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Bacterial diseases Flashcards

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Dermatology Board Prep flashcards
1
Q

Is pseudintermedius resident or transient?

A

Resident in nares, oropharynx, and perianally

Transient on skin

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1
Q

What is the most common bacterial infection of the canine skin?

A

Staphylococcus pseudintermedius

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2
Q

Factors for the classification of pyoderma

A

Site
Depth - most useful
Aetiology
1o or 2o

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3
Q

What depths can pyoderma infection rest?

A

Epidermis
Dermis
Sub-cutis
Deeper tissues that then burst out through the skin

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4
Q

How can you confirm pyoderma?

A

Cytology (cocci, rods, malassezia, neutrophils)

C&S (only witih concurrent cytology)

Histopathology (for unusual agents)

Response to therapy (if all else fails)

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5
Q

Surface pyodermas

A

Used to describe superficial erosions of the skin.

The bacterial involvement is usually secondary.

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6
Q

Acute moist dermatitis

A

AKA: pyotraumatic dermatitis, hot spot, wet eczema

Lesion is the result of trauma due to licking and scratching (self-inflicted trauma) and is secondary to some other problem.

Commonest in summer months

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7
Q

Signalment of acute moist dermatitis

A

Occurs in all breeds, but most frequently in dense coated breeds eg: German shepherd or Labrador.

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8
Q

Pathogenesis of acute moist dermatitis

A

Lesion is the result of trauma due to licking and scratching (self-inflicted trauma) and is secondary to some other problem.

Primary problem may be: fleas, impacted anal glands, infected ears, other ectoparasites, or minor skin irritations, eg poor grooming technique.

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9
Q

Clinical signs of acute moist dermatitis

A

Rapid onset

Red, moist raw lesion develops very quickly

Acutely painful at this stage

Exudative lesion, which later scabs over

Scab often incorporates surrounding hair which can lead to pain when handling

Hair loss will result

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10
Q

Treatment of acute moist dermatitis

A

Don’t delay!!

Sedate/anaesthetise/sample

If possible treat predisposing factor/disease.

Clip area gently.

Soak off scab, chlorhexidine rinse, gently dry

Cleanse in a dilute antiseptic e.g.: chlorhexidine, ethyl lactate.

Use an antibiotic and corticosteroid cream topically. Parenteral corticosteroids may be indicated for about 7-10 days.

Buster collar

Recovery usually rapid.

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11
Q

Skin fold pyodermas “intertrigo”

A

Seen in a number of breeds in association with anatomical defects or poor conformation which create a moist, dark warm environment.

All are characterised by exudative, smelly, red, raw lesions within skin folds.

Once ulcerated the condition is exacerbated by the granulation tissue rubbing against the opposing side of the fold.

Intertrigo - erythema caused by chafing of the skin between two adjacent areas.

Beware Malassezia/Demodex

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12
Q

General treatment for skin fold pyodermas

A

Dilute chlorhexidine clean then gently dry

CLX wipes

Intermittent topical steroid?

Clotrimazole cream +/- hydrocortisone

Some clients use vinegar/50% vinegar

Treat for 7 days then decrease to minimal effective level

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13
Q

Surgical treatment for skin fold pyoderma

A

Cheiloplasty

Episioplasty

Fold ablation/tail amputation

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14
Q

Facial fold pyoderma

A

seen in brachycephalic dogs. Pekingese, Pugs, Bull dogs.

These dogs have a thick roll of skin between the nose and eyes.

Intertriginous irritation plus ocular discharges lead to secondary pyoderma between the folds.

The corneal irritation may result in pigment infiltration, ulceration and loss of sight.

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15
Q

Treatment of facial fold pyoderma

A

Clean with a mild antiseptic regularly, i.e. daily.

Topical antibiotic/corticosteroid cream e.g. Isaderm gel

If very severe surgically remove the fold.

Always examine the eyes for ulcers, which may cause increased lacrimation.

