Learn and Travel……. stories from the vets! Dr Daniela Bajenaru at Central Vet Clinic in Sofia

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Dr Daniela Bajenaru and Dr Ivelina Valcheva

Dr Daniela Bajenaru, working in vet clinic Tazy-vet in Bucharest, Romania with the sponsorship of Pamas Trading SRL have done her externship at Cenral Vet Clinic in Sofia, Bulgaria. Let’s her tell us about it :

                   My wonderful experience in Sofia at the Central Vet Clinic

It all started with a simple decision to try my luck at a contest organized by the Vets on The Balkans, that was a first step in a wonderful walk. Dr. Luba Gancheva told me about this possibility of externship at the Central Vet Clinic in Sofia, and I said why not, we always have something to learn from those around us.
At the Central Vet Clinic I met only welcoming and beautiful people. The management is at a very high level, they are very well organized. I admired very much their way of dealing with the hospitalized patients and their X-ray techniques.There the doctors, besides their great experience, have all the necessary equipment to establish a quick diagnosis of certainty.
On my first day I remember that I was very impressed by the large number of patients who walk into the clinic, I think they were around 150. They always manage this with a lot of professionalism.16 5 3
The surgery rooms are very rarely free. I think that the most difficult cases from Sofia (and not only) come to them.
Because my greatest passion in the veterinary field is dermatology, my time spent in the Central Vet Clinic has been allocated , for the most part of it, in the dermatology department with Dr. Iveline Vacheva. For her I have only wonderful words. I see in her a very dedicated doctor, with many ambitions. I had the opportunity to see a lot of interesting cases, one of them was about a young cat with degenerative mucinotic mural folliculitis. I know that this affection is quite rare…so, great job Dr. Iveline!7111 2
My days were my own to plan and fill. I had a little time to visit also Sofia. I took a walk on the Witashe Mountains, I climbed up to the Boulder slopes, called ” stone rivers” or “morains” in Bulgarian and in some English language guidebooks.
It was a great experience for me, I left with a lot of practical ideas for home. I will definitely come back again in Sofia to the Central Vet Clinic!8 9

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Thanks to the all team for all the goodwill they have shown, they always answered to my questions.
Thank you Dr. Ranko Georgiev for all the kindness, for sure in the future you will do more then that for the Central Vet Clinic!
Thank you Vet on The Balkans, Dr. Luba Gancheva, Pamas Traiding and Tazy-vet, because you made this possible!12814393_1673705086236432_1339900710371625092_n

Craniomandibular osteopathy

8months old, American bully, Female

 

History: pain, jaw swelling.

 

Findings: Periosteal new bone formation, palisading type, affecting the mandible bilateral.

The tympanic bullae and temporomandibular joints are not affected.

 

Diagnostic:  Craniomandibular osteopathy.

rx rx1 rx2

Discussion: Craniomandibular osteopathy is a non-neoplastic, proliferative  bone disease that affects primarily the mandible, tympanic bullae, frontal bone and occasionally long bones in dogs of about three to eight months.

The proliferation of new bone of the head and jaws decreases as the endochondral ossification of the long bones slows after 7 to 8 months of age.

Learn and Travel…..stories from vets!

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Dr Constantin Ifteme

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externship

In March 2017, Dr Nadejda Tsureva, working at Veterinary Clinic ” Dobro Hrumvane” in city of Sofia, Bulgaria, has done her externship at Centru de Endoscopie si Chirurgie Minim Invasiva Veterinara with Dr Constantin Ifteme in city of Bucharest, Romania.endo3endo6

What is the opinion of Dr Nadejda Tsureva:

“Dear colleagues and friends,

I want to thank you for the opportunity of spending some precious time in Centru de endoscopie si chirurgie digestiva veterinara in Romania. Thanks a lot to Vets on the Balkans and the Vet team of the endoscopic center.
I had the chance of meeting new friends and family. Had the chance of learning from great professionals and great people. Working with love for the animals is really important and when combined with knowledge and great skills that is how “magic” is happening. I am really pleased to know that there are more people of that special “breed”.
Thank you all for the knowledge and the smiles you shared with me.
Hope to see you again.
To my Romanian family with love.
d-r Nadezhda Tsureva
We would like to express our gratitude to Dr Constantin Ifteme and brilliant team for everything. We are proud to have you on The Balkans , such a high level of professionalism and big heart!endo4 endo2 endo5

