Canine Leptospirosis

Leptospirosis – An Overview

  • “Leptospirosis” is caused by disease-causing members of the bacterial genus Leptospira.
  • Sudden (acute) and long-term (chronic) diseases of dogs (mainly inflammation of the kidney [known as “nephritis”] and inflammation of the liver [known as “hepatitis”]) and other animals, including cats, although rarely.
  • Dogs—serovars causing disease vary by geographic region, recent serovars of concern in the United States include Leptospira grippotyphosa,Leptospira autumnalis, and Leptospira pomona; “serovars” are subdivisions of a species that are different from other strains.
  • Dogs—ideally vaccines should include representative serovars found in the geographic region where the dog lives.
  • Young dogs—more likely to exhibit severe disease.
  • Old dogs with adequate protection from vaccinations—seldom exhibit clinical disease, unless exposed to a serovar not in the vaccine.

Signs/Observed Changes in the Pet

  • Vary with age and immune status of the pet, environmental factors that affect Leptospira survival, and disease-causing nature of the infecting serovar
  • May have no clinical signs.

Very Sudden (Peracute) Disease to Disease with Signs over a Moderate Amount of Time (Known as “Subacute Disease”)

  • Fever
  • Sore muscles
  • Stiffness
  • Shivering
  • Weakness
  • Lack of appetite (known as “anorexia”)
  • Depression
  • Vomiting
  • Rapid dehydration
  • Diarrhea—with or without blood
  • Yellowish discoloration to the gums and other tissues of the body (known as “jaundice” or “icterus”)
  • Spontaneous cough
  • Difficulty breathing (known as “dyspnea”)
  • Increased thirst (known as “polydipsia”) and increased urination (known as “polyuria”) progressing to production of no urine (known as “anuria”)
  • Bloody vaginal discharge
  • Death—without clinical signs

Very Sudden (Peracute) to Sudden (Acute) Disease

  • Rapid breathing (known as “tachypnea”)
  • Rapid, irregular pulse
  • Poor blood flow in the capillaries (smallest blood vessels; condition known as “poor capillary perfusion”)
  • Vomiting blood (known as “hematemesis”)
  • Passage of blood in the bowel movement or stool (known as “hematochezia”)
  • Black tarry stools, due to the presence of digested blood (known as “melena”)
  • Bleeding in the nose and nasal passages (known as “epistaxis” or a “nosebleed”)
  • Widespread small, pinpoint areas of bleeding (known as “petechia”); bruises or purplish patches under the skin, due to bleeding (known as “ecchymoses”)
  • Reluctance to move, overly sensitive to pain or touch (known as “hyperesthesia”) along the spine, stiff gait
  • Inflammation of the moist tissues of the eyes (known as “conjunctivitis”)
  • Inflammation of the nose (known as “rhinitis”)
  • Blood in the urine (known as “hematuria”)
  • Mildly enlarged lymph nodes (known as “lymphadenopathy”)

Long-Term (Chronic) Disease

  • May have no apparent illness
  • Fever of unknown origin
  • Increased thirst (polydipsia) and increased urination (polyuria)—long-term (chronic) kidney failure

Causes

  • Dogs—Leptospira canicola, Leptospira icterohaemorrhagiae, Leptospira pomona, Leptospira grippotyphosa, Leptospira copenhagenii, Leptospira australis, Leptospira autumnalis, Leptospira ballum, and Leptospira bataviae
  • Cats—Leptospira canicola, Leptospira grippotyphosa, Leptospira pomona, and Leptospira bataviae

Risk Factors

Transmission

  • Direct—host-to-host contact via infected urine, postabortion discharge, infected fetus/ discharge, and sexual contact (semen).
  • Indirect—exposure (via urine) to a contaminated environment (such as vegetation, soil, food, water, bedding) under conditions in whichLeptospira can survive.
  • Disease agent—Leptospira serovar, each with its own disease-causing factors, infectious dose, and route of exposure.
  • Leptospirosis in companion animals often is the result of spillover from disease occurring in wildlife (many different types of mammals) in the area; wildlife may act as “hosts” and maintain the different serovars.

Host Factors

  • Vaccine—protection is serovar-specific; prevents clinical disease as a result of specific serovar; may not prevent kidney colonization of Leptospiraand subsequent shedding of the bacteria in the urine; serovars not included in the vaccine may infect and cause disease in vaccinated pet.
  • Outdoor pets or hunting dogs—exposure of moist tissues of the body (mucous membranes) to water; exposure of abraded or water-softened skin increases risk of infection.

Environmental Factors

  • Warm and moist environment; wet season (high rainfall areas) of temperate regions; low-lying areas (marshy, muddy, irrigated); warm humid climates of tropical and subtropical regions.
  • Environmental temperature range—7–10 dg C (44.6–50 dg F) to 34–36 dg C (93–96 dg F).
  • Water—organism survives better in stagnant than in flowing water; neutral or slightly alkaline pH.
  • Organism survives 180 days in wet soil and longer in standing water.
  • Dense animal population—kennels and urban settings; increases chances of urine exposure.
  • Exposure to rodents and other wildlife.

Treatment

Health Care

  • Sudden (acute) severe disease—inpatient; extent of supportive therapy depends on severity of disease; kidney failure requires closely monitored, medically induced increased production of urine (known as “diuresis”).
  • Dehydration and shock—intravenous fluids (such as lactated Ringer’s solution).
  • Severe bleeding—blood transfusion may be needed in association with treatment for the blood-clotting disorder, known as “disseminated intravascular coagulopathy” or DIC.
  • Production of only small amounts of urine (known as “oliguria”) or no urine (known as “anuria”)—initially rehydrate; then give medications to increase production of urine (known as “diuretics”); peritoneal dialysis (a type of dialysis in which fluids are put into the abdomen and the lining of the abdomen [known as the “peritoneum”] acts as a filter to remove waste products from the blood; after a certain amount of time, the fluids and waste products are removed from the abdomen) may be necessary.

Activity

  • Suddenly (acutely) ill pets and pets with the presence of bacteria in their blood (known as “bacteremia”) or generalized disease caused by the spread of bacteria in the blood (known as “septicemia” or “blood poisoning”)—restricted activity; cage rest; monitoring; and warmth.

Diet

  • Severely ill pets—often have lack of appetite (anorexia); provide nutrition through intravenous feeding for prolonged anorexia.

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive:

  • Procaine penicillin G—an antibiotic; administer until kidney function returns to normal
  • Dihydrostreptomycin—an antibiotic; administer for 2 weeks to eliminate organism from kidney tissues; try streptomycin if no kidney failure (drug not available everywhere)
  • Doxycycline—an antibiotic; administer for 2 weeks; use alone to clear Leptospira from the blood and urine
  • Ampicillin or amoxicillin—antibiotics; may be used instead of penicillin; administer for 2 weeks
  • Erythromycin—an antibiotic

Follow-Up Care

Patient Monitoring

  • Monitor bloodwork and urinalysis for kidney function and monitor bloodwork for liver function and electrolytes.
  • Monitor bloodwork (blood urea nitrogen [BUN] and serum creatinine) and urine specific gravity in dogs with kidney failure for indication of prognosis.

Preventions and Avoidance

  • Vaccine (dogs)—whole-cell bacterin vaccines contain the serovars Leptospira canicola and Leptospira icterohaemorrhagiae (some also now includeLeptospira pomona and Leptospira grippotyphosa); promotes immunity to these serovars and protection from overt clinical disease; serovar specific; does not promote protection against other serovars present in nature; may not prevent colonization of the kidneys of Leptospira, resulting in a long-term (chronic) carrier state; a “carrier state” is one in which the animal has no signs of disease, but harbors Leptospira and can transmit it to other animals.
  • Newer subunit vaccine contains the serovars Leptospira pomona, Leptospira icterohaemorrhagiae, Leptospira grippotyphosa, and Leptospira canicola; claims are made that the vaccine provides protection from clinical disease and prevents kidney colonization of Leptospira.
  • Vaccines—vaccinate dogs per current label recommendations; bacteria-induced immunity lasts only 6–8 months and is serovar specific (no cross-protection outside of the serogroup); revaccination at least yearly; vaccinate dogs at risk (such as dogs that hunt, show dogs, and dogs with access to water/ponds) every 4–6 months, especially in areas where Leptospira is found (known as “endemic areas”); the veterinarian will assess the risk of exposure and will recommend a vaccination protocol for your pet.
  • Kennels—strict sanitation to avoid contact with infected urine; control rodents; monitor and remove carrier dogs until treated; isolate affected dogs during treatment; “carrier dogs” are infected, but have no signs of disease—they harbor Leptospira and can transmit it to other animals.
  • Activity—limit access to marshy/muddy areas, ponds, low-lying areas with stagnant surface water, heavily irrigated pastures, and access to wildlife.

Possible Complications

  • Blood-clotting disorder (disseminated intravascular coagulopathy)
  • Liver and/or kidney dysfunction may be permanent
  • Inflammation of the iris and other areas in the front part of the eye (known as “uveitis”)
  • Abortion

Expected Course and Prognosis

  • Most infections are subclinical or long-term (chronic); a “subclinical infection” is one in which the animal is infected, but has no signs of disease.
  • Prognosis guarded for sudden (acute) severe disease.

