Infectious Disease Management in Animal Shelters. Группа авторов

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No abnormalities found Examples included but not limited to:Ocular, nasal, aural discharge;Heart murmur or arrhythmia;Coughing, sneezing, difficulty breathing;Painful abdomen, vomiting, diarrhea;Hair loss, flaking, crusting, redness of skin

      a Normal heart rate (beats per minute or bpm) and respiratory rate (breaths per minute or bpm) will vary considerably based on age, species, and breed and may exceed the parameters listed. In general, puppies and kittens have higher rates than adult animals and large breed dogs will have lower rates than smaller breeds. Environmental influences such as stress and ambient temperature can also temporarily impact heart rate, respiratory rate and body temperature.

      4.3.1.3 Response to Treatment

      A final core diagnostic tool with which the shelter practitioner should be proficient is the appropriate use of response to treatment to make a presumptive diagnosis. Response to treatment refers to the empirical prescribing of medications or courses of treatment without confirmation of a diagnosis. Rather, a presumptive diagnosis and treatment are based on historical information and physical examination findings, and the diagnosis is presumed to be correct based on the resolution of the clinical problem. Careful utilization of this technique can provide benefits of immediately addressing existing conditions, minimizing opportunities for infectious disease transmission, and, when the presumptive diagnosis is correct, reducing the time and costs associated with obtaining a definitive diagnosis before initiating treatment. However, there are significant downsides to relying on this technique on a routine basis. When used indiscriminately, reliance on response to treatment can result in misdiagnosis; misuse of pharmaceuticals; prolonged time to diagnosis, treatment, and disease resolution; and an overall ineffective use of resources. Utilizing response to treatment as a basic diagnostic tool may be considered in the following circumstances:

       An urgent threat to animal health or welfare

       Severe medical resource limitations

       Diagnostic testing options are limited in accuracy, availability, or practical turnaround time

       Inability to obtain veterinary care (e.g. after‐hours or irregular access to veterinary support)

       Treatment is likely to provide substantial benefit but unlikely to cause harm.

      In each case, a response to treatment protocol should be developed under the direction of a veterinarian familiar with the shelter population, community resources, and limitations. Model protocols include the following components:

       Re‐evaluation of patient status after starting treatment and regularly thereafter

       The appropriate use of first‐line antimicrobials (e.g. amoxicillin vs. amoxicillin and clavulanic acid) (See Chapter 7 for more information.)

       Defined end‐points after which definitive diagnostics or a revised treatment plan will be pursued

       Periodic review of SOPs including evaluation of antimicrobial choices based on definitively diagnosed conditions.

      Common shelter scenarios in which response to treatment may be beneficial include mild upper respiratory infections (URIs), mild enteritis, first‐time urinary tract infections (UTIs), minor wounds, and superficial pyoderma.

      4.3.2 Primary Diagnostic Testing

      4.3.2.1 ELISA

Diagnostic Test Indications Collection and Handling Techniques
Cytology
Fine needle aspirate Evaluate mass lesions in the skin, subcutaneous tissue, thorax, and abdomen (A) Insert a 21–25 g needle attached to a ≥5 ml syringe into the lesion; apply 3–5 ml of vacuum; move the needle forward and back while altering direction; release the vacuum and withdraw needle; (B) Insert a 21–25 g needle directly into the lesion; move the needle forward and back while altering direction; withdraw the needle.Remove needle (A) and aspirate 3–5 ml of air into the syringe; (A, B) attach the needle to the syringe and depress the plunger to deposit a drop of aspirated material onto the slide.
Impression smears, imprints, or swabs Superficial lesions, otic cytology, surgical biopsy specimens Ensure the sample site is clean and dry.Gently press clean glass slide on or rub cotton swab across the surface of the tissue.Roll cotton swab across a clean microscope slide.
Scrapings Diagnosis of external parasites (e.g., Demodex spp.), pyoderma, cutaneous lesions, surgical biopsy specimens Hold a sterile scalpel blade at a 90° angle to the surface of the tissue; scrape vigorously across the surfaceThe edge of a glass slide can also be utilized to obtain superficial surface samplesFor diagnosis of demodicosis, utilize a scalpel blade and scrape until capillary bleeding occursFor cutaneous lesions and surgical biopsy specimens, ensure the tissue is clean and dry prior to scraping
Immunoenzyme assays
ELISA Antigen or antibody detection: infection or exposure (e.g., Anaplasma spp., Borrelia burgdorferi, canine parvovirus, Dirofilaria immitis, Ehrlichia spp., feline panleukopenia, feline leukemia, Giardia), antibody titer assessment (canine parvovirus, canine distemper, feline panleukopenia) Hormonal assays: luteinizing hormone, relaxin Vary by assay; see individual techniques below and refer to test manufacturer guidelines
Multi‐well test kits (e.g. ASSURE®/FeLV, DiroCHEK®, TiterCHEK® CDV/CPV [Zoetis, Parsippany‐Troy Hills, NJ]) Anticoagulated whole blood, serum or plasma samplesaSamples can be fresh, refrigerated for up to 7 days, or frozen and thawedaStore test kits under refrigeration until the expiration
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