Infection Flashcards
True or False:
Cats can be seroposotive for leptospirosis but do not shed organism in their urine.
False – can be urine PCR+, consistent with urine shedding
JFMS 2021, Bourassi
Over half of dogs treated with leptospirosis will have a negative urine PCR by what time frame?
1-2 weeks
JVIM 2021, Hetrick
In one study from 2021, which two abx were most successful for treating lepto?
A) Aminopenicillins
B) Doxycycline
C) Fluoroquinolone
D) Clarithromycin
E) Chloramphenicol
Doxy, clarithromycin
JVIM 2021, Hetrick
In one study from 2021, which two abx were least successful for treating lepto? What is an interesting point about each?
A) Aminopenicillins
B) Doxycycline
C) Fluoroquinolone
D) Clarithromycin
E) Chloramphenicol
Aminopenicillins – would not expect success at all, since thought of as clearing lepto from blood but not renal tubules
Fluoroquinolones – another study found better success, r/o different serovars
JVIM 2021, Hetrick
–Which endothelial marker(s) (sICAM-1, VEGF, Ang-2) can discriminate lepto dogs with and without pulmonary hemorrhagic syndrome?
–Which can differentiate lepto vs other causes of AKI?
–sICAM-1
–None – similar elevation in lepto and AKI
JVIM 2021, Sondregger
Regarding bartonella:
–Gram positive or negative?
–Three most common species in N. America?
–Which are considered pathogenic?
–In general, what types of diseases are associated with it?
–Gram neg
–B. vinsonii subsp berkhoffii, B. henselae, B. koehlerae
–All are pathogenic
–Endocarditis, vascular and lymphatics issues, granulomatous disease
JVIM 2021, Lashnits
Where in the US is bartonella most common?
South (Texas to N Carolina)
JVIM 2021, Lashnits
Which is the most accurate test for septic peritonitis?
–Paired peripheral/effusion glucose
–Paired peripheral/effusion lactate
–Cytology (read by pathologist)
–RIA for bacteria
Cytology
RIA sens 87%, spec 76% – not good enough to rely on by itself
JVIM 2021, Human
A 2yr MN DSH is presented for pelvic limb lameness. Physical exam also reveals retained deciduous teeth and multiple digits are swollen and inflamed around the nails. What is your primary differential? What is the most effective treatment for the nailbeds?
Patellar fracture and dental anomaly syndrome (PADS)
Paronychia – most need amputation
JFMS 2021, Pilot
Regarding schistosomiasis:
–Causative agent? (species, type of organism)
–Life cycle?
Heterobilharzia americana – trematode
Racoon –> eggs in feces –> fresh water –> snails –> cercariae penetrate intact skin of new host –> lungs –> liver –> mesenteric veins –> adults mate –> eggs make proteolytic enzymes to get to intestines (pyogranulomatous inflamm) –> feces
JVIM 2021, Cridge
Regarding schistosomiasis:
–Common signalment?
–Common presentation?
–How do you find asymptomatic dogs?
–Young to middle aged large breed dogs (likely reflects exposure to water, outdoorsy activities)
–Nonspecific GI signs, PU/PD; hepatopathy
–Asymptomatic dogs are usually in the same community as symptomatic dogs (exposed to same water source)
JVIM 2021, Cridge
JVIM 2021, Graham
Regarding workup of schistosomiasis:
–Most common CBC/Chem findings?
–AXR?
–AUS?
–CBC: anemia, eosinophilia (40%)
–Chem: high glob (40%), Ca, LEs, azotemia; low alb (25%)
–AXR: mineralized GI walls, hepatosplenomegaly
–AUS: heterogenous SI wall layering; pinpoint hyperechoic foci in SI, liver, LNs
JVIM 2021, Cridge
What are the two main tests used to diagnose schistosomiasis, and how do they compare to each other?
Fecal saline sedimentation and fecal PCR. The latter is more sensitive (so probably better for tx monitoring) and equally specific.
JVIM 2021, Cridge
What is the treatment for symptomatic schistosomiasis? Cure rate? Outcome if not initially cured?
One small study treated asymptomatic dogs. How did tx differ and how many were durably cured?
Symptomatic: High dose praziquantel x1-3d + fenbendazole x4-14d. Tx failure ~50% (but not all dogs were re-tested – possible bias to refractory cases), all re-treated and cured. May be due to parasite life cycle, reinfection, etc.
Asymptomatic: lower dose prazi (b/c expensive) + fenbendazole
67% durably cured
JVIM 2021, Cridge
JVIM 2021, Graham
Which time interval(s) should follow up testing be done to ensure clearance of schistosomiasis?
What is the survival rate at 6mo?
1 and 2mo
At least 75% survived to 6mo (long term outcome only available for ~1/2 of dogs in the study)
JVIM 2021, Graham
True or False:
Immunocompetent cats rarely develop clinical toxoplasmosis.
True
JVIM 2021, McKenna
True or False:
A positive toxo IgM titer means the cat was infected within the previous 2 weeks.
