兽医师猫传染病专题等多个文件-015esavs-猫病ii15大肠疾病diseases of the large intestine cats

DiseasesoftheLargeIntestineinCats猫的大肠疾Dr.StefanUntererDiplomateECVIM MacroscopicAnatomyQCaecumQColonQRectumLargebowellength:0,3大肠长度Dr.SvenReese,

MicroscopicAnatomy微观4layers4MucosaSubmucosaMuscularisSerosacomparedtosmallintestine,largecontainsnovillilessmicrovillimoremucus-producinggoblet

Abb.LiebichFunction功extractionofwaterand吸收水分和电解storageof粪microbialfermentationofundigestedhighestconcentrationofbacteriainthemucusproductionfacilitatesdefecationprotectsthemucosaDiseasesoftheLarge大肠疾largebowel大肠性腹Acutechronic(youneeda慢性（需要诊断reducedorabsentdefecationforseveraldaystoweeksDISTINGUISHLARGEBOWELFROMSMALLBOWELDISEASE区别大肠和小肠的疾LargebowelSmallbowelWeightloss体重减Veryrare极罕YesPolyphagia多NoMaybe可能VomitingInfrequent少Sometimes有时发Freshblood见血Sometimes有时发NoNoRare罕Fecalmucus粪便粘Sometimes有时发NoTenesmus里急后Sometimes有时发Infrequent少Case‚Madonna‘Case‚Madonna‘ChronicdiarrheaQacquiredfrombreeder5weeks ‚Madonna‘–intermittentpastyfrequent‚Elvispastytoliquidy,unconsciouslossoffecesQBAR,goodappetite,noweightBAR,Case‚Madonna‘HistorybreederQqueenandlitterpastyQsomeotheradultrelapsingclinicallyfecalCase‚Madonna‘History

QCBC&chemWNLCase‚Madonna‘History

therapywithFenbendazolefor5no芬苯达唑五日无改Metronidazolefor7no甲硝唑7日无改Giardiasnaptest贾地鞭毛虫快速检 Case‚Madonna‘PresentedtothecfSmallAnimalMedicineinMunich转诊QCauseofchronic慢性腹泻的原因 Case‚Madonna‘examinatio‚lQQBCS4- areareddened,swollenmildrectumprolapseProblemlistchronicdiarrheafecalincontinencerectumprolapseCase‚Madonna‘DDchronicdiarrlvis‘慢性腹泻的鉴别诊QDietQ Qinflammatory,non- QObstructive堵塞性QCongential QNeoplastic肿瘤性Qextra-Case‚Madonna‘DDchronicQDietQ Q(inflammatory,non-infectious)炎症、性QObstructive堵塞性QCongenital性QNeoplastic肿瘤性Qextragastrointestinal/metabolicCase‚Madonna‘DiagnosticTherapeuticCase‚Madonna‘Fecal fecalsamplecollectedover3daysFlotationGiardia贾地鞭毛虫Tritrichomonasfoetus胎三 Case‚Madonna‘anddirectdetectionwithNaCl氯化钠直接Diagnosis:TritrichomonasCase‚Madonna‘andDiagnosis:TritrichomonasWhyispersistentinfectionwithGiardia wastreated negativeantigenELISAafter治疗后抗原GiardiasppCat猫的贾ProtozoasimilartoT.Moderateprevalencecats1.5–GiardiawithcystinfectionviaingestionofhygeneduringtherapyveryGiardiasppCat猫的贾Pathogenesis发destructionofintestinalepithelialcellsshorteningofvilliclinicalcourserelatedtovirulenceofparticularGiardiastrain个别种类贾地鞭patient‘simmunestatusClinicalsigns临asymptomaticcarrierDiarrheaacutediarrheainyounganimalsself-limiting/intermittent/chronic自限性/间断性/GiardiasppCat猫的贾Diagnosis诊zincsulfateflotation„3differentfecalsamplesarenecessarywithzincsulfateflotationtoreacha94%positivepredictivevalueforGiardia 检测，这样可以得到94%阳性预测值ImmunoassayELISAalsoforfrozenfeces)goodsensitivityand犬的慢性贾地鞭毛 诊'conclusionandclinicalrelevance:in-houseGiardiadiagnostictestshavepoorcorrelationwiththegoldstandardmethod(fluorescentantibodycoproscopy)院内的贾地鞭毛虫诊 和标准诊断方法（荧光抗体显微镜之间相关性很goodnegativepredictivevalues,butpoorpositivepredictivevaluesatprevalenceratescommoninmostclinicalsettings良好 预测值，但在大部分的临床条件下阳性预测值较negativein-housetest=infectioncanbe院内检 =可排positivetestwithlowprevalence≠低流行率的阳性结果Giardiaspp.'Therapy治

