Flashcards in Diseases of the nasal cavity Deck (49)
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1
What are the clinical signs associated with nasal disease?
- Nasal discharge
- Sneezing
- Pawing at face/pain
- Resiratory difficulty on inspiration
- Stertor--noisy respiration (blockage)
2
Nasal discharge: what should we consider
Signalment?
History and PE findings?
- Signalment
- Age--young vs. old
- Breed--dolichocephalic and brachycephalic
- History and physical exam findings
- Character of discharge--unilateral vs. bilateral, serous, mucoid, purulent, hemorrhagic
- Facial symmetry/asymmetry (soft vs. firm)
- Dental disease--always check
- Depigmentation of nasal area (ex: aspergillosis)
- Local lymph nodes
- Oropharyngeal examination and otic examination--when polyp is suspected
- Ocular examination--ocular retropulsion
- Age--young vs. old
- Breed--dolichocephalic and brachycephalic
- Character of discharge--unilateral vs. bilateral, serous, mucoid, purulent, hemorrhagic
- Facial symmetry/asymmetry (soft vs. firm)
- Dental disease--always check
- Depigmentation of nasal area (ex: aspergillosis)
- Local lymph nodes
- Oropharyngeal examination and otic examination--when polyp is suspected
- Ocular examination--ocular retropulsion
3
Nasal discharge: what should we consider
Advanced clinical tests?
- Bloodwork (make sure animal can clot)
- Imaging
- Rads (not usually helpful)
- CT/MRI
- Endoscopy--rhinoscopy
- Cytology/biopsy/culture and sensitivity
- Serology titres and PCR--infectious diseases
- Rads (not usually helpful)
- CT/MRI
4
Nasal discharge--differential list?
- Neoplasia--important in dogs
- Rhinitis--important in cats
- Infectious
- Fungal, viral (feline upper respiratory disease complex), bacterial, parasitic
- Inflammatory
- Lymphocytic/plasmacytic
- Nasal foreign body
- Dental disease/oronasal fistulas
- Trauma
- Congenital
- Ciliary dyskinesia
- Nasopharyngeal stenosis
- Systemic disorder
- Coagulopathy
- Pneumonia (occasionally)
- Infectious
- Fungal, viral (feline upper respiratory disease complex), bacterial, parasitic
- Inflammatory
- Lymphocytic/plasmacytic
- Ciliary dyskinesia
- Nasopharyngeal stenosis
- Coagulopathy
- Pneumonia (occasionally)
5
Nasal foreign bodies
History
- Sudden onset
- Acute sneezing
- Gagging/reverse sneezing
- Pawing at nose
- Discharge--serous to mucoid purulent (won't show immediately)
6
Nasal foreign bodies
Diagnostic/therapy
- Rads--only good for radiodense material
- CT/MRI
- Rhinoscopy (endoscope vs. otoscope)
- Remember to examine caudal nasopharynx
- Nasal flush
- Alligator forceps/biopsy
- Cytology of discharge (rule out other dz)
- Culture/sensitivity (usually unnecessary)
- Explorative sx (unlikely)
- Remember to examine caudal nasopharynx
7
Infectious rhinitis--feline upper respiratory disease complex
Potential infectious agents?
- 90% of cases
- Feline herpes virus
- Feline calicivirus
- 10% of cases
- Chlamydophila felis
- Mycoplasma spp
- Coronavirus
- Bordetella spp
- Feline herpes virus
- Feline calicivirus
- Chlamydophila felis
- Mycoplasma spp
- Coronavirus
- Bordetella spp
8
Infectious rhinitis--feline upper resp. disease complex
Clinical signs
- Similar for all agents
- Differences include:
- Herpes virus
- Ulcerative keratitis
- Punctate or dendritic ulcers
- Calicivirus
- Ulcers on nose, tongue, hart palate
- Pneumonia
- Lameness
- Chlamydophila felis
- Conjunctivitis w/ chemosis
- Carrier states w/ all
- Herpes virus shed during stress
- Calicivirus and chlamydophila can be shed w/ or w/o stress
- Herpes virus
- Ulcerative keratitis
- Punctate or dendritic ulcers
- Calicivirus
- Ulcers on nose, tongue, hart palate
- Pneumonia
- Lameness
- Chlamydophila felis
- Conjunctivitis w/ chemosis
- Carrier states w/ all
- Herpes virus shed during stress
- Calicivirus and chlamydophila can be shed w/ or w/o stress
9
Feline herpes virus--rhinotracheitis
Spread?
Shed?
Disease?
Latency?
Diagnosis?
- Spread--direct contact, fomites
- Shed in ocular, nasal, pharyngeal secretions
- Nasal disease--serous then mucopurulent due to secondary bac. infection
- Establishes lifelong latency--esp. trigeminal nerve ganglia
- Diagnosis--clinical signs, viral isolation, PCR
10
Feline herpes virus--rhinotracheitis
Sequelae?
