Pulmonary disease Flashcards
1
Q
What are the various pulmonary disorders (list–9)?
A
- Pneumonia
- Eosinophilic bronchopneumopathy (EBP)
- Pulmonary neoplasia
- Pulmonary edema: non-cardiogenic
- Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)
- Pulmonary contusions
- Pulmonary thromboembolism (PTE)
- Idiopathic pulmonary fibrosis (progressive interstitial fibrosis)
- Lung lobe torsion and diaphragmatic hernias
2
Q
Pulmonary disease–clinical signs
A
- Difficulty breathing–often expiratory pattern
- Inc. rate and effort
- Coughing
- Exercise intolerance
- Abnormal pulmonary sounds
- Compare to pleural disease
- Abnormal posture–orthopnea
3
Q
Pneumonia
Overview
A
- Inflammatory disorder of pulmonary parenchyma
- Etiology (infectious)
- Bacterial–most common cause in dogs
- Viral–most common cause in cats
- Aspiration
- Fungal
- Parasitic (Paragonimus spp, Aelurostrongylus spp)
4
Q
Pneumonia
Radiographs?
Characterized by?
Other clinical signs?
A
- Radiographic pattern helps distinguish dif. etiologies
- Characterized by soft, ineffectual cough
- Difficulty in breathing on expiration (animals often have both inspiratory and expiratory attern), dyspnea, tachypnea, cyanosis if severe
- Other clinical signs
- Nasal discharge
- Exercise intolerance
- Systemic signs–pyrexia, lethargy, anorexia
5
Q
Bacterial pneumonia
More common in?
What occurs?
Primary bac. pneumonia?
A
- More common in dogs than cats
- Inflammation and consolidation of pulmonary tissue occurs
- Primary
- Younger dogs
- Bordetella
- Pasteurella
- Younger dogs
6
Q
Bacterial pneumonia
Secondary bac. pneumonia
If history of recent sedation/anesthesia?
A
- Secondary bac. pneumonia
- Often older animals
- Aspiration
- Iatrogenic, loss of normal airway protection, megaesophagus, cleft palate, nasogastric tube, laryngeal paralysis, consciousness: anesthesia or neuro disease
- Foreign body (not common in lung tissue)
- Neoplasia
- Viral or fungal infection
- Bronchitis
- If hx of recent sedation/anesthesia, organism most likely is more resistant b/c it is assoc. w/ hospital infection; hospital/super bug
7
Q
Bacterial pneumonia
Diagnosis
A
- Hematology
- L shift neutrophilic leucocytosis
- Monocytosis if more chronic
- Thoracic rads
- Interstitial pattern early in disease
- Alveolar pattern: air bronchograms are classical
- Often assoc. w/ R middle lung lobe pathology or cranioventral distribution
- Look for foreign bodies, megaesophagus, and other thoracic disease
- Radiographic changes lag behind clinical signs
- Transtracheal/endotracheal wash and cytology/culture
- Bronchoscopy w/ BAL and culture/cytology
- Can direct endoscopy to the lesion
- Usually get BAL samples from R middle and L caudal lung lobes (unless pus is visible elsewhere)
- Cytology–degen. neut, monocytes, intracellular bac.
- Bac. pneumonia can result in sepsis which can lead to ALI and ARDS (death)
8
Q
Bacterial pneumonia
Treatment: antibiotics
A
- Begin empirical treatment pending culture results
- Broad coverage
- 4 quadrants: gram (+), (-), anaerobes, Mycoplasma spp
- Begin w/ injectable therapy, then change over to oral medication once under control
- Long-term therapy usually required–4-8wks, esp. if secondary
9
Q
Bacterial pneumonia
Treatment: nebulization
Supportive care
A
- Nebulization
- Travels all the way down to lungs–> attaches to pus–> easier for animal to cough it up
- Mobilizes airway secretions
- Sterile saline +/- gentamycin
- May result in bronchoconstriction, may need to use a bronchodilator before nebulization
- Supportive care
- IV fluids, O2 therapy, and coupage
- Bronchodilators if required
10
Q
Mycotic pneumonia
Etiology
A
- Blastomycosis
- Histomycosis
- Coccidiomycosis
- Aspergillosis
- Others
11
Q
Mycotic pneumonia
Respiratory clinical signs
A
- Similar for all (chronic)
- Abnormal resp pattern
- Tachypnea
- Cough
- Exercise intolerance
- Systemic signs
- Inappetance, weight loss, fever, lameness, lymphadenopathy, chorio-retinitis or anterior uveitis, draining fistula tracts
12
Q
Mycotic pneumonia
Diagnosis
Treatment
A
- Diagnosis
- Urine or serum ag titres
- Cytology/histopathology (biopsy)
- Treatment
- Depends on fungal sensitivity
- Polyene antifungals–amphotericin B ($$$)
- Triazoles–itraconazole, posaconazole, voriconazole, fluconazole
- Imadazoles–clotrimazole, ketoconazole
13
Q
Mycotic pneumonia
How to tell which fungal organism is causing the clinical signs?
