Infectious Flashcards
What kind of bacteria is Ehrlichia?
Intracellular
Gram-negative
How is Ehrlichia transmitted in the vector (tick)?
Trans-stadial transmission
Pathogen remains with vector from one life stage to another (but not from parent to eggs).
Who causes canine monocytic ehrlichiosis
E. canis
Which tick carries E. canis?
Rhipicephalus sanguineous (Brown dog tick)
Who causes Canine granulocytic ehrlichiosis?
E. ewingii
What tick carries E. ewingii (Canine granulocytic ehrlichiosis)?
Amblyomma americanum (lone star tick)
Who causes human monocytic ehrlichiosis
E. chaffeensis
True or false: Ehrlichia, Anaplasma and Neorickettsia are in the same family?
True
Rickettsiae is a separate family
What dog breed is more susceptible to E. canis with a worse prognosis?
German Shepherds
What is the pathogenesis of E. canis? (Canine monocytic ehrlichiosis)
- Organism multiplies within vacules in monocytes - lyse cells
- Immune-mediated mechanism
- Presence of spleen contributes to severity of disease
What are the phases of the disease for canine monocytic ehrlichiosis (E. canis)?
- Acute 8-20 days after infection, may resolve spontaneously.
- Subclinical - Organisms sequestered in spleen
- Chronic phase
- Can see pancytopenia from BM involvement
What are some secondary opportunistic infections with E. canis (canine monocytic ehrlichiosis)?
- Viral papillomatosis
- Protozoal infections
- Bacterial UTIs
What is a protein electrophoresis finding of E. canis?
Sometimes can have a monoclonal gammopathy => misdiagnosis of lymphocytic leukemia or multiple myeloma
What type of hypersensitivity reaction can you see with E. canis?
Type III hypersensitivity (Immune complex deposition) and protein losing nephropathy (glomerulonephritis)
What are some clinical signs of E. canis (canine monocytic ehrlichiosis)?
Fever, lethargy, splenomegaly, lymphadenopathy, anterior uveitis, neurologic CS
What are CBC findings of E. canis?
Thrombocytopenia!
Occasional mild leukopenia
Pancytopenia in chronic phase
Morulae in circulating monocytes
What are common chemistry findings of E. canis?
- Hyperglobulinemia (polyclonal most common, but can be monoclonal) with hypoalbuminemia.
- ALT/ALP elevations
- Azotemia if PLN
What is the gold standard diagnostic for Ehrlichia canis?
IFA (there is cross-reactivity)
What is the consensus treatment for E. canis?
Doxycycline 10mg/kg Q24h x 28d
Does Ehrlichia ewingii (Canine granulocytic ehrlichiosis) have a chronic phase?
NO
Only E. canis
What are symptoms for E. ewingii (Canine granulocytic ehrlichiosis)?
Usually NONE
Fever
Anorexia
Neutrophilic Polyarthritis
True or false: Dogs can be reservoir host for E. ewingii (canine granulocytic ehrlichiosis)
TRUE
What is the pathogen for human monocytic ehrlichiosis and what tick carries it?
- Ehrlichia chaffensis
2. Amblyomma americanum (lone star tick)
Diagnosis for E. ewingii is limited to:
ELISA, western blot, PCR
Can do IFA for E. canis only
What organism causes granulocytic anaplasmosis?
Anaplasma phagocytophilum
What tick carries Anaplasma phagocytophilum (granulocytic anaplasmosis)
Ixodes ricinuspersulcatus complex
What cells are affected by Anaplasma phagocytophilum?
Neutrophils and eosinophils
What organism causes THROMBOCYTOTROPIC ANAPLASMOSIS?
Anaplasma platys - Aka….Canine Cyclical Thrombocytopenia
What cells does Anaplasma platys infect?
Platelets
What is A. phagocytophilum effect on neutrophils?
delays neutrophil apoptosis => allows longer survival periods within the neutrophil.
What is the most common symptoms with A. phagocytophilum?
