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Diseases of Pigs

North American Veterinary Licensing Examination (NAVLE). 360 multiple choice questions6 blocks of 60 questionsApprox. 60 images (xrays, diagrams, photos, microscope images, etc)Total 7.5 hours55-65% to pass (90% pass). North American Veterinary Licensing Examination (NAVLE). Blueprint by specie

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Diseases of Pigs

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    1. Diseases of Pigs

    2. North American Veterinary Licensing Examination (NAVLE) 360 multiple choice questions 6 blocks of 60 questions Approx. 60 images (xrays, diagrams, photos, microscope images, etc) Total 7.5 hours 55-65% to pass (90% pass)

    3. North American Veterinary Licensing Examination (NAVLE) Blueprint by species Small animal Canine 26% Feline 22% Pet bird 3% Other (fish, lab, exotics) 3% Food animal Bovine 15% Pigs 7% Sheep / goat 2% Horses 16% Public health, poultry 6%

    4. Gram positive or gram negative? SS BECLR DAMN (a ship) S - Staphylococcus sp. S - Streptoccoccus sp. B - Bacillus sp. E - Erysipelothrix rhusiopathiae C - Clostridium sp. L - Listeria monocytogenes R - Rhodococcus equi D - Dermatophilus congolensis A - Actinomyces (Arcanobacterium) pyogenes M - Mycobacterium sp. (acid fast) N - Nocardiasp.

    5. On to the pigs....

    6. Ages of pigs are important Neonates 0-3 weeks <4 kg Weanlings/nursery 3-10 weeks 4-25 kg Growers/finisher 10-26 weeks 25-120 kg Breeders/adults >6-8 months >120 kg

    7. Pig management Backyard herds All in / all out SPF Segregrated early weaning Depop / repop

    8. Pig medicine Blood collection Jugular vein / anterior vena cava IV injection Auricular vein Rubberband

    9. Orderly thinking... Multisystemic Diseases Respiratory Diseases Gastrointestinal Diseases Neurologic Diseases Musculoskeletal Diseases Reproductive Diseases Dermatology Miscellaneous

    10. Multisystemic diseases Erysipelas (Erysipelothrix rhusiopathiae) Glasser’s disease (Haemophilus parasuis) Salmonella PRRS (arterivirus) PWMWS (circovirus) Pseudorabies virus (herpes virus) Vitamin E / selenium deficiency

    11. Erysipelas Erysipelothrix rhusiopathiae Gram positive rod Environmental contaminant most herds have carriers Septicemia diamond skin, arthritis, endocarditis, necrosis

    12. Diamond skin disease

    13. Valvular endocarditis

    14. Erysipelas cont... Treatment Penicillin Tetracyclins Prevention and control Sanitation Vaccinate at weaning and then q6 months

    15. Glasser’s disease (polyserositis) Haemophilus parasuis Gram negative coccobacillus Endemic, initiated by stress Polyserositis, septicemia (fibrinous) Pleuritis Pericarditis Peritonitis Meningitis!!!

    16. Glasser’s disease

    17. Glasser’s cont... Diagnosis Culture is difficult (but try it) Go with suspicion from gross lesions Treatment Penicillins Tetracyclins Prevention and control Reduce stress Vaccine at weaning then again 3-4 weeks later

    18. Salmonella sp. Salmonella cholerasuis Salmonella typhimurium Zoonotic Low-level endemnicity, carriers Septicemia pyrexia, anorexia purple discoloration of the ears (infarction) Small or large intestinal diarrhea (button ulcers) Pneumonia Rectal strictures

    19. Salmonella

    20. Salmonella cont... Diagnosis Aerobic culture Treatment Neomycin in the feed/water for whole group Naxcel (ceftiofur) for individual Prevention and control Sanitation All in - all out operation Various vaccines (live avirulent)

    21. PRRS Porcine reproduction and respiratory syndrome Arterivirus Clinical signs - neonates anorexia, lethargy, fever cyanosis of the ears, respiratory distress secondary bacterial pneumonia delayed or abnormal estrus cycle with increased numbers of stillborns/mummies

    22. PRRS cont... Diagnosis serology, virus isolation IFA, IHC most common test used in the USA Treatment Supportive care, treat secondary bacteria Control closed herds change feed if contaminated by mycotoxins (*) RespPRRS vaccine

    23. Post weaning multisystemic wasting syndrome (PWMWS) Porcine circovirus -2 Relatively new disease Responsible for many of the clinical signs associated with “atypical PRRS virus”.

