. Differential diagnosis and laboratory examination ● Differential diagnosis General clinical differential diagnosis of deep bacterial folliculitis and furunculosis includes demodex with or without secondary bacterial infection, subcutaneous and deep...
● Differential diagnosis
General clinical differential diagnosis of deep bacterial folliculitis and furunculosis includes demodex with or without secondary bacterial infection, subcutaneous and deep fungal diseases, conditioned pathogenic fungal infections, severe dermatophytic diseases, sterile granuloma/chemical granuloma, histocytosis, idiopathic nodular lipidoplastic leukemia, pupils aseptic granuloma dermatitis and lymphadenitis (puppy cellulitis), vasculitis, pyrethyroid disease, epithelial lymphoma, etc.
Based on the listed differential diagnosis, the examination direction is formulated, the appropriate examination method is selected, and the laboratory examination is further carried out to rule out some differential diagnosis and confirm the diagnosis. The relationship between the two is inseparable. Laboratory examinations include skin scraping, hair plucking examination, skin cytology examination, blood examination, bacterial culture and drug sensitivity tests. If necessary, fungal culture, skin biopsy, imaging examinations, etc.
● Demodex disease
Hair plucking and deep skin scratching are mainly used to check for dementia, dermatology, etc. Deep-encephalopathy with or without secondary bacterial infection is the most common differential diagnosis. After microscopic diagnosis of demodex disease, ivermectin or biformin can be used for treatment. 1% ivermectin 0.04-0.06 mlfkg, daily oral or biforminamidine 250 pbm, soaked throughout the body once a week. However, it is necessary to pay attention to gradually increase the dosage when taking oral ivermectin (first week). For Collie, if you want to use ivermectin, you can first perform an MDR-1 gene deletion (ivermectin sensitivity). Regular monitoring during the treatment period, with hair removal/deep scratching examination every month. The appearance of live insects or eggs during the re-examination indicates that the treatment effect is not good. At this time, you should consider changing the treatment plan or increasing the dosage/concentration of the drug. Only if there is no insect or egg seen more than two times, you can consider stopping the drug. Regular monitoring is carried out after stopping the drug, for 2 months and six months. Simultaneous sterilization surgery is performed to prevent recurrence, especially female dogs. In the case of secondary bacterial infection, the treatment method is used for treatment of dermatosis.
● Cytologic examination
Cytologic is used to rule out the necessary means of differential diagnosis. As a dermatologist, it is essential to do it yourself. If it is difficult to achieve clinically, at least ensure good communication between the sub-test operators and explain the sampling location, method and sampling purpose. For oozing impotence sampling, a moist sterile cotton swab can be used to extend the impotence into the impotence.
Cytological examination of deep pyoderma usually shows a large number of red blood cells, inflammatory cells, and bacteria, but compared with superficial dermatology, the lesions are deep, causing bleeding, and blood-diluted samples, and the amount of relatively inflammatory cells and bacteria is sometimes smaller than that of superficial dermatology.
Bacterial culture and drug sensitivity testBacterial resistance is derived from bacterial mutation after exposure to antibiotics, and the durability of bacteria is proportional to the selection density. Since the first methicillin-resistant Staphylococcus aureus infection was reported in 1961, more and more methicillin-based bacteria and multidrug-resistant (3 or more) bacteria have been reported.
The following conditions are required to meet the selection of antibiotics based on experience: No or few history of infection, no treatment failure, no other recurrent infections; superficial dermatosis; cytology examination is cocci; antibiotic sensitivity is predictable. Various bacterial infections are common in deep dermatosis, and their sensitivity to drugs is also different. It is essential for bacterial culture and drug sensitivity experiments in such cases.
Other laboratory examinationsSystemic deep mistreatment disease is often accompanied by mild elevation of white blood cells and globulin. Blood tests help further evaluate the basic health status of the diseased animals, and at the same time suggest the underlying cause. The UK chooses different examinations according to the different conditions of the diseased animals. Some tests may be performed after initial treatment to find potential causes, such as allergies (food exclusion) tests.
Treatment ofDeep Gap Dermatology usually includes symptomatic treatment of systemic symptoms, systemic antibiotic treatment, local antibacterial treatment, shampoo treatment, finding potential causes and treatment.
Symptom-based treatment, cooling down when fever occurs. Anorexia infusion support. Give high-nutrition and easy-to-digest foods, etc. Nutritional support is suitable for many skin diseases, especially for creeping. Give high-protein and easy-to-digest foods, Sunday-slimming chicken breasts, etc., and monitor the dosage and dosage, so as not to show thin and soft stools. Egg yolks are nutritious and easy to digest and absorb, and are rich in a variety of amino acids to enhance immunity. Drugs such as immune polysaccharides (yellow watpolysaccharides) can also be used to improve the body's immunity and promote disease recovery. Reasonable traditional Chinese medicine treatment also has good therapeutic effects.
The systemic antibiotic application should last for at least 4-6 weeks, and the dose used in the drug should be selected with a relatively high dose in the normal range. For example, the ammonia section is 20-30mg/kg, and a dose of about 25mg/kg is generally used. And after clinical recovery, it will last for at least 2 weeks, so as not to continue some invisible lesions after drought.
During local treatment, the affected area of long-haired animals should be shaved and then routine surgical debridement. The affected area can infiltrate the pulp fluid. To reduce local stimulation, diluted pulp fluid (1:9) can be considered.
Appropriate use of antibacterial shampoo can also make the treatment more effective. Common antibacterial shampoo active ingredients include chlorine, benzoxo peroxy and ethyl lactate. Do not dilute most antibacterial shampoos when used again. Rub the animal's body and apply it directly, and rub it for 5-15 minutes. After that, rinse the dog with warm water for 10-20 minutes, and extend it to 30 minutes. Short-haired dogs or shaved can be wiped directly, and if they need to be blown dry, 80% dry. Excessive dryness can cause further damage to the skin barrier.
Most deep pyoderma have various potential causes, and finding potential causes and actively treating them is the key to thorough treatment and preventing recurrence. It is also the basis for judging prognosis. Especially for some cases of deep pyoderma that have repeated attacks and failed treatment. For cases with failed treatment, we should understand the reasons for the failure of treatment, improper selection of antibiotics (sensitivity), premature ending of treatment ('relapse'), and real recurrence - potential cause.
