Canine Infectious Disease Flashcards
what does infection with parvovirus cause?
severe haemorrhagic vomiting and/or diarrhoea with leukopenia
what is a major cause of haemorrhagic gastroenteritis in dogs?
canine parvovirus (CPV2)
how is canine parvovirus (CPV2) spread?
highly effective faeco-oral spread
large amounts shed in diarrhoea
low infective dose
what makes canine parvovirus (CPV2) so highly transmissible?
large amounts shed in diarrhoea
low infective dose
virus is resistant and remains infective for up to 1 year
what is canine parvovirus (CPV2) inactivated by?
formalin and hypochlorite disinfectants
is canine parvovirus (CPV2) vaccine part of the CORE protocol?
yes
what tissue is targeted by canine parvovirus (CPV2)?
rapidly dividing tissue e.g. neonatal myocardium, intestinal crypts and bone marrow
what rapidly dividing tissues are targeted by canine parvovirus (CPV2)?
neonatal myocardium
intestinal crypt
bone marrow
how does canine parvovirus (CPV2) cause haemorrhagic diarrhoea and vomiting?
attacks crypts which produce new enterocytes, no more are produced leaving villi bald and leads to ulceration and leaking blood from GI wall
what is the signalment for canine parvovirus (CPV2)?
inadequately protected puppy - 3-6 months old concurrent infections (e.g. Campylobacter spp) unvaccinated adult (less common)
does the severity of canine parvovirus (CPV2) infection vary?
yes
what are the clinical signs of canine parvovirus (CPV2)?
hemorrhagic diarrhoea (+/- vomiting) anorexia depression abdominal pain neutropenia
what causes haemorrhagic diarrhoea in canine parvovirus (CPV2)?
intestinal crypt necrosis
what causes neutropenia in canine parvovirus (CPV2) cases?
bone marrow necrosis
what are canine parvovirus (CPV2) patients at extreme risk of?
sepsis
why are canine parvovirus (CPV2) at extreme risk of sepsis?
due to ulcerated GI tract which will allow intestinal bacteria into blood stream and neutropenia which reduces host defences
what are the signs of sepsis?
pyrexia
cardiovascular compromise
possibly death
what may lead to suspicion of canine parvovirus (CPV2)?
presentation and history
what animals should be tested for canine parvovirus (CPV2)?
every puppy with SI haemorrhagic diarrhoea and/or neutropenia
what signs may be seen in an animal with canine parvovirus (CPV2) due to GI blood loss?
anaemia and hypoproteinaemia
electrolyte imbalances
what test may be used to diagnose canine parvovirus (CPV2)?
faecal parvovirus antigen ELISA
if the patient with suspected canine parvovirus (CPV2) tests negative but you remain suspicious what should you do?
repeat test
when may a false + for canine parvovirus (CPV2) on an ELISA be gained?
4-8 days post live vaccine
how is canine parvovirus (CPV2) treated?
aggressive IVFT
naso-oesophageal tube trickle feeding once vomiting is under control
what route of administration may be required for IVFT for a patient with canine parvovirus (CPV2)?
IO
what route of administration is not appropriate for IVFT for a patient with canine parvovirus (CPV2)?
SQ
what electrolytes should be monitored in the patient with canine parvovirus (CPV2)?
K+ and glucose
why does glucose need to be monitored in a puppy with canine parvovirus (CPV2)?
reduction in glycogen stores due to small liver and possibility of not eating for a number of hours
what is early feeding of canine parvovirus (CPV2) patients linked to?
faster recovery
lower mortality
what drugs may be given to canine parvovirus (CPV2) patients?
anti-emetic (Mariopitant)
antiobiotics
why may antibiotics be given to canine parvovirus (CPV2) patients?
risk of bacteria from GI tract entering the blood stream
when may antibiotics be given to canine parvovirus (CPV2) patients?
if severe haemorrhagic diarrhoea and / or neutropenic
what antibiotic will be given to canine parvovirus (CPV2) patients?
