Nasal Disease Flashcards
What should be considered for acute-onset, persistent sneezing?
- nasal FB
- feline upper respiratory infection
less common: canine nasal mites, exposure to irritating aerosols
How does reverse sneezing affect the respiratory system?
creates a negative pleural and tracheal pressure from rapid inhalation that tears off irritant particles and accumulated mucous by aspiration from the nasopharynx to the oropharynx
(scratches the back of the throat)
What is stertor? What is the main intranasal cause?
low pitched, snoring sounds most commonly a result for pharyngeal disease
obstructions —> congenital deformities, masses, exudate, blood clots
What are the main causes of mucoid and mucopurulent discharge?
MUCOID - inflammation, excessive draining from elsewhere
MUCOPURULENT - puss + mucus = irritation, inflammation, and infection
(some serous discharge is normal)
How can respiratory disease cause epiphora? How does the presentation point toward disease?
ocular discharge can result from the blocking of the nasolacrimal duct
- BILATERAL = systemic disorders and infectious disease
- UNILATERAL = FB, polyps, tooth root abscesses
- UNILATERAL TO BILATERAL = neoplasia
What are common clinical signs associated with nasal disease?
- open-mouth breathing +/- expiratory cheek puff
- heat intolerance
- sleeping problems
- respiratory problems while eating (cannot eat without stopping to breath out of the mouth)
- halitosis without dental disease
- exophthalmos
- rubbing face on the ground
- head shaking
- facial deformities or ulcerations of nasal dorsum
- respirator difficulty on inspiration
- systemic: lethargy, inappetence, weight loss
- CNS signs rare
What actions on physical exam can aid in diagnosing nasal disease?
- auscultate for breathing sounds: stertor vs stridor
- symmetry of face and muzzle
- character of nasal discharge and laterality
- facial deformity or ulceration (Aspergillosis, neoplasia)
- patency of airflow through each nostril
- condition of teeth and gums (tooth root abscess)
- examination of roof of mouth and pharynx
- ability to retropulse eyes
- pain associated with opening or manipulating muzzle
- epiphora
- ear examination for polyps or otitis media
- percuss sinuses and nose
- pigmentation/depigmentation of nasal planum
- size and texture of submandibular LNs
- look around and feel the nose
What is the DAMNIT scheme?
a scheme used to rule out diagnoses
Degenerative, developmental (congenital)
Anomalous
Metabolic
Neoplastic, nutritional
Infectious, idiopathic, inflammatory, immune-mediate
Trauma, toxins
What are the best noninvasive tests used for diagnosing nasal disease?
- history
- physical exam
- fundoscopic examination (retina) —> tumultuous vessels from hypertension, depigmentation from infection, petechia
- thoracic radiographs
- mandibular LN cytology
- nasal swab cytology
What blood work should be done to diagnose nasal disease? If the lesion is bleeding what 5 tests can be added?
CBC + platelet count
- coagulation time
- buccal mucosal bleeding time
- tests for tick-borne disease in dogs
- arterial blood pressure
- von Willebrand factor assay in dogs
What 2 specific additional testing can be added to diagnose nasal disease in dogs?
- Aspergillus titer
- fecal flotation for migrating Capillaria or Eucoleus
What 3 specific additional testing can be added to diagnose nasal disease in cats?
- nasal swab cytology or Ag titer for Cryptococcus
- viral testing for FeLV, FIV, FHV, and FCV
- Mycoplasma felis PCR or culture
What are some invasive diagnostics for nasal disease that require sedation?
- thorough oral exam
- open mouth nasal radiography
- CT
- MRI
- rhinoscopy of external nares and nasopharynx
- dental radiographs
- biopsy/histo
- nasal mucosal brushing or flush
- deep nasal culture
Open mouth dorsoventral radiograph, dog presenting for a unilateral right-sided mucopurulent nasal discharge
unilateral, localized, increased density associated with the disappearance of the ethmoid turbinate pattern in the caudal portion of the right nasal cavity
(decreased definition caused by bone destruction and replacement with soft tissue)
- nasal adenocarcinoma confirmed by biopsy
CT, dog with nasal adenocarcinoma
soft tissue density invading the left nasal cavity with erosion of the nasal septum allowing for the invasion of the ventral portion of the left orbit through the frontal bone
How do CTs and MRIs compare?
