兽医师猫传染病专题-中文3panleukopenia esavs katrin呕吐两天了大约每天5次

家养短毛 8weeks母History

hasbeenvomitingfor2days y5times两天了（大约每天5次diarrheasince1day(not1天前腹泻（非血性anorectic食欲缺doesn‘tplayanymore,sleepsa不再玩耍，嗜environment:livesnowindoors(withnewownersinceoneweek)vaccination:notyet免疫：尚未免worming:驱虫：最physicalexaminationslightlyto ytemperature:40.5°C(105体温：40.5C1055dehydration5%脱水ongoingvomitingand持续 和腹Units参考范x5-Hemoglobin血红蛋5.5-Hematocrit红细胞0.30-Plaets血小x200-Leucocytes白细x5-0x0--Lymphocytes淋巴细x1.5--band-杆状核中性粒细0x0--seg.-分叶核中性粒细x3-0x0-0x0-reference0-0-0-ALP00--0-Cholinesterase胆碱2300--Amylase-0-0-0-CK肌酸激0-Substrates底Unitsreferencerange范Bilirubin胆红0-0-0-Cholesterol胆固1.8-Triglycerides甘油0.57-totalprotein总蛋55-Albumin25-Urea5-Creatinine0-Glucose葡萄4-Fructosamine果糖0-RemarksreferenceP1.0-110-145-K3.5-2.1-12.5-0.7-blood.reference7.34-35-pO2(arterial)85-19---2.5-Urinalysis尿参考范Sample样-nitrite亚硝酸---5--protein------- ----Blood+-1.015-Sediment沉nextstepnextstepnextstep antigenELISA细 抗原nextstep antigenELISA细 抗原Treatment

-neutralizingantibodies中和抗体intravenousantibioticsIV(amoxicillin/clav.acid+antiemeticsgetics 啡enterale结after7daysnodiarrheaandvomitingnormallyeatingand吃喝正no没有白细胞减dischargedfrom出isthisatypicalcaseof这是一例典型的猫泛白细胞减少症isthereevidencethatthistreatmentis 显示这个治疗有效么FelineParvovirosis细 性疾diseaseindogsandcats犬猫上的疾causedbyinfectionwith 细 引parvovirosisincats猫的细 ==“feline

泛白细胞减少“猫瘟FelinefirstdiseaseincatswithdetectionofviralVerge&Cristoforoni,在猫上发 体的第一种疾felines (FPV)猫细small(20nm),non-single-stranded

粒子小（20mm），没有囊膜，单链extremelystableintheenvironment(>1在环境中极其稳定（1年closelyrelatedtocanineparvowhichdevelopedin1978和1978年发现的犬细 密切相CatswithKruseetal.,studydesignretrospectivestudy19902007)回顾性研Patients244 244只presentedtotheClinicofSmallAnimalMedicine,LudwigilianUniversity,Munich到慕尼黑大学小动物诊所就诊的病inclusioncriteriadiagnosisoffeline为猫泛白细胞减少Catswith猫的泛白细胞减少症Kruseetal.,agedistributionn median:4months,range:2weeks–14ageofpatientsatclinicalpresentation(n=numberofnumberofnumberof0 ageof

ageof患 （岁Catswith猫的泛白细胞减少症Kruseetalagedistribution<1year(n=1岁（n174agedistribution<1year(n=numbernumberof0ageofpatientsCatswith猫的泛白细胞减少症Kruseetalsexdistribution(n=分布

