Sykes Flashcards
What drugs are recommended to treat Lyme arthritis?
- Doxycycline 4 week course as also treats coinfections (eg, Anaplasma, Ehrlichia, Leptospira spp.), and purported antiarthritic, anti-inflammatory properties
otherwise:
- amoxycillin
- cefovecin x 2 injections
- Azithromycin
- Clarithromycin
- Erythromycin
- Cefotaxime
- Ceftriaxone
+ analgesia
What drugs are recommended to treat lyme glomerulonephritis?
- Doxycycline
+ management of proteinuria (ACEi/ARB), hypertension (amlodipine + RAAS inhib), hypercoagulability (antithrombotic - clopidogrel, asparin, rivaroxaban)
If nephrotic syndrome or not responding well, likely also needs immunsuppressant (mycophenolate +/- pred as first line) as well.
What is the cause of lyme disease and how is it transmitted + where is it found?
How is it diagnosed?
Borrelia burgdorferi - gram negative spirchete bacteria
Ixodes scapularis - Northeastern, Mid-Atlantic, upper Midwestern states, and adjacent areas of Canada
Ixodes. pacificus in the Pacific states and Canada;
Ixodes. ricinus in Europe
Diagnosis:
- clinical signs + serology
- PCR - rapid but insensitive, may be better on synovial fluid.
Serology options: * +ve serology does NOT = lyme disease
- C6 (SNAP 4Dx) - IgG antibodies 3-6 weeks after exposure
- whole cell IFA or ELISA - can cross react with vx
- Western blot - confirm natural infection with those that test positive on IFA/ELISA - increased specificity.
- multiplex fluorescent bead assay - test for OpsA (Vx assoc), OpsC (Early infection < 3month) and OpsF (chronic infection)
- multitarget silicon disc assay (Accuplex 4) - OpsA, OpsC, OpsF, P39 and SLP - correlates well with western blood and can differentiate vx vs natural and recent vs chronic infections.
What drugs are used to treat leishmania?
- Meglumine antimoniate + allopurinol
Not recommended anymore
- Miltefosine + allopurinol
- Amphotericin B
- Posaconazole/Azoles
What drugs are used to treat trypanosomia crusi (chagas disease)?
- Benxnidazole
- amiodarone + Itraconazole
Not recommended anymore:
- Nifurtimox
- allopurinol
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Trypomastigote of Trypanosome crusi in dog blood.
Generally in macrophages or cardiac myocytes. Rupture cell when exiting it after replication.
Clinical signs:
Acute disease => generalized lymphadenopathy, lethargy, organomegaly (spleen and liver), pallor, and acute myocarditis. sudden death
Chronic disease => chronic myocarditis and dilation of the heart
Diagnosis:
- clinical suspicion + Abs on serology *(cross react with leishmania)
+/- seen on blood smear/effusion/LN aspirate
+/- PCR/culture
Treat:
- *- Benznidazole for 2 months**
- amiodarone + Itraconazole
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Aelurostrongylus abstrusus – feline lungworm.
Lifecycle:
Eggs passed by adult female worms hatch in the lungs,
=> larvae pass up the trachea, down the intestinal tract, and out in the feces.
=> Snail and slugs are the intermediate hosts,
=> cat eats transport hosts, e.g., rodents, birds, amphibia, and reptiles.
=> Ingested larvae are liberated in the intestine, penetrate the mucosa, and migrate to the lungs.
=>Adult worms in the alveolar ducts and terminal bronchioles 8 to 9 days after infection.
Clinical signs:
- Mimic other diseases including feline bronchial disease or asthma, verminous pneumonia, pulmonary edema, and pulmonary contusion.
- chronic coughing, dyspnea, open-mouth breathing, sneezing, wheezing or no clinical signs.
+/- anorexia, weight loss and lethargy.
Diagnosis:
- First stage larvae in BAL or faeces (faecal float or baermann)
- pulmonary FNA
Treatment:
- Fenbendazole +/- pred
- Advocate (imidacloprid 10%/moxidectin 1%)
What diseases does Amblyomma americanum (Lone star tick) and Amblyoma maculatum (gulf coast tick) transmit and where is it found?
Lone star tick:
- Ehrlichia chaffensis (Human monocytic ehrlichiosis)
- Ehrlichia ewingii (Granulocytic ehrlichiosis)
- Rickettsia amblyommii (Rickettsiosis)
- Francisella tularensis (Tularemia)
- Cytauxzoon felis (Cytauxzoonosis)
- Unidentified (Southern tick-associated rash illness (STAR))
Gulf coast tick
- Hepatozoon americanum (American canine hepatozoonosis)
- Rickettsia parkeri (Rickettsiosis)
What diseases does Ixodes scapularis(deer tick, eastern black legged tick) and Ixodes pacificus (Western black-legged tick or deer tick) transmit and where are they found?
Ixodes scapularis:
- Babesia microti (Human babesiosis)
- Borrelia burgdorferi (Lyme disease)
- Anaplasma phagocytophilum (Anaplasmosis)
- Ehrlichia muris/EML agent (Ehrlichiosis)
- Borrelia mayonii
- Powassan virus
Ixodes pacificus:
- Borrelia burgdorferi (Lyme disease)
- Anaplasma phagocytophilum (Anaplasmosis)
What diseases does Dermatocentor ticks transmit?
Dermatocentor ticks:
- Rickettsia rickettsii (Rocky Mountain spotted fever
- Francisella tularensis (Tularemia)
What disease does Rhipicephalus sanguineous (brown dog tick) transmit and where is it found?
