Clinical techniques in small animal practice最新文献

The medically important groups of Hymenoptera are the Apoidea (bees), Vespoidea (wasps, hornets, and yellow jackets), and Formicidae (ants). These insects deliver their venom by stinging their victims. Bees lose their barbed stinger after stinging and die. Wasps, hornets, and yellow jackets can sting multiple times. Most deaths related to Hymenoptera stings are the result of immediate hypersensitivity reactions, causing anaphylaxis. Massive envenomations can cause death in nonallergic individuals. The estimated lethal dose is approximately 20 stings/kg in most mammals. Anaphylactic reactions to Hymenoptera stings are not dose dependent or related to the number of stings. Bee and wasp venoms are made up primarily of protein. Conversely, fire ant venoms are 95% alkaloids. Four possible reactions are seen after insect stings: local reactions, regional reactions, systemic anaphylactic responses, and less commonly, delayed-type hypersensitivity. Clinical signs of bee and wasp stings include erythema, edema, and pain at the sting site. Occasionally, animals develop regional reactions. Onset of life-threatening, anaphylactic signs typically occur within 10 minutes of the sting. Diagnosis of bee and wasp stings stem from a history of potential contact matched with onset of appropriate clinical signs. Treatment of uncomplicated envenomations (stings) consists of conservative therapy (antihistamines, ice or cool compresses, topical lidocaine, or corticosteroid lotions). Prompt recognition and initiation of treatment is critical in successful management of anaphylactic reactions to hymenopteran stings. Imported fire ants both bite and sting, and envenomation only occurs through the sting. Anaphylaxis after imported fire ant stings is treated similarly to anaphylactic reactions after honeybee and vespid stings. The majority of Hymenopteran stings are self-limiting events, which resolve in a few hours without treatment. Because life-threatening anaphylactic reactions can progress rapidly, all animals stung should be closely monitored and observed. In the following review article, we will examine the sources and incidence, toxicokinetics, pathological lesions, clinical signs, diagnosis, treatment, and prognosis for dogs and cats suffering Hymenoptera stings.

The venom from spiders of the genus Loxosceles, the most famous being Loxosceles recluse (the most brown recluse spider) can cause serious poisoning. These spiders inhabit the south and south central states from Georgia through Texas and north to southern Wisconsin. They are commonly called violin spiders because of the violin-shaped marking on the dorsum of the cephalothorax. Many dermonecrotic lesions are incorrectly diagnosed as Brown recluse bites, as up to 50% of the diagnoses are in geographic regions of the country which do not have Loxosceles spiders. Sphingomyelinase D is the primary venom dermonecrotic factor. The toxin depletes serum hemolytic complement, prolongs the activated partial thromboplastin time and depletes clotting factors VIII, IX, XI, and XII. The venom induces rapid coagulation and occlusion of small capillaries, causing subsequent tissue necrosis. A classic “bulls eye” lesion develops, an erythematous area inside of which is a pale ischemic region that develops a dark necrotic center as the lesion matures. Healing is slow, and these ulcers may persist for months leaving a deep scar. Systemic signs occur less commonly but can be life threatening. The most prevalent sign is a hemolytic anemia with significant hemoglobinuria. There is no specific antidote. Dapsone a leukocyte inhibitor has been shown to be effective in treating dermal lesions in animal models. Conservative therapy includes several cleanings daily with Burrow’s solution and hydrogen peroxide. Systemic signs of Loxosceles envenomation are potentially fatal and should be aggressively addressed. Hospitalization and intravenous fluid therapy may be needed to maintain adequate hydration and to protect renal function.

Pit vipers are the largest group of venomous snakes in the United States and are involved in an estimated 150,000 bites annually of dogs and cats. The severity of any pit viper bite is related to the volume and toxicity of the venom injected as well as the location of the bite, which may influence the rate of venom uptake. The toxicity of rattlesnake venom varies widely. It is possible for pit vipers’ venom to be strictly neurotoxic with virtually no local signs of envenomation. Venom consists of 90% water and has a minimum of 10 enzymes and 3 to 12 nonenzymatic proteins and peptides in any individual snake. The onset of clinical signs after envenomation may be delayed for several hours. The presence of fang marks does not indicate that envenomation has occurred, only that a bite has taken place. Systemic clinical manifestations encompass a wide variety of problems including pain, weakness, dizziness, nausea, severe hypotension, and thrombocytopenia. The victim’s clotting abnormalities largely depend upon the species of snake involved. Venom induced thrombocytopenia occurs in approximately 30% of envenomations. Many first aid measures have been advocated for pit viper bite victims, none has been shown to prevent morbidity or mortality. Current recommendations for first aid in the field are to keep the victim calm, keep the bite site below heart level if possible, and transport the victim to a veterinary medical facility for primary medical intervention. The patient should be hospitalized and monitored closely for a minimum of 8 hours for the onset of signs of envenomation. The only proven specific therapy against pit viper envenomation is the administration of antivenin. The dosage of antivenin needed is calculated relative to the amount of venom injected, the body mass of the victim, and the bite site. The average dosage in dogs and cats is 1 to 2 vials of antivenin.