59.540.5Catswith猫的泛白细胞减少症KruseetalBreedn=% 家养短毛Persian波斯 Mixed混种 Siamese暹罗 Shorthair英cerebellar

cellfreeviremia脱细

瘟瘟bonebonemarrow&replicationreplicationincellsS-phaseof在细 SFPV发病机理：口-粪便途径/cerebellar

cellfreeviremia脱细

瘟瘟bonebonemarrow&replicationreplicationincellsS-phaseof在细 SFPV发病机理：口-粪便途径/cerebellar

cellfreeviremia脱细

瘟瘟bonebonemarrow&replicationreplicationincellsS-phaseof在细 SFPV发病机理：口-粪便途径/kittens&fetaldeath小猫和死胎

cellfree脱细 血

bacterialhemorrhagicGE

clinicalpictureFPV 的临Clinicalsubclinical亚临systemic系统性疾cerebellarhypoplasia(CNS小脑发育不全（中枢神经系 reproductive(earlyinutero Meursetal.,DestructionofIntestinalPicture:W.Hermanns,DepletionofBonePicture:W.Hermanns,differencescanineparvovirosisanddifferencescanineparvovirosisanddifferencescanineparvovirosisandCatswithKruseetal.,anorexia(71.2anorexia(71.2diarrhea(69.3(62.7depression沉 (54.9Fever发 (23.2hemorrhagic (14.1Catswithlaboratory (65.2(46.7(38.7-neutro-+(24.1Anemia贫

(54.2(48.4高血糖(28.6高血糖(28.6(6.8低钾血Kruseetal.,laboratory发(44.6低白蛋白血(30.1低蛋白血Treatmentsymptomaticandlackofcontrolledspecificantiviral antiviral 化passive的免疫疗Supportivefluidtherapybalancedisotonic平衡的等渗输>20oncotic syntheticcolloidse.ghetastarch(20plasma/bloodtransfusion输血浆/TPNoxygentubeSupportiveTreatmentAntiemeticsrationaluseenteralfeedingearlyenteral(micro-早期肠道（微）营

