兽医师猫传染病专题-panleukopenia esavs katrin翻译

KatrinHartmannProf.Dr.med.vet.,Dr.habil.,Dipl.ECVIM-CAPanleukopenia

猫泛白细胞减少症DSH家养短毛猫8weeks8周female母猫“Finja”History病史●hasbeenvomitingfor2days(approximately5timesdaily)

呕吐两天了（大约每天5次）●diarrheasince1day(notbloody)1天前腹泻（不带血）●anorectic食欲缺乏●doesn‘tplayanymore,sleepsalot

不再玩耍，嗜睡●environment:livesnowindoors

(withnewownersinceoneweek)

环境：室内生活（一周前和新主

人一起生活）●vaccination:notyetvaccinated

免疫：尚未免疫●worming:current

驱虫：最近

“Finja”physicalexamination体检●slightlytomoderatelydepressed

轻微到中度抑郁●temperature:40.5°C(105°F)

体温：40.5°C(105°F)●5%dehydration5%脱水●ongoingvomitinganddiarrhea

持续的呕吐和腹泻

“Finja”CBCUnits单位referencerange参考范围redbloodcells红细胞5.9x1012/l5-10Hemoglobin血红蛋白5.6mmol/l5.5-10.5Hematocrit红细胞压积0.30l/l0.30-0.45Platelets血小板210x109/l200-600Leucocytes白细胞1.1x109/l5-18-Monocytes单核细胞0x109/l0-1.0-Lymphocytes淋巴细胞0.7x109/l1.5-7.0bandneutroph.杆状核中性粒细胞0x109/l0-0.4seg.neutroph.分叶核中性粒细胞0.4x109/l3-11-Eosinophils嗜酸性粒细胞0x109/l0-1.0-Basophils嗜碱性粒细胞0x109/l0-0.4remarks备注Enzymes酶类Units单位referencerange参考范围ASTU/l0-50ALT91U/l0-100ALP24U/l0-50ALPstableU/l0GLDHU/l0-10g-GTU/l0-5Cholinesterase胆碱酯酶U/l2300-4500a-Amylasea-淀粉酶U/l0-2000Lipase脂肪酶U/l0-300LDH乳酸脱氢酶U/l0-300CK肌酸激酶U/l0-400Remarks备注Substrates底物Units单位referencerange范围Bilirubin胆红素1.5μmol/l0-5NH3μmol/l0-60SBAμmol/l0-20Cholesterol胆固醇mmol/l1.8-3.9Triglycerides甘油三酯mmol/l0.57-1.14totalprotein总蛋白57.4g/l55-80Albumin白蛋白23.6g/l25-40Urea尿素12.3mmol/l5-10Creatinine肌酐190μmol/l0-170Glucose葡萄糖8.2mmol/l4-7Fructosamine果糖胺μmol/l0-340Remarks备注Electrolytes电解质Units单位referencerange参考范围P1.41mmol/l1.0-2.3Cl118mmol/l110-130Na149mmol/l145-155K3.2mmol/l3.5-5.5Ca2.1mmol/l2.1-2.6Feµmol/l12.5-37.6Mgmmol/l0.7-2.6remarksbloodgasanal.血气分析Units单位referencerange参考范围pH7.317.34-7.44pCO241mmHg35-45pO2(arterial)pO2（动脉）mmHg85-95HCO318.5mmol/l19-24BE-5.3mmol/l-2.5-2.5remarksUrinalysis尿检referencerange参考范围Sample样本Cystocentesis膀胱穿刺nitrite亚硝酸盐--pH5.55-7protein蛋白质---Glucose葡萄糖---Ketones酮类--Urobilinogen尿胆素原---Bilirubin胆红素---Blood血+-spec.gravity尿比重1.0451.015-1.045Sediment沉渣Erythrocytes红细胞0-2/hpf“Finja”nextstep?下一步？parvovirusantigenELISA细小病毒抗原ELISAPositive阳性Treatment治疗virus-neutralizingantibodies(Feliserin®)病毒中和抗体（Feliserin®）interferon-ω

