獸醫(yī)師貓傳染病專題等多個文件-015esavs-貓病ii15大腸疾病diseases of the large intestine cats

DiseasesoftheLargeIntestineinCats貓的大腸疾Dr.StefanUntererDiplomateECVIM MacroscopicAnatomyQCaecumQColonQRectumLargebowellength:0,3大腸長度Dr.SvenReese,

MicroscopicAnatomy微觀4layers4MucosaSubmucosaMuscularisSerosacomparedtosmallintestine,largecontainsnovillilessmicrovillimoremucus-producinggoblet

Abb.LiebichFunction功extractionofwaterand吸收水分和電解storageof糞microbialfermentationofundigestedhighestconcentrationofbacteriainthemucusproductionfacilitatesdefecationprotectsthemucosaDiseasesoftheLarge大腸疾largebowel大腸性腹Acutechronic(youneeda慢性（需要診斷reducedorabsentdefecationforseveraldaystoweeksDISTINGUISHLARGEBOWELFROMSMALLBOWELDISEASE區(qū)別大腸和小腸的疾LargebowelSmallbowelWeightloss體重減Veryrare極罕YesPolyphagia多NoMaybe可能VomitingInfrequent少Sometimes有時發(fā)Freshblood見血Sometimes有時發(fā)NoNoRare罕Fecalmucus糞便粘Sometimes有時發(fā)NoTenesmus里急后Sometimes有時發(fā)Infrequent少Case?Madonna‘Case?Madonna‘ChronicdiarrheaQacquiredfrombreeder5weeks ?Madonna‘–intermittentpastyfrequent?Elvispastytoliquidy,unconsciouslossoffecesQBAR,goodappetite,noweightBAR,Case?Madonna‘HistorybreederQqueenandlitterpastyQsomeotheradultrelapsingclinicallyfecalCase?Madonna‘History

QCBC&chemWNLCase?Madonna‘History

therapywithFenbendazolefor5no芬苯達唑五日無改Metronidazolefor7no甲硝唑7日無改Giardiasnaptest賈地鞭毛蟲快速檢 Case?Madonna‘PresentedtothecfSmallAnimalMedicineinMunich轉診QCauseofchronic慢性腹瀉的原因 Case?Madonna‘examinatio?lQQBCS4- areareddened,swollenmildrectumprolapseProblemlistchronicdiarrheafecalincontinencerectumprolapseCase?Madonna‘DDchronicdiarrlvis‘慢性腹瀉的鑒別診QDietQ Qinflammatory,non- QObstructive堵塞性QCongential QNeoplastic腫瘤性Qextra-Case?Madonna‘DDchronicQDietQ Q(inflammatory,non-infectious)炎癥、性QObstructive堵塞性QCongenital性QNeoplastic腫瘤性Qextragastrointestinal/metabolicCase?Madonna‘DiagnosticTherapeuticCase?Madonna‘Fecal fecalsamplecollectedover3daysFlotationGiardia賈地鞭毛蟲Tritrichomonasfoetus胎三 Case?Madonna‘a(chǎn)nddirectdetectionwithNaCl氯化鈉直接Diagnosis:TritrichomonasCase?Madonna‘a(chǎn)ndDiagnosis:TritrichomonasWhyispersistentinfectionwithGiardia wastreated negativeantigenELISAafter治療后抗原GiardiasppCat貓的賈ProtozoasimilartoT.Moderateprevalencecats1.5–GiardiawithcystinfectionviaingestionofhygeneduringtherapyveryGiardiasppCat貓的賈Pathogenesis發(fā)destructionofintestinalepithelialcellsshorteningofvilliclinicalcourserelatedtovirulenceofparticularGiardiastrain個別種類賈地鞭patient‘simmunestatusClinicalsigns臨asymptomaticcarrierDiarrheaacutediarrheainyounganimalsself-limiting/intermittent/chronic自限性/間斷性/GiardiasppCat貓的賈Diagnosis診zincsulfateflotation?3differentfecalsamplesarenecessarywithzincsulfateflotationtoreacha94%positivepredictivevalueforGiardia 檢測，這樣可以得到94%陽性預測值ImmunoassayELISAalsoforfrozenfeces)goodsensitivityand犬的慢性賈地鞭毛 診'conclusionandclinicalrelevance:in-houseGiardiadiagnostictestshavepoorcorrelationwiththegoldstandardmethod(fluorescentantibodycoproscopy)院內(nèi)的賈地鞭毛蟲診 和標準診斷方法（熒光抗體顯微鏡之間相關性很goodnegativepredictivevalues,butpoorpositivepredictivevaluesatprevalenceratescommoninmostclinicalsettings良好 預測值，但在大部分的臨床條件下陽性預測值較negativein-housetest=infectioncanbe院內(nèi)檢 =可排positivetestwithlowprevalence≠低流行率的陽性結果Giardiaspp.'Therapy治

