Frequent asked questions

  1. » What is leishmaniosis ?
  2. » How can I know if my dog has leishmaniasis?
  3. » Leishmaniosis in Spain?
  4. » What is filariosis or heartworm disease?
  5. » What to know about fleas?
  6. » What to know about canine arthritis?
  7. » What is canine Urinary Tract Infeccion?
  8. » What is a torsion of the stomach?
  9. » What is hip dysplasia?
  10. » What is osteomyelitis?
  11. » How to cure wounds?
  12. » What are aerobic Infections ?
  13. » What are anaerobic Infections?
  14. » How do infections start?
  15. » Clues to Anaerobic Infections
  16. » What are the clinical symptoms ?
  17. » How to treat anaerobic infection ?
What is leishmaniosis ?

It is a disease caused by a parasite (Leishmania) that invades different organs of the dog causing lesions of diverse consideration, and even causing the pet´s death.

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How can I know if my dog has leishmaniasis?

The diagnosis of leishmaniasis requires a clinical exam done by a professional veterinary whether it is suffering from this disease.

If your dog contracts leishmaniasis, there is no cure, but it can be controlled by traetment. But a good, regular veterinary control and treatment, ensure a good quality of life.

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Leishmaniosis in Spain?

The most affected regions in Spain are Aragón, Cataluña, Madrid, Baleares, Levante, Murcia, Andalucía, Castilla-La Mancha, Extremadura, Castilla y León.

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What is filariosis or heartworm disease?

It is a disease which mostley affects dogs, but can also affect humans. It consist in the presents of a worm (dirofilaria immitis) form up to 30 cm which live in the main vaines between heart an lungs here they produce multiple alterations in the infested animal, going from a simple cough to death.

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What to know about fleas?

Fleas are difficult to eradicate and may even cause serious injury to the animal and transmit disease.

One of the diseases transmitted by fleas is flea allergy dermatitis. This happens when the animal is allergic to the components of flea saliva, with symptoms as generalised itching, loss of fur on the rear part of the body, darkening, swelling and loss of elasticity of the skin. Cats may even injure themselves, causing considerable wounds.

The other disease is the flatworm which causes problems as nutritional losses, diarrhoea, bad genaral condition and anaemia.

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What to know about canine arthritis?

Canine arthritis is more common than you may think. It can affect dogs of any age, breed or sex. In fact, studies have shown that as many as 1 in 5 adult dogs have arthritis.2 Although there is no cure, chronic arthritis pain can be managed with the help of diet, exercise, surgery and proper medication.

Constant activity can damage your dog's cartilage, putting strain on joints and inducing arthritis, a degenerative joint disease. Unfortunately, the symptoms of arthritis are easily missed and often misinterpreted. Contact your veterinarian if you notice any of the following signs: Trouble getting up, tires easily, climbs stairs reluctantly, limps or lags behind, trembles or shakes, reluctant to play.

General risk factors – how does your dog measure up?

AGE
There are many factors that can affect the biological age in dogs: breed, size, weight and activity level. DogAge.com helps determine the biological age of a dog by using science and statistics. This will replace the old, inaccurate "times 7" method and allow you to know how old your dog really is.

SIZE & WEIGHT
Heavier dogs place more stress on their joints. Your dog is at considerably higher risk for arthritis and other joint problems if overweight.

What are additional risk factors?

BREED
Breeding involves years of careful genetic selection. While this process has produced many of the traits you love, it also can predispose dogs to certain hereditary conditions. For example, hip dysplasia is a common joint disease that can become a serious issue in certain breeds as young as 1-3 years old.

ACTIVITY LEVEL
Just as with humans, an active pet is a healthy pet. Frequent exercise can help stretch the muscles and keep joints functioning well. See your veterinarian to develop an exercise regimen that's right for your pet's specific needs.


What can you do to help manage canine arthritis?

Although canine arthritis is incurable, it can be managed. By following a few steps, you can ensure that you and your dog will have many healthy and happy years together.

  • Lighten their load If needed, reducing your pet's weight can significantly decrease the burden on loadbearing joints. Consult your veterinarian for a weight management program for your pet.
  • Get their paws in gear Moderate exercise can help strengthen joints and reduce the chances of further damage. To establish an adequate, low-impact routine, consult your veterinarian.
  • Get safe effective help With modern advances in medication, there's no reason for your dog to be slowed down by the pain and discomfort of arthritis.
  • Stick with the program Arthritis is a chronic disease that requires continuous treatment. Although you will probably notice an improvement with medication and therapy, it is important to stay faithful to your veterinarian's instructions in order to maintain your dog's quality of life.

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What is canine Urinary Tract Infeccion?

Causes

Bacterial urinary tract infections (UTI) are common in dogs. Infection can occur at a single site, setting off inflammation in the kidneys (pyelonephritis), ureters (ureteritis), bladder (cystitis), urethra (urethritis) or the prostate gland (prostatitis); at multiple sites; or in the urine (bacteriuria). Upper UTIs include pyelonephritis, pyelitis and ureteritis. Lower UTIs include urethritis and cystitis.

 


Clinical Signs (Symptoms)

Clinical signs (objective evidence) of UTI include:

  • Painful or difficult urination (dysuria)
  • Increased frequency of urination (pollakiuria)
  • Increased volume of urination (polyuria)
  • Excessive thirst (polydipsia)
  • Pus in the urine (pyuria)
  • Blood in the urine (hematuria)
  • Crystals in the urine (crystalluria)
  • Lower back (lumbar) pain

Dysuria, frequency, urgency, hematuria or lumbar pain suggests kidney diseases such as urolithiasis (formation of urinary calculi or mineral salt "pebbles"), abnormal growth in the bladder (neoplasm), kidney (renal) masses or urinary obstruction. (Urolithiasis is most common in these breeds: miniature schnauzer, dachshund, Dalmatian, pug, bulldog, Welsh corgi, basset hound, beagle and terrier.)

Of course, some of these clinical signs are also associated with other diseases, so a veterinarian's task is to differentiate the specific cause of the dog's clinical condition from other possible causes.

 


Anatomy of the Canine Urinary Tract

The urinary system eliminates waste by-products and excess water from the body. Kidneys, which weigh about 1.5 to 2 ounces (42.5 to 56.7 grams), purify the blood through a filtration process.

The canine urinary tract has upper (proximal) and lower (distal) portions. The upper urinary tract consists of the kidneys and ureters, tubes that connect the kidneys to the bladder. The lower urinary tract consists of the bladder and the urethra, which is surrounded by the prostate gland in males.