False – can take 4-10 weeks. Also, may never develop IgM (20% of cases).
JVIM 2021, McKenna
True or False:
Persistently high toxo IgG titers are suggestive of treatment failure.
False – can remain high despite adequate treatment
JVIM 2021, McKenna
Regarding Cytauxzoon felis:
–What type of organism is this?
–How is it transmitted?
–Natural reservoir?
–Typical duration of disease in domestic cats?
–What is the only point of care test and the best sample type(s) for it?
–Protozoan
–Amblyomma americanum (lone star tick)
–Bobcats
–Rapidly fatal
–FNA –> schizont-laden macrophages. Looks kind of like the macrophage ate a clump of platelets. Most frequently found in spleen > PLN > blood smear.
JVIM 2021, Sleznikow
Regarding Chagas disease:
–Causative agent species and type of organism?
–Where is it endemic in the US?
–Transmission?
–Target organ?
–Most common clinical sign?
–Do dogs usually die in the acute or chronic phase?
–Trypanosoma cruzi (protozoan)
–Southern US (Texas and east)
–Kissing bugs or vertical
–Heart –> myocarditis
–Usually presented for arrhythmia
–Chronic
JVIM 2021, Matthews
Regarding Chagas disease (T. cruzi) heart workup:
–What proportion have an abnormal ECG? What two types of arrhythmia are most common?
–What proportion have heart chamber enlargement? Which is most common? Is this associated with outcome?
–Is cTnI usually normal or high?
–95% have abnormal ECG, usually ventricular arrhythmia or AV block
–63% have at least one enlarged chamber. RV most common and associated with higher risk of death.
–cTnI usually high
JVIM 2021, Matthews
How is Chagas disease (T. cruzi) diagnosed?
Usually IFA (degree of titer not proven to correlated with clinical disease)
PCR is not great since primarily an intracellular parasite
JVIM 2021, Matthews
Regarding Leishmania:
–Causative agent and type of organism?
–Transmission?
–Where (worldwide) is it endemic?
–Where is it most common in the US?
–Why are foxhounds overrepresented in the US?
–If a non-foxhound dog is diagnosed in the US, how did they usually get it?
–How is it usually diagnosed? What other organism can cross react with this test?
–Leishmania infantum, protozoa
–Sandflies
–Central and S. America, Europe (esp Spain)
–US: West coast (esp CA), eastern US
–Foxhounds –> vertical transmission
–Non-foxhounds –> most (but not all) have traveled to endemic area (imported rescues, military dogs)
–Titer (T. cruzi can cross-react)
JVIM 2021, Gin
True or False:
Disseminated invasive aspergillosis usually only occurs in immunocompromised cats.
How is it likely transmitted?
True
Inhalation –> lungs –> hematogenous spread (angiotrophic), also hitches a ride in monocytes –> LNs
JVIM 2021, Cormack
Regarding Valley Fever:
–Causative agents, type of organism?
–Transmission?
–Are infections usually clinical or subclinical?
–Primary body site affected? Proportion that develop disseminated disease? How long can this take to happen after initial infection?
–Coccidioides immitis or posadasii, dimorphic fungi
–Inhale arthroconidia
–Usually subclinical
–Most cases are respiratory, 25% disseminated (can develop weeks to years after initial infection)
JVIM 2021, Reagan
JVIM 2021, Kelley
Regarding Valley Fever diagnosis:
–Gold standard? Drawbacks?
–Serology sens/spec, drawbacks?
–Ag test types, pros and cons?
–Gold standard = cyto, histo, culture; low sensitivity, not usually pursued clinically
–Serology (AGID) near 100% sens/spec at UC Davis (not necessarily elsewhere), but expensive and takes 1 week, 5-10% of cases don’t seroconvert
–Ag test (MiraVista EIA) – good test (sens 89/spec 97), takes 2d
–Lateral flow assay (LFA) – fast (30 min) and easy to do, good screening test (some false negatives but a positive is usually trustworthy)
JVIM 2021, Reagan
JVIM 2021, Kelley
What is the first line treatment for coccidiomycosis? Typical duration?
One small study looked at an alternative treatment for refractory cases. What was it, and the success rate? How should treatment be monitored?
First line: fluconazole + itraconazole x 6-18mo
Refractory cases: posaconazole, median 18mo. Therapeutic drug monitoring to tailor dose ($$, potential for hepatotoxicity). 8/8 dogs clinically improved, 6/8 resolution of disease, 2 ultimately died.
JVIM 2021, Schubitz
Regarding CNS coccidiomycosis:
–Typical signalment?
–Clinical signs?
–Typically very high or very low titers?
–Typical MRI?
–Less common form on MRI and associated breed?
