case #8. patient presentation signalment: ~4-5yr old, intact, male, dmh presenting complaint:...

CASE #8

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.


• PHYSICAL EXAM:– Gingivitis, stomatitis– Wt. loss– Temp: 103.5, HR: 200, RR:36– Mm: pale , CRT: 2sec

• Other clinical signs may include:– Gingivitis, stomatitis– Chronic fever– Vomiting– Diarrhea– Chronic URI– cachexia– Chronic, unresponsive skin/ear infections


• CBC/SERUM CHEMISTRIES• FeLV/FIV ELISA– All unvaccinated outdoor cats should be tested for

these diseases as they are contagious and without cure

DIAGNOSTIC TESTS

• 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

DIAGNOSTIC TEST RESULTS

• 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.

TRANSMISSION

• SEE FELINE LEUKEMIA VIRUS

• DENTAL SURGERY– Whole mouth extraction of teeth may be

necessary in cats with chronic stomatitis and gingivitis

TREATMENT

• 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

CLIENT INFO & PROGNOSIS

CASE #9

• 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


• 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


• 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

DIAGNOSTIC TESTS

PNEUMONIA IS MOST COMMON IN NEONATALLY NEONATALLY OR TRANSPLACENTALLY INFECTED CATS

TOXOPLASMA OOCYTSTHESE OOCYTSARE DIFFICULT & RARETO FIND

• 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 OOCYTSIN THE FECES FOR 1-2 WEEKSTHE OOCYTS BECOME INFECTIVEAFTER 1-5 DAYS

TACHYZOITES ARE THE RAPIDLYDIVIDING STAGE OF THIS PARASITETHAT INFECTS THE TISSUES

• 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

TREATMENT & PROGNOSIS

• 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

CLIENT INFORMATION

CASE # 10

• 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.


• 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


• CBC/SERUM CHEMISTRIES– Anemia– Leukocytosis w/left shift– Thrombocytopenia– Increased liver enzymes (ALT, ALP)– Hypoproteinemia

• SERUM TITERS – 4-fold increase between titers• TISSUE BIOPSY & FLUORESCENT STAINING

DIAGNOSTIC TESTS

• 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…

DIAGNOSTICS & TREATMENT

DERMACENTOR VARIABILIS

TICKS MUST BE ATTACHED TO HOST FOR 5-20HOURS BEFORE TRANSMITTING INFECTIOUS ORGANISM

DERMACENTOR ANDERSONI

• TREATMENT– Doxycycline– Tetracycline– Antibiotics only reduce the number of organisms,

the animal must have a good immune system to eliminate them.

DIAGNOSIS & TREATMENT

• 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

CLIENT INFORMATION

CASE #11

• 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.


• PHYSICAL EXAM– Temp: 103.8, HR: 120, RR: 28– Mild epistaxis– Petechial hemorrhages– Edema of the extremities– Ticks found in the coat


• CBC/SERUM CHEMISTRY– 25% have pancytopenia– Anemia– Thrombocytopenia– Hyperglobulinemia

• Blood smear• Observe morula in mononuclear cells

• IFA

DIAGNOSTIC TESTS

• 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

DIAGNOSIS

RHIPICEPHALUS SANGUINEUS

• ANTIBIOTICS– Doxycycline– Tetracycline– +/- blood transfusions

TREATMENT

CASE #12

• 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


• PHYSICAL EXAM– Temp:103.5, HR: 100, RR: 24– Lethargic– Wt. bearing lameness on the rt. Rear limb that

seems to come and go.


• Radiographs– Would be normal

• ELISA TEST– Lyme Positive

• SYNOVIAL FLUID ANALYSIS– Increased nucleated cells

DIAGNOSTIC TESTS

• 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:– Fever– Anorexia– Lymphadenopathy– Chronic flare-ups– Myocardial abnormalities– Nephritis, esp in Labs

LYME DISEASE

• 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

TREATMENT & PREVENTION

case #8. patient presentation signalment: ~4-5yr old, intact, male, dmh presenting complaint:...

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