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Dermatology (VEM 5387) > Nodules (Marsella) > Flashcards

Nodules (Marsella) Flashcards

1
Q

Nodules

A

Solid elevations that extend deep into the dermal or subcutaneous tissue (inflammatory or neoplastic)

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2
Q

DDX for nodules: Fungal

A
  • Cryptococcus
  • Histoplasma
  • Coccidiodomycosis
  • Sporotrichosis
  • Kerion
  • Mycetoma/pseudomycetoma
  • Phaeohyphomycosis
  • Oomyces (pythiosis)
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3
Q

DDX for nodules: Bacterial

A
  • Deep pyoderma
  • Acral lick dermatitis
  • Cutaneous bacteral granuloma
  • Botryomycosis
  • Abscess
  • Staphylococcus furunculosis
  • Opportunistic/atypical mycobacteria
  • Actinomyces
  • Actinobacillus
  • Leprosy
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4
Q

DDX for nodules: non-infectious/sterile

A
  • Allergy (cats)
    • Eosinophilic granuloma
    • Mosquito hypersensitivity
  • Sterile nodular panniculitis
  • Sterile nodular granuloma/pyogranuloma
  • Plasma cell pododermatitis (cats)
  • Neoplastic
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5
Q

Nodule diagnostic approach

A
  • FNA
  • Biopsy for histopath & culture
  • R/O other infectious causes
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6
Q

Systemic fungal infections

A
  • Cryptococcosis
  • Histoplasmosis
  • Blastomycosis
  • Coccidiodomycosis
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7
Q

Subcutaneous fungal infections

A
  • Sporotrichosis
  • Phaeohyphomycosis
  • Mycetoma
  • Kerion
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8
Q

Sporotrichosis (general info)

A
  • Sporothrix schenckii
  • Thermally dipmorphic (yeast in tissues)
  • In soils and decaying organic matter
  • Spread by inoculation (contaminate wound) or inhalation (rare)
  • ZOONOTIC
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9
Q

Infection of sporotrichosis from cats (to humans)

A
  • Large number of organisms in feline exudate
  • No immune suppression necessary
  • Wear gloves
  • Wash hands in chlorohexidine and povidone iodine
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10
Q

Feline sporotrichosis

A
  • Draining nodules (head, distal limb, tail)
  • Hx of poor response to abx
  • Autoinoculation in other parts by grooming
  • Most cats develop disseminated dz
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11
Q

Sporotrichosis diagnosis

A

Easiery in cats due to large number of organisms

  • Cytology
  • Culture
  • Histopath
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12
Q

Sporotrichosis treatment

A
  • Itraconazole
  • Ketoconazole
  • Iodides
  • Treat at least 1 month past resolution of clinical signs
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13
Q

Iodism

A
  • Oral iodine treatment not tolerated well
  • Vomit, anorexia, depression
  • Twitching, hypothermia
  • Ocular & nasal discharge
  • Dry coat, excessive scaling
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14
Q

Kerion

A
  • Exudative nodular lesions
  • Reaction to dermatophytic infection
    • M. gypseum
    • T. mentagrophytes
    • Furunculosis

(Dermatophytes don’t like to be in dermis, usually die and act as foreign body)

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15
Q

Dermatophytic psuedomycetoma

A
  • Subcutaneous nodules
  • Most common on trunk
  • Frequent ulceration
  • M. canis
  • Persian cats
  • Histopath - pyogranulomatous dermatitis w/ fungal hyphae, tissue grains
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16
Q

Pythiosis (general info)

A
  • “Swamp cancer” (not actual cancer)
  • Fungus/algae-like oomycete
  • Plant parasite
  • Subtopical/tropical areas
  • Infection by contact w/ contaminated water
17
Q

Pythiosis affects what species?

A
  • Humans
  • Dogs (esp. german shepherds, golden retrievers)
  • Horses (not as aggressive as in dogs)
  • Cattle
18
Q

Pythiosis clinical signs

A
  • Rapidly developing nodules & draining tracts
  • Intense pruritis
19
Q

Pythiosis diagnosis

A
  • Cytology - eosinophils, rarely hyphae
  • Biopsy
    • Histopath
      • Nodular to diffuse pyogranulomatous dermatitis
      • “Ghost” hyphae (hard to see)
    • Culture
    • Immunohistochem
20
Q

Pythiosis treatment

A
  • 100% mortality w/ out treatment
  • Response dependent on age of lesions
  • WIDE surgical excision
  • Treat 2º bacterial infections
  • Amphotericin B
  • Itraconazole (synergistic w/ doxy)
  • Terbinafine
  • Hyperbaric chamber
  • Vaccine changes immune response, not preventative
21
Q

Lagenidiosis

A
  • Oomyces
  • Infeciton occurs by contact w/ contaminated water
  • Nodules & draining tracts
22
Q

Zygomycosis

A
  • Caused by fast growing, sapropytic fungi
  • Wound contamination
  • Nodular lesions (pyogranulomatous dermatitis & panniculitis)
  • Clinically indistinguishable from pythiosis
  • Poor prognosis
23
Q

Deep pyoderma

A
  • Furuncolosis
  • Panniculitis
  • Diagnos by clinical signs, cytology, biopsy
  • Tx 2-3 mos of systemic abx
  • ID & corrent underlying dz
24
Q

Acral lick dermatitis presentation

A
  • Raised, ulcerated mass usually on extremities
  • Caused by or worsened by licking
  • Incr. incidence in large breeds
  • Furunculosis
  • Associated w/ 2º infections
25
Q

Possible underlying causes of acral lick dermatitis

A
  • Demodex
  • Dermatophytes
  • Allergies (fleas)
  • Hypothryroidism
  • Pain
26
Q

Acral lick dermatitis diagnosis

A
  • Skin scrape
  • Fungal culture
  • Biopsy - histopath, culture
  • R/O pythium
27
Q

Acral lick dermatitis treatment

A
  • Abx for 6+ wks
  • Tx underlying cause
  • Mechanical devices
  • Topicals
  • Hycodan (narcotic)
  • Naltrexone (narcotic antagonist)
  • Behavior modification
  • Acupuncture
  • Cryosurgery
  • Guarded long term prognosis
28
Q

Opportunistic mycobacteria

A
  • Non-healing wounds
  • Chronic ulcers
  • Draining tracts
  • Lesions in cats often in ventral fat pads
29
Q

Diagnosis of mycobacteria

A
  • Cytology (very few organisms)
  • Biopsy - histopath, culture (may still be false negative)
30
Q

Mycobacteria treatment

A
  • Specific sensitivity testing
  • Fluoroquinolones
  • Doxycycline
  • Clarithromycin
31
Q

Nocardia

A
  • Mimic mycobacteria, but animal is sick, anorexic
  • Culture
  • Tx w/
    • penicillin and sulfa
    • Na iodide
  • Guarded prognosis
32
Q

Sterile nodular panniculitis

A
  • Uncommon
  • Nodules w/ discharge
  • Systemic signs
  • Combo of foreign body & hypersensitivity
  • Associated w/ vax & injections
  • Dachshunds, collies, GSD predisposed
  • R/O infection
33
Q

Sterile pyogranulomas

A
  • Rare
  • Typically solitary lesions, frequently on head
  • R/O infectious causes
  • Immunomodulation successful in some cases

Dermatology (VEM 5387) (17 decks)

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