Amoxicillin clavulanate (IV)
what treatment for canine parvovirus (CPV2) is not commonly used?
feline interferon
what are the key elements of nursing care for canine parvovirus (CPV2) patients?
ensure comfortable ensure warm ensure euhydrated and euvolaemic early nutrition is essential dedicated nurse or nurse last
how can canine parvovirus (CPV2) patients be made comfortable?
reduce risk of scald:
keep bottom clean and dry
keep face/jaw clean and dry
apply barrier cream
what conditions of the canine parvovirus (CPV2) patient must be reported straight away?
pyrexia or hypothermia
what is essential to canine parvovirus (CPV2) recovery?
early eating - time, patience and company required
what sort of nursing is required for canine parvovirus (CPV2)?
barrier nursing
what does recovery from canine parvovirus (CPV2) infection lead to?
lifelong protection
what does the prognosis of canine parvovirus (CPV2) patients depend on?
multiple patient factors (e.g. viral load, immunity, patient health)
provision of supportive care
how much may fatality from canine parvovirus (CPV2) with low level care?
> 50%
what is feline parvovirus known as?
feline panleukopenia
feline infectious enteritus
how can cats be protected from feline parvovirus?
CORE modified live vaccine
how is feline parvovirus similar to canine parvovirus (CPV2)?
same clinical syndrome
what can natural infection or live vaccination of the queen during pregnancy lead to in kittens?
cerebellar hypoplasia (ataxia when born)
where are leptospiral organisms found?
ubiquitous globally
what can leptospiral organisms cause?
systemic infection of many mammals
how do cats respond to leptospiral diseases?
relatively resistant
what are leptospira species divided into?
serogroups
what are leptospira serogroups divided into?
serovars
where are some leptospira serovars found?
saprophytic so found on dead or dying matter
how many leptospira serovars are recognised?
> 250
how many leptospira serovars are associated with canine disease?
at least 10
what are leptospiral serovars adapted to?
host (single or multiple)
how do leptospires contaminate the environment?
infected urine
can Leptospires replicate outside the host?
no
what inactivates Leptospires?
exposure to heat/frosts
UV irradiation
where do leptospires survive well?
in warm / wet conditions for weeks to months
what are the risk factors for Leptospirosis?
lifestyle reflecting environmental exposure
e.g. working dogs, swimming, often muddy
how does Leptospirosis infection occur?
via contaminated urine (including fomites) contacting MM or compromised skin
where do Leptospires replicate?
within the blood stream (leptospiraemia)
how do leptospires come to be shed in urine?
cause renal infection and are then shed in urine (leptospiruria)
what is the incubation period for Leptospirosis?
approx. 1 week
what is the incubation period of Leptospirosis determined by?
serovar pathogenicity, infecting dose and the host response
what is the typical presentation of Leptospirosis?
acute
what is the clinical presentation of Leptospirosis?
hepatic injury (+/- jaundice)
renal injury (+/- failure)
acute pulmonary haemorrhage
Vasculitis
what are the main non-specific signs of hepatic and renal injury?
lethargy
inappetance
vomiting
diarrhoea
what are the key signs of Leptospirosis?
pyrexia
lethargy
inappetance
signs relating to affected organ systems
what are the common examination findings of an animal with leptospirosis?
lethargic dull frequently pyrexic \+/- jaundice \+/- petechial haemorrhages mild generalised lymphadenomegally
why are petechial haemorrhages often seen in Leptospirosis patients?
due to poor platelet function
what are the common laboratory findings in patients with leptospirosis?
thrombocytopenia
hepatic injury +/- jaundice
renal injury - azotemia - due to AKI
what is the urine output of a patient with Leptospirosis likely to be like?
anuria or polyuria possible due to AKI
how should urine output be monitored in a patient with Leptospirosis?
roughly monitor by eye as there should be no direct contact due to zoonotic risk
how is Leptospirosis diagnosed?
demonstration of serologic conversion
organism identification before antibiotic therapy
what test is commonly used to identify Leptospirosis organism to diagnose?
PCR
when should treatment for Leptospirosis begin?
if suspicious should start before results of test become available (can take up to a week)
what drug is used to treat Leptospirosis?
Doxycycline
how long is the course of Doxycycline needed to treat Leptospirosis?
2 weeks
who else may need to be treated with Doxycycline if a dog has Leptospirosis?
contacts
what is a risk associated with Doxycycline?
oesophageal stricture if drug remains in oesophagus for any length of time
what drug is often used to treat Leptospirosis before the dog is able to eat?
amoxicillin clavulanate (IV) pending clinical improvement
what supportive treatment will be offered when treating Leptospirosis?
for any affected organs
how many Leptospirosis patients make a full recovery?