Rupture of the atrial septum in dog with degenerative mitral valve disease

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Dr Todor Kalinov

Dr Todor Kalinov

ZaraVet- city of Plovdiv, Bulgaria

Introduction

Degenerative mitral valve disease (DMVD) is the most common cardiologic disorder in canine population. It has been estimated to account for 75% to 80% of canine cardiac disease1. It is common in small breed dogs, but also can be encountered in large breeds like german shepherd and other . The disease characterizes with thickening and enlarging of the mitral leaflets, elongation of chrdae tendineae and mitral regurgitation. Histopathologic  features are expansion of extracellular matrix with glycosaminoglycans and proteoglycans; valvular interstitial cell alteration; and attenuation or loss of the collagen-laden fibrosa layer2. Because of the mitral regurgitation the usual course of this disorder represents volume overloud of the left atrium and left ventricle , eccentric hypertrophy of the left ventricle , dilation of the left atrium ,and  left sided congestive heart failure . Increased pressure in left atrium and pulmonary veins leads to pulmonary edema . Often complication is so called passive pulmonary hypertension , consequence of increased pressure in pulmonary veins. Really rare complication is left atrial rupture .

 

Case presentation

fig 1

Fig. 1

fig 3

Fig.3

fig 2

Fig.2

Richka is 12 years old mixed breed dog with history of DMVD , threated only with enalapril . She was admitted in our clinic for cardiologic examination, because recently increasing in coughing and exercise intolerance. During the examination she was tachypneic , normal mucous membrane color , alert and responsive .She had increased heart rate. Auscultation revealed right and left apex systolic heart murmurs. The abdomen was swollen with palpable fluid thrill. We have made echocardiographic examination, with the patient on left and right lateral recumbency, with all parasternal views according to the accepted standards. We found eccentric hypertrophy of the left and right ventricles, left and right atrial dilation, thickening and prolapse of the mitral valve. Doppler examination shows mitral and tricuspid regurgitation with pressure gradient of 162 mmHg and 62 mmHg respectively (figures 1,2,3) . Abdominal echography revealed ascites. So we diagnosed degenerative mitral valve disease with secondary pulmonary hypertension. We prescribed following: pimobendan – 0.25 mg/kg/bid , furozemid – 4.0 mg/kg/bid , spironolactone – 1.0 mg/kg bid enalapril – 0.5 mg/kg/bid , sildenafil – 1.0 mg/kg/tid.

Week later on control examination Richka was better, ascites resolved , mitral and tricuspid regurgitation was with gradient 125 mmHg and 43 mmHg respectively. So we decreased the dose of furosemide to 2.0 mg/kg/bid, and the other drugs were continued with the same doses.

fig 4

Fig 4

fig 5

Fig 5

fig6

Fig 6

fig 7

Fig 7

fig 8

Fig 8

Several months later the owners noticed again swelling of the abdomen and the dog collapsed after exercise. When they came in the clinic Richka was tachypneic with cyanotic mucous membrane. On auscultation we have found 5/6 systolic murmur on the right haemithorax with palpable precordial thrill. Electrocardiography revealed sinus tachycardia – 156 bpm , with premature supraventricular and multifocal ventricular complexes (fig 4). We have made roentgenography in right lateral (fig 5) and dorsoventral (fig 6) position. There was generalized cardiomegaly with dilation of the pulmonary vessels. On echocardiographic examination we have found eccentric hypertrophy of the left and right ventricles, paradoxical motion of the ventricular septum (fig 7), mitral and tricuspid regurgitation with gradient – 118 mmHg and 42 mmHg respectively. Abdominal ultrasonography showed ascites with no collapse of the caudal vena cava with respiration (fig 8). Despite the medications and lower then before pulmonary pressure in this dog the signs of right heart failure were predominant. Because of that and the palpable precordial thrill on the right side we suggested right to left intracardiac shunt. The presence of ventricular septal rupture is less possible, so we decide to search for rupture of the atrial septum. On the right parasternal 4 chambers view modified for better visualization of the right and left atrium with atrial septum, we have found rupture of the septum in the region of the fossa ovalis with left to right shunt.

 

 

 

Video 1 and 2 are same loops with and without colour Doppler demonstrating the defect and shunt of the blood. In this region very often because of the echo dropout on 2d image can be seen a hole in the atrial septum. To be sure that this is a real defect we decided to make a bubble contrast study. We injected 10 ml of agitated saline in v.cephalica antebrachii thru i.v. catheter.  When there is right to left shunt the microbubbles are seen in left atrim, left ventricle or arterial circulation – usually the abdominal aorta. But in left to right shunt the goal of the bubble study is to notice contrast washout during right atrium passing of the bubbles. Video 3 and 4 show right parasternal short axis view of the base of the heart with cranial vena cava. We can see the entrance of the contrast and the following washout like a flame because of the left to right shunting of the blood.

