Any advice for a nasal pseudomonas infection?

RE: Any advice for a nasal pseudomonas infection?

Andrew Kent — Sat, 15 Jun 2024 09:37:56 GMT

Absolutely agree these are frequently nightmare cases and if you are back to a manageable level that may be the best you get to.

Also agree some of these are probably aerodigestive so we will sometimes trial medical management of oesophageal reflux in some cases.

I generally don't find systemic steroids helpful in chronic rhinitis so would be more likely to use inhaled or topical +/- other immunosuppressants.

Good luck!

Andy

RE: Any advice for a nasal pseudomonas infection?

Desiree Scott — Mon, 10 Jun 2024 11:40:19 GMT

Hi Andy and Alasdair,

Thanks again for your help. I'm not sure how to respond to the thread in the normal way (I'm a newbie at asking questions) so apologises for that.

I do know that secondary infections in the nasal passages are (almost always?) secondary. I've not seen pseudomonas before and think I had a bit of a fright considering how hard it is to treat in other circumstances.

After speaking to the client about repeat biopsies they've decided to hold off for now as the pup seems stable. The nasal discharge is on/off but improved, with no signs of infection (clear discharge from what they say). I had recommended a hypoallergenic diet way back and they are working with a nutritionist on that (novel proteins and all). They don't seem to want my advice on that factor ; )

I find these lymphoplasmacytic rhinitis cases are really difficult to manage sometimes. This is the first time I've seen a (possible) secondary aspiration pneumonia. I spoke with someone at Edinburgh Vet school who suggested a possible "on-going micro-regurgitation that could be also a cause of on-going rhinitis and the reason for the aspiration pneumonia" which is an interesting thought. The owner has not reported GI problems and I imagine the advice from the nutritionist should help if so.

Also I've had some advice that NSAIDs and doxycycline are often used instead of steroids. I feel NSAIDs have not be useful in my cases so far but I've not combined them with the doxycycline.

Unfortunately there is only one scope image and I don't think it would be that helpful.

Thank you both for the help!

Kind regards,

Desiree

RE: Any advice for a nasal pseudomonas infection?

Alasdair Hotston Moore — Sun, 09 Jun 2024 19:44:12 GMT

Also late to the party but I’d like to add that Pseudomonas here is secondary not primary. Also I’m afraid there are cases of chronic hyperplasticity or lymphocytic plasmacytic rhinitis like this that simply don’t get better.

RE: Any advice for a nasal pseudomonas infection?

Andrew Kent — Sun, 09 Jun 2024 08:18:29 GMT

Sorry for the slow reply, be interesting to see the scope images if you can. The CT is not that exciting and could certainly still fit with an ongoing chronic rhinitis. Repeat biopsy could certainly be useful if that’s possible?

how are things going?

Andy

RE: Any advice for a nasal pseudomonas infection?

Desiree Scott — Fri, 17 May 2024 09:11:35 GMT

Hi Andy, Andrew Kent

Thank you for the reply!

I was thinking of repeating the nasal biopsies, esp. since there is more material in the frontal sinuses compared to the previous scans.

The patient is about 9yrs old, male entire Vizsla. I've attached the CT report from VetCT but I'm not at work today (on my holidays) to get a hold of the rhinoscopy images. I can upload them next week.

Thank you again!

Kind regards,

Desiree

www.vetsurgeon.org/.../VETCT_2D00_718705-Ollie-greene-Final.pdf

RE: Any advice for a nasal pseudomonas infection?

Andrew Kent — Fri, 17 May 2024 08:59:05 GMT

Hi Desiree

Interesting case - any chance you could post the CT and rhinoscopy images?

I guess the question for me would be whether the pseudomas is causing the destruction or whether something else is causing the destruction and the pseudomonas has taken advantage of the altered environment. Did you re-biopsy? Could this be a sinonasal aspergillosis?

What's the age/breed of the patient?

Andy