3泛白細(xì)胞減少癥esavs

KatrinProf.Dr.med.vet.,Dr.habil.,Dipl.ECVIM-Ludwig-ilians-Universit?t88

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-neutralizingantibodies中和抗體intravenousantibioticsIV lav.acid+靜脈抗生素（阿莫西林克拉維酸+頭孢噻肟antiemetics止吐劑getics止痛劑（ le after7daysnodiarrheaandvomiting normallyeatingandnodischargedfromisthisatypicalcaseofisthereevidencethatthistreatmentis Feline diseaseindogsandcatscausedbyinfectionwith ats貓的細(xì) “feline Felinefirst atswithdetectionofviralVerge&Cristoforoni, felines (FPV)small(20nm),non- extremelystableintheenvironment(>1在環(huán)境中極其穩(wěn)定（1年closelyrelatedtocaninewhichdevelopedinCatswithKruseetal.,studydesignretrospectivestudy19902007)Patients244 presentedtotheClinicofSmallAnimalMedicine,LudwigilianUniversity,MunichlusioncriteriadiagnosisoffelineCatswithagedistribution

白細(xì)胞減少癥Kruseetalmedian:4months,range:2weeks–14numberofageofpatientsatclinicalpresentation(nnumberofnumbernumberof0 ageof

ageof患 （歲Catswithagedistribution<1year(n=1歲（n174

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Kruseetal.,Catswithn=%Mixed6211cerebellar

bonemarrowbonemarrow&瘟 intestinal瘟intestinalellsS-phaseof pathogenesispathogenesisFPVoro-fecalroute/systemicinfectioncerebellar

瘟bonemarrow&瘟bonemarrow&intestinalreplication ellsS-phaseofemicemicV:oro-fecalcerebellar

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bacterialtranslocationhemorrhagicGE細(xì)菌移位，

DehydrationclinicalclinicalpictureFPVinfection ShockClinicalsystemiccerebellarhypo sia(CNSinfection) reproductiveproblems(earlyinutero Meursetal.,DestructionofIntestinalPicture:W.Hermanns,DepletionofBonePicture:W.Hermanns,canineparvovirosisandfelinecanineparvovirosisandfelinecanineparvovirosisandfelineCatswithKruseetal.,clinicalfindingsanorexia(71.2diarrhea(69.3vomiting(62.7depression(54.9Fever(23.2hemorrhagic(14.1Catswithlaboratory

Kruseetal., 白細(xì)胞減 (65.2neutropenia(46.7lymphopenia(38.7-neutro-+(24.1(54.2Anemia(48.4CatsCatswithKruseetal.,(44.6(30.1(28.6

(6.8Treatmentsymptomaticandlackofcontrolledspecificantiviral 治antiviral passiveSupportivefluidtherapybalancedisotonicpotassium cement>20oncotic syntheticcolloidse.g.hetastarch(20sma/bloodtransfusion輸血漿/TPNoxygentubeSupportiveTreatmentrationaluse lfeedingearlyen l(micro-)

