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Feline Acne Treatment

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Feline Acne Treatment Powered By Docstoc
					Infectious disease in shelters and foster
           homes: ringworm


              Kate F. Hurley, DVM, MPVM
                Shelter Medicine Program
           Center for Companion Animal Health
             University of California, Davis
                www.sheltermedicine.com
  What is different about managing
    ringworm in a population?
• Screening is a big deal – a missed lesion can
  be very, very costly
• Treatment has to be effective – it must work
  fast and protect the environment
• Confirmation of cure is critical – a missed
  fungus can be very, very costly
• Decontamination must be successful –
  future exposure of naïve cats is inevitable
    Why does it matter so much?
• Human health risk =
  ethical, P.R. and liability
  issue
• Treatment is relatively
  expensive, labor intensive
  and prolonged
• Long term contamination
  can cripple a shelter or
  foster home
         Time costs




Which one is easier to find a home for?
         Time costs




What happens when all the cages are full?
           The bottom line
• We need to keep ringworm from getting in
  to feline populations
• If it gets in, we need to deal with it as
  rapidly and effectively as possible while
  protecting the rest of the population
• We need to keep ringworm from getting out
  to adopter’s homes
            Who are the players?

• M. canis
   – Greater zoonotic potential
   – Much more readily spread
• Trichophyton
  mentagrophytes
• M. gyspeum
 What pre-disposes to ringworm?
• Being a kitten
• Compromised skin
   – Trauma, allergies, parasites,
     matting
• Poor grooming habits
   – Long hair, stress, matted
     hair coat, URI, e-collar
• Compromised immune
  system
   – FeLV, FIV, steroids,
     pregnancy…
• High risk environment
Sitting duck
Classic presentations
      What else does it look like?
•   Focal or multifocal
•   Milliary Dermatitis
•   Eosinophilic Plaques
•   Indolent Lip Ulcers
•   Pinnae Alopecia
•   Chin acne
•   Paronychia
•   “Stud tail”
•   Granulomatous lesions
      What else does it look like?
•   Over-grooming
•   Shedding
•   Hair loss
•   Pruritus (or not)
•   Crusting and Scaling
•   Erythema
•   Comedones
                      Woods lamp             Dang!
                                             Dang!!
•   Correct wavelength
•   Plug-in, not battery
•   Dark room
•   Ideally:
    – 10 minute warm up
    – 5 minute exam
• Positive: very suspicious
    – Watch out for tetracyline,
      KMR, others                  Busted!
• Negative: Not ruled out
          Fungal culture: why?
• Screening tool
   – For all?
   – Lesions and high risk?
• Diagnostic tool
   – Treatment guidance
• Confirmation of cure
• Confirmation of
  cleaning
       In-house fungal culture
• Cost effective
• Allows earlier
  diagnosis
• Allows assessment of
  degree of infection
• Allows creative
  culturing of
  environment
        Fungal culture collection
 Wipe cat with damp cloth to remove coat contaminants
 Fresh toothbrush in package
    Pluck 2nd choice for suspect lesions
 At least 30 strokes
    Especially face, inside pinnae, around nail beds, lesions
 Swiffer for environment
    Cut into small sections, wipe until visibly dirty
 Individual labeled baggies if multiple samples
 Avoid heat exposure during transport
            Fungal culture details
 Room temperature media
    Plate style preferred
 Press firmly but not so much that culture is disrupted
    Press Swiffer firmly numerous times
 Incubate at 75º- 85º F in the dark with humidity source
 Examine daily until growth or for 21 days
    Most M. canis will grow within 10 days – tentative negative at that
     point
              Identification
• False negatives and positives possible with
  red color change
• Tape prep:
  – Lactophenol blue on slide
  – Tape on colony
  – Tape on slide
• Resources for microscopic ID
Definitive diagnosis
   Risk assessment for exposed
• Baseline sanitation
  level?
• Degree of exposure?
• Evidence of spread?
• Ideally toothbrush
  culture all at risk
• Pathogen score to
  identify treatment
  candidates
  P Score 1: Less than four colonies
• Probable environmental
  contamination
• Careful exam
• Repeat culture
• Lime sulfur dip
• Probably okay to place for
  adoption while awaiting
  second culture results



