scott@vtx-cpd.com
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Replying to Francesca Lamb 08/08/2023 - 08:16
Hey Fran.
We did touch on this a little at the live Q&A. It is a great question. The exact epidemiology of lung worm in Scotland is not exactly determined. It is definitely more of a problem than when I first graduated. Seems to be more prevalent in Glasgow than the east, but I would keep it on my list of DDX for sure up your way!
I am always a fan of 5-7 days of fenbendazole in my my respiratory cases just in case!
Hope that helps.
Scott ๐
Replying to Nadia C. 09/08/2023 - 23:00
Hello!
I am glad you enjoyed the case. I would indeed use N-acetylcysteine (NAC) when there is suspicion of oxidative damage to red blood cells for its potential antioxidant effect.
NAC is usually given as a 10% solution diluted 1 to 2 with saline as an IV bolus over 20 minutes through a 0.25 micron non-pyrogenic in-line filter at a dosage of 140โฏmg/kg initially followed by dosages of 70โฏmg/kg q 8-12โฏh.
Hope that helps.
Scott ๐
Replying to Francesca Lamb 11/08/2023 - 16:09
Thanks again Fran.
I agree! The patient received treatment for possible lungworms (Advocate; Bayer) and underwent bronchoscopy. The airways appeared macroscopically normal; bronchoalveolar lavage fluid (BALF) was sent for routine bacterial and fungal culture (which were negative), Mycoplasma felis PCR (this was negative) and cytology (which showed severe pyogranulomatous inflammation). In addition to routine haematoxylin and eosin staining, the BALF was stained with Grocott methenamine silver to evaluate the presence of fungi (negative) and ZiehlโNeelsen (ZN), which showed acid-fast bacilli morphologically consistent with mycobacterial infection. The interferon gamma release assay (IGRA) was performed, and the results were compatible with infection by the less pathogenic member of the Mycobacterium tuberculosis complex (MTBC); that is, Mycobacterium microti (โthe vole bacillusโ). Combining clinical signs and results, the patient was diagnosed with pneumonia and hypercalcaemia caused by M microti; that is, the cat had a form of tuberculosis commonly seen in cats in certain UK regions, including Scotland.
The patient was treated with rifampicin (Rifadin [Sanofi]; 10โmg/kg PO q24h), azithromycin (Zithromax [Pfizer]; 15โmg/kg PO q24h) and marbofloxacin (Marbocyl P [Vetoquinol]; 3โmg/kg PO q24h) for 2 months initially. A month after starting treatment, the catโs body weight and appetite had improved, and iCa was normal. After 2 months of triple antibiotic therapy, haematology, serum biochemistry and thoracic radiographs were unremarkable, and rifampicin was stopped. After an additional 4 months, iCa and thoracic radiographs were unremarkable, IGRA was negative and serum vitamin D concentration was now normal, and so azithromycin and marbofloxacin were stopped.
Thank you for all of your brilliant answers and interaction!
Scott x
Replying to Raquel M. 19/08/2023 - 03:21
Hey.
I would normally go for 0.5mg/kg BID in most patients.
Hope that helps!
Scott ๐
Misoprostol is also interesting!
Results from 41 control dogs and 39 dogs treated with misoprostol and aspirin at dosages ranging from 25 to 35โmg/kg q8h have been published in refereed journals, (but only 1 was a randomized controlled trial). Misoprostol dosages ranged from 3 ฮผg/kg PO q12h to 15โฮผg/kg PO q8h. Dosing misoprostol once daily appears inadequate compared to administration q8h to q12h. Misoprostol significantly decreased GUE or haemorrhage associated with aspirin, but it did not completely eliminate gastric lesions. Misoprostol can be considered as prophylaxis for NSAID treatment if there is clearly a need for prophylaxis and PPIs fail or cannot be used. Except for aspirin, effectiveness of misoprostol for GI injury from other NSAIDs has not been tested in dogs and cats. Misoprostol is less effective for treating or preventing duodenal ulcer compared to gastroduodenal ulceration and erosion in both dogs and cats.
Misoprostol is effective for decreasing gastric lesions in dogs treated with high-dose aspirin, but it is unknown if misoprostol is effective for preventing gastroduodenal ulceration and erosion associated with administration of other NSAIDs in dogs and cats. There is no evidence that misoprostol decreases GUE from glucocorticoids in dogs and cats.
Overall, in sever cases of NSAID toxicity, I would still consider misoprostol use.
I hope that helps!
Scott ๐
Hello Raquel.
Great to hear from you. I hope you are well. This is a really interesting question. Generally when the GI bleeding is due to NSAIDs, omeprazole (1mg/kg BID) +/- sucralfate is often enough to manage the problem. In more severe/difficult to control GI haemorrhage cases, I would sometimes reach for tranexamic acid. There is very little evidence in veterinary medicine for tranexamic use in this context. There is a bit more in human medicine:
https://pubmed.ncbi.nlm.nih.gov/34709209/
https://pubmed.ncbi.nlm.nih.gov/33041136/Human evidence on the effects of tranexamic acid in patients with gastrointestinal bleeding is limited or highly heterogeneous. Some data suggests it is helpful and one of these reviews even suggests oral and lower dose therapy may be more helpful.
So, I would consider using tranexamic acid in severe cases of GI haemorrhage. Especially those cases where bleeding was uncontrolled with other therapy. Hope that helps.
Scott ๐
Replying to Alice L 16/08/2023 - 18:16
Hey Alice.
Hope you are well. We chatted about this question at the Q&A. We will let you know when the recording is available. If you want to chat about this anymore or have any other questions let me know!
Have a lovely weekend.
Scott ๐
Hello Nadia.
Sorry you were not able to make the session. Life is busy!
I hope your week has been OK. The session is indeed recorded and we will let you know when that is available.
Scott ๐
Replying to Alice L 16/08/2023 - 18:16
Hello Alice.
I hope you are well! I will make sure we cove this in the session tomorrow night!
Thanks again for the great question.
Scott ๐
Sarah!
Lovely to hear from you! Thank you for your brilliant questions!
I really hope you are enjoying the course.
I will pass these question on.
Scott ๐
Replying to Laura Jones 02/08/2023 - 15:25
Hey Laura.
Really interesting topic indeed, thank you so much for sharing.
Scott ๐
Replying to Nadia C. 09/08/2023 - 23:03
No problem.
Let me know if you have any other questions.
Scott ๐
Replying to Dan T. 03/08/2023 - 20:00
Hey Dan.
This is really interesting, thank you for sharing.
It was good to touch on this in the live session too, it is such an interesting topic.
Thank you again for all of the brilliant contribution.
Scott ๐
Replying to Matteo R. 05/08/2023 - 08:19
Hello Matteo!
So lovely to hear from you. Thank you so much for being a part of the course.
Thank you so much for your contribution, really looking forward to your lesson.
Have a great week.
Scott ๐
Replying to Harry S. 03/08/2023 - 10:59
Hey Harry.
I hope you are well. Great to see you here and thank you so much for your contribution!
I am a bit jealous deep down, I truly wish I understood fluid therapy like you did!
Your brilliance is noted and appreciated.
Thanks again.
Scott ๐
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