獸醫(yī)師貓傳染病專題-panleukopenia esavs katrin翻譯

KatrinHartmannProf.Dr.med.vet.,Dr.habil.,Dipl.ECVIM-CAPanleukopenia

貓泛白細(xì)胞減少癥DSH家養(yǎng)短毛貓8weeks8周female母貓“Finja”History病史●hasbeenvomitingfor2days(approximately5timesdaily)

嘔吐兩天了（大約每天5次）●diarrheasince1day(notbloody)1天前腹瀉（不帶血）●anorectic食欲缺乏●doesn‘tplayanymore,sleepsalot

不再玩耍，嗜睡●environment:livesnowindoors

(withnewownersinceoneweek)

環(huán)境：室內(nèi)生活（一周前和新主

人一起生活）●vaccination:notyetvaccinated

免疫：尚未免疫●worming:current

驅(qū)蟲：最近

“Finja”physicalexamination體檢●slightlytomoderatelydepressed

輕微到中度抑郁●temperature:40.5°C(105°F)

體溫：40.5°C(105°F)●5%dehydration5%脫水●ongoingvomitinganddiarrhea

持續(xù)的嘔吐和腹瀉

“Finja”CBCUnits單位referencerange參考范圍redbloodcells紅細(xì)胞5.9x1012/l5-10Hemoglobin血紅蛋白5.6mmol/l5.5-10.5Hematocrit紅細(xì)胞壓積0.30l/l0.30-0.45Platelets血小板210x109/l200-600Leucocytes白細(xì)胞1.1x109/l5-18-Monocytes單核細(xì)胞0x109/l0-1.0-Lymphocytes淋巴細(xì)胞0.7x109/l1.5-7.0bandneutroph.桿狀核中性粒細(xì)胞0x109/l0-0.4seg.neutroph.分葉核中性粒細(xì)胞0.4x109/l3-11-Eosinophils嗜酸性粒細(xì)胞0x109/l0-1.0-Basophils嗜堿性粒細(xì)胞0x109/l0-0.4remarks備注Enzymes酶類Units單位referencerange參考范圍ASTU/l0-50ALT91U/l0-100ALP24U/l0-50ALPstableU/l0GLDHU/l0-10g-GTU/l0-5Cholinesterase膽堿酯酶U/l2300-4500a-Amylasea-淀粉酶U/l0-2000Lipase脂肪酶U/l0-300LDH乳酸脫氫酶U/l0-300CK肌酸激酶U/l0-400Remarks備注Substrates底物Units單位referencerange范圍Bilirubin膽紅素1.5μmol/l0-5NH3μmol/l0-60SBAμmol/l0-20Cholesterol膽固醇mmol/l1.8-3.9Triglycerides甘油三酯mmol/l0.57-1.14totalprotein總蛋白57.4g/l55-80Albumin白蛋白23.6g/l25-40Urea尿素12.3mmol/l5-10Creatinine肌酐190μmol/l0-170Glucose葡萄糖8.2mmol/l4-7Fructosamine果糖胺μmol/l0-340Remarks備注Electrolytes電解質(zhì)Units單位referencerange參考范圍P1.41mmol/l1.0-2.3Cl118mmol/l110-130Na149mmol/l145-155K3.2mmol/l3.5-5.5Ca2.1mmol/l2.1-2.6Feμmol/l12.5-37.6Mgmmol/l0.7-2.6remarksbloodgasanal.血?dú)夥治鯱nits單位referencerange參考范圍pH7.317.34-7.44pCO241mmHg35-45pO2(arterial)pO2（動(dòng)脈）mmHg85-95HCO318.5mmol/l19-24BE-5.3mmol/l-2.5-2.5remarksUrinalysis尿檢referencerange參考范圍Sample樣本Cystocentesis膀胱穿刺nitrite亞硝酸鹽--pH5.55-7protein蛋白質(zhì)---Glucose葡萄糖---Ketones酮類--Urobilinogen尿膽素原---Bilirubin膽紅素---Blood血+-spec.gravity尿比重1.0451.015-1.045Sediment沉渣Erythrocytes紅細(xì)胞0-2/hpf“Finja”nextstep?下一步？parvovirusantigenELISA細(xì)小病毒抗原ELISAPositive陽性Treatment治療virus-neutralizingantibodies(Feliserin?)病毒中和抗體（Feliserin?）interferon-ω

干擾素-ω

intravenousfluids靜脈輸液antibioticsIV(amoxicillin/clav.acid+cefotaxime)靜脈抗生素（阿莫西林克拉維酸+頭孢噻肟）antiemetics(maropitant)止吐劑（馬羅匹坦）analgetics(buprenorphine)止痛劑（丁丙諾啡）enteralfeeding腸內(nèi)飼喂“Finja”e結(jié)果after7daysnodiarrheaandvomiting7天之后沒有腹瀉以及嘔吐normallyeatinganddrinking吃喝正常noleukopenia沒有白細(xì)胞減少dischargedfromhospital出院“Finja”“Finja”isthisatypicalcaseofpanleukopenia?這是一例典型的貓泛白細(xì)胞減少癥么？isthereevidencethatthistreatmentiseffective?有證據(jù)顯示這個(gè)治療有效么？Parvovirosis細(xì)小病毒性疾病

