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Clinical and histopathologic features of dorsally located furunculosis in dogs following water immersion or exposure to grooming products: 22 cases
22例在浸水或理毛后出现的背部疖病的患犬的临床及组织病理学特征
Christine L. Cain, DVM, and Elizabeth A. Mauldin, DVM
翻译：王帆
Objective—To describe clinical and histopathologic features of furunculosis in dogs following water immersion or exposure to grooming products.
Design—Retrospective case series.
Animals—22 dogs with skin lesions consistent with furunculosis and a history of water immersion or grooming prior to onset.
Procedures—Information collected from the medical records of affected dogs included signalment, clinical signs, bathing or grooming procedure, diagnostic tests, treatment, and outcome.
Results—German Shepherd Dogs (4/22 [18%]) and Labrador Retrievers (4/22 [18%]) were most commonly affected. Skin lesions, particularly hemorrhagic pustules and crusts, were dorsally located in all dogs and occurred a median of 2 days (range, 1 to 7 days) following water immersion or exposure to grooming products. Twenty (91%) dogs were bathed at home or at a commercial grooming facility prior to lesion onset; 1 dog developed skin lesions following hydrotherapy on an underwater treadmill, and 1 dog developed peri-incisional skin lesions after surgery. Lethargy, signs of neck or back pain, and fever were common clinical signs. Pseudomonas aeruginosa was the most common bacterial isolate from dogs with bacteriologic culture performed on skin samples (10/14). The main histologic feature was acute follicular rupture in the superficial dermis with suppurative inflammation and dermal hemorrhage. Systemic antimicrobial treatment, particularly oral administration of fluoroquinolones, resulted in excellent clinical response in 16 of 22 (73%) dogs.
Conclusions and Clinical Relevance—Acute-onset furunculosis with characteristic clinical and histopathologic features in dogs following water immersion or exposure to grooming products was described. Knowledge of the historical and clinical features of this syndrome is essential for accurate diagnosis and appropriate treatment of affected dogs.
研究目的-在浸水或洗澡后出现的犬疖病的临床及组织病理学特征。
设计-回顾性病例分析。
研究动物-22只有疖病皮肤病变表现的患犬，且发病前进行过浸水或洗澡。
研究方法-从患犬病例中收集信息，包括特征描述、临床症状、洗澡或理毛程序、诊断性试验、治疗方法和结果。
研究结果-最常感染的犬是德国牧羊犬(4/22 [18%])和拉布拉多犬(4/22 [18%])。皮肤病变表现为：特有的出血性脓疱和结痂，所有犬都位于背部且平均出现在浸水或洗澡后2天（范围：1-7天）。有20只(91%)犬发病前在家或去商业化美容店洗澡；1只犬在手术后切口周围出现皮肤病变。常见临床症状有嗜睡、颈部或背部疼痛和发烧。铜绿假单胞菌是犬皮肤样本的(10/14)细菌学培养中最常见的分离菌。主要的病理组织学特征是表皮真皮层急性毛囊破裂，伴有化脓性炎性反应和真皮层出血。全身抗生素治疗，尤其是口服氟喹诺酮类药物，在22只患犬中有16只(73%)临床反应良好。
讨论和临床相关性-对犬在浸水或洗澡后急性发病的疖病的临床特点和组织病理学特征进行描述。了解这种症状的病史和临床特征，对患犬的确诊和合理治疗至关重要。
Community-acquired skin infections, particularly folliculitis (hot tub folliculitis) or painful nodules on the hands and feet (hot hand-foot syndrome), are well documented in humans as the result of exposure to contaminated swimming pools, hot tubs, whirlpool baths, and saunas. Infections are generally associated with ubiquitous gram-negative bacteria such as Pseudomonas aeruginosa, and common-source exposure may result in outbreaks of several individuals.
