Advances in Puppy & Kitten Health Care

Transcription

1 Advances in Puppy & Kitten Health Care Presented at Iams Clinical Nutrition Symposium 2005 Seville, Spain January 29, 2005 Practice Management Nutrition Skeletal Internal Medicine DHA and Puppies Skin and Coat DHA and Infants Paedodontics Behaviour

2 Reprinted in the IVIS Website with the permission of IAMS Close widow to return to IVIS Medical approach to puppies and kittens with diarrhoea bacteria consistent with Campylobacter spp., or for the presence of increased white blood cells. Caution should be heeded in over interpreting these common findings, as the diagnostic value of increased faecal endospores (fig 1) is virtually zero. In addition, healthy dogs and cats Procedure for centrifugal flotation 1. Prepare a faecal emulsion using 2-5 grams of faeces and 5-10 ml of flotation solution. Zinc sulphate flotation medium is optimal with a specific gravity of 1.18 to Strain the emulsion through a tea strainer or cheese- commonly have spiral-shaped bacterial organisms in cloth, washing it through with an additional ml their faeces, and many Campylobacter spp. are non- flotation solution, into ml conical centrifuge pathogenic. Stained faecal smears are useful for making tubes. Professor Stanley L. Marks BVSc, PhD, Dip. ACVIM (Internal Medicine, Oncology), Dip. ACVN a diagnosis of intestinal lymphoma, intestinal Histoplasmosis or Prototheca, although these diseases are extremely rare in puppies and kittens. Faecal smears can be performed by using a cotton swab introduced into 3. Fill the tubes with flotation medium to create a positive meniscus. 4. Place a coverslip on top of each tube. 5. Balance the tubes in the centrifuge. School of Veterinary Medicine, University of California at Davis, USA the rectum, and gently rotating the swab several times. The cotton swab is rolled onto a glass slide, which is then 6. Centrifuge the tubes for 10 minutes at 1,500 to 2,000 rpm. stained after air drying. 7. Carefully remove the coverslips from each tube by Author s Profile Introduction Diarrhoea in puppies and kittens is one of the most common maladies facing small animal veterinarians today. Despite the clinical importance of diarrhoea in puppies and kittens, there is a paucity of veterinary literature providing specific lifting straight up and place them on a clean slide. 8. Examine the slide within 10 minutes. Examine entire coverslip at 10X. Use 40X to confirm identification by visualising internal structures and measuring the organism. Dr. Marks graduated from the University of Pretoria, South Africa in 1986 and completed an internship in small animal medicine and surgery at the University of Missouri, Columbia in He completed a small animal internal medicine residency program at the University of Florida and an oncology residency program at the University of California, Davis. Dr. Marks received his PhD in nutrition from the University of California, Davis, where he is currently Professor of Medicine in the Department of Medicine and Epidemiology. Dr. Marks is a Diplomate of the American College of Veterinary Internal Medicine (ACVIM) in the subspecialties of internal medicine and oncology, and a Diplomate of the American College of Veterinary Nutrition (ACVN). His research interests are in the area of small animal gastroenterology, with an emphasis on dietary modulation of intestinal mucosal barrier function and bacterial gastroenteritis. information on the causes and diagnosis of this problem. Antibiotics are commonly administered injudiciously to diarrhoeic puppies and kittens, and subsequent resolution of clinical signs is often wrongly equated with eradication of a putative infectious pathogen. Indiscriminate antibiotic therapy may even exacerbate the animal s diarrhoea or lead to development of antibiotic resistance. Although diarrhoea in puppies and kittens can be associated with a number of different aetiologies, infectious causes are believed to play an important role in many of these cases. Performing a comprehensive faecal examination is integral to the diagnostic work-up of puppies and kittens with diarrhoea, vomiting, and weight loss. Maximising the diagnostic yield of a faecal examination The techniques used most commonly include stained faecal smear, direct faecal smear (wet preparation), and a faecal floatation. A Baermann technique is indicated when parasitic larval stages are being evaluated. Stained faecal smear Staining faecal smears with Diff-Quick, New Methylene