Brown dog tick
- Anaplasma platys* (Anaplasmosis)
- Babesia gibsoni (Canine babesiosis)
- Babesia vogeli (Canine babesiosis)
- Ehrlichia canis (Ehrlichiosis)
- Hepatozoon canis (Hepatozoonosis)
- Rickettsia rickettsii (Rocky Mountain spotted fever)
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Hepatozoon Americanum gamont in neutrophil + polychromatophilic RBC
Trasmitted via Amblyomma maculatum tick and found in southern United States including Alabama, Florida, Georgia, Louisiana, Mississippi, Oklahoma, Tennessee, and Texas.
Clinical signs:
- Periodic or persistent fever,
- weakness, muscle atrophy, generalized pain or hyperesthesia, reluctance to move (severe inflam response as merons relsease from muscle=> myositis)
- mucopurulent ocular discharge (reduced tear production)
- Loss of body condition
- neutrophilic leukocytosis
- mild to moderate nonregenerative anemia,
- mild elevation inALP +/- hyperglobulinemia.
Radiography may demonstrate periosteal proliferation of various bones,
Diagnosis:
- meronts in muscle biopsy samples (most reliable) or gamonts in peripheral blood smears.
- PCR
- ELISA to Antigens (not commercially available)
Treatment
1. acute parasiticde with either:
- Ponazuril for14 days.
OR
- triple-combination therapy: TMS, clindamycin and pyrimethamine for 14 days
Followed by:
1. Decoquinate for 2 years.
if relapse, restart protocol with ponazuril or triple combo
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Anaplasma phagocytophilum morulae in neutrophil + keratocyte (Arrow) + thrombocytopenia
Granulocytic anaplasmosis via Ixodes ricinuspersulcatus in upper mitwest, northeast and western USA states. Often co-infection with ehrlichia.
Clinical signs:
- *- fever, lethargy, inappetence + thrombocytopenia**
- lameness due to neutrophilic polyarthritis, +/- morulae in synovial fluid
- lymphadenopathy/splenomegaly
- Epistaxis, petechial haemorrhate
- vomiting, diarrhea, cough,
- neck pain/circling, reded placing reactions
- occasionally uveitis, chorioretinitis, and retinal detachment (cats more?)
- thrombocytopenia
- anaemia (mild nonregen)
- neutrophilia or neutropenia with morulae in Neutrophils or eosinophils (can’t differentiate from E.ewingii)
-lymphopenia in cats
+/- low albumin, K+, Na+ and increased globulin, ALP, ALT and met. acidosis.
+/- proteinuria (but no evidence of severe glomerulonephritis)
Diagnosis:
Early in disease with no circ morulae => PCR + clinical signs
>8 days post infection => IFA antibodies + 4 fold increase or ELISA (+ likely to have morulae on blood smear)
- Cytology=> morulae in circ monocytes, neutrophils or platelets.
- PCR (can have false positive and neg)
- ELISA (Snap 4Dx) for antibodies but these can persist for years
- IFA for IgM and IgG with 4 fold increase in titres recommended to confirm infection. may be negative early in disease.
- Cell culture isolation (gold standard but rarely used apart from research)
Treatment:
- Doxycycline
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Anaplasma Platy infected platelets. Vector unknown but thought to be brown dog tick.
Canine cyclic thrombocytopenia or thrombocytotropic anaplasmamosis.
Dogs only. +/- coinfection with E. canis
Clinical signs:
- thrombocytopenia
+/- other clinical signs inc: fever, lethargy, lymphadenopathy, uveitis,
=> cycles of thrombocytopenia and bacteremia every 7-14 days
Diagnosis:
- *- morulae in platelets
- PCR**best if no morulae in circ.
- ELISA or IFA (acute and convalesent) antibodies but does cross react with A. phagocytophilum.
- Direct fluoresent antibody - not readily available.
Treatment:
-Doxycycline
What are the clinic signs of Angiostrongylus cantonensis infection?
A. cantonensis
- History of ingesting the mollusk intermediate hosts.
- progressive neurologic signs including hyperasethesia, loss of balance, bilateral hind limb and tail paresis, muscle wasting, incontinence, facial twitching, vomiting and diarrhea
- eosinophilic meningitis
- PCR CSF
- ELISA used in people
Pred + fenbendazole
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Babesia Canis piroplasm merizoites in dog RBC. Note - paired organism consistent with b.canis or B. rossi - large babesia.
Transmitted by brown dog tick. +/- co-infection with bartonella
Clinical signs: variable
Mild - extravascular haemolytic anaemia
Severe - intravascular haemolytic anaemia +DIC
- splenomegaly, fever, anorexia, pallor etc
=> regenerative, coombs positive IMHA
+/- Thrombocytopenia
+/- increase bilirubin
+/- polyclonalgamopathy, renal azotaemia, renal casts, and haemoglobinuria.
Diagnosis
- PCR + clinical
- visualised in RBC
- serology with rising antibody titres.
Treatment:
Babesia canis
- imidocarb diproprionate
or
- azithromycin + atovaquone or buparvaquone for 10 days
- diminazene aceturate + pentamidine isethionate (2 doses)
- doxycycline, enroflox and metornidazole for 6 weeks.
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Babesia Canis piroplasm merizoites in dog RBC. Note - paired organism consistent with b.canis or B. rossi - large babesia.
