Module 3 MiniModule 1: Pruritus - Infections Flashcards
Canine Pyoderma:
Pyodermas should be considered a ___________ clinical manifestation
Secondary
- Of a primary problem
General considerations: Canine Pyoderma
Part of the stratum corneum, they have antibacterial properties
Epidermal Lipids
General considerations: Canine Pyoderma
Alterations cause dysbiosis allowing for proliferation of pathogenic bacteria
Sebum
General considerations: Canine Pyoderma
Maintaining a normal microbiome discourages the growth of pathogenic bacteria
Normal non-pathogenic flora
List Predisposing conditions of Canine Pyoderma:
- Allergic dermatitis
- Endocrinopathies
- Immunologic incompetence
- Long term glucocorticoid therapy
Definition:
Bacteria infection within the skin
Pyoderma
Canine Pyoderma:
What is the most commonly involved pathogen, particularly in superficial pyoderma?
Staphylococcus pseudintermedius
Canine Pyoderma:
What spp. are found as secondary invaders, especially in cases of deep pyoderma?
Proteus spp., Corynebacterium spp., Bacillus spp., E. coli and Pseudomonas
Canine Pyoderma: Agents
- Produce beta-lactamase (destroys penicillin, amoxicillin and ampicillin)
- Is usually resistant to streptomycin and tetracycline
- DO NOT empirically use these antibiotics!
S. pseudintermedius
Canine Pyoderma: Common Clinical Presentations
- Small circumscribed elevations of the epidermis that is filled with pus (bacteria/inflammatory cells)
- Very superficial, below stratum corneum, rupture easily
Pustules (primary lesions)
Canine Pyoderma: Common Clinical Presentations
- Small solid, palpable elevation of the skin
Papules (primary lesions)
- “Infection is under”
Canine Pyoderma: Common Clinical Presentations
- Dried exudate, serum, pus, blood, cells, scales, or medication adhere to the skin surface
Crusts (Secondary lesions)
Canine Pyoderma: Common Clinical Presentations
- Remnants of the roof of a pustule or papule
Epidermal Collarettes (secondary lesions)
Canine Pyoderma: Less common Clinical Presentation
- In short coated breed - small groups of hair tufting together
Moth eaten alopecia
Canine Pyoderma: Less common Clinical Presentation
- Superficial spreading pyoderma is a rapidly expanding, and often erythematous and pruritic large (several centimeters) epidermal collarette
“Spreading” pyoderma
Canine Pyoderma: Less common Clinical Presentation
- Large Pustules with a ring of erythema
- Puppies or immunosuppressed adult dogs
- Seen with spontaneous or iatrogenic hyperadrenocorticism or other immunosuppressive disease
Bullous impetigo
Canine Pyoderma:
(T/F) Most pyodermas are secondary to underlying skin or systemic disease
True
Definition:
Infection confined to the interfollicular epidermis
Surface pyoderma
Definition:
The most frequent type of pyoderma in dogs
Superficial pyoderma
- invasion of the epidermis and folicular ostium by bacteria
- “bacterial folliculitis”
Definition:
- Expansion into the dermis and proximity to blood vessels
- Furunculosis = rupture of the hair follicle is present
- The infection affects tissue deeper than the hair follicle
Deep pyoderma
Bullous impetigo can be seen in:
- Young and immunosuppressed dogs
- Dogs receiving immunosuppressive therapy
What are not good choices for empirical therapy for superficial pyoderma?