50mg/kgpoq24hfor5 15mg/kgpoq12hfor7 mendeddosemaybetoxicincats)甲硝唑：（高于推薦劑量可能對貓有一定毒性patient: area cleanWhatanswerregardingepidemiologyoffelineT.foetusinfection catsgetinfectedprimarilybycontactwithcattle,i.e.especiallyoutdoorcatsareinfected T.foetusisveryresistenttoenvironmentalinfluences,i.e.destroytheinfectiousagentawidespreaddesinfectionregimenisnecessary rawmeatisaseriouspotentialsourceof felineinfectionswithT.foetusareprimarilydiagnosedinmulti-cathouseholdsTfoetusPathogenesisdirectorofecalcolonizemucosaofterminalcecum盲腸colon結腸excretedwithnocyst無包verysensitiveagainstcold,O2,dehydrationtablesurviveforupto7daysinmoist對于寒冷，氧氣和干燥及敏感但可在濕潤糞便中存活7T.foetus-Predisposing發(fā)病誘multi-nocontacttofarmwatersourcefeedingrawmeatPrevalenceofT.foetusinPrevalenceinEuropeamongstcatswithdiarrhea:2–歐洲腹瀉的貓中 ：2- 14outof111catswithdiarrhea 24outof45catswithchronicdiarrhea 32%outof74feralcatsinshelterwithGunn-Mooreetal.,2007;Hollidayetal.,2008;Freyetal.,PrevalenceofT.foetusinPrevalenceinGermanycatswith 9.6%outof376of0.85%of腹瀉的貓：376只貓中 其中純種貓 短毛貓

15.7%outof23018.5%outof124breeding 124只繁育用貓中Kleinetal.,2010;Kuehneretal.,2009(ECVIM- Prevalenceofentericparasitesin Purebreed(n=perpercent

breeders(n=18,5%perpercent

DetectionofTfoetusdirect糞便抹fecal糞便培fecal糞便biopsyofcolonic結腸粘膜活culture entinInPouchTMTF在InPouchTMuserectalfreshPolymerasechainreactionmaterials&methodsrefridgeratedfecalsamplefrom3consecutivedays(atleast200mg)連續(xù)三 的糞便樣品冷藏保存（每份至少sendtospecializedlaboratory(e.g.IDEXXVetMedLabor,Alomed,Laboklin) Proverygoodsensitivityand100%極好的敏感性和100%的特PolymerasechainreactionConscosts:~30€falsenegative catstreatedwithnotallavailablePCRtestshavegood不是所有的PCR檢查都有較好的敏感TfoetusSymptoms癥sage 分s

studypopulation(n=T.foetus(n=36)胎三毛蟲Giardia(n=22)賈地鞭毛蟲Isospora(n16等孢子球蟲Cryptosporidium(n6correlated與年輕動物相關（≤1歲QT.foetusinfection(p=0,017;OR3,25;95%-KI1,43–Qcoccidiosis(p<0,001;OR11,09;95%-KI2,48–TfoetusSymptoms癥breed品

