upper respiratory SA

History

·    How long been going on for? Acute vs chronic?

·    Any known/obvious cause, e.g. trauma?

·    Unilateral or bilateral? Has it changed? – unilateral ® bilateral epistaxis = aspergillosis

·    Nature of discharge? Mucus? Serous? Bloody? – green/bloody = aspergillosis, mucopurulent in cat = chronic rhinitis

·    Any other respiratory signs? Sneezing? Coughing? Reverse sneezing? – reverse sneezing = NP issue

·    Still eating and drinking?

·    Smelly breath?

·    Other clinical signs? – neuro signs = aspergillosis

Clinical examination

Specific to nasal disease:

·    Assess face for symmetry

·    Eyes normal

·    Any pain when feeling? – neoplasia

·    Is air flow normal through both nares? Use microscope slide to see if condensation

·    Check teeth – dental disease?

·    Look at nasal planum – any depigmentation, ulceration, growths? – depigmentation = aspergillosis

·    Feel SM LNs

Management

Further investigations:

·    Rhinoscopy

·    CT

·    Nasal radiography

·    Nasal flush – non-invasive, quick, clear debris, obtain sample for histopathology (but requires GA and cuffed ET tube)

·    Dental x-rays if suspect dental disease

Differentials

·    Epistaxis – neoplasia, aspergillosis

o  Neoplasia – unilateral epistaxis, nasal d/c, sneezing/snuffling

§ Diagnosis: radiography, CT, rhinoscopy, biopsy

§ Treatment: radiotherapy, chemotherapy, surgery (prognosis depends on location)

o  Aspergillosis – ZOONOTIC

§ Clinical signs: mucopurulent nasal d/c, epistaxis, ulceration/depigmentation of nasal planum, pain, sneezing, neuro signs

§ Diagnosis: CT, rhinoscopy, sampling

§ Treatment: topical clotrimazole or enilconazole

·    Foreign body

·    Rhinitis – viral, fungal (aspergillosis)

·    Dental disease extending into nasal cavity

·    Chronic post-viral disease in cats

·    Primary bacterial rhinitis (RARE)

Pathogens and transmission

·    Pathogens:

o  Canine PI virus

o  Canine adenovirus-2

o  Bordetella bronchiseptica

·    Transmission: aerosol, direct transmission between animals

Presentation and clinical signs

·    Hacking cough

·    Enlarged SM LNs

·    Ocular + nasal discharge

·    Lethargy

·    Pyrexia

Treatment

·    Treat if nasal discharge, systemically unwell, or pyrexic

·    Symptomatic treatment: avoid choke chains/pulling on collar, clean eyes/nose, NSAIDs/paracetamol if pyrexic, glycerin as moisturiser

·    Amoxy-clav if suspect Bordetella bronchiseptica involvement (good penetration into trachea/bronchi)

Prevention

·    Environmental hygiene

·    Reduce dog-to-dog contact

·    Decrease fomite transmission

·    Increase ventilation

·    Vaccination (intra-nasal, ask O if immunocompromised)

Pathogens and transmission

·    Pathogens:

o  Feline herpes virus – can shed with/without disease

o  Feline calicivirus – can be shed with/without disease

o  Chlamydia felis

o  Mycoplasma felis

·    Transmission: close contact

Presentation and clinical signs

·    FHV:

o  Ocular ulcers

o  Herpetic dermatitis (ulceration around nose/paws)

·    FCV:

o  Ulcers on tongue

o  Floppy kittens (causes synovitis)

o  Feline chronic gingivitis stomatitis – painful, chronic, inflammation in mouth

·    Chlamydia felis:

o  Very swollen conjunctiva (initially unilateral)

Diagnosis

·    Oral or ocular swabs – viral transport medium (not gel)

·    Virus isolation for FCV (more different strains)

·    PCR for FHV (more similar strains)

Treatment

·    Supportive: nutrition, take into steamy bathroom, appetite stimulation, anti-inflammatories, clean eyes

·    Chlamydia felis – doxycycline

·    FHV – antivirals (famciclovir)

·    FCV

o  FCGS – corticosteroids, teeth extraction

Prevention

·    Improve hygiene, good disinfectant

·    Reduce cat-to-cat contact, esp. in shelters

·    Reduce stress

·    Vaccination – FHV, FCV part of core vaccination