No clinical signs
What is the most common CBC finding with A. phagocytophilum?
Thrombocytopenia in 90% of canine cases (+/- other cytopenias
What tick carries Anaplasma platys
Rhipicephalus sanguineus
What kind of organism is Babesia spp.
Intracellular protozoan
What cells does babesia spp infect?
RBC
What babesia cell stage is observed within RBC?
Merozoites
What type of immune response does babesia cause?
Induces immune-mediated destruction of erythrocytes
Anti-erythrocyte antibodies may develop as well (self-antigen), contributing to IMHA
What kind of organism is Cytauxzoon?
Apicomplexan protozoal
What does Cytauxzoon use to invade cells?
apical complex
What are the vectors for Cytauxzoon?
Lone Star tick (Amblyomma americanum)
American dog tick (Dermacentor variabilis)
How does Cytauxzoon live in the blood?
Monocytes - Schizont
Erythrocytic - Piroplasm
What is the pathogenesis of Cytauxzoon?
Schizogenous phase - FAT monocytes with schizonts > block blood vessels > microvascular hypoxia, SIRS/sepsis, DIC, organ failure
Piroplasm phase - RBC hemolysis
What is the treatment for Cytauxzoon?
Atovaquone and azithromycin
GIVE WITH FOOD - increased oral bioavailability for atovaquone
Is Cytauxzoon zoonotic?
NO - has not been known to infect people
Hepatozoonosis:
Is it zoonotic?
Does it affect the liver?
NO and rarely lol
How is Hepatozoon transmitted to the dog?
Ingestion of an infected tick (not from tick bite)
What is the life cycle of Hepatozoon americanum?
Sporozoites infect monocytes; Then monocytes go to the muscle; pyogranuloma forms in the muscle (Onion-skin cysts). Burst and release gamonts
What is the life cycle of Hepatozoon canis?
Does not invade the muscle like H americanum.
Dog ingests infected tick, micromerozoites invade neutrophils and and monocytes.
Transplacental transmission
Facts about feline Hepatozoonosis (Hepatozoon felis)
- Usually asymptomatic
* Usually cats with FIV/FeLV
What causes salmon poisoning?
Neorickettsia helminthoeca
What kind of microorganism is Neorickettsia helminthoeca?
Gram-negative coccobacillary organism
Describe the life cycle of Neorickettsia helminthoeca (salmon poisoning)
Vector is Nanophyetus salmincola - a trematode that infects snail, fish, then mammal
What is the pathogenesis of Neorickettsia helminthoeca?
- Dog ingests fish with infected trematode
- Adult fluke innoculates dog with Neorickettsia
- Rickettsial organisms replicate initially in the epithelial cells of the intestinal villi or intestinal
lymphoid tissue then enter the blood stream and spread to the lymph nodes, spleen, tonsils, thymus, liver, lungs, and brain
What is the vector of Neorickettsia helminthoeca?
Nanophyetus salmincola - A trematode/fluke
How do you diagnose Neorickettsia helminthoeca?
- Fecal - May see Nanophyetus salmincola eggs.
- Lymph node cytology - reactivity and histiocytic hyperplasia; Intracytoplasmic rickettsial organisms within histiocytes.
- PCR
What is the treatment for Neorickettsia helminthoeca (Salmon poisoning disease)
Doxycycline for Neorickettsia
Praziquantel for Nanophyetus salmincola fluke
What is the geographic distribution of Neorickettsia helminthoeca (salmon poisoning)
Pacific northwest
Where does R. Rickettsii replicate in the host?
Endothelial cells
What is the mechanism for thrombocytopenia in rocky mountain spotted fever? (R. Rickettsii)
- Immune-mediated destruction
2. Coagulatory consumption
Which organism has been known to cause SIADH? What electrolyte disturbance does SIADH cause?
R. Rickettsii
Hyponatremia
What is the broad pathogenesis of RMSF?
- Vasculitis, increased vascular permeability
- Thrombocytopenia, hemorrhage, DIC
- Edema (brain, lung)
How do you confirm a RMSF diagnosis?
