Piodermita Caine
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Transcript of Piodermita Caine
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Managementul piodermitelor la caine
Conf.univ.dr. Viorel Andronie FMV-Spiru Haret
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Infectiile bacteriene-etiologie
• Organisme rezidente se multiplica pe pielea normala • Organisme tranzitorii nu se multiplica pe pielea normala • Organisme patogene adevaratele cauze ale bolii • Coci: Staphylococcus pseudintermedius +++ • Bacili: Pseudomonas spp., E. coli, ...
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Staphylococcus pseudointermedius
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Infectii bacteriene-patogeneza
Adeziune Colonizare Multiplicare Invazie Apararea cutanata... •Bariera cutanata •Peptide antimicrobiene •Sistemul imun al pielii
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Infectii bacteriene-secundare
• trauma • stres • hipersensibilitate • tulburari hormonale • ectoparaziti
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Infectiile bacteriene-patogeneza
Contrar altor specii, cainii prezinta predispozitie pentru infectiile bacteriene:
• stratum corneum este mult mai subtire si mai compact fata de alte specii
• emulsia intercelulara este insuficienta…lipide • la caine, foliculul pilos prezinta un
infundibulum deschis, lipsit de un dop de sebum
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Infectiile bacteriene-clasificare
• Superficiale si benigne (membrana bazala nu este distrusa)
• Profunde si severe (membrana bazala este distrusa)
• Pseudopiodermite (infectii secundare)
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Infectiile bacteriene-clasificare
• De suprafata si superficiale • Intertrigo • Impetigo • Foliculita • Profunde • Furunculoza • Celulita • Pseudopiodermite • Piodermita juvenila
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Piodermite de suprafata
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Impetigo
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Foliculita
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Furunculoza
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Celulita
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Celulita
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Infectiile bacteriene NOI-clasificare
• Piodermita superficiala • Sindromul de supracrestere bacteriana (BOG) • Foliculita/furunculoza piotraumatica • Piodermita muco-cutanata • Piodermita gram negativa • SSTCS • Fasciita necrozanta • Sindromul granulomatos leproid
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Diagnostic
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Semne clinice
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Semne clinice
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Citologie
intertrigo si dermatita piotraumatica: colonizare bacteriana • neutrofile sanatoase si degenerate • germeni patogeni extra- and intracelulari
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Citologie
impetigo si foliculita: invazie bacteriana • reactie supurativa : neutrofile decolorate,
umflate, cu nuclei hipersegmentati si picnotici • fagocitoza la nivelul leziunii cutanate :
sugestiva pentru patogenitate • uneori eozinofile
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Citologie
Piodermita profunda: • reactie piogranulomatoasa • fagocitoza mai rara • eozinofile • eritrocite
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Citologie
BOG : • absenta celulelor inflamatorii • numerosi coci • aderenta la corneocite
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Cultura bacteriana:cand????
• Piodermite ce nu raspund la terapia “empirica” • • Posibil a avea un « patogen rezistent » • Prezenta unui bacil in citologie • • Posibil a fi dificil de tratat • Piodermite profunde • • Posibil a necesita tratament de lunga durata • Diferenta intre bacterian vs steril • • Pot sa nu necesite antibiotice
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Cultura bacteriana: cum?
• Prelevare de probe cu tampon
• • Cand sunt prezente pustule/furuncule/fistule
• Prelevare de probe prin biopsie
• • Cea mai buna metoda in cazul piodermitei profunde
• Examen bacteriologic competent!
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Biopsia pentru cultura bacteriana
• Prelevare aseptica de probe cu ajutorul biopsiei
• Proba se injumatateste • Se trimite la laborator
jumatatea inferioara a probei
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Tratament
• Antiseptice topice
• Antibiotice topice
• Antibiotice sistemice
• Tratamentul cauzei
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Antiseptice topice
• Sampoane • Lotiuni • Tampoane ...
• Clorhexidina • Peroxid de benzoil • Etil-lactat • Iod • Piroctona-olamina
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Antibiotice topice
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Antibiotice sistemice • Prima optiune • A doua optiune • Cefalexine • Amoxicilina+acid
clavulanic • Clindamicina • Sulfonamide potentate • Fluoroquinolone • Durata • 3 saptamani(Superficiale) • 6-12 sapatamani(Prof.)
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Selectia antibioticelor • Bactericide • Activitate anti stafilococi
coagulazo + • Nu sunt inactivate de B-
lactamaze • Buna distributie la nivelul pielii • Timp si concentratie adaptate • Fara efecte secundare • Usurinta administrarii
• Eficacitatea terapiei cu antibiotice depinde de obtinerea si mentinerea unei concentratii suficiente la locul infectiei, incat sa poata omori, sau produce scaderea cresterii bacteriene
• Trebuie administrate dozele ideale
• Durata terapiei trebuie sa fie suficient de lunga pentru a efectua o cura (cateva saptamani pana la cateva luni si intotdeauna peste durata curativa clinica)
• Glucocorticoizii nu trebuie niciodata folositi in tratamentul piodermitei canine
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Problema de viitor…cea a rezistentei
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Rezistenta antimicrobiana
* Rezistenta a existat intotdeauna... • Mutatia bacteriana: celulele rezistente • Contactul cu antimicrobienele este selectiv
pentru acestea, daca nu se depaseste concentratia de prevenire a mutatiei
• Rezistenta este proportionala cu densitatea selectiei
* Rezistenta pare sa creasca in dermatologie
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Selectia antibioticelor • Cefalexina (15-30 mg/kg de doua ori/zi)
• Amoxicilina-Acid clavulanic (12,5-15
mg/kg de doua ori/zi)
• Clindamicina (11 mg/kg o data/zi)
• Sulfamida + trimetoprim (30 mg/kg o data sau de doua ori/zi)
• Enrofloxacina (10 mg/kg o data/zi), Marbofloxacina (2 mg/kg o data/zi), Pradofloxacina (3 mg/kg o data/zi)
• Cefovecina (8 mg/kg SC o data/14 zile)
• Clasa 1: de preferat pt administrare • 1a: eficacitate>90% in SPI (cefalexina,
amoxicilina, acid clavulanic, ac fuc) • 1b: eficacitate>70% in SPI (trimetoprim si
sulfamida, clindamicina) • Clasa 2: administrare “restrictionata” • 2a: indicatii precise dupa cultura bacteriana:
fluoroquinolone • 2b: cazuri rare de conformitate: cefovecine • Clasa 3: antibiotice cutanate
nerecomandate (rezistenta frecventa la ampicilina,
amoxicilina, penetrare scazuta tetraciclina, potentiala toxicitate gentamicina)
• Clasa 4:Nu se utilizeaza niciodata: csp de generatia a-3-a autorizate pentru alte animale, ab de uz uman, ab pentru utilizare in spital
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Justificarea dozei si a duratei • NU se utilizeaza: • Rifampicina • Vancomicina • Pristamicina • Imipenem • NU se utilizeaza niciodata doze
mici!
• Absenta tratamentului etiologic 81%
• Durata prea mica de administrare 61%
• Doza prea mica de antibiotic 54% • Ritm inadaptat sau AB inadaptat
17% • Utilizarea concomitenta a
corticoizilor 74% • Insuficienta monitorizare a
cazului 58% • Terapie topica insuficienta 88% • Informatii insuficiente oferite
proprietarilor
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Va multumesc!