Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
CASE #8 PATIENT PRESENTATION 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. PATIENT PRESENTATION • 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 DIAGNOSTIC TESTS • CBC/SERUM CHEMISTRIES • FeLV/FIV ELISA – All unvaccinated outdoor cats should be tested for these diseases as they are contagious and without cure DIAGNOSTIC TEST RESULTS • 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 TRANSMISSION • 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. TREATMENT • SEE FELINE LEUKEMIA VIRUS • DENTAL SURGERY – Whole mouth extraction of teeth may be necessary in cats with chronic stomatitis and gingivitis CLIENT INFO & PROGNOSIS • 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 CASE #9 PATIENT PRESENTATION PATIENT PRESENTATION • 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 PATIENT PRESENTATION • 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 PATIENT PRESENTATION DIAGNOSTIC TESTS • 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 PNEUMONIA IS MOST COMMON IN NEONATALLY NEONATALLY OR TRANSPLACENTALLY INFECTED CATS TOXOPLASMA OOCYTS THESE OOCYTS ARE DIFFICULT & RARE TO FIND TRANSMISSION & LIFE CYCLE • 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 OOCYTS IN THE FECES FOR 1-2 WEEKS THE OOCYTS BECOME INFECTIVE AFTER 1-5 DAYS TACHYZOITES ARE THE RAPIDLY DIVIDING STAGE OF THIS PARASITE THAT INFECTS THE TISSUES TREATMENT & PROGNOSIS • 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 TRANSMISSION & LIFE CYCLE CLIENT INFORMATION • 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 CASE # 10 PATIENT PRESENTATION PATIENT PRESENTATION • 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. PATIENT PRESENTATION • 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 PATIENT PRESENTATION DIAGNOSTIC TESTS • 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 DIAGNOSTICS & TREATMENT • 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… DERMACENTOR VARIABILIS TICKS MUST BE ATTACHED TO HOST FOR 5-20 HOURS BEFORE TRANSMITTING INFECTIOUS ORGANISM DERMACENTOR ANDERSONI DIAGNOSIS & TREATMENT • TREATMENT – Doxycycline – Tetracycline – Antibiotics only reduce the number of organisms, the animal must have a good immune system to eliminate them. CLIENT INFORMATION • 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 CASE #11 PATIENT PRESENTATION PATIENT PRESENTATION PATIENT PRESENTATION • 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. PATIENT PRESENTATION • PHYSICAL EXAM – Temp: 103.8, HR: 120, RR: 28 – Mild epistaxis – Petechial hemorrhages – Edema of the extremities – Ticks found in the coat DIAGNOSTIC TESTS • CBC/SERUM CHEMISTRY – – – – 25% have pancytopenia Anemia Thrombocytopenia Hyperglobulinemia • Blood smear • Observe morula in mononuclear cells • IFA DIAGNOSIS • 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 RHIPICEPHALUS SANGUINEUS TREATMENT • ANTIBIOTICS – Doxycycline – Tetracycline – +/- blood transfusions CASE #12 PATIENT PRESENTATION PATIENT PRESENTATION • 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 PATIENT PRESENTATION • PHYSICAL EXAM – Temp:103.5, HR: 100, RR: 24 – Lethargic – Wt. bearing lameness on the rt. Rear limb that seems to come and go. PATIENT PRESENTATION DIAGNOSTIC TESTS • Radiographs – Would be normal • ELISA TEST – Lyme Positive • SYNOVIAL FLUID ANALYSIS – Increased nucleated cells PATIENT PRESENTATION LYME DISEASE • 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 TREATMENT & PREVENTION • 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