Download Medical approach to puppies and kittens with diarrhoea

theVeterinarian
a regular clinical update brought to you by The Iams Company
issue 1 november 2006
Medical approach
to puppies and kittens
with diarrhoea
By Professor Stanley Marks,
BVSc, PhD, Dip. ACVIM
(Internal Medicine, Oncology),
Dip. ACVN
Welcome to the first issue of ‘theVeterinarian’ from The Iams
Introduction
Company. The aim of ‘theVeterinarian’ is to give the busy clinician
Diarrhoea in puppies and kittens (fig 1) is
quick and easy to read practical information, and top-tips, on
common clinical problems.
extremely common. Antibiotics are often
administered injudiciously to diarrhoeic
puppies and kittens, and subsequent resolution of clinical signs is often wrongly
equated with eradication of a “putative”
About the author
infectious pathogen. Indiscriminate antibiotic therapy may even exacerbate the
Professor Marks graduated from the University of Pretoria, South Africa. He was a
animal’s diarrhoea or lead to develop-
small animal medicine resident at the University of Florida and oncology resident
ment of antibiotic resistance. This article
at the University of California, Davis, where he also received his PhD in nutrition
and is currently Professor of Medicine. Professor Marks is a Diplomate of the
will highlight the key practical facts about
American College of Veterinary Internal Medicine and of the American
puppy and kitten diarrhoea needed in
College of Veterinary Nutrition. His research interests are in the area of small
day-to-day clinical practice. A practical
animal gastroenterology.
reference and reading list will be found at
the end of this article.
Differential Diagnoses
Figure 1. A 5-month-old Bengal cat with
Although diarrhoea in puppies and kittens
a 3-month history of severe chronic
can be associated with a number of different
diarrhoea, characterized by a marked
aetiologies, infectious causes are believed
increase in frequency, haematochezia,
to play an important role.
and increased faecal mucous.
The diarrhoea was secondary to infection
with Tritrichomonas foetus, and complete-
Diagnostic Tests
ly resolved following medical therapy with
The most important diagnostic tests are
ronidazole.
faecal analyses. Common techniques include
stained faecal smears, direct faecal smears
(wet preparation), and faecal floatations.
Medical approach to puppies and kittens with diarrhoea
i. Stained faecal smear: This test is of
foetus, has recently been recognised as an
limited diagnostic value. Diff-Quick,
important cause of colitis in cats (fig 2).
New Methylene Blue, or Wrights stain
Infected cats are generally young but
will allow visualisation of endospores of
range in age from 3 months to 13 years.
Clostridium perfringens, and spiral-shaped
Campylobacter spp. Caution should be
Clinical signs:
heeded in over interpreting these
T. foetus infection in cats is associated with
common findings, as the diagnostic
chronic or recurrent large intestinal
value of increased faecal endospores is
diarrhoea.1 Most cats are usually bright,
virtually zero, and healthy dogs and
alert, and responsive, and in good body
cats commonly have Campylobacter-
condition with a normal appetite.
like organisms in their faeces.
Tritrichomonas foetus can also be cultured
Figure 2. Giemsa stained faecal smear
from the faeces of asymptomatic cats,
showing characteristic appearance of
ii. Faecal centrifugation floatation: Faecal
many of whom will not develop diarrhoea.
Tritrichomonas foetus with its 3 anterior
floatations are used to find cysts,
Diagnosis: T. foetus can be diagnosed via
flagellae and long undulating membrane.
oocysts, and ova in faeces. Fresh faeces
direct wet prep, faecal culture (InPouch™
should be examined whenever possible.
see Reference Section), or PCR on faeces.
