Solution for case 17


Tentative Diagnosis: Parvovirus infection


Differentials: 

  • Coronavirus infection
  • Bacterial gastroenteritis
  • Foreign body
  • Hemorrhagic gastroenteritis
  • Intussusceptions
  • Intestinal parasites
  • Toxins
Further diagnostic tests: 

  • ELISA for Parvovirus
  • Fecal exam
  • Radiograph
ELISA was positive for this patient and as this patient had no recent history of Parvo-vaccination the test was a true positive. 
ELISA can have false negatives and false positives for Parvo. False positives are because of recent vaccination which was not in this case. Supporting the diagnosis of Parvo is the leukopenia which is very commonly seen in Parvo generally due to a neutropenia. It is often common to have an azotemia (increased BUN and Creatine) with Parvo. Icterus can also be associated with Parvo but not commonly.

Parvo is a highly contagious disease and positive dogs should be kept in isolation.

Complications to be aware of are sepsis, shock, disseminated intravascular coagulopathy, intussusception, and acute respiratory distress syndrome. Sepsis prevented by administering antibiotics. Shock and DIC are prevented by fluid therapy. Intussusceptions must be monitored for by doing abdominal palpation and possibly radiographs. These puppies are at a high risk of this because of the hypermotility of the gut.

Treatment and management: There is no cure for Parvo only palliative treatment. 

Lactated Ringers solution and antibiotics (Ampicillin and Enrofloxacin) were administered to the patient. Hetastarch was also added to the fluids because of the decrease of Total Protein to compensate for the decrease in oncotic pressure. Metaclopramide was also given to stop vomiting. Nothing per os was prescribed for 24 hr. Once infected and recovered, animals will be immune for life. 

Case 17

Presentation: A 6 week old intact female puppy was presented to AcaseAweek Clinic for vomiting, bloody diarrhea and anorexia for last two days. 

Physical Exam: 
  • Quiet Alert and Responsive.
  • Membranes were jaundiced.
  • Otherwise Physical Exam was unremarkable.
CBC:
  • HCT 17.8% (37-55)
  • HGB 6.5 g/dl (12-18) 
  • MCHC 36.5 g/dl (30-36.9)
  • WBC 2.4 x109/L (6.0-16.9)
  • Gran 1.8 x109/L (3.3-12)
  • PLTs 48 x109 /L (175-500)
Chemistry:
  • ALKP 841 U/L (46-337)
  • ALT 10 U/L (8-75)
  • BUN 102 mg/dl (7-29)
  • Crea 2.6 mg/dl (0.3-1.2)
  • Glu 365 mg/dl (77-150)
  • TP 4.7g/dl (4.8-7.2) 

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