Cardiorespiratory Diseases

Heart Chambers• 4 Chambers– R atrium

• Receives deoxygenated blood from body– Vena cava

– R ventricle• Pumps deoxygenated blood to lungs

– Pulmonary artery

– L atrium• Receives oxygenated blood from lungs

– Pulmonary vein

– L ventricle• Pumps oxygenated blood to body

– Aorta

Cardiorespiratory Physiology• R side of heart– Blood

• Low O2

• High CO2

– Pressure • Low—short distance to lungs

• L side of heart– Blood

• High O2

• Low CO2

– Pressure • High—far distance to body

Alveoli-Capillary Gas Exchange• Alveoli surrounded by capillaries– Incoming RBCs low in O2

– Exiting RBCs rich in O2

– Thin capillary membrane (epithelium?)

Electrical Conduction of Heart• SA node

• Pacemaker (fastest rate of contraction)• In R atrium

• AV node• Impulse travels along internodal tract• Slight delay

– Filling of ventricles

• Bundle of HIS– Interventricular septum

• Purkinje fibers– To myocardial cells– Apex contracts first

Electrocardiogram (ECG)• P wave– Contraction of atria

• QRS complex– Contraction of ventricles– Repolarization of atria (hidden by vent activity)

• T wave– Repolarization of ventricles

Measures electrical activity of heart at skin surface

Cardiovascular Diseases• Heart Failure—returning blood is not pumped fast enough to meet

body’s needs• Heart failure is not a heart attack

– 2 causes• Myocardial (heart muscle) dysfunction

– Cardiomyopathy– Myocarditis– Taurine (an amino acid) deficiency in cats

• Circulatory failure– Hypovolemia (shock, hemorrhage, dehydration)– Anemia– Valvular dysfunction– Congenital shunts or defects

• Congestive heart failure—when failing heart leads to fluid congestion a) in lungs (pulmonary edema), b) in body (edema)– Heart failure almost always progresses to congestive heart failure

Cardiomyopathy: 2 Types

• Dilated Cardiomyopathy (DCM)

• Hypertrophic Cardiomyopathy (HCM)

Canine Dilated Cardiomyopathy• One of the most commonly acquired heart diseases in dogs– Boxers, Dobermans

• Seen in older large/giant breeds• Heart chambers dilate because heart wall becomes thin,

weak, flabby• ↓ CO (cardiac output), ↑ blood left in heart after systole

Canine Dilated Cardiomyopathy• Signs– Giant/large breed dogs; older

(4-10 y)– Exercise intolerance– R sided failure• Ascites/abdominal distension• Hepatomegaly• Wt loss

– L sided failure• Coughing• Pulmonary edema• Syncope

Canine DCM

• PE– Weakness, depression– Hypokinetic femoral pulse from low CO– Pulse deficits– Jugular pulses– HR – fast 150-200+

Canine Dilated Cardiomyopathy• Dx– X-rays may show dilated heart– Ultrasonography will show dilated heart chambers– ECG

• widened/large QRS and P waves• rhythm disturbances

• Rx—no cure– Diuretics to ↓ fluid buildup

• Furosemide– Digoxin

• ↑strength of contraction (↑CO)– Nitroglycerin x 24-48 hrs– OXYGEN!!!– Vasodilators (enalopril,etc)– Pimobendan - + inotrope, increases survival

Canine DCM• Client info– Fatal disease (6mo to 2 y) – SUDDEN DEATH– More prevalent in large breeds– Diet – decrease Na intake– Minimal exercise – let patient be guide

http://www.vetspecialistsofrochester.com/Cardiology/Canine_Conditions.aspx

Canine Hypertrophic CardiomyopathyUncommon in dogsL ventricular muscle enlarges, decreasing chamber size of L ventricleHeritable

• Signs– Fatigue– Cough– Tachypnea– Syncope– ± cardiac murmurs– Sudden death– Some animals will be asymptomatic

• PE– Systolic heart murmur– Cardiac gallop rhythm– LH failure: cough, dyspnea, cyanosis, exercise intolerance

Normal Hypertrophy

Canine HCM• Dx

– X-rays may be normal, have La or LV enlargement and/or pulmonary edema

– Ultrasound shows thickened L vent wall– EKG: Normal or ST segment and T wave abn