CT: $$, best for observing bony structures and lysis or proliferation
MRI: $$$$, best for soft tissue (brain), mucous, and fluid
In what kinds of animals are cleft palates most common? What is the main cause?
purebreds and brachycephalic dogs: Boston Terriers, Pekingese, Bulldogs, Mini Schnauzers, Beagles, Cockers, Dauchshunds, Siamese cats
genetics (also nutrition, viruses, poisoning during dam’s pregnancy)
What is the most common presentation for cleft palates? What are the most common symptoms?
very young animals that are sneezing and snorting due to food and saliva passing through the nose
- runny nose after eating or before nursing
- cough and gag when drinking
- trouble eating = poor development
- trouble breathing and exercising
DEVELOP PNEUMONIA AND ARE POOR DOERS
What systemic diseases are typically on the rule out list for epistaxis?
- clotting disorders
- thrombocytopenia
- thrombocytopathy
- coagulation defects
- vasculitis (RMSF)
- hyperviscosity syndrome
- polycythemia
- systemic hypertension
What nasal diseases are typically on the rule out list for epistaxis?
- acute trauma
- acute FB
- neoplasia
- fungal infection
What is the classic presentation of tooth root abscesses? How can this cause nasal disease?
sore under eye
tooth roots have connections in the nasal passage
How do oronasal fistulas cause nasal disease?
food, mucus, and debris will enter the nasal passage through the mouth
(must be surgically fixed)
What are the major signs in a history of nasal foreign bodies?
- sudden onset of acute sneezing fits
- gagging or reverse sneezing
- pawing at nose
- serous, mucopurulent, or bloody discharge from nose depending on severity and time the FB has been there
- no other pets in house sneezing
What is the most common cause of feline upper respiratory disease complex? What are 2 examples?
90% viral —> FHV1, FCV
What are 3 bacterial causes of feline upper respiratory disease complex?
- Chlamydophila felis
- Mycoplasma
- Bordetella
(more commonly secondary bacterial infection from immunosuppression)
What cats more likely acquire feline upper respiratory disease complex? How?
young kittens —> stressed and immunocompromised
spreads through close contact with actively infected cats, carrier cats, and fomites (ocular, nasal, pharyngeal secretions)
What are 2 key symptoms are seen with feline herpesvirus infection? What symptoms are also seen?
- corneal ulceration - dendritic ulcers, superficial ulcers
- dermatitis and ulcerations on nose and face
- acute rhinitis, conjunctivitis, or fever
- abortion or neonatal death
- inappetence
- progression to mucopurulent discharge with secondary bacterial infections
How can conjunctivitis from FHV be differentiated from C. felis?
conjunctival ulcers will also be present
FHV, deep corneal ulcer:
What immune reaction is typically seen in the eyes with feline herpesvirus infections?
stromal keratitis —> reaction in the cornea to virlal particles
- gray-white stomal infiltration
What is the incubation period of feline herpesvirus? When will signs typically resolve? What status do nonclinical patients typically have?
2-6 days; sick quickly after exposure
1-3 weeks —> chronic rhinitis can develop later in life
become carriers, where the virus lays latent in the trigeminal nerve ganglia and can shed following stress
Why is it important to do other diagnostics other than PCR for FHV infections?
a positive PCR and also be from recent intranasal vaccines or a carrier state
What is the most common treatment of FHV infections (feline viral rhinotracheitis)? What antiviral works?
SUPPORTIVE - humidify air, topical decongestants (saline), systemic antibiotics for secondary infection, topical antibiotics or antivirals in the eyes, PROPER NUTRITION to maintain potassium, BG, and hydration
oral Famcylovir
What are the 4 most common sequelae of FHV infection?
