pneumonia Flashcards
Radiographic lung patterns: interstitial pattern
blood vessel margins are indistinct/hazy
infiltration within extracellular space of lung
Radiographic lung patterns: bronchial pattern
doughnut, tramlines
thickening of airway walls, infiltrates in or around airway walls
radiographic lung patterns: alveolar pattern
air bronchograms
fluid/infiltrate within airspace, alveolar space
pneumonia
inflammation of pulmonary parenchyma
types of pneumonia
broncho
interstitial
granulomatous (fungal)
mixed: bronchinterstitial (viral)
bronchopneumonia
grossly affects cranial ventral lung
consolidation
micro lesions: inflammatory exudative airway
bacterial, aspiration
interstital pneumonia
grossly diffuse, locally extensive
micro lesions: alveolar septa
causes: viral, toxoplasmosis, toxin, sepsis, Leptosporosis, hypersensitivity
etiology of pneumonia
bacterial
fungal
aspiration
viral
parasitic
protozoal
trauma/hemorrhage
allergic/immune mediated
foreign body
neoplasia
uremia
causes of viral pneumonia
Canine distemper virs
FIP
FCV
CAV2
Canine parainfluenza virus
canine influenza
H1N1-cats
Canine influenza virus
caused by type A Orthomyxovirus
first outbreak in 2004 in FL
winter and summer to early fall
Canine influenza virus transission
aerosolized resp secretion
contaminated fomites
2-5 day incubation period
almost all exposed dogs become infected
80% develop clin sxs
other 20% shed virus
Canine inluenza virus clinical signs
DDx: kennel cough
mild form-Cough for 2-3 weeks, purulent nasal d/c, low grade fever, most common
severe form-high grade fever, pneumonia (bacterial), tachypnea, dyspnea
Canine influenza: dx
no reliable rapid dx test
serology-most reliable and sensitive
PCR on TTW, oropharyngeal swab-use early in inf
Canine influenza: tx
supportive care
broad spectrum abx with severe nasal d/c, pneumonia
fluid and nutritional support
isolation
disinfection
canine influenza: px
80% morbidity
5-8% mortality
vax
easily killed by common disinfectants
bacterial pneumonia causes
combo of factors
compromise of defense mechanisms
pathogenic potential of offending bacteria
nature of exposure to bacteria
Bacterial pneumonia: pathogens
primary: Bordetella, Mycoplasma (cats)
secondary: Strep, Saph, Pasteurella, E coli, Klebsiella, mixed, anaerobes
Bacterial pneumonia: routes of infection
aspiration of various substances
hematogenous spread
Bacterial pneumonia: predisposing factors
primary resp innf
d/o of swallowing
trauma
recumbency, CNS dz
smoke inhalation
FB rxn
noeplasia
sepsis
ciliary dyskinesia
immune suppression
breed predisposition
Bacterial pneumonia: hx and clin sxs
soft, moist cough during daytime
tachypnea, poss dyspnea
nasal d/c
anorexia, lethargy
hx of v, regurg
ADR
fever
Bacterial pneumonia: PE findings
Depression, dehydration
fever (<50%)
cyanosis
crackles, wheezes, decreased lung sounds
chest auscultation may be normal
Bacterial pneumonia: dx
CBC
chest rads
arterial blood gas
airway sampling
PCR
T/F: the absence of fever rules out bacterial pneumonia
False, only 50% of case report fevers
True or false: an alveolar pattern is usually present in a dog with bacterial pneumonia
True
cats usually have bronchial pattern
Bacterial pneumonia: dx-airway sampling
TTW, bAL
septic inflammation
intracellular bacteria
Bacterial pneumonia: dx- arterial blood gas
-hypoxemia, hypocapnea
bacterial pneumonia: dx-chest rads
alveolar pattern (cats-bronchial pattern),
ventral region of cranial and middle lobes,
localized if lobar,
lung lobe consolidation,
caudodorsal if hematogenous
Bacterial pneumonia: dx-CBC
- leukocytosis, left shift
Bacterial pneumonia: dx-PCR
Canine infectious respirator PCR panel
includes Bordetella, Strepococcus zooepidemicus, plus viral pathogens
nasal, conjunctiva swabs
pharyngeal swabs
airway wash sample
Bacterial pneumonia: tx
Abx
fluid therapy
oxygen therapy
humidification of airways
physical therapy
poss bronchodilators
address underlying cause
Bacterial pneumonia: tx-abx
-based on C&S, bactericidal preferred
mild to modrate case: doxy, clavamox, TMPS, cephelosporins
Severe cases: flouroquinolones + amp/clavamox
cats: doxy
lifethreatening: Unisyn + flouroquinolone or aminoglycoside
all IV initially
cont 1-2 weeks after resolution of sxs
Bacterial pneumonia: patient monitoring
expect clin improvement within 3-5 d
daily auscultation
monitor temp
follow up chest rad-esp prior to stopping abx
