Can be misleading - cat bites look innocuous - dog bites may leave foreign bodies/teeth etc imbedded

Copious irrigation of the wound - isotonic NaCl Treat for - polymicrobial coverage - esp staph and anaerobes - tetanus prophylaxis - rabies prophylaxis (situation dependent)

Bartonella henselae - carried by cats and fleas

If pt is immunocompetent - symptomatic only - usually self limited - macrolide (z-pack) if needed Paringuad oculoglandular syndrome - also self limited

18 - Pet and why ms booker hates them Flashcards by michael english

Dog bite vs cat bite, which one is going to the hospital?

Cats almost always

Cat bites - 80% infection rate

Dog bites - 5% infection rate

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Why are cats worse?

Their teeth are small and pointy

They can inject bacteria deep into the tissue

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MC location for dog and cat bites?

The hand that feeds them

Dog - 50% of bites on hand
Cat - 63% of bites on hand

Next up
Cats - shoulder, arm, forearm 23%
Dogs - thigh and face/neck tied at 16%

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History taking?

Yeah you need one, there are legal ramifications sometimes

Also if its not a domestic animal it may help to know what it was and the conditions

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Physical?

Can be misleading

cat bites look innocuous
dog bites may leave foreign bodies/teeth etc imbedded

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Labs and diagnostic studies?

Ms booker says they are generally not helpful

Having had a very bad infection (red streaks of death) previously from a dog bite, i assure you that a culture can be a very important thing for a complicated bite

Especially cats, those dirty mouthed shits

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Tx for bites?

Copious irrigation of the wound
- isotonic NaCl

Treat for

polymicrobial coverage
- esp staph and anaerobes
tetanus prophylaxis
rabies prophylaxis (situation dependent)

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DOC for cat and dog bite?

Amoxicillin clavulante (augmentin)

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MC pathogen in a cat bite?

Pasturella multocida

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Surgical tx for bites?

Debridement - esp necrotic tissue

Primary vs 2ndary intent closure depends on the wound’s likelihood of infection

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Primary v secondary closure?

Primary

well cleaned wounds
face (rarely gets infected)

Secondary

hands
lower extremeties

Delayed primary
- older than 6 hrs

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Consults for bites?

Plastic surgeon - disfiguring inj
Hand specialist - hands duh
Orthopedist - join inj
Neurosurgeon - skull
Vascular - neck wounds
ID - immunocompromised

These consults may be emergent

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Complications for animal bites?

- big long list

Meningitis
Sepsis
Septic arthritis
Osteomyelitis
Cellulitis
Wound infection
Face/neck deformities
Limb deformities
Limb loss
Pet going to “live on a farm”

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Cat scratch fever?

Bartonella henselae

carried by cats and fleas

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Cat scratch fever is the MC cause of?

Chronic adenopathy - kids

Regional adenopathy

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Common complaints with cat scratch disease?

A cat scratch

Classic 
- rash (90%)
- lymhadenitis
FOUO (33%)
Fatigue (33%)

Rare
Parinaud oculoglandular syndrome
CNS findings

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S/s (classic disease of cat scratch fever

Rash - 1 + red papules

0.5cm or less
site of inoculation (cat)

Lymphadenitis - x 4-6 weeks

up to 1 yr
sinus track may form
axillary nods (MC)

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What lymph nodes are MC affected with cat scratch fever?

Axillary
- cervical -> submandibular -> preauricular

1/2 of pts only have 1 node

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S/s fever and fatigue?

Fever x 1-2 wks

fatigue - wks - months

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Parinaud oculoglandular syndrome?

If the site of inoculation is

eyelid
conjunctiva

Can be lick, scratch or bite

Symptoms after a few weeks

nonpurulent conjunctivitis
ocular granuloma
preauricular adenopathy

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Parinaud oculoglandular syndrome prognosis?

self resolve (months)

- no residual damage

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Cat scratch disase CNS symtpoms?

Encephalitis

seizures
myelitis
peripheral neuropathy
retinitis
bell palsy
extremity weakness

Slow onset
Long recover (up to 1 yr)

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Diagnosis for CSD?

H and P 
Lymph node biopsy
Serology tests
- IFA
- antibody titer to bartonella
- indirect immunofluorescence (CDC)
- PCR

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CSD tx?

If pt is immunocompetent

symptomatic only
- usually self limited
- macrolide (z-pack) if needed

Paringuad oculoglandular syndrome
- also self limited

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Toxoplasmosis (toxoplasma gondii) is a?

Obligate intracellular parasite

What patients have a hard time w toxo?

Fetuses Newborn HIV

Toxo route?

