August's Consultations in Feline Internal Medicine, Volume 7 - E-Book

August's Consultations in Feline Internal Medicine, Volume 7 - E-Book

Susan E. Little, Susan Little

• Publisher: Saunders
• Year: 2015
• Print ISBN: 9780323226523
• eBook ISBN: 9780323243391
• Topic: Medicine
• Subtopic: Veterinary Medicine

Stay current with cutting-edge information from the leading feline experts! August's Consultations in Feline Internal Medicine, Volume 7 takes the popular Current Therapy approach to the latest issues, advances, and therapies in feline care. The 103 new chapters are organized by body systems, making information easy to access, and include more than 800 new detailed photographs, diagrams, and MRI and ultrasound images. Discussions of scientific findings always emphasize clinical relevance and practical application. This edition addresses new topics ranging from feline obesity and food allergies to respiratory mycoplasmal infections. From feline expert Susan Little, with chapters written by more than 130 international specialists, this practical resource will be an invaluable addition to every small animal clinician's library.- The Current Therapy format focuses on the latest advances in feline care and includes broad, traditional, and controversial subjects of real clinical importance.- Clinically relevant approach is supported with scientific research and promotes practical, progressive clinical management.- More than 130 world-renowned contributors provide expert insight across the full spectrum of feline internal medicine.- Extensive references make it easy to find additional information about specific topics most important to your practice.- 103 ALL-NEW chapters reflect the latest findings, reports, and evidence-based coverage of pressing topics such as: - Managing respiratory mycoplasmal infections- Continuous glucose monitoring in cats with diabetes- Feline food allergy- Stem cell therapy for chronic kidney disease- Feline idiopathic cystitis- Electrochemotherapy- Current concepts in preventing and managing obesity- Recognition and treatment of hypertensive crises- Feline social behavior and personality- NEW Emergency and Critical Care Medicine section contains 13 chapters covering complicated and serious internal medical problems.- NEW! More than 800 colorful new images clarify concepts and demonstrate clinical examples.

Section 1

Infectious Diseases

Outline

Chapter 1 Rational Approach to Diagnosing and Managing Infectious Causes of Diarrhea in Kittens

Chapter 2 Respiratory and Ocular Mycoplasmal Infections: Significance, Diagnosis, and Management

Chapter 3 Update on Mycobacterial Infections: Diagnosis, Management, and Zoonotic Considerations

Chapter 4 Practical Antimicrobial Therapy

Chapter 5 Emerging Aspects of Streptococcal Infections in Cats

Chapter 6 Dealing with Toxoplasmosis: Clinical Presentation, Diagnosis, Treatment, and Prevention

Chapter 7 Update on Antiviral Therapies

Chapter 8 The Gut Microbiome

Chapter 1

Rational Approach to Diagnosing and Managing Infectious Causes of Diarrhea in Kittens

Stanley L. Marks

Diarrhea in kittens is a frequent disorder facing veterinarians and managers of feline shelters and catteries;¹ however, there is scant literature providing specific information on causes and management of this problem. An innumerable number of kittens are abandoned or relinquished shortly after birth to be fostered by 4,000 to 6,000 American animal shelters (Humane Society of the United States report, www.humanesociety.org), and a recent survey of the Association of Shelter Veterinarians identified kitten diarrhea as one of the top two concerns of veterinarians treating shelter cats, second only to upper respiratory infections (K. Hurley, personal communication). Infectious disease was reported by Cave et al. to be the most common cause (55%) of kitten mortality identified from the necropsy findings of 274 kittens from private homes and rescue centers within the United Kingdom, with 25% of kitten mortality being attributed specifically to feline parvovirus (FPV).²

Knowledge of the most common causes of diarrhea in kittens is integral to formulating appropriate diagnostic and therapeutic plans, as well as guiding the veterinarian when standard therapeutic recommendations fail (Table 1-1). Diarrhea in kittens is often associated with the effects of stress,³ dietary intolerance, primary intestinal disease (congenital short colon, intussusception,⁴ or inflammatory bowel disease [IBD]), and infections with enteropathogenic bacteria, viruses,⁵ parasites, and protozoa.⁶ Although bacterial enteropathogens have been associated with diarrhea in kittens, identifying a causal relationship is difficult because potentially pathogenic enteric organisms can frequently be isolated in clinically healthy kittens. Routine bacterial examination of 57 clinically healthy kittens presented for initial vaccination revealed bacterial enteropathogens and intestinal parasites in 45% of the kittens.⁷ These findings were substantiated by a study that documented a significantly higher incidence of Campylobacter spp. in 28% of 54 nondiarrheic cats compared to 10% of 219 diarrheic cats.⁸ In addition, this study demonstrated that there was no significant difference in the prevalence of intestinal parasites between diarrheic and nondiarrheic cats.⁸ Determination of the frequency of enteropathogens in 100 cats entering an animal shelter in Florida confirmed that cats with diarrhea were no more likely to be infected with one or more (84%) enteropathogen than were cats with normal feces (84%).⁹ Only feline coronavirus (FCoV) was significantly more prevalent in cats with diarrhea (58%) compared with cats with normal feces (36%).⁹

