Upper Respiratory Disease: nasal passage Flashcards
1
Q
describe common clinical exam findings for nasal disease
A
- sneezing:
-paroxysmal
-intermittent
-reverse sneeze: indicates irritation to nasopharyngeal mucosa - nasal discharge:
-symmetry
-character
-onset/duration
-progression
-inciting causes or triggers - stertor
- other:
-reduced appetite: esp cats
-dysphagia
-pawing/rubbing face
-masses/facial distortion
-nasal planum ulceration
-seizures
2
Q
describe physical exam for nasal disease
A
- open mouth: check for masses, etc.
- ocular retropulsion (gentle)
- checking nasal patency
3
Q
give differentials for unilateral nasal discharge
A
- neoplasia
- tooth root abscess
- foreign body
- fungal
- trauma
4
Q
give differentials for bilateral nasal discharge
A
- inflammatory rhinitis
- systemic disease:
-hypertension
-coagulopathy - infectious:
-secondary bacterial
-viral - highly erosive disease
-neoplasia
-fungal (aspergillus, crypto) - severe trauma
5
Q
describe the confusion between unilateral and bilateral nasal discharge
A
- unilateral disease that is very caudal could appear bilateral from discharge looping around the back of the nasal septum or refluxing up the contralateral nasal choanae
- unilateral discharge can BECOME bilateral if the disease process erodes through the nasal septum
6
Q
describe serous/serosanguineous nasal discharge
A
- most nasal discharge starts out serous
- often associated with:
-viral, allergic, or inflammatory rhinitis
-early sign of fluid overload - sanguineous usually indicates
-disease progression
-chronic mucosal irritation
-mucosal erosion/destruction
7
Q
describe mucopurulent/mucoid nasal discharge
A
- often indicated SECONDARY bacterial infection
-primary nasal bacterial infections = VERY RARE - chronic inflammation (increased mucus production)
- puppy? have DISTEMPER on the differential list!!!
- sometimes an early indicator of developing pneumonia
8
Q
describe nasal discharge progression
A
- most start out serous
- often progresses to serosanguinous
-chronic mucosal irritation and inflammation
-mucosal erosion - may become mucoid to mucopurulent
-chronic inflammation +/- secondary bacterial infection from impaired host defenses!
not worth culturing, going to get a mixture of bacteria (duh)
9
Q
describe hemorrhagic nasal discharge (epistaxis)
A
- erosive diseases:
-neoplasia
-fungal: aspergillosis - trauma
- look for signs of systemic disease!
-coagulopathy: inherited v. acquired
-platelet disorder: thrombocytopenia (rickettsial vs. immune-mediated), thrombocytopathia
-hypertension
-vasculitis
-hyperviscosity syndrome
10
Q
describe lymphoplasmacytic rhinitis
A
- immune-mediated disease
- cause unknown, likely multifactorial
-aberrant immune response: dysfunctional PRRs?
-chronic exposure to allergens, irritants, infection? seasonal allergies, previous feline herpes virus
-hypersensitivity manifestation: environmental, commensal fungi? extension of atopy, IBD? - signalment:
-usually middle-aged dogs and cats
-dolichocephalic over-represented: dachshunds - clinical signs:
-chronic BILATERAL nasal discharge: commonly serous to mucoid
-nasal congestion (stertor)
- +/- open mouthed breathing
- +/- sneezing
-cats: reduced appetite
11
Q
describe diagnosis of lymphoplasmacytic rhinitis
A
- diagnosis of exclusion!