• Rx—none routinely used unless signs of HF• Client info

– Sudden death and CHF may occur– Certain breeds more susceptible (G Shep, Rott, Dalm, C Span, Bostons,

Shih Tzu)

Feline Dilated CardiomyopathyPrior to late 1980’s, this was frequently seen in catsAssociated with taurine deficiency; addition to cat feed has

greatly reduced incidenceSimilar pathology to DCM in dogs

• Signs– Older, mixed breed (Siamese, Burmese,

Abyssinian)– Dyspnea, tachypnea– Inactivity– Anorexia– Acute lameness/paralysis (rear legs)– Pain/lack of circulation in affected

limbs (no pulse due to thromboemboli)

Feline DCM • PE: – HR variable (fast, normal or slow)– Systolic heart murmur– Gallop rhythm– +/- arrhythmia– Hypothermia– Increased CRT– Tachypnea– Quiet lung sound (if pleural effusion)– Crackles if pulmonary edema– Hypokinetic femoral pulses– +/- posterior paresis/paralysis

Feline DCM• Dx– Clin signs; ECG; ultrasound

– Taurine levels–X-rays

Feline Dilated Cardiomyopathy• Rx– Oral taurine supplement (250-500 mg/d)– Furosemide– Oxygen– Digoxin– Aspirin or heparin – prevent thromboemboli– Vasodilator; ↓vascular resistance

• Hydralazine• Cutaneous nitroglycerin paste

• Client info– Most dangerous time is first 2 wks of treatment– If cat responds to taurine treatment, good Px– Unresponsive to taurine treatment, poor long-term Px

Feline Hypertrophic CardiomyopathySimilar to HCM in dogsL vent hypertrophy is predominant pathologyMore common in neutered males

• Signs– Soft, systolic murmur (grade 2-3/6)– Gallop rhythm and other arrhythmias– Acute onset of heart failure or thromboembolism

• Dx– X-rays—may be normal– ECG

• ↑P wave duration• ↑QRS width• Sinus tachycardia

– Ultrasound • ↑L vent wall; dilated L atrium

Feline Hypertrophic Cardiomyopathy• Rx– Diuretics to decrease fluid load on heart

• Furosemide

– Beta blocker to decrease sinus heart rate• Propanolol

– Calcium channel blocker to reduce blood pressure• Diltiazem

• Client info– Affected cats may experience heart failure, arterial embolism,

sudden death– Cats with HR <200 bpm have better Px than >200 bpm– Median survival time ~2 y

ThromboembolismCommon in myocardial disease in cats (10-20% of HCM)Forms in L side of heartLodge at femoral trifurcation

Thromboembolism• Signs

– Acute onset of rear leg pain/paresis– Cold, bluish foot pads– Lack of femoral pulse– Hx of myocardial disease

• Dx– Clinical signs– Angiography (if available)

• Rx– Dissolve clot

• TPA (Activase [Genentech])• Heparin

– Aspirin for prophylaxis• Aspirin is slowly metabolized in cats; must be monitored

• Client info– Painful, cold, or paralyzed rear legs in cats is an emergency– Px is guarded to poor– Surgical removal of thrombus is difficult/expensive

Fetal Heart

Vena cava

Right atrium

Congenital Heart Disorders• Patent Ductus Arteriosus (PDA)—failure of ductus arteriosus

to close after birth– Blood shunts from systemic circulation to pulmonary artery

– Normally, prostagladins are released at birth to cause ductus arteriosus to close

Ductus arteriosus

To lungsTo lungs To lungs

PDA• Clinical signs

– Usually female– Predisposed breeds: chi, collie, maltese, poodle, poms, E Spring, kees,

bichons frises, Shetlands– Presence of a loud heart murmur over L thorax– Some puppies are asymptomatic

• Dx– ECG

• L vent dilation– X-ray

• L atrial and L vent enlargement

• Rx—surgical correction• Client info

– Px is excellent following surgery– 64% of PDA will die within 1 y without surgery– Dog should not be used for breeding

