Week 8 - Infectious Flashcards

Question

What types of "Drug Fever" are there?

Answer 1

1. Malignant hyperthermia -Autosomal dominant mutation of the ryanodine (RYR1) receptor in dogs 2. Serotonin syndrome in humans 3. Opioids in cats -Excitement, excessive sedation, staring, hyperthermia

Answer 2

* Extremes of age * Renal failure -Uremic toxins are endogenous cryogens or antipyretics, or alter basal metabolic rate -Fever = > 101F * Immunosuppression * Anti-inflammatory drugs

Answer 3

1. Persistent = above normal throughout day, does not vary more than 2 degrees F 2. Remittent = above normal throughout day, varies more than 2 degrees F e.g. endocarditis 3. Intermittent or relapsing e.g. Borrelia, cyclic neutropenia

Answer 4

-Prolonged fever of > 3 weeks duration associated with vague, nonspecific signs of illness -Temperature > 1.5oF above normal on several occasions -Diagnosis uncertain after 1 week of hospitalization involving repeated physical examination and routine laboratory tests * Three outpatient visits OR * Three days in the hospital without elucidation of a cause OR * One week of “intelligent and invasive” ambulatory (outpatient) investigation

Answer 5

INFLAMMATION not infection

Answer 6

1. To improve the specific immune response in an animal -provides protection against an infectious disease (or toxin exposure) -lowers the risk of developing signs of illness when naturally exposed or reduces the clinical signs associated with infection if contracted 2. Less morbidity (animal and client suffering) 3. Less mortality 4.Lower cost of pet care (illness $$$ > vaccine $)

Answer 7

FVR: feline herpes virus (feline viral rhinotracheitis) C: calicivirus P: Panleukopenia

Answer 8

FVRCP FelV - sometimes Rabies

Answer 9

Rabies Canine Distemper (D) Canine adenovirus 2 (A) Canine parvovirus (P) Leptospira +/-

Answer 10

▪6-8 weeks, then every 3-4 weeks until at least 16 weeks for FVRCP or DAP -trying to aim for time where maternal antibodies aren't enough to protect animal anymore ▪Booster within 1 year then every 1 or 3 years except for -Leptospira and Borrelia (bacterins) -Bordetella -FHV1 and FCV in high-risk situations

Answer 11

▪Enveloped RNA virus ▪Family Paramyxoviridae, Genus Morbillivirus ▪Readily inactivated in the environment ▪Disease in dogs, raccoons, ferrets, exotic felids ▪Strain virulence and neurotropism varies

Answer 12

▪Shed in respiratory secretions, feces and urine (all body secretions) for up to 3 months after infection ▪Spread by direct contact, aerosol, or respiratory droplet exposure ▪Raccoons may be a source ▪Many infections subclinical ▪Infections often occur when maternal antibody wanes

Answer 13

Early signs: ▪Lethargy, inappetence, fever ▪Conjunctivitis, cough, serous ocular and nasal discharge Progression to: ▪Obtundation, anorexia, vomiting, diarrhea ▪Mucopurulent ocular and nasal discharge ▪Moist cough, tachypnea ▪Neurologic signs ▪Nasal and footpad hyperkeratosis (‘hard pad’) ▪Optic neuritis and chorioretinitis (‘gold medallion lesions’) ▪ENAMEL HYPOPLASIA Neuro signs: ▪May be delayed up to 12 weeks ▪Development unpredictable ▪Hyperesthesia ▪Ataxia, circling, head tilt, tremors ▪Paralysis ▪MYOCLONUS ▪Partial or generalized seizures

Answer 14

There are 2 stages Stage 1: Lymphoid Tissue -Virus inhaled, contacts upper resp tract epithelium -Replication in local macrophages -> lymphatic spread -Tonsils and bronchial nodes -Systemic lymphoid tissue - GIT, spleen, MLN, Kupffer cells -results in FEVER LYMPHOPENIA Stage 2: Epithelial and Nervous Tissue -Once in the lymphoid tissue, it will spread to the blood -It will go into epithelial tissue and CNS via hematogenous spread: 1. Good humoral and Cell Mediated response > virus eliminated 2. Intermediate response > Persistent infection (CNS, cutaneous, ocular signs) 3. Poor response > Fulminant epithelial infection (severe GI signs, pneumonia, +/- CNS signs) ▪Immunosuppression is a key feature (lymphocytolysis) ▪Race between virus and host ▪Opportunistic infections can occur

Answer 15

1. CBC ▪Lymphopenia ▪Distemper virus inclusions 2. Conjunctival scrapings for inclusions ▪Fluorescent antibody ▪False positives and false negatives (more false neg) 3.RT-PCR ▪Respiratory secretions, CSF, feces, urine ▪False positive possible within 1-3 weeks of vaccination 4. Thoracic radiographs ▪Bronchopneumonia 5. NECROPSY AND HISTOPATHOLOGY are considered to be the gold standard

Answer 16

Supportive care ▪Isolation ▪IV fluids ▪Parenteral antimicrobial drugs ▪Oxygen supplementation Neurologic signs usually permanent ▪May or may not be compatible with life ▪Warn owners if not yet present

