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1000 Ulcerative and Erosive Skin Disorders

• Specific antimicrobial therapy is required, Recommended Monitoring Prevention
but comparative efficacy studies for cats are • Monitor temperature, heart rate, respiratory • Control of arthropod vectors
VetBooks.ir cin, or doxycycline is most commonly used, status, and blood pressure; monitor for Technician Tips
rate and effort, body weight and hydration
lacking. In humans, gentamicin, ciprofloxa-
• Limit exposure to rabbits, rodents, and other
wild mammals.
with relapse more commonly reported after
complications of sepsis.
treatment with bacteriostatic antimicrobials
(tetracycline, chloramphenicol). • For patients receiving aminoglycosides, • Tularemia is extremely infectious and
monitor urine sediment and serum blood
○ For cats, gentamicin (only once the urea nitrogen (BUN) and creatinine. readily transmitted from infected animals
patient is well hydrated), fluoroquino- to humans.
lones, tetracyclines, erythromycin, and PROGNOSIS & OUTCOME • Strict protective measures should be used
chloramphenicol have been used. in handling animals, their bedding, and all
○ Beta-lactam antibiotics and azithromycin • Can be rapidly fatal in untreated cats with laboratory samples.
are not effective. overt clinical signs • Use of hoses to clean cages of infected
○ Pradofloxacin 7.5 mg/kg PO q 24h for • Self-limited infection in most dogs animals, or blow dryers or fans in the
10 days, or • Rapid resolution of fever follows administra- proximity of the patient, is contraindicated.
○ Enrofloxacin 5 mg/kg IM, IV q 24h for tion of appropriate antibiotic. Resulting aerosols may cause exposure by
10 days (if IV, dilute with saline and inhalation and subsequent pneumonic
administer slowly), or PEARLS & CONSIDERATIONS tularemia, the most highly fatal form of
○ Gentamicin 5-8 mg/kg IV, SQ, or IM q the disease in people.
24h for 7-14 days. Ensure hydration and Comments
normal renal function before treatment to • May be underreported in dogs because of Client Education
reduce risk of nephrotoxicity; in animals the mild, self-limited nature of disease. • Multiple reports of transmission to humans
with chronic kidney disease, decrease • Highly infectious and zoonotic: multiple from infected cats (cat bite, cat scratch,
dose of aminoglycoside or choose another reports of tularemia in humans acquired cutaneous contact) and from pet prairie dogs
antibiotic. by cat bite • No recorded transmission from infected dogs
• Centers for Disease Control and Prevention to humans, but the possibility is not excluded
Drug Interactions (CDC) class A pathogen; potential bioter-
• Aminoglycosides: avoid concurrent use of rorism agent SUGGESTED READING
other renally excreted or potentially ototoxic • Tularemia awareness is important for Larson MA, et al: Francisella tularensis bacteria associ-
drugs (e.g., furosemide, cephalosporins). veterinarians to (1) recognize, treat, and ated with feline tularemia in the United States.
• Fluoroquinolones may alter metabolism prevent disease in animal patients; (2) Emerg Infect Dis 20:2068, 2014.
of other drugs, leading to toxicosis (e.g., prevent disease exposure to themselves and AUTHOR: Marcella D. Ridgway, VMD, MS, DACVIM
theophylline); avoid > 5 mg/kg/day of other people in contact with infected animals; EDITOR: Joseph Taboada, DVM, DACVIM
enrofloxacin in cats due to retinal toxicity. and (3) recognize potential bioterrorism in
an unexplained increase in cases.
Possible Complications • Tularemia is a reportable disease in most
• Sepsis (p. 907) U.S. states; many states require immediate
• Disseminated intravascular coagulation (p. reporting (within 3 hours). Reporting regula-
269) tions vary by country, state, and within-state
• Acute kidney injury/anuria (p. 23) region and may change.

Ulcerative and Erosive Skin Disorders

BASIC INFORMATION GENETICS, BREED PREDISPOSITION • Presence of signs of systemic illness (e.g.,
Some diseases have a genetic basis or are related lethargy, anorexia, lameness) may narrow
Definition to anatomic defects (e.g., intertrigo in English the differential diagnosis (e.g., systemic
A cutaneous erosion is a shallow epidermal defect bulldogs and Chinese Shar-peis). lupus erythematosus [SLE], leishmaniasis,
that does not penetrate the basement membrane. Clinical Presentation systemic mycoses), and diagnostic methods
Erosions are usually associated with self-trauma are oriented differently.
or mild epidermal conditions. A cutaneous ulcer HISTORY, CHIEF COMPLAINT • Prior treatments: response to prior treatment
is produced by a break in the continuity of A thorough history is important, consider- or therapy administered before onset of clini-
the epidermis, with exposure of the underlying ing the extensive list of differential diag- cal signs allows the inclusion or exclusion
dermis. Ulcers are usually a consequence of a noses. Some clues may help pinpoint the of some dermatoses (e.g., cutaneous adverse
deep and serious pathologic process. Healing condition: drug reaction).
ulcers typically result in scarring. • Travel history (e.g., leishmaniasis in dogs
traveling to Europe), grooming and boarding PHYSICAL EXAM FINDINGS
Epidemiology (contagion risk such as herpesvirus infection • Dermatologic exam for identifying erosive
SPECIES, AGE, SEX in cats), and similar environmental factors and ulcerative lesions and general physical
Vary according to the underlying pathologic may affect a patient’s risk of developing a exam to detect signs of underlying systemic
process certain condition. diseases

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