在人类中有充分的记录证明，社区获得性皮肤感染，特别是毛囊炎(热浴盆毛囊炎)或手足疼痛性结节(热手足综合征)，是因为去过受污染的游泳池、使用过热浴盆、漩涡浴和桑拿浴后导致的结果。感染通常与普遍存在的革兰氏阴性菌(如铜绿假单胞菌)有关，共同来源的接触可能导致数个个体的暴发。
A similar syndrome of acute-onset furunculosis following water immersion or grooming has been described in dogs. Furunculosis has been proposed as a sequela to follicular trauma from vigorous manipulation of the skin and coat(ie, brushing or coat-stripping), followed by bathing with contaminated shampoos or conditioners, particularly bulk formulations that are diluted for use in commercial grooming facilities. Pseudomonas aeruginosa and other gram-negative bacteri have been isolated most commonly from skin lesions of affected dogs. Gross and Crowa reported 2 cases of acute, dorsally located furunculosis in dogs following use of grooming products. In one dog, P aeruginosa was isolated from skin lesions and diluted conditioner; in the other dog, Serratia marcescens was isolated from skin lesions and undiluted shampoo, supporting bacterial contamination of grooming products as the infection source for these dogs.
在犬中也描述了浸水或理毛后出现急性发作的疖病的相似综合征。有人提出疖病是用力处理皮肤和被毛(即刷牙或拔毛)，然后用受污染的香波或护毛素洗澡，特别是在商业化美容机构中使用的稀释的散装配方后造成的毛囊损伤的后遗症。从患病犬的皮肤病变中最常分离出铜绿假单胞菌和其他革兰阴性菌。Gross和Crowa报告了2例犬在使用美容产品后出现急性背部疖病。1只犬，从皮肤病变和稀释的护毛素中分离出铜绿假单胞菌;在另一只犬中，从皮肤病变和未稀释的香波中分离出粘质沙雷菌，支持这些犬的感染来源是美容产品的细菌污染。
Although this clinical syndrome is a recognized entity in dogs, reports of acute-onset, dorsally located furunculosis following water exposure are primarily anecdotal at this time. To our knowledge, no published case series has specifically described furunculosis in dogs with a recent history of grooming or water immersion. The purpose of the study reported here was to determine the clinical, histopathologic, and microbiological features as well as treatment of dogs with compatible clinical lesions of furunculosis and a recent history of water immersion or exposure to grooming products.
虽然这种临床综合征在犬中已被公认，但目前关于接触水后急性发作的背部疖病的报道主要是轶事。据我们所知，没有专门描述关于最近有理毛或浸水史的犬发生疖病的病例系列发表。本文报告的研究目的是确定具有符合疖病临床病变和近期有浸水或接触美容产品史的犬的临床、组织病理学和微生物特征，以及治疗。
Materials and Methods
材料和方法
This study was designed as a retrospective analysis of canine patients with a histopathologic or clinical diagnosis of acute furunculosis following water immersion or exposure to grooming products. Computer searches of the University of Pennsylvania Laboratory of Pathology and Toxicology biopsy database and the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania patient hospital discharge system were performed for medical records of dogs with a morphological or clinical diagnosis of furunculosis from January 1, 2005, to January 31, 2013. Inclusion criteria consisted of acute onset of skin lesions consistent with furunculosis (papules, pustules, plaques, nodules; with or without erosions, ulcers, and crusts) and a history of water immersion or grooming within 7 days prior to onset of skin lesions.
本研究旨在回顾性分析因浸水或使用理毛产品而出现急性疖病的患犬的组织病理结构或临床诊断。计算机检索2005年1月1日至2013年1月31日宾夕法尼亚大学病理与毒理学实验室活检数据库和宾夕法尼亚大学马修·J·瑞恩兽医医院患病动物出院系统，收集形态学或临床诊断为疖病的犬的病历。病例纳入标准包括急性发病的符合疖病的皮肤病变(丘疹、脓疱、斑块、结节;有或无糜烂、溃疡和结痂)，并且在皮肤病变发生前7日内有浸水或理毛史。
Medical records review—Medical records were reviewed for the following information: patient signalment, month of onset of clinical signs, location and description of skin lesions, time of lesion onset in days following water immersion or grooming, location of bathing or grooming (home vs commercial grooming facility), shampoo type if used (over the counter vs prescription; medicated vs nonmedicated), history of brushing prior to lesion onset, associated clinical signs, clinical diagnostic tests performed and any abnormal results, results of bacteriologic culture of the skin samples (if performed), histopathologic features (if performed), treatment, and treatment response. For specimens of affected dogs submitted to the University of Pennsylvania Laboratory of Pathology and Toxicology by outside veterinarians, submitting veterinarians were contacted by email, fax, or telephone for additional follow-up information.
