Portosystemic shunts are anomalies that allow blood returning from the gastrointestinal systems to bypass the liver and pass directly into the systemic circulation. When this occurs, toxins from gastrointestinal tract that are normally cleared by the liver are shunted directly into the systemic circulation. This build-up of these toxins in the bloodstream leads to the clinical signs commonly seen in animals with these shunts. Three categories of clinical signs commonly are associated with the presence of these shunts: neurological, gastrointestinal and urinary. Neurological signs include seizures, head pressing, circling, lethargy and blindness among others- hepatic encephalopathy. Gastrointestinal signs include vomiting, anorexia, weight loss and a reduced rate of growth. Urinary tract signs, including stranguria, pollakiuria and hematuria are generally related to the development of urate cystoliths secondary to the presence of ammonium biurate crystals in the urine.
Contrast CT study with 64 slice scanner was performed with i.v administration of iopamidol solution 370g/ml (contrast agent) in dosage 1ml/kg.
CT findings: There is a abnormal communication between the portal vein and the caudal vena cava using the splenic vein. The portal vein decreases in diameter cranial to the shunt exit and splienic vein is enlarged. The both kidneys are too big and liver is too small.
Congenital extrahepatic splienocaval-caval shunt
The treatment consisted of medical and surgical approach. Ten days before the surgery the condition was managed with amoxicillin 12,5 mg/kg p.o q12h for 15, Lactose oral solution 67g/ 100ml in dosage 1ml/kg p.o q12h and hydrolyzed protein food.
The surgery was planned in great teamwork with d-r Kaloyan Voichev in Multidisciplinary Veterinary Clinic Bulgaria. The operation was performed with the kind assistance of the whole team. The operational approach consisted of midline celiotomy and isolation of the shunt from surrounding structures and placement of thin cellophane band surround the vessel.
Max recovered well from the anesthesia and was discharged after 48 hours with amoxicillin 12,5 mg/kg p.o q12h for 10days, Lactose oral solution 67g/100ml in dosage 1ml/kg p.o q12h for 15 days and hydrolyzed protein food. In postoperative period Max was vomiting sporadic within one week, but with good appetite. The vomiting was stopped with maropitant 1mg/kg s.c q 24h for 3 days.
One month after the surgery Max doesn’t show any clinical signs.
United Veterinary Clinic, 34 Tzarevetz street, Varna, Bulgaria
The aim of this case report is to describe the technique and clinical outcome of limb salvage procedure in a cat with а distal segmental femoral bone deficit due to bone nonunion using customised expandable stifle arthrodesis plate.
3.5 years old female cat was presented to us after unsuccessful repair of multiple fractures of the right femur. The current condition of the cat was as follow: Gustilo-Anderson type 3b open intercondylar and distal diaphyseal femoral fracture, fracture of the femoral head, fracture of the greater trochanter, patella ligament rupture and extensive skin and soft tissue loss in the right stifle region (1). The aim of the treatment was anatomical reconstruction of the femoral fractures, temporary transarticular fixation and soft tissue reconstruction using ipsilateral mammary chain (caudal superficial epigastric axial pattern flap) with a future plan of performing stifle arthrodesis due to a non repairable patella tendon rupture (2). Surgical goal was achieved, but sequestration of the whole distal femoral segment was confirmed radiographically two and a half months after the revision surgery. As the owner declined amputation and insisted for limb salvage procedure, personalised 3D expandable arthrodesis plate was designed, fabricated and used for achieving stifle arthrodesis.
Picture 1-Gustilo-Anderson Grade 3b open distal femur fracture
Picture 2-Shirley, soon after the first surgery when reconstruction of the femur and closure of the soft tissues were performed using caudal superficial epigastric axial pattern flap
Two radiographic examinations immediately postoperatively and five months after surgery were performed. Four months follow up x-rays showed no signs of periprosthetic bone resorption which seems to be in the main concern in this clinical case and whether the porous spacer will be integrated to both the femur and the tibia.
