Download Nasal discharge in cats

NASAL DISCHARGE IN CATS
Douglas Palma, DVM, DACVIM (SAIM)
The Animal Medical Center
New York, New York
CHRONIC OR ACUTE SIGNS
OF NASAL DISCHARGE
Acute signs (<3 weeks)
Epistaxis
No additional
clinical
abnormalities
DIAGNOSIS
Green/yellow mucoid/
mucopurulent
hStructural
disease
(eg, neoplasia,
mycotic or dental
disease)
hLess likely:
systemic disease,
coagulopathy,
hypertension
DIAGNOSIS
workup
(eg, blood
pressure, CBC,
serum chemistry
profile, coagulation
profile)
hA dvanced imaging/
diagnostics
DIAGNOSIS
rhinitis (FHV-1,
feline calicivirus)
h
A llergic/
inflammatory/
bacterial rhinitis
(B bronchiseptica,
C felis)
hV iral
NEXT STEPS
Peracute nature;
unilateral
Facial pain
Oral/lingual
ulceration;
ocular signs
DIAGNOSIS
hForeign
h
D ental
body
hInfectious
rhinitis
rhinitis
(bacterial, viral)
h
S econdary
infection
h
N eoplasia
h
L ess likely:
foreign body
NEXT STEPS
Abnormal results
DIAGNOSIS
hInfectious
hS ystemic
hViral
Physical exam
NEXT STEPS
disease
h
L ess likely (acute
nature): destructive
rhinitis (mycotic,
chronic viral,
immune-mediated)
h Neoplasia
hydropulsion
Serous/
serohemorrhagic
PCR testing (FHV-1, feline
calicivirus)
h
S upportive care (eg, hydration,
antipyretics, appetite
stimulants)
h
A ntiviral therapy (eg, L-lysine,
famciclovir, polyprenyl
immunostimulant, intranasal
vaccine)
h
A ntihistamine trials
NEXT STEPS
imaging/
diagnostics
Antibiotics
if infectious
hD entistry
h+/-
care
h+/- Empirical
antibiotics
hN asal flushing
h+/- Nasal
culture
(localized pain to
teeth)
hC ryptococcal LCAT
hR adiography
(dental, nasal)
hA dvanced
imaging/
diagnostics
Postanesthesia;
postemesis
DIAGNOSIS
hNasopharyngitis
hNasopharyngeal
stenosis
hNasal/
nasopharyngeal
foreign body
DIAGNOSIS
nasopharyngeal exam
hS aline hydropulsion
h+/- Antibiotics
hA dvanced imaging/
diagnostics
polyps
h
Nasopharyngeal
stenosis
h
Fungal
granuloma
NEXT STEPS
hS edated
nasopharyngeal
exam
hR adiography
(open-mouth,
lateral)
hA dvanced
imaging/
diagnostics
hC ryptococcal
LCAT
DIAGNOSIS
h<1
year:
nasopharyngeal
polyp
h>5 years:
neoplasia
Ear infection;
ear mass
hC ryptococcal
hS edated
h
Nasopharyngeal
disease testing
(PCR)
h
S upportive
care (eg,
hydration,
antipyretics)
h
A ntiviral
therapy (eg,
l-lysine,
famciclovir,
polyprenyl
immunostimulant,
intranasal
vaccine)
NEXT STEPS
NEXT STEPS
<1 year of
age
rhinitis
(FHV-1, feline
calicivirus)
hI nfectious
hA dvanced
hS upportive
DIAGNOSIS
h
V iral
NEXT STEPS
hS aline
NEXT STEPS
Deviation of soft
palate; palpable
nasopharyngeal
lesion
NEXT STEPS
hS edated
nasopharyngeal
exam
LCAT
hA dvanced
imaging/
diagnostics
Neurologic
signs
>1 year
of age
DIAGNOSIS
h
N eoplasia
h
M ycotic
disease
FHV-1 = feline herpesvirus-1
FNA = fine-needle aspiration
LCAT = latex cryptococcal
agglutination test
LSA = lymphosarcoma
PCR = polymerase chain reaction
84 cliniciansbrief.com December 2016
MANAGEMENT TREE h RESPIRATORY h PEER REVIEWED
Chronic signs (>3 weeks)
Chronic,
intermittent; normal
between episodes
Abnormal retropulsion;
exophthalmos; pain on
opening mouth
Soft-tissue
swelling/mass
Predominantly
hemorrhagic
(intermittent or
isolated)
Chronic,
nonprogressive
>1 year duration;
>2 years of age
at onset
Responsive to antibiotics?