=diseaseindogsandcats犬貓上的疾病

causedbyinfectionwithparvovirus由感染細(xì)小病毒引起parvovirosisincats貓上的細(xì)小病毒病 =panleukopenia泛白細(xì)胞減少癥 =“felinedistemper”“貓瘟”FelinePanleukopenia貓泛白細(xì)胞減少癥firstdiseaseincatswithdetectionofviralagentVerge&Cristoforoni,1928在貓上發(fā)現(xiàn)病毒體的第一種疾病felinesparvovirus(FPV)貓細(xì)小病毒

small(20nm),non-envelopped, single-strandedDNA-Virus

病毒粒子?。?0mm），沒有囊膜，單鏈DNA病毒extremelystableintheenvironment

(>1year)

在環(huán)境中極其穩(wěn)定（>1年）closelyrelatedtocanineparvovirus whichdevelopedin1978

和1978年發(fā)現(xiàn)的犬細(xì)小病毒密切相關(guān)

icb.usp.br/~mlracz/animations/bock/FelinePanleukopenia貓泛白細(xì)胞減少癥studydesign研究設(shè)計(jì)retrospectivestudy(1990–2007)回顧性研究Patients病例244cats244只貓presentedtotheClinicofSmallAnimalMedicine,LudwigMaximilianUniversity,Munich 到慕尼黑大學(xué)小動(dòng)物診所就診的病例inclusioncriteria入選標(biāo)準(zhǔn)diagnosisoffelinepanleukopenia 診斷為貓泛白細(xì)胞減少癥CatswithPanleukopenia貓的泛白細(xì)胞減少癥Kruseetal.,submittedagedistribution(n=233)年齡分布median:4months,range:2weeks–14years中值：4個(gè)月，范圍：2周~14歲

4-5y5-6y6-7y7-8y8-9y9-10y10-11y11-12y12-13y13-14y14-15y20454453213125174ageofpatients

(years)患者年齡（年）numberofpatients<1y1-2y2-3y3-4yCatswithPanleukopenia貓的泛白細(xì)胞減少癥Kruseetal.,submittedagedistribution<1year(n=174)年齡分布<1歲（n=174）

Kruseetal.,submittedCatswithPanleukopenia貓的泛白細(xì)胞減少癥sexdistribution(n=237)性別分布（n=237）Male雄性 59.5%Female雌性 40.5%Kruseetal.,submittedCatswithPanleukopenia貓的泛白細(xì)胞減少癥Breed品種n=242%DomesticShorthair家養(yǎng)短毛21990.5Persian波斯貓135.5Mixed混種貓62.4Siamese暹羅貓20.8Burmese緬甸貓10.4BritishShorthair英短10.4Kruseetal.,submittedCatswithPanleukopenia貓的泛白細(xì)胞減少癥FPV貓瘟oropharynxReplication口咽部復(fù)制cellfreeviremia脫細(xì)胞病毒血癥FPVFPVFPVbonemarrow&lymphoiddepletion骨髓和淋巴消耗intestinalreplication腸道復(fù)制cerebellarhypoplasia小腦發(fā)育不全pathogenesisFPV:oro-fecalroute/systemicinfectionFPV發(fā)病機(jī)理：口-糞便途徑/系統(tǒng)感染replicationincellsS-phaseofdivision在細(xì)胞分裂S期復(fù)制FPVcellfreeviremia脫細(xì)胞病毒血癥fever,sepsis,SIRS,hyperbilirub.,DIC發(fā)熱，敗血癥，全身炎癥反應(yīng)綜合癥，高膽紅素血癥，DICFPVFPVneutropenia/lymphopenia(thrombocytopenia&anemia)中性粒細(xì)胞減少癥/淋巴細(xì)胞減少癥（血小板減少癥和貧血）bacterialtranslocationhemorrhagicGE細(xì)菌移位，出血性腸道疾病non-progressiveataxia非進(jìn)行性共濟(jì)失調(diào)kittens&fetaldeath小貓和死胎clinicalpictureFPVinfectionFPV感染的臨床圖片

vomiting/diarrhea嘔吐/腹瀉Dehydration脫水Hypovolemia低血容量Hypokalemia低鉀血癥Shock休克subclinicalinfection亞臨床感染systemicdisease系統(tǒng)性疾病cerebellarhypoplasia(CNSinfection)小腦發(fā)育不全（中樞神經(jīng)系統(tǒng)感染）reproductiveproblems

(earlyinuteroinfection)生殖問題（早期在子宮感染）myokarditis/cardiomyopathy?心肌炎/心肌病？Meursetal.,2000ClinicalPictures臨床圖片DestructionofIntestinalEpithelium