Designing and fabrication of the customised implant is a complex, time consuming and cost depending process, but 3D printed expandable stifle arthrodesis plate could be a realistic option for hind limb preservation in cats. Further cases and long term follow up are required to determine the success and complication risk of the procedure.
The femur is the most commonly fractured bone in cats, accounting for more than 30% of feline fractures (3). Those involving the shaft and the distal femur are most commonly seen. Inadequate fracture fixation leads to poor mechanical stability and further compromise of the biological environment, especially if there are migrating implants. The basic tenets for treatment of joint fractures are reestablishment of articular congruity, joint stability, axial alignment and preservation of joint mobility (4). Patella tendon rupture is unusual condition and it is most commonly due to a sharp trauma (5). In our case, an iatrogenic rupture of the patella tendon was suspected due to migrating implants following surgical stabilisation of the distal femur fracture. Arthrodesis of the stifle joint is a salvage treatment option if joint function cannot be preserved with another methods. Arthrodesis will leave the cat with significant gait alterations, and careful consideration should be made before electing for this option. The angle of fusion is estimated from the standing angle of the contralateral limb, and is around 110°. Strict attention should be paid to surgical technique to avoid complications. These tend to occur because of the long lever arm created, which can result in fracture of the femur or tibia at the implant–bone junction. Implants should end in metaphyseal areas and not over the narrowest part of the diaphysis to avoid this complication (6).
3.5 years spayed female cat was presented to us after unsuccessful repair of multiple fractures of the right femur. After removal of the existing implants, reconstruction of the articular fracture was performed using 2.4mm lag screw and antirotational K-wire. 2.0 mm SOP plate was applied as medial transarticular stabilising implant and for fixation of the supracondylar fracture of the femur. Two K-wires and tension band wire were used for fixation of the greater trochanter. The femoral head seemed already stable and no attempt for surgical stabilisation was performed.
Bacterial culture was done during the first surgery and the results came back as Methicillin-resistant staphylococcus. Based on antibiotic susceptibility testing, Amikacin was used as an appropriate antibiotic for seven days. Unfortunately no signs of fracture healing were noticed in the next 8 weeks and small fistulous tract appeared at the lateral aspect of the stifle joint.
Picture 3-Femur fracture configuration with loosed implants before, and the Picture 3-femur anatomically reconstructed after the revision surgery. At the most right radiograph – signs of osteomyelitis and sequestration of the whole femoral condylar segmen
In a subsequent surgery all implants were removed together with the distal femoral fragment, a transarticular external skeletal fixator was applied and CT was performed immediately after that. Bacterial culture has been obtained and came back again positive for Methicillin-resistant staphilococcus. Chloramphenicol was initiated for 7 days p.o. based on bacterial sensitivity testing.
A further attempt was initiated for designing and producing of expandable stifle arthrodesis plate. The aim of the proposed implant was to provide stifle arthrodesis but at the same time to replace the distal femoral segment for overall limb length preservation. The implant was designed by CABIOMEDE Vet, Poland and consisted of two solid portions with locking screw holes and central porous portion for promoting bone ingrowth. The length of the porous part of the plate was 28mm and was intended to replace the missing distal femoral segment.
Picture 4-Shirley with an applied transarticular ESF, waiting for a stifle arthrodesis surgery
Two DCP holes were designed at both sides of the solid part of the plate in order to provide compression on the osteotomised bone segments against the porous part of the plate. The rest of the plate holes were locking ones and were arranged in such a way so they can engage each bones in a different angle providing some sort of orthogonal fixation and at the same time avoiding the holes form the existing ESF pins. The plate was designed to span almost the entire length of both the femur and the tibia, avoiding possible periprosthetic fracture. Limited contact under-plate surface was designed, reducing the implant footprint on the bone because of the concern of too much implant wrapping and possible implant-associated infection. The customised implant and dedicated cutting guides were printed from Polygon Medical Engineering, Russia.
