Proteus infestion...any ideas?

[Traci]

Karen, neither dogs nor cats have an appendix.

IMO, the vet should be thinking multiple-condition rather than focusing on proteus only...whether that be fungal or dermal, etc. A swab or tracheal wash can be done to get clear samples for cytology from those oral and throat ulcers. The lesions elsewhere just might be something else entirely. An endoscopy has already been done, so if intestinal bacteria were suspected and found, I would assume samples were tested for various bacteria (not just proteus).

If the condition has progressed for some time, then perhaps it's time for a new opinion/second opinion. Fresh minds oftentimes can assist when the primary vet may be perplexed or may have missed something obvious.

[k9Karen]

Karen, neither dogs nor cats have an appendix.

That's what I thought, but anatomy (human or canine) is not my strong suit. I think your suggestion of a second opinion is a good one.

[Sophia]

..

[k9Karen]

This so so sad. I wish I knew how to help. You've obviously done so much already with only limited success. If the Proteus grows out again, and it's the species that can be tested for ESBL, it would be a good idea to have the testing done (it might have been, but just wasn't listed as such on the report.) We put a note on our reports indicating that there is an ESBL so the doctor won't use any penicillins or cephalosporins, but, it may not be common practice in your area (or in veterinary medicine) to add that. (Or,it may have been negative, so there was no need to make any type of comment on the report). A repeat culture and sensitiity is good, since the bacteria can change in only a couple of days and become resistant to something that used to work, which can cause even more problems when trying to treat something long term.

I wish you the best of luck.

[Sophia]

..

[Traci]

Your vet could probably approach interferon or immunoregulin, but they are not without side effects, so be sure to discuss this thoroughly before proceeding...you would also want to repeat bloodwork during the course of the medication. To my knowledge, they are not available for online purchase, and they DO need to be properly prescribed by the vet and mixed and stored properly.

If your vet is a top specialist in your area, then she should have available access to a pathologist to review any biopsy resport she has, and an experienced microbiologist can assist her with culture reports....whether this is in her area or from a US veterinary university, I suppose depends on her choice and access available.

[k9Karen]

I've also seen articles on the use of bacteriophages, and, to the best of my knowledge, they are still experimental. That said, the experiments are usually performed in animals, and, restrictions on testing in animals are no where near the same as in humans. Since you're in Italy, you may have something available to you that we in the U.S. do not have. It is an option you may wish to explore as an option if nothing else works.

As for the antibiotics, I'd want to wait until the new culture results are back. I have worked in human microbiology for 30 years, and even though antibiotic treatment in canines is similar to that in humans, there are some differences because of the ways the drugs work in the different species, so I can hopefully assist from the bacteriological standpoint, but your vet should be the best judge of what would work in your dog. You need to make sure that the drug used penetrates well into the type of tissue that is infected, and that the sensitivity pattern reported by the lab is clinically accurate. (This is difficult to explain to someone not familiar with medical microbiology, but, I'll try to make it easy to understand. )

There are many factors affecting antibiotic testing and whether or not it will work in an individual case. Here are some that immediately come to mind:

1. The first is the antibiotic susceptibility pattern performed in the lab. This is a standardized statistical measument based on mathematical formulas and scientific judgement, not something proven in clinical studies, so the results are not necessarily 100% correct. The accuracy of the report can be very dependent upon the knowledge of the personnel performing the testing. It is not uncommon for antibiotics that are known not to work on a particular organism to be called "sensitive" based soley on lab test results. There are multiple rules that govern what is reported and what isn't based on the site of the infection and the identity of the organism tested, and sometimes the people doing the testing aren't aware of these guidelines. The doctor can also sometimes misinterpret the results he receives.

2. The area of the infection - whether or not a particular antibiotic will be adequately absorbed into the tissue that area. This includes whether or not there is some problem with blood circulation to the area. (Bad circulation, such as would be seen in necrotic tissue = no antibiotic delivery to the infection)

3. The immune status, plus the kidney and liver functions of the infected patient, or any other disease state or congenital disorder that could affect healing and the inflammatory process.

4. Dosing and length of treatment - too little of either can be the cause of ineffective treatment.

I can try to help with #1 on this list to help make sure the antibiotic(s) chosen for use should be effective based upon the laboratory data. The other factors will be taken into consideration by your vet when he chooses the treatment.

[Sophia]

..

[Traci]

You need to be very careful using herbal supplements with other medications your vet has prescribed or you are currently giving your dog. Many herbal supplements can interact with them, causing harm. I wouldn't use them anyway, a large majority of them have no proven effectiveness.

[k9Karen]

I'm curious, in humans, oral problems are often treated with antimicrobial rinses (many contain peroxide or other agents). I know with animals this type of thing would have to be used cautiously because they will probably swallow it, but does anyone know if something like that would be an option?

If the infection is Proteus (a gram-negative enteric bacillus), do you know why your vet would put the dog on clarithromycin, a drug that is predominantly for gram-postiive organismsand just a few non-enteric gram negative bacilli? Clarithromycin will not be effective against Proteus. I know there is a possibility of some other underlying infection that hasn't been successfully cultured, but your vet has put the dog on a 1st generation cephalosporin, when the sensitivity pattern said it was resistant to 3rd generation drugs - a clear indication that 1st generation drugs will also not work, and now he is using a drug that wasn't even tested because it's known it will not work on the infecting Proteus. I find this information puzzling, and frankly, it is not logical based on culture reports.