The urinary tract is normally sterile except for the distal urethra. Pathogens usually invade by ascending the tract, entering through the urethra and spreading proximally.*

* The Readers Digest Illustrated Book of Dogs, revised edition 1989.

 


Diagnosing Canine Urinary Tract Infections

Making a differential diagnosis is the process of determining the specific cause of a dog's urinary tract infection (UTI) in preparation for treatment. A thorough evaluation should include questions about the dog's history.

  • What breed is the dog?
  • How old is the dog?
  • How often does it urinate?
  • How much urine is produced?
  • Anything unusual about the appearance or odor of the urine?
  • Is the dog excessively thirsty?
  • Has the dog broken house-training?
  • When were the symptoms first noticed?
  • Has the dog been treated for previous urinary tract infections? When and how?
  • What has the dog been eating?

Physical Examination

The veterinarian will examine the dog carefully, giving special attention to the organs of the upper and lower urinary tract.

  • The bladder should be felt, or palpated.
  • The external genitalia should be examined.
  • A rectal examination allows evaluation of the distal urethra in both sexes and of the prostate in male dogs.
  • If the dog is unable to control urination (incontinent), a neurologic exam should also be conducted.

Upper UTI often affects kidney function. Special radiographic techniques can identify renal scarring caused by pyelonephritis, which should be treated differently than other UTI. Renal calculi act as foreign bodies and perpetuate infection. Magnesium ammonium phosphate calculi also grow as a result of infection and can injure the kidneys.

Lower UTI is often associated with urinary tract obstruction, urolithiasis and congenital anomalies of the lower urinary tract and trauma. Although treating lower UTI is important for the animal's continued health, these infections may have little effect on kidney function.

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What is a torsion of the stomach?