病历记录回顾—查阅病历以获取以下信息:患病动物的特征、临床症状出现的月份、皮肤病变部位和描述、浸水或理毛后至出现皮肤病变的时间、洗澡或理毛的地点(家中vs商业美容机构)、使用的香波类型(非处方药vs处方;用药与未用药)、病变发生前的梳毛史、相关临床症状、进行的临床诊断检查和任何异常结果、皮肤样本的细菌培养结果(如有进行)、组织病理学特征(如有进行)、治疗和治疗效果。对于外部兽医向宾夕法尼亚大学病理和毒理学实验室提交的患犬的样本，我们通过电子邮件、传真或电话联系提交的兽医，以获得更多的随访信息。
Results
结果
Twenty-two dogs met the inclusion criteria. Nine (41%) dogs were castrated males, 3 (14%) were sexually intact males, 9 (41%) were spayed females, and 1 (4%) was a sexually intact female. The median age was 4 years (range, 0.75 to 13 years). Ten breeds were represented, with 4 (18%) German Shepherd Dogs, 4 (18%) Labrador Retrievers, 3 (14%) Golden Retrievers, and 3 (14%) Welsh Corgis. There were 3 mixed-breed dogs. The remainder of the patient population consisted of 1 each of the following breeds: Beagle, Bloodhound, Weimaraner, Jack Russell Terrier, and Rottweiler. Three of 4 German Shepherd Dogs and 1 of 4 Labrador Retrievers were working police dogs.
22只犬符合纳入标准。9只(41%)为已去势雄犬，3只(14%)为未去势雄犬，9只(41%)为已绝育雌犬，1只(4%)为未绝育雌犬。年龄0.75-13岁，中位年龄4岁。有10个品种，4只(18%)德国牧羊犬、4只(18%)拉布拉多猎犬、3只(14%)金毛猎犬、3只(14%)威尔士柯基犬。混血犬3只。其余患犬由以下品种各1只组成:比格犬、寻血猎犬、魏玛犬、杰克罗素梗和罗威纳。4只德国牧羊犬中的3只和4只拉布拉多猎犬中的1只是工作警犬。
Onset of clinical signs was perennial, with all months represented except for February and June. The most common month for diagnosis was September (6/22 [27%]), followed by August (3/22 [14%]) and December (3/22 [14%]).
临床症状的发作是无季节性的，除2月和6月外，所有月份都有。最常见的诊断月份为9月(6/22[27%])，其次为8月(3/22[14%])和12月(3/22[14%])。
Skin lesion distribution and description—Skin lesions were dorsally distributed on the neck and trunk in all dogs; 1 dog was also affected on the dorsal aspect of the tail. In addition to dorsally located skin lesions, 2 dogs had lesions involving the inguinal region and hind limbs, 1 had lesions on the head and lateral aspect of the abdomen, 1 had lesions on the flanks and lateral aspect of the thorax, and 1 had lesions on the cranial aspect of the thorax.
皮肤病变分布及描述-所有犬皮肤病变均背侧分布于颈部和躯干;1只犬的尾部也患病。除背部皮肤病变外，2只犬的皮肤病变累及腹股沟区和后肢，1只犬的皮肤病变位于头部和腹部外侧，1只犬的皮肤病变位于两侧和胸部外侧，1只犬的皮肤病变位于胸部颅侧。
The most commonly reported skin lesions were hemorrhagic crusts (15/22 [68%]), followed by papules and pustules (10/22 [45%]), plaques (8/22 [36%]), pinpoint ulcers or draining tracts (6/22 [27%]), and nodules (3/22 [14%]) or hemorrhagic furuncles (3/22 [14%]). For 3 dogs, oozing of hemorrhagic to purulent exudate from hair follicle ostia was specifically noted in the medical records. Intense macular erythema surrounded skin lesions along the dorsum of 2 dogs (Figure 1).
