Veterinary Medicine Quiz on Rhinitis and Shelter Care

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Questions and Answers

Which breed is notably over-represented in cases of lympho-plasmacytic rhinitis?

Bulldogs

Dachshunds (correct)

German Shepherds

Golden Retrievers

What is a common clinical sign observed in cats with lympho-plasmacytic rhinitis?

Persistent cough

Increased activity levels

Reduced appetite (correct)

Vocalization

Which diagnostic method is NOT recommended for diagnosing lympho-plasmacytic rhinitis?

Rhinoscopy

Blood test (correct)

Nasal biopsy

CT scan

What is the main goal of treatment for lympho-plasmacytic rhinitis?

Improvement of clinical signs Signup and view all the answers

Which treatment is considered effective for dogs but often works well for cats in managing lympho-plasmacytic rhinitis?

Oral glucocorticoids Signup and view all the answers

What is the recommended dilution for bleach for disinfection purposes?

1:32 Signup and view all the answers

Which of the following is NOT a recommended preventative practice for shelter medicine?

Using food as a primary cleaning agent Signup and view all the answers

What does the FVRCP vaccine do regarding disease severity?

It reduces disease severity and duration. Signup and view all the answers

What procedure is commonly utilized for treating nasopharyngeal polyps?

Traction avulsion Signup and view all the answers

In a quarantine scenario, what is a recommended strategy for housing incoming animals?

House alone in cages or kennels Signup and view all the answers

Which of the following is NOT a classic sign of Horner’s Syndrome?

Exophthalmos Signup and view all the answers

Which product is mentioned as a disinfectant alternative to bleach?

Virkon® Trifectant® Signup and view all the answers

What is an important part of good hygiene in a shelter environment?

Washing hands with soap and water Signup and view all the answers

What is the reported recurrence rate for nasopharyngeal polyps after traction avulsion?

41% Signup and view all the answers

Which of the following strategies is recommended to protect a practice from a URTI outbreak?

Immediately place URTI suspects in a room upon arrival. Signup and view all the answers

What is the significance of exposure to FHV-1 in cats?

Most cats are exposed during their lifetime. Signup and view all the answers

Which of the following is true about Feline Calicivirus (FCV)?

It can survive outside the host for more than 30 days. Signup and view all the answers

What clinical signs indicate a Urinary Respiratory Tract Infection (URTI) in cats?

History of known exposure and unique signs such as a 'lightning bolt' corneal ulcer. Signup and view all the answers

In the management of viral URTI in cats, which strategy is recommended?

Supportive care and stress avoidance. Signup and view all the answers

What percentage of URTI cases are caused by viral infections according to the information provided?

80-90% Signup and view all the answers

What could unilateral nasal discharge indicate?

Nasal masses Signup and view all the answers

Which of the following is NOT a potential cause of bilateral nasal discharge?

Foreign body Signup and view all the answers

What is a common clinical sign of both unilateral and bilateral nasal issues?

Pawing at the face Signup and view all the answers

Which type of nasal discharge is characterized by the presence of blood?

Hemorrhagic Signup and view all the answers

What diagnostic test can help differentiate between fungal and bacterial causes of nasal disease?

Endoscopy Signup and view all the answers

Which of the following is a possible treatment recommendation for lymphoplasmacytic rhinitis in pets?

Steroids Signup and view all the answers

What symptom might indicate severe trauma affecting the nasal passages?

Facial distortion Signup and view all the answers

Which condition is associated with a risk of nasal discharge becoming bilateral due to erosion?

Neoplasia Signup and view all the answers

What percentage of primary infections in cats are represented by Feline herpesvirus-1?

<blockquote> 80% </blockquote> Signup and view all the answers

Which of the following bacterial infections is not opportunistic in nature?

Escherichia coli Signup and view all the answers

What is the primary cause of systemic signs/illness in secondary infections?

Bacterial pathogens Signup and view all the answers

Which of the following statements about Feline herpesvirus-1 (FHV-1) is true?

FHV-1 is a dsDNA virus. Signup and view all the answers

Which organism is least likely to contribute to co-infections in cats with upper respiratory tract infections?

Escherichia coli Signup and view all the answers

What is a common method of transmission for pathogens causing upper respiratory infections in cats?

Close/direct contact Signup and view all the answers

What is NOT a typical clinical sign of an upper respiratory tract infection in cats?