Blue, or Wrights stain can be used to evaluate faecal specimens for the presence of endospores associated with Gram positive Clostridium perfringens, and spiral-shaped, Gram negative Figure 1. Stained faecal smear (modified Wright s stain) from a healthy, non-diarrhoeic dog showing numerous endospores of Clostridium perfringens (magnification X 1000) Faecal flotation Faecal flotations are indicated to find cysts, oocysts, and ova in faeces. Fresh faeces should be examined whenever possible, or a fresh specimen can be refrigerated for up to 72 hours for detection of cysts, oocysts, or eggs via a concentration technique. Although standing (gravitational) flotation methods are easier and quicker to perform than centrifugation flotation (fig 2), the latter has clearly superior sensitivity (up to 8 times). 1 Animals with low parasite burdens could have a false negative result if the gravitational method is utilised. Modification If your centrifuge is fixed-angle, and does not have free swinging buckets, proceed as above but fill the centrifuge tubes to within 2.5cm or so from the top, and do not add a coverslip for the final spin.when the final centrifugation step is complete, carefully set the tubes upright in a test tube rack. Use a pipette to gently run additional flotation solution down the side of each tube while disturbing the contents as little as possible. Create a positive meniscus and set a coverslip on top. Let this preparation stand for 5 minutes only. Remove the coverslip to a slide and examine as described in step 8. Figure 2. Centrifuge with free swinging buckets showing a coverslip in place before centrifugation

3 Direct wet preparation diagnosis of T. foetus is relatively low in cats with Therapy of a Ziehl Neelsen stain, direct fluorescent antibody Fresh faeces (ideally <2 hours old) should always be used spontaneous disease (14%). 4 T. foetus can be distin- There is currently no therapy for elimination of T. foetus, technique, and 3 ELISA tests (Table 1) 10 revealed that the to preserve the motility of trophozoites such as Giardia guished from Giardia based on morphology and motility. and cats infected with T. foetus have failed treatment with ProSpecT Microplate ELISA was the most sensitive spp. and Tritrichomonas foetus (fig 3). A small amount of Giardia trophozoites have a concave ventral disc and recommended and higher dosages of numerous antimi- diagnostic test for Cryptosporidium on a single day, faeces is placed on a warm slide and a drop of 0.9% saline motility mimicking a falling leaf, whereas trichomonads crobial drugs, including metronidazole and fenbendazole. 2 whereas the ProSpecT Rapid ELISA was highly insensitive is mixed with the faeces. It is important that the smear is are spindle-shaped, have an undulating membrane Greater than 50% of cats diagnosed with T. foetus- and should not be utilised by veterinary diagnostic not too thick, as trophozoites will be easily missed. A that courses the entire length of the body, and move associated diarrhoea were still shedding the organism up laboratories. simple rule of thumb is that you should be able to read in a more irregular and jerky fashion. T. foetus does to 5 years following diagnosis based on PCR confirmation, the fine newsprint of a newspaper through the smear. not have a cyst stage, underscoring the limitations of and diarrhoea persisted for up to 3 years in many cats, After application of a coverslip, the smear is evaluated for faecal flotation for diagnosing this organism. despite aggressive antimicrobial administration. 6 Eradication of this parasite has proven difficult, and motile organisms by examining at 10X magnification, 2) Faecal cultures performed with an InPouch TF kit many putatively effective drugs are either toxic or inef- with confirmation at 40X magnification. A commercially-available system marketed for diagnosis Cryptosporidium spp fective. The aminoglycoside, paramomycin, is potentially of T. foetus infection in cattle (InPouch TF, Biomed Infection with the ubiquitous protozoan parasites, nephrotoxic and ototoxic in cats, and should preferably Parasitic causes of diarrhoea Diagnostics, White City, Oregon) is more sensitive Cryptosporidium parvum and C. felis, in puppies and kittens not be used. A recent prospective double-blind study Trichomonosis than the direct wet preparation. 