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Infectious respiratory diseases Flashcards

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1
Q

CIRD = ?

Describe it.

A

Canine infectious respiratory disease
complex

  • CIRD, kennel cough, infectious tracheobronchitis
  • Very common worldwide
  • Highly contagious
  • Most prevalent in dense dog populations
  • Affects larynx, trachea, bronchi, nasal mucosa
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2
Q

CIRD – etiology (5+3)

A

multifactorial

  • Viruses
     Canine parainfluenza virus
     Canine respiratory coronavirus
     Canine adenovirus-2
     Canine herpesvirus
     Canine influenza virus
  • Bacteria
     Bordetella bronchiseptica
     Mycoplasma spp.
     Streptococcus equi sp. zooepidemicus
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3
Q

Which of these CIRD pathogens can be vaccinated against?

  • Viruses
     Canine parainfluenza virus
     Canine respiratory coronavirus
     Canine adenovirus-2
     Canine herpesvirus
     Canine influenza virus
  • Bacteria
     Bordetella bronchiseptica
     Mycoplasma spp.
     Streptococcus equi sp. zooepidemicus
A

parainfluenza
adenovirus
bordetella

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4
Q

CIRD – clinical signs and findings (4)

A
  • Loud and persistent cough
  • Bright, alert, no fever
  • Normal respiratory rate and pattern
  • No crackles or wheezes on auscultation,
    lung sound may be increased
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5
Q

CIRD – diagnostic evaluation

A

Physical exam, no further testing
 Otherwise healthy dog
 Cough but in good condition
 History of Recent exposure to other dogs

Usually is mild and self-limiting disease (< 10 days).

Complications:
 Bacterial pneumonia (especially irish wolfhounds), Bordetella -tracheobronchitis (which can last weeks)

All coughing dogs do not need antibiotic treatment!

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6
Q

CIRD – diagnostic evaluation.
Do further diagnostic testing in which cases?

A

 Febrile, inappetent, lethargic dog
 Concurrent illnesses
 Immunosuppressive medication
 Breed
 History of Long-lasting cough

Do Thoracic radiography, blood work,
bronchoscopy, bacterial culture

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7
Q

Describe Bacterial tracheobronchitis.

A

Occurs in Dogs. Is a Bacterial infection of the airways, but not parenchyma (so not pneumonia). Can be a complication of CIRD.

Most commonly Bordetella bronchiseptica.

You can die of pneumonia but not of tracheobronchitis cause its on the surface of the airways not within the parenchyma.

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8
Q

Bacterial tracheobronchitis presents with (4)

A

Acute or chronic cough
+ bacterial growth in respiratory sample
+ lack of alveolar infiltrates in thoracic radiographs
+ usually no fever or hematological changes

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9
Q

Treatment of Bacterial tracheobronchitis.

A
  • Treatment
     Doxycycline 10-14 days

NB enamel discoloration can occur

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10
Q
A

Left: normal

Right: bacterial pneumonia with inflammatory cell infiltrate

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11
Q

Describe Bacterial pneumonia

A

Bacterial infection of airways and
pulmonary parenchyma.

Also called bronchopneumonia

Is more common in Dogs > cats

A potentially severe systemic infection!
 50-70 % of cases require hospital treatment

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12
Q

Canine bacterial pneumonia - predisposing factors. (9)

A
  • Viral respiratory infections
  • Aspiration
  • Ciliary dyskinesia
  • Neoplasia
  • Trauma, bleeding
  • Smoke inhalation
  • Pulmonary parasites
  • Structural changes
     Tracheal collapse, bronchiectasis,
    bronchoesophageal fistula
  • Immune dysfunction
     Medications, illnesses, primary dysfunction
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13
Q

Bronchiectasis is…

A

a long-term condition where the airways of the lungs become widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection.

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14
Q

mirrored organ syndrome also called

A

Situs inversus

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15
Q

Canine bacterial pneumonia - causative bacteria (4)

A
  • Gram negative rods (40-60% of cases)
     E. coli, Pasteurella spp., Klebsiella spp.
  • Gram positive cocci (5-20% of cases)
     Streptococcus spp., Staphylococcus spp.
  • Bordetella bronchiseptica
     Significant in puppies and young dogs
  • Mycoplasma spp.
     Commonly a co-infection
  • Mixed infection in 10-40% of cases
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16
Q

Canine bacterial pneumonia - typical patient

A
  • Large breed dogs
  • Less than 5 years of age
  • Males overrepresented but we don’t know why
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17
Q

Canine bacterial pneumonia - clinical signs and findings

A

most typical: tachypnea, lethargy, abnormal auscultation

Next,
* Cough
* Fever
* Respiratory distress
* Anorexia
* Nasal discharge
* Weight loss

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18
Q

Irish Wolfhounds are prone to what respiratory disease?