 

 

In this situation sildenafil makes the pulmonary pressure lower and facilitate the shunt from high pressure left atrium to low pressure right atrium. So we decided to use pulmonary hypertension properly and make the dose of sildenafil lower – 1 mg/kg/24 h. with presumption that higher right ventricle and right atrium pressure will make the amount of the shunt lower. 72 hours after this change the ascites resolves and the condition of the dog became better. On the time of the written of the article Richka is about half year on this medications with sildenafil once per day and no changes in other medications and the only clinical sign is exercise intolerance.

 Discussion

Rupture of the atrial septum is really rare complication of mitral valve disease. Most commonly the rupture occurs in caudal weaker part of atrial wall. In a study of Buchanan JW from 30 dogs only in 4 was found rupture of the interatrial septum with signs of right heart failure3. In another study from the same investigator from 50 dogs 7 have acquired ASD4. The еtiology for rupture of the left atrium is uncleаr , but probably is related with the high pressure in the left and right atrium and the so called jet lesions from the mitral and tricuspid regurgitation. Usually the mitral regurgitation jet is toward lateral wall of the left atrium like in this case (video 5). Tricuspid regurgitation jet was directed to interatrial septum so probably contributed to rupture of the septum. The thin fossa ovalis is weak and suitable place for this kind of lesions. In human medicin rupture of the septum is reported after blunt chest trauma , most often accompanied with rupture of the tricuspid valves 5,6. The proposed reason is that compressivе force occurred during isovolumic contractiоn with maximally dilated ventricles and closed atrioventricular valves5. In humans  right ventriсle is right behind the sternum , and this predispоse it to injury. In those cаses when there is rupture of the tricuspid valve and massive regurgitation , the increased pressure in right atrium leads to rupture of the septum and right to left shunt. In canine patients with degenerative mitral valve disease after the rupture of caudal atrial wall and following haemopericardium the clinical signs are collapse and sudden death. After rupture of the atrial septum the predominant signs are of right heart failure. In this case the right atrium and ventricle serves as a low pressure “sink” for severely dilated left atrium.

There are several publications about echocardiographic diagnosis of acquired atrial septal defect and rupture of the atrial septum with haemopericardium3,4. The bubble contrast study has been validated in veterinary echocardiography for diagnosis of congenital and acquired intra and extra cardiac defect and shunt7,8. In this case we have demonstrated the usefulness of so called contras washout – result of bubbles free blood entering contrast rich compartment.

In conclusion in any dog with degenerative mitral valve disease and predominated signs of right heart failure we have to look echocardiographically for atrial septal rupture. More we scan , more we find , and more we learn.

 

Learn and Travel……. stories from the vets!

learn and travelLast month started for the first time our project ” LEARN AND TRAVEL WITH VETS ON THE BALKANS”. Dr Andrey Ginchev from Bulgaria, working in Blue Cross veterinary clinic in city of Sofia, and Dr Cristian Badulescu, main vet and owner of Blue Point Vet veterinary clinic in city of Bucharest, Romania have done their externship at Clinica Veterinara Lago Maggiore – Dr Lugi Venco , Dr Luca Formaggini and Dr Mariangela De Franco. Both of them have stayed 2 weeks. I think is better they to speak about the adveture.

Dr Andrey Ginchev:

I have so many good things to say about this externship. Firstly, it was the best experience of my life! The doctors  are amazing,especially Dr Luca Formaginni and Doctor Luigi Venco –  the best doctors I ‘ve ever seen in my life.17309856_1747923415519034_2303429150324906549_n 17342975_1747923572185685_5866766753935364961_n

The team was very well organized,very welcoming and really friendly with me. I met a lot of people from Italy and had great time with them. I became more flexible to changes, more ambitious and more sociable. My desire to travel is increased. Also this practise  helps me to gain my confidence in my own abilities,so now I am more self – confident in my work.I improved my English language and also I learned a little bit Italian…,Grazie and Thank you!!!I hope to see my  Italian friends again.