腸上皮的損壞Picture:W.Hermanns,MünchenDepletionofBoneMarrow骨髓的消耗Picture:W.Hermanns,Munichdifferencesbetween

canineparvovirosisandfelinepanleukopenia犬細(xì)小病毒病和貓泛白細(xì)胞減少癥的區(qū)別clinicalfindings臨床發(fā)現(xiàn)anorexia厭食 166/233 (71.2%)diarrhea腹瀉 165/238 (69.3%)vomiting嘔吐 148/236 (62.7%)depression沉郁

129/235 (54.9%)Fever發(fā)熱 54/233 (23.2%)hemorrhagicdiarrhea33/234 (14.1%) 出血性腹瀉

CatswithPanleukopenia貓泛白細(xì)胞減少癥Kruseetal.,submittedlaboratoryfindings實(shí)驗(yàn)室檢查leukopenia白細(xì)胞減少 122/187 (65.2%)

-neutropenia中性粒細(xì)胞減少 64/137 (46.7%) -lymphopenia淋巴細(xì)胞減少 53/137 (38.7%) -neutro-+lymphopenia 33/137 (24.1%)

中心粒細(xì)胞+淋巴細(xì)胞減少thrombocytopenia血小板減少83/153 (54.2%)Anemia貧血 91/188 (48.4%)

Kruseetal.,submittedCatswithPanleukopenia貓泛白細(xì)胞減少癥laboratoryfindings實(shí)驗(yàn)室發(fā)現(xiàn)hypoalbuminemia 45/101 (44.6%) 低白蛋白血癥hypoproteinemia 46/153(30.1%) 低蛋白血癥hyperglycemia 48/168 (28.6%) 高血糖癥hypokalemia 9/132 (6.8%) 低鉀血癥

Kruseetal.,submittedCatswithPanleukopenia貓泛白細(xì)胞減少癥symptomaticandsupportive

對(duì)癥和支持療法lackofcontrolledstudies缺少對(duì)照研究sameprinciplesasindogs和狗狗的原則一樣specificantiviraltreatment特異性抗病毒治療

antiviralchemotherapy抗病毒化療passiveimmunotherapy被動(dòng)的免疫療法Treatment治療fluidtherapy輸液治療

balancedisotonicfluid 平衡的等滲輸液potassiumreplacement鉀置換>20mval/loncoticsupport膠體滲透壓支持syntheticcolloids合成膠體e.g.,hetastarch羥乙基淀粉(20ml/kg/day)plasma/bloodtransfusion輸血漿/輸血TPN腸外營養(yǎng)oxygentube氧氣管SupportiveTreatment支持療法Antiemetics止吐劑rationaluse合理運(yùn)用(metoclopramide)胃復(fù)安Maropitant馬羅匹坦enteralfeeding腸內(nèi)飼喂earlyenteral前段腸管

(micro-)nutrition（微）營養(yǎng)painmedication止疼藥物buprenorphine/丁丙諾啡 phentanyl/芬太尼 lidocaine利多卡因SupportiveTreatment支持療法broad-spectrumantibiotics廣譜抗生素bactericidal,IV,higherdose殺菌，靜脈，高劑量combinations聯(lián)合用藥

amoxicillin/clavul.ac.+pradofloxacin3mg/kgPOq24h 阿莫西林克拉維酸鉀+普拉沙星3mg/kg

口服q24hamoxicillin/clavul.ac.+enrofloxacin5mg/kgSQq24h 阿莫西林克拉維酸鉀+恩諾沙星5mg/kg

皮下q24hamoxicillin/clavul.ac.+gentamicin6mg/kgIVq24h 阿莫西林克拉維酸鉀+慶大霉素6mg/kg

靜脈q24h

amoxicillin/clavul.ac.+3rdgenerationcephalosporinsIV 阿莫西林克拉維酸鉀+三代先鋒靜脈

1st+3rdgenerationcephalosporinsIV 一代+三代先鋒靜脈otheroptions其他選擇 imipenem5-10mg/kgIVq6–8h(inselectedcases)

亞胺培南5-10mg/kg靜脈q6–8h（在選出的病例）Antibiotics抗生素passiveimmunotherapy被動(dòng)的免疫療法commerciallyavailableimmunoglobulins

Feliserin?0,4ml/kgSQ3consecutivedays

市面上可買的免疫球蛋白Feliserin?0,4ml/kg皮下，連續(xù)3天transferofantibodies轉(zhuǎn)用抗體1-3ml/kghyperimmuneserumorplasmaSQ1-3ml/kg高免血清或者血漿felineinterferon-w貓干擾素-w2.5x106IU/kgIVq24hfor3consecutivedays2.5x106IU/kg靜脈q24h，連續(xù)3天AntiviralTreatment抗病毒治療

antiviraleffects抗病毒作用?

specificvirus-neutralizingantibodies(Feliserin?incats,

Stagloban?indogs)

特異性病毒中和抗體

（貓F(tuán)eliserin?,

犬Stagloban?