> 50%
if the animal doesn’t make a full clinical recovery from Leptospirosis what are the other outcomes?
chronic disease due to permanently damaged organs
fatal
how should Leptospirosis cases be nursed?
barrier nursing
what disinfectants must be used when cleaning after / around a Leptospirosis case?
chlorine or phenol based
what must you ensure happens to the cage of an animal with Leptospirosis while they are in?
adequate signage to ensure people are aware of zoonotic potential
where should Leptospirosis cases be allowed to urinate?
designated area to avoid any other dogs coming into contact
what are the considerations that must be made regarding phlebotomy in Leptospirosis patients?
they have low platelets so samples should only be taken from peripheral veins where adequate pressure can be placed
what must humans treating Leptospirosis cases avoid contact with?
bodily fluid of the affected animal, especially urine and blood
what is the name of Leptospirosis caused disease in humans?
Weil’s disease
what are the typical symptoms of Weil’s disease in humans?
typically mild and flu like
what are the less typical signs of Weil’s disease in humans?
severe multisystemic life threatening illness (+/- abortions)
why must pregnant women not handle Leptospirosis cases?
as Weil’s disease can lead to abortion
what type of virus is Distemper?
enveloped RNA virus
what family is canine distemper virus part of?
paramyxoviridae
how long can canine distemper virus survive in the environment?
less than 1 day
how is canine distemper virus inactivated?
heat, drying and disinfectants
why is canine distemper virus rare in the UK?
due to vaccination
where is the main risk of canine distemper virus infection found?
within high concentrations of unvaccinated dogs (e.g. puppy farms)
how is canine distemper virus transmitted?
oronasal secretions through direct contact or large particle aerosol
where does canine distemper virus replicate within the body?
tonsils / lymphoid tissue of upper respiratory tract
how does canine distemper virus disseminate to entire reticuloendothelial system?
enters monocytes and uses them to move round the body
where is canine distemper virus shed from?
all body secretions / excretions
when is canine distemper virus shed?
before clinical signs
where does canine distemper virus tend to localise?
epithelial tissue
where in the body does canine distemper virus often affect?
respiratory GI CNS urinary skin RBC/WBC
why does the acute presentation of canine distemper virus vary?
due to host health/immunity, pathogenicity of strain, dose received etc
how may canine distemper virus present?
sub-clinical to rapidly progressive and fatal
what are the main signs of canine distemper virus?
pyrexia lethargy respiratory signs GI \+/- neurological secondary infection common
do canine distemper virus patients show all signs?
no
what are the main respiratory signs of canine distemper virus?
cough
naso-ocular discharge
+/- pneumonia
what are the main GI signs of canine distemper virus?
vomiting
diarrhoea
can patients recover from acute presentation of canine distemper virus?
yes
what is the main chronic manifestation of canine distemper virus?
CNS signs
what are the main CNS signs of chronic canine distemper virus?
seizures
ataxia
myoclonus (twitching)
in how many canine distemper virus dogs are CNS signs seen?
30%
what are the other chronic canine distemper virus signs aside from CNS?
occular signs
dental
dermatological
what are the ocular signs of canine distemper virus?
various inflammatory manifestations +/- blindness
what are the dental signs of chronic canine distemper virus?
enamel and dentine hypoplasia
what are the dermatological signs of canine distemper virus?
foot pad and nasal planum hyperkeratosis
are there any specific laboratory screening signs associated with canine distemper virus?
none specific - lymphopenia is common
how is canine distemper virus diagnosed?
identification of the organism using swabs and samples
what techniques are used to diagnose canine distemper virus?
cytology
antigen / ELISA assays
PCR
post mortem histopathology
what are you looking for in cytology to diagnose canine distemper virus?
viral inclusions in leukocytes, conjunctival cells, fluid samples etc
what nursing is required for canine distemper virus?
barrier and isolation
is there a direct treatment available for canine distemper virus?
no anti viral currently available
what must be managed when treating canine distemper virus?
secondary infections
what could the role of vitamin A be in treatment of canine distemper virus?
has been shown to reduce morbidity and mortality in ferrets when given before infection
what are surviving, apparently recovered canine distemper virus dogs at risk of?
future CNS signs
when may a dog with canine distemper virus be euthanised?
if CNS signs become progressively worse leading to poor QOL
what does recovery from canine distemper virus infection lead to?
life long immunity
what does immunity to canine distemper virus require?
antibodies
cell mediated immunity
what does canine adenovirus 1 (CAV-1) lead to?
infectious canine hepatitis
what does CAV-2 lead to?
mild respiratory disease
what disease complex is CAV-2 part of?
