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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.

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do your best

DO YOUR BEST!

“A creative man is motivated by the desire to achieve, not by the desire to beat others.”

-Ayn Rand

pansytemic diseases

PANSYTEMIC DISEASES

These diseases are covered predominantly in chapter 9 of your textbook

patient presentation1
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 presentation2
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 presentation3
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 presentation4
PATIENT PRESENTATION

HYPERKERATOSIS OF NOSE & FOOT PADS

ENAMEL HYPOPLASIA

diagnostics and treatment
DIAGNOSTICS AND TREATMENT
  • 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 treatment1
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
diagnosis canine distemper virus
DIAGNOSIS:CANINE DISTEMPER VIRUS

http://www.youtube.com/watch?v=HyEFS77rOzU

http://www.youtube.com/watch?v=QL4S4MA2zT0

*Myoclonus is characteristic for Canine Distemper

diagnostics and treatment2
DIAGNOSTICS AND TREATMENT
  • 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
prognosis client information
PROGNOSIS & CLIENT INFORMATION
  • 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
prevention
PREVENTION
  • Vaccination
  • Thorough cleaning – the virus is labile and can be killed with common disinfectants, and heat
  • Isolation of infected animals
patient presentation6
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 presentation7
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
diagnosis canine respiratory disease complex
DIAGNOSIS: CANINE RESPIRATORY DISEASE COMPLEX
  • Aka Infections Tracheobronchitis
  • Major causes
    • VIRUSES: Canine Adenovirus-2, Parainfluenza, Canine herpesvirus, Canine Influenza, canine distemper virus
    • BACTERIA: mycoplasma, bordetella bronchiseptica, streptococcus sp.

http://www.youtube.com/watch?v=amGKQX9zdug

diagnostics treatment
DIAGNOSTICS & TREATMENT
  • 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 treatment1
DIAGNOSTICS & TREATMENT
  • TREATMENT
    • Adequate hydration
    • Antibiotics
    • Antitussives
      • Hycodan (hydrocodone)
      • Butorphanol
      • Cough Tabs (dextromethorphan, guafenesin)
      • Bronchial dilators
        • Aminophylline
        • terbutaline
prognosis client information1
PROGNOSIS & CLIENT INFORMATION
  • 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
prevention1
PREVENTION
  • Isolate infected animals
  • Vaccinate appropriately
  • Most routine disinfectants, bleach, quarternary ammonium compounds will kill these viruses and bacteria
  • Proper sanitation
patient presentation9
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 presentation10
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 presentation11
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
diagnostics
DIAGNOSTICS
  • 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)
pathogenesis
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
treatment
TREATMENT
  • 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
prognosis
PROGNOSIS
  • PROGNOSIS: generally good with aggressive and early treatment; 80%-90% success
    • Concurrent infections and GI parasites can worsen prognosis
prevention client information
PREVENTION & CLIENT INFORMATION
  • 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.
patient presentation12
PATIENT PRESENTATION
  • 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 presentation13
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
diagnostics1
DIAGNOSTICS
  • 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
treatment1
TREATMENT
  • FLUIDS
  • ANTIBIOTICS
  • NURSING CARE
    • Warm, clean
    • Force feed, warm, food
    • Pain meds for oral or corneal ulcers
  • DECREASE STRESS
  • AVOID STEROID
  • ANTIVIRAL
    • Idoxuridine
prognosis client information2
PROGNOSIS & CLIENT INFORMATION
  • 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
prevention2
PREVENTION
  • VACCINATION
    • Vaccines will reduce severity and duration of clinical signs
  • Isolate infected animals
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