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SA DX & TX II > Exam 2 - Pyoderma > Flashcards

Exam 2 - Pyoderma Flashcards

1
Q

what is the most common agent involved in pyoderma?

A

staphylococcus pseudintermedius

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2
Q

what is pyoderma? why is it important?

A

pyogenic (pus-producing) bacterial infection of the skin

common cause of skin disease in companion animals - especially dogs

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3
Q

T/F: pyoderma is almost always occurring secondarily to an underlying cause

A

true

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4
Q

why does depth of infection matter?

A

dictates the appropriate duration of antibiotic therapy & helps guide treatment

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5
Q

how do we determine depth on skin infections?

A

diagnostic work up - look at lesion types, clinical signs, cytology/skin scrape, & biopsies

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6
Q

what is another name for pyotraumatic dermatitis?

A

hotspot

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7
Q

what is this lesion?

A

hot spot - pyotraumatic dermatitis

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8
Q

do you need systemic antibiotic therapy for superficial bacterial skin infections?

A

lecture she gave said no, but the notes state otherwise???

yes - required for most cases along side topical therapies

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9
Q

can you tell by looks alone that a patient has a methicillin-resistant staph infection?

A

nope

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10
Q

what is the difference between resident bacteria & transient bacteria in regards to the normal commensal organisms of the skin?

A

resident - capable of living & multiplying on normal skin

transient - not capable of multiplying on normal skin

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11
Q

commensal bacteria will not normally evoke an immune response from the host unless what?

A

conditions favoring overgrowth are occurring

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12
Q

______ bacterial skin conditions are uncommon while _______ bacterial skin conditions are common because of opportunistic pathogens

A

primary - uncommon

secondary - common

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13
Q

T/F: staphylococcus pseudintermedius is RARELY isolated from normal and diseased human skin/mucosa

A

true

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14
Q

what is the most common bacterial agent involved in human skin disease?

A

staph aureus

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15
Q

what is the pathophysiology of pyoderma?

A

bacterial adherence leads to colonization & penetration of abnormal skin which may produce/release enzymes & toxins which act as super antigens

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16
Q

what are some examples of alteration & function in the skin that lead to conditions allowing pyoderma to occur?

A
  1. faulty epidermal barrier function
  2. abnormal cutaneous microclimate
  3. aberrant immune response - either allergic response or immunosuppression
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17
Q

if you see cocci on skin cytology, what are you thinking?

A

staphylococcal bacteria until proven otherwise!!!!

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18
Q

T/F: often times, treating the staphylococcal component of a mixed infection with rod-shaped bacteria will result in clinical resolution of the pyoderma

A

true

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19
Q

what are the most common pathogens isolated from pyoderma in cats?

A

s. pseudintermedius & s. aureus

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20
Q

what are the agents involved in cat-bite abscesses?

A

pasteurella multocida (normal inhabitant of the mouth), strep spp., & anaerobic pathogens

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21
Q

how is canine pyoderma classified?

A

based off of the cutaneous depth of infection & appropriate duration of therapy

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22
Q

T/F: pyoderma is assumed to be related to staph spp unless there is a qualifier to denote otherwise

A

true

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23
Q

why are b-lactam antibiotics empirically prescribed for animals with superficial pyoderma/folliculitis? what are examples of drugs used?

A

most commonly associated with staph organisms & they have a wide spectrum of activity against staph spp - all used for at least 3-4 weeks, 1 week past clinical resolution

cephalexin 22-30mg/kg twice daily
cefpodoxime 10mg/kg once daily
clavamox 20mg/kg 3x a day
cefovecin 8mg/kg q 14 days

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24
Q

other than abscesses & cellulitis, other forms of what disease are not as common in cats when compared to dogs?

A

other forms of pyoderma

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25
Q

what diseases may mimic superficial bacterial folliculitis & deep pyoderma?

A

demodectic mange & dermatophytic folliculitis/furunculosis

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26
Q

when a dog has pyoderma, what should you immediately evaluate for?

A

concurrent demodicosis

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27
Q

if you treat a patient with empiric b-lactam antibiotics for superficial pyoderma, and they fail to respond, what should you do next?

A

culture the skin - need to exclude methicillin-resistant/multi-drug resistant organism

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28
Q

why do you need to do a culture for an animal with deep pyoderma?

A

the duration of systemic antibiotic therapy will be many weeks!!! be a good shepherd of antibiotics

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29
Q

what are some recognized diseases/conditions associated with surface depth pyoderma?

A

pyotraumatic dermatitis - hot spots

intertrigo

bacterial overgrowth syndrome

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30
Q

what are some recognized diseases/conditions associated with superficial depth pyoderma?

