WikiVet English - User contributions [en]

Rabbit Reproduction - Anatomy & Physiology

2022-10-27T13:58:00Z

JoeWright:

== Male ==
The male rabbit is known as the '''buck'''.

=== Penis===
The penis has a rounded penile sheath and urethra. It can be easily extruded in rabbits over 2 months of age.

=== Testes ===
The rabbit has two testes that descend at approximately 12 weeks of age. These testes are large with epididymal fat pads. In the adult male they lie in two almost hairless scrotal sacs which are cranial to the penis (in the majority of placental mammals they lie caudal to the penis). The inguinal canal remains open throughout life.

=== Accessory Sex Glands===
The seminal vesicles open into the prostatic section of the urethra. The bulbourethral glands are small and paired. They form a bilobed swelling in the dorsal wall of the urethra, just behind the prostate.

=== Mammary Gland ===
Male rabbits do not possess nipples.

== Female ==
The female rabbit is known as the '''doe'''.

=== Uterus ===
The female rabbit has a [[Uterus - Anatomy & Physiology#Anatomical_Types_of_Uteri|bicornuate duplex uterus]]. This has two separate uterine horns and no uterine body. Each horn has its own [[Cervix - Anatomy & Physiology|cervix]], and the two cervices open into a single vagina.

The mesometrium is a major fat storage organ. It is very friable and contains many vessels, however only minor anastomoses exist between the uterine and ovarian vasculature.

== Puberty and Sexual Maturity ==

The age of sexual maturity varies with breed:
* Small breeds mature at ~5 months
* Larger breeds mature as late at as 8 months.

== Breeding Characteristics ==
Rabbits are induced [[Ovulation - Anatomy & Physiology|ovulators]] with no well-defined [[Oestrous Cycle - Anatomy & Physiology|oestrous cycle]]. The female rabbits have periods of sexual receptivity every 4-6 days and the oestrus period lasts ~14 days. [[Ovulation - Anatomy & Physiology|Ovulation]] occurs within 10 hours of coitus.

The breeding season lasts from January to October in the UK.

Does can become quite territorial and this needs to be taken into account when planning any matings. It is advisable to take the doe to the buck rather than the other way round.

== Gestation and Offspring ==
===Pregnancy diagnosis===
Foetuses may be felt by gentle abdominal palpation as early as 10 days post breeding as 1 to 1.5cm masses in the caudal ventral abdomen. At 18 days they should be 2.5 to 3cm in length.

Radiography or ultrasonography can be used after 21 days if necessary.

=== Gestation ===
The gestation period of a rabbit is 29-35 days.

Pseudopregnancy may occur, which lasts approximately 18 days. It can be caused by infertile mating, or the presence of a male nearby. The dam is unable to conceive during this time. During pseudopregnancy, the [[Corpus Luteum - Anatomy & Physiology|corpus luteum]] secretes progesterone, which causes the uterus and mammary glands to grow.

=== Litter ===
The litter size can vary from 4-12 offspring.

The young are altricial - born hairless, deaf and blind. Offspring are totally dependent on their mother for the first few weeks of life. They are protected from the environment and predators by the nest which is made by the doe using hair from her dewlap. If the nest is disturbed, the doe may cannibalise the offspring.

=== Mammary Gland and Lactation ===

The doe has four or five pairs of nipples. The mammary gland develops in the last week of pregnancy. Suckling is stimulated by a [[Attractivity Behaviour - Anatomy & Physiology#Pheromones|pheromone]] produced by a gland near the nipple.

Consumption of water and caecotrophs by the doe increases 10-fold during lactation.

Rabbit milk is richer than cow's milk, it has an unusually low [[Milk Composition and Biosynthesis- Anatomy & Physiology#Carbohydrate:Lactose|lactose]] content and a very high protein and fat content.

Composition:
* 13% Protein
* 9% Fat
* 1% Lactose
* 2.3% minerals

==Sexing==

Kits are best sexed at birth or at weaning (5-8 weeks of age). In between those times it can be difficult to exteriorise the genitalia.

Sexing is performed by gentle pressure on the genital orifice which everts the penis or vulva. The male has a cylindrical organ with a rounded to oval-shaped urethral opening. The female vulva has a leaf-like appearance with a slit-like opening.

In the male the testicles descend at around 12-14 weeks of age and can be palpated, although they can be retracted into the abdomen if the rabbit is stressed.

{{Learning
|flashcards = [[Small Mammals Q&A 17]]
}}

==References==

Richardson, V. (2000) '''Rabbits Health, Husbandry and Diseases''', ''Blackwell Science''

[[Category:Small Mammal Reproduction]][[Category:Rabbit]]
[[Category:Expert Review - Exotics]]

Rabbit Reproduction - Anatomy & Physiology

2022-10-27T13:55:30Z

JoeWright:

{{OpenPagesTop}}
== Male ==
The male rabbit is known as the '''buck'''.

=== Penis===
The penis has a rounded penile sheath and urethra. It can be easily extruded in rabbits over 2 months of age.

=== Testes ===
The rabbit has two testes that descend at approximately 12 weeks of age. These testes are large with epididymal fat pads. In the adult male they lie in two almost hairless scrotal sacs which are cranial to the penis (in the majority of placental mammals they lie caudal to the penis). The inguinal canal remains open throughout life.

=== Accessory Sex Glands===
The seminal vesicles open into the prostatic section of the urethra. The bulbourethral glands are small and paired. They form a bilobed swelling in the dorsal wall of the urethra, just behind the prostate.

=== Mammary Gland ===
Male rabbits do not possess nipples.

== Female ==
The female rabbit is known as the '''doe'''.

=== Uterus ===
The female rabbit has a [[Uterus - Anatomy & Physiology#Anatomical_Types_of_Uteri|bicornuate duplex uterus]]. This has two separate uterine horns and no uterine body. Each horn has its own [[Cervix - Anatomy & Physiology|cervix]], and the two cervices open into a single vagina.

The mesometrium is a major fat storage organ. It is very friable and contains many vessels, however only minor anastomoses exist between the uterine and ovarian vasculature.

== Puberty and Sexual Maturity ==

The age of sexual maturity varies with breed:
* Small breeds mature at ~5 months
* Larger breeds mature as late at as 8 months.

== Breeding Characteristics ==
Rabbits are induced [[Ovulation - Anatomy & Physiology|ovulators]] with no well-defined [[Oestrous Cycle - Anatomy & Physiology|oestrous cycle]]. The female rabbits have periods of sexual receptivity every 4-6 days and the oestrus period lasts ~14 days. [[Ovulation - Anatomy & Physiology|Ovulation]] occurs within 10 hours of coitus.

The breeding season lasts from January to October in the UK.

Does can become quite territorial and this needs to be taken into account when planning any matings. It is advisable to take the doe to the buck rather than the other way round.

== Gestation and Offspring ==
===Pregnancy diagnosis===
Foetuses may be felt by gentle abdominal palpation as early as 10 days post breeding as 1 to 1.5cm masses in the caudal ventral abdomen. At 18 days they should be 2.5 to 3cm in length.

Radiography or ultrasonography can be used after 21 days if necessary.

=== Gestation ===
The gestation period of a rabbit is 29-35 days.

Pseudopregnancy may occur, which lasts approximately 18 days. It can be caused by infertile mating, or the presence of a male nearby. The dam is unable to conceive during this time. During pseudopregnancy, the [[Corpus Luteum - Anatomy & Physiology|corpus luteum]] secretes progesterone, which causes the uterus and mammary glands to grow.

=== Litter ===
The litter size can vary from 4-12 offspring.

The young are altricial - born hairless, deaf and blind. Offspring are totally dependent on their mother for the first few weeks of life. They are protected from the environment and predators by the nest which is made by the doe using hair from her dewlap. If the nest is disturbed, the doe may cannibalise the offspring.

=== Mammary Gland and Lactation ===

The doe has four or five pairs of nipples. The mammary gland develops in the last week of pregnancy. Suckling is stimulated by a [[Attractivity Behaviour - Anatomy & Physiology#Pheromones|pheromone]] produced by a gland near the nipple.

Consumption of water and caecotrophs by the doe increases 10-fold during lactation.

Rabbit milk is richer than cow's milk, it has an unusually low [[Milk Composition and Biosynthesis- Anatomy & Physiology#Carbohydrate:Lactose|lactose]] content and a very high protein and fat content.

Composition:
* 13% Protein
* 9% Fat
* 1% Lactose
* 2.3% minerals

==Sexing==

Kits are best sexed at birth or at weaning (5-8 weeks of age). In between those times it can be difficult to exteriorise the genitalia.

Sexing is performed by gentle pressure on the genital orifice which everts the penis or vulva. The male has a cylindrical organ with a rounded to oval-shaped urethral opening. The female vulva has a leaf-like appearance with a slit-like opening.

In the male the testicles descend at around 12-14 weeks of age and can be palpated, although they can be retracted into the abdomen if the rabbit is stressed.

{{Learning
|flashcards = [[Small Mammals Q&A 17]]
}}

==References==

Richardson, V. (2000) '''Rabbits Health, Husbandry and Diseases''', ''Blackwell Science''

[[Category:Small Mammal Reproduction]][[Category:Rabbit]]
[[Category:Expert Review - Exotics]]

Test page rss

2022-10-14T12:05:18Z

JoeWright:

<rss highlight="respiratory">https://www.thewebinarvet.com/respiratory/webinars/feed</rss>

Test page rss

2022-10-14T12:05:09Z

JoeWright: Blanked the page

Test page rss

2022-10-11T11:01:26Z

JoeWright: Created page with "<rss highlight="community wiki foundation">https://www.thewebinarvet.com/dentistry/webinars/feed</rss>"

<rss highlight="community wiki foundation">https://www.thewebinarvet.com/dentistry/webinars/feed</rss>

Category:Video

2022-09-29T09:15:58Z

JoeWright:

{{frontpage
|pagetitle =WikiVideos
|pagebody = Welcome to WikiVideos...the new video section of WikiVet. This section contains multimedia videos on a wide range of veterinary topics at all levels of the veterinary course.
|contenttitle = Content
|contentbody =<big><categorytree mode=pages>WikiVideo - BY TOPIC</categorytree></big>
 
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<big><categorytree mode=pages>WikiVideo - Global WikiVet Ed Fest 2022</categorytree></big>
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Category:Video

2022-09-29T09:15:51Z

JoeWright:

Acute Diarrhoea In Dogs And Cats

2022-09-29T09:15:00Z

JoeWright:

{{Resource
|Name = Acute Diarrhoea in dogs and cats
|VimeoID = 683923142
|Description = Acute diarrhoea is a common complaint seen in first-opinion small animal veterinary practice. Even though it is often self-limiting and likely to resolve with symptomatic treatment alone, antibiotics are frequently prescribed as part of the therapeutic management plan. Faecal analysis can be a useful diagnostic tool to guide our treatment choices, however it may be difficult to distinguish the significance of these results. In this webinar, we cover these interesting topics in more detail to help answer some common uncertainties surrounding the use of antibiotics in cases of acute diarrhoea.
|Source = [https://www.protexinvet.com/?utm_campaign=Wikivet&utm_medium=content&utm_source=google '''Protexinvet''']
|Author = James Kyffin
}}
[[Category:Pathology Video]][[Category:WikiVideo - Global WikiVet Ed Fest 2022]]

Category:Video

2022-09-29T09:12:03Z

JoeWright:

Category:Video

2022-09-29T09:11:54Z

JoeWright:

How To Best Support Your Co Worker Who Is Suffering From Mental Ill Health

2022-09-29T09:03:54Z

JoeWright: Created page with "{{Resource |Name = How To Best Support Your Co Worker Who Is Suffering From Mental Ill Health |Link = https://www.thewebinarvet.com/webinar/how-to-best-support-your-co-worker-..."

{{Resource
|Name = How To Best Support Your Co Worker Who Is Suffering From Mental Ill Health
|Link = https://www.thewebinarvet.com/webinar/how-to-best-support-your-co-worker-who-is-suffering-from-mental-ill-health
|Image = WikiVideo.png
|Description = For too long, a stigma around mental health has fuelled misunderstandings around mental health that have prevented people from seeking support. This talk is based on the understanding that mental health and wellbeing, just like physical health, can be sustained and improved through some simple yet effective steps. Similar to the ABC in physical first aid, we can all give Mental Health First Aid. Everyone within a team is able to learn the specific safe steps to take & signpost colleagues to the correct support.
|Author = Dr Tshidi Gardiner
|Date = Wed 28th September 2022, 11:21 am
|Source = [https://www.thewebinarvet.com/ '''The Webinar Vet''']
}}
[[Category:WikiVideo - Global WikiVet Ed Fest 2022]]

It Starts With You Creating Confidence In The Face Of Imposter Thoughts

2022-09-29T08:58:25Z

JoeWright: Created page with "{{Resource |Name = It Starts With You Creating Confidence In The Face Of Imposter Thoughts |Link = https://www.thewebinarvet.com/webinar/it-starts-with-you-creating-confidence..."

{{Resource
|Name = It Starts With You Creating Confidence In The Face Of Imposter Thoughts
|Link = https://www.thewebinarvet.com/webinar/it-starts-with-you-creating-confidence-in-the-face-of-imposter-thoughts
|Image = WikiVideo.png
|Description = You’re preparing for an exciting career in a profession full of possibilities, but then a whisper appears: “how did I get here?”, “am I good enough?”, “everyone else is doing so much better”. Sound familiar? You are not alone, and not just amongst your peers, but many of those that you look up to as well. Join us for an empowering session on how to back yourself in your career moving forward.
|Author = Katie Ford
|Date = Wed 28th September 2022, 11:21 am
|Source = [https://www.thewebinarvet.com/ '''The Webinar Vet''']
}}
[[Category:WikiVideo - Global WikiVet Ed Fest 2022]]

Navigating The Cost Of Gold Standard Crisis In The Veterinary World

2022-09-29T08:52:54Z

JoeWright: Created page with "{{Resource |Name = Navigating The Cost Of Gold Standard Crisis In The Veterinary World |Link = https://www.thewebinarvet.com/webinar/navigating-the-cost-of-gold-standard-crisi..."

{{Resource
|Name = Navigating The Cost Of Gold Standard Crisis In The Veterinary World
|Link = https://www.thewebinarvet.com/webinar/navigating-the-cost-of-gold-standard-crisis-in-the-veterinary-world
|Image = WikiVideo.png
|Description = You've just qualified, your brain is brimming with knowledge and interest, and you have a plethora of fancy diagnostic and treatment options at your fingertips. But what you might not have is an insured patient, an NHS for pets, or an owner with a bottomless pit of money. Dealing with the financially constrained case can be clinically frustrating, but when approached well it can also be immensely rewarding. With a wealth of experience from the general practice and charity sectors, Neil & Alice will be sharing their top tips on how to give a 'gold-standard' service, no matter what the budget is.
|Author = Neil Sandercock, Alice Moore
|Date = Wed 28th September 2022, 11:21 am
|Source = [https://www.thewebinarvet.com/ '''The Webinar Vet''']
}}
[[Category:WikiVideo - Global WikiVet Ed Fest 2022]]

Practical Approaches To Calf Health And Welfare Without Breaking The Bank

2022-09-29T08:47:24Z

JoeWright: Created page with "{{Resource |Name = Practical Approaches To Calf Health And Welfare Without Breaking The Bank |Link = https://www.thewebinarvet.com/webinar/practical-approaches-to-calf-health-..."