A

immune mediated ciliary deficiency / ciliary dyskinesia / Rhinitis/Bronchopneumonia Syndrome

a rare congenital defect where the ciliary throughout the body do not function properly.

This can cause respiratory issues such as coughing, nasal congestion and exercise intolerance.

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19
Q

Canine bacterial pneumonia
- typical blood work (4+2)

A

Hematology
 Left shift (too many immature in circulation)
 Neutrophilia
 Leukocytosis
 Leukopenia

Hypoxemia common

Elevated C-reactive protein (CRP)

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20
Q

Canine bacterial pneumonia - thoracic radiography findings.

A
  • Most important single diagnostic measure.
  • Typical findings
     Alveolar pattern
     Usually several lung lobes affected
     Cranial and ventral lobes, both sides
  • Take 2-3 views! (VD + 2 x lat)
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21
Q
A

patchy alveolar pattern

only 10% of dogs have this type of change in bacterial pneumonia

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22
Q

Canine bacterial pneumonia - respiratory sample

Study These Flashcards
A
  • Sampling, yes or no?
     Antibiotic selection according to susceptibility
     Bacterial culture takes time
     Samples do not always grow
     Bronchoalveolar lavage vs. transtracheal wash
     Consider sampling at least in recurrent infections
  • Neutrophilic inflammation
     Possibly intracellular bacteria
23
Q

Canine bacterial pneumonia - antibiotic treatment.

Study These Flashcards
A

Antibiotics
 Mild pneumonia
 Doxycycline (not when liver disease! cause elevation of liver values) / TMS / amoxicillin-clavulanate po

Pneumonia in a dog less than 1 year of age
 Doxycycline

Severe pneumonia
 Ampicillin + enrofloxacin iv

Treatment length? Is debatable.
 Conventional treatment Continue 1-2 weeks after resolution of radiographic findings so up to ~4-6 weeks.

Or CRP-guided therapy
 Continue 5-7 days after CRP normalization
 ~3 weeks

24
Q

Canine bacterial pneumonia
- treatment other than AB.

Study These Flashcards
A

 Supplemental oxygen
 Fluid therapy iv!

 Gastric acid blockers if severely hypoxemic
 Couppage q 4-6 h

 No NSAIDs! (not if they have endotoxemic shock, too much for the kidneys)