Transmitted by brown dog tick. +/- co-infection with bartonella
Clinical signs: variable
Mild - extravascular haemolytic anaemia
Severe - intravascular haemolytic anaemia +DIC
- splenomegaly, fever, anorexia, pallor etc
=> regenerative, coombs positive IMHA
+/- Thrombocytopenia
+/- increase bilirubin
+/- polyclonalgamopathy, renal azotaemia, renal casts, and haemoglobinuria.
Diagnosis
- PCR + clinical
- visualised in RBC
- serology with rising antibody titres.
Treatment:
Babesia canis
- imidocarb diproprionate
or
- azithromycin + atovaquone or buparvaquone for 10 days
- diminazene aceturate + pentamidine isethionate (2 doses)
- doxycycline, enroflox and metornidazole for 6 weeks.
What are the recommended treatment options for the diseases in A, B and C?
What is the recommended treatment option for cats with a similar disease?
A. Large un-named babesia (similar to B canis).
Treat with Imidocarb diproprionate,
Or Diminazene aceturate,
or azithromycin and avaquone
B. Babesia gibsoni (small). Treat with azithromycin and avaquone
C. Babesia conradae (small). Treat with azithromycin and avaquone
Cats = babesia felis. very small. Treat with primaquine phosphate.
none will completely eliminate infection.
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Babesia Gibsoni piroplasm merozoite in dog RBC. Note - single, annular organism
Transmitted by dog fights
Clinical signs: variable severity
Mild - extravascular haemolytic anaemia
Severe - intravascular haemolytic anaemia +DIC
- splenomegaly, fever, anorexia, pallor etc
=> regenerative, coombs positive IMHA
+/- Thrombocytopenia
+/- increase bilirubin
+/- polyclonalgamopathy, renal azotaemia, renal casts, and haemoglobinuria.
Diagnosis
- PCR + clinical
- visualised in RBC
- serology with rising antibody titres.
Treatment:
Babesia gibsoni, B. conradae and small babesia
- azithromycin + atovaquone or buparvaquone for 10 days
or
- diminazene aceturate + pentamidine isethionate (2 doses)
- doxycycline, enroflox and metornidazole for 6 weeks.
- clindamycin for 10 days.
- doesn’t eliminate carrier state
What are the options for diagnosis of Borrelia burgdorferi?
Lyme borreliosis
Diagnosis:
- *- clinical signs + serology**
- PCR - rapid but insensitive, may be better on synovial fluid.
Serology options: * +ve serology does NOT = lyme disease
- C6 (SNAP 4Dx) - IgG antibodies 3-6 weeks after exposure
- whole cell IFA or ELISA - can cross react with vx
- Western blot - confirm natural infection with those that test positive on IFA/ELISA - increased specificity.
- multiplex fluorescent bead assay - test for OpsA (Vx assoc), OpsC (Early infection < 3month) and OpsF (chronic infection)
- multitarget silicon disc assay (Accuplex 4) - OpsA, OpsC, OpsF, P39 and SLP - correlates well with western blood and can differentiate vx vs natural and recent vs chronic infections.
Where does coccidia/isospora affect and what are the clinical signs?
What is the diagnosis and treatment for coccidiosis?
Nonsporulated (noninfective) oocysts in feces
Sporulated (infective) oocysts in the environment
Schizonts (asexual stages) in the small and/or large intestine
Gametes (sexual stages) in the small and/or large intestine
Zoites, which may be sporozoites ormerozoites, are found in extraintestinal tissues (i.e., mesenteric lymph nodes, liver, or spleen) of definitive host as well as in paratenic (transport hosts
=> watery diarrhoea in young animals with weight loss, dehydration +/- haemorrhage, anorexia, vomiting
Diagnosis:
- oocysts in faeces
Treatment:
- *- Sulfadimethonine (Registered)
- Ponazuril or toltrazuril** (probably more effective)
- TMS
- amprolium +/- sulfadimethoxine
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Cytauxzoon felis (various forms) in cat blood.
Transmitted by amblyomma tick - eastern seaboard/middle eastern USA
Clinical signs:
- Acute fever & lethargy => icterus and pallor (haemolysis in later stages)
- Multiorgan failure secondary to vascular occlusion by schizont distended mononuclear cells esp liver, lung, spleen and LN => SIRS, sepsis, DIC and multiorgan failure.
- Pancytopenia/bicytopenia with signet ring intraRBC inclusion.
- thrombocytopenia +/- increase aPTT/PT (DIC)
- anaemia is initially non-regenerative (due to acuteness)
Diagnosis:
- cytology: schizont laden mononuclear cells or RBC signet ring piroplasm (ddx haemoplasma, Howell-Jolly bodies) on blood smear or LN/spleen/liver/lung aspirates.
- PCR
Treatment:
- Atovaquone + azithromycin for 10 days.
- supprtive care inc blood transfusion, analgesia, feeding support.
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Cytauxzoon felis schizont in a macrophage of a cat.
Transmitted by amblyomma tick - eastern seaboard/middle eastern USA
Clinical signs:
- Acute fever & lethargy => icterus and pallor (haemolysis in later stages)
- Multiorgan failure secondary to vascular occlusion by schizont distended mononuclear cells esp liver, lung, spleen and LN => SIRS, sepsis, DIC and multiorgan failure.
- Pancytopenia/bicytopenia with signet ring intraRBC inclusion.
