一例犬细小病毒病的诊治
6一例犬细小病毒病的诊治【摘 要】犬细小病毒病是一种高度接触性传染病,发病率和死亡率都较高。细小病毒能引起犬的出血性肠炎和心肌炎,出血性肠炎型临床多发。笔者在某动物医院诊治了一例病犬,主要表现为胃肠炎症状,并伴有番茄汁样粪便,有腥臭味,经过临床初步诊断和实验室诊断,该犬患有细小病毒病。经过采用犬细小病毒单抗和犬干扰素进行特异性治疗,以及对症和支持疗法,病犬取得了痊愈。【关键词】犬,细小病毒病,诊治Diagnosis and Treatment of A Case of Canine Parvovirus【Abstract】Canine parvovirus disease is a highly contagious infectious diseases,incidence of a disease and mortality are higher. Parvovirus can cause the dog hemorrhagic enteritis and myocarditis,hemorrhagic enteritis is a type of clinical multiple. The author in a certain animal hospital treated a case of sickness dog,mainly for gastroenteritis symptoms to be accompanied by watery stool like tomato juice with stink odour,through a preliminary diagnosis and clinical laboratory diagnosis,the dog with canine parvovirus disease. After the canine parvovirus monoclonal antibody and canine interferon for specific treatment,and symptomatic and supporting treatment,ill dog has healed.【Keywords】Canine,Canine parvovirus,Diagnosis and Treatment目录前言···························································11. 发病情况················································12. 诊断················································12.1临床初步诊断·······································12.2试纸条检测·········································12.3血常规检查 ······························22.4诊断意见·········································23. 治疗················································33.1治疗方案············································33.2治疗病程····················································34. 讨论与体会··········································34.1及时发现诊断本病·····································34.2疫苗免疫预防本病·····································44.3预防继发感染································44.4正确选用止吐药·········································44.5治疗期间的注意事项···········································44.6生活环境的消毒··················································4参考文献··············································5致谢··················································5前言 犬细小病毒病又叫犬细小病毒性肠炎,是由细小病毒科的犬细小病毒引起的犬急性传染性疾病,临床上以急性出血性肠炎和非化脓性心肌炎为主要特征1。心肌炎型犬细小病毒感染在临床上比较少见,且该型常表现为突然发病,表现出心力衰竭,心有杂音,心率不齐,常在数小时内死亡。该类型细小病毒感染治疗意义不大,常来不及治疗,便转归死亡2。目前,本病的诊疗以临床检查结合快速诊断试剂盒进行诊断,以抗病毒血清或单克隆抗体为主进行综合治疗。1发病情况2012年1月11日,扬州市某动物医院接诊一只4月龄土种公犬,体重1.8千克,为自家繁殖所得,之前已有同胞另一只犬病死,平时饮食缺乏营养,体型消瘦,精神沉郁,病程约4日,无食欲,呕吐,呕吐物为黄色,腹泻呈番茄汁样稀便,有特殊腥臭味,(见图1、2),体温39.4,未接种过疫苗。