干扰素-ω

intravenousfluids静脉输液antibioticsIV(amoxicillin/clav.acid+cefotaxime)静脉抗生素（阿莫西林克拉维酸+头孢噻肟）antiemetics(maropitant)止吐剂（马罗匹坦）analgetics(buprenorphine)止痛剂（丁丙诺啡）enteralfeeding肠内饲喂“Finja”e结果after7daysnodiarrheaandvomiting7天之后没有腹泻以及呕吐normallyeatinganddrinking吃喝正常noleukopenia没有白细胞减少dischargedfromhospital出院“Finja”“Finja”isthisatypicalcaseofpanleukopenia?这是一例典型的猫泛白细胞减少症么？isthereevidencethatthistreatmentiseffective?有证据显示这个治疗有效么？Parvovirosis细小病毒性疾病

=diseaseindogsandcats犬猫上的疾病

causedbyinfectionwithparvovirus由感染细小病毒引起parvovirosisincats猫上的细小病毒病 =panleukopenia泛白细胞减少症 =“felinedistemper”“猫瘟”FelinePanleukopenia猫泛白细胞减少症firstdiseaseincatswithdetectionofviralagentVerge&Cristoforoni,1928在猫上发现病毒体的第一种疾病felinesparvovirus(FPV)猫细小病毒

small(20nm),non-envelopped, single-strandedDNA-Virus

病毒粒子小（20mm），没有囊膜，单链DNA病毒extremelystableintheenvironment

(>1year)

在环境中极其稳定（>1年）closelyrelatedtocanineparvovirus whichdevelopedin1978

和1978年发现的犬细小病毒密切相关

icb.usp.br/~mlracz/animations/bock/FelinePanleukopenia猫泛白细胞减少症studydesign研究设计retrospectivestudy(1990–2007)回顾性研究Patients病例244cats244只猫presentedtotheClinicofSmallAnimalMedicine,LudwigMaximilianUniversity,Munich 到慕尼黑大学小动物诊所就诊的病例inclusioncriteria入选标准diagnosisoffelinepanleukopenia 诊断为猫泛白细胞减少症CatswithPanleukopenia猫的泛白细胞减少症Kruseetal.,submittedagedistribution(n=233)年龄分布median:4months,range:2weeks–14years中值：4个月，范围：2周~14岁

4-5y5-6y6-7y7-8y8-9y9-10y10-11y11-12y12-13y13-14y14-15y20454453213125174ageofpatients

(years)患者年龄（年）numberofpatients<1y1-2y2-3y3-4yCatswithPanleukopenia猫的泛白细胞减少症Kruseetal.,submittedagedistribution<1year(n=174)年龄分布<1岁（n=174）

Kruseetal.,submittedCatswithPanleukopenia猫的泛白细胞减少症sexdistribution(n=237)性别分布（n=237）Male雄性 59.5%Female雌性 40.5%Kruseetal.,submittedCatswithPanleukopenia猫的泛白细胞减少症Breed品种n=242%DomesticShorthair家养短毛21990.5Persian波斯猫135.5Mixed混种猫62.4Siamese暹罗猫20.8Burmese缅甸猫10.4BritishShorthair英短10.4Kruseetal.,submittedCatswithPanleukopenia猫的泛白细胞减少症FPV猫瘟oropharynxReplication口咽部复制cellfreeviremia脱细胞病毒血症FPVFPVFPVbonemarrow&lymphoiddepletion骨髓和淋巴消耗intestinalreplication肠道复制cerebellarhypoplasia小脑发育不全pathogenesisFPV:oro-fecalroute/systemicinfectionFPV发病机理：口-粪便途径/系统感染replicationincellsS-phaseofdivision在细胞分裂S期复制FPVcellfreeviremia脱细胞病毒血症fever,sepsis,SIRS,hyperbilirub.,DIC发热，败血症，全身炎症反应综合症，高胆红素血症，DICFPVFPVneutropenia/lymphopenia(thrombocytopenia&anemia)中性粒细胞减少症/淋巴细胞减少症（血小板减少症和贫血）bacterialtranslocationhemorrhagicGE细菌移位，出血性肠道疾病non-progressiveataxia非进行性共济失调kittens&fetaldeath小猫和死胎clinicalpictureFPVinfectionFPV感染的临床图片

vomiting/diarrhea呕吐/腹泻Dehydration脱水Hypovolemia低血容量Hypokalemia低钾血症Shock休克subclinicalinfection亚临床感染systemicdisease系统性疾病cerebellarhypoplasia(CNSinfection)小脑发育不全（中枢神经系统感染）reproductiveproblems