Kennel cough complex
what are dogs vaccinated against to prevent CAV-1?
CAV-2
why does vaccination against CAV-2 protect against CAV-1?
due to the antigenic similarities between CAV-1 and 2
what did vaccination using CAV-1 lead to in some dogs?
glomerulopathy and corneal oedema (blue eye)
is CAV-2 vaccine part of the CORE vaccine?
yes
how long can CAV-1 survive at room temperature?
for months
what is CAV-1 inactivated by?
disinfectants
what dogs are typically affected by CAV-1?
juvenile or unvaccinated
is CAV-1 common in the UK?
no
why may prevalence of CAV-1 increase in the UK?
puppy trading and imports
in what other species does CAV-1 cause disease?
other dog like species (not ferrets)
how is CAV-1 shed?
in saliva, urine and faeces
how long is CAV-1 shed for?
months following infection
how is CAV-1 transmitted?
direct dog to dog contact or via fomites
where does CAV-1 enter the body?
oro-nasopharynx / conjunctiva
where does CAV-1 replicate?
tonsils
where does CAV-1 spread to?
Lymph nodes and blood stream through lymphatic system
what are the main target cells of CAV-1?
hepatocytes and endothelial cells
what is seen in the nucleus of CAV-1 affected cells?
intra-nuclear inclusion bodies
what causes widespread tissue damage in CAV-1 infection?
cell injury and lysis due to replication of CAV-1 in host cell nucleus
how long is CAV-1 incubated for before clinical signs are seen?
4-9 days
what level of CAV-1 disease will be seen in dogs with immunological competence?
mild or subclinical disease
what are the 3 reported clinical disease syndromes of CAV-1?
per-acute
acute
sub acute to chronic
how fast is the onset of per acute CAV-1 infection?
sudden
describe per acute CAV-1 infection
circulatory collapse and death in 1-2 days
when will sub acute to chronic CAV-1 infection occur?
if partially immune
what happens during sub acute to chronic CAV-1 infection?
progression of disease to hepatic failure and death
what is the most common clinical CAV-1 disease syndrome?
acute
what is the mortality of acute CAV-1 infection?
up to 30%
describe acute CAV-1 infection
severe disease lasting 1-2 weeks
what are the clinical signs of CAV-1?
hepatic injury petechial / ecchymotic haemorrhages \+/- GI haemorrhage conjunctivitis pyrexia lethargy inappetance vomiting diarrhoea tachypnoea \+/- glomerular / tubular damage
when will further injury cease in CAV-1 cases?
when there is a robust immune response (~7 days)
what haematology findings are often seen with CAV-1?
leukopenia
neutropenia
+/- pancytopenia
what will biochemistry results for CAV-1 diagnosis reflect?
hepatocellular injury and dysfunction
frequent coagulopathies
what will serum results show in CAV-1 patients if they survive acute illness?
rising antibodies - if they survive
how is CAV-1 identified in samples from the patient?
PCR
what samples are used to perform PCR for CAV-1 diagnosis?
nasal/occular/rectal swabs
body fluids
tissues
what type of nursing is required for CAV-1 patients?
isolation and barrier
what supportive therapies will be needed for CAV-1 patients?
fluids nutrition nausea? - anti emetic encephalopathic pain specific ophthalmic care (if signs present)
why may CAV-1 patients be encephalopathic?
accumulation of toxins in the brain due to liver compromise
what can be seen in survivors of CAV-1?
chronic hepatitis and glomerulonephritis
what does recovery from natural infection with CAV-1 provide?
life long immunity
what does canine herpes virus cause latent infection of?
neural ganglia
when can canine herpes virus reactivate?
at times of stress
what is the typical transmission method of canine herpes virus in adults?
venereal
what does canine herpes virus infection present like in adults?
subclinical upper respiratory tract disease and genital disease
why is canine herpes virus disease usually only seen in puppies?
replicates at <37 degrees which is cooler than adult body temperature
what is canine herpes virus known as?
fading puppy syndrome
what can exposure of a naive pregnant bitch to CAV-1 in the last trimester lead to?
abortion / neonatal death in up to 100% of litter
what 3 pathogens are part of the kennel cough complex?