painmedication lidocaine利多卡Antibioticsbroad-spectrumantibioticsbactericidal,IV,higherdose杀菌，静脉，高剂combinations联合用amoxicillin/clavul.ac.+pradofloxacin3mg/kgPOq24阿莫西林克拉维酸钾 沙星3mg/kg口服q24amoxicillin/clavul.ac.+enrofloxacin5mg/kg 24阿莫西林克拉维酸钾+恩诺沙星5mg/kg皮下q24amoxicillin/clavul.ac.+gentamicin6mg/kgIVq24阿莫西林克拉维酸钾+庆大霉素6mg/kg静脉q24hamoxicillin/clavul.ac3rdgenerationcephalosporinsIV1st+3rdgenerationcephalosporins一代+三代头孢菌素静Antiviral 治passive commerciallyavailableimmunoglobulinsFeliserin®0,4ml/kgSQ3consecutivedaysFeliserin®0,4ml/kg皮下，连续3transferofantibodies1-3ml/kghyperimmuneserumorplasmaSQ1-3ml/kg高免 felineinterferon- 2.5x106IU/kgIVq24hfor3consecutive2.5x106IU/kgq24h，连续3Passive的免疫疗antiviraleffects 作 -neutralizing(Feliserin®incats,Stagloban®in （猫Feliserin®犬Stagloban®Dosage forprophylaxis1injection 预防剂量1 fortreatment3injectionsSQ(3consecutivepanleukopenia,calici andherpes infection(cat) parvovirosis,distemper,ICH(dog) sideeffectsanaphylacticreactionincats(repeated猫的过敏反应（重复运用StudiesonPassiveITinprophylacticuse预防使experimentalstudy实验研efficacyproven效果证therapeuticuse治疗使placebo-controlleddouble-blindstudyindogswith和犬细 病用安慰剂-对照组双盲研passiveimmunotherapyasadditional的免疫疗法作为额外的治lesssevereclinicalsymptomsshorterperiodinhospitallowercostsMacintireetal.,antiviraleffects 效 assemlyandbudding抑 组装和出cytokineimmunomodulatoryeffect细胞因子和免疫调节作DosagehuIFN-highdose105–106IU/kgq24hSQ(short人FN-105106IU/kgq24h皮下（短期使用huIFN-lowdose1(-50)IUPOq24h(long-人FN-低剂150IUq24h长期feIFN-2.5x106IU/kgIVq24hfor3consecutive猫FN-2.5x106IU/kgq24h，连续3Spectrum范 infections所sideeffects副作rarelyallergicreactions(huIFN-过敏反应罕见（人FN-StudiesonInterferon-ωin犬干扰素-ω 研Martinetal.,placebo-controlled安慰剂-对infectionof10SPFbeaglepuppies10只SPF比格allstandardtreatment”所有采用“标准治疗5pups5只小felineinterferon-ω2.5x106IU/kg 24hfor3猫干扰素-ω2.5x106IU/kg皮下q24h持续3=>4/5pupssurvivedinFeIFN-在猫干扰素-组4/5小狗存=>0/5pupssurvivedinplacebo安慰剂组0/5只小狗存=>statistically统计学上差异显StudiesonInterferon-ωin干扰素-ωfieldstudyinnaturallyinfecteddogs在自 Minagawaetal.,placebo-controlleddouble-blindstudy安慰剂-93dogswithparvovirosis(33vethospitals) =>statisticallysignificanthighersurvival=>fieldstudyinnaturallyinfecteddogs 在自 的犬上研究（法国DeMarietal.,placebo-controlleddouble-blind 安慰剂-92dogswithparvovirosis(19vet 92只患细 =>statisticallysignificanthighersurvivalStudiesonInterferon-ωin干扰素-ωfieldstudyinnaturallyinfectedcats在自 的猫上研究（意大利uncontrolledstudyinaFPVoutbreakina23catspre-treatedwithfelineinterferon-ω23只猫使用干扰素-ω预治疗17catsnotpre- 17只未进行预治nosignificantdifference没有显著差insurvivalrate在存活intimeuntildevelopmentofclinical直到出现临床症状的时间Paltrinierietal.,WhatcanwelearnfromthisWhatcanwelearnfromthis从这 上我们能够学到什么Whatcanwelearnfromthis从这 上我们能够学到什么kittensarehighlysusceptiblewhenmaternalantibodieswaneWhatcanwelearnfromthis从这 上我们能够学到什么kittensarehighlysusceptiblewhenmaternalantibodieswane当母源抗体消退，小猫是高危易感群Whatcanwelearnfromthis从这 上我们能够学到什么kittensarehighlysusceptiblewhenmaternalantibodieswane当母源抗体消退，小猫是高危易感群antiviralchemotherapycombinedwithsymptomatictreatmentimportant(intensivecarepatients)Whatcanwelearnfromthis从这 上我们能够学到什么kittensarehighlysusceptiblewhenmaternalantibodieswane当母源抗体消退，小猫是高危易感群antiviralchemotherapycombinedwithsymptomatictreatmentimportant(intensivecarepatients) 化学疗法结合对症治疗很重Whatcanwelearnfromthis从这 上我们能够学到什么kittensarehighlysusceptiblewhenmaternalantibodieswane当母源抗体消退，小猫是高危易感群antiviralchemotherapycombinedwithsymptomatictreatmentimportant(intensivecarepatients) 化学疗法结合对症治疗很重（重症监护患者DSH家养短毛 6monthsfemale绝育母History

stoppedeatingthismorningpresentedinlateralrecumbentenvironment:livesindoorswithoutdooraccessvaccination:worming:physicalexaminationseverelytemperature:36.3°C(97,4体温：36.3C97,4slightlypainfulmildocularreferenceredbloodcellsx5-5.5-0.30-x200-x5-0x0-x1.5--band-杆状核粒细0x0--seg.-分叶核粒细x3-胞0x0-0x0-remarksnext next antigen next antigen edead2hoursafteradmissiontotheNecropsyfibrinousenteritis,totaldepletionofpeyerdepletionoflymphnodesand 和脾脏的耗diagnosticforwhywasthe antigentest docaninefecaltestsworkincats?whatistheprognosisinfeline猫、泛白细胞减少症的预后如 detectionin粪便 的直接检 electron电 detectionin血液 的直接检indirectdetection(ofantibodies)in直接检 中（抗体-hemagglutinationinhibitionnothelpfulfordiagnosis abletopredict detectionofpathognomonicnecropsytoolateComparisonbetweenParvo细 测试的比200fecalsamplesofcatsrandomlyselectedhealthycats/catswithgoldstandard=>electronComparisonbetweenParvo ParvosensitivityspecificityPPVNPVinvalidtests0000testsdifficulttointerpretNeuereretal.,测试的原inapproproatefecalsamples不合适的粪便样notenoughmaterialtoodilute(liquidfeces)过稀（液体粪便intermittendshedding间歇性排notdetectable 不可被检测的细 highcontentofantibodiesin粪便中的抗体含量Catswith猫泛白细胞减少症Kruseetal.,e(n 结果(n231恢