Congenital Disorder: Atrial Septal Defects

An abnormal opening in the atrial wallForamen ovale—a hole in fetal atrial septum to allow oxygenated blood from the

placenta to by-pass lungs (like ductus arteriosus)-should seal at birth

• Signs– Soft, systolic murmur– CHF before 8 wk old

C

After birth, blood is shunted from L to R atria (high press to low)

Atrial Septal Defect

Congenital Disorder: Ventricular Septal Defects

An abnormal opening in the ventricular wall

• Signs– Harsh, holosystolic murmur, R sternal border– CHF before 8 wk old

• Rx (ASD, VSD)– open heart surgery unusual in animals– Management of CHF

• Client info (ASD, VSD)– Most will develop CHF

C

Congenital Disorder: Tetralogy of Fallot

Polygenic malformation of heart (4 abnormalities)1. Pulmonic stenosis2. 2° R ventricular hypertrophy3. Ventricular septal defect4. Overriding aorta• Breeds (Keeshond, E bulldog, cat)• Signs

– Failure to grow– Cyanosis– Exercise intolerance– Weakness– Seizures– Syncope, sudden death

• Dx– X-ray—normal size heart– ECG

• R vent hypertrophy• R outflow obstruction

Tetralogy of Fallot

• Rx– Surgical procedures can improve condition (cardiology

specialty practice)– Medical treatment includes phlebotomy to keep PCV

between 62-68%• Client info– Genetic disease; don’t breed– Sudden death is common; may live for years– CHF is rare– Limit stress/exercise– Tranquilizers/sedatives may have adverse effects– Regular phlebotomies will be required

Acquired Valvular Diseases• Mitral Valve Insufficiency (most common acquired heart disease in dogs

(progressive); rare in cats)– Caused by proliferation of fibroblastic tissue within valve leaflets causing

thickening of valvular free edges, causing valves to roll up– Thickened leaflets fail to close sufficiently during systole → regurgitation into L

atrium → CHF– A main cause is periodontal disease → endocarditis from bacteria in dental

tartarMitral valves What are white bands?

Upper leaflet normalLower leaflet thickened

Mitral Valve Insufficiency• Signs (L CHF)

– Small breed dog >10 y– Cough: deep, productive; worse at night or with exercise– Dyspnea, tachypnea– Decreased appetite– Systolic murmur, L apex

► DxDx X-rayX-ray

►Pulmonary edema may be Pulmonary edema may be present; cotton-like alveolar present; cotton-like alveolar diseasedisease

► L atrial, vent enlargmentL atrial, vent enlargment(Elevation of trachea, loss of (Elevation of trachea, loss of

cardiac waist)cardiac waist)

Mitral Valve Insufficiency• Rx—there is no cure; goal is to improve quality of life

– Diuretics—furosemide to reduce fluid volume of heart– Digoxin—to increase efficiency of heart and ↓HR

• Client info– MVI is a progressive disease; periodic

evaluation/readjustment of Rx– No cure– Low salt diet helps prevent fluid accumulation– Eventually medication will not control the condition Mitral

valve(L A-V)

Tricuspid Insufficiency• Same disease as Mitral Valve Insufficiency except R

sided heart failure results instead of L sided failure• Signs (R CHF)

– Pleural effusion (fluid in pleural cavity not lung tissue)– Abdominal distension– Hepatomegaly

• Rx—same as MVI– Abdominocentesis may be required periodically

Tricuspid valve(R A-V)

Cardiac ArrhythmiasAbnormal heart rate or rhythm or rhythm arising from abnormal

locationAbnormal rhythm result from either:

1. abnormal impulse formation (ectopic beats)– Ischemia (↓ blood supply)– Hypocalcemia– Cardiomyopathy– Hypercalcemia– Excess catecholamines (↑ adrenalin)

2. abnormal impulse conduction

Sinus arrhythmia

• Normal in dogs; not in cats– P wave for each QRS– Irregular ventricular rhythm

P waves

Atrial FibrillationNo organized atrial contractionEasier to occur in larger heart, so more of a problem in lg breed dogs

• Signs– Weakness, syncope– Collapse– Rapid, irregular HR

• Dx– Auscultation

• rapid, irregular HR

– ECG• No P waves• Rapid, irregular HR

Many ectopic foci activating small areas of atrium

Only ectopic foci close to AV node are able to cause impulse to travel to ventricle