4 Approximately 0.05 causes a spectrum of disease ranging from asymptomatic completed by the author failed to show any benefit for Tritrichomonas foetus, the primary causative agent of grams (less than a peppercorn) of freshly voided carrier state to mild, transient diarrhoea, cholera-like tylosin in naturally infected kittens. Azithromycin is used bovine trichomoniasis, has recently been recognised as a faeces can be placed in the InPouch for culture, or illness, or prolonged severe life-threatening malabsorption in humans for management of Cryptosporidiosis, and protozoal pathogen in cats (fig 3). 2,3 Infected cats are alternatively, a saline-moistened cotton-tipped swab syndrome. In addition, C. parvum infection has been appears safe in dogs and cats when administered at a generally young, but have ranged in age from 3 months can be placed in the rectum and then gently agitated diagnosed in association with intestinal cellular infiltrates dosage of 7-10 mg/kg BID for 7 days; however, its efficacy to 13 years (median 9 months). The prevalence of T. foetus in the InPouch for culture. The InPouch should be indistinguishable from those seen with inflammatory is unknown. infection at an international cat show was found to be incubated at 37 C or room temperature in an upright bowel disease in cats. 7 31% (36 out of 117 cats), with 28 out of 89 catteries affec- position in the dark, and examined q 48 hours for up ted. 3 Co-infection by T. foetus and Giardia was common to 12 days for motile trophozoites using a 20 or 40X and was documented in 12% of cats. Misdiagnosis of objective. The media in the InPouch does not support The laboratory detection of this ubiquitous protozoan Giardia is common in cats having T. foetus infection, and the growth of Giardia or Pentatrichomonas hominis. parasite in diarrhoeic puppies and kittens is difficult, pre- may explain why cats diagnosed with apparent Giardia 3) Single tube nested PCR of DNA extracted from faeces dominantly because the organism is so small (average infection do not respond to appropriate therapy. A sensitive and specific single-tube nested PCR from 4.6 x 4.0 µm) and difficult to find in faecal specimens via feline faeces has been described. 5 The PCR test is light microscopy, and because faecal shedding may be Clinical signs more sensitive than faecal culture and tested positive intermittent. Immunofluorescent detection procedures are T. foetus infection in cats can be associated with a chronic in 55% of cultures that were negative for T. foetus, more sensitive and specific than acid-fast stains, and are or recurrent large intestinal diarrhoea characterised by even when faeces were normal. generally the method of choice for morphological diagnosis increased mucous, tenesmus, occasional haematochezia, in humans 8 (fig 4). The newer enzyme immunoassays and increased frequency.the anus is frequently red, swollen, and painful, and faecal incontinence is not uncommon. Most cats are usually bright, alert, and responsive, and in designed to detect Cryptosporidium antigens in faeces, have proven more sensitive than microscopic techniques. 9 A recent study comparing the performance characteristics Figure 4. Direct immunofluorescent assay (Meifluor Cryptosporidium/Giardia direct Immunofluorescent kit, Meridian Diagnostics Inc, Cincinnati, OH) showing fluorescent Giardia cysts (larger, oval) and Cryptosporidum oocysts (smaller, round). good body condition with a normal appetite. Tritrichomonas foetus can also be cultured from the faeces of asymptomatic cats, many of whom will not develop diarrhoea. Detection Method Ziehl Neelsen technique Day 1 72% Day 3 91% Day 4 94% 1) Multiple direct wet preparations on diarrhoeic faecal specimens Direct faecal smears are performed to evaluate for the presence of Tritrichomonas foetus trophozoites. The sensitivity of direct faecal smear examination for Figure 3. Giemsa stained faecal smear showing characteristic appearance of Tritrichomonas foetus with its 3 anterior flagellae and long undulating membrane. Direct Immunofluorescence Detection Meridian Premier ELISA Remel ProSpecT Microplate ELISA Remel ProSpecT Rapid ELISA Table 1: Cumulative sensitivities of 5 methods of detection of Cryptosporidium spp. in faecal specimens collected once daily over 4 consecutive days from 104 naturally exposed kittens 10 50% 80% 89% 15% 83% 93% 94% 43% 84% 93% 95% 49% 42 43