{{Resource
|Name = Practical Approaches To Calf Health And Welfare Without Breaking The Bank
|Link = https://www.thewebinarvet.com/webinar/practical-approaches-to-calf-health-and-welfare-without-breaking-the-bank
|Image = WikiVideo.png
|Description =Calf health and welfare have a major impact on the economic viability of cattle operations, due to the direct costs of calf losses, treatment and the long-term effects on performance. It is therefore crucial that as farm vets, we support the farmer by working to pro-actively support high standards in this area. However, due to economic pressures on farmers, it is important we also look at ways of promoting good health and welfare which does not cost huge amounts of money but also saves money. This talk will discuss the principles of good calf health and welfare and the theory of how to achieve it. We will look at methods of assessing welfare and health before discussing what tools we have to maintain this at a high standard. Finally, the talk will highlight a real U.K. case example from initial setup to implementation of ideas to create a profitable calf rearing unit. You should go away feeling more confident in using a similar approach on your farms and being able to adapt and change for different setups and conditions.
|Author = Navaratnam Partheeban
|Date = Wed 28th September 2022, 11:21 am
|Source = [https://www.thewebinarvet.com/ '''The Webinar Vet''']
}}
[[Category:WikiVideo - Global WikiVet Ed Fest 2022]]

Category:Video

2022-09-29T08:42:31Z

JoeWright:

The First Day Of The Rest Of Your Life Setting Yourself Up For Success

2022-09-29T08:41:45Z

JoeWright:

{{Resource
|Name = The First Day Of The Rest Of Your Life Setting Yourself Up For Success
|Link = https://www.thewebinarvet.com/webinar/the-first-day-of-the-rest-of-your-life-setting-yourself-up-for-success
|Image = WikiVideo.png
|Description = A discussion about preparing for your first day, week, month in practice. Advice from a first-opinion vet in mixed practice.
|Author = Nicole Mant
|Date = Wed 28th September 2022, 11:21 am
|Source = [https://www.thewebinarvet.com/ '''The Webinar Vet''']
}}
[[Category:WikiVideo - Global WikiVet Ed Fest 2022]]

The First Day Of The Rest Of Your Life Setting Yourself Up For Success

2022-09-29T08:40:23Z

JoeWright:

{{Resource
|Name = The First Day Of The Rest Of Your Life Setting Yourself Up For Success
|Link = https://www.thewebinarvet.com/webinar/the-first-day-of-the-rest-of-your-life-setting-yourself-up-for-success
|Image = WikiVideo.png
|Description = A discussion about preparing for your first day, week, month in practice. Advice from a first-opinion vet in mixed practice.
|Author = Nicole Mant
}}
[[Category:WikiVideo - Global WikiVet Ed Fest 2022]]

The First Day Of The Rest Of Your Life Setting Yourself Up For Success

2022-09-29T08:39:35Z

JoeWright:

{{Resource
|Name = The First Day Of The Rest Of Your Life Setting Yourself Up For Success
|Link = https://www.thewebinarvet.com/webinar/the-first-day-of-the-rest-of-your-life-setting-yourself-up-for-success
|Image = WikiVideo.png
|Description = A discussion about preparing for your first day, week, month in practice. Advice from a first-opinion vet in mixed practice.
}}
[[Category:WikiVideo - Global WikiVet Ed Fest 2022]]

Category:WikiVideo - Global WikiVet Ed Fest 2022

2022-09-29T08:36:16Z

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The First Day Of The Rest Of Your Life Setting Yourself Up For Success

2022-09-29T08:35:04Z

JoeWright: Created page with "{{Resource |Name = The First Day Of The Rest Of Your Life Setting Yourself Up For Success |Vimeo = |Link = https://www.thewebinarvet.com/webinar/the-first-day-of-the-rest-of-y..."

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|Description = A discussion about preparing for your first day, week, month in practice. Advice from a first-opinion vet in mixed practice.
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[[Category:WikiVideo - Global WikiVet Ed Fest 2022]]

MediaWiki:Sidebar

2022-06-13T13:39:49Z

JoeWright:

The Microbiota Probiotics Prebiotics

2022-06-06T15:41:43Z

JoeWright:

{{Resource
|Name = The Microbiota, Probiotics & Prebiotics
|Vimeo =
|Link = https://www.thewebinarvet.com/webinar/the-microbiota-probiotics-prebiotics
|Description = In this webinar we take a look at the microbiota, what it is, why it is relevant to our veterinary patients and what happens when it becomes imbalanced (known as a dysbiosis). We then go on to learn about probiotics and prebioitcs and how they can be beneficial to our patients, before finishing up looking at some evidence supporting their use.
|Source = [https://www.protexinvet.com/?utm_campaign=Wikivet&utm_medium=content&utm_source=google '''Protexinvet''']
|Author = Gemma Ives
|Image = Microbiota Webinar Thumbnail.png
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[[Category:WikiVideo - BY TOPIC]]

The Microbiota Probiotics Prebiotics

2022-06-06T15:41:28Z

JoeWright:

{{Resource
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|Vimeo =
|Link = https://www.thewebinarvet.com/webinar/the-microbiota-probiotics-prebiotics
|Description = In this webinar we take a look at the microbiota, what it is, why it is relevant to our veterinary patients and what happens when it becomes imbalanced (known as a dysbiosis). We then go on to learn about probiotics and prebioitcs and how they can be beneficial to our patients, before finishing up looking at some evidence supporting their use.
|Source = [https://www.protexinvet.com/?utm_campaign=Wikivet&utm_medium=content&utm_source=google '''Protexinvet''']
|Date =
|Author = Gemma Ives
|Image = Microbiota Webinar Thumbnail.png
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[[Category:WikiVideo - BY TOPIC]]

Category:Video

2022-06-06T15:40:48Z

JoeWright:

Category:Video

2022-06-06T15:40:37Z

JoeWright:

{{frontpage
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|contenttitle = Content
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The Microbiota Probiotics Prebiotics

2022-06-06T15:40:25Z

JoeWright:

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|Source = [https://www.protexinvet.com/?utm_campaign=Wikivet&utm_medium=content&utm_source=google '''Protexinvet''']
|Date =
|Author = Gemma Ives
|Licensing =
|Image = Microbiota Webinar Thumbnail.png
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[[Category:WikiVideo - BY TOPIC]]

Category:Video

2022-06-06T15:39:55Z

JoeWright:

Category:Video

2022-06-06T15:39:46Z

JoeWright:

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The Microbiota Probiotics Prebiotics

2022-06-06T15:37:04Z

JoeWright:

{{Resource
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|Vimeo =
|Link = https://www.thewebinarvet.com/webinar/the-microbiota-probiotics-prebiotics
|Description = In this webinar we take a look at the microbiota, what it is, why it is relevant to our veterinary patients and what happens when it becomes imbalanced (known as a dysbiosis). We then go on to learn about probiotics and prebioitcs and how they can be beneficial to our patients, before finishing up looking at some evidence supporting their use.
|Source = [https://www.protexinvet.com/?utm_campaign=Wikivet&utm_medium=content&utm_source=google '''Protexinvet''']
|Date =
|Author = Gemma Ives
|Licensing =
|Image = Microbiota Webinar Thumbnail.png
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[[Category:Microbiota Video]]

The Microbiota Probiotics Prebiotics

2022-06-06T15:32:32Z

JoeWright:

{{Resource
|Name = The Microbiota, Probiotics & Prebiotics
|Link = https://www.thewebinarvet.com/webinar/the-microbiota-probiotics-prebiotics
|Description = In this webinar we take a look at the microbiota, what it is, why it is relevant to our veterinary patients and what happens when it becomes imbalanced (known as a dysbiosis). We then go on to learn about probiotics and prebioitcs and how they can be beneficial to our patients, before finishing up looking at some evidence supporting their use.
|Source = [https://www.protexinvet.com/?utm_campaign=Wikivet&utm_medium=content&utm_source=google '''Protexinvet''']
|Date =
|Author = Gemma Ives
|Licensing =
|Image = Microbiota Webinar Thumbnail.png
}}
 
[[Category:Microbiota Video]]

Category:Microbiota Video

2022-06-06T15:31:05Z

JoeWright: Created page with "Category:WikiVideo - BY TOPIC"

[[Category:WikiVideo - BY TOPIC]]

The Microbiota Probiotics Prebiotics

2022-06-06T15:21:32Z

JoeWright:

The Microbiota Probiotics Prebiotics

2022-06-06T15:18:34Z

JoeWright:

The Microbiota Probiotics Prebiotics

2022-06-06T15:17:35Z

JoeWright:

File:Microbiota Webinar Thumbnail.png

2022-06-06T15:16:17Z

JoeWright:

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The Microbiota Probiotics Prebiotics

2022-06-06T15:14:29Z

JoeWright:

The Microbiota Probiotics Prebiotics

2022-06-06T15:14:00Z

JoeWright:

{{Resource
|Name = The Microbiota, Probiotics & Prebiotics
|Link = (for exapmle: www.rvc.ac.uk)
|Description = In this webinar we take a look at the microbiota, what it is, why it is relevant to our veterinary patients and what happens when it becomes imbalanced (known as a dysbiosis). We then go on to learn about probiotics and prebioitcs and how they can be beneficial to our patients, before finishing up looking at some evidence supporting their use.
|Source = [https://www.protexinvet.com/?utm_campaign=Wikivet&utm_medium=content&utm_source=google '''Protexinvet''']
|Date =
|Author = Gemma Ives
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The Microbiota Probiotics Prebiotics

2022-06-06T15:11:44Z

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Management of Acute Diarrhoea

2022-05-26T14:42:28Z

JoeWright:

==Management of Acute Diarrhoea==
Acute diarrhoea is a common complaint seen in first-opinion small animal veterinary practice. One study reported 14.9% of dogs had experienced an episode of diarrhoea within the previous two-week period<ref name=":1">Hubbard K, Skelly BJ, McKelvie J, Wood JLN. Risk of vomiting and diarrhoea in dogs. Vet Rec 2007; 161: 755–757.</ref>
; another reported 28.6% of dogs visiting the vets had diarrhoea as their presenting complaint or had experienced an episode of diarrhoea within the previous month.<ref name=":2">Stavisky J, Pinchbeck GL, German AJ et al. Prevalence of canine enteric coronavirus in a cross-sectional survey of dogs presenting at veterinary practices. Vet Microbiol 2010; 140: 18–24</ref> Data from pet cats is limited, but one study showed that prevalence of diarrhoea in a rescue cat population was 11.9%.<ref name=":3">German AC, Cunliffe NA, Morgan KL. Faecal consistency and risk factors for diarrhoea and constipation in cats in UK rehoming shelters. J Feline Med Surg 2017; 19(1): 57-65.</ref>

Diarrhoea is defined as an increase in frequency, fluidity or volume of faeces and is a common complaint in dogs and cats.<ref name=":4">Battersby I, Harvey A. Differential diagnosis and treatment of acute diarrhoea in the dog and cat. In Practice 2006; 28: 480-488.</ref> Diarrhoea lasting for less than two weeks is generally described as acute<ref name=":5">Chandler ML. The chronically diarrhoeic dog. In Pract 2002; 24: 18–27.</ref> and commonly resolves without the requirement for veterinary intervention.<ref name=":1"/> Therefore, animals are often presented at the vets due to owner concern or difficulty in managing the symptoms. Despite the fact that it is often self-limiting and likely to resolve with symptomatic treatment alone, antibiotics are frequently prescribed as part of the therapeutic management plan.

Ideally, antibiotics should be reserved for cases where pathogenic bacteria have been detected in the faeces of animals with severe disease, or if there is a high risk of septicaemia. In reality, it was found that 71% of canine cases presenting with diarrhoea in first-opinion practice were given antibiotics.<ref name=":6">German AJ, Halladay LJ, Noble PJ. First-choice therapy for dogs presenting with diarrhoea in clinical practice. Vet Rec 2010; 167(21):810–814. </ref> This statistic has reduced according to a more recent study, in which 49.7% of dogs were prescribed antibiotics when initially presented at the vets with diarrhoea.<ref name=":7">Singleton DA, Noble PJM, Sánchez-Vizcaíno F et al. Pharmaceutical Prescription in Canine Acute Diarrhoea: A Longitudinal Electronic Health Record Analysis of First Opinion Veterinary Practices. Front Vet Sci 2019; 6: 218.</ref> Despite the fact that almost half of the dogs in the latter study were dispensed antibiotics, faecal bacteriology/ parasitology was performed in only 3.2% of these cases, suggesting a large discrepancy between antibiotic administration and prior demonstration of an underlying bacterial infection.

==Why are antibiotics so commonly prescribed?==
Pyrexia and haemorrhagic diarrhoea appear to be clinical findings associated with antibiotic prescription,<ref name=":6"/>,<ref name=":7"/> indicating there may be a concern regarding the development of septicaemia caused by bacterial translocation across a damaged intestinal epithelium. However, 88%6 and 37.5%7 of normothermic animals were prescribed antibiotics, making concern over sepsis a less likely justification. Furthermore, multiple studies demonstrate that bacteraemia is not necessarily associated with clinical disease, questioning the use of antibiotics even if bacteraemia may be present.<ref name=":8">Unterer S, Lechner E, Mueller RS et al. Prospective study of bacteraemia in acute haemorrhagic diarrhoea syndrome in dogs. Vet Rec 2015; 176(12): 309. </ref><ref name=":9">Unterer S, Strohmeyer K, Kruse BD, Sauter-Louis C, Hartmann K. Treatment of aseptic dogs with hemorrhagic gastroenteritis with amoxicillin/clavulanic acid: a prospective blinded study. J Vet Intern Med 2011; 25(5): 973-979.</ref><ref name=":10">Mortier F, Strohmeyer K, Hartmann K, Unterer S. Acute haemorrhagic diarrhoea syndrome in dogs: 108 cases. Vet Rec 2015; 176(24): 627.</ref><ref name=":11">Dahlinger J, Marks SL, HirshDC. Prevalence and identity of translocating bacteria in healthy dogs. J Vet Intern Med 1997; 11(6): 319-322.</ref> However, the potential for development of septicaemia or sepsis is a valid concern and if suspected due to deteriorating systemic clinical signs, haematological changes and/or positive blood culture, then appropriate parenteral antibiotics should be started immediately.

In certain cases, antibiotics may be prescribed due to concern over zoonotic disease, particularly if children or immunocompromised people are in close contact with the animal. However, use of antibiotics in healthy individuals can promote the establishment of a carrier state and may favour development of antimicrobial resistance.<ref name=":23">Weese JS. Bacterial Enteritis in Dogs and Cats: Diagnosis, Therapy, and Zoonotic Potential. Vet Clin North Am Small Anim Pract 2011; 41(2): 287-309</ref>

Alternatively, it has been shown that medications may be prescribed due to owner expectation or pressure when antibiotics may be selected based on owner compliance and willingness to pay, rather than suitability for the bacterial infection in question.<ref name=":12">Mateus AL, Brodbelt DC, Barber N, Stark KD. Qualitative study of factors associated with antimicrobial usage in seven small animal veterinary practices in the UK. Prev Vet Med 2014; 117(1): 68–78. </ref>

Following detection of pathogenic bacteria in the faeces, irrespective of the pathogen isolated, the empirical use of antibiotics is not recommended in cases of uncomplicated acute diarrhoea. Antibiotic use should be considered only following detection of the bacteria, or its toxin, in patients with acute, severe disease (e.g. haemorrhagic gastroenteritis), or where there is concern regarding the development of sepsis. In these cases, antimicrobial selection should ideally follow in vitro sensitivity testing.<ref name=":23"/>,<ref name=":24">Hall E. Canine diarrhoea: a rational approach to diagnostic and therapeutic dilemmas. In Practice 2009; 31: 8-16.</ref>

Finally, antibiotics may be given in the hope that they will accelerate the resolution of the diarrhoea. A recent study of 31 dogs reported that dogs given metronidazole had a shorter time to resolution of diarrhoea compared to control dogs receiving a placebo.<ref name=":13">Langlois DK, Koenigshof AM, Mani R. Metronidazole treatment of acute diarrhea in dogs: A randomized double blinded placebo-controlled clinical trial. J Vet Intern Med 2019 REF</ref> However, another study of 60 dogs reported that whilst dogs given metronidazole recovered slightly faster than those given a placebo, the group given probiotics recovered fastest.<ref name=":14">Shmalberg J, Montalbano C, Morelli G, Buckley GJ. A Randomized Double Blinded Placebo-Controlled Clinical Trial of a Probiotic or Metronidazole for Acute Canine Diarrhea. Front Vet Sci 2019; 6: 163.</ref> Several further studies have reported the use of various probiotic formulations to accelerate the resolution of acute diarrhoea compared to a placebo.<ref name=":15">Kelley RL, Minikhiem D, Kiely B, et al. Clinical benefits of probiotic canine-derived Bifidobacterium animalis strain AHC7 in dogs with acute idiopathic diarrhea. Vet Ther 2009; 10(3): 121-130.</ref><ref name=":16">Kelley RL, Minikhiem D, Kiely B, et al. Clinical benefits of probiotic canine-derived Bifidobacterium animalis strain AHC7 in dogs with acute idiopathic diarrhea. Vet Ther 2009; 10(3): 121-130.</ref>-<ref name=":17">Nixon SL, Rose L, Muller AT. Efficacy of an orally administered anti-diarrheal probiotic paste (Pro-Kolin Advanced) in dogs with acute diarrhea: A randomized, placebo-controlled, double-blinded clinical study. J Vet Intern Med 2019; 33(3): 1286-1294.</ref><ref name=":18">Ziese AL, Suchodolski JS, Hartmann K, et al. Effect of probiotic treatment on the clinical course, intestinal microbiome, and toxigenic Clostridium perfringens in dogs with acute hemorrhagic diarrhea. PLoS One 2018; 13: e0204691.</ref> Given the widespread concern over growing antimicrobial resistance, nutraceuticals may be a more appropriate choice for first-line management of acute diarrhoea compared to antibiotics.<ref name=":13"/>