Bordetella bronchiseptica
Canine parainfluenza virus (CPiV)
canine adenovirus 2 (CAV-2)
what is kennel cough known as?
canine infectious respiratory disease complex (CIRDC) or infectious tracheobronchitis
what signs does canine infectious respiratory disease complex (CIRDC) lead to?
acute and self limiting harsh and hacking cough
what technique is sometimes used to test for canine infectious respiratory disease complex (CIRDC)?
tracheal pinch
what are the limitations of tracheal pinch to diagnose canine infectious respiratory disease complex (CIRDC)?
non-specific
cough can often be triggered by this method in a healthy animal
what are the less common signs associated with canine infectious respiratory disease complex (CIRDC)?
concurrent oculo-nasal signs
progression to pneumonia
what are the risk factors for canine infectious respiratory disease complex (CIRDC)?
high density of dogs in an environment
previous exposure
how is canine infectious respiratory disease complex (CIRDC) transmitted?
aerosol - direct and fomite
what should be considered if owner phones to book an appointment for a coughing dog?
possibility of kennel cough (canine infectious respiratory disease complex (CIRDC))
what should owners of a coughing dog be advised to do before they visit the vet?
wait in the car
avoid socialising with other dogs
how should a non-pyrexic, otherwise healthy dog with kennel cough be managed?
given time (1-2 weeks)
+/- NSAIDs
+/- cough suppressants if cough non-productive
how should a pyrexic dog with kennel cough and lower respiratory or systemic signs be managed?
doxycycline
radiography if LRT signs
consider other infectious diseases / diagnostics if systemic
what bacteria can all be isolated from healthy dog faeces?
e. coli
Clostridium perfringens
campylobacter spp.
salmonella spp.
what is the zoonotic potential of alot of bacteria that are found in dog faeces?
zoonotic and reverse zoonotic
what is the challenge when trying to demonstrate bacteria are the cause of patient illness?
as these bacteria can be found in healthy animals it is hard to know the significance of findings and proving they are the cause
when should you only look for bacteria in faecal samples?
if you genuinely think they are causing the problem
what animals are at risk of bacterial enterocolitis?
raw fed
cats who hunt birds
young
crowded / unsanitary environment
when may investigation into bacterial enterocolitis be begun sooner?
if owner is immunocompromised
what are the clinical signs of bacterial enterocolitis?
haemorrhagic vomiting or diarrhoea pyrexia sepsis \+/- abdominal pain enterotoxaemia is possible with some
what should be considered in cases exhibiting clinical signs of bacterial enterocolitis?
faecal culture
ensure evaluation for parvovirus
where is campylobacter spp. found?
present in faeces of around 50% of healthy dogs and cats - especially young/kennelled
what can campylobacter spp. lead to?
ulcerative colitis due to attachment and invasion of GI wall
what should be done if a faecal culture is positive for campylobacter spp.?
speciate with PCR
what 3 campylobacter species are there?
C. jejuni
C. coli
C. upsaliensis
what is campylobacter jejuni related to?
disease in dogs specifically with concurrent viral infections
what is campylobacter coli related to?
disease in cats
what is campylobacter upsaliensis related to?
likely a canine commensal
what is the first line of treatment for a pathogenic campylobacter species infection?
off licence erythromycin
in what numbers of cats and dogs is subclinical carriage of salmonella spp. common?
30% of dogs
18% of cats
what clinical signs of salmonella spp. infection are not always seen in cats?
GI signs
what are the main signs of salmonella spp. infection?
pyrexia
leukocytosis
GI signs
how is salmonella spp. infection diagnosed?
faecal culture and/ or blood culture and PCR
when should salmonella spp. infection be treated?
only if patient is systemically unwell
what can antibiotics do if given during salmonella spp. infection?
may encourage carrier status
what antibiotics are least likely to cause salmonella spp. carrier state?
fluoroquinolones
how long does antibiotic treatment for salmonella spp. last if needed?
10 days and then re-culture (prolonged courses may be needed)
what should be aimed for to confirm salmonella spp. infection elimination?
serial negative faecal cultures post treatment
what forms may escherichia coli take?
various pathogenic types
may be commensal
what can be caused by escherichia coli?
acute or chronic diarrhoea
what is escherichia coli infection often seen alongside?
other pathogens (e.g. parvovirus)
what is the specific chronic presentation of escherichia coli?
granulomatous colitis
how is escherichia coli infection diagnosed?
positive faecal culture
what can a faecal culture containing escherichia coli be evaluated for?
pathogenicity genes - still doesn’t prove causality
how is escherichia coli infection treated?
antimicrobials
vaccination, oral immunoglobulins - not proven
how many healthy animals is clostridium perfringens found in?