Key Points

  • Leptospirosis has zoonotic potential from contaminated urine of affected dogs and their environment; “zoonotic diseases” can be passed from animals to people.

Canine Distemper

Canine Distemper – An Overview

  • Distemper is a contagious disease that appears suddenly (acute) or over a moderate amount of time (known as “subacute”), characterized by fever and a variety of signs involving the eyes, central nervous system, and respiratory, urogenital, and gastrointestinal tracts; often a fatal disease
  • Caused by the canine distemper virus
  • Affects many different species of the order Carnivora (dogs, fox, wolves, hyenas, weasels, ferrets, mink, raccoons, skunks and civets); mortality rate varies greatly among species
  • Young dogs, especially unvaccinated, dogs are more susceptible to infection than are adults

Signs of Distemper/Observed Changes in the Dog

  • Fever—first fever occurs 3–6 days after infection, may go undetected; second fever several days later (and intermittent thereafter), usually associated with discharge from the nose and eyes, depression, and lack of appetite (known as “anorexia”)
  • Gastrointestinal and/or respiratory signs follow, often enhanced by secondary bacterial infection.
  • Central nervous system signs—occur in many infected dogs; often, but not always, after generalized (systemic) disease; depends on the virus strain; either sudden (acute) gray or white matter disease (“gray matter” is the nerve tissue of the brain and spinal cord that contains the nerve cell bodies; “white matter” is the part of the brain and spinal cord that contains nerve fibers covered with myelin, a fatty covering that increases conduction of nerve impulses).
  • Gray-matter disease—affects the brain and spinal cord; may cause inflammation of the meninges (the membranes covering the brain and spinal cord; inflammation of the meninges known as “meningitis”), seizures, stupor, hysteria, and wobbly, uncoordinated or “drunken” appearing gait or movement (known as “ataxia”); dogs may die in 2–3 weeks; some dogs recover (associated with prompt immune response), while others progress to develop white-matter disease; “gray matter” is the nerve tissue of the brain and spinal cord that contains the nerve cell bodies; “white matter” is the part of the brain and spinal cord that contains nerve fibers covered with myelin, a fatty covering that increases conduction of nerve impulses.
  • White-matter disease—variable signs of disease involving multiple locations of the central nervous system; commonly see weakness and wobbly, uncoordinated or “drunken” appearing gait or movement (ataxia) secondary to spinal cord disease; occasionally may see twitching or contraction of a group of muscles (known as “myoclonus”); some dogs die 4–5 weeks after initial infection; some dogs may recover with minimal central nervous system injury.
  • Inflammation of the optic nerve (the nerve that runs from the back of the eye to the brain; condition known as “optic neuritis”) and lesions in the back of the eye (known as the “retina”) may occur.
  • Hardening of the footpads (known as “hyperkeratosis”) and nose—some virus strains; but relatively uncommon.
  • Abnormal development of the enamel layer of the teeth (known as “enamel hypoplasia”) after neonatal infection is common.

Risk Factors

  • Contact of animals that have not been vaccinated or have not responded to vaccinations with animals that are infected with canine distemper virus (dogs or wild carnivores)

Treatment for Distemper

  • Inpatient treatment in isolation, to prevent infection of other dogs
  • Supportive treatment, including intravenous fluids—cases with lack of appetite (anorexia) and diarrhea
  • Once fever and secondary bacterial infections are controlled, pets usually begin to eat again
  • Carefully clean away discharges from the nose and eyes

Activity

  • Limited

Diet

  • Depends on the extent of gastrointestinal involvement

Medications for Distemper

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive:

  • Antiviral drugs—none known to be effective in treating canine distemper viral infections.
  • Antibiotics—to reduce secondary bacterial infection, because canine distemper virus decreases the ability of the dog to develop a normal immune response (known as “immunosuppression”).
  • Medication to control seizures (known as “anticonvulsant therapy”)—phenobarbital, potassium bromide.

Follow-Up Care

Patient Monitoring

  • Monitor for signs of pneumonia or dehydration from diarrhea in the sudden (acute) phase of the disease
  • Monitor for central nervous system signs, because seizures often follow

Preventions and Avoidance

  • Routine vaccination against canine distemper virus is key to prevention and avoidance; series of vaccinations administered initially followed by periodic booster vaccinations, as directed by your pet’s veterinarian
  • Avoid infection of puppies by isolation to prevent infection from wildlife (such as raccoons, fox, skunks) or from canine distemper virus-infected dogs

Possible Complications

  • Secondary bacterial infections, frequently involve the respiratory and gastrointestinal systems
  • Possibility of occurrence of central nervous system signs for 2–3 months after discharge from the eyes and nose has subsided
  • Seizures
  • Death

Expected Course and Prognosis

  • Depending on the strain of virus and the individual host response—dog may be infected, but have no signs of disease (known as a “subclinical infection”) or have signs of disease involving various areas of the body; the infection may be fatal or non-fatal.
  • Mild central nervous system signs—pet may recover; twitching or contraction of a group of muscles (myoclonus) may continue for several months or indefinitely.
  • Death—2 weeks–3 months after infection; mortality rate approximately 50%.
  • Euthanasia—owner may elect euthanasia, if or when nervous system signs develop; indicated when uncontrollable seizures occur.
  • Fully recovered dogs are not carriers, as they do not shed canine distemper virus.

Key Points

  • Mortality rate is about 50%
  • Dogs that appear to recover from early signs (such as discharge from the eyes and nose) may later develop fatal central nervous system signs
  • Fully recovered dogs are not carriers, as they do not shed canine distemper virus
  • Routine vaccination against canine distemper virus is key to prevention and avoidance; series of vaccinations administered initially followed by periodic booster vaccinations, as directed by your pet’s veterinarian

Bacterial Pneumonia

Bacterial Pneumonia – An Overview

  • Inflammation in the lung as a response to disease-causing bacteria, characterized by accumulation of inflammatory cells and fluid in the lung, conducting airways (bronchi and bronchioles), and alveoli (the terminal portion of the airways, in which oxygen and carbon dioxide are exchanged).
  • “Pneumonia” is inflammation of the lungs.
  • “Broncho” refers to the bronchi, the airways leading from the windpipe (known as the “trachea”) into the lungs.
  • “Upper respiratory tract” (also known as the “upper airways”) includes the nose, nasal passages, throat (pharynx), and windpipe (trachea).
  • “Lower respiratory tract” (also known as the “lower airways”) includes the bronchi, bronchioles, and alveoli (the terminal portion of the airways, in which oxygen and carbon dioxide are exchanged).
  • Inherited inflammation of the nose and inflammation of the smaller bronchi and lungs (known as rhinitis-bronchopneumonia complex”)—Irish wolfhound.
  • Dogs can get pneumonia, less common in cats

Breed Predilections

  • Dogs—sporting breeds, hounds, working breeds, and mixed-breed dogs (greater than 12 kg [26 lbs] of body weight)

Mean Age and Range

  • Dogs—common in young and old dogs; range, 1 month–15 years; many cases in puppies less than 1 year of age

Risk Factors

  • Contact of animals that have not been vaccinated or have not responded to vaccinations with animals that are infected with canine distemper virus (dogs or wild carnivores)

Signs/Observed Changes in the Pet

  • Cough
  • Fever
  • Labored breathing
  • Exercise intolerance
  • Lack of appetite (known as “anorexia”) and weight loss
  • Sluggishness (lethargy)
  • Nasal discharge
  • Difficult or rapid breathing
  • Abnormal breath sounds on listening to the lungs with a stethoscope (known as “auscultation”)—increased intensity or breath sounds over the bronchi; short, rough snapping sounds (known as “crackles”); and squeaking or whistling sounds (known as “wheezes”)
  • Dehydration

Causes

Dogs

  • Most common primary disease-causing organisms of the respiratory tract— Bordetella bronchiseptica and Mycoplasma.
  • Most common gram-positive bacteria—Staphylococcus, Streptococcus, and Enterococcus; gram staining is a technique in which slides with potential bacteria on them are stained in a sequential manner; gram-positive bacteria stain dark purple while gram-negative bacteria stain pink; gram staining allows differentiation of bacteria into groups (that is, gram-positive or gram-negative).
  • Most common gram-negative bacteria— Escherichia coli, Klebsiella, Pseudomonas, Pasteurella
  • Anaerobic bacteria (bacteria that can live and grow in the absence of oxygen)—found in lung abscesses and various types of pneumonia (particularly with aspiration or foreign bodies); approximately 20% of pets with bacterial pneumonia have anaerobic bacterial infections.

Cats

  • Bacteria—Bordetella bronchiseptica, Pasteurella, and Moraxella most frequently reported; Mycoplasma considered a primary disease-causing microorganism (known as a “pathogen”) in the lower respiratory tract.
  • Carrier state—may exist; periods of shedding Bordetella bronchiseptica after stress; infected female cats (queens) may not shed the organism during pregnancy (prepartum) but begin shedding it after delivering the kittens (postpartum), serving as a source of infection for kittens.

