CASE 5 PATIENT PRESENTATION http www youtube

CASE #5

PATIENT PRESENTATION http: //www. youtube. com/watch? v=x. Ll. L 24 sh. W 7 E

PATIENT PRESENTATION • SIGNALMENT: 4 week 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.

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

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

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

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 reinfected later in life. They acquire life-long immunity.

CASE #6

PATIENT PRESENTATION

PATIENT PRESENATION • SIGNALMENT: 3 mth 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

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: 2 sec Temp: 102. 9. HR: 200, RR: 30

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

DIAGNOSTIC TESTS

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

DIAGNOSTIC TESTS

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 •

DIAGNOSTICS

TRANSMISSION & PATHOPHYSIOLOGY

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

DRY FORM UVEITIS, RETINITIS, IRITIS

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

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

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

CASE # 7

PATIENT PRESENTATION

PATIENT PRESENTATION • SIGNALMENT: ~2 -3 yr 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

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

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

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

DIAGNOSTIC TESTS

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) • Fe. LV ELISA – positive

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

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

TRANSMISSION & PATHOPHYSIOLOGY • POSSIBLE OUTCOMES OF Fe. LV 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 Fe. LV-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

TREATMENT • NO CURE for Fe. LV • 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

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

CASE #8

PATIENT PRESENTATION

PATIENT PRESENTATION • SIGNALMENT: ~4 -5 yr 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.

PATIENT PRESENTATION • PHYSICAL EXAM: – – Gingivitis, stomatitis Wt. loss Temp: 103. 5, HR: 200, RR: 36 Mm: pale , CRT: 2 sec • Other clinical signs may include: – – – – Gingivitis, stomatitis Chronic fever Vomiting Diarrhea Chronic URI cachexia Chronic, unresponsive skin/ear infections

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

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

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.

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

CLIENT INFO & PROGNOSIS • Although FIV is morphologically and biochemically similar to HIV, it poses no threat to humans • Infected cats may survive for prolonged periods before experiencing advanced stages of the disease – Some may be asymptomatic for 10+ yrs • Keep FIV pos cats indoors • Keep FIV pos cats free of stress and concurrent disease