最常见的皮肤病变为出血性结痂(15/22[68%])，其次为丘疹和脓疱(10/22[45%])、斑块(8/22[36%])、针尖溃疡或瘘道(6/22[27%])、结节(3/22[14%])或出血性疖(3/22[14%])。3只犬的病历中专门记录了毛囊口出血至脓性渗出物。2只犬沿背部皮肤病变周围有明显的发红斑点(图1)。
Grooming history—Water immersion or exposure to grooming products occurred a median of 2 days prior to onset of clinical signs (range, 1 to 7 days). Of the 22 dogs, 10 (45%) were bathed at home (Figure 1), 9 (41%) at commercial grooming facilities, and 1 (4.5%) while boarding at a veterinary hospital; 1 dog was immersed in an underwater treadmill 1 day prior to onset of clinical signs, and 1 dog had hair clipped from the dorsal aspect of its coat and its skin scrubbed in preparation for hemilaminectomy 2 days prior to onset of clinical signs. In this dog, lesions were only found on the dorsal portion of the back where hair was clipped surrounding the surgical incision.
理毛史-在出现临床症状(范围，1-7日)之前，浸水或使用理毛产品的中位时间为2日。在22只犬中，10只(45%)在家中洗澡(图1)，9只(41%)在商业美容机构洗澡，1只(4.5%)在兽医医院洗澡。1只犬在出现临床症状前1天使用水下跑步机，1只犬在出现临床症状前2天背部毛发剃毛并进行半椎板切除术术前备毛。在这只犬，病变只发现在背部部分区域，在手术切口周围的毛发被剪短。
The shampoo type was unknown for 12 of 22 (55%) dogs. For the remaining 10 dogs, 5 were bathed with over-the-counter nonmedicated shampoos, and 1 each was bathed with an over-the-counter flea and tick shampoo, a prescription nonmedicated cleansing shampoo, and a prescription antiseborrheic shampoo. One dog was scrubbed with chlorhexidine-based surgical scrub prior to hemilaminectomy. The remaining dog developed lesions after physical therapy on an underwater treadmill and was towel-dried only (no products used). For the dog bathed with a prescription nonmedicated cleansing shampoo, the shampoo was known to be within the manufacturer’s recommended use-by date. It is unknown whether the other shampoos were expired or within recommended use-by dates. It is also unknown whether shampoo concentrates were diluted prior to use.
22只犬中有12只(55%)的香波类型不详。对于其余10只犬，5只犬使用非处方非药物香波，1只犬使用非处方除跳蚤和蜱虫的香波、1只犬使用处方非药物的清洁香波和1只犬使用处方抗皮脂溢香波。1只犬在半椎板切除术前用氯己定洗刷备毛。另一犬在水下跑步机上接受物理治疗后出现了病变，只用毛巾擦干(没有使用任何产品)。对于使用处方非药物清洁香波洗澡的犬，香波在保质期内。目前尚不清楚其他香波是否已经过期或在保质期内。香波在使用前是否被稀释也是未知的。
Two dogs were brushed with a commercial brush meant to remove undercoat to prevent shedding. One dog was brushed immediately prior to bathing; skin lesions were noticed 1 day after brushing and bathing in this dog. The other dog was brushed immediately following bathing; skin lesions were observed 3 days after bathing and brushing in this dog.
两只犬用商业刷子刷毛，目的是去除底毛，防止脱毛。一只犬在刷毛后立即洗澡;这只犬在刷毛和洗澡后1天发现皮肤病变。另一只犬在洗澡后立即刷毛;在洗澡和刷毛后3天观察到皮肤病变。
Associated clinical signs—Twenty of 22 (91%) dogs had clinical signs of systemic illness in addition to skin lesions. Clinical signs of systemic illness were acute in onset and temporally related to skin lesions in all 20 dogs. Lethargy was reported for 15 of 20 (75%) dogs. Signs of back, neck, or tail pain were reported for 15 of 20 (75%) dogs: 12 dogs had signs of back pain, 2 had signs of neck pain, and 1 had signs of tail pain (the same dog with skin lesions involving the tail). Fever (body temperature range, 39.67° to 41.17°C [103.4° to 106.1°F]) was documented for 14 of 20 (70%) dogs during the physical examination at the veterinary hospital. Ten of 14 dogs had body temperatures > 40.0°C (104°F), and 6 of these 10 dogs had body temperatures > 40.56°C (105°F). Other reported clinical signs of systemic illness included inappetence (10/20 dogs), stiff gait with reluctance to walk upstairs or jump (2/20 dogs), dehydration (2/20 dogs), diarrhea (3/20 dogs), and head tremors (1/20 dogs).
相关临床症状-22只犬中有20只(91%)除皮肤病变外还有全身疾病的临床症状。20只犬全身性疾病的临床症状在发病时都是急性的，并且在时间上与皮肤病变相关。20只犬中有15只(75%)有嗜睡。20只犬中有15只(75%)有背部、颈部或尾部疼痛的症状:12只犬有背部疼痛的症状，2只犬有颈部疼痛的症状，1只犬有尾部疼痛的症状(同一只犬有涉及尾部的皮肤病变)。在兽医医院进行的体格检查中，20只犬中有14只(70%)有发热(体温范围为39.67°~ 41.17°C[103.4°~ 106.1°F])。14只犬中有10只体温升高;40.0°C(104°F)，这10只犬中有6只体温＞40.56°C(105°F)。其他报告的全身性疾病的临床症状包括食欲不振(10/20只犬)，步态僵硬伴有不愿上楼或跳(2/20只犬)，脱水(2/20只犬)，腹泻(3/20只犬)，头部震颤(1/20只犬)。
Clinical diagnostic tests and abnormalities— Clinical diagnostic tests, other than histologic evaluation or bacteriologic culture of skin samples with antimicrobial susceptibility testing, were performed for systematic diagnostic evaluation in 14 of 22 (64%) dogs. A CBC with or without serum biochemical analysis was performed for 13 of these 14 dogs, urinalysis was performed for 8 dogs, radiography (vertebral, shoulder, tail, thoracic, or abdominal) was performed for 8 dogs, tick-borne disease testing was performed for 6 dogs, bacteriologic culture of urine was performed in 4 dogs, and abdominal ultrasonography was performed for 3 dogs. One of 14 dogs each underwent Brucella canis serologic testing, resting cortisol concentration determination, semiquantitative canine pancreas-specific lipase testing, fecal flotation, bacteriologic culture of blood, coagulation panel (including prothrombin time, partial thromboplastin time, D-dimers concentration, and platelet count), CSF evaluation, Cryptococcus latex agglutination test, Neospora immunofluorescence test, and Toxoplasma gondii ELISA.
临床诊断试验和异常-临床诊断试验除了组织学评估或皮肤样本细菌培养和药敏试验以外，还对22只犬中的14只(64%)进行了系统性诊断评估。对14只犬中13只犬进行了血细胞计数(含或不含血清生化分析)，对8只犬进行了尿液分析，对8只犬进行了x线检查(椎体、肩、尾、胸或腹部)，对6只犬进行了蜱传疾病检测，对4只犬进行了尿液细菌培养，对3只犬进行了腹部超声检查。14只犬中各有1只进行了犬布病血清学检测、静息皮质醇浓度测定、犬胰腺特异性脂肪酶半定量检测、粪便漂浮、血液细菌培养、凝血功能检测(包括凝血酶原时间、部分凝血活酶时间、D-二聚体浓度和血小板计数)、脑脊液检查、隐球菌乳胶凝集试验、新孢子菌免疫荧光试验和弓形虫ELISA检测。
Laboratory abnormalities were reported in 12 dogs undergoing diagnostic testing. The most commonly reported laboratory abnormality was leukocytosis (10/12 dogs). Leukocytosis was further characterized as neutrophilia in all 10 dogs, with neutrophilia detected in 5 dogs and neutrophilia with a left shift in 4 dogs. Monocytosis was also detected in 4 of the 10 dogs. Other CBC abnormalities in the 12 dogs included lymphopenia in 6; mild thrombocytopenia in 5; mild normocytic, normochromic anemia in 2; and eosinopenia in 1. Serum biochemical analysis revealed abnormal values in the 12 dogs including high alkaline phosphatase enzyme activity in 5, mild hypokalemia in 3, and high alanine aminotransferase enzyme activity, hypophosphatemia, hypocalcemia, and hyponatremia in 1 dog each. The coagulation panel performed in 1 dog revealed mildly elevated D-dimers concentration (0.36 µg/mL; reference limit, < 0.2 µg/mL). Cytologic analysis of CSF from the dog with head tremors revealed mild mixed pleocytosis. Two dogs had splenomegaly and 1 dog had prostatomegaly diagnosed via abdominal radiography or ultrasonography.