Risk Factors

  • Preexisting viral infection.
  • Regurgitation (return of food or other contents from the esophagus or stomach back up through the mouth), dysphagia (difficulty swallowing), or vomiting (forceful ejection of stomach contents up through the esophagus and mouth).
  • Functional or structural (anatomic) defects—paralysis of the voice box or larynx (known as “laryngeal paralysis”); enlarged esophagus (known as “megaesophagus”); cleft palate; inherited disorder in which the normal secretion clearance mechanism of the lungs is defective (known as “primary ciliary dyskinesia”).
  • Reduced level of consciousness—stupor, coma, or anesthesia.
  • Foreign body in the bronchi (part of the airway).
  • Long-term (chronic) dilation of bronchi or bronchioles, as a consequence of inflammation or blockage of the airway (known as “bronchiectasis”).
  • Drugs to decrease the immune response (known as “immunosuppressive drugs”)—such as chemotherapeutic drugs and steroids.
  • Severe metabolic disorders—excess levels of urea and other nitrogenous waste products in the blood (known as “uremia” or “azotemia”); sugar diabetes (diabetes mellitus); excessive production of steroids by the adrenal glands (known as “hyperadrenocorticism” or “Cushing’s syndrome”).
  • Presence of pus-forming bacteria and their poisons in the blood or tissues (known as “sepsis”).
  • Age—very young more susceptible to fatal infections.
  • Vaccination status.
  • Environment—housing, sanitation, ventilation.
  • Abnormal function of cells that normally remove bacteria and foreign materials from the body (known as “phagocyte dysfunction”)—feline leukemia virus (FeLV) infection and diabetes mellitus.
  • Complement (a protein substance in the blood that contributes to the destruction and removal of bacteria from the body) deficiency—rare.
  • Selective immunoglobulin A (IgA) deficiency; immunoglobulin A is an immune protein, found in the intestines; it functions as a protective barrier to prevent limit antigens (substance to which the immune system is responding and producing antibodies) and disease-causing microorganisms from entering the body through the intestines—rare.
  • Combined T-cell and B-cell dysfunction—rare; a lymphocyte is a type of white blood cell, formed in lymphatic tissue throughout the body; lymphocytes are further divided into T lymphocytes (which are involved in cell-mediated immunity), so-called “T-cells” and B lymphocytes (which produce antibodies as part of the immune process), so-called “B-cells”—rare.

Treatment

Health Care

  • Inpatient—recommended with signs involving multiple body systems (such as lack of appetite [anorexia], high fever, weight loss, and sluggishness [lethargy]).
  • Maintain normal hydration—important to aid the normal secretion clearance mechanism of the lungs; use a balanced electrolyte solution.
  • Administration of medication in a fine spray (known as “nebulization”) with saline aerosol—results in more rapid resolution, if used with physiotherapy and antibiotics.
  • Physiotherapy—efforts to dislodge secretions in the lungs and to induce coughing (known as “coupage”); windpipe manipulation to stimulate mild cough; and postural drainage; may enhance clearance of secretions; always do immediately after nebulization; avoid allowing the pet to lie in one position for a prolonged time.
  • Oxygen therapy—for pets with low levels of oxygen in their blood (known as “hypoxemia”) and signs of severe breathing difficulties (known as “respiratory distress”).

Activity

  • Restrict during treatment (inpatient or outpatient), except as part of physiotherapy after administration of medication in a fine spray (nebulization).

Diet

  • Ensure normal intake of food, with foods high in protein and calorie or energy density.
  • Feeding directly into the intestinal tract (known as “enteral feeding”) or through the veins (known as “parenteral nutrition”)—indicated in severely ill pets.
  • Use caution in feeding pets with an enlarged esophagus (megaesophagus); lack of normal function of the voice box or larynx (known as “laryngeal dysfunction”) or surgery on the voice box or larynx; disease of the throat or pharynx (known as “pharyngeal disease”), and pets that are unable to get up (they are recumbent).

Surgery

  • Surgical removal of a lung lobe (known as “lung lobectomy”)—may be indicated with lung abscesses or foreign body in the bronchus with secondary pneumonia; may be indicated if the pet is unresponsive to conventional treatment and disease is limited to one or two lobes of the lung(s).

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive:

Antibiotics

  • Antibiotics are best selected based on results of bacterial culture and susceptibility testing from transtracheal wash (a technique in which samples from the lower airways are obtained for bacterial culture and/or for evaluation through a microscope) or other diagnostic techniques.
  • Reasonable initial antibiotic choices pending culture results include amoxicillin–clavulanic acid, cephalexin, enrofloxacin, or trimethoprim-sulfonamide.
  • Gram-positive cocci—ampicillin, ampicillin-sulbactam; amoxicillin; amoxicillin–clavulanic acid; azithromycin; chloramphenicol, erythromycin; gentamicin; trimethoprim-sulfonamide; first-generation cephalosporins.
  • Gram-negative rods—enrofloxacin; chloramphenicol; gentamicin; trimethoprim-sulfonamide; amikacin; marbofloxacin; carboxypenicillins.
  • Bordetella—doxycycline; chloramphenicol; enrofloxacin; azithromycin.
  • Mycoplasma—doxycycline, enrofloxacin, marbofloxacin, chloramphenicol.
  • Anaerobes (bacteria that can live and grow in the absence of oxygen)—amoxicillin–clavulanic acid; chloramphenicol; metronidazole; clindamycin; ticarcillin-clavulanic acid.
  • Administration of gentamicin in a fine spray (known as “gentamicin nebulization”) for Bordetella—typically used in conjunction with antibiotics given by mouth or injection.
  • Continue treatment for at least 10 days beyond clinical resolution and/or 1–2 weeks following resolution of x-ray (radiograph) evidence of pneumonia.

Antibiotics

  • Recommended by some veterinarians; no objective evidence that they increase movement of mucus or mobilization of secretions.

Bronchodilators

  • Recommended by some veterinarians; used to decrease spasm of the bronchi; bronchodilators are medications that enlarge the bronchi and bronchioles in the lungs.

Follow-Up Care

Patient Monitoring

  • Monitor breathing rate and effort.
  • Complete blood count (CBC) should be performed periodically; CBC should return to normal as the pet responds to treatment.
  • Arterial blood gases, to monitor levels of oxygen and carbon dioxide in the blood—most sensitive monitor of progress.
  • Monitor pulse oximetry; : “pulse oximetry” is a means of measuring oxygen levels in blood.
  • Listen to the pet’s lungs (auscultate) frequently.
  • Chest x-rays (radiographs)—improve more slowly than the clinical signs.

Preventions and Avoidance

  • Vaccination—against upper respiratory viruses; against Bordetella bronchiseptica, if dog is boarded or exposed to large number of other dogs.
  • Catteries—environmental strategies to lower the number of cats or the close proximity in which they are housed (known as “population density”) and improve hygiene help control outbreaks of bordetellosis (infection caused by Bordetella).

Possible Complications

  • Presence of pus-forming bacteria and their poisons in the blood or tissues (sepsis).

Expected Course and Prognosis

  • Prognosis—good with aggressive anti-bacterial and supportive therapy; more guarded in young pets, pets with decreased ability to develop a normal immune response (immunodeficiency), and pets that are debilitated or have severe underlying disease.
  • Prolonged infection—potential for long-term (chronic) inflammation of the bronchi (bronchitis) or chronic dilation of bronchi or bronchioles, as a consequence of inflammation or blockage of the airway (bronchiectasis) in any pet.
  • High death rates are associated with severely low levels of oxygen in the blood (hypoxemia) and presence of pus-forming bacteria and their poisons in the blood or tissues (sepsis).

Key Points

  • Inflammation in the lung as a response to disease-causing bacteria, characterized by accumulation of inflammatory cells and fluid in the lung, conducting airways (bronchi and bronchioles), and alveoli (the terminal portion of the airways, in which oxygen and carbon dioxide are exchanged).
  • More common in dogs than in cats.
  • Antibiotics are best selected based on results of bacterial culture and susceptibility testing.
  • High death rates are associated with severely low levels of oxygen in the blood (hypoxemia) and presence of pus-forming bacteria and their poisons in the blood or tissues (sepsis).

Emergency Care

Your Plan Should Include All Family Members

The best way to protect your household from the effects of a disaster is to have a disaster plan. If you are a pet owner, that plan must include your pets. Being prepared can save their lives.

Different disasters require different responses. But whether the disaster is a hurricane or a hazardous spill, you may have to evacute your home.

In the event of a disaster, if you must evacuate, the most important thing you can do to protect your pets is to evacuate them too. If it’s not safe for you to stay behind then it’s not safe to leave pets behind either. Take action now so you know how to best care for your furry friends when the unexpectecd occurs.

Know a Safe Place to Take Your Pets

  • Local and state health and safety regulations do no permit the Red Cross to allow pets in disaster shelters. (Service animals are allowed in Red Cross shelters.)
  • Contact hotels and motels outside your local area to check their policies on accepting pets and restrictions on number, size and specicies. Ask if “no pet” policies can be waived in an emergency. Keep a list of “pet friendly” places, including phone numbers, with your disaster supplies.
  • Ask friends, relativies or others outside the affected area whether they could shelter your animals.
  • Make a list of boarding facilities and veterinarians who could shelter animals in an emergency; include 24-hour phone numbers.
  • Ask local animal shelters if they provide emergency shleter or foster care for pets during a disaster.

