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Pyodermas are considered a(n) ____________ of a(n) ___________.
secondary clinical manifestation; primary problem
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Any _____________ can cause a pyoderma.
predisposing condition that alters the normal cutaneous defense mechanisms
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What are the cutaneous defense mechanisms against pathogenic bacteria? (8)
hair cot, epidermal turnover, stratum corneum, epidermal lipids,sebum, immunoglobulins, interferon, normal non-pathogenic flora
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What are common predisposing conditions to pyoderma? (8)
environment (temperature and humidity), allergic dermatitis, endocrinopathies, immunologic incompetence (neoplasia), idiopathic keratinization defects, ectoparasites, poor nutrition, long term glucocorticoid therapy
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What are common lesions associated with pyoderma? (3)
pustules, epidermal collarettes, papules
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What is the main cutaneous pathogen in canine pyoderma? What is a less common primary pathogen?
Staphylococcus pseudintermedius; less commonly Staph aureus
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What are secondary pathogens that are often involved in canine pyoderma? (5)
Proteus, Corynebacterium, Bacillus, E. coli, ad Pseudomonas
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What drugs are ineffective against Staph pseudintermedius and aureus? Why? (5)
penicillin, amoxicillin, and ampicillin- these bacteria produce beta-lactamase, which destroys these antibiotics; additionally, they usually have inherent resistance to tetracycline and stroptomycin
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What are the 2 types of surface pyodermas?
acute moist dermatitis (hot spots), skin fold pyoderma
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What is the etiology of acute moist dermatitis? What are 5 common underlying causes?
- self-inflicted: underlying problem causes licking, chewing, scratching--> trauma--> secondary infection
- Underlying problems: allergic skin disease, ectoparasites, otitis externa, dirty matted coat, foreign body
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What are clinical signs/lesions associated with acute moist dermatitis? (4)
erythema, edema, seropurulent exudate (yellow crust), painful
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How do you diagnose acute moist dermatitis? (3)
history and clinical signs, try to ID underlying disease, skin cytology shows cocci and degenerate neutrophils
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How do you treat acute moist dermatitis? (6)
control underlying disease process, clip hair around lesion, clean area, [if mild] topical steroid, [if severe] oral prednisone, [if generalized or multiple lesions] oral antibiotic
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Exudative, odiferous, and erythematous lesions within the skin folds.
skin fold pyoderma
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What anatomic defects in certain breeds predispose them to maceration of the stratum corneum? (3)
constant skin friction, poor air circulation, accumulation of moisture (tears, sebum, saliva, urine)
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What breeds are predisposed to lip fold pyoderma? (3)
cock and springer spaniels, St. Bernards, bulldogs
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What is commonly the clients complaint with lip fold pyoderma?
halitosis
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In what breeds is facial fold pyoderma most common? What are common concurrent conditions?
Brachycepalics; traumatic corneal abrasions or ulcerations (due to scratching at face)
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What are common client complaints with vulvar fold pyoderma? (4)
frequent licking at vulva, foul odor, painful urination, +/- secondary ascending UTI
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What breeds are predisposed to tail fold pyoderma? (3)
English bulldog, boston terrier, pugs
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How do you treat skin fold pyoderma?
- palliative therapy: clip hair, gentle daily cleansing, +/- topical steroid and antibiotics
- Surgical ablation of defect: if owner wants permanent cure
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What are the most common locations for skin fold dermatitis? (4)
nose, lips, vulva, tail
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Puppy pyoderma, superficial pyoderma occurring in puppies less than 1 year old.
impetigo
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Describe the presentation of impetigo.
subcorneal pustules that affect sparsely haired skin of the groin, abdomen, and axillae
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Impetigo may be associated with... (4)
parasitism, poor nutrition, dirty environment, and viral infections
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Describe the treatment for impetigo. (4)
none if mild, antibacterial shampoo or ointment, eliminate underlying cause, [severe/persistent] systemic antibiotics
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Bacterial infection involving the hair follicle and adjacent epidermis, but not beyond the hair follicle.
superficial bacterial folliculitis
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Clinical signs/lesions of superficial bacterial folliculitis. (7)
papules, pustules, erythema, epidermal colarettes, focal areas of alopecia; [short coated breeds only] moth-eaten alopecia, small tufts of hair stand up
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Superficial bacterial folliculitis RARELY affects what locations? (3)
face, pinnae, distal extremities
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What are common pruritic underlying causes of superficial bacterial folliculitis? (4)
atopic dermatitis, food allergy, flea allergy, scabies/chyeletiella
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What are common non-pruritic underlying causes of superficial bacterial folliculitis? (4)
hypothyroidism, hyperadrenocorticism, idiopathic seborrhea, demodicosis
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How do you diagnose superficial bacterial folliculitis? (4)
history/clinical signs, skin scrape to rule out demodex, skin scraping shows cocci and degenerate neutrophils, negative dermatophyte culture
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How do you treat superficial bacterial folliculitis?
identify and treat underlying disease, systemic antibiotic 1 week past resolution of lesions, +/- antimicrobial shampoo
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What types of deep pyodermas present in SA medicine? (5)
canine acne, nasal pyoderma, interdigital pyoderma, generalized deep pyoderma, pyotraumatic folliculitis (deep hot spot)
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What is the usual distribution of canine acne?
