Treatment in Parvovirosis and

Hemorragic gastroenteritis
Dr. Sharon Regev
Ramat Gan Animal Hospital
ISRAEL
Canine Parvovirus infection
Hemorrhagic Gastroenteritis
Syndrome
Google 4 months Yorkie
Canine parvovirus - cpv
Systemic illness - GI and immunological .
Clinical anorexia, vomiting , diarhea ,
In severe cases Sepsis, endotoxemia,DIC.
Infection Oral fecal route.
Incubation 7-14 days.
Sick animals will show Leukopenia &
Neutropenia
Canine parvovirus - cpv
Breed Predilections Rottweiller,
Doberman, Labrador, Golden, German
shephard etc.
CPV-2 in utero infection myocardial
form.(Tiger heart )
Canine parvovirus - cpv
Diagnosis
History : Incomplete vacc. Protocol/Shelter/endemic
zone.
Clinical signs : young dogs, vomiting and diarrhea
associated with depression
Hemaotology - 50% with severe Leukopenia ,
lymphopenia and neutropenia.
Serum Chemistry nonspecific: hypokalemia, prerenal
azotemia, hypoglicemia, increase in liver enzymes,
Hypoproteinemia and Hypoalbuminemia.
Canine parvovirus - cpv
Serology
Anti CPV antibody titer inssuficient (95% of
dogs has seroconversion from prior exposure or
vaccines
Detection of Igm from recent exposure
presumptive
Definitive diagnosis active excretion of virus
or viral antigen in feces.
PCR.
Canine parvovirus - cpv
In office tests that we use.
Snap Parvo test by IDDEX.
Canine Parvovirus test kit by VAL (korea).

PCR Polymerase chain reaction (Karnieli
Labs ISRAEL) Detection of antigen in
serum.

Hemorrhagic Gastroenteritis
Hemorrhagic gastroenteritis
syndrome=HGS

Hemorrhagic Gastroenteritis
Peracute hemorrhgic enteritis charactarized by
sudden bloody diarrhea with vomiting,
severe dehydration and hypovolemia and
loss of electrolytes.
The syndrom is uniqe because the acute onset
of mucosal destruction with movement of
fluids and electrolytes into the lumen
resulting in rapid shock sepsis and toxemia.
Hemorrhagic Gastroenteritis
CPV mainly pups
HGS adult dogs mean 5 years.
Etiology unknown.
Type 1 hypersensitivity
Cultures in some dogs Cl. Perfringens
E. coli toxins unrewording results.
Shon- 5 Y old black Lab.
Hemorrhagic Gastroenteritis
Differentials
Viral enteritis (distemper, Corona CPV)
Bacterial enteritis (Salmonella, Campylobacter etc)
Parasitic enteritis (Giardia, Trichomonas, Helmints erc)
Intestinal obstrucion, intussusception,
Addisons disease.
Acute pancreatitis
Coagulopathies
Thrombocytopathies.
Treatment
CPV
HGS
We call them PARVOIDS

Treatment - Hospitalization
Dogs with CPV or HGS should be
hospitalized.
CPV Isolation . Educate personal to
change and to desinfect.
NPO 12-24 h.
Treatment - fluids


Fluid therapy is the cornerstone of tratment
for CPV and HGS.
Fluid administers only IV.
Use Balanced crystaloids Lactate ringer
solution.
Hypovolemic and shocky animals use shock
rythm 90/ml/kg/hr for 1-2 hours.
Fluids
In Shock 70-90/ml/kg/h
Maintenance - 2.5ml/kg/h X2, X3
Correct dehydration in first 24 hours.
After Maintenance + losses ( X2, X3)
Fluid in constant rate 24 h.
Use infussion pumps.


Drop counting pumps.
Volumetric Infussion Pump

Electronic Pump
Electrolytes
Add 20-30 meq/L routinly or measure.
K in Serum KCL/L Max rate ml/kg/h
3.6-4.5 20 24
3.1-3.5 30 16
2.6-3 40 12
2.1-2.5 60 8
<2 80 6
Therapy-Dextrose
Add Dexrose at 2.5% (50ml Dextrose
50%to 1 L of LRS).
AVOID SC Fluids (infection, Celulitis, skin
necrosis)
Antibiotics
We use combination Therpy
Ampi Genta Ampi 20mg/kg TID
Genta 6 mg/kg SID
Genta can be used only after hydration to prevent
nephrotoxicity.
Much better then TID.

