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Proteus infestion...any ideas?
Re: Proteus infestion...any ideas?
Did your vet mention the possibility of this being a multiple-condition as opposed to strictly a proteus isolate? I.e., the oral ulcers and in the throat, was a cytology done from oral secretions specifically and tested for bacteria and virals?
Was proteus also found in any urinalyses?
Your vet should be able to consult any veterinary university either in dermatology or immunology departments for further help. If your vet felt an infection may have originated in the GI tract, then an endocrinology dept may also be able to help him further.
Was proteus also found in any urinalyses?
Your vet should be able to consult any veterinary university either in dermatology or immunology departments for further help. If your vet felt an infection may have originated in the GI tract, then an endocrinology dept may also be able to help him further.
..........Traci
I definitely concur with Traci that this is most likely a multi-organism infecton. Unfortunately, the Proteus was probably the easiest to grow, but it may not be the primary infectant. Proteus likes already dead tissue. Whenever we see it in humans, it is almost always a sign of tissue necrosis (tissue death), often caused by a different organism. Proteus 'swarms' over the bacteriological growth media, and by doing so can hide the other organisms that might be present. Rifamycin will not work against Proteus at all, and in humans at least, is only used in combination with other antibiotics. The combination of the rifamycin and the cephalosporin (cefazolin) would be used in some difficult-to-treat human infection, but mainly Staph infection. If the Rifocin worked on the skin ulcers, that is a pretty clear indicator that the Proteus is not the problem, since that antibiotic is not effective against gram-negative organisms, such as Proteus, at all. Personally, I suspect an anaerobic organism may be involved. You might want to ask your vet about adding an antibiotic with anaerobic coverage, such as metronidazole (Flagyl).
Has a blood culture been performed?
My suggestion is to have a blood culture done plus repeat the culture, including anaerobic and possibly also fungal cultures, but have your vet request they report 'ALL ORGANISMS' isolated. Some or them will be normal skin or throat organims that are not involved on the infection, so it could be difficult to determine which is/are the infectant(s). He should then consult with a veterinary microbiologist to determine what they all mean. A clean, surgically obtained tissue sample would be the preferred sourse for the culture, rather than a swab, which will be contaminated with contaminating 'normal flora'. It is also possible that the 'normal flora' has been severely disrupted, which may be a factor in resolving the problem.
BTW - Do do you know what species of Proteus? There is a significant difference in the antibiograms of P.mirabilis (fairly sensitive to most common antiobiotics) and P. vulgaris (usually quite resistant, including resistance to the first generation cephosporins, such as cefazolin). Also. do you know what type of lab performed the original cultures? I'm very curious about the technique they used and their experience with interpreting mixed cultures.
Has a blood culture been performed?
My suggestion is to have a blood culture done plus repeat the culture, including anaerobic and possibly also fungal cultures, but have your vet request they report 'ALL ORGANISMS' isolated. Some or them will be normal skin or throat organims that are not involved on the infection, so it could be difficult to determine which is/are the infectant(s). He should then consult with a veterinary microbiologist to determine what they all mean. A clean, surgically obtained tissue sample would be the preferred sourse for the culture, rather than a swab, which will be contaminated with contaminating 'normal flora'. It is also possible that the 'normal flora' has been severely disrupted, which may be a factor in resolving the problem.
BTW - Do do you know what species of Proteus? There is a significant difference in the antibiograms of P.mirabilis (fairly sensitive to most common antiobiotics) and P. vulgaris (usually quite resistant, including resistance to the first generation cephosporins, such as cefazolin). Also. do you know what type of lab performed the original cultures? I'm very curious about the technique they used and their experience with interpreting mixed cultures.
"A dog is the only thing on earth that loves you more than he loves himself." ~ Josh Billings.
Two quick questions....when she was first presented with fever and bloody diarrhea, did your vet suspect or diagnose parvo or distemper? Had she been previously vaccinated for these and current on her vaccinations?
Was a fungal profile done specifically....it's guessing, but has your vet ruled out cryptococcosis?
Lastly, and twofold: has food allergy been ruled out? What are you feeding her, and have you changed her diet at any time during the course of this condition? Has flea/mite/ectoparasites been ruled out?
Was a fungal profile done specifically....it's guessing, but has your vet ruled out cryptococcosis?
