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Small Animal Medicine II > Pyoderma - Bacterial Dermatitis > Flashcards

Pyoderma - Bacterial Dermatitis Flashcards

1
Q

Bacterial overgrowth vs. pyoderma:

A

with pyogerma, there are commonly degenerative netrophils

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2
Q

What is the most common cause of pyoderma? What 4 toxins does it produce?

A

Staph pseudintermedius

  • beta-lactamase
  • protein A - degranulates mast cells, fixes compliment
  • proteases
  • slime
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3
Q

What other staphylococci are associated with pyoderma?

A
  • S. schleferi - coagulase negative
  • S. aureus - zoonotic
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4
Q

What are 4 steps to the pathogenesis of pyoderma? What can contribute to bacterial multiplication?

A
  1. increased adherence of S. pseudintermedius to skin cells in atopic animals due to binding site exposure
  2. inflammatory mediators promote changes to the microclimate
  3. changes in permeability allow serum leakage and increased humidity of skin
  4. barrier dysfunction

cutaneous temperature

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5
Q

What are the 2 most common underlying causes of pyoderma? What are some other causes?

A
  1. allergic skin disease (atopy) - 42%
  2. endocrine disease - hypothyroidism (11%), Cushing’s (6%)
  • ectoparasites - demodicosis, flea allergy
  • cornification disorders
  • immunodeficiencies - primary, systemic illness
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6
Q

How does pyoderma progress? What other lesions are seen?

A

papule –> pustule –> epidermal collarette

  • erythema
  • crusts, scale
  • exudative lesions
  • fistulous draining tracts
  • alopecia - hair follicles shift phases
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7
Q

What are some differential diagnoses for pustules?

A
  • pyoderma
  • autoimmune disease - pemphigus foliaceous, panniculitis
  • sterile eosinophilic pustulosis
  • dermatophytosis - Trichophyton
  • sterile pyogranulomatous dermatitis
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8
Q

What are the major clinical features of pyoderma?

A
  • pruritus
  • patchy alopecia to diffuse thinking of hair coat due to folliculitis

vary with depth of infection, duration, primary factors, and severity

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9
Q

What are 5 parts of the diagnostic approach to suspected cases of pyoderma?

A
  1. history
  2. PE, dermatological exams
  3. dermatology database
  4. CBC/chem to look for primary causes
  5. cytology - swab suppurative exudate from pustules or rupture with a 20g needle like a lancet, impression smear of papules after lancing while minimizing contact with surrounding hair –> recommend multiple slides with Dif-Quik and Gram stain
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10
Q

How can epidermal collarettes be samples is suspected cases of pyoderma?

A
  • clip hair
  • roll edges up or lift up crusts
  • sample underneath - if doing an impression smear, only touch the lesion
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11
Q

Pyoderma, cytology:

A

likely Staphylococcus pseudintermedius

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12
Q

How are aspirates from pustules properly prepared?

A
  • aspirate exudate onto slide
  • immediately spread with a brush before it dries to decrease nuclear streaming compared to slide squashing
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13
Q

What are 4 indications for performing a bacterial culture and sensitivity in suspected cases of pyoderma? What are 2 important aspects to proper technique?

A
  1. history of extensive antibiotic treatment
  2. failure to respond to standard-of-care
  3. recurring cases
  4. unexpected cytology - rod-shaped bacteria, filamentous bacteria
  • sample intact lesions
  • avoid surgical preps that would damage the lesion
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14
Q

What are 4 options for topical antimicrobial therapies used for pyoderma?

A
  1. benzoyl peroxide
  2. mupirocin
  3. OTC triple antibiotic ointment (Bacitracin)
  4. SSD

+ antiseptics or enhancers for adjunctiv therapy (Miconazole, Chlorhexidine)

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15
Q

What are 8 active ingredients that work well for shampoo therapy in cases of pyoderma? When are they most useful?

A
  1. benzoyl peroxide
  2. chlorhexidine
  3. ethyl lactate
  4. triclosan
  5. salicylic acid
  6. sulfur
  7. tamed iodines
  8. silver

superficial infections

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16
Q

What are 3 parts of proper technique when using shampoo therapy for pyoderma?

A
  1. cool water to reduce pruritus
  2. contact time of 10 mins
  3. proper frequency - q 2-7 days
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17
Q

What are 2 options for hydrotherapy in cases of pyoderma? What advantages do they have?

A
  1. whirlpools - remove surface debris, reduce pain, increase blood flow to skin
  2. ultrasonic bathing - bactericidal, cleansing
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18
Q

How often are topical therapies recommended to be performed?

A

BATHE 1-3x weekly depending on concurrent therapy

SPRAYS, MOUSSE, GEL - apply daily

(expect success within 3-4 months)

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19
Q

What are 4 major limitations to topical therapy in cases of pyoderma?