Torsion of the stomach in the dog is characterized by life-endangering distension of the stomach with gas; the stomach is usually found to be severely dilated and congested, and often to have rotated about an axis in the plane of the esophagus. There are many unknown features of this disease. Even the correct mane for the disease is not known. It is commonly called torsion of the stomach; however, many veterinarians, including the author, believe the primary condition is not torsion, but distension or dilation of the stomach with gas. This distension may or may not be followed by torsion or twisting of the stomach. Incidence Torsion of the stomach is seen most commonly in large breeds including the Great Dane and Bloodhound, as well as some of the intermediate size breeds. Most people agree it is a serious problem in the first-two named breeds. There does not appear to be any association with the sex or the age of the animal. It has been reported in young adults as well as fully mature dogs. There is no doubt it can occur suddenly after eating in a previously healthy dog. The Cause of Torsion of the Stomach A commonly expressed explanation is that the disease is purely a mechanical twist of the stomach. The stomach, containing some comparatively heavy food material, is pictured as swinging in a pendulum-like fashion. Then, as a result of a sudden jump from a high bench or from rolling or playing, the pendulum is swung completely around the point of fixation of the stomach, the point where the esophagus passes through the diaphragm, giving rise to a twist. This occludes both the entrance to and the exit from the stomach so that gas, which is produced in the stomach, cannot escape, giving rise to the distension. As stated previously, there is considerable doubt concerning the validity of this explanation. In criticism of this mechanical theory, several objections can be raised. In many cases, there is no evidence that a sudden or vigorous movement of the dog after feeding has occurred. In addition, the contents of the stomach are not such that would facilitate a pendulum-like movement. In the normal, tightly packed, abdominal cavity of the dog, the tonicity of the abdominal muscles, the shortness of the gut, and the normal absence of much gas or fluid, tend to preclude the free mobility visualized for the stomach. In addition, it has been shown experimentally if the stomach of the dog is distended with air by means of a stomach tube, the stomach eventually twists in either a clockwise or counter-clockwise direction, depending on the position of the spleen at the onset of distension. If the previous theory is correct, there must be some factor which causes the initial distension of the stomach. This factor is not known, but it is probably due to a condition which causes atony or paralysis of the wall of the stomach associated with a large meal and then gas production. Much of the gas found in the stomach could be caused by swallowing air. The Development of the Disease in the Dog According to the theory that distension is the primary condition, following distension with gas, the stomach rotates in a clockwise or counter-clockwise direction. The dog is usually severely ill, and can die within one or two hours. The stomach is severely distended, the wall of the stomach is congested, and may even be deprived of blood. The spleen is also twisted and enlarged. A second situation can occur which is not so serious; the condition is more chronic, and may last several days. Some dogs eventually become severely distended, and may die; however, many recover spontaneously. What Causes the Death of the Dog? This condition in the dog has a sudden onset, usually within one to two hours of eating a large meal. The dog is first breathless and, if examined closely, the abdomen is excessively large. The dog will stand, lie still, or move only with caution. He will generally pass feces and gas so that eventually the entire gut with the exception of the stomach has been emptied. There are often attempts at vomiting although these attempts are rarely successful. In a period varying from one-half to three hours, the stomach becomes grossly distended, and there is severe dyspnea, or difficulty in breathing. The dog may live up to 36 hours but many will die within one to two hours. There are several explanations for the rapid onset of severe signs and rapid death. It has long been suggested one of the important aspects is the stomach pressing forward on the diaphragm thus compressing the lungs so that the animal has difficulty in breathing. There is experimental and clinical evidence, however, that the rapid development of severe signs can be better explained by the pressure of the enlarged stomach on the vena cava, the large vein which carries blood to the heart from the abdomen and hind legs. As a result of this pressure, there is an inadequate amount of blood returning to the heart, which cannot function effectively as a pump, and therefore, the blood pressure of the animal falls. This produces shock and rapid death. Other factors contribute to a lessor degree to the development of the clinical signs. There is a loss of fluids and electrolytes from the body into the distended gut, and there probably is some pressure by the distended stomach on the lungs, interfering with their function. It can be seen from this discussion of the cause of death in torsion of the stomach, that the first priority in the treatment of torsion of the stomach must be relief of the distension. Management of the Dog with Torsion of the Stomach This is one of the true emergencies in veterinary medicine, and treatment must be instituted immediately if the animal is to survive. If the dog cannot be treated immediately by a veterinarian, the owner may be forced to render first aid to his dog. This is difficult, and there is no uniformly successful method to relieve the distension. In some dogs, a stomach tube can be passed. This can be done by the owner. Unfortunately, it is not possible to do this in dogs with major torsion of the stomach since the entrance into the stomach is obstructed by the twist in the esophagus. Some owners puncture the stomach with a large-bore needle so that the gas will escape. It is probably best to do this on the right side of the dog over the point of greatest distension. Again, unfortunately, this is not always successful. The needle can become obstructed by stomach contents, and there maybe a leakage of fluids and gas into the abdominal cavity with risk of peritonitis. If the animal is severely affected, the owner may have no choice but to attempt one of these methods to relieve the distension. The dog should be treated by a veterinarian as soon as possible. Unfortunately, there has been insufficient experimental work done by veterinarians on the treatment of torsion of the stomach, and opinions vary on the correct form of therapy. Many veterinarians advise immediate anesthesia and surgery to relieve the distension and the twist of the stomach. If large volumes of fluids and electrolytes are given by intravenous injection before and during the operation, reasonably good results can be expected. More satisfactory results have been obtained by a method in which the distension is relieved by a simple surgical procedure. This is later followed by correction of the torsion when the dog is no longer in shock and better able to withstand anesthesia and surgery. This is the method recommended by this author. A small opening is made into the stomach using a local anesthesia. The wall of the stomach is sutured to the skin so that leakage into the abdominal cavity with subsequent peritonitis cannot occur. Fluid and electrolytes are given by intravenous injection; surgery is performed later to close the hole in the stomach and reposition the stomach, if necessary. Strict control of food and water intake for many days after surgery is needed to avoid a recurrence of the condition. Prevention The treatment of torsion of the stomach is unsatisfactory for two reasons. First, the condition develops so quickly that the animal can die in such a short time that many dogs die before treatment can be instituted. Second, it is not possible to save all animals with any of the presently accepted forms of treatment. Using the method in which the distension is relieved and the torsion corrected at a later date, it is expected that 75 to 80 % of dogs should survive. Some dogs are so close to death before treatment that they cannot be saved, and in others, the stomach wall is severely injured by lack of blood supply so that recovery cannot occur. Therefore, we should direct our attention to prevention of this condition. Unfortunately, there are not generally accepted methods for prevention, and much investigative work is needed. In some large populations of dogs, such as those in the armed forces, a high incidence of torsion of the stomach has been seen with certain feeding regimens. In many cases, the condition disappears when these dogs are given food ad lib., that is, the dogs have access to a large amount of food so that the dog may eat a small amount of food on many occasions during the day. Obviously, with this management system, the dog has no incentive to eat one large meal at any given time and he does not eat hurriedly. The most common advice given to owners of large breed dogs is based on experiences such as the one described previously. If there is a high risk, it is best to avoid one large meal per day. The dog should be fed at least twice daily; he should be discouraged from eating rapidly, and he should not be allowed to play actively before and after feeding. The dog should have access to water continuously so there is less chance he will drink a large amount immediately after eating. It seems there is a high risk of torsion of the stomach if the animal is given one feeding a day, the dog is allowed to drink and to indulge in vigorous exercise after eating. All these factors should be avoided. Certain drugs that alter the mobility of the gastrointestinal tract have been advocated to prevent gastric torsion. There is no experimental or clinical evidence that any of the presently available drugs is useful. An operation known as pyloroplasty has been advocated by some to increase the size of the exit opening in the stomach. Again, there are no reports in the scientific literature that this procedure should be