12只犬进行了诊断测试，报告了实验室异常。最常见的实验室异常为白细胞增多症(10/12只)。10只犬白细胞均呈中性粒细胞增多，其中5只为中性粒细胞增多，4只为中性粒细胞伴核左移。10只犬中有4只出现单核细胞增多。12只犬的其他血细胞计数异常包括淋巴细胞减少6只;轻度血小板减少5只;轻度正细胞、正色素性贫血2只;嗜酸性粒细胞减少1只。12只犬血清生化检查结果异常，其中碱性磷酸酶活性升高5只，轻度低钾血症3只，丙氨酸转氨酶活性升高、低磷血症、低钙血症、低钠血症各1只。1只犬进行凝血检查，D-二聚体浓度轻度升高(0.36µg/mL;参考范围＜0.2µg / mL)。从头部震颤的犬的脑脊液细胞学分析显示轻度混合性细胞增多。经腹部x线或超声检查，2只犬有脾肿大，1只犬有前列腺肿大。
Bacteriologic culture of skin samples—Punch biopsy specimens from lesional skin or culture swab samples of the contents of pustules or furuncles were submitted for aerobic bacteriologic culture and antimicrobial susceptibility testing for 14 of 22 (64%) dogs. Pseudomonas aeruginosa was the most common bacterial isolate (10/14 dogs). Pseudomonas aeruginosa was isolated alone on bacteriologic culture of skin in 5 of 10 dogs, there was coisolation of other bacterial species on bacteriologic culture of skin in 5 of 10 dogs (with Staphylococcus pseudintermedius from 1 dog, Staphylococcus epidermidis from 1 dog, Enterobacter cloacae and Staphylococcus epidermidis from 1 dog, and S marcescens from 1 dog). Staphylococcus hominis was isolated alone from 1 patient that was concurrently receiving enrofloxacin. Aerobic bacteriologic culture of samples from the remaining 3 dogs revealed pure growth of Klebsiella oxytoca from the skin of 1 dog, pure growth of Burkholderia cepacia from the skin of 1 dog, and no bacterial growth from the remaining culture, which was performed while the dog was receiving enrofloxacin. All P aeruginosa isolates were susceptible to fluoroquinolones. In the 2 dogs receiving enrofloxacin at the time of bacteriologic culture of skin, the antimicrobial had been prescribed for associated clinical signs of systemic illness prior to the discovery of skin lesions.
皮肤样本的细菌学培养- 对22只犬中的14只(64%)的病变皮肤打孔活检样本或脓疱或疖内容物的培养拭子样本，进行需氧细菌培养和药敏测试。铜绿假单胞菌是最常见的分离细菌(10/14只犬)。10只犬皮肤细菌学培养中，5只分离出铜绿假单胞菌，5只同时分离出其他细菌(1只分离出假中间型葡萄球菌、1只分离出表皮葡萄球菌、1只分离出阴沟肠杆菌和表皮葡萄球菌、1只分离出粘质沙雷菌)。从1例同时接受恩诺沙星治疗的患犬中单独分离出人葡萄球菌。对其余3只犬的样本进行的需氧细菌培养显示，1只犬的皮肤中只有产酸克雷伯菌生长，1只犬的皮肤中只有洋葱伯克霍尔德菌生长，其余培养中无细菌生长，这些培养是在犬服用恩诺沙星期间进行的。所有铜绿假单胞菌对氟喹诺酮类药物均敏感。在皮肤细菌学培养时接受恩诺沙星治疗的2只犬中，在发现皮肤病变之前，该药已被用于治疗系统性疾病的相关临床症状。
Bacteriologic culture was performed for the shampoo used for bathing prior to onset of skin lesions in 2 of 22 dogs. Shampoo concentrate alone was submitted for bacteriologic culture for one of these dogs, and both shampoo concentrate and diluted shampoo for the other dog. No bacteria were isolated from shampoo cultures. For 1 dog, bacteriologic culture was also performed from one of the antishedding brushes used following bathing, with isolation of very few colonies of Bacillus spp.