–Young, large breed – though can happen in geriatric dogs
–Sudden onset tonic-clonic seizures, esp clusters
–Most have low titers
–Typical MRI: single > multiple intraparenchymal granulomas
–Secondary type: bilaterally symmetrical T2 and FLAIR hyperentensity in the caudate nuclei and frontal lobes, usually mini schnauzers
JVIM 2021, Kelley
You are seeing a dog with CNS coccidiomycosis as a second opinion. He is not responding to compounded fluconazole, phenobarbital, and carprofen. How to you alter his treatment plan and why?
–Switch to generic fluconazole – compounded doesn’t work
–Transition to another antiepileptic – shouldn’t use flu+pheno together long term (CYP450)
–Discontinue carprofen – decreases clearance of fluconazole –> hepatotoxicity
JVIM 2021, Kelley
Prognosis for CNS coccidiomycosis? What is a poor prognostic indicator?
> 80% do well for >1yr
Worse prognosis with ventriculitis (leads to obstructive encephalitis)
JVIM 2021, Kelley
What are the pros and cons of the following tests for blastomycosis diagnosis? Which is the gold standard? Which can be used for tx monitoring?
–Organism ID (cytology, histo)
–Serology
–Antigen
–Organism ID = gold standard, but not always safe/practical
–Serology (AGID) – poor sensitivity, not really used
–Ag (EIA MiraVista) – galactomannan, urine sens/spec very high (better than blood) but cross reacts with histo; decreases with successful tx
JVIM 2021, Motschenbacher
Regarding blastomycosis:
–Most common cause of death?
–Most deaths occur during which time frame?
–What test provides the best prognostic information?
–Cure and relapse rates?
–Respiratory failure
–75% of deaths are in the first week of tx
–Radiographic lung severity score is prognostic. Lower baseline urine Ag (<5ng/mL) may be prognostic as well, unclear if offers more info than RLS score.
–Cure 50-75%, relapse 20-25%
JVIM 2021, Motschenbacher
Regarding disseminated mold infection with Rasamsonia argillacea:
–Typical signalment?
–Most common body site(s) affected?
–How diagnosed?
–Conventional morphology/microbiology can be misleading. R. argillacea is frequently misidentified as what other organism? How would this adversely affect treatment?
–Overall prognosis?
–FS German shepherds
–Discospondylitis, some fungal granulomas
–PCR
–Looks like disseminated asper, which is treated with posa or voriconazole – but R. argillacea is fairly resistant to this (amphotericin B is better)
–Prognosis is guarded to poor; half euth/died during initial hospitalization, survivors MST 10mo, none lived >2yrs
JVIM 2021, Dear
A large study (3600 animals) looked at whether COVID could infect and kill cats/dogs. What did they conclude?
A miniscule proportion were positive, even fewer died around the time they were positive, may have contributed to death in 1 dog and 1 cat, in general critical illness could be fully explained by the pet’s other comorbidities.
SO – COVID+ status was usually incidental, interpret test with caution in critically ill pets.
JAVMA 2021, Carpenter
In a small study of 4 cats with dry FIP and associated neuro disease treated with GS drug:
–How many did well?
–How does the dose for neuro dry FIP compare with the dose to treat wet FIP? (same, lower, higher)
–How quickly do signs improve after starting tx?
–3/4
–Much higher dose needed for neuro dry FIP (for adequate CNS penetration)
–24-36 hours
JVIM 2020, Dickinson
Regarding Tritrichomonas foetus:
–Risk factors? (Signalment, housing)
–Most sensitive test?
–Sample collection method to maximize chance of a positive? Why might this be most effective?
–Treatment of choice?
–Young, purebred (esp Abyssinian); NOT multicat household (but this conflicts with other studies)
–Fecal PCR
–Fecal loop 2x more likely to have pos PCR than colon flush. Might be collecting organism from epithelial lining where they like to live.
–Ronidazole – but there may be issues with fully clearing the organism
JVIM 2020, Hedgespeth et al
Regarding endocarditis:
–Which carries a better prognosis: infected mitral or aortic valve?
–Top three culturable causes?
–Mitral – MST 476d. Aortic MST 3d.
–Staph, strep, E. coli
JVIM 2020, Ernst
Regarding Bartonella endocarditis:
–Which valve does it tend to infect?
–Do you expect a positive or negative blood culture? Why?
–What is the typical treatment and duration of tx?
–Aortic
–Neg – grows too slow
–Doxy +/- baytril x 6-8 weeks or for life
JVIM 2020, Ernst
List at least 5 differentials for eosinophilic effusions. Which is the most common cause?
–Neoplasia (LSA, MCT, HSA) – most common
–Parasites (HW, lungworm)
–CHF
–Pneumonia
–Hypereosinophilic syndrome
–Liver lobe torsion
–Coccidiomycosis
JVIM 2020, Piech
What is the most common pathophysiologic cause of pleural effusion associated with coccidiomycosis?
Dissemination involving the pericardium –> adhesions –> constrictive pericarditis –> R CHF
JVIM 2020, Piech
True or False:
A slow kill protocol for heartworm (monthly Advantage Multi + doxycycline) has similar outcomes compared with gold standard (doxy, monthly macrocyclic lactone, melarsomine) but takes longer for clinical cure.