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Dr Andrey Ginchev with the team of the clinic

I´m so thankful for this experience, Thank you very much for this opportunity that you gave to me!17352518_1843303222609950_1508220180873091218_n


Dr Cristian Badulescu :

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Dr Cristian Badulescu with the team of the clinic

Before I go to Lago Maggiore Clinic, I looked on the internet to see what’s going on there. I saw them with equipment high-technology facilities. I saw that they are capable and do surgical maneuvers excellent and it’s a veterinary clinic with a very good reputation. I can therefore expect to find here and a little superciliousness, or even some superiority. But it was not so! I found wonderful people, full of positive energy. Highly trained people who know exactly what they do. But what I liked most is modesty and their openness to sharing information. They do not want to hide anything. If you know what questions to put, you get all the information you need. 17522631_1751933485118027_6444855593354748323_n 17498712_1751933001784742_8726199192797128569_nI had the honor to talk to Luca Formaggini, Luigi Venco and Giorgio Romanelli. They are true celebrities in the world of veterinary medicine in Italy. I talked a lot about a lot. The impression to me of all is that all are governed by modesty and good will. So, I thank you Vets on the Balkans for this oportunity to meet great people! Great job! Bright future!17626459_1751932908451418_3868390825708698876_n 17554387_1751934088451300_4726607108209581561_n

And of course the opinion of Dr Luigi Venco:

It ‘s Always a great experience to meet and work with enthusiastic and motivated people like Dr. Andrey Ginchev and Dr Cristian Badulescu. Exchanging knowledge and experiences and find to be friends at the end. Thanks Andrey and Cristian! Thank you Vet on the Balkans!
 Vets on The Balkans
The team of Vets on The Balkans would like to express their gratitude to ALL THE VETS included in the project! THANK YOU Clinica Veterinara Lago Maggiore – Dr Lugi Venco , Dr Luca Formaggini and Dr Mariangela De Franco for the opportunity! In fact, You are Vets on The Balkans, we are just the technical part.
Thank you as well to our sponsors Pamas Trading SRL , Romania and Bayer , Romania. Because of you Vets on The Balkans is alive.

 

FELINE PLASMA CELL PODODERMATITIS

okan 2

Dr Okan Kahraman

Case Presentation

 

Vet.Okan KAHRAMAN Greenpet Veterinary Clinic     İstanbul/Turkey

 

 

 

Signalament and History

. 3month unvaccinated female cat

. The cat licking the affected foot pads also smelling bad at foot pads sometimes lamess were observed

 

 

Pysical Examination

.All foot pads were affected

.Swollen,soft,ulcerated/erosions (also contaminated with bacteria )

.and some of them were paintful while pysical examination espacially whish one has ulcerated

.vital signs were completly well

okan 1

Picture 1

.photos (include each foot pads) ( Picure 1)

 

Laboratory results

. Just Leucocystosis other parameters were okay. FIV And FelV test was (-)

Differential Diagnosis.Plasma Cell Pododermatitis.FIV ,FelV.Autoimmune Dermatoses (pemhigus complex,lupus eryt.).Neoplasia

 

Diagnosis and Treatment.

Feline plasma cell pododermatitis .

prednisolon 1mg/kg X 2 PO (3 day ) after 3.

Day 4mg/kg Metilprednisolon asetat

S.c.cefovesin (convenia ) 8mg/kg S.C.

clindamycin 15mg/kg X 2 PO (5 day ) .

 

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Picture 2

After 10 days later Photos( Picture 2)

FELINE LYMPHOPLASMACYTIC GINGIVITIS STOMATITIS COMPLEX

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Dr Adriana Moise

CASE PRESENTATION

  1. MOISE ADRIANA

TAZY-VET, BUCHAREST

 

SIGNALMENT AND HISTORY

  • FEMALE CAT , 2 YEARS OLD WAS PRESENTED FOR A CLINICAL EXAMINATION WITH HYPERSALIVATION , HALITOSIS, LACK OF APPETITE FOR PROCESSED DRY FOOD

CLINICAL FINDINGS

-THE CAT HAD NORMOTHERMIA AND A NORMAL BODY WEIGHT

-AT PHYSICAL EXAMINATION SHE PRESENTED ULCERATIVE LESIONS IN ORAL CAVITY, LOCALISED ON GINGIVAL MUCOSA, INFLAMATION ON PALATOGLOSSAL FOLDS AND PHARYNGEAL WALLS

-EDEMA WAS PRESENTED AND LOCAL LYMPHNODES WERE REACTIVE TOO

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photo 1

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photo 2

LESIONS WERE PRESENTED BILATERAL ( photo 1,2)