==Rationale and evidence for the use of probiotics in acute diarrhoea==
The rationale for the use lactic acid probiotic bacteria (LAB) in the management of acute diarrhoea is based on their ability to suppress growth of enteric pathogens. LAB lower intestinal pH, provide increased competition for nutrients and mucosal binding sites, and can exert a direct inhibitory effect through production of antimicrobial substances. Furthermore, probiotics can activate innate and adaptive immune responses to increase host disease resistance.<ref name=":19"/>

Probiotics are commonly combined with other ingredients that possess properties which can be useful in animals experiencing diarrhoea. Various clays have absorptive and adsorptive properties, meaning they can bind fluid and bacterial or viral toxins.<ref name=":20">Fomina M, Skorochod I. Microbial Interaction with Clay Minerals and Its Environmental and Biotechnological Implications. Minerals. 2020; 10(10):861.</ref> Soluble fibres, such as psyllium, can also be useful due to their gel-forming ability when mixed with water. Other common ingredients are the yeast wall extracts mannan-oligosaccharides (MOS) and beta-glucans which can play a role in preventing pathogenic bacteria binding to the intestinal wall and increasing disease resistance through the activation of intestinal immunity.<ref name=":21">Pignataro G, Di Prinzio R, Crisi PE, Belà B, Fusaro I, Trevisan C, De Acetis L, Gramenzi A. Comparison of the therapeutic effect of treatment with antibiotics or nutraceuticals on clinical activity and the fecal microbiome of dogs with acute diarrhea. Animals. 2021 Jun;11(6):1484.</ref>

Assessing the clinical outcomes of probiotic supplementation in dogs with acute diarrhoea has been the subject of numerous placebo-controlled studies.<ref name=":15"/>-<ref name=":19">Li Y, Xia S, Jiang X, Feng C, Gong S, Ma J, Fang Z, Yin J and Yin Y (2021) Gut Microbiota and Diarrhea: An Updated Review. Front. Cell. Infect. Microbiol. 11:625210. doi: 10.3389/fcimb.2021.625210</ref>,<ref name=":22">Gómez-Gallego C, Junnila J, Männikkö S, et al. A canine-specific probiotic product in treating acute or intermittent diarrhea in dogs: A double-blind placebo-controlled efficacy study. Vet Microbiol. 2016;197:122-128. </ref> Amongst these studies, findings in the probiotic treated groups included: shorter times to diarrhoea resolution, <ref name=":15"/><ref name=":16"/><ref name=":17"/> greater improvement in stool consistency score,18 faster improvement in Canine Haemorrhagic Diarrhoea Severity Index (CHDSI),18 greater decrease of faecal C. perfringens,<ref name=":17"/> and a lower requirement for additional medical interventions. <ref name=":15"/>,<ref name=":17"/>

==Summary==
Acute diarrhoea is often self-limiting and likely to resolve without veterinary intervention. Diagnostic investigations are infrequently performed in these cases and even when faecal analysis is carried out, the results can be difficult to interpret given that many potentially pathogenic bacteria are also found in healthy individuals. Antibiotics are still frequently prescribed to dogs or cats that present with acute diarrhoea, however this can contribute to the development of antibacterial resistance, as well as causing disruptions to the normal gastrointestinal microbiota and can result in adverse effects for the patient. Therefore, antibiotics should be reserved for specific cases where bacterial infection is confirmed or highly suspected, and/or there is concern of bacterial translocation or sepsis.

==References==
<references />

[[Category:Alimentary_System_-_Microbiota]]

Management of Acute Diarrhoea

2022-05-26T14:31:15Z

JoeWright:

Management of Acute Diarrhoea

2022-05-26T14:30:08Z

JoeWright:

==Management of Acute Diarrhoea==
Acute diarrhoea is a common complaint seen in first-opinion small animal veterinary practice. One study reported 14.9% of dogs had experienced an episode of diarrhoea within the previous two-week period<ref name=":1">Hubbard K, Skelly BJ, McKelvie J, Wood JLN. Risk of vomiting and diarrhoea in dogs. Vet Rec 2007; 161: 755–757.</ref>
; another reported 28.6% of dogs visiting the vets had diarrhoea as their presenting complaint or had experienced an episode of diarrhoea within the previous month.<ref name=":2">Stavisky J, Pinchbeck GL, German AJ et al. Prevalence of canine enteric coronavirus in a cross-sectional survey of dogs presenting at veterinary practices. Vet Microbiol 2010; 140: 18–24</ref> Data from pet cats is limited, but one study showed that prevalence of diarrhoea in a rescue cat population was 11.9%.<ref name=":3">German AC, Cunliffe NA, Morgan KL. Faecal consistency and risk factors for diarrhoea and constipation in cats in UK rehoming shelters. J Feline Med Surg 2017; 19(1): 57-65.</ref>

Diarrhoea is defined as an increase in frequency, fluidity or volume of faeces and is a common complaint in dogs and cats.<ref name=":4">Battersby I, Harvey A. Differential diagnosis and treatment of acute diarrhoea in the dog and cat. In Practice 2006; 28: 480-488.</ref> Diarrhoea lasting for less than two weeks is generally described as acute<ref name=":5">Chandler ML. The chronically diarrhoeic dog. In Pract 2002; 24: 18–27.</ref> and commonly resolves without the requirement for veterinary intervention.<ref name=":1"/> Therefore, animals are often presented at the vets due to owner concern or difficulty in managing the symptoms. Despite the fact that it is often self-limiting and likely to resolve with symptomatic treatment alone, antibiotics are frequently prescribed as part of the therapeutic management plan.

Ideally, antibiotics should be reserved for cases where pathogenic bacteria have been detected in the faeces of animals with severe disease, or if there is a high risk of septicaemia. In reality, it was found that 71% of canine cases presenting with diarrhoea in first-opinion practice were given antibiotics.<ref name=":6">German AJ, Halladay LJ, Noble PJ. First-choice therapy for dogs presenting with diarrhoea in clinical practice. Vet Rec 2010; 167(21):810–814. </ref> This statistic has reduced according to a more recent study, in which 49.7% of dogs were prescribed antibiotics when initially presented at the vets with diarrhoea.<ref name=":7">Singleton DA, Noble PJM, Sánchez-Vizcaíno F et al. Pharmaceutical Prescription in Canine Acute Diarrhoea: A Longitudinal Electronic Health Record Analysis of First Opinion Veterinary Practices. Front Vet Sci 2019; 6: 218.</ref> Despite the fact that almost half of the dogs in the latter study were dispensed antibiotics, faecal bacteriology/ parasitology was performed in only 3.2% of these cases, suggesting a large discrepancy between antibiotic administration and prior demonstration of an underlying bacterial infection.

==Why are antibiotics so commonly prescribed?==
Pyrexia and haemorrhagic diarrhoea appear to be clinical findings associated with antibiotic prescription,<ref name=":6"/>,<ref name=":7"/> indicating there may be a concern regarding the development of septicaemia caused by bacterial translocation across a damaged intestinal epithelium. However, 88%6 and 37.5%7 of normothermic animals were prescribed antibiotics, making concern over sepsis a less likely justification. Furthermore, multiple studies demonstrate that bacteraemia is not necessarily associated with clinical disease, questioning the use of antibiotics even if bacteraemia may be present.<ref name=":8">Unterer S, Lechner E, Mueller RS et al. Prospective study of bacteraemia in acute haemorrhagic diarrhoea syndrome in dogs. Vet Rec 2015; 176(12): 309. </ref><ref name=":9">Unterer S, Strohmeyer K, Kruse BD, Sauter-Louis C, Hartmann K. Treatment of aseptic dogs with hemorrhagic gastroenteritis with amoxicillin/clavulanic acid: a prospective blinded study. J Vet Intern Med 2011; 25(5): 973-979.</ref><ref name=":10">Mortier F, Strohmeyer K, Hartmann K, Unterer S. Acute haemorrhagic diarrhoea syndrome in dogs: 108 cases. Vet Rec 2015; 176(24): 627.</ref><ref name=":11">Dahlinger J, Marks SL, HirshDC. Prevalence and identity of translocating bacteria in healthy dogs. J Vet Intern Med 1997; 11(6): 319-322.</ref> However, the potential for development of septicaemia or sepsis is a valid concern and if suspected due to deteriorating systemic clinical signs, haematological changes and/or positive blood culture, then appropriate parenteral antibiotics should be started immediately.

In certain cases, antibiotics may be prescribed due to concern over zoonotic disease, particularly if children or immunocompromised people are in close contact with the animal. However, use of antibiotics in healthy individuals can promote the establishment of a carrier state and may favour development of antimicrobial resistance.<ref name=":23">Weese JS. Bacterial Enteritis in Dogs and Cats: Diagnosis, Therapy, and Zoonotic Potential. Vet Clin North Am Small Anim Pract 2011; 41(2): 287-309</ref>

Alternatively, it has been shown that medications may be prescribed due to owner expectation or pressure when antibiotics may be selected based on owner compliance and willingness to pay, rather than suitability for the bacterial infection in question.<ref name=":12">Mateus AL, Brodbelt DC, Barber N, Stark KD. Qualitative study of factors associated with antimicrobial usage in seven small animal veterinary practices in the UK. Prev Vet Med 2014; 117(1): 68–78. </ref>

Following detection of pathogenic bacteria in the faeces, irrespective of the pathogen isolated, the empirical use of antibiotics is not recommended in cases of uncomplicated acute diarrhoea. Antibiotic use should be considered only following detection of the bacteria, or its toxin, in patients with acute, severe disease (e.g. haemorrhagic gastroenteritis), or where there is concern regarding the development of sepsis. In these cases, antimicrobial selection should ideally follow in vitro sensitivity testing.<ref name=":23"/>,<ref name=":24">Hall E. Canine diarrhoea: a rational approach to diagnostic and therapeutic dilemmas. In Practice 2009; 31: 8-16.</ref>

Finally, antibiotics may be given in the hope that they will accelerate the resolution of the diarrhoea. A recent study of 31 dogs reported that dogs given metronidazole had a shorter time to resolution of diarrhoea compared to control dogs receiving a placebo.<ref name=":13">Langlois DK, Koenigshof AM, Mani R. Metronidazole treatment of acute diarrhea in dogs: A randomized double blinded placebo-controlled clinical trial. J Vet Intern Med 2019 REF</ref> However, another study of 60 dogs reported that whilst dogs given metronidazole recovered slightly faster than those given a placebo, the group given probiotics recovered fastest.<ref name=":14">Shmalberg J, Montalbano C, Morelli G, Buckley GJ. A Randomized Double Blinded Placebo-Controlled Clinical Trial of a Probiotic or Metronidazole for Acute Canine Diarrhea. Front Vet Sci 2019; 6: 163.</ref> Several further studies have reported the use of various probiotic formulations to accelerate the resolution of acute diarrhoea compared to a placebo.<ref name=":15">Kelley RL, Minikhiem D, Kiely B, et al. Clinical benefits of probiotic canine-derived Bifidobacterium animalis strain AHC7 in dogs with acute idiopathic diarrhea. Vet Ther 2009; 10(3): 121-130.</ref><ref name=":16">Kelley RL, Minikhiem D, Kiely B, et al. Clinical benefits of probiotic canine-derived Bifidobacterium animalis strain AHC7 in dogs with acute idiopathic diarrhea. Vet Ther 2009; 10(3): 121-130.</ref>-<ref name=":17">Nixon SL, Rose L, Muller AT. Efficacy of an orally administered anti-diarrheal probiotic paste (Pro-Kolin Advanced) in dogs with acute diarrhea: A randomized, placebo-controlled, double-blinded clinical study. J Vet Intern Med 2019; 33(3): 1286-1294.</ref><ref name=":18">Ziese AL, Suchodolski JS, Hartmann K, et al. Effect of probiotic treatment on the clinical course, intestinal microbiome, and toxigenic Clostridium perfringens in dogs with acute hemorrhagic diarrhea. PLoS One 2018; 13: e0204691.</ref> Given the widespread concern over growing antimicrobial resistance, nutraceuticals may be a more appropriate choice for first-line management of acute diarrhoea compared to antibiotics.<ref name=":13"/>

==Rationale and evidence for the use of probiotics in acute diarrhoea==
The rationale for the use lactic acid probiotic bacteria (LAB) in the management of acute diarrhoea is based on their ability to suppress growth of enteric pathogens. LAB lower intestinal pH, provide increased competition for nutrients and mucosal binding sites, and can exert a direct inhibitory effect through production of antimicrobial substances. Furthermore, probiotics can activate innate and adaptive immune responses to increase host disease resistance.<ref name=":19"/>

Probiotics are commonly combined with other ingredients that possess properties which can be useful in animals experiencing diarrhoea. Various clays have absorptive and adsorptive properties, meaning they can bind fluid and bacterial or viral toxins.<ref name=":20">Fomina M, Skorochod I. Microbial Interaction with Clay Minerals and Its Environmental and Biotechnological Implications. Minerals. 2020; 10(10):861.</ref> Soluble fibres, such as psyllium, can also be useful due to their gel-forming ability when mixed with water. Other common ingredients are the yeast wall extracts mannan-oligosaccharides (MOS) and beta-glucans which can play a role in preventing pathogenic bacteria binding to the intestinal wall and increasing disease resistance through the activation of intestinal immunity.<ref name=":21">Pignataro G, Di Prinzio R, Crisi PE, Belà B, Fusaro I, Trevisan C, De Acetis L, Gramenzi A. Comparison of the therapeutic effect of treatment with antibiotics or nutraceuticals on clinical activity and the fecal microbiome of dogs with acute diarrhea. Animals. 2021 Jun;11(6):1484.</ref>

Assessing the clinical outcomes of probiotic supplementation in dogs with acute diarrhoea has been the subject of numerous placebo-controlled studies.<ref name=":15"/>-<ref name=":19">Li Y, Xia S, Jiang X, Feng C, Gong S, Ma J, Fang Z, Yin J and Yin Y (2021) Gut Microbiota and Diarrhea: An Updated Review. Front. Cell. Infect. Microbiol. 11:625210. doi: 10.3389/fcimb.2021.625210</ref>,<ref name=":22">Gómez-Gallego C, Junnila J, Männikkö S, et al. A canine-specific probiotic product in treating acute or intermittent diarrhea in dogs: A double-blind placebo-controlled efficacy study. Vet Microbiol. 2016;197:122-128. </ref> Amongst these studies, findings in the probiotic treated groups included: shorter times to diarrhoea resolution, <ref name=":15"/> -<ref name=":17"/> greater improvement in stool consistency score,18 faster improvement in Canine Haemorrhagic Diarrhoea Severity Index (CHDSI),18 greater decrease of faecal C. perfringens,<ref name=":17"/> and a lower requirement for additional medical interventions. <ref name=":15"/>,<ref name=":17"/>

==Summary==
Acute diarrhoea is often self-limiting and likely to resolve without veterinary intervention. Diagnostic investigations are infrequently performed in these cases and even when faecal analysis is carried out, the results can be difficult to interpret given that many potentially pathogenic bacteria are also found in healthy individuals. Antibiotics are still frequently prescribed to dogs or cats that present with acute diarrhoea, however this can contribute to the development of antibacterial resistance, as well as causing disruptions to the normal gastrointestinal microbiota and can result in adverse effects for the patient. Therefore, antibiotics should be reserved for specific cases where bacterial infection is confirmed or highly suspected, and/or there is concern of bacterial translocation or sepsis.

