Maine Coon with pus in chest

Re: Maine Coon with pus in chest

Bob Russell — Mon, 18 Oct 2010 11:40:45 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Bob Russell"]Next question is how long to stay on antibiotics and what will happen when they stop![/quote]

If you want to be high-tech about it, ask your lab for acute phase proteins: roughly speaking, if they are still high then continue antibacterial drug.

I'm not being critical, but if in a month his symptoms are good and you are happy on auscultation, why take the risk of more radiography?

[/quote]

Curiosity, hopefully satisfaction and if there is still evidence of fluid present guidance as to whether longer antibiotic course is required. The cat is very good and will lie flat on the plate so not risks with sedation/anaesthesia.

Re: Maine Coon with pus in chest

Andrew Mellor — Mon, 18 Oct 2010 09:54:40 GMT

[quote user="Evelyn Barbour-Hill"]Bob Russell"]Next question is how long to stay on antibiotics and what will happen when they stop[/quote]

4-6 weeks at least i have found, if you stop too soon invariably you will wish you had not as symptoms will come back. i had one cat who appeared clear for over 12 months then restarted and had to do thoracotomy (needle drained first time) to clear it. I never could work out if that was a recurrence or just an extremely unlucky cat!

Re: Maine Coon with pus in chest

Evelyn Barbour-Hill — Sat, 16 Oct 2010 14:42:59 GMT

[quote user="Bob Russell"]Next question is how long to stay on antibiotics and what will happen when they stop![/quote]

If you want to be high-tech about it, ask your lab for acute phase proteins: roughly speaking, if they are still high then continue antibacterial drug.

I'm not being critical, but if in a month his symptoms are good and you are happy on auscultation, why take the risk of more radiography?

Re: Maine Coon with pus in chest

Mark Hedberg — Sat, 16 Oct 2010 12:37:06 GMT

I think just keeping him on antibiotics until next month would be better than risking a relapse. Probably a lot of fibrin and scar tissue in there. Good luck!

Re: Maine Coon with pus in chest

Bob Russell — Sat, 16 Oct 2010 12:11:39 GMT

Saw him yesterday - eating owner out of house and home. Happy as Larry, no dyspnoea. I did introduce clindamycin when he had a bad day last week so he is on that and higher dose nisamox (250mg 1/4 tablet bd).

Not very scientific I know but he has gone from nearly gasping his last to fit as a flea in a short time. Next question is how long to stay on antibiotics and what will happen when they stop!

He is coming back in a month for further X-rays and I will decide then!!!

Re: Maine Coon with pus in chest

Bob Russell — Mon, 04 Oct 2010 16:19:53 GMT

He is home at night - breathing much improved and eating like a horse. Radiographs a bit disappointing considering the clinical improvement but only managed to remove 8ml fluid this morning!

Re: Maine Coon with pus in chest

Bob Russell — Fri, 01 Oct 2010 13:03:36 GMT

Update - lab have found heavy growth of beta haemolytic strep Group G. Sensitive to most but resistant to Marboflox. Removed less than 20ml fluid this morning. Cat is getting fed up with being mucked about - good sign!

We are sending him home at night so he can sleep on the owners bed and they can tempt him to eat. Appetite not good but picked at food this morning on his own!!

May be jumping the gun but first day I have felt optimistic!!!

Many thanks for the advice.

Re: Maine Coon with pus in chest

Bob Russell — Thu, 30 Sep 2010 16:15:24 GMT

Had quite a poor day yesterday - confirmed by lab that it is pus. Cocci seen - still waiting for culture and sensitivity. Went home overnight and owners managed to get him to eat a bit.

Today 120mls of now straw coloured fluid. Breathing is a lot easier!!!

After days on augmentin, metronidazole and Baytril changed from augmentin to synulox!!

Cat is starting to complain about being mucked about so, perhaps a little optimistically think we may have turned a bit of a corner but not sure if it is the right one!!!!

Will keep everyone informed.

They have now insured their other cats and so has the mother!!

Re: Maine Coon with pus in chest

Andrew Mellor — Thu, 30 Sep 2010 11:07:29 GMT

How is your pyothorax doing?