chin +/- lips of short-haired breeds [young animals]
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Canine acne involves what two pathologic processes?
folliculitis and furunculosis
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What types of lesions are associated with canine acne? (6)
- Primary: papules, nodules, pustules
- Secondary: ulcerations, draining tracts, purulent exudate
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How do you diagnose canine acne? (3)
history/clinical signs, skin scraping to rule out Demodex, skin cytology usually shows pyogranulmatous, eosinophils
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Describe the txt of canine acne. (6)
none if mild, Benzoyl peroxide shampoo periodic bathing, antiseptic wipes, topical steroids, mupirocin ointment, [if severe] systemic antibiotics
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What breeds are more commonly affected with painful nasal pyoderma? (4)
GSD, Bull terrier, Collies, Pointers
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What lesions are associated with nasal pyoderma? (6)
papules, pustules, crusting, folliculitis and furunculosis with draining tracts [all on dorsal aspect of muzzle]
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How do you diagnose nasal pyoderma? (4)
history/clinical signs, skin scraping to rule out demodex, biopsy to rule out pemphigus and eosinophilic furunculosis, fungal culture to rule out dermatophytosis
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How do you treat nasal pyoderma? (3)
gentle soak, antibacterial shampoo, systemic antibiotic
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What are 2 focal and 3 systemic causes of interdigital pyoderma?
- focal: foreign body, local trauma
- systemic: allergic dermatitis, psychogenic dermatitis, hypothyroidism
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What is the most common cause of interdigital pyoderma?
idiopathic
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What lesions are associated with interdigital pyoderma? (5)
papules, nodules, bullae, ulcers, draining tracts
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How do you diagnose interdigital pyoderma? (5)
history/clinical signs, skin scraping to rule out parasites, cytology consistent with deep pyoderma, fungal culture if suspect fungal deep infection, [more chronic cases] skin biopsy
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How do you treat interdigital pyoderma? (4)
systemic antibiotics 8-12 weeks, topical soaks, surgery if formed dermal granulomas, try to ID underlying problem
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What breed is predisposed to generalized deep pyoderma?
GSD
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What lesions are associated with generalized deep pyoderma? (6)
pustules, crusts, erosions, ulcers, draining tracts, pain
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What areas are most commonly affected by local deep pyoderma? (4)
rump, lateral thighs, chest, legs
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____________ is important to rule out with ANY deep pyoderma.
Demodex
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How do you diagnose generalized deep pyoderma?
deep skin scraping to rule out demodex, cytology, bacterial culture and susceptibility, +/- biopsy, fungal cultures to rule out deep fungal infection
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How do you treat generalized deep pyoderma? (3)
antibiotic therapy based on culture and sensitivity, antibacterial baths, topical antibacterial medications/chlorhex spray
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What breed commonly gets deep hot spots?
Golden Retrievers
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What are big rule-outs to diagnose deep hot spots?
true hot spot (superficial), deep fungal infection
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What is important for management of deep hot spots?
find an underlying cause
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How do you treat deep hot spots? (5)
ID and treat underlying disease, systemic antibiotic based on culture and sensitivity, clip and remove hair in the area, antibacterial soaks, +/- oral prednisone
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What is a major difference between treating superficial and deep pyoderma?
- uncomplicated superficial pyoderma- it is acceptable to try empirical therapy
- deep- always culture and sensitivity
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What drugs should NOT be used as empirical treatment for pyoderma?
penicillin, ampicilin, amoxicillin, tetracycline, streptomycin
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What drugs are acceptable to use as empirical therapy for pyoderma? (9)
- Cephalosporins- first choice
- Clindamycin
- Lincomycin
- Eryhtromycin (has to be given every 8 hours...low client compliance)
- Oxacillin (injectable, expensive, every 8 hrs)
- Trimethoprim sulfas (severe side effects)
- Chloramphenicol (dangerous to human exposure- aplastic anemia; severe side effects; every 8 hrs)
- Clavamox (good but has broader spectrum)
- Enrofloxacin
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__________ is almost always used as adjunctive therapy for treatment of pyoderma.
Topical therapy (wet soaks, antibacterial shampoos, antibacterial ointments and wipes)
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What is the most common cause of treatment failure for pyoderma?
insufficient duration of therapy
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How long should you treat superficial vs deep pyoderma?
- superficial- 7-10 days past clinical cure
- deep- 14-20 days past clinical cure
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Methicillin resistance is conferred by ________.
mecA gene
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Multi-Drug Resistant (MDR) staph is an organism that is...
resistant to 3 or more classes of antimicrobial agents.
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What are risk factors for MRSP? (2)
treated with antimicrobials in 30d prior to onset, have been hospitalized
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How can you prevent spread/colonization with MRSP? (4)
prevent infection, diagnose and treat infection effectively, use antimicrobials wisely, prevent transmission
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When is staphage lysate used?
important to control the infection with recurrent idiopathic resistant staph infection; concurrent antibiotic therapy; for life
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