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Diagnosis and Management of Pneumonia
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Primary bacterial pneumonia is uncommon in dogs and cats. Therefore, the diagnostic work-up of animals with pneumonia must include a search for underlying diseases that allow development of pneumonia. Similarly, underlying disorders must be controlled in order to achieve effective therapy.
Bacterial Pneumonia
Dogs or cats with bacterial pneumonia often have a history of a productive cough, fever, tachypnea, and respiratory distress. However, some animals present with more vague signs such as malaise, depression, anorexia, and weight loss, and their presentation may be acute or chronic. A change in the respiratory pattern can be an early indicator of parenchymal disease, since alveolar flooding by inflammatory debris leads to restrictive lung disease and a rapid shallow breathing pattern. Thoracic auscultation is typically abnormal with loud bronchial noises and moist crackles variably detected throughout the lung fields. Absence of lung sounds in an area may be suggestive of lobar consolidation. A mucopurulent nasal discharge can be seen if animals cough respiratory secretions into the nasopharynx or have coincident nasal infection.
A complete database will aid in establishing the severity of the pneumonia and identifying predisposing conditions. Leukocytosis with a left shift supports the diagnosis of bacterial pneumonia in an animal with appropriate signs, however a normal white blood count is commonly found. Neutropenia with a degenerative left shift suggests fulminant pneumonia with pulmonary sequestration of neutrophils and would be an indicator for initiation of aggressive diagnostics and therapy to control disease. A biochemical profile and urinalysis assist in the diagnosis of underlying conditions and systemic involvement. FeLV/FIV serology should be performed in cats with pneumonia although a direct association has not been made between viral status and the incidence of bacterial pneumonia. Canine distemper virus, canine influenza virus, and calicivirus should be considered as predisposing causes of pneumonia in young animals.
Diagnostic Imaging and Sampling
Alveolar infiltrates with air bronchograms are considered the classic radiographic findings in bacterial pneumonia. Lobar consolidation occurs as alveolar infiltration coalesces to involve an entire bronchial tree. A cranioventral distribution of infiltration is often found with aspiration pneumonia. The right middle lung lobe or both middle lobes are often involved when pneumonia occurs secondary to aspiration or bronchial obstruction because of the ventral branching of these lobar bronchi from the trachea. Hematogenous spread of bacteria would be expected to result in a more generalized bronchoalveolar pattern.
Direct airway sampling through tracheal wash, bronchoscopy with bronchoalveolar lavage, or fine needle aspiration of the lung is indicated to confirm a bacterial etiology of pneumonia and to obtain samples for gram stain, culture/antibiotic sensitivity testing, and cytology. Gram staining characteristics and cytologic findings of septic suppurative inflammation can be useful for initiating early antibiotic therapy. [...]
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