Answer 17

-vaccines! (Modified Live Vaccines) -vax before shelter entry -In shelter outbreaks, consider serological testing ▪Separate and vaccinate seronegative animals ▪Foster incoming seronegative animals until they seroconvert ▪Any positive titer is protective

Answer 18

If you're SERONEGATIVE you DON'T have antibodies. you are NOT protected

Answer 19

▪Caused by canine adenovirus-1 (CAV-1) -related to CAV-2 (respiratory disease) ▪Systemic viral infection of dogs - usually young puppies ▪Targets endothelial cells and hepatocytes (liver issues)

Answer 20

▪Oronasal exposure: animal-to-animal contact or exposure to contaminated fomites ▪CAV-1 is shed in feces, urine, and saliva ▪Shedding of CAV-1 in the urine can last for 6-9 months.

Answer 21

-mostly subclinical Peracute form ▪Circulatory collapse ▪Death in 24-48 hours Acute form ▪Puppies aged 6-10 weeks ▪Fever, anorexia, lethargy, tonsillitis ▪Cough, tachypnea ▪Hepatomegaly, abdominal pain, edema, ascites ▪Vomiting, diarrhea ▪Hemorrhages ▪CNS signs (hepatic encephalopathy, direct damage) ▪Fever common in early phase ▪Corneal edema (‘blue eye’) and anterior uveitis -Hallmark lesion -Type III (immune complex) hypersensitivity -May be the only sign -Can be painful

Answer 22

Bloodwork ▪CBC: lymphopenia, neutropenia ▪Chemistry: Increased liver enzymes, hypoglycemia UA: Bilirubinuria, proteinuria Organism detection ▪PCR (e.g., on blood, respiratory secretions, urine) ▪Histopathology at necropsy ▪Intranuclear inclusions in Kupffer cells, hepatocytes, glomeruli, blood vessels (meninges, renal tubular vascular endothelium)

Answer 23

-Panleukopenia in cats ▪Severe enteritis and leukopenia in dogs and cats ▪Highly contagious, often fatal if untreated ▪Parvovirus is is one of the world’s most common canine infectious diseases -Panleuk does not infect dogs

Answer 24

▪Tiny, non-enveloped viruses ▪Require rapidly dividing cells to replicate ▪Shed for max. 4 weeks after infection (rarely > 2 weeks) ▪Resist disinfection and survive > 1 year on fomites

Answer 25

▪Puppies and kittens 6 weeks to 6 months ▪Declining maternal antibody ▪Rapidly dividing cells ▪Concurrent viral, bacterial and parasitic infections ▪Rottweilers, Dobermans, Americans Pit Bull Terriers, GSDs, Chihuahuas? ▪Prevalence highest in summer (3 times more likely in July, August, and September)– flies?

Answer 26

▪Transmission by contact with feces, vomit, fomites

Answer 27

-Oronasal exposure -Oropharyngeal lymphoid tissue -GI epithelium, lymphoid tissue, marrow (also lungs, spleen, liver, kidney, heart) Causes: Intestinal crypt cell destruction > -Neutrophil sequestration -Impaired cell turnover -Villous blunting -Malabsorption -Increased permeability +/- Intussusception Results in Bacterial translocation > SEPSIS, ENDOTOXEMIA, DIC

Answer 28

▪Dam subclinical ▪Myocarditis and CHF (congestive heart failure) in puppies (rare due to maternal antibody) ▪Cerebellar hypoplasia in kittens (and rarely dogs) -Also optic nerve atrophy, retinopathies ▪Reproductive failure or fading puppies/kittens

Answer 29

Cerebellar Hypoplasia ▪Infection in utero or at <~ 9 days ▪Ataxia, intention tremors, incoordination, broad-based stance ▪Clinical signs appear at 2-3 weeks ▪Mental status normal, acceptable pets ▪Other signs less common -Seizures -Behavioral changes -Retinal degeneration, folding -Optic nerve hypoplasia

Answer 30

▪Incubation period -3-14 days CPV-2 -2-10 days FPV ▪Lethargy, fever, then inappetence, vomiting and diarrhea -Usually bile-stained vomit in cats -Yellow-gray, blood-streaked, or dark red malodorous diarrhea -Abdominal pain, dehydration ▪Leukopenia ▪Peracture form: Death in 1-2 days -Secondary to gram-negative bacterial sepsis, DIC

Answer 31

▪History, clinical signs ▪CBC -Leukopenia (not always present, not specific) ▪Chemistry -Electrolyte abnormalities -Hypoglycemia -Prerenal azotemia ▪Fecal antigen ELISA -Approx. 50% sensitive -Detects FPV -May get false positive post recent (10 days) vaccine - modified live virus ▪Fecal PCR -Positive after vaccination ▪Serology -Tests for protective antibody titers, not for infection ▪Histopathology -Intestinal crypt necrosis -Intra-nuclear inclusion bodies -Immunohistochemistry