4 Giardia spp experimentally infected kittens when given at twice the routine vaccination for Giardia is not recommended in Giardia infections in adult cats and dogs are often sub- recommended dose. The dose of febantel used was household dogs and cats. The large ova (approximately 80 µm) with a characte- clinical or associated with a transient softening of the 56.5mg/kg. 14 ristic thick wall are easy to recognise on faecal flotation stool early in the infection; however, acute diarrhoea tends Coccidia (fig 7). to occur in puppies and kittens shortly after infection. Puppies are infected with two species of coccidia, Isospora canis and I. ohioensis, whereas kittens are infected with Isospora rivolta and I. felis (fig 6). Pyrantel at 20 mg/kg is safe in puppies and kittens. The The diagnosis of Giardia infection traditionally has treatment should be repeated at approximately 3 weeks. depended on microscopic identification of trophozoites Fenbendazole is also an effective anthelmintic, and or cysts (fig 5) in faeces from affected animals. However, Faecal flotation with zinc sulphate is the recommended can be administered to newborn puppies and kittens at microscopic diagnosis of Giardia infection can be difficult, method. 50mg/kg for 3 days to kill more than 90% of prenatal larvae. because cysts may be shed intermittently and because Puppies and kittens should be routinely dewormed every cysts are so delicate. Many artifacts (grass pollen, yeast, 2 weeks, starting at 2 weeks of age, until 8 weeks. etc.) mimic to varying degrees the morphology of Giardia Sulfadimethoxine given at 50 mg/kg orally once a day cysts, and care must be exercised in differentiating these from Giardia. ELISA tests that detect Giardia cyst wall Figure 5. Zinc sulphate faecal flotation showing Giardia cysts with distinctive fibrils coursing the length of the cyst (magnification X 400). for 10 to 14 days will eliminate oocyst excretion in most dogs and cats. 16 The combination of ormetoprim (11 protein I (GCWP 1) are advantageous because they are mg/kg) and sulfadimethoxine (55 mg/kg) given orally for generally easy to perform and results are easy to interpret. 11 Control of Giardia Infection up to 23 days has been used effectively in dogs. In addition, the test does not rely upon morphological There are 4 fundamental steps that should be taken to Amprolium given orally once a day at 300 to 400 mg/kg identification of cysts or oocysts via microscopy, thus control Giardia infection, and minimise reinfection of for 5 days or 110 to 220 mg/kg for 7 to 12 days is effective saving technician time and potentially avoiding false treated animals: in treating coccidiosis in dogs. Other agents such as negative interpretations. The ELISA tests can also detect 1) Decontaminate the environment furazolidone, quinacrine, and metronidazole probably are GCWP 1 in the absence of detectable cysts. 11 A novel Simultaneous treatment of animals with the of little clinical value. SNAP Giardia Test Kit (IDEXX Laboratories, Inc., medications discussed and decontamination of the Westbrook, Maine) for detection of GCWP 1 in canine and feline faeces was recently released. This test is a rapid environment with a quaternary ammonium-based (QUAT) disinfectant (Roccal D, Totil, Quatsyl 256, or Aqua Figure 7. Faecal flotation showing large, thick-walled ova of Toxocara cati and Ancylostoma caninum ova (magnification X 400). in-house enzyme immunoassay that can be performed Quat 400) should improve effectiveness of treatment on fresh faeces, previously frozen faeces, or faeces stored and maximise the possibility of eliminating Giardia Hookworms at 2-7 C for up to 7 days. from the kennel or colony. Cages should be sponged Ancylostoma spp. and Uncinaria spp. are voracious blood clean on a daily basis with a dilute disinfectant or mix suckers, where the worms live in the small intestinal of Clorox diluted at 1:32 and Quatsyl 256 at 1: lumen and attach to the mucosa. Dogs are infected when Metronidazole was shown to be highly effective and safe 2) Treat the animal with effective drugs ingesting the ova or through transcolostral transmission. when given at 25 mg/kg PO q12h for 7 days to cats with 3) Bathe the animal to clean cysts from the coat Puppies can occasionally have life-threatening blood loss experimental infections, 12 although it is less effective in 4) Prevent reintroduction of infection or iron-deficiency anaemia, melena, haematochezia, and dogs with eradication of the organism occurring in 67% failure to thrive. of treated dogs. Albendazole is also relatively effective when dosed at 25 mg/kg BID for 5 days; however, the Giardia Vaccine A commercial Giardia vaccine (GiardiaVax, Fort Dodge Figure 6. Zinc sulphate faecal flotation showing Isospora sp. oocysts