    24. PWMWS Clinical signs Wasting in weanling pigs Enlarged peripheral lymph nodes Evidence of pneumonia Diagnosis Necropsy- Granulomatous lymphadenitis and pneumonia Intracytoplasmic inclusions Serology, IFA

    25. PWMWS Treatment None Supportive care Euthanasia of affected animals Control Difficult at this time Carrier animals are important

    26. Pseudorabies Aujesky’s disease Herpes virus Dogs, cats, domestic ruminants Not humans!

    27. Pseudorabies cont... Baby piglets up to 100% mortality neurologic dz, vomiting, diarrhea Ulcers on oral cavity and esophagus Weanling/growers up to 60% mortality in weanlings, 0-15% in finishers pneumonia impt, neurologic dz, vomiting, extreme pyrexia Adults - often inapparent can cause stillbirth/abortion

    28. Pseudorabies cont... Reportable disease! Diagnosis Necropsy - histologic lesions in brain, ulcers in gi tract Serum neutralization is standard test ELISA can be used as a screening test Treatment - none Prevention closed herd! quarantine! restrict wildlife vaccination

    29. Pseudorabies

    30. Pseudorabies Regulation use of vaccine regulated by states federal regulations for monitoring all animals over 6mo old must be tested 25% of herd tested q3months or... 10% of herd tested q1month

    31. White muscle disease / Mulberry heart disease Nursery or grower pigs Vitamin E / Selenium deficiency Propionic acid destroys Vit E / Sel Rancid fat can destroy Midwest U.S. is selenium deficient Clinical signs acute death (mulberry heart disease) muscle weakness (white muscle disease)

    32. Vit E / Selenium cont... Diagnosis Necropsy - hydropericardium, fibrinous epicarditis, myocardial hemorrhage Diffise hepatic necrosis - hepatosis dietetica Liver selenium < 0.5 ug/g

    33. Mulberry heart disease

    34. Cardiovascular disease Encephalomyocarditis virus Hog cholera African swine fever Erysipelas Vitamin E / selenium deficiency

    35. EMC virus Cardiovirus Clinical signs neonates - sudden death older pigs - subclinical chronic myocarditis Pathology Epicardial hemorrhage often only lesion May see white streaks or spots in myocardium Heart may be enlarged, soft and pale Hydropericardium, hydrothorax, pulmonary edema, etc. Non-suppurative myocarditis, meningitis, encephalitis

    37. Other cardiovascular conditions Hog cholera - FAD African swine fever - FAD Erysipelas - valvular endocarditis Vitamin E / selenium deficiency Mulberry heart disease Necrosis / degeneration of myocardium

    38. Respiratory diseases Atrophic rhinitis Swine influenza Mycoplasma pneumoniae Actinobacillus pleuropneumoniae Pasteurella Verminous pneumonia

    39. Atrophic rhinitis Bordatella bronchiseptica Pasteurella multocida High ammonia Clinical signs sneezing, sniffling twisted snouts excessive lacrimation epistaxis

    40. Atrophic rhinitis cont... Diagnosis Necropsy - cut snout at 2nd premolar Nasal culture for either organism Treatment tetracyclines in the feed LA200 to neonates Control and prevention all in all out, reduce stress, clean air vaccinate sows

    41. Atrophic rhinitis

    42. Swine influenza Influenza virus Zoonotic Outbreaks associated with movement or extreme weather changes up to 100% morbidity low mortality unless secondary bacterial infection complicates things

    43. Swine influenza cont... Diagnosis Necropsy - cranioventral pneumonia Fluorescent antibody test Treatment - supportive Prevention closed herd control secondary infections keep away from humans (no shows!)