False. Cured the majority of dogs BUT took 10mo, during which there was ongoing damage with very little difference in bloodwork, imaging, and necropsy in treated dogs vs untreated controls. It is not an equivalent protocol compared with the gold standard.
JVIM 2020, Savadelis
What is the frequency of pulmonary bullae in untreated heartworm dogs? What is a potential sequela?
50% sometime in the first 10mo. Can rupture –> pneumothorax.
JVIM 2020, Savadelis
You diagnosed a dog with chronic hepatitis and want to start him on immunosuppressants. Last year, he had acute E. canis infection which was treated. Should you be concerned about reactivating occult E. canis?
No. A study of 7 experimentally infected and treated dogs had no E. canis reactivation when immunosuppressed. But, may not apply to chronic E. canis dogs (harder to clear).
JVIM 2020, Sato
Which is/are prognostic indicators in cats with panleukopenia?
–SIRS
–Acute phase proteins
–Chol
–T4
Low T4
JVIM 2020, Petini
True or False:
D-Lactate in parvo dogs correlates with survival.
False
JVIM 2020, Venn
Regarding tests for lepto:
Which are NOT helpful?
Which can be positive due to vaccine?
Blood PCR
Urine PCR
Dark field microscopy
Urine culture
MAT
Not helpful: dark field microscopy (low sens, special equipment), urine culture (takes a month)
MAT - can be positive with vaccine, though typically titer wanes by 4mo
VCNA 2019 Reagan
How could CRP be used in patients with lepto?
A) Differentiate lepto vs other cause of AKI
B) High initial CRP –> worse px
C) Decreasing CRP over time –> better px
D) Not helpful with lepto
C
JSAP 2019 Buser
When AND how should you investigate for lepto as a cause for chronic hepatitis?
A) Only if unvaccinated and Ab positive
B) Only if unvaccinated and PCR positive
C) PCR positive regardless of vaccine status
D) Only if concurrent renal involvement
E) Any dog regardless
E
FISH, PCR
JVIM 2019 McCallum
True or False: In the southeastern US, prevalence of vector borne disease in proteinuric dogs is associated with lower alb and higher creat.
True
JVIM 2020 Purswell
What is the treatment and duration of choice for Bartonella in cats?
Doxy + Prado x 28d – eliminated infxn in an experimental study
VCNA 2019 Qurollo
Regarding cytauxzoon in cats:
–Transmission?
–Basic pathophys?
–CS?
–Dx?
–Tx?
–Proportion that survive?
Ticks – Amblyomma americanum, Dermacenter variabilis
Schizont-laden macrophages –> thrombi
Fever, anorexia, icterus, dyspnea, pain
Pancytopenia, hyperbilirubinemia
PCR, cytology (blood, spleen, liver, LN)
Atovaquone + azith
60%
VCNA 2019 Qurollo
True or False: Cats can become infected with Borrelia burgdorferi but there are no reports of clinical illness.
False – most asymptomatic but can develop Lyme or relapsing fever borrelia
CS as expected – leth/anorexia, fever, ataxia, lameness
VCNA 2019 Qurollo
True or False: Rickettsia rickettsii can infect cats but rarely causes illness. So, interpret positive titer with caution.
True
VCNA 2019 Qurollo
What two disease syndromes are caused by Borrelia?
Which can NOT be detected via PCR? What test should you use instead?
Lyme
Relapsing fever borrelia – no PCR for it, use blood smear cytology (but still low sens)
VCNA 2019 Kidd
Why is clinical bleeding uncommon in E. canis dogs despite severe thrombocytopenia?
They are hypercoagulable – incr plt activation, decr fibrinolysis
JVIM 2019 Shropshire
6yr FS pitbull with UPC >5.0 and Lyme C6 positive (lyme endemic area). What features for the following would increase your suspicion that the PLN is due to active Lyme disease?
–PC, PE
–CBC
–Chem
–UA
PC, PE: clinical illness, polyarthritis
CBC: almost all are anemic; thrombocytopenia common
Chem: almost all are hyperphosphatemic, creat >2.2
UA: glucosuria, hematuria, pyuria (very uncommon in non-Lyme PLN)
JVIM 2019 Borys
Which do and don’t confer immunity for Lyme when incorporated into a vaccine? Why?
Lysate
OspA
OspC
No immunity:
–Lysate (Lyme proteins and cellular bits; BACTERIN vaccine): will be intracellular during an infection, so anti lysate Ab will not have access
–OspA (SUBUNIT vaccine): only in tick, not once in host
Immunity:
–OspC (SUBUNIT vaccine): OspA in tick gut –> OspC in tick saliva –> infect host. Ab can target early in infection.
VCNA 2019 Izac
True or False: There is good cross protection across different strains of Lyme after natural infection.