Fourfold increase in IgG seroreactivity
or Positive IgM seroreativity.
There is 5-15% seroreactivity in healthy dogs across the Atlantic
What babesia species can cause red biliary syndrome?
B. canis rossi
What is red biliary syndrome regarding B. canis rossi?
Severe intravascular hemolysis AND
hemoconcentration.
Hemoglobinemia, hemoglobinuria (in some combination) and elevated HCT due to fluid shifts into extracellular spaces
How do you treat Babesia spp. (Other than B. gibsoni)?
Imidocarb diproprionate
How do you treat Babesia gibsoni?
Combination with azithromycin and atovaquone
In addition to Doxy, what drug do you ned to treat a patient with Neorickettsia helminthoeca?
Praziquantel for trematode vector (Nanophyetus salmonicola)
Which would be most specific for the diagnosis of toxoplasma in a cats with clinical signs?
a. Oocysts in feces
b. IgM > 1:64 in CSF
c. IgG > 1:64 in serum
d. Blood culture
b. IgM > 1:64 in CSF
What is the most accurate way to diagnose ocular or CNS toxoplasmosis in cats?
The combination of T. gondii–specific antibody
detection in aqueous humor or CSF and organism DNA amplification by PCR
Which one is acid fast and which one isn’t?
a. Nocardia
b. Actinomyces
a. Nocardia - Acid fast
b. Actinomyces - Non-acid fast
What is the most common cause of pyothorax in cats?
Pasteurella
What is the most common cause of diskospondilytis?
Staph aureus
You have a cat with FIV. Four weeks ago, she gave birth to kittens who tested positive for FIV. What should you do with the kittens?
Isolate the kittens and test them again in 6 months.
Horses and dogs are reservoirs for humans for which pathogen?
Staph aureus
Which tick carries anaplasma phagocytophilum?
Ixodes spp. (co-transmitted with borrelia)
Which virus causes myocarditis in dogs, cerebellar hypoplasia in cats and diarrhea in pigs?
Parvovirus
How is rabies diagnosed?
IFA on the brainstem or cerebellum
How is cryptococcus diagnosed?
Latex agglutination test - Detects capsular antigen
How does leptospirosis cause azotemia?
Interstitial nephritis, renal swelling, and vasculitis => decreased renal perfusion
Lepto also invades renal tubular cells
How is the MAT test for lepto performed?
The patient’s serum is incubated with a suspension of live leptospires and evaluated by dark-field microscopy for agglutination
How is Hepatozoon americanum diagnosed?
Muscle biopsy
What percentage of cats with coronavirus develop FIP?
1/10
Where does the feline coronavirus replicate? Where does the FIP virus replicate?
Feline coronavirus - Enterocytes
FIP - Macrophages
What is the pathogenesis of FIP?
Infected monocytes attach to vascular endothelium
Virus attracts complement - Release of vasoactive amines and vasculitis
Major damage by antibody dependent enhancement
Which cats with coronavirus DO NOT get FIP?
The ones that DO NOT mount humoral response
What are the clinical findings for most uncomplicated Feline coronavirus infections?
Most subclinical, some develop URI, diarrhea and vomiting
What is the acute form of FIP?
Effusive
What is the chronic form of FIP?
Non-effusive
What are signs of chronic FIP (non-effusive)?
Ocular - Iritis, uveitis and keratitic precipitates
Neurologic (25-33%) of cats - Ataxia, HYDROCEPHALUS
Intestinal granulomas less common
What is the gold-standard for diagnosing FIP?
Immunohistochemistry of lesions (pyogranuloma, area of vasculitis)
What are the potential outcomes with FeLV infection?
- Effective CMI eliminates virus completely
- Transient viremia (<3 weeks)- Virus spreads to lymph nodes, thimus, spleen etc. Virus is shed. Potentially cleared by immune response
- Bone marrow infection - Persistent viremia (>3 weeks). Incorporation into hosts’ DNA. Cannot be cleared at this stage
What does the FeLV ELISA test for?
p27 antigen (FeLV core protein) - indicates viremic cat
How is Mycoplasma hemofelis transmitted?