blood gas analysis-improvement in PaO2
improvement on CBC
Bacterial pneumoia: Px
good in general
poss recurrence
prevention: fasting prior to sedation, PEG tube feedings, etc
Aspiration pneumonia-causes and predisposing factors
entry of foreign material into airway
esophageal dz, oropharyngeal dz, CNS dz, anesthesia, chronic V, iatrogenic
Aspiration pneumonia: Clinical findings
cough, tachypnea, dyspnea
acute resp distress
chronic cough poss
crackles, wheezes, esp cranial ventral (absence of resp sxs poss)
fever
poss neurologic deficits
poss oral cavity abn
Aspiration pneumonia: Chest rads
alveolar pattern most common (esp right middle and right cranial)
interstitial pattern 2nd most common
lung lobe consolidation poss
mineral oil can cause diffuse interstitial or nodular pattern
Aspiration pneumonia: airway fluid analysis
inflammatory cels
intracellular bacteria
foreign debris
use in chronic pneumonia cases
Aspiration pneumonia: tx
bronchoscopy
airway suctioning and flushing
oxygen therapy
abx therapy
proper feeding techniques
Aspiration pneumonia: Px
variable but usually good
Blastomycosis
most common respiratory fungal inf in MN and great lakes region
soil saprophyte
Blastomycosis: hx and clin sxs
travel to endemic area
cough, dyspnea
depression, lethargy
ocular signs: choriorenititis, blindness, glaucoma
skin lesions
fever-104.5-105
lymphadenopathy
lameness
Blastomycosis: pathogenesis
spores inhaled and deposited in alveoli
phagocytized by macs
transformed from mycelial to yeast phase
multiplies in macs
yeast cells released into alveoli–> infl
incubation time: 5-12 weeks
Blastomycosis: clinical forms
Primary pulmonary
disseminated-hematogenous, lymphatic
local cutaneous
Blastomycosis: rad findings
small or large interstital nodules
alveolar pattern
masses
unstrcutred perihilar infiltrate
lymphadenopathy
lung lobe consolidation
pleural effusion
Blastomycosis: Dx
consider geography
Cytology of lung node skin or bone-most common
histopath
fungal culture
fungal titers
urine ag test
response to tx
Blastomycosis: Dx-cytology
pyogranulomatous inflammation
large, thick-walled budding yeast
Blastomycosis: antifungal drug therapy
imidazole drugs-expensive, given with food, poss liver and GI toxicity, Itraconazole
Amphotericin B-risk of renal toxicity, must be infused with IV fluids, poor penetration, combine with Itraconazole
Blastomycosis: supportive care
IV fluid therapy
oxygen therap
anti-inflammatory meds-NSAIDs, low dose steroids
nutritional support
Blastomycosis: patient monitoring
repeat chest rads in 4-6 weeks
recheck rad no shorter than monthly
rad lesions resolve within 185 days
urine ag test
blastomycosis: Px
~60% survival rate
poor for dogs in resp distress at presentation
poor with CNS dz
fair for dogs treated early in dz course
relapse common
enucleation may be necessary
Noncardiogenic Pulmonary Edema
abnormal accumulation of lfuid within the lung
caused by increased vascular endothelial permeabiilty
high protein fluid
Noncardiogenic Pulmonary Edema: etiology
lung injury-examples: aspiration of gastric contents, smoke inhalation, near drowning, trauma, handing, choking, prolonged high conc oxygen inspiration
Extrapulmonary causes: SIRS, sepsis, neurologic dz, pulmonary thromboembolism, pancreatitis, uremia
Noncardiogenic Pulmonary Edema: Clinical sxs
acute dyspnea, tachypnea
diffuse crackles
poss cardiac abn
fever
CNS signs
burns in oral cavity
evidence of strangulation
Noncardiogenic Pulmonary Edema: Dx workup
chest rads if stable
arterial blood gas
ECG
CBC, chem UA
Noncardiogenic Pulmonary Edema: Dx-Chest rads
early signs: interstitial pulmonary edema
progression to mixed insterstitial-alveolar or alveolar
typically caudodorsal lung lobes
symmetric cahnges with extrapulmonary causes
asymmetrical with primary lung insult
Noncardiogenic Pulmonary Edema: dx-arterial blood gas
hypoxemia
intially hypocapnia
later hypercapnia
Noncardiogenic Pulmonary Edema: Tx
eliminate underlying cause
descrease vascular infl with steroids, other anti-inflammatories
support resp and cardiac function-oxygen, ventilator, fluid therapy (colloids)
diuertic therapy
vasodilators
support bp-dopamine dobutamine
Noncardiogenic Pulmonary Edema: Px
fair to poor
Pulmonary thromboembolism
thrombus formation in pulmonary artery
pulmonary thromboembolism: cause
injury to vessel endothelium
impairment of blood flow