used. Torsion of the stomach in the dog is characterized by life-endangering distension of the stomach with gas; the stomach is usually found to be severely dilated and congested, and often to have rotated about an axis in the plane of the esophagus. There are many unknown features of this disease. Even the correct mane for the disease is not known. It is commonly called torsion of the stomach; however, many veterinarians, including the author, believe the primary condition is not torsion, but distension or dilation of the stomach with gas. This distension may or may not be followed by torsion or twisting of the stomach. Incidence Torsion of the stomach is seen most commonly in large breeds including the Great Dane and Bloodhound, as well as some of the intermediate size breeds. Most people agree it is a serious problem in the first-two named breeds. There does not appear to be any association with the sex or the age of the animal. It has been reported in young adults as well as fully mature dogs. There is no doubt it can occur suddenly after eating in a previously healthy dog. The Cause of Torsion of the Stomach A commonly expressed explanation is that the disease is purely a mechanical twist of the stomach. The stomach, containing some comparatively heavy food material, is pictured as swinging in a pendulum-like fashion. Then, as a result of a sudden jump from a high bench or from rolling or playing, the pendulum is swung completely around the point of fixation of the stomach, the point where the esophagus passes through the diaphragm, giving rise to a twist. This occludes both the entrance to and the exit from the stomach so that gas, which is produced in the stomach, cannot escape, giving rise to the distension. As stated previously, there is considerable doubt concerning the validity of this explanation. In criticism of this mechanical theory, several objections can be raised. In many cases, there is no evidence that a sudden or vigorous movement of the dog after feeding has occurred. In addition, the contents of the stomach are not such that would facilitate a pendulum-like movement. In the normal, tightly packed, abdominal cavity of the dog, the tonicity of the abdominal muscles, the shortness of the gut, and the normal absence of much gas or fluid, tend to preclude the free mobility visualized for the stomach. In addition, it has been shown experimentally if the stomach of the dog is distended with air by means of a stomach tube, the stomach eventually twists in either a clockwise or counter-clockwise direction, depending on the position of the spleen at the onset of distension. If the previous theory is correct, there must be some factor which causes the initial distension of the stomach. This factor is not known, but it is probably due to a condition which causes atony or paralysis of the wall of the stomach associated with a large meal and then gas production. Much of the gas found in the stomach could be caused by swallowing air. The Development of the Disease in the Dog According to the theory that distension is the primary condition, following distension with gas, the stomach rotates in a clockwise or counter-clockwise direction. The dog is usually severely ill, and can die within one or two hours. The stomach is severely distended, the wall of the stomach is congested, and may even be deprived of blood. The spleen is also twisted and enlarged. A second situation can occur which is not so serious; the condition is more chronic, and may last several days. Some dogs eventually become severely distended, and may die; however, many recover spontaneously. What Causes the Death of the Dog? This condition in the dog has a sudden onset, usually within one to two hours of eating a large meal. The dog is first breathless and, if examined closely, the abdomen is excessively large. The dog will stand, lie still, or move only with caution. He will generally pass feces and gas so that eventually the entire gut with the exception of the stomach has been emptied. There are often attempts at vomiting although these attempts are rarely successful. In a period varying from one-half to three hours, the stomach becomes grossly distended, and there is severe dyspnea, or difficulty in breathing. The dog may live up to 36 hours but many will die within one to two hours. There are several explanations for the rapid onset of severe signs and rapid death. It has long been suggested one of the important aspects is the stomach pressing forward on the diaphragm thus compressing the lungs so that the animal has difficulty in breathing. There is experimental and clinical evidence, however, that the rapid development of severe signs can be better explained by the pressure of the enlarged stomach on the vena cava, the large vein which carries blood to the heart from the abdomen and hind legs. As a result of this pressure, there is an inadequate amount of blood returning to the heart, which cannot function effectively as a pump, and therefore, the blood pressure of the animal falls. This produces shock and rapid death. Other factors contribute to a lessor degree to the development of the clinical signs. There is a loss of fluids and electrolytes from the body into the distended gut, and there probably is some pressure by the distended stomach on the lungs, interfering with their function. It can be seen from this discussion of the cause of death in torsion of the stomach, that the first priority in the treatment of torsion of the stomach must be relief of the distension. Management of the Dog with Torsion of the Stomach This is one of the true emergencies in veterinary medicine, and treatment must be instituted immediately if the animal is to survive. If the dog cannot be treated immediately by a veterinarian, the owner may be forced to render first aid to his dog. This is difficult, and there is no uniformly successful method to relieve the distension. In some dogs, a stomach tube can be passed. This can be done by the owner. Unfortunately, it is not possible to do this in dogs with major torsion of the stomach since the entrance into the stomach is obstructed by the twist in the esophagus. Some owners puncture the stomach with a large-bore needle so that the gas will escape. It is probably best to do this on the right side of the dog over the point of greatest distension. Again, unfortunately, this is not always successful. The needle can become obstructed by stomach contents, and there maybe a leakage of fluids and gas into the abdominal cavity with risk of peritonitis. If the animal is severely affected, the owner may have no choice but to attempt one of these methods to relieve the distension. The dog should be treated by a veterinarian as soon as possible. Unfortunately, there has been insufficient experimental work done by veterinarians on the treatment of torsion of the stomach, and opinions vary on the correct form of therapy. Many veterinarians advise immediate anesthesia and surgery to relieve the distension and the twist of the stomach. If large volumes of fluids and electrolytes are given by intravenous injection before and during the operation, reasonably good results can be expected. More satisfactory results have been obtained by a method in which the distension is relieved by a simple surgical procedure. This is later followed by correction of the torsion when the dog is no longer in shock and better able to withstand anesthesia and surgery. This is the method recommended by this author. A small opening is made into the stomach using a local anesthesia. The wall of the stomach is sutured to the skin so that leakage into the abdominal cavity with subsequent peritonitis cannot occur. Fluid and electrolytes are given by intravenous injection; surgery is performed later to close the hole in the stomach and reposition the stomach, if necessary. Strict control of food and water intake for many days after surgery is needed to avoid a recurrence of the condition. Prevention The treatment of torsion of the stomach is unsatisfactory for two reasons. First, the condition develops so quickly that the animal can die in such a short time that many dogs die before treatment can be instituted. Second, it is not possible to save all animals with any of the presently accepted forms of treatment. Using the method in which the distension is relieved and the torsion corrected at a later date, it is expected that 75 to 80 % of dogs should survive. Some dogs are so close to death before treatment that they cannot be saved, and in others, the stomach wall is severely injured by lack of blood supply so that recovery cannot occur. Therefore, we should direct our attention to prevention of this condition. Unfortunately, there are not generally accepted methods for prevention, and much investigative work is needed. In some large populations of dogs, such as those in the armed forces, a high incidence of torsion of the stomach has been seen with certain feeding regimens. In many cases, the condition disappears when these dogs are given food ad lib., that is, the dogs have access to a large amount of food so that the dog may eat a small amount of food on many occasions during the day. Obviously, with this management system, the dog has no incentive to eat one large meal at any given time and he does not eat hurriedly. The most common advice given to owners of large breed dogs is based on experiences such as the one described previously. If there is a high risk, it is best to avoid one large meal per day. The dog should be fed at least twice daily; he should be discouraged from eating rapidly, and he should not be allowed to play actively before and after feeding. The dog should have access to water continuously so there is less chance he will drink a large amount immediately after eating. It seems there is a high risk of torsion of the stomach if the animal is given one feeding a day, the dog is allowed to drink and to indulge in vigorous exercise after eating. All these factors should be avoided. Certain drugs that alter the mobility of the gastrointestinal tract have been advocated to prevent gastric torsion. There is no experimental or clinical evidence that any of the presently available drugs is useful. An operation known as pyloroplasty has been advocated by some to increase the size of the exit opening in the stomach. Again, there are no reports in the scientific literature that this procedure should be