- thrombocytopenia +/- increase aPTT/PT (DIC)
- anaemia is initially non-regenerative (due to acuteness)
Diagnosis:
- cytology: schizont laden mononuclear cells or RBC signet ring piroplasm (ddx haemoplasma, Howell-Jolly bodies) on blood smear or LN/spleen/liver/lung aspirates.
- PCR
Treatment:
- Atovaquone + azithromycin for 10 days.
- supprtive care inc blood transfusion, analgesia, feeding support.
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Ehrlichia canis (or chaufeensis)
Clinical signs:
- Acute phase follows an incubation period of 1 to 3 weeks
- fever, anorexia, weight loss,
- oculonasal discharge,
- lymphadenopathy + splenomegaly
- thrombocytopenia, leukopenia, low anaemia and hypergammaglobulinaemia.
* *-** oedema of the limbs and the scrotum
- CNS signs secondary to inflam and bleeding - hyperesthesia, muscle twitching and cranial nerve deficits - Subclinical phase: After 2 to 4 weeks:
- mild thrombocytopenia
- no clinical signs.
- immunocompetent animals may eliminate it - Chronic phase
- Severe thrombocytopenia with haeomrrhage inc CNS signs, anterior uveitis
- pancytopenia +/- increase granular lymphocytes, plasma cell and monoclonal Ag (+ reduced ALB)
- Lymphadenomegaly, splenomegaly
- ICGN => PLN
- polymoysitis +/- muscle atrophy and tetraparesis
Diagnosis:
- cytology - morulae in macrophage, monocytes or lymphocytes.
- PCR (confirm infection in the first week but otherwise can be low)
- Serology: Abs only after 7-28d
- IFA (cross reacts with other e or anaplasma spp)
- ELISA - not increase in acute, stay increased post exposure and also increase anaplasma. >1:800 likely
- SNAP 4Dx Plus ELISA - Abs and antigen for E.canis and Ewingii - can’t differentiate but good sens and spec
Treatment:
- Doxycycline for 28 days
or
- chloramphenicol,
- imidocarb dipropionate
- (enro effective but due to resistance, not recommended)
Consider:
- IVFT
- Darbepoetin
- granulocyte colony stimulating factor
- immunosuppressive pred (if thrombocytopenia fails to respond)
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Ehrlichia canis (or chaufeensis)
Clinical signs:
-
Acute phase follows an incubation period of 1 to 3 weeks
- fever, anorexia, weight loss,
- oculonasal discharge,
- lymphadenopathy + splenomegaly
* *- thrombocytopenia + haemorrhage, leukopenia, low anaemia and hypergammaglobulinaemia.**
- oedema of the limbs and the scrotum
- CNS signs secondary to inflam and bleeding - hyperesthesia, muscle twitching and cranial nerve deficits - Subclinical phase: After 2 to 4 weeks:
- mild thrombocytopenia
- no clinical signs.
- immunocompetent animals may eliminate it - Chronic phase
- Severe thrombocytopenia with haeomrrhage inc CNS signs, anterior uveitis
- pancytopenia +/- increase granular lymphocytes, plasma cell and monoclonal Ag (+ reduced ALB)
- Lymphadenomegaly, splenomegaly
- ICGN => PLN
- polymoysitis +/- muscle atrophy and tetraparesis
Diagnosis:
- cytology - morulae in macrophage, monocytes or lymphocytes (blood, LN, fluids etc)
- PCR (confirm active infection in the first week but otherwise can be low in chronic disease)
- Serology: Abs only after 7-28d
- IFA (cross reacts with other e or anaplasma spp)
- ELISA - not increase in acute, stay increased post exposure and also increase anaplasma. >1:800 likely
- SNAP 4Dx Plus ELISA - Abs and antigen for E.canis and Ewingii - can’t differentiate but good sens and spec
Treatment:
- Doxycycline for 28 days
or
- chloramphenicol,
- imidocarb dipropionate
- (enro effective but due to resistance, not recommended)
Consider:
- IVFT
- Darbepoetin
- granulocyte colony stimulating factor
- immunosuppressive pred (if thrombocytopenia fails to respond)
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Ehrlichia ewingii in neutrophil. vector = Amblyomma americanum
Clinical signs:
Acute only
- no signs
- fever, lethargy, anorexia
- Neutrophilic polyarthritis
- V+/D+ or neuro signs rarely
- Non-regen anaemia and thrombocytopenia
Diagnosis:
- cytology - morulae in neutrophils and eosinophils but cannot distinguish from A. phagocytophilium
- PCR (confirm infection in the first week but otherwise can be low)
- SNAP 4Dx Plus ELISA - Abs and antigen for E.canis and Ewingii - can’t differentiate but good sens and spec
Treatment:
- Doxycycline for 2-4 weeks
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Leishmania amastigote in macrophages
Clinical signs:
- asymptomatic
Cutaneous:
Cats - nodular, ulcerative, granuloma lesions of the ear, pinnae or nose
Dog - hyperkeratosis, thick scaley skin, mucocutaneous ulcers, nodules on feet/face
Visceral:
- splenomegaly and lymphadenopathy
- ATE, vasculitis, haemorrhage (thrombocytopenia/thrombocytosis, impared secondary haemostasis)
- liver - icterus, increased ALT/ALP/Tbili, reduced ALB
- Lameness - IMPA (erosive vs non-erosive), osteomyelitis, polymyositis
- PLN
- fever, V+/D+ or increased appetite, weight loss, lethargy
- CNS signs
Occular:
- Blephritis
- KCS
- Anterior uveitis
Lab:
- non-regn anaemia, pancytopenia, thrombocytopenia, leukopenia or monocytosis, neutrophilia, leukocytosis, thrombocytosis
- increase globulins, reduced albumin
- increased renal, liver and proteinuria
Diagnosis:
- cytology/histopath - in Macrophages or blood.