）Dosage劑量?

forprophylaxis1injectionSQ

預(yù)防劑量1個(gè)單位皮下注射?

fortreatment3injectionsSQ(3consecutivedays)

治療劑量3個(gè)單位皮下注射（連用3天）Spectrum范圍panleukopenia,calicivirusandherpesvirusinfection(cat)泛白細(xì)胞減少癥，杯狀病毒和皰疹病毒感染（貓）parvovirosis,distemper,ICH(dog)

細(xì)小病毒，犬瘟，

ICH（犬）sideeffects副作用anaphylacticreactionincats(repeatedapplication)貓的過敏反應(yīng)（重復(fù)運(yùn)用）PassiveImmunotherapy被動(dòng)的免疫療法prophylacticuse預(yù)防使用 experimentalstudy實(shí)驗(yàn)研究 =>efficacyproven效果證明therapeuticuse治療使用 placebo-controlleddouble-blindstudyindogswithparvovirosis

和犬細(xì)小病毒病用安慰劑-對(duì)照組雙盲研究

passiveimmunotherapyasadditionaltreatment

被動(dòng)的免疫療法作為額外的治療

=>lesssevereclinicalsymptoms不那么嚴(yán)重的臨床癥狀 =>shorterperiodinhospital住院時(shí)間更短 =>lowercosts花費(fèi)低 Macintireetal.,1999

StudiesonPassiveITinDogs被動(dòng)的免疫療法在犬上的研究

antiviraleffects抗病毒效果?

inhibitvirusassemlyandbudding抑制病毒組裝和出芽?

cytokine,immunomodulatoryeffect細(xì)胞因子和免疫調(diào)節(jié)作用Dosage劑量huIFN-ahighdose105–106IU/kgq24hSQ(shortuse)人FN-a高劑量105–106IU/kgq24h皮下（短期使用）

huIFN-alowdose1(-50)IUPOq24h(long-term)

人FN-a

低劑量1(-50)IU口服q24h(長期)feIFN-w2.5x106IU/kgIVq24hfor3consecutivedays貓F(tuán)N-w2.5x106IU/kg靜脈q24h，連續(xù)3天Spectrum范圍?

allvirusinfections所有病毒感染sideeffects副作用rarelyallergicreactions(huIFN-a)過敏反應(yīng)罕見（人FN-a）

Interferons干擾素experimentalstudy實(shí)驗(yàn)室研究Martinetal.,2002

placebo-controlled安慰劑-對(duì)照 infectionof10SPFbeaglepuppies10只SPF比格犬感染 all“standardtreatment”所有采用“標(biāo)準(zhǔn)治療”

5pups5只小狗 felineinterferon-ω2.5x106IU/kgSQq24hfor3days

貓干擾素-ω2.5x106IU/kg皮下q24h持續(xù)3天=>4/5pupssurvivedinFeIFN-wgroup

在貓干擾素-w組4/5小狗存活=>0/5pupssurvivedinplacebogroup

安慰劑組0/5只小狗存活=>statisticallysignificant

統(tǒng)計(jì)學(xué)上差異顯著

StudiesonInterferon-ωinDogs犬干擾素-ω

的研究fieldstudyinnaturallyinfecteddogs(Japan)在自然感染的犬上研究（日本）Minagawaetal.,1999

placebo-controlleddouble-blindstudy安慰劑-對(duì)照雙盲實(shí)驗(yàn)93dogswithparvovirosis(33vethospitals)93只患細(xì)小病毒的犬（33只獸醫(yī)醫(yī)院） =>statisticallysignificanthighersurvivalrate=>在統(tǒng)計(jì)學(xué)上顯著較高的存活率fieldstudyinnaturallyinfecteddogs(France)在自然感染的犬上研究（法國）DeMarietal.,2003placebo-controlleddouble-blindstudy安慰劑-對(duì)照雙盲實(shí)驗(yàn)92dogswithparvovirosis(19vethospitals)92只患細(xì)小病毒的犬（19只獸醫(yī)醫(yī)院）=>statisticallysignificanthighersurvivalrate

在統(tǒng)計(jì)學(xué)上顯著較高的存活率StudiesonInterferon-ωinDogs干擾素-ω

在犬上的研究fieldstudyinnaturallyinfectedcats(Italy)在自然感染的貓上研究（意大利）uncontrolledstudyinaFPVoutbreakinacattery在一個(gè)爆發(fā)貓瘟的貓舍進(jìn)行的無對(duì)照研究23catspre-treatedwithfelineinterferon-ω23只貓使用干擾素-ω