Answer 32

▪Isolation ▪Aggressive IV fluid therapy ▪Broad-spectrum IV antimicrobials -Cefazolin -Enrofloxacin/ampicillin ▪Intravenous dextrose ▪Plasma for hypoalbuminemia ▪Antiemetics ▪Immune plasma? -Need large doses parenterally (6.6 – 11 mL/kg)? -Best after infection but before clinical signs ▪NPO or early enteral feeding via NE tube ▪Central parenteral nutrition ▪Gradual reintroduction of water then food ▪Treat parasites ▪Outpatient protocol – SC fluids, maropitant and cefovecin -Not optimal

Answer 33

▪Vaccination -Attenuated live vaccines -Avoid use in pregnancy, kittens and puppies < 4 weeks -Immunosuppressed animals ▪Pregnant queens in shelters? ▪Vaccinate to 16-18 weeks ▪Titers correlate with protection -ANY antibody titer = protection in dogs > 20 weeks -Lack of antibody titer does not necessarily mean lack of protection ▪Hygiene and appropriate disinfection

Answer 34

▪Enveloped RNA virus, fecal-oral transmission ▪Infects villus tips ▪Susceptible to desiccation and disinfection ▪Many strains ▪Widespread subclinical infection ▪Disease in pups < 6 weeks, often with co-pathogens -Short incubation period -Shedding for 2 weeks -Usually mild, self-limiting diarrhea

Answer 35

▪RT-PCR (‘fecal PCR panels’)

Answer 36

-hygiene -vaccines - unproven benefit

Answer 37

▪Wild and domestic animal reservoir hosts -Shed in urine -Different serovars/genotypes adapted to different reservoir hosts ▪Widespread subclinical exposure ▪Young, lepto-unvaccinated adult dogs ▪Rare in cats ▪Survives in stagnant or slow-moving, warmer water ▪Temperatures 0 to 25 degrees C (32-68 degrees F) ▪Increased rainfall/flooding is a risk factor but not required ▪Disease seen in small-breed dogs from urban areas

Answer 38

▪Direct contact with contaminated urine, bite wounds or ingestion of infected tissues ▪Indirect contact with urine- contaminated food, water, soil, bedding

Answer 39

▪Organisms penetrate intact mucous membranes or abraded skin -Bacteremia with spread to liver and kidney as well as other tissues (pancreas, lung, meninges, genital tract, eye etc) ▪Extent of disease depends on strain virulence and host susceptibility ▪Acute kidney injury, +/- hepatic insufficiency, +/- hemorrhagic disease (liver dz, NOT liver failure)

Answer 40

▪Fever, inappetence, vomiting, dehydration ▪Reluctance to move ▪PUPD or anuria/oliguria ▪Abdominal pain ▪Mild peripheral lymphadenomegaly ▪Icterus ▪+/- uveitis ▪+/- tachypnea due to pulmonary hemorrhage

Answer 41

CBC ▪leukocytosis ▪anemia ▪thrombocytopenia (50-60%) Chemistry ▪azotemia ▪+/- elevated liver enzymes (ALP>ALT) ▪ normal cholesterol ▪normo- or hypokalemia ▪hypoalbuminemia ▪ high CK ▪UA: casts, glucosuria, organisms not seen ▪Significant proteinuria not a feature (interstitial nephritis) ▪Differential diagnosis: other causes of AKI thoracic Rads ▪Normal ▪Mild interstitial to patchy or diffuse alveolar pattern US ▪Hyperechoic renal cortices ▪+/- perirenal fluid ▪Renomegaly

Answer 42

1. History, clinical signs, laboratory findings 2. Antibody-detection tests ▪Microscopic agglutination test, paired titers (interval 2-4 weeks) ▪Initial titers often negative ▪Positive titers from subclinical exposure and vaccination (up to 1:6400) ▪Fourfold rise in titer required over >2 weeks ▪Positive titers to multiple serovars due to cross-reactivity ▪Highest titer is NOT predictably the infecting serovar 3. SNAP Lepto 4. WITNESS Lepto (Zoetis) - IgM based 5. Darkfield microscopy of urine: insensitive 6. Culture: special media, 4-6 weeks, not done 7. PCR 8. Kidney biopsy

Answer 43

▪Ampicillin or penicillin for vomiting dogs ▪Doxycycline for 2 weeks after vomiting stops (d/c penicillin) ▪Aggressive IV fluid therapy ▪Diuretics ▪Antiemetics ▪Hemodialysis – the sooner the better if rehydrated and oliguric (low urine output)

Answer 44

Good - 85% survival rate with aggressive therapy CKD could be sequela

Answer 45

▪Treat co-exposed household dogs ▪Restriction of access to wildlife/rodents ▪Vaccination -Shift to ‘core’ -annual vaccine ▪No need to place in isolation

Answer 46

-Diseases (infections) transmitted by blood-feeding arthropods (mosquitoes, ticks, fleas) -can be viral, bacterial, protozoal, parasitic

Answer 47

1. IXODES Ixodes pacficus Ixodes scapularis (deer tick - black legged tick) 2. RHIPICEPHALUS Rhipicephalus sanguineus (brown dog tick) 3. DERMACENTOR Dermacentor Andersoni (rocky mountain wood tick) Dermacentor variabillis (american dog tick) 4. AMBLYOMMA Amblyomma aermicanum (lone star tick) Ambylomma maculatum (gulf coast tick)

Answer 48

-Arthropod-transmitted -Gram-negative pleomorphic BACTERIA - coccobacilli -Obligately intracellular, may form morulae -seen with bacteria: Ehrlichia spp., Anaplasma spp., Rickettsia spp., Neorickettsia spp.