51.151.1mediandurationofhospitalization7 48.948.9 todeath/euthanasia2平 时间Catswithnosignificantcorrelation eand 和以下特征之间没有显著联signalement(breed,age,体貌特征（品种 housingconditions(indoor/outdoor居住条件（室内/室外猫vaccinationstatus免疫状态（免疫/未免疫clinicalsigns临床症FIV/FeLVstatusFIV/FeLV状12

Catswith Kruseetal.,p=1086420

3.5

non-

3.8Catswith猫泛白细胞减少Kruseetalprognosticbadprognosisiflowleukocytelow etlowalbumin

lowpotassiumconcentrationCatswithleukocytes/µl白细

p=0

survivors存

e结

non-survivors未存Catswithleukocytes/µl白细

p=ififtotalnumberofleukocytes<relativeriskofdeath如果白细胞总数=>1.77xhighercomparedcatswith>1,000leukocytes/µl(p=0

survivors存

e结

non-survivors未存whatcanwelearnfromthiswhatcanwelearnfromthiswhatcanwelearnfromthiscaninetestcanbetodiagnosepanleukopeniainwhatcanwelearnfromthiscaninetestcanbetodiagnosepanleukopeniain whatcanwelearnfromthiscaninetestcanbetodiagnosepanleukopeniain testsmaybefalse(fecalorbloodPCR mendedfor测试可能是 whatcanwelearnfromthiscaninetestcanbetodiagnosepanleukopeniain testsmaybefalse(fecalorbloodPCR mendedfor测试可能是 ageisnotprognostic,butleucocytes, ets,potassiumareusefulprognosticwhatcanwelearnfromthiscaninetestcanbetodiagnosepanleukopeniain testsmaybefalse(fecalorbloodPCR mendedfor测试可能是 ageisnotprognostic,butleucocytes, ets,potassiumareusefulprognosticwhatcanwelearnfromthiscaninetestcanbetodiagnosepanleukopeniain testsmaybefalse(fecalorbloodPCR mendedfor测试可能是 ageisnotprognostic,butleucocytes, ets,potassiumareusefulprognosticwhatcanwelearnfromthiscaninetestcanbetodiagnosepanleukopeniain testsmaybefalse(fecalorbloodPCR mendedfor测试可能是 ageisnotprognostic,butleucocytes, ets,potassiumareusefulprognosticDSH家养短毛5 5female 母猫绝Historysince5daysdepressed,eatslessthan5天前开始沉郁，比平时吃得since2daysconditionworsening,stopseatinganddrinking onedayofpresentationunabletoget1天前开始出现不能站environment:livesindoors(hasneverbeen环境：室内猫（从未出过门vaccination:免疫：从来没worming:驱虫：从来没physicalexaminationdepressed temperature:35.7°C(96.3体温：35.7C96.36 6%的脱x5-Hemoglobin血红蛋5.5-Hematocrit红细胞压0.30-x200-ets血小Leucocytes白细x5-0x0-x1.5-x0-x3-0x0--0x0-nextstep?nextstep? antigen nextstep? antigenELISA Positive阳性antiviralsandsupportive 以及支持治erecoveredanddischargedfromhospitalafter10nextstep? antigenELISA Positive阳性antiviralsandsupportive 以及支持治erecoveredanddischargedfromhospitalafter10doadultcatsalsodevelopthe成年猫也能患此howcommonare“atypical”clinicalsigns? Catswithagedistributionn median4monthsrange2weeks14 平均：4个月,范围：2周-14ageofpatientsatclinicalpresentation(n=numberofnumberofnumberof0 ageof

