猫肺炎病因并非细菌感染翻译feline pneumonia

Felinepneumonianotalwaysabacterial猫肺炎Felinepneumonianotalwaysabacterial猫肺炎-病因并非总是细菌感BiankaDipl.ECVIM-Differentetiologiesof••••bacterialpneumoniaviralDifferentetiologiesof••••bacterialpneumoniaviralpneumoniamycoticpneumoniaparasiticpneumonia•••aspirationpneumoniaeosinophilicpneumonialipidpneumonia•DSH,mc,1yfromshelterinSpain3wk•DSH,mc,1yfromshelterinSpain3wk••coughingsincephysicalexam••Cough(x - - -(x -(x -(x(x - - -(x -(x -(x -(x -(x -segm.(x -(x -ThoracicThoracicBALBALBAL•••sensitivitytestingDoxycyclin+多BAL•••sensitivitytestingDoxycyclin+多西环素Clindamycin–克林霉素-Amoxi/Clav–阿莫西林克拉维酸-Enrofloxacin+恩诺沙星+Marbofloxacin马坡沙星•••••felinelowerrespiratorytractinfections(LRTI)clinicalsigns•Macdonaldetal.,JAVMA2003(39coughfelinelowerrespiratorytractinfections(LRTI)clinicalsigns•Macdonaldetal.,JAVMA2003(39cough(8咳嗽dyspnea/tachypnea(49%)呼吸困难/呼吸急促nasaldischarge(21鼻腔分泌物pyrexia(15发热norespiratorysigns(36没有呼吸系统症状•Fosteretal.,JFMS2004(21cough(76咳嗽dyspnea/tachypnea(67%)呼吸困难/呼吸急促pyrexia(21%)发热felinelowerrespiratorytractinfectionsclinicalandlaboratorysuddendeathfelinelowerrespiratorytractinfectionsclinicalandlaboratorysuddendeathcanbeonlyclinicalsignofLRTIin突发性死亡可能是猫LRTI•laboratoryabnormalities•leukocytosisandneutrophilianeutropenia,leftshiftuncommonin(Macdonaldetal.,2003,Fosteretal.,•hematologyoftenoflittlehelpfelinelowerrespiratorytractinfectionsradiographic•••67%alveolarfelinelowerrespiratorytractinfectionsradiographic•••67%alveolar81%bronchialorbronchial-mixednodularpatternincasesoftoxoplasmosisandmycoplasmalabscess(Fosteretal.,2004)•%(Macdonaldetal.,felinelowerrespiratorytractinfections(LRTI)radiographicchanges猫下呼felinelowerrespiratorytractinfections(LRTI)radiographicchanges猫下呼吸道感染的放射学改felinelowerrespiratorytractinfections(LRTI)radiographicchanges猫下呼felinelowerrespiratorytractinfections(LRTI)radiographicchanges猫下呼吸道感染的放射学改felinelowerrespiratorytractinfectionsradiographicfelinelowerrespiratorytractinfectionsradiographicinfectiousorganismscausingpneumoniain-infectiousorganismscausingpneumoniain-parasitesBacterial•primarypathogenicbacteria-BordetellabronchisepticaBacterial•primarypathogenicbacteria-BordetellabronchisepticaMycoplasmaspp-Mycobacteria(M.bovis,M.M.secondarybacterialinfectionscausedbynormalrespiratorymicrobacterialconcentration<104colonyformingunits/mlnormalinhealthycats•BordetellaPathogenesis•adhesiononmucusmembraneswithtoxinscauseBordetellaPathogenesis•adhesiononmucusmembraneswithtoxinscauseciliostasis->impairmentof“mucociliaryclearance”->pneumonia•promotesinfectionwithother•clinicalsigns•••CoughFevernasaldischargeBordetella/Bordetella/Schnurri,somali,mc,7ySchnurri,somali,mc,7yMycoplasmaMycoplasmaSecondarybacterialpredisposing发病诱viralinfectionSecondarybacterialpredisposing发病诱viralinfection病毒感anatomicor解剖结构或功能上的缺免疫抑aspiration吸trauma损neoplasia肿foreignbody异BALFculturesofcatswithrespiratory(n=neg.阴Bord博得特氏Strep链球菌(n=(n=Staph葡萄球菌(n=EColi大肠杆(n=BALFculturesofcatswithrespiratory(n=neg.阴Bord博得特氏Strep链球菌(n=(n=Staph葡萄球菌(n=EColi大肠杆(n=(n=%0Symptomatictherapyof•mucolytics:化痰bromhexin:0.2Symptomatictherapyof•mucolytics:化痰bromhexin:0.2–0.5mg/kgp.o.,s.c.,i.v.,q80.20.5mg/kgp.os.c.,i.vq8acetylcystein:5mg/kgp.o.,q8乙酰半胱氨酸：5mg/kgp.oq8ivfluidsnebulization(NaCl)雾化Nutrition•••Antibiotic•choiceofantibiotics:cultureandsensitivityAntibiotic•choiceofantibiotics:cultureandsensitivity抗生素的选择：培养及药敏试treatmentatleast34weeks至少治疗3-4•Infectiousorganismscausing-viruses病Infectiousorganismscausing-viruses病fungi真parasitesViral•••felineCalicivirus(FCV)felineherpesvirusViral•••felineCalicivirus(FCV)felineherpesvirus(FHV)猫疱疹病avianinfluenzaAvirus(H5N1•••felinecowpoxvirus猫牛痘病paramyxovirus,equinemorbillivirus,Nipahvirus,felinefoamyvirus…•interstitialpneumoniainexperimentalandnaturalbronchointerstitialpneumonia•interstitialpneumoniainexperimentalandnaturalbronchointerstitialpneumoniaincatswithvirulantsystemicFCVinfection•猫患烈性系统性FCVhigh•Pesavantoetal.,VetPathol•rarecauseofpneumoniamostlyinkittensandimmunosuppressedcats•recentlyreports•rarecauseofpneumoniamostlyinkittensandimmunosuppressedcats•recentlyreportsofFHV-pneumoniainmaturecatsconcurrent近期报导的成年猫FHV-fibrinonectrotisingpneumoniasuddendeathonlyclinicalFHV-FHV-肺炎诊断不足•nodataonefficacyofantiviraltherapyincasesofFHV-H5N1andH1N1influenzavirus•avian•••mostcasesH5N1andH1N1influenzavirus•avian•••mostcasesincatsinthailand3casesinGermany德国有3infectionprobablythroughcontactwithwild•swinefluinfluenzacasesdescribedinseveralcountries(USA,Italy,casesofhumanH1N1virusdescribedincatshighseroprevalenceincatsH1N1infectionlinkedtorespiratorydiseasein••••Infectiousorganismscausing--Infectiousorganismscausing--Fungalinfectionsofthe•••••CryptococcusHistoplasmaFungalinfectionsofthe•••••CryptococcusHistoplasmacapsulatumSporothrixschenkiiAspergillussppMucorspp••••••CandidasppCoccidioidesimmitis球孢子菌Blastomycesdermatitidis皮炎芽生菌Ochrochonisgallopavum线虫捕捉真菌Paecilomyciclilacinus淡紫拟青霉••usuallysystemicinfectionpulmonarylesionsin38••usuallysystemicinfectionpulmonarylesionsin38%ofcatswithsystemic38%•29%radiographic29%Davies&Troy,JAAHAdiagnosisbyBAL,lungFNAorAG-•CryptococcosisLorente-Mendezetal.,JAVMA2009CryptococcosisLorente-Mendezetal.,JAVMA2009Therapyfungaldoseq5氟康2.5-5amphotericinTherapyfungaldoseq5氟康2.5-5amphotericin两性霉素0.25amphotericinBlipidformulation两性霉素B脂化3-5InfectiousorganismscausingparasitesInfectiousorganismscausingparasites•catsaredefinitivehosts猫是终宿infectionafteringestionof•catsaredefinitivehosts猫是终宿infectionafteringestionofinfectedmeat,摄入感染的肉、粪便后会感••gastrointestinalcycleonlyin仅在猫胃肠循•tissuecystsindogs,cats,humans,在犬，猫，人等体内可形成组织•lifelongpersistenceofcystsintissue(lungs,liver,CNS,muscles,pancreas)reactivationbymanyreportsontoxoplasmosisaftercyclosporinetherapyincatsknownriskfactors•hunting,doginhousehold,feedingrawmeet,formerstrayknownriskfactors•hunting,doginhousehold,feedingrawmeet,formerstray打猎，家养犬，饲喂生肉，流浪Opsteeghetal.,PrevVetMedclinicalsignsnon-临床症状不具有特异•cough,dyspnea,fever,uveitis,musclepain,CNS-signs,icterus,状，黄疸，腹Diagnosisfeline•BALFNAcytologylung•Diagnosisfeline•BALFNAcytologylung•Diagnosisfelineserology•4-timesincreaseoftiterDiagnosisfelineserology•4-timesincreaseoftiterhighIgMnegativeIgG-titer••PCRfromtissue,BAL,notnecessarilycorrelationwithclinical••elevatedmuscleenzymesimprovementafterspecifictherapy•nostudiesonclinicaleffectofin•nostudiesonclinicaleffectofinexperimentalstudyofacutetoxoplasmosisclindamycingroupworsethanplacebogroupDavidsonetal.,AntimicrobAgentsChemother••soleclindamycintherapynotrecommendedanyrecommendationbasedonpublishedcases:12.5mg/kg,po,q24handPyrimethamine0.25–0.5mg/kgpoq12hpo,q24h，乙胺嘧啶0.25–0.5mg/kg,poq12h•Lungworm••••Aelurostrongylus猫圆线Eucoleus(CapillariaLungworm••••Aelurostrongylus猫圆线Eucoleus(Capillariaaerophila毛细线Paragonimusspp.并殖吸Cytauxzoonfelis猫包簇•Aelurostrongylus•••lungwormofthecatlivesinbronchiolesandAelurostrongylus•••lungwormofthecatlivesinbronchiolesandalveoliprevalenceinstraycats:••2.75.6inGermany德国的感染率是2.75.613.8inAustralia澳大利亚13.8•24inItaly意大利24•youngimmunosuppr.catsmoreintermediatehosts:transporthosts:smallmammals,birds,••Aelurostrongylusclinicalsigns(onlywithsevere临Aelurostrongylusclinicalsigns(onlywithsevere临床症状（严重感染时才有•cough,dyspnea,nasal咳嗽，呼吸困难，流鼻AelurostrongylusAelurostrongylusAelurostrongylusdiagnostics•larvaeinBALBaermanfecalAelurostrongylusdiagnostics•l