- chronic rhinitis and sinusitis common in short-nosed breeds where turbinate damage predisphoses to secondary bacterial infections
- chronic conjunctivitis
- fibrosis of lacrimal ducts leads to epiphora
- carrier status with shedding when stressed
How does the vaccine for FHV help?
helps prevent disease symptoms and decreases severity, but will not prevent carrier status
What 2 versions of the FHV vaccine are available?
- parenteral —> blocked by maternal Abs
- intranasal —> not blocked by maternal Abs, useful in outbreaks, may prevent carrier state
Why are vaccines for FCV not often helpful? Why is a clean environment crucial?
virus has a high mutation rate, with new strains able to develop without cross protection
FCV can remain infection in flea feces for up to 8 days
What is the incubation period for FCV? How long are cats often sick?
2-4 days
2-3 weeks
What is the most characteristic sign of feline calicivirus infection? What else is seen?
oral ulceration on the tongue, mouth, skin, or eyes from popped vesicles, which causes cats to drool
classical URI signs: sneezing, serous nasal discharge
In what 4 ways is a FCV infection different from FHV?
- milder URI signs
- interstitial and bacterial pneumonia is more common
- GI signs are sometimes seen
- cats do not require stress to shed
What 2 distinct syndromes are seen with FCV infection?
- limping kitten syndrome - lameness, ulcers on paws, sore joints with or without URI symptoms
- virulent hemorrhagic syndrome (mutation) - UR symptoms precede systemic signs
What cats are most affected by virulent hemorrhagic systemic syndrome from FCV infection? What are some symptoms?
adults
- fever
- cutaneous edema
- hepatitis
- diarrhea
- pustular dermatitis
- crusted lesions, ulcers, and alopecia on nose, lips, eyes, footpads
- hemorrhagic cystitis
What is the main treatment used for feline calicivirus infection? What medication is thought to help?
SUPPORTIVE
human alpha 2b interferon
What is thought to lessen disease in chronically infected cats with FHV or FCV infections?
modified live intranasal vaccines potentiates cell-mediated immunity
- if there is a positive response, this can be considered a form of immunotherapy
What are the most common sequelae of FCV infection?
- chronic rhinitis
- sinusitis
- conjunctivitis
- carrier state for 30 days to years
How are FCV infections prevented?
- vaccines*
- decrease cat group sizes
- quarantine newly introduced cats
- separate sick cats
- hygiene
- wash clothes at high temperatures
- annual boosters with changing vaccines antigen if disease persists
Other than Famcylovir, what medication is thought to help with FHV infection? Why is it not as commonly used?
lysine 250 mg PO BID is thought to slow down viral replication
no proof that is actually helps, one more pill to give to a sick cat
What is the best form of supportive care for feline upper respiratory infections?
- blending food and making it highly palatable and warm to increase smell
- treat dehydration and electrolyte disturbances by IV fluids
- appetite stimulants: mirtazapine, capromorelin (Elura), maropitant (Cerenia)
- place a feeding tube if the cat has not eaten in 3 days
What are the main 2 options for feeding tubes in cats with upper respiratory infection?
- naso-esophageal tube: no sedation for placement
- esophagostomy tube: short general anesthesia, allows for medicating, wide bore tube away from cat’s face
When are NSAIDs indicated for cats with upper respiratory infection? What is the point of nebulization?
decreases fever and oral pain, but is only able to be used when dehydration is corrected and there is food intake
saline in nebulizer rehydrated the URT, loosens secretions, and reduced congestion
What are most nasal bacterial infections caused by?
SECONDARY to FBs, viral infections, tooth abscesses, fungal infections, neoplasia, or other concurrent disease
What are 4 possible bacterial causes of rhinitis in dogs and cats?
- Chlamydophila felis
- Bordetella
- Streptococcus equi
- Mycoplasma
primary bacterial rhinitis is rare, look for other causes!