A

impetigo

superficial bacterial folliculitis (superficial pyoderma)

superficial spreading pyoderma (exfoliative superficial pyoderma)

mucocutaneous pyoderma

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31
Q

what are some recognized diseases/conditions associated with deep pyoderma?

A

deep bacterial folliculitis/furunculosis - nasal, chin, pressure point, pedal, & pyotraumatic

post-traumatic grooming furunculosis

cellulitis

acral lick dermatitis

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32
Q

what treatment is used for surface pyoderma? are systemic antibiotics indicated?

A

may only require topical therapy to remove excessive bacteria/sebum until clinical signs resolve & topicals are used for maintenance therapy once the infection is controlled!!

not really - topicals are your friend here

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33
Q

what is the minimum treatment duration for systemic antibiotics when treating superficial pyoderma? what additional treatment will you use?

A

3 weeks - must treat 1 week beyond clinical resolution

may use sole topical therapy for very focal lesions!!!!

otherwise, adjuvant topical therapy will speed up time to resolution

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34
Q

what is the minimum treatment duration for systemic antibiotics when treating deep pyoderma? what additional treatment will you use?

A

6-12 weeks + - treat at least 2 weeks beyond clinical resolution!!

base your abx off of the antibiogram, may need to biopsy to confirm infectious agent

adjuvant topical therapy will speed up resolution of disease

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35
Q

what is affected in surface pyoderma?

A

infection of the stratum corneum

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36
Q

what is affected in superficial pyoderma?

A

infection of the superficial interfollicular and/or follicular epithelium

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37
Q

what is affected in deep pyoderma?

A

infection of the dermis, subcutis, and/or deep soft tissue

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38
Q

what are some examples of underlying causes that lead to the development of pyoderma?

A

parasites, allergies, immune-mediated condition, neoplasia, microbial infection, & endocrine problem

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39
Q

what is the minimum database for dermatological diagnostics?

A

flea combing, skin scrapings, impression cytology, claw fold cytology, ear swabs, woods lamp/DTM, & +/- acaricidal mite treatment trial

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40
Q

are bacteria more likely to be resistant to antiseptics or antibiotics?

A

antibiotics! this is why antiseptics used as topical treatment is indicated for surface pyoderma treatment!!!

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41
Q

what are the standard go to ingredients in your topical drugs for treating surface pyoderma?

A

chlorhexidine, triz EDTA, & benzoyl peroxide

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42
Q

T/F: it is common to see moist exudation causing pruritus in dogs with hot spots which is an example of surface pyoderma

A

true

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43
Q

what is the name of this condition? what type of pyoderma is it associated with?

A

intertrigo - surface pyoderma

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44
Q

what is your mainstay treatment for surface pyoderma?

A

TOPICAL THERAPY

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45
Q

T/F: with superficial pyoderma, you may see pruritus & alopecia

A

true - it is +/-

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46
Q

what is the name of this condition? what type of pyoderma is it associated with?

A

mucocutaneous pyoderma - superficial pyoderma

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47
Q

what differentials are you considering in a case of surface pyoderma?

A

scabies mites

yeast infection - malassezia overgrowth

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48
Q

what kind of pyoderma has you considering what is pictured as differentials?

A

surface pyoderma

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49
Q

when do you want to reassess your patient with pyoderma while on recommended therapy?

A

2-4 weeks in depending on the severity of pyoderma

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50
Q

what dogs are commonly affected by hot spots?

A

dense coat breeds - st bernards, rotties, GSD, goldens, & labs

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51
Q

what time of year do we see a higher prevalence of hot spots in dogs?

A

warmer/humid weather

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52
Q

what is the pathogenesis of hot spots? what are they usually secondary to?

A

bacterial skin disease that results from self-trauma

secondary to pruritic skin disease such as fleas, parasites, allergic skin disease, & otitis or painful conditions such as OA, anal sac impaction, or trauma

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53
Q

what is the lesion distribution of hot spots?

A

caudodorsal rump, tail base, lateral thighs, cheeks, or neck

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54
Q

what are the clinical signs of a hot spot?

A

rapidly developing, pruritic/painful well-circumscribed, alopecic, eroded, excoriated erythematous patch +/- slightly raised plaque

surface oozing with adherent exudate & mats of hair - may see papules/pustules at the periphery of lesions

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55
Q

what are your main differentials for a dog with hot spots?

A

folliculitis - bacterial, demodicosis, or dermatophytosis

pyotraumatic folliculitis

sweat gland adenocarcinoma for lesions that aren’t responsive to therapy

56
Q

what is seen on cytology taken from a hot spot?