DIFFERENTIAL DIAGNOSTIC

-FELINE LYMPHOPLASMACYTIC GINGIVITIS-STOMATITIS COMPLEX

-FELINE CALICIVIRUS INFECTION

-FELINE HERPESVIRUS INFECTION

-FeLV-FIV

-FELINE EOSINOFILIC SINDROME

-NEOPLASIA

FURTHER INVESTIGATIONS

-FELINE CALICIVIRUS Ac –NEGATIVE

-FELINE IMMUNODEFICIENCY – FIV Ac-ELISA –NEGATIVE

-FELINE LEUCHEMIA –FELV Ag-ELISA – NEGATIVE

-THE CORONAVIRUS Ac TITRE – INCREASE

-CITOLOGY FROM IMPRESSION SMEAR – INCREASE NUMBER OF BACTERIA AND NUMEROUS ACTIVE INFLAMATORY CELLS

BLOOD TEST (BIOCHEMISTRY)  WAS NORMAL

-HEMATOLOGY REVEALS LYMPHOCYTOSIS

-CYTOLOGY AND HYSTOPATOLOGIC EXAM CONFIRMED THE DIAGNOSTIC – FELINE LYMPHOPLASMACYTIC GINGIVITIS STOMATITIS COMPLEX

 

DIAGNOSTIC

FELINE LYMPHOPLASMACYTIC GINGIVITIS STOMATITIS COMPLEX

TREATMENT

UNTIL WE GOT THE RESULTS THE OWNER BEGINS TO TREAT THE CAT WITH

-STOMODINE GEL TWISE A DAY, 14 DAYS

-CEFA CURE 20MG/KG/DAY, 10 DAYS

-SYNBIOTIC D-C 1CPS/DAY, 10 DAYS

-K9 IMMUNE SUPPORT CAT

 

-AFTER 10 DAYS OF TREATMENT THE INFLAMATION BEGAN TO REDUCE BUT THE ULCERS DO NOT HAVE THE TENDANCE OF HEALING

AFTER WE GOT THE DIAGNOSTIC THE CAT GETS THE FURTHER TREATMENT

-PREDNISON 2MG/KG/DAY, 5 DAYS; THEN 1MG/KG/DAY , 5 DAYS FOLLOWEDBY EVERY OTHER DAY

-STOMODINE GEL TWICE A DAY LOCAL

-HONNEY WITH PROPOLIS LOCAL

WHEN SHE CAME FOR THE EVALUATION AFTER 5 DAYS OF TREATMENT WE SAW THAT THE LESIONS HAD A TENDANCE TO REDUCE, BUT AFTER ANOTHER 5 DAYS THE LESIONS WERE EXACTLY THE SAME AS THE BEGINNING

-WE DECIDED TO INTRODUCE CYCLOSPORINE IN THE TREATMENT

-CYCLOSPORIN 7MG/KG/DAY

derder1

-THE CAT IS PERMANENTLY MONITORIZED ; HLG IS MADE EVERY 2 WEEKS

-AFTER 2 WEEKS OF TREATMENT THE LOCAL INFLAMATION BEGINS TO REDUCE

-AFTER 1 MONTH OF TREATMENT THE LESIONS FROM ONE SIDE WERE HEALD

-THE CAT IS STILL UNDER TREATMENT

-THERE IS NO SIGN OF SECOND EFFECTS OF CYCLOSPORINE

 

Bacterial species isolated from cats with lower urinary tract infection and their susceptibilities to cefovecin

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Dr Banu Dokuzeylül

Banu Dokuzeylül1, Beren Başaran Kahraman2, Alper Bayrakal1, Belgi Diren Siğirci2, Baran Çelik2, Serkan Ikiz2,
Abdullah Kayar1* and M Erman OR1

Abstract

Background: The aim of this study was to determine the bacterial species recovered from 61 cats with lower
urinary tract infection (LUTI), and their susceptibility to cefovecin in vitro.
Results: The clinical signs and final clinical diagnosis for cats with confirmed LUTI were also reported. After physical
examination of the cats, urine samples including ≥5-6 leucocytes in microscopic evaluation were cultured using
bacteriological techniques. The isolates were identified by conventional microbiological methods and tested for
in vitro susceptibility using the Kirby-Bauer disc diffusion method recommended by the Clinical Laboratory Standards
Institute. Bacterial growth was observed in 16 of 61 urine samples. Antimicrobial susceptibility tests showed that 13 of
16 (81%) isolates were susceptible to cefovecin. The most frequently isolated bacterium from cats with signs of lower
urinary tract infection, was Escherichia coli.
Conclusion: Cefovecin was found to be effective in cats with LUTI. Because cefovecin is a new antimicrobial agent in
veterinary medicine, there are only few studies about urine culture of cats with LUTI. It is the first study on in vitro
activity of cefovecin against bacterial isolates from cats with lower urinary infections in Istanbul, Turkey.
Keywords: Cat, Urinary tract infection, Urine culture, Antimicrobial susceptibility, Cefovecin