預(yù)治療17catsnotpre-treated17只未進(jìn)行預(yù)治療nosignificantdifference沒有顯著差異

-insurvivalrate在存活率上

-intimeuntildevelopmentofclinicalsigns

在時(shí)間上直到出現(xiàn)臨床癥狀的發(fā)展

Paltrinierietal.,2007

StudiesonInterferon-ωinCats干擾素-ω

在貓上的研究Whatcanwelearnfromthiscase?從這些病歷上我們能夠?qū)W到什么？kittensarehighlysusceptible

whenmaternalantibodieswane當(dāng)母源抗體消退，小貓是高危易感群體antiviralchemotherapycombinedwith

symptomatictreatmentimportant

(intensivecarepatients)抗病毒化學(xué)療法結(jié)合對(duì)癥治療很重要（重癥監(jiān)護(hù)患者）“Finja”DSH6months6個(gè)月femaleneutered絕育母貓“Emily”History病史●stoppedeatingthismorning今早上開始不吃飯●lethargic嗜睡●presentedinlateralrecumbentposition

處于側(cè)臥姿勢●environment:livesindoors

withoutdooraccess

環(huán)境：室內(nèi)生活，可以接觸室外●vaccination:no

疫苗：無●worming:no

驅(qū)蟲：無?Emily“physicalexamination體檢●severelydepressed

嚴(yán)重沉郁●temperature:36.3°C(97,4°F)

體溫：36.3°C(97,4°F)●slightlypainfulabdomen

輕微疼痛的腹部●mildoculardischarge

輕微的眼分泌物?Emily“CBCunitsreferencerangeredbloodcells紅細(xì)胞10.6x1012/l5-10Hemoglobin血紅蛋白8.39mmol/l5.5-10.5Hematocrit紅細(xì)胞壓積0.38l/l0.30-0.45Platelets血小板150x109/l200-600Leucocytes白細(xì)胞0.5x109/l5-18-Monocytes單核細(xì)胞0x109/l0-1.0-Lymphocytes淋巴細(xì)胞0.3x109/l1.5-7.0bandneutroph.桿狀核粒細(xì)胞0x109/l0-0.4seg.neutroph.分葉核粒細(xì)胞0.2x109/l3-11-Eosinophils嗜酸性粒細(xì)胞0x109/l0-1.0-Basophils嗜堿性粒細(xì)胞0x109/l0-0.4remarks備注“Emily”nextstep?下一步？parvovirusantigenELISA細(xì)小病毒抗原ELISANegative陰性e結(jié)果dead2hoursafteradmissiontothehospital入院2小時(shí)之后死亡Necropsy尸檢fibrinousenteritis,

totaldepletionofpeyerpatches纖維素性腸炎，派爾集合淋巴結(jié)整體消耗panmyelophtisis

depletionoflymphnodesandspleen淋巴結(jié)核和脾臟的消耗diagnosticforpanleukopenia診斷為泛白細(xì)胞減少癥“Emily”whywastheparvovirusantigentestnegative?為什么細(xì)小病毒抗原測試是陰性？docaninefecaltestsworkincats?在犬的糞便測試在貓上也試用么？whatistheprognosisinfelinepanleukopenia?貓、泛白細(xì)胞減少癥的預(yù)后如何？

“Emily”directvirusdetectioninfeces糞便中病毒的直接檢測

-ELISA(in-practicetests)

ELISA（臨床上測試） -electronmicroscopy

電鏡 -PCRdirectvirusdetectioninblood血液中病毒的直接檢測PCR

Diagnosis診斷indirectdetection(ofantibodies)inserum直接檢測血清中（抗體）

-hemagglutinationinhibitiontest

血凝抑制實(shí)驗(yàn)nothelpfulfordiagnosis對(duì)診斷沒有幫助abletopredictprotection能夠

預(yù)測保護(hù)detectionofpathognomonicchanges檢測特征性的改變-necropsy

尸檢toolate太遲

Diagnosis診斷200fecalsamplesofcats200個(gè)貓的糞便樣本randomlyselectedhealthycats/catswithdiarrhea隨機(jī)選擇健康的貓/腹瀉的貓goldstandard=>electronmicroscopy金標(biāo)準(zhǔn)=>電鏡檢查ComparisonbetweenParvoTests細(xì)小病毒測試的比較

WitnessParvo?SnapParvo?SASParvo?FASTestParvoStrip?SpeedParvo?sensitivity(%)敏感性50.060.080.070.050.0specificity(%)特異性100.0100.096.893.7100.0PPV(%)陽性預(yù)測值100.0100.057.136.8100.0NPV(%)陰性預(yù)測值97.497.998.998.397.4invalidtests(%)無效測試000.500testsdifficulttointerpret(%)難以解釋的測試1.54.514.112.00.0Neuereretal.,2008ComparisonbetweenParvoTests細(xì)小病毒檢測的比較ReasonsforNegativeTestResults