recovered from a diarrhoeic kitten (magnification X 400). drug has been associated with pancytopenia and is Animal Health, Overland Park, KS) containing chemically Faecal flotation is the procedure of choice for seeing teratogenic. A recent trial evaluating the efficacy of inactivated trophozoites has been prepared and licensed Roundworms the characteristic eggs. fenbendazole in cats co-infected with Cryptosporidium for use in dogs and cats in the United States. Because Roundworms are common in puppies (Toxocara canis and parvum revealed that the drug was safe; however, it was infection is readily diagnosed and treated, and many Toxascaris leonina) and kittens (Toxocara cati and relatively ineffective (50%) in cats co-infected with infected dogs and cats are asymptomatic, the merit of Toxascaris leonina) and can cause diarrhoea, failure to Fenbendazole, pyrantel, and milbemycin are effective. Cryptosporidium. 13 Fenbendazole is the author s first vaccination against giardiasis has not been convincingly thrive, a poor haircoat, and a potbellied appearance. drug of choice for treating infected puppies. Drontal demonstrated. The vaccine does not prevent infection Vomiting is occasionally observed when the roundworms Plus was shown to be relatively safe and effective in but only reduces shedding of trophozoites or cysts. Thus gain access to the stomach

5 Bacterial causes of diarrhoea by examining stained smears (Gram stain or Romanovsky- Canine parvovirus-2 (CPV-2) causes classic parvovirus of the faeces for the presence of the virus (CPV-1 is indis- Veterinarians are faced with a quandary when attempting type stain) of fresh faeces from the patient. The organism s enteritis 5-12 days after infection via the faecal-oral route. tinguishable from CPV-2), haemagglutination inhibition to diagnose puppies and kittens with suspected bacterial- characteristic morphology (slender, curved rods with an Canine parvovirus-2b is a more recently recognised for serum IgM, histopathology of intestinal lesions, and associated diarrhoea because the isolation rates for putative S shape or sea gull-shaped appearance) allows it to be mutated form of CPV-2, which may be more pathogenic immunohistochemistry of intestinal biopsies. bacterial enteropathogens are often similar in diarrhoeic identified relatively easily. Unfortunately, microscopic in some dogs. Doberman Pinschers, Rottweilers, Pit Bulls, and non-diarrhoeic animals, and because the incidence of evaluation of the spiral-shaped bacteria does not allow and Labrador Retrievers appear more susceptible than bacterial-associated diarrhoea is extremely variable. Faecal you to differentiate between Campylobacter spp. or other breeds. Dogs are predisposed to sepsis secondary is supportive and similar to other severe, cultures and toxin analyses for specific bacteria should be related organisms such as Helicobacter spp. For optimal to neutropaenia associated with viral damage to bone acute infectious enteropathies. Intravenous fluid and reserved for a) puppies and kittens developing diarrhoea isolation (culture) of Campylobacter spp., faeces or faecal marrow progenitors, and bacterial translocation due to electrolyte therapy is indicated, with particular attention after kenneling once parasitic causes of diarrhoea have swabs should be fresh or placed immediately into intestinal damage. given to potassium repletion. The intramedullary route been ruled out, b) in puppies and kittens with an acute anaerobic transport medium before refrigeration at 4 C. can be utilised in very small puppies; the subcutaneous onset of bloody diarrhoea in association with evidence of The specimen should be mailed as soon as possible to a Clinical Signs route is likely to be inadequate. Dextrose solution (2.5- sepsis, c) outbreaks of diarrhoea occurring in more than reputable veterinary microbiology laboratory that has Anorexia, lethargy, fever, vomiting, and dehydration are 5%) is added to the IV fluids if the dog is hypoglycaemic. one household pet, and d) screening for enteropathogens the formulated selective media containing antimicrobial common. Diarrhoea can be absent in the early stages Plasma or colloids (dextran 70 or hetastarch) are indicated (C. difficile, Campylobacter spp., or Salmonella spp.) when agents and microaerophilic incubation conditions to of infection, and usually occurs 24 to 48 hours after onset if the serum albumin concentration drops below 20 g/l. zoonotic concerns are present. isolate the organism. of