-rule out other diseases/triggers! - definitive diagnosis:
-CT: thickened turbinates, fluid
-rhinoscopy: mucus, hyperemia
-nasal biopsy + histopathology - concern for secondary bacterial infection
-significant mucopurulent nasal discharge
-LP and neutrophilic inflammation on histopath
-culture biopsied piece of nasal TISSUE (not discharge); should only culture one organism (if getting more than one, probs contamination)
-CHECK THAT THE PATIENT CAN CLOT BEFORE BIOPSY!!! (check PT/PTT)
12
Q
describe treatment of lymphoplasmacytic rhinitis
A
- difficult to manage
-NOT GOING TO CURE so set client expectations
-goal: improved clinical signs - various treatment protocols:
-antihistamines: RARELY helpful unless see eosinophilic inflammation on biopsy
-anti-inflammatories
-immunosuppression
-immune modulation
- +/- antibiotics for secondary infections
13
Q
describe treatment protocols of lymphoplasmacytic rhinitis
A
- glucocorticoids
-oral prednisone/prednisolone: anti-inflammatory dose, immunosuppression (can give either?)
-dogs: maybe helpful
-cats: often works well
-if + response to oral steroids, consider
-inhaled or topical to avoid longterm oral steroids - NSAID + antibiotic:
-dogs: doxycycline + piroxicam or meloxicam (decently good success in dogs)
-cats: azithromycin + meloxicam - immunosuppression: cyclosporine, chlorambucil, radiation therapy
- immunomodulation:
-hypoallergenic diet?
-fish oil supplementation
-allergy shots?
-dilute cerenia? probs more placebo effect than anything else - other considerations:
-treat secondary infections if present, ideally based on culture and sensitivity - environment modification:
-humidification
-TRIGGER AVOIDANCE: cigarette smoke, perfumes, cleaners/air fresheners, dusty litter
14
Q
describe fungal rhinitis- cryptococcus neoformans
A
- worldwide distribution; found in pigeon poop
- cats:
-nasal (granuloma)
-cutaneous
-systemic - dogs: rare
-CNS
-disseminated - clinical signs:
-roman nose
-mucopurulent +/- hemorrhagic nasal discharge
-sneezing
15
Q
describe cyrptococcus diagnosis and treatment
A
- cytology of nasal discharge
-yeast with THICK non-staining capsule - serum latex agglutination (SLA) titer
-detects capsule ANTIGEN - treatment:
- +/- surgical debulking
-oral anti-fungal therapy:
–intra- or fluconazole
–if severe disease or CNS involvement, amphotericin B
-treatment time up to 6 months, monitor SLA titer (ideally treat until negative)
16
Q
describe aspergillus fumigatus
A
- sino-nasal disease of dogs
-often unilateral mucoid discharge, but can be hemorrhagic, epistaxis
- +/- planum depigmentation - german shepherds!!! rottweilers!
- cats: sino-orbital disease
17
Q
describe aspergllosis diagnosis
A
- nasal CT:
-loss of nasal turbinates
-fluid/debris in nose, sinuses
- +/- bone destruction
–orbital bones, palate, frontal sinus, cribriform (invading CNS)
–bc immune response to aspergillosis is highly destructive and erosive - rhinoscopy:
-visualize plaque: white, grey, necrotic, can look metallic
-cytology +/- fungal culture
18
Q
describe aspergillosis treatment
A
- if isolated to nasal passages
-plaque debulking followed by
-topical 1% clotrimazole: 1 tx = 80-85% success, 2 tx = >90% success
-keep treating until negative culture - if infiltrated beyond nose into CNS
-topical clotrimazole cream: CAUTION with liquid formulations
-oral antifungals:
–itraconazole + terbinafine, unlikely to successfully clear alone
19
Q
describe feline upper respiratory disease complex
A
- viral:
-feline herpesvirus-1
-feline calcivirus - bacterial:
-mycoplasma species
-bordetella bronchiseptica
-chlamydia felis - primary infections: most commonly VIRAL (>80% of cases)
-co-infections common: increase disease severity, most are opportunistic - secondary infections: most commonly bacterial; not present in every case
-strep, staph, pasteruella, E. coli - often causes:
-mucopurulent discharge
-systemic signs/illness: patient feels bad, fever, tachypnea, etc.
