Page 72 - Problem-Based Feline Medicine

64 PART 2 CAT WITH LOWER RESPIRATORY TRACT OR CARDIAC SIGNS

● Initial empirical choices can be based upon Gram is worse in patients with pre-existing illness (neopla-
stain of the cytology sample. sia, multiple trauma, multiple organ failure), or
– Gram negative rods – amikacin, fluoro- patients on immunosuppressive therapy for immune-
quinolones, trimethoprim-sulfa, chloramphenicol. mediated disease or organ transplantation.
– Gram positive cocci – beta-lactams, trimetho-
Prognosis for cryptococcal pneumonia is generally
prim-sulfa, chloramphenicol.
fair to good provided the cat is not debilited on pres-
– Bordetella – amikacin, tetracycline, chloram-
entation, and therapy is continued sufficiently long
phenicol.
enough for antibody titers to fall to zero.
– Anaerobes – beta-lactams, second-generation
cephalosporins, clindamycin.
Fungal pneumonia requires antifungal therapy.
Prevention
● Itraconazole at 5–10 mg/kg PO daily is the drug
of choice, with 50–60% response rates quoted in Avoid the source of infectious agents, such as bird
cats. droppings and other risk factors, for example, aspira-
● Amphotericin B (0.25 mg/kg IV q 2 days), alone tion after anesthesia.
or in combination with itraconazole.
● If CNS signs are present with cryptococcosis, flu-
conazole (2.5–5.0 mg/kg PO daily) is the drug of
choice to cross the blood–brain barrier (see LARYNGEAL EDEMA
Cryptococcosis, page 27 in The Cat With Signs of
Chronic Nasal Disease). Classical signs
Viral pneumonia treatment is mostly supportive. ● Inspiratory dyspnea.
There is no clear evidence to suggest antiviral therapy ● Stertorous breathing.
is of benefit. Low-dose oral alpha interferon (30 IU
PO daily) may possibly be beneficial, although reports See main reference page 42 (The Cat With Stridor).
are anectdotal.
Supportive care is vital. Airway and systemic hydra-
tion are essential for mucociliary clearance. Clinical signs
● Intravenous crystalloids need to be used judiciously
Inspiratory dyspnea which may be associated with
if there is increased vascular permeability in the
severe respiratory distress.
lung.
● Nebulization with saline may be helpful. Stertor occurs, which is worsened with excitement or
● Physical therapy, such as positional changes, exercise.
coupage of the chest wall (percussion with a cupped
hand) and enforced mild exercise, all enhance the
clearance of debris from the lung.
Diagnosis
● Oxygen enrichment via nasal O catheter, oxygen
2
tent or cage may be essential in critical cases. Acute onset of inspiratory dyspnea.
● Bronchodilator therapy remains controversial in the
Laryngoscopic inspection under heavy sedation or
treatment of pneumonia.
light anesthesia with a rigid laryngoscope and blade
reveals erythema and edema of the laryngeal mucosa.
Prognosis
Prognosis depends on the agent and the severity of the
infection. Differential diagnosis

Bacterial pneumonia has a fair to good prognosis if Laryngeal paralysis, laryngeal mass lesion or foreign
there are no other debilitating factors, but prognosis bodies.