Picture7-Renderings of the femur, tibia and lower extremity showing the position of the custom plate. The arrows are indicating the position of the two non-locking screws which are going to provide compression of the bone segments against the porous part of the plate.
Picture 8-A cutting guides designed for precise osteotomies of the bone ends and proper fit of the customised plate
Picture 9-The stifle arthrodesis expandable plate is printed from titanium alloy (Ti6Al4V ELI) which is the gold standard for orthopedic implants when osteointegration is required. Figure 9
During the surgery, the patient was positioned in a lateral recumbency with the affected limb upermost and cranial skin incision was performed starting from the most proximal aspect of the femur to the the most distal aspect of the tibia. A standard lateral approach to the femur was made which continued over the cranial aspect of the stifle area and on the craniomedial aspect of the tibia. The cutting guides were secured and the bone ends were osteotomised. The plate was then attached to the cranial aspect of the tibia and the femur using temporary K-wires through dedicated holes. The most distal tibial plate hole and the most proximal femoral one were designed for 2.0mm non locking cortical screw to be inserted in a neutral position and two gliding holes at both sides of the porous part of the plate for 2.4mm cortical screws in a compression mode. Autogenous cancellous bone graft was obtained from the proximal aspect of the contralateral humerus and applied at both sides of the porous part of the plate. All needed 2.4mm locking screws were predetermined and their length marked on the plate for faster and precise application.
Picture 10-Tibial cutting guide on place and secured with K-wires (on the left). The 3D printed arthrodesis plate fixed to its final position (on the right)
Picture 11-Medio-lateral radiographs immediately after removal of the transarticular ESF and the application of the printed arthrodesis plate
Picture12-Shirley a few days after performing the limb salvage surgery
This case report describes fracture complications in a feline femur multiple fracture and application of customised 3D printed expandable plate for stifle arthrodesis as a limb salvage procedure. The customised plate made of Titanium alloy has the features of the replacement of missing bone, providing initial fixation using screws (both non-locking and locking ones) and long-term bone fixation (bone ingrowth) (7). Our main concern was mainly the long-term bone ingrowth and the bending and shear strength of the plate at the porous/solid part of the implant. Five months after the surgery (at the time of this article has been published) there are positive radiographic signs for osteointegration (no signs of peri-implant bone osteolysis, lack of osteolysis around the screws and progressive bone bridging over the porous part of the plate). In a recent paper (8), porous implants without hydroxyapatite coating showed a consistent bone ingrowth in a canine transcortical model. Despite the concern of poor functional limb after limb sparing/fuse of the stifle joint (4) , our cat was performing extremely well and almost fully weight-bearing on the operated leg about ten days after surgery. Till today she improved her gait a lot and the limb use while she is running and playing with toys.
“Shirley is doing great. She really behaves as a kitten which never had an issue with that leg” – Shirley’s owner, 25.09.2020
Picture 13-Five months follow up radiograph. Close up views to the bone-implant interface
Picture 14-Abnormal sitting “on a side”. Shirley, about five months after stifle arthrodesis
2 weeks after the surgery:
Kim P.H, Leopold S.S. Gustilo-Anderson classification. Clinical Orthopaedics and Related Research 2012, 470:3270-3274
Moors, A. Axial pattern flaps. In: BSAVA Manual of Canine and Feline Wound Management and Reconstruction. BSAVA: 2009; 100 – 111
Hill, F.W.G. A survey of bone fractures in the cat. J.Small Animal Practice 1977, 18, 457-463
DeCamp C.E, Johnston A.Spencer et al. Principles of joint surgery. In: Handbook of small animal orthopedics and fracture repair. Elsevier, Inc. 2016; 211-229
Das S., Langley-Hobbs S., et al. Patellar ligament rupture in the cat: repair methods and patient outcomes in seven cases. Journal of Feline Medicine and Surgery 2015, Vol. 17(4) 348-352
Glioblastoma is a malignant tumor of the nervous tissue. This is the fourth degree of astrocytoma. It is more common in the frontal and temporal lobes. Good contrast enhancement in magnetic resonance imaging, edema of the surrounding tissue is often observed. Macroscopically, it has well-defined borders.
