SA Upper Respiratory Diseases (above oropharynx)

Question 1

disease localization to nose/nasopharynx

(cranial to oropharynx)

Answer 1

• stertor
• nasal discharge
• sneezing
• open mouth breathing
• …

Question 2

epidemiology of feline URI

Answer 2

• common
• several infectious agents involved
• contact transmission
  
  • actively infected cats, carriers, fomites
• signalment
  
  • young, old, immunosuppressed cats more likely to show clinical signs
• latent (FCV and FRV) carriers for weeks to years after resolution

Question 3

causative agent(s) of feline URI

Answer 3

• several infectious agents involved:
  
  • Feline Herpes Virus-1 (FHV-1)
  • Feline Calicivirus (FCV)
  • Chalmydiophila felis
  • Bordatella bronchiseptica
  • Mycoplasma spp

Question 4

clinical features of feline URI

Answer 4

• acute form more common
• common signs: sneezing, serous to mucopurulent nasal discharge, conjunctivitis with ocular d/c
• classic signs vary with infectious agent
  
  • FRV-corneal ulceration; FCV-oral ulceration; Chalmydiophila: conjunctivitis
• chronic: 80-100% persistently infected
  
  • only small % are clinical
  • clinical signs occur more often in stressed or immunosuppressed cats

Question 5

diagnosis of feline URI

Answer 5

• often presumptive (hx, clinical signs)
• PCR
• outbreak in catteries
• diagnostic and prognostic info
• chronic rhinitis?

Question 6

treatment of acute signs of feline URI

Answer 6

• self limiting in most cases: supportive tx
• nutrition, fluids, cleaning/suction
• nebulization?
• pediatric nasal decongestants? (no NSAIDS!)
• abx rarely needed
• corticosteroids contraindicated

Question 7

treatment of chronic signs of feline URI

Question 8

prognosis of feline URI

Answer 8

• acute:
  
  • GOOD
• chronic
  
  • good for quality of life
  • cure is very unlikely

Question 9

prevention of feline URI

Answer 9

• for individual
  
  • avoid exposure
  • vaccinate
    
    • modified live against FCV and FRV
• for multi-cat households
  
  • herd-health
  • minimize exposure
  • strengthen immunity

Question 10

nasal tumors

Answer 10

• majority are malignant
  
  • carcinomas most common in dogs
  • adenocarcinoma and lymphoma most common in cats
• benign tumors occur rarely
• consider TVT in endemic areas

Question 11

clinical features of nasal tumors

Answer 11

• more frequent in older animals
• no sex or breed predisposition
• signs usually chronic: reflect slow growing, locally invasive nature of the tumors
  
  • nasal d/c
  • sneezing, decreased airflow, deformation of face
  • nonspecific signs such as wt loss and anorexia

Question 12

diagnosis of nasal tumors

Question 13

treatment of nasal tumors

Answer 13

• benign tumors should be surgically excised
• malignant tumors
  
  • radiation is tx of choice for most
  • surgical excision unlikely to yield clear margins
  • chemo for lymphoma
  • analgesics, NSAIDs, abx…

Question 14

prognosis

Answer 14

• prognosis w/out treatment is poor
  
  • survival time ~ few months from dx
• survival times with radiation tx ~1 year

Question 15

nasopharyngeal polyps

Answer 15

• benign growths
• kittens and young cats
• often attached to base of Eustachian tube
• generally pink, pedunculated

Question 16

clinical features of nasopharyngeal polyps

Answer 16

• stertorous breathing: altered vocalization
• nasal discharge
  
  • serous to mucopurulent
  • often unilateral
  • upper airway obstruction
  • otitis externa/media/interna

Question 17

diagnosis of nasopharyngeal polyps

Answer 17

• otic exam
• radiographs
• thorough oropharyngeal exam
• nasopharyngoscopy (retroflexed)
• histopathology confirms dx

Question 18

treatment of nasopharyngeal polyps

Answer 18

• surgical excision usually curative
• typically performed via oral cavity

Question 19

prognosis of nasopharyngeal polyps

Answer 19

• excellent if entire polyp removed

Question 20

fungal rhinitis

Answer 20

• aspergillosis: Aspergillus fumigatus
• cryptococcosis: Cryptococcus neoformans
• other: Penicilium, Rhinosporidium, Sporothrix…

Question 21

nasal cryptococcosis and clinical signs

Answer 21

• most common systemic fungal disease in cats
• sneezing, nasal discharge
  
  • unilateral or bilateral
  • serous to mucopurulent
• may also see:
  
  • granulomatous lesions in nares
  • facial deformity
  • ulceration of nasal planum

Question 22

nasal cryptococcosis diagnosis

Answer 22

• cytology of nasal discharge
  
  • pyogranulomatous inflammation
  • organisms often present
• serology
  
  • latex agglutination for capsular antigen
• histopathology

Question 23

nasal cryptococcosis treatment

Answer 23

• systemic fluconazole, itraconazole
• nasal and cutaneous disease normally respond well to tx, but tx may be prolonged
• can develop resistance to anti-fungals

Question 24

nasal aspergillosis

Answer 24

• dogs
  
  • generally dolichocephalic or mesocephalic
  • typically younger, middle-aged
  • can occur in immunocompetent dogs
• very rare in cats
• opportunistic
  
  • pre-existing nasal disease
  • long-term abx

Question 25

clinical signs of nasal aspergillosis

Answer 25

• nasal discharge
  
  • serous, mucopurulent, sanguino-purulent, or epistaxis
• nasal pain
• ulceration of external nares

Question 26

nasal aspergillosis diagnosis

Answer 26

• false + or - from Ab serology, cytology, histopathology, and cultures
• skull radiographs and/or CT
• rhinoscopy may allow direct visualization
• need to combine info from various tests
• important to differentiate from neoplasia

Question 27

nasal aspergillosis treatment

Answer 27

• topical clotrimazole, enilconazole
• good prognosis

Question 28

idiopathic rhinitis

Answer 28

• Lymphoplasmacytic rhinitis
• rare (?) disease in dogs and cats
• chronic nasal discharge +/- sneezing
• histopathology
• inhaled irritants/particulate matter, unknown infection, or auto-immune origin?
• tx with corticosteroids

Question 29

bacterial rhinitis

Answer 29

• uncommon as primary nasal disease
  
  • Bordatella bronchisepptica, Mycoplasma spp, and Chlamydia felis can act as primary pathogens
• very common secondary complication of other nasal dz

Question 30

allergic rhinitis

Answer 30

• uncommon manifestation of allergy
• sneezing and nasal discharge
• sometimes seasonal or related to specific environmental changes

Question 31

diagnosis of allergic rhinitis

Answer 31

• response to removal of allergen +/- re-exposure challenge
• nasal biopsies generally indicate eosinophilic inflammation
• skin testing helpful?

Question 32

treatment of allergic rhinitis

Answer 32

• removal of offending allergen
• antihistamines indicated if this not possible or sufficient
• corticosteroids (anti-inflammatory doses) in refractory cases
• hyposensitization?