DR.JANTU MONI HAZARIKADR.JEREESH.K.M

About the patientAbout the patient

Animal: DogAnimal: Dog Species: CanineSpecies: Canine Breed: BoxerBreed: Boxer Sex: femaleSex: female Age: 4 yrsAge: 4 yrs Parity: 1Parity: 1 Body weight: 24kgBody weight: 24kg

Owner’s complaintOwner’s complaint

Reported that animal is having severe dry Reported that animal is having severe dry cough started 2 days back.cough started 2 days back.

HistoryHistory No history of cough reported earlier.No history of cough reported earlier. Vaccination & deworming proper.Vaccination & deworming proper.

ObservationsObservations

Animal was active and alert.Animal was active and alert. On auscultation tracheal sounds highly On auscultation tracheal sounds highly

exaggerated. Palpation of trachea elicited exaggerated. Palpation of trachea elicited cough.cough.

Lung sounds exaggerated. Heart sounds Lung sounds exaggerated. Heart sounds masked by lung sounds.masked by lung sounds.

Pre-scapular & sub-maxillary lymph nodes Pre-scapular & sub-maxillary lymph nodes enlarged.enlarged.

Respiration 102/min.(15-25)Respiration 102/min.(15-25) Pulse: 100/min (100-130)Pulse: 100/min (100-130) Temperature: 103.2Temperature: 103.2°F°F MM: slightly congestedMM: slightly congested Palpation of pharynx revealed no Palpation of pharynx revealed no

structural abnormalities.structural abnormalities.

C-arm reportC-arm report

No evidence of any obstruction in trachea. No evidence of any obstruction in trachea. Lung area was almost normal.Lung area was almost normal.

X-ray reportX-ray report No abnormalities could be detected in No abnormalities could be detected in

trachea & esophagus.trachea & esophagus.

TreatmentTreatment

Given, Given, inj. Anistamine 30ml vial inj. Anistamine 30ml vial × 1 × 1

inj.sig. 2ml I/m inj.sig. 2ml I/m (chlorpheniramine maleate@ 0.4-2mg/kg )(chlorpheniramine maleate@ 0.4-2mg/kg )

Inj. Deriphyllin 2ml ampule ×1Inj. Deriphyllin 2ml ampule ×1

Inj. Sig. 2ml i/mInj. Sig. 2ml i/m

(Theophyllin @6-11mg/Kg,etofyllin ) (Theophyllin @6-11mg/Kg,etofyllin )

RR×× Tab. DoxyTab. DoxyII 100mg × 10 100mg × 10

Sig. 1tab daily orallySig. 1tab daily orally

(Doxycycline @ 5mg/kg BID PO)(Doxycycline @ 5mg/kg BID PO) Deriphyllin retord 300mg × 10Deriphyllin retord 300mg × 10

Sig. 1tab BID orallySig. 1tab BID orally Glycodine syrup × 1Glycodine syrup × 1

Sig. 2 tsp BID orallySig. 2 tsp BID orally Tab. Decaris 150mg × 9(Levamisole@7.5mg/kg)Tab. Decaris 150mg × 9(Levamisole@7.5mg/kg)

Sig. 1.5 tab dailly orallySig. 1.5 tab dailly orally

Result of laboratory examinationResult of laboratory examination

Wet film examination of blood: negativeWet film examination of blood: negative Faecal sample: negative for ova of parasitesFaecal sample: negative for ova of parasites Blood smear: Blood smear: E.canis E.canis morulae morulae could be could be

seen in the monocytes.seen in the monocytes. Blood smear: No bacteria of pathogenic Blood smear: No bacteria of pathogenic

significance could be seen.significance could be seen.

Hb - 10 g%(12-18)Hb - 10 g%(12-18) ESR- 1mm/hr (5-15)ESR- 1mm/hr (5-15) TLC - 7300/cmm (6000-17000)TLC - 7300/cmm (6000-17000) RBC - 4.3 million/cmm (5.5-8.5)RBC - 4.3 million/cmm (5.5-8.5) Band cell – 2% (0-3%)Band cell – 2% (0-3%) Eosinophil – 3% (2-10%)Eosinophil – 3% (2-10%) Monocyte – 3% (3-10%)Monocyte – 3% (3-10%) Lymphocyte – 13%(12 – 30 %)Lymphocyte – 13%(12 – 30 %) Neutrophil – 79% (60-70%)Neutrophil – 79% (60-70%)

Animal was brought 2 days after & there Animal was brought 2 days after & there was slight improvement in the condition.was slight improvement in the condition.

Temperature -104Temperature -104°F°F

Pulse – 98/ minPulse – 98/ min

Respiration - pantingRespiration - panting

GivenGiven Inj. Terramycin 6ml (30ml vial) Inj. Terramycin 6ml (30ml vial) × 1× 1

Aqua dest add 4mlAqua dest add 4ml

Mft. Inj sig 10ml as i/v(@10-20mg/kg)Mft. Inj sig 10ml as i/v(@10-20mg/kg) Inj. Anistamine 30ml ×1Inj. Anistamine 30ml ×1

Inj. Sig 1.5ml i/m Inj. Sig 1.5ml i/m Inj. Deriphyllin 2ml × 1Inj. Deriphyllin 2ml × 1

Inj. Sig 2ml i/mInj. Sig 2ml i/m

(Theophylline 25.3mg,Etofylline 84.7mg)(Theophylline 25.3mg,Etofylline 84.7mg)

Advised the owner to continue the Advised the owner to continue the treatment for 3 days.treatment for 3 days.

RR××

Tab DoxyTab DoxyII 100mg 100mg × 24× 24

Sig 1tab BID orallySig 1tab BID orally

Follow-upFollow-up Animal showed improvement in condition & Animal showed improvement in condition &

the cough was reduced & stopped.the cough was reduced & stopped.