50mg/kgpoq24hfor5 15mg/kgpoq12hfor7 mendeddosemaybetoxicincats)甲硝唑：（高于推荐剂量可能对猫有一定毒性patient: area cleanWhatanswerregardingepidemiologyoffelineT.foetusinfection catsgetinfectedprimarilybycontactwithcattle,i.e.especiallyoutdoorcatsareinfected T.foetusisveryresistenttoenvironmentalinfluences,i.e.destroytheinfectiousagentawidespreaddesinfectionregimenisnecessary rawmeatisaseriouspotentialsourceof felineinfectionswithT.foetusareprimarilydiagnosedinmulti-cathouseholdsTfoetusPathogenesisdirectorofecalcolonizemucosaofterminalcecum盲肠colon结肠excretedwithnocyst无包verysensitiveagainstcold,O2,dehydrationtablesurviveforupto7daysinmoist对于寒冷，氧气和干燥及敏感但可在湿润粪便中存活7T.foetus-Predisposing发病诱multi-nocontacttofarmwatersourcefeedingrawmeatPrevalenceofT.foetusinPrevalenceinEuropeamongstcatswithdiarrhea:2–欧洲腹泻的猫中 ：2- 14outof111catswithdiarrhea 24outof45catswithchronicdiarrhea 32%outof74feralcatsinshelterwithGunn-Mooreetal.,2007;Hollidayetal.,2008;Freyetal.,PrevalenceofT.foetusinPrevalenceinGermanycatswith 9.6%outof376of0.85%of腹泻的猫：376只猫中 其中纯种猫 短毛猫

15.7%outof23018.5%outof124breeding 124只繁育用猫中Kleinetal.,2010;Kuehneretal.,2009(ECVIM- Prevalenceofentericparasitesin Purebreed(n=perpercent

breeders(n=18,5%perpercent

DetectionofTfoetusdirect粪便抹fecal粪便培fecal粪便biopsyofcolonic结肠粘膜活culture entinInPouchTMTF在InPouchTMuserectalfreshPolymerasechainreactionmaterials&methodsrefridgeratedfecalsamplefrom3consecutivedays(atleast200mg)连续三 的粪便样品冷藏保存（每份至少sendtospecializedlaboratory(e.g.IDEXXVetMedLabor,Alomed,Laboklin) Proverygoodsensitivityand100%极好的敏感性和100%的特PolymerasechainreactionConscosts:~30€falsenegative catstreatedwithnotallavailablePCRtestshavegood不是所有的PCR检查都有较好的敏感TfoetusSymptoms症sage 分s

studypopulation(n=T.foetus(n=36)胎三毛虫Giardia(n=22)贾地鞭毛虫Isospora(n16等孢子球虫Cryptosporidium(n6correlated与年轻动物相关（≤1岁QT.foetusinfection(p=0,017;OR3,25;95%-KI1,43–Qcoccidiosis(p<0,001;OR11,09;95%-KI2,48–TfoetusSymptoms症breed品