    44. Mycoplasma hyopneumoniae Enzootic pneumonia Most common cause of chronic pneumonia Chronic, non-productive cough Low mortality Secondary bacterial complication

    45. Mycoplasma cont... Diagnosis Necropsy - “plum colored”or pale cranio-ventral pneumonia Culture to rule out secondary bacteria Fluorescent antibody test on lung

    46. Mycoplasma cont... Treatment - Lincomycin in feed Prevention - improve management

    47. Actinobacillus pleuropneumonia Intensive swine operations Inapparent carriers Peracute, acute, and chronic forms Clinical signs severe respiratory distress death

    48. Actinobacillus cont... Diagnosis necropsy - fibrinous pleuropneumonia often diaphragmatic lobes most severe culture is difficult complement fixation serology Treatment ceftiofur (Naxcel) and procaine penicillin Control vaccination of young pigs

    49. Contagious pleuropneumonia

    50. Pasteurella multocida Most common bacterial isolate from pig lungs opportunistic pathogen mycoplasma, influenza, actinobacillus, stress clinical signs moist productive cough dyspnea some die

    51. Pasteurella cont... Diagnosis necropsy - suppurative cranio-ventral bronchopneumonia may be pleuritis similar to actinobacillus culture Treatment - penicillin, tetracyclines Control look for underlying disease medicate feed and water (tetracyclines)

    52. Pasteurella pneumonia

    53. Verminous pneumonia Ascaris suum - direct life cycle Metastrongylus elongatus - earthworm intermediate Problem with pasture pigs Clinical signs poor doer respiratory distress Secondary bacterial infection “Milk spots” liver, worms in the GI Levamisole, ivermectin

    54. Gastrointestinal diseases Stomach Ulcers Small intestine E. coli (piglets) TGE (piglets) Clostridium (piglets) Coccidiosis (>7 days) Rota virus (post weaning) Salmonella (any)

    55. Gastrointestinal disease cont... Large intestine Swine dysentery (grower/finishers) Proliferative enteropathy (grower/finishers) Hemorrhagic bowel syndrome Proliferative illeitis Whipworms (growers) Salmonella (any)

    56. Gastric ulcer disease Almost always the pars esophagea Non-specific lesions Can lead to “bleed-out” Predisposing factors... Finely ground feed Stress Vit E/Selenium def Melena, ulceration of squamous portion of stomach, anorexia

    57. “Bleed out”

    58. Colibacillosis E. coli Most impt cause of diarrhea in piglets <5 days old!!! Clinical signs clear watery to pasty brown feces dehydration and depression death losses higher in younger pigs

    59. Colibacillosis cont... Diagnosis ph of feces (>8) culture of organism (large number) necropsy - dilated gas filled small intestine Treatment Ampicillin, tetracyclin, gentamicin, fluids Control sanitation, vaccination of sow

    60. Colibacillosis

    61. TGE - transmissable gastroenteritis Coronavirus (similar to FIP) Epidemic form (all ages) Endemic form (1-8 weeks old) WINTER disease Clinical signs Neonates - diarrhea with undigested milk Growers, finishers - diarrhea recovers <7days Morbidity and mortality high in pigs <2weeks old

    62. TGE cont... Diagnosis ELISA, immunoflourescence of gut contents Necropsy undigested milk in small intestine thin walled, transparent small intestine Treatment - supportive Control isolate new additions for 2 weeks, keep dogs and bird away (carriers) Immunization of sows or piglets Grind up piglet guts and feed to pregnant sows

    63. TGE

    64. Clostridial enteritis Clostridium perfringens type C sudden death in 1-2 day old piglets Clinical signs BLOODY DIARRHEA Diagnosis Necropsy - blood in jejunum with flecks of mucosa, necrosis of small intestine Clinical signs Histopathology - large gram positive rods

    65. Clostridial enteritis

    66. Clostridial enteritis cont.... Treatment usually die too quickly type C antitoxin Control Sanitation Type C antitoxin within minutes of birth Vaccination of sow Prophylactic bacitracin or penicillin to piglets

    67. Coccidiosis Isospora suis piglets 5 days old to weaning Clinical signs diarrhea (7-10 days of age) no blood acidic feces (in contrast to E. coli) Dehydration

    68. Coccidiosis cont... Diagnosis Diarrheas in pigs <7days old are not Isospora! Necropsy - fibrinonecrotic enteritis Histopathology - oocysts, merozoites Fecal flotation can be falsely negative Treatment Adding coccidiostats to feed is ILLEGAL amprolium to piglets Control - disinfection of farrowing area

    69. Coccidiosis

    70. Rota virus Reovirus Almost all pigs are infected Diarrhea in post-weaned pigs Diagnosis - difficult Necropsy-thin walled small intestine Histopathology Flourescent antibody test Electron microscopy

    71. Rota virus cont... Treatment Glucose and fluids Antimicrobials for concurrent infections E. coli Isospora Control Wean pigs on good nutritional diet MLV vaccine at 7 and 21 days (in water)