False - no broad cross protection
VCNA 2019 Izac
True or False: Bartonella usually causes minimal CBC/Chem changes, even when causing severe clinical illness (ex: endocarditis, polyarthritis, seizures).
True
JVIM 2020 Ernst
Are repeat culture/sensitivity necessary during treatment for mycobacterium in cats? Why or why not?
Yes – will likely develop resistance during tx
JVIM 2021 Munro
Regarding brucellosis:
–Tropism for what two tissue types?
–Any major CBC/Chem changes?
–Which serology tests are screening vs confirmatory tests?
AGID (cell wall Ag)
AGID (cytoplasmic Ag)
IFA
RSAT
2-Mercaptoethanol RSAT
Tube agglut test (TAT)
–What is the gold standard test and relative sens/spec?
Lymphendoreticular system, repro
CBC/Chem usually normal or nonspecific
Screening:
AGID (cell wall)
IFA
RSAT
TAT
Confirmatory:
AGID (cytoplasmic Ag)
2-ME RSAT
Gold standard: blood culture (low sens, high spec)
VCNA 2019 Kauffman
True or False: Technique for culturing wounds (swab prior to wound prep, swab after debridement/lavage, bx) overall does NOT impact abx choice.
True
Some mild variation in what each sample type will grow, but overall the type and number of abx used will be the same regardless of sample type
JVECC 2020 Concannon
Animals with critical illness have altered metabolism of abx with a certain characteristic.
–What is that characteristic?
–Which two abx classes does it apply to?
–How does this change your dosing regimen?
Hydrophilic. In critical illness, will have incr Vd (therefore decr conc at site of infxn) and incr GFR –> incr renal clearance.
**Note – lipophilic abx tend to be cleared by liver.
Beta lactams, aminoglycosides
Consider loading dose and CRI
JVECCS 2019 Stewart
What 3 criteria should be met prior to using an abx of critical importance such as carbapenems?
–Culture/sens - susceptible to a carbapenem but resistant to other reasonable options
–High chance of survival and cure
–Consult with infectious disease expert
JVIM 2019 Smith
Which ticks are a concern on imported dogs and why?
Amblyomma
Dermacentor
Haemaphylsalis longicornis (Longhorned tick)
Ixodes
Rhipicephalus sanguineus
Rhipicephalus – can complete entire life cycle on one host and live indoors
Longhorn tick – can transmit bynyavirus (severe fever, thrombocytopenia), parthenogenic
VCNA 2019 Anderson
4yr FS lab with cervical swelling and fever. Which of the following is true?
A) CT has high sensitivity and specificity for foreign material
B) CT almost always shows a distinct fluid pocket or mass
C) Polymicrobial infections are common
D) Actinomyces is common
E) Relapses after treatment are common
Likely a deep neck infection
C is correct. Also, clavamox is usually a good empiric choice.
CT is poorly predictive of foreign material (false pos and neg) and ~60% have a distinct mass/fluid pocket.
Most dogs do well with complete resolution.
JAVMA 2022 Rajeev
Regarding Francisella tularensis in dogs:
–Transmission?
–Endemic area?
–CS?
–One possible coinfection (overlaps endemic area and CS)?
–Gold standard and most common test for diagnosis?
–Treatment?
–Prognosis?
–Contact with rabbits/rodents or their fleas/ticks
–Nevada, some parts of Colorado and Oregon
–Usually subclinical; if sick –> nonspecific CS, fever, lymphadenopathy 20%
–Yersinia pestis
–Gold standard = culture BUT not typically done b/c requires high biosafety lab. Usually use acute and convalescent titers.
–Usually doxy or Baytril
–Prognosis: very good, dz is usually self limiting
JAVMA 2020 Jan
What organ system is usually affected in cats with Rhodococcus equi?
Lungs»_space;> skin
JFMS 2020 Aslam
Which is most predictive of discospondylitis vs non-infectious cause of myelopathy?
Fever
Leukocytosis
CRP
CRP
JVIM 2021 Trub
How does positive vs negative toxoplasma titer affect candidacy and post op tx for renal transplants in cats?
Seropositive cats are still renal transplant candidates and may even do better than neg cats. Give prophylactic clinda lifelong post op.
JAVMA 2021 Ludwig
In dogs with meningoencephalitis, an elevation in which two biochem values should significantly increase your suspicion for neospora?
CK >485, AST >57
Very high sens/spec/NPV for both
JVIM 2020 Jones
What is the best treatment for Trypanosoma cruzi? How do they work mechanistically? What proportion of dogs respond?
Itraconazole. Blocks sterol production.
Amiodarone. Antiarrhytmic AND directly hurts T. cruzi (disrupts Ca homeostasis, blocks the protease cruzipain, and inhibits sterol production).
95% of dogs respond – resolved arrhythmia, neg PCR
JVIM 2019 Meyers
JAVMA 2019 Madigan
6yr MN boxer with a history of positive T. cruzi titer. New VPCs on PE today. Do you retest for T. cruzi? Why or why not?