Sudden weight gain Signup and view all the answers

Which of the following is considered a primary viral infection in cats?

Feline calicivirus Signup and view all the answers

Study Notes

Upper Respiratory Disease: Nasal Passage

Presentation is by Amber Harris, DVM, DACVIM(SAIM), Clinical Assistant Professor, VETM5291, CRH II, on January 17, 2025.

Objectives

Differentiate unilateral vs. bilateral nasal discharge.
List differentials for various types of nasal discharge (serous/serosanguinous, mucopurulent, and hemorrhagic).
Discuss diagnostic tests for nasal disease, including their pros and cons.
Explain lymphoplasmacytic rhinitis (LPR) management in dogs and cats, including owner expectations.
List common infectious nasal diseases in dogs and cats (e.g., fungal, viral, bacterial).
Discuss treatment recommendations for these nasal diseases.
Discuss nasopharyngeal polyps diagnosis, treatment, and outcome in cats.

Outline

Review of brief physical exam and clinical findings.
Nasal discharge analysis.
Categorization of disease processes: inflammatory/immune-mediated, infectious, and non-neoplastic masses.

Clinical Findings

Sneezing: paroxysmal?, intermittent?, reverse?
Nasal discharge: symmetry?, character?, onset/duration?, progression?
Other clinical findings: inciting causes/triggers?, stertor, reduced appetite (especially in cats), dysphagia, pawing/rubbing face, masses/facial distortion, nasal planum ulceration, seizures.
Review Nasal Discharge Review slides on eLC.

Physical Examination

Ocular retropulsion.
Checking nasal patency.

Reverse Sneeze

Irritation to the nasopharyngeal mucosa.

Nasal Discharge

Unilateral: Neoplasia, tooth root abscess, foreign body, fungal, trauma.
Bilateral: Inflammatory rhinitis, systemic disease (hypertension, coagulopathy), infectious (secondary bacterial, viral), highly erosive disease, fungal (Aspergillus, Cryptococcus), severe trauma.

Serous/Serosanguinous Discharge

Most nasal discharge initially starts serous.
Often associated with viral, allergic, or inflammatory rhinitis.
Early sign of fluid overload.
"Sanguineous" discharge indicates disease progression, chronic mucosal irritation, and mucosal erosion/destruction.

Mucopurulent/Mucoid Discharge

Often indicates a secondary bacterial infection.
Primary nasal bacterial infections are very rare.
Chronic inflammation often increases mucus production.
Puppies may have distemper on the differential list.
May be an early indicator of developing pneumonia.

Nasal Discharge Progression

Commonly progresses from serous to serosanguinous.
Chronic mucosal irritation and inflammation, mucosal erosion.
May transition to mucoid or mucopurulent due to chronic inflammation plus secondary bacterial infections (impaired host defenses).

Hemorrhagic (Epistaxis) Discharge

Indicates erosive diseases, neoplasia, fungal (Aspergillosis), or trauma.
Also a sign of systemic disease like coagulopathy (inherited or acquired), platelet disorders (thrombocytopenia, rickettsial diseases, immune-mediated thrombocytopathia), hypertension, vasculitis, or hyperviscosity syndrome.

Inflammatory/Immune-Mediated Disease Processes

Lymphoplasmacytic rhinitis (LPR): Immune-mediated disease of unknown, possibly multifactorial, cause.
Aberrant immune response and dysfunctional PRRs (pattern recognition receptors) are possible causes.
Chronic exposure to allergens, irritants, and infections.
Seasonal allergies, previous Feline Herpes virus, hypersensitivity manifestation, and environmental/commensal fungi are also considered.
Expansion of atopy, IBD are possibilities.
In dogs and cats, typically affects middle-aged individuals, with dolichocephalic breeds (like Dachshunds) potentially over-represented.
Clinical signs include chronic bilateral nasal discharge (often serous to mucoid), nasal congestion (stertor), and possible open-mouth breathing or sneezing; cats may have reduced appetite.

LPR Diagnosis

Diagnosis of exclusion: Ruling out other diseases or triggers.
Definitive diagnosis: CT scan (thickened turbinates and fluid), Rhinoscopy (mucus and hyperemia), and nasal biopsy with histopathology.
Possible concern for secondary bacterial infection.
Significance of muco-purulent discharge.
Histopathological examination for neutrophilic inflammation in nasal samples.
Culture of nasal tissue is used for determining the specific bacterial type.