 

Background
Lower urinary tract infections (LUTI) are rarely seen in cats, dogs and human beings. Various lower urinary tract
disorders can predispose to opportunistic infections as a complication of the underlying disease or its treatment,
while bacteria can be the initial cause [1]. Urine culture is the gold standard used to confirm the diagnosis of urinary tract infection (UTI). The urine sample used for this purpose should be obtained by cystocentesis to avoid bacterial contamination from the lower urogenital tract flora [2]. In urinary tract infections of cats and dogs, the most
commonly isolated bacterial species were reported as Escherichia coli, Proteus spp., Staphylococcus spp. and Streptococcus spp., although the prevalence of the various species varied considerably [3,4]. Cephalosporins belong to the beta-lactam group of antibiotics and they are originally derived by hydrolysis from the natural compound of Cephalosporin C. This class is bactericidal and acts by inhibiting the synthesis of the peptidoglycan
layer of the bacterial cell wall through binding to the penicillin binding protein (PBP) [5]. Cefovecin sodium [Convenia®; Pfizer Animal Health; USA] is a newly developed, semi-synthetic, extended-spectrum injectable third-generation cephalosporin administered at 8 mg/kg subcutaneously (SC) for the treatment of
UTI and skin and soft tissue infections in dogs and cats and it has been approved for subcutaneous (SC)
injections in cats since 2006 in EU and 2008 in USA [4,6-9].Third generation cephalosporins are generally less active
than members of the first or second generation formulations against gram-positive organisms (e.g., Streptococcus
spp. or Staphylococcus spp.) [5]. Stegemann et al. [4]have reported that cefovecin showed good activity
against Gram-negative organisms isolated from dogs and cats, including Escherichia coli, Pasteurella multocida,
Klebsiella spp. (including K. pneumonia), Enterobacter spp. and anaerobic-growing pathogens Fusobacterium spp.,
Bacteriodes spp., Prevotella oralis. However it was not effective against most Pseudomonas aeruginosa isolates.
The aim of this study was to determine the bacterial species recovered from cats with LUTI, and their susceptibility
to cefovecin in vitro. The clinical signs and final clinical diagnosis for cats with confirmed LUTI
were also reported.

Methods
Samples
In this study, 90 cats with one or more urinary clinical signs such as stranguria, haematuria, pollakiuria, inappropriate urination, excessive licking of the genital area and frequent and/or prolonged attempts to urinate were physically examined at the Department of Internal Medicine,Faculty of Veterinary Medicine, Istanbul University and
their anamnesis was gathered. Complete Blood Count(CBC), blood serum biochemistry (Serum glucose, blood
urea nitrogen (BUN), creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST)) and urine analyseswere performed in all patients. Twenty-nine cats were excluded from the study because antimicrobial treatment had already commenced in private veterinary clinics prior to our physical examination. Sixty-one cats with no antimicrobial treatment and including ≥5-6 leucocytes in urine microscopic examination were included in the study.The examination focussed on the presence of pyuria (≥5 white blood cells/high magnification (40x objective; highpower field, (hpf)) which were indicator of LUTI. The cats in the sample group were from different breeds: mixed (n:38), Persian (n:11), Siamese (n:5), Turkish Van (n:3), Turkish Angora (n:4). Forty-one cats were male, 20 catswere female. Five of the cats were one year old or younger, 38 between 2–7 years old and 18 were 8 years old or older. Samples of 5 ml of urine were collected by ultrasoundguided cystocentesis. Cats were restrained in lateral recumbency, the caudal abdomen area was cleaned with alcohol then the needle was inserted. Urine samples
for culture and antimicrobial susceptibility tests were sent to the laboratory within 1 hour, stored in cooling
boxes.Medical imaging Abdominal radiography and ultrasonography were also performed to diagnose underlying urinary diseases/disorders of the cats. Abdominal ultrasonography was performed using a 3.75-MHz convex transducer (Schimadzu 350-A,Shimadzu Corporation, Kyoto, Japan).

