 103.8, HR: 116, RR: 20 – lung fields sound
slightly moist, and the puppy coughs a few times during the exam
– Mm: pink, CRT: 2.5sec– Mucopurulent ocular/nasal discharge– The nose looks, dry, thick, and crusty
PATIENT PRESENTATION
PATIENT PRESENTATION
ENAMEL HYPOPLASIA
HYPERKERATOSIS OF NOSE & FOOT PADS
• DIAGNOSTIC TEST RESULTS:CBC shows:– Leukopenia –early in the disease– Mild anemia
• WORSENING OF CLINICAL SIGNS: 1 week later, the client returns. The puppy is weak and appears to have muscle twitching; muscle of the mouth appear as if the puppy is “chewing gum”; there are pustules on the abdomen, and hyperkeratotic foot pads
DIAGNOSTICS AND TREATMENT
• TREATMENT– ANTIBIOTICS– FLUIDS– SYMPTOMATIC TREATMENT• Anti-emetics• Ophthalmic ointments• Cleaning ocular/nasal discharge frequently• Nutrition• Clean, dry environment; low stress
• DIAGNOSTICS– Blood work is drawn for a CBC, serum chemistry
profile and Canine Distemper titers
DIAGNOSTICS AND TREATMENT
DIAGNOSIS:CANINE DISTEMPER VIRUS
http://www.youtube.com/watch?v=QL4S4MA2zT0
http://www.youtube.com/watch?v=HyEFS77rOzU
*Myoclonus is characteristic for Canine Distemper
• FURTHER DIAGNOSTICS:– Blood work drawn to compare paired serum titers and CBC
results; Flourescent antibody(FA)• CBC: Leukocytosis with neutrophilia found due to
secondary infection
• FA: Viral inclusions are found in mononuclear cells of the blood smear– Post-mortem tissue sample taken from mucous membranes
or epithelial cells of the urinary, respiratory, or GI tract may also display viral inclusions.
• Titers have increased since last measurement
DIAGNOSTICS AND TREATMENT
• Transmission of this (single-stranded, RNA, paramyxo-) virus is through aerosolization of bodily fluids, fomites
• Fatality rate may be as high as 90%• Prognosis is guarded at best, especially if neurologic signs are
present• Neurologic signs may be focal to general including seizures
– Could occur weeks to years after initial infection
• Although Distemper is contagious, it is unlikely to affect the clients older, vaccinated dogs– CVD does not affect cats
PROGNOSIS & CLIENT INFORMATION
• Vaccination• Thorough cleaning – the virus is labile and can
be killed with common disinfectants, and heat• Isolation of infected animals
PREVENTION
CASE #2
PATIENT PRESENTATION
• SIGNALMENT: 4yr old, female spayed, daschund
• PRESENTING COMPLAINT: dry, hacking cough; dog is still active and eating and drinking well. Coughing began about 1 week ago.
• Hx: Owner began sending the dog to day care everyday while she was at work; After the puppy set of vaccines, dog was vx at 1yr and 2 yrs old. She received an injectable Bordetella vaccine 1 day before beginning daycare.
PATIENT PRESENTATION
• Hx: – Diet: Purina One– Patient is current on HW and flea prevention– No other significant illnesses– HW negative
• PHYSICAL EXAM FINDINGS:– Temp: 102.1, HR: 140, RR: 36– Sneezing and occasional coughing on exam
• Cough can be ellicited on tracheal palpation• Mild, clear nasal discharge
– Normal hydration status– Mm: pk CRT: <2sec
PATIENT PRESENTATION
• Aka Infections Tracheobronchitis• Major causes– VIRUSES: Canine Adenovirus-2, Parainfluenza,
Canine herpesvirus, Canine Influenza, canine distemper virus
– BACTERIA: mycoplasma, bordetella bronchiseptica, streptococcus sp.