LPR Management

Difficult to manage; not curable.
Set client expectations, goal: improved clinical signs.
Commonly used protocols include antihistamines (often not helpful), anti-inflammatories, immunosuppression, and immune modulation.
Consider antibiotics if secondary infections are present.
Glucocorticoids (e.g., oral prednisone/prednisolone; anti-inflammatory dose).
Immunosuppression (dogs- maybe helpful; cats, often well).
If steroids improve signs, consider inhaled or topical treatments.

Other Management Considerations

Treating secondary infections based on tissue culture and sensitivity testing, environment modification (especially avoiding triggers such as cigarette smoke, perfumes/air fresheners, dusty litter), and humidification.

Infectious Disease Processes

Fungal rhinitis (Cryptococcus neoformans): Worldwide distribution, found in bird droppings.
Possible nasal granuloma, cutaneous lesions, and systemic involvement in cats.
Possible CNS involvement in dogs.
Cryptococcus Diagnosis: Cytology of nasal discharge (yeast with thick non-staining capsule detected via serum latex agglutination testing (SLA) for detecting capsular antigens.
Treatment: Surgical debulking plus oral antifungal medication (itraconazole or fluconazole).
Severe/CNS disease potentially requires amphotericin B.
Aspergillus fumigatus: Sino-nasal disease of dogs, characterized by often unilateral mucoid nasal discharge.
This can be hemorrhagic (epistaxis).
This pathogen can involve the nasal planum (depigmentation).
Affected breeds: German shepherds and Rottweilers; cats may have sino-orbital involvement.

Aspergillosis Diagnosis

Nasal CT scan: loss of nasal turbinates, fluid and debris in sinuses, possible bone destruction. Specifics such as the orbital bones, palate, and frontal sinus can be examined. The possibility of the fungus invading the cribriform plate and central nervous system (CNS) needs evaluation.
Rhinoscopy: Visualizing plaque (white, gray, necrotic) which might appear metallic. Samples are examined via cytology and fungal culture.

Aspergillosis Treatment

Isolated to nasal passages: debulking plus topical clotrimazole (80-85% and >90% success after 1 and 2 treatments respectively).
Infiltrative/CNS involvement: Topical clotrimazole (with caution regarding liquid formulations), plus oral antifungals (itraconazole or terbinafine). Success is less likely.

Feline Upper Respiratory Disease Complex

Viral: Feline herpesvirus-1, Feline calicivirus, Influenza, Covid-19.
Bacterial: Mycoplasma species, Bordetella bronchiseptica, Chlamydia felis.

Primary Infections

Most often viral (Feline herpesvirus-1 and Feline calicivirus represent >80% of cases).
Co-infections with Mycoplasma species, Bordetella bronchiseptica, Chlamydia felis, Streptococcus canis, and Streptococcus equi subsp zooepidemicus are common.

Secondary Infections

Most commonly bacterial (Streptococcus sp., Staphylococcus sp., Pasteurella multocida, Escherichia coli).
May present with mucopurulent discharge, systemic signs, and patient illness (e.g., fever, tachypnea).
Uncommon in every case.

Pathogen Generalities

Pathogen transmission: shedding from oculo-nasal/oral secretions, direct contact, mutual grooming, overcrowding, fomites (bowls, cages, toys).
Aerosolization is a danger over ~4 feet.
Morbidity is high, and mortality rates are low.

General Clinical Signs

Possible oculo-nasal discharge (serous-to-mucopurulent), squinting (conjunctivitis), sneezing (keratitis- rhinitis), stertor (nasal congestion), possible systemic illness or lower airway signs, and/or death (primarily seen in kittens).

Feline Herpesvirus (FHV-1)

Large, enveloped, dsdNA alphaherpesvirus.
Minimal strain variation. Similar to canine type.
Fragile outside host. Easily disinfected.
Most cats exposed during their lifetime.
May develop URTIs, dendritic ulcerations, and ulcerative/eosinophilic dermatitis.

Feline Calicivirus (FCV)

Small, unenveloped ssRNA.
Survives outside the host for ~30 days, resisting usual disinfection.
Shed continuously following infection, with 45% shedding for <30 days, 45% shedding for >75 days, and ~10% becoming chronic carriers.
Known to cause URTI, oral/nasal planum ulcerations, and reported lameness.