Assemble a Pet Emergency Preparedness Kit

Keep your pet’s ssential supplies in sturdy containers that can be easily accessed and carried (a duffle bag or covered trash containers, for exmpale). Your pet emergency preparedness kit should include:

  • Medications and medical records (stored in a waterproof container) and a First Aid kit.
  • Sturdy leashes, harness, and/or carriers to transport pets safely and ensure that your animals can’t escape.
  • Current photos of your pets in case they get lost.
  • Food, drinkable water, bowls, cat litter/pan, and manual can opener.
  • Information on feeding schedules, medical conditions, behavior problems, and the name and number of your veterinarian in case you have to foster or board your pets.
  • Pet bed or toys if easily transportable.

Help Emergency Workers Help Your Pets

The ASPCA recommends using a rescue sticker alert to let people know that pets are isnide your home. Make sure it is visible to rescue worker, and that it includes the types and number of pets in your household and your veterinarian’s phone number.

If you must evacuate with your pets (and if time allows) write “EVACUATED” aross the stickers so rescue workers don’t waste time looking for them.

Skin Ulcers

Ulcers of the Skin – An Overview

  • Erosions are shallow defects in the skin, which only affect the skin’s upper layers; erosions can be quite painful, but tend to heal quickly if protected (and the underlying cause is eliminated)
  • Ulcers are deeper defects in the skin, where the surface layers are compromised completely; ulcers require careful wound care to prevent infection, and tend to heal slowly
  • Erosive or ulcerative dermatoses are a group of dissimilar skin disorders, characterized by the presence of erosions or ulcers

Genetics

  • Some diseases characterized by erosions or ulcers of the skin are likely inherited since they tend to occur in certain breeds; however, no genetic screening tests are available

Signalment/Description of Pet

Species

  • Dogs
  • Cats

Signs/Observed Changes in the Pet

  • Depend on cause
  • Erosions or ulcers; they may be found anywhere on the body
  • Hair loss (known as “alopecia”)
  • Single or multiple lesions; lesions may be inflamed (indicated by redness)
  • May see lesions over pressure points (such as skin over bones)
  • May have dried discharge on the surface of a skin lesion (known as a “crust”) or may have moist discharge
  • May have loss of pigment of skin and/or hair (known as “depigmentation”)

Causes

  • Wide variety of diseases may result in erosions or ulcers of the skin; common causes are burns, trauma, and skin infections; more complicated diseases, such as drug reactions, certain types of cancers, auto-immune diseases of the skin, and viruses also may cause erosions or ulcers that appear identical to burns or trauma—your pet’s veterinarian may need to run a battery of tests (including bloodwork, cultures for different types of infections, and skin biopsies) to identify the cause and prescribe proper treatment
  • In some cases, an underlying cause cannot be identified and the cause is “unknown,” so-called “idiopathic” disorder or disease
  • Disorders that cause erosions or ulcers of the skin include the following (a partial list):
  • Immune-Mediated Disorders
  • Inflammation of blood vessels (known as “vasculitis”)
  • Canine juvenile cellulitis (puppy strangles)
  • Toxic epidermal necrolysis (usually medication-induced)
  • Feline indolent ulcer (rodent ulcer)
  • Auto-immune disorders (such as pemphigus or lupus) in which the immune system attacks the skin
  • Infectious Disorders
  • Skin infection characterized by the presence of pus (known as “pyoderma”) caused by Staphylococcus
  • Deep fungal or mycotic infections (such as sporotrichosis, cryptococcosis, histoplasmosis)
  • Superficial fungal infections (Malassezia dermatitis, dermatophytosis)
  • Actinomycetic bacteria (such as Nocardia, Actinomyces, Streptomyces)
  • Feline cow pox
  • Feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV) related disease
  • Parasitic Disorders
  • Demodectic mange (demodicosis)
  • Sarcoptic or notoedric mange
  • Flea-bite allergy
  • Congenital/Hereditary Disorders
  • Various skin disorders in which the skin is abnormal at birth (that is, a “congenital” abnormality) that may or may not be inherited
  • Metabolic Disorders
  • Liver disease
  • Excessive production of steroids by the adrenal glands (known as “hyperadrenocorticism” or “Cushing’s syndrome”), especially when complicated by secondary infections or calcium deposits in the skin (known as “calcinosis cutis”
  • Cancer
  • Squamous cell carcinoma
  • Mast cell tumors
  • Lymphoma of the skin (“mycosis fungoides”)
  • Nutritional Disorder
  • Zinc-responsive dermatosis
  • Generic dog-food dermatosis
  • Miscellaneous
  • Thermal, electrical, solar, or chemical burns
  • Frost bite
  • Chemical irritants
  • Venomous snake and insect bites

Risk Factors

  • Depend on underlying cause

Treatment

Health Care

  • Outpatient for most diseases
  • Varies widely according to the cause
  • Keeping eroded or ulcerated skin clean and protected are key to healing; if the cause is known, specific drug therapies may be prescribed
  • Pain management may be necessary for some pets, based on cause of condition
  • Your veterinarian will tailor a management program that is best for your pet’s individual case
  • Hydrotherapy, which may be achieved with either a whirlpool bath or by spraying cool water under pressure against the ulcerated skin can be helpful in many cases; ask your pet’s veterinarian first to be sure that hydrotherapy is appropriate for your pet’s condition
  • Avoid the temptation to apply “over-the-counter” creams and ointments to erosions and ulcers, without first checking with your veterinarian—some commonly used products (such as those containing neomycin) actually may delay healing in some cases; other products may contain types of alcohol or other ingredients that could cause pain upon application

Diet

  • Supportive therapy with fluid and nutritional supplementation is indicated in cases with severe fluid and protein loss through the damaged skin
  • Good quality diet
  • Supplementation of zinc in the diet for pets with zinc-responsive skin conditions

Surgery

  • Skin biopsy may be necessary for diagnosis

Medications

Vary widely according to cause.

Follow-Up Care

Patient Monitoring

  • Case-by-case basis, depending on the disease process, presence of generalized (systemic) disease(s), medications used, and potential side effects expected
  • Follow-up care is important, especially for slowly healing ulcers; a veterinarian should check progress of the wound at least every other week to be sure that healing is proceeding properly and that infection has not complicated the healing process

Possible Complications

  • Depend on cause
  • Some diseases are potentially life-threatening
  • Some diseases are caused by agents that may be spread to people (known as having “zoonotic potential”)
  • Superinfections and drug side effects are possible in cases requiring medications to decrease the body’s immune response (known as “immunosuppression”)
  • Some infectious diseases (such as nocardiosis, atypical mycobacteriosis) may be controlled, but not cured

Expected Course and Prognosis

  • Vary widely according to cause

Key Points

  • Wide variety of diseases may result in erosions or ulcers of the skin; common causes are burns, trauma, and skin infections; more complicated diseases, such as drug reactions, certain types of cancers, auto-immune diseases of the skin, and viruses also may cause erosions or ulcers that appear identical to burns or trauma—your pet’s veterinarian may need to run a battery of tests (including bloodwork, cultures for different types of infections, and skin biopsies) to identify the cause and prescribe proper treatment
  • Follow-up care is important, especially for slowly healing ulcers; a veterinarian should check progress of the wound at least every other week to be sure that healing is proceeding properly and that infection has not complicated the healing process

Skin Inflammation

Inflammation of the Skin and Muscles (Dermatomyositis) – An Overview

  • “Dermatomyositis” is an inherited inflammatory disease of the skin, muscles, and blood vessels that develops in young collies, Shetland sheepdogs, and their crossbreeds

Genetics

  • Collies and Shetland sheepdogs—inherited as an autosomal dominant trait, with variable expression

Signalment/Description of Pet

Species

  • Dogs

Breed Predilections

  • Collies, Shetland sheepdogs, and their crossbreeds
  • Similar signs have been reported in other breeds, such as the Beauceron shepherd, Welsh corgi, Lakeland terrier, chow chow, German shepherd dog, and Kuvasz
  • Some dogs in other breeds with similar signs are now classified as having “ischemic dermatopathy” (dermatomyositis-like skin disease) and not “dermatomyositis” as previously reported

Mean Age and Range

  • Skin lesions typically develop before six months of age, and may develop as early as 7 weeks of age
  • The full extent of lesions usually is present by 1 year of age, and may lessen thereafter
  • Adult-onset dermatomyositis can occur, but is rare

Signs/Observed Changes in the Pet

  • Clinical signs vary from subtle skin lesions and inflammation of muscles that is does not cause clinical signs (known as “subclinical myositis”) to severe skin lesions and a generalized decrease in muscle mass (known as “muscle atrophy”) with an abnormal gait, and an enlarged esophagus (part of the digestive tract, the tube running from the throat to the stomach; condition known as “megaesophagus”)
  • Skin lesions around the eyes, lips, face, inner surface of the prick ears, tip of the tail, and bony prominences vary in intensity; the entire face may be involved—skin lesions may increase and decrease over time (known as a “waxing and waning” course); signs usually seen in affected dogs before they are 6 months of age
  • Skin lesions—characterized by variable degrees of crusted areas with loss of the top surface of the skin (known as “erosions” or “ ulcers” based on depth of tissue loss) and hair loss (known as “alopecia”), with reddening of the skin (known as “erythema”), accumulations of surface skin cells, such as seen in dandruff (known as “scales”), and scars
  • Pressure points and exposed areas of skin over boney prominences commonly are affected first
  • Scars may occur as a sequela to initial skin lesions
  • More severely affected dogs may have difficulty eating, drinking, and swallowing
  • Stiff or high-stepping gait
  • Several litter mates may be affected, but the severity of the disease often varies significantly among affected dogs
  • Foot-pad ulcers and ulcers in the mouth, as well as nail abnormalities or loss, may occur
  • Inflammation of the muscles (myositis)—signs may be absent or vary from subtle decrease in the mass of the muscles extending from the top and side of the head, behind the eye, to the lower jaw (known as the “temporal muscles”) to generalized, symmetric loss of muscle mass (muscle atrophy) and stiff or high-stepping gait
  • Decrease in muscle mass (muscle atrophy) of the muscles extending from the bone below the eye to the lower jaw (known as the “masseter muscles”) that act to close the jaw and muscles extending from the top and side of the head, behind the eye, to the lower jaw (temporal muscles) that act to close the jaw—may be evident
  • Dogs with enlarged esophagus (megaesophagus) may present with aspiration pneumonia (inflammation of the lungs, caused by accidentally inhaling food, vomit, or liquids)

