www.veterinaryworld.org Veterinary World Vol.2, No.9, September 2009

IntroductionBronchopneumonia is the most commonly

observed pattern of pneumonia in clinical small animalveterinary medicine. In almost all the cases,bronchopneumonia is thought to arise as aconsequence of primary disease process or as a resultof injury to the lung, either of which would result incompromise of lungs innate immunity. Broncho-pneumonia can be challenging condition to diagnoseand treat as patient can exhibit a wide range of clinicalpresentations ranging from mild coughing, fever,lethargy, rapid progressive weight loss and ultimatelyfatal clinical syndrome (Carey, 2009). The presentcommunication deals with a case of chronicbronchopneumonia, its clinicopatholgy, diagnosis,treatment and prognosis in a Great Dane pup.Case history & Clinical Observations

A 6 month old, female Great Dane pup (Reg no.9681), color fawn was admitted to Bai SakarbaiDinshaw Petit hospital, Parel, Mumbai with complaintof difficulty in breathing, discharge from nostrils,inappetance, rise in body temperature. The pup waspreviously treated with antibiotics such as Ampicilinand Cloxacilin along with supportive thearpy for 4-5days prior to admission to BSPCA hospital, howeverthe case didnt show any response to treatment. Clinicalexamination of pup revealed anemic oral mucusmembrane, moderate dehydration, emaciation, passingof bilateral muco-porulent nasal discharge. Therespiration was shallow and deep indicating laboredbreathing. The heart and pulse rate were found innormal limits. Auscultation of lung revealed presenceof crackling sound (moist rales) on the left side of chestarea. There was no organomegaly detected onpalpation .On the basis of clinical observation, the casewas provisionally suspected as broncho-pneumonia.Diagnosis

For further confirmation, the dog was subjectedto thoracic radiograph (lateral and dorsoventral view),

Chronic Bronchopneumonia in a Great Dane Pup

Ms.P.K. Amrute, V.D.Muley*, D.G.Dighe, R.D.Velhankar and D.V.Keskar

Department of Veterinary MedicineBombay Veterinary College, Parel, Mumbai-12

* Corresponding author email: vmuley1@gmail.com

nasal swab for microbiological culture and blood forroutine haematobiochemical examination. Lateralthoracic radiograph revealed presence of diffusedpatchy pulmonary infiltration, cloudy appearance onthe both the sides of heart indicating inflammatorychanges in lung parenchyma as well as bronchioles.Ventrodorsal view showed pneumonic changespredominantly on left side of lung- parenchyma. Nasalswab which was sent for microbial culture revealedpresence of Gram +ve organisms such asStaphylococci Spp,Streptococci Spp and Gram-vebacilli like E.coli indicating there was infection of mixedorigin. Fungal culture on Sabrauds agar showed smallcolonies of Aspergillus niger & Aspergillus flavus whichare not known to cause pneumonia in dogs. A completeblood count revealed decrease in Hb (5.5 gm%),RBC(3.62million/cu mm) Neutrophilia (85%) with shift to left,slight thrombocytopenia(1.91 lac),hypoalbuminaemia(1.5 g/dl).Liver function test revealed slight increase intotal bilurubin (0.6mg/dl) and direct bilurubin (0.3mg/dl) ,other parameters found in normal limits. Kidneyfunction tests revealed normal values.

On the basis of the clinical observations bilateralmuco-purulent nasal discharge, crackling sound (moistrales) on auscultation of lung area, thoracic radiographyand bacterial culture, the case was diagnosed asbronchopneumonia of bacterial origin.Therapeutic management

The dog was further treated with specific therapyof Inj. Intacef-Tazo (Ceftriaxone+Tazobactum)562.5mg intravenously to counteract the bacterialinfection along with inj. Dextrose 25% 50 ml i/v as anenergy source. Inj. Prednisolone 10mg i/m wasadministered to improve platelet count as well as anti-inflammatory effect .Considering severity of infectionand inflammation in lung, Inj Meloxicam @ 0.5 mg/kgb.wt i/m was also infused. Inj Deriphylline (Etophylline&Theophylline) 1ml i/m was administered as abronchodilator. Inj. Astymin (Amino-acid supplement)30ml i/v, inj Imferon (iron-dextran) 1ml deep i/m (everyforth day) and Inj .358

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www.veterinaryworld.org Veterinary World Vol.2, No.9, September 2009

Conciplex (B-complex supplement) 1ml i/m were givenas a supportive treatment. Nebulization was carriedout with Asthalin (Theophylline & Etophylline).OrallyTab Chymoral forte (Chymotrypsin enzyme) was giventwice daily to enhance penetration of antibiotic andreduce inflammation along with expectorant coughsyrup. The treatment regimen was continued for 9 daysfrom the date of admission.

