What to do if your dog or cat is bitten or scratched by a bat?

This is Jingle, who by the way HASN'T been bitten by a bat...he was just at a party I went to recently.

Exposure of Australian pets to bats is a big deal, as both microbats and fruit bats (aka flying foxes) can carry the deadly Australian Bat Lyssavirus (ABLV).

The NSW Department of Primary Industries has released guidelines for post-exposure prophylaxis for dogs and cats bitten or scratched by bats. 

The prevalence of ABLV in the general bat population is round 1 per cent, but that shoots up to 30 per cent in the sick bat population. Unfortunately, sick bats are more likely to come into contact with domestic animals because they have impaired abilityto fly and may not be alert enough to evade potential predators. They are also more likely to sustain injuries or get caught in fences.

ABLV can be transmitted to domestic animals (and we shouldn't forget, also humans - but this post is about pets) via bites or scratches, or through eating infected bats. Therefore if your pet is bitten it is important to seek veterinary attention.

The Nobivac Rabies vaccine is cross-protective against ABLV. It is used by AQIS certified veterinarians in Australia, but any veterinarian can apply to the Chief Veterinary Officer for emergency use which is permitted under a permit.

The testing of bats can be difficult for a range of reasons. Owners are NOT encouraged to capture live bats due to the risk of being bitten themselves. Dead bats must be handled with care. Those without a head (gory but true - many animals will eat this part) can't be tested as brain tissue is required.

A bat flies over the city. Bats are beautiful creatures, but should only be handled by experienced, vaccinated handlers.

What is the post-exposure protocol?

According to current NSW DPI guidelines, any exposed pet should be vaccinated as soon aspossible following suspected exposure. All animals must be microchipped prior to vaccination.

On the day of the first vaccination, serum is also obtained and sent to the State Veterinary Diagnostic Laboratory for antibody testing.

A second vaccination is administered on days 5-7, followed by a second serum sample on days 28-35. This should demonstrate an anti-rabies antibody titre of >2 IU/ml. For 60 days following exposure, animals must be closely observed for any signs of illness (e.g. neurological signs, aggression, sudden behaviour changes), and only restricted contact permitted. Unrestricted contact may be permitted in vaccinated animals after 60 days.

The full protocol for veterinarians is outline here.

Jingle holds court at the party. Again, he's never been exposed to a bat - but he is gorgeou and doesn't mind posing for the camera, two criteria for featuring on SAT.

Antibiotic-seeking behaviour and booties to prevent interdigital dermatitis

Superman blows a snot bubble: not every runny nose should be treated with antibiotics.

Antibiotic-seeking behaviour is common in any health care setting, partly because most of us were raised in the era when antimicrobials were prescribed willy-nilly. Guidelines about prudent use have since emerged, as has data on increasing antimicrobial resistance and the real prospect of a "post-antibiotic era". But owners still ask for them and clinicians feel a pressure to prescribe.

In an interesting study lead by Mohammed Mustafa, family medical physicians assumed that most patients or parents of patients wanted antibiotics to treat acute upper respiratory tract infections. In humans, as in many animal species, most of these are caused by viral pathogens that aren't susceptible to antibiotics. And antibiotic use isn't eactly benign - it can be associated with side effects such as minor gastrointestinal upsets to severe alteration of gut flora and subsequent colonisation with bugs like C. difficile. 

Some authors have recommended that physicians simply ask patients point blank: do you want antibiotics? The problem is, if they say yes, then the recommendation is no, it gets uncomfortable for everyone.

Instead, family physicians would "build a case" against antimicrobials by providing a running commentry around the physical exam. And it makes sense...clients bring their animals to us at least in part for reassurance that there is nothing sinister going on. Being able to provide evidence for that assessment is one of the most helpful things we can do. Its not enough to simply state "I'm not giving your cat antibiotics because its a virus". We should be explaining in more detail our differentials and indicators of bacterial involvement that clients can look out for.

What was interesting was that a lot of clinicians knowingly over- or understated findings of the physical examination to fit with their recommendation. The problem with this stance is that it can backfire.

So we need evaluate the evidence we accrue objectively and draw conclusions AFTER and not BEFORE we gather the evidence.

When it comes to non-prudent use of antimicrobials, the clients are only one part of the equation. The suppliers (prescribing physicians or vets) are human and are influenced by patient demand, percieved patient expectations, previous bad experiences where antimicrobials were not used and the physician-patient relationship.