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16
Q

Orbitaldermatitis

A

Caused by an overflow of tears (epiphora) with secondary bacterial infection.

Results in hair loss, erythema and ulceration of the skin, which may be extensive.

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17
Q

Causes of orbital dermatitis

A

Faulty conformation.

Common in breeds showing entropion or ectropion.

Blocked or absence of nasolacrimal ducts.

Distichiasis or extra cilia

Corneal ulceration/abrasion

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18
Q

Treatment of orbitaldermatitis

A

Correct defect e.g.: entropion/ectropion

Flush out nasolacrimal ducts.

Topical antibiotic eye ointment including surrounding area.

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19
Q

Important differential diagnoses for orbitaldermatitis

A

Demodectic mange

Sarcoptic mange

Ringworm

Autoimmune skin disease

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20
Q

Lip fold pyoderma

A

Seen in cocker & springer spaniels and occasionally in setters.

Saliva runs down the groove in lower lip near the canine tooth.

The groove becomes macerated, secondarily infected and is the source of the foul smell.

In the majority of cases the dogs are not worried by the lesions, but owners frequently complain of the halitosis.

Check teeth and mouth to see if there is any cause for excessive salivation e.g.: gingivitis or ulceration.

Treat these if thought to be a problem.

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21
Q

Treatment of lip fold pyoderma

A

Clip and clean area with dilute antiseptic

Antibiotic/corticosteroid cream

In severe or recurrent cases surgically resect skin folds on both sides.

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22
Q

Vulval fold pyoderma

A

Seen mostly in obese bitches which have been spayed before the first oestrus.

The vulva is immature.

Can occur in entire or late-spayed bitches.

Intertriginous irritation between skin folds.

Secondary infection, foul smell.

Check that bitch is not incontinent, or diabetic and that there is no vaginitis predisposing to the pyoderma.

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23
Q

Treatment of vulval fold pyoderma

A

Clip and clean.

Topical antibiotic/corticosteroid cream, but may get fungal infection with Candida if used long term.

Medical treatment usually has poor results.

Dieting can help.

Surgical resection of the folds or plastic repair to lift the recessed vulva (episioplasty). If well done, it is curative.

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24
Q

Tail fold pyoderma

A

Affects screw tailed breeds e.g.: Bulldog, Boston terrier.

Tail tightly pressed down over anal region.

This leads to maceration of the skin, ulceration and secondary infection.

Malodorous.

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25
Q

Clinical signs of tail fold pyoderma

A

Dog permanently bites tail or perineum.

Slides along on backside.

In some cases so tightly pressed down over rectum that dog will actually strain to pass a motion.

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26
Q

Treatment of tail fold pyoderma

A

Medical treatment is usually only temporary.

Surgery is usually necessary:
1) resect skin fold.
2) amputate tail further.
3) fillet out offending vertebrae.

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27
Q

Impetigo

A

‘Puppy pyoderma’

Common

Relatively benign condition usually seen in young pups- Especially at weaning.

Occasionally older dogs with IMS

Lesions found on hairless areas of the abdomen and groin.

28
Q

Impetigo lesions

A

Lesions are very superficial.

Non-follicular pustules (ventral/axillary/inguinal)

They start as vesicles or pustules (subcorneal) with typical yellow purulent material.

Friable adherent crusts develop later and multiple discrete macules.

29
Q

Aetiology of impetigo

A

Staphylococcus pseudointermedius infection usually.

30
Q

Treatment of impetigo

A

If left usually heal in 2-3 weeks but can treat

Mild antiseptics (chlorhex, benzoyl peroxide, ethyl lactate) or topical antibiotics

If lesions very extensive or dog in poor condition its best to give antibiotic systemically

31
Q

Superficial folliculitis incidence

A

This is more common and severe than impetigo.

Affects adult dogs of all ages.

32
Q

Lesions of superficial folliculitis

A

The lesions consist of multiple red erythematous papules (<5mm).

These develop into pustules, which typically have a hair shaft protruding from the centre.