Male dog, named Jazz, 9 years old, husky, brought to the clinic on 01.07.2020
There is worsening of the condition since the day before, the animal was no longer interested in food or water, there was lack of coordination. The clinical examination reveals that the animal was obtunded, but still responsive and it was responding to commands, given by the owners, it was also consciously resisting some tests, during the examination, which it doesn’t seem to like. No evidence of seizures. Posture – head turn to the left and tilt to the right. Gait – vestibular ataxia. Cranial nerves – absent menace reaction on the left. Postural reactions – decreased proprioception of the left pelvic limb, decreased hopping reaction of the right thoracic limb. Spinal reflexes – normal. Localization – the decreased proprioception only on the left pelvic limbs cannot definitively determine the localization. Due to the left head turn, the localization is determined in the left forebrain or peripheral vestibular syndrome. Differential diagnoses: ischemia, metabolic disease, neoplasia. MRI is recommended.
On 02.07.2020 blood was taken for CBC – nothing remarkable, Biochemistry – a slight increase in glucose and AST, ALP – 455.99 (10.6-109 U / L). FT4 and TSH are normal.
On 03.07.2020, an MRI was performed. The imagining showed a mass in the left cerebellum, with mass effect on the brainstem and cerebellum, obstruction of the normal outflow of cerebrospinal fluid and for that causing hydrocephalus. Also edema in the surrounding tissue.
Preoperative preparation was started with Mannitol 1.5 g/kg/12h i.v., Methylprednisolon 15.78 mg/12h i.v. Antibiotic therapy – Ceftriaxone – 1 g/12h i.v.
On July 4, 2020, a left suboccipital craniectomy was performed for removing the mass, part of which was sent for histopathology to Laboklin, Germany. Part of the capsule of the tumor has not been removed due to adhesions with the brainstem and the risk of injury during the process of removing it. An artificial dura was placed on the defect to prevent the leakage of cerebrospinal fluid.
After the surgery Jazz was recovering very well. There was a manifestation of vertical nystagmus, which disappeared quickly by itself. Antibiotic therapy was continued, as well as mannitol and methylprednisolone therapy 24 hours after the surgery. Meloxicam was included for pain management 12 hours after the steroids were stopped
The first day after the surgery Jazz was still slightly uncoordinated and his head was still with negligible turn, but he was able to get up and walk on his own.
On July 6, 2020, 48 hours after the surgery, Jazz was more stable, progressively getting better and eating and drinking water.
On July 9, 2020, in the middle of the day Jazz’s condition got worse. He started to turn his head to the left again. On the same day, the histology result was received:
Glioblastoma with high degree of malignancy.
On 10.07.2020, steroid therapy was started, which led to a fast improvement. On the next day Jazz was sent home with home therapy of prednisolone 0.5mg/kg/12h.
Consultation with oncology department for chemotherapy was recommended
On 17.07.20 the sutures were removed from the skin incision, Jazz’s therapy with prednisolone (0.5 mg/kg /12h) was continued. There was a slight incoordination and tilt of the head.
The nerve sheath is a layer of myelin and connective tissue that surrounds and insulates fibers in the peripheral nerves. A nerve sheath tumor is an abnormal growth within the cells of this covering. Nerve sheath tumors include schwannomas, neurilemmomas, and neurofibromas. The trigeminal nerve is the most frequently affected cranial nerve. This results in unilateral atrophy of the temporalis and masseter muscles and facial dysesthesia or anesthesia. Eventually, brain-stem compression can develop.
Signalmen: 12 years old, female, castrated Labrador retriever
History: The owner noticed that dog`s head has not normal shape.