used. Torsion of the stomach in the dog is characterized by life-endangering distension of the stomach with gas; the stomach is usually found to be severely dilated and congested, and often to have rotated about an axis in the plane of the esophagus. There are many unknown features of this disease. Even the correct mane for the disease is not known. It is commonly called torsion of the stomach; however, many veterinarians, including the author, believe the primary condition is not torsion, but distension or dilation of the stomach with gas. This distension may or may not be followed by torsion or twisting of the stomach. Incidence Torsion of the stomach is seen most commonly in large breeds including the Great Dane and Bloodhound, as well as some of the intermediate size breeds. Most people agree it is a serious problem in the first-two named breeds. There does not appear to be any association with the sex or the age of the animal. It has been reported in young adults as well as fully mature dogs. There is no doubt it can occur suddenly after eating in a previously healthy dog. The Cause of Torsion of the Stomach A commonly expressed explanation is that the disease is purely a mechanical twist of the stomach. The stomach, containing some comparatively heavy food material, is pictured as swinging in a pendulum-like fashion. Then, as a result of a sudden jump from a high bench or from rolling or playing, the pendulum is swung completely around the point of fixation of the stomach, the point where the esophagus passes through the diaphragm, giving rise to a twist. This occludes both the entrance to and the exit from the stomach so that gas, which is produced in the stomach, cannot escape, giving rise to the distension. As stated previously, there is considerable doubt concerning the validity of this explanation. In criticism of this mechanical theory, several objections can be raised. In many cases, there is no evidence that a sudden or vigorous movement of the dog after feeding has occurred. In addition, the contents of the stomach are not such that would facilitate a pendulum-like movement. In the normal, tightly packed, abdominal cavity of the dog, the tonicity of the abdominal muscles, the shortness of the gut, and the normal absence of much gas or fluid, tend to preclude the free mobility visualized for the stomach. In addition, it has been shown experimentally if the stomach of the dog is distended with air by means of a stomach tube, the stomach eventually twists in either a clockwise or counter-clockwise direction, depending on the position of the spleen at the onset of distension. If the previous theory is correct, there must be some factor which causes the initial distension of the stomach. This factor is not known, but it is probably due to a condition which causes atony or paralysis of the wall of the stomach associated with a large meal and then gas production. Much of the gas found in the stomach could be caused by swallowing air. The Development of the Disease in the Dog According to the theory that distension is the primary condition, following distension with gas, the stomach rotates in a clockwise or counter-clockwise direction. The dog is usually severely ill, and can die within one or two hours. The stomach is severely distended, the wall of the stomach is congested, and may even be deprived of blood. The spleen is also twisted and enlarged. A second situation can occur which is not so serious; the condition is more chronic, and may last several days. Some dogs eventually become severely distended, and may die; however, many recover spontaneously. What Causes the Death of the Dog? This condition in the dog has a sudden onset, usually within one to two hours of eating a large meal. The dog is first breathless and, if examined closely, the abdomen is excessively large. The dog will stand, lie still, or move only with caution. He will generally pass feces and gas so that eventually the entire gut with the exception of the stomach has been emptied. There are often attempts at vomiting although these attempts are rarely successful. In a period varying from one-half to three hours, the stomach becomes grossly distended, and there is severe dyspnea, or difficulty in breathing. The dog may live up to 36 hours but many will die within one to two hours. There are several explanations for the rapid onset of severe signs and rapid death. It has long been suggested one of the important aspects is the stomach pressing forward on the diaphragm thus compressing the lungs so that the animal has difficulty in breathing. There is experimental and clinical evidence, however, that the rapid development of severe signs can be better explained by the pressure of the enlarged stomach on the vena cava, the large vein which carries blood to the heart from the abdomen and hind legs. As a result of this pressure, there is an inadequate amount of blood returning to the heart, which cannot function effectively as a pump, and therefore, the blood pressure of the animal falls. This produces shock and rapid death. Other factors contribute to a lessor degree to the development of the clinical signs. There is a loss of fluids and electrolytes from the body into the distended gut, and there probably is some pressure by the distended stomach on the lungs, interfering with their function. It can be seen from this discussion of the cause of death in torsion of the stomach, that the first priority in the treatment of torsion of the stomach must be relief of the distension. Management of the Dog with Torsion of the Stomach This is one of the true emergencies in veterinary medicine, and treatment must be instituted immediately if the animal is to survive. If the dog cannot be treated immediately by a veterinarian, the owner may be forced to render first aid to his dog. This is difficult, and there is no uniformly successful method to relieve the distension. In some dogs, a stomach tube can be passed. This can be done by the owner. Unfortunately, it is not possible to do this in dogs with major torsion of the stomach since the entrance into the stomach is obstructed by the twist in the esophagus. Some owners puncture the stomach with a large-bore needle so that the gas will escape. It is probably best to do this on the right side of the dog over the point of greatest distension. Again, unfortunately, this is not always successful. The needle can become obstructed by stomach contents, and there maybe a leakage of fluids and gas into the abdominal cavity with risk of peritonitis. If the animal is severely affected, the owner may have no choice but to attempt one of these methods to relieve the distension. The dog should be treated by a veterinarian as soon as possible. Unfortunately, there has been insufficient experimental work done by veterinarians on the treatment of torsion of the stomach, and opinions vary on the correct form of therapy. Many veterinarians advise immediate anesthesia and surgery to relieve the distension and the twist of the stomach. If large volumes of fluids and electrolytes are given by intravenous injection before and during the operation, reasonably good results can be expected. More satisfactory results have been obtained by a method in which the distension is relieved by a simple surgical procedure. This is later followed by correction of the torsion when the dog is no longer in shock and better able to withstand anesthesia and surgery. This is the method recommended by this author. A small opening is made into the stomach using a local anesthesia. The wall of the stomach is sutured to the skin so that leakage into the abdominal cavity with subsequent peritonitis cannot occur. Fluid and electrolytes are given by intravenous injection; surgery is performed later to close the hole in the stomach and reposition the stomach, if necessary. Strict control of food and water intake for many days after surgery is needed to avoid a recurrence of the condition. Prevention The treatment of torsion of the stomach is unsatisfactory for two reasons. First, the condition develops so quickly that the animal can die in such a short time that many dogs die before treatment can be instituted. Second, it is not possible to save all animals with any of the presently accepted forms of treatment. Using the method in which the distension is relieved and the torsion corrected at a later date, it is expected that 75 to 80 % of dogs should survive. Some dogs are so close to death before treatment that they cannot be saved, and in others, the stomach wall is severely injured by lack of blood supply so that recovery cannot occur. Therefore, we should direct our attention to prevention of this condition. Unfortunately, there are not generally accepted methods for prevention, and much investigative work is needed. In some large populations of dogs, such as those in the armed forces, a high incidence of torsion of the stomach has been seen with certain feeding regimens. In many cases, the condition disappears when these dogs are given food ad lib., that is, the dogs have access to a large amount of food so that the dog may eat a small amount of food on many occasions during the day. Obviously, with this management system, the dog has no incentive to eat one large meal at any given time and he does not eat hurriedly. The most common advice given to owners of large breed dogs is based on experiences such as the one described previously. If there is a high risk, it is best to avoid one large meal per day. The dog should be fed at least twice daily; he should be discouraged from eating rapidly, and he should not be allowed to play actively before and after feeding. The dog should have access to water continuously so there is less chance he will drink a large amount immediately after eating. It seems there is a high risk of torsion of the stomach if the animal is given one feeding a day, the dog is allowed to drink and to indulge in vigorous exercise after eating. All these factors should be avoided. Certain drugs that alter the mobility of the gastrointestinal tract have been advocated to prevent gastric torsion. There is no experimental or clinical evidence that any of the presently available drugs is useful. An operation known as pyloroplasty has been advocated by some to increase the size of the exit opening in the stomach. Again, there are no reports in the scientific literature that this procedure should be used.