Ventricles are activated at a very fast rate and at irregular intervals

Atrial Fibrillation

• Rx (aim is to slow HR; it will not correct fibrillation)– Digitalis (digoxin) to slow HR– Ca++ channel blockers (diltiazem HCl) to slow AV node

conduction

• Client info– Rx will not cure atrial fibrillation– Concurrent heart disease will progress even with treatment– CHF will occur eventually

Ventricular TachycardiaRapid HR reduces vent filling time, and, therefore decreases COIf untreated, may lead to vent fibrillation (cardiac arrest), a life-threatening situation

• Causes:– Cardiomyopathy, CHF, endocarditis, neoplasia– Electrolyte or acid/base imbalance

• Signs– Weakness, collapse, syncope with rapid HR– Sudden death not uncommon– CHF

Ventricular Tachycardia

• Dx– Auscultation: rapid, irregular HR– ECG: widened, bizarre QRS complexes of vent origin (PVC’s)

• V fib: no QRS complexes

• Rx– Procainamide and Tocainide decrease myocardial excitability– Lidocaine decreases automaticity of heart muscle– For v fib, cardiac defibrillation

• Px—Guarded unless underlying cause can be corrected

Normal beats?

Sinus bradycardiaDef: normal P, QRS complexes; HR <70 bpm

• May be symptom of disease:– ↑ Intracranial pressure– Hypothyroidism – Hypothermia – Hyperkalemia – Hypoglycemia

• Also seen in athletic, well-conditioned dogs

Sinus bradycardia• Signs

– Episodic weakness, syncope, collapse

• Dx– Auscultation: slow HR– ECG: slow HR; normal P, QRS complexes

• Rx– Treat underlying disease– Atropine increases HR– Placement of artificial pacemaker

• Client info– May be normal in athletic dog– Correction of underlying problem may correct bradycardia– Most dogs can live normal life with this condition

Heartworms (Dirofilaria immitis)

• World-wide distribution– With 150 mi of Gulf and Atlantic coasts and Mississippi River– Males dogs infected more than females (4:1)– Outside dogs more likely to be infected than indoor dogs– Rare in cats

Heartworm Cases

Heartworms - canine• Life cycle (Adult → L1 (microfilaria),

L2, L3, L4, L5 [small adult]– Mosquito bites infected dog, picks up

microfilaria (L1)• Microfilaria may live up to 2 y in dog• May be passed transplacentally (will

not develop into adult)– Microfilaria mature in mosquito to L3

stage (2-3 wk)• L3 is capable of infecting new dog

– L3 migrates thru soft tissue to heart• 5-7 mo then becomes L5 (small adult)

– Adults breed and produce L1– Adults can live in heart for 5-7 years

Canine Heartworms

Canine Heartworms• Disease severity

– # adult worms– Inflammation of endothelium– R-sided heart failure

• Dx– Knott’s test—filter technique to

see microfilaria in blood– Antigen tests detect antigen of

female heartworms– Antibody tests detect antibodies

dog has produced against larvae; positive test confirms dog has been exposed to larvae

Canine Heartworms

HW Life Cycle

Heartworms • Signs– Usually asymptomatic; diagnoses on routine screening– Exercise intolerance– Coughing, dyspnea– R-sided heart failure

• Rx—pretreatment lab workup (CBC, Chem Panel)– Melarsomine (Immiticide; Merial)—kills adult worms– Ivermectin—kills microfilaria and migrating worms (L3, L4)– +/- Doxycycline– Prevention—many products– Diethylcarbamazine (daily)– Ivermectin (monthly)– Milbemycin (monthly)

Feline Heartworms

• Prevalence – 1997 necropsy survey in SE Texas – 10% of shelter cats had adult HW– Greater infection rate than FeLV or FIV

Feline Heartworms• Epidemiology

– Female mosquito feeds on infected dog; picks up mf– Become L1 to L3 in mosquito– Deposited on skin of cat or dog in saliva– L3 enter thru bite, molt to L4, migrate through tissues for 2 months– Final molt to immature adult (previously L5); enter peripheral vein– Immature worms carried to heart – 75-90 days PI– By day 100 – worms 2 inches long– Matures to adult over 2-3 months– Most juvenile worms die shortly after arriving in pulmonary arteries– Initiates an inflammatory reaction– A few worms live 2-4 years in small percentage of cats