DIAGNOSIS: CANINE RESPIRATORY DISEASE COMPLEX
http://www.youtube.com/watch?v=amGKQX9zdug
• DIAGNOSTICS– Based on physical exam, clinical signs and history
– Virus isolation from swabs of the pharynx, nasal passageways, trachea
– Thoracic rads if pneumonia suspected
DIAGNOSTICS & TREATMENT
• TREATMENT– Adequate hydration– Antibiotics– Antitussives• Hycodan (hydrocodone)• Butorphanol• Cough Tabs (dextromethorphan, guafenesin)• Bronchial dilators
– Aminophylline– terbutaline
DIAGNOSTICS & TREATMENT
• Transmission of these organisms is by inhalation of respiratory droplets or contact with fomites
• The prognosis is good with proper treatment– It is a self-limiting disease– May take 2-3 weeks to resolve
• Vaccinate 2-3 weeks prior to expected exposure when using the injectable vaccine– If using the intranasal vaccine 2-3 days prior to exposure is
recommended
PROGNOSIS & CLIENT INFORMATION
• Isolate infected animals• Vaccinate appropriately• Most routine disinfectants, bleach,
quarternary ammonium compounds will kill these viruses and bacteria
• Proper sanitation
PREVENTION
CASE #3
PATIENT PRESENTATION
• SIGNALMENT: 3mth old Rottweiler puppy, intact male
• PRESENTING COMPLAINT: lethargy, poor appetite, bloody diarrhea for 2 days; puppy has vomited twice this morning
• Hx: Owner purchased puppy from local trader’s market at 10 weeks old. The breeder gave the first set of vaccinations at 3 weeks old and a booster @ 7 weeks
PATIENT PRESENTATION
• Hx: owner already has a 6mth old, intact female Rottweiler he got as a gift from a family member. He purchased the new puppy as a playmate.– The 6mth old puppy had 3 sets of vaccinations
given by the family member.– Neither puppy has been started on heartworm or
flea prevention.– Diet: Blue Buffalo
PATIENT PRESENTATION
• PHYSICAL EXAM FINDINGS:– ~8% dehydrated• Mm:pale, CRT: >2.5sec
– Depressed– Rear soiled in blood-tinged diarrhea, strong, foul
odor– Temp: 103.5, HR: 120 RR: 24
PATIENT PRESENTATION
• Fecal• Parvo ELISA (snap test)– Detects viral antigen
• CBC/Serum Chemistries– Marked lymphopenia, neutropenia, increased PCV– Hypoglycemia, hypokalemia
• Parvo titers– High titers (1:10,000)
DIAGNOSTICS
PARVO ELISA
PATHOGENESIS
• TRANSMISSION: fecal-oral route– Virus has affinity for rapidly dividing cells such as
intestinal epithelium & bone marrow; severe cases affect the myocardium (esp in utero)• Affect on bone marrow lymphopenia,
neutropenia WBCs may be <2000
– Possible sequelae: septicemia, intussusception
• ISOLATE INFECTED ANIMALS• HOSPITALIZATION– IV fluids w/added electrolytes, added dextrose– ANTIBIOTICS– ANTI-EMETICS
• Reglan• Maropitant (cerenia)• Ondansetron
– NSAIDs– +/- Plasma transfusion for hypoproteinemia– +/-ANTIVIRAL
• Tamiflu
TREATMENT
• PROGNOSIS: generally good with aggressive and early treatment; 80%-90% success– Concurrent infections and GI parasites can worsen
prognosis
PROGNOSIS
• VACCINATION– Keep puppies isolated until they have firm immunity,
usually about 18-22 weeks of age– Vaccinate at 6-8 weeks then q3-4 weeks until 16
weeks of age
• CLIENT INFO– In this case, the 1st 2 vaccines are not valid– Client should isolate the new puppy from the older
one– Treatment is expensive– The virus is resistant in the environment and may
survive for years. A 1:30 solution of bleach is effective.
PREVENTION & CLIENT INFORMATION
CASE #4
• SIGNALMENT: ~6 week old intact, male kitten, DSH
• PRESENTING COMPLAINT: mucopurulent ocular/nasal discharge, congestion, head shaking, sneezing, inappetance – has gotten progressively worse in the last week
• Hx: owner has been feeding a family of stray cats outside her home. Several of the kittens look like this. This is the only kitten she could catch
PATIENT PRESENTATION
• Hx: no known vaccinations, no flea or HW prevention– Diet: owner feeds canned Whiskas
• PHYSICAL EXAM– Patient is QAR– Temp: 104.1, HR: 200, RR:40– Audible upper respiratory congestion– ~6-8% dehydrated– Mm: pale pk, CRT: 2 sec
PATIENT PRESENTATION
• DIAGNOSTICS– Clinical signs– Nasal, pharyngeal swabs
• DIAGNOSIS:– Feline Viral Rhinotracheitis(FVR)
• Feline Herpesvirus-1– Feline Calicivirus (FCV)
• 80-90% of all URI is cause by 1 of these 2 viruses
Chlamydophila felis– Bordetella– Mycoplasma
DIAGNOSTICS
DIAGNOSIS
• FLUIDS• ANTIBIOTICS• NURSING CARE– Warm, clean– Force feed, warm, food– Pain meds for oral or corneal ulcers
• DECREASE STRESS• AVOID STEROID• ANTIVIRAL– Idoxuridine
TREATMENT
• Both FVR and FCV are highly contagious– Transmitted via fomites (hands, clothes) and
aerolsolization of respiratory droplets withing 5 feet
• Morbidity is high, mortality is low– Oral ulcers can last 7-10 days
PROGNOSIS & CLIENT INFORMATION
• VACCINATION– Vaccines will reduce severity and duration of
clinical signs
• Isolate infected animals
PREVENTION