Download 4.4differential diagnosis of diarrhoea in primates

4.4DIFFERENTIAL DIAGNOSIS OF DIARRHOEA
IN PRIMATES
W. Boardman (Reviewer S. Unwin)
Dietary – fruits,
Food poisoning
Chronic inflammatory bowel disease
Psychogenic
Shigella dysenteriae, flexneri
mild to dysentery
Salmonella typhimurium
Campylobacter coli, jejuni,
Yersinia enterocolitica, pseudotuberculosis
E.coli
Clostridium difficile
Aeromonas
Vibrio parahaemolyticus
Entamoeba histolytica
Balantidium coli
Giardia
Other protozoa
Enterobius
Trichuris
Necator
Ancylostoma
Adenovirus – often respiratory disease too
Cytomegalovirus
Coxsackivrus
Rotavirus
Hepatitis A
DIARRHOEA CONTROL
What is diarrhoea?
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It is characterised by increased frequency and excess water content
Leads to loss of large volumes of fluids which can lead to dehydration if
intake of fluids is not adequate
Leads to loss of electrolytes ie sodium, potassium and bicarbonate
Small bowel
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Large volume
Malodorous
Unformed/liquid
Minimal mucous
Loss of body weight
Large bowel
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Increased urgency and frequency
Tenesmus (straining)
Small volume
Mucous
Frank blood
Excess intake
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Excess fat
Usually vomit
Maldigestive
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Decreased absorption of nutrients because of impaired digestion
Pancreatic insufficiency
Bile acid deficiency
Following GI surgery
Lactase deficiency
Malabsorptive
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Mucosal or sub mucosal disease impairing normal absorption
Sodium transport mechanisms affected
Exudation of blood, mucous and protein into lumen due to damagie
ulcerative colitis
Secretory
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Increased secretion of water and electrolytes without damage
Bacterial toxins
Mechanical obstruction
CAUSES OF DIARRHOEA
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Bacterial
Campylobacter
Salmonella
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Shigella
E. coli
Clostridial difficle
Pseudomonas
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Non Infectious
Dietary – excess or incorrect food or hypersensitivity
Stress/Psychological
Food poisoning
Inflammatory bowel disease
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Parasites
Strongyloides
Trichuris
- whipworms
Enterobius
– pinworms
Necator
- hookworms
Ancylostoma - hookworms
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Viruses
Hepatitis A
Rotavirus
Adenovirus
Measles
Cytomegalovirus
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Protozoal
Balantidium coli  Common
Entamoeba histolytica  Common
Giardia lamblia  Common
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Other
Candida
TREATMENT
What to do first
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Attempt to make a diagnosis
History
Clinical signs
Faecal cytology
Faecal culture
Faecal wet prep and flotation
Haemogram – if severe
Electrolytes – if severe
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Get a full history
When started
How many affected
How depressed are the animals
Characteristics of the diarrhoea
Frequency
Volume
Colour
Blood – severe sign
Take a stool sample and have it checked
Examine to check consistency, content
Wet preparation immediately to check for protozoa
Faecal flotation for parasites
Faecal cytology - stain with methylene blue to check for white and red
blood cells
Enterobius – use adhesive tape on perineum and applied to slide to
check for eggs
Culture for bacteria
Observe the animals and check with primary care givers
Weigh animals accurately – this is the best indicator of patients
hydration
Check demeanour, activity, appetite
Check whole group
Minimise contamination by isolation and regular removal of faecal
material
Treat the cause
Oral anti protozoals
Metronidazole
Tinidazole
Paromomycin
Secnedazole
Oral antibiotics are useful if indicated:
Ciprofloxacin
Trimethoprim/ sulpha drugs
Gabrorral - aminosidine
Amoxycillin/ clavulanic acid
Chloramphenicol
If Mild – i.e. watery with no blood, behaviour normal
Check faeces as soon as possible
Feed only boiled rice, posho, human liquid supplements
No fruit in particular and no formula of 24 hours
Give oral rehydration fluids with a little cordial/ juice added to add
taste
Give probiotics to improve intestinal flora
Treat the cause if there is one
Give multivitamins
Continue to monitor
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If Moderate – i.e. watery with no blood, slightly depressed, appetite reduced
Check faeces as soon as possible
Feed only boiled rice, posho, human liquid supplements
No fruit in particular and no formula for 24 hours
Give oral rehydration fluids with a little cordial/ juice added to add
taste
Give probiotics to improve intestinal flora
Start on antiprotozoals and or antibiotics
Give multivitamins
Continue to monitor
If severe and acute, often blood/mucous, appetite very poor, very depressed,
often several affected.
Possible causes  Shigella, Salmonella, Entamoeba
Check faeces as soon as possible
Treat immediately with ciprofloaxacin and antiprotozoal / gabbroral –
may need to give IV
Oral – normally all that is needed in chimps. Use oral fluids little and
often
May need to resort to IV fluids – consider 10% dehydrated
Start treatment – may need to sedate – very small dose of ketamine – 45mg/kg
Give IV fluids slowly i.e. normal saline - 30ml/kg/hour for 2 hours
under mild sedation
Add bicarbonate at 1mEq/kg in 1:3 dilution with IV saline
IV bolus of dextrose 5ml of dextrose 10% /kg over 15min
Potassium can be added IV but extreme caution required
Offer boiled rice, posho, human liquid supplements – consider naso
gastric tubing
Milk formula can be given after 48hours if drinking
Give multivitamins
Prevention
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Good nutrition and good quality diets
Regular faecal checks every 3 months, more frequent if continued problem
Regular worming of whole group
Minimise or discourage coprophagy
Good staff hygiene
Good enclosure hygiene and sanitation
Effective quarantine system in place
Control pests – insects, rats