Antibiotics
Cefa Baytril
Cefazolin 25mg/kg TID
Baytril 5mg/kg BID

Ceftifour (III gen)-Clinda in life threatening
sepsis.
Antiemetics
Metoclopramide 0.5mg/kg TID.
Better in constant rate, 1-2mg/kg/24H.

Antacid Ranitidine (zantac) 2 mg/kg TID.
Severe Cases Zofran 0.1-0.2mg/kd TID
Cerenia (Maropitant) 1mg/kg SID.
Hypoproteinemia
Serum albumin drops with the progression
of the disease if anorexia is present.
If Albumin drops under 2g/dl add Fresh
plasma at 5-10 mg/kg iv (mix with NaCl).
Start feed ASAP. With small frequent
amounts of GI Diet.
Use Gastro/Esophageal tube if anorexia
persist for more then 24 h.
Parasite Contol
Pyrantel Pamoate
Fenbendazole
Immunotherapy-GCSF
Human Granulocyte Colony stimulation
factor.
1-5 mcg/kg/ sc SID
Monitoring
PE 3/d
T-Proteine 1/d (PCV/TS)
Urine SG
CBC
K 1/d
BUN/Creat 1/d
Glucose 2/d
PCV/TS
Refractometer
Refractometer
Prognosis
80-95% Recovery with intensive therapy.
Price is a MAJOR problem.
1-5 % die due to Sepsis and toxemia.
Case 1
Google 4 m old yorkie
Google
History
1 month with the owners
A week ago was for 24h in a kennel.
Vacciated only once.
yesterday many episodes of vomiting.
Anorexia
Apathy
Google-Day 1
PE
Apathy
Dehydration 5-7%.
No abdominal pain.
No foreign body. (palpation)
Vomited twice during PE.
Temp 39.
Google-Day1
Lab.
CBC
Urinalysis
Fecal
Parvo- Serology
Distemper PCR
Abdominal Rads.
Google- cbc 27-11-2007

Google plan Day1
Fluids Maintenace X 4
LRS _ 20Meq KCl I.V
Metoclopramide in constant rate.
Zantac Ranitidine
Antibiotics Synulox.
Google Day1
Urinalysis SG >1.060
Fecal Bloody feces with a large amount of
white and red cells.
Eggs of Trichuris Vulpis
Treated with Fenbendazole
ParvoSerology Val - Positive.
Distemper PCR Negative.
Abdominal Rads NPF.

Google Day 2
Still NPO
1 big bloody diarhea
2 vomitings
Apathic
T-39.7

Google cbc Day 2
Google Day 2
Urinalysis SG 1.035
Blood Glucose 112

Google plan day 2
Fluids LRS + 20Meq KCl + 2.5%
Dextrose
Metoclopramide in constant rate 1mg/kg/h
Zantac/Ranitidine
ABs switch to Ampi-Genta. (after
rehydration).


Google Day 3

No change
Google day 4
PE
Prostration.
Bloody diarrhea and vomiting.
Lost 250 g
T-37.8

Google day 4 - CBC
Google day 4 chem.
Fluids LRS+20Meq KCl +2.5% dextrose
Rate 3XM
Antacids Metoclop.+ranitidine
Abs Ampi+Genta
FFP Fresh frozen Plasma.Blood bank.
Owner did not agree financial decision.
Google plan day 4
Google day 5
PE dog doing a little better,
More active,
Very little diarhea
Vomited twice.
Edema of both hindlimbs and Vulvar area.
Google day 5 Plan
Cbc+chem
Urinalysis
Fluids (LRS+KCl+Dextrose)
Antacides
Abs
FFP

Google day 5 cbc
Google day 5 chem.
Google Day 5
FFP was brought from the Blood Bank.
Typing.
Dose of 15ml/kg.
Paralel with Saline- not LRS.

Google Day 6
Google started to eat small amounts of
Inetstinal Eukanuba,
Vomited only once.
Tratment still the same.
Google Day 7
Looking great
Eating 4-5 /day intestinal eukanuba.
No vomiting
Going Home.

-
Day WBC TP Albumin Hgb RBC
1 12.4 9 4.11
2 5.04 8.3 3
4 4.38 4.1(5-7) 1.4 9.6 4.58
5 1.06 3.2 0.9 10.2 4.32