Causes

  • Hereditary in the collie, Shetland sheepdog, and their crosses
  • Infectious agents or medications may be triggering events
  • Immune-mediated disease in other dog breeds

Risk Factors

  • Mechanical pressure and trauma, and ultraviolet-light exposure may worsen skin lesions

Treatment

Health Care

  • Most dogs can be treated as outpatients
  • Dogs with severe inflammation of the muscles (myositis) and enlarged esophagus (megaesophagus) may need to be hospitalized for supportive care
  • Euthanasia may be indicated in severe cases

Activity

  • Avoid activities that may traumatize the skin
  • Keep indoors during the day to avoid exposure to intense sunlight

Diet

  • May need to change diet, if dog has enlarged esophagus (megaesophagus) or has difficulty eating and/or swallowing
  • Feed dog with food bowl elevated if enlarged esophagus (megaesophagus) develops
  • Assist dog with eating, if muscles involved with chewing are affected

Surgery

  • Skin biopsy—may be diagnostic for dermatomyositis, although this disease can be difficult to diagnose definitively
  • Muscle biopsy

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive:

  • Non-specific symptomatic therapy includes hypoallergenic shampoo baths, treating secondary bacterial skin infections and Demodex mange (known as “demodicosis”), and avoiding trauma and sunlight
  • Vitamin E
  • Essential fatty acid supplements
  • Steroids (such as prednisone) to decrease inflammation
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), as prescribed by your pet’s veterinarian
  • Pentoxifylline to improve blood flow and to reduce inflammation

Follow-Up Care

Preventions and Avoidance

  • Do not breed affected pets
  • Neuter intact pets to decrease the influence of hormones on clinical signs
  • Minimize trauma and exposure to sunlight

Possible Complicatoins

  • Secondary bacterial skin infection and Demodex mange (demodicosis)
  • Mildly to moderately affected dogs may have residual scarring
  • Severely affected dogs may have trouble chewing, drinking, and swallowing
  • Enlarged esophagus (megaesophagus) may develop, increasing the likelihood of aspiration pneumonia

Expected Course and Prognosis

  • The effectiveness of medical treatment can be difficult to assess because the disease tends to be cyclic in nature and often is self-limiting
  • Long-term prognosis—variable, depending on severity of disease
  • Minimal disease—prognosis good; tends to resolve spontaneously with no evidence of scarring
  • Mild to moderate disease—tends to resolve spontaneously, but residual scarring is common
  • Severe disease—prognosis for long-term survival is poor as the inflammation of the skin (known as “dermatitis”) and muscles (myositis) may be lifelong

Key Points

  • Dermatomyositis is considered an inherited disease in collies, Shetland sheepdogs, and their respective crosses
  • Affected dogs should not be used for breeding
  • The disease is not curable, although spontaneous resolution or waxing and waning of signs may occur

Pigment Loss

Loss of Pigment in Dogs & Cats

Overview

  • Disease or cosmetic condition involving loss of pigmentation of the skin and/or hair coat either by lack of pigmentation or by melanocyte damage; “melanocytes” are cells that produce pigment in the skin or hair
  • Normal pigment in the skin and hair coat is melanin
  • “Leukotrichia” is the medical term of whitening of the hair, without indication of location of the whitened hairs
  • “Poliosis” is the medical term of whitening of the hair on the head and/or face
  • “Leukoderma” is the medical term of whitening of the skin

Signalment/Description of Pet

Species

  • Dogs
  • Cats

Breed Predilections

  • Mucocutaneous pyoderma (bacterial skin infection involving areas of the lips, eyelids, nostrils)—German shepherd dogs
  • Systemic lupus erythematosus (auto-immune disease in which the body attacks its own skin and other organs) and discoid lupus erythematosus (auto-immune disease involving the skin only, usually the face)—collies, Shetland sheepdogs, German shepherd dogs
  • Pemphigus foliaceous (auto-immune disease involving the skin, characterized by inflammation with crusting and lesions containing pus)—chow chows, Akitas
  • Uveodermatologic syndrome (a rare syndrome in which the pet has inflammation in the front part of the eye, including the iris [condition known as “anterior uveitis”] and coexistent inflammation of the skin [known as “dermatitis”], characterized by loss of pigment in the skin of the nose and lips)—Akitas, Samoyeds, Siberian huskies
  • Vitiligo (condition characterized by symmetrical lack of pigment in the skin and white hair coat, especially involving the face and nose) in dogs—Belgian Tervuren, German shepherd dogs, Doberman pinschers, rottweilers, German shorthaired pointer, Old English sheepdog, and dachshund
  • Seasonal nasal hypopigmentation (loss of pigment in the tough, hairless skin of the nose [known as the “nasal planum”] that occurs seasonally)—Siberian huskies, Alaskan malamutes, yellow Labrador retrievers, and golden retrievers
  • Proliferative arteritis of the nasal philtrum (inflammation of the arteries of the nasal philtrum, the juncture between the sides of the upper lip extending to the nose)—Saint Bernards, giant schnauzers
  • Vitiligo in cats–Siamese
  • Periocular leukotrichia (whitening of the hair coat around the eyes) in cats–Siamese
  • Chediak-Higashi syndrome (an inherited disorder that affects many tissues in the body; causes lack of pigment in the skin and eyes)–Persian

Mean Age and Range

  • Vitiligo (condition characterized by symmetrical lack of pigment in the skin and white hair coat, especially involving the face and nose) in dogs—usually less than 3 years of age
  • Epitholiotropic lymphoma (a type of skin cancer; also known as “mycosis fungoides”)—typically dogs over 10 years of age

Predominant Sex

  • Discoid lupus erythematosus (auto-immune disease involving the skin only, usually the face)—may occur more often in females than in males
  • Vitiligo in Siamese cats—females

Signs/Observed Changes in the Pet

  • White hair (known as “leukotrichia”)
  • Partial or total lack of pigment in the skin (known as “leukoderma”)
  • Lightening of the pigment in the skin, often seen as a “graying” or “browning” of previously pigmented areas
  • Reddening of the skin (known as “erythema”)
  • Loss of the top surface of the skin (known as “erosion” or “ulceration,” based on depth of tissue loss)

Causes

  • Mucocutaneous pyoderma (bacterial skin infection involving areas of the lips, eyelids, nostrils)
  • Systemic lupus erythematosus (auto-immune disease in which the body attacks its own skin and other organs)
  • Discoid lupus erythematosus (auto-immune disease involving the skin only, usually the face)
  • Pemphigus foliaceous (auto-immune disease involving the skin, characterized by inflammation with crusting and lesions containing pus)
  • Pemphigus erythematosus (auto-immune disease involving the skin of the face and ears, characterized by reddening of the skin [erythema] and lesions containing pus)
  • Uveodermatologic syndrome (a rare syndrome in which the pet has inflammation in the front part of the eye, including the iris [anterior uveitis] and coexistent inflammation of the skin [dermatitis], characterized by loss of pigment in the skin of the nose and lips)
  • Contact hypersensitivity (increased sensitivity or reaction in the skin to the presence of a foreign agent that comes in contact with the skin)
  • Vitiligo (condition characterized by symmetrical lack of pigment in the skin and white hair coat, especially involving the face and nose)
  • Seasonal nasal depigmentation (loss of pigment in the tough, hairless skin of the nose [known as the “nasal planum”] that occurs seasonally)
  • Albinism (inherited disorders characterized by lack of pigment in the skin, hair, and/or eyes, due to abnormal production of melanin)
  • Schnauzer gliding syndrom (young, gray miniature schnauzers develop golden hair color, primarily in the body)
  • Hormonal disorders
  • Drug reaction
  • Erythema multiforme (skin disorder caused by reaction of medications, infections, or other diseases)
  • Proliferative arteritis of the nasal philtrum (inflammation of the arteries of the nasal philtrum, the juncture between the sides of the upper lip extending to the nose)
  • Loss of pigment in the skin and/or hair following skin inflammation
  • Dermatophytosis (fungal infection on the surface of the skin)

Risk Factors

  • Sun exposure—systemic lupus erythematosus (auto-immune disease in which the body attacks its own skin and other organs), discoid lupus erythematosus (auto-immune disease involving the skin only, usually the face), and pemphigus erythematosus (auto-immune disease involving the skin of the face and ears, characterized by reddening of the skin [erythema] and lesions containing pus)

