Topic rounds

Our role in Public health

Kayla Townsend

Case presentation

Diagnostics and differentials

Disease review

Next steps

Case conclusion

Case presentation

• Signalment:
• "Aries" -1 yr MN DSH

• History:
• Chronic URI as kitten, treated with multiple rounds of antibiotics
• Had a foxtail removed from his throat in a few months prior
• Increased respiratory effort a few days prior to presentation
• Indoor only
• FeLV/FIV negative
• No current medications

• Physical Exam:
• Yellow nasal discharge bilaterally
• Intermittent open-mouth breathing
• Crackles ausculted bilaterally
• Enlarged right submandibular lymph node

Initial Diagnostics

Thoracic radiographs

Thoracic radiographs

Thoracic radiographs

Top differential(s)

• Infectious
• viral (i.e. FIP)
• bacterial
• fungal
• parasitic

Radiology report

Unusual asymmetric nodular interstitial and alveolar pulmonary pattern with concurrent diffuse bronchial infiltrate as described. The most likely differentials are infectious processes. Given the lack of response to previous antimicrobial therapy, nonbacterial or atypical bacterial organisms are considered most likely, including fungal diseases such as cryptococcus or histoplasmosis, protozoal diseases such as toxoplasmosis or cytauxzoonosis, atypical bacterial diseases such as Yersinia pestis or tuleremia, or parasitic diseases such as lungworms.

My reaction

Plague (Yersinia pestis)

Prevalence

Transmission

Symptoms

• Animals
• Flea bite
• Ingestion of infected animals
• People
• Flea bite
• Direct contact/inhalation with infected tissue

• Bubonic
• "Bubos"- swollen, inflamed lymph nodes
• Septicemic (aka "Black plague")
• necrotic toes, fingers, nose
• septic shock
• Pneumonic

• Utah
• 0 confirmed cases last 5 years
• USA
• Most common in Colorado, New Mexico, and Arizona

Plague Worldwide

Reported* Plague Cases by Country, 2013-2018

*Data reported to World Health Organization (WHO)

Plague (Yersinia pestis)

Diagnostics

• Microscopic identification using Gram, Wright, Giemsa, or Wayson stained smears
• Peripheral blood
• Sputum
• Bubo fluid
• CSF
• Culture (do not culture in-house)

• Immunofluorescence
• PCR

Treatment

• Aminoglycosides (Gentamicin)
• Fluoroquinolones (Enrofloxacin, Pradofloxacin)

• Tetracyclines

*Patient should be isolated during the first 48-72 hours of antibiotic therapy and until clinical improvement

https://www.cliniciansbrief.com/article/plague-cats-dogs-public-health-concern

Tularemia (Francisella tularensis)

van Hoek, Monique & Hoang, Ky & Gunn, John. (2019). Two-Component Systems in Francisella SpeciesTable_1.docx. Frontiers in Cellular and Infection Microbiology. 9. 10.3389/fcimb.2019.00198.

Tularemia (Francisella tularensis)

Cats

Humans

Dogs

Cats can range from non-clinical infection to sepsis and death.

In dogs, clinical illness is inapparent or mild.

Incubation period: 3-5 days, but can range 1-14 days.

Clincal signs may include:

• Fever
• Malaise
• Cephalalgia (head pain)
• Myalgia (muscle pain)
• Vomiting

Clincal signs may include:

• Fever
• Lymphadenopathy
• Abscesses
• Gastroenteritis
• Hepatomegaly
• Splenomegaly
• Icterus
• Anorexia
• Weight loss
• Pneumonia
• Spesis

Clincal signs may include:

• Fever
• Mucopurulent oculonasal discharge
• Pustules at inoculation site
• Lymphadenopathy
• Anorexia

Map of Reported Cases of Tularemia in U.S. -2020

According to the CDC, no reported cases in Utah between 2018-2020.

https://www.cdc.gov/tularemia/statistics/index.html

Tularemia (Francisella tularensis)

Diagnosis

• PCR
• Blood
• Aspirates of affected tissues (i.e. lymph nodes or spleen)
• Serology via tube agglutination or ELISA
• Culture

Treatment

• Gentamicin and tetracycline are the antibiotics of choice
• Other antibiotics considered effective include:
• Fluoroquinolones (Enrofloxacin)
• Chloramphenicol

