皮肤是猫整体健康的指标：感染性疾病的皮肤临床表现-（5）原生动物及相关的皮肤病

王帆

SKIN AS A MARKER OF GENERAL FELINE HEALTH

皮肤是猫整体健康的指标

Cutaneous manifestations of infectious disease

感染性疾病的皮肤临床表现

作者：Katherine Backel and Christine Cain
翻译：何梦婷 校对：王帆、刘欣

Protozoa–and associated cutaneous disease

原生动物及相关的皮肤病
Protozoal disease rarely produces cutaneous lesions in cats. The below discussion focuses on diseases that may be considered as differentials in patients with a history of immunosuppression or in those from areas where the disease agents are known to be endemic.
原生动物疾病很少在猫身上产生皮肤病变。下面的讨论集中在可能被认为是有免疫抑制病史的患猫或那些已知病原体为地方病的地区的鉴别诊断疾病。

Toxoplasma gondii

弓形虫
Toxoplasmosis is a systemic coccidial disease for which cats are the definitive host. Cutaneous lesions have been reported in only a few cases and are characterized by single or multiple nodules that may ulcerate. In these cases, organisms have been visible on cytologic samples and biopsy specimens.Importantly, severe disseminated infections have been reported in association with immunosuppressive states induced by concurrent diseases and medications such as corticosteroids and ciclosporin modified.
弓形虫病是一种全身性球虫病，猫是其终末宿主。皮肤病变仅在少数病例中有报道，其特征是单个或多个结节可能溃疡。在这些病例中，在细胞学和活检标本上可以看到有机体，重要的是，严重的弥散性感染与并发疾病和药物(如皮质类固醇和改良环孢素的药物)引起的免疫抑制状态有关。

It has been clearly demonstrated that cats which become infected by Toxoplasma gondii after commencing ciclosporin therapy are at the highest risk of developing severe or disseminated disease.
已经清楚地证明，猫在开始环孢素治疗后感染弓形虫是最有可能发展成严重或弥散性疾病的。

Leishmania species

利什曼原虫
Leishmaniosis is a protozoal infection that typically affects humans and dogs in endemic areas. The disease is transmitted by bloodsucking sand flies and occurs where these flies are found in high numbers (the Middle East, South and Central America, the Mediterranean basin and Portgual).Although disease is rare in the USA, Leishmania mexicana is considered endemic in Texas.
利什曼病是一种原虫感染，通常会影响流行地区的人和犬。该病是通过吸血白蛉传播的，发生在苍蝇数量较多的地方（中东、南美洲和中美洲、地中海盆地和葡萄牙）。虽然这种疾病在美国很少见，但墨西哥利什曼原虫在得克萨斯州被认为是地方病。

When cats with dermatologic lesions were examined in Southeast Brazil, close to half (27/55) were found to be positive for Leishmania species.
在巴西东南部对猫进行皮肤病检查时，发现近一半（27/55）的利什曼原虫阳性。

Cats are considered resistant to disease and reports of infections are infrequent. In Southeast Brazil, surveillance has revealed low numbers of positives on samples from healthy cats (4–6%). However, when cats with dermatologic lesions were examined from a similar area, close to half were found to be positive. These results indicate that patients presenting with dermatologic lesions in endemic areas should be closely evaluated for Leishmania species.
猫被认为对疾病有抵抗力，感染的报告很少。在巴西东南部，监测发现健康猫的样本中，阳性检出率很低（4-6%）。然而，当在相似的区域对皮肤病变的猫进行检查时，发现接近一半的感染是阳性的。这些结果表明，在流行地区出现皮肤病变的患猫应密切评估利什曼原虫病。

Cats with cutaneous leishmaniosis typically present with focal alopecia, nodules, crusting and scaling, most often on the head (especially the pinna), limbs and trunk. Systemic signs, particularly lymphadenopathy, dehydration, weight loss and diarrhea, often accompany skin lesions.
皮肤利什曼病的猫通常表现为局灶性脱毛、结节、结痂和皮屑，最常见于头部（尤其是耳廓）、四肢和躯干。全身症状，尤其是淋巴结病、脱水、体重减轻和腹泻，常伴有皮肤病变。

This disease should be considered as a differential for head/neck ulcers in patients that live in or have traveled to endemic areas. The most straightforward method of diagnosis is via identification of the organisms within aspirates or tissue samples (spleen, lymph nodes, bone marrow or liver). Samples from affected skin can be submitted for histopathologic analysis and immunohistochemistry. Histologic diagnosis has relatively low sensitivity;however, immunohistochemistry may help to identify additional cases. Serology (ELISA and immunofluorescence antibody test) shows poor correlation with parasitological diagnosis and may underestimate infections in cats due to differences between individual immune responses to the disease.
这种疾病应该被认为是生活在流行区或曾前往流行区的患者的头/颈部溃疡的区别。最直接的诊断方法是通过对抽吸物或组织样本（脾、淋巴结、骨髓或肝）中的微生物进行鉴定。来自病变皮肤的样本可以提交组织病理学分析和免疫组化。组织学诊断敏感性相对较低，但免疫组化可帮助鉴别其他病例。血清学（酶联免疫吸附测定和免疫荧光抗体试验）与寄生虫学诊断相关性较差，由于个体对疾病的免疫反应不同，可能低估了猫的感染。

KEY POINTS 要点 Many of the cutaneous manifestations of infectious disease are uncommon. It is important always to look for the common first, and then consider other differentials when conventional therapy is not working. 许多感染性疾病的皮肤表现是不常见的。重要的是，在常规治疗无效的情况下，总是先寻找共同点，然后再考虑其他鉴别诊断。 When approaching atypical cutaneous disease in cats, start by identifying the main reaction pattern to narrow down the differential list. 当猫患上非典型性皮肤病时，首先要确定主要的反应模式，以缩小鉴别列表的范围。 Diagnosis can be difficult–diagnostic tests likely to give the most information should be pursued first. Cytologic examination should always be performed prior to biopsy collection. 诊断可能很困难-首先应该进行可能提供最多信息的诊断测试。在活检采样之前都要进行细胞学检查。 Consider biopsy early in cases that do not follow the typical pattern. 考虑尽早活检而不是遵循典型病例的模式。 Consider FIV/FeLV status in cats with skin lesions consistent with squamous cell carcinoma or Boweno in-situ carcinoma. 考虑猫免疫缺陷病毒/猫白血病毒在皮肤病变与鳞状细胞癌或皮肤原位癌一致的猫中的状态。 Keep in mind regional variations in disease. 记住疾病的区域性变化。

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