Case presenting signs: Chronic right trigeminal nerve deficit with atrophy of the temporalis and masseter muscles. Reduced facial sensation, absent palpebral reflex with normal menace response reaction and reduced right corneal sensation and enophtalmus.
Clinical examination: The overall condition of the dog was normal with normal appetite, good muscle and body condition except the right temporalis and masseter muscles. Internal body temperature 38,8 ; Normal respiratory and heart rate; Color of mucous membranes – pink; CRT – 1,5 sec.
Mentation and behavior- Normal
Gait – Normal
Cranial nerves – right trigeminal nerve deficit
There was no change in conscious proprioception and bladder function was normal.
Case work-up: CBC – without changes; Biochemistry – Elevation of Liver enzymes (ASAT 69 IU/L; ALAT 90 IU/L)
Contrast MRI study of the head was performed with GE MRI 1.5 Tesla.
There is a large extra-axial T1 hypointense, T2 hyperintense tubular mass that arises at the origin of the right trigeminal nerve and extends rostrally through the trigeminal canal of the temporal bone. The right oval foramen is enlarged because of involving the mandibular branch. Atrophy and denervation of the masticatory muscles (temporalis, masseter and pterygoid muscles) is present with T1-, T2-hyperintesity, reduction of the muscle mass and replacement by fatty tissue. Post contrast images shows marked contrast enhancement of the right trigeminal nerve compared with the left (mild enhancement of the left trigeminal nerve is physiologic).
Right Trigeminal nerve sheath tumor
Intracranial peripheral nerve sheath tumors are relatively uncommon tumors in dogs. Clinically, dogs with intracranial PNST have one or more of the following clinical signs: ipsilateral masticatory muscle atrophy, loss of facial sensation, and Horner’s syndrome. Signs from intracranial brainstem compression can also occur. Radiation therapy is a commonly used modality in the treatment of intracranial PNST. Stereotactic radiation therapy (SRT) is one method used to deliver a curative dose of external beam radiation therapy. This precise and conformal treatment directly targets the radiation at the tumor with rapid dose drop-off, which allows for very high doses of radiation to be administered without increasing toxicity to adjacent normal tissues.
Uterine prolapse is a relatively uncommon complication of parturition, occurring infrequently in cats. Ekstrand and Linde-Forsberg reported it as accounting for 0.6% of the maternal causes of dystocia. The etiology of uterine prolapse is unknown in queens. The prolapse can be complete, with both horns protruding from the vulva, or limited to the uterine body and one horn. Uterine prolapse requires immediate attention. It is an obstetric emergency.
A 1-year-old female European Shorthair outdoor cat weighing 2.5 kg was presented to our clinic with 96h after parturition. Two days before presentation his caretaker saw “something like placenta to hanging behind the cat”.
On physical examination, the animal was alert, 38.3 °C and slightly dehydrated. The pulse and respiratory rate were both within normal ranges. The prolapse of the uterus was complete, with both horns protruding from the vulva. The exposed tissue was congested and slightly edematous with a few small areas of necrosis, and was covered with debris.
The exposed uterus was palpated to rule out the possible presence within it of any abdominal organs such as the urinary bladder.
Tips & Tricks. Ultrasound examination of the abdomen and the uterine prolapse can be performed to reveal the position of the urinary bladder and the intestine.
Tips & Tricks. Topical application of Manitol 10% can be performed to reduce the oedema in prolapsed tissue.
CBC and biochemical analysis were performed. CBC showed WBC 38.8 x109/l, HGB 89 g/l, HCT 0.265 l/l. Other parameters of the biochemical analysis and packed cell volume were all normal in range.
After premedication with domitor/buprenorphine/ketamine, anesthesia was induced with propofol after preoxygenation. An endotracheal tube was inserted and anesthesia was maintained with isoflurane. Preoperative antibiotics: Cefazoline i.v. and enrofloxacine s.c.
The surgery was performed in two steps: first the replacement of the prolapsed horns and uterus and then ovariohysterectomy.