Virulent Systemic FCV

Unique, uncommon strain, high pathogenicity, and high mortality.

Chlamydia felis

Obligate intracellular bacteria, primitive with few metabolic pathways.
Most common in ~2-12 month old cats.
Induces only conjunctivitis plus possible chemosis and blepharospasm.

Other Pathogens

Bordetella bronchiseptica: gram-aerobic coccobacillus, rarely causes coughs in cats.
Mycoplasma species: fastidious organisms lacking cell walls, often part of a co-infection, potential opportunistic pathogens. Can be associated with signs like lower respiratory infections.

URTI Diagnosis

History of known exposure.
Clinical signs and exam.
Unique associations: lightning bolt corneal ulcers, coughing in other dogs, conjunctivitis only, or URTI + systemic illness.
PCR/organism identification.
Oronasal/conjunctival swab.
Important considerations.

Viral URTI Management

Stress avoidance.
Supportive care. Partial anorexia? Warm, smelly food; clean nose; systemically ill? Fluid, nutritional support; Treat secondary infections.
Relative isolation
Remember most cases are viral; signs are mild and self-limiting. There are no consistently effective primary therapies.

Viral URTI Management (Antibiotics?)

Viral infections are the most common cause in ~80-90% of cases.
Secondary bacterial infections as a possible differential.
Antibiotic selection as a treatment for secondary bacterial infections. Examples of therapies: Lysine, Famciclovir, FVRCP vaccine (minimal protection, reduces disease severity/duration).

Disease Processes—Non-Neoplastic Masses

Nasopharyngeal polyps (NPs): Originate in the middle ear or auditory tube, sometimes extending into the ear canal, and sometimes into nasopharynx.
Composed of fibrovascular granulation tissues covered by epithelium. Minimal inflammation. Can have ulceration.
Fatty/avascular stalk.
Affecting young cats (often <1 yr).
Clinical signs: stertor, bilateral mucoid nasal discharge, dysphagia, regurgitation, and /or meow modification. Possible vestibular signs.

NP Polyp Diagnosis

Visualize polyp under heavy sedation during anesthesia using spay hooks to pull rostrally through the soft palate.

NP Polyp Treatment

Traction avulsion (“Grab and Rip”).
Possible Horner's Syndrome after removal in ~43% of cases (particularly likely if surgery was required), characterized by miosis, ptosis, enophthalmos, and third eyelid protrusion.
Recovery typically occurs within 1-4 weeks.

Traction Avulsion Success

~41% recurrence rate reported, higher when bullae involvement occurs.
Aural involvement is a more common cause for recurrence than the nasopharyngeal involvement.
Following treatment with glucocorticoids (like prednisolone at 0.5-1 mg/kg/day) over 6-8 weeks, recurrence risk drops.
Recurrence commonly seen between approximately 19 days and up to 9 months post-treatment.

Outbreak Prevention/Management: Shelter Medicine

General considerations for shelter medicine.
Quarantine of incoming animals.
Minimal stress-inducing modifications to the shelter environment/practices.
Dedicated cages, low-stress traffic areas, and hiding spaces.
Cages separated by > 4-5 feet.
Consider impermeable separation between cages?
Immediate disinfection is important, plus clean equipment, PPE for staff, and visitor precautions.

How to Protect the Practice From an Outbreak

Advanced screening/scheduling for minimizing risk.
Treatment of URTIs on an outpatient basis.
URTI suspect animal patients should be isolated upon arrival.
Appropriate handling/transport in carriers.
Limiting the number of staff involved in caring for URTI patients.
Disinfecting equipment (stethoscopes, thermometers, etc) after contact with affected patients.
Disinfection of the rooms and prompt clean up of soiled equipment/materials.

Disinfection/Prevention Practices

Disinfection with diluted bleach (1:32). Diluted bleach is 1/2 cup of bleach per gallon of water.
Potassium Peroxymonosulfate (Virkon Trifectant).
Accelerated Hydrogen Peroxide (Accel).
Good hygiene: hand washing (with sanitizers, including 60-90% alcohol) and PPE to prevent contamination of equipment.

Further Considerations

Questions?
Contact information: [email protected]

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Test your knowledge on lympho-plasmacytic rhinitis and shelter medicine practices. This quiz covers important topics such as clinical signs, treatment methods, and infection control measures for veterinary care. Explore various disorders and their management in a clinical setting.