对22只犬中的2只在皮肤病变发生前用于洗澡的香波进行细菌培养。其中一只犬单独用香波进行细菌培养，另一只犬用香波和稀释香波进行细菌培养。从香波培养中未分离出细菌。对于1只犬，我们还对洗澡后使用的一个防脱毛刷进行了细菌培养，分离出很少的芽孢杆菌菌落。
Cytologic findings—Cytologic evaluation of impression smears from skin lesions was performed for 9 of 22 dogs. Inflammatory cells (neutrophils and macrophages, with or without eosinophils) were observed on impression smears from all dogs. Red blood cells were observed on impression smears from 2 of 9 dogs. Intracellular or extracellular bacteria were observed on impression smears from 6 of 9 dogs; in 3 of these dogs, bacterial cocci were present, and in 3 of these dogs, bacterial rods were present.
细胞学检查-22只犬中有9只进行了皮肤病变压片细胞学检查。在所有犬的压片检查上均观察到炎症细胞(中性粒细胞和巨噬细胞，伴或不伴嗜酸性粒细胞)。9只犬中有2只在压片上观察到红细胞。9只犬的压片检查中，6只观察到细胞内或细胞外的细菌;其中3只犬存在球菌，另外3只犬存在杆菌。
Histopathologic findings—Histologic evaluation was performed on punch biopsy specimens of lesional skin in 16 of 22 (73%) dogs. Histopathologic features were similar in all dogs. Typical histopathologic findings included acute follicular rupture with suppurative to pyogranulomatous furunculosis, most pronounced within the superficial dermis (Figure 2). Superficial dermal hemorrhage was also a frequent finding, as was superficial dermal edema and vascular congestion. Epidermal and follicular outer root sheath necrosis with associated erosions, ulcers, and serosuppurative to hemorrhagic crusts was found in several dogs. Bacterial rods were documented within the inflammatory infiltrate on H&E-stained sections in 1 dog that developed skin lesions after hemilaminectomy. Pseudomonas aeruginosa and S marcescens were cultured from skin lesions of this dog.
组织病理学发现-对22只犬中16只(73%)的皮肤病变打孔活检样本进行了组织学评估。所有犬的组织病理学特征相似。典型的组织病理学表现包括急性毛囊破裂伴化脓性至化脓性肉芽肿性疖病，在真皮浅层内最明显(图2)。真皮浅层出血、真皮浅层水肿和血管充血也是常见表现。在几只犬中发现表皮和毛囊外根鞘坏死伴糜烂、溃疡和血清化脓性至出血性结痂。1只半椎板切除术后出现皮肤病变的犬HE染色切片中可见炎性浸润内有杆菌。从该犬皮肤病变中培养出铜绿假单胞菌和粘质沙雷菌。
Periodic acid-Schiff and Gram staining was performed on sections from all skin biopsy specimens. Results of periodic acid-Schiff staining were negative for fungal organisms in all dogs. Gram staining showed multifocal clusters of gram-negative rods and gram-positive cocci within inflammatory infiltrate and follicular ostia in one dog (the same dog in which bacterial rods were present on H&Estained sections), large numbers of mixed gram-negative rods and gram-positive cocci within a serocellular crust and small extracellular gram-positive cocci within the superficial dermal inflammatory infiltrate under an ulcer in another dog, and moderate numbers of small gram-positive cocci in areas of hemorrhage and follicular perforation in a third dog. Results of Gram staining were negative for bacteria in all other dogs.
对所有皮肤活检样本进行过碘酸希夫染色和革兰染色。过碘酸希夫染色结果均为阴性。革兰染色显示，在一只犬的炎症浸润和毛囊口内有多灶性革兰阴性杆菌和革兰阳性球菌聚集(在同一只犬的HE染色切片上有杆菌)，在另一只犬的血清性结痂内有大量革兰阴性杆菌和革兰阳性球菌混合，在溃疡下的真皮浅层炎症浸润内有小的革兰阳性球菌。第三只犬的出血和毛囊孔区域有中等数量的小革兰阳性球菌。所有其他犬革兰染色结果均为阴性。
Treatment—Systemic antimicrobial treatment was administered in 20 of 22 (91%) dogs. Antimicrobial selection was made on the basis of bacteriologic cultur and antimicrobial susceptibility testing in 11 of 20 dogs; fluoroquinolones (marbofloxacin or enrofloxacin) were prescribed for treatment in all dogs. Antimicrobials were selected in 9 of 20 dogs without bacterial culture results; the most common of these empirically prescribed antimicrobials were fluoroquinolones (marbofloxacin or enrofloxacin; 5/9 dogs) and cephalosporins (cephalexin or cefpodoxime; 4/9 dogs). Marbofloxacin dosage ranged from 3.7 to 6.3 mg/kg (1.7 to 2.9 mg/lb), PO, every 24 hours; enrofloxacin dosage ranged from 10 to 12.2 mg/ kg (4.5 to 5.5 mg/lb), PO, every 24 hours. Treatment was unknown for 1 dog, and 1 dog was not treated with antimicrobials. Median duration of antimicrobial treatment was 30 days (range, 5 to 42 days). Treatment duration was unknown for 2 of 20 dogs treated with antimicrobials.