Answer 49

Doxycylcine!

Answer 50

Monocytes: -Ehrlichia canis Granulocytes (neutrophils and eosinophils) -Ehrlichia ewingii, Anaplasma phagocytophilum Platelets -Anaplasma platys

Answer 51

Canine Monocytic Ehrlichiosis attacks monocytes mainly in SE/SW states, warmer climates rare in cats

Answer 52

Rhipicephalus sanguineus - dog brown tick

Answer 53

-no transovarial transmission - Transstadial --larvae acquire pathogen by feeding off animal/canids -Incubation period 8-20 days -Acute phase (first 2-4 weeks) --Multiplies in monocytes with splenomegaly, lymphadenopathy --Infected cells adhere to endothelium in lungs, meninges and kidneys -- can cause systemic vasculitis-like signs --Thrombocytopenia, +/- mild leukopenia, anemia

Answer 54

Pathogen transmitted through successive generations of ticks Pathogens are present in eggs laid by ticks, when eggs hatch, larvae are infected

Answer 55

Pathogen is transmitted from one life stage of the tick to another Larvae are hatched uninfected -- must acquire infection later in life

Answer 56

-Lymphadenopathy, splenomegaly -Pallor, bleeding tendencies (thrombocytopathia) -Weight loss, debilitation -Anterior uveitis, retinal hemorrhage - +/- Neurologic signs -secondary infections

Answer 57

-Variable anemia, pancytopenia, lymphocytosis, thrombocytopenia -Morulae (mostly only acute) -Hyperplastic (acute/chronic) or hypoplastic (chronic) marrow -Polyclonal or rarely monoclonal gammopathy - +/- protein-losing nephropathy -Organism Detection Tests: Morulae, PCR panels - best for acute -Antibody detection tests: Lack sensitivity early, Cross-reactivity among Ehrlichia species --SNAP 4Dx Plus ELISA --Quantitative serology (IFA)

Answer 58

-Persistent infection = prolonged treatment -Doxycycline 5 mg/kg PO q12h 6-8 weeks -Prognosis good for acute ehrlichiosis -Poorer for chronic ehrlichiosis

Answer 59

Bacteria: Anaplasma phagocytophilum in Upper Midwest, northeast, CA, OR and Europe -Ixodes scapularis in the midwest -Ixodes pacificus in northern CA -Same vectors as Borrelia burgdorferi, often co-transmitted

Answer 60

-Widespread subclinical infection -Fever, lethargy, lymphadenopathy, SPLENOMEGALY, scleral injection -Thrombocytopenia, mild anemia, neutropenia/neutrophilia, lymphopenia, hypoalbuminemia, elevated ALP

Answer 61

Organism detection tests -Morulae within granulocytes (look like Ehrlichia ewingii but different geographic distribution) -PCR – best test Antibody detection tests - usually negative initially -Not really useful for diagnosis -IDEXX SNAP 4Dx Plus, Accuplex -Acute and convalescent phase serology

Answer 62

Ehrlichia ewingii ehrlichiosis Ehrlich ewingii's vector is Amblyomma americanum

Answer 63

-Bacteria: Rickettsia rickettsii -Vector: Dermacentor spp. and Rhipicephalus sanguineus (brown dog tick)

Answer 64

-Most cases March-October -Ticks attach for 5 to 20h -transstadial transmission (tick acquires bacteria from a host) -Rickettsiae infect ENDOTHELIAL CELLS of small blood vessels --Vasculitis, necrosis, increased vascular permeability --Edema, hemorrhage, hypotensis, shock

Answer 65

-Incubation period 2-14 days -Fever, anorexia, depression -Edema, hyperemia and necrosis of extremities -Mucopurulent ocular discharge -Vomiting, diarrhea -Neurologic signs -Respiratory signs -Joint pain and swelling, muscle pain -Cardiac arrhythmias -Bleeding/thrombosis -Permanent cardiovascular, renal and neurologic damage possible

Answer 66

-Leukopenia/leukocytosis, anemia, thrombocytopenia**, rarely DIC -Hypoalbuminemia, elevated liver enzymes

Answer 67

-an ACUTE disease -Indistinguishable from acute ehrlichiosis but SHORT course -Dead or better in 2 weeks - +/- tick infestation, season, travel history -Acute and convalescent phase titers -IFA (eg. Protatek) – but no point-of-care tests -Cross-reactivity with other SFG rickettsiae -Organism detection tests?

