1. DO YOUR BEST! “A creative man is motivated by the desire to achieve, not by the desire to beat others.” -Ayn Rand

2. PANSYTEMIC DISEASES These diseases are covered predominantly in chapter 9 of your textbook

3. CASE #1

4. PATIENT PRESENTATION

5. SIGNALMENT: 12 week old, male/neutered, mixed breed puppy PRESENTING COMPLAINT: lethargy, ocular and nasal discharge for the past 3 days; mild cough, appetite is poor; puppy had diarrhea last night and vomiting/diarrhea this morning – Diet: Science diet puppy dry Hx: puppy adopted from local shelter 2 weeks ago; has received one set of vaccinations – owner was planning to schedule booster shots in one week PATIENT PRESENTATION

6. Hx: Puppy received his first doses of Heartworm and flea prevention 2 weeks ago at time of adoption. Other Info: Client has 1 other dog who is 1 year old and fully vaccinated; and 2 cats who are 2 and 5 yrs old that are fully vaccinated PATIENT PRESENTATION

7. PHYSICAL EXAM FINDINGS: – Lethargy – ~8% dehydrated – Temp: 103.8, HR: 116, RR: 20 – lung fields sound slightly moist, and the puppy coughs a few times during the exam – Mm: pink, CRT: 2.5sec – Mucopurulent ocular/nasal discharge – The nose looks, dry, thick, and crusty PATIENT PRESENTATION

8. ENAMEL HYPOPLASIA HYPERKERATOSIS OF NOSE & FOOT PADS

9. DIAGNOSTIC TEST RESULTS: CBC shows: – Leukopenia –early in the disease – Mild anemia WORSENING OF CLINICAL SIGNS: 1 week later, the client returns. The puppy is weak and appears to have muscle twitching; muscle of the mouth appear as if the puppy is “chewing gum”; there are pustules on the abdomen, and hyperkeratotic foot pads DIAGNOSTICS AND TREATMENT

10. TREATMENT – ANTIBIOTICS – FLUIDS – SYMPTOMATIC TREATMENT Anti-emetics Ophthalmic ointments Cleaning ocular/nasal discharge frequently Nutrition Clean, dry environment; low stress DIAGNOSTICS – Blood work is drawn for a CBC, serum chemistry profile and Canine Distemper titers DIAGNOSTICS AND TREATMENT

11. DIAGNOSIS: CANINE DISTEMPER VIRUS http://www.youtube.c om/watch?v=QL4S4M A2zT0 http://www.youtube.c om/watch?v=HyEFS77 rOzU *Myoclonus is characteristic for Canine Distemper

12. FURTHER DIAGNOSTICS: – Blood work drawn to compare paired serum titers and CBC results; Flourescent antibody(FA) CBC: Leukocytosis with neutrophilia found due to secondary infection FA: Viral inclusions are found in mononuclear cells of the blood smear – Post-mortem tissue sample taken from mucous membranes or epithelial cells of the urinary, respiratory, or GI tract may also display viral inclusions. Titers have increased since last measurement DIAGNOSTICS AND TREATMENT

14. Transmission of this (single-stranded, RNA, paramyxo-) virus is through aerosolization of bodily fluids, fomites Fatality rate may be as high as 90% Prognosis is guarded at best, especially if neurologic signs are present Neurologic signs may be focal to general including seizures – Could occur weeks to years after initial infection Although Distemper is contagious, it is unlikely to affect the clients older, vaccinated dogs – CVD does not affect cats PROGNOSIS & CLIENT INFORMATION

15. Vaccination Thorough cleaning – the virus is labile and can be killed with common disinfectants, and heat Isolation of infected animals PREVENTION

16. CASE #2

17. PATIENT PRESENTATION

18. SIGNALMENT: 4yr old, female spayed, daschund PRESENTING COMPLAINT: dry, hacking cough; dog is still active and eating and drinking well. Coughing began about 1 week ago. Hx: Owner began sending the dog to day care everyday while she was at work; After the puppy set of vaccines, dog was vx at 1yr and 2 yrs old. She received an injectable Bordetella vaccine 1 day before beginning daycare. PATIENT PRESENTATION

19. Hx: – Diet: Purina One – Patient is current on HW and flea prevention – No other significant illnesses – HW negative PHYSICAL EXAM FINDINGS: – Temp: 102.1, HR: 140, RR: 36 – Sneezing and occasional coughing on exam Cough can be ellicited on tracheal palpation Mild, clear nasal discharge – Normal hydration status – Mm: pk CRT: <2sec PATIENT PRESENTATION

20. Aka Infections Tracheobronchitis Major causes – VIRUSES: Canine Adenovirus-2, Parainfluenza, Canine herpesvirus, Canine Influenza, canine distemper virus – BACTERIA: mycoplasma, bordetella bronchiseptica, streptococcus sp. DIAGNOSIS: CANINE RESPIRATORY DISEASE COMPLEX http://www.youtube.com/wat ch?v=amGKQX9zdug

21. DIAGNOSTICS – Based on physical exam, clinical signs and history – Virus isolation from swabs of the pharynx, nasal passageways, trachea – Thoracic rads if pneumonia suspected DIAGNOSTICS & TREATMENT

