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CASE #5

CASE #5. PATIENT PRESENTATION. http://www.youtube.com/watch?v=xLlL24shW7E. PATIENT PRESENTATION. SIGNALMENT: 4week old, intact female, DSH PRESENTING COMPLAINTS: kitten is depressed and appears to be very thin, has blood-tinged diarrhea, occasional vomiting

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CASE #5

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  1. CASE #5

  2. PATIENT PRESENTATION http://www.youtube.com/watch?v=xLlL24shW7E

  3. PATIENT PRESENTATION • SIGNALMENT: 4week old, intact female, DSH • PRESENTING COMPLAINTS: kitten is depressed and appears to be very thin, has blood-tinged diarrhea, occasional vomiting • Hx: client lives in an apartment complex and found this kitten outside. She thinks she know the owner, but the owner doesn’t seem to be taking care of her.

  4. PATIENT PRESENTATION • PHYSICAL EXAM FINDINGS • 103.9 • ~6% dehydrated • Ataxic, unstable • Infected neonate may develop cerebellar hypoplasia or retinal defects • Lethargic • Fecal-soiled rear-end

  5. DIAGNOSTICS • CBC • Moderate to severe panleukopenia • Positive parvo snap test • Antibody titers • Virus isolation is difficult

  6. TREATMENT • Maintain hydration and electrolyte balance • Force-feeding • Broad-spectrum antibiotics

  7. PREVENTION & CLIENT INFO • Proper vaccination is required to prevent disease • Like canine parvovirus, this virus can remain in the environment for years. • Infected cats should be isolated as all body secretions contain the virus • Cats who survive the infection will not get re-infected later in life. They acquire life-long immunity.

  8. CASE #6

  9. PATIENT PRESENTATION

  10. PATIENT PRESENATION • SIGNALMENT: 3mth old, intact female, DSH • PRESENTING COMPLAINT: kitten is sometimes lethargic and seems to be bloated. She eats, although appetite is decreased. Owner can still feel and see the backbone and pelvic bones. • Hx: owner is fostering a litter of kittens from a shelter for the past 3 weeks, until they are healthy enough for adoption. The kittens have had intermittent diarrhea over the past 2 weeks, but has resolved

  11. PATIENT PRESENTATION • Hx: The other 5 kittens are generally healthy • Diet: dry kitten Iams • PHYSICAL EXAM: • Distended abdomen, although BCS:2/5 • Depression • ~6% dehydrated • Mm: pale pk, CRT:2sec • Temp: 102.9. HR: 200, RR: 30

  12. DIAGNOSTIC TESTS • FECAL • ABDOMINAL RADIOGRAPHS • CBC/SERUM CHEMISTRY • ABDOMINOCENTESIS • ANTIBODY TITERS(?)

  13. DIAGNOSTIC TESTS

  14. DIAGNOSTIC TESTS

  15. DIAGNOSTIC TESTS

  16. DIAGNOSTIC TESTS

  17. DIAGNOSTIC TEST RESULTS • FECAL(?) • There is NO “FIP SPECIFIC” antibody titer test • CBC/SERUM CHEMISTRY • Low albumin/globulin ratio (<0.8) in the blood • ABDOMINAL RADIOGRAPHS • Ascites found • ABDOMINOCENTESIS • Viscous, clear to yellow fulid, high protein, low cellularity • RIVALTA TEST positive • DIAGNOSIS: FELINE INFECTIOUS PERITONITIS

  18. DIAGNOSTIC TESTS

  19. RIVALTA TEST • Fill a clear test tube ¾ full with distilled water, add one drop 98% acetic acid and mix (or vinegar). • Carefully place one drop Of the cat’s effusion on the surface of the acid. • If drop disappears Test = negative • If drop retains shape Test = positive

  20. DIAGNOSTICS

  21. TRANSMISSION & PATHOPHYSIOLOGY

  22. TRANSMISSION & PATHOPHYSIOLOGY

  23. TRANSMISSION & PATHOPHYSIOLOGY • FIP occurs in 2 forms: the “wet” or effusive form (75%) and the non-effusive or “dry” form. • DRY FORM • Fever • Anorexia • Depression • Wt. loss • Ocular lesions – hyphema, iritis, retinal hemorrhage • Neurologic lesions • Rarely, enlarged kidneys • This form of the disease is vague and progresses slowly – these animals may live months to years

  24. DRY FORM UVEITIS, RETINITIS, IRITIS

  25. FIP: DRY FORM MESENTERIC LYMPHADENOPATHY IRREGULARLY MARGINATED KIDNEYS, POSSIBLE RENOMEGALY

  26. TREATMENT & PREVENTION • SUPPORTIVE CARE • Thoracocentesis/abdominocentesis to make pet more comfortable • Daily steroids • Antibiotics • PREVENTION • Control of the virus shedding is key • House cats separately • Clean litter boxes frequently • The virus can last up to 4 weeks in the environment, but is killed easily by disinfectants • Lower number of cats • Lower stress • Vaccinate against feline coronavirus

  27. CLIENT INFO & PROGNOSIS • Clinical FIP is almost always a fatal disease with a mortality rate >95%. • Cats with the effusive form usually progress more quickly and often die within 2 months of initial diagnosis