These are usually quite transient in nature and may be difficult to find before they begin to scale around the edge (epidermal collarette) and crusting over in the centre.

There is hair loss and pigmentation (macules) of these areas in the later stages.

These are healed lesions.

The distribution may be generalised but is often worse on the ventral abdomen, groin and axilla.

There may be a seborrhoeic problem as well.

The degree of pruritus varies from extreme to non-existent.

33
Q

Aetiology of superficial folliculitis

A

Most cases are caused by Staphylococcus intermedius and may be primary or secondary.

In short-haired breeds e.g.: great Danes, dobermanns, dalmatians, weimaraners, dachshunds, you can get a slightly different variation.

34
Q

Clinical presentation of superficial folliculitis

A

presents as small “bumps” diffusely affecting the trunk

Discrete patches of alopecia and hyperpigmentation may develop, mimicking urticaria or ringworm.

35
Q

Treatment of superficial folliculitis

A

Start with topical 3-5x week
- chlorhex
- benzoyl peroxide
- ethyl lactate
- fusidic acid

If not clearing in 2-3 wks use systemic ABx for 3-4wks
- clindamycin
- pot. sulphonamides
- cephalexin
- clavamox
- erythromycin
- lincomycin

Take swabs for C&S

Bath with antibacterial shampoo

May be allergic primary disease, or resistance

36
Q

Treatment of recurrent pyoderma

A

Most often this is associated with an underlying hypersensitivity disorder.

Very occasionally we may end up with a diagnosis of idiopathic recurrent pyoderma.

If so, repeated courses of antibiotics required, bacterial hypersensitivity is considered a possibility in some cases and immunodeficiency in others.

Some people report encouraging results with autogenous vaccines.

Non-specific immune stimulation with levamisole has been successful in some cases. Dose 5.0 - 6.0 mg/kg daily for 3 days every two weeks.

37
Q

Superficial spreading pyoderma

A

Common

Pruritic

Seen +/- superficial folliculitis

Most often in inguinum and axillae

Secondary

Treat in same way

?? Shetland sheepdogs increased severity

38
Q

Deep pyoderma

A

A bacterial infection involving structures beneath and beyond the hair follicle.

Suppuration, necrosis and fistula formation are frequently seen.

The areas involved are often hot and painful.

39
Q

Furunculosis

A

Usually develops as an extension of bacterial folliculitis as a result of follicular rupture and the spread of bacterial infection.

Pathogenesis controversial

Lesions larger than a folliculitis and pus can be expressed from them.

Thus, they are a more obvious form of pyoderma.

40
Q

Clinical findings of furunculosis

A

Larger pustules, firmer nodules +/- discharging tracts, poorly defined oedematous & erythematous plaques, crusts.

Haemopurulent discharge, haemorrhagic bullae, alopecia, pain, Pruritus, possible pyrexia.

41
Q

When can furunculosis develop?

A

As a secondary complication to generalised demodectic mange - lesions widespread

More localised form over back and loins (Boxers etc.)

In association with foreign bodies

Nasal pyoderma

42
Q

Furunculosis secondary to generalised demodectic mange

A

Lesions widespread.

Staph pseudintermedius commonest

Secondary invaders: Proteus, E. coli, pseudomonas

Most cases have underlying cause e.g. hair follicle disorders, demodicosis, HAC

N.B. traumatic furunculosis: ALD (acral lick dermatitis) and grooming

43
Q

Nasal pyoderma

A

Fairly rare.

Presents as a painful, swollen furunculotic area on the bridge of the nose.

Seen particularly in German shepherds, springer spaniels, pointers, Labradors and collies.

Thought to arise from dog rooting around the ground or in kennels around wire. May develop from a sting.

Progression:
a. Reddened skin
b. Loss of hair
c. Becomes secondarily infected in time
d. Pustules
e. Fistulae

Primary differential diagnosis is nasal eosinophilic folliculitis and furunculosis.