No. Infection is lifelong, thus a single positive titer is synonymous with infection.
JVIM 2019 Meyers
What is the MST of leishmania cats with and without immunosuppressive comorbidities?
With - 1yr
Without - 3.5yrs
JFMS 2020 Fernandez-Gallego
Which is NOT associated with Babesia conradae?
A) Anemia
B) Thrombocytopenia
C) Hyponatremia
D) Hyperglobulinemia
E) Hypoalbuminemia
F) Hypocholesterolemia
F) Hypocholesterolemia
Hyponatremia is the weird one – poss SIADH?
JVIM 2019 Dear
What is the treatment for babesia? How do you monitor for tx efficacy?
Azithromycin + atovaquone x 10d
Recheck PCR at 60 and 90d
JVIM 2018 Birkenheuer
Which has the highest sens/spec for Giardia duodenalis?
A) IFA
B) Fecal float
C) Giardia SNAP
D) Fecal float + SNAP
IFA - “gold standard” but still not 100% accurate
Fecal float + SNAP - close second
JVIM 2019 Saleh
4yr FS DLH with cataract and uveitis. Indoor/outdoor and there are rabbits and other wildlife in the yard.
–Most likely diagnosis?
–Best test?
–Treatment?
–Owner is undergoing chemotherapy. Any concerns?
Encephalitozoon cuniculi
PCR – ideally on cataract > aqueous humor
Fenbendazole x3 weeks, phaco to remove E. cuniculi nidus
Spore shedding has not been proven in cats but may still be possible; zoonotic
JFMS 2020 Addie
8yr FS DMH with acute inspiratory distress. This is their first fall in Texas. Indoor only and no prior hx resp signs.
–What age and resp pattern would you expect for asthma? Why?
–What parasite should be on your ddx list? How does this cause resp signs?
–What is one good test and two low sensitivity tests for this parasite?
–Asthma: young, EXPIRATORY dyspnea b/c obstructive lung disease
–Heartworm. Chronic/fibrotic lung changes –> restrictive lung disease –> inspiratory or mixed dyspnea.
–HW Ab. Low sens tests are HW Ag (but would prove adult worms) and microfilaria (uncommon in cats with adult HW, only seen 7-8mo post infxn)
JFMS 2019 Garrity
What is the difference between heartworm associated respiratory disease (HARD) and heartworm disease (HWD) in cats? Which is more common?
HARD: immature worms in pulmonary arteries die –> severe inflamm; should improve over 6-8mo as long as no reinfection
HWD: 1-2 adult worms, immune system kills most baby worms. Adults live 2-4 years. When they die –> severe inflamm, thromboembolism.
**RARE!! Only practical thing that proves HWD rather than HARD is HW Ag test.
JFMS 2019 Garrity
What measurement on CXR strongly suggests HW infection in cats?
Right pulmonary artery to 9th rib ratio on D/V or V/D
If >1:6 –> likely HW
JFMS 2019 Garrity
How does BAL cytology differ in asthma vs HW cats?
It’s the same – eosinophilic inflamm
JFMS 2019 Garrity
Which two would be the best options for HW treatment in cats and why?
Doxycycline
Ivermectin
Melarsomine
Milbemycin
Moxidectin
Selamectin
Selamectin and moxidectin b/c they target immature worms
The rest is adulticidal –> risk for anaphylaxis, thromboembolism, death
JFMS 2019 Garrity
What is the name of the feline liver fluke and where is it endemic in the US?
Which is the most sensitive fecal test for it?
Mini-Parasep sediment
Mini-Parasep foat
Sheather’s sugar float
Platynosomum fastosum
Florida, other southern states, Hawaii
Sheather’s
JFMS 2020 Eisenbraun
Which, if any, of the following has the best success rate with sinonasal asper in dogs?
A) Debridement, 1hr antifungal contact time with catheters and rotating
B) Debridement, single instillation of antifungal, wake up
C) No trephination; debridement via endoscopy only, instill antifungal via catheter into sinus
First time tx success was most related to complete debridement > clotrimazole
A and B had similar success rates. C had a bit less first time successes.
JVIM 2018 Ballber
JSAP 2018 Vangrinsven
What is the MST for systemic asper in dogs with itraconazole only vs multimodal antifungals?
What is one negative prognostic indicator on biochem?
MST itra 2mo vs multimodal 2.3yrs
Incr creat
JVIM 2022 Lim
Deep nasal swab PCR for aspergillus:
–Relative sens and spec for sinonasal asper?
–Two ways you could use this test?
Low sens but high spec
1) Confirm asper if bx and culture are neg
2) Tx monitoring to see if another CT/rhino is needed (but, swab needs to be collected under anesthesia so kind of defeats the purpose)
JVIM 2022 Biendes
How do osteosarcoma (OSA) coccidiodes osteomyelitis (COM) dogs differ?
–Signalment
–Quality of bone lesions
–Quantity of bone lesions
COM dogs tended to be younger, uncommon to have more than one bone affected but rare in OSA. Quality of bone lesions were the same.