  28. CASE # 7

  29. PATIENT PRESENTATION

  30. PATIENT PRESENTATION • SIGNALMENT: ~2-3yr old intact male DSH • PRESENTING COMPLAINT: cat seems to have lost weight in the last few months and seems lethargic • Hx: unknown, client feeds this stray cat who is very friendly. She brings him in out of concern for his health

  31. PATIENT PRESENTATION • PHYSICAL EXAM • BCS: 2/5 • Temp:103.1, HR: 160, RR: 30 • Enlarged mandibular lymph nodes and popliteal lymph nodes (see pic below) • Firm, mid-abdominal mass palpated Enlarged popliteal lymph node Lbah.com

  32. DIAGNOSTIC TESTS • CBC/SERUM CHEMISTRIES • ABDOMINAL RADIOGRAPHS • FeLV/FIV Test • All cats that go outdoors or come from unknown backgrounds should be tested for FeLV and FIV when first examined by a veterinarian

  33. DIAGNOSTIC TESTS TUMOR OF THE THYMUS – WOULD OCCUR IN A YOUNG ANIMAL INFECTED

  34. DIAGNOSTIC TESTS

  35. DIAGNOSTIC TESTS

  36. DIAGNOSTIC TESTS • CBC • Nonregenerative anemia • Leukopenia – this virus can affect the bone marrow resulting in feline panleukopenia-like syndrome • These patients are at a higher risk for contracting Hemobartonellosis (feline infectious anemia) • FeLV ELISA • positive

  37. TRANSMISSION & PATHOPHYSIOLOGY • Feline Leukemia is a retrovirus and is associated with both neoplastic and nonneoplastic disease • Lymphoma is the most common neoplastic disease – tumors can occur in the thymus, GI tract, or lymph nodes throughout the body • Other clinical signs • Secondary infections • Wt. loss • Anorexia • Neurologic signs • Spontaneous abortion

  38. TRANSMISSION & PATHOPHYSIOLOGY • TRANSMISSION: • The most likely route of infection is through continued intimate contact such as grooming, sharing food and water bowls (virus shed in saliva, urine, tears) – this is horizontal transmission • The virus can also be transmitted to neonates in utero and through the milk of infected queens – this is vertical transmission

  39. TRANSMISSION & PATHOPHYSIOLOGY • POSSIBLE OUTCOMES OF FeLV INFECTION • 1. Cat may mount an immune response, clear the virus, and become resistant to future infection • 2. some cats fail to mount an effective immune response, become persistently viremic, and succumb to FeLV-associated diseases • 3. the virus is cleared from the plasma or serum but persists in a latent form in the bone marrow or lymphatic tissue. • Outcome depends on: • Age, immunocompetence, concurrent disease, viral strain, dose, duration of exposure

  40. TREATMENT • NO CURE for FeLV • IMMUNOMODULATING DRUGS • Human interferon-α – interferes with viral replication • Acemannan – from the aloe vera plant is known to have antiviral, immunostimulant, and antineoplastic properties • Proprionibacterium acnes – killed form of this bacteria can be given to stimulate the immune system to fight disease • ANTIVIRAL DRUGS -*can be toxic to bone marrow in cats • AZT – antiretroviral • ANTIBIOTICS • POSSIBLE CHEMOTHERAPY

  41. CLIENT INFO & PROGNOSIS • FeLV positive cats should be retested 3-4 months after initial test • FeLV cats should be isolated from all other cats • FeLV cats should be kept indoors • FeLV cats should have reduced stress and regular vaccination and veterinary check-ups • Life expectancy is approximately 2 years after diagnosis

  42. CASE #8

  43. PATIENT PRESENTATION

  44. PATIENT PRESENTATION • SIGNALMENT: ~4-5yr old, intact, male, DMH • PRESENTING COMPLAINT: inappetant, hypersalivation, lethargy • Hx: indoor/outdoor cat, has not had vaccinations in over 3 years. Cat has had a few fights with other neighborhood cats over the years, but nothing serious.

  45. PATIENT PRESENTATION • PHYSICAL EXAM: • Gingivitis, stomatitis • Wt. loss • Temp: 103.5, HR: 200, RR:36 • Mm: pale , CRT: 2sec • Other clinical signs may include: • Gingivitis, stomatitis • Chronic fever • Vomiting • Diarrhea • Chronic URI • cachexia • Chronic, unresponsive skin/ear infections

  46. DIAGNOSTIC TESTS • CBC/SERUM CHEMISTRIES • FeLV/FIV ELISA • All unvaccinated outdoor cats should be tested for these diseases as they are contagious and without cure

  47. DIAGNOSTIC TEST RESULTS • CBC • Anemia, lymphopenia • ELISA positive • THIS IS AN ANTIBODY TEST, not antigen – there will be interference by maternal antibodies and vaccination! • Test result may be supported by other lab tests such as IFA, Western blot, & PCR

  48. TRANSMISSION • TRANSMISSION • Most infections are acquired through horizontal transmission among adult male, sexually intact cats • Fight and bite wounds appear to be the major route of transmission. • It is possible to transmit the virus vertically to neonatal kittens, but the virus is not easily transmitted this way.

  49. TREATMENT • SEE FELINE LEUKEMIA VIRUS • DENTAL SURGERY • Whole mouth extraction of teeth may be necessary in cats with chronic stomatitis and gingivitis

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