**Patient should be isolated during the first 48 hours of antibiotic therapy

Bioterrorism Agents/Diseases

Category C

Category A

Category B

Third highest priority agents include emerging pathogens that could be engineered for mass dissemination because of:

• Availability
• Ease of production and dissemination
• Potential for high morbidity and mortality rates and major health imapct

• Are moderately easy to disseminate
• Result in moderate morbidity rates and low mortality rates
• Require specific enhancements of CDC's diagnostics capacity and enhanced disease surveillance

• Can be easily disseminated or transmitted from person to person
• Result in high mortality rates and have the potential for major public health impact
• Might cause public panic and social disruption
• Require special action for public health preparedness

Next steps

Suspect

If you suspect, discover, or have a reason to believe that an animal is either affected with a reportable disease or contimanated with a toxic substance

Contact

Immediately contact the State Veterinarian

• Call: (801) 982-2243
• Submit online form at https://ag.utah.gov/farmers/animal-industry/animal-health-program/reportable-diseases/

Isolate

Isolate the animal and ensure proper PPE is used by all staff in contact with the animal.

Collecte samples

If instructed by the State Veterinarian, collect appropriate samples for submission prior to antimicrobial therapy.

Case Conclusion

Necropsy Report

Neisseria infection is an uncommon but reported cause of lymphadenitis and pneumonia in cats. Due to the rarity of cases, the pathogenesis is not clear, but the distribution suggests hematogenous spread, potentially from the oral cavity where Neisseria is an oral commensal. In the few reported cases, the prognosis is poor, with death occuring within hours or at most days of the onset of clinical signs.

Necropsy Report

Neisseria animaloris/zoodegmatis

• Neisseria is a gram-negative coccobacillus bacteria. It is considered a commensal of the canine and feline oral cavity.

• Makino et al., they described two cases of severe pneumonia in cats. Both cats passed away the same day of presentation. Neisseria species were isolated from both cats lungs.
• Carr et al, described a nasofacial infection in a cat which responded to prolonged antimicrobial therapy of doxycycline and trimethoprim sulfamethoxazole
• Foster et al, N. animaloris isolated in harbour porpoises following a traumatic injury caused by grey seals.

Carr SV, Martin PA, Keyes SL, et al. Nasofacial infection in a cat due to a novel bacterium in Neisseriaceae. Journal of Feline Medicine and Surgery Open Reports. 2015;1(2). doi:10.1177/2055116915597240

Citations

1. https://epi.utah.gov/wp-content/uploads/Monthly-Communicable-Disease-Summary.html
2. https://www.cdc.gov/plague/maps/index.html
3. https://www.avma.org/plague
4. https://www.who.int/news-room/fact-sheets/detail/plague
5. van Hoek, Monique & Hoang, Ky & Gunn, John. (2019). Two-Component Systems in Francisella SpeciesTable_1.docx. Frontiers in Cellular and Infection Microbiology. 9. 10.3389/fcimb.2019.00198.
6. https://www.cliniciansbrief.com/article/plague-cats-dogs-public-health-concern
7. https://www.avma.org/tularemia-facts
8. https://ag.utah.gov/farmers/animal-industry/animal-health-program/reportable-diseases/
9. Makino, Herica, De Sousa, Alessandra Tammy Hayakawa Ito, Pavelegini, Lucas Avelino Dandolini, Trevisan, Yolanda Paim Arruda, Colodel, Edson Moleta, Sousa, Valéria Régia Franco, Dutra, Valéria and Nakazato, Luciano. "Pneumonia in Cats associated with Neisseria sp." Acta Veterinaria, vol.71, no.2, 2021, pp.211-218. https://doi.org/10.2478/acve-2021-0018
10. Carr SV, Martin PA, Keyes SL, et al. Nasofacial infection in a cat due to a novel bacterium in Neisseriaceae. Journal of Feline Medicine and Surgery Open Reports. 2015;1(2). doi:10.1177/2055116915597240
11. Foster, G., Whatmore, A.M., Dagleish, M.P. et al. Forensic microbiology reveals that Neisseria animaloris infections in harbour porpoises follow traumatic injuries by grey seals. Sci Rep 9, 14338 (2019). https://doi.org/10.1038/s41598-019-50979-3