==References==
<references />

[[Category:Alimentary_System_-_Microbiota|10]]

Management of Acute Diarrhoea

2022-05-26T14:28:02Z

JoeWright: Created page with "==Management of Acute Diarrhoea== Acute diarrhoea is a common complaint seen in first-opinion small animal veterinary practice. One study reported 14.9% of dogs had experience..."

==Management of Acute Diarrhoea==
Acute diarrhoea is a common complaint seen in first-opinion small animal veterinary practice. One study reported 14.9% of dogs had experienced an episode of diarrhoea within the previous two-week period<ref name=":1">Hubbard K, Skelly BJ, McKelvie J, Wood JLN. Risk of vomiting and diarrhoea in dogs. Vet Rec 2007; 161: 755–757.</ref>
; another reported 28.6% of dogs visiting the vets had diarrhoea as their presenting complaint or had experienced an episode of diarrhoea within the previous month.<ref name=":2">Stavisky J, Pinchbeck GL, German AJ et al. Prevalence of canine enteric coronavirus in a cross-sectional survey of dogs presenting at veterinary practices. Vet Microbiol 2010; 140: 18–24</ref> Data from pet cats is limited, but one study showed that prevalence of diarrhoea in a rescue cat population was 11.9%.<ref name=":3">German AC, Cunliffe NA, Morgan KL. Faecal consistency and risk factors for diarrhoea and constipation in cats in UK rehoming shelters. J Feline Med Surg 2017; 19(1): 57-65.</ref>

Diarrhoea is defined as an increase in frequency, fluidity or volume of faeces and is a common complaint in dogs and cats.<ref name=":4">Battersby I, Harvey A. Differential diagnosis and treatment of acute diarrhoea in the dog and cat. In Practice 2006; 28: 480-488.</ref> Diarrhoea lasting for less than two weeks is generally described as acute<ref name=":5">Chandler ML. The chronically diarrhoeic dog. In Pract 2002; 24: 18–27.</ref> and commonly resolves without the requirement for veterinary intervention.<ref name=":1"/> Therefore, animals are often presented at the vets due to owner concern or difficulty in managing the symptoms. Despite the fact that it is often self-limiting and likely to resolve with symptomatic treatment alone, antibiotics are frequently prescribed as part of the therapeutic management plan.

Ideally, antibiotics should be reserved for cases where pathogenic bacteria have been detected in the faeces of animals with severe disease, or if there is a high risk of septicaemia. In reality, it was found that 71% of canine cases presenting with diarrhoea in first-opinion practice were given antibiotics.<ref name=":6">German AJ, Halladay LJ, Noble PJ. First-choice therapy for dogs presenting with diarrhoea in clinical practice. Vet Rec 2010; 167(21):810–814. </ref> This statistic has reduced according to a more recent study, in which 49.7% of dogs were prescribed antibiotics when initially presented at the vets with diarrhoea.<ref name=":7">Singleton DA, Noble PJM, Sánchez-Vizcaíno F et al. Pharmaceutical Prescription in Canine Acute Diarrhoea: A Longitudinal Electronic Health Record Analysis of First Opinion Veterinary Practices. Front Vet Sci 2019; 6: 218.</ref> Despite the fact that almost half of the dogs in the latter study were dispensed antibiotics, faecal bacteriology/ parasitology was performed in only 3.2% of these cases, suggesting a large discrepancy between antibiotic administration and prior demonstration of an underlying bacterial infection.

==Why are antibiotics so commonly prescribed?==
Pyrexia and haemorrhagic diarrhoea appear to be clinical findings associated with antibiotic prescription,<ref name=":6"/>,<ref name=":7"/> indicating there may be a concern regarding the development of septicaemia caused by bacterial translocation across a damaged intestinal epithelium. However, 88%6 and 37.5%7 of normothermic animals were prescribed antibiotics, making concern over sepsis a less likely justification. Furthermore, multiple studies demonstrate that bacteraemia is not necessarily associated with clinical disease, questioning the use of antibiotics even if bacteraemia may be present.<ref name=":8">Unterer S, Lechner E, Mueller RS et al. Prospective study of bacteraemia in acute haemorrhagic diarrhoea syndrome in dogs. Vet Rec 2015; 176(12): 309. </ref><ref name=":9">Unterer S, Strohmeyer K, Kruse BD, Sauter-Louis C, Hartmann K. Treatment of aseptic dogs with hemorrhagic gastroenteritis with amoxicillin/clavulanic acid: a prospective blinded study. J Vet Intern Med 2011; 25(5): 973-979.</ref><ref name=":10">Mortier F, Strohmeyer K, Hartmann K, Unterer S. Acute haemorrhagic diarrhoea syndrome in dogs: 108 cases. Vet Rec 2015; 176(24): 627.</ref><ref name=":11">Dahlinger J, Marks SL, HirshDC. Prevalence and identity of translocating bacteria in healthy dogs. J Vet Intern Med 1997; 11(6): 319-322.</ref> However, the potential for development of septicaemia or sepsis is a valid concern and if suspected due to deteriorating systemic clinical signs, haematological changes and/or positive blood culture, then appropriate parenteral antibiotics should be started immediately.

In certain cases, antibiotics may be prescribed due to concern over zoonotic disease, particularly if children or immunocompromised people are in close contact with the animal. However, use of antibiotics in healthy individuals can promote the establishment of a carrier state and may favour development of antimicrobial resistance.23

Alternatively, it has been shown that medications may be prescribed due to owner expectation or pressure when antibiotics may be selected based on owner compliance and willingness to pay, rather than suitability for the bacterial infection in question.<ref name=":12">Mateus AL, Brodbelt DC, Barber N, Stark KD. Qualitative study of factors associated with antimicrobial usage in seven small animal veterinary practices in the UK. Prev Vet Med 2014; 117(1): 68–78. </ref>

Following detection of pathogenic bacteria in the faeces, irrespective of the pathogen isolated, the empirical use of antibiotics is not recommended in cases of uncomplicated acute diarrhoea. Antibiotic use should be considered only following detection of the bacteria, or its toxin, in patients with acute, severe disease (e.g. haemorrhagic gastroenteritis), or where there is concern regarding the development of sepsis. In these cases, antimicrobial selection should ideally follow in vitro sensitivity testing.23,24

Finally, antibiotics may be given in the hope that they will accelerate the resolution of the diarrhoea. A recent study of 31 dogs reported that dogs given metronidazole had a shorter time to resolution of diarrhoea compared to control dogs receiving a placebo.<ref name=":13">Langlois DK, Koenigshof AM, Mani R. Metronidazole treatment of acute diarrhea in dogs: A randomized double blinded placebo-controlled clinical trial. J Vet Intern Med 2019 REF</ref> However, another study of 60 dogs reported that whilst dogs given metronidazole recovered slightly faster than those given a placebo, the group given probiotics recovered fastest.<ref name=":14">Shmalberg J, Montalbano C, Morelli G, Buckley GJ. A Randomized Double Blinded Placebo-Controlled Clinical Trial of a Probiotic or Metronidazole for Acute Canine Diarrhea. Front Vet Sci 2019; 6: 163.</ref> Several further studies have reported the use of various probiotic formulations to accelerate the resolution of acute diarrhoea compared to a placebo.<ref name=":15">Kelley RL, Minikhiem D, Kiely B, et al. Clinical benefits of probiotic canine-derived Bifidobacterium animalis strain AHC7 in dogs with acute idiopathic diarrhea. Vet Ther 2009; 10(3): 121-130.</ref><ref name=":16">Kelley RL, Minikhiem D, Kiely B, et al. Clinical benefits of probiotic canine-derived Bifidobacterium animalis strain AHC7 in dogs with acute idiopathic diarrhea. Vet Ther 2009; 10(3): 121-130.</ref>-<ref name=":17">Nixon SL, Rose L, Muller AT. Efficacy of an orally administered anti-diarrheal probiotic paste (Pro-Kolin Advanced) in dogs with acute diarrhea: A randomized, placebo-controlled, double-blinded clinical study. J Vet Intern Med 2019; 33(3): 1286-1294.</ref><ref name=":18">Ziese AL, Suchodolski JS, Hartmann K, et al. Effect of probiotic treatment on the clinical course, intestinal microbiome, and toxigenic Clostridium perfringens in dogs with acute hemorrhagic diarrhea. PLoS One 2018; 13: e0204691.</ref> Given the widespread concern over growing antimicrobial resistance, nutraceuticals may be a more appropriate choice for first-line management of acute diarrhoea compared to antibiotics.<ref name=":13"/>

==Rationale and evidence for the use of probiotics in acute diarrhoea==
The rationale for the use lactic acid probiotic bacteria (LAB) in the management of acute diarrhoea is based on their ability to suppress growth of enteric pathogens. LAB lower intestinal pH, provide increased competition for nutrients and mucosal binding sites, and can exert a direct inhibitory effect through production of antimicrobial substances. Furthermore, probiotics can activate innate and adaptive immune responses to increase host disease resistance.19

Probiotics are commonly combined with other ingredients that possess properties which can be useful in animals experiencing diarrhoea. Various clays have absorptive and adsorptive properties, meaning they can bind fluid and bacterial or viral toxins.<ref name=":20">Fomina M, Skorochod I. Microbial Interaction with Clay Minerals and Its Environmental and Biotechnological Implications. Minerals. 2020; 10(10):861.</ref> Soluble fibres, such as psyllium, can also be useful due to their gel-forming ability when mixed with water. Other common ingredients are the yeast wall extracts mannan-oligosaccharides (MOS) and beta-glucans which can play a role in preventing pathogenic bacteria binding to the intestinal wall and increasing disease resistance through the activation of intestinal immunity.<ref name=":21">Pignataro G, Di Prinzio R, Crisi PE, Belà B, Fusaro I, Trevisan C, De Acetis L, Gramenzi A. Comparison of the therapeutic effect of treatment with antibiotics or nutraceuticals on clinical activity and the fecal microbiome of dogs with acute diarrhea. Animals. 2021 Jun;11(6):1484.</ref>

Assessing the clinical outcomes of probiotic supplementation in dogs with acute diarrhoea has been the subject of numerous placebo-controlled studies.<ref name=":15"/>-<ref name=":19">Li Y, Xia S, Jiang X, Feng C, Gong S, Ma J, Fang Z, Yin J and Yin Y (2021) Gut Microbiota and Diarrhea: An Updated Review. Front. Cell. Infect. Microbiol. 11:625210. doi: 10.3389/fcimb.2021.625210</ref>,<ref name=":22">Gómez-Gallego C, Junnila J, Männikkö S, et al. A canine-specific probiotic product in treating acute or intermittent diarrhea in dogs: A double-blind placebo-controlled efficacy study. Vet Microbiol. 2016;197:122-128. </ref> Amongst these studies, findings in the probiotic treated groups included: shorter times to diarrhoea resolution, <ref name=":15"/> -<ref name=":17"/> greater improvement in stool consistency score,18 faster improvement in Canine Haemorrhagic Diarrhoea Severity Index (CHDSI),18 greater decrease of faecal C. perfringens,<ref name=":17"/> and a lower requirement for additional medical interventions. <ref name=":15"/>,<ref name=":17"/>

==Summary==
Acute diarrhoea is often self-limiting and likely to resolve without veterinary intervention. Diagnostic investigations are infrequently performed in these cases and even when faecal analysis is carried out, the results can be difficult to interpret given that many potentially pathogenic bacteria are also found in healthy individuals. Antibiotics are still frequently prescribed to dogs or cats that present with acute diarrhoea, however this can contribute to the development of antibacterial resistance, as well as causing disruptions to the normal gastrointestinal microbiota and can result in adverse effects for the patient. Therefore, antibiotics should be reserved for specific cases where bacterial infection is confirmed or highly suspected, and/or there is concern of bacterial translocation or sepsis.

==References==
<references />

[[Category:Alimentary_System_-_Microbiota|10]]

Prebiotics

2022-05-04T15:31:37Z

JoeWright: Created page with "==What are prebiotics?== Prebiotics are generally non-digestible fibres, with the most widely accepted definition of a prebiotic being “ a selectively fermented ingredient t..."

==What are prebiotics?==
Prebiotics are generally non-digestible fibres, with the most widely accepted definition of a prebiotic being “ a selectively fermented ingredient that results in specific changes in the composition and/or activity of the gastrointestinal microbiota, thus conferring benefit(s) upon host health”.<ref name=":1">Davani-Davari D, Negahdaripour M, Karimzadeh I, et al. Prebiotics: Definition, Types, Sources, Mechanisms, and Clinical Applications. Foods 2019; 8(3):92</ref>

Prebiotics act to support both the growth and activity of beneficial bacterial species resulting in maximal production of beneficial metabolites called short chain fatty acids (SCFAs). SCFAs have numerous advantageous effects on intestinal health; for example SCFAs act to reduce luminal pH, thereby suppressing growth of pathogenic bacterial species and allowing numbers of beneficial bacteria (Bifidobacteria and Lactobacillus spp.) to increase.<ref name=":2">Oku T, Nakamura S. Fructooligosaccharide: metabolism through gut microbiota and prebiotic effect. Food Nutr. J. 2017;2:128</ref>Furthermore the SCFA, butyrate, acts as the preferred energy source for colonocytes, providing approximately 70% of their total energy requirement.<ref name=":3">Fernández J, Redondo-Blanco S, Gutiérrez-del-Río I, Miguélez EM, Villar CJ, Lombo F. Colon microbiota fermentation of dietary prebiotics towards short-chain fatty acids and their roles as anti-inflammatory and antitumour agents: A review. J. Funct. Foods 2016;25:511-22.</ref><ref name=":4">Ahmad MS, Krishnan S, Ramakrishna BS, et al. Butyrate and glucose metabolism by colonocytes in experimental colitis in mice. Gut 2000;46:493-499</ref>

As with probiotics, there are certain criteria which prebiotics need to fulfil order to be defined as an ideal prebiotic, including:
* Resistance to the stomach acid
* Undigestible to mammalian digestive enzymes within the stomach and small intestine
* Prebiotics should not absorbed from the gastrointestinal tract prior to bacterial fermentation
* Easily fermented by beneficial bacteria of the microbiota, thereby selectively stimulating the growth of species that are advantageous to host health

