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Vasculitis cut - neas and syst - micas

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Phlebitis in dogs It is characterized by a condition known as superficial thrombophlebitis, which refers to an inflammation of the superficial veins (or veins near the surface of the body). Phlebitis is usually due to an infection or thrombosis - the formation of a clot (or thrombus) inside a blood vessel, which in turn obstructs the flow of blood in the body.

Superficial venous thrombophlebitis is the most common form of this disease, and is usually located in an area.

In contrast, deep tissue thrombophlebitis is associated with clinical signs of sepsis, in which a bacterial infection occurs due to the presence of pathogenic organisms and their toxins in the blood or tissues. This type of thrombophlebitis is also associated with deep tissue thromboembolism, in which a clot or thrombus formed in one part of the body breaks off and moves to another of the blood vessels, which causes a blockage.

Phlebitis can affect dogs and cats.

The main symptom of phlebitis is a localized inflammation, which is characterized by heat, swelling, pain, hardened vessels, or a reddening of the skin known as erythema. If at least two of the aforementioned signs are present, they can be taken into account as a sign of local inflammation. Suppuration or fever may also be present, both associated with the body's response to infections.

There is no specific age, race or sex known to be more susceptible to the development of phlebitis. However, very young or elderly dogs may be at greater risk simply due to a less developed or malfunctioning immune system.

Other characteristics that are considered risk factors for the development of phlebitis include obesity, lack of mobility, poor quality of the veins, chronic diseases of the heart or kidneys, pregnancy and / or an immunodeficiency disorder in which the immune system of the Dog does not work properly.

The main cause of phlebitis is due to the use of intravenous catheters (IV). Poor quality or poor catheter care can lead to bacterial colonization of a catheter, which can infect the dog. Catheters are often used during surgery, or in emergency situations to treat trauma victims.

Diagnosis

A series of diagnostic procedures are necessary to properly diagnose phlebitis. The Doppler test is a cheap means of examining blood flow in the animal's veins, and can reveal irregularities in blood circulation and blockage. Blood cultures may also indicate the signs associated with systematic inflammation. Other diagnostic techniques may include x-ray images and urinalysis.

Treatment

If an infection is suspected, antibiotic treatment is the most likely treatment. The specific antibiotic prescribed to your dog will depend on the location of the infection, as well as the suspicious contaminants behind the infection (if there is no culture available at the moment). Additional medications can help make your dog more comfortable, relieving related symptoms.

Life and Management

After initial treatment, antibiotic therapy should be adjusted based on follow-up culture tests. Certain veins, known as phlebotic veins, should not be used for intravenous therapy or blood collection until your dog has fully recovered. With proper antibiotic treatment, the most serious cases may still take up to three weeks to resolve.

Prevention

Because the main cause of phlebitis is poor quality catheters or improper catheter care, these are the main objective when thinking about prevention. Any site of the IV catheter should be cleaned regularly with antimicrobials and treated with an antimicrobial ointment, in order to avoid bacterial infection that can lead to phlebitis. Sterile dressings should be used, and catheters should be changed within 24 hours, especially if placed in an emergency situation. Longer catheters can reduce the incidence of phlebitis.

Classification and pathological, clinical and therapeutic aspects

Dr. Fernando Fariñas Guerrero
Dermatodiagnostics
Institute of Pathology and Infectious Diseases (IAMA)
[email protected], [email protected]
Images courtesy of the author
Article courtesy of Schering-Plow

The term vasculitis indicates inflammation and alteration of blood vessels. It may be primary, or more commonly secondary to underlying disease (infections, neoplasia, SLE, drug reactions, etc.). Vasculitis may be limited to the skin (cutaneous vasculitis) or involve other organs (systemic vasculitis) with very varied clinical manifestations. The mechanisms that cause the development of a vasculitis are rapid and transitory, which makes both the clinical-pathological diagnosis and the treatment complicated. It is usually a pathology that affects dogs more than cats.

• Demodicosis
• Iatrogenic (glucocorticoids)
• Endocrine disorders: hyperadrenocorticism, hypothyroidism, diabetes mellitus.
• Systemic diseases: leishmaniosis, ehrlichiosis, systemic lupus erythematosus.
• Tumors