Lastly, and twofold: has food allergy been ruled out? What are you feeding her, and have you changed her diet at any time during the course of this condition? Has flea/mite/ectoparasites been ruled out?
..........Traci
Re: Proteus infestion...any ideas?
I would still suggest a fungal profile and rule out food allergy/sensitivity.
The P/D may be adding nutrients and calories to her diet, but you may want to consider a hypoallergenic diet, in the event she may respond. Preferrably a single-source protein, one she has never been exposed to before. Intradermal allergy testing is also available, but depending on what is available in your area, and your vet's experience, will depend on the validity of the allergy testing.
Only other thing I can think of is contact dermatitis, i.e., something in her environment, either indoors or outdoors (house mites, food mites, molds, fungals, straw/hay bedding, etc)
The P/D may be adding nutrients and calories to her diet, but you may want to consider a hypoallergenic diet, in the event she may respond. Preferrably a single-source protein, one she has never been exposed to before. Intradermal allergy testing is also available, but depending on what is available in your area, and your vet's experience, will depend on the validity of the allergy testing.
Only other thing I can think of is contact dermatitis, i.e., something in her environment, either indoors or outdoors (house mites, food mites, molds, fungals, straw/hay bedding, etc)
..........Traci
I am concerned that the sensitivity profile (if I read your post correctly) shows the organism to be resistant to ceftriaxone, a third-generation cephalosporin. Your dog is being treated with a first generation cephalosporin (cefazolin). There is absolutely NO WAY that an organism resistant to 3rd generation cephalosporins will be sensitive to first generation drugs. Judging from the resistance pattern, I suspect the organism may be producing an ESBL (extended spectrum beta-lactamase - an enzyme produced by certain bacteria, including Proteus) which will cause the organism to be resistant to all penicillin and cephalosporin class antibiotics EXCEPT the cefamycins (I'm sorry, I don't know if the cefamycins are available for veterinary use; the ones available for human use in the U.S. are cefoxitin and cefotetan. Since you aren't in the U.S., I'm at a even greater loss to make any suggestions). If It were me, I would insist on a change in the antibiotic being used to one that is not a penicillin or cephalosporin, unless it is a cefamycin.
I'm impressed that the cultures you've had performed were done at the Univeristy of Turin - I doubt they made any mistakes, which is good. That means the interpretation is likely to be correct. I still think having a blood culture done would be a good idea, and a fungal process can't be ruled-out.
BTW - ESBL testing is available, but may not have been done when your cultures were performed. In the U.S., it would be routinely performed in any reputable lab, but this is a fairly new development in the work-up of Proteus.
I'm impressed that the cultures you've had performed were done at the Univeristy of Turin - I doubt they made any mistakes, which is good. That means the interpretation is likely to be correct. I still think having a blood culture done would be a good idea, and a fungal process can't be ruled-out.
BTW - ESBL testing is available, but may not have been done when your cultures were performed. In the U.S., it would be routinely performed in any reputable lab, but this is a fairly new development in the work-up of Proteus.
"A dog is the only thing on earth that loves you more than he loves himself." ~ Josh Billings.
Re: Proteus infestion...any ideas?
I had another thought. This reminds me so much of when my daughter had a problem that just wasn't being diagnosed, but, as long as she stayed on antibiotics, she was fine. It turned out with her, that her tonsils had become necrotic and had to be removed. We went through a year of hell, and a lot of yelling at her doctor (whom I still despise).
I think you need to look for a necrotic process - possibly in the intestines, but consider the tonsils or some other organ. Traci - do dogs have an appendix (or it's equivalent)? Something is wrong, and it isn't healing, and there could be necrotic tissue somewhere. I'm thinking the skin ulcers, etc. may be a symptom of something else. Is there an infectious disease expert you can consult?
I think you need to look for a necrotic process - possibly in the intestines, but consider the tonsils or some other organ. Traci - do dogs have an appendix (or it's equivalent)? Something is wrong, and it isn't healing, and there could be necrotic tissue somewhere. I'm thinking the skin ulcers, etc. may be a symptom of something else. Is there an infectious disease expert you can consult?
"A dog is the only thing on earth that loves you more than he loves himself." ~ Josh Billings.