==Types of prebiotics==
*'''Fructo-oligosaccharide (FOS)''' consists of fructose units and is a naturally occurring oligosaccharide found within plants such as onion, chicory, asparagus, banana, artichoke, and many more.<ref name=":5">Sabater-Molina M, Larqué E, Torrella F, Zamora S. Dietary fructooligosaccharides and potential benefits on health. J Physiol Biochem 2009;65(3):315-328</ref> FOS is able to bypass small intestinal digestive enzymes and enter the proximal colon intact where it is then readily fermented by the microbiota into SCFAs.<ref name=":2"/>
*'''Acacia gum''' is a highly branched and complex structure which is fermented more slowly than FOS, primarily by bacteria within the distal colon. Acacia gum has shown to significantly increase Bifidobacteria proliferation (similar to FOS), whilst inhibiting bacteria commonly associated with gastrointestinal dysbiosis e.g. Clostridium histolyticum.<ref name=":6">Rawi M, Abdullah A, Ismail A, Sarbini S. Manipulation of Gut Microbiota Using Acacia Gum Polysaccharide. ACS omega 2021; 6(28):17782–17797 </ref>
*'''Galacto-oligosaccharide (GOS)''' is formed from a chain of galactose units, produced through the enzymatic conversion of lactose and are naturally found in human milk where they are known as human milk oligosaccharides. GOS is able to increase Bifidobacteria and Lactobacilli and reduce gastrointestinal adherence of Clostridia, Salmonella and E.coli.<ref name=":7">Shoaf K, Muvey GL, Armstrong GD, Hutkins RW. Prebiotic galactooligosaccharides reduce adherence of enteropathogenic Escherichia coli to tissue culture cells. Infect Immun 2006;74(12):6920–8.</ref><ref name=":8">8. Sinclair HR, et al. Galactooligosaccharides (GOS) inhibit Vibrio cholerae toxin binding to its GM1 receptor. J. Agric. Food Chem 2009; 57(8):3113–3119</ref>
*'''Mannan-oligosaccharide (MOS)''' is a complex carbohydrate usually derived from yeast cell walls, most commonly Saccharomyces cerevisiae. As well as having a prebiotic effect on the microbiota, MOS can also support intestinal immunity by increasing disease resistance; MOS can bind to the fimbriae of pathogens, resulting in a reduction in adherence and colonisation of the gastrointestinal tract.<ref name=":9">Van den Abbeele P, Duysburgh C, Rakebrandt M, Marzorati M. Dried yeast cell walls high in beta-glucan and mannan-oligosaccharides positively affect microbial composition and activity in the canine gastrointestinal tract in vitro. J Anim Sci 2020;98(6)</ref>
*'''Inulin'''- Similar to FOS, inulin is a fructan comprised of fructose units and has been shown to increase levels of Bifidobacterium and concentrations of faecal SCFAs.<ref name=":10">Rawi M, Abdullah A, Ismail A, Sarbini S. Manipulation of Gut Microbiota Using Acacia Gum Polysaccharide. ACS omega 2021; 6(28):17782–17797 </ref>
*'''Resistant starch (RS)''' is the indigestible component of starch often found in sources such as corn, potatoes, and rice and cannot be broken down by digestive enzymes. Instead, RS passes into the large intestine where it undergoes slower microbial fermentation helping to minimise post prandial glucose elevations, as well as producing large quantities of SCFAs. As such, the potential role of RS in the management and/or prevention of colon cancer, obesity and diabetes is of growing interest.<ref name=":11">Birt DF, Boylston T, Hendrich S, et al. Resistant starch: promise for improving human health. Adv Nutr 2013;4(6):587-601. </ref>

==What are synbiotics?==
When given together, probiotics and prebiotics are called synbiotics, named so because of the symbiotic relationship that exists between them. It is suggested that provision of a prebiotic with a probiotic can improve the live microorganism’s viability, enhancing its survival through the upper gastrointestinal tract and stimulating its growth and/or activity within the colon.<ref name=":12">Pandey KR, Naik SR, Vakil BV. Probiotics, prebiotics and synbiotics- a review. J Food Sci Technol 2015;52(12):7577-7587. </ref>

From a clinical standpoint, there is a rationale for synbiotic therapy alongside antibiotic use in both dogs and cats. It is well documented that antibiotics (e.g. metronidazole, enrofloxacin, clindamycin) can have a long-lasting and profound impact on the faecal microbiome that can take weeks, months or even years to recover.<ref name=":13">Pilla R, Gaschen FP, Barr JW, et al. Effects of metronidazole on the fecal microbiome and metabolome in healthy dogs. J Vet Intern Med 2020;34(5):1853-1866. </ref><ref name=":14">Whittemore JC, Price JM, Moyers T, Suchodolski JS. Effects of Synbiotics on the Fecal Microbiome and Metabolomic Profiles of Healthy Research Dogs Administered Antibiotics: A Randomized, Controlled Trial. Front Vet Sci 2021;8:665713.</ref> Concurrent synbiotic therapy can support greater recovery of both microbiome and metabolome (metabolites produced by the microbiome) composition after antibiotic discontinuation.<ref name=":14"/> Furthermore, synbiotic supplementation has been shown to reduce the incidence of diarrhoea in dogs following entry into boarding kennels. Hence, the role of synbiotic therapy in improving animal welfare and increasing chances of rehoming, as well as decreasing the need for medical interventions, is relevant to many professionals in the animal health sector.<ref name=":15">Rose L, Rose J, Gosling S, Holmes M. Efficacy of a Probiotic-Prebiotic Supplement on Incidence of Diarrhea in a Dog Shelter: A Randomized, Double-Blind, Placebo-Controlled Trial. J Vet Intern Med 2017;31(2):377-382</ref>

'''Author: Pippa Coupe BVSc, MRCVS Veterinary Product Manager at Protexin Veterinary. Protexin Veterinary is a brand of ADM Protexin Ltd'''

[https://www.protexinvet.com/?utm_campaign=Wikivet&utm_medium=content&utm_source=google '''www.protexinvet.com''']

[[File:ProtexinVeterinary.jpg|thumb|201x201px|In Partnership With Protexin Veterinary]]

==References==
<references />

[[Category:Alimentary_System_-_Microbiota|9]]

Examination of aborted ovine foetuses

2022-04-29T15:56:38Z

JoeWright:

[[File:NationWide Logo.jpeg|right|link=https://www.nwlabs.co.uk/|alt=NationWide Logo|240x240px|frameless]]

== Introdcution ==
This outlines the procedure that can be used for the post mortem examination and subsequent laboratory examination of tissues retrieved from aborted ovine foetuses.

== Safety ==
Ovine foetuses may be infected with several potentially serious zoonotic organisms: Chlamydia psittaci (EAE), Coxiella burnetii (Q-fever), Listeria, Campylobacter, Salmonella and Toxoplasma. Wherever possible post mortem examinations should be carried out in a safety cabinet, but if the foetus is too large or there is no safety cabinet available, a disposable dust mask should be used and appropriate safety precautions taken. Gloves and disposable aprons and sleeve guards should be worn. Any person who is or suspects they may be pregnant must not handle aborted ovine material.

== Procedure ==

=== Post mortem ===

* Weigh the foetus and note the appearance, for example fresh, autolysed, mummified, swollen joints etc
* After opening the body cavities take an aliquot of thoracic or peritoneal fluid with a syringe for toxoplasma serology
* Record whether the lungs are expanded or unexpanded. This can be determined by placing a section of lung in water – expanded lung will float and unexpanded will sink
* If sufficient stomach contents are present collect material in a sterile plain vacutainer. If minimal stomach contents , soak two plain swabs with material. Make air dried smears of stomach contents and if possible heat fix
* Collect a portion of liver; note any abnormalities such as white spots ‘sawdust liver’ indicative of Listeriosis
* Check the foetus for any obvious congenital abnormalities
* Examine the placenta if available and remove up to 3 cotyledons, prepare air dried impression smears for microscopy by cutting each cotyledon in half and touching onto a slide several times. Heat fix if possible
* Check for obvious abnormalities such as white foci in the cotyledons or yellow necrotic cotyledons
* Dispose of all material appropriately as clinical waste

=== Schmallenberg virus PCR ===
Remove 1cm3 sample of brain (cerebral cortex) as aseptically as possible. Place ‘fresh’ sample in an appropriate sterile container. If brain is not available, use umbilicus. A secondary sample shown be removed and frozen until results are received. Submit all samples labelled to the laboratory.

Please visit www.nwlabs.co.uk or see our current price list for more information

=== Laboratory examination ===

* Toxoplasma serology
* Liver culture
* Culture of stomach contents including CampylobacterSmears stained using modified ZN and examined for Chlamydial (EAE) or Rickettsial inclusion bodies (Q fever). Campylobacter may also be seen

Significant isolates from ovine foetuses are

* Salmonellae
* Campylobacter
* Listeria
* Pure growths such as ß-Streptococci, Staphylococcus aureus

Please visit www.nwlabs.co.uk or see our current price list for more information

== Authors & References ==
[[NationWide Laboratories]]
[[Category:LabFacts Book NWL|ABCDEFGHIJKLMNOP]]

Chlamydia psittaci and Chlamydia felis

2022-04-29T15:56:25Z

JoeWright:

[[File:NationWide Logo.jpeg|right|link=https://www.nwlabs.co.uk/|alt=NationWide Logo|240x240px|frameless]]

== Diagnostic tests ==
Confirmation of Chlamydia psittaci formerly known as Chlamydophila psittaci infection relies upon the detection of genus specific lipopolysaccharide antigen via ELISA or species specific Chlamydophila psittaci DNA by PCR which is more sensitive. Chlamydia felis can also be detected using ELISA, or species specific PCR,

== Zoonotic hazards ==
To minimise the zoonotic hazards for Chlamydia psittaci, carcasses of potentially infected birds should be placed in a polythene bag and sealed in an impervious outer container with sufficient absorbent material to absorb any leakage prior to incineration.

Owners of cats in which chlamydial infection has been diagnosed should be advised to maintain hygienic precautions when handling the cat or the litter tray.

== Antigen test ==
{| class="wikitable"
|+
|Samples
|Conjunctival swab (cats), post mortem tissues (avian)
Use dry cotton swabs on plastic, wire or paper sticks. Transport medium is not required
|-
|Techniques
|Conjunctival swabs (feline): reflect the eyelid and roll the swab across the conjunctiva to harvest cells

Post mortem tissues (avian): sear the tissue surface and stab insert the swab, rotating to harvest cells. Suitable tissues are liver, spleen and lungs
|-
|Comments
|Faeces or faecal swabs are not suitable for the ELISA test due to the possibility of false positive results
|}

== PCR test ==
{| class="wikitable"
|+
!
!
!
!
|-
|Smples
|Conjunctival swab (cats), faeces (birds only), tissue, blood.
Use dry cotton swabs on plastic, wire or paper sticks. Faeces and

tissues should be submitted fresh, unfixed in a sterile container. Blood samples should be submitted in EDTA. Transport media is not required and may interfere with the assay
|
|
|-
|Techiniques
|Conjunctival swabs (cats and symptomatic birds): reflect the eyelid and roll the swab across the conjunctiva to harvest cells.

Faeces (avian): with an asymptomatic carrier bird, collect faeces on days 1, 3, 10 and 12 and pool in a sterile container without fixative. 0.5g is the optimum amount (about 1/4 tsp) but smaller volumes may be adequate. A single sample from a diarrhoeic bird may be sufficient.

Post mortem tissues (avian): sear the tissue surface and stab insert the swab, rotating to harvest cells. Suitable tissues are liver, spleen and lungs.
|
|
|-
|Comments
|Faecal samples are the preferred samples in avian species. A virulent infection may kill the bird before colonisation of the intestines occurs therefore ocular or tracheal swabs should also be submitted from symptomatic birds. In cats ocular infections may not lead to colonisation of the intestines, therefore ocular swabs should be submitted from symptomatic cases.
|
|
|}

== Screening results for Chlamydia psittaci ==
'''Positive faeces.''' Bird is shedding chlamydia, may be clinically ill or an asymptomatic carrier and poses a zoonotic health risk to in contact humans.

'''Negative faeces.''' No support for current shedding, however, this does not prove that the bird is free from Chlamydia. If there is clinical suspicion of infection, further samples should be obtained and tested at regular intervals

Please visit www.nwlabs.co.uk or see our current price list for more information

== Authors & References ==
[[NationWide Laboratories]]
[[Category:LabFacts Book NWL|ABCDEFGHIJKLMNO]]

Feline infectious disease

2022-04-29T15:56:09Z

JoeWright:

[[File:NationWide Logo.jpeg|right|link=https://www.nwlabs.co.uk/|alt=NationWide Logo|240x240px|frameless]]

== Chlamydia felis (formerly Chlamydophila felis) ==
Chlamydia felis (formerly Chlamydophila felis and C. psittaci var. felis) predominantly causes conjunctivitis in affected cats but may be involved in upper respiratory tract disease. Infection can become endemic in some cat colonies and recurrent signs are common. An antigen ELISA test and PCR are available for diagnosis. PCR is more sensitive. Conjunctival, nasal or pharyngeal swabs (plain) may be submitted but the organism is reportedly shed predominantly in conjunctival secretions. Samples are collected by reflecting the eyelid and rolling the swab vigorously across the conjunctiva to harvest cells. If necessary, the swab can be moistened with sterile saline prior to sampling. If submission is delayed, then samples may be stored at 2-8°C for up to 48 hours.

== Feline leukaemia virus ==
General. The prevalence of FeLV is not clear, but has probably fallen to <1% (Gruffyd Jones 2006). With the introduction of PCR testing our understanding of the pathogenesis and outcomes of infection has been challenged. More recent proposals have suggested the following stages in infection and FeLV status categories (Greene 2012):

Abortive/complete elimination. Virus replicates in local oropharyngeal lymphoid tissue but systemic spread is prevented by humoral and cell-mediated responses. Exposure to infection is indicated by the presence of antibodies but cats are negative for antigen and proviral DNA. It is unclear how often this occurs in natural infection but it is likely to be very uncommon. Studies using newer, sensitive PCR techniques indicate that proviral DNA may be detected at a later date in many patients previously believed to have eliminated the virus. However, the clinical significance of persistence of proviral DNA is unclear since the life expectancy is the same as for cats which have never been infected.

Regressive infection (transient viraemia). Infected cats become viraemic (primary viraemia) but an effective antibody response is mounted and virus replication/viraemia is terminated before or shortly after bone marrow infection (around 3 weeks post infection). In most cats the primary viraemia lasts 3-6 weeks (maximum 16 weeks) during which time, FeLV p27 antigen (ELISA) is detected in the plasma and cats are infectious. Previously, it was thought that termination of the viraemia was accompanied by rapid, total elimination of the virus from all cells (based on negative ELISA results within 2-8 weeks). However, recent studies suggest that FeLV becomes integrated into the cat’s genome and thus can be detected by qPCR for months after the initial viraemia. It has been proposed that integration of proviral DNA is essential for solid protective immunity and some investigators propose that small quantities of proviral DNA may actually persist for life.

The clinical significance of an antigen negative/proviral DNA positive pattern is unclear but cats with this outcome of infection have effective immunity, are likely protected against new exposure and have a low risk of developing FeLV associated diseases. They are unlikely to shed virus via oronasal secretions but may pose a risk to other cats via blood transfusion.

Some cats do not clear the primary viraemia prior to infection of the bone marrow precursors (secondary viraemia) and in these patients viral antigen is detected within platelets and granulocytes by immunofluorescence testing (IF). Once infection is established in the stem cells the virus cannot be eliminated from the bone marrow by the host immune response and most of these patients go on to develop progressive infection (see below). Progressive infection is more likely when viraemia persists for more than 16 weeks. However, in a small number of cats the immune response does limit systemic replication of the virus shortly after bone marrow infection. Although proviral DNA persists in the stem cells of these cats, it is not translated into proteins and affected individuals do not produce virus, become negative for FeLV antigen (ELISA, IF) and are not infectious to other cats. This is termed latency and may be a permanent state but it appears that the majority of cats lose functional viral material for example, through gene reading errors during cell division by 16 months after infection, with only 10% still affected at 30 months.

Regressive (latent) infections may reactivate if the host immunity wanes for example, during pregnancy, periods of stress or after high doses of glucocorticoids. Reactivation is more likely if the stressful event occurs shortly after the initial viraemia and is considered unlikely to occur after 2 years.

Regressive infections are likely to be a stage in the elimination of the virus. Most regressive infections are not clinically significant (reactivation is uncommon under non-experimental conditions) but clinical signs may occur and include cytopaenias, suppurative inflammatory conditions and haematopoietic neoplasia.

=== Progressive infection ===
In progressive infections there is an ineffective immune response allowing extensive viral replication in lymphoid tissues, bone marrow and mucosal/glandular tissue, accompanied by virus shedding. If the viraemia persists unchecked for 16 weeks then cats remain persistently viraemic and infectious and most develop FeLV related diseases, often within 3 years. FeLV DNA provirus is detected in both regressive and progressive infections and these can only be differentiated by repeat antigen tests, which in regressive infections become negative after 2-8 weeks, or occasionally, after some months.

=== Focal Infections ===
Focal infections of specific tissues (mammary gland, spleen, lymphoid tissue, small intestine) can lead to low grade or intermittent virus production and affected cats may have weak positive or discordant results (ELISA, IF) or variable results over time. They should be considered a potential source of infection to other cats.
[[File:NWL Map FeLV Infection.png|center|thumb|FeLV Infection Map ©NationWide Laboratories 2017]]

=== Tests for FeLV ===

==== ELISA (Enzyme-linked immunosorbent assay) ====
ELISA and rapid immunomigration methodologies are commonly employed in in-clinic tests. They detect free viral protein (p27) in plasma, tears or saliva. Testing serum or plasma is preferred and the use of saliva or tears is not recommended. The specificity of many of these tests is 98-99%, but because of the very low incidence of FeLV, approximately half of the positive tests will be false positives. True positive results could reflect transient or persistent viraemia and further testing (by immunofluorescence) is recommended initially. If immunofluorescence (IF) is initially negative repeat testing 6 and 16 weeks after the initial test is indicated to determine whether the patient has a regressive infection (transient viraemia) or progressive infection. Cats with a persistent ELISA positive, IF negative pattern may have a focal infection.