Re: Maine Coon with pus in chest

Martin Atkinson — Tue, 28 Sep 2010 17:11:44 GMT

[quote user="Nixthevet"]

I find unless you have three sets of hands* you otherwise end up jiggling the needle when you move the position of the three way tap to empty your syringe.

[/quote]

*Isn't that otherwise known as a veterinary nurse?

Re: Maine Coon with pus in chest

Michael Woodhouse — Tue, 28 Sep 2010 16:03:16 GMT

[quote user="Nixthevet"]I find unless you have three sets of hands you otherwise end up jiggling the needle when you move the position of the three way tap to empty your syringe.[/quote]

I use an IV catheter so there is no needle jiggling about and a three way tap.

Not that I do a lot of this sort of thing!

Re: Maine Coon with pus in chest

Nixthevet — Tue, 28 Sep 2010 15:21:16 GMT

Sounds like everyone has it covered. The only thing I would add is that the MIla Centesis valves- which allow you to drain the chest wihtout having to fiddle with a three way tap are brilliant as I find unless you have three sets of hands you otherwise end up jiggling the needle when you move the position of the three way tap to empty your syringe.

Re: Maine Coon with pus in chest

Mark Holmes — Tue, 28 Sep 2010 15:12:47 GMT

The last one I treated, I did a thoracotomy.... really very straight forward, flushed pleural space +++ and drained for a couple of days. Astonishing how much stuff came out and really very simple. Actually I found it more straight forward than managing and flushing drains repeatedly for a week.

Re: Maine Coon with pus in chest

Kate Richardson — Tue, 28 Sep 2010 15:04:08 GMT

As others have said, iv abs (augmentin and metronidazole cover most). Often culture negative and no cause found. Frequent drainage via chest drains is the main stay of treatment, and lavage of pleural spaace with warmed 0.9% saline or Hartmans. The lavage fluid can be left in the pleural space for up to an hour as long as not causing respiratory distress before being withdrawn. Ideally regular analysis of the fluid being removed to assess WBC counts, but if costs are a factor, keep draining until getting less than 2mls/kg/day which usually takes about 4-6 days. Supportive treatment really important, especially monitor potassium levels as often get very low and may need potassium adding to the iv fluids and lots of good nursing and make sure they get nutrition support either by syringe feeding or NO/oes tubes if nec. Also +++ pain relief. 4-6 weeks oral antibs once (optimistic) getting better!

Re: Maine Coon with pus in chest

Vikki Halliday LLB — Mon, 27 Sep 2010 23:59:08 GMT

I had one of these about 12 years ago, no history or evidence of trauma, and nocardia cultured by lab. Managed by surgical placement of chest drain, daily sedation and flushing with copious volumes saline, and tried intra-pleural antibiotics, which I have to admit I never would again, as the cat had a small seizure every time penicillin was flushed into the pleura.

IV augmentin and Metronidazole alongside copious fluids seemed to do the trick and the chest drain was removed after 3-4 days, cat did ok, was discharged about 2 days after that on oral medication.

Re: Maine Coon with pus in chest

Noweia — Mon, 27 Sep 2010 22:51:13 GMT

[quote user="Andrew Mellor"]Thoracic placement of ab's no longer advised by kate murphy from bristol ( senior clinical fellow in sa emerg med and intensive care)

[/quote]

I'll bet. Intrathoracic tetra- or doxycycline is a human treatment for recurrent spontaneous pneumothorax as it stimulates a massive reaction with lots of pleurisy and adhesions!

Re: Maine Coon with pus in chest

Andrew Kent — Mon, 27 Sep 2010 20:01:01 GMT

Agree that the majority of these are surgical cases at some point and sooner better than later. If that isn't an option then medically I manage as follows:

IVFT + Analgesia

Bilateral Chest Drains - drain every 4 hours and instill warmed fluid prior to this if now flowing freely. Despite the previous study on small-bore chest drains I still think something wider gives better drainage in the majority of cases.

Antibiotics - start with IV augmentin plus fluoroquinolone and change if needed based on culture.