painmedicationbuprenorphine/phentanyl/lidocaineAntibioticsbroad-spectrumantibioticsbactericidalIVhigherdose lavul.ac.+pradofloxacin3mg/kgPOq24 3mg/kg口服q24 lavul.ac.+enrofloxacin5mg/kgSQq24 5mg/kg皮下q24 lavul.ac.+gentamicin6mg/kgIVq24h阿莫西林克拉維酸鉀+慶大霉素6mg/kg靜脈q24h lavul.ac.+3rdgenerationcephalosporinsIV1st+3rdgenerationcephalosporinsAntiviral 治passive commerciallyavailableimmunoglobulinsFeliserin?0,4ml/kgSQ3consecutivedaysFeliserin?0,4ml/kg皮下，連續(xù)3transferofantibodies1-3ml/kghyperimmuneserumor smaSQ1-3ml/kg felineinterferon- 2.5x106IU/kgIVq24hfor3consecutive2.5x106IU/kgq24h，連續(xù)3Passiveantiviraleffects 作 -neutralizing ats,Stagloban?in特 （貓F(tuán)eliserin?犬Stagloban?Dosage forprophylaxis1injection fortreatment3injectionsSQ(3consecutive panleukopenia,calici andherpes infection(cat) parvovirosis,distemper,ICH(dog) sideeffectsanaphylactic ats(repeated貓的過敏反應(yīng)（重復(fù)運(yùn)用StudiesonPassiveITinprophylacticuseexperimentalstudyefficacyproventherapeuticusecebo-controlleddouble-blindstudyindogswith passiveimmunotherapyasadditionallesssevereclinicalsymptomsshorterperiodinhospitallowercostsMacintireetal.,antiviraleffects 效 assemlyandbudding抑 組裝和出DosagehuIFN-highdose105–106IU/kgq24hSQ(short人FN-105106IU/kgq24h皮下（短期使用huIFN-lowdose1(-50)IUPOq24h(long-人FN-150IUq24h長期feIFN-2.5x106IU/kgIVq24hfor3consecutive貓F(tuán)N-2.5x106IU/kgq24h，連續(xù)3Spectrum infectionssideeffectsStudiesonInterferon-ωin犬干擾素-ωexperimental al.,infectionof10SPFbeaglepuppies10只SPF比格犬a(chǎn)ll“standardtreatment”所有采用“標(biāo)準(zhǔn)治療”5pups5felineinterferon-ω2.5x106IU/kgSQq24hfor3貓干擾素-ω2.5x106IU/kg皮下q24h持續(xù)3=>4/5pupssurvivedinFeIFN-=>0/5pupssurvived cebo=>statisticallyStudiesonInterferon-ωin干擾素-ωfieldstudyinnaturallyinfecteddogs在自 的犬上研究 Minagawaetal.,cebo-controlleddouble-blindstudy安慰劑-93dogswithparvovirosis(33vethospitals) =>statisticallysignificanthighersurvivalfieldstudyinnaturallyinfecteddogs 在自 的犬上研究（法國DeMarietal.,cebo-controlleddouble-blind 92dogswithparvovirosis(19vet =>statisticallysignificanthighersurvivalStudiesonInterferon- 干擾素-ωfieldstudyinnaturallyinfectedcats uncontrolledstudyinaFPVoutbreakina23catspre-treatedwithfelineinterferon-ω23只貓使用干擾素-ω預(yù)治療17catsnotpre- nosignificantdifferenceinsurvivalrateintimeuntildevelopmentofclinicalPaltrinierietal.,WhatcanwelearnfromthisWhatcanwelearnfromthis Whatcanwelearnfromthis kittensarehighlysusceptiblewhenmaternalantibodieswaneWhatcanwelearnfromthis kittensarehighlysusceptiblewhenmaternalantibodieswaneWhatcanwelearnfromthis kittensarehighlysusceptiblewhenmaternalantibodieswane antiviralchemotherapycombinedwithsymptomatictreatmentimportant(intensivecarepatients)Whatcanwelearnfromthis kittensarehighlysusceptiblewhenmaternalantibodieswane antiviralchemotherapycombinedwithsymptomatictreatmentimportant(intensivecarepatients) Whatcanwelearnfromthis kittensarehighlysusceptiblewhenmaternalantibodieswane antiviralchemotherapycombinedwithsymptomatictreatmentimportant(intensivecarepatients) DSH femaleHistory

stoppedeatingthismorningpresentedin lrecumbent environment:livesindoorswithoutdooraccessvaccination:worming:physicalexaminationseverelytemperature:36.3°C(97,4體溫：36.3C(97,4slightlypainfulmildocularreferenceredbloodcellsx5-5.5-0.30-x200-x5-0x0-x1.5--band0x0--seg.x3-胞0x0-0x0-remarksnext next antigen細(xì) 抗原next antigen細(xì) 抗原edead2hours dmissiontothefibrinousenteritis,totaldepletionofpeyerdepletionoflymphnodesand全骨髓炎， diagnosticforwhywasthe antigentest docaninefecaltestswork whatistheprognosisinfeline detectionin electron detectionin indirectdetection(ofantibodies)in直接檢 中（抗體-hemagglutinationinhibitionnothelpfulfordiagnosisabletopredict detectionofpathognomonicnecropsytoolateComparisonComparisonbetweenParvo 200fecalsamplesofrandomlyselectedhealthycats/catswithgoldstandard=>electronComparisonbetweenParvo細(xì) ParvoStrip?sensitivityspecificityPPVNPVinvalidtests0000testsdifficulttointerpretNeuereretal.,ReasonsforNegativeTestinapproproatefecalsamplesnotenoughmaterialtoodiluteliquidfeces)過稀（液體糞便intermittendsheddingnotdetectable strains(e.g.,CPV- highcontentofantibodiesinCatswith貓泛白細(xì)胞減少癥Kruseetal.,en 結(jié)果(n231 51.1 51.1mediandurationofhospitalization7 48.948.9 todeath/euthanasia2 時間Catswithnosignificantcorrelation eand signalement(breed,age, housingconditions(indoor/outdoorvaccinationstatusclinicalsigns12

