33. Paralysis tick

Question 1

Features?

Answer 1

Features:
-lag phase: Ticks generally attach for 1 - 2 days before clinical signs
- Pathophysiology: Toxin inhibits presynaptic release of acetylcholine at the neuromuscular Junction

Question 2

Clinical signs?

Answer 2

Clinical signs:
- Dysphonia, retching/gagging, drooling
- Ascending paresis/paralysis, dilated pupils
- Dyspnoea, cyanosis

Question 3

Differential diagnosis?

Answer 3

Differential Diagnosis:
- Trauma, spinal cord disease, myasthenia gravis, myopathy, snake envenomation

Question 4

Stages?

Answer 4

Question 5

Treatment?

Answer 5

**Treatment:
- Remove ticks: Immediately
- Administer tick anti-toxin:
-C. Laboured breathing
- D. Severe dyspnoea and cyanosis
- It any cllnical signs are present, then treat immdeiately
- Best administered pre-emptively as the patient will get worse before getting better
- Dose: 0.5 * 1ml/kg, up to 2ml/kg In cats slow IV
- Premedicatlon:
- Feline: Prednisolone sodium succinate 2mg/kg slow IV &/or adrenaline 0.02mg/kg IM 10mins later
(but Just prior to antitoxin administration)
- Beware of acute side effects of cardiovascular, shock, collapse:
> If bradycardia and hypotension (poor mucous membrane colour), stop anti-toxin administration and
atropine 0.04mg/l<g IV ·
- II anaphylactlc: Collapse, vomiting, hypotension, stop anti-toxin administer oxygen, IV fluid boluses,
adrenalin 0.02mg/kg IV and prednisolone sodium succinate 10mg/kg slow IV

Question 6

Symptomatic and supportative care?

Answer 6

Symptomatic and supportive care:
- General care and monitoring:
- Bladder expression, change bedding, eye lubrication, maintenance of hydration (maintenance IV
fluids), repeat searches q4 hours
- Stress:
- Sedation: Combinations of acepromazine 0.01-0.03mg/kg IV, butorphanol 0.1 -0.3mg/kg IV/SC .
> Sedation Is Important as it Improves breathing dynamics and oxygen demand by reducing stress
- Gastrointestlnal dysfunction:
- Nil per os until normal gag reflex
- Pharyngeal suctioning
- Antiemetic: Metoclopramide O.5mg/kg IV then CAI in IV flulds, maropitant 1 mg/kg SC SID for <5
days
> Gastric protectants: Ranitidine 2mg/l<g IV BID, esomeprazole 1mg/kg IV SID
> Respiratory complications:
> Sedation: Combinations of acepromazine 0.01-0.03mg/kg IV, butorphanol 0.1-0.3mg (g IV/SC)
- Oxygen therapy: Nasal line 50-100ml/kg/min per line
> +/- Ventilation If respiratory effort is unsustainable, hypoxaemic (SP02 <90%, or Pa02: <60mmHg)
despite oxygen therapy or hypercapnic (PC02: >6DmmHg)
:,. Antibiotics If aspiration haS occurred
> Atropine 0.1 ml SC 6/D to reduce salivation, not with pneumonia
- Myocardlal dysfunction and left-sided congestive heart failure:
- Rarely clinical
- Diuretics, oxygen
Tick search and clip:
- Very Important repeat searches q4 hours
Tick preventive bath

Question 7

Tick control advice?

Answer 7

Tick control advice:
- Daily searching, most important
- Cllp long haired dogs
- Avoid tick habitats, long grass, forest areas
- Pharmacotoglcal control measures: Should not be relied upon as the only control measure
- Tick collars: Amltraz/flumethrin: 2 months (dogs only)
- Dellamelhrin: 3 months (dogs only)
» Frontline spray®: 2 week protection
» Frontline PLUS® spot-on: 2 week protection, dogs and cats (off-label use In cats)
» Advantix > imidacloprid and permethrin spot-on: 2 week protection (dogs only)
> Permethrin shampoo/rinses: 1 week protection (dogs only)
> Natural pyrethrlns shampoos: Safe on cats, 3 day protection
> Proban®tablets (Cythioate - organophosphate): Given every 48 hours (dogs only)
> NexGard® tablets (Afoxolaner): Monthly (dogs only)
> Bravecto® tablets (Fluralaner): 3 monthly tablets (dogs only)

Question 8

Discharge?

Answer 8

Discharge:
- Only if can walk, urinate, swallow properly and no retching
- Reduced activity for 4 weeks, small risk of sudden cardiac arrest