Treatment

Health Care

  • Outpatient, except for systemic lupus erythematosus (auto-immune disease in which the body attacks its own skin and other organs), erythema multiforme (skin disorder caused by reaction to medications, infections, or other diseases), and lymphoma of the skin (a type of skin cancer), when severe multiple organ dysfunction is present
  • Reduce exposure to sunlight—systemic lupus erythematosus (auto-immune disease in which the body attacks its own skin and other organs), discoid lupus erythematosus (auto-immune disease involving the skin only, usually the face) and pemphigus erythematosus (auto-immune disease involving the skin of the face and ears, characterized by reddening of the skin [erythema] and lesions containing pus)
  • Replace plastic or rubber dishes—particularly if roughened edges cause abrasions
  • Application of water-resistant sun-block ointments or gels (with a SPF UVA and UVB greater than 30) to depigmented areas
  • Vitiligo and nasal depigmentation–no treatment

Activity

  • Restrict outdoor activity to minimize exposure to sunlight—systemic lupus erythematosus (auto-immune disease in which the body attacks its own skin and other organs), discoid lupus erythematosus (auto-immune disease involving the skin only, usually the face) and pemphigus erythematosus (auto-immune disease involving the skin of the face and ears, characterized by reddening of the skin [erythema] and lesions containing pus)

Surgery

  • Skin biopsy

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive.

  • Vary based on underlying cause
  • Systemic lupus erythematosus (auto-immune disease in which the body attacks its own skin and other organs)—immunosuppressive therapy with steroids (such as prednisolone or dexamethasone) and chemotherapy drugs (such as azathioprine [dogs] or chlorambucil [cats])
  • Tetracycline and niacinamide—to treat pemphigus erythematosis (auto-immune disease involving the skin of the face and ears, characterized by reddening of the skin [erythema] and lesions containing pus) and discoid lupus erythematosus (auto-immune disease involving the skin only, usually the face) in dogs
  • Medications to decrease the immune response (known as “immunosuppressive therapy”)—to treat systemic lupus erythematosus (auto-immune disease in which the body attacks its own skin and other organs), pemphigus foliaceous (auto-immune disease involving the skin, characterized by inflammation with crusting and lesions containing pus), pemphigus erythematosus (auto-immune disease involving the skin of the face and ears, characterized by reddening of the skin [erythema] and lesions containing pus)
  • Cyclosporine to decrease the immune response in auto-immune disorders
  • Steroids applied to the skin directly (known as “topical steroids”)
  • Tacrolimus, 0.1% gel or pimecrolimus 1% cream applied daily to lesions in combination with or to replace steroids
  • Imiquimod 5% cream for actinic keratosis (a precancerous skin condition caused by sun exposure)
  • Antibiotics–trimethoprim-sulfadiazine, cephalexin, or amoxicillin-clavulanate; effective in some cats
  • Antibiotics for bacterial skin infection (known as “pyoderma”)
  • Chlorambucil, a chemoterapeutic drug
  • Medications to treat fungal infections (known as “antifungal drugs”) to treat dermatophytosis (fungal infection on the surface of the skin)

Follow-Up Care

Patient Monitoring

  • Varies with specific disease and treatment prescribed

Preventions and Avoidance

  • Restrict outdoor activity to minimize exposure to sunlight—systemic lupus erythematosus (auto-immune disease in which the body attacks its own skin and other organs), discoid lupus erythematosus (auto-immune disease involving the skin only, usually the face) and pemphigus erythematosus (auto-immune disease involving the skin of the face and ears, characterized by reddening of the skin [erythema] and lesions containing pus)

Possible Complications

  • Systemic lupus erythematosus (auto-immune disease in which the body attacks its own skin and other organs)—scarring
  • Squamous cell carcinoma ( a type of skin cancer) in cases of sun-damage to the skin, with resulting loss of skin pigment

Expected Course and Prognosis

  • Vary with specific disease

Mange (Demodectic)

Mange (Demodectic) – An Overview

  • An inflammatory parasitic skin disease of dogs and rarely cats, caused by a species of the mite genus, Demodex
  • Skin disease is characterized by an increased number of mites in the hair follicles and top layer of the skin (known as the “epidermis”), which often leads to secondary bacterial infections and infections deep in the hair follicles, often with resultant rupturing of the hair follicle (known as “furunculosis”)
  • May be localized (in which one or a few small patches of affected skin are present, frequently seen on the face or forelegs) or generalized (in which numerous skin lesions are present on the head, legs, and body)
  • “Demodectic mange,” “demodicosis,” and “red mange” (dogs) are all terms for the same skin disease
  • Three species of Demodex mites have been identified in dogs: Demodex canis, Demodex injai, and Demodex cornei; two species have been identified in cats:Demodex cati and Demodex gatoi

Genetics

  • The initial increase in number of demodectic mites in the hair follicles may be the result of a genetic disorder

Signalment/Description of Pet

Species

  • Dogs – common
  • Cats – rare

Breed Predilections

  • West Highland white terrier and wirehaired fox terrier—greasy inflammation of the skin with increased accumulations of surface skin cells, such as seen in dandruff (accumulations known as “scales”; condition known as “seborrheic dermatitis”) associated with Demodex injai
  • Potential of demodectic mange in cats is increased in Siamese and Burmese

Mean Age and Range

  • Localized demodectic mange (in which one or a few small patches of affected skin are present, frequently seen on the face or forelegs)—usually in young dogs; median age is 3–6 months
  • Generalized demodectic mange (in which numerous skin lesions are present on the head, legs, and body)—both young and old dogs
  • No age data collected for the cat

Signs/Observed Changes in the Pet

Dogs

Localized, Juvenile-Onset
  • One or a few small patches of affected skin are present, frequently seen on the face or forelegs
  • Lesions—usually mild; consist of reddened skin (known as “erythema”) and a light accumulations of surface skin cells, such as seen in dandruff (scales)
  • Patches—several may be noted; most common site is the face, especially around the mouth and eyes and on the front legs; also may be seen on the trunk and rear legs
Generalized, Juvenile-Onset or Adult-Onset
  • Numerous skin lesions are present on the head, legs, and body
  • Can be widespread from the onset, with multiple, poorly circumscribed patches of reddened skin (erythema), hair loss (known as “alopecia”), and accumulations of surface skin cells, such as seen in dandruff (scales)
  • As hair follicles become distended with large numbers of mites, secondary bacterial infections , often with resultant rupturing of the hair follicle (furunculosis) are common
  • With progression of disease, the skin can become severely inflamed, leading to the escape of fluid and inflammatory cells in or on the skin (known as “exudation”), and the development of nodular, inflammatory lesions (known as “granulomas”)
  • Demodex injai may be associated with a greasy inflammation of the skin with increased accumulations of surface skin cells, such as seen in dandruff (accumulations are “scales”; condition is “seborrheic dermatitis”) of the dorsal trunk, plugs of keratin and oil in the follicles of the skin (known as “comedones”), reddened skin (erythema), hair loss (alopecia), and darkening of the skin (known as “hyperpigmentation”)

Cats

  • Often characterized by multiple partial to complete areas of hair loss (alopecia) of the eyelids, as well as the skin around the eyes, head, neck, flank and the under surface of the body
  • Lesions—variable itchiness (known as “pruritus”) with reddened skin (erythema), accumulations of surface skin cells, such as seen in dandruff (scales), and dried discharge on the surface of the skin lesions (known as “crusts”); those caused by Demodex gatoi often are quite itchy (pruritic) and may be contagious
  • Inflammation of the outer ear, characterized by the presence of waxy material (known as “ceruminous otitis externa”) has been reported
  • Demodex cati often is associated with a disease that decreases the immune response (known as “immunosuppressive disease”)

Causes

  • Dog—Demodex canis, Demodex injai, and Demodex cornei
  • Cat—Demodex cati and Demodex gatoi

Risk Factors

Dogs

  • Exact mechanism related to the influence of the immune system on demodectic mange is unknown
  • Studies indicate that dogs with generalized demodectic mange (in which numerous skin lesions are present on the head, legs, and body) have a subnormal percentage of interleukin-2 (IL-2) receptors on their lymphocytes and subnormal IL-2 production; “lymphocytes” are a type of white-blood cell that are formed in lymphatic tissues throughout the body; lymphocytes are involved in the immune process
  • Genetic factors (especially for localized, juvenile-onset demodectic mange), decreased ability to produce a normal immune response (immunosuppression), and/or metabolic diseases may increase the likelihood that the dog will develop demodectic mange

Cats

  • Often associated with metabolic diseases (such as feline immunodeficiency virus [FIV], systemic lupus erythematosus [autoimmune disease in which body attacks its own skin and other organs], diabetes mellitus [sugar diabetes])
  • Demodex gatoi—may be transferable from cat to cat within the same household

Treatment

Health Care

  • Outpatient
  • Localized demodectic mange (in which one or a few small patches of affected skin are present, frequently seen on the face or forelegs)—conservative; most cases (90%) resolve spontaneously with no treatment
  • Generalized demodectic mange (in which numerous skin lesions are present on the head, legs, and body) in dogs—requires application of medication to kill the mites directly onto the skin (known as “topical treatment”) and/or medications administered by mouth (known as “systemic treatment”); antibiotics may be necessary to treat secondary bacterial skin infections
  • Evaluate the general health status of dogs with either localized or generalized demodectic mange