- serology (IFAT, ELISA or qualitative rapid test)
- PCR
Treatment:
- Antimony (meglumine antimonate or sodium stibogluconate) + allopurinol long term
Not recommended anymore
- Miltefosine + allopurinol
- Amphotericin B
- Posaconazole/Azoles
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Canine distemper
two smears from a dog with distemper, the upper one stained with Wright’s stain and the lower with Hemacolor® or Diff-quik. The viral inclusions, present in each smear in both a red cell and a leukocyte, stain much more darkly with Hemacolor and other quick hematology stains; this facilitates their detection.
Large aggregates of viral nucleocapsid particles can form in erythrocytes, leukocytes, and epithelial cells in many tissues during the acute phase of infection with Canine distemper virus, resulting in cytoplasmic inclusions visible by light microscopy. Their presence in blood is transient; they are very rarely encountered but are pathognomonic when identified.
Oronasal spread=> Macrophage/monocytes, URT epithelium and LN=> epithelial cells of multiple organs and BM
Clinical signs:
- asymptomatic (mild or partial immunity)
lymphoid organ:
- lymphopenia (T+B cell) => immunosuppression
- pneumonia - cough, mucopurulent nasal discharge
- V+/D+/HGE
Occular:
- conjunctivitis
- photophobia
- anterior uveitis
- Chorioretinitis => retinal detach or hyper-reflective renal leasion from atrophy and scar
- optic neuritis => blind or mydriasis
Neuro:
- CNS disease (assoc with hyperkeratosis of nose/pads)
=> reflect site affected inc seizures, ataxia, hypermetira, parapresis, tetraparesis, neck pain, myoclonus
- hippocampal disease => status epilepticus.
Epithelial damage:
- renal/LUT disease
- skin - rash, pustules, hyperkeratosis of nasal planum and foot pads
- dental enamel hypoplasia
- osteoscelrosis of long bones
Diagnosis:
* all antibody/antigen can be false positive with vx and false neg with low viral numbers.
- cytology: Intranuclear and intracytoplasmic viral inclusions can be seen in monocytes, lymphocytes, neutrophils, or erythrocytes (first 1-2 weeks only) or seen in epithelial cells (eg conjunctival scraping)
- Direct immunostaining for Abs
- RT-PCR
- ELISE for antigen (conjunctival swabs may be better?)
- Serology (IgG and IgM) - acute and convalescent req for diagnosis, so diagnosis is retrospective.
- virus isolation (not widely offered)
Treatment:
- supportive
- secondary bacterial infections => broad spec Abs
- seizure control
maybe ribavirin as inhibits virus replication in vitro but no used in dogs as yet.
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Mycoplasma haemofelis - small blue cocci, rings, or rods on the edges or across the faces of red cells.
Clinical signs:
- acute, severe, primarily extravasc (occasionally intravasc) haemolytic anaemia wuth agglutination and positive Coombs test.
- icterus rare, hyperbilirubinaemia usually due to haemolysis and hypoxic liver damage (increased ALT)
- can be long term asymptomatic carriers (more common with other types)
Diagnosis:
- Cytology (doesn’t differentiate species though)
- *- PCR**
- Serology (research only)
Treatment:
- Doxycycline for 4 weeks or pradofloxacin
- maybe pred if lack of response to antibiotics and persistent RBC-bound antibodies
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Neospora caninum - tachyzoites in tissues cysts. tissue wall thickness >1micron (toxo = < 1 micron)
Clinical signs: - associated with tissue cyst locations
- Congenital => ascending paralysis with hyperextension of HL
- Polymyositis
- Multifocal CNS => often intention tremor with cerebellar involvement (CSF = increased protein and cell count + mixed inflam pleocytosis)
- Other:
- myocarditis
- dysphagia
- pneumonia
- hepatitis
- ulcerative dermatitis.
Diagnosis:
- cytology/histopath
- clinical signs + serum IgG >1:800 or four fold increase
- PCR (can be positive in normal)
- faecal float/PCr - not generally useful.
Treatment:
- Clindamycin for >8 weeks +/- TMS or pyrimethamine
- Ponazuril (extra-label)
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Rickettsia rickettsii - Rocky Mountain Spotted Fever - req staining with Gimenez or IFA to show up. Generally in LN or other tissues. Transmitted by dermacentor, r.sanguinous and amblyomma spp.
Clinical signs:
lymphatics => endothelial cells => vasculitis
1. non-sepcific, fever, lethargy, lymphadenopathy/splenomegaly
2. Cutaneous & mucucutaneous - red/rash, oedema => gangrene of periphery
3. Multiorgan inflam/vasculitis - myalgia, neutrophilic polyarthritis, myocarditis, hepatitis, AKI
4. Thrombocytopenia => haemorrhage/petechiae and anaemia
=> CNS: focal or generalized and include paraparesis, tetraparesis, ataxia, hyperesthesia, ataxia, central or peripheral vestibular signs, stupor, seizures, and/or coma.