(n=

cats(n=

(n=00NorwegianForrest挪威森林66.787.5andere

NorwegianForrestp<0.001;RRNorwegianForrestCat→p<0.001;RR6,9 18,2 ClinicalrelevanceofTfoetus?abnormalfecesondayoftesting異常糞便 n%n%p研究對32.2n%n%p研究對32.239.6--T.Foetus胎63.911.1<Giardia甲第鞭毛50.050.0n.Isospora.等孢子球蟲62.537.5n.-33.366.6--ClinicalrelevanceofT.胎三毛蟲的臨Diarrheainthepast6 n%pn%pn%p41.3--49.2--TFoetus胎三61.169.6Giardia甲第鞭毛46.6n.47.8n.Isospora等孢子球蟲61.1n.50.0n.-sporidium50.0--66.6--

breeders種TfoetusSymptoms胎三毛蟲—QlargebowelchronictorelapsingintermittentpastytoliquidyQfecalQrectumTfoetusSymptomsSeverityofsymptoms癥狀的嚴重Variablenotdependentonage notdependentonco-infectionwithotherenteric QInmulti-cathouseholds/breeding在多貓家庭/繁殖者常發(fā)…notallanimalsinfected…onlysomecatswithdiarrheaHowdowetreataninfectionwithT. 甲硝羅硝芬苯達卡硝TfoetustherapyDrugofchoice藥物Ronidazole30mg/kgoncedailyevery14羅硝唑，30mg/kg每日一次，連服14Qantibiotic:5-抗生素：5-硝基咪QinGermanyonlylicensedforcarrierpidgeons,onlyasRidzol10%Bt(Rh?nfried,TherapyoffelineTritrichomonasinfectionwithRonidazolele……leadstoeliminationofTritrichomonasinmost…shouldonlybedoneafterdefinitivediagnosisduethenarrowtherapeutic…canbestartedpromptlyinallinfected …canleadtoneurologicsignsevenwithmendedTfoetusTherapyProblemsT.foetusnotsensitivetomostdevelopmentofresistenceinnodrugwith100%efficacyso至今沒有100%有效的藥MetronidazolenotRonidazolenotalwayseffectiveineliminatingT.foetus,butusuallyresolutionofclinicalsigns羅硝唑并不能完全清除三毛蟲，但通常會解決臨床癥TfoetusTherapyMicroaerophilicinvivoandin ofT. with5-Nitroimidazoledrugs(commonuseofMetronidazole???)newdrugsmustbeTFoetusTherapyRonidazole–sideeffects羅硝唑—副作用neurotoxic神經(jīng)毒性mutagenic/teratogenic致突變性/致畸性Important重要事handleonlywithpre-treatment:informedconsentregardingcloselymonitorpatientforneurologicsigns,e.g.lethargy,ataxia,seizures密 stopdrugimmedia yifanyneurologicsignsoccur!出現(xiàn)任何神經(jīng)癥狀時立即停藥TfoetusTherapyRonidazolesideeffects羅硝唑—副作Important重要事havepharmacycompounddailydose準確應用藥物學劑onlyusewithdefinitivediagnosis,notin 僅限于確診病例使用，不可用于疑似病donotusein不animals<12<12周的幼齡動pregnantorlactating懷孕或泌乳動TfoetusTherapySupportive支atleastonecleananddisinfectlitterbox貓砂盆有規(guī)律的清潔和滅clean regioniffecesnowidespreaddisinfectionnecessary,nocyst三 TFoetusPrognosissubsidingdiarrheawithRonidazoleusuallyafteracoupleofdaysinrarecasesafter≥2weeksElimination病原消notalwayssuccessful,therefore不經(jīng)常有效，因此…checktreatmentsuccessvia用PCR檢查是否成功治514daysaftertherapy治療后5-14日進ifstillpositive,considerRonidazolefor14如果仍然陽性，考慮用14日的羅硝唑afteraminimumof20至少20周后復TfoetusPrognosisLong-term長Symptomswithouttreatmentclinicalremissionafter9months(4months–2years)臨床癥狀在沒有治療的情況下9個月后消除（4個月-2年88after2yearsasymptomaticbut:canrelapseafter diarrheadue但是：下列原因引起的腹瀉會導致復dietstressadministrationEliminationT.foetusPCRin50%after2–5Jahrennegative Isthereahuman是否對人類健康有害T.foetus–ZoonoticTransmissionfromcatto從貓傳染給人1casereportofaT.foetusinfectioninhumanmedicine epididymitisandmeningoencephalitisinimmuno- afterbonemarrow Case?Madonna‘Therapy治