A
  1. client compliance
  2. exposure of clients to antiseptics - adverse reactions, irritation
  3. delivery of active agent to skin - hair coat, depends on biocidal activity, concentration, contact time, pH, temperature, biofilm presence, and microorganism
  4. bacterial resistance (to antiseptics AND systemic antibiotics)
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20
Q

What are the 4 best practices for antimicrobial therapy for cases of pyoderma?

A
  1. selection of proper agent based on cytology and culture
  2. proper dosages
  3. appropriate time period - 3-4 weeks for most cases, with 1-2 weeks past clinical resolution
  4. monitor patient and therapy progress - requires rechecks
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21
Q

How long is antibiotic therapy recommended for most cases of pyoderma? What are some ineffective and intermediate antimicrobials?

A

30 days

INEFFECTIVE - Penicillin, Ampicillin, Amoxicillin, Sulfas, Tetracycline

INTERMEDIATE - Lincomycin, Erythromycin, Chloramphenicol, potentiated Sulfas (high chances of adverse reactions, like arthropathy, euthyroid sick syndrome, and KCS)

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22
Q

What are the 4 most commonly effective antimicrobials used for pyoderma?

A
  1. potentiated Amoxicillin - Clavamox
  2. Cephalexin/Cephadroxil/Cefpodoxime - Simplicef
  3. Flurorquinolones
  4. synthetic Penicillin
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23
Q

What 3 cephalosporins are most commonly used to treat pyoderma?

A
  1. Cephalexin - BID, 250 and 500 mg capsules
  2. Cefpodoxime (Simplicef) - SID, multiple sizes
  3. Cefovecin (SQ Convenia) - q 14 days
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24
Q

Which Fluoroquinolone is not commonly recommended for pyoderma cases?

A

Ciprofloxacin - wide absorption range

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25
Q

What are 5 limitations of systemic therapy for pyoderma cases?

A
  1. client compliance
  2. adverse effects to patient
  3. health of patient can affect distribution or metabolism of drugs
  4. concurrent medications - drug interactions, metabolism (Chloramphenicol, Erythromycin)
  5. antibiotic resistance
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26
Q

What are the 4 classifications of pyoderma?

A
  1. surface - increased colonization, epidermis intact
  2. superficial - epidermis +/- follicles involved
  3. deep - extension into dermis
  4. cellulitis - invasion of fascial planes and aubcutis
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27
Q

What is acute moist dermatitis? What are they most commonly secondary to? How to patients typically present?

A

hot spots - pyotraumatic dermatitis

trauma, flea infestation, environment

acute onset of rapidly progressive lesions and intensive focal pruritus

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28
Q

Acute moist dermatitis:

A
29
Q

What are 3 parts to therapy in cases of acute moist dermatitis? How can it be prevented?

A
  1. clip, clean, dry lesions
  2. antimicrobials - staphylococci
  3. glucocorticoids to reduce pain and pruritus

control primary factors (atopy, fleas) and use topical antimicrobials and glucocorticoids early

30
Q

What early topical treatments are recommended for cases of acute moist dermatitis?

A
  • MiconaHex+ Triz spray
  • MalAcetic wipes
  • antimicrobial sprays
  • Genesis spray - Triamcinolone
31
Q

What is impetigo? What are 3 predisposing factors? How do patients present?

A

puppy pyoderma - staphylococcal dermatitis in young dogs

  1. husbandry
  2. parasitism
  3. nutrition

subcorneal pustules commonly on ventral abdomen with mild to absent pruritus

32
Q

Impetigo:

A

puppy pyoderma

  • common on belly
33
Q

What 2 forms of therapy is recommended for impetigo?

A
  1. topicals - shampoo every 3-4 days, sprays (focal), Chlorhexidine/Miconazole
  2. systemic antimicrobials - 21-30 day course for generalized cases

may resolve spontaneously

34
Q

What is canine acne? What therapy is recommended>

A

folliculitis and furunculosis of the chin, commonly seen in younger dogs –> rule out demodicosis

  • topcial - SSD, triple antibiotics, etc for focal cases
  • systemic - 21-30 days
35
Q

Canine acne:

A
36
Q

What is intertrigo? What breeds are predisposed? Conformation?

A

skin fold dermatitis common on face, lips, tail bed, and vulva - ideal environment for microbial proliferation –> Staphylococci, Malassezia

  • Chinese Shar Pei
  • American Cocker Spaniel
  • English Bulldog

obese

37
Q

What management is recommended for intertrigo?

A
  • clean and dry lesion
  • topical antimicrobials
  • surgical correction
38
Q

Intertrigo:

A

can predispose to UTI

39
Q

Intertrigo:

A

common in corkscrew tails

  • may call for hydrocortisone
40
Q

Intertrigo:

A
41
Q

What is folliculitis? What are 3 common causes?

A

inflammation of hair follicle

  1. demodicosis
  2. dermatophytosis
  3. bacterial –> S. pseudintermedius
42
Q

What lesions are associated with folliculitis?