22. TREATMENT – Adequate hydration – Antibiotics – Antitussives Hycodan (hydrocodone) Butorphanol Cough Tabs (dextromethorphan, guafenesin) Bronchial dilators – Aminophylline – terbutaline DIAGNOSTICS & TREATMENT

23. Transmission of these organisms is by inhalation of respiratory droplets or contact with fomites The prognosis is good with proper treatment – It is a self-limiting disease – May take 2-3 weeks to resolve Vaccinate 2-3 weeks prior to expected exposure when using the injectable vaccine – If using the intranasal vaccine 2-3 days prior to exposure is recommended PROGNOSIS & CLIENT INFORMATION

24. Isolate infected animals Vaccinate appropriately Most routine disinfectants, bleach, quarternary ammonium compounds will kill these viruses and bacteria Proper sanitation PREVENTION

25. CASE #3

26. PATIENT PRESENTATION

27. SIGNALMENT: 3mth old Rottweiler puppy, intact male PRESENTING COMPLAINT: lethargy, poor appetite, bloody diarrhea for 2 days; puppy has vomited twice this morning Hx: Owner purchased puppy from local trader’s market at 10 weeks old. The breeder gave the first set of vaccinations at 3 weeks old and a booster @ 7 weeks PATIENT PRESENTATION

28. Hx: owner already has a 6mth old, intact female Rottweiler he got as a gift from a family member. He purchased the new puppy as a playmate. – The 6mth old puppy had 3 sets of vaccinations given by the family member. – Neither puppy has been started on heartworm or flea prevention. – Diet: Blue Buffalo PATIENT PRESENTATION

29. PHYSICAL EXAM FINDINGS: – ~8% dehydrated Mm:pale, CRT: >2.5sec – Depressed – Rear soiled in blood-tinged diarrhea, strong, foul odor – Temp: 103.5, HR: 120 RR: 24 PATIENT PRESENTATION

30. Fecal Parvo ELISA (snap test) – Detects viral antigen CBC/Serum Chemistries – Marked lymphopenia, neutropenia, increased PCV – Hypoglycemia, hypokalemia Parvo titers – High titers (1:10,000) DIAGNOSTICS

31. PARVO ELISA

33. PATHOGENESIS TRANSMISSION: fecal-oral route – Virus has affinity for rapidly dividing cells such as intestinal epithelium & bone marrow; severe cases affect the myocardium (esp in utero) Affect on bone marrow lymphopenia, neutropenia WBCs may be <2000 – Possible sequelae: septicemia, intussusception

34. ISOLATE INFECTED ANIMALS HOSPITALIZATION – IV fluids w/added electrolytes, added dextrose – ANTIBIOTICS – ANTI-EMETICS Reglan Maropitant (cerenia) Ondansetron – NSAIDs – +/- Plasma transfusion for hypoproteinemia – +/-ANTIVIRAL Tamiflu TREATMENT

35. PROGNOSIS: generally good with aggressive and early treatment; 80%-90% success – Concurrent infections and GI parasites can worsen prognosis PROGNOSIS

36. VACCINATION – Keep puppies isolated until they have firm immunity, usually about 18-22 weeks of age – Vaccinate at 6-8 weeks then q3-4 weeks until 16 weeks of age CLIENT INFO – In this case, the 1 st 2 vaccines are not valid – Client should isolate the new puppy from the older one – Treatment is expensive – The virus is resistant in the environment and may survive for years. A 1:30 solution of bleach is effective. PREVENTION & CLIENT INFORMATION

37. CASE #4

39. SIGNALMENT: ~6 week old intact, male kitten, DSH PRESENTING COMPLAINT: mucopurulent ocular/nasal discharge, congestion, head shaking, sneezing, inappetance – has gotten progressively worse in the last week Hx: owner has been feeding a family of stray cats outside her home. Several of the kittens look like this. This is the only kitten she could catch PATIENT PRESENTATION

40. Hx: no known vaccinations, no flea or HW prevention – Diet: owner feeds canned Whiskas PHYSICAL EXAM – Patient is QAR – Temp: 104.1, HR: 200, RR:40 – Audible upper respiratory congestion – ~6-8% dehydrated – Mm: pale pk, CRT: 2 sec PATIENT PRESENTATION

41. DIAGNOSTICS – Clinical signs – Nasal, pharyngeal swabs DIAGNOSIS: – Feline Viral Rhinotracheitis(FVR) Feline Herpesvirus-1 – Feline Calicivirus (FCV) 80-90% of all URI is cause by 1 of these 2 viruses Chlamydophila felis – Bordetella – Mycoplasma DIAGNOSTICS

42. DIAGNOSIS

43. FLUIDS ANTIBIOTICS NURSING CARE – Warm, clean – Force feed, warm, food – Pain meds for oral or corneal ulcers DECREASE STRESS AVOID STEROID ANTIVIRAL – Idoxuridine TREATMENT

44. Both FVR and FCV are highly contagious – Transmitted via fomites (hands, clothes) and aerolsolization of respiratory droplets withing 5 feet Morbidity is high, mortality is low – Oral ulcers can last 7-10 days PROGNOSIS & CLIENT INFORMATION

45. VACCINATION – Vaccines will reduce severity and duration of clinical signs Isolate infected animals PREVENTION