We can forget that while we are bombarded with literature on antimicrobial resistance and guidelines for prudent use, clients may not be - and it is really helpful information! Sharing this kind of information and making our decision making explicit can aid in shared decision making. We can also utilise diagnostic tests to determine whether infection is present.

Booties for dogs

Making world news this week is this story (if nothing else, click on this link for a great photo) about Bluey, a weimeranar with interdigital dermatitis. Its a bit of a stretch to claim that Bluey's vets would have been "stumped" by the "bizarre" condition, since allergic dermatitis commonly affects the feet and booties are a great way to minimise exposure to allergens. Its just that many dogs won't accept them initially.

But minimising contact with surface allergens can help reduce exposure and subsequent itching. Similarly, dog-clothes, custom rashies and other clothing items can be used to minimise exposure - so long as one remembers that it can get awfully hot under those layers.

Reference:
Mustafa M, Wood F, Butler CC and Elwyn G (2014) Managing expectations of antibiotics for upper respiratory tract infections: a qualitative study. Annals of Family Medicine 12(1):29-36.

How can vets do behaviour better?

Dr Kersti Seksel with companion Indi.

Did you know that over two thirds of pet owners ask their vet questions about behaviour – but they often walk away with unanswered questions. SAT talked to veterinary behaviour specialist Dr Kersti Seksel about what exactly behaviour vets do and how we can all do behaviour a bit better.

Dr Seksel is a registered veterinary specialist in Behavioural Medicine, and principal of Sydney Animal Behaviour Service (SABS). She is also the proud owner of GSD Indi.

How is what a veterinary behaviour specialist does different from what a trainer does?

Unfortunately there are no clear definitions that the public can easily find. – the word ‘behaviourist’ is used very loosely and often isn’t in reference to a veterinary behaviour specialist or any specialised qualifications or training.

A dog trainer can call themselves a canine behaviour specialist or a behaviourist and there are no laws governing that; they don’t need to have any qualifications.

This is where the problem lies. While training is useful for helping teach basic manners, it won’t assist with medically based behaviour issues. The two professions deal with very different issues however the distinction isn’t well understood by pet owners.

The general public still tends to think that if an animal is behaving badly then you just need to train it to resolve the issue.  However training will not address medical issues such as anxiety disorders. Similarly, if you had a child with ADHD, you would see a doctor or psychologist not seek advice from a teacher although both may be considered professionals in their respective fields. It’s just taking a while for that to be recognised in the animal world.

Veterinary behaviour specialists

It’s important to understand that someone who calls themselves a ‘behaviourist’ or ‘behaviour specialist’ may not necessarily have any formal training. Veterinary behaviourists however are vets who have extra qualifications in behaviour and have done extensive study in this field.

Veterinary behaviourists firstly do a veterinary degree and then a further qualification called a membership of the Australian College of VeterinaryScientists in Animal Behaviour.  To be able to call themselves a specialist a veterinarian also has to complete a Fellowship qualification in the Australian College, a Diplomate qualification in the USA College or a Diplomate qualification in the European College.

There are about 50 veterinary behaviourists in Australia, but only three specialists in Behaviourial Medicine. To become a specialist involves completing a residency which may take an additional three to five years and conducting scientific research, publishing papers and seeing cases under the supervision of a specialist.

Dog trainers

Just as the name suggests, dog trainers primarily deal with training problems. The focus is very different to behaviour consultations; obedience training is primarily to teach a dog good manners and correct any simple training problems.

The most common training problems include:

• Pulling on the lead
• Jumping on people
• Digging
• Barking at other dogs
• Basic manners such as sitting and staying
• Toilet training

To modify these problems, a training program should include rewards for desirable behaviours, and correction of undesirable behaviours where possible.

Dog trainers work with veterinary behaviourists to help modify a dog’s behaviour and together they can help many owners and dogs live together, harmoniously.

Kersti performs a training exercise with Indi.

What are the most common behaviour problems you see in dogs and cats?

I see mostly anxiety based problems such as separation anxiety, aggression, obsessive compulsive disorders.

What kinds of other species do you treat and for what?

We see birds, horses, rabbits, tigers, cheetahs- we will help all species great and small.

