Pyothorax

PYOTHORAX

ET ORIGINES FRéquentes chez le chat et le chien

ROTAtion SIAMU

Qu'est-ce qu'un pyothorax ?

Pyothorax = Infection bactérienne grave ; épanchement cavitaire pleural de type exsudat : liquide purulent septique.

Incidence ? Cause identifiée 2–22% des chiens 35–67% des chats

Animaux jeunes + Diagnostic 3-6 ans ∅ sexe ou race

Pronostic : Taux de survie de 83% chez les chiens et 62% chez les chats.¹

Signes cliniques ¹

Symptômes tardifs (jours/mois), urgence !

Prostration, léthargie

Perte d'appétit, anorexie, amaigrissement

Difficultés respiratoires, tachypnée, dyspnée, toux

Tachycardie, essouflement à l'effort

Possible hyperthermie ou hypothermie (CT)

A l'origine de SIRS / sepsis

Ponctionner l'épanchement !

Protéines Totales cellularité

PT > 3 g/dL cell > 7000/uL

PT < 25 g/L cell < 1500/uL

PT 2.5 à 7.5 g/dl cell 1000 à 7000 /ul

exsudat

Pyothorax ?

Transsudat

Transsudat modifié

GLUCOSE

LACTATES

CYTOLOGIE

pnn Dégénérés Figures de phagocytose bactéries

Glucose epanchement < glucose sang - 0.2 g/L

lactates epanchement > Lactates sang + 2 mmol/L

Examens biologiques : Biochimie, NF, analyse urinaire Adapter la prise en charge

Imagerie thoracique : Diagnostiquer un épanchement (caractérisation requiert d'autres EC) +/- Identifier une cause

Analyse de sang : statut FIV/FeLV ? "No association has been demonstrated between pyothorax and feline leukemia virus or feline immunodeficiency virus status" ¹

Culture bactérienne : Obtenir un antibiogramme Adapter le traitement

Causes majeures de pyothorax chez le chien

Demeure souvent indéterminée !

Iatrogène

Corps étranger migrants

"the most common cause of pyothorax in dogs may be more regionally dependent, with grass awns migration common in endemic areas" ⁴ Inhalation : rarement décrit

Complication post-opératoire dans 6.5% de cas de chiens après une chirurgie thoracique. ⁵ Biopsies et thoracocentèses : facteurs de risque

Autres causes

Plaie thoracique pénétrante (morsure, griffure , AVP...)

Migration hématogène ou lymphatique, perforation oesophagienne, migration parasitaire, progression de discospondylite ou d'ostéomyélite vertébrale, parapneumonique, néoplasie, ruptures d'abcès pulmonaires ¹

Causes majeures de pyothorax chez le chat

Demeure souvent indéterminée !

Pneumonie / bronchite infectieuse

"oral cavity and upper respiratory tract appear to be the most common source of microorganisms causing pyothorax in dogs and cats" ², ³

Corps étranger migrants

Plaie thoracique pénétrante (morsure, griffure , AVP...)

Autres causes

Migrations parasitaires, septicémies chez les jeunes en particulier.

"One of the most common mechanisms believed to be responsible for pyothorax in cats is direct inoculation of the pleural space by bite wounds from other cats" ¹

"The approach to treatment for pyothorax varies greatly in veterinary medicine and remains controversial." ¹

Drain thoracique

Thérapie antimicrobienne

Stabilisation de l'animal

Antibiothérapie à large spectre Antibiothérapie ciblée après réception de l'antibiogramme

+/- Lavage thoracique Fibrinolytiques intrapleuraux (controversé) ¹ Héparine intrapleurale (+ survie court terme) ⁶

Aerobies + :Escherichia coli, Pasteurella spp., Actinomyces spp., Nocardia spp., Streptococcus spp., Staphylococcus spp., and Corynebacterium spp. Anaérobies + : Fusobacterium spp., Peptostreptococcus anaerobius, Bacteroides spp., Prevotella spp., and Porphyromonas spp

Oxygénothérapie Fluidothérapie (+ pour SIRS) Antibiotiques à large spectre Thoracocentèse

Chirurgie ? + survie long terme ? (selon articles)

+ Traitement étiologique

+ Analgésie, Nutrition, Monitoring

Thank you!

¹ Stillion JR, Letendre JA. A clinical review of the pathophysiology, diagnosis, and treatment of pyothorax in dogs and cats. J Vet Emerg Crit Care (San Antonio). 2015 Jan-Feb;25(1):113-29. doi: 10.1111/vec.12274. Epub 2015 Jan 13. [en ligne] ² Barrs VR, Allan GS, Martin P, et al. Feline pyothorax: a retrospective study of 27 cases in Australia. J Feline Med Surg 2005; 7(4): 211–222. ³ Davies C, Forrester SD. Pleural effusion in cats: 82 cases (1987 to 1995). J Small Anim Pract 1996; 37(5): 217–224. ⁴ Brennan KE, Ihrke PJ. Grass awn migration in dogs and cats: a retrospective study of 182 cases. J Am Vet Med Assoc 1983; 182(11): 1201–1204. ⁵ Meakin LB, Salonen LK, Baines SJ, et al. Prevalence, outcome and risk factors for postoperative pyothorax in 232 dogs undergoing thoracic surgery. J Small Anim Pract 2013; 54(6): 313–317. ⁶ Boothe HW, Howe LM, Boothe DM, et al. Evaluation of outcomes in dogs treated for pyothorax: 46 cases (1983-2001). J Am Vet Med Assoc 2010; 236(6): 657–663.

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Does the window allow for adding more extensive content? You can enrich your genially by incorporating PDFs, videos, text... The content of the window will appear when you click on the interactive element. Multimedia content is essential to achieve a WOW effect in your classes. Include a soundtrack, audio or sound effects here...

Always add up!

Use tables and infographics

Visual communication is a key tool. We find it easier to 'read' images than to read written text.