Culture
The samples were sent for bacteriological examination to the Laboratory of the Microbiology Department of
Istanbul University, Faculty of Veterinary Medicine. Urine samples were inoculated onto nutrient agar supplemented with 7% sheep blood (blood agar) and MacConkey agar plates. While the MacConkey agar plates were incubated aerobically, the blood agar plates were incubated under aerobic and microaerobic conditions at 37°C for 7 days.The colonies were examined macroscopically and then microscopically using Gram staining. Biochemical identification was performed by conventional methods and all the isolates were confirmed with API systems (BioMérieux, SA, Marcy I’Etolie, France) [10,11]. A bacterial count of more than 103 cfu/ml was considered diagnostic of UTI [9]. Cultures with no growth after 7 days were interpreted as negative.

Antimicrobial susceptibility tests

The antibiotic susceptibility tests were performed according to the Kirby-Bauer method recommended by
the Clinical Laboratory Standards Institute (CLSI) to select the optimal antimicrobial agent for treatment [12].
The zone of inhibition around the disk (30 μg cefovecin) was measured. The inhibition zone of ≥ 23 mm was considered as susceptible, while 20–22 mm as intermediate and ≤ 19 mm as resistant [6,12].banu

Statistical analyses
The results were analysed with the SPSS 13.0 programme. The Chi-squared test was used for the comparisons of
gender groups and age groups with respect to bacterial growth. Differences were considered significant at
p < 0.05.

Results
Clinical signs
The most common presenting clinical signs of bacterial lower urinary tract infection in cats were pollakiuria (n = 41)
followed by stranguria and haematuria, respectively. Clinical disorders associated with lower urinary tract signs
Disorders and the number of cats involved are given in Table 1. Sixteen culture-positive cats were diagnosed
with the following conditions: urethral plaque (n:4), feline idiopathic cystitis (n:1), haemorrhagic cystitis
(n:2), bladder stones (n:1), acute renal failure (n:3), chronic renal failure (n:2), diabetes mellitus (n:1), other diseases
(n:2). The final diagnosis was reached following anamnesis, physical examination, blood and urine analysis, medical
imaging and urine culture.banu1

Complete Blood Count (CBC) and blood serum biochemistry
All the animals in the study were found to be within the normal range of CBC parameters. At the same time,
leucocytosis was not observed in 16 culture-positive cats. Biochemical blood serum values (Serum glucose, blood
urea nitrogen, creatinine, alanine aminotransferase, aspartate aminotransferase) were determined for every patient.
In our study, these parameters were found not to be significant.
Medical imaging
Blood clot formation was seen in the urinary bladder in cats diagnosed with haemorrhagic cystitis. The echogenicity of the clots was variable (hypo- to hyper-) and the bladder wall was thickened. Bladder stones were seen hyperechoic
and distal shadows were detected. The bladder wall was also thickened in cats diagnosed with renal failure and cystitis. No abnormal findings were seen in cats with urethritis.The sonographic appearance of transitional cell carcinoma was irregular, its shape was irregular and the echogenicity seemed non-homogenous. The ultrasonographic findings are compatible with our diagnosis.
Urine analysis microscopic evaluation
Leucocyte numbers detected by urine microscopic evaluation are summarized in Table 2. Bacterial growth was observed in 16 of 61 (26.2%) cats urine samples with a leucocyte count ≥ 5–6 leucocytes
(Figure 1). All the isolates were pure cultures.

Bacterial growth and susceptibility testing

Bacterial growth was observed in 5 of 20 (25%) urine samples of female cats and in 11 of 41 (26.8%) samples of male cats (p > 0.05). Three in five cats (60%) with bacterial LUTI were 1 year old or younger, 9/38 (23.6%) 2–7 years old and 4/18 (22.2%) 8 years old or older (p > 0.05). In this study, no significant difference was found between female and male cats with bacterial LUTI (p = 0.879). The differences among age groups were also not significant
(p = 0.200). Antimicrobial susceptibility tests results showed that 13 of 16 (81%) isolates were susceptible to cefovecin. E. avium and S. epidermidis isolates were resistant and Arcanobacterium renale isolate was intermediate.banu2