Answer 68

- Doxycycline - 5 mg/kg q12h 2 weeks - Improvement in 24-48 h - Use fluids with caution - bc of vasculitis, so can easily fluid overload - Lifelong immunity following natural infection - Effective vaccination not available - Tick prevention - Dogs a sentinel for human disease

Answer 69

-Bacteria: Neorickettsia helminthoeca -bacteria lives in a fluke! -Fluke/trematode: Nanophyetus salmincola fluke wil penetrate salmon dog eats salmon affects dogs, NOT cats

Answer 70

-Mature flukes in intestine release rickettsiae into intestinal epithelial cells -Spread to rest of body via lymphatics -Ulcerohemorrhagic enteritis -Lymphoid tissue invasion by macrophages and plasma cells -Trematode eggs are in the feces 5-8 days after fish ingested; shed for 60-250 days

Answer 71

-incubation period 5-8 d (up to 33 d) -Fever, anorexia, vomiting, diarrhea, profound weight loss, lymphadenopathy, splenomegaly, DEATH in 7-10 days if untreated

Answer 72

-History of fish exposure in 50% of cases -CBC: lymphopenia, thrombocytopenia (90%) -Chem: hypoalbuminemia and ALP -Trematode eggs best identified by combining flotation and sedimentation - > 80% of cases - Inclusions in macrophages in LN aspirates - PCR on feces or LN aspirates

Answer 73

- Tetracyclines for 2 weeks - Doxycycline - Parenteral oxytetracycline if vomiting - Praziquantel for the fluke infestation - IV fluids +/- blood products - Dogs should not eat raw fish!

Answer 74

Northeast - 90% of cases

Answer 75

Ixodes scapularis (deer tick - brown legged tick)

Answer 76

-Ixodes scapularis ticks are usually infected after feeding on the white-footed mouse -Nymphs most likely to transmit infection --Small --Engorge quickly --Most prevalent in spring, summer -transtaddial -- need to feed off of rodents - white footed mouse/grey squirrel/birds

Answer 77

Borrelia burgdorferi

Answer 78

-tick (Ixodes scapularis) takes up blood meal -tick gets infected by spirochetes -spirochetes attach to tick midgut using outer surface protein called OspA -OspA adheres to TrospA on midgut -now the infected tick will take another blood meal on a different animal -the spirochetes will travel from midgut to the salivary glands > infect animal -saliva can surround spirochete and prevent it from being detected by animal's immune system - saliva associated transmission --Inhibits CD4+ cell activation, proinflammatory cytokine production

Answer 79

Borellia migrates through connective tissue. NOT in blood.

Answer 80

-lesion of Lyme dz -big rash - target lesion dogs don't get this -- humans do dogs can get rash, just not erythema migrans

Answer 81

* No signs – 95% of infected dogs * Neutrophilic polyarthritis – Thrombocytopenia, arthritis – 2-5 months after infection * Protein-losing nephropathy (Lyme nephritis) – Sterile immune-complex disease? – Retriever breeds – Thrombocytopenia – Sterile immune-complex disease

Answer 82

CS Organism detection tests not really useful -Blood? -Skin biopsies? -Synovial fluid? Serology

Answer 83

Outer surface proteins of borellia: -OspA - helps spirochete to adhere, down regulated when tick feeds on host, briefly expressed, also vaccine antigen -> when taken up in blood meal, antibodies work in tick and kills spirochete -OspC - starts to be expressed when spirochete migrates to salivary gland of tick, expressed in salivary gland, lots of variants - leads to reinfection -C6/VSLE - only expressed during natural infection, diagnostic antigen -OspF - light outer surface protein, immune response would mean chronic infection C6 peptide -SNAP 4Dx® Plus, IDEXX -Quant C6® ELISA, IDEXX -Antech Accuplex Multi-target antibody assays -Western blotting -Cornell bead: OspA, OspC, and OspF -Zoetis VETSCANTM: VlsE, OspC, flagellin (single line) --Canine Flex4 Rapid (includes Anaplasma, Ehrlichia, HW Ag) --Lyme Rapid

Answer 84

Dogs w lyme dz will NOT get negative results -Incubation period 2 to 5 months -IgM/IgG not useful -Antibody negative Lyme rare in dogs

Answer 85

-monitor -Doxycycline 4 weeks for sick dogs --Amoxicillin --Cefovecin 8 mg/kg SC, 2 doses, 14 days apart -Organism elimination? -Monitoring with quantC6? --Reinfections may occur -Immunosuppressive drugs for Lyme nephropathy --Mycophenolate -Healthy seropositive dogs --Emphasize ectoparasite control --Consider vaccination

Answer 86

Feline Leukemia Virus -Leading cause of feline mortality -Immunosuppression, bone marrow disorders, hemopoietic neoplasia -enveloped RNA virus - retrovirus > goes into genome -Susceptible to dessication, heat and disinfectants

Answer 87

-Transmission difficult: requires close contact -Shed in saliva -Transmission via blood transfusion - so SCREEN donor cats

Answer 88

-in this case, FelV is very rare to be found in cats more then 10 years of age - only young to middle aged cats -however, can be more common if immune-suppressed

Answer 89

Regressive: cat becomes infected, virus is a part of genome, but silent. Not making virus. Possibly affect oncogenes, etc. Progressive: progress into felv associated dz Progressive disease (persistent viremia) occurs in -70-100% of neonates without maternal antibody -30-50% of 8-12 week old kittens -< 10-20% of adult cats after prolonged exposure