development of pro-thrombotic tendencies in blood
pulmonary thromboembolism: Risk factors
hypercoaguable state
IV catheters
prolonged recumbency
blood transfusions
glucocorticoid excess-endogenous or exogenous
pulmonary thromboembolism: disease association
Heartworm dz
IMHA, ITP
pancreattitis
PLE
PLN
cardiac dz
sepsis
DIC
Cushing’s
DM
Polycythemia
vasculitis
hyperlipidemia
pulmonary thromboembolism: Clinical presentation
acute onset tachypnea, dyspnea
cyanosis
lethargy
hemopytsis
increased bronchovesicular sounds
known predisposing conditions
pulmonary thromboembolism: Dx
high index of suspicion
CBC, coag
arterial blood gas-hypoxemia, hypocapnia
Chest rads
D-Dimer
ventilation perfusion scan
angiography
CT scan with angiography
necropsy
pulmonary thromboembolism: Dx-chest rads
may be normal
hyperlucency
pulmonary infiltrates
pleural effusion
PA changes
severe of changes may not match severity of signs
pulmonary thromboembolism: Dx-D-dimer
fibrin degradation product
elevation signify active coag and fibrinolysis
short half life
not specific
pulmonary thromboembolism: Tx
ICU care
oxygen therapy
thrombolytic therapy
address underlying cause
vasodilator therapy
pulmonary thromboembolism: Cats
rare
severe concurrent clinical dz
pulmonary thromboembolism: prevention
ID at risk patients
heparin therapy
low molecular weight heparin
Plavix
low dose aspirin
warfarin
7 yo MC Rottweiler
presenting complaint: anemia, recurrent IMHA
Current therapy: SID Pred
PE: pale, tachycardic, lethargic, pot-belly, splenomegaly, thin hair coat, panting
lab: HCT 16%, spherocytes, RBC agglutanation, leukocytosis with mature neutrophilia, ALP and ALT increased, Bilirubin increased, PT/PTT normal
problem list?
IMHA
Iatrogenic Cushing’s
leukocytosis
increased liver enzymes
increased biliruing
tachycardia
panting
7 yo MC Rottweiler
presenting complaint: anemia, recurrent IMHA
Current therapy: SID Pred
PE: pale, tachycardic, lethargic, pot-belly, splenomegaly, thin hair coat, panting
lab: HCT 16%, spherocytes, RBC agglutanation, leukocytosis with mature neutrophilia, ALP and ALT increased, Bilirubin increased, PT/PTT normal
tx plan?
blood transfusion
increase pred dose
add cyclosporine
ICU monitoring
7 yo MC Rottweiler
presenting complaint: anemia, recurrent IMHA
Current therapy: SID Pred
PE: pale, tachycardic, lethargic, pot-belly, splenomegaly, thin hair coat, panting
lab: HCT 16%, spherocytes, RBC agglutanation, leukocytosis with mature neutrophilia, ALP and ALT increased, Bilirubin increased, PT/PTT normal.
next night:
HCT:23%, panting more heavily, cyanotic, uncomfortable, unable to walk outside, harsh lung sounds bilateral
DDx?
Pulmonary thromboembolism
noncardiogenic pulmonary edema
heart failure
pleural space dz
pneumnoia
cushing’s
lung lobe torsion
laryngeal dz
7 yo MC Rottweiler
presenting complaint: anemia, recurrent IMHA
Current therapy: SID Pred
PE: pale, tachycardic, lethargic, pot-belly, splenomegaly, thin hair coat, panting
lab: HCT 16%, spherocytes, RBC agglutanation, leukocytosis with mature neutrophilia, ALP and ALT increased, Bilirubin increased, PT/PTT normal.
next night:
HCT:23%, panting more heavily, cyanotic, uncomfortable, unable to walk outside, harsh lung sounds bilateral
Next step?
pulse oximeter
arterial blood gas
chest rads
7 yo MC Rottweiler
presenting complaint: anemia, recurrent IMHA
Current therapy: SID Pred
PE: pale, tachycardic, lethargic, pot-belly, splenomegaly, thin hair coat, panting
lab: HCT 16%, spherocytes, RBC agglutanation, leukocytosis with mature neutrophilia, ALP and ALT increased, Bilirubin increased, PT/PTT normal.
next night:
HCT:23%, panting more heavily, cyanotic, uncomfortable, unable to walk outside, harsh lung sounds bilateral
chest rads-normal; arterial blood gas: pH7.39, pO2=64, pCO2=36
alkalosis
pO2 very low-hypoxemia
pCO2 decrease-hypocapnia
7 yo MC Rottweiler
presenting complaint: anemia, recurrent IMHA
Current therapy: SID Pred
PE: pale, tachycardic, lethargic, pot-belly, splenomegaly, thin hair coat, panting
lab: HCT 16%, spherocytes, RBC agglutanation, leukocytosis with mature neutrophilia, ALP and ALT increased, Bilirubin increased, PT/PTT normal.
next night:
HCT:23%, panting more heavily, cyanotic, uncomfortable, unable to walk outside, harsh lung sounds bilateral
chest rads-normal; arterial blood gas: pH7.39, pO2=64, pCO2=36
Most likely dx?
pulmonary thromboembolism
a