> 80% of healthy dogs
what is clostridium perfringens subtyped based on?
various toxins
what toxin is the main pathogenic toxin of clostridium perfringens?
clostridium perfringens enterotoxin (CPE)
does identification of clostridium perfringens enterotoxin (CPE) imply causality?
no
what is clostridium perfringens netF toxin associated with?
canine acute haemorrhagic diarrhoea syndrome (AHDS)
how is clostridium perfringens diagnosed ideally?
ELISA for CPE in faeces
PCR of CPE gene
in reality how is clostridium perfringens diagnosed?
faecal culture which has hige limitations
what signs are seen with clostridium perfringens?
LI diarrhoea (SI or mixed also common)
should systemically well dogs with diarrhoea be treated?
no
when will dogs with clostridium perfringens be treated?
if systemically ill
what are the signs of a dog who is systemically ill with clostridium perfringens?
haemorrhagic gastroenteritis
pyrexia
inflammatory leukogram
what treatment will be given to systemically unwell clostridium perfringens patients?
antibiotics
what was acute haemorrhagic diarrhoea syndrome previously called?
haemorrhagic gastroenteritis
what is acute haemorrhagic diarrhoea syndrome a syndrome of?
acute haemorrhagic diarrhoea (+/- vomiting) and marked haemoconcentration
what bacterial toxin is involved in acute haemorrhagic diarrhoea syndrome pathogenesis?
C. perfringens netF
what is the effect of C. perfringens netF toxin?
pore created in enterocytes leading to massive water loss into the intestine (dehydration and hypovolaemia)
what dogs are most commonly affected by acute haemorrhagic diarrhoea syndrome?
small breed dogs of any age
what is the clinical presentation of a dog with acute haemorrhagic diarrhoea syndrome?
acute onset haemorrhagic vomiting and diarrhoea abdominal pain obtunded hypovolaemic shock (due to extreme fluid loss in gut lumen) marked haemoconcentration (elevated PCV)
how is acute haemorrhagic diarrhoea syndrome diagnosed?
consistent clinical signs
marked (>60%) increase in PCV without commensurate increase in TP
what other causes of signs should be excluded before diagnosing acute haemorrhagic diarrhoea syndrome?
acute dietary indiscretion / intoxication pancreatitis hypoadrenocorticism parvovirus other bacterial enteritides intussusception (especially if young)
how is acute haemorrhagic diarrhoea syndrome treated?
IVFT with boluses to correct hypovolaemia and CRI to counteract ongoing losses
antibiotics when indicated
when are antibiotics not indicated for acute haemorrhagic diarrhoea syndrome treatment?
if apart from hypovolaemia the animal is systemically well (no pyrexia or signs of sepsis)
what antibiotic will be given to acute haemorrhagic diarrhoea syndrome patients when indicated?
amoxicillin clavulanate
what animals carry clostridium difficile asymptomatically?
small proportion
what is clostridium difficile disease likely secondary to?
toxin production
what is clostridium difficile infection seen as a complication of in people?
antimicrobial therapy
is there evidence of similar pathogensis of clostridium difficile infection due to antimicrobial therapy in dogs and cats?
no
how is clostridium difficile infection diagnosed?
faecal culture and / or common antigen test
ELISA or toxins
what clostridium difficile toxins are tested for on an ELISA?
TcdA and TcdB
how is clostridium difficile treated?
antibiotics (metronidazole) when indicated (systemically unwell)
when should antibiotic treatment stop if related to clostridium difficile infection?
immediately
when should a bacterial pathogen be considered?
acute haemorrhagic vomiting and/or diarrhoea with signs of:
pyrexia
sepsis
inflammatory leukogram
if bacterial pathogen is not indicated by signs what should you do?
avoid looking as it will be very difficult to tell significance when carriage in normal animals is so common
how should bacterial enterocolitis patients be nursed?
barrier
what should you pay careful attention to when monitoring bacterial enterocolitis patients?
fluid balance (euvolaemia, euhydration) severity of haemorrhagic component abdominal pain nausea appetite changes in body temperature