    72. Dont forget Salmonella Salmonella typhimurium Salmonella cholerasuis Fibrinonecrotic enteritis or colitis at necropsy Rectal strictures Culture of organism

    73. Swine dysentery Serpulina hyodysenteriae Grower / finishers Mortality can be up to 30% Clinical signs diarrhea sometimes with blood eventually watery, bloody, mucoid most recover in 2 weeks but 30% may die

    74. Swine dysentery cont... Diagnosis Necropsy - mucohemorrhagic colitis histopathology Spiral shaped organism on dark field microscopy Culture is definitive Treatment Lincomycin in water Control medicated water, depopulation, close herd vaccine only reduces clinical signs

    75. Swine dysentery

    76. Swine dysentery

    77. Proliferative enteropathy Lawsonia intracellulare proliferative illeitis, hemorrhagic bowel syndrome Large intestine Weanlings and older Clinical signs intermittant diarrhea can be hemorrhagic diarrhea anemia (think gastric ulcer first)

    78. Proliferative enteropathy cont... Diagnosis Necropsy - “garden hose” ilium and colon can be hemorrhagic or fibrinonecrotic Histopathology - intracellular, silver positive DNA probes Treatment and control No specific treatment Reduce stress Medicate feed - tetracyclines, carbadox

    79. Proliferative illeitis

    80. Whipworms Trichuris suis 2-6 months of age Large intestine Clinical signs diarrhea with mucus and blood anemia (2 DDX?) Diagnosis - fecal float, fibrinnecrotic colitis Control - dichlorvos and fenbendazole

    81. Whipworms

    82. Don’t forget Salmonella! Salmonella typhimurium Salmonella cholersuis associated with rectal strictures? Can be large intestine Fibrinonecrotic colitis Rectal strictures Culture

    83. Parasites of pigs Trichuris suis - colon Ascaris suum - small intestine, milk spots Stephanurus edentatus - kidney Macrocanthorynchus hirudinaceous -small intestine

    84. Neurological diseases Hypoglycemia Streptococcus suis Salt poisoning Edema disease

    85. Hypoglycemia Newborn piglets Blood glucose <50 may develop signs Clinical signs convulsions shivering hypothermia gait abnormalities

    86. Hypoglycemia cont... Diagnosis Blood glucose Empty stomach Treatment 20ml/kg 5% glucosa, warm em up Control make sure the milk is flowing

    87. Streptococcus suis Streptococcal meningitis 3-12 weeks of age Clinical signs fever, anorexia, depression tremors, blindness, ataxia, convulsions Diagnosis Necropsy - suppurative meningitis Culture of CSF or meningeal swab

    88. Strep suis cont... Treatment penicillin, tetracyclines must be quick! Control minimize stress prophylactic antibiotics Can be zoonotic - meningitis, headaches

    89. Streptococcal meningitis

    90. Salt poisoning Usually due to water deprivation rather than too much Na Causes hyperosmalarity of CNS resulting in swelling and edema Clinical signs thirst, constipation depression, blindness, convulsions

    91. Salt poisoning cont... Diagnosis History Clinical pathology-eosinopenia, hypernatremia Histopathology - eosinophilic meningitis Treatment None Control provide free access to water reduce salt in diet

    92. Edema disease E. coli - toxin differs from GI form Shiga like toxin - vascular injury - edema 1-3 weeks post weaning Clinical signs sudden death ataxia, convulsions, palpebral edema Diagnosis palpebral edema, widespread edema in multiple sites Culture - pure culture from SI or colon Detection of toxin

    93. Edema disease

    94. Edema disease cont... Treatment ineffectual if clinical signs have developed Control Antibiotics in feed/water High fiber diets?