We know these problems impact on the human animal bond, but how do behaviour problems impact on the wellbeing of pets?

It is now recognised that 20 per cent of dogs have an anxiety disorder, which is very similar to that of humans. Studies have also shown that dogs with anxiety disorders have a shorter life expectancy and are more likely to have skin problems and gastrointestinal problems.

What are the barriers to practicing good behaviour medicine?

Every animal we see as vets we need to consider their behaviour. After all the reason an owner brings a pet to the vet is that its behaviour has changed in some way - that is it is dull, depressed, lethargic, with physical signs like vomiting, diarrhoea anorexia, scratching more – so awareness of behaviour is important.

Vets often talk about lack of time yet they manage to schedule time for surgery so the same has to be made for behaviour- similar for charging for this.  We now know that stressed animals have a shorter quantity of life as well as a poorer quality of life and many vets are recognising this.

Also 68% of owners that visit the vet ask about behaviour but some vets unfortunately do not see that behaviour problems are medical problems so they need to educate themselves and their staff.

How important is medication in managing behaviour problems?

All behaviour in every species is determined by genetic predisposition, learning from previous experiences and the current environment. How behaviour problems are treated involves addressing all these three factors- behaviour modification for modifying the learning, environmental management for the environmental issues and medication to address the genetic predisposition. Not dissimilar from treating diabetes- diet and exercise and insulin. Medication alone is rarely the answer but is in an integral part of the treatment.

How can veterinarians decrease stress in their patients?

By understanding that animals are non - verbal communicators vets can learn to read the animal’s body language. This way they can recognise when their patient may be getting concerned. They can design the waiting room, schedule appointments times and train their staff about the importance of rewards. Keeping up to date with behavioural medicine is also important so they use the latest techniques and medications to help their patients.

What can veterinary students and veterinarians do to improve their behaviour medicine?

Further training might include:

• Distance education (Dr Seksel teaches a year long distance education course on veterinary behaviouralmedicine through the Centre for Veterinary Education)
• Audit the behaviour workshop hosted by the North American Veterinary Community
• Join the AustralianVeterinary Association’s Australian Veterinary Behaviour Interest Group
• Head to the AVA's annual conference and sit in on the behaviour stream
• Join the Academy ofVeterinary Behaviour Technicians

Aside from including behaviour questions in the history, increasing our awareness of behaviour issues and investing in continuing education, are there any other websites or books you recommend?

• www.dogwelfarecampaign.org
• Decoding Your Dog
• Training Your Cat

…and generally reading books by qualified veterinary behaviourists and trainers.

What do parasitologists eat for dessert?

These are the kinds of vectors I don't mind in my kitchen.

This beautiful vector-themed tart is the creation of Italian parasitologist Fabrizio Montarsi (you can read some of his work here).

When he is not collecting mosquitos in the Alps with his wonderful colleague and fiance Patrizia (a veterinarian and mycologist, currently undertaking a PhD on cryptococcus spp.), Fabri whips up masterpieces in the kitchen. 

On the left is a tick - but not any old tick. This is Rhipicephalus sanguineus or the brown dog tick, the most widespread tick in the world and vector of loads of pathogens including Rickettsia spp. In fact, the brown dog tick has been bothering dogs forever - even being retrieved from an ancient Egyptian dog mummy (you can read about that work, lead by Professor Dominico Otranto, here). But its distribution is changing and that alters the epidemiology of many tick-borne diseases.

On the right is the sand fly, Phlebotomus perniciosus, vector of Leishmania spp. We are fortunate enough not to have this disease in Australia, but that could change. I love a dessert that is delicious AND thought provoking!!!

I've seen other veterinary themed cakes, but Fabrizio's creation has an elegance and is abstract enough to be edible.

And if this has you excited about vector-borne diseases, I highly recommend Peter Irwin's paper, discussed here, on the way veterinarians need to change the way they think about VBDs.

Canine transmissible venereal tumour sequenced - and a great dane puppy

We made a new friend on our walk this weekend. Sonny (left) is 20 weeks old. Look at the size of those paws!!! 

This year SAT will be discussing oncology a little more as we're currently undertaking a distance education program on small animal clinical oncology through the Centre for Veterinary Education. (The course hasn't officially begun yet but the reading is fascinating and full of new and very useful information about how to help dogs and cats with benign and malignant tumours).