A

suppurative inflammation with mixed bacteria

57
Q

how are hot spots diagnosed?

A

acute history, clinical signs, & exclusions of the other differentials

clipping - diagnostic & therapeutic attributes

58
Q

when are antibiotics indicated for treating a hot spot in a dog?

A

if papules/pustules are a feature indicating combo of surface & superficial pyoderma - appropriate b-lactam abx at correct dose for 3-4 weeks (1-2 weeks beyond clinical resolution)

59
Q

what drug may be used instead of glucocorticoids for preventing self trauma in a dog with a hot spot?

A

oclacitnib - short course for 3-10 days

60
Q

why use glucocorticoids for a dog with hot spots?

A

stop self trauma - use a topical preparation without alcohol or pred at 0.5-1.0mg/kg PO every 24 hours for 3-10 days

61
Q

what is the treatment used for hot spots?

A

clip & clean affected area

topical therapies that don’t have alcohol!!!!!! peroxide, chlorohex, etc is okay & avoid occlusive ointments because it will keep the lesion moist

mechanical barrier - t-shirt or ecollar

appropriate flea control & treatments for any other potential underlying cause

+/- : systemic abx, glucocorticoids/oclacitnib

62
Q

what is intertrigo?

A

skin fold pyoderma

63
Q

what is the pathogenesis of intertrigo?

A

anatomical defect in which opposing frictional folds of skin result in a warm & moist environment favoring bacterial & yeast overgrowth & excessive sebum accumulation on the epidermal surface

seen in animals with natural body folds & acquired (obesity)

64
Q

what animals are predisposed to intertrigo of the facial/nasal folds?

A

bracycephalic breeds

65
Q

what animals are predisposed to intertrigo of the lip folds?

A

bracycephalic & dolichocephalic breeds

66
Q

what animals are predisposed to intertrigo of the body folds including the axilla, inguinal area, truncal, & limb folds?

A

sharpei, hounds, spaniels, bull dogs, pugs, & certain terriers

67
Q

what animals are predisposed to intertrigo of the tail folds?

A

corkscrew tail dogs - english bull dogs & pugs

68
Q

what animals are predisposed to intertrigo of the vulvar fold?

A

dogs with recessed/poorly developed vulvas or obese dogs

69
Q

what are the clinical signs seen with intertrigo?

A

stinky stinky stinky

pain, pruritus, erythema with moist surface exudates, & erosions from moist macerations

70
Q

what are your main differentials for intertrigo?

A

folliculitis - dermatophytosis, demodicosis, or bacterial

malassezia dermatitis

urine scald

71
Q

what is seen on cytology taken from a lesion of intertrigo?

A

mixed bacterial population +/- yeast +/- leukocytes

72
Q

how is intertrigo diagnosed?

A

history, clinical signs, & exclusion of other differentials

cytology, oral exam, & cystocentesis UA to exclude ascending UTI

73
Q

what therapy is used to treat intertrigo?

A

possibly clip & clean

topical therapy without alcohol - more frequent use & then taper to a maintenance frequency of administration

weight correction or corrective surgery

74
Q

what is bacterial overgrowth syndrome?

A

newly recognized clinical pruritic syndrome of bacterial overgrowth on the skin surface (not hair follicle) without any typical lesions of pyoderma (papules, pustules, epidermal collarettes, crusts, exudation), but responds remarkably to antibiotic treatments

75
Q

is bacterial overgrowth syndrome a true pyoderma? why?

A

no - it is not pyogenic

76
Q

what are the typical distributions of bacterial overgrowth syndrome?

A

predominantly ventral trunk & occasionally otic canal

77
Q

what lesions are associated with bacterial overgrowth syndrome?

A

erythema, oily seborrhea, hyperpigmentation, excoriation, lichenification, & ceruminous otitis

78
Q

what are your main differentials for bacterial overgrowth syndrome?

A

intertrigo

malassezia dermatitis - may be concurrent

allergic skin disease - may be concurrent

79
Q

what treatment is indicated for bacterial overgrowth syndrome?

A

topical therapy - antibacterial products

systemic abx - most cases require them, prescribed in a manner similar to superficial pyoderma

any treatments needed for any underlying diseases/conditions

80
Q

what are some other names of impetigo?

A

puppy pyoderma or superficial pustular dermatitis

81
Q

what is impetigo?

A

subcorneal skin infection not associated with the hair follicle

82
Q

what agent is most commonly associated with impetigo?

A

staphylococcal bacteria

83
Q

what animals do we most commonly see with impetigo? why?