ageof

Catswith猫泛白细胞减少症Kruseetal.,nical 临床发anorexia厌 (71.2diarrhea(69.3(62.7depression沉 (54.9fever(23.2hemorrhagic (14.1Catswith30.7%neverhad30.7%从来没有腹37.3%neverhad34.2%neverhad34.2%从来没有白细胞减15cats15只neithergastrointestinalsignsnor既没有胃肠道症状也没有白细胞减whatcanwelearnfromthiswhatcanwelearnfromthis我们从这个病例学到了什whatcanwelearnfromthis我们从这个病例学到了什adultcatscandeveloppanleukopenia(ifnotvaccinatednaturallyboostered)whatcanwelearnfromthis我们从这个病例学到了什adultcatscandeveloppanleukopenia(ifnotvaccinatednaturallyboostered)成年猫也能泛白细胞减少症（如果没有自然加强免疫接种catsmaynothavegastrointestinalsignsormaynotbeleukopenicwhatcanwelearnfromthis我们从这个病例学到了什adultcatscandeveloppanleukopenia(ifnotvaccinatednaturallyboostered)成年猫也能泛白细胞减少症（如果没有自然加强免疫接种catsmaynothavegastrointestinalsignsormaynotbeleukopenic猫可能没有胃肠道症状或者没有白细胞减少whatcanwelearnfromthis我们从这个病例学到了什adultcatscandeveloppanleukopenia(ifnotvaccinatednaturallyboostered)成年猫也能泛白细胞减少症（如果没有自然加强免疫接种catsmaynothavegastrointestinalsignsormaynotbeleukopenic猫可能没有胃肠道症状或者没有白细胞减少DSH家养短毛12weeks12周female母History

presentedwithhersister 姐妹一起来就generalizedataxia,stumbling,andsincethecatsstarted全身共济失调 ，一走路就摔litterofsixkittens(3 一窝6只小猫（3 enviroment:bornattheindowntownMunich,indoorsmotherwiththeownerformanyyears(multi-catmothernever vaccination:once(at8weeksof免疫：一次（8周的时候worming:驱虫：最

intentiontremorofthe(mostpronouncedwhenoffered头部意向性震颤（当给予食物时特别明显truncalwithintermittenttoeithersymmetriconall44肢对称性的运动范围过

intentiontremorofthe(mostpronouncedwhenoffered头部意向性震颤（当给予食物时特别明显truncalwithintermittenttoeithersymmetriconall44肢对称性的运动范围过neurologicexaminationabsentmenaceresponse缺 反otherwisenormalnextstep?

antigen细 抗原nextstep?

antigenELISA Noneownerelectedtokeepthe3kittensslightimprovementofataxiaovertimenextstep?

antigenELISA Noneownerelectedtokeepthe3kittensslightimprovementofataxiaovertimedifferentialdiagnoses/ruling-outothercerebellar

