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Juvenile Cellulitis 567

○ Diazepam 0.5-1 mg/kg IV, or • Amiodarone and allows higher levels of ivermectin into
○ Midazolam 0.1-0.3 mg/kg IV, IM • Cyclosporine • Activated charcoal is beneficial even with
the CNS).
VetBooks.ir • Lipid emulsion therapy 20% solution (p. • Erythromycin parenteral overdoses of ivermectin due to Diseases and Disorders
• Bradycardia: atropine 0.01-0.02 mg/kg IV,
• Diltiazem
IM
• Fluoxetine, paroxetine
enterohepatic recirculation of ivermectin.
1127)
○ Initial bolus 1.5 mL/kg, then 0.25 mL/ • Itraconazole, ketoconazole Prevention
• Spironolactone
kg/min for 30-60 minutes; repeat every 4 • Spinosad • Double check strength and dose before
hours provided no hyperlipemia is present • Tacrolimus sending home extra-label dosing.
and patient is responding to therapy. If no • Do not use extra-label doses of ivermectin
response after three doses, discontinue. If Possible Complications with spinosad-containing flea control
patient is hyperlipemic, discontinue until Watch for declining mental status, loss of gag products.
serum clears. reflex, or respiratory depression because they • Test at-risk breeds for ABCB1 mutation
○ Adverse effects include potential binding of increase the risk of aspiration, particularly before using ivermectin at doses higher than
therapeutic lipophilic drugs, hyperlipemia, with administration of activated charcoal or approved for prevention of heartworm.
pancreatitis, hemolysis, liver enzyme eleva- vomiting.
tion, and corneal lipid deposition. Technician Tips
• Nursing care for recumbent patients Recommended Monitoring Check and double check math before giving
○ Ocular lubricant Monitor mental status, cardiovascular, and any ivermectin by injection.
○ Appropriate bedding, frequent rotation to respiratory systems closely.
prevent decubital ulcers and urine scalding Client Education
○ Thermoregulation PROGNOSIS & OUTCOME • Educate owners to the dangers of using large-
• Fluid therapy for hydration and proper animal products in small animals because
electrolyte balance Prognosis largely depends dose and severity of they can quickly lead to severe intoxication.
• Mechanical ventilation may be needed for clinical signs. Animals that become symptomatic • Educate owner about potential adverse
more severely affected patients (p. 1185) within the first 4 hours have a worse prognosis. effects with extra-label dosing, and advise
• Physostigmine 1-2 mg IV; nonspecific In severe cases, significant care (ventilator, monitoring for ataxia and mydriasis with
CNS stimulant; can wake dog up for 30-90 feeding tube, nursing care) may be needed for extended treatment.
minutes so it can eat (repeated dosing to extended periods (days to weeks). No long-
keep dog awake can cause seizures) term sequelae are expected for patients that SUGGESTED READING
recover. Merola VM, et al: Toxicology of avermectins and
Nutrition/Diet milbemycins (macrocylic lactones) and the role of
Feeding tube may be needed for recumbent/ PEARLS & CONSIDERATIONS P-glycoprotein in dogs and cats. Vet Clin North
comatose patients as signs may last weeks Am Small Anim Pract 42(2):313-333, 2012.
(pp. 1106 and 1107) Comments AUTHOR: Kirsten Waratuke, DVM, DABT
• When prescribing ivermectin for extra-label EDITOR: Tina Wismer, DVM, MS, DABVT, DABT
Behavior/Exercise use, make sure strength and dose are clear
Exercise restriction may be needed until signs on the label.
fully resolve. • Other drugs in this class (moxidectin,
milbemycin, selamectin, doramectin, and
Drug Interactions abamectin) have similar toxic effects and
Avoid concurrent use of other drugs that can treatment.
inhibit P-glycoprotein or may be G-glycoprotein • Avoid use of extra-label doses of ivermectin
substrates. with spinosad (spinosad affects P-glycoprotein

Juvenile Cellulitis

BASIC INFORMATION confirmed cases in young adults have been edematous pinnae, and/or submandibular
reported. One or more puppies in the same lymphadenopathy.
Definition litter may be affected.
A sterile vesiculopustular to granulomatous skin PHYSICAL EXAM FINDINGS
disease of the face, pinnae, and submandibular GENETICS, BREED PREDISPOSITION • Initially, acute swelling of face
lymph nodes primarily affecting dogs < 4 Heritability is supported by an increased • Within 24-48 hours, vesicles and pustules
months old occurrence in certain breeds and breeding appear around mouth, eyes, and on muzzle.
lines. Predisposed breeds include golden Lesions rapidly develop into a serous to
Synonyms retrievers, Labrador retrievers, dachshunds, purulent exudative dermatitis with or without
Puppy strangles, juvenile sterile granulomatous and Lhasa apsos, although mixed breeds can be fistulation.
dermatitis and lymphadenitis affected. • Serous to purulent bilateral otitis externa
with edematous pinnae is common.
Epidemiology Clinical Presentation • Marked regional (submandibular and
SPECIES, AGE, SEX HISTORY, CHIEF COMPLAINT prescapular) to diffuse lymphadenopathy is
Puppies of either sex between 3 weeks and 4 Puppies are presented for an acutely swollen common. Submandibular lymphadenopathy
months old are typically affected, although face (especially the eyelids, lips, and muzzle), may occur as only clinical abnormality.

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