44
Q

Diagnosis of furunculosis

A

History, examination, cytology

Clipping hair is a help to diagnosis

C&S is obligatory

Scrape/biopsy for Demodex

45
Q

Treatment of furunculosis

A

Remember the dermis will become fibrosed and scarred, which will reduce the blood supply to the area and will leave pus in pockets of scar tissue. These will be very difficult to get at.

Cleanse and bathe with mild antiseptics frequently.

Moisten and remove crusty lesions. Antibacterial soaks.

Antibiotics according to sensitivity for at least 4-6 weeks

Treat for 3 weeks minimum and reassess every 2 weeks

46
Q

Prognosis of furunculosis

A

Guarded to poor as recurrence is common

47
Q

Muzzle furunculosis

A

Characteristically seen on the face of young dogs 3 - 12 months of age.

Boxer and Bulldog commonly affected and in these breeds the condition may persist throughout life. Almost exclusively in short coated dogs.

The chin is the most common site followed by the upper lips.

Papules and pustules are present.

Usually very few clinical signs, although the dog may rub its chin and this will intensify the lesions.

48
Q

Treatment of muzzle furunculosis

A

Often resolves as the dog matures

If severely affected or not settlig down:
- suitable antibiotic therapy
- daily shampooing of affected areas e.g. with hibi
- topical treatment with benzoyl peroxide cream

Consider the possibility of demodicosis

49
Q

Pedal furunculosis

A

Infection involving hair follicles and or sebaceous glands.

Often all four feet

Firm nodules, draining fistulas

Solitary or multifocal

Often interdigital

Increased in short coated breeds

50
Q

Possible causes of pedal furunculosis

A

Underlying disease +/- self trauma

FB

Weight bearing trauma

Rupture of follicular retention cysts

51
Q

General treatment of pedal furunculosis

A

?? Underlying cause

Frustrating, often chronic

Scar tissue impedes drainage and AB penetration

If infection is significant treat as per deep pyoderma + topical

May need surgery
- podoplasty
- separation podoplasty
- fusion podoplasty

52
Q

Three types of pedal furunculosis

A

Swelling in one area between toes

Granulomatous reaction but all 4 feet affected

Associated with bacterial infection, mainly staphylococcal

52
Q

Pedal furunculosis - swelling in one area between toes

A

Comes up and bursts, heals, then comes up again.

Occasionally rim of granulation tissue around discharging fistula.

Think of a foreign body.

Grass awn may travel proximally coming out at the carpus or shoulder.

53
Q

Treatment of pedal furunculosis when there is just swelling in one area between toes

A

Surgically remove foreign body.

Curette out diseased tissue.

Swab for culture, if thought necessary.

54
Q

Pedal furunculosis - granulomatous reaction with all four feet affected

A

Seen particularly in dogs with feather between toes.

Thought hair comes out of skin then back in causing a foreign body reaction.

Seen on dorsal and ventral aspect.

Made worse by chewing at feet, e.g. atopic dermatitis

Difficult to treat, but check for underlying allergic disease.

Prognosis guarded.

Radical surgery may help.

55
Q

Pedal furunculosis associated with bacterial infection

A

mainly staphylococcal, which causes a suppurative reaction.

Dorsal part of interdigital web.

Painful condition causing lameness.

Occurs mainly in short-coated breeds.

Appears as a papule.

Progresses to a nodular stage.

Then becomes reddish purple, shiny and fluctuant and ruptures to exude a thick bloody material.

There may be one or more nodules on one or more feet, but seem to be more common on the fore feet.

Prognosis guarded.

56
Q

Treatment of Pedal furunculosis associated with bacterial infection

A

Odd lesion will burst and clear up with a short course of antibiotics.

Dog with recurrent multiple lesions is a problem. Check for underlying generalised skin disease.
1) Keep dogs off roads, gravel and dirty areas.
2) Keep feet clean, wash regularly.
3) Long term systemic antibiotics
4) Surgery - fine for odd lesion but beware multiple lesions unless radical surgery contemplated. Cryosurgery also used for the odd lesion.