Anyway, naturally our ears pricked up when we read that the genomes of two canine transmissible venereal tumours (CTVTs) had been sequenced. 

WARNING: If you scroll down you will see two images of CTVTs - they often appear very inflamed and ulcerated and as the name suggests they have a predilection for the genitalia of dogs. The photos were taken as clinical records and not arranged in the nice neat way you see in medical journals. Apologies in advance. Both patients were sedated but they were sedated "in the field".

Before that, though, this is a photo of my paw beside Sonny's pawprint. Big, huh?

I first encountered CTVTs in the Northern Territory in a remote Indigenous community. I've also seen them in Papua New Guinea. They are remarkable in that these cancers are contagious (and a very good reason for desexing dogs as one mode of transmission is sexual) but they are also highly treatable if the funds and resources are available.

The team who sequenced the CTVTs estimate that they arose around 11,000 years ago. They worked this out by comparing the rate of mutations in these tumours to the rate of mutations in human medulloblastoma.

Since it arose, CTVT has collected 1.9million mutations (typical human tumours acquire 1-5K). Incredibly, now it is pretty stable. So the question is - do cancers go through a mutation phase and eventually stablise and become more amenable to treatment? Of course no cancer patient has 11,000 years to kill. But understanding tumour biology is the key to effective treatment.

A canine transmissible venereal tumour (CTVT) on the vulva of a dog in Port Moresby. The dog is sedated to facilitate examination and sample collection.

CTVTs, along with Tasmanian Devil Facial Tumour Disease (DFTD) are the only known clonally transmissible cancers, transmitted by physical transfer of tumour cells. 

The prevalence of CTVTs in Australia is unknown but they are more common in the tropical North. In overseas studies affected dogs are around 4-5 years old or older (in very young or immunosuppressed dogs the tumour grows rapidly and metastasizes early).

Clinical signs

CTVTs are most likely to affect entire females but they can be transmitted by sniffing or inoculation of tumour cells into the skin. For this reason they sometimes occur on the lips, tongue, pharynx or tonsils, as well as the nasal passages. They can also spread haematogenously, or via lymphatics, to regional lymph nodes, intestine, the liver, spleen, lungs and central nervous system.

Affected animals may have a bulge in the perineal region, or apparent prolapsed tissue from the vulva. Other clinical signs include urogenital discharge, dysuria, pollakiuria, tenesmus and urinary incontinence. Affected animals have a high rate of bacterial urinary tract infection, possibly secondary to partial urethral obstruction by tumour tissue.

A CTVT in a male dog anaesthetised for examination during a dog program. Note haemorrhagic discharge and marked swelling of the prepuce and penis. (Apologies for the grubby hand, lifting the dog on the table was a little messy but the hand is in the photo for scale).

If extragenital sites are involved, signs might include nasal discharge, sneezing, lymphadenomegaly, cutaneous or subcutaneous swelling, dysphagia or facial deformation.

They are uncomfortable, painful and always inflamed.

Diagnosis

Diagnosis in the late stages is reasonably easy as most lesions are visible, often ulcerated and very friable. Masses can be solitary or multiple, a bit cauliflower like, pedunculated, nodular, papillary or multilobulated (in other words pretty gross).

But in the early stages may require vaginal/rectal palpation, contrast vaginoscopy and cytology (CTVTs are an undifferentiated round cell tumour of reticuloendothelial origin. They exfoliate well but inflammatory cell infiltrates are common, nonethless they are easily diagnosed on cytology). Thoracic and abdominal imaging is recommended to screen for mets. 

Some of these tumours regress spontaneously after about six months, probably thanks to effective cell mediated immunity.

Treatment

Surgical excision of these tumours tends to be unsuccessful. They have a high local recurrence rate (up to 68%) but they also tend to be huge, located in surgically awkward sites and so friable that seeding from the tumour is highly likely.

Chemotherapy with vincristine weekly is very successful and curative of many patients (39 out of 41 in one study) - even those with metastatic disease. Vincristine resistant CTVTs may be treated with doxorubicin.

Reference

Rogers KS (1997) Transmissible venereal tumour. Compendium on Continuing Education 19(9):1036-1045.

Withrow SJ, Vail DM & Page RL (eds) Withrow & MacEwen's Small Animal Clinical Oncology: 5th edition. St Louis: Elsevier.