    95. Musculoskeletal diseases Arthritis S. suis, Erysipelothrix, A. pyogenes Mycoplasma hyosynoviae Myodegenerative disease Malignant hyperthermia (PSE) White muscle disease Rickets Fibrocartilagenous infarcts Osteochondrosis

    96. Suppurative arthritis Streptococcus suis Erysipelothrix rhusiopathiae Actinomyces pyogenes May see loss of cartilage Due to fighting, surgical contamination Distended joints, abscesses Penicillin - treatment often no good

    97. Suppurative arthritis

    98. Mycoplasmal arthritis Mycoplasma hyosynoviae 4-12 weeks of age acute or chronic lameness non-suppurative arthritis/synovitis edema of synovial tissue Lincomysin to treat

    99. Mycoplasmal arthritis

    100. Malignant hyperthermia Porcine stress syndrome, Pale soft edudative pork Autosomal recessive gene Stress predisposes Fighting, movement, handling Halothane anesthesia Clinical signs muscle tremors, dyspnea, red areas of skin, increased body temperature, muscle rigidity

    101. Malignant hyperthermia Treatment Remove stress Cool Dantrolene Control genetic selection - DNA probe avoid stress

    102. Malignant hyperthermia

    103. White muscle disease / Mulberry heart disease Nursery or grower pigs Vitamin E / Selenium deficiency Propionic acid destroys Vit E / Sel Rancid fat can destroy Midwest U.S. is selenium deficient Clinical signs acute death (mulberry heart disease) muscle weakness (white muscle disease)

    104. Vit E / Selenium cont... Diagnosis Necropsy - hydropericardium, fibrinous epicarditis, myocardial hemorrhage hepatic necrosis - hepatosis dietetica Liver selenium < 0.5 ug/g Treatment and control Vit E or selenium injection feed supplements

    105. Mulberry heart disease

    106. Rickets Ca/P imbalance or Vit D deficiency Decreased mineralization of bone 3-5 months of age Pathologic fractures Distorted bones Adjust diet

    107. Osteochondrosis Grower pigs Rapid growth Usually involves humero-radial joint Stifle less common

    108. Fibrocartilagenous infarcts Heavily muscled lean pigs Usually present down in hindlimbs Evidence of discospondylitis Rupture of nucleus pulposus Embolism of nucleus pulposus with subsequent infarction of spinal cord

    109. Reproductive disease Parvovirus Leptospirosis PRRS Cystitis / pyelonephritis Brucellosis

    110. Porcine parvovirus 100% prevalence Signs depend on time of infection <30days - embryo resorbed 30-70days - mummy >70days - dead or weak, survive normally no other signs of illness SMEDI - stillbirth, mummy, embryonic death, infertility Diagnosis - detection of virus in mummy by immunofluorescence or by rising titer

    111. Parvo - SMEDI

    112. Porcine parvovirus cont... Control Natural infection of gilts before breeding Commingle gilts with sows Grind up mummies and feed to gilts Vaccination! may still get some losses

    113. Leptospirosis Leptospira interrogans serovar pomona - most common serovar bratislava Clinical signs Pyrexia, last trimester abortion, stillbirths Diagnosis Culture difficult Dark field microscopy of fetal fluids, urine Serology (<1:800)

    114. Leptospirosis cont... Treatment Chlortetracycline in feed Control Vaccination Gilts twice before first breeding Sows before every breeding

    115. PRRS Porcine reproductive/respiratory syndrome Premature farrowing Small weak piglets or stillborns increased numbers of mummies Delayed or abnormal estrus Serology to diagnose Vaccination for prevention

    116. Cystitis / Pyelonephritis Eubacterium suis Clinical signs pyrexia, blood or pus in urine high urine pH Diagnosis necropsy - hemorrhagic cystitis Culture difficult - anaerobic Treatment - penicillin

    117. Brucellosis Brucella suis Clinical signs abortion at any time in gestation infertility - many sows coming back into heat infected sows recover and deliver normally Lesions mild endometritis arthritis orchitis

    118. Brucellosis

    119. Brucellosis cont... Diagnosis Serology - card test Culture Treatment and control Test and slaughter Zoonotic

    120. Abortions/stillbirths Parvo virus PRRS Pseudorabies Lepto

    121. Dermatologic diseases Mange Greasy pig disease Swine pox Erysipelas Pityriasis rosea (JPPD) PRRS associated vasculitis/glomerulonephritis

    122. Mange Sarcoptes scabei var suis Young nursery or grower pigs Clinical signs intense pruritis, thickened skin poor production susceptible to other diseases Diagnosis - clinical signs, skin scrape Treatment and control acaricide (amitraz) topically, ivermectin injection

    123. Mangy piglet

    124. Mangy piglet

    125. Sarcoptes scabei

    127. Greasy pig disease Exudative dermatitis Staphylococcus hyicus Affects late preweaning pigs Clinical signs exfoliation of skin, excess sebaceous secretion pruritis not a feature unless complicated my mange Diagnosis - clinical signs and culture