Treatment
Treatment and Control of Giardia Infection:
iii.Direct wet preparation: A small amount
The nitroimidazole, ronidazole, has been
There are 4 steps that should be taken to
of fresh faeces (ideally <2 hours old) is
demonstrated to kill the organism in affec-
control Giardia infection:
mixed with 0.9% saline on a warm slide.
ted cats, although infrequent cases of
1)Treat the animal with effective drugs
It is important that the smear is not too
neurotoxicosis have been reported in
• Fenbendazole (the author’s first choice)
thick, as trophozoites can be easily mis-
association with drug administration. The
50 mg/kg PO q24h for 4 consecutive
sed. After application of a coverslip, the
currently recommended dose is 30mg/kg
days for puppies and kittens or
smear is evaluated for motile organisms
q 12h for 14 days.
• Metronidazole 25 mg/ kg PO q12h
for 7 days for puppies and kittens
at 10X and 40X magnification.
2
Cryptosporidium spp
Infectious Causes of Diarrhoea
in Puppies and Kittens
Infection with Cryptosporidium parvum and
C. felis in puppies and kittens causes a wide
spectrum of disease ranging from asymp-
1. Parasitic causes of diarrhoea
tomatic carriers to prolonged severe life-
Trichomoniasis
threatening malabsorption syndrome.
The protozoal pathogen, Tritrichomonas
Treatment:
Top Tips
• The most important diagnostic tests in
puppies or kittens with diarrhoea are
faecal analyses
• Fresh faeces (ideally <2 hours old)
should always be used to preserve the
motility of trophozoites such as Giardia
spp. and Tritrichomonas foetus
• A simple rule for direct wet faecal
smear preparations is that you should
be able to read the fine newsprint of a
newspaper through the smear on the
slide
2)Decontaminate the environment daily
with quaternary ammonium-based
disinfectants
3)Bathe the animal to clean cysts from
the coat
4)Prevent reintroduction of infection
This can be challenging, with many
Coccidia
recommended drugs either toxic or inef-
Puppies are infected with two species of
fective. Tylosin appears to provide no
coccidia, Isospora canis and I. ohioensis,
benefit, paramomycin is nephrotoxic and
whereas kittens are infected with Isospora
ototoxic, and nitazoxanide is also toxic
rivolta and I. felis.
in cats. Azithromycin which is used in
Treatment Options:
humans appears safe in dogs and cats at
7-10 mg q 12h for 10 days, but its efficacy
is unknown.
§ Sulfadimethoxine 50 mg/kg PO q24h
for 10 to 20 days (puppies and kittens)
§ Amprolium 300 to 400 mg (total) PO
q24h for 5 days (puppies)
Giardia spp
Giardia infections in adult cats and dogs
are often subclinical; however, acute
diarrhoea tends to occur in puppies and
kittens shortly after infection.
§ Toltrazuril 10-30 mg/kg PO q 24h for
3 days (puppies)
§ Ponazuril 20 mg/kg PO q 24h for
3 days (puppies and kittens)
§ Diclazuril 25 mg/kg PO q 24h for 1day
(puppies)
Medical approach to puppies and kittens with diarrhoea
For Roundworms and Hookworms please
canine parvo ELISA snap tests cross react

refer to the Further Reading list in the
with feline panleukopaenia and can be
could have secondary deficiencies of
reference section.
used as an aid in diagnosis.
vitamin B12. Repeat injections should
Puppies and kittens with chronic ileitis
be based on serum cobalamin concen-
2. Bacterial causes of diarrhoea
trations.
§ Probiotics
in puppies and kittens because bacterial
Empiric therapy for puppies
and kittens with diarrhoea of
unknown cause
enteropathogens are commonly found in
Unlike acute diarrhoea, which is often
menting the immunomodulatory effects
the faeces of healthy pets.
self-limiting and may be managed with
of probiotics, and the beneficial effects
symptomatic therapy, chronic diarrhoea
on the intestinal microflora.
It is very difficult to make a definitive
diagnosis of bacterial-associated diarrhoea

Research trials in rodent models,
people, and dogs and cats are docu-
Campylobacter spp
requires specific diagnosis and therapy.