- Chronic rhinitis/sinusitis--feline chronic rhinosinusitis
- Short nosed breeds
- Turbinate damage predisposes to secondary bac. infections of the nasal cavity--chronic snuffler
- Chronic conjunctivitis
- Fibrosis of lacrimal ducts--epiphora
- Short nosed breeds
- Turbinate damage predisposes to secondary bac. infections of the nasal cavity--chronic snuffler
80% of recovered cats become carriers and shed when stressed
11
Feline herpes virus--rhinotracheitis
Transmission cycle?
12
Feline herpes virus
Treatment
- Topical antivirals for ocular disease
- Idoxuridine, trifluridine, cidofovir
- Oral antivirals
- Famciclovir, acyclovir
- Supportive care
- Antibiotics for secondary bac. infection
- Fluid therapy if required
- Humidify environment
- Nasal decongestant
- L-lysine?
- Not effective, but >80% of vets use it--DON'T USE
- Idoxuridine, trifluridine, cidofovir
- Famciclovir, acyclovir
- Antibiotics for secondary bac. infection
- Fluid therapy if required
- Humidify environment
- Nasal decongestant
- L-lysine?
- Not effective, but >80% of vets use it--DON'T USE
13
Feline herpes virus
Vaccine
- Does not prevent infection
- Does reduce severity
- Parental or intra-nasal
- Parental--blocked by maternal antibodies, does not prevent a carrier state
- Intranasal--useful in outbreaks, not blocked by maternal antibodies
- Post-vaccine sneezing common
- May prevent a carrier state
- Shed
- Parental--blocked by maternal antibodies, does not prevent a carrier state
- Intranasal--useful in outbreaks, not blocked by maternal antibodies
- Post-vaccine sneezing common
- May prevent a carrier state
- Shed
14
Feline calicivirus (FCV)
Survival?
Resistance?
Mutation rates?
Isolates?
Transmission?
Incubation period?
- Longer survival in the environment
- Can be resistant to routine disinfectants
- High mutation rate--new strains always being produced w/ no cross-protection from vaccines or other strains (RNA virus)
- Many isolates--various antigenic and pathogenic types
- Direct transmission or via fomites
- Incubation period short: 2-4 days
15
Feline calicivirus
Transmission cycle?
16
Feline calicivirus
Clinical signs?
Difference from feline herpes virus?
Shedding?
- Clinical signs
- Typical signs for feline viral rhinotracheitis
- Oral and nare ulcers are common
- FCV vs. FHV
- Pneumonia more common w/ FCV
- FCV can result in GI signs
- FCV can cause lameness
- 50% of infected cats will shed the virus at 75 days post-infection; don't need stress to shed the virus
- Typical signs for feline viral rhinotracheitis
- Oral and nare ulcers are common
- Pneumonia more common w/ FCV
- FCV can result in GI signs
- FCV can cause lameness
17
18
Feline calicivirus
2 other syndromes associated w/ FCV?
- Limping kitten syndrome
- Lameness, ulcers on paws, sore joints, polyarthritis
- Virulent hemorrhagic systemic syndrome
- Outbreak in 2000, group of housed cats
- Affected even well-vaccinated cats, the traditional vaccine did not protect the cats from this variant
- Upper resp signs preceded systemic signs
- Edema, hepatitis, diarrhea, pustular dermatitis, hemorrhagic cystitis found
- 40-60% mortality w/ this strain
- Lameness, ulcers on paws, sore joints, polyarthritis
- Outbreak in 2000, group of housed cats
- Affected even well-vaccinated cats, the traditional vaccine did not protect the cats from this variant
- Upper resp signs preceded systemic signs
- Edema, hepatitis, diarrhea, pustular dermatitis, hemorrhagic cystitis found
- 40-60% mortality w/ this strain
19
Feline calicivirus
Treatment
Sequelae
- Treatment
- Largely supportive
- Antibiotics
- Nursing care/rehydration
- Interferon may be effective
- Sequelae
- Chronic rhinitis/sinusitis/conjunctivitis
- Carrier state
- Largely supportive
- Antibiotics
- Nursing care/rehydration
- Interferon may be effective
- Chronic rhinitis/sinusitis/conjunctivitis
- Carrier state
20
Chlamydophila felis
Bac. type
Clinical signs
Diagnosis
- Intracellular bacteria
- Clinical signs are similar to FHV and FCV
- Conjunctivitis and chemosis are hallmark signs
- Diagnosis
- PCR--swab from conjunctiva, nares, or oropharynx
- Cytology--conjuntival swab--intracytoplasma inclusion
- Conjunctivitis and chemosis are hallmark signs
- PCR--swab from conjunctiva, nares, or oropharynx
- Cytology--conjuntival swab--intracytoplasma inclusion
21
Chlamydophila felis
Treatment?
Prevention?