(earlyinuteroinfection)生殖问题（早期在子宫感染）myokarditis/cardiomyopathy?心肌炎/心肌病？Meursetal.,2000ClinicalPictures临床图片DestructionofIntestinalEpithelium

肠上皮的损坏Picture:W.Hermanns,MünchenDepletionofBoneMarrow骨髓的消耗Picture:W.Hermanns,Munichdifferencesbetween

canineparvovirosisandfelinepanleukopenia犬细小病毒病和猫泛白细胞减少症的区别clinicalfindings临床发现anorexia厌食 166/233 (71.2%)diarrhea腹泻 165/238 (69.3%)vomiting呕吐 148/236 (62.7%)depression沉郁

129/235 (54.9%)Fever发热 54/233 (23.2%)hemorrhagicdiarrhea33/234 (14.1%) 出血性腹泻

CatswithPanleukopenia猫泛白细胞减少症Kruseetal.,submittedlaboratoryfindings实验室检查leukopenia白细胞减少 122/187 (65.2%)

-neutropenia中性粒细胞减少 64/137 (46.7%) -lymphopenia淋巴细胞减少 53/137 (38.7%) -neutro-+lymphopenia 33/137 (24.1%)

中心粒细胞+淋巴细胞减少thrombocytopenia血小板减少83/153 (54.2%)Anemia贫血 91/188 (48.4%)

Kruseetal.,submittedCatswithPanleukopenia猫泛白细胞减少症laboratoryfindings实验室发现hypoalbuminemia 45/101 (44.6%) 低白蛋白血症hypoproteinemia 46/153(30.1%) 低蛋白血症hyperglycemia 48/168 (28.6%) 高血糖症hypokalemia 9/132 (6.8%) 低钾血症

Kruseetal.,submittedCatswithPanleukopenia猫泛白细胞减少症symptomaticandsupportive

对症和支持疗法lackofcontrolledstudies缺少对照研究sameprinciplesasindogs和狗狗的原则一样specificantiviraltreatment特异性抗病毒治疗

antiviralchemotherapy抗病毒化疗passiveimmunotherapy被动的免疫疗法Treatment治疗fluidtherapy输液治疗

balancedisotonicfluid 平衡的等渗输液potassiumreplacement钾置换>20mval/loncoticsupport胶体渗透压支持syntheticcolloids合成胶体e.g.,hetastarch羟乙基淀粉(20ml/kg/day)plasma/bloodtransfusion输血浆/输血TPN肠外营养oxygentube氧气管SupportiveTreatment支持疗法Antiemetics止吐剂rationaluse合理运用(metoclopramide)胃复安Maropitant马罗匹坦enteralfeeding肠内饲喂earlyenteral前段肠管

(micro-)nutrition（微）营养painmedication止疼药物buprenorphine/丁丙诺啡 phentanyl/芬太尼 lidocaine利多卡因SupportiveTreatment支持疗法broad-spectrumantibiotics广谱抗生素bactericidal,IV,higherdose杀菌，静脉，高剂量combinations联合用药

amoxicillin/clavul.ac.+pradofloxacin3mg/kgPOq24h 阿莫西林克拉维酸钾+普拉沙星3mg/kg

口服q24hamoxicillin/clavul.ac.+enrofloxacin5mg/kgSQq24h 阿莫西林克拉维酸钾+恩诺沙星5mg/kg

皮下q24hamoxicillin/clavul.ac.+gentamicin6mg/kgIVq24h 阿莫西林克拉维酸钾+庆大霉素6mg/kg

静脉q24h

amoxicillin/clavul.ac.+3rdgenerationcephalosporinsIV 阿莫西林克拉维酸钾+三代先锋静脉

1st+3rdgenerationcephalosporinsIV 一代+三代先锋静脉otheroptions其他选择 imipenem5-10mg/kgIVq6–8h(inselectedcases)

亚胺培南5-10mg/kg静脉q6–8h（在选出的病例）Antibiotics抗生素passiveimmunotherapy被动的免疫疗法commerciallyavailableimmunoglobulins

Feliserin®0,4ml/kgSQ3consecutivedays

市面上可买的免疫球蛋白Feliserin®0,4ml/kg皮下，连续3天transferofantibodies转用抗体1-3ml/kghyperimmuneserumorplasmaSQ1-3ml/kg高免血清或者血浆felineinterferon-w猫干扰素-w2.5x106IU/kgIVq24hfor3consecutivedays2.5x106IU/kg静脉q24h，连续3天AntiviralTreatment抗病毒治疗

antiviraleffects抗病毒作用Ø

specificvirus-neutralizingantibodies(Feliserin®incats,

Stagloban®indogs)

