Page 1356 - Cote clinical veterinary advisor dogs and cats 4th

684 Necrotizing Fasciitis

• Foreign body/abscess out infectious causes can exacerbate infectious brace so it fits properly, and the owner and
clinician should monitor the animal.
diseases.
• Trauma/fracture • If spinal instability is suspected, a neck brace • Paralysis or death is possible with acute spinal
VetBooks.ir Initial Database for immobilizing the neck can provide pain Recommended Monitoring
• Neoplasia
injury.
relief and prevent further tissue damage. Cage
• Neurologic and orthopedic exams (p. 1136
the same purpose.
and 1143) rest and exercise restriction are important for Any dog with signs of neck pain should be
• CBC, serum biochemistry panel, urinalysis closely monitored for the development of
• Neck radiographs Chronic Treatment neurologic conditions such as ataxia, paresis,
Specific treatment of the underlying cause is paralysis, and respiratory impairment. These
Advanced or Confirmatory Testing paramount. Nonspecific treatment should not conditions often warrant further intervention
• Myelography, CT, or MRI (p. 1132): very interfere with diagnosis or treatment of the and intensive care.
useful for spinal imaging underlying cause:
○ Myelograms with dynamic views (under • Nonsteroidal antiinflammatory drugs PROGNOSIS & OUTCOME
careful patient manipulation) may be (NSAIDs (e.g., carprofen 2 mg/kg PO q 12h,
useful for diagnosis of CSM and for IVDD etodolac 10-15 mg/kg PO q 24h, deracoxib Varies, depending on underlying disease process
and some spinal tumors. 1-2 mg/kg PO q 24h, firocoxib 4-5 mg/kg
○ MRI is best for spinal cord and nerve PO q 24h, grapiprant 2 mg/kg PO q 24h, PEARLS & CONSIDERATIONS
lesions and increasingly used for IVDD. or meloxicam 0.1 mg/kg PO q 24h)
○ CT is best for evaluating bony lesions • Low-dose glucocorticoids: never combine Comments
(spinal tumors or fractures) and can be with NSAIDs. Glucocorticoids should be • Neck pain in certain dog breeds is a common
used as an adjunct to myelography. tapered after improvement. Typical recom- problem in clinical practice.
• Cerebrospinal fluid (CSF) tap if meningitis or mended course: prednisone 0.25-0.5 mg/kg • All dogs being considered for nonspecific
neoplasia is suspected (pp. 1080 and 1323) PO q 12h × 4-5 days, then q 24h for 4-5 supportive treatment should first have cervi-
• Serologic titers or polymerase chain reaction days, then q 48h for 4-5 doses cal spinal radiographs.
(PCR) testing of blood or CSF as appropriate • Amantidine 3-5 mg/kg PO q 24h, tramadol • Cage rest, typically for at least 4 weeks, is a
(e.g., CDV, Brucella card test) 1-4 mg/kg PO q 8-12h, or gabapentin critical component of conservative treatment
• Aspiration or biopsy of abnormal tissues 10 mg/kg PO q 8h for adjunctive pain for dogs with IVDD.
• Ultrasound of soft tissues to locate an control • If a dog does not respond appropriately
abscess, foreign body, neoplasm, or other • Acupuncture (p. 1056) to nonspecific supportive therapy, the
such abnormalities • Surgery if indicated by imaging, emergent clinician should perform further diagnostic
• Surgical exploration: histopathologic evalu- disorder, and/or lack of response to conserva- testing.
ation of tissue samples, bacterial culture and tive therapy
susceptibility (C&S) • Treatment of specific infectious disease if Technician Tips
• Urine culture ± blood culture (p. 1333) if identified • Observe for any signs of developing weakness
there is a concern about discospondylitis or neurologic deficits.
Behavior/Exercise • Progressive swelling/pain and heat may
TREATMENT • Exercise restriction alert to need for additional diagnostics and
• Use of a harness instead of a collar for walks treatment.
Treatment Overview • Elevation of food and water bowls
In most cases, therapeutic tenets are relief of Client Education
pain, immobilization if movement is detrimental Drug Interactions • Owners should be informed to use a harness
or painful, and treatment of underlying disease Do not coadminister NSAIDs with glucocorti- for walks.
process. coids due to risk of serious or life-threatening • Cage rest is critical in conservative manage-
gastroenteritis and gastrointestinal (GI) ment of IVDD.
Acute General Treatment ulceration. • The clinician should inform the owner about
• Animals with acute severe neck pain are exercise restrictions.
often initially treated with cage rest and Possible Complications
medications such as analgesics (hydromor- • Adverse reactions to the medication, SUGGESTED READING
phone 0.1-0.2 mg/kg SQ, IM, or IV q especially GI ulceration caused by taking Platt SR, et al: Cervical spine. In Tobias KM, et al,
4-6h, buprenorphine 10-30 mcg/kg IV q glucocorticoids and NSAIDs simultaneously editors: Veterinary surgery: small animal, St. Louis,
6-8h, or butorphanol 0.1-0.2 mg/kg IV as • Pneumonia is a common complication in 2012, Saunders, pp 410-448.
needed up to q 4h) and/or muscle relaxants dogs that have tetraparesis and are recumbent. AUTHOR: David A. Puerto, DVM, DACVS
(methocarbamol 20-50 mg/kg PO q 8h). • Respiratory obstruction is possible with a EDITOR: Leah A. Cohn, DVM, PhD, DACVIM
Empirical glucocorticoids given before ruling neck brace; it is important to adjust the

Necrotizing Fasciitis Client Education
Sheet

Epidemiology
BASIC INFORMATION to tissue necrosis, severe pain, and septic
shock SPECIES, AGE, SEX
Definition Dogs and cats of any age or sex
Fulminant, rapidly progressing infection of Synonyms
the skin, subcutis, and fascia that can lead Flesh-eating disease, flesh-eating bacteria

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