DIAGNOSIS
DIAGNOSIS
hRetrobulbar
abscess/cellulitis
disease/
abscessation
hInfiltrative disease
(eg, LSA,
Cryptococcus spp,
Aspergillus spp)
hDental
disease/
inflammation
(periocular swelling,
severe conjunctivitis)
hFungal granuloma
hNeoplasia
DIAGNOSIS
disease
(primary [rare],
secondary)
hDental disease (eg,
fistula, abscess)
NEXT STEPS
hD ental
radiography
LCAT
hC ryptococcal
hO cular
ultrasonography
hA dvanced imaging/
diagnostics
Severe stertor;
open-mouth breathing
disease
exposure history
h
V iral PCR testing
(FHV-1, feline
calicivirus)
h
E mpirical treatment
of clinical signs
h
F NA and/or biopsy
(soft-tissue mass)
h
C ryptococcal LCAT
h
A dvanced imaging/
diagnostics
idiopathic
rhinitis
h Allergic rhinitis
h
L ess likely: foreign
body, neoplasia,
viral disease
NEXT STEPS
NEXT STEPS
systemic workup
(eg, blood
pressure, CBC,
serum chemistry
profile, FeLV/
FIV testing,
coagulation
profile)
hA dvanced
imaging/
diagnostics
NEXT STEPS
as needed
Nasal flushing/
culture
hD ental radiography
hE xtraction/cleaning
h+/- Advanced
imaging/diagnostics
h+/-
NO
(serous,
concurrent ocular)
DIAGNOSIS
rhinitis (FHV-1, feline calicivirus)
rhinitis (secondary)
hYoung animals: nasopharyngeal
stenosis, polyps
hAllergic/inflammatory rhinitis
hLess likely (acute nature): neoplasia,
fungal rhinitis, primary bacterial
rhinitis
hChronic
hR ecommend
hA ntibiotics
Strong suspicion
of dental disease
hViral
DIAGNOSIS
hBacterial
hI nfectious
NEXT STEPS
hChronic
disease (eg,
neoplasia,
mycotic or
dental disease)
hLess likely:
systemic
disease
YES
hViral
DIAGNOSIS
hNeoplasia
hStructural
DIAGNOSIS
Chronic,
progressive, or
>5 years of age
hA ntihistamine
trials
hA ntiviral trial (highdose famciclovir)
hA nti-inflammatory
trials
hI mmunomodulatory trials
h+/- Advanced
imaging/
diagnostics
rhinitis (viral
recrudescence,
recurrent
bacterial
infection)
hFungal rhinitis
NEXT STEPS
hI nfectious
disease testing
(PCR,
+/- bacterial
culture, FeLV/
FIV testing)
hCryptococcal
LCAT
hAdvanced
imaging/
diagnostics
<1 year
of age at onset
hBacterial
DIAGNOSIS
hDental
disease
DIAGNOSIS
hViral
rhinitis (FHV-1,
feline calcivirus)
hAllergic rhinitis
DIAGNOSIS
hNasopharyngeal
stenosis
hNasopharyngeal
polyp
palate
hCleft
hV iral
NEXT STEPS
PCR testing (FHV-1, feline calicivirus)
hA ntiviral trial (high-dose famciclovir)
hN asal flushing/culture (aerobic,
mycoplasma)
hS edated nasopharyngeal exam
hS kull radiography (open-mouth, lateral)
hC ryptococcal LCAT
hA dvanced imaging/diagnostics
NEXT STEPS
hD ental
radiographs
hTooth
extraction/
cleaning
hViral
NEXT STEPS
NEXT STEPS
hS edated
nasopharyngeal
exam
hN asal
radiography
hA dvanced
imaging/
diagnostics
PCR testing (FHV-1, feline calicivirus)
hFeLV/FIV testing
hSupportive care (eg, hydration, antipyretics, appetite
stimulants)
hAntiviral therapy (eg, l-lysine, famciclovir, polyprenyl
immunostimulant, intranasal vaccine)
hAntihistamine trials
December 2016 cliniciansbrief.com 85