Management depends on individual dog. Many tolerate it quite well.

57
Q

Staphylococcal resistance

A

Prevalence increasing

Methicillin R Staph pseudintermedius (MRSP)

D&C may be colonised by MRSA

D&C may be colonised by MRSS (schleiferi)

Topical shampoo therapy very helpful

Ethyl lactate, chlorhexidine

Bleach: cup of bleach in half a bathtub full of warm water (beware carpets and furniture!)

58
Q

Cellulitis

A

A deep pyoderma characterised by diffuse spreading, oedematous and sometimes suppurative inflammation.

Poorly defined and tends to dissect widely along and through tissue planes.

Tracking under the skin may lead to sloughing of the skin.

It is a very serious, life-threatening condition.

59
Q

Treatment of cellulitis

A

Intensive antibiotic therapy at high dosages, usually continued over a long period.

Recurrence is common.

60
Q

Callus formation and callus deep pyoderma

A

Particularly common in large and heavy breeds of dogs.

Usual sites include the elbow and hock. May also see sternal callus formation.

The callus is hairless, grey in colour and has a wrinkled surface.

Most calluses are harmless and require no treatment.

The owner may need reassuring that the condition is not ringworm or mange.

It is worth suggesting that affected dogs are kept on soft bedding e.g.: rubber mattress, carpet etc.

Can be a problem if they get traumatised and become secondarily infected.

Infection can go quite deep with ulceration and fistula formation.

There may be an associated chronic bursitis in the elbow region.

61
Q

Treatment of calluses and callus deep pyoderma

A

Antibiotics may control in early case.

Surgery in advanced cases to remove callus and dissect out bursa or hygroma, but high risk of wound breakdown. Apply a pressure bandage post operatively.

Remember soft bedding (for the dog) to prevent recurrence.

62
Q

Feline cutaneous bacteriology and pyoderma

A

Far less studied

Pustules/papules/epidermal collarettes are very much a rarity

Staph. Felis isolated from 35% cats (resident)

Staph pseudintermedius 20% cats: mainly associated with skin lesions

Isolation rates very low from healthy skin

?? Low adherence of bacteria to feline skin

Deep pyoderma in cats often the result if penetrating fight wounds (CBA)

Pasteurella sp, Staphs, E. coli, and anaerobes

Don’t forget FeLV/FIV as a cause of IMS

Evidence for role of Abs in EG complex

63
Q

Feline acne

A

Essentially a keratinization disorder but may be complicated by 2ry infection with either bacteria or occasionally Malassezia.

Occasionally seen.

All ages affected.

Greyish-black comedomes and follicular casts are seen, otherwise clinically very similar to dogs.

Chin most commonly affected and may become swollen and oedematous.

64
Q

Treatment of feline acne

A

In acute stages antibiotics are indicated.

Topical antibiotic/corticosteroid cream.

Regular cleansing with a mild antiseptic.

65
Q

Mycobacterial granulomas

A

Can involve obligate pathogens (e.g. Mycobacterium lepraemurium [feline leprosy] or rarely Mycobacterium bovis) or opportunistic pathogens (e.g. Mycobacterium fortuitum).

Acid fast bacilli in skin granuloma.

Small, firm circumscribed nodules.

Occur on any part of the body.

Some will ulcerate producing a purulent discharge.

Touch smear reveals acid fast organisms.

Difficult to culture.

Drainage lymph nodes may be enlarged.

Little effect on cats general health.

66
Q

Treatment of mycobacterial granulomas

A

Surgical excision is the treatment of choice, if feasible

Fluoroquinolones (e.g. enrofloxacin 5 mg/kg SID) have been used successfully

Doxycyline (5 mg/kg BID) and clofazimine (2-3 mg/kg SID) have also been suggested

Treatment should continue for 4-6 weeks after the lesions have resolved.

SA Dermatology (20 decks)

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