Feline Heartworms- Heartworm Asocciated Respiratory Disease (HARD)

• 3 stages– 1st

• Acute inflammatory reaction to presence and death of worms• Coughing, dyspnea• Intermittent vomiting• 28% asymptomatic• X-rays – inflammatory infiltrates around R caudal lobar

artery• Similar to allergic bronchitis or asthma• Responds to steroids

Feline HARD

• 2nd stage– Adult HW (if survives) suppresses immune system =>

decreased signs– Worm dies – no more immune suppression– Intense inflammatory reaction occurs– Thromboembolism => acute lung injury and sudden death

• 3rd stage– If cat lives => permanent injury and chronic resp disease

Feline Heartworms

• Diagnosis– Filtration for mf useless – usually single sex infections (1-2

worms only)– X-rays as above – 55% have radiographic signs– US – 70-100% accurate– Serology

• Ag tests – do not detect early or male only infections– Negative result does not r/o HW dz

• Ab test – confirms recent infection with L4 or older but not disease

• Ag test in process of being added to FeLV/FIV test.

Feline Heartworm Testing

Feline Heartworm X-rays

Feline Heartworms• Rx—– Acute respiratory distress

• Steroids (Dex SP 1-2 mg/kg IM/IV, PredSS 50-100 mg/kg/cat IV• Bronchodilator• Supportive – IV fluids, etc

– If not demonstrating clinical signs, supportive care until heartworm dies• Prednisolone to reduce pulmonary effects

– +/- doxycycline

Feline Heartworms

• Prevention– Safe for all cats because mf infection rare or minimal– Heartgard® for Cats (Ivermectin, orally) from Merial– Interceptor® (Milbemycin oxime, orally) from Novartis– Revolution® (Selemectin, topically) from Pfizer– Advantage Multi™ for Cats (Moxidectin / imidacloprid,

topically) from Bayer

Respiratory Diseases

Upper Respiratory DiseasesUpper Respiratory Tract is any resp structure above the trachea

• Rhinitis—inflammation/infection of nasal passagesUsually occurs with other resp diseases

– Signs• Nasal discharge; crusty nares• Pawing at nose• Staphylococcus spp

– Rx• Clean nares• Antibiotics if necessary

Upper Respiratory Diseases

• Sinusitis– Usually due to abscess of 4th premolar (Carnassial tooth)

• Largest tooth; roots extend into frontal/maxillary sinus

– Signs• Swelling under eye on infected side• Unilateral nasal discharge

– Rx• Remove infected tooth• Antibiotics• Flush fistula with iodine solution

Upper Respiratory Diseases• Tonsillitis (Tonsils provide lymphoid protection to lower resp tract)

– Signs• Anorexia• Increased salivation• Pain on opening mouth• It is more common in small dog breeds

– Dx• Visualized inflamed, swollen tonsils• Tonsils may be coated with mucus/pus

– Sx• Antibiotics• Surgical removal of chronic cases

Tonsillitis

Upper Respiratory Diseases• LaryngitisMost common cause is excessive barking**Rabies can also change vocal quality

• Signs– Loss of voice or alteration of voice– Increased mucus production in back of throat

• Rx– Restrict barking– Anti-inflammatory medication (glucocorticoids)

• Client info– Most Upper Respiratory Infections are self-limiting

Lower Respiratory DiseasesLower Respiratory Tract includes trachea, bronchi, lungs, pleural cavity

• Infectious Canine Tracheobronchitis (Kennel Cough)– Causes (a collection of several causative agents including viruses,

bacteria, mycoplasmas, fungi, parasites• Canine parainfluenza virus• Canine adenovirus• Canine herpesvirus• Reovirus• Bordetella bronchiseptica• mycoplasma

– Signs• Hx of exposure to animals at a kennel, hospital, groomer, show• Dry hacking cough in an otherwise healthy animal