As others have said spin the fluid down to make sure it is pus and not chyle!

Give a guarded prognosis!

Andy

Re: Maine Coon with pus in chest

Rob Loxley — Mon, 27 Sep 2010 19:40:24 GMT

Last one I managed with intermittent needle thoracocentesis, broad spectrum antibiotics (iv then oral) and supportive treatment. With hindsight I might have gone for a small bore chest tube (see 3rd article) to avoid repeated needle centesis.

Some reading matter I found:

Vet J. 2009 Feb;179(2):163-70. Feline pyothorax - new insights into an old problem: part 1. Aetiopathogenesis and diagnostic investigation.
Vet J. 2009 Feb;179(2):171-8. Feline pyothorax - new insights into an old problem: part 2. Treatment recommendations and prophylaxis.
J Small Anim Pract. 2009 Jun;50(6):290-7. Evaluation of small-bore wire-guided chest drains for management of pleural space disease.

Re: Maine Coon with pus in chest

Hannah Wynne Richards — Mon, 27 Sep 2010 17:40:17 GMT

I suppose it's a matter of courage-and thoracotomies absolutely terrify me, but it's good advice if I'm ever absolutely forced to try it

Wynne

Re: Maine Coon with pus in chest

Malcolm Ness — Mon, 27 Sep 2010 17:07:40 GMT

I tend to treat these surgically (I am a surgeon after all, and when all you have is a hammer, everything looks like a nail!)

Bilateral thoracotomies (one side at a time under the same GA) to allow drainage and copious flushing with body temp isotonic electrolyte solution. I usually needle drain first to restore some tidal volume but you will be amazed how much gunk is left behind even after meticulous needle drainage. The surgery is not difficult and well within the capability of anyone who has repaired a diaphragmatic rupture in a cat. Most cats will do very well, and quite quickly, following such surgery and recurrences/poor outcomes, in my experience, have been attributable to undiagnosed primary pathology (FelV/FIV/Foreign body etc).

Re: Maine Coon with pus in chest

Bob Russell — Mon, 27 Sep 2010 16:57:15 GMT

Fluids +++ at moment as still very dehydrated. I/v augmentin. Will give more Baytril. I have injected metronidazole through the chest drain so will hold fire with more for the moment.

Re: Maine Coon with pus in chest

Andrew Mellor — Mon, 27 Sep 2010 15:18:23 GMT

You always have to be much more aggressive with these than you would expect to get good outcome, the ones I have no don't make it or have recurred with terrible pleural scarring, when you start thoracotomy to strip fibrin of pleural surfaces things are really bad so be aggressive today is all I would say. Just looking at notes from AVSTS AUTUMN MEETING LAST YEAR BRILLIANT SESSION ON SURGICAL AND NON-SURGICAL PYOTHORAX, lots of i/v fluids to stop the cat dehydrating and therefore the pus thickening because you will not easily get it out , synulox best to start with i/v augmentin better if available at high dose 15-20mg/kg qid, and drain every 2-3 hours, if lots of fluid consider chest drain and if the pus is thick or pocketted so having to reposition the needle a lot then irrigate with warm saline 10-20ml/kg, this is a good way of guaging wether you need to up your IVFT as if not fully hydrated you will only get a fraction of the fluid back out again. If patient really poorly add baytril or marbocyl in mix as well.

Thoracic placement of ab's no longer advised by kate murphy from bristol ( senior clinical fellow in sa emerg med and intensive care)

good luck, hope owners will give you enough time to get on top of things challenging but can be very rewarding

Andrew.

Re: Maine Coon with pus in chest

Hannah Wynne Richards — Mon, 27 Sep 2010 14:59:05 GMT

Possibility of penetrating grass awn carrying infection, so instill antibiotic (broad-spectrum ) into pleural cavity Culture and sens Possibility of Nocardia, so take precautions-not sure what the recomended treatment is for this Possibility of trauma and chyle not pus

Anyway treatment will need to be lengthy, so the referral not possible comment is ominous, as you may not be allowed to treat as extensively as you would wish if the reason for this is financial

Anyway good luck

Wynne