Feces from acutely infected cats Transported via lymphatics Disseminated hematogenously throughout the body

If a pt has toxo you should?

Screen their family | - esp pregos and immunocompromised

If you arent one of the high risk pts? (Toxo)

Typically asymptomatic (80-90%)

Immunosuppressed pts with toxo?

Rapidly progressive disease - fatal - toxoplasmic encephalitis (1-5% of AIDS pts)

S/s of toxo in immunocompetent pt (i guess that unlucky 10%)

``` Mononucleosis-like Cervical lymphadenopathy Fever Malaise Night sweats Myalgias Pharyngitis ```

Toxo s/s in imjunocompromised?

AIDS = toxoplasmic encephaltiis Non AIDS - CNS disease (50%) - similar to immunocompetent s/s - myocarditis - pneumonitis

MC manifestation of toxoplasmosis?

Toxoplasmic encephalitis (AIDS pts)

Pt reports vision changes?

Could be CNS presentation of toxo in an immunocompromised pt

Congenital toxo s/s?

``` Most severe - early pregnancy Often asymptomatic (67%) Ocular involvement (15%) Intracranial calcifications (10%) ```

Congenital toxo at birth s/s?

``` Anemia Thrombocytopenia Jaundice Microcephaly Hydrocephalus ```

Congenital toxo later presentation?

``` Chorioretinitis (MC) - 4yrs old - blurred vision - exudative bilateral retinal lesions MR Seizures Visual defects Spasticity Severe neurological sequelae ```

Countries where congenital toxo is a big deal?

South america - columbia - brazil

Labs/diagnostics for toxo?

Toxoplasma organism - blood - body fluids - tissue - amniotic fluid - ELISA Head CT - cerebral toxo Amniocentesis (20-24 wks)

Toxo tx?

Asymoptomatic host? - no tx - <5 y/o is the exception Other stuff is treated based on presentation

Toxo chorioretinitis, congenital and pregnancy >18 wks tx?

``` Pyrimethamine + Sulfadiazine + Leucovorin ```

Acute toxo in pregnancy < 18 wks?

Spiramycin

AIDS toxo tx?

``` Cerebral toxo (acute) and (suppression) - pyrimethamine + sulfadizine + leucovorin ```

Primary prophylaxis of toxo for AIDS pt?

Trimethoprim-sulfamethoxazole

What causes fish tank granuloma?

Mycobacterium marinum | - atypical mycobacterium

Who gets mycobacterium marinum?

``` Skin trauma + Contact w - aquarium - salt water - marine animals ```

S/S of fish tank granuloma?

``` Papule/nodule at site - can ulcerate Sporotrichotic type Pain/induration Tenosynovitis/septic arthritis ```

Systemic fish tank granuloma infection?

Rare except in immunocompromised

Fish tank granuloma is best cultured, what will the results look like (for pos)?

Photochromogenic - dark - white - light - yellow

False pos for fish tank granuloma?

PPD

Abx for fish tank granuloma?

Clarithrymycin + ethambutol Ethambutol + rifampin Min 1 month - up to 6 months

MC zoonosis in the world?

leptospirosis

What causes leptospirosis?

Pathogenic spirochetes | - leptospira

Though found w/w leptorspirosis is mostly concentrated in?

The tropics

High risk areas for leptospirosis?

``` India Sri-lanka Thailand Vietnam Malaysia China Seychelles Caribbean Brazil Pacific islands ```

Transmission of leptospirosis?

Acutely infected animal - Direct contact w body fluid Chronic carrier animal - contaminated w urine

High risk activities or leptospirosis?

Activities involving fresh water, soil and animals - hiking in jungle - kayaking - swimming

Clinical syndromes of leptospirosis?

``` Anicteric leptospirosis (90%) - self limiting/mild ``` ``` Icteric leptospirosis (weil disease) - sever/multi organ ```

What determines which condition will develop (lepto)

- serovar involved - health - nutritional status - age (elderly) - immunocompromised - rapidity of tx

S/s of ictric leptospirosis?

- Multi-organ involvement - high temp (100-104) - rigors - sudden HA - N/V and diarrhea - anorexia - cough - pharyngitis - nonpuritic skin rash - muscle pain (classic)

Anicteric leptospirosis s/s?

- self limited | - mild flulike illness

Gold standard lab for leptospirosis?

Isolation of leptospires - human tissue/fluids (Typically urine)

Studies to determine the extent of organ involvement (lepto)?

CBC Liver panel Coagulation studies

Leptospirosis tx?

Sever - Penicillin G Outpatient - doxycycline

Dont stop retrieving 🎼

Hold on to that feline 🎼