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serovars. Generally, quadrivalent vaccines are in handling animals, their bedding, and all the greatest risk comes from contact with
preferred. laboratory samples, especially urine. Spraying • The Centers for Disease Control and Preven-
infected urine.
VetBooks.ir reactions have been reported with leptospi- be avoided because aerosols can spread the tion (CDC) maintains an informational page Diseases and Disorders
• Although there is a perception that adverse
cages of infected animals with a hose should
rosis vaccines with a disproportionately high
for pet owners: Leptospirosis and Your Pet
organisms.
frequency, one large study demonstrated that
they were no more likely to cause reactions • Laundering patient bedding inactivates (http://www.cdc.gov/leptospirosis/pets/).
leptospires; however, those handling soiled
than other canine vaccines. laundry should wear PPE. Alternatively, SUGGESTED READING
• Rodent control, avoidance of contact with disposable bedding may be used, and the Sykes JE, et al: 2010 ACVIM small animal consensus
reservoir hosts, and proper sanitation/ bedding should be disposed of in biohazard statement on leptospirosis: diagnosis, epidemiol-
drainage are also important. bags. ogy, treatment, and prevention. J Vet Intern Med
25:1-13, 2011.
Technician Tips Client Education
• Leptospirosis can be transmitted from • Owners should be advised to contact a AUTHOR: Mark J. Acierno, MBA, DVM, DACVIM
EDITOR: Joseph Taboada, DVM, DACVIM
infected animals to humans. To prevent physician with expertise in infectious dis-
exposure of people and other animals, eases for recommendations after exposure
strict protective measures should be used to an infected pet and should understand

Lethargy

BASIC INFORMATION RISK FACTORS color, pulse quality, stertor, stridor, crackles,
• Conformation wheezes, decreased heart/lung sounds
Definition ○ Dolichocephalic: aspergillosis, meningioma • Abdominal and lymph node palpation: mass
An abnormal state that is characterized by ○ Brachycephalic: obstructive airway effect, pain, fluid wave, organomegaly
a lower level of consciousness, listlessness, syndrome, chemodectoma • Rectal exam: masses, polyp, melena, hema-
stupor, or inactivity. A common complaint ○ Toy breeds: hypoglycemia, patellar luxa- tochezia, lymph nodes
during veterinary visits, alone or com- tion, tracheal collapse • Orthopedic exam: joint pain, crepitus, or
bined with other clinical signs, lethargy is ○ Large breeds: panosteitis, osteosarcoma, effusion
nonspecific. wobbler syndrome, hip dysplasia • Neurologic exam: cranial nerves, reflexes,
• Geographic location: infectious disease (rick- gait, postural reactions, hyperesthesia
Synonyms ettsial, fungal, oomycotic, parasitic, or bacte- • Ophthalmic exam: vision, glaucoma, uveitis,
Fatigue, apathy, asthenia, weakness, malaise, rial), snake envenomation, dysautonomia fundic lesions
depression • Obesity or malnutrition • Dermatologic exam: petechiae, ecchymosis,
• Electrolyte and/or acid-base disturbance wounds, masses
Epidemiology • Inflammatory or infectious disease
SPECIES, AGE, SEX • Immune-mediated disease Etiology and Pathophysiology
• Puppies or kittens: infectious, metabolic • Organ dysfunction or disease (e.g., cardio- Because the causes for lethargy are diverse, a
(hypoglycemia), or congenital disease; toxin vascular, respiratory, renal, hepatic) systematic approach (see Differential Diagnosis
ingestion • Drugs (e.g., tetrahydrocannabinol [THC], below) is recommended.
• Older animals: endocrine, neoplastic, sedatives, beta-blockers)
cardiovascular, orthopedic, or neurologic • Physiologic stress or pain DIAGNOSIS
disease
• Males: hemophilia A and B, hypertrophic Clinical Presentation Diagnostic Overview
cardiomyopathy (cats), X-linked muscular HISTORY, CHIEF COMPLAINT Diagnostics should be tailored to the individual
dystrophy (dogs) A complete history must address the following patient based on pertinent history and physical
• Females: immune-mediated disease, patent questions: exam findings. In the absence of an identified
ductus arteriosus • Duration of clinical signs higher yield problem, a minimal database (i.e.,
• Concurrent illness or clinical signs CBC, chemistry profile, urinalysis, and blood
GENETICS, BREED PREDISPOSITION • Current medications pressure) may provide diagnostic direction.
Some conditions causing lethargy have a docu- • Vaccination status
mented genetic basis, and others are congenital • Timing of symptoms in relation to exercise, Differential Diagnosis
with a predisposition for specific dog or cat eating, or urination/defecation Organization of differentials can use any of the
breeds. Some examples: • Environment (indoor, outdoor, roaming) following methods:
• Arrhythmogenic right ventricular cardiomy- • Organ system: cardiovascular, respiratory,
opathy in boxers, dilated cardiomyopathy PHYSICAL EXAM FINDINGS gastrointestinal (GI), hepatic, renal, ocular,
in Dobermans, mitral valve endocardiosis Findings depend on the underlying cause of neuromuscular, hematologic
in Cavalier King Charles spaniels lethargy; the exam is often key in narrowing the • Category: metabolic (electrolyte, acid-base
• Copper storage hepatopathy in Bedlington enormous list of potential causes of lethargy. disturbance), inflammatory, infectious,
terriers When present, fever suggests infectious, inflam- immune-mediated, hematologic (anemia),
• Renal amyloidosis in the Shar-pei dog and matory, or neoplastic disorders. endocrine, nutritional disease or derangement
Bayesian cat • Cardiovascular and thoracic auscultation: • DAMN-IT V scheme: degenerative or devel-
• Hypoadrenocorticism in the standard poodle murmur, arrhythmia, mucous membrane opmental, anomalous/allergic/autoimmune,

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