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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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