DO YOUR BEST!

1. DO YOUR BEST! “A creative man is motivated by the desire to achieve, not by the desire to beat others.” -Ayn Rand

2. PANSYTEMIC DISEASES These diseases are covered predominantly in chapter 9 of your textbook

3. CASE #1

4. PATIENT PRESENTATION

5. 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

6. 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

7. 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

8. PATIENT PRESENTATION HYPERKERATOSIS OF NOSE & FOOT PADS ENAMEL HYPOPLASIA

9. 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

10. 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

11. DIAGNOSIS:CANINE DISTEMPER VIRUS http://www.youtube.com/watch?v=HyEFS77rOzU http://www.youtube.com/watch?v=QL4S4MA2zT0 *Myoclonus is characteristic for Canine Distemper

12. 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

14. 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

15. PREVENTION • Vaccination • Thorough cleaning – the virus is labile and can be killed with common disinfectants, and heat • Isolation of infected animals

16. CASE #2

17. PATIENT PRESENTATION

18. 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.

19. 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

20. 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

21. 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

22. DIAGNOSTICS & TREATMENT • TREATMENT • Adequate hydration • Antibiotics • Antitussives • Hycodan (hydrocodone) • Butorphanol • Cough Tabs (dextromethorphan, guafenesin) • Bronchial dilators • Aminophylline • terbutaline

23. 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

24. PREVENTION • Isolate infected animals • Vaccinate appropriately • Most routine disinfectants, bleach, quarternary ammonium compounds will kill these viruses and bacteria • Proper sanitation

25. CASE #3

26. PATIENT PRESENTATION

27. 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

28. 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

29. 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

30. 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)

31. PARVO ELISA

33. 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

34. 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

35. PROGNOSIS • PROGNOSIS: generally good with aggressive and early treatment; 80%-90% success • Concurrent infections and GI parasites can worsen prognosis

36. 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.

37. CASE #4

39. 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

40. 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

41. 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

42. DIAGNOSIS

43. TREATMENT • FLUIDS • ANTIBIOTICS • NURSING CARE • Warm, clean • Force feed, warm, food • Pain meds for oral or corneal ulcers • DECREASE STRESS • AVOID STEROID • ANTIVIRAL • Idoxuridine

44. 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

45. PREVENTION • VACCINATION • Vaccines will reduce severity and duration of clinical signs • Isolate infected animals