Fleas and flea dirt
Can Mycoplasma haemofelis be opportunistic?
Yes - 40-50% of cats with mycoplasma have FeLV
How is mycoplasma hemofelis different from mycoplasma hemominutum?
M. hemominutum usually doesn’t cause clinical signs (unless the cat has FeLV)
How is FIV transmitted?
Bites
What is the target cell for FIV?
Primarily CD4+ T lymphocytes
Can also use CD8, B cells, macrophages, dendritics
What does the FIV ELISA test for?
ANTIBODIES to p24 core protein or gp40 transmembrane protein
What cats will have a false positive for FIV?
Vaccinated cats
Kittens <6 months of age (maternal antibodies)
How is a positive FIV test confirmed?
Western Blot
How is FeLV transmitted?
Salivary secretions - Licking, grooming, shared water and food dishes
What does E. canis look like on flow cytometry?
CD8+ T cell leukemia
Treatment of tritrichomonas in cats?
Ronidazole
What is the mechanism behind botulism toxin?
Inhibition of Ach release from presynaptic membrane
When should you treat salmonella?
When clinically necessary due to signs
For what organsim do you see morulae in neutrophils?
Anaplasma
Which cat is most likely to have toxoplasma?
- Cat with high IgM and FIV
- Cat that ingested contaminated meat 12 hours ago
- Cat with diarrhea
- Cat with increased but stable IgG titers
- Cat with high IgM and FIV
What percentage of hospitalized patients develop nosocomial infections?
16%
Who sheds toxoplasma oocytes?
Cats that ingest bradyzoites in tissues of prey.
Bradyzoites infect enterocytes and undergo sexual reproduction
What tick transmits lyme disease?
Ixodes
What does the Lyme ELISA test for?
Antibodies for C6
What type of gromerulonephritis does lyme disease cause?
Membranoproliferative GN
What organism transmits Leishmaniasis?
Sand flies
What are the clinical signs of leishmaniasis?
Fever
Weight loss
Cutaneous lesions
Immune complex disease (e.g. nephrotic syndrome)
How do you treat leishmaniasis?
Meglumine antimoniate (antimoniate drugs) Allopurinol
Is Brucella zoonotic?
Yes
How is brucella diagnosed?
Rapid slide agglutination test
What is the treatment of brucella?
Doxy + aminoglycoside (castrate)
What tick carries Anaplasma phagocytophylum?
Ixodes spp
How can blastomycosis be transmitted?
Inhalation of spores
Direct inoculation on skin with trauma
What contributes to the virulence of blastomycosis?
Dependent on BAD-1 (Blastomyces adhesion-1)
Inhibits immune response (suppress TNF-a and CD4+ lymphocytes)
How is blastomycosis diagnosed?
Cytology or histopath Urine antigen (elisa)
What is the canine influenza variant?
H3N8 (originated from racing grayhounds)
What type of virus is FIV?
Lentivirus, retrovirus
What is the best test to detect rabies?
Direct fluorescence assay on brainstem/cerebellum
What is the MOA of rifampin?
Inhibits B-subunit of bacterial RNA polymerase
What is the MOA of doxycycline?
Inhibits 30S ribosomal subunit - inhibits protein synthesis
What is the MOA of TMS?
Inhibits folic acid metabolism
Affects purine/DNA synthesis
What is dermatophilus congolensis?
Gram + bacteria - Causes rain scald (horses, people, dogs)
What are dermatophytic mycetomas?
PERSIANS predisposed. Microsporum canis causing coalescing SQ granulomas.
AKA granulomatous dermatitis; Majocchi’s granuloma; pseudomycetomas
What percentage of dogs with E. canis have thrombocytopenia?
70%
Which organisms have morulae?
Monocytes - E. canis, E. chaffensis
Granulocytes - A. phagocytophilum, E. ewengii
What part of the intestinal villi does parvo attack?
Crypt (more pathogenic viruses attack crypts)
What part of the intestinal
What part of intestinal villi does coronavirus infect?
Tip of villi
What part of intestinal villi does rotavirus infect?
top 1/3 of villi
Which intestinal organisms infect:
a. Villi
b. Crypts
c. Both
a. Villi - Rotavirus, coronavirus, giardia, cryptosporidium, enteropathogenic E. Coli
b. Crypts - Parvovirus, helicobacter
c. Both - Salmonella, campylobacter
What kind of virus is canine hepatitis virus?
Adenoviridae
What kind of virus is distemper?
Paramyxoviridae; morbilivirus
What is the family of parvovirus and panleukopenia virus?
Parvoviridae
What is the family/genus of rabies virus?
Rhabdoviridae/lyssavirus
What is the family of rotavirus?
Reoviridae
What is phaeohyphomycosis?
Fungal infection caused by many species of dark, melanin-pigmented dematiaceous fungi
What is the treatment for phaeohyphomycosis?
Pigmented fungi are poorly responsive to medical therapy.
SURGICAL RESECTION is tx of choice
Itraconazole can be tried if non-surgical
Does babesia cause intra- or extravascular hemolysis?
Intravascular - When merozoites are released, the RBC will burst. Also complement mediated (Ag on RBC surface)
Extravascular - There is some (Ag on surface of cell)
Is lyme zoonotic?
Yes, but most go through a tick vector
What is sporotrichosis? How is it transmitted?
Dimorphic, cigar-shaped fungus. Inoculated by punctur
How do you treat sporotrichosis?
Itraconazole
Dogs - Can do supersaturated sln of potassium iodide with food (30 days post resolution)
What is the difference between E. canis and A. phagocytophylum?
E. canis - Monocytic. Can be chronic (e.g. BM involvement). Can have monoclonal gammopathy
A. phagocytophylum - Granulocytic. Acute presentation (although most dogs show no signs)
What is the definitive way to diagnose FIP?
Histopath - The use of IHC or IFA on diseased tissue is typically the gold-standard for definitive
diagnosis of FIP
How do you effectively treat cryptosporidium?
Azithromycin
Tylosin
What is the treatment for nocardia? (filamentous, acid-fast)
TMS
What are the causes for distempter-induced thrombocytopenia?
Virus-antibody complexes on platelet surface - first
Direct infection of megakaryocytes - later
How do cats transplacentally infect the kittens with toxoplasma?
Tachyzoite stage infects fetus
What is the most sensitive test for bartonella?
Serology
What stage of Cytauxzoon lives in macrophages?
Schizonts - Live in macrophages and occlude blood vessels
Why is amphotericin B lipid-encapsulated less nephrotoxic when compared to the deoxycholate amphotericin B?
Decreased nephrotoxicity results from a reduced rate of transfer of amphotericin B to mammalian cell membranes and increased drug clearance from the blood by the mononuclear phagocyte system
Which one is less nephrotoxic?
Lipid-encapsulated amphotericin B
Amphoterixin B deoxycholate
Lipid-encapsulated amphotericin B is LESS nephrotoxic
How does FIP cause abdominal effusion?
Production of vascular endothelial growth factor (VEGF) - Increased vascular permeability
Also complex deposition (Type III HS) around small venules
What is the most consistent clinicopathological finding of Hepatozoon americanum?
SEVERE neutrophilia
Also periosteal bone reaction
What does the FeLV ELISA test for?
p27 antigen
What lungworms can you detect with a Baermann?
Aelurostrongilus sp
Crenosoma sp
What tick carries hepatozoon americanum?
Amblyomma maculatum
How do you treat mycobacteria?
Enrofloxacin, rifampin, azythromycin
Cats with FIV and UTI - How do you treat UTI?
Always use a cidal drug
How is Neospora transmitted in the dog?
Ingest tissue cyst or transplacentally
What is the most common sign of lyme disease?
Polyarthropathy
How you treat mycoplasma in a cat?
Fluoroquinolone and doxycycline
How do you treat salmon poisoning?
Doxycycline
Which of the following are zoonotic? (Pythium, Staph aureous, sarcocystis, histoplasma)
Staph aureous
What is the best way to diagnose leptospirosis 5 days after exposure?
PCR - Do MAT after 7-10 days
Highested specificity test for Bartonella?
Culture
serology has highest sensitivity
What stage of babesia causes hemolysis?
merozoite, ookinete, sporozoite, trophozoite
Merozoite
Most sensitive bloodwork abnormality for Hepatozoonosis americanum?
High CK (pyogranulomatous inflammation from tissue phase)
In addition to doxycycline, what drug do you need to treat a patient with Neorickettsia
helmintheca?
Praziquantel
Young cat with acute, hemolytic anemia with epicellular RBC parasites? How would you
treat this cat?
Doxy
+/- quinolone
Dog with pleural effusion, elevated temperature (104.5). On cytology of pleural fluid, you
see non-acid fast filamentous organism. Aerobic culture is negative. What is the most
likely cause?
Actinomyces
Most common cause of pyothorax in cat?
Pasteurella
3 year old dog with large bowel diarrhea. On rectal scrapings you see small (2-4 um)
organisms inside macrophages. What is the diagnosis?
Histoplasma
Horses and dogs are a reservoir for humans for which of the following?
a. Staph auerus
b. Pythium
c. Blasto
d. Sarcocystis
Staph aureus
What tick carries Anaplasma phagocytophilum?
Ixodes
How do you diagnose Rabies?
IFA on brainstem, cerebellum
How can you definitely diagnosed hepatozoon americanum?
Muscle biopsy
When can spontaneous remission be seen with Tritrichomonas foetus?
In 2 years
Regarding treatment of prostatitis - What drug qualities do you need?
pKa (high/low) Protein binding (high/low)
Low pKa (weak base) allowing non-ionic form of the drug to cross lipid prostatic membrane
Low protein binding
What is the most likely bacteria to cause prostatitis?
E. coli
What abx are recommended for the treatment of prostatitis?
TMS, chloramphenicol, fluoroquinolones
What bacteria is not susceptible to clavamox?
Enterococci
In what percentage of healthy dogs can salmonella be found?
30%
What part of the small intestine does salmonella have predilection for?
Invades ileal epithelium and causes mucosa sloughing/secretory d+.
What kind of immune response is expected with leishmania?
Cell mediated immunity via Th1 CD4 cells
Cats are more likely to have (male/female) heartworm infections?
Male - more likely to miss antigen
What tick carries E. canis?
Rhipicephalus sanguineous
What tick carries E. ewengii?
Amblyoma americanum
How is the organism transmitted within ticks?
Ehrlichia anaplasma, neorickettsia
Rickettsia
Ehrlichia anaplasma, neorickettsia - transtadial
Rickettsia - Transovarial
What is the host of anaplasma phagocytophilum?
Deer, rodents
What drug has been shown to decrease the burden of Trypanosoma cruzi infection?
Benznidazole
What are the common clinical signs of Trypanosoma cruzi infection?
Cardiomyopathy, arrhythmia, occasional neurologic disease and laryngeal paralysi
Which breed is commonly affected by Babesia gibsoni?
American pit bull terriers
Which antifungal crosses BBB?
Fluconazole
Voriconazole (to a lesser extent)
What is the most efficacious treatment for cryptococcus?
Amphotericin B
How is coccidiodes acquired?
Inhalation
For coccidioidomycosis, is antigen or antibody testing recommended?
Antibody
What does the urine antigen test for blasto detect?
gallactomannan
As opposed to dogs, what group of cats are overrepresented in cases of upper respiratory tract aspergillosis?
Brachycephalic cats
What fungal organism can be highly zoonotic from infected patients to humans?
Sporothrix – cat scratches
Which form of sporothrix is most common in cats?
Disseminated
dogs - cutaneous, cutaneolympatic