25
Canine bacterial pneumonia - what NOT to give as treatment
 No cough suppressants  No NSAIDs  No conventional-dose furosemide
26
Describe Feline bacterial pneumonia
* Less common than in dogs * Less well documented * No breed predisposition * Likely underdiagnosed? Can be tricky to diagnose!
27
Feline bacterial pneumonia - signs and findings.
* Clinical signs  Depression, anorexia, cough, respiratory distress, tachypnea, weight loss, nasal discharge, fever * Clinical findings  Abnormal auscultation  Wheezes, crackles, increased or decreased lung sounds  Dyspnea, tachypnea, abnormal respiratory pattern Feline bacterial pneumonia can be chronic and mimic inflammatory airway disease!
28
Feline bacterial pneumonia - diagnosis
* Hematology can be normal  Leukocytosis  Leukopenia and left shift uncommon SAA can be elevated in acute cases but also can be normal. But you should do SAA anyway. * Thoracic radiography (min. 2 views!)  Any pattern is possible!  Often alveolar changes  Interstitial, bronchial pattern  Can be normal * Respiratory sample? Can be challenging in cats.
29
Feline bacterial pneumonia - etiology
* Predisposing cause?  Viral upper respiratory tract infection  Retrovirus infection (FIV,FeLV)  Immunosuppressive medication  Foreign body  Aspiration  Environmental conditions
30
Feline bacterial pneumonia - possible bacteria (5)
* Mycoplasma spp. * Pasteurella spp. * Bordetella bronchiseptica * Streptococcus spp., Staphylococcus spp. * E. coli
31
Feline bacterial pneumonia - treatment
* Antibiotics  Ideally selected on basis of bacterial culture and antibiotic sensitivity testing  Choice Depending on the severity of the disease Mild disease – PO treatment  Doxycycline, amoxicillin-clavulanate +/- enro/pradofloxacin Severe pneumonia, sepsis – iv treatment  Ampicillin iv + enrofloxacin iv + Supportive treatment
32
Aspiration pneumonia
* Inhalation of materials to the lower respiratory tract. * Chemical damage leading to Inflammation and edema leading to Secondary bacterial infection * More common in dogs than in cats
33
Diagnosis of Aspiration pneumonia
 Anamnesis, physical exam, radiography Xray: Cranioventral parts of cranial and middle lung lobes. Right middle lung lobe typical.
34
Treatment of Aspiration pneumonia
 Supportive treatment such as in bacterial pneumonia  Amoxicillin-clavulanate
35
FURTD = ? Agents? (5)
Feline upper respiratory tract disease * Worldwide distribution despite vaccinations * Problem in multi-cat households * Young, old, otherwise sick cats * Causative agents  Feline calicivirus  Feline herpesvirus  Bordetella bronchiseptica  Chlamydia felis  (Mycoplasma felis?)
36
FURTD – epidemiology
Transmission  Direct contact  Through fomites  Aerosol herpes & calici viruses (can also include chlamydia bact.) Clinically recovered carrier cats:  Fe herpes virus leads to a lifelong latent infection which can be reactivated  Feline calici virus carriers shed virus continuously
37
FURTD – clinical signs
Nasal and ocular discharge, conjunctivitis should self-resolve in 1-2 weeks unless complications. Calicivirus  Oral ulceration  Hypervirulent strains Herpesvirus  Ulcerative keratitis, sometimes coughing and systemic disease Image: left is calici, right is herpes
38
FURTD – clinical signs of Chlamydia felis (bacteria)
 More an ocular than a respiratory pathogen!  Acute and chronic conjunctivitis, ocular ulceration uncommon.
39
How to differentiate herpes and calici?
Calicivirus causes ulcers in the mouth. Herpesvirus causes ulcers in the eyes.
40
FURTD - diagnosis
In practice, Based on Typical clinical signs and course of disease.  Usually self-limiting in a week * What is the causative agent?  Important in cat shelter/cattery outbreaks. Use RT-PCR. Sample by Nasal swab or swab from conjunctival sack or oropharynx. False negative and false positive results can occur.
41
FURTD - treatment
* Supportive therapy * Antibiotics only in more severe cases  Consider if you could have Bordetella? Mycoplasma?  Choose Doxycycline, amoxicillin clavulanate, pradofloxacin but not all of these have efficacy against mycoplasma. * Antiviral treatment in severe or chronic herpes infections (famciclovir/famvir) * Oral L-lysine for herpes infection can be tried (flumax). * Prevention by vaccination and management measures.
42
Name Respiratory parasites
* Non-lungworms  Pulmonary migration of intestinal worms e.g. Toxocara, Ancylostoma  Usually few symptoms * Lungworms  Final destination the airways, pulmonary parenchyma or both e.g. crenosoma vulpis, filaroides osleri/oslerus osleri, capillaria aerophila, aelurostrongylus abstrusus (cat lungworm) etc. Resp parasite Infection can easily be confused with other respiratory disease!
43
Diagnosis of Respiratory parasites