Catswithp=

Kruseetal.,1086420years3.5

3.8CatswithKruseetalprognostic badprognosisif lowleukocyte et low lowpotassiumconcentrationCatswithleukocytes/μl白細(xì)p=

00 μlCatswithleukocytes/μl白細(xì)

p=ififtotalnumberofleukocytes<relativeriskofdeath=>1.77xhighercomparedcatswith>1,000leukocytes/μl(p=

00 μlwhatcanwelearnfromthiswhatwhatcanwelearnfromthis whatcanwelearnfromthis estcanbetodiagnose whatcanwelearnfromthis estcanbetodiagnose whatcanwelearnfromthis estcanbetodiagnose testsmaybefalse(fecalorbloodPCR mendedfor whatcanwelearnfromthis estcanbetodiagnose testsmaybefalse(fecalorbloodPCR mendedfor ageisnotprognostic,butleucocytes, ets,albumin,potassiumareusefulprognosticparameterwhatcanwelearnfromthis estcanbetodiagnose testsmaybefalse(fecalorbloodPCR mendedfor ageisnotprognostic,butleucocytes, ets,albumin,potassiumareusefulprognosticparameterwhatcanwelearnfromthis estcanbetodiagnose testsmaybefalse(fecalorbloodPCR mendedfor ageisnotprognostic,butleucocytes, ets,albumin,potassiumareusefulprognosticparameterwhatcanwelearnfromthis estcanbetodiagnose testsmaybefalse(fecalorbloodPCR mendedfor ageisnotprognostic,butleucocytes, ets,albumin,potassiumareusefulprognosticparameterDSH5 female e5daysdepressedeatslessthanusual e2daysconditionworsening,stopseatinganddrinking onedayofpresentationunabletogetenvironment:livesindoors(hasneverbeenvaccination:worming:physicalexaminationdepressed temperature:35.7°C(96.3體溫：35.7C(96.36 redbloodcellsx5-5.5-0.30-x200-x5-0x0-x1.5-x0-segneutroph.x3-0x0-0x0-remarksnextstep?nextstep? antigen細(xì) 抗原nextstep? antigenELISA Positive陽性Treatmentantiviralsandsupportive erecoveredanddischargedfromhospitalafter10nextstep? antigenELISA Positive陽性Treatmentantiviralsandsupportive erecoveredanddischargedfromhospitalafter10doadultcatsalsodevelopthehowcommonareatypicalclinicalsigns? Catswithagedistribution(n median4monthsrange2weeks14 numberofnumberof

ageofpatientsatclinicalpresentation(n=numberof numberofageof

患貓（歲Catswith貓泛白細(xì)胞減少癥Kruseetal.,clinical anorexia(71.2diarrhea(69.3vomiting(62.7depression(54.9fever(23.2hemorrhagic(14.1Catswith30.7%neverhad37.3%neverhad37.334.2%neverhad15cats15neithergastrointestinalsignsnorwhatcanwelearnfromthiswhatcanwelearnfromthiswhatcanwelearnfromthis adultcatscandeveloppanleukopenia(ifnotvaccinate turallyboostered)whatcanwelearnfromthis adultcatscandeveloppanleukopenia(ifnotvaccinateturallyboostered)成年貓也能泛白細(xì)胞減少癥 catsmaynothavegastrointestinalsignsormaynotbeleukopenicwhatcanwelearnfromthis adultcatscandeveloppanleukopenia(ifnotvaccinateturallyboostered)成年貓也能泛白細(xì)胞減少癥 catsmaynothavegastrointestinalsignsormaynotbeleukopenicwhatcanwelearnfromthis adultcatscandeveloppanleukopenia(ifnotvaccinateturallyboostered)成年貓也能泛白細(xì)胞減少癥 catsmaynothavegastrointestinalsignsormaynotbeleukopenicDSH12weeksfemale

presentedwithhersister generalizedataxia,stumbling,andfalling ethecatsstartedwalking litterofsixkittens(3 enviroment:bornattheindowntownMunich,indoorsmotherwiththeownerformanyyears(multi-cathousehold)mothernevervaccinated vaccination:once(at8weeksofworming:physicalexamination

intentiontremorofthe(mostpronouncedwhenofferedtruncalwithintermittentfallingtoeitherside onall4limbs physicalexamination

intentiontremorofthe(mostpronouncedwhenofferedtruncalwithintermittentfallingtoeitherside onall4limbs neurologicexaminationabsentmenaceresponse缺 反otherwisenormalnextstep?