Answer 90

-Challenge dose - how much of virus -Viral strain -Immune status -Age

Answer 91

-Most persistently viremic cats die in 4 years -Malignant transformation results from proviral integration into the genome near a cellular oncogene

Answer 92

1. Abortive infection 2. Primary Viremia 2a. Regressive Infection 2b. Progressive Infection

Answer 93

Antigen negative RNA negative DNA negative Antibody positive

Answer 94

Antigen positive RNA positive (by 1 week) DNA positive/negative Antibody positive

Answer 95

Antigen negative RNA negative DNA positive Antibody positive

Answer 96

Antigen positive RNA positive DNA positive Antibody positive

Answer 97

-lymphoma -leukemia -Myelodysplasia -Myelofibrosis -Anemia -Immunosuppression -Immune Complex Diseases -Reproductive Diseases -Peripheral lymphadenopathy -Enteritis -Neurologic Disease -Multiple cartilagenous exostoses -Olfactory neuroblastoma -Keratin horns

Answer 98

mediastinal lymphoma -80% are FeLV + -Pleural effusion containing lymphoblasts -Dyspnea, regurgitation, Horner’s syndrome, decreased chest compressibility

Answer 99

1. Multicentric lymphoma -Multiple site involvement 2. Renal lymphoma GI lymphoma is usually FeLV negative!!! -most common lymphoma in cats -usually in 8+ year olds

Answer 100

-Acute granulocytic, erythroid, lymphoid or megakaryocytic -Pancytopenia with lethargy, bacterial infections, sepsis, hemorrhage

Answer 101

Anemia through multiple mechanisms 1. Impaired erythroid production -Nonregenerative anemia --Isolated and severe = pure red cell aplasia --With leuko- and/or thrombocytopenia = aplastic anemia -Macrocytosis without regeneration 2. immune-mediated destruction 3. Anemia of inflammatory disease

Answer 102

-Mechanism poorly understood -Impaired T cell and neutrophil function -Predisposes to: --Bacterial infections --Viral infections eg. FIP, URTD --Protozoal infections --Fungal infections eg. cryptococcosis

Answer 103

1. Antigen-detection ELISA and IFA -Detect p27 core antigen -ELISA first choice for screening and diagnosis --Cheaper and more sensitive than IFA --Sensitivity and specificity 98% --False positives more likely when incidence is low**** --50% chance of a false positive when used for screening --Retest using diagnostic lab or another test kit 2. PCR -proviral DNA -blood screening Verify progressive infection -Retest ELISA+ cats 3 months later OR -Do an IFA test OR -Do a quantitative PCR assay

Answer 104

-Chemotherapy for lymphoma -Blood transfusions, erythropoieitin/darbepoietin -Glucocorticoids for immune-mediated disease with some cases -Antimicrobials for secondary infections -Antivirals (AZT, raltegravir) have shown some clinical activity but have significant drawbacks

Answer 105

-Retest first -Some may develop regressive infection -Other cats in the household may be infected or immune -House all cats indoors -Vaccinate FeLV+ cats as necessary -FVRCP as normal

Answer 106

Vaccines! -Whole inactivated (killed) vaccines -Nonadjuvanted recombinant canarypox vaccine (BI) -Two doses SC, from 9 weeks of age then annually (recombinant) or every 3 years -core in kittens, then based on risk -Test first, vaccinate only FeLV negative cats -vaccination does not interfere with testing

Answer 107

Feline Immunodeficiency Virus -Enveloped, single-stranded RNA virus -Infection is for life -Antibody positivity = current infection -Prevalence 2-3 times greater in males --More profound than for FeLV -retrovirus

Answer 108

Prevalence 2-3 times greater in males -More profound than for FeLV Free-roaming and feral cats Mean age 6-8 years -80% of cats are over 2 years -Disease mostly in adult/geriatric cats

Answer 109

Saliva by biting Transplacental transmission depends on: -Strain -Degree of maternal viremia -Most kittens probably infected via saliva or milk Indoor housing DECREASES transmission

Answer 110

Targets: -T helper (CD4+) lymphocytes -Later CD8+ cells and B cells -Tissue macrophages -For some strains, other cells such as astrocytes Results in -Gradual destruction of the immune system -Promotion of neoplastic disease (less than FeLV) -Neurologic disease

Answer 111

Lymphoid tissues Salivary glands transient primary illness (acute phase) heads to mononuclear cells lungs, kidneys, GIT leads to subclinical carrier phase: decreased CD4+/CD8+ ratio decreased CMI and humoral immunity decreased memory responses decreased mitogen responsiveness decreased Il-12 and Il-2 production decreased MHC-II expression decreased neutrophil function

Answer 112

-3-6 months, often unrecognized -Transient lymphadenopathy, pyrexia, depression, anorexia -Transient neutropenia and lymphopenia -Sometimes URTD, enteritis and stomatitis -Occasionally neurologic signs -Behavior changes -Partial or generalized seizures, paresis, anisocoria, motor abnormalities