JAVMA 2022 Shaver
What is the treatment of choice for Coccidiodes osteomyelitis?
How likely and how soon to see benefit?
How do titers change with tx?
Itra (better bone penetration) > fluconazole (but still high chance of success). Improvement soon after starting tx but can take months – be patient.
Titers decr with tx but uncommon to completely go negative. Optimal duration of tx is unknown.
JAVMA 2022 Carter
JAVMA 2022 Shaver
Coccidioides in cats:
–Top two affected organs?
–Findings on thoracic imaging? How is this different than dogs?
Which is more common?
–Disseminated vs local disease
–Indoor only vs outdoor
–Positive vs negative titer
Treatment and relative success rate?
Lungs and skin
CXR – highly variable BUT hilar lymphadenopathy uncommon (unlike in dogs)
Common: disseminated dz, indoor only, positive titer
Fluconazole is highly successful, could also try other antifungals
JFMS 2020 Arbona
9yr MN DSH with unilateral nasal signs and owner is on the fence about CT/rhinosocopy. You run an in house crypto Ag lateral flow assay test.
Next steps if positive?
Next steps if negative?
If positive –> might be crypto (vs cross reactivity with other fungal or other cause of false pos), do more confirmatory testing prior to committing to antifungals.
**Note – lateral flow will be positive earlier in disease vs latex agglut. So if you do both, may get discordant results.
If negative –> very unlikely to be crypto, do the CT/rhino
JVIM 2019 Reagan
JVIM 2022 Langener
Blastomycosis in cats:
–Proportion with ocular lesions?
–Affected portion(s) of the eye?
–Likelihood of uni- vs bilateral blindness?
–Proportion with CNS disease? Is this more or less frequent than in dogs?
60% ocular lesions
All portions but esp posterior segment
Roughly equal ~30%
26% – more common than in dogs
JAVMA 2022 Morris
In a specialty setting, what is the prevalence of ocular lesions in histoplasma cats? Most common lesion?
82%
Uveitis, chirioretinitis, and partial retinal detachment 80%
JAVMA 2022 Pucket
3yr MN DSH presented with shifting leg lameness. General labwork shows hyperglobulinemia and a nonregenerative anemia.
You are in a histoplasma endemic area and this is your top ddx, but urine histo Ag returned negative. How do you proceed?
Neg urine Ag is uncommon but possible if disease is localized to bone/joints
Rads – most will have more than one joint affected
Joint tap – most will have histoplasma BUT low numbers, need to look for a long time
JFMS 2019 Fielder
2yr MI lab with 1mo hx large bowel diarrhea. Colon bx showed hyphae.
What disease do you suspect? How do you confirm?
Treatment? How soon to see improvement/resolution of CS?
How will you monitor tx efficacy?
Pythiosis. Do a titer.
Tx: itraconazole, terbinafine, anti-inflamm pred. Weird to use antifungals b/c no ergosterols in pythium capsule but it seems to work.
Few weeks
Monitor AUS and titer
JVIM 2019 Reagan
List risk factors (1 dog, 2 cat, 1 both) for Candida UTI.
Dog: immunosuppression
Cat: LUT disease, LUT procedure
Both: recent abx
**Note - GSD breed NOT a risk factor
JVIM 2019 Reagan
FIP:
–RNA or DNA virus?
–Who sheds the most – kittens vs adults vs both the same?
–Is reinfection possible?
RNA
Kittens
Yes
JFMS 2022 Thayer
8mo FI Ragdoll with positive Rivalta’s test and blood alpha-1 acid glycoprotein >3.
–Top ddx?
–What are two other noninvasive tests that would bolster suspicions? What sample types can you use?
–What is the gold standard to definitively diagnose?
FIP
FIP real time reverse transcription PCR
–Tissue (FNA just as good as bx)
–Blood (least specific)
FIP Ag immunocytochemistry
–Aqueous humor
–Tissue FNA (low sensitivity)
Both: effusion, CSF
Gold standard = bx with IHC showing FCoV assoc with macrophages
JFMS 2019 Sangl
JFMS 2019 Dunbar
JFMS 2022 Thayer
True or False: Venereal transmission is unlikely with FIP.
True
JFMS 2020 Stranieri
3yr MN DSH with a corneal ulcer and URI signs. The owner read about ganciclovir and wants to try it. What do you tell her?
We have a study that showed in VITRO efficacy for herpes and a small number of healthy cats tolerated it topically (eye drop), but insufficient safety/efficacy data in cats to recommend it.
JFMS 2021 Lewin
Which two are true about famciclovir?
A) Giving famciclovir prophylactically the first week of admit to shelter reduces conjunctival FHV-1 shedding AND clinical signs.
B) Giving famciclovir prophylactically the first week of admit to shelter reduces conjunctival FHV-1 shedding but NOT the clinical signs.
C) Famciclovir alters the conjunctival microbiome, but too subtly to cause clinical signs.