Ronidazole30mg/kgfor14羅硝30mg/kg每日一次，14sideeffects:Diarrhea?Madonna“–normalfecesaftercoupleof數(shù)日后糞?Elvis“–fecalincontinencedisappearedafter3days,normalconsistencyafter1.5weeks Case?Madonna‘Elimination病after14days14.foetuscultureboth:?Madonnanegative?Elvispositive Take-homeMessageT.foetus胎三毛Qhighprevalenceinpurebreedcatsin QsymptomaticinfectionrarelyasymptomaticQriskfactorsmultiplecathouseholdyoungage1year)breed→NorwegianForrestCatssig.moreoftenT.foetusQfecalPCRveryCAE:Handling,sideeffects,narrowtherapeuticindex!Qsymptomsandinfectionoftenself- CatbreedersinGermany…QhighprevalenceofT.foetusandGiardia QnohelmithsQT.foetus&Isosporamorecommoninyounganimals(≤1year)胎三毛蟲和等孢球蟲常見于年輕動物（<1歲QonlyT.foetusinfectionsig.associatedwith Case 家養(yǎng)短毛8yearsoldspayed絕育公lives室外生History

diarrheasinceweekspainfulmucusandsometimesfreshbloodonvaccination:current免疫：deworming:current驅蟲：physicalexamination身alerttemperature:mucusmembranes:pale-abdominalpalpation:problemlistruleoutlisttherapeuticanddiagnosticfurtherexamination進ultrasoundabdomen腹prominentintestinallargefurtherexamination進ultrasoundabdomen腹prominentintestinallargeultrasoundguidedbiopsy超ultrasoundguidedbiopsyConstipationHypomotility活動性Obstruction堵Neoplasia腫 a淋巴肉瘤mastcelltumorscommonsitesofcolonicdescendingcolonhighrate(63%)oflocalcauseintraluminal腔內(nèi)堵塞的原FIPgranulomafibrosinglinearycosisConstipationCausesidiopathicmegacolon ypelvic stenosisnerveinjuryManxsacralspinalcorddeformityConstipationdilatedmegacolonistheendstageofcolonicdysfunctioninidiopathiccases permanentlossofcolonicstructureandearlyappropriatetherapytostop早期恰當?shù)闹委?疾病進Constipationidiopathicmegacolonmiddle-aged(mean:5.8years)male中年雄貓（平均5.8歲domesticshorthair(46%),domesticlonghair(15%),Siamese家養(yǎng)短毛貓（46%），家養(yǎng)長毛貓（15%），暹羅貓reduced,absent,orpainful排便減少，無排便或Dehydrationmildmesenteric輕度的腸系膜 Constipationidiopathicmegacolon:diagnosticwork自發(fā)性巨結腸：建立診CBC,serumchemistryurinalysis DehydrationHypokalemiaHypercalcemiaT4(ifsignsconsistentwithhypothyroidism)Constipationidiopathicmegacolon:diagnosticworkabdominalintraluminalradiopaqueforeignintraluminalorextraluminalmasspelvicfracturesspinalcordabnormalitiesabdominalultrasoundextraluminalmasslesionsIdiopathicMegacolonremovalofimpactedadministrationof灌腸處warmisotonicsaline(5to10溫熱等滲生理鹽水(5to10mineraloil(5to10礦物油(5to10manualextractionofimpacted手工取出壓緊的糞Idiopat