=> GIT - melena, V+
=> epistaxis
5. Eyes - mucopurulent discharge, scleral haemorrhage, conjuncitivits, uveitis, retinal haemorrhage.
*leukocytosis with left shift, anaemia, thrombocytopenis, increased ALT/ALP/CK +/- azotaemia and increased tbili. reduce albumin.
Diagnosis:
- Immunofluorescence of infected tissues
ideally + PCR and use skin biopsies from lesion = best.
- microimmunocluorescene antibody detection - 4 fold increase in IgG or >1:1024 (not detected until 7-10d post + cross reacts). less useful in initial stage of disease.
Treatment:
- Doxycycline
- Chloramphenicol
- fluorquinolones
+ supportive care.
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Toxoplasma gondii - tachyzoites. tissue wall thickness <1micron (neospora = < 1 micron)
Clinical signs: - associated with tissue cyst locations + fever
- Resp - dysponea, diffuse intersitial=>alveolar pattern +/- effusion
- Neuromusc - myositis => LMN paralysis, myocarditis, muscle pain (increased CK)
* *Multifocal CNS** - ataxia, seizures, etc + CSF increased protein, increased mononuclear cells +/- neutrophils - GIT - V+/D+
- Liver and panc => icterus, increased ALT/ALP
- Eyes - uveitis, chorioretinitis, optic neuritis
Diagnosis:
- cytology/histopath
- serology: IgM = correlates best with active recent infection, esp increasing IgM titres. IgG = infection > 10 days.
- PCR (can be positive in normal)
- faecal float/PCr - not generally useful.
Treatment:
- Clindamycin for 4 weeks
- TMS
- azithromycin
- Ponazuril (extra-label)
- topical pred for eyes.
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Anaplasma phagocytophilum morulae in neutrophil + keratocyte (Arrow) + thrombocytopenia
Granulocytic anaplasmosis via Ixodes ricinuspersulcatus in upper mitwest, northeast and western USA states. Often co-infection with ehrlichia.
Clinical signs:
- *- fever, lethargy, inappetence + thrombocytopenia**
- lameness due to neutrophilic polyarthritis, +/- morulae in synovial fluid
- lymphadenopathy/splenomegaly
- Epistaxis, petechial haemorrhate
- vomiting, diarrhea, cough,
- neck pain/circling, reded placing reactions
- occasionally uveitis, chorioretinitis, and retinal detachment (cats more?)
- thrombocytopenia
- anaemia (mild nonregen)
- neutrophilia or neutropenia with morulae in Neutrophils or eosinophils (can’t differentiate from E.ewingii)
-lymphopenia in cats
+/- low albumin, K+, Na+ and increased globulin, ALP, ALT and met. acidosis.
+/- proteinuria (but no evidence of severe glomerulonephritis)
Diagnosis:
Early in disease with no circ morulae => PCR + clinical signs
>8 days post infection => IFA antibodies + 4 fold increase or ELISA (+ likely to have morulae on blood smear)
- Cytology=> morulae in circ monocytes, neutrophils or platelets.
- PCR (can have false positive and neg)
- ELISA (Snap 4Dx) for antibodies but these can persist for years
- IFA for IgM and IgG with 4 fold increase in titres recommended to confirm infection. may be negative early in disease.
- Cell culture isolation (gold standard but rarely used apart from research)
Treatment:
- Doxycycline
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Ehrlichia canis (or chaufeensis). Morulae in monocytes (A, B, D) and lymphocyte (C)
Clinical signs:
- Acute phase follows an incubation period of 1 to 3 weeks
- fever, anorexia, weight loss,
- oculonasal discharge,
- lymphadenopathy + splenomegaly
- thrombocytopenia, leukopenia, low anaemia and hypergammaglobulinaemia.
- oedema of the limbs and the scrotum
- CNS signs secondary to inflam and bleeding - hyperesthesia, muscle twitching and cranial nerve deficits - Subclinical phase: After 2 to 4 weeks:
- mild thrombocytopenia
- no clinical signs.
- immunocompetent animals may eliminate it - Chronic phase
- Severe thrombocytopenia with haeomrrhage inc CNS signs, anterior uveitis
- pancytopenia +/- increase granular lymphocytes, plasma cell and monoclonal Ag (+ reduced ALB)
- Lymphadenomegaly, splenomegaly
- ICGN => PLN
- polymoysitis +/- muscle atrophy and tetraparesis
Diagnosis:
- cytology - morulae in macrophage, monocytes or lymphocytes.
- PCR (confirm infection in the first week but otherwise can be low)
- Serology: Abs only after 7-28d
- IFA (cross reacts with other e or anaplasma spp)
- ELISA - not increase in acute, stay increased post exposure and also increase anaplasma. >1:800 likely
- SNAP 4Dx Plus ELISA - Abs and antigen for E.canis and Ewingii - can’t differentiate but good sens and spec
Treatment:
- Doxycycline for 28 days
or
- chloramphenicol,
- imidocarb dipropionate
- (enro effective but due to resistance, not recommended)
Consider:
- IVFT
- Darbepoetin
- granulocyte colony stimulating factor
- immunosuppressive pred (if thrombocytopenia fails to respond)
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Ehrlichia ewingii morulae in neutrophil. vector = Amblyomma americanum
Clinical signs:
Acute only
- no signs
- fever, lethargy, anorexia
- Neutrophilic polyarthritis
- V+/D+ or neuro signs rarely
- Non-regen anaemia and thrombocytopenia
Diagnosis:
- cytology - morulae in neutrophils and eosinophils but cannot distinguish from A. phagocytophilium
- PCR (confirm infection in the first week but otherwise can be low)
- SNAP 4Dx Plus ELISA - Abs and antigen for E.canis and Ewingii - can’t differentiate but good sens and spec
Treatment:
- Doxycycline for 2-4 weeks
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Anaplasma Platy infected platelets. Vector unknown but thought to be brown dog tick.