Baermann sedimentation and flotation from feces. Due to Intermittent shedding, 3-day sample! (even when its respiratory parasites - you need both baerman and flotation) Blood test also possible for specifically Angiostrongylus vasorum (french heartworm) (Immunochromatography, ELISA, PCR) and dirofilaria with 4Dx.
44
Describe Crenosoma vulpis (only dogs)
 Indirect transmission after ingesting a snail or slug.  Matures in the bronchi and bronchioles  Subclinical infection, cough, nasal discharge  Larvae in fecal or BAL Baermann test so order both flotation and baermann.  Treat with Fenbendazole 50mg/kg daily 3 days, moxidectin, ivermectin, milbemycin oxime
45
In chronically coughing dogs, what parasite should you rule out first?
crenosoma vulpis / french heartworm
46
Describe Oslerus osleri (Filaroides osleri)
 Direct transmission  Causes Granulomatous nodules to distal trachea and proximal bronchi  Subclinical infection, cough, respiratory distress, pneumothorax  Nodules at carina  Fenbendazole, moxidectin?, ivermectin?
47
Describe Eucoleus aerophilus (Capillaria aerophila) (in both dogs and cats)
 Transmission from Ingesting eggs or earthworms  Infects airway mucosa and becomes embedded  Subclinical infection, chronic cough, respiratory distress. Can cause Eosinophilic bronchitis.  Fecal flotation better than Baermann in this case. But false negatives can occur so deworm anyway.  Fenbedazole 50mg/kg daily 10-14 days, ivermectin, maybe moxidectin too. NB long AB course
48
Describe Aelurostrongylus abstrusus (affects cats)
 Common feline lungworm  Transmission by Ingestion of an intermediate host (snail, slug) or a bird or rodent which has ingested it.  Adult worms reside in terminal bronchioles and alveolar ducts.  Cough, wheezing, respiratory distress, even death  Mimics asthma!  Larvae in feces (Baermann) or BAL  Fenbendazole 50mg/kg daily 10-14 days, ivermectin, selamectin NB long AB course
49
Describe Filaroides hirthi and milksi (dogs)
A type of filaroides, canine lungworm  Feco-oral transmission  Reside in the alveolar space and terminal bronchioles  Subclinical infection, cough, respiratory distress, even death  Larvae in feces (Baermann) or BAL  Fenbendazole 50mg/kg 10-14 days, ivermectin
50
Describe Paragonimus kellicotti (dogs and cats)
 Lung fluke  Indirect infection after eating crayfish  Migration from intestines into pleural space and pulmonary parenchyma  Subclinical infection, cough, respiratory distress, pneumothorax  Eggs in feces or BAL (sedimentation)  Praziquantel 25 mg/kg q 8h for 3 days, fenbendazole
51
Describe Angiostrongylus vasorum (dogs)
 French heart worm  Indirect infection after eating snails, slugs, frogs etc.  Mature parasites reside in pulmonary artery, right heart and pulmonary arterioles  Causes cardiopulmonary symptoms, systemic bleeding  Anemia, eosinophilia, thrombocytopenia, hypercalcemia  Fecal Baermann sedimentation, BAL, ELISA from blood  Fenbendazole 25-50 mg/kg daily for 10-20 days, ivermectin, milbemycin oxime, imidacloprid/moxidectin spot-on, levamisole
52
Angiostrongylus vasorum vs. Dirofilaria immitis predilection site? size? transmission? migration?
Both parasites reside in the right heart and pulmonary arteries. Dirofilaria can grow up to 30 cm and Angiostrongylus only up to 1 inch. Differences in Transmission:  Av: Eating slug, snail, frog containing infective larvae  Di: Transmitted by a bite of a mosquito containing infective larvae Migration:  Av travels through the gut wall – liver – liver vasculature to right heart and pulmonary arteries, L1 penetrate bronchial and alveolar walls, are coughed up and ingested and passed out in feces.  Di travels in SC tissue and ends up pulmonary arteries and right heart.
52
Differences in Diagnosis of dirofilaria vs angiostrongylus.
 Av: Fecal Baermann, BAL, ELISA from blood  Di: IDEXX Snapp 4Dx ELISA for adult heart worm and modified Knott's test or PCR for microfilaria
53
Differences in treatment of dirofilaria vs angiostrongylus.
 Av: Fenbendazole 25-50 mg/kg daily for 10-20 days, ivermectin, milbemycin oxime, imidacloprid/moxidectin spot-on, levamisole  Di: From the American heart worm association: Monthly administration of macrocyclic lactones (e.g., ivermectin, milbemycin) to kill microfilariae and inhibit the maturation of new larvae. Administering doxycycline (10 mg/kg twice daily for 4 weeks) to target Wolbachia bacteria, an endosymbiont crucial to the survival of heartworms. Reducing Wolbachia weakens heartworms and reduces inflammatory responses. Adulticide Therapy: a three-dose protocol using melarsomine dihydrochloride. First injection is followed one month later by two more injections given 24 hours apart. This regimen is preferred over the two-dose protocol due to its greater safety and efficacy.

Small animal internal medicine (31 decks)

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