图1 犬的黄色呕吐物 图2 犬的番茄汁样稀便2诊断2.1临床初步诊断询问犬主人得知,病犬病程约4日,无食欲,呕吐,腹泻,精神沉郁,体型消瘦,经测量体温39.4,怀疑为细小病毒病。2.2试纸条检测对病犬做犬细小病毒检测。用棉签采集病犬粪便,盛入稀释液中,充分摇匀后,静置5min,取上清液35滴,逐滴缓慢滴于由韩国RapiGen公司生产的犬细小病毒抗原检测试剂盒的样品区中,水平放置,5min后试纸上检测区T区和C区分别出现一条紫红色线,表明犬细小病毒感染示呈强阳性,见图3,进一步诊断为细小病毒病。图3犬细小病毒感染呈强阳性 注:试剂盒上C线为对照线,T线为检测线。测试结果若同时有C线T线则为判断为阳性,根据T线深浅还可估计强弱程度;若只有C线无T线则判断为阴性;若无C线有T线,则表示该试剂盒无效。2.3血常规检查 从犬前肢内侧头静脉抽取适量血液做血常规检查,检查项目有白细胞数、淋巴细胞数、单核细胞数、嗜中性粒细胞数、血小板数、血小板分布宽度、红细胞数、血红蛋白、血细胞比容、平均红细胞体积、平均红细胞血红蛋白量、平均红细胞血红蛋白浓度、红细胞体积平均分布宽度、平均血小板体积、血小板压积,其中平均红细胞体积(MCV)和平均红细胞血红蛋白量(MCH)数值偏高,单核细胞数偏低,具体检测结果见表1。表1 犬患细小病毒病血常规检查结果血液项目和单位结果参考值血液项目和单位结果参考值白细胞(WBC)×109/L7.36.017.0红细胞(RBC)×1012/L6.205.58.5淋巴细胞数(Lymph#)×109/L1.61.04.8血红蛋白(HGB)g/L157120180单核细胞数(Mon#)×109/L0.20.31.5血细胞比容(HCT)%46.73260嗜中性粒细胞数(Gran#)×109/L5.53.011.4平均红细胞体积(MCV)fL75.46075淋巴细胞(Lymph)%21.31230平均红细胞血红蛋白量(MCH)pg25.319.524.5单核细胞(Mon)%2.9310平均红细胞血红蛋白浓度(MCHC)g/L336320360嗜中性粒细胞(Gran)%75.66387红细胞体积平均分布宽度(RDW)%12.31018血小板(PLT)×109/L207200500平均血小板体积(MPV) fL8.5713血小板分布宽度(PDW)%15.510.030.0血小板压积(PCT)%0.1750.10.322.4诊断意见根据临床初步检查和试纸条检测,基本可以诊断该犬患细小病毒病,血常规检查结果显示平均红细胞体积(MCV)和平均红细胞血红蛋白量(MCH)数值偏高,说明犬有贫血,这很可能是由于病犬便血造成的,此外单核细胞数偏低表明该犬可能有急性传染性的疾病,最终确诊该犬患细小病毒病。3治疗3.1治疗方案3.1.1特异性治疗治疗本病首先要抗病毒,可以选用犬细小病毒单抗2.5ml,干扰素100万单位,利巴韦林15ml。3.1.2对症治疗 对于本病出现的呕吐、腹泻便血症状,预防肠道继发细菌感染,可以选用胃复安0.2ml,盐酸消旋山莨菪碱0.2mL,止血敏0.2ml,庆大霉素2ml。3.1.3支持疗法本病导致的严重腹泻使得犬脱水,体内电解质失衡,因此需要給犬进行补液补能,防止低血钾症,调节体内电解质平衡,同时抑制胃酸分泌过多,可以选用ATP0.25ml, 辅酶A20万单位,10%氯化钾0.2ml,维生素B60.2ml,维生素C0.2ml,100ml 5%葡萄糖盐水中静脉滴注;雷尼替丁0.2ml,皮下注射。病愈初期还需对胃肠道进行护理,每天一袋优生元饮水服用。以上用药一般连用五天,但可根据病程实际情况稍作调整。3.2治疗病程第一天,病犬精神沉郁,双耳耷拉,四肢无力,频现呕吐动作,拉出番茄汁样腥臭稀便,挂水期间呕出黄色物,体温39.4。第二天,病犬精神略微好转,但仍有呕吐动作,腹泻情况有所减轻,体温39。第三天,病犬精神又好转些,仍有呕吐动作,呕吐物为灰白色,腹泻物也不再是番茄汁样腥臭味,渐趋正常。第四天,病犬精神好转,双眼有神,双耳喜动,据主人介绍能自行随意跑动以寻找食物,说明食欲转好,呕吐腹泻症状基本消除,可略微饮水。第五天,病犬精神明显好转,饮水未吐,无腹泻,有食欲,体温正常,判定该犬基本痊愈。4讨论与体会4.1及时发现诊断本病犬细小病毒性肠炎发病率和致死率较高,所以尽可能做到早发现,早诊断,早治疗,降低死亡率。4.2疫苗免疫预防本病疫苗免疫对于预防犬细小病毒病非常重要,但临床中也有部分犬接种疫苗后仍然发病。免疫失败的原因很多,如未遵循免疫程序、母源抗体的影响、操作不当、疫苗失效以及机体自身的免疫缺陷等。另外,病毒的变异也是原有疫苗免疫失败的原因之一,据张仁舟等2010年4月报道7,中国国内首次检测到犬细小病毒CPV-2c。目前国内外生产的CPV疫苗基本都是CPV-2,但应用流行株CPV-2b作为疫苗可能会提供更好的保护效果,而在欧洲,用流行株CPV-2b生产的疫苗已经批准上市。4.3预防继发感染在病犬肠道,犬细小病毒的复制杀死了肠腺的胚上皮细胞,导致肠上皮脱落,固有膜暴露,引起水、盐代谢失衡,肠壁出血8,同时,病毒的复制导致淋巴结坏死,产生免疫抑制现象,病犬在发病后期易继发大肠杆菌、葡萄球菌、链球菌和沙门氏菌感染9。因此,在临床治疗中除了使用高免血清、单克隆抗体、干扰素等,以中和病毒、抑制病毒的复制,还应选用敏