陰性測試的原因inapproproatefecalsamples不合適的糞便樣本notenoughmaterial材料不夠toodilute(liquidfeces)過?。ㄒ后w糞便）intermittendshedding脫落中止notdetectableparvovirusstrains(e.g.,CPV-2c) 不可被檢測的細(xì)小病毒毒株(e.g.,CPV-2c)highcontentofantibodiesinfeces 糞便中的抗體含量高e(n=231)結(jié)果(n=231)recovery 51.1% 恢復(fù)51.1%mediandurationofhospitalization7d 平均住院時(shí)間7ddeath 48.9% 死亡48.9%mediantimetodeath/euthanasia2d 平均死亡/安樂死時(shí)間2d

CatswithPanleukopenia貓泛白細(xì)胞減少癥Kruseetal.,submittednosignificantcorrelationbetweeneand… 在結(jié)果和。。。之間沒有顯著聯(lián)系signalement(breed,age,gender) 體貌特征（品種，年齡，性別）housingconditions(indoor/outdoorcats) 居住條件（室內(nèi)/室外貓）vaccinationstatus(vaccinated/unvaccinated) 免疫狀態(tài)（免疫/未免疫）clinicalsigns 臨床特征FIV/FeLVstatus FIV/FeLV狀態(tài)CatswithPanleukopenia貓泛白細(xì)胞減少癥Kruseetal.,submittedesurvivorsnon-survivors10years12years8years4years6years2years0years3.8months3.5monthsp=0.292

CatswithPanleukopenia貓泛白細(xì)胞減少癥Kruseetal.,

submittedprognosticparameters預(yù)后參數(shù)badprognosisif…預(yù)后不良，如果。。。lowleukocytecount白細(xì)胞計(jì)數(shù)低lowplateletcount血小板計(jì)數(shù)低lowalbuminconcentration白蛋白濃度低lowpotassiumconcentration鉀濃度低

CatswithPanleukopenia貓泛白細(xì)胞減少癥Kruseetal.,submittedp=0.002e結(jié)果leukocytes/μl白細(xì)胞1,200/μl4,400/μl

survivors存活non-survivors未存活40,00020,0000CatswithPanleukopenia貓泛白細(xì)胞減少癥Kruseetal.,submitted iftotalnumberofleukocytes<1,000/μl

relativeriskofdeathis如果白細(xì)胞總數(shù)<1,000/μl，死亡的相對(duì)風(fēng)險(xiǎn)是 =>1.77xhighercomparedto

catswith>1,000leukocytes/μl(p=0.038)

=>和白細(xì)胞總數(shù)>1,000

的貓相比高1.77xwhatcanwelearnfromthiscase?從這個(gè)病例我們學(xué)到了什么？caninetestcanbeused

todiagnosepanleukopeniaincats犬的測試也可以用于診斷貓的泛白細(xì)胞減少癥testsmaybefalsenegative

(fecalorbloodPCRismendedforverification)測試可能是假陰性的（推薦運(yùn)用糞便或者血液PCR確診）ageisnotprognostic,年齡是沒有預(yù)兆性的butleucocytes,platelets,albumin,potassium

areusefulprognosticparameter但是白細(xì)胞，血小板，白蛋白，鉀是有用的預(yù)后參數(shù)

“Emily”DSH5years5歲femaleneutered母貓絕育“Fleckchen”History病史●since5daysdepressed,eatslessthanusual5天前開始沉郁，比平時(shí)吃得少●since2daysconditionworsening,stopseatinganddrinking

2天前情況惡化，不吃不喝●onedayofpresentationunabletogetup1天前開始出現(xiàn)不能站立●environment:livesindoors(hasneverbeenoutside)

環(huán)境：室內(nèi)貓（從未出過門）●vaccination:never

免疫：從來沒有●worming:never

驅(qū)蟲：從來沒有“Fleckchen”physicalexamination體檢●depressed沉郁●anorectic厭食●temperature:35.7°C(96.3°F)

體溫：35.7°C(96.3°F)●6%dehydration6%的脫水“Fleckchen”CBCunitsreferencerangeredbloodcells紅細(xì)胞9.11x1012/l5-10Hemoglobin血紅蛋白7.15mmol/l5.5-10.5Hematocrit紅細(xì)胞壓積0.34l/l0.30-0.45Platelets血小板264x109/l200-600Leucocytes白細(xì)胞2.5x109/l5-18-Monocytes單核細(xì)胞0x109/l0-1.0-Lymphocytes淋巴細(xì)胞1.6x109/l1.5-7.0-bandneutroph.桿狀核粒細(xì)胞0.1x109/l0-0.4-seg.neutroph.分葉核粒細(xì)胞0.8x109/l3-11-Eosinophils嗜酸性粒細(xì)胞0x109/l0-1.0-Basophils嗜堿性粒細(xì)胞0x109/l0-0.4remarks備注“Fleckchen”nextstep?下一步？parvovirusantigenELISA細(xì)小病毒抗原ELISAPositive陽性Treatment治療antiviralsandsupportivetherapy抗病毒以及支持治療e結(jié)果recoveredanddischargedfromhospitalafter10days恢復(fù)，10天之后出院“Fleckchen”doadultcatsalsodevelopthedisease?成年貓也能患此??？howcommonare“atypical”clinicalsigns?“非典型”臨床癥狀有多常見？agedistribution(n=233)年齡分布（n=233）median:4months,range:2weeks–14years平均：4個(gè)月,范圍：2周-14歲

