Download 3 groups Surface pyoderma Surface pyoderma

Pyoderma
Pyoderma = bacterial skin infection
Canine pyoderma: my clinical
impression with Convenia®
Hill PB and al. Vet . Rec. 2006
Survey of the prevalence, diagnosis and treatment of
dermatological conditions in small animals in general
practice. 3707 consultations - 21,4% skin disease
Pyoderma = one of the most frequent diagnosis
Systemic antibiotics prescribed in 25% of the cases
Luc BECO, DMV, Dip. ECVD
Avenue Reine Astrid, 104
4900 Spa - Belgique
www.monvt.eu
Diagnostic procedure
History
Differential
Diagnosis
Other tests
or
Treatments
First
differential
Diagnosis
Examen
clinique
Classification: 3 groups
Problem list
Special procedure
or
Therapeutic trial
Revised
differential
diagnosis
Surface pyoderma
Superficial pyoderma
Deep pyoderma
Diagnosis not confirmed
Final diagnosis
Treatment
Surface pyoderma
Surface pyoderma
Acute moist dermatitis = pyotraumatic
dermatitis = hot spot
Skin fold pyoderma (intertrigo)
Mucocutaneous pyoderma
Damage and bacterial proliferation of the outermost layer
of the skin
« Acute moist
dermatitis »
Pyotraumatic pyoderma
1
Surface pyoderma
Surface pyoderma
Facial fold pyoderma
Mucocutaneous
pyoderma
Vulvar fold pyoderma
Superficial pyoderma
Superficial Pyoderma: Impetigo
Impetigo
Bacterial
folliculitis
Superficial spreading pyoderma
The bacterial infection involves the epidermis and follicular
epithelium
Papules, pustules, epidermal collarettes, crusts and
circular patches of alopecia
Impetigo
Superficial Pyoderma: folliculitis
Superficial Pyoderma: folliculitis
2
Superficial Pyoderma: folliculitis
Superficial Pyoderma
Superficial Pyoderma
Superficial Pyoderma: folliculitis
Superficial
Spreading
Pyoderma
Deep pyoderma
© M. Heimann
Pyotraumatic folliculitis
Pyotraumatic
folliculitis and furonculosis
Muzzle folliculitis and furonculosis
Localized deep pyoderma
Generalized deep folliculitis and
furonculosis
German shepherd dog pyoderma
The bacterial infection involves the tissue deeper than the
hair follicle
Papules, pustules, furoncles, nodules, crusts, ulcerations
3
Deep pyoderma
Muzzle folliculitis and furonculosis (« Chin acne »)
Localized deep pyoderma
Pedal furonculosis
Deep pyoderma
Bacterial
Bacterial Cellulitis
Deep pyoderma
Day 0
7 months later
Localized deep pyoderma
Pedal furonculosis
Deep pyoderma
German Shepherd Dog
Pyoderma
4
GSD Pyoderma
Deep Pyoderma: furonculosis
© M. Heimann
Methicillin Resistant
Staphylococcus (MRS)
Staphylococcus Intermedius
Major
agent
Carriage sites and bacterial folliculitis
Higher population at mucosal sites/normal dogs
Anal and nasal carriage >
Same strains in pustules
and at carriage site (94,4%)
MRS:
mecA gene encodes a special Penicillin-Binding
Protein (PBP2a) with low activity for βlactam AB
Survival of the bacteria
MRSI in dogs
17% of 336 isolates in USA
Disk diffusion test (Oxacillin/Cefoxitin) / Vitec
PCR assay for nuc genes and for mecA genes
Molecular typing
Other Staphylococci
Staphylococcus aureus in dogs and cats
From humans (prefer human keratinocytes !)
Wounds, hospitalisation, immunosuppressive therapy
MRSA in US Vet University +/- 30%
Staphylococcus schleiferi subsp. coagulans
Staphylococus pseudintermedius
Dogs with otitis and dogs with recurrent pyoderma
Many are MRSS
Pathogenic potential?
MRSP in Japan and Canada
Coagulase negative staphylococci
S. Epidermidis, S. Hominis, S. Hemolyticus, S. Xylosus
Opportunistic pathogens ?
Other bacteria
Secondary
invaders
Proteus sp
Pseudomonas sp. (Hillier et al. Veterinary Dermatology 17, 2006)
E. Coli
Beta-hemolytic streptococci
In
cats
Bacterial diseases are most commonly secondary
to bite wounds
Pasteurella multocida
and anaerobes Porphyromonas spp.,
Fusobacterium spp., Bacteroides spp.,
Peptostreptococcus spp., Clostridium spp
5
Multicentric efficacy trial
Clinical skin of soft tissue infection
Clinical lesions: papules (dog), pustules (dog) ,
nodules, furoncles, erythematous macules (dog),
erythema, epidermal collarettes (dog), purulent
discharge, erosions/ulcerations (dog), swelling (cat
only)
Severity index: absent, mild, moderate, severe
Cytology
Bacterial culture
Owner consent form
Inclusion / exclusion criteria
Convenia® injection / 2 weeks
Multicentric efficacy trial
Control
of clinical signs every 2 weeks
Convenia® injection if lesions are still
observed
Control 2 weeks after the last injection
Control for recurrence 4 weeks after the
last injection
Multicentric efficacy trial
Bacterial
folliculitis
13 dogs
Superficial Pyoderma
« mothmoth-eaten » folliculitis
Bordeaux dogues (3), Giant Schnauzer (2)
American Staffordshire Terrier (2), Dachshund,
Great Dane, Golden retriever, Flanders bouvier
Scottish terrier, Weimaraner
Type of visit
First opinion vet.: 5
Second / third vet. consulted : 3
Referral cases: 5
Bordeaux Dogue
Bacterial folliculitis
Bordeaux
Dogue
3/13 dogs
2 referral cases
1 second opinion
Usually more difficult to treat ?
