Upper Airway Diseases in Small Animals pt 2

Question 1

Nasal Mass
- clinical signs
- next steps / dx tests

Answer 1

• Nasal discharge or epistaxis
• Usually unilateral
• Non patent nostril on one side
• +/- deformity of the face
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• Chest radiographs (possible metastasis)
• Aspiration of local lymph node if enlarged
• CT-scan and nasal biopsies

Question 2

Nasal Tumors common in dogs and cats

Answer 2

• Dogs: Carcinoma and Chondrosarcoma
• Cats: Lymphoma

Question 3

nasal biopsies should stop at what depth

Answer 3

dont go farther than medial canthus of the eye, to ensure we are not going into brain

Question 4

Nasal Mass prognosis

Answer 4

• Locally aggressive but rare metastasis
• Median survival time:
• 3 to 6 months if surgery, chemo or no treatment
• 8 to 14 months if radiation therapy (palliative)
  > due to owner feeling that the dog does not have a good quality of life (euthanaisa)

Question 5

Nasal mass treatment

Answer 5

• NSAIDs
• Alendronate
• Curative or palliative radiation therapy depending on tumor type

Question 6

Nasal Foreign Bodies
- which are common?
- signs?
- what should we do??

Answer 6

• Grass awns: most common
• Unilateral nasal discharge +/-sneezing
• Examination of the nostril with an otoscope
• FLUSH, FLUSH, FLUSH
• +/- Advanced imaging

Question 7

Chronic Inflammatory Rhinitis
- who gets it?
- type of cells we see?
- etiology?

Answer 7

• Dogs & cats of any age
• Inflammatory cell infiltrate variable
  > Lymphocytic-plasmacytic, suppurative, eosinophilic
• Unknown etiology-idiopathic

Question 8

Diagnosis of Chronic Inflammatory Rhinitis

Answer 8

• Skull radiographs and CT-Scan: No significant findings
• Nasal biopsies: inflammatory cells +++
• Exclusion of Aspergillosis, tumor and foreign body

Question 9

Chronic Rhinitis Treatment

Answer 9

• Effective treatment protocol not established
• Combination of:
• Anti-inflammatory
• Antibiotic
• Antihistamine
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• Corticosteroid
  > Possible immune mediated or allergy cause
  > Variable success with topical or oral steroids, inhalers
  > Side effects with oral form
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• Or NSAIDs
  > May help decrease nasal inflammation
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• Antibiotic
  > Treat secondary infections
  > May help reduce severity of discharge
  > Doxycycline may also have anti-inflammatory benefits
  > Extended or intermittent treatment may be needed
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• Antihistamine
  > Typically poor response
  > Useful if allergies suspected
  > Side effect of drying secretions may exacerbate signs
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• Saline drops
  > Aid in evacuating nasal cavity

Question 10

Chronic Rhinitis Prognosis

Answer 10

• Counsel owner that cure unlikely
• Treatment trials of anti-inflammatories, antibiotics as
  needed, and other agents
• Can be a frustrating disease

Question 11

Feline URT Infections
- causes

Answer 11

Caused by one or more agents:
- Feline herpesvirus-1 (FHV)
- feline calicivirus (FCV)
- Bordetella bronchiseptica
- Chlamydophila felis
- Mycoplasmas, other viruses
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Majority of Infection in Cats
* Feline herpesvirus-1 (FHV)
* Feline calicivirus (FCV)

Question 12

Feline URT Infections
* Initial clinical signs, duration

Answer 12

• Sneezing, ocular & nasal discharge, conjunctivitis
• ± mucopurulent nasal discharge, ocular changes (~ 5 days after onset of sneezing)
• Can persist for 1-3 weeks

Question 13

FHV-1 symptoms

Answer 13

Rhinitis, stomatitis, conjunctivitis, keratitis, facial dermatitis, corneal ulcerations / sequestrae
- eyes

Question 14

FCV symptoms

Answer 14

Rhinitis, stomatitis, oral ulcerations, conjunctivitis, polyarthritis (rare)
- mouth

Question 15

B. bronchiseptica symptoms

Answer 15

Conjunctivitis, mild upper airway signs, pneumonia/severe respiratory disease in conjunction with other agents

Question 16

C. felis symptoms

Answer 16

Conjunctivitis, tracheobronchitis, pneumonia

Question 17

Feline URT Infections diagnosis

Answer 17

• Often presumptive based on history & clinical signs
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• Infectious agent testing PCR, culture * FHV, FCV, Bordetella, C. felis
• Oropharyngeal or ocular swabs

Question 18

Feline URT Infections treatment

Answer 18

• Most cats have self-limiting signs
• Supportive care
  > Maintain hydration & nutrition
• Antiviral agents?
• Antibiotics?

Question 19

Antiviral Agents in URT Infections

Answer 19

• Some studies suggest efficacy in acute FHV infection
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• Famciclovir / trifluridine
• Interferon omega (not in North America)
• L-lysine
  > May reduce severity of ocular signs of FHV when given prior to outbreak
• Need further information from controlled clinical trials

Question 20

Antibiotics in URT Infections

Answer 20

• Most cases do not require antibiotics
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• Indicated if signs of secondary bacterial infection:
• Purulent nasal discharge
• Fever
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• Amoxicillin, Clavamox > Broad spectrum; not effective vs. Mycoplasma
• azithromycin, Doxycycline, Enrofloxacin, Cephalexin

Question 21

Feline URT Infections
* Prevention? spread?

Answer 21

• Viruses spread rapidly among kittens
• Infection results from cat-to-cat contact
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• Chronic carriers common
  > 80% kittens that recover from acute infections become carriers

Question 22

Feline URT Infections
* Vaccination

Answer 22

• FHV & FCV considered “core” for cats
• May decrease severity of infection
• Vaccinated cats can still be carriers and can become infected
• Does not protect against all pathogens in this infectious complex

Question 23

FHV shedding

Answer 23

FHV becomes latent
* Reactivated (stress)
* Intermittent shedding

Question 24

FCV shedding

Answer 24

FCV carriers shed continuously
* Even with no or mild clinical signs

Question 25

Feline URT Infections Prognosis

Answer 25

• Self-limiting infections
• Resolve within 7-14 days
• Recurrence common