Tips & Tricks. If the prolapsed organ is in very good condition and the cat is a valuable breeding animal you can try conservative treatment. Replacement, following by medical treatment Oxitocin (0.5-1.0 UI) and antibiotics. Complications may develop from minor laceration of the uterus to septicemia or uterine rupture.
Tips & Tricks. Do OHE! It is the safest option in this situation.
Tips & Tricks. OHE can be performed before reduction if the uterus is too contaminated or necrotic or ruptured.
In this reported case the uterus looked in good condition.
Gross debris was removed gently from the prolapsed organ by irrigation with hypertonic solution.
Then the uterus was reponeted carefully, starting from tip of the horns, one by one.
Tips & Tricks. Use some type of lubricant, like Vaseline.
Tips & Tricks. Oxytocin 0.5 IU can be administered directly in prolapsed tissue to facilitate uterine involution prior to replacement. Attention! Oxitocin make uterine tissue fragile.
Tips & Tricks. An episiotomy may be performed to assist uterine replacement.
Tips & Tricks. Cystocentesis may be performed before attempting to reposition the uterus.
Tips & Tricks. Use monofilament suture material, like PDS 2-0 for cervix ligatures. Polyfilament suture can cut the weakened uterine tissues like saw.
Apposition of vulvar lips was performed with a horizontal mattress pattern without tightening to allow vulvar discharge and normal urination.
This suture was removed after 24 h.
The queen recovered well. Postoperative treatment included the use of an Elizabethan collar and intravenous fluid therapy.
The day after surgery, the cat was alert, urinated normally and there was mild discharge from the vulva.
Antibiotic treatment for 5d amoxicillin/clavulanic acid -Synulox and Enrofloxacin.
Tips & Tricks. Postoperatively, urination should be monitored as swelling and pain can lead to urethral obstruction.
Although rare, uterine prolapse should be managed as an emergency. The treatment for uterine prolapse depends upon the severity of damage to the uterus. The prognosis following treatment for a uterine prolapse is guarded to good, depending on the timing of veterinary intervention.
Veterinarians from 12 countries have shown their concern for the veterinary world in time of Pandemic and social isolation.
We would like to express our gratitude to all of them:
Romania: Dr Robert Popa, Dr Constantin Ifteme, Dr Florin Delureanu, Dr Raluca Zvorasteanu, Dr Lucian Fodor, Dr Diana Soare, Dr Giulia Nadasan, Dr Alexandra Curac, Dr Alexandru Vitalaru, Vet student Ilinca Zarinschi
Bulgaria: Dr Yovko Haralanov, Dr Spas Spasov. Dr Luba Gancheva, Dr Todor Kalinov, Dr Sofia Sinadinova, Dr Yavor Stoyanov
Serbia: Dr Andrija Dakovic, Dr Zoran Loncar, Dr Nikola Katic, Dr Goran Cvetkovic, Dr Ivana Jovandine
Slovenia: Dr Ana Nemec
Croatia: Dr Lea Kreszinger
North Macedonia: Dr Svetla Drakulovska
Turkey: Dr Murat Saroglu
Italy: Dr Luca Formaggini
UK: Dr Luca Ferasin
Belgium: Dr Ann Criel
Switzerland: Dr Katharina Brunner
Portugal: Dr Dr Goncalo Da Garca Periera
Here you can watch all of them here in our channel: https://www.youtube.com/channel/UCj3rBMaB1sD1hXHWIhcrkmw/videos
Sandra is a French bulldog whose case I have been following for 2 years.
Sandra is regularly vaccinated and with regular tick and flea treatmen and dewormig as well .
When we first met, Sandra was prescribed 2 mg of Prednisolone per kg in the morning and evening.
There were already 2-3 diets with hypoallergenic food with no results .
When the dog is on Prednisolone is very good, with no symptoms.
Sandra has been on immunotherapy for two years and during this time there are a total of 3-4 exacerbated periods with superficial bacterial infection.