After 9th day, the dog showed markedimprovement in health. Appetite of the dog improved,there was reduced muco-purulent nasal discharge,absence of crackling sound on auscultation. Howeversuddenly the dog died on 10th day evening afterexhibiting clinical signs like open mouth breathing,watery discharge from eyes, anaemic mucusmembrane, temperature 1030f, severe dyspnoea.Thepostmortem investigations could not be obtained forwant of permission from the owner.Discussion

Bronchopneumonia is characterized byinflammation of the small airway and pulmonaryparenchyma as a result of inhalation of pathogenicparticulates. The development of bacterial pneumoniain dogs and cats is often viewed as a complication ofloss of one or more pulmonary defense mechanism.Bacterial pneumonia may complicate viral respiratoryinfection followed by injury to respiratory epithelium,disruption of the epithelial barrier, loss of mucociliaryfunction and local or systemic immunosupression(Ettinger and Feldman, 1983)

Carey (2009) reported clinical signs in dogsuffering from bronchopneumonia which includepresence of nasal discharge, moist productive cough,fever, tachypnea, physical examination findings suchas dyspnoea, muco-purulent nasal discharge,inspiratory crackles and wheezes on thoracicauscultation. In most sever cases systemic illness maybe present including fever, lethargy and progressiveweight loss. The set of clinical signs exhibited by thedog under discussion are similar to those reportedabove.

Thayer and Robinson (1984) discusseddiagnostic approach to the patient with broncho-pneumonia often involves physical examinationfindings, haematobiochemical assessment, culturalexamination and thoracic radiography as a first linetest. According to Ettinger and Feldman (1983)abnormalities in complete blood count could bevariable and neutrophilia with or without shift to left,thrombocytopenia would be associated with systemiccomplications. Hypoalbuminaemia reflects increasedpulmonary and systemic capillary permeability.Thoracic radiograph are useful in assessment of patientwith bacterial pneumonia which most commonly show

alveolar pattern may be focal or diffused. The similarfindings were observed in this case like neutrophilia,thrombocytopenia & hypoalbuminaemia.Thoracicradiograph revealed consolidation of lung tissue atvarious places.

Corcoran (2004) reported the organisms typicallylocated within the respiratory system, and that are thenready to proliferate under the right circumstances, wereusually gram negative aerobes and include Pasturella,Klebsiella, Proteus spp., E. Coli. and Gram positivelike Staphylococcus and Streptococcus organisms. Therole of ageing, immunocompromise and systemicillness in the development of bronchopneumonia is wellrecognized in humans, but is not fully characterized inthe dog and cat. In the present case bacterial culturewas also found positive for similar mixed origin of Gram+ve and Gram ve bacteria. The present case showedpresence of fungi Aspergillus spp was probably acontamination & these species of fungi are not knownto add to the pathogenesis of bronchopneumonia in dogs.

Ettinger and Feldman (1983) discussed treatmentof patient of bacterial pneumonia by usage of B-lactumantibiotics like Ampicilin or Amoxicilin, new generationCephalosporin along with supportive therapy. Thepatient exhibiting positive clinical response should betreated at least once a week beyond the clinical andradiographic resolution of pneumonia in dogs. Thepresent case was also treated with Ceftriaxone andTazobactum combination along with supportivetreatment for 9 days. The clinical response obtainedafter 4-5 days of treatment up to 9th day, however thedog died on 10th day due to severe dyspnoea.

In the present case the dog suddenly expiredafter showing signs of miracle recovery both in clinicalsigns & improvement in behaviour.However the causeof sudden death could probably be the anemia thatwas aggravated whose severity could not beascertained after initial investigation report due to lackof permission from owner, leading to hypoxia,respiratory distress or failure and death.References1. Carey S. A (2009) Bronchopneumonia in the small

animal patient International summit on AdvancingVeterinary Medical care: Challenges and Strategies &27th ISVM convention Satellite seminar on VeterinaryInternal Medicine, 19-21 Feb 09 Pp 59-69.

2. Corcoran,B.M(2004) Bacterial Bronchopneumonia:Diagnosis, Management and Treatment29th worldcongress of the World Small Animal VeterinaryAssociation,Oct 6-9,2004

3. Ettinger S.J, Feldman E.C (1983) Text book ofVeterinary Internal Medicine Vol-2, 6th edition, pp.1247-1255.

4. Thayer, GW, Robinson, SK (1984). Bacterialbronchopneumonia in the dog: a review of 42 cases.JAAHA, 20: 731-735.

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Chronic Bronchopneumonia in a Great Dane Pup