What is a major sign of bacterial rhinitis? Why must diagnosis be done carefully?
mucopurulent or purulent nasal discharge
PCRs may come up positive, but most of the bacteria they screen for are part of the normal flora
What is Chlamydohila felis? What is a hallmark symptom? What else is seen?
obligate intracellular G- coccobacillus that cannot survive outside of the feline nasal passage
conjunctivitis with chemosis with or without URI symptoms
- chronic conjunctivitis (most often unilateral)
- mild rhinitis, bronchitis, and bronchiolitis
- infection of genitourinary membranes without clinical signs
How is Chlamydophila felis infection diagnosed?
- conjunctival smear shows intracytoplasmic inclusions*
- culture on special media
- PCR conjunctiva, nasal, or oropharyngeal areas
How is Chlamydophila felis infection treated? What is used with systemic signs?
topical tetracycline or erythromycin opthalmic ointment applied TID for at least 14 days after signs have resolved
oral doxycycline or azithromycin for at least 4 weeks to prevent recurrence
What treatment for Chlamydophilus felis is avoided?
neomycin or polymixin —> associated with anaphylaxis in cats
no NPB or Vetropolycin
What fungus can cause nasal disease in dogs? What kind of dogs does it prefer? What is characteristic?
Aspergillus fumigatus
dolicephalic Shepherds
mold form develops into a visible fungal plaque that invade the nasal mucosa and form fungal granulomas
What is the most common clinical sign associated with nasal Aspergillosis? What else is seen?
nasal ulceration and depigmentation
- nasal pain
- facial distortion
- normal nasal air flow
- turbinate destruction
- sneezing
- mucopurulent +/- hemorrhagic nasal d/c
- systemically healthy
How are radiographs and CTs/MRIs used to diagnose nasal Aspergillosis?
RADIOGRAPHS: can help localize lesions, but can’t distinguish between neoplasia and fungal rhinitis
CT/MRI: more helpful to observe turbinate lysis
Can serology solely be used to diagnose nasal Aspergillosis?
NO - common false negatives due to the localization of disease
How is rhinoscopy used to diagnose nasal Aspergillosis? Cytology/biopsy?
can observe turbinate destruction and white, green, or black plaques
may see hyphae, most accurate on scope swab over direct smear
How is nasal Aspergillosis treated? What risk does it pose?
infuse 1% Clotrimazole or 2% Enilconazole into nasal cavity over 1 hour
aspiration pneumonia or neuro signs if the cribriform plate is involved
What treatment is used for nasal Aspergillosis if infection extends beyond the nasal cavity?
oral Itraconazol or Terbinafine
What is the main cause of systemic (and nasal) fungal infection in cats? How do cats typically become infected?
Cryptococcus neoformans/gatti
pigeon poop or decaying vegetation
What is the most common nasal symptom of Cryptococcus infection in cats? What else is seen?
deformity of the nose
- chronic nasal discharge (serous, mucopurulent, bloody)
- stertor and inspiratory dyspnea
- sneezing, snuffling
- CNS: blindness, seizures
Other than the nasal cavity, what are 3 other systemic signs of Cryptococcus infection in cats?
- EYES - uveitis chorioretinitis
- SKIN AND SQ TISSUE - non-pruritic, non-painful alopecia
- LN - submandibular lymphadenopathy
What are the 2 preferred methods of diagnosing Cryptococcus infection in cats?
- antigen detection in blood serum, urine, and body fluids
- biopsies submitted for cytology, culture, histopath, and PCR (easy to ID on diff quick)
What treatment is used for Cryptococcus infection in cats?
- surgical excision of nodules on the skin and nasal or oral mucosa
- Amphotericin B, ketoconazole, itraconazole
What nasal mite can cause URI symptoms? Where do they live? What are the most common symptoms?
Pneumonyssus canium (NOT IN CATS)
nasal cavity and sinuses
sneezing, reverse sneezing
How are nasal mites diagnosed? Treated?
visualizing in nasopharynx and nasal cavity by endoscope
Ivermectin or Milbemycin (careful in collies!)