Black widow spiders are found throughout the continental United States and north into the southern Canadian provinces. Male black widow spiders are of little medical importance. Female black widow spiders can be 20 times larger than males. The female can be identified by the hourglass pattern, red or orange in color, on the ventral aspect of her shiny, globose black abdomen. Black widow spiders control the amount of venom they inject; an estimated 15% of bites to humans are non-envenomating. Cats are very sensitive to the venom and deaths are common. Dogs have severe clinical signs but are considered more resistant than cats. A single bite is capable of delivering a lethal dose of venom to companion animals. There are several toxic components consisting of five or six biologically active proteins. These include a potent mammalian neurotoxin called alpha-latrotoxin, which induces neurotransmitter release from nerve terminals. Acetylcholine, noradrenalin, dopamine, glutamate, and enkephalin systems are all susceptible to the toxin. Onset of clinical signs usually occurs during the first 8 hours post envenomation. The condition is extremely painful in moderate to severe envenomations. Abdominal rigidity without tenderness is a hallmark sign of Latrodectus envenomation. In cats, paralytic signs may occur early and are particularly marked. Hypertension is a significant threat. First aid is of no value in the treatment. The primary treatment for black widow spider envenomation is the administration of specific antivenin, which provides the most permanent and quickest relief of the envenomation syndrome, usually within 30 minutes of infusion. The prognosis of Latrodectus envenomation is uncertain of several days, and complete recovery may take weeks.

Toxicology is the medical discipline that studies the often dramatic effects that poisons can have on living organisms. The body of toxicological information that the practicing veterinarian must deal with is growing exponentially. The veterinary clinician must come to understand the source of potential toxicants, circumstances leading up to poisoning episodes, must recognize the clinical signs of a wide variety of poisons, be able to diagnose intoxications, successfully treat and manage exposed animals, and institute strategies that educate the public and help prevent future poisonings. This is a tremendously tall order and can be not a little bit overwhelming. Fortunately, the clinicians are not alone and have tremendous resources in their corner, including veterinary schools, regional poison and drug centers, national veterinary hot lines utilizing board-certified veterinary toxicologists, local toxicologists and an ever-growing body of literature concerning small animal poisoning management. This discussion will investigate ways in which to make this seemingly daunting field much more palatable to small animal practitioners.

North American coral snakes are distinctively colored beginning with a black snout and an alternating pattern of black, yellow, and red. They have fixed front fangs and a poorly developed system for venom delivery, requiring a chewing action to inject the venom. The severity of a coral snake bite is related to the volume of venom injected and the size of the victim. The length of the snake correlates positively with the snakes venom yield. Coral snake venom is primarily neurotoxic with little local tissue reaction or pain at the bite site. The net effect of the neurotoxins is a curare like syndrome. In canine victims there have been reports of marked hemolysis with severe anemia and hemoglobinuria. The onset of clinical signs may be delayed for as much as 10 to 18 hours. The victim begins to have alterations in mental status and develops generalized weakness and muscle fasciculations. Progression to paralysis of the limbs and respiratory muscles then follows. The best flied response to coral snake envenomation is rapid transport to a veterinary medical facility capable of 24 hour critical care and assisted ventilation. First aid treatment advocated in Australia for Elapid bites is the immediate use of a compression bandage. The victim should be hospitalized for a minimum of 48 hours for continuous monitoring. The only definitive treatment for coral snake envenomation is the administration of antivenin (M. fulvius). Once clinical signs of coral snake envenomation become manifest they progress with alarming rapidity and are difficult to reverse. If antivenin is not available or if its administration is delayed, supportive care includes respiratory support. Assisted mechanical ventilation can be used but may have to be employed for up to 48 to 72 hours.

Topical therapy is extremely important in the management of allergic, infectious, and seborrheic disorders. It can be used as a sole therapy or adjunctive therapy for these disorders, often minimizing the need for systemic therapy. In allergic diseases, pruritus can be decreased by removing allergen, desensitizing the skin or other antipruritic effects. Many agents can also maintain or replace moisture to the skin and have emollient effects. When used for infectious conditions, topical therapy can decrease microbial counts and reduce surface colonization of microbes and help to prevent relapses. Antiseborrheic products function by normalizing keratinocyte turnover rates by reducing epidermal division (keratoplastic), normalizing keratinization, and increasing desquamation (keratolytic). There are many different topical vehicles and modes of application: shampoos, whirlpools, soaks, rinses, sprays, lotions, gels, creams, and ointments. Shampoos are often the most practical and effective. The practitioner needs to become familiar with many active ingredients to learn what products are indicated for specific diseases.

The laser is a tool that will augment the surgical techniques available to the veterinarian. When using the laser compared with traditional surgery there are multiple procedures that can be performed with much greater ease, and some procedures that previously could not be performed. Specialty and academic practices have used lasers for photodynamic therapy, lithotripsy of urinary calculi, and percutaneous disk ablation. This article will focus on the lasers use in dermatology. It is essential that the surgeon learn the basics of laser physics, how the laser interacts with tissue and the safety issues one needs to consider during its use. On deciding to use the laser the surgical techniques chosen should always be based on considering the advantages and disadvantages the laser has to offer. The use of biomedical lasers is a “cutting edge” technique now available to our veterinary field.

Cutaneous tissue can become infected when fungal organisms contaminate or colonize the epidermal surface or hair follicles. The skin can be a portal of entry for fungal infection when the epithelial barrier is breached or it can be a site for disseminated, systemic fungal disease. The two most common cutaneous fungal infections in small animals are dermatophytosis and Malassezia dermatitis. Dermatophytosis is a superficial cutaneous infection with one or more of the fungal species in the keratinophilic genera Microsporum, Trichophyton, or Epidermophyton. Malassezia pachydermatis is a nonlipid dependent fungal species that is a normal commensal inhabitant of the skin and external ear canal in dogs and cats. Malassezia pachydermatis is the most common cause of Malassezia dermatitis. The diagnosis and treatment of these cutaneous fungal infections will be discussed.