4-5y5-6y6-7y7-8y8-9y9-10y10-11y11-12y12-13y13-14y14-15y20454453213125174ageofpatients

(years)患貓年齡（年）numberofpatients<1y1-2y2-3y3-4yCatswithPanleukopenia貓泛白細(xì)胞減少癥Kruseetal.,submittedclinicalfindings臨床發(fā)現(xiàn)anorexia厭食 166/233 (71.2%)diarrhea腹瀉 165/238 (69.3%)vomiting嘔吐 148/236 (62.7%)depression沉郁 129/235 (54.9%)fever高熱 54/233 (23.2%)hemorrhagicdiarrhea33/234 (14.1%)

出血性腹瀉

CatswithPanleukopenia貓泛白細(xì)胞減少癥Kruseetal.,submitted30.7%neverhaddiarrhea30.7%從來沒有腹瀉37.3%neverhadvomiting37.3%從來沒有嘔吐34.2%neverhadleukopenia34.2%從來沒有白細(xì)胞減少15cats15只貓neithergastrointestinalsignsnorleukopenia

既沒有胃腸道癥狀也沒有白細(xì)胞減少CatswithPanleukopenia貓泛白細(xì)胞減少癥Kruseetal.,submittedwhatcanwelearnfromthiscase?我們從這個(gè)病例學(xué)到了什么？adultcatscandeveloppanleukopenia

(ifnotvaccinatednaturallyboostered)

成年貓也能感染泛白細(xì)胞減少癥（如果沒有免疫自然感染）catsmaynothavegastrointestinalsignsormaynotbeleukopenic

貓可能沒有胃腸道癥狀或者沒有白細(xì)胞減少

“Fleckchen”DSH12weeks12周female母貓“Kitty”History病史●presentedwithhersister和她的姐姐一起來就診●generalizedataxia,stumbling,andfalling

sincethecatsstartedwalking

全身共濟(jì)失調(diào)，障礙，一走路就摔倒●litterofsixkittens(3affected)

一窩6只小貓（3只感染）●enviroment:bornattheowner

indowntownMunich,indoorsonlymotherwiththeownerformanyyears(multi-cathousehold)

mothernevervaccinated

環(huán)境：主人住在慕尼黑市區(qū)，只在室內(nèi)，媽媽跟著主人有很多年了（多貓生活環(huán)境），母貓沒有免疫●vaccination:once(at8weeksofage)

免疫：一次（8周的時(shí)候）●worming:current

驅(qū)蟲：最近

“Kitty”physicalexamination體檢●intentiontremorofthehead

(mostpronouncedwhenofferedfood)

頭部意向性震顫（當(dāng)給予食物時(shí)特別明顯）●generalizedataxia全身共濟(jì)失調(diào)●broad-basedstance分腿站姿●truncalsway

withintermittentfalling

toeitherside

軀干搖晃，并間歇性的向一側(cè)倒●symmetrichypermetria

onall4limbs4肢對(duì)稱性的運(yùn)動(dòng)范圍過渡“Kitty”neurologicexamination神經(jīng)學(xué)檢查●absentmenaceresponse

缺少威脅反應(yīng)●otherwisenormal

其他的正?！癒itty”“Kitty”nextstep?下一步？parvovirusantigenELISA細(xì)小病毒抗原ELISAnegative陰性Treatment治療None無e結(jié)果ownerelectedtokeepthe3kittensslightimprovementofataxiaovertime主人選擇繼續(xù)養(yǎng)3只小貓隨著時(shí)間推移共濟(jì)失調(diào)有緩慢的改善differentialdiagnoses/ruling-outotherdiseases

cerebellarhypoplasia =>slightimprovement

小腦發(fā)育不全

=>緩慢改善

(“felineataxia”,inutero/earlyFPVinfection)（“貓共濟(jì)失調(diào)”，子宮內(nèi)/早期貓瘟感染）

cerebellaratrophy =>deterioration

小腦萎縮

=>惡化(genetic)（遺傳的）

storagedisease =>deterioration貯積病=>惡化(genetic)（遺傳的）

dysmyelogenesis =>recovery

髓鞘形成不良=>恢復(fù)(myelinmaturationdefect,geneticindogs) （髓鞘形成缺陷，狗狗上遺傳性的）

toxiccerebellardegeneration =>slightimprovement

毒性小腦變性=>緩慢改善(afteranesthesia,e.g.,ketamin)（麻醉之后，例如氯胺酮）(history!)（病史?。癒itty”“Kitty”whatiscerebellarhypoplasia?什么是小腦發(fā)育不全？shouldthesekittensbeeuthanized?這些小貓應(yīng)當(dāng)安樂么？“felineataxia”“貓共濟(jì)失調(diào)”

infectioninuterountil<6weeks

子宮內(nèi)感染到<6周 oftenseveralkittens/wholelitteraffected

通常是幾只小貓/整窩受到感染notcurable,butmanykittenscanlivewithit

sometimesgetslightlybetterwithtime不可治愈，但是很多小貓能夠這樣生存，有時(shí)隨著時(shí)間有輕微改善definitivediagnosis最終診斷intravitamnotpossible 在體診斷不可能postmortemPCR,insituhybridization死后運(yùn)用PCR，原位雜交CerebellarHypoplasia小腦發(fā)育不全CerebellarHypoplasia