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What is hip dysplasia?

Canine Hip Dysplasia is a condition which begins in immature dogs with instability or a loose fit of the hip joint (Figure 1). The hip joint laxity is responsible for early clinical signs and joint changes. The abnormal motion of the hip stretches the fibrous joint capsule and ligament connecting the head of the femur to the pelvis, producing pain and lameness. The acetabulum (the hip socket) is easily deformed by continual movement of the femoral head. Micro fractures of the acetabular bone may occur, causing further pain and lameness in the immature dog. The dog’s physiologic response to joint laxity is proliferative fibroplasia or thickening of the joint capsule and formation of osteophytes or new bone on the rim of the acetabulum and the femoral neck (Figure 2). Figure 1. Hip dysplasia present in young animals as instability of the hip joint. As the dog bears weight, the head of the femur (the “ball”) comes out of the acetabulum (the “socket”) as far as the joint capsule and ligament will allow. The joint capsule and ligament gradually get stretched allowing the femoral head to come out of the acetabulum even further. Figure 2. The result of the instability in the joint is abnormal wear of the cartilage. Cartilage wear leads to the formation of osteophytes (bone spurs) and joint capsule thickening, which are the characteristic signs of osteoarthritis or degenerative joint disease. These responses help to stabilize the hip joint. The new bone formation is visible on radiographs and considered to be osteoarthritis or degenerative joint disease (Figure 3). Figure 3. A pelvic radiograph of a dog with degenerative joint disease (osteoarthritis) of the hips secondary to hip dysplasia. The osteoarthritis progresses over the life of the dog. However, radiographic signs of osteoarthritis do not always correlate with clinical function. Causes Causes of hip dysplasia are considered to be multifactorial; including both hereditary and environmental factors. Rapid weight gain and growth through excessive nutritional intake may encourage the development of hip dysplasia. Mild repeated trauma causing synovial (joint lining) inflammation may also be important. Incidence and Prevalence The incidence of hip dysplasia is greatest in large breed dogs. Two populations of animals show clinical signs of lameness: (1) patients 5 to 10 months of age, and (2) patients with chronic degenerative joint disease. Signs and Symptoms The clinical signs of hip dysplasia are lameness, reluctance to rise or jump, shifting the weight to the forelimbs, loss of muscle mass on the rear limbs, and pain when the hips are manipulated. Dogs may show clinical signs at any stage of development of the disease, although many dogs with hip dysplasia do not show overt clinical signs. Some dogs are painful at 6 to 8 months of age but recover as they mature. As the osteoarthritis progresses with age, some dogs may show clinical signs similar to people with arthritis such as lameness after unaccustomed exercise, lameness after prolonged confinement, and worse problems if they are overweight. Risk Factors Risk factors for CHD include breed (genetic), rapid growth and nutrient excesses. When to Seek Veterinary Advice Recent research and new evidence prooved that early diagnosis and treatment are mandatory for best results. Radiographing the hips at the age of 12 to 16 weeks with the new Penn Hip method, enables the Vet to predict the existence of CHD and enables the Surgeon to perform a juvenile pubic symphysiodesis at the age of 16 to 19 weeks, which produces excellent results. Some veterinarians prefer to use the traditional radiographing of hips at 6 months of age to help identify dogs with hip dysplasia to perform a triple pelvic osteotomy which is a much more agressive and expensive option. For many dogs, the owners seek veterinary surgery advice when the dog has been consistently lame, and has not responded to medical therapy. All the surgical methods should only be carried out by Specialists. Exam, Screening Tests, and Imaging Physical examination includes an evaluation of lameness and palpation of the hips. Many dogs are painful when the hip joint is extended by pulling the leg back. The standard radiographic view for diagnosis of hip dysplasia is the ventrodorsal view of the pelvis with rear limbs extended symmetrically and rotated inward to center the patellas over the trochlear grooves. (Figure 3) The dog must be heavily sedated or anesthetized for proper relaxation and positioning. The Orthopedic Foundation for Animals, a screening agency for canine hip dysplasia, will certify a dog after 2 years of age. Stress radiographs can be used to detect breed susceptibility to hip dysplasia as early as 3 months. A dorsal acetabular rim view can be used to define the angle and condition of the dorsal acetabular rim when evaluating a dog for candidacy for a triple pelvic osteotomy. Differential Diagnosis A number of neurologic and orthopedic problems cause similar clinical signs to those seen with hip dysplasia. In immature dogs, lameness caused by panosteitis, osteochondrosis and occasionally partial or complete cranial cruciate ligament injury must be differentiated from hip dysplasia. In older patients it is necessary to rule out pain and lameness associated with pressure on the nerve roots in the lower back and lameness associated with rupture of the cranial cruciate ligament, polyarthritis, or bone neoplasia (cancer) conditions before attributing clinical signs to hip dysplasia. Many dogs have hip dysplasia evident on radiographs, yet the lameness is caused by another problem. Complications Caused By The Disease The primary complication caused by hip dysplasia is the development of osteoarthritis or degenerative joint disease. Dogs with unstable hips secondary to hip dysplasia are also more likely to dislocate a hip with minimal trauma, such as falling while running in the yard. Treatment Options Treatment depends on the dog’s age and degree of discomfort, physical and radiographic findings, and owner’s expectations and finances. Conservative and surgical options are available for juvenile and mature animals with hip pain secondary to hip dysplasia. Most immature animals are best treated with conservative or medical management. Although early surgical intervention with juvenile pubic symphysiodesis or triple pelvic osteotomy may increase the prognosis for long-term acceptable clinical function, approximately 75% of young patients treated conservatively return to acceptable clinical function with maturity. The remaining 25 % require further medical or surgical management at some point in life. In puppies less than 20 weeks of age, juvenile pubic symphysiodesis (JPS), a technique for stopping the growth of the pubis (part of the pelvis) may be performed to alter the growth of the pelvis and increase the degree of coverage of the acetabulum over the femoral head. Most puppies of this age do not show clinical signs of hip dysplasia, so diagnosis depends upon use of a screening technique for documenting hip laxity, such as Penn Hip, to determine which animals may be candidates for the procedure. Although specific criteria for application of JPS have not been developed, puppies under 20 weeks of age that have palpable and radiographic evidence of laxity on a hip distracted view can be considered for the procedure. Immature dogs (less than one year) with loose fitting hips, but no arthritic changes can be treated with a pelvic osteotomy (also sometimes called a triple pelvic osteotomy). This procedure involves cutting the pelvic bone in three places and rotating it to stabilize the hip joint and in many cases slow the progression of osteoarthritis. (Figure 4). Figure 4. A pelvic radiograph of a dog following a triple pelvic osteotomy. The object of this surgery is to create an acetabulum (socket) that is deep enough that the femoral head will no longer tend to come out of the socket at the dog bears weight. Immature dogs with osteoarthritis already present will not benefit from this procedure and are treated medically as needed. You should seek veterinary advise on treating the pain and lameness with nonsteroidal anti-inflammatory drugs (NSAIDS). Concurrent treatment with a nutraceutical agent may also be recommended. Mature dogs with hip dysplasia which are not showing clinical signs do not need medical or surgical treatment. These dogs should be kept slim and encouraged with consistent moderate exercise to develop good muscle mass to support the hips. Mature dogs with occasional lameness can be treated with non steroidal anti-inflammatory drugs and rest when they are lame. If the lameness can be associated with a certain activity, it is best to avoid the activity. After the lameness subsides, a slowly increasing, consistent exercise program should be instituted. If lameness recurs, exercise is decreased and the drugs are administered again. Every effort should be made to maintain the dog at a slim weight. Ideally one should be able to easily feel the ribs. In obese dogs, weight loss alone may alleviate clinical signs. When medical therapy does not provide pain relief and reasonable function, the dog is a candidate for one of two surgical procedures to reconstruct the hip joint. The femoral head and neck ostectomy involves removing the femoral portion of the hip joint. (Figure 5) The joint heals with fibrous tissue and in many cases allows a more pain free existence. Figure 5. A pelvic radiograph of a dog following a femoral head ostectomy (FHO). The object of this procedure is to eliminate the bone to bone contact of the degenerating hip joint and allow the formation of a scar tissue pseudarthrosis (false joint) which results in less pain The total hip replacement (THR) involves replacing the hip joint with a metal and polyethylene prosthesis (Figure 6). This procedure results in the most normal limb function in large dogs. The procedure is expensive because of the implants and the technical requirements of the surgery, and requires a commitment from the owners for follow up care. Figure 6. A pelvic radiograph of a dog following a total hip replacement (THR). The object of this procedure is to replace the cartilage of the acetabulum (socket) with a polyethylene socket, and the femoral head with a metal prosthesis. Most dogs have excellent return to function following a total hip replacement. Potential Complications Following Surgery Risks of complications after juvenile pubic symphysiodesis are low and failure of the procedure to reduce hip subluxation does not preclude further surgical treatment in the future. Reported complications after pelvic osteotomy include implant failure, loss of limb abduction, and pelvic outlet narrowing. However, the incidence of complications is low and reports of long-term clinical function are good to excellent. Results after femoral head ostectomy vary. The prognosis is highly dependent upon patient size and postoperative physical therapy. In large patients, 50% of animals have good or excellent function. The rest of the dogs have varying degrees of lameness, but function is usually improved when compared with preoperative status. Medium and small patients usually have good or excellent limb function. Total hip replacement results in excellent return to normal function unless complications occur. Complications after total hip replacement include infection, hip luxation, and fracture. Aftercare for Surgical Patients After juvenile pubic symphysiodesis, the dog can return to normal activity the following day. Almost all patients behave completely normal after surgery. Normally physiotherapy is not necessary. After triple pelvic osteotomy the dog’s activity should be restricted to leash exercise until the osteotomies are healed, generally 6 weeks. Most patients are weight bearing soon after surgery and must be closely confined to prevent overuse of the leg during the healing period. After femoral head and neck ostectomy, patients are encouraged to use the limb as soon as possible. Physical therapy and controlled exercise to increase the range of motion of the hip is essential for an optimal outcome. It may take up to 6 weeks or longer after surgery for some dogs to show improvement. After total hip replacement, most patients feel comfortable enough to use the leg because the prostheses are stabilized with bone cement. Many dogs will quickly become too active and must be confined to a small area with activity restricted to leash walking only. The dog should avoid stairs, slippery surfaces and interactions with other dogs. If all goes well, after 4-6 weeks, activity can be slowly increased back to normal.

