Bir Kedide Dirençli Piyotoraks Olgusu ve Tedavisi

Year 2023, Volume: 34 Issue: 1, 81 - 85, 19.03.2023

Umut Fikret Korkmaz , Duygu Kahraman , Mehmet Fatih Bozkurt , Ebubekir Ceylan

https://doi.org/10.36483/vanvetj.1248328

Abstract

Bu olgu sunumunda, plevral efüzyon ile karakterize vakalarda ayırıcı tanıyı koymakta veteriner hekimlere yardımcı olmak ve rutinde tercih edilen geniş spektrumlu antibiyotik kullanımı sonucunda yanıt alınamadığı durumlarda bakteri identifikasyonu ve antibiyogram analizinin önemini vurgulayarak klinisyenlere tedavide izlenecek yollara dair yardımcı olması hedeflenmiştir. Bu olgunun materyalini toraks radyografisinde plevral efüzyon varlığı tespit edilmiş, dispne, dilde morarma, yüksek ateş ve ağrılı oturuş şikayetleri olan 1,5 yaşlı, Scottish Fold ırkı, erkek bir kedi oluşturmaktadır.Efüzyon örneğinin serolojik incelemesinde Feline Coronavirus pozitif sonucu üzerine Immuncomb FCoV IgG antikor titre testi bakılmış olup S2 düşük pozitif olduğu görülmüştür. Hastalığın klinik seyri ve diğer laboratuvar bulguları Feline Enfeksiyöz Peritonitis hastalığının efüziv formu ile paralel gitmediği için ayırıcı tanı amacıyla alınan efüzyonun sitolojik olarak incelenmesi uygun görülmüştür. Yapılan immunositokimyasal analizde FCoV negatif sonuç tespit edilmiştir. Sitolojik incelemeler sonrası piyotoraks tanısı kesinleşmiştir.Bakteriyel identifikasyon sonucunda Mycoplasma spp. tespit edilmiştir. Antibiyogram sonucunda ise klindamisin duyarlılığı tespit edilmiştir. Tedavi protokolü olarak kullanılan diüretikler dışında başlanan klindamisin (Clindan®, Bilim Ilac, Istanbul) 5.5 mg/kg, intravenöz, q12h, 14 gün olarak kullanılmış olup sonrasında olgunun efüzyon şiddetinde azalma, iştahta artış, genel durumda iyileşme gözlemlenmeye başlanmış ve belli aralıklarla tekrarlanan toraks radyografilerinde yeniden şekillenen bir plevral efüzyon tablosuna rastlanmamıştır.

Keywords

Dispne, Feline enfeksiyöz peritonitis, Mycoplasma, Piyotoraks, Pleural Efüzyon

A Case and Treatment of Resistant Pyothorax in a Cat

Abstract

In this case report, it is aimed to assist veterinarians in making the differential diagnosis in cases characterized by pleural effusion and to assist clinicians in the treatment pathways by emphasizing the importance of bacterial identification and antibiogram analysis in cases where there is no response as a result of the routine use of broad-spectrum antibiotics. The material of this case is a 1.5-year-old Scottish Fold male cat with pleural effusion detected on thorax radiographs, dyspnea, bruising on the tongue, high fever and painful sitting. In the serological examination of the effusion sample, Immuncomb FCoV IgG antibody titer test was checked on the positive result of Feline Coronavirus and it was found to be S2 low positive. Since the clinical course of the disease and other laboratory findings did not go in parallel with the effusive form of Feline Infectious Peritonitis, cytological examination of the effusion taken for differential diagnosis was deemed appropriate. FCoV negative result was detected in the immunocytochemical analysis. The diagnosis of pyothorax was confirmed after cytological examinations. As a result of bacterial identification, Mycoplasma spp. detected. As a result of the antibiogram, clindamycin susceptibility was detected. Apart from the diuretics used as a treatment protocol, clindamycin (Clindan®, Bilim Ilac, Istanbul) was started at 5.5 mg/kg, intravenous, q12h, for 14 days. Afterwards, a decrease in the severity of effusion, an increase in appetite, an improvement in general condition were observed, and thorax repeated at regular intervals and, no remodeling pleural effusion picture was found in the radiographs.