Answer 113

-hyperglobulinemia

Answer 114

Secondary infections: -STOMATITIS, recurrent URTD -Diarrhea, weight loss -Chronic skin disease --Dermatophytosis, mites, bacterial infections -Other opportunistic infections --eg. cryptococcosis, toxoplasmosis, mycobacteriosis -Hyperglobulinemia Ocular disease -anterior uveitis, conjunctivitis, glaucoma Eventually neurologic signs -opportunistic infections, neoplasia, direct damage Chronic wasting Azotemia due to interstitial nephritis Wasting, neurologic disease and tumors are the most common reasons for euthanasia

Answer 115

Antibody testing PCR is not helpful/organism detection tests are not helpful bc it's low levels of virus (except terminal phase)

Answer 116

Maternal antibody up to and including 6 months of age -Retest after 6 months Antibody from previous FIV vaccination (no longer available, but can last 7+ years) Retest adult SNAP ELISA+ cats? -Low risk populations -Western blotting -Not a DIVA: Antigen and Witness vs IDEXX Positive test results may be irrelevant to clinical problem Negative results may occur in -Cats in the acute stage (rarely recognized) -Cats with end-stage disease (test with PCR)

Answer 117

- No good antivirals - Keep cats indoors - Identify and treat opportunistic infections - Manage stomatitis - Vaccinate for other pathogens (FVRCP)

Answer 118

CHRONIC INFECTION

Answer 119

inflammatory process, chronic stimulation

Answer 120

young - 3mo to 3years purebred

Answer 121

– Fecal-oral spread of feline enteric (avirulent) coronavirus – Acquired from another cat – Mutation to virulent FIPV (‘internal mutation hypothesis’) ■ Multiplication in macrophages – Strains vary in virulence – Genetic susceptibility

Answer 122

Infectious: FIP (viral) bacterial/atypical bacteria (bartonella) protozoal (Toxo) fungal (histoplasma) parasitic

Answer 123

– Single cat vs. multicat household – Infection, shedding, recovery – Persistently-infected cats

Answer 124

DOES NOT you don't transmit FIP, you transmit feline coronavirus

Answer 125

Enterocytes > mild to inapparent enteritis

Answer 126

Macrophages > fulminant dz

Answer 127

■ Tachypnea ■ Muffled heart sounds ■ Icterus ■ Hepatomegaly ■ Splenomegaly ■ Irregular renomegaly ■ Abdominal masses ■ Anterior uveitis ■ Retinal detachment, hemorrhage ■ Neurologic signs (seizure, vestibular)

Answer 128

■ NNN anemia ■ Neutrophilia ■ Lymphopenia ■ Thrombocytopenia ■ Azotemia ■ Elevated liver enzymes ■ Hyperbilirubinemia ■ Hypoalbuminemia ■ Hyperglobulinemia – >50% effusive – >70% noneffusive

Answer 129

FIP has it own type of effusion: – Relatively low cellularity (2-5k) – Proteinaceous/high protein – Straw colored & viscous

Answer 130

■ Positive serology = exposure to any coronavirus (CCV, TGEV, FCoV) ■ Does not predict FIP – Titers > 1:1600 may be suggestive ■ 98% specific, 67% sensitive in cats with compatible clinical signs ■ High titers useful for cats from households with 1 or 2 cats ■ Ensure go to endpoint ■ Titer results VARY between laboratories – Some cats with end-stage FIP lack antibodies ■ Does not predict shedding ■ Does not indicate immunity to FIP ■ Paired titers are NOT helpful for diagnosis

Answer 131

1. RT-PCR – No specific mutation distinguishes virulent from nonvirulent strains ■ Some genes important (eg. 3c, 7b, spike protein genes) – IDEXX FIP RealPCR detects mutations in spike protein gene associated with virulence – False negatives with degradation, strain variability – Avirulent coronavirus strains can be found at any site in healthy and sick cats ■ Testing tissues and effusion not helpful alone 2. Biopsy 3. Cytology 4. Immunohistochemistry - gold standard

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– Supportive care (fluids, nutrition, fluid removal) – Anti-inflammatory and immunosuppressive drugs – Novel antiviral medications Nucleoside analogs: Inhibition of coronavirus RDRP (NSP12) Protease inhibitor: Inhibition of coronavirus protease (NSP5)

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■ What is the prognosis for a cat with FIP? – Without treatment: Days to > 1 year (most 5 – 7 weeks) – With treatment: good to excellent ■ Negative prognostic factors – CNS involvement – Prognosis dismal for cats that fail to respond beyond 3 days

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-RBC parasites - intracellular PROTOZOAL parasites! * Feline babesiosis not documented in US

Answer 135

* Tick-borne (potentially) * Blood transfusions * Transplacental transmission (vertical transmission) * Direct transmission

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* Large piriform organisms * Singly or paired in RBCs * B. vogeli: Rhipicephalus sanguineus (Cosmopolitan) * B. canis: Dermacentor spp (Europe, Africa, Asia) * B. rossi: Haemaphysalis leachi (South Africa)

Answer 137

Babesia Vogeli least pathogenic higher rates in * Kenneled dogs * Adults * Greyhounds - they're just more exposed due to geographic location, not that they're genetically predisposed

Answer 138

* Vector: Haemaphysalis spp. -small babesia -In the US most cases of B. gibsoni are diagnosed in Pitbull and Staffordshire bull terriers -Some coinfected with Babesia vulpes