治疗-22只犬中有20只(91%)接受了全身性抗菌治疗。对20只犬中的11只进行了细菌培养和药敏试验，确定了抗生素。所有犬都使用了氟喹诺酮类药物(马坡沙星或恩诺沙星)进行治疗。20只犬中，9只未检出细菌。这些经验性处方中最常见的抗生素是氟喹诺酮类(马坡沙星或恩诺沙星;5/9只犬)和头孢菌素(头孢氨苄或头孢泊肟;4/9的犬)。马坡沙星剂量为3.7-6.3 mg/kg (1.7-2.9 mg/lb)，口服，每24小时1次;恩诺沙星剂量为10-12.2 mg/ kg (4.5 - 5.5 mg/lb)，口服，每24小时1次。1只犬的治疗未知，1只犬未接受抗生素。抗生素治疗的中位持续时间为30日(范围，5-42日)。在20只接受抗生素的犬中，有2只的治疗时间未知。
Excellent clinical response to systemic antimicrobial treatment, with full resolution of skin lesions, was documented for 16 of 20 (80%) dogs. Treatment response was unknown for the remaining 4 dogs treated with antimicrobials. Clinical signs such as lethargy, signs of neck or back pain, inappetence, and fever also resolved in all 16 dogs, often within 24 to 48 hours after initiating antimicrobial treatment. One dog had head tremors on initial examination; these were completely resolved at reevaluation 2 weeks after the start of antimicrobial treatment. Hematologic evaluation was repeated after 1 week of antimicrobial treatment in 1 dog that had had mild normocytic, normochromic anemia, mild thrombocytopenia, leukocytosis with neutrophilia and monocytosis, lymphopenia, hypophosphatemia, hypocalcemia, hyponatremia, and hypokalemia; all abnormalities were resolved.
20只犬中有16只(80%)对全身性抗菌治疗有良好的临床效果，皮肤病变完全消退。其余4只犬接受抗生素后的反应尚不清楚。所有16只犬的临床症状(如嗜睡、颈部或背部疼痛、食欲不振和发热)也均消退，通常在开始抗生素后24-48小时内消退。1只犬在初次检查时出现头部震颤;在开始抗生素后2周再次评估时，这些症状完全缓解。1只出现轻度正细胞性、正色素性贫血、轻度血小板减少、白细胞增多伴中性粒细胞增多和单核细胞增多、淋巴细胞减少、低磷血症、低钙血症、低钠血症和低钾血症的犬在抗生素治疗1周后重复进行血液学评估;所有异常均得到缓解。
In addition to systemic administration of antimicrobials, 5 of 20 dogs were treated with NSAIDs (carprofen, deracoxib, or aspirin). Of 22 dogs, 5 were treated with tramadol, 2 were treated with diphenhydramine, 1 was treated with famotidine, and 1 was treated with sucralfate. Three dogs were treated with topical antimicrobial treatment in addition to systemic antimicrobials, 2 were bathed twice weekly with medicated shampoos containing ethyl lactate and 4% chlorhexidine, and 1 was treated with 1% silver sulfadiazine cream applied twice daily to lesional skin. Three of 22 dogs received tapering courses of oral administration of corticosteroids (prednisone) at anti-inflammatory dosages (starting dosage, 0.5 mg/kg [0.23 mg/lb], PO, q 12 to 24 hours). One dog was treated solely with prednisone at a starting dosage of 0.5 mg/kg, PO, every 24 hours, tapered over 28 days, with full resolution of skin lesions.
除全身性给予抗生素外，20只犬中的5只还接受了非