A
- Geographical location
- Coccidiomycosis–Arizona
- Blastomycosis/Histoplasmosis–Ohio river valley
- Difference in clinical signs or organs that are affected
- GI signs–histoplasmosis (+/- organism on rectal scrape)
- Cytology–lymph nodes, draining lesions, TTW, ETW, BAL, pulmonary aspirate
- Serology
- Serum antigen titre for Cryptococcus spp., Aspergillosis spp.
- Urine antigen titre for blastomycosis and histoplasmosis and valley fever (Miravista lab), Aspergillosis
14
Q
Mycotic pneumonia
Treatment
A
- Expensive and long-term (4-12 mo)
- Oral medications
- Itraconazole more costly, fluconazole generics now avail.
- Posaconazole very $$–less hepatotoxic, esp. for cats
- Voriconazole very $$
- Side effects: inappetance, elevated liver enzymes
- IV/SC
- Amphotericin B–nephrotoxic (monitor BUN and Cr)
- Lipid complex form is more $$ but has fewer side effects, less nephrotoxic
- Amphotericin B–nephrotoxic (monitor BUN and Cr)
15
Q
Mycotic pneumonia
Prognosis
A
- How disseminated is the infection
- Poorer prognosis if CNS is involved
- 1st week of treatment–greater chance of worsening resp signs
- Blastomycosis and cryptococcus–80% effectively treated
- Histoplasmosis–disseminated form has guarded prognosis, localized form has better prognosis
- Coccidiomycosis–60% recovery rate but medication often needed for 6-12 mo or longer (lifelong)
16
Q
Blastomycosis
Geographical distribution?
Mode of infection?
Location in body?
A
- Distribution–North America
- Mississippi, Missouri and Ohio river valleys, Mid-Atlantic states and Canadian provinces of Quebec, Manitoba, and Ontario
- MOI
- Inhalation of spores from mycelial growth in environment
- Blastomyces dermatitis establishes in the lungs then disseminates throughout body
- Lungs
- Skin, eyes, bones, LN, SQ, nares, brain, testes
17
Q
Blastomycosis
Clinical findings
A
- Often show no clinical signs–but then the signs develop and worsen very quickly
- 40-60% w/ fever
- Emaciated
- Lymphadenomegaly common
- 85% w/ dry harsh cough
- Exercise intolerance
- 40% w/ ocular lesions–uveitis, iridic hyperemia, aqueous flare, myosis, chorioretinitis, optic neuritis, retinal detachment
- 20-50% w/ skin lesions
- 30% w/ bone lesions
18
Q
Blastomycosis
Diagnosis
A
- Imaging–rads, U/S, MRI
- Hematology and biochemistry
- Chronic anemia
- Moderate leucocytosis w/ L shift + lymphopenia
- Hyperglobulinemia
- Hypercalcemia
- Cytology or histopathology
- LN, skin lesions, TTW (69-76% sensitive), FNA of lung (81% sensitive) (pot. risk of pneumothorax w/ FNA)
- Serology
- PCR available
19
Q
Blastomycosis
Diagnosis–serology
A
- AGID test
- Serum and urine samples
- 41-90% sensitive
- 90-100%
- Radioimmunoassays for Blastomyces
- 92% sensitive
- ELISA on urine
- 93.5% sensitive; also cross-react w/ histoplasma and blastomyces
20
Q
What is this?