(n=

cats(n=

(n=00NorwegianForrest挪威森林66.787.5andere

NorwegianForrestp<0.001;RRNorwegianForrestCat→p<0.001;RR6,9 18,2 ClinicalrelevanceofTfoetus?abnormalfecesondayoftesting异常粪便 n%n%p研究对32.2n%n%p研究对32.239.6--T.Foetus胎63.911.1<Giardia甲第鞭毛50.050.0n.Isospora.等孢子球虫62.537.5n.-33.366.6--ClinicalrelevanceofT.胎三毛虫的临Diarrheainthepast6 n%pn%pn%p41.3--49.2--TFoetus胎三61.169.6Giardia甲第鞭毛46.6n.47.8n.Isospora等孢子球虫61.1n.50.0n.-sporidium50.0--66.6--

breeders种TfoetusSymptoms胎三毛虫—QlargebowelchronictorelapsingintermittentpastytoliquidyQfecalQrectumTfoetusSymptomsSeverityofsymptoms症状的严重Variablenotdependentonage notdependentonco-infectionwithotherenteric QInmulti-cathouseholds/breeding在多猫家庭/繁殖者常发…notallanimalsinfected…onlysomecatswithdiarrheaHowdowetreataninfectionwithT. 甲硝罗硝芬苯达卡硝TfoetustherapyDrugofchoice药物Ronidazole30mg/kgoncedailyevery14罗硝唑，30mg/kg每日一次，连服14Qantibiotic:5-抗生素：5-硝基咪QinGermanyonlylicensedforcarrierpidgeons,onlyasRidzol10%Bt(Rhönfried,TherapyoffelineTritrichomonasinfectionwithRonidazolele……leadstoeliminationofTritrichomonasinmost…shouldonlybedoneafterdefinitivediagnosisduethenarrowtherapeutic…canbestartedpromptlyinallinfected …canleadtoneurologicsignsevenwithmendedTfoetusTherapyProblemsT.foetusnotsensitivetomostdevelopmentofresistenceinnodrugwith100%efficacyso至今没有100%有效的药MetronidazolenotRonidazolenotalwayseffectiveineliminatingT.foetus,butusuallyresolutionofclinicalsigns罗硝唑并不能完全清除三毛虫，但通常会解决临床症TfoetusTherapyMicroaerophilicinvivoandin ofT. with5-Nitroimidazoledrugs(commonuseofMetronidazole???)newdrugsmustbeTFoetusTherapyRonidazole–sideeffects罗硝唑—副作用neurotoxic神经毒性mutagenic/teratogenic致突变性/致畸性Important重要事handleonlywithpre-treatment:informedconsentregardingcloselymonitorpatientforneurologicsigns,e.g.lethargy,ataxia,seizures密 stopdrugimmedia yifanyneurologicsignsoccur!出现任何神经症状时立即停药TfoetusTherapyRonidazolesideeffects罗硝唑—副作Important重要事havepharmacycompounddailydose准确应用药物学剂onlyusewithdefinitivediagnosis,notin 仅限于确诊病例使用，不可用于疑似病donotusein不animals<12<12周的幼龄动pregnantorlactating怀孕或泌乳动TfoetusTherapySupportive支atleastonecleananddisinfectlitterbox猫砂盆有规律的清洁和灭clean regioniffecesnowidespreaddisinfectionnecessary,nocyst三 TFoetusPrognosissubsidingdiarrheawithRonidazoleusuallyafteracoupleofdaysinrarecasesafter≥2weeksElimination病原消notalwayssuccessful,therefore不经常有效，因此…checktreatmentsuccessvia用PCR检查是否成功治514daysaftertherapy治疗后5-14日进ifstillpositive,considerRonidazolefor14如果仍然阳性，考虑用14日的罗硝唑afteraminimumof20至少20周后复TfoetusPrognosisLong-term长Symptomswithouttreatmentclinicalremissionafter9months(4months–2years)临床症状在没有治疗的情况下9个月后消除（4个月-2年88after2yearsasymptomaticbut:canrelapseafter diarrheadue但是：下列原因引起的腹泻会导致复dietstressadministrationEliminationT.foetusPCRin50%after2–5Jahrennegative Isthereahuman是否对人类健康有害T.foetus–ZoonoticTransmissionfromcatto从猫传染给人1casereportofaT.foetusinfectioninhumanmedicine epididymitisandmeningoencephalitisinimmuno- afterbonemarrow Case‚Madonna‘Therapy治