小腦發(fā)育不全Video:A.Lloret,BarcelonaPicture:A.Lloret,Barcelonawhatcanwelearnfromthiscase?這個(gè)病例我們學(xué)到了什么？cerebellarhypoplasiararetoday

目前小腦發(fā)育不全很罕見usuallyseveralkittensinonelitteraffected 通常一窩中幾只小貓都受感染

invivoonlyexclusiondiagnosispossiblekittensdonotshedparvovirus

活體只能排除可能不排細(xì)小病毒的小貓mayslightlyimprove

(morphologicstructuresdonotchange,

butkittensmaysomehow“adapt”)可能輕微改善（形態(tài)結(jié)構(gòu)沒有改變，但是小貓可能會(huì)“適應(yīng)”）“Kitty”DSH8years8歲femaleneutered絕育母貓“Samantha”History病史●since3daysanorectic

從3天前厭食●

verylethargic

非常嗜睡●environment:strictlyindoors

(appartmenton27thfloor)

環(huán)境：嚴(yán)格的室內(nèi)貓（公寓在27樓）●vaccination:askitten

with8and12weeksofage

neversincethen免疫：8周和12周時(shí)進(jìn)行過免疫，之后就再也沒有了●worming:askitten

驅(qū)蟲：小貓時(shí)“Samantha”physicalexamination體檢●lethargic嗜睡●anorectic厭食●slightlydehydrated輕微脫水“Samantha”CBCunitsreferencerangeredbloodcells紅細(xì)胞9.2x1012/l5-10Hemoglobin血紅蛋白8.49mmol/l5.5-10.5Hematocrit紅細(xì)胞壓積0.40l/l0.30-0.45Platelets血小板175x109/l200-600Leucocytes白細(xì)胞2.4x109/l5-18-Monocytes單核細(xì)胞0.1x109/l0-1.0Lymphocytes淋巴細(xì)胞1.4x109/l1.5-7.0bandneutroph.桿狀核粒細(xì)胞0.1x109/l0-0.4seg.neutroph.分葉核粒細(xì)胞0.8x109/l3-11-Eosinophils嗜酸性粒細(xì)胞0x109/l0-1.0-Basophils嗜堿性粒細(xì)胞0x109/l0-0.4remarks備注“Samantha”nextstep?下一步？parvovirusantigenELISA細(xì)小病毒抗原ELISANegative陰性fecalelectronmicroscopy糞便電鏡檢查parvovirus細(xì)小病毒BVDNAparvo.htmle結(jié)果3daysinICU在重癥監(jiān)護(hù)病房3天startedeatingafter72hours72小時(shí)之后開始吃飯gradualincreaseinneutrophilcountover4days4天之后嗜中性粒細(xì)胞逐漸增加dischargedhomeafter1week1周之后出院fecalsample糞便樣本stillpositive(EM)atweek6afterdischarge出院之后6周仍然陽性negative(EM)atweek8afterdischarge出院之后8周陰性parvovirusantibodies

stillpresent3yearslater細(xì)小病毒抗體3年周仍然存在“Samantha”“Samantha”howcanacompletelyindooronlycatbeinfected?一直完全室內(nèi)生活的貓?jiān)趺锤腥荆縞anacatbeinfectedfromadog?貓能被犬感染么？canadogbeinfectedfromacat?狗能被貓感染么？whydidthevaccinationnotprotect?為什么疫苗沒有起到保護(hù)作用？environmentalconditions(n=138)環(huán)境條件（n=138）indooronlycats室內(nèi)貓62.1%outdoorcats室外貓 37.9%housholdconditions(n=153)家庭條件multi-cathousehold 85.5%多貓生活環(huán)境single-cathousehold 14.5%單貓生活環(huán)境CatswithPanleukopenia貓泛白細(xì)胞減少癥Kruseetal.,submittedcanineparvovirus犬細(xì)小病毒(CPV-2a,-2b,-2c)firstdescriptionin19781987年首次描述CPV-2(CPV-1)?changed“toCPV-2a,CPV-2b,(recentlyCPV-2c)“變異為”CPV-2a,CPV-2b,(目前是CPV-2c)CPV-2a,-2b,-2ccaninfectcats能夠感染貓

cancausepanleukopenia能夠?qū)е仑埛喊准?xì)胞減少癥C