==== IF (Immunofluorescence) ====
IF detects viral protein (p27) in the cytoplasm of leucocytes (predominantly neutrophils) and platelets. Positive results are highly likely to reflect persistent infection, <10% of cats with positive IF result have regressive infections (transient viraemia). IF is a suitable staging test for positive results obtained using ELISA, but is not recommended as an initial screening test because cats with primary viraemia (which may be infectious to other cats) are not detected. False negative IF results may be noted in cats with neutropaenia and/or thrombocytopenia.

==== FeLV DNA (provirus) ====
FeLV proviral DNA qPCR allows quantification of FeLV DNA in the blood or bone marrow. High levels are found in ELISA and IF positive cats, low levels are found in cats which are negative using antigen methods. These cats may have latent infections and qPCR is recommended where there is a strong clinical suspicion of FeLV-related disease but negative antigen tests. Cats with regressive and progressive infections are expected to be positive for FeLV proviral DNA thus qPCR will not allow differentiation in ELISA positive patients, particularly in acute infection. In the future, quantification of the viral load in leucocyte subsets may allow differentiation later in the infection, when most cats with virus in the granulocytes have progressive infection while cats with regressive infection appear to possess only a small quantity of proviral DNA in lymphocytes.

As a retrovirus, FeLV mutates naturally and a mutated viral strain may not be detected using specific primers. A negative result does not, therefore, exclude infection.

=== FeLV infection status ===
The likely FeLV status of a cat can be determined using the results of ELISA, IF and proviral DNA. However, collection of multiple samples over weeks/months may be required for clarification, particularly for differentiation between regressive infection (transient viraemia) and progressive infection (persistent viraemia). Most cats (>90%) with a positive IF result have progressive infection.

Cats with discordant results (ELISA positive, IF negative) may have a false positive ELISA result, a primary viraemia or focal infection. Isolation of the patient, followed by retesting in 6 weeks and 16 weeks is recommended and provides clarification of the status in many patients. A positive qPCR test would indicate infection and allows confirmation of the infection status (false positive ELISA versus infection). However, a negative qPCR result does not completely exclude infection. Further testing may be required for some individuals.
{| class="wikitable"
|+
!Status
!ELISA
!IF
!FeLV DNA
|-
|Not infected
| -
| -
| -
|-
|Abortive/complete elimination
| -
| -
| -
|-
|Regressive (primary viraemia; no secondary viraemia
| +
| -
|<nowiki>+</nowiki>
|-
|Regressive (with secondary viraemia)*
| +
| +
| +
|-
|Regressive; latent
| -
| -
| +**
|-
|Progressive
| +
| +
| +
|-
|Focal
| +/-
| -
|Currently unknown
|}
<nowiki>*</nowiki>Most cats with this pattern have progressive disease

<nowiki>**</nowiki>Positive more likely in bone marrow than peripheral blood
[[File:NWL FeLV ELISA map.png|center|thumb|©NationWide Laboratories 2017]]

=== When to test for FeLV ===
Testing is recommended when:

* Cats present with clinical illness (irrespective of previous test results)
* Cats are to be re-homed (even if there are no cats currently in the household). Cats with negative results should be re-tested after at least 4 weeks. Kittens may be tested at anyage but kittens which have been infected by maternal transmission may not be positive for to months after birth (once the virus starts replicating)
* There has been potential exposure to FeLV. If testing is negative then it should be repeated after at least 4 weeks (ideally also after 12 weeks). In a cat with a single exposure the risk of developing progressive infection averages 3% (Greene 2012)
* Cats with high risk lifestyles or living in households with infected cats should be tested on a regular basis. Introduction of an FeLV shedding cat into a group of naive cats for an extended period increases the risk of naive cats developing progressive infection to 30% (Greene 2012)
* Prior to FeLV vaccination. FeLV vaccination does not affect the test result but samples should not be collected shortly after vaccination since some investigators report the risk of detecting vaccine antigens. The duration of this phenomenon is unclear
* Screening of blood donors, using antigen detection methods and qPCR

== Feline immunodeficiency virus ==

=== Tests for FIV ===
The prevalence of FIV is reported as 4-6% in the general cat population and 12-18% in sick cats (Gruffyd Jones 2006). Tests for FIV infection detect antibody production using ELISA, immunofluorescence (IF) or Western Blot methodologies. Positive ELISA results should be confirmed by IF. Most cats have seroconverted by 60 days post infection, some take longer; in addition, antibody production in some individuals may be insufficient for detection, particularly in the terminal phase of infection. In these patients infection may be confirmed by measurement of FIV (proviral) DNA by PCR.

Confirmation of infection in kittens born to infected queens is problematic since kittens under 6 months of age may have maternally derived antibodies. If a positive ELISA result is obtained in a kitten <6 months, repeat testing at 60 day intervals is recommended. Possible sources of infection should be considered and the kitten’s final test should be no less than 60 days after the last potential exposure. Positive test results in cats over 6 months of age are an indication of infection.

FIV (proviral) DNA may be measured by PCR to confirm infection in kittens in which antibody test results may be misleading and repeat ELISA testing causes an unacceptable delay in diagnosis. In addition, the PCR test can be used to monitor proviral loads in infected cats. The test is reliable for the detection of the clade A subtype which is to date, the cause of infection in the UK.

=== When to test for FIV ===
The American Association of Feline Practitioners recommendations include testing cats when:

* They present with clinical illness, even if they have tested negative in the past
* They are to be re-homed. Negative cats should be retested in 60 days
* If a positive result is obtained in a young kitten then further testing is recommended at > 6 months (and no less than 60 days after any potential exposure)
* There has been potential exposure. FIV negative cats should be tested at least 60 days after the potential exposure
* There is a high risk lifestyle. Regular testing is recommended for cats with bite/fight wounds and individuals housed with FIV infected cats

== Feline infectious peritonitis (FIP) ==
Feline Coronavirus infection is common, especially when cats are group housed, however, the majority of infected cats do not go on to develop FIP. FIP is an immune mediated disease, associated with viral mutation which allows replication of the virus in macrophages and monocytes. Following infection with Feline Coronavirus (FCoV), most cats shed virus for a variable period of time although the majority have ceased shedding by 9 months PI. In at least 25% of these cases, virus can also be detected in the blood. Over 90% of cats exposed to FCoV seroconvert; the antibody titre eventually decreases and becomes undetectable. Thirteen percent of cats become lifelong carriers and permanently shed virus (faecal). Only 10% of seropositive cats go on to develop FIP. A small proportion of cats appear to be naturally resistant to infection, they do not develop an antibody response and do not shed virus.

=== Diagnosis ===
A definitive diagnosis is difficult; the gold standard requires demonstration via immunostaining, of FCoV antigen within tissue or effusion macrophages, along with consistent histopathological changes. A tentative diagnosis may be made based upon the weight of evidence from the following tests:

* Multicat household. The seroprevalence of FCoV in single cat households is reported as 25% but can be up to 100% in multicat households
* Signalment. Most affected cats are aged between 3 months and 2 years, there is a second peak at >10 years
* History. The clinical signs are often noted following a stressful event such as re-homing or surgery
* Clinical signs. Anterior uveitis, pyrexia, lethargy, anorexia, weight loss, palpable mesenteric lymph nodes, ascites (25% of these also have pleural effusion), neurological signs (seizures, nystagmus, hyperaesthesia)
* Biochemistry. Hyperglobulinaemia, polyclonal gammopathy and A:G <0.7 (<0.40 highly likely, >0.8 FIP unlikely). Raised globulins are present in more than 50% of cats with wet FIP and 75% of cats with the dry form. Other profile changes include normocytic normochromic anaemia, neutrophilia, lymphopaenia and proteinuria if there is renal involvement
* Hyperbilirubinaemia. In the absence of pre-hepatic, intra- hepatic or post-hepatic causes. Hyperbilirubinaemia of sepsis is thought to reflect impaired transport of bilirubin across the canalicular membrane, due to high levels of TNF alpha
* Abdominal effusion. Total protein >35g/l and A:G ratio <0.7 (<0.40 highly likely, >0.8 FIP unlikely)
* FCoV antibodies (IF). Serology can be performed on serum or effusion. Cats from a multicat household or rescue centre within the previous 6-12 months are likely to have antibodies to FCoV. Approximately 9 out of 10 of these cats will not develop FIP
* FCoV antibody titre. In dry FIP the titre is often >1280. Wet FIP titres vary from 0 to >2560.
* APP. Serum or effusion alpha 1-acid glycoprotein >1.5g/l
* PCR. Detects viral genetic material in effusions and is useful in seronegative cats with suspected wet FIP. A positive result significantly increase the index of suspicion. A negative result does not exclude the diagnosis

=== Serological testing in other circumstances ===

==== Testing when there is suspected exposure of a healthy cat ====
FCoV is highly infectious and most in-contact cats will be seropositive. Only 10% of infected cats will develop FIP. The following may be useful:

A seronegative cat is unlikely to develop FIP and is not shedding virus. However, a small number of cats with wet FIP have a titre of 0. It is probably safe to get another cat, but the new cat should also be seronegative.

There is a one in ten chance of a seropositive cat developing FIP and a one in three chance that the cat is shedding virus. It is probably unwise to bring in a new cat at this time. Retest at 3-6 month intervals. The titres eventually decline in most unaffected cats.

==== Screening before mating. ====
A seronegative cat is not excreting virus and can be mated to another seronegative cat. A seropositive cat should be mated to a cat which is also seropositive.

==== Screening a cattery ====
Since FCoV is highly infectious, sampling 3-4 individuals at random gives an overview of the status. Cats may eventually become seronegative if they are housed in small groups (<3) or the total number of cats is relatively small (<10). Test every 6-12 months to determine if the proportion of seronegative cats is increasing.

==== Screening a cat for introduction into a new household ====
Seronegative cats may be introduced. Seropositive cats may be shedding virus.

== Haemoplasmosis (Feline infectious anaemia) ==
There are three species of haemotrophic feline Mycoplasma species, Candidatus Mycoplasma haemominutum (the small form), Mycoplasma haemofelis (the large form) and Candidatus Mycoplasma turicensis. Infection with C. Mycoplasma haemominutum causes mild anaemia and more severe disease in immunocompromised patients. The other two species cause severe haemolytic anaemia. In some cases the organisms are identified in a blood film made from blood which does not contain an anti-coagulant. A PCR test is available for all three species and is much more sensitive. Post treatment samples can be submitted to determine whether the infection has been cleared successfully. Since the PCR test is quantitative, it may be used during treatment to monitor the therapeutic response. PCR screening of blood donors is highly recommended.

== Respiratory viruses (FRV, FCV) ==
Feline rhinotracheitis virus (FRV; Herpesvirus) and Calicivirus (FCV) are significant causes of respiratory disease in cats. Infection with FRV usually results in a carrier state. During latent periods the virus is not shed and cannot be detected, but shedding often occurs approximately one week after a stressful event and may persist for 1-2 weeks. During shedding the cat is infectious. A carrier state is also a common sequel to infection with FCV but shedding is usually continuous. The infection may eventually be cleared but some cats are long term carriers. In experimental studies, 50% of cats were still shedding virus at 75 days post infection.

=== Diagnosis ===
Oropharyngeal swabs (ideally within the first week of illness) in viral transport medium for viral isolation or dry swabs (can be soaked in sterile saline prior to sampling) for testing vio PCR.

== Toxoplasmosis ==
Toxoplasmosis is caused by the intracellular coccidian parasite Toxoplasma gondii, cats are the definitive host. Infection usually results from the ingestion of bradyzoites in tissues of vertebrate intermediate hosts.

The majority of infected cats do not show clinical signs. Transient small bowel diarrhoea may accompany the gut epithelial stage of primary infection. Systemic signs may develop during tachyzoite replication in extra-intestinal tissues and will reflect organ involvement. Hepatic, pulmonary, CNS and pancreatic involvement are common. Risk factors for clinical disease include concurrent retroviral infection, FIP or the administration of immunosuppressive drugs including cyclosporine A.

Clinical signs in acute disseminated infection include anorexia, lethargy, pyrexia or hypothermia, dyspnoea, abdominal effusion, diffuse or multifocal CNS signs, uveitis, jaundice. On routine profiles there may be non-regenerative anaemia, neutrophilia, lymphocytosis, monocytosis, hypoproteinaemia, raised liver enzymes, hyperbilirubinaemia and proteinuria. Serology is a useful component of the investigation, but there is some controversy over interpretation, especially regarding IgM titres when used in isolation for diagnosis. A tentative ante mortem diagnosis may be based upon appropriate clinical signs, exclusion of other differentials, supportive IgG and IgM titres and a positive response to anti-Toxoplasma drug therapy.

=== Diagnosis ===
Antibodies (IgG and IgM) to Toxoplasma gondii are identified by IF.

==== IgG titres ====
A negative titre (<50) is not consistent with active infection although the cat may have been exposed in the last 3 weeks and seroconversion has not occurred.

A positive titre (50 or >50) indicates exposure, but need not reflect active disease. Some cats do not develop an IgG titre until 4-6 weeks after infection and then maximal titres are reached within a further 2-3 weeks. There is some evidence that higher titres (>400) are associated with active infection but other investigators suggest that serology should be used only as a screening tool to rule out exposure. Very high IgG titres (>800) may be noted where rheumatoid factor (RF) is present. RF may cause false positive or negative IgM results.

Paired serum samples taken 2-4 weeks apart can also help in the interpretation of positive titres. An increase of ≥4 fold indicates recent or active infection (true positive).

A <4 fold increase in titre does not support recent or active infection (true negative), unless the maximal titre was achieved before taking the first sample or the titre failed to rise, as with recrudescent disease (false negative).

High titres can persist for many years due to latent infection (bradyzoite tissue cysts).

==== IgM titres ====
IgM antibodies are commonly identified in the serum of clinically ill cats and not healthy cats, but titres should still be interpreted with care. Titres of 20 and above are likely to be associated with active infection (when accompanied by an appropriate IgG titre), but titres may persist with chronic infection in some healthy cats, cats with concurrent FIV or those receiving glucocorticoid therapy. The presence of this antibody class does not accurately predict the period of oocyst shedding. Positive IgM titres with negative IgG titres should be interpreted with caution since there may be some cross-reactivity with other parasites. Ideally, a second sample should be tested in 2-3 weeks to check for a rising IgG titre. The presence of rheumatoid factor (Toxoplasma IgG titre usually >800) may cause false negative and positive IgM results. A definitive diagnosis of Toxoplasmosis requires detection of tachyzoites in body cavity effusions, BAL fluids, CSF, tissue aspirates or biopsy material via cytology, histology or immunohistochemistry. The sensitivity is low but specificity is high.

=== Screening a cat whose owner is pregnant ===

==== Negative IgG titre ====
(<50) No evidence of exposure (although the cat could have been exposed in the last 3 weeks and not yet seroconverted). The patient is at risk of infection from hunting and eating undercooked meats. Indoor cats fed on a tinned diet are unlikely to become infected but faeces should be removed from the litter tray within 24 hours, ideally by a non-pregnant individual. Unsporulated oocysts are not infective but sporulation occurs within 1-5 days. If litter trays are cleaned and disinfected daily any risks from cleaning them should be minimised.

==== Positive IgG titre ====
(50 or >50) The cat has been exposed. In general, oocysts are shed for only 1-2 weeks post infection. Cats are unlikely to be shedding once an IgG titre has developed, however, some cats may shed low numbers of oocysts if re-challenged or treated with immunosuppressive doses of prednisolone. Potential exposure to oocysts should still be minimised (as above). Most human infection is acquired following ingestion of tissue cysts in undercooked meat or oocysts from the environment (contaminated vegetables, gardening without wearing gloves or inadequate hand washing etc).