D) Famciclovir does not alter the conjunctival microbiome.
B, C
JFMS 2019 Cooper
JFMS 2021 Lucyshyn
Intranasal FVRCP is reduces CS of herpes (prior to even developing Ab) and cross protects against Bordetella. How? And how can we use this information?
FVRCP induces liposomal toll like receptors –> nonspecific immune response
A study showed that giving mucosal LTC (liposome TLR complex) prior to FHV-1 challenge reduced conjunctivitis and viral shedding
JVIM 2019 Contreras
2.5yr MI Devon rex. Skin biopsy showed a Bowenoid in situ carcinoma with wide, clean margins.
What infection is this associated with? What future issues do you prepare the owner for?
Papillomavirus – so may develop new lesions
BISCs in Devon rexes and Sphinxes tend to progress to highly aggressive SCC and metastasize quickly
JFMS 2019 Munday
5yr MN DLH presented with an ulcerated mass on his face. He is a barn cat.
–What is your top differential and likely underlying cause(s)?
–Dx was confirmed with incisional bx, but unable to remove the whole thing due to location. What topical tx can you try and how does it work?
R/o feline sarcoid secondary to bovine papillomavirus 14 (BPV-14). May be related to immunosuppression – screen for FIV and FeLV.
Imiquimod – stimulates immune system
JFMS 2019 Munday
When examining a Bowenoid in situ carcinoma for papillomavirus:
–What is one advantage of FISH over PCR, and one disadvantage?
–Which layer of the bx most frequently had PV on FISH?
FISH: can find DNA in viral lesions that are not actively productive; but, less sensitive than PCR
Usually FISH PV positive in the superficial epidermis
JFMS 2019 Demos
Which is NOT true about feline panleukopenia?
A) Healthy cats commonly have high titers due to previous vaccine or hx clinically silent exposure.
B) Retrovirus cats commonly have high titers due to previous vaccine or hx clinically silent exposure.
C) Cats with high titers do not benefit from vaccination.
D) Retrovirus cats are at risk of developing illness post panleuk vaccine.
D
Healthy and retrovirus cats commonly have high panleuk titers (so check prior to vax - no reason to risk inj site sarcoma), but if they don’t, BOTH can respond adequately to the vaccine and it doesn’t make them sick.
JFMS 2019 Bergmann
Feline panleuk testing:
–Can the panleuk vaccine give a false positive on fecal Ag and/or PCR?
–Relative sens/spec of IH parvo fecal Ag?
–Which can be used to determine viral shedding: fecal PCR, fecal SNAP, clinical signs
Yes to both if vax recently (PCR) or within the past 2 weeks (fecal Ag)
Sens 50-80, spec 95. So you can trust a positive, but neg doesn’t rule out.
Only fecal PCR. Based on one study, can assume shedding is over by 2 weeks.
VCNA 2019 Barrs
JFMS 2022
Which has the lowest sensitivity for canine parvo on qRT-PCR?
Blood
Feces
Pharyngeal swab
Feces – but still moderately high sens (at lest 83%)
JVIM 2022 Segev
What is the overall survival rate for outpatient canine parvo? Which features would a poor candidate for outpatient therapy?
Acute illness
Sick for several days
Hypothermia
80%
Acute illness, hypothermia
JVECC 2020 Perley
What effect does hyperimmune plasma have on parvo duration of hospitalization and mortality?
None
JVECC 2020 Acciacca
5mo FI JRT with focal seizures, GI signs, and mild L forelimb lameness. You take rads of both forelimbs and notice bilateral metaphyseal sclerosis.
How is this different from HOD lesions?
What are your two top differentials?
HOD –> lysis –> “double physis” sign
R/o distemper vs lead toxicity – get a good hx!
JVIM 2022 Johnson
Which are true about canine influenza?
A) It is always confined to the upper respiratory tract
B) It is usually a mild URI but occasionally causes more severe LRT disease
C) It usually causes severe LRT disease
D) Vaccination is recommended for dogs who socialize
B, D
VCNA 2019 Parrish
True or False: Domestic cat hepadnavirus is rare in the US but strongly associate with chronic hepatitis.
True – same family of viruses as human Hep B
JVIM 2022 Piewbang
True or False: There is no proven association between Morbillivirus and CKD in cats.
True
JFMS 2019 Beatty
What are the requirements for an animal with possible rabies exposure who has:
–Never been vaccinated
–A current rabies vaccine
–Out of date vaccine with proof
–Out of date vaccine without proof
Never vax: Euth or vaccinate + 4mo strict quarantine
Current vax OR out of date vax with proof: Booster, owner quarantine 45 days
Out of date without proof: euth OR booster + 4mo strict quarantine OR booster and check titer in 1 week, if high proves prev vax –> quarantine 45d
VCNA 2019 Moore
True or False: Vaccinated dogs/cats exposed to rabies have nearly 100% survival.
True
VCNA 2019 Moore