For a better understanding of the relationships between morphology, etiopathogenesis and clinical vasculitis, in Medicine various classifications have been developed, although currently none of them is universally accepted.
Vasculitis can be classified according to its etiology, but in both Medicine and Veterinary medicine 50% of them are considered idiopathic.
Traditionally, the classification of vasculitis in man has been carried out according to its etiology: infectious and non-infectious, or according to the size of the affected vessels: large vessels (aorta and major arteries), arteries and veins, and small vessels ( arterial and venous capillaries). Numerous syndromes have been described in the literature, such as: polyarteritis nodosa (PAN), Kawasaky syndrome, Wegener's granulomatosis, microscopic polyangeitis, Schölein-Henoch purpura, etc.
The classification proposed by pathologists is based on the type of inflammatory infiltrate and distinguishes three main categories: acute vasculitis (neutrophilic), chronic lymphocytic vasculitis and granulomatous vasculitis.
However, the limitations of this type of classification are linked to the fact that the inflammatory process is dynamic, the evolution of the acute to the chronic stage can be observed in the same disease, and the same etiologic agent can produce different manifestations of vasculitis.
Veterinary has sought to adapt the medical classifications of human vasculitis, but there are substantial differences. For example, in dogs, cutaneous vasculitis is characterized, in most cases, by the presence in the capillaries of a neutrophilic infiltrate and more rarely lymphocytic, eosinophilic or multicellular (vasculopathy). The classification proposed by Dr. Outerbridge, from the University of Davis, aims at simplification, distinguishing two broad categories (see picture):
A) Infectious vasculitis in which there is a long list of pathogens (bacteria, rickettsia, viruses, protozoa and fungi).
B) Non-infectious vasculitis secondary to environmental agents, drugs, food additives or unknown endogenous agents (tumors).

Vasculitis is relatively common in dogs without predisposition of sex or age. Although they can develop in any breed, there are some that do show a certain predisposition such as the Zarcero Dog (Teckel), Rottweiler, Colley, Shetland, Dachshunds and Jack Russell terriers.

Vaccine-induced vasculitis has been described primarily in small breeds such as Poodle Toy, Silky Terrier, Yorkshire Terrier, Pekingese, Maltese Dog and Bichon, and some syndromes associated with specific breeds (vaculitis secondary to trimethoprim-sulfamethoxazole administration have been described in Doberman, vasculopathies in Greyhound, etc.).
From a clinical point of view, vasculitis can start as acute systemic vasculitis, where the most common clinical signs are: fever, prostration, anorexia, myalgia, arthralgia, epistaxis, ptialism, and other manifestations that depend on the type of organ affected (glomerulonephritis , perimiocarditis, neuropathy, etc.). The most severe cases can trigger states of shock and disseminated intravascular coagulation.
Another form of localized vasculitis is cutaneous vasculitis normally secondary to the deposition of immune complexes in the vessel walls. This type of vasculitis can be associated with an underlying infection (bacteria, rickettsia, viruses, fungi), malignant tumors, food hypersensitivity, drug reaction, rabies vaccine, metabolic diseases (diabetes mellitus, uremia), systemic lupus erythematosus or exposure to cold (cold agglutinin disease) or it can be idiopathic. It is uncommon in dogs and rare in cats.
The picture is characterized by the presence of clinical signs such as purpura, necrosis and dotted ulcers, especially in the ears, lips, oral mucosa, pads, tail and scrotum, and acrocyanosis can be observed (figures 1, 2 Y 3). In dogs with underlying food hypersensitivity, urticarial vasculitis (acute onset of severe erythroderma, with erythematous hives that bind and do not bleach) has been described.
In some dogs with alopecia caused by the rabies vaccine, in the allopathic area that develops at the vaccination site, 1 to 5 months later appear multifocal skin lesions caused by a generalized ischemic dermopathy. The differential diagnosis of cutaneous vasculitis includes SLE, erythema multiforme, toxic epidermal necrolysis, bullous pemphigus, vulgar pemphigus, freezing and cutaneous drug reaction. In dogs that only have lesions in the ears, the differential diagnosis should also include dermatosis of the edge of the ears. Some particular examples of vasculitis in dogs are described below.

Figure 1. Plantar pad vasculitis.Figure 2. Vasculitis of the tip of the tail.
Figure 3. Vasculitis of the ear.Although they can develop in any breed, there are some that show a certain predisposition to suffer from vasculitis, such as the Zarcero Dog (Teckel), Rottweiler, Colley, Shetland, Dachshunds and Jack Russell terriers.

Previously related to cutaneous vasculitis, it is described in many breeds, especially in small dogs (wool dogs) bichones, and is secondary to rabies vaccination. From 1 to 5 months after vaccination, a granuloma and focal alopecia are observed at the point of inoculation, sometimes with the formation of ulcers and scabs that mainly affect truffles, lips, ears, tip of the tail and feet. More rarely ischemic dermatopathy is associated with myopathy.

It affects puppies 4-6 weeks and manifests 7-10 days after the first vaccinations. Revaccination can aggravate pre-existing injuries that initially affect the truffle and plantar bearings. The lesions are edematous, sometimes exudative, depigmented, crusted and ulcerative. Puppies also manifest systemic signs such as prostration, fever and arthralgia. There is a family predisposition of an autosomal recessive nature to the development of this vasculopathy in the German Shepherd.