Discussion and Conclusions

Incorrect therapy of urinary tract disease, overuse and misuse of antimicrobials can have negative effects on patient
health (e.g. failure to resolve infections), the allocation of resources (e.g. need for repeated or prolonged
treatment), and public health (e.g. antimicrobial resistance) and may raise regulatory concerns (e.g. antimicrobial use)[13]. The antimicrobial activity of cefovecin is similar to that of other cephalosporin antibiotics, which share low
toxicity and good activity against many Gram-positive and Gram-negative aerobic bacteria [6]. Bacterial urinary tract infections (UTIs) in cats are relatively rare [14]. Studies of cats with clinical signs of lower urinary tract disease (dysuria, stranguria, pollakiuria) have consistently shown that the overall prevalence of positive bacterial urine cultures is <3% [2,15]. Some studies have reported much higher prevalence rates (15–43%) in cats that have their urinary tract defence mechanisms compromised by the effects of other diseases and/or by the treatment [2]. In this study, bacterial growth was observed in 26.2% of cats’ urine samples with ≥ 5–6 leucocytes. Our findings confirm to a
large extent to the results reported by Weese et al. [15]. Bacteriuria is generally seen in older cats [16]. In our
study, the percentage of young cats (≤1 years old) was highest. Most of the younger cats in our sample group
spent time both indoor and outdoor. They generally hunted and usually drank water from flower bowls and
ponds. These risk factors and their close contact with stray cats, may have contributed to the high prevalence
of urinary problems in this age group compared to indoor and older cats. Urine analyses were shown to be a useful indicator for UTIs. The most commonly isolated bacteria of cats with urinary tract infections were reported to be Escherichia coli, Enterococcus spp., Staphylococcus spp. and Streptococcus spp. [4,6,9]. Our results support these findings.
Proper and timely diagnosis is critical for the treatment of lower urinary tract infections as well as for the
selection of appropriate antimicrobials and drugs. Cefovecin has been specifically developed for the animal
practice as a long-acting third-generation cephalosporin with duration of action of 14 days. Stegemann et al. [4]
reported that cefovecin exhibited a broad activity against a range of Gram-negative pathogens and was not active
in vitro against P. aeruginosa. Wernick and Müntener [5] have reported that cefovecin showed no bactericidal
activity against Enterococcus spp. but it is active against Arcanobacterium renale. Our results (81% of isolates
susceptible to cefovecin) are in agreement with these findings. However, E. avium isolate was found to be resistant,
and Arcanobacterium renale isolate to be of intermediate susceptible to cefovecin. Stegemann et al. [4] reported that cefovecin was not appreciably active against Enterococcus spp., although in this study E. faecalis
isolates were found to be susceptible in vitro. While literature suggests good activity of cefovecin against coagulasenegative staphylococci, in this study S. epidermidis isolate
was resistant to cefovecin [4,8]. It is known that antimicrobials are the cornerstone of LUTI therapy. Despite the high cost of cefovecin in Turkey, its effectiveness and usefulness have been discussed in this study. Cefovecin is one of the antimicrobial agents that can be used in lower urinary tract infections and it is easy to administer a single injection.

Scabies incognito in dog

stef artStroe Marina- Ștefania

6-th year student at FMVB, Faculty of Veterinary Medicine of Bucharest

Rottweiler dog, 1 year old, male, intact develop intense pruritus, mild erythema, crusts and less-hairy skin on the phalanges, hocks; no other cutaneous lesion than this diffuse erythema.

  • Other differentials (demodicosis, dermatophytosis, contact dermatitis, Malassezia dermatitis, hipersensitivity).
  • Pinnal-pedal reflex: rubbing of the ear margin and may obtain a scratch reflex.
  • The pinnal-pedal reflex in this case was positive
  • Microscopy

Superficial skin scraping: negative but false-negative results are commnon because mites are extremely difficult to find.

derm3

Macroconidia Alternaria alternata

derm2

Eggs/ova mites

Deep skin scraping: negative (for Demodex).

derm4

Malassezia spp.

Scotch test: detection of eggs/ova mites Sarcoptidae like, derm5 derm6Malassezia 8/OIF, bacterial cocci, macroconidia Alternaria alternata.

Serology (ELISA): detection of IgG antibodies against Sarcoptes. This is highly specific and sensitive test but false-negative results can occur. In this case the test was negative.

 

Diagnosis: “Scabies incognito”

 

Treatment and prognosis

  • Topical treatment applied to the entire body two times per week, 4-6 weeks. Bathing with a shampoo that contain chlorhexidine and antifungal (ketoconazole) – KetoHexidine shampoo 1%ketoconazole, 2%chlorhexidine.
  • Omega 3 and Omega 6 fatty acid supplements, which reduce inflammation and itching – Megaderm >10 kg, 1 dose/day, 1-2 months.
    • Systemic treatment with Ivermectin: 300-400 mcg/kg po or sc, once weekly for weeks. I use this scheme for 5 administration.
    • Recheck: progress, hair regrowth, decrease of the lesions.
    • The prognosis is good. S. scabiei is a highly contagious to other animals and to humans.