Poor immunity ?
Associated demodicosis and/or malassezia
dermatitis
Compliance: cost – duration of treatment ?
Multicentric efficacy trial
Bacterial
Bull Terrier: referral case
Berger de Beauce: second vet
Feline
furonculosis
2 dogs:
abscess
1 cat:
DSH
First opinion case
6
Deep pyoderma
Convenia ®: Day 0
Deep pyoderma
Convenia ®: Day 14
Deep pyoderma
Deep pyoderma
Convenia ®: Day 28
Convenia ®: Day 42
Deep pyoderma
Deep pyoderma
Convenia ®: Day 56
Convenia ®: Day 73 (21days post treatment)
treatment)
7
Multicentric efficacy trial
Bacterial folliculitis
Bacterial folliculitis
Staphylococcus intermedius (single): 2
Feline Abscess (1 case !)
Actinomyces viscosus, Fusobacterium nucleatum,
Prevotella oralis
1
2
3
4
injection: (day 0): 2 dogs
injections (day 0-15): 7 dogs
injections: (day 0-15-30): 3 dogs
injections: (day 0-15-30-45): 1 dog (Bordeaux D.)
Bacterial furonculosis
Bacterial furonculosis
Staphylococcus intermedius (single): 10
Staph. intermedius (S), Strepto. β hem. (S), Proteus
mirabilis (I): D09
Staph intermedius, Staph aureus: D03
Staph intermedius, Pseudomonas stutzeri: D12
Convenia®: treatment
5 injections: (day 0-15-30-45-60): Bull Terrier with
bacterial furonculosis
2 injections with good improvement.
Withdrawal because of pulmonary tromboembolism
secondary to surgery/anesthesia
Feline Abscess (1 case !)
1 injection
Oral: treatment
Convenia®: 30 days post-injection
Bacterial
Bacterial
folliculitis
Oral treatment: q 8h / q 12h / q 24h
Duration ≥ 3 weeks
Bacterial
furonculosis
Oral treatment: q 8h / q 12h / q 24h
Duration ≥ 6 weeks
Feline
Abscess
Oral treatment: q 8h / q 12h / q 24h
Duration ≥ 7 days
Compliance
Oral
folliculitis
12 cured
1 minor recurrence:
Great dane
Referal case
Some papules/pustules
St. Intermedius
Bacterial
Feline
furonculosis
2 cured without recurrence
abscess (1 case !)
No recurrence
Antibiotics: how to choose ?
antibiotics
Owner
Tablets / Capsules / Solution / Gel
Compliance ???
Compliance
Convenia®
Patient
SC injection: one / 14 days
15 cases : 100% compliance
Antibiotic
Antibiotic
Bacteria
Bacteria
8
Side effects
Oral
antibiotics
Side effects
Convenia®
GI tract dysfunction
GI tract dysfunction
1 dog with soft stools (Great Dane)
Vomiting, diarrhea, anorexia……
No local reaction
Easy to administer
No other signs
Chondrocytes (growing dogs - quinolones)
Retinal toxicity in cats (enrofloxacin)
Idiosyncrasic reactions, KCS, hypothyroidism,
bone marrow aplasia, cutaneous drug reactions
(sulfonamides)
…
Failure of the antibiotherapy
Wrong diagnosis
Inappropriate antibiotic
Dosage, duration, frequency of
administration
Antibiotic resistance
Poor compliance
Deficient patient immunity
Failure to recognize underlying cause
Pharmacokinetic / drug interactions
Cefovecin clinical studies
M.R. Stegemann et al. Clinical efficacy and
safety of cefovecin in the treat ment of canine
pyoderma and wound infections.
Journal of Small Animal Practive (2007) 48, 378-386.
MATERIAL AND METHODS
354 dogs included in 3 different studies
Randomized, blinded study (versus placebo in 1 study)
Cefovecin SC / 14d up to four courses (Convenia)
Oral amoxicillin/clavulanic acid bid (Synulox)
Efficacy 28d after initiation of the final course of AB
Efficacy assessed by scoring the clinical signs
Topical antibacterial treatment not permitted
Cefovecin clinical studies
M.R. Stegemann et al. Clinical efficacy and
safety of cefovecin in the treat ment of canine
pyoderma and wound infections.
Journal of Small Animal Practive (2007) 48, 378386.
RESULTS
Efficacy: Cefovecin 96,9%, amoxicillin/clav 92,5%
Superficial pyoderma:
87% cured with 1 or 2 courses of treatment
No dog with more than 3 courses of treatment
Deep pyoderma
Cefovecin 68% < 4 courses of treatment
Amoxi/Clav 72% < 4 courses of treatment
Conclusion
Convenia®
is easy to administer
Owners love this way to treat
(useful and very easy for reluctant cats)
In
my hands, until now, Convenia® is as
efficient to treat canine pyoderma than
the other « good » antibiotics
However, a good diagnosis is always
needed before using antibiotics
9
ESVD – ECVD
23rd Annual Congress
Bled, Slovenia
September 2009
Q
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