特异性病毒中和抗体

（猫Feliserin®,

犬Stagloban®

）Dosage剂量Ø

forprophylaxis1injectionSQ

预防剂量1个单位皮下注射Ø

fortreatment3injectionsSQ(3consecutivedays)

治疗剂量3个单位皮下注射（连用3天）Spectrum范围panleukopenia,calicivirusandherpesvirusinfection(cat)泛白细胞减少症，杯状病毒和疱疹病毒感染（猫）parvovirosis,distemper,ICH(dog)

细小病毒，犬瘟，

ICH（犬）sideeffects副作用anaphylacticreactionincats(repeatedapplication)猫的过敏反应（重复运用）PassiveImmunotherapy被动的免疫疗法prophylacticuse预防使用 experimentalstudy实验研究 =>efficacyproven效果证明therapeuticuse治疗使用 placebo-controlleddouble-blindstudyindogswithparvovirosis

和犬细小病毒病用安慰剂-对照组双盲研究

passiveimmunotherapyasadditionaltreatment

被动的免疫疗法作为额外的治疗

=>lesssevereclinicalsymptoms不那么严重的临床症状 =>shorterperiodinhospital住院时间更短 =>lowercosts花费低 Macintireetal.,1999

StudiesonPassiveITinDogs被动的免疫疗法在犬上的研究

antiviraleffects抗病毒效果Ø

inhibitvirusassemlyandbudding抑制病毒组装和出芽Ø

cytokine,immunomodulatoryeffect细胞因子和免疫调节作用Dosage剂量huIFN-ahighdose105–106IU/kgq24hSQ(shortuse)人FN-a高剂量105–106IU/kgq24h皮下（短期使用）

huIFN-alowdose1(-50)IUPOq24h(long-term)

人FN-a

低剂量1(-50)IU口服q24h(长期)feIFN-w2.5x106IU/kgIVq24hfor3consecutivedays猫FN-w2.5x106IU/kg静脉q24h，连续3天Spectrum范围Ø

allvirusinfections所有病毒感染sideeffects副作用rarelyallergicreactions(huIFN-a)过敏反应罕见（人FN-a）

Interferons干扰素experimentalstudy实验室研究Martinetal.,2002

placebo-controlled安慰剂-对照 infectionof10SPFbeaglepuppies10只SPF比格犬感染 all“standardtreatment”所有采用“标准治疗”

5pups5只小狗 felineinterferon-ω2.5x106IU/kgSQq24hfor3days

猫干扰素-ω2.5x106IU/kg皮下q24h持续3天=>4/5pupssurvivedinFeIFN-wgroup

在猫干扰素-w组4/5小狗存活=>0/5pupssurvivedinplacebogroup

安慰剂组0/5只小狗存活=>statisticallysignificant

统计学上差异显著

StudiesonInterferon-ωinDogs犬干扰素-ω

的研究fieldstudyinnaturallyinfecteddogs(Japan)在自然感染的犬上研究（日本）Minagawaetal.,1999

placebo-controlleddouble-blindstudy安慰剂-对照双盲实验93dogswithparvovirosis(33vethospitals)93只患细小病毒的犬（33只兽医医院） =>statisticallysignificanthighersurvivalrate=>在统计学上显著较高的存活率fieldstudyinnaturallyinfecteddogs(France)在自然感染的犬上研究（法国）DeMarietal.,2003placebo-controlleddouble-blindstudy安慰剂-对照双盲实验92dogswithparvovirosis(19vethospitals)92只患细小病毒的犬（19只兽医医院）=>statisticallysignificanthighersurvivalrate

在统计学上显著较高的存活率StudiesonInterferon-ωinDogs干扰素-ω

在犬上的研究fieldstudyinnaturallyinfectedcats(Italy)在自然感染的猫上研究（意大利）uncontrolledstudyinaFPVoutbreakinacattery在一个爆发猫瘟的猫舍进行的无对照研究23catspre-treatedwithfelineinterferon-ω23只猫使用干扰素-ω