    128. Greasy pigs

    129. Greasy pig disease cont... Treatment Injectible penicllin, oxytetracyline Tetracyclines in feed Control Sanitation Control external parasites Good nutrition

    130. Swine pox Swine pox virus Only pigs less than 4months old Clinical signs papules 1-6 mm in diameter pustules, crusts clear spontaenously Diagnosis - clinical signs, biopsy intracytoplasmic inclusion bodies Treatment - not necessary

    131. Swine pox

    132. Erysipelas Erysipelothrix rhusiopathiae Diamond skin disease pigs 3months - 3years old Clinical signs widespread ecchymotic hemorrhages due to microthrombi arthritis, endocarditis Diagnosis Diamond skin lesions pathognomonic Culture of blood, joints, lung, liver

    133. Diamond skin disease

    134. Erysipelas cont... Treatment Penicillin is the drug of choice Control General sanitation Bacterins or attenuated live vaccines

    135. Pityriasis rosea Juvenille pustular psoriaform dermatitis Pseudo-ringworm Spontaneous regression

    136. PRRS associated Vasculitis/glomerulonephritis Newly described condition associated with PRRS virus infection Type III hypersensitivity reaction Causing vasculitis Dermal and cutaneous infarction Large red sloughing skin lesions usually over rear and legs Commonly associated renal disease

    137. PRRS vasculitis/glomerulonephritis

    138. Miscellaneous diseases Swine lice Baby piglet anemia Eperythrozoonosis

    139. Swine lice Haematopinus suis Indicator of poor management Clinical signs pruritis (mild), anemia, poor growing Diagnosis visible to naked eye Treatment - same as for mange

    140. Baby pig anemia Iron deficiency Piglets iron demand is greater than the sows milk Clinical signs anemia within 2-3 days of birth dyspnea, edema, pale skin, lethargy Diagnosis - clinical signs, CBC Treatment - 200mg iron dextran at 1-3 days of age

    141. Eperythrozoonosis Eperythrozoan suis Obligate intracellular parasite of RBC’s Clinical signs pyrexia, icterus, anemia intravascular hemolysis necropsy - large spleen Diagnosis - Giemsa stained blood smear Serology - 1:80 considered positive

    142. Eperythrozoonosis cont... Treatment Oxytetracycline injected or in feed Control Control lice and fomite transmission Surgical instruments, needles, etc...

    143. Pigweed Amaranthus retroflexus Common in southeast Severe perirenal edema

    144. Fumonensin Fusarium moniliforme Hypertension Arteriolar medial proliferation Hemorrhagic pleural and pulmonary edema*

    145. Foreign diseases Hog cholera pestivirus - splenic infarction is pathognomonic African swine fever iridovirus - hemorrhage in multiple areas

    146. Vesicular diseases of swine Foot and mouth disease - apthavirus* Swine vesicular disease - enterovirus Vesicular exanthema - calicivirus Vesicular stomatitis - rhabdovirus

    147. Case #1 Signalment: 10 weanling pigs History: dead and dying Necropsy findings: yellow fibrin covering lungs yellow fibrin covering abdominal organs meninges are reddened DDX?

    148. Case #2 Signalment: several growers History: poor doers, chronic cough Clinical signs: non-productive cough harsh lung sounds Euthanize and necropsy: cranioventral pneumonia, plum-red color DDX?

    149. Case #3 Signalment: 2 grower pig females History: diarrhea, weak Clinical signs: pale mucous membranes perineum stained with feces One dies - necropsy findings: Large intestine markedly thickened and contains small amount of blood DDX

    150. Case #4 Signalment: 1 piglet just weaned History: sudden death Clinical signs: dead! Necropsy findings: subQ expanded by fluid, eyelids swollen mesentery and omentum expanded by fluid Diagnosis? How do you confirm?

    151. Case #5 Signalment: breeding sows History: decreased fertility litters have contained dried up small fetuses Clinical signs: none in the sows DDX? How do you confirm your top differential?

    152. Case #6 Signalment: many weanlings History: lameness Clinical signs swollen painful hocks fever, one has pulmonary edema on xrays Aspiration of joint reveals pus DDX?

    153. Case #7 Signalment: young nursery pigs History: very itchy, bad skin Clinical signs: dermatitis, pustules intense pruritis, self trauma DDX? Diagnostic tests?

    154. THE END!!!

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