Keywords

Mycoplasma, Dyspnea, Feline infectious peritonitis, Mycoplasma, Pyothorax, Pleural Effusion

References

• Barrs VR, Allan GS, Martin P, Beatty JA, Malik R (2005). Feline pyothorax: a retrospective study of 27 cases in Australia. J Feline Med Surg, 7 (4), 211-222.
• Beatty J, Barrs V (2010). Pleural effusion in the cat: a practical approach to determining aetiology. J Feline Med Surg, 12 (9), 693-707.
• Cola V, Del Magno S, Valentini S et al. (2019). Deep vegetal foreign bodies in cats: a retrospective study of 10 cases. J Am Anim Hosp Assoc, 55 (5), 249-255.
• Demetriou JL, Foale RD, Ladlow J, et al. (2002). Canine and feline pyothorax: a retrospective study of 50 cases in the UKand Ireland. J Small Anim Prac, 43(9), 388-394.
• Epstein SE (2014). Exudative pleural diseases in small animals. Vet Clin North Am Small Anim Pract, 44 (1), 161-180.
• Fossum TW (2000). In: Textbook of Veterinary Internal Medicine, S. J. Ettinger and E. C. Feldman (Eds). Pleural and extrapleural disease. (pp 1098-1111). W. B. Saunders, Philadelphia.
• Foster SF, Martin P, Allan GS, Barrs VR, Malik R (2004). Lower respiratory tract infections in cats: 21 cases (1995-2000). J Feline Med Surg, 6 (3), 167-180.
• Gorris F, Faut S, Daminet S, et al. (2017). Pyothorax in cats and dogs. Vlaams Diergeneeskd Tijdschr, 86 (3), 183-197.
• Papich MG (2012). Selection of antibiotics for meticillin-resistant Staphylococcus pseudintermedius: time to revisit some old drugs?. Vet Dermatol, 23 (4), 352–e64.
• Gulbahar MY, Gurturk K (2002). Pyothorax associated with a Mycoplasma sp and Arcanobacterium pyogenes in a kitten. Aust Vet J, 80 (6), 344-345.
• Jones RF, Sabine M (1970). The isolation of mycoplasmas from clinically normal cats. Australian Vet J, 46 (7), 343.
• Krämer F, Rainer J, Bali MS (2021). Short‐and long‐term outcome in cats diagnosed with pyothorax: 47 cases (2009‐2018). J Small Anim Prac, 62 (8), 669-676.
• Lee-Fowler T (2014). Feline respiratory disease: What is the role of Mycoplasma species?. J Feline Med Surg, 16 (7), 563-571.
• MacPhail CM (2007). Medical and surgical management of pyothorax. Vet Clin North Am Small Anim Pract, 37 (5), 975-988.
• Malik R, Love DN, Hunt GB, Canfield PJ, Taylor V (1991). Pyothorax associated with a Mycoplasma species in a kitten. J Small Anim Prac, 32 (1), 31-34.
• Ottenjann M, Lübke-Becker A, Linzmann H, et al. (2008). Pyothorax bei 26 Katzen: Klinik, Labordiagnostik und Therapie (2000-2007). Berliner und Münchener Tierärztliche Wochenschrift, 121 (9-10), 365-373.
• Randolph MB (2012). The Thoracic Cavity. Little S (Ed). The Cat Clinical Medicine and Management(pp. 892-913). W.B. Saunders: Saint Louis, MO, USA.
• Rooney MB, Monnet E (2002). Medical and surgical treatment of pyothorax in dogs: 26 cases (1991-2001). J Am Med Assoc, 221 (1), 86-92.
• Stillion JR, Letendre JA (2015). A clinical review of the pathophysiology, diagnosis, and treatment of pyothorax in dogs and cats. J Vet Emergency Critical Care, 25 (1), 113-129.
• LaRocco MT, Franek J, Leibach EK, Weissfeld AS, Kraft CS, et al. (2015). Effectiveness of Preanalytic Practices on Contamination and Diagnostic Accuracy of Urine Cultures: a Laboratory Medicine Best Practices Systematic Review and Meta-analysis. Clinical Microbiology Reviews, 29 (1), 105-146.
• Waddell LS, Brady CA, Drobatz KJ (2002). Risk factors, prognostic indica-tors, and outcome of pyothorax in cats: 80 cases (1986-1999). J Am Med Assoc, 221 (6), 819-824.
• Wong WT, Noor F (1984). Pyothorax in the cat-a report of two cases. Kajian Veterinar Malaysia, 16 (1),15-17.