Canine cyclic thrombocytopenia or thrombocytotropic anaplasmamosis.
Dogs only. +/- coinfection with E. canis
Clinical signs:
- thrombocytopenia
+/- other clinical signs inc: fever, lethargy, lymphadenopathy, uveitis,
=> cycles of thrombocytopenia and bacteremia every 7-14 days
Diagnosis:
- *- morulae in platelets
- PCR**best if no morulae in circ.
- ELISA or IFA (acute and convalesent) antibodies but does cross react with A. phagocytophilum.
- Direct fluoresent antibody - not readily available.
Treatment:
-Doxycycline
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Neorickettsia helminthoeca - Salmon Poisoning.
Fluke (Nanophyetus salmincola)=> snail => fish. NW USA to SW canada
Clinical signs:
- replicates in macrophages => granulomatous inflammation esp stomah, intestines, LN, spleen +/- meningitis (mental obtundation, myoclonic twitching, seizures, and neck pain)
- *- fever**
- lethargy
- V+/D+ +/- blood (may be fluke related)
- Acute and die.
*Thrombocytopenia (+ DIC), anaemialymphopenia, neutrophilia w toxic change *NOT EOSINOPHILIA (despite fluke)
* reduced K+, Na+, iCa++, albumin, glob and chol. Increased ALP +/- ALT/AST/tbili. Proteinuria.
Diagnosis:
- Faecal sediment for N. salmincola ova - nearly 100% spec, sens >90%
- Cytology/histopath - wnl marcophages. Giema stain in histo
- PCR - not commercially available.
Treatment:
- *- Doxycycline + prazequantel**
- enro or TMS other options
- supportive care.
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Mycobacterium in macrophages. 1. Diff quick shoung negative staining, intracellular mycobacterium bacilli with granulomatous lymphadenitis. 2. Acid fast stain => pick staining mycobacterium bacilli in macrophages.
Clinical signs.
-
Tuberculosis at site of infection (cat >dogs)- skin, GIT, resp
- SC abscess, draining tracts,
- lymphadenopathy and generally unwell
- +/- cough, dyponea, V+/D+. neuro or lamness. - Saprophytic: (cat >dog)
Rapid growth => diffuse SC or cutaneous infection (panniculitis) +/- pumlnary or systemic disease (like Tb). M fortunitum or m. smegmatis
Slow growth
- local and systemic granulomatous disease (m. avium)
- ulceration (m. ulcerans with macrolide toxin) - Leproid
Cats
- young males =>ulcers and rapidly progressive disease
- older => FIV - slower and diffuse
Single to multiple cutaneous/SC nodules +/- ulcers esp head and limbs
Dogs:
- opportunistic infection, gen large short hair dogs.
- firm non-painful, well circumscripbed dermal to SC nodules on HAIRED skin esp head and pinnae. (spontaneous remission possible)
Diagnosis:
- cytology/histopath
- PCR
- culture (slow)
- Gamma interferon response assay - differentiate bovis and microti??
Treatment
surgery + 2months of rifampicin + fluroquinolone + clarithromycin/azithromycin. + further 4-6 months of rifampicin + one of the other drugs.
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Cryptococcus neoformans. in india ink
- inhaled => nasal +/- pulmonary => direct extension or haematogenous spread
=> granulomatous inflammation with few organisms or gelatinous masses of organisms with little inflammation
Clinical signs:
-
URT signs
- sneezing, snuffling, uni/bilat mucopurulent nasal discnarge +/- blood
- prolif soft tissue masses or ulceative lesions in/around nose.
- nasopharyngeal lesions inc snoring/insp stridor +/- auditory tube => vestibular signs - Eyes - granulomatous chorioretinitis +/- retinal detachment or optic neutritis
- CNS - forebrains signs predominantly
- Multisystemic - osteomyelitis, renal failure, generlized lymphadenopathy
*dogs - primarily CNS, > URT, occular or cutaneous. dissemination more common in dogs than cat
diagnosis:
- Cytology/histo - inc CSF samples. India inc, PAS, Gridley fungal Grocott’s methenamine silver or Gomori methenamine silver for organism. Mucicarmine for capsule.
- Culture
- LCAT for antigen
(imaging - MRI contrast enhancing masses, hyperintense on T2W and hypointense on T1W. may appear fluid filled. )
Treatment:
- systemic or CNS cases - amphotericin B +/- flucytosine
- Otherwise itraconazole or fluconazole appropriate for all options. +/- terbinafine if resistance.
- some may req surgical excision of cutaneous or SC granulomas
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Mycobacterium in macrophages. 1. Diff quick shoung negative staining, intracellular mycobacterium bacilli in macrophages.
Clinical signs.
-
Tuberculosis at site of infection (cat >dogs)- skin, GIT, resp
- SC abscess, draining tracts,
- lymphadenopathy and generally unwell
- +/- cough, dyponea, V+/D+. neuro or lamness. - Saprophytic: (cat >dog)
Rapid growth => diffuse SC or cutaneous infection (panniculitis) +/- pumlnary or systemic disease (like Tb). M fortunitum or m. smegmatis
Slow growth
- local and systemic granulomatous disease (m. avium)
- ulceration (m. ulcerans with macrolide toxin) - Leproid
Cats
- young males =>ulcers and rapidly progressive disease
- older => FIV - slower and diffuse
Single to multiple cutaneous/SC nodules +/- ulcers esp head and limbs
Dogs:
- opportunistic infection, gen large short hair dogs.