Medications

  • Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive

Amitraz (Mitaban; Taktic EC; ProMeris)

  • A treatment that is applied directly to the skin (topical treatment) to kill demodectic mange mites; agents that kill mites are known as “miticides”
  • Use weekly to every-other-week until resolution of clinical signs and no mites are found on skin scrapings; do not rinse off; let air-dry; use as directed by your pet’s veterinarian
  • ProMeris—apply to skin every 2–4 weeks
  • Treat for 1 month following negative skin scrape
  • Apply a benzoyl peroxide shampoo before application of the amitraz to kill bacteria (known as “bactericidal therapy”) and to increase exposure of the mites to the miticide through flushing activity of the hair follicles
  • Between 11% and 30% of cases will not be cured; may need to try an alternative therapy or control with maintenance treatment every 2–8 weeks
  • Rarely used in cats (do not use on diabetic cats)

Ivermectin

  • Dog—daily administration by mouth has been very effective, even when amitraz fails; use as directed by your pet’s veterinarian
  • Treat for 30–60 days beyond negative skin scrapings (average length of treatment is 3–8 months)
  • Reported as a treatment option in the cat; exact dose has not been established

Milbemycin (Interceptor)

  • Administered by mouth
  • Has been effective in 50–85% of cases
  • Treat for 30–60 days beyond multiple negative skin scrapings
  • Very expensive

Cats

  • Exact treatment protocols are not defined
  • Lime-sulfur dips applied to the skin (topical treatment) every 3–7 days for 4–8 treatments is the suggested treatment; often lead to good resolution of clinical signs
  • Studies of treatment with ivermectin and milbemycin are lacking, although numerous anecdotal reports suggest effectiveness
  • Doramectin also has been reported to be effective when given by injection under the skin (subcutaneous route) once weekly

Follow-Up Care

Patient Monitoring

  • Repeat skin scrapings and monitor for evidence of resolution of signs

Preventions and Avoidance

  • Do not breed pets with generalized form of demodectic mange (in which numerous skin lesions are present on the head, legs, and body)

Possible Complications

  • Secondary bacterial infections and infections deep in the hair follicles, often with resultant rupturing of the hair follicle (furunculosis)

Expected Course and Prognosis

  • Prognosis (dogs)—depends heavily on genetics, status of the immune system, and underlying diseases
  • Localized demodectic mange (in which one or a few small patches of affected skin are present, frequently seen on the face or forelegs)—most cases (90%) resolve spontaneously with no treatment; less than 10% of localized demodectic mange cases progress to generalized demodectic mange (in which numerous skin lesions are present on the head, legs, and body)
  • Adult-onset of demodectic mange in dogs—often severe disease and poorly responsive to non-responsive to treatment
  • Feline cases with Demodex cati may have a poor prognosis associated with underlying disease

Key Points

  • Localized demodectic mange (in which one or a few small patches of affected skin are present, frequently seen on the face or forelegs)—most cases resolve spontaneously
  • Generalized demodectic mange (in which numerous skin lesions are present on the head, legs, and body)—frequent management problem; expense and frustration with the long-term (chronic) nature of disease and treatment are issues; many cases are medically controlled, not cured; juvenile-onset is considered to have a genetic influence and affected animals should not be used for breeding

Itchiness in Dogs & Cats

Itchiness in Dogs & Cats – An Overview

  • “Pruritus” is the medical term for itching or itchiness; it is the itching sensation that provokes the desire to scratch, rub, chew or lick
  • Pruritus is an indicator of inflamed skin
  • The term is not a diagnosis but rather is a description of a clinical sign

Species

  • Dogs
  • Cats

Signs/Observed Changes in the Pet

  • Scratching
  • Licking
  • Biting
  • Rubbing
  • Chewing
  • Self-trauma
  • Inflammation of the skin (known as “dermatitis”)
  • Hair loss (known as “alopecia”); hair loss without inflammation may be the only sign in some cats
  • Other signs determined by underlying cause

Causes

  • Parasites—fleas; mites (canine scabies [Sarcoptes], Demodex, ear mites [Otodectes], feline scabies [Notoedres], “walking dandruff” [Cheyletiella], harvest mite or red bud [Trombicula]); lice; rhabditic dermatitis (Pelodera strongyloides); or migration of internal parasites
  • Allergies—parasite allergy; atopy (disease in which the pet is sensitized [or “allergic”] to substances found in the environment [such as pollen] that normally would not cause any health problems); food allergy; contact allergy; drug allergy; allergy to skin bacteria (known as “bacterial hypersensitivity”); allergy to Malassezia (a yeast found on the skin)
  • Bacterial or fungal infections—Staphylococcus (a bacteria) and Malassezia pachydermatis (a yeast or fungus); rarely a dermatophyte (fungus living on the skin, hair, or nails); however, Trichophyton is a dermatophyte that tends to cause more itchy skin disease than the other dermatophytes
  • Miscellaneous—excessive scaling of the skin (known as “seborrhea”); calcium deposits in the skin (known as “calcinosis cutis”); skin tumors or cancer
  • Immune-mediated skin diseases and hormonal skin diseases can be variably itchy
  • Psychological skin diseases may be associated with itchiness

Risk Factors

  • Exposure to other animals with parasites

Treatment

Health Care

  • More than one disease can contribute to itching
  • The use of mechanical restraint (such as an Elizabeth collar) can be a helpful option, but is seldom feasible in long-term treatment
  • Treat for secondary infections, which are common

Diet

  • Depends on underlying cause
  • Usually no change in diet needed, unless suspected food allergey

Medication

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive

Medications Applied to the Skin Directly (Known as “Topical Therapy”)

  • Topical therapy is helpful in mildly itchy pets
  • For localized areas of itchiness or skin inflammation, sprays, lotions and creams are most appropriate
  • If the itching involves many areas or widespread areas, shampoos are the preferred means of application
  • Antibacterial shampoos help control bacterial infections that cause itching; however, some antibacterial shampoos (such as those containing benzoyl peroxide or iodine) can cause increased itching
  • Colloidal oatmeal is common in all forms of topical therapy; its duration of effect usually is less than two days
  • Topical antihistamines may be found alone or in combination with other ingredients; they may not have a beneficial effect
  • Topical anesthetics may offer only a very short duration of effect
  • Antimicrobial shampoos help control bacterial infections that cause itching; however, some contain ingredients (such as benzoyl peroxide or iodine) that can increase itchiness through excessive drying
  • Lime sulfur (which has a bad odor and can stain) can decrease itching, while also having anti-parasitic, antibacterial, and antifungal properties
  • Topical steroids probably are the most useful topical medications; hydrocortisone is the mildest and most common topical steroid; stronger steroids (such as betamethasone) may be more effective and are more expensive; a triamcinolone-containing prescription spray (Genesis® Topical Spray, Virbac) is effective in decreasing itchiness (pruritus)
  • Some topical steroid medications also contain ingredients (such as alcohol), which can aggravate already irritated skin
  • In some pets, the application of any substance, including water (especially warm water), can result in an increased level of itchiness; however, cool water often is soothing

Medications Administered by Mouth or by Injection (Systemic Therapy)

  • Steroids to decrease inflammation and itchiness of the skin
  • Cyclosporine to decrease the immune response
  • For pets affected with airborne allergies for more than a few months out of the year, “allergy shots” (known as “allergen specific immunotherapy”) are appropriate, frequently beneficial, and may lead to a cure (in some cases)
  • Antihistamines (such as hydroxyzine, diphenhydramine, and chlorpheniramine) to prevent inflammation and itching
  • Fatty acids are available in powders, liquids, and capsules; they help block pathways that lead to inflammation, but may require 6–8 weeks of use until maximum effect is observed; fatty acids work better as preventive medications, rather than stopping the inflammation once it has become a problem; they also help reduce dry or flaky skin, which can cause itching
  • Medications to relieve anxiety or depression (known as “psychogenic drugs”) can be helpful in controlling itchiness; include such drugs as amitriptyline, fluoxetine, and diazepam
  • In rare cases, alternative medications to decrease the immune response (known as “immunosuppressive drugs,” such as azathioprine) may be utilized; however, they should be reserved for instances when all other treatments have failed

Follow-Up Care

Patient Monitoring

  • Patient monitoring is imperative; pets should be examined periodically to evaluate response to treatment
  • Pets receiving long-term (chronic) medications should be evaluated every 3–12 months for potential side effects as well as occurrence of new contributing factors

Preventions and Avoidance

  • Prevent infestation with parasites (such as fleas and mites)
  • Avoid foods identified as causing food allergy for your pet

Possible Complications

  • Owner frustration is common
  • Complications (such as increased thirst [known as “polydipsia”] and increased urination [known as “polyuria”]) are common with long-term (chronic) steroid use

Expected Course and Prognosis

  • Depend on underlying cause
  • Many causes of itchiness in pets are extremely frustrating to control