– Rx—antibiotics, glucocorticoids, antitussives– Client info

• Self-limiting (2-3 wks); Rx is to make animal/owner more comfortable• Vaccinate 2-3 wk before chance of exposure

Lower Respiratory Diseases• Collapsing trachea

Failure of proper development of tracheal rings

– Signs• Cough, esp during excitement or exercise

– Dx• Goose-like honk on tracheal palpation• r/o other causes of coughing

– Rx• Acepromazine to calm excitement• Antitussives (Hycodan, Butorphanol)• Glucocorticoids• Bronchial dilators• Prosthetics have been surgically implanted, but complications have occurred

– Client info• Wt reduction• Use shoulder harness rather than neck collar

Lower Respiratory Diseases• Feline Bordetella Infection

Bordetella bronchiseptica grow in ciliated respiratory mucosa; release toxins

– Signs (look like respiratory viral infections)• Fever• Sneezing, nasal discharge, coughing, rales• Submandibular lymphadenopathy

– Rx (usually self-limiting)• Antibiotics (oral tetracycline or doxycycline)

– Prevention• Eliminate stress• Good hygiene, good nutrition• Vaccination

– Client info• Looks like resp infections caused by feline herpes and calicivirus• Usually self-limiting• Vaccination effective

Lower Respiratory Diseases• Feline asthma (bronchoconstriction, inflamed/hyperreactive airways)

– Signs• Coughing, wheezing• Labored breathing

– Dx• Clinical signs• X-rays show “doughnuts” typical of airway inflammation

– Rx• Long-term corticosteroids (prednisone, DepoMedrol)• Bronchodilators (terbutaline [Brethine], cyproheptadine)

– Client info• Prognosis is variable

– If allergens can be determined and exposure limited, most cats do well– A cure is not usually possible

Feline Asthma• Same cat

– Top—normal– Bottom—asthmaAirways more prominent because of

inflammation and mucus buildupDoughnuts (end-on view) and

tramways (lateral view) of airways

Feline Viral Resp Infections• 2 viruses responsible for most feline resp diseases– Feline Viral Rhinotracheitis (FVR; Feline Herpesvirus)– Feline Calicivirus (FCV) Caliciviridae family

• Highly contagious• High mobidity• Low mortality• Most severe in kittens

Feline Viral Rhinotracheitis• Signs

– Acute onset of sneezing– Conjunctivitis, severe rhinitis– Fever, depression, anorexia– Ulcerated hard palate, excess salivation– Corneal ulcers

• Rx– Supportive Rx

• IV fluids, broad spectrum antibiotics, decongestants• Nursing care: clean nose, eyes; force feed food; decrease stress• Antiviral therapy

• Prevention– Vaccination

• Client info– FVR highly contagious; can transmit via clothing, hands, etc; only cats– Warming food may improve palatability– Vaccinated cats may show mild symptoms– Disinfectants kill herpesvirus type I virus

Feline Calicivirus• Signs

– Fever– Serous ocular/nasal discharge; mild conjunctivitis– Oral ulcers, salivation– Pneumonia– Diarrhea

• Rx– Supportive care– Antibiotics– Force feed disinfect using bleach

• Prevention– Vaccination

• Client info– Highly contagious– Signs last 5-7 d– Force-feeding may be necessary (if cats can’t smell, they won’t eat)

What do you see? or What do you not see?

Pleural Effusion

Fluid in thorax• Types of fluid Causes

– Transudate R-sided CHF, FIPplasma-like fluid; straw colored

– Blood trauma, neoplasia– Chyle neoplasia, pancreatitis, traumalymphatic fluid from intestine; high fat content infection, parasites --Empyema Infection, foreign body, traumapus in thorax

All types of fluid cause same signs– dyspnea– may show cough, fever, pleural pain

Dx—x-ray

Pleural Effusion• Thoracentesis– Clip hair, scrub skin, block with local anesthetic

• Most dependent space (7th-8th intercostal space)– Aspirate using 3 way valve– Remove as much fluid as possible

• Do not create pheumothorax– Analyze aspirate

• Rx—depends on pathology causing effusion• Client info– Owner may need to continue pleural drainage– Unless 1° is treated, effusion will return– Rx can be long and expensive