20
Q
describe pathogen generalities of feline upper respiratory complex
A
- pathogen shedding:
-oro-nasal and oral secretions - transmission:
-close/direct contact: mutual grooming, overcrowding
-fomites: bowls, cages, toys, YOU
- +/- aerosolization: over 4 feet - high morbidity, low mortality
21
Q
describe general clinical signs of URTI
A
- oculo-nasal discharge: serous to mucopurulent
- squinting
- sneezing
- stertor: nasal congestion
- +/- systemic illness
- +/- lower airway signs
- +/- death (kittens or older cats)
- facial deformity
- congested meow
22
Q
describe feline herpesvirus-1 (FHV-1)
A
- feline viral rhinotracheitis (FVR)
- large enveloped dsDNA alphaherpesvirus
-strain variation minimal
-similar to virus of dogs and seals
-fragile outside host so easily disinfected - most cats are exposed during their lifetime but exposure DOES NOT EQUAL INFECTION
- can cause URTI, dendritic ulcer (harry potter lightning bolt in eye), and ulcerative, eosinophilic dermatitis
23
Q
describe feline calicivirus
A
- small, unenveloped ssRNA
- survives outside host for prolonged periods
- at leasy 30 days, resists routine disinfection - following infection:
-shed continuously for 1-2 months and less than 10% become chronic carriers and shed for life - causes URTI +/- ulcerations
-tongue, lips, nasal planum
-lameness reported - virulent, systemic FCV
-unique, uncommon FCV strain
-highly pathogenic
-high mortality (over 50%)
24
Q
describe chlamydia felis
A
- obligate intracellular bacteria
-primitive class of bacteria, resembles gram (-)
-lack essential metabolic pathways - most common in young cats
-2-12 months of age - includes only conjunctivitis
-acute, chronic, or recurrent disease
- +/- chemosis, blepharospasm
25
Q
describe other pathogenic causes of feline URTI
A
- bordetella bronchiseptica
- gram negative aerobic coccobacillus - mycoplasma species
-fastidious organism (lacks cell wall) - most commonly part of a co-infection
-opportunistic
-lower resp signs»_space;> URTI
-rarely causes cough in cats
26
Q
describe URTI diagnosis
A
- history of known exposure
- clinical signs and exam:
-remember unique associations
-lightning bolt corneal ulcer: herpes
-coughing dog at home: bordetella
-conjuntivitis only: chlamydia
-URTI + multi-systemic illness: FCV - +/- organism ID
-PCR
-oronasal +/- conjunctival swabs
27
Q
describe viral URTI management
A
- stress avoidance
- relative isolation
- supportive care:
-partial anorexia: warm smelly food, clean nose
-systemically ill: fluids and nutritional support, treat secondary infections - antibiotics
-viral infections are most common! but may have secondary bacterial infections - oral targeted therapies:
-leucine
-famciclovir - FVRCP vaccine:
-not 100% protective but does reduce disease severity and duration
28
Q
describe nasopharyngeal polyps
A
- young cats!! most commonly less than 1 year; cause unknown
- clinical signs:
-stertor
-nasal discharge: bilateral, mucoid
-dysphagia: +/- regurgitation
-meow change
-+/- vestibular signs - diagnosis:
-visualize polyp under anesthesia or heavy sedation, using a spay hook to pull the soft palate rostrally - treatment:
-traction avulsion (grab and rip)
-clamp the base/stalk of the polyp, once clamped, first push INTO the mouth to rip the stalk
-aural removal more successful than nasopharyngeal
-post-removal glucocorticoids: prednisolone, associated with reduced risk of recurrence
-recurrence reported from 19 days up to 9 months post removal - horner’s syndrome! loss of sympathetic innervation to the eye
-miosis
-ptosis
-third eyelid elevation
-enophthalmos
-induced by polyp removal in 43%, typically resolves 1-4 weeks following removal