Key Points

  • Many different unrelated diseases may contribute to itchiness (pruritus), and control of one disease does not mean that other causes cannot be contributing to itchiness or cannot occur later
  • Multiple causes (such as flea allergy, inhalant allergy, and bacterial skin infection [known as “pyoderma”]) commonly are present in a single patient
  • Elimination of bacterial skin infection (pyoderma) and flea-associated disease may not be enough to significantly reduce itchiness
  • Food-allergy and inhalant-allergic pets may do well during the winter season with a hypoallergenic diet, only to become itchy during the warmer months in association with inhalant allergies

Hair Loss with No Skin Inflammation

Hair Loss Without Inflammation of The Skin in Dogs — An Overview

  • “Alopecia” is the medical term for hair loss
  • Non-inflammatory alopecia is a group of uncommon skin disorders, characterized by hair loss that is associated with an abnormal hair growth/shed cycle
  • Hormonal and non-hormonal diseases can be associated with non-inflammatory hair loss (alopecia)
  • Alopecia X is a non-inflammatory alopecia related to an abnormal hair growth/shed cycle; it has been called by many names previously, including “growth hormone-responsive alopecia,” “castration-responsive alopecia,” and “adrenal hyperplasia-like syndrome”
  • “Estrogen,” “progesterone,” and “estradiol” are female hormones; “testosterone” and “androgen” are male hormones
  • An “intact” pet is one that has its reproductive organs; an “intact female” has her ovaries and uterus and an “intact male” has his testicles
  • A “neutered” pet has had its reproductive organs surgically removed; females commonly are identified as “spayed,” but may be identified as “neutered”; males may be identified as “castrated” or “neutered”

Genetics

  • Breed predilections exist for alopecia X; however, the mode of inheritance is unknown

Signalment/Description of Pet

Species

  • Dogs

Breed Predilections

  • Increased levels of estrogen (known as “hyperestrogenism”) in females and increased levels of androgen (known as “hyperandrogenism”) in males—none
  • Alopecia X—miniature poodle and plush-coated breeds, such as the Pomeranian, chow chow, Akita, Samoyed, Keeshonden, Alaskan malamute, and Siberian husky

Mean Age and Range

  • Increased levels of estrogen (hyperestrogenism) in females and increased levels of androgen (hyperandrogenism) in males—middle-aged to old, intact dogs
  • Alopecia X—range, 1–5 years of age; older dogs may develop alopecia X

Predominant Sex

  • Increased levels of estrogen (hyperestrogenism)—primarily intact female or male dogs; male dogs due to testicular cancer producing excessive levels of estrogen
  • Increased levels of androgen (hyperandrogenism)—primarily intact males
  • Alopecia X—neutered or intact dogs of either sex

Signs/Observed Changes in The Pet

  • Overall change in the hair coat—dry or bleached, because hairs are not being replaced; lack of normal shedding
  • Male dogs with increased levels of estrogen (hyperestrogenism) may attract other male dogs
  • Hair loss (alopecia)—usually generalized and bilaterally symmetrical; involves the trunk, along the sides of the body (known as “truncal alopecia”) and spares the head and lower legs; hair loss is uncommon in dogs with increased levels of androgens (hyperandrogenism)
  • Secondary excessively oily or dry scaling of the skin (known as “seborrhea”); itchiness (known as “pruritus”); skin infection characterized by the presence of pus (known as “pyoderma”); hair follicles filled with oil and skin cells (known as “comedones”); inflammation of the outer ear, characterized by an oily discharge (known as “ceruminous otitis externa”); and darkened skin (known as “hyperpigmentation”)—variable
  • Enlargement of nipples, mammary glands, vulva (external genitalia of the female), prepuce (fold of skin that covers the penis)—may be associated with increased levels of estrogen (hyperestrogenism)
  • Abnormal sized testicles—may be associated with increased levels of estrogen (hyperestrogenism) or increased levels of androgen (hyperadrogenism); however, testicles may be normal in size
  • Increase in the number of cells in the tail glands (known as “tail gland hyperplasia”) and increase in the number of cells in the perianal gland (known as “perianal gland hyperplasia”) with localized change in color of the skin due to deposits of melanin (known as “macular melanosis”)
  • Signs of generalized disease (known as “systemic signs”), such as increased thirst (known as “polydipsia”), increased urination (known as “polyuria”), or increased appetite (known as “polyphagia”) are NOT present

Causes

Skin Disorders due to Increased Levels of Estrogen (Hyperestrogenism)–Female

  • Estrogen excess or imbalance owing to a condition characterized by the presence of fluid-filled sacs or cysts in the ovaries (cystic ovaries), ovarian tumors (rare), or excess/overdose of estrogen-containing medications
  • Pets with normal serum estrogen concentrations may have a increased number of estrogen receptors in the skin

Skin Disorders due to Increased Levels of Estrogen (Hyperestrogenism)–Male Dogs with Testicular Tumors

  • Estrogen excess due to a tumor in the testicles, such as Sertoli cell tumor (most common), seminoma, or interstitial cell tumor (rarely)
  • Lack of normal descent of one or both testicles into the scrotum, resulting in the testicle(s) being located in the abdomen or inguinal canal (known as “cryptorchidism”) increases the likelihood that affected pets will develop testicular tumors
  • Associated with male pseudohermaphrodism in miniature schnauzers; “pseudohermaphrodism” is a condition where the pet has either ovaries or testicles, but has uncertain (ambiguous) external genitalia

Skin Disorder due to Increased Levels of Androgen (Known as “Hyperandrogenism”) Associated with Testicular Tumors

  • Androgen-producing testicular tumors (especially interstitial cell tumors) in intact male dogs

Alopecia X

  • Hairs fail to cycle normally; an underlying hormonal cause has not been identified

Risk Factors

  • Intact male and female dogs are at increased risk for developing testicular tumors and ovarian cysts/tumors, respectively
  • Lack of normal descent of one or both testicles into the scrotum, resulting in the testicle(s) being located in the abdomen or inguinal canal (known as “cryptorchidism”) increases the likelihood that affected pets will develop testicular tumors
  • Administration of medications containing estrogen
  • Alopecia X—breed (miniature poodle and plush-coated breeds, such as the Pomeranian, chow chow, Akita, Samoyed, Keeshonden, Alaskan malamute, and Siberian husky)

Treatment

Health Care

  • Depends on cause of skin disorder
  • Discontinue administration of estrogen-containing medications, as directed by your veterinarian, if excessive estrogen is the likely cause of the skin disorder

Surgery

  • Skin biopsy
  • Surgical removal of testicles (neuter or castration) of pets with lack of normal descent of one or both testicles into the scrotum, resulting in the testicle(s) being located in the abdomen or inguinal canal (cryptorchidism); neuter when young
  • Surgical removal of testicles (neuter or castration)— testicular tumors
  • Exploratory surgery (known as a “laparotomy”)—diagnosis and treatment (such as surgical removal of the ovaries and uterus [spay or ovariohysterectomy] and surgical removal of testicles located in the abdomen [castration]) for ovarian cysts and tumors and abdominal testicular tumors
  • Alopecia X—surgical removal of reproductive organs (ovariohysterectomy in females and neuter or castration in males) may lead to hair regrowth in some dogs; hair regrowth may take up to 3 months before becoming evident

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive

General Treatment

  • Topical (applied to the skin directly) medication to treat seborrhea (known as “antiseborrheic therapy”)—conditions with associated keratinization defects and comedones (in which the hair follicles are filled with oils and skin cells)
  • Antibiotics—to treat associated skin infections, characterized by the presence of pus (pyodermas)

Alopecia X

  • Melatonin—hair regrowth can take up to 3 months to become evident; this treatment is effective in approximately 40% of affected dogs; should be tried following neutering; once hair growth has occurred, discontinue melatonin treatment
  • Other MedicationsConsider mitotane or o,p’-DDD (Lysodren) to stimulate hair regrowth in some dogs; can take up to 3 months for hair regrowth to become evident
  • Trilostane to stimulate hair regrowth in some dogs; can take up to 3 months for hair regrowth to become evident

Follow-Up Care

Patient Monitoring

  • Treatment with mitotane or o,p’-DDD (Lysodren)—bloodwork (electrolytes) and adrenocorticotropic hormone (ACTH)-stimulation testing regularly
  • Treatment with trilostane—bloodwork (electrolytes) and ACTH-stimulation testing regularly

Expected Coourse and Prognosis

  • Female increased levels of estrogen (hyperestrogenism)—improvement should occur within 3–6 months after surgical removal of the ovaries and uterus (spay or ovariohysterectomy)
  • Estrogen- and androgen-secreting tumors—resolution of signs noted within 3–6 months after surgical removal of the ovaries and uterus (spay or ovariohysterectomy) or the testicles (castration), respectively

Surgery

  • Biopsy of a tumor or the skin may be indicated in the diagnostic workup for some causes of hair loss (alopecia)
  • Hormonal disorders causing hair loss (treatment determined by specific hormonal disorder)—surgery may include removal of ovaries and uterus (known as “ovariohysterectomy” or “spay”), removal of testicles (known as “castration”), or removal of adrenal glands (known as “adrenalectomy”)
  • Surgical removal of skin cancer or tumors
  • Alopecia X–hair regrowth will occur only in some dogs, regardless of treatment; hair loss may recur in spite of continued treatment

Key Points

  • Alopecia X is a cosmetic condition, resulting in hair loss only; no cure has been determined to treat the hair loss; hair regrowth will occur only in some dogs regardless of treatment; hair loss may recur months to years later in spite of continued treatment