What is the most common nasal worm? What are common clinical signs? How are they diagnosed?
Capillaria (Eucoleus) boehmi - adults shed eggs that are swallowed and pass in feces
sneezing, mucopurulent d/c, +/- hemorrhage
How are nasal worms diagnosed? Treated?
- eggs on routine fecal flotation
- visualization of adults on rhinoscopy
Ivermectin or Fenbendazole
How is allergic rhinitis diagnosed? What histologic finding is characteristic?
- survey radiology, nasal CT
- rhinoscopy, biopsy
- nasal flushing
lymphoplasmacytic, neutrophilic, segmental rhinitis with turbinate remodeling and multifocal intraepithelial IN eosinophilic inclusions
What is characteristic of lymphoplasmacytic rhinitis? What dogs are most affected?
lymphocytic, plasmacytic infiltration of nasal mucosa in the absence of an obvious underlying etiology (histopath may not be a true picture of what is going on)
medium to large breeds with long noses
What is the most common sign of lymphoplasmacytic rhinitis? What else is seen?
uni- or bilateral mucoid or mucopurulent nasal discharge
- sneezing
- ocular discharge
- reverse sneezing
- stertor
What will a rhinoscopy show in dogs with lymphoplasmacytic rhinitis? CT/MRI?
red, edematous mucosa with possible hemorrhage, turbinate atrophy or destruction
can be normal; fluid accumulation, turbinate destruction, sinus involvement
What findings on CT/MRI rule out lymphoplasmacytic rhinitis?
destruction of nasal septum, frontal sinus, or cribriform plate
What is the general 9 step plan of managing chronic rhinitis and sinusitis in dogs?
- assess periodontal disease
- identify secondary hypersensitivities, followed up by desensitization therapy*
- therapeutic nose drops to moisturize: Vetericyn drops or Manuka honey-saline mixes
- Mucinex to break up and move congestion
- corticosteroids, Atopica, cyclosporine
- antihistamines
- hypoallergenic diet
- repeat antibiotics courses
trial and error!
Why is the use of antihistamines controversial for treating chronic rhinitis and sinusitis in dogs?
can dehydrate the nasal mucous, reducing its movement and making the condition worse
What is feline chronic rhinosinusitis associated with?
FHV or FCV —> destroys nasal turbinates and mucosa, making an environment conducive to secondary bacterial colonization = difficult and chronic treatment
In what animals is nasal neoplasia most common? Are most benign or malignant?
older, long-nosed dogs > 8 years, any cats
MALIGNANT - locally invasive and can metastasize to regional lymph nodes
What are the most common types of nasal neoplasia in dogs and cats? What is the treatment of choice?
- DOGS = adenocarcinomas, SCC, chondrosarcoma, osteosarcoma, fibrosarcoma, TVT
- CATS = adenocarcinomas, lymphoma
radiation
What are the most common signs of nasal neoplasia?
- progressive onset of unilateral nasal discharge that becomes bilateral
- loss of airflow due to mass
- sneezing, dyspnea, open-mouth breathing
- facial deformity
- epiphora
- exophthalmia
- dysphagia
How is nasal neoplasia diagnosed?
- cytology of discharge (lucky)
- FNA of ipsilateral nearby LN
- radiography with pre-anesthetic blood screen
- CT and MRI more sensitive to tissue destruction
- rhinoscopy for biopsy or flush
How do the types of nasal tumors affect prognosis? How do dogs and cats compare?
- better survival times with adenocarcinomas and sarcomas after radiation
- undifferentiated carcinomas and SCC = shorter survival
cats live longer than dogs with radiation therapy
Chemotherapy is effective for all nasal neoplasia, except…
lymphosarcoma
How can surgery aid in prognosis of nasal neoplasia? What is the most common cause of death in animals with nasal neoplasia?
palliative with radiation —> can add 12-16 months of survival with surgical debulking
airway obstruction, euthanasia due to labored respiration, persistent epistaxis, discharge spread to brain