vomiting. The diarrhoea can often be profuse and Antibiotics are administered to febrile or severely neutro- The main bacterial enteropathogen that should be haemorrhagic. Hypothermia, icterus, and disseminated paenic dogs. If the animal is neutropaenic, but afebrile, considered in diarrhoeic puppies or kittens <4 months old intravascular coagulation are typically seen in severe the administration of a first-generation cephalosporin is is Campylobacter spp. Other bacterial enteropathogens Although diarrhoea produced by Campylobacter orga- cases with bacterial sepsis or endotoxaemia. Clinical reasonable. Dogs in septic shock should be treated with a that are considered in older dogs and cats include nisms is usually self-limiting, the zoonotic potential of signs can be exacerbated with concurrent infection with broad-spectrum aerobic and anaerobic antibiotic (e.g., Clostridium perfringens, Clostridium difficile, Salmonella the organism often necessitates medical therapy. It is distemper virus, coronavirus, Giardia, Salmonella, ampicillin plus amikacin). Human granulocyte colony- spp., and Escherichia coli. now recognised that Campylobacter are a leading cause Campylobacter, or intestinal parasites. stimulating factor (G-CSF) at 5 µg/kg q 24 h subcutaneously of enteric disease in people and that diarrhoeic and non- or intravenously has been used to increase neutrophil Campylobacter spp diarrhoeic dogs can serve as sources of infection for humans. numbers, but may not influence patient outcome, Campylobacter spp. are small ( µm X µm), The drugs of choice are the macrolides (erythromycin at The diagnosis is often made tentatively on the basis of whereas some benefit has been shown for ω-interferon. microaerophilic, gram-negative, curved rod-shaped 10 to 15 mg/kg TID) or quinolones (enrofloxacin at 5 clinical details, history, and physical examination findings. Antiemetics such as prochlorperazine, metoclopramide, bacteria. Campylobacter jejuni, C. coli, C. helveticus, and mg/kg BID). Erythromycin is the preferred drug due to A history of sudden onset of vomiting and diarrhoea in a or ondansetron, are indicated if the vomiting is intractable. C. upsaliensis have been associated with diarrhoea in the increased rate of antibiotic resistance with the young dog, particularly if the puppy is unvaccinated or Metoclopramide is most effective when administered as puppies and kittens, although recent studies have shown quinolones. 17 The duration of excretion in infected dogs only partially vaccinated, warrants consideration. The a constant rate infusion at a dose of 1mg/kg/24hours. more sensitive species such as C. upsaliensis or other and cats can be as long as 4 months and infected animals presence of neutropaenia on the haemogram in associa- Gastric protectants including H 2 -receptor antagonists and catalase-negative or weakly-positive species can be should be quarantined away from children during this tion with signs of enteritis is suggestive of CPV; however, sucralfate are indicated if there is evidence of secondary missed with routine culture techniques. Faecal shedding period. salmonellosis or severe infections can also be associated oesophagitis. Broad spectrum anthelmintics to treat con- of C. jejuni is significantly greater in dogs < 6 months old with neutropaenia. There are no pathognomonic findings current intestinal parasites should be administered and during the summer and autumn periods. The higher Viral causes of diarrhoea on a serum biochemistry profile, although hypoglycaemia, when the dog is no longer vomiting. Most dogs can be prevalence of infection in pups versus adult dogs may Canine and feline viral enteritis is usually diagnosed in hypokalemia, prerenal azotaemia, and increased bilirubin gradually weaned onto a bland diet of cottage cheese reflect increased exposure of young animals to faecal younger unvaccinated animals. The animal s signalment, or liver enzymes are commonly found. Abdominal radio- and rice, or a commercially available highly digestible excrement and confinement to a limited space. In history, clinical signs, and haematological findings are graphs are indicated to help rule out an intestinal foreign intestinal diet; however, the presence of intractable addition, the unexposed immune system of the pups important in ranking a viral aetiology as a likely cause of body, and may reveal intestinal gas, intestinal fluid, and vomiting might warrant the administration of partial or may increase the susceptibility to