=>slight 内/早期猫细 cerebellar(genetic（遗传性storage(genetic)（遗传的

=>=>=>(myelinmaturationdefectgeneticindogs（髓磷脂成熟缺陷，狗上为遗传性的toxiccerebellar

=>slight(afteranesthesia,e.g.,ketamin)（麻醉之后，例 (history!)（病史whatiscerebellar什么是小脑发育不shouldthesekittensbe这些小猫应当安乐Cerebellar“feline infectioninuterountil<6 直到<6周oftenseveralkittens/wholelitter通常是几只小猫/notcurable,butmanykittenscanlivewithsometimesgetslightlybetterwithdefinitivediagnosisintravitamnot postmortemPCR,insitu死后运用PCR，原位杂Cerebellar小脑发育不:A.Lloret,Picture:A.Lloret,Cerebellar小脑发育不:A.Lloret,Picture:A.Lloret,whatcanwelearnfromthiswhatcanwelearnfromthiswhatcanwelearnfromthiscerebellarhypoplasiararewhatcanwelearnfromthiscerebellarhypoplasiararewhatcanwelearnfromthiscerebellarhypoplasiarareusuallyseveralkittensinonelitterinvivoonlyexclusiondiagnosiswhatcanwelearnfromthiscerebellarhypoplasiarareusuallyseveralkittensinonelitterinvivoonlyexclusiondiagnosiskittensdonotshedwhatcanwelearnfromthiscerebellarhypoplasiarareusuallyseveralkittensinonelitterinvivoonlyexclusiondiagnosiskittensdonotshed whatcanwelearnfromthiscerebellarhypoplasiarareusuallyseveralkittensinonelitterinvivoonlyexclusiondiagnosiskittensdonotshed mayslightly(morphologicstructuresdonotbutkittensmaysomehowwhatcanwelearnfromthiscerebellarhypoplasiarareusuallyseveralkittensinonelitterinvivoonlyexclusiondiagnosiskittensdonotshed mayslightly(morphologicstructuresdonotbutkittensmaysomehowDSH家养短毛8 8female绝育母History

since3daysveryenvironment:strictlyindoors(appartmenton27thfloor)环境：严格的室内猫（公寓在27楼vaccination:aswith8and12weeksofageneversincethen免疫：8周和12周时进行worming:asphysicalexaminationlethargicanorecticslightlydehydratedredbloodcells红细x5-Hemoglobin血红蛋5.5-Hematocrit红细胞0.30-x200-ets血小Leucocytes白细x5-x0---淋巴细x1.5--band-杆状核粒细x0--seg.-分叶核粒细x3-0x0--0x0- nextstep? nextstep? antigen nextstep? antigenELISA nextstep? antigenELISA fecalelectron nextstep? antigenELISA fecalelectron 结

3daysin 在重症监 3startedeatingafter7272小时之后开始吃gradualincreaseinneutrophilcountover44天之后嗜中性粒细胞逐渐增dischargedhomeafter11周之后出fecalsample粪便样stillpositive(EM)atweek6after出院之后6周仍然阳negative(EM)atweek8after出院之后8 stillpresent3years细 抗体3年后仍然存howcana yindooronlycatbe canacatbeinfectedfromadog? canadogbeinfectedfroma狗能被 么whydidthevaccinationnot为什 没有起到保护作用Catswithenvironmentalconditions(n=环境条件outdoorcats室外housholdconditions(n=家庭条multi-catmulti-cat85.5多猫生活环single-cat14.5单猫生活环●

62.137.9Caninecanine 犬细 (CPV-2a,-2b,-firstdescriptionin19781987年首次描„changed“toCPV-2aCPV-2b(recentlyCPV-CPV-2a,-2b,-caninfectcats能 cancause能够导致猫泛白细胞减少canacatbeinfectedfroma犬 猫么canadogbeinfectedfroma猫 狗么

since3daysanorectic从3verylethargicenvironment:strictlyindoors(appartmenton27thfloor)vaccination:aswith8and12weeksofneversinceworming:asImmunologic4serumantibodyserumantibodytiter抗体滴度2 minimaltitertoblock replicationminimaltitertoblockvaccination0 Vaccination 免疫接

CatswithKruseetal.,vaccinationstatusn184)免疫状60.3%(111/184)从来没有进行过免疫接39.7%(73/184)atleastone39.7%(73/184)至少接种一79.5%(58/73)onevaccineprior of1279.5%(58/73)12周龄之前有接种一11.0%(8/73)twovaccinesprior of1211.0%(8/73)12周龄之前有两9.5%(7/7