A
  • papules, pustules
  • epidermial collarettes
  • alopecia
  • “lumpy bumpy” skin
43
Q

What breeds are most commonly affected by folliculitis? What does it result in?

A

shorthaired - Doberman Pinscher, English Bulldog, Dalmatian

shift in follicles to telogen, where hairs are easilty dislodged –> patchy “moth-eaten” alopecia

44
Q

Folliculitis:

A

patchy alopecia

45
Q

Folliculitis:

A
  • patchy
  • crusts
  • epidermal collarettes
46
Q

Folliculitis, Doberman:

A
  • patchy, thin coat
  • will leave tons of hair on exam table
47
Q

Folliculitis, Dalmatian:

A
  • palpate and rub skin in direction of hair coat to better appreciate papules
  • hair sticking out
  • focal alopecia
48
Q

What therapies are recommended for folliculitis?

A
  • TOPICAL - bathe q 3-7 days with antimicrobial champoos –> Chlorhexidine, Miconazole/Chlorhexidine*, Benzoyl peroxide OR Mupirocin/BPO for focal lesions
  • SYSTEMIC - antimicrobials (Cephalexin) for 30 days
49
Q

What is furunculosis? What lesions are characteristic?

A

progression of folliculitis where follicles rupture, releasing their debris into the dermis, which causes a FB-type reaction

fistulous tracts +/- papules, nodules, permanent (cicatricial) alopecia, mild to moderate pruritus

50
Q

Furunculosis:

A

squeeze –> serosanguinous exudate from fistulous tracts

51
Q

Furunculosis:

A
52
Q

Furunculosis:

A

fistulous tracts common over pressure points

53
Q

Furunculosis:

A
  • fistulous tracts with serosanguinous exudate
  • heavy head = pressure point
54
Q

What therapies are recommended for furunculosis?

A
  • TOPICAL - whirlpools/ultrasonic baths, antibacterial shampoos are of little value
  • SYSTEMIC - antibacterial therapy for 30-60 days, choice based onf C&S
55
Q

What is post-bathing furunculosis? What is the most common cause?

A

furunculosis developing with pain and pruritus within 2-7 days after bathing –> can look like IVDD!

Pseudomonas aeruginosa contaminated shampoo + trauma

56
Q

How is post-bathing furunculosis diagnosed? Treated?

A
  • cytology - rod-shaped G- bacteria
  • C&S

topical and systemic antimicrobial therapy

57
Q

Nasal/mucocutaneous pyoderma:

A
  • remove heavy crust and perform an impression smear underneath
  • common at nose and lip margins
  • treat with systemic antimicrobials for 21-30 days, topical is difficult due to location
58
Q

Interdigital pyoderma:

A

furunculosis

59
Q

Nasal furunculosis:

A

cytology!

60
Q

Pressure point pyoderma:

A

behavioral - continuous rubbing ventrum on carpet

61
Q

What is acral lick dermatitis? What is the most common cause?

A

non-behavioral folliculitis/furunculosis on extremities associated with focal intense pruritus

S. pseudintermedius

62
Q

GSD pyoderma:

A

furunculosis!

63
Q

What is paronychia? How is it treated?

A

claw (nail) bed infection —> patient may present sore and lame and draining tracts may form

systemic antimicrobials + foot soak in Miconazole/Chlorhexidine

64
Q

What is the most common cause of cat pyoderma?

A

puncture wounds from fights –> most commonly found on forelimbs and tail base

  • caused by Staph and Pasteurella
  • commonly reaches deep and progresses to cellulitis without proper treatment
65
Q

What are 4 parts of managing deep pyoderma?

A
  1. systemic therapy
  2. whirlpool
  3. surgical intervention to open/remove fistulous lesions or FBs
  4. client education - long-term management, identify primary/predisposing factors

wait until infection is treated to check thyroid levels –> euthyroid sick syndrome

66
Q

What is treatments are recommended for pyoderma maintenance?

A
  • intermittent baths - Chlorhexidine, BPO, combos
  • regular use of wipes and sprays on trouble spots –> feet, lip folds, facial folds
67
Q

What are the 5 best antibiotics for treating MRSP cases? What else is recommended to add to treatment?

A
  1. Clindamycin
  2. TMS
  3. Chloramphenicol
  4. Doxycycline
  5. Rifampin
    - monitor ALT!

topical therapy more frequently - bleach at 120 mL per 4 L (1 gal)

68
Q

What are some dermatological conditions that can mimic pyoderma?

A
  • juvenile cellulitis
  • dermatophytosis - Trichophyton
  • autoimmune disease - pemphigus foliaceus/erythematosus, panniculitis, drug reactions
  • FB reactions
  • sterile pyogranulomatous diseases
  • eosinophilic folliculitis/furunculosis,
  • sterile eosinophilic pustulosis
  • intertrigo due to yeast infection
  • callus/hygroma
  • cutaneous lesions of systemic mycoses
  • subcorneal pustular dermatosis
  • neoplasia

Small Animal Medicine II (57 decks)

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