intestinal colonisation the animal s diarrhoea. ileus. A faecal ELISA test for CPV-2 should always be done total parenteral nutrition. by C. jejuni. The isolation of Campylobacter spp. from on faeces, even if diarrhoea is not present. The test is a diarrhoeic animal does not necessarily implicate Canine Parvoviral Enteritis considered sensitive and specific; however, the ELISA test Feline Panleucopaenia (FP) Campylobacter as a cause of the diarrhoea. Dogs are susceptible to infection by two types of parvovirus. may be negative if the assay is performed early in the Feline Panleucopaenia is a viral disease characterised by Canine parvovirus-1 (CPV-1) is a relatively nonpathogenic clinical course of the disease, or after days following fever, depression, anorexia, vomiting, and diarrhoea. virus that is occasionally associated with myocarditis, infection. Other tests that can be done to confirm the Historically, feline panleucopaenia was caused exclusive- Campylobacter-like organisms (CLO s) can be identified pneumonitis, and gastroenteritis in very young puppies. diagnosis of CPV include electron microscopic evaluation ly by feline panleucopaenia virus (FPV); however, it has 46 47

6 now been confirmed that FP can be caused by CPV-2a can be fed a diet containing a select protein source role in many of these cases, and implementation of simple 7. Lappin MR, Dowers K, Taton-Allen G, Cheney J. and CPV-2b. 18 Feline panleucopaenia has become an (Eukanuba Veterinary Diet Dermatosis LB Formula for bench-top techniques such as faecal flotation, faecal wet Cryptosporidiosis and inflammatory bowel disease in uncommon disease because of routine vaccination; howe- Cats). Alternatively, a home-cooked turkey or chicken diet preparation, and judicious use of faecal ELISA s for a cat. Feline Practice 25:10-13, ver, outbreaks are occasionally seen in unvaccinated ani- (without carbohydrates) can be fed for 5-10 days before bacteria or viruses should give a diagnosis in the majority 8. Arrowood MJ and Sterling CR. Comparison of con- mals, particularly feral populations and catteries. The clini- balancing this diet or switching to a commercial diet of cases. Appropriate anthelmintic administration, fluid ventional staining methods and monoclonal antibody- cal signs are similar to those described for dogs with par- containing a similar protein source. Dietary fat restriction and electrolyte administration, dietary modification, and based methods for Cryptosporidium oocyst detection. voviral enteritis. does not appear to be as important in cats with intestinal avoidance of indiscriminate antibiotic administration J Clin Microbiol 27: , disease as it is in dogs. Home-cooked diets are not com- should ensure a successful outcome in most cases. 9. Garcia LS and Shimizu RY. Evaluation of nine immu- plete and balanced, and should not be fed to puppies and noassay kits (enzyme immunoassay and direct fluo- is based on the history, physical examination kittens for more than 10 days. rescence) for detection of Giardia lamblia and findings, results of a haemogram (neutropaenia), and fae- Inflammatory bowel disease is primarily a disease of Cryptosporidium parvum in human fecal specimens. J cal ELISA. The ELISA test used to detect canine parvovirus middle-aged to older dogs and cats, and puppies and kittens Clin Microbiol 35(6): , has been reported to cross-react with feline parvovirus. are more likely to have diarrhoea due to an infectious 10. Marks SL, Hanson TE, Melli AC. Comparison of direct cause. The author discourages the administration of immunofluorescence, modified acid-fast staining, prednisone to diarrhoeic puppies and kittens unless a and enzyme immunoassay techniques for detection is supportive and virtually identical to that comprehensive work-up, including intestinal biopsies, of Cryptosporidium spp. in naturally exposed kittens. J described for the dog with parvovirus enteritis. warrants this therapy. Puppies and kittens with chronic Am Vet Med Assoc 225: , ileitis could have secondary deficiencies of vitamin B Boone JH, Wilkins TD, Nash TE. Techlab and Alexon Empiric therapy for puppies and kittens with diarrhoea (cobalamin), an important micronutrient for DNA Giardia enzyme-linked immunosorbent assay kits detect of unknown cause replication in the intestinal crypts. Vitamin B12 can be cyst wall protein 1. J Clin Microbiol 37: , Unlike acute diarrhoea, which is often self-limiting and administered empirically to puppies and kittens at 12. Scorza AV and