Faecal shedding of C. jejuni is significantly
Serologic screening for FeLV is recommen-
Summary
greater in dogs <6 months old probably
ded for kittens with chronic diarrhoea
The presentation of a puppy or kitten with
reflecting increased exposure of young
that have not responded to antiparasitic
diarrhoea must be managed promptly
animals to faecal excrement and their
and dietary therapy. Empiric therapies
before potentially life-threatening develop-
underdeveloped immune system allowing
which can be considered are:
ments occur. Infectious causes of diarrhoea
increased colonisation by C. jejuni. The organism can cause a haemorrhagic diarrhoea
with increased amounts of mucous.
Treatment Options:
§ Erythromycin 10 to 15 mg/kg q8h
§ Deworming even in the face of a negative
faecal flotation
§ Metronidazole
§ Dietary modification

for 10 days
§ Azithromycin 7 to 10 mg/kg q12h
play an important role in many of these
cases, and implementation of simple faecal
tests should usually provide a diagnosis.
Appropriate medications, fluids and elec-
The author has had good success uti-
trolytes and dietary modification should
lising a diet that is highly digestible and
ensure a successful outcome in most cases.
contains fermentable fibres (Eukanuba
Veterinary Diet® Puppy Intestinal).
for 10 days
§ 4 months quarantine away from children
Kittens can be fed a select protein source
(Eukanuba Veterinary Diet® Dermatosis
(shedding period)
LB for Cats). Dietary fat restriction does
3. Viral causes of diarrhoea
not appear to be as important in cats
Infections with Canine Parvovirus and
with intestinal disease as it is in dogs.
Feline Panleukopaenia are well-recognised
§ Vitamin B12 (cobalamin) 100 - 400 µg per
conditions affecting mainly unvaccinated
kitten or puppy, respectively, given sub-
pets (see the Further Reading list). The
cutaneously once weekly for 4-6 weeks.
Did you know?
References
1. Chronic diarrhoea associated with
Tritrichomonas foetus infection in a British
cat. Mardell EJ, Sparkes AH. Veterinary
Record 2006; 158, 765- 766
2. Comparison of direct immunofluorescence,
modified acid-fast staining, and enzyme
immunoassay techniques for detection of
Cryptosporidium spp. in naturally exposed
kittens. Marks SL, Hanson TE, Melli AC.
J Am Vet Med Assoc 2004; 225:15491553
InPouch“ TF kit. Biomed Diagnostics, USA.
http://www.biomed1.com
• Bacterial enteropathogens are commonly found in the faeces of healthy pets
• Ronidazole is the current drug of choice for treatment of Tritrichomonas foetus
• Cryptosporidium parvum infection has been diagnosed in association with intestinal cellular
infiltrates indistinguishable from those seen with inflammatory bowel disease in cats.
• The main bacterial enteropathogen that should be considered in diarrhoeic puppies or kittens
<6 months old is Campylobacter spp
• When facing a diarrhoeic puppy or kitten that is not responding to therapy and for which a
diagnosis has not been made, it is often more helpful to repeat previously negative diagnostic
tests as opposed to performing endoscopy and biopsy
Further Reading
1. Professor Mark s original full length article
can be found in: Advances in Puppy and
Kitten Health Care: Iams Clinical Nutrition
Symposium 2005 available at
www.eukanuba-scienceonline.com (symposium library section). Some of the drug
and treatment regimens have been updated
in theVeterinarian 2006 article
2. Canine Viral Diseases. Sellon, RK: pp 646652, Other Feline Virus Diseases. Gaskell
RM, Dawson S: pp 667-671 and, Diseases
of the Small Intestine (helminths). Hall EJ,
German AJ: pp 1358-1359. all in:
Textbook of Veterinary Internal Medicine,
6th edn. Eds SJ Ettinger and EC Feldman,
WB Saunders, Philadelphia, 2005.
ResearchNews
from The Iams Company
manufacturers of Eukanuba, Iams and Eukanuba Veterinary Diets
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