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What is osteomyelitis?

Bad to the Bone

Osteomyelitis is inflammation of the bone and its structures caused by pathogenic bacteria. The bone marrow, cortex (hard outer layer of bone) and periosteum (fibrous bone sheath) may all be affected. Osteomyelitis is easier to prevent than to treat. Once established, the stubborn infection often resists surgical and medical therapy.

Pathogenesis

Pathogens invade bone following trauma or by traveling through the bloodstream from other sites of infection. The body first responds by rushing immune-system cells to the area to fight the infection. As white blood cells die, they release enzymes and other cellular debris (exudate), creating an acute inflammatory response. In some cases, the host animal is able to control the infection by isolating and destroying the pathogens.

More often the host response is insufficient or the pathogens too virulent, and the infection spreads. As exudate accumulates, it blocks the blood supply to the affected bone. A segment of cortical bone that is isolated from its blood supply is called a sequestrum. Newly formed bone may surround the sequestrum in an attempt to control the infection and attach the sequestrum to normal bone. However, without an adequate blood supply, the isolated sequestrum is cut off from nourishing blood, immune system cells and antibiotics.

Pathogens proliferate, creating more exudate, which often drains through open sores in the skin. The infection spreads into the marrow cavity and more sequestra form. In chronic osteomyelitis, periods of active infection often alternate with periods of dormancy. But the infection persists, progressively destroying more and more bone.

Bacterial Involvement

Staphylococcus aureus is the most common aerobe identified in osteomyelitis of dogs. Escherichia coli, Proteus and Streptococcus species may also be present. Osteomyelitis is polymicrobial, and careful culture for anaerobes often identifies Bacteroides, Fusobacterium and Clostridium species. Anaerobic bacteria should be suspected if a Gram stain indicates multiple microorganisms but bacteria fail to grow in an aerobic culture.

The Importance of Glycocalyx

Glycocalyx, a protein capsule that surrounds bacteria, contributes to the persistence of osteomyelitis. Glycocalyx and associated slime can be attached to bacteria, trailing bacteria, or detached in the surrounding medium. Glycocalyx can also bind cells together to form microcolonies. Bacteria embedded in glycocalyx adhere to the bone surfaces, allowing successful colonization.

Staphylococcus aureus and a number of Bacteroides species produce large amounts of slime. In mixed infections of these bacteria, the slime layer is particularly thick and smooth. In addition, the bacterial cell walls may be four to five times thicker than usual. These adaptations improve the adherence of bacteria to bone surfaces and also protect these pathogens from antibodies, phagocytosis and antibiotics.