Lappin MR. Metronidazole for the may be managed with symptomatic or supportive therapy, µg per kitten or puppy, respectively, given sub- treatment of feline giardiasis. J Feline Med Surg. chronic diarrhoea usually requires specific diagnosis and cutaneously once weekly for 4-6 weeks. Repeat injections 6(3):157-60, therapy. Finding intestinal parasites in the faeces of a should be based on determination of serum cobalamin References: 13. Keith CL, Radecki SV, Lappin MR. Evaluation of fen- puppy or kitten with diarrhoea does not establish concentrations. Cobalamin is safe, easy to administer, 1. Alcaino HA and Baker NF. Comparison of two flotation bendazole for treatment of Giardia infection in cats parasitism as the cause of the intestinal disease, although and cheap. Use of pre- and probiotics for diarrhoeic methods for detection of parasite eggs in feces. J Am concurrently infected with Cryptosporidium parvum. many puppies and kittens will show a partial or complete animals has recently received tremendous attention; Vet Med Assoc 164 (6): , Am J Vet Res 64(8):1027-9, resolution of clinical signs following administration of a however, most studies completed to date have not been 2. Gookin JL, Breitschwerdt EB, Levy MG, et al. Diarrhea 14. Scorza AV, Radecki SV, Lappin MR. Efficacy of febantel/ broad-spectrum anthelmintic. Diarrhoeic puppies and performed in animals with clinical disease. Furthermore, associated with trichomonosis in cats. J Am Vet Med pyrantel/praziquantel for the treatment of Giardia kittens should be empirically dewormed even in the face caution should be heeded when purchasing over-the- Assoc 215 (10): , infection in cats. J Vet Int Med, Abstract, 18(3):388, of a negative faecal flotation. Serologic screening for FeLV counter commercial probiotics because there is little federal 3. Gookin JL, Stebbins ME, Hunt E, et al. Prevalence of is recommended for kittens with chronic diarrhoea that regulation and quality control over many products, and and risk factors for feline Tritrichomonas foetus and 15. Zimmer JF, Miller JJ, Lindmark DG. Evaluation of the have not responded to antiparasitic and dietary therapy. label descriptions do not always match the ingredients. Giardia infection. J Clin Microbiol 42 (6): , efficacy of selected commercial disinfectants in inac- Metronidazole administration is often associated with some When facing a diarrhoeic puppy or kitten that is not tivating Giardia muris cysts. J Am Anim Hosp Assoc amelioration of diarrhoea, possibly due to alteration of the responding to therapy and for which a diagnosis has not 4. Gookin JL, Foster DM, Poore MF, et al. Use of a com- 24: , intestinal microflora, dampening cell-mediated immunity, been made, it is often more helpful to repeat previously mercially available culture system for diagnosis of 16. Lindsay DS and Blagburn BL. Practical treatment and or killing a specific pathogen such as Clostridium difficile. negative diagnostic tests as opposed to performing Tritrichomonas foetus infection in cats. J Am Vet Med control of infections caused by canine gastrointestinal Dietary modification should be considered in puppies and endoscopy and biopsy. Assoc 222: , parasites. Vet. Med 89: , kittens failing to respond to empiric antiparasitic therapy 5. Gookin JL, Birkenheuer AJ, Breitschwerdt EB, Levy MG. 17. Groat R, Monn M, Flynn L, et al. Survey of clinic practices and metronidazole administration. Summary Single-tube nested PCR for detection of Tritrichomonas and testing for diagnosis of Giardia infections in dogs The author frequently utilises commercial intestinal The presentation at the clinic of a new puppy or kitten foetus in feline feces. J Clin Microbiol 40(11): , and cats. Abstract, IDEXX Laboratories, Information diets, and has had success utilising a diet for puppies that with diarrhoea must be managed promptly to ensure brochure, is highly digestible and contains fermentable fibres appropriate health care is implemented before potential 6. Foster DM, Gookin JL, Poore MF, et al. Outcome of cats 18. Nakamura K, Sakamoto M, Ikeda Y, et al. Pathogenic (Eukanuba Veterinary Diet Intestinal Formula for Puppies). life-threatening developments can take place. Infectious with diarrhea and Tritrichomonas foetus infection. J potential of canine parvovirus types 2a and 2c in Kittens failing to improve on a standard commercial diet causes of diarrhoea are believed to play an important Am Vet Med Assoc 15;225(6):888-92, domestic cats. Clin Diag Lab Immunol 8: ,