== Authors & References ==
[[NationWide Laboratories]]
[[Category:LabFacts Book NWL|ABCDEFGHIJKLMN]]

Canine infectious disease

2022-04-29T15:55:53Z

JoeWright:

[[File:NationWide Logo.jpeg|right|link=https://www.nwlabs.co.uk/|alt=NationWide Logo|240x240px|frameless]]

== Canine Adenovirus (CAV-1) ==
CAV-1 is the cause of infectious canine hepatitis and may cause acute upper respiratory tract disease.

=== Clinical signs ===
Infectious canine hepatitis is most common in dogs <1 year of age. Clinical signs include fever, lethargy, abdominal discomfort, tonsillar enlargement, cervical lymphadenopathy, respiratory signs, vomiting, diarrhoea, hepatic encephalopathy and haemorrhage secondary to DIC. Jaundice is uncommon despite hepatic necrosis.

=== Diagnosis ===
A tentative diagnosis is based on the presence of hepatic necrosis in an unvaccinated dog. Virus isolation and serology may be useful; inclusion bodies may be observed on histological examination of liver biopsies. Virus isolation from the liver is often not rewarding.

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== Canine Adenovirus (CAV-2) ==

=== Clinical signs ===
CAV-2 causes respiratory disease and is a potential cause of canine infectious tracheobronchiti (kennel cough).

=== Diagnosis ===

* Susceptibility to infection is suspected in a non-vaccinated dog and diagnostic tests are not routinely performed in clinical cases. Radiography is unremarkable unless there is secondary bronchopneumonia due to coinfection with other respiratory pathogens or preexisting disease
* Virus isolation (pharyngeal swab in viral transport medium). Detects CAV1 and CAV2. Ideally samples should be collected early in the course of disease and asymptomatic in contact animals may also be sampled (may be actively shedding). Samples should be collected into viral transport medium, which restricts growth of bacterial contaminants, refrigerated and submitted to the laboratory without delay. Freezing at -20˚C may reduce virus viability
* Demonstration of a rising antibody titre in acute and convalescing serum (paired samples, 2 weeks apart) could confirm infection but since infection is short-lived this often has no clinical utility for the individual patient

=== Is booster vaccination necessary? ===
Little is published about protective titres in vaccinated dogs. A titre >40 is usually associated with protective immunity. It is possible that lower titres are actually protective since local and systemic immunity are involved in protection.

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== Babesia ==

=== Clinical signs ===
The presentation is variable, depending on the infecting species and host factors; there may be a peracute, acute or chronic clinical course. Clinical signs include anaemia, lethargy, weakness, fever and haemoglobinuria with tachycardia, tachypnoea, splenomegaly and possibly lymphadenopathy, on clinical examination. Concurrent anaemia and thrombocytopenia is common. A more severe form of the disease may be associated with severe acid-base disturbances, hypoglycaemia, hypotensive shock and secondary organ failure, for example acute renal failure.

=== Diagnosis ===

* Classical clinical presentation along with identification of organisms on blood smear examination. Babesia merozoites within erythrocytes are most commonly identified in smears made from capillary blood (ear vein) rather than venous blood. Organism may also be identified in bone marrow and splenic aspirates
* PCR. In chronic cases with less virulent species for example, B canis canis, B canis vogeli then the infection may be below the limit of detection of microscopy. PCR is a sensitive and specific technique which amplifies the protozoal DNA for detection
* Serology: not routinely available in the UK

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== Distemper ==

=== Clinical signs ===
Signs are most common after maternal immunity has waned between 3-6 months of age. Mild disease is common with anorexia and upper respiratory tract signs, progressing to oculonasal discharge and coughing. Severe generalised infection is characterised by conjunctivitis (serous to purulent), coughing, anorexia, vomiting and diarrhoea. Nasal and digital hyperkeratosis, keratoconjunctivitis sicca and neurological signs may be noted following infection.

=== Diagnosis ===

* Diagnosis is usually based on the presence of clinical signs in an unvaccinated puppy
* Antibody titres may be determined in paired samples, collected at a 2-3 week interval. This test is also suitable for investigation of infection in ferrets and phocid (seal) distemper
* PCR may be performed on CSF, whole blood, deep pharyngeal swabs (with organic material) and conjunctival swabs. A quantitative PCR is available for respiratory samples which may help to differentiate between recent vaccination and infection

=== Is vaccination necessary? ===
Studies in this area have used different methods and it is difficult to formulate a consensus view of the literature. A titre >40 is normally associated with protective immunity. It is possible that lower titres are actually protective since local and systemic immunity are involved in protection.

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== Ehrlichia ==

=== Clinical signs ===
The clinical signs seen with Ehrlichiosis depend on the infecting species. The signs reported with Ehrlichia canis, which infects monocytes and macrophages, include fever, anorexia, weight loss, bleeding disorders (petechiation, ecchymosis, mucosal haemorrhage), lymphadenopathy and neurological signs. Clinical signs of chronic monocytic Ehrlichiosis may develop some months after importation from an endemic region. Infection is reported in Europe, USA and Africa but has been reported in a dog in SE England with no travel history (J Small Anim Pract. 2013 54(8):425-7). Anaplasma phagocytophilum which infects granulocytes is endemic in the UK. Signs include fever, anorexia, depression, lameness and lymphadenopathy. In addition, anaemia, thrombocytopenia and DIC have been reported in some patients.

=== Diagnosis ===

* Clinical pathology: anaemia, leucopaenia, thrombocytopenia, hyperglobulinaemia and proteinuria are possible with E.canis infection. Thrombocytopenia, anaemia and DIC have been reported in A.phagocytophilum infections
* Blood film examination (or buffy coat exam): demonstration of Ehrlichia morulae in leucocytes
* PCR testing (EDTA peripheral blood, splenic or bone marrow aspirate). PCR testing for Ehrlichia spp detects A.phagocytophilum but a specific PCR is available for the latter if required

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== Herpes virus ==

=== Clinical signs ===
Infection in bitches can cause abortion, stillborn or fading pups. Pups infected after birth develop an acute, fatal condition between 1-3 weeks of age. There is depression, anorexia, vocalisation, petechiation and the development of an erythematous rash (sometimes with oedema) on the ventral abdomen and inguinal region. Primary genital infections in adult bitches may show vaginal hyperaemia and submucosal haemorrhages. Vesicular lesions are reported during pro-oestrus, but regress in anoestrus. Infected male dogs may have similar lesions over the penis, sometimes with a preputial discharge.

=== Diagnosis ===
The following options could be considered but the first two are preferred:

* Post mortem of affected puppies: reveals typical multifocal haemorrhages and characteristic kidney lesions
* Virus isolation from genital lesions: a genital swab in viral transport medium is required
* Serological testing: antibodies rise after infection but are only high for approximately 2 months. Low titres may be detected for some years after infection. The presence of antibodies only indicates exposure and not active infection, although latent infection might be inferred

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== Leishmania ==

=== Clinical signs ===
Clinical signs may develop many months or years after infection. They are very variable but include exercise intolerance, weight loss, lymphadenopathy, skin disease (often an exfoliative dermatitis but also periorbital alopecia), anorexia, diarrhoea, lameness, epistaxis, melena and coughing.

=== Diagnosis ===

* Clinical pathology: hyperglobulinaemia, hypoalbuminaemia and proteinuria are common (>80% of cases). Thrombocytopenia is reported in approximately 50% of infections
* Organisms may be identified in smears made from lymph node aspirates or bone marrow
* PCR on EDTA blood, bone marrow aspirate, lymph node aspirate, fresh biopsy material and conjunctival swab. Sampling of tissues most likely to be infected (as judged by the clinical presentation) is recommended but the sensitivity of the test is higher for lymph node and bone marrow aspirates. A negative result, particularly in peripheral blood, does not exclude infection. Fresh biopsy material should be placed on saline soaked gauze in a sterile container to keep moist. Formalin fixed specimens are not recommended. Conjunctival swabs should be moistened with sterile saline before use. After collection, the end should be cut off and placed in a sterile container. PCR may be used for diagnosis and generally the quantity of DNA correlates with the severity of clinical disease. In addition, qPCR can be used to monitor therapy and sampling at 1, 4, 6 and 12 months after the start of treatment is recommended. Correlation with serology may be useful in some patients, particularly if the PCR result is negative despite strong clinical suspicion of disease or the test is positive, despite only mild clinical signs. Testing for Leishmania may be combined with PCR tests for other arthropod borne infections such as Ehrlichia and Babesia
* Serology. Given the long incubation period, dogs with clinical disease are expected to demonstrate antibody production and high titres are noted in dogs with active disease. Low titres imply infection but are less likely to indicate active disease and correlation with qPCR and further serological monitoring in 2-6 months is recommended to check for a rising titre. Serology is also used to determine the response to therapy but titres only start to decline at 4-6 months after initiation of successful therapy

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== Leptospirosis ==

=== Clinical signs ===
Infection should be considered in dogs with acute renal or hepatic disease. It has also been proposed that infection may play a role in the development of chronic hepatopathies. Signs are more severe in young animals and include pyrexia, muscle tenderness, vomiting, dehydration, vascular collapse, increased thirst and coagulation defects. Icterus and renal failure are commonly noted but some animals may die per acutely, prior to development of typical clinicopathological changes.

=== Diagnosis ===

* Clinical pathology: azotaemia is most common. Leucocytosis and thrombocytopenia may also be noted. Raised ALT, ALP and bilirubin are noted with hepatic involvement
* Serological testing. A presumptive diagnosis may be made on the basis of a single high titre, with appropriate clinical signs, in a dog which has not been vaccinated recently. However, the titres may be negative in the first 7-10 days and further testing in 2-3 weeks is required to demonstrate a rising titre. Two serological tests are available. The Leptospira antibody screen (immunofluorescent antibody test; Leptospira antibody screen detects antibodies against a genus-specific antigen and is expected to detect antibodies against pathogenic serovars likely to cause clinical disease in the UK. However, it does not allow confirmation of the infecting serovar. A microscopic agglutination test is also available in which the patient sample is tested against serovar pools. If a positive result is obtained then the sample is tested against individual serovars (at an additional cost). Dogs with positive titres often have sera which cross reacts with a variety of serovars and historically the highest titre may be presumed to indicate the infecting serovar. However, this assumption has been questioned since it was found that the highest titre may vary between laboratories, over time, in the same patient
* PCR on urine. Organism shedding is typically noted from day 7-14 after infection, prior to development of an antibody titre. A positive result confirms infection and urinary shedding

=== Is booster vaccination necessary? ===
Vaccination usually only produces a very short-lived humoral response and prevaccination screens are not advised.Serology should be reserved for suspected clinical cases. Annual booster vaccination is recommended for dogs with a reasonable risk of exposure.

== Lyme disease ==

=== Clinical signs ===
Lyme disease is caused by infection with the tick-borne spirochaete, Borrelia burgdorferi. Clinical signs may develop from 3-30 days post infection and include fever, lethargy and most commonly an inflammatory polyarthropathy. The characteristic skin rash associated with human infection is rarely seen in the dog. Owners may or may not be aware of a recent tick bite.

=== Diagnosis ===

* A polyarthropathy with neutrophilic (suppurative) inflammation is typically evident on cytological examination of synovial fluid from affected joints
* Serology. The presence of an antibody titre only demonstrates exposure and does not confirm a diagnosis. Correlation with the clinical presentation and PCR is recommended. If there is no antibody titre early in the clinical course then repeat sampling in 2 weeks is recommended in suspect cases. If there is no antibody production by approximately one month after the onset of signs then Lyme Disease is unlikely
* PCR on synovial fluid or blood (EDTA)

== Neospora caninum ==

=== Clinical signs ===
Neuromuscular signs are most common, particularly in young puppies >6 months of age and include progressive hind limb paralysis and lower motor deficits of the bladder and rectum. Tremors, head tilt, seizure, hepatitis and pneumonia are reported in older dogs (>6 months). Infection of puppies is trans-placental and therefore if one puppy is affected then others are at risk. In addition, subsequent litters may be affected.

=== Diagnosis ===

* Serology. Antibodies are detected by IFA. High titres are likely to be associated with clinical disease
* PCR on CSF (EDTA)
* Histology. Cysts may be seen in affected tissue

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== Parvovirus ==

=== Clinical signs ===
Parvovirus enteritis produces vomiting, diarrhoea (which may be haemorrhagic), anorexia and dehydration. Infection may be fatal. Parvovirus myocarditis develops after in utero infection or infection of very young puppies (<8 weeks). It is seen in pups born to an unvaccinated, isolated bitch and is now uncommon.

=== Diagnosis ===

* Faecal PCR is a sensitive test which may detect virus shedding for some weeks after infection. This quantitative test allows differentiation between prior vaccination and field infection. A negative result does not exclude infection
* Serological testing: the presence of a high antibody titre in a single sample collected at least 3 days after clinical presentation, indicates infection. Demonstration of a rising titre in samples at a 14 day interval may be required. The humoral response after vaccination is similar to that of natural infection

=== Is booster vaccination necessary? ===
A titre >40 is expected to be associated with protective immunity.

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== Toxoplasma gondii ==

=== Clinical signs ===
Clinical signs may be localised to neuromuscular, respiratory or GI systems, or may be generalised (seen most commonly in dogs <1 year old). Neuromuscular signs depends on the region affected but include seizures, cranial nerve deficits, tremors, ataxia, paresis and myositis. Retinitis and uveitis has been reported although is uncommon. Dogs do not support the sexual stages of the parasite and are therefore not a risk to pregnant humans or sheep.

=== Diagnosis ===

* Serology: IgG and IgM. There is no reliable specific data for interpretation of canine serology but it is recommended to broadly follow the advice for interpretation of feline antibody titres. The presence of IgG antibodies indicates exposure, while IgM antibodies may be more indicative of early/active disease
* PCR on CSF (EDTA)

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== Authors & References ==
[[NationWide Laboratories]]
[[Category:LabFacts Book NWL|ABCDEFGHIJKLM]]

LabFacts Microbiology

2022-04-29T15:55:36Z

JoeWright:

[[File:NationWide Logo.jpeg|right|link=https://www.nwlabs.co.uk/|alt=NationWide Logo|240x240px|frameless]]

== Introduction ==
Use of the correct sampling technique and method of sample submission will optimise the recovery of pathogenic organisms. Samples should be collected prior to treatment. Swabs for bacterial culture should be submitted in transport medium to prevent desiccation. Other samples should be submitted in sterile universal containers. If submission is delayed, samples should be refrigerated (NOT frozen). Samples should be clearly marked and accompanied by a submission form including patient details, the site from which the sample was taken and any relevant history.

== Sampling techniques ==
The following information is not exhaustive. Please contact the laboratory for specific advice on any aspect of collection or submission of samples.

=== Abscess material ===
Collect approximately 3ml of pus along with scrapings from the abscess wall if practicable and submit in a sterile universal container. The number of actively dividing bacteria is low in chronic lesions, reducing the chance of isolating them in vitro.

=== Anaerobic cultures ===
Abscesses, deep wounds, thoracic or abdominal effusions, direct lung aspirates, tissue and blood are examples of materials which may require anaerobic culture. Preferred samples include swabs in charcoal transport medium, whole tissue or fluids. Air should be excluded as far as possible.

=== Blood cultures ===
Use routine aseptic technique to prepare the skin over the venipuncture site. Withdraw between 5-10ml of blood depending on the size of the patient. Immediately change the hypodermic needle, remove the outer foil cap from the blood culture bottle or bottles (available on request) and transfer 5ml of blood to each bottle. Do not remove the screw cap from the bottle.

=== Dermatophytes ===
Hairs, plucked or scraped from the periphery of a lesion or coat brushings collected with a toothbrush can be submitted in a sealed, labelled paper envelope. If a scalpel blade is included, the sample must be submitted in a sterile universal bottle, labelled and clearly marked. Clip or scrape claws as close to the base as possible. Please do not send slides treated with potassium hydroxide.

=== Ear swabs ===
Swabs should be taken from the horizontal canal if possible. If cytology is required, roll the swab along one or two sterile glass slides before immersing into transport medium. Label both the swab and the slides before submission.

=== Genital swabs ===
For vaginal swabs, to minimise perineal contamination, insert the swab through a speculum. Swabs in transport medium, unfixed tissue or fluids in a sterile universal bottle can be cultured for bacteria or yeasts, however, fungal culture is only performed on request.