This condition, whose etiology is unknown, is only observed in the greyhound. It is manifested by the development of edematous, erythematous and then ulcerative lesions in the tarsus, the inner face of the posterior limbs and more rarely of the anterior limbs.
Some dogs develop systemic signs with fever, prostration and then polyuria, polydipsia, vomiting and diarrhea when kidney failure develops.

Intense erythroderma is observed, with swelling, exudation, erosions and ulcers, limited to areas of non-pigmented skin and with little hair. It may be secondary to inflammatory or post-inflammatory depigmentation (discoid lupus erythematosus) or after administration of drugs and photosensitizing plants.

Crusty, exudative and linear ulcerated lesions are observed in dogs with cut ears.

Normally bilateral symmetric lesion, with very painful and progressive distal necrosis of the ear in dogs.

It appears especially in dogs of San Bernardo breed.
These are linear ulcerative lesions of the nasal plane with major hemorrhages in this area.

Figure 4. Leukocytoclastic neutrophilic vasculitis.Figure 5. Granulomatous vasculitis.

Necrotizing ulcers, purpura and hemorrhagic bullae, associated with systemic signs with fever, malaise and anorexia are observed.
It occurs in systemic bacterial processes, including bacterial endocarditis, pyoderma, Rocky Mountain fever, ehrlichiosis and insidious Erysipelothrix infections.

It is a pathology mediated by the presence of IgM or more rarely IgG antibodies that are "activated" in the presence of intense cold (0-4 ° C), and that produce vasculitis phenomena in the extremities with the development of acrocyanosis and of erythematous lesions, purpura and necrosis in the skin of the extremities.

The microscopic aspect of vasculitis of small vessels is described below.

In animals it is difficult to observe the presence of all the classic criteria of acute vasculitis present in man: fibrinoid necrosis of the vascular wall and cariorrexis of neutrophils with formation of nuclear detritus around the capillaries (leukocytoclastic vasculitis, figure 4).
The criteria to consider in animals are: edema of the endothelial cells and presence of neutrophils in the vessel wall, while the dermis will have to be poor in cells, with the exception of ulcerated tissues and inflamed mucous membranes.
The presence of apoptosis in the cells of the epitriquial sweat glands can make you suspect vasculitis. The other aspects that should be investigated are microhemorrhages and marked edema of the dermis.
In the dog, non-leukocytoclastic vasculitis is more frequent, bringing into play a type III hypersensitivity phenomenon (mediated by immune complexes).
Examples of neutrophilic vasculitis are reactions to drugs, infectious vasculitis (bacteria, viruses, leishmaniasis, rickettsiosis, babesiosis, borreliosis),
toxic, dermatomyositis, acute phase ischemic dermatopathy, SLE, rheumatoid arthritis, cryoglobulinemia, Scottish Terrier vasculitis, etc.

They are rare in animals and may represent a transition phase towards chronic vasculitis. They are produced by an immune reaction of cell type mediated by CD8 + lymphocytes (cytotoxic / suppressors). Examples of lymphocyte vasculitis are again drug reactions, dermatomyositis, paniculitis induced by rabies vaccine and familial vasculopathy of the German Shepherd.

They are also rare and secondary to a type I hypersensitivity phenomenon (mediated by IgE). Some examples are: reactions to arthropod bites, mastocytoma and granuloma-eosinophilic complex.

Primary granulomatous vasculitis are also rare, but they can be secondary to a fibrinoid vessel necrosis or represent the final evolution of a neutrophilic vasculitis. Some examples are: drug reaction and sterile idiopathic panniculitis.

In this case, the chronicity of the lesions determines very limited and difficult to observe alterations such as: thickening of the vascular wall, possible cariorrexis of endothelial cells, the appearance of inflammatory cells in the wall being rare: essentially lymphocytes, tissue hypoxia with disappearance of the follicles and, sometimes, dermatitis of the dermo-epidermal junction poor in cells.
Examples of this type of alteration are: focal alopecia secondary to rabies vaccination, dermatomyositis and lupoid dermatosis.

Evolution of Charly's splenic liposacorma

Weeks ago I talked about the diagnosis and treatment of splenic liposarcoma that was detected to Charly (http://wp.me/p2cDmE-2vj).

After five chemotherapy sessions with Doxorubicin separated three weeks from each other, Charly has already finished her treatment.

In general everything went well, although we have encountered a complication since it has had a cumulative effect secondary to chemotherapy batches. A few days after the last session of chemo Charly began limping from one of his forelimbs, specifically in which the path was placed for the last session.

Upon examination, it was observed that his limb was quite inflamed and hot, Charly had phlebitis (inflammation of the vein) secondary to the passage of chemotherapy through his cephalic vein.

To avoid the reactions or inflammations in his veins, an attempt was made to change the limb in which chemotherapy was introduced on each occasion, however it is one of the possible complications that we can find during a chemotherapy treatment.

