The sneeze and snot of feline nasal disease (Proceedings)


The sneeze and snot of feline nasal disease (Proceedings)

Apr 01, 2010

The goal of this presentation is to simply the diagnostic approach and treatment of nasal disease in the feline patient.

Case studies will be utilized in this presentation.

Characterize the nasal disease

     Unilateral or bilateral
     Type of discharge - serous, mucoid, mucopurulent, hemorrhagic
     Duration of disease – acute or chronic
     Response to previous therapy

Consider disease rule-outs

     Dental disease/ tooth root abscess
          Cats – most common tooth affected is the canine tooth
     Foreign object (grass, needle, other)
     Nasopharyngeal polyp
     Nasal/Sinus Infection
          Bacterial – primary pathogens such as Mycoplasma, Chlamydia psittaci, Bordatella bronchiseptica
          Bacterial – secondary bacterial overgrowth (not the primary problem)
          Viral – Feline herpes virus 1, Calicivirus
           Fungal – Cryptococcus neoformans, Aspergillus spp.
          Parasitic – nasal mites
     Neoplasia squamous cell carcinoma, adenocarcinoma, lymphoma, fibrosarcoma, osteosarcoma, chondrosarcoma, other
     Dysphagia, vomiting, regurgitation
     Congenital/ palate defects
     Coagulopathy, platelet disorder
     Systemic hypertension

Perform a complete physical exam, paying particular attention to

     Checking teeth/ thorough oral exam (hard and soft palate)
     Checking ear canals
     Ophthalmic exam/retropulsion of globes
     Checking patency of nasolacrimal ducts (fluorescein stain)
     Glass slide test to assess nasal airflow (visualize steam on glass slide)

Start diagnostic testing (progress from least invasive to more invasive procedures)

     Obtain minimum database – CBC, biochemistry profile, urinalysis, feline viral tests, blood pressure measurement, chest radiographs
     If discharge is primarily hemorrhagic – blood pressure measurement, coagulation tests (prothrombin time (PT), activated partial thromboplastin time (PTT), or activated clotting time (ACT), platelet count
     Nasal cytology - low yield but may help identify fungal infections
     Viral detection tests – PCR, direct fluorescent antibody staining, virus isolation by culture; document presence of virus; low value for proving disease as many healthy cats are positive
     Laryngeal function exam
     Imaging (Skull radiographs, CT scan) under general anesthesia = Road Map
     Nasal flush - may help remove foreign objects like grass
Nasal culture - helps identify secondary bacterial infections, may occasionally isolate fungal infection; culture of deep tissue obtained by biopsy more useful.
     Nasal biopsy – rhinoscopy allows visualization of lesion(s) and biopsies of the affected areas; biopsies may also be obtained without rhinoscopy