预治疗17catsnotpre-treated17只未进行预治疗nosignificantdifference没有显著差异

-insurvivalrate在存活率上

-intimeuntildevelopmentofclinicalsigns

在时间上直到出现临床症状的发展

Paltrinierietal.,2007

StudiesonInterferon-ωinCats干扰素-ω

在猫上的研究Whatcanwelearnfromthiscase?从这些病历上我们能够学到什么？kittensarehighlysusceptible

whenmaternalantibodieswane当母源抗体消退，小猫是高危易感群体antiviralchemotherapycombinedwith

symptomatictreatmentimportant

(intensivecarepatients)抗病毒化学疗法结合对症治疗很重要（重症监护患者）“Finja”DSH6months6个月femaleneutered绝育母猫“Emily”History病史●stoppedeatingthismorning今早上开始不吃饭●lethargic嗜睡●presentedinlateralrecumbentposition

处于侧卧姿势●environment:livesindoors

withoutdooraccess

环境：室内生活，可以接触室外●vaccination:no

疫苗：无●worming:no

驱虫：无„Emily“physicalexamination体检●severelydepressed

严重沉郁●temperature:36.3°C(97,4°F)

体温：36.3°C(97,4°F)●slightlypainfulabdomen

轻微疼痛的腹部●mildoculardischarge

轻微的眼分泌物„Emily“CBCunitsreferencerangeredbloodcells红细胞10.6x1012/l5-10Hemoglobin血红蛋白8.39mmol/l5.5-10.5Hematocrit红细胞压积0.38l/l0.30-0.45Platelets血小板150x109/l200-600Leucocytes白细胞0.5x109/l5-18-Monocytes单核细胞0x109/l0-1.0-Lymphocytes淋巴细胞0.3x109/l1.5-7.0bandneutroph.杆状核粒细胞0x109/l0-0.4seg.neutroph.分叶核粒细胞0.2x109/l3-11-Eosinophils嗜酸性粒细胞0x109/l0-1.0-Basophils嗜碱性粒细胞0x109/l0-0.4remarks备注“Emily”nextstep?下一步？parvovirusantigenELISA细小病毒抗原ELISANegative阴性e结果dead2hoursafteradmissiontothehospital入院2小时之后死亡Necropsy尸检fibrinousenteritis,

totaldepletionofpeyerpatches纤维素性肠炎，派尔集合淋巴结整体消耗panmyelophtisis

depletionoflymphnodesandspleen淋巴结核和脾脏的消耗diagnosticforpanleukopenia诊断为泛白细胞减少症“Emily”whywastheparvovirusantigentestnegative?为什么细小病毒抗原测试是阴性？docaninefecaltestsworkincats?在犬的粪便测试在猫上也试用么？whatistheprognosisinfelinepanleukopenia?猫、泛白细胞减少症的预后如何？

“Emily”directvirusdetectioninfeces粪便中病毒的直接检测

-ELISA(in-practicetests)

ELISA（临床上测试） -electronmicroscopy

电镜 -PCRdirectvirusdetectioninblood血液中病毒的直接检测PCR

Diagnosis诊断indirectdetection(ofantibodies)inserum直接检测血清中（抗体）

-hemagglutinationinhibitiontest

血凝抑制实验nothelpfulfordiagnosis对诊断没有帮助abletopredictprotection能够

预测保护detectionofpathognomonicchanges检测特征性的改变-necropsy

尸检toolate太迟

Diagnosis诊断200fecalsamplesofcats200个猫的粪便样本randomlyselectedhealthycats/catswithdiarrhea随机选择健康的猫/腹泻的猫goldstandard=>electronmicroscopy金标准=>电镜检查ComparisonbetweenParvoTests细小病毒测试的比较

WitnessParvo®SnapParvo®SASParvo®FASTestParvoStrip®SpeedParvo®sensitivity(%)敏感性50.060.080.070.050.0specificity(%)特异性100.0100.096.893.7100.0PPV(%)阳性预测值100.0100.057.136.8100.0NPV(%)阴性预测值97.497.998.998.397.4invalidtests(%)无效测试000.500testsdifficulttointerpret(%)难以解释的测试1.54.514.112.00.0Neuereretal.,2008ComparisonbetweenParvoTests细小病毒检测的比较ReasonsforNegativeTestResults