DISCUSSIONDISCUSSION

EtiologyEtiology

Ehrlichia canisEhrlichia canis affecting wild & affecting wild & domestic canids. domestic canids.

Tropism for circulating leukocytes.Tropism for circulating leukocytes. Replicate in the phagosomes of leukocytesReplicate in the phagosomes of leukocytes

Stages in life cycleStages in life cycle

Elementary bodyElementary body Initial bodyInitial body MorulaeMorulae

TransmissionTransmission: by tick : by tick bite.bite.

Vector: Vector: Rhipicephalus Rhipicephalus sanguineussanguineus

PathogenesisPathogenesis

Commonly called Canine monocytic Commonly called Canine monocytic ehrlichiosis.ehrlichiosis.

Incubation period:8-20 days.Incubation period:8-20 days. ACUTE PHASEACUTE PHASE: Rapid multiplication in the : Rapid multiplication in the

WBCs, spreads throughout the body WBCs, spreads throughout the body reaching various parenchymatous organs reaching various parenchymatous organs like lungs, liver etc. In this phase symptoms like lungs, liver etc. In this phase symptoms are manifested.are manifested.

Lab findings in acute phase:Lab findings in acute phase:

Anaemia, leukaemia, Anaemia, leukaemia, ThrombocytopaeniaThrombocytopaenia

Mechanisms of thrombocytopaenia:Mechanisms of thrombocytopaenia:

1.Increased platelet consumption by 1.Increased platelet consumption by endothelial blood vessels.endothelial blood vessels.

2.Increased platelet destruction by spleen.2.Increased platelet destruction by spleen.

3.Antiplatelet antibodies.3.Antiplatelet antibodies.

CHRONIC PHASE:CHRONIC PHASE:

Bone marrow depression or bone marrow Bone marrow depression or bone marrow hypoplasia – reduction in all type of cells.hypoplasia – reduction in all type of cells.

Tropical canine pancytopaeniaTropical canine pancytopaenia

Very low parasitaemia at this stage.Very low parasitaemia at this stage.

Clinical findingsClinical findings

Due to involvement of hemic & Due to involvement of hemic & lymphoreticular systems.lymphoreticular systems.

Commonly progress from acute to chronic Commonly progress from acute to chronic depending ondepending on

- Strain of the organism.Strain of the organism.

- Immune status of the animal.Immune status of the animal.

- Improper treatment. Improper treatment.

In Acute casesIn Acute cases: Fever, anorexia, depression, : Fever, anorexia, depression, lymph node enlargement, reluctance to lymph node enlargement, reluctance to walk, edema of limbs, coughing, dyspnoea, walk, edema of limbs, coughing, dyspnoea, polyarthritis, diarrhoea etc.polyarthritis, diarrhoea etc.

Haemogram- usually normal with mild Haemogram- usually normal with mild normocytic normochromic anaemia, normocytic normochromic anaemia, leukopaenia or mild leukocytosis, leukopaenia or mild leukocytosis, thrombocytopaenia etc. thrombocytopaenia etc.

Chronic casesChronic cases: marked spleenomegaly, : marked spleenomegaly, renal failure, interstitial pneumonitis, renal failure, interstitial pneumonitis, cerebellar ataxia, depression, paresis, cerebellar ataxia, depression, paresis, severe weight loss.severe weight loss.

Haemogram usually abnormal with severe Haemogram usually abnormal with severe thrombocytopaenia leading to epistaxis, thrombocytopaenia leading to epistaxis, melena, hematuria, petichae & melena, hematuria, petichae & ecchymoses of skin & mucous membrane ecchymoses of skin & mucous membrane occur in all breeds especially German occur in all breeds especially German shepherds.shepherds.

LesionsLesions

Spleenomegaly, lymphadenopathy, Spleenomegaly, lymphadenopathy, haemorrhage in the liver, kidney, GIT.haemorrhage in the liver, kidney, GIT.

DiagnosisDiagnosis

- symptoms- symptoms

-Demonstration of organisms (morulae) -Demonstration of organisms (morulae) with in the WBCs in blood smear or buffy with in the WBCs in blood smear or buffy coat smear.(Giemsa stain)coat smear.(Giemsa stain)

-Indirect immuno fluorescence test-Indirect immuno fluorescence test

-Molecular diagnosis- PCR.-Molecular diagnosis- PCR.

Differential DiagnosisDifferential Diagnosis Acute cases: Acute cases: Hepatozoon canis, Babesia Hepatozoon canis, Babesia

canis, Haemobartonella caniscanis, Haemobartonella canis Lymphadenopathy.Lymphadenopathy. Chronic cases: Immune mediated pan Chronic cases: Immune mediated pan

cytopaenia, other diseases associated with cytopaenia, other diseases associated with specific organs like glomarulo nephritis. specific organs like glomarulo nephritis.

Babesia canis Hepatozoon canisBabesia canis Hepatozoon canis

TreatmentTreatment Tetracyclines – 10-20mg/Kg parenterally Tetracyclines – 10-20mg/Kg parenterally

for 14 days, 22mg/Kg TID orally for 2 for 14 days, 22mg/Kg TID orally for 2 weeks in acute cases & 1-2 months in weeks in acute cases & 1-2 months in chronic caseschronic cases

Doxycycline – 5-10mg/Kg PO or i/v for 10-Doxycycline – 5-10mg/Kg PO or i/v for 10-14 days (if tetracycline fails or in old dogs 14 days (if tetracycline fails or in old dogs with kidney problems)with kidney problems)

Supportive therapy to combat wasting & Supportive therapy to combat wasting & specific organ dysfunction.specific organ dysfunction.