A

young, prepubescent dogs

may be idiopathic, or it occurs secondary to poor husbandry, nutrition, endoparasitism, ectoparasitism, urine scald, or fecal debris

84
Q

what is the typical lesion distribution of impetigo?

A

glabrous (non-haired) skin most often restricted to the axillae & inguinal areas

85
Q

is impetigo a painful or pruritic condition?

A

nope

86
Q

what lesions are seen in animals with impetigo?

A

interfollicular lesions that ARE NOT folliculitis - creamy, fragile pustules/crusted papules, & epidermal collarettes not oriented around hairs/hair follicles that are usually partially bilaterally symmetrical

87
Q

what are the main differentials for impetigo?

A

folliculitis - bacterial, demodicosis, & dermatophytosis

sarcoptic mange

pemphigus foliaceus

88
Q

how is impetigo diagnosed?

A

history of the animal, clinical signs, & exclusions of other differentials

cytology - suppurative inflammation with cocci

89
Q

T/F: topicals alone are beneficial for treating impetigo

A

true

90
Q

how is impetigo treated?

A

topical therapy

systemic antibiotics for at least 3 weeks if the patient isn’t responding to sole topical therapy

91
Q

what is the most common clinical presentation of pyoderma in the dog that has no age or sex predispositions?

A

superficial bacterial folliculitis

92
Q

T/F: breed predilections for superficial bacterial folliculitis parallel those predisposed to underlying diseases & conditions

A

true

93
Q

what is the agent involved in superficial bacterial folliculitis until proven otherwise?

A

s. pseudintermedius

94
Q

what is the pathogenesis of superficial bacterial folliculitis?

A

infection begins in the follicular ostia & spreads peripherally under the stratum corneum to other nearby follicles - infection tends to be secondary to other diseases

if left untreated or treated inappropriately, it may progress down the follicle leading to follicular rupture (furunculosis/deep pyoderma)

95
Q

what are the most frequently encountered underlying diseases & conditions seen that cause superficial bacterial pyoderma?

A

DEMODICOSIS!!!!!!

pruritic/inflammatory/allergic skin disease, endocrinopathies (including iatrogenic hyperadrenocorticism), cornification defects, follicular dysplasias, nutritional abnormalities, & immune dysfunction

96
Q

primary idiopathic superficial bacterial folliculitis may be seen in what animals?

A

short-coated adult dogs

97
Q

superficial bacterial folliculitis is often mistaken for what in short-coated adult dogs?

A

hives - example is the boxer

98
Q

T/F: because superficial bacterial folliculitis is so common in the dog, it is okay to perform an appropriate antibiotic treatment trial when in doubt

A

true

99
Q

T/F: superficial bacterial folliculitis & malassezia dermatitis may coexist in a dog

A

true

100
Q

what is the typical lesion distribution of superficial bacterial folliculitis?

A

axillary, inguinal, trunk, proximal limbs, interdigital webs

may generalize but spares the head

101
Q

what is your main differential for superficial bacterial folliculitis?

A

folliculitis - demodicosis & dermatophytosis!!!!!

102
Q

how can glucocorticoids cause misdiagnosis of superficial bacterial folliculitis?

A

glucocorticoids may lessen visible inflammation & development of typical lesions causing you to miss it

103
Q

what lesions are seen in superficial bacterial folliculitis?

A

since pustules are transient, erythematous papules with or without crusting is the lesion most commonly seen

fragile, transient pustules with erythematous halo centered around the hair follicle leading to -> crusted papules -> epidermal collarettes -> alopecia -> hyperpigmentation

104
Q

what type of alopecia is seen in animals with superficial bacterial folliculitis?

A

moth eaten alopecia in short-coated dog breeds

subtle alopecia/coat thinning/shedding in long-coated dog breeds

105
Q

how is superficial bacterial folliculitis & superficial spreading pyoderma diagnosed?

A

history/clinical signs/exclusion of other differentials

cytology - cocci, activated neutrophils, +/- eosinophils

skin scrapes to exclude demodicosis

culture if not responding to empiric therapy

DTM for cats with folliculitis

106
Q

why should you avoid using glucocorticoids when treating superficial bacterial folliculitis?

A

you can’t assess the influence of abx on pruritus in the face of steroids because they may reduce the inflammatory signs of pyoderma making you think it is resolved

107
Q

what therapy is indicated for treating superficial bacterial folliculitis & superficial spreading pyoderma?

A

topical therapies

systemic abx - required for most cases, appropriate b-lactams for at least 3-4 weeks (at least 1-2 weeks beyond clinical resolution)

108
Q

what is superficial spreading pyoderma similar to as far as clinical presentation is concerned? what animals do we commonly see it in?