阴性测试的原因inapproproatefecalsamples不合适的粪便样本notenoughmaterial材料不够toodilute(liquidfeces)过稀（液体粪便）intermittendshedding脱落中止notdetectableparvovirusstrains(e.g.,CPV-2c) 不可被检测的细小病毒毒株(e.g.,CPV-2c)highcontentofantibodiesinfeces 粪便中的抗体含量高e(n=231)结果(n=231)recovery 51.1% 恢复51.1%mediandurationofhospitalization7d 平均住院时间7ddeath 48.9% 死亡48.9%mediantimetodeath/euthanasia2d 平均死亡/安乐死时间2d

CatswithPanleukopenia猫泛白细胞减少症Kruseetal.,submittednosignificantcorrelationbetweeneand… 在结果和。。。之间没有显著联系signalement(breed,age,gender) 体貌特征（品种，年龄，性别）housingconditions(indoor/outdoorcats) 居住条件（室内/室外猫）vaccinationstatus(vaccinated/unvaccinated) 免疫状态（免疫/未免疫）clinicalsigns 临床特征FIV/FeLVstatus FIV/FeLV状态CatswithPanleukopenia猫泛白细胞减少症Kruseetal.,submittedesurvivorsnon-survivors10years12years8years4years6years2years0years3.8months3.5monthsp=0.292

CatswithPanleukopenia猫泛白细胞减少症Kruseetal.,

submittedprognosticparameters预后参数badprognosisif…预后不良，如果。。。lowleukocytecount白细胞计数低lowplateletcount血小板计数低lowalbuminconcentration白蛋白浓度低lowpotassiumconcentration钾浓度低

CatswithPanleukopenia猫泛白细胞减少症Kruseetal.,submittedp=0.002e结果leukocytes/µl白细胞1,200/µl4,400/µl

survivors存活non-survivors未存活40,00020,0000CatswithPanleukopenia猫泛白细胞减少症Kruseetal.,submitted iftotalnumberofleukocytes<1,000/µl

relativeriskofdeathis如果白细胞总数<1,000/µl，死亡的相对风险是 =>1.77xhighercomparedto

catswith>1,000leukocytes/µl(p=0.038)

=>和白细胞总数>1,000

的猫相比高1.77xwhatcanwelearnfromthiscase?从这个病例我们学到了什么？caninetestcanbeused

todiagnosepanleukopeniaincats犬的测试也可以用于诊断猫的泛白细胞减少症testsmaybefalsenegative

(fecalorbloodPCRismendedforverification)测试可能是假阴性的（推荐运用粪便或者血液PCR确诊）ageisnotprognostic,年龄是没有预兆性的butleucocytes,platelets,albumin,potassium

areusefulprognosticparameter但是白细胞，血小板，白蛋白，钾是有用的预后参数

“Emily”DSH5years5岁femaleneutered母猫绝育“Fleckchen”History病史●since5daysdepressed,eatslessthanusual5天前开始沉郁，比平时吃得少●since2daysconditionworsening,stopseatinganddrinking

2天前情况恶化，不吃不喝●onedayofpresentationunabletogetup1天前开始出现不能站立●environment:livesindoors(hasneverbeenoutside)

环境：室内猫（从未出过门）●vaccination:never

免疫：从来没有●worming:never

驱虫：从来没有“Fleckchen”physicalexamination体检●depressed沉郁●anorectic厌食●temperature:35.7°C(96.3°F)

体温：35.7°C(96.3°F)●6%dehydration6%的脱水“Fleckchen”CBCunitsreferencerangeredbloodcells红细胞9.11x1012/l5-10Hemoglobin血红蛋白7.15mmol/l5.5-10.5Hematocrit红细胞压积0.34l/l0.30-0.45Platelets血小板264x109/l200-600Leucocytes白细胞2.5x109/l5-18-Monocytes单核细胞0x109/l0-1.0-Lymphocytes淋巴细胞1.6x109/l1.5-7.0-bandneutroph.杆状核粒细胞0.1x109/l0-0.4-seg.neutroph.分叶核粒细胞0.8x109/l3-11-Eosinophils嗜酸性粒细胞0x109/l0-1.0-Basophils嗜碱性粒细胞0x109/l0-0.4remarks备注“Fleckchen”nextstep?下一步？parvovirusantigenELISA细小病毒抗原ELISAPositive阳性Treatment治疗antiviralsandsupportivetherapy抗病毒以及支持治疗e结果recoveredanddischargedfromhospitalafter10days恢复，10天之后出院“Fleckchen”doadultcatsalsodevelopthedisease?成年猫也能患此病？howcommonare“atypical”clinicalsigns?“非典型”临床症状有多常见？agedistribution(n=233)年龄分布（n=233）median:4months,range:2weeks–14years平均：4个月,范围：2周-14岁