=== Skin lesions ===
Intact pustules can be aseptically incised for culture of their contents. Superficial pyoderma must be sampled without prior preparation, preferably from the edge of a lesion. Biopsies for culture should be submitted in a sterile universal bottle wrapped in a sterile saline soaked swab to prevent tissue desiccation.

=== Synovial fluid ===
This should be obtained aseptically and submitted in joint culture medium. 0.5ml of joint fluid should be added to 5ml of the fast anaerobe broth. See instructions for blood culture.

=== Tissue from biopsies ===
Submit the biopsy in a sterile container wrapped in a swab soaked insterile saline to prevent desiccation. A second biopsy sample fixed in 10% formalin should be submitted concurrently for histology.

=== Tissues and organs post mortem ===
Samples for bacteriology should be collected as soon as possible after death. Use a heated scalpel blade to sear the surface of the organ and stab insert a sterile bacterial swab. Rotate the swab within the incision then place it in transport medium for submission to the laboratory.

=== Urine ===
Samples for culture should ideally be obtained by cystocentesis. Catheterised samples and mid stream, voided urine are acceptable but repeat culture may be required to determine the significance of any organisms isolated. A plain sample is required for routine urinalysis, a preserved sample in boric acid (filled to the line) is required for culture. Boric acid samples are suitable for preservation for up to 72 hours. Please state the method of collection when submitting a urine sample.

== Sampling materials ==
The following materials are available on request.

* Sterile bacterial swabs in charcoal transport medium
* Blood culture bottles
* Joint culture bottles

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== Authors & References ==
[[NationWide Laboratories]]
[[Category:LabFacts Book NWL|ABCDEFGHIJKL]]

LabFacts Histology

2022-04-29T15:55:20Z

JoeWright:

[[File:NationWide Logo.jpeg|right|link=https://www.nwlabs.co.uk/|alt=NationWide Logo|240x240px|frameless]]

== Making the most of your surgical biopsy submission ==
Our histology department is appealing for your clinical data. This means the information that should accompany your surgical biopsy submission form. As a general rule the smaller your submission the more clinical data we need to accompany it.

So, what to put on the submission form that accompanies a surgical biopsy?

* Please send one
* Signalment. Many lesions are age, sex and breed specific (and some are species specific)
* An outline of the location and distribution of the lesion along with lesion-specific clinical history
* Any other recent clinical findings
* Reference to any previous surgical biopsies or clinical tests
* Recent medication

We are always happy to discuss cases over the telephone or by email so please contact us if you would like to discuss a case and we are always interested in images of the lesion, as gross lesions, radiographs or ultrasound images. These can be sent with the submission or electronically to admin@nwlabs.co.uk. Don’t forget to put the patient’s name on them so we can match them to the submission when it arrives.

== Emerging diseases ==
From a histology perspective we have a small but significant and increasing number of cases of more exotic diseases emerging. Two of the most common scenarios cutaneous Leishmaniasis and transmissible venereal tumour are described on the opposite page.

=== Cutaneous Leishmaniasis ===
This is an intracellular protozoal parasite which in endemic areas is transmitted by sandflies.

There are a number of species of Leishmania which cause infection in the dog. The most common cause is Leishmania infantum, which is primarily responsible for infection in humans. Leishmaniasis in dogs is often a combination of the cutaneous and visceral forms. It is most commonly found around the Mediterranean and Eastern Europe but has a worldwide distribution.

In our histology department we most commonly see canine Leishmaniasis in skin or lymph node biopsies with the diagnostic intracellular amastigotes best seen in lymph node cytology preparations. Two patterns of skin lesions are seen. The most common is a nonpruritic exfoliative dermatitis with alopecia, often observed around the eyes, muzzle and pinnae. Clinically it can resemble autoimmune disease, zinc responsive dermatosis or sebaceous adenitis. The nodular form of the disease is less common and thought to be associated with immunosuppression. It can resemble any form of granulomatous disease, including cutaneous lymphoma. The condition can also be associated with brittle nails. Skin biopsy is very important in differentiating these conditions. Biopsies should be taken from multiple areas of affected scaling skin or nodules . Lymph node or bone marrow cytology may also be helpful in establishing a diagnosis. In addition we can also detect Leishmania infection using immunofluorescent antibody or real-time PCR techniques so please see our price list or telephone our laboratory for more information.
[[File:NWL Leishmania organisms.jpg|center|thumb|Leishmania organisms ©NationWide Laboratories 2017]]
[[File:NWL Transmissible venereal tumour.jpg|center|thumb|Transmissible venereal tumour ©NationWide Laboratories 2017]]

=== Transmissible venereal tumour ===
This is an interesting and unusual tumour which is unique to the dog and is transmitted by spread of tumour cells from dog to dog. The tumour spreads rapidly where dogs roam freely or are in large breeding colonies. Despite extensive research the origin of these tumour cells is unknown. They most closely resemble canine leucocytes but they exhibit a different karyotype to canine cells. They present as nodular, often papillary, cutaneous masses which tend to ulcerate and become infected. They can present anywhere on the skin or mucosa, including the nose and oral cavity. They occur most commonly on the genitalia. They develop rapidly, initially. Growth then tends to decrease, indicative of a developing immune response. Many tumours spontaneously regress and dogs are then immune to further infection. However, in some dogs which are immunosuppressed, there can be development of multiple skin tumours as well as spread to lymph nodes and other organs in a manner similar to any other malignant tumour. Diagnosis is by surgical biopsy and histological examination.

Either of these conditions can develop months to years after the dog has been abroad, therefore a detailed history going back to puppyhood may be required. Also, with increasing travel abroad and ongoing climate change, we must be vigilant to these conditions becoming more prevalent in the UK.

== Unusual biopsy specimens ==
Most biopsy specimens arrive at the histology laboratory in good order and can be easily orientated and sectioned, however some samples are not straightforward and can provide frustrating results. Here is a quick guide to some of the more common problems. As always, if you have any queries please call our office and they will be happy to direct you to a pathologist or member of the histology laboratory staff who can advise you. Please don’t forget to include the submission form indicating how many pots should be present, how many samples in each pot and biopsy sites, with as much signalment and history as possible.

=== Large specimens ===
All biopsies should be fixed in 10% neutral buffered formalin (NBF). Maximum tissue thickness to allow optimal penetration of NBF is 10mm.

==== Several options: ====

* Take multiple representative samples of up to 10mm from different areas of the lesion. We will examine up to 4 specimens for the same price
* If you want to send the whole sample you can slice through the tissue using parallel slices which do not quite reach the bottom of the sample. This means that we can reconstruct the sample in the lab and orientate it better. Such samples really need to be fixed in 20x the volume of NBF
* If the quantity of NBF required is too large and costly the sample can be sliced and fixed in NBF for 24 hours at your practice before being transferred to NBF-soaked paper towel, double bagged in zip lock plastic bags (without NBF) and sent to our laboratory

==== Margins ====

* The outer surface can be inked, using surgical ink, to outline the margins. Allow the ink to begin to dry before immersing in NBF. Rinsing the inked sample in a weak acetic acid solution prior to fixing has been found to help the ink to stay on the sample
* Margins can be tagged using different colours, lengths or numbers of sutures. Please do not under any circumstance use needles to mark margins. This is a safety issue for our laboratory staff
* If submitting separate biopsies please submit in separately labelled pots. Tissues can shrink, change texture and colour when fixed, making it very difficult to differentiate multiple tissues from the same pot

=== Small or friable specimens ===
Small or friable specimens such as endoscopic samples, punch biopsies and needle core biopsies are best placed in cell safe or screen cassettes which we can supply on request. Please pre-soak the cassettes in NBF before putting the sample inside. This helps to prevent the tissue sticking to the foam material inside. Pre-labelling the cassettes using a number 2 pencil before immersion in NBF means that multiple cassettes can be placed in the same pot. Samples can be fixed free in NBF; however, although we endeavour to sieve these samples, inevitably some fragments can be left behind – particularly if they are placed in the same pot as larger biopsies. Submission on gauze or card can cause samples to rip when removing for processing.

A single line drawn along the centre of skin punch biopsies in the direction of hair growth prior to biopsy can greatly assist us when orientating these samples.

=== Eyes ===
Enucleated eyes can be submitted whole in 10% NBF. There is no need to section the eye or inject the fixative as this causes significant artefactual damage.

=== Bone ===
Bone biopsies can be difficult to obtain and frustrating to interpret. This is because of the high risk of fracture during the biopsy procedure and, histologically, due to the presence of large quantities of reactive periosteum in most lesions, regardless of pathogenesis. A diagnosis of reactive hyperplasia is often of little clinical help. To try to alleviate this frustration it is useful to take as large a sample as possible and/or to take multiple biopsies with some from the centre of the lesion (which we don’t often ask for). This is more likely to demonstrate the true lesion rather than reactive hyperplasia. Multiple biopsies reduce the risk of obtaining only haemorrhage or necrotic tissue. Fixation in 10% NBF is adequate for routine diagnostic biopsies.

=== Claws ===
Claws need to be softened and phalangeal bone needs to be decalcified, so biopsies from claws and digits will take longer to report. The digital site is naturally very restrictive, therefore any expansile mass will cause similar clinical signs; abnormal nail growth, swelling, pain, lameness and lysis of the third phalanx. For this reason, amputation of one or more phalanges is the biopsy technique of choice. This includes inflammatory conditions of the nail bed, such as lupoid onychitis. Punch biopsy techniques have been described, however these can be very difficult to orientate in the lab and can result clinically in permanent disfigurement of the claw. If possible, an affected dew claw can be sacrificed. In most cases we will issue a preliminary report based on a soft tissue biopsy taken in the histology laboratory. In many cases this may reveal a definitive diagnosis, however in some cases we may need to wait for the final decalcified or softened sections before concluding the diagnosis or to establish excision margins.

== Sampling lesions for osteosarcoma ==
When sampling suspicious bone lesions there are a number of methods which may be employed. All require a general anaesthetic and the sample should be radiograph guided. In each case the centre of the lesion should be sampled as peripheral tissue is often simply reactive.

Samples for cytological evaluation need to be taken aggressively in order to cause cell exfoliation and achieve a good cell yield for interpretation. Even with very good samples it can be difficult to differentiate these masses completely from plasmacytoma (multiple myeloma) and histiocytic sarcoma on the basis of cytology alone.

As a result the most commonly submitted histological samples are Jamshidi needle biopsies but owners should be warned even these can be non diagnostic. In order to increase the chance of getting a diagnosis three good solid samples should be the minimum submitted and the samples should be taken again from the centre of the lesion as identified by radiography. The risk of pathological fracture using this technique is very low and should fracture occur, it was likely to happen regardless of any interventional method.

Ideally the larger the sample the more likely it is to be representative of the underlying lesion although the risk of pathological fracture is increased. Again samples should be taken from the centre of the lesion. While this type of sample is unlikely to be non diagnostic chondroblastic osteosarcomas and chondrosarcomas appear very similar in small section and the sub type of osteosarcoma may not be truly represented in the wedge sample submitted. While in many cases this is not prognostically significant, telangiectatic osteosarcomas are much more aggressive with a poorer short term prognosis than any other sub types.

After excisional surgery the entire tumour should be assessed for definitive diagnosis before considering chemotherapy. This may be submitted within an entire limb or a reduced sample including the tumour portion of the bone only. Both of these must be formalin fixed in an adequate volume of formalin (ten times the tissue volume) for a minimum of 24 hours (formalin penetrates at a rate of 1cm every 24 hours so larger samples will require longer). Once fixed, samples may then be wrapped in formalin soaked tissue/swabs and double wrapped in thick plastic bags to prevent leakage.

== Immunohistochemistry in tumour diagnosis ==
Increasingly general practitioners are faced with a histology report which suggests they use immunohistochemistry to further classify their tumour. Many of you must ask yourselves “Why hasn’t malignant melanoma (for example) always been malignant melanoma? Of course the answer is “Yes” but not all tumours previously diagnosed as malignant melanoma were in fact of melanocyte origin. With the development of immunohistochemical markers retrospective studies have shown that tumours were previously misclassified on the basis of H&E exam alone.

Although there are still clear indicators of a tumours origin, in many cases those masses that exhibit multiple conflicting features, or are so poorly differentiated that no typical features are present, can only be further diagnosed with the use of immunohistochemical means. In addition, some markedly reactive lesions, particularly those of lymphocytic origin, can mimic neoplasia and immunophenotyping may help to differentiate between reactive and neoplastic change.

=== Why has the use of immunohistochemistry increased? ===
Many of you will remember a time when immunohistochemistry was a test rarely recommended. This was in part due to the limited availability of antibodies for accurate tumour identification but also due to the limitations and costs of veterinary oncology. For many owners, hearing their animal has cancer is very distressing and for some the thought (and expense) of chemotherapy or radiotherapy is more than they wish to consider. However, with an increasing numbers of insured pets, and rapid advances in veterinary oncology, survival times for even some of the most aggressive cancers have been greatly improved. The increasing range of chemotherapeutics available for our patients makes an accurate diagnosis imperative; if the most up to date advice regarding the prognosis and possibilities of further treatment are to be provided to the owner.

=== How does it work? ===
Immunohistochemistry (IHC) is the process of detecting ‘tissue antigens’ using target antibodies, in histological sections. In the case of tumours the ‘antigens’ are typically structural proteins inherent to the specific cell of origin for example, cytokeratins in carcinomas. The antibodies bind specifically to these antigens and the subsequent antibody-antigen complex is then visualised, typically by means of a conjugated enzyme, such as peroxidase, that can catalyse a colour producing reaction. Alternatively a fluorophore, such as fluorescein or rhodamine, can be used to label the antibody. The sections are then examined microscopically and the neoplastic cells can be identified by means of positive or negative staining.

=== Do I need to submit special samples? ===
Immunohistochemistry is performed on fixed paraffin embedded tissue sections identical to those examined in H&E staining for routine histopathology. We can send the blocks of tissue you have already submitted for immunohistochemical staining, in most cases no additional tissue is required.

=== What are the limitations? ===
Although there are a large number of commercially available antibodies, the time and costs of processing an individual antibody are huge and many are prohibitively expensive. As a result, many published antibodies are, as of yet, only available in research establishments. However, the approach we use offers a diverse range, which should cover the majority of the neoplastic lesions encountered in practice. We always endeavour to offer our clients the best advice we can when it comes to ancillary testing; if there is a potentially relevant antibody you have encountered in your reading, which is not listed in our price list, we will try endeavour to source this for you. Antibodies we routinely offer are detailed in our current price list. We are here to offer help and advice on the most appropriate test or tests for your particular case. Please contact us to discuss your options.

Please visit www.nwlabs.co.uk or see our current price list for more information

== Authors & References ==
[[NationWide Laboratories]]
[[Category:LabFacts Book NWL|ABCDEFGHIJK]]

Calcium disorders

2022-04-29T15:55:05Z

JoeWright:

[[File:NationWide Logo.jpeg|right|link=https://www.nwlabs.co.uk/|alt=NationWide Logo|240x240px|In Partnership with NationWide Laboratories|frameless|thumb]]
Parathyroid hormone (PTH) and ionised calcium (iCa) measurements are the mainstay of calcium investigations and their combined measurement should be considered in both hypocalcaemic and hypercalcaemic situations where the cause is not immediately obvious. Total calcium measurement may not provide a true reflection of calcium status in all cases. This is particularly so in animals with compromised renal function. Sample preparation is critical for the accurate analysis of PTH and ionised calcium: separated EDTA plasma shipped frozen for PTH and separated serum for ionised calcium (see sample preparation later in the section. The combination of iCa and PTH measurement usually permits differentiation between the four main categories of calcium regulation disorders:

* Primary hyperparathyroidism (parathyroid dependent hypercalcaemia): functional parathyroid neoplasia
* Parathyroid independent hypercalcaemia: hypercalcaemia of malignancy (for example lymphoma apocrine gland adenocarcinoma), vitamin D toxicosis (calciferol containing rodenticides, calcitriol), Addison’s disease, feline idiopathic hypercalcaemia* and granulomatous disease processes

=== PTH/ionised calcium interpretation chart ===
[[Category:LabFacts Book NWL|ABCDEFGHIJ]]