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* California and other southern states * Medium-sized organism * Initially misidentified as B. gibsoni * Coyotes

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* Incubation period 10-21 days * Anemia, fever, hypotensive shock in peracute/acute cases * Sometimes icterus, splenomegaly and immune- mediated thrombocytopenia * Chronic carrier state - usually subclinical -less pathogenic -clinically well

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* Incubation period 1-2 weeks * Fever, anorexia, weakness * Anemia, thrombocytopenia * Splenomegaly, lymphadenopathy * Icterus rare

Answer 142

1. Bloodwork * Thrombocytopenia, increased MPV * Anemia (+/-) regeneration * Leukopenia * Hypoalbuminemia, hyperglobulinemia 2. Detection of organisms on blood smears -Degree of parasitemia varies 3. PCR – current test of choice -Not all assays detect all species 4. Serology -Indirect IFA or ELISA -Titers > 1:80 positive -False negatives common -Cross-reactions occur unreliably

Answer 143

* Blood transfusions * Fluids * Antibabesial drugs -Imidocarb diproprionate > clears large species -Atovaquone and azithromycin for B. gibsoni and B. conradae * Steroids used with care - bc may look like IMHA

Answer 144

* Tick control * Avoid splenectomy and immunosuppression in chronically infected dogs -- spleen plays a big role in clearing out bad RBCs * Screen blood donors serologically

Answer 145

fever, thrombocytopenia, hemolytic anemia (+/- regenerative anemia)

Answer 146

IMHA any other vector-borne dz zinc toxins - onion/garlic hyperphosphatemia

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* Usually (not always!) fatal, tick-borne disease of cats * Cytauxzoon felis - PROTOZA * Southern and SE US (Missouri, Arkansas, Oklahoma, Texas, Mississippi, Louisiana, Florida) * April to September * Outdoor cats - 80% of outdoor cats have it, just not clinical * Bobcat reservoir

Answer 148

Amblyomma americanum - lodestar tick

Answer 149

rapidly fatal Schizogonous phase * Infected mononuclear phagocytes/macrophages obstruct veins in spleen, liver, lung, lymph nodes * Rupture and release organisms * Leads to DIC, shock Intraerythrocytic phase * 1-3 days after schizonts appear * Hemolytic anemia, high fever * Ring-shaped organisms in RBCs

Answer 150

* Usually rapidly fatal * Anorexia, lethargy * High fever * Dark urine, dehydration, icterus, pallor, prolonged CRT, hypothermia * Death within 5 days * Attenuated strains have been found * Mild or no signs

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Bloodwork * CBC: Nonregenerative anemia, leukopenia, thrombocytopenia * Chemistry: hyperbilirubinemia, hyperglycemia, hypoalbuminemia, elevated ALT * Prolonged coagulation times Organism detection * Blood smear * PCR serology is not helpful bc it is an acute dz, so no antibodies would be made

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* High mortality despite treatment * Atovaquone and azithromycin - antiprotozoals * Supportive care, heparin? * Some cats have survived without treatment

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-caused by PROTOZOA - Leishmania -public health concern bc zoonosis -Dogs and rodents (cats?) reservoirs for human infection

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* Flagellated promastigotes injected into vertebrate host, engulfed by macrophages * Transform into amastigotes, which replicate and infect new cells * Sandfly ingests amastigotes

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Cutaneous - Derm Issues * Cutaneous lesions form in 90% of infected dogs 1 month to 7 years post infection * Hyperkeratosis and intradermal nodules Visceral * Splenomegaly * Lymphadenopathy * Polyarthritis * Glomerulonephritis * Uveitis * Rhinitis * Icterus * Thrombocytopenia * poly- and monoclonal gammopathies

Answer 156

* Visualization of amastigotes in biopsies or aspirates * PCR - GOLD STANDARD * Serology - could mean exposure, just not infection

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* Meglumine antimonate, sodium stibogluconate, amphotericin B, allopurinol

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* Prognosis variable, most recur * Treatment of dogs in the US controversial - bc of resistance. Don't want resistance to treatment in humans.

Answer 159

Hepatozoon canis - PROTOZOA - infects dogs and cats in Africa, the southern US, southern Europe and Asia Hepatozoon americanum - dogs and coyotes in southern US

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Canis: Rhipicephalus sanguineus - brown dog tick Americanum: Amblyomma maculatum (Gulf coast tick)

Answer 161

the entire tick is swallowed, not just blood meal of spirochetes in saliva of tick

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* Incubation period 1 month * WASTING DISEASE * Fever, mucopurulent ocular discharge * Pain, gait abnormalities * Glomerulonephritis, amyloidosis

Answer 163

1. Bloodwork * Marked leukocytosis * Nonregenerative anemia * Hypoglycemia * Elevated ALP * Hypoalbuminem 2. Skeletal radiographs -myositis - periosteal rxn on appendicualr skeleton 3. Clear ovoid gamonts in PMNs on a blood smear 4. Muscle biopsy to detect cysts or pyogranulomas is more sensitive 5. ELISA for H. americanum antibodies 6. Tests for H. canis are not useful