4-5y5-6y6-7y7-8y8-9y9-10y10-11y11-12y12-13y13-14y14-15y20454453213125174ageofpatients

(years)患猫年龄（年）numberofpatients<1y1-2y2-3y3-4yCatswithPanleukopenia猫泛白细胞减少症Kruseetal.,submittedclinicalfindings临床发现anorexia厌食 166/233 (71.2%)diarrhea腹泻 165/238 (69.3%)vomiting呕吐 148/236 (62.7%)depression沉郁 129/235 (54.9%)fever高热 54/233 (23.2%)hemorrhagicdiarrhea33/234 (14.1%)

出血性腹泻

CatswithPanleukopenia猫泛白细胞减少症Kruseetal.,submitted30.7%neverhaddiarrhea30.7%从来没有腹泻37.3%neverhadvomiting37.3%从来没有呕吐34.2%neverhadleukopenia34.2%从来没有白细胞减少15cats15只猫neithergastrointestinalsignsnorleukopenia

既没有胃肠道症状也没有白细胞减少CatswithPanleukopenia猫泛白细胞减少症Kruseetal.,submittedwhatcanwelearnfromthiscase?我们从这个病例学到了什么？adultcatscandeveloppanleukopenia

(ifnotvaccinatednaturallyboostered)

成年猫也能感染泛白细胞减少症（如果没有免疫自然感染）catsmaynothavegastrointestinalsignsormaynotbeleukopenic

猫可能没有胃肠道症状或者没有白细胞减少

“Fleckchen”DSH12weeks12周female母猫“Kitty”History病史●presentedwithhersister和她的姐姐一起来就诊●generalizedataxia,stumbling,andfalling

sincethecatsstartedwalking

全身共济失调，障碍，一走路就摔倒●litterofsixkittens(3affected)

一窝6只小猫（3只感染）●enviroment:bornattheowner

indowntownMunich,indoorsonlymotherwiththeownerformanyyears(multi-cathousehold)

mothernevervaccinated

环境：主人住在慕尼黑市区，只在室内，妈妈跟着主人有很多年了（多猫生活环境），母猫没有免疫●vaccination:once(at8weeksofage)

免疫：一次（8周的时候）●worming:current

驱虫：最近

“Kitty”physicalexamination体检●intentiontremorofthehead

(mostpronouncedwhenofferedfood)

头部意向性震颤（当给予食物时特别明显）●generalizedataxia全身共济失调●broad-basedstance分腿站姿●truncalsway

withintermittentfalling

toeitherside

躯干摇晃，并间歇性的向一侧倒●symmetrichypermetria

onall4limbs4肢对称性的运动范围过渡“Kitty”neurologicexamination神经学检查●absentmenaceresponse

缺少威胁反应●otherwisenormal

其他的正常“Kitty”“Kitty”nextstep?下一步？parvovirusantigenELISA细小病毒抗原ELISAnegative阴性Treatment治疗None无e结果ownerelectedtokeepthe3kittensslightimprovementofataxiaovertime主人选择继续养3只小猫随着时间推移共济失调有缓慢的改善differentialdiagnoses/ruling-outotherdiseases

cerebellarhypoplasia =>slightimprovement

小脑发育不全

=>缓慢改善

(“felineataxia”,inutero/earlyFPVinfection)（“猫共济失调”，子宫内/早期猫瘟感染）

cerebellaratrophy =>deterioration

小脑萎缩

=>恶化(genetic)（遗传的）

storagedisease =>deterioration贮积病=>恶化(genetic)（遗传的）

dysmyelogenesis =>recovery

髓鞘形成不良=>恢复(myelinmaturationdefect,geneticindogs) （髓鞘形成缺陷，狗狗上遗传性的）

toxiccerebellardegeneration =>slightimprovement

毒性小脑变性=>缓慢改善(afteranesthesia,e.g.,ketamin)（麻醉之后，例如氯胺酮）(history!)（病史！）“Kitty”“Kitty”whatiscerebellarhypoplasia?什么是小脑发育不全？shouldthesekittensbeeuthanized?这些小猫应当安乐么？“felineataxia”“猫共济失调”

infectioninuterountil<6weeks

子宫内感染到<6周 oftenseveralkittens/wholelitteraffected

通常是几只小猫/整窝受到感染notcurable,butmanykittenscanlivewithit

sometimesgetslightlybetterwithtime不可治愈，但是很多小猫能够这样生存，有时随着时间有轻微改善definitivediagnosis最终诊断intravitamnotpossible 在体诊断不可能postmortemPCR,insituhybridization死后运用PCR，原位杂交CerebellarHypoplasia小脑发育不全CerebellarHypoplasia