- firm non-painful, well circumscripbed dermal to SC nodules on HAIRED skin esp head and pinnae. (spontaneous remission possible)
Diagnosis:
- cytology/histopath
- PCR
- culture (slow)
- Gamma interferon response assay - differentiate bovis and microti??
Treatment
surgery + 2months of rifampicin + fluroquinolone + clarithromycin/azithromycin. + further 4-6 months of rifampicin + one of the other drugs.
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Cryptococcus neoformans. Prominent capsule (clear halo) and narrow necked budding
- inhaled => nasal +/- pulmonary => direct extension or haematogenous spread
=> granulomatous inflammation with few organisms or gelatinous masses of organisms with little inflammation
Clinical signs:
-
URT signs
- sneezing, snuffling, uni/bilat mucopurulent nasal discnarge +/- blood
- prolif soft tissue masses or ulceative lesions in/around nose.
- nasopharyngeal lesions inc snoring/insp stridor +/- auditory tube => vestibular signs - Eyes - granulomatous chorioretinitis +/- retinal detachment or optic neutritis
- CNS - forebrains signs predominantly
- Multisystemic - osteomyelitis, renal failure, generlized lymphadenopathy
*dogs - primarily CNS, > URT, occular or cutaneous. dissemination more common in dogs than cat
diagnosis:
- Cytology/histo - inc CSF samples. India inc, PAS, Gridley fungal Grocott’s methenamine silver or Gomori methenamine silver for organism. Mucicarmine for capsule.
- Culture
- LCAT for antigen
(imaging - MRI contrast enhancing masses, hyperintense on T2W and hypointense on T1W. may appear fluid filled. )
Treatment:
- systemic or CNS cases - amphotericin B +/- flucytosine
- Otherwise itraconazole or fluconazole appropriate for all options. +/- terbinafine if resistance.
- some may req surgical excision of cutaneous or SC granulomas
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Coccidioidomycosis
- pyogranulomatous - granulomatous
Clinical signs:
- subacute to chronic course, with mild systemic signs such as intermittent fever lethargy, inappetence, and weight loss.
- Resp: harsh cough, increased respiratory effort, tachypnea and/or exercise intolerance, diffuse fungal pneumonia (rare)
- Dissemination: CNS (multifocal), skin (draining or sc mass), peripheral lymph nodes, pericardium (RSCHF, ascites, pleural effusion), joints/bones, eyes (chorioretinitis, uveitis, and endophthalmitis), testes, gastrointestinal tract, prostate, liver/GIT, spleen, and urinary in ICGN/PLN.
Diagnosis:
- cytology/histo (not sensitive)
- *- culture**
- Serology - IgM (2-5 weeks post) or IgG (8-12w post). >1:16 is positive.
Treatment:
- Fluconazole
- Itraconazole (bone esp)
- Voriconazole (CNS)
+/- amphotericin B for disseminated or refractory.
What is this?
What are the clinical signs?
How to confirm diagnosis?
What is used to treat it?
Blastomycosis - thick-walled yeasts (8 to 12 microns in diameter, with 0.5- to 0.75-micron-thick walls) that bud to form daughter cells from a broad base.
Clinical signs:
- Nonspecific signs fever, anorexia, depression, weight loss, cachexia,
- Pulmonary: cough, hypoxia/cyanosis, exercise intolerance, enlarged perihilar LN, infiltrative broncointestitial and alveolar disease, pleural effusion/chylothorax, PTE, solid granulomatous masses.
- Diffuse lymphadenopathy
- Cutaneous - small papules, plaques, nodules +/- ulceration/drainage. * large abscesses in cats.
- Eyes- optic neuritis, conjunc, keratitis, ant uveitis +/- secondary glaucoma.
- Osteomyelitis
- CNS - diffuse/multifocal
- Genital - mastitis, prostatitis, orchitis
Diagnosis:
- Cytology/histo - yeasts. (PAS), Gridley’s fungal, and Gomori’s methenamine silver (GMS) stains.
- PCR
- Antigen testing - confirms fungal disease but not blasto vs histo.
- Serology - low sen and spec
(Imaging - thorax - nodular->diffuse interstitial or bronchointerstitial pattern.
Treatment:
- Itraconazole
- Amphotericin B
Where are blasto, histoplasma and coccidiodomycosis found in the USA?
Histo: Central/east
Blasto: central east extending to coast in south, great lakes and canada in north.
(follows Mississippi, Ohio, Missouri, Tennessee, and St. Lawrence Rivers, the southern Great Lakes, the southern Mid-Atlantic states, northern California, Pacific Northwest, and the Canadian provinces of Alberta, Manitoba, Ontario, Quebec, and southern Saskatchewan)
Coccidiomycosis: coast along the south west + california.
(southwestern and western USA, eastern Washington state, Mexico, and parts of Central and South America. In the USA, highly endemic regions include the south-central valley of California (“valley fever”) and Arizona, especially the greater Tucson and Phoenix areas)
(upper midwestern area of the United States and south central Canada, with the geographic distribution following the Mississippi, Ohio, and Missouri Rivers)