- Treatment
- Topical tetracyclines or erythromycin
- Systemic signs require oral doxycycline and azithromycin
- Prevention
- Vaccination (not a core vaccine)
- Vaccination is more reactive than other antigens
- Topical tetracyclines or erythromycin
- Systemic signs require oral doxycycline and azithromycin
- Vaccination (not a core vaccine)
- Vaccination is more reactive than other antigens
22
Overview of treatment for cat flu (11 steps)
- Outpatient treatment if possible--or isolation
- Keep warm and hydrated
- Remove crusts from nose and eyes, use saline nasal drops
- Humidify air--steam vs. nebulization
- Topical decongestants for 1-2 days
- Pseudoephedrine, phenylephrine (preferred), oxymetazoline
- Systemic antibiotics for secondary bac. infection
- Enrofloxacin, azithrymycin, amoxicillin, clavulanic acid, doxycycline, marbofloxacin?
- Topical opthalmic solutions--antiviral? Antibac? Or both
- Interferon
- Oral antiviral?
- Lysine? Does it work in FHV?
- Anti-inflammatories--steroid vs. non-steroidal (piroxicam) for a few days
- Pseudoephedrine, phenylephrine (preferred), oxymetazoline
- Enrofloxacin, azithrymycin, amoxicillin, clavulanic acid, doxycycline, marbofloxacin?
23
Bacterial rhinitis
Primary disease process?
Discharge?
Antibiotics response?
Usually what?
- VERY RARELY primary disease process
- Mucopurulent to purulent nasal discharge
- Transient response to antibiotics
- Usually secondary to an underlying disease process
- Foreign body?
- Tooth root abscess?
- Chronic viral infection?
- Fungal infection?
- Neoplasia?
- Foreign body?
- Tooth root abscess?
- Chronic viral infection?
- Fungal infection?
- Neoplasia?
24
Fungal rhinitis
Organism?
- Dogs--predominantly Aspergillus fumigatus
-
Worldwide distribution
- Dessiminated disease in dogs often involved A. terreus, A. deflectus, or A. niger
- Cats and dogs--Cryptococcus neoformans var. neoformans
- Often found in avian droppings/fowl manure (esp. pigeons)
-
C. neoformans var. gatii found in specific eucalyptus trees
- Worldwide distribution
- Dessiminated disease in dogs often involved A. terreus, A. deflectus, or A. niger
- Often found in avian droppings/fowl manure (esp. pigeons)
- C. neoformans var. gatii found in specific eucalyptus trees
25
Nasal aspergillosis--dog
Clinical signs?
- Sneezing, uni/bi nasal discharge
- Nasal ulceration and depigmentation
- +/- facial distortion
- Nasal airflow usually ok; turbinate destruction (compare to neoplasia)
- Most cases systemically ok
26
Nasal aspergillosis--dog
Cribiform plate invasion--tests
- Imaging--do before rhinoscopy or nasal flush
- Rads--can't distinguish between fungal rhinitis or neoplasia
- CT or MRI--more helpful than rads
- Rhinoscopy--white plaques
- Tissue biopsy/cytology--hyphae
- C/S--best done from plaque, not discharge
27
Nasal aspergillosis--dog
Treatment
- Debridement
- Break off plaques, soak in nose to treat nasal passage
- Can drill hole in frontal sinus to aid in location of plaques
- Be careful not to damage cribiform plate
- Infuse 1% clotrimazole or 2% eniloconazole into nasal cavity for 1hr
- Rotate nose around--turn 90o every 15 min
- Risks: aspiration pneumonia (severe irritant), neuro signs (damaged cribiform plate--contraindication)
- Reeat procedure every 4wks, repeat rhinoscopy, remove any plaques and repeat soak if required
- Systemic antifungal medication
- Can use in cases of osteolysis arounf cribiform plate
- Get a fungal sensitivity
- Itraconazole, posaconazole, voriconazole (last 2 $$$)
- Break off plaques, soak in nose to treat nasal passage
- Can drill hole in frontal sinus to aid in location of plaques
- Be careful not to damage cribiform plate
- Rotate nose around--turn 90o every 15 min
- Risks: aspiration pneumonia (severe irritant), neuro signs (damaged cribiform plate--contraindication)
- Reeat procedure every 4wks, repeat rhinoscopy, remove any plaques and repeat soak if required
- Can use in cases of osteolysis arounf cribiform plate
- Get a fungal sensitivity
- Itraconazole, posaconazole, voriconazole (last 2 $$$)
28
Nasal aspergillosis--dog
When is it better to NOT do nasal flushes?
When there is osteolysis
29
Fungal rhinitis--overview
Dogs: Aspergillosis
- Dolichocephalics, young adults
- Unilateral nasal discharge may become bilateral
- 20% chance of seeing hyphae on cytology of d/c
- White plaque on rhinoscopy
- Antibody titer not reliable
- C/S: from plaque, not discharge
- Rule out neoplasia: biopsy
- Clotrimazole locally
30
Fungal rhinitis--overview
Cats and sometimes dogs: cryptococcosis