Apart from controlling the limb feblitis, what follow-up should Charly follow?

Now that you have done all the treatment you should check that it has really worked correctly and that no metastasis occurs.

The other day, an abdominal ultrasound was performed to ensure that no suspicious spots of a new tumor appear on any of the abdominal organs or in the mesentery.

Charly right kidney - image: Sonovet

Charly's left kidney - image: Sonovet

Charly's left adrenal - image: Sonovet

As can be seen in the different images both the kidneys, as the liver, intestines and mesentery do not show any signal that can alarm us.

So for now we will be performing periodic chest radiographs and abdominal ultrasound to ensure that liposarcoma is controlled and does not appear anywhere else.

What is thrombophlebitis or phlebitis

Thrombophlebitis or phlebitis is the inflammation of a vein that is caused by a blood clot, thrombus. These blood clots can interfere with normal blood flow throughout the body and can become dangerous.

Thrombophlebitis can occur in the most superficial veins or in the deepest layers.
It is a condition that affects, above all, the legs but no part of the body is free to suffer it.

Symptoms of thrombophlebitis or phlebitis

When it comes to a superficial vein, it is usually evident. The vessels appear hard and tense, like a rope, extremely sensitive to pressure, the surrounding area is reddened (erythematous) and warm to the touch, the rest of the limb may appear pale, cold and swollen. Deep vein thrombophlebitis is characterized by hurting pain and tingling, especially in the heel, when the patient walks or flexes the foot dorsally.

In summary, the symptoms of thrombophlebitis that can be noticed near the affected area are:

As we have already said thrombophlebitis is caused by blood clots. These clots can occur for several reasons, for example:

  • Vascular trauma
  • Hypercoagulation
  • Bloody
  • Infection.
  • Chemical irritation
  • Long standing or sitting position.
  • Immobility for prolonged periods.
  • Obesity.
  • Stroke.

Other causes that can influence the appearance of thrombophlenbitis or phlebitisd are: lesions caused in the blood vessels by needles or intravenous catheters during a medical intervention, trauma affecting the blood vessels.

Natural products

Food is essential to take care of our health and in the case of thrombophlebitis it could not be otherwise. We will know that food and medicinal herbs are the most recommended to produce blood clots:

    Eat foods such as garlic, ginger, onion and hot peppers, which protect against heart attacks and accidents> Natural treatments

The consumption of fiber, according to many scholars, is the best way to prevent it, in addition to exercise, practice yoga and lie down slightly raising the lower limbs. First of all, constipation and constipation should be avoided. It is advisable to purify the blood of impurities, relieve the work of the kidneys and take food and plants that make the blood more fluid.

How to react if your dog suffers from phlebitis?

It is important to know the infection symptoms, the most normal and easy to visualize is inflammation in an area.

It may be present on one leg, in which a swelling of the entire leg or a part of it, it is also possible that your pet feels pain or heat in the area, you will usually see that it bites or licks the area so that it tries to heal or relieve pain, it is also normal for the dog's body to react to inflammation, so You will usually have a fever or even a suppuration through the affected area.

It is common that during the life of your dog you experience a phlebitis infection and without any apparent risk, however dogs that are younger or older have more likely to suffer from any of them, because when they are very young, their immunology system is not developed properly or on the contrary, when they are old, this system is fully developed, however it does not work in the correct way.

There are also some pathologies that ensure a risk in the development of phlebitis, such as obesity, suffering from the kidneys or heart disease, poor quality of veins or even lack of mobility. Another case that is very prone to suffer from this disease are the bitches that are pregnant, in case a dog suffers from a malfunction in the immune system it can also be prone to suffer this phlebitis infection.

For any symptoms you have in your pet it is necessary to go to the veterinarian To solve the problem, he will make a diagnosis corresponding to the case and look for solutions to treat it as quickly as possible.

What will a veterinarian do to treat this disease?

For this diagnosis several tests are carried out, which include a urine test, x-ray images, tests in which blood flow analysis or some blood cultures.

The most usual is that the specialist begins by providing some anti-inflammatory medicationTo reduce inflammation in the affected area and if the veterinarian suspects that it is an infection, an antibiotic may be prescribed, this medication will depend on the area where phlebitis is located.

It is important that you follow the indications given by the veterinarian about the administration of medicationsIt may also happen that you are prescribed some medications so that your pet feels better, relieving pain in the area. But in the most severe cases it may take up to three weeks for a full recovery. Now, if it's a deep thrombophlebitisThe veterinarian will have to make a diagnosis through other tests and possibly prescribe an anticoagulant.

For avoid phlebitis in your pet, it is necessary and important to take care of your health, for this you must avoid that your pet is overweight, since not only can it cause phlebitis but also problems in the heart and keep in mind that both younger and older dogs must be older cares.

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