Clinical Features

Early symptoms of osteomyelitis include pain, soft tissue swelling and fever. The animal may be depressed, anorexic and unable to move the affected limb. Joints often swell as the infection spreads. As the condition becomes chronic, fluid or pus drains from the soft tissue surrounding the bone. X-ray examination will show soft-tissue swelling, roughening of the fibrous sheath surrounding the bone, and eventually new bone growth. If the infection persists, bone necrosis will be evident.

These clinical features are common with anaerobic osteomyelitis:

  • Follows fractures, trauma or bite wounds
  • Sequestra
  • Putrid exudate or gas in soft tissues
  • "Sterile" cultures
  • Multiple microorganisms in Gram-stained specimens
  • Lack of response to antibiotics

Treatment

Successful treatment of osteomyelitis begins with surgical removal of all dead tissue and sequestra. Unstable fractures must be stabilized. Bone and tissue samples should be cultured for aerobic and anaerobic pathogens and to determine bacterial susceptibility to antibiotics.

Antibiotic therapy is directed at the causative organisms, usually Staphylococcus aureus and Bacteroides species. Appropriate antibiotics must penetrate bone well, and should be administered for extended periods.

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How to cure wounds?

Wounds, whether accidental or intentional (surgery) can result in pain, bleeding, infection and loss of function. Basic wound management includes:

  • control of bleeding
  • removal of debris and tissue debridement
  • drainage
  • promotion of vascularization
  • wound closure

Unattended wounds are an ideal breeding ground for infection.

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What are aerobic Infections ?

A common aerobic pathogen, Staphylococcus intermedius, is implicated in many infected wounds. Staphylococcus aureus is sometimes isolated as well. Gaining entry through broken skin or mucous membranes, the cocci begin to multiply. Tissue trauma often produces ischemia, reduced or obstructed blood supply, which shields the bacteria from the host's immune system and favors continued growth. Certain staphylococci also produce enzymes and toxins that accelerate the death, or necrosis, of surrounding cells and tissue. Some strains encapsulate themselves, creating a physical barrier between the infection and the body's defenses.

The typical staph infection produces inflammation, necrosis and pus-filled abscesses. If staphylococci enter the bloodstream, they readily invade almost any tissue and organ in the body, including bone. Osteomyelitis (infection of the bone and associated tissues), pyoderma (pus-associated skin infection), and pyometra (pus in the uterus) can all be caused by staphylococci.

Effective treatment of staphylococcal infections often starts with surgical drainage of the pus and wound cleansing. Antibiotic therapy requires a drug active against staphylococci that penetrates beyond the body's circulation to the site of infection.

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What are anaerobic Infections?

The body's normal bacterial population (flora) is predominantly anaerobic. Obligate anaerobes colonize virtually every mucous membrane surface of the body. In the mouth, for example, obligate and facultative anaerobes outnumber other bacteria 10 to 1. Anaerobes survive in the mouth because oral streptococci lower the oxidation-reduction, or redox potential, creating a welcoming environment. Such bacterial synergy is important in the pathogenesis of anaerobic infections.

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How do infections start?

Most anaerobic infections begin with a break in the skin or mucous membranes that permits normally present bacteria to invade underlying tissues. Strict aerobes and facultative anaerobes deplete the available oxygen, creating the ideal environment for obligate anaerobes. Most anaerobic infections are polymicrobial or mixed, containing both obligate and facultative anaerobes. Mixed infections often progress through several stages as the bacterial populations shift in accordance with the changing microenvironment.

The virulence of anaerobic infections increases if the bacteria produce enzymes or toxins capable of destroying surrounding tissue. Common veterinary pathogens, including Bacteroides, Fusobacterium and Clostridium perfringens, all release enzymes or toxins. Dense bacterial populations within abscesses often manufacture beta-lactamase, which can inactivate cephalosporins and penicillins.

Bacterial synergy also increases the virulence of anaerobic infections. In a mixed infection, Bacteroides melaninogenicus sometimes protects nearby bacteria by inhibiting the body's immune system response. And nonpathogenic streptococci produce the vitamin K, required by Bacteroides melaninogenicus for continued growth.

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Clues to Anaerobic Infections

Suspect anaerobic infections when:

  • foul-smelling discharge is present
  • standard culture techniques produce no microbial growth from abscess samples
  • infection sets in after surgery
  • abdominal trauma or sepsis involves penetration of mucosal surfaces
  • deep abscesses, infection of malignant tumors, or pyometra occur
  • infections do not respond to conventional antibiotic therapy

Anaerobic infections typically smell foul, produce little or no swelling, spread along tissue planes, and result in necrosis.

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What are the clinical symptoms ?

Because anaerobes are difficult to culture in the laboratory, they may be overlooked in treatment decisions. However, these clinical syndromes frequently involve anaerobes.

  • Periodontal disease and bacterial endocarditis from dental manipulations - Bacteroides is consistently present in gingivitis; Fusobacterium and Peptostreptococcus are also common
  • Lung infection resulting from aspiration pneumonia - Bacteroides, Fusobacterium and Peptostreptococcus are frequently found
  • Postsurgical infection
  • Bacteremia and intra-abdominal sepsis
  • Gynecologic infections, usually due to Bacteroides
  • Central nervous system infection or cerebral abscesses
  • Osteomyelitis, typically associated with Bacteroides, Fusobacterium and Clostri

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How to treat anaerobic infection ?

Preliminary diagnosis of an anaerobic infection is usually based on clinical clues, because culturing anaerobes is a difficult and time-consuming process. Successful treatment of anaerobic infections almost always begins with drainage and debridement, strategies that restore normal circulation and tissue oxygenation. Antimicrobial therapy aims to eradicate anaerobic pathogens and prevent their spread to adjacent tissues. If necrotic tissue remains or antimicrobial therapy is inappropriate, the infection is sure to recur.

Several factors influence the choice of an appropriate antimicrobial. Among them:

  • The polymicrobial nature of anaerobic infections. The additive effect of toxins and enzymes can increase the severity of the infection, and production of beta-lactamase by one bacterium species can protect the entire microbial population
  • The consistent presence of Bacteroides, some strains of which are resistant to penicillins, cephalosporins and tetracycline
  • The frequent failure of beta-lactamase antibiotics. Beta-lactamase inhibitors sometimes fail because:
    • bacteria produce sufficient beta-lactamase to overwhelm them
    • exposure to beta-lactams stimulates some bacteria to produce large amounts of beta-lactamase
    • beta-lactamase inhibitors cannot stop all beta-lactamase production

Source: Pfizer Animal health care

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