小脑发育不全Video:A.Lloret,BarcelonaPicture:A.Lloret,Barcelonawhatcanwelearnfromthiscase?这个病例我们学到了什么？cerebellarhypoplasiararetoday

目前小脑发育不全很罕见usuallyseveralkittensinonelitteraffected 通常一窝中几只小猫都受感染

invivoonlyexclusiondiagnosispossiblekittensdonotshedparvovirus

活体只能排除可能不排细小病毒的小猫mayslightlyimprove

(morphologicstructuresdonotchange,

butkittensmaysomehow“adapt”)可能轻微改善（形态结构没有改变，但是小猫可能会“适应”）“Kitty”DSH8years8岁femaleneutered绝育母猫“Samantha”History病史●since3daysanorectic

从3天前厌食●

verylethargic

非常嗜睡●environment:strictlyindoors

(appartmenton27thfloor)

环境：严格的室内猫（公寓在27楼）●vaccination:askitten

with8and12weeksofage

neversincethen免疫：8周和12周时进行过免疫，之后就再也没有了●worming:askitten

驱虫：小猫时“Samantha”physicalexamination体检●lethargic嗜睡●anorectic厌食●slightlydehydrated轻微脱水“Samantha”CBCunitsreferencerangeredbloodcells红细胞9.2x1012/l5-10Hemoglobin血红蛋白8.49mmol/l5.5-10.5Hematocrit红细胞压积0.40l/l0.30-0.45Platelets血小板175x109/l200-600Leucocytes白细胞2.4x109/l5-18-Monocytes单核细胞0.1x109/l0-1.0Lymphocytes淋巴细胞1.4x109/l1.5-7.0bandneutroph.杆状核粒细胞0.1x109/l0-0.4seg.neutroph.分叶核粒细胞0.8x109/l3-11-Eosinophils嗜酸性粒细胞0x109/l0-1.0-Basophils嗜碱性粒细胞0x109/l0-0.4remarks备注“Samantha”nextstep?下一步？parvovirusantigenELISA细小病毒抗原ELISANegative阴性fecalelectronmicroscopy粪便电镜检查parvovirus细小病毒BVDNAparvo.htmle结果3daysinICU在重症监护病房3天startedeatingafter72hours72小时之后开始吃饭gradualincreaseinneutrophilcountover4days4天之后嗜中性粒细胞逐渐增加dischargedhomeafter1week1周之后出院fecalsample粪便样本stillpositive(EM)atweek6afterdischarge出院之后6周仍然阳性negative(EM)atweek8afterdischarge出院之后8周阴性parvovirusantibodies

stillpresent3yearslater细小病毒抗体3年周仍然存在“Samantha”“Samantha”howcanacompletelyindooronlycatbeinfected?一直完全室内生活的猫怎么感染？canacatbeinfectedfromadog?猫能被犬感染么？canadogbeinfectedfromacat?狗能被猫感染么？whydidthevaccinationnotprotect?为什么疫苗没有起到保护作用？environmentalconditions(n=138)环境条件（n=138）indooronlycats室内猫62.1%outdoorcats室外猫 37.9%housholdconditions(n=153)家庭条件multi-cathousehold 85.5%多猫生活环境single-cathousehold 14.5%单猫生活环境CatswithPanleukopenia猫泛白细胞减少症Kruseetal.,submittedcanineparvovirus犬细小病毒(CPV-2a,-2b,-2c)firstdescriptionin19781987年首次描述CPV-2(CPV-1)„changed“toCPV-2a,CPV-2b,(recentlyCPV-2c)“变异为”CPV-2a,CPV-2b,(目前是CPV-2c)CPV-2a,-2b,-2ccaninfectcats能够感染猫

cancausepanleukopenia能够导致猫泛白细胞减少症C