- Penicillin
- Amoxicilin
- Streptomycin
** Filler Card **
Canine Surface Pyoderma
Surface pyoderma:
- Common
- More common in dogs with long, thick hair coat
- Golden retrievers, St. Bernards
- Most common in hot humid weather
- Rapid onset
Acute moist dermatitis - “hot spot”
- Etiology: self-inflicted
- Underlying problem causes licking, chewing, scratching -> scratching -> trauma -> secondary infections
List the Clinical Signs of Surface pyoderma:
- Erythema
- Edema
- Sero-purulent exudate - yellowish crust
- Pain
Treatment for Surface pyoderma:
- Mild: topical steroid cream or lotion
- Severe: oral prednisone
- Oral antibiotic if multiple lesions or associated with generalized pyoderma
(T/F) Hot spots are self-induced and always look for an underlying condition
True
Intertrigo or Skin Fold Pyoderma:
Exudative, odoriferous, and erythematous lesions within skin folds
Intertrigo
Intertrigo or Skin Fold Pyoderma:
Anatomic defects in some breeds predispose to maceration of the stratum corneum and bacterial growth
Skin Fold Pyoderma
- Affect most commonly lower lips
- Client main complain is usually halitosis
Lip Fold Pyoderma
Definition:
an oral health problem where the main symptom is bad-smelling breath
Halitosis
- More common in brachycephalic breeds
- Concurrent traumatic corneal abrasions or ulcerations are common
Facial Fold Pyoderma
- More common in obese animals and animals with infantile vulva
- Client complaints include frequent licking at the vulva, foul odor, and painful urination
- Secondary ascending UTI may occur
Vulvar fold pyoderma
- Most common in corkscrew tails
Tail fold pyoderma
List skin folds pyoderma treatments:
Palliative therapy
- Gentle daily cleaning
- Treat infection and inflammation
- may need topical steroids or systemic antibiotics
Surgical ablation of the anatomic defect offers the potential for a permanent cure
List the topical therapies for fold pyoderma:
- Antiseptic solution
- Medicated wipes
- Antiseptic ointment/lotion
- Bacterial infection that involves the epidermis and follicular epithelium
- Impetigo or puppy pyoderma
- dogs less than 1 year
- subcorneal pustuled that affects sparsely-haired skin
- Self-limiting (don’t need to implement therapy)
- usually requires only topical therapy
- look and control any underlying condition
-
Bacterial folliculitis
- bacterial infection involving the hair follicle and adjacent epidermis, but NOT beyond the hair follicle
- Secondary to an underlying cause
- Very common and often under-diagnosed
- Short haired
- Mucocutaneous pyoderma
- Impetigo or puppy pyoderma
Superficial pyoderma
- Pruritus may be non-existent to intense
- Can be a recurrent problem if the underlying primary condition is not controlled
- Rarely affects only face
Bacterial Folliculitis
List differential diagnosis for bacterial folliculitis:
- Demodicosis
- Dermatophytosis
- Pemphigus foliaceus
If it looks like ringworm, it is probably ______________
bacterial folliculitis
- A relapsing dermatosis of unknown etiology
- Lips, perioral skin, nasal planum, and nares can be affected
- German shepherds and their crosses are at increased risk of developing it
Mucocutaneous pyoderma
Definition:
Is a general term used to describe any skin defect or lesion on the skin
Dermatosis
Erythema and swelling that progress to crusting, fissuring, erosion, ulceration, and focal depigmentation
These are the Clinical signs of:
Mucocutaneous pyoderma
How long do we treat superficial pyoderma?
At least 1-week past the resolution of all skin lesions
- recheck is important
** FILLER CARD **
Canine Deep Pyoderma
Deep Pyoderma (2) :
- Chin acne
- Chin and Lips
- Papules (draining tracts)
- Nodules (draining tracts)
- Pustules
- Interdigital furuculosis
- inflammatory, multifactorial disease
- complex to diagnose and treat
- short-coated dogs
- Deep hot spot
Localized deep pyoderma
Deep Pyoderma (2) :
- Post grooming furunculosis
Generalized deep pyoderma
Canine Deep Pyoderma:
- Folliculitis and furunculosis
- More common in short-coated breeds
- Usually seen in young (<12 months) dogs but it may persist throughout adulthood
Canine Acne
Definition:
A parasitic skin disease with medical and veterinary importance caused by the Demodex mites
Demodicosis
- deep pyoderma: important to rule out demodicosis
Pain and pruritus are variable
- lameness
These are the Clinical signs of:
Interdigital furuculosis
- papules
- nodules
- bullae
- ulcers
- draining tracts
List the differential diagnosis for Interdigital furuculosis:
- Parasitic
- Demodicosis
- Pelodera
- Hookworms
- Fungal
- Blastomycosis
- Mycetomas (subcutaneous fungal mass)
(T/F) For Interdigital furunculosis topical therapy is sufficient
False, deep lesions are not reached and systemic antibiotic (8-12 weeks) therapy is needed
- Commonly seen in Golden retrievers
- Looks like a hot spot but the skin is thicker and if you squeeze the skin, draining tracts will noticed
- Rule out true hot spot
- Rule out deep fungal infections
- Identify and control underlying problem
Deep Hot Spots
Treatment for deep hot spots
- Systemic antibiotic => Based on culture and susceptibility
- Oral prednisone for pruritus
** FILLER CARD **
Generalized Deep Pyoderma
- Uncommon form of deep pyoderma
- Commonly affects dogs with thick hair coats
- Unique and severe clinical presentation
- Acute: 24 to 48 hours after bathing, hand stripping, or traumatic brushing e.g. using Furminator
Post Grooming Furunculosis
- Bacterial contamination of shampoo or cream rinse
- Presence of Pseudomonas (Rod-shaped bacteria)
List the clinical signs for Post Grooming Furunculosis:
- The dorsal trunk is most commonly affected
- Lesions
- pustules, hemorrhagic bullae, and draining tracts
- The affected skin is painful
- Systematic signs of illness and fever often precede the onset of skin lesions
List the treatment for Post Grooming Furunculosis:
- Systemic therapy with an antibiotic targeting gram-negative bacteria while culture/susceptibility is available
- fluoroquinolones
-
6-8 weeks
- rechecks
- document resolution before discontinuing therapy
Generalized Deep Pyoderma:
Areas more commonly affected are …
- Rump
- Lateral thighs
- Chest
- Legs
(German shepherd commonly affected)
What are the steps for diagnosing Generalized Deep Pyoderma?