A

superficial bacterial folliculitis

long-coated dog breeds - shetland sheep dogs

109
Q

what is the typical lesion distribution of superficial spreading pyoderma?

A

truncal distribution especially in axilla & groin

110
Q

what lesions are seen in superficial spreading pyoderma?

A

multiple, expanding, & coalescing epidermal collarettes with central erythema, crusting, or hyperpigmentation

111
Q

what are the main differentials for superficial spreading pyoderma?

A

folliculitis - bacterial, demodicosis, & dermatophytosis

autoimmune dermatosis - pemphigus foliaceus & erythema multiforme

112
Q

what is another name for superficial spreading pyoderma?

A

exfoliative superficial pyoderma

113
Q

what animals are commonly affected by mucocutaneous pyoderma?

A

GSD & crosses of any age/sex - usually idiopathic without an underlying cause present

114
Q

what is mucocutaneous pyoderma?

A

bacterial infection limited to the skin bordering the mucus membranes

115
Q

what is the classic distribution of lesions from mucocutaneous pyoderma?

A

symmetric lesions along lip margins with increasing severity towards the commissures

rare to see signs along other mucocutaneous junctions

116
Q

whats lesions are seen with mucocutaneous pyoderma?

A

erythema, swelling, exudation, adherent crusting, matting, erosions, ulcers, fissures, & depigmentation

pain & pruritus!!!!

117
Q

how is mucocutaneous pyoderma diagnosed?

A

history, clinical signs, & exclusion of other differentials

cytology - cocci, rods, malassezia yeast, leukocytes

118
Q

what is seen on a biopsy of a lesion of mucocutaneous pyoderma?

A

superficial crusting & erosions, epidermal hyperplasia, intraepidermal pustules with a lichenoid band at the dermoepidermal junction

119
Q

how is mucocutaneous pyoderma treated?

A

topical therapy

systemic abx - b-lactams for 4-5 weeks

120
Q

feline superficial pyoderma is clinically indistinguishable from what other skin condition?

A

dermatophytosis

121
Q

what is the most commonly affected location of the body in cats with superficial pyoderma?

A

the face

122
Q

what lesions are seen in cats with superficial pyoderma?

A

indolent ulcers & eosinophilic plaques (manifestations of allergic skin disease) are commonly infected with bacteria & usually improve with systemic abx therapy

123
Q

what is the difference in regards to lesion distribution when it comes to superficial pyoderma in dogs & cats?

A

cats have a different distribution pattern & mimics many feline hypersensitivities

124
Q

what is the common lesion distribution of feline superficial pyoderma?

A

cervicofacial, pinnae, ventral abdomen, trunk, flank, limbs

125
Q

what lesions are seen in cats with superficial pyoderma?

A

erythema, papules (miliary dermatitis), plaques, scale, crusts, alopecia, erosions, ulcers, exudation, & swelling

pruritus is usually present

126
Q

how is feline superficial dermatitis diagnosed?

A

history, clinical signs, & exclusion of other ddx

fungal culture/DTM to rule out dermatophytes

127
Q

what antibiotics are commonly used for feline superficial pyoderma?

A

amoxi/clav, cefovecin, & TMS

128
Q

what therapy is indicated for treating feline superficial pyoderma?

A

topical therapies when & if possible for focal lesions

systemic abx for 3-4 weeks

129
Q

what lesions are typically seen in surface pyoderma?

A

erythema, surface exudates, erosions, excoriation, & slightly raised plaques

130
Q

what lesions are typically seen in superficial pyoderma?

A

macule, papule, pustule, epidermal collarette, & crusts

131
Q

a puppy comes in, & you see this lesion in their inguinal area - what do you suspect?

A

puppy pyoderma - impetigo

132
Q

what are you big three differentials that should be considered for a patient with superficial pyoderma/folliculitis?

A

superficial bacterial pyoderma - most common cause of folliculitis in dogs

dermatophytosis - most common cause of folliculitis in cats

demodicosis

133
Q

what lesions are seen with deep pyoderma?

A

gelatinous skin, devitalized skin, necrosis, pain, sloughing, edema, & cellulitis

134
Q

what are some indications you should get a culture from an animal with deep pyoderma?

A

deep pyoderma - nodules or draining tracts are present

rods are present on cytology of skin & ears (otitis media)

135
Q

what are some indications you should get a culture for an animal with superficial pyoderma?

A

empirical therapy isn’t working

lesions are unresolved with adequate treatment

new lesions are developing while on treatment

patient has recurrent pyoderma

SA DX & TX II (62 decks)

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