Ronidazole30mg/kgfor14罗硝30mg/kg每日一次，14sideeffects:Diarrhea„Madonna“–normalfecesaftercoupleof数日后粪„Elvis“–fecalincontinencedisappearedafter3days,normalconsistencyafter1.5weeks Case‚Madonna‘Elimination病after14days14.foetuscultureboth:‚Madonnanegative‚Elvispositive Take-homeMessageT.foetus胎三毛Qhighprevalenceinpurebreedcatsin QsymptomaticinfectionrarelyasymptomaticQriskfactorsmultiplecathouseholdyoungage1year)breed→NorwegianForrestCatssig.moreoftenT.foetusQfecalPCRveryCAE:Handling,sideeffects,narrowtherapeuticindex!Qsymptomsandinfectionoftenself- CatbreedersinGermany…QhighprevalenceofT.foetusandGiardia QnohelmithsQT.foetus&Isosporamorecommoninyounganimals(≤1year)胎三毛虫和等孢球虫常见于年轻动物（<1岁QonlyT.foetusinfectionsig.associatedwith Case 家养短毛8yearsoldspayed绝育公lives室外生History

diarrheasinceweekspainfulmucusandsometimesfreshbloodonvaccination:current免疫：deworming:current驱虫：physicalexamination身alerttemperature:mucusmembranes:pale-abdominalpalpation:problemlistruleoutlisttherapeuticanddiagnosticfurtherexamination进ultrasoundabdomen腹prominentintestinallargefurtherexamination进ultrasoundabdomen腹prominentintestinallargeultrasoundguidedbiopsy超ultrasoundguidedbiopsyConstipationHypomotility活动性Obstruction堵Neoplasia肿 a淋巴肉瘤mastcelltumorscommonsitesofcolonicdescendingcolonhighrate(63%)oflocalcauseintraluminal腔内堵塞的原FIPgranulomafibrosinglinearycosisConstipationCausesidiopathicmegacolon ypelvic stenosisnerveinjuryManxsacralspinalcorddeformityConstipationdilatedmegacolonistheendstageofcolonicdysfunctioninidiopathiccases permanentlossofcolonicstructureandearlyappropriatetherapytostop早期恰当的治疗 疾病进Constipationidiopathicmegacolonmiddle-aged(mean:5.8years)male中年雄猫（平均5.8岁domesticshorthair(46%),domesticlonghair(15%),Siamese家养短毛猫（46%），家养长毛猫（15%），暹罗猫reduced,absent,orpainful排便减少，无排便或Dehydrationmildmesenteric轻度的肠系膜 Constipationidiopathicmegacolon:diagnosticwork自发性巨结肠：建立诊CBC,serumchemistryurinalysis DehydrationHypokalemiaHypercalcemiaT4(ifsignsconsistentwithhypothyroidism)Constipationidiopathicmegacolon:diagnosticworkabdominalintraluminalradiopaqueforeignintraluminalorextraluminalmasspelvicfracturesspinalcordabnormalitiesabdominalultrasoundextraluminalmasslesionsIdiopathicMegacolonremovalofimpactedadministrationof灌肠处warmisotonicsaline(5to10温热等渗生理盐水(5to10mineraloil(5to10矿物油(5to10manualextractionofimpacted手工取出压紧的粪Idiopat