                               “Dust Mop Syndrome”
          P score 2: 4-9 colonies
• Super careful visual and
  Wood’s lamp exam
• Inside pinnae, face, chin,
  tail, top and bottom of feet
• If suspect lesions, treat as
  infected
• If not, re-culture, “dip and
  go” as with P score of 1
   – Hold until 2nd culture
     negative to be extra careful
P score 3: initiate treatment for sure

                             RATS!
              Lime sulfur dip
• Top priority in order
  to reduce
  environmental
  contamination
• Sufficient as sole
  treatment in many
  cases
• Optimally, combine
  with systemic
          Lime sulfur details
• Use 8% concentration
• Twice weekly if at all possible
• Okay in pregnant and nursing cats, kittens >
  2-3 weeks old
  – Wipe nursing moms, keep kittens warm
• E-collar afterward may not be necessary
        Lime sulfur application
• Do not pre-wet
• Pesticide sprayer
   – Powder first, then
     water
   – Keep close to cat
• Or, hold by feet and
  dunk
• Sponge dip on face,
  nose and ears
The prophylactic dunk

                For my own
                 good, you
                    say?
              Systemic treatment
• Speeds recovery in all
• Itraconazole drug of choice
• Fluconazole 2nd choice (10
  mgs/kg)
• Terbinafine (Lamasil)
  works but is costly and may
  require higher than published
  dose
                                  Especially important for
• Higher risk and/or less
                                  generalized ringworm or
  effective: Griseofulvin and       immunosuppressed
  ketoconazole
                   Itraconazole
• Get compounded, divide
  into capsules, or mix into
  food or butter
• OK in kittens > 3 weeks
• Remember to adjust dose
  as kittens grow
• Avoid in pregnant queens
• Adverse effects: GI,
  hepatoxicity                 100 mg capsules being split into 4
                                       25 mg capsules
        To clip or not to clip?
• Usually not necessary; may temporarily
  worsen lesions
• Consider in nursing moms, long haired,
  unkempt, unable to groom, or coat that is
  unmanageable after dipping
• Be careful to avoid clipper burn
• Bag hair and don’t use the surgery clippers!
         Some things not to use
• Ineffective:
   – Lufenuron
   – Chlorhexidine alone
   – Locally applied topical
     ointments
• Potentially toxic:
   – Ketoconazole in cats
• Not legal:                   Alas, not the magic
   – Enilconazole                     bullet
                  Verifying cure
• Effective treatment: fungal cure prior to clinical cure
• Ineffective treatment: clinical cure prior to fungal cure
• Bottom line: need to verify fungal cure
• 3 consecutive negative cultures, one week apart (can use
  only 2 if treat with lime sulfur plus itraconazole)
• Begin after week one of treatment
   Infection control during treatment
• Immediate dip to reduce risk
   – In home, limit access until 2
      weeks treatment

• Isolation and cat-hair control
   – Separate clothing, supplies
   – Daily bedding wash in hot
      water, bleach, dryer

• Written directions in shelter
              What kills ringworm?
• Bleach 1:10
   – Clean surface
   – Repeated twice
• High heat (> 110º F)
   –   Commercial steam cleaner
   –   Commercial dish washer
   –   Dryer
   –   Hot car
• Dry environment and sunlight
  helps
    What doesn’t kill ringworm?
• Chlorhexidine
• Quaternary ammonium
  compounds
• Potassium
  peroxymonosulfate
  (Trifectant, Virkon-S)
• Povidone-iodine
• Time
                             What’s on your exam tables?
      Environmental cure: 5 D’s
• Diagnose
   – Recognize and treat infected
     and carrier animals and
     humans
• Discard
   – Toss heavily exposed items
• Debulk
   – Careful mechanical cleaning
• Disinfect
   – Bleach 1.5 cups per gallon
• Document
   – Environmental culture
                Thank you!




And many thanks to the Shelter Medicine Dermatology Project,
a partnership between the Dane County Humane Society and the
    University of Wisconsin - School of Veterinary Medicine
               Dermatology Research Laboratory

				
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posted:7/25/2009
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