antigen細(xì) 抗原nextstep?

antigenELISA eownerelectedtokeepthe3kittensslightimprovementofataxiaovertimenextstep?

antigenELISA eownerelectedtokeepthe3kittensslightimprovementofataxiaovertimedifferentialdiagnoses/ruling-outothercerebellar =>slight小腦發(fā)育不 =>緩慢改(“felineataxia”,inutero/earlyFPVinfection)（“貓共濟(jì)失調(diào) cerebellar => ic（遺傳性storage =>貯積 =>骨髓形成不 =>恢(myelinmaturationdefect, icindogs（髓磷脂成熟缺陷，狗上為遺傳性的toxiccerebellar =>slight =>緩慢改善 nesthesia,e.g.,ketamin)（麻醉，例如whatwhatiscerebellarshouldthesekittensbeCerebellar “feline infectioninuterountil<6 直到<oftenseveralkittens/whole notcurable,butmanykittenscanlivewithitsometimesgetslightlybetterwithtime definitivediagnosisintravitamnot postmortemPCR,insituCerebellar :A.Lloret,Cerebellar :A.Lloret,Picture:A.Lloret,whatcanwelearnfromthiswhatcanwelearnfromthis whatcanwelearnfromthis cerebellar siararewhatcanwelearnfromthis cerebellar siararewhatcanwelearnfromthis cerebellar siarareusuallyseveralkittensinone invivoonlyexclusiondiagnosiswhatcanwelearnfromthis cerebellar siarareusuallyseveralkittensinone invivoonlyexclusiondiagnosispossiblekittensdonotshedparvowhatcanwelearnfromthis cerebellar siarareusuallyseveralkittensinone invivoonlyexclusiondiagnosispossiblekittensdonotshedparvowhatcanwelearnfromthis cerebellar siarareusuallyseveralkittensinone invivoonlyexclusiondiagnosispossiblekittensdonotshedparvomayslightly(morphologicstructuresdonotchange,butkittensmaysomehow“adapt”)whatcanwelearnfromthis cerebellar siarareusuallyseveralkittensinone invivoonlyexclusiondiagnosispossiblekittensdonotshedparvomayslightly(morphologicstructuresdonotchange,butkittensmaysomehow“adapt”)DSH8 femaleHistory

e3daysvery environment:strictlyindoors(appartmenton27thfloor)vaccination:aswith8and12weeksofagenevers ethen worming:asphysicalexaminationlethargicanorecticslightlydehydratedredbloodcellsx5-5.5-0.30-x200-x5-x0-x1.5--bandx0--seg.x3-0x0-0x0-remarksnextstep?nextstep? antigen細(xì) 抗原nextstep? antigenELISA nextstep? antigenELISA fecalelectronnextstep? antigenELISA fecalelectron

3daysin startedeatingafter72hours reaseinneutrophilcountover4days dischargedhomeafter1week stillpositive(EM)atweek6after negative(EM)atweek8after stillpresent3yearshowcana yindooronlycatbe canacatbeinfectedfromadog? canadogbeinfectedfroma whydidthevaccinationnot Catswithenvironmentalconditions(n=indooronlycats室內(nèi) 62.1 37.9housholdconditions(n=multi-cat 85.5single-cat 14.5Caninecanine (CPV-2a,-2b,-firstdescriptionin19781987CPV-2(CPV-?changed“toCPV-2aCPV-2brecentlyCPV-2c)“變異為”CPV-2a,CPV-2b,(CPV-2c)CPV-2a,-2b,-caninfectcats能 cancausecanacatbeinfectedfroma canadogbeinfectedfroma

e3daysanorectic從3verylethargic environment:strictlyindoors(appartmenton27thfloor)vaccination:aswith8and12weeksofagenevers ethen worming:asImmunologic4serumserumantibodytiter2 minimaltiterto minimaltitertoblockvaccination作用的最低滴0

CatswithKruseetal.,vaccinationstatusn184)60.3%(111/184)never39.7%(73/184)atleastone39.773/184)79.5%(58/73)onevaccineprior of1279.5 11.0%(8/73)twovaccinesprior of1211.0 9.5%(7/73)twovaccinespriorto of12weeksandseveralvaccinesonayearlybase9.5%(7/73)12之前有兩次，進(jìn)行過數(shù)次年度免noneofthecatsprimaryvaccinationcourseafterof12weekscorecurrentcurrent(6weeks689weeks8-912weeks1216weeks16booster1year every3y