Table 1-1

Parasitic, Bacterial, and Viral Causes of Diarrhea in Kittens

Disease	Clinical Signs	Diagnostic Test(s)	Infectious Agent	Comments	Treatment
Parasitic Causes of Diarrhea in Kittens
Trichomoniasis	Large bowel diarrhea Subclinical infection is common	1. Direct fecal smear 2. InPouch fecal culture 3. Fecal PCR	Tritrichomonas blagburni trophozoites identified on fecal smear and culture DNA detected via PCR	Fecal PCR testing is the most sensitive method. Fecal InPouch culture can take up to 10 days to yield a positive result	Ronidazole 30 mg/kg PO every 24 h for 14 days. Isolate infected cats. Retest.
Cryptosporidiosis	Subclinical infection is common Small bowel or mixed-bowel diarrhea	1. Acid-fast stain on fecal cytology 2. DFA testing 3. Fecal PCR	Cryptosporidium felis oocysts	More common in kittens and immunocompromised cats. Infection can be self-limiting.	Treatment can be challenging. No drug is FDA approved. Azithromycin (7-10 mg/kg PO every 12 h for 10 days) is recommended.
Giardiasis	Small bowel diarrhea Subclinical infection is common	1. Direct fecal smear 2. Fecal flotation (centrifugation) 3. Fecal ELISA 4. Fecal DFA 5. Fecal PCR (recommended for determination of Giardia assemblages if warranted)	Giardia intestinalis (has 8 assemblages [A-H] that determine its zoonotic potential) Flotation and DFA detect cysts via microscopy and ELISA detects soluble antigen	Fecal flotation combined with fecal ELISA has a combined sensitivity of > 97% PCR testing has a lower sensitivity than ELISA and flotation ELISA testing should be used for baseline screening only	None of the treatments are FDA approved. Metronidazole 25 mg/kg PO every 12 h for 7 days or Fenbendazole 50 mg/kg PO every 24 h for 5 days. Environmental control is important.
Coccidiosis	Subclinical infection is common Large bowel to mixed-bowel diarrhea	Fecal flotation (centrifugation)	Cystoisospora felis oocysts Cystoisospora rivolta oocysts	Coccidiosis is typically a disease of kittens, and diarrhea can be self-limiting.	Sulfadimethoxine is approved but is coccidiostatic, label dose is 55 mg/kg PO initial dose followed by 27.5 mg/kg every 24 h for up to 14 days. Ponazuril 50 mg/kg PO every 24 h for 4 days. Environmental control.
Whipworms	Large bowel diarrhea	Fecal flotation (centrifugation)	Trichuris serrata	Rare in domestic cats.	Fenbendazole 50 mg/kg PO every 24 h for 5 days (not FDA approved).
Roundworms	Small bowel diarrhea, failure to thrive, “pot-bellied” appearance	Fecal flotation (centrifugation)	Toxocara cati Tocascaris leonina	Common in kittens < 6 months old.	Pyrantel pamoate 20 mg/kg PO beginning at 2 wks of age, or Fenbendazole 50 mg/kg PO every 24 h for 5 days.
Hookworms	Small bowel diarrhea, melena, iron-deficiency anemia, failure to thrive	Fecal flotation (centrifugation)	Ancylostoma tubaeforme, Ancylostoma braziliense, Uncinaria stenocephala Ancylostoma caninum	Relatively uncommon in cats.	Selamectin, moxidectin, milbemycin oxime, emodepside. Fenbendazole and pyrantel pamoate are not FDA approved but are used off-label.
Bacterial Causes of Diarrhea in Kittens
Clostridium perfringens	Subclinical infection is occasionally seen Diarrhea can be small bowel, large bowel, or mixed in nature	1. ELISA test for C. perfringens enterotoxin 2. Fecal PCR for enterotoxin gene (should not be used alone to make a diagnosis)	C. perfringens enterotoxin	The pathogenicity of C. perfringens is unclear in cats, and detection of the enterotoxin via ELISA in diarrheic kittens and cats is far less common compared with dogs. A stained fecal smear for detecting endospores is highly insensitive and is not recommended. Fecal culture alone is of no diagnostic utility.	Supportive treatment is sufficient in most cases. In cats with systemic illness, metronidazole (10 mg/kg PO every 12 h for 5-7 days), amoxicillin (22 mg/kg PO every 12 h for 5-7 days), or tylosin (10 mg/kg PO every 24 h for 5-7 days) is recommended.
Clostridium difficile	Subclinical infection is occasionally seen Diarrhea can be small bowel, large bowel, or mixed in nature	1. Fecal culture (negative culture rules out infection) 2. ELISA test for C. difficile toxins A&B	C. difficile toxins A&B	Detection of C. difficile toxins A&B in asymptomatic kittens is not uncommon.	Supportive treatment is sufficient in most cases. In cats with systemic illness, metronidazole (10 mg/kg PO every 12 h for 5-7 days) is the drug of choice.
Campylo-bacteriosis	Subclinical infection is commonly seen with nonpathogenic species C. jejuni can cause large bowel diarrhea	1. Fecal culture 2. Fecal PCR 3. Stained fecal smear is extremely unreliable and insensitive	Over 14 species described in dogs and cats C. jejuni is pathogenic and zoonotic	Most Campylobacter spp. are non-pathogenic. Prevalence rates...

Table of contents

• Cover image
• Title page
• Table of Contents
• About The Cover
• Copyright
• Dedication
• Preface
• Section Editors
• Contributors
• Section 1 Infectious Diseases
• Section 2 Gastrointestinal Diseases
• Section 3 Endocrine and Metabolic Diseases
• Section 4 Dermatology
• Section 5 Cardiology and Respiratory Medicine
• Section 6 Upper and Lower Urinary Tract Diseases
• Section 7 Oncology
• Section 8 Nutrition
• Section 9 Population Medicine
• Section 10 Emergency and Critical Care Medicine
• Section 11 Behavioral Medicine
• Section 12 Pediatric and Geriatric Medicine
• Index