To control these infections we tried various antibacterial shampoos and the ONLY systemic antibiotic we used was amoxicillin with clavulonic acid (at least one month ingestion)
During immunotherapy, Sandra takes 1/4 of Prednisolone at 5 mg every 36 hours (Sandra weights about 15 kg throughout the therapy).
For two years, Sandra was very good, and controlling the pyoderma was relatively easy without changing the doses of immunotherapy and without changing the dose of Prednisolone.
The last case of bacterial infection was the beginning of November 2019.
We began the scheme with Chloroxiderm and Amoxicillin with clavulonic acid.
10 days later, it had no effect, even the opposite.
Sandra’s skin was flushed with pustules, color and intense itching.
We did cytology, bacteriology and antibiogram.
The results (Staph. intermedius ) were completely resistant to 15 types of antibiotic from different groups.
The only antibiotic that worked was Rifampim, which is a strategic antibiotic in human medicine and we decided not to use.
Sandra’s improvement has been much slower and in the last few months we have changed several different regimens of local therapy.
Peptive Shampoo & Foam, Duoxo tampons & duoxo spo on (First Month Every Day)
Omega 3 and 6 fatty acids, Chloroxiderm shampoo, Duxo pyo shampoo and foam (second month every day)
Since the beginning of January, Sandra has been on Peptive again with a bath twice a week and a hermitra spray.
The itching has decreased to normal, there are no new pustules and the hair is gradually recovering.
In conclusion, every time we use an antibiotic for systemic therapy or topical therapy, we should think very carefully about all the possible options because resistance is one of the greatest problems of our future.
“Recent high-profile reports warn of the dangers of not taking action. A bleak report by economist Jim O’Neill, commissioned by the British government and released in May, estimates that 700 000 deaths globally could be attributed to AMR this year and that the annual toll would climb to 10 million deaths in the next 35 years. The report projects US$ 100 trillion in losses by 2050 if nothing is done to reverse the trend.”
Aa quote from the World Health Association website.
1.Clinical case of Azar .
Azar is a 3 years old cane corso dog.
There is a regular vaccination and tick and flea teratments with tablets (isoxazolines).
Case history .
A month and a half ago, the owner has taken Azar to another clinic because of the many pustules on the dog’s chin.
Clinical symptoms include itching in the facial area, redness, and many of about 0.5 cm pustules all over the chin.
Systemic antibiotic therapy and topical once-daily chloroxidine therapy were prescribed for Azar.
Two weeks later there was no change in the condition of the dog.
Bacteriology and antibiogram were performed( Staph. Aureus ) , a second systemic antibiotic was added after the result (the first antibiotic was discontinued).
Staphyococcus aureus is extracted from the antibiogram.
Both antibiotics show the sensitivity of the causative agent.
Two weeks after the second antibiotic, there was no change in Azar’s condition.
At the initial examination, Azar was in good general condition, but there were numerous pimples throughout the chin area, which were very easily bleeding and pussing.
In addition, Azar defecates 3-5 times a day and most times the stools are not well formed.
We did cytology and deep scraping of the skin.
Mass neutrophils, macrophages, and cocci bacteria.
No demodex or other parasites of deep skin scraping.
Local therapy with daily chloroxiderm shampoo, duxo pio tampons and duxo seb spot form and Diprogenta 0.5 mg / 1 mg / g cream
betamethasone / gentamicin for 10 days.
The effect after the first 10 days is significant and more than satisfactory, so the therapy prescribed after day 10 was changed only with shampoo with peptide.
10 days later, there were almost no signs of infection.
10 days later, Azar’s therapy was limited to once daily administration of the duxo self-tampons and once a week the duxo-seb spot form, as well as a curative diet with the Analergenic diet.
There are no signs of bacterial infection now, gastrointestinal symptoms are no longer observed, and therapy is just cleansing with duxo swabs (suitable for daily use).