A
Blastsomyces dermatitis
21
Q
Blastomycosis
Pathological findings?
Therapy?
A
- Pathological findings–pyogranulomatous lesions
- Therapy
- Amphotericin B
- Nephrotoxic–give slowly through IV
- 0.5mk/kg every other day
- Accumulated dose of 8-10mg/kg is required to cure blastomycosis
- Comes in lipid complex (less toxic)
- Costs more, high dose required
- Amphotericin B
22
Q
Blastomycosis
Treatment
A
- Triazole
- Itraconazole
- Oral administration 5mg/kg OD for dogs, TD for cats
- In dogs start w/ TD administration for 5 days to inc. serum conc., then reduce to OD
- 60-90 days administration
- 68% response rate
- Adverse effects, anorexia assoc. w/ hepatotoxicity
- Oral administration 5mg/kg OD for dogs, TD for cats
- Itraconazole
23
Q
Histoplasmosis
Epidemiology
A
- Histoplasma capsulatum
- Worldwide
- Midwestern and Southern US
- Regions along Mississippi, Missouri and Ohio river
- Likes soil that is high in bird or bat feces
- Midwestern and Southern US
24
Q
Histoplasmosis
Clinical findings: dogs vs. cats
A
- Cats
- 2nd most common systemic fungal disease
- Disseminated dz
- Mental depression, wt. loss, fever, anorexia, pale mm
- Coughing uncommon, but dyspnea, tachypnea, and abnormal lung sounds are found
- Dogs
- Inappetance, wt. loss, fever unresponsive to antibiotics
- Signs can be limited to resp tract–dyspnea, coughing, abnormal lung sounds
- Signs are generally disseminated
25
Q
Histoplasmosis
Diagnosis
A
- Hematology
- Chronic anemia
- Thrombocytopenia (50% dogs, 33% cats)
- Leukocyte counts vary–often get neutrophilic leucocytosis, monocytosis, and eosinopenia
- Biochemistry–may show hypoalbuminemia
- Imaging–rads, U/S
- TTA/BAL (cytology)
- Organism found w/in mononuclear-phagocyte system
- Single or multiple organisms
- FNA/biopsy–cytology/histo
- Serology–no test is reliable
26
Q
What is this?
A
Histoplasmosis
27
Q
Histoplasmosis
Therapy
A
-
Itraconazole treatment of choice
- 10mg/kg once to twice daily (some cats)
- Treat 4-6mo
- Fluconazole
- Better penetration into brain and eye (good for cats w/ neuro signs)
- But not that effective
- Voriconazole and posaconazole
- Penetrates blood brain barrier
- Amphotericin B used in severe cases
31
Q
What organism is this?
A
Cryptococcus spp
(Cytology on L, histopathology on R)
37
Q
What organism is this?
A
Coccidioides spp
40
Q
Aleurostrongylus abstrusus
What is it?
Signs?
Diagnosis?
Treatment?
A
- Feline lungworm
- Can have subclinical to clinical signs similar to asthma
- Usually younger cats
- Diagnosis
- Hematology–poss. eosinophilia
- Thoracic rads–diffuse nodular densities, caudal lobes
- TTW/BAL–inc. # of eosinophils and/or larvae
- Fecal–larvae evident
- Treatment
- Fenbendazole
- Ivermectin
41
Q
Aleurostrongylus abstrusus
Life cycle?
A
43
Q
Paragonimus spp pneumonia
Diagnosis?
A
- CBC–eosinophilia
- Thoracic rads–air-filled cysts
- TTW/BAL
- Fecal–zinc sulphate fecal float
- Operculated egg
44
Q
Paragonimus spp
Life cycle?
A
57
Q
Non-cardiogenic pulmonary edema
Thoracic auscultation?
Thoracic rads?
Looks for what?
A
- Hear crackles–caudal/dorsal area
- Thoracic rads
- Alveolar pattern–bilateral
- Caudo-dorsal lung fields
- Looks for underlying disease
63
Q
Pulmonary contusions
Thoracic radiographs
Treatment
A
- Radiographic evidence can take 2-12hrs to show up
- Consolidation
- Treatment
- Monitor closely for 24-48hrs
- O2 therapy
- IV fluids
- Pain medication for trauma