Fungi

Fungal DiseasesUsually result from inhalation of fungal spores or wound contaminationFungi release enzymes/toxins that damage host’s cellsEndemic along east coast, Great Lakes, river valleys of the Miss, Ohio, St

Lawrence

• Commonly seen fungal diseases of animals– Blastomycosis– Coccidioidomycosis– Histoplasmosis– Aspergillosis

Blastomycosis (Blastomyces dermatitides)• Signs (non specific)

– Anorexia, depression, wt loss– Fever, cough, dyspnea– Enlarged LN

• Dx– X-rays—diffuse, nodular interstitial lung pattern (x-ray)– Serology testing is available– Most cases are diagnosed in the fall.

• Rx– Amphotericin B

• Client info– Blastomycosis usually not zoonotic disease, however, use caution with

animals with draining wounds– Owners share same environment and are likely to be exposed– Relapses are common– Rx is expensive

Coccidioidomycosis (Coccidioides immitis)• Signs

– Mild, non-productive cough– Low-grade fever, anorexia, wt loss– Weakness, depression– Lameness, pain is bone involvement– LN enlargement

• Dx– Parenchymal changes on x-ray– Serology

• Rx– Ketoconozole– Itraconazole

• Client info– Usually not zoonotic disease, however, use caution with animals with draining

wounds– Response to Rx is good, but recurrence is common– Rx is expensive

radius-ulna

Histoplasmosis (Histoplasma capsulatum)• Organism which grows in bird manure, bat dropings or organically

enriched soil. • Signs

– Feline (pulmonary signs)• Wt loss, anorexia• Fever, pale mm, swollen LN

– Canine (GI signs)• Wt loss, diarrhea, low-grade fever• Dyspnea, cough, pale mm

• Dz– CBC: anemia– X-ray: diffuse pulmonary interstitial pattern

• Rx– Ketoconazole– Itraconazole

• Client info– Px fair to good for pulmonary form; guarded to grave for systemic

form

Cryptococcosis (Cryptococcus neoformans)A yeast-like fungus found in soil contaminated with pigeon and other bird droppings.Inhalation major route of infection. Immunocompromised animal more susceptiblethan normal animal• Signs

– Feline• Lesions in nasal and sinus cavities; chronic nasal discharge• enlarged LN, wt loss, anorexia, lwo-grade fever

– Canine• Usually CNS lesions (vestibular dysfunction)

• Dx– Cytology of aspirates, impression smears– Antigen test available

• Rx– Amphotericin B– Ketoconozole– Itraconazole

• Px– Fair to good unless CNS involvement– No known health hazard to humans

Aspergillosis (Aspergillus fumigatus)Inhalation major route of infection; nasal cavity is main location of lesions

• Signs– Feline (uncommon)

• May be immunocompromised (FeLV)• Lethargy, fever, wt loss, anorexia

– Canine (localized)• Young to middle age• Chronic nasal discharge, sneezing, loud breathing (like snoring)

– Canine (generalized infection)• Primarily seen in G Shep• Wt loss, anorexia• fever, lameness, paresis/paralysis

• Dx– X-ray—loss of nasal turbinates– endoscopy:--yellow-green to black fungal plaques on nasal mucosa

• Rx—topical clotrimazole• Client info

– Localized dis—poor Px; Generalized dis—grave Px; not zoonotic

Pulmonary NeoplasmsTumors in lungs are usually metastatic, although primary lung tumors do

occur

• Signs– Primary neoplasia

• Cough, exercise intolerance• Wt loss, poor condition• Dysphagia, vomiting, anorexia

– Metastatic neoplasia• Evidence of primary tumor at other location• Same signs as above for Primary neoplasia

Pulmonary Neoplasms

• Dx– Chest X-rays—mass occupying lesions; can be mistaken for

abscess, parasitic dis, fungal infect, bact infect– Biopsy—provides definitive diagnosis

Pulmonary Neoplasms

• Rx—surgical removal is TOC– Lobectomy for solitary tumor

• Chemotherapy (may reduce tumor size, may not increasse survival time

• Client Info– Px is guarded to grave– By the time these tumors are diagnosed, they are usually

in advanced stages– Chemotherapy may reduce clinical symptoms

Same dog as x-ray