- Deep scrapings to r/o demodicosis
- Skin cytology
- Bacterial culture and susceptibility
- Biopsy
- Fungal cultures
What is the treatment for Generalized Deep Pyoderma?
- Appropriate antibiotic therapy based on culture and susceptibility results
- Adjunctive therapy
- Antibacterial baths
- Topical antibacterial leave-ons
- Mupirocin ointment
- chlorhexidine spray/mousse
- diluted bleach spray
Generalized Deep Pyoderma
List the possible underlying disease that must be ruled out:
- Allergies
- Endocrinopathies
- Immunodeficiencies
- Parasitic skin diseases
** FILLER CARD **
Management Pyoderma
(T/F) For pyoderma there is no “gold standard” method of treatment
True, treatment must be tailored to each patient
Bacteria that cause superficial pyoderma
List the less commonly identified causes of superficial pyoderma:
- S. schleiferi
- S. aureus
- Streptococcus spp.
Bacteria that cause superficial pyoderma:
(T/F) Gram-negative bacteria such as Pseudomonas aeruginosa and Corynebacterium spp are rarely identified
True
What are the most important factors leading to the emergence of antimicrobial resistance?
Use and misuse of antimicrobial therapy
- Inappropriate duration
Staphylococcus species resistant to:
- all beta-lactam antimicrobials
- cephalosporins
- penicillins (including potentiated amoxicillin)
- carbapenem antimicrobials
Definition:
Bacteria that demonstrate in vitro resistance to at least 3 antimicrobial classes
Multidrug-resistant (MDR) bacteria
List the reasons to do culture and susceptibility:
- Recurrent superficial pyoderma
- Deep pyoderma
- When cytology reveals mixed infection
- Any case with poor response to empirical treatment
Immune modulatory therapy:
- Contain cellular products of Staphylococcus
- Staphage Lysate
- Effective in about 77% of recurrent cases of pyoderma
- Improvement is determined by a decrease in frequency or severity
Bacterins
** FILLER CARD **
Malassezia Infections
- Causative agent of Malassezia dermatitis and otitis
- Is lipophilic, nonmycelial, saprophytic, thick-walled, ovoid to ellipsoid, unipolar budding yeast
- Skin lesions are not specific
Malassezia pachydermatis
(T/F) Malassezia pachydermitis can be part of the normal cutaneous microflora of dogs and cats
True
- Facultative pathogen when predisposing factors are present
Definition:
Nail inflammation that may result from trauma, irritation, or infection
Paronychia
Malassezia dermatitis in cats can also be localized:
- Paronychia
- Chin acne
- Otitis externa
Malassezia infection in Cats:
when generalized, often associated with an underlying condition such as:
- FIV, FeLV
- Neoplasia
- Diabetes
- Allergies
What technique identifies yeast more frequently than the other cytologic techniques?
The Acetate Tape Impression
List Treatment options for Malassezia:
- 2% miconazole/2% chlorhexidine shampoo
- oral ketoconazole or oral itraconazole for 3 weeks
- Itraconazole might be preferred to ketoconazole because it is better tolerated
- Alone or in combination with systemic antifungals
Topical Therapy for Malassezia:
- Keratolytic $ keratoplastic
- Mild follicular flushing
- Not a good degreaser
Sulphur
Topical Therapy for Malassezia:
- Keratolytic
- Act synergistically
- Usually, come together with Sulphur
- eg. GentleSeb
Salicylic acid
Topical Therapy for Malassezia:
- Keratolytic
- Follicular flushing (Demodex)
- Degreasing - “seborrhea oleosa”
- good for oily skin
- Can bleach hair, cloth, furniture
- eg. DermaBenSs, Oxiderm PS
Benzoyl peroxide 2.5 - 3%
Topical Therapy for Malassezia:
- Keratolytic & keratoplastic
- Very degreasing
- Mild antifungal effect
- No veterinary products
- MAY BE TOXIC IN CATS
Selenium sulfide
(T/F) Allylamines - Terbinafine has also shown to be effective in cases of Malassezia dermatitis
True
(T/F) Malassezia pachydermatis is not considered a potential zoonotic agent
False, it is considered a potential zoonotic agent, especially in immunocompetent or immuno- compromised individuals
Pulse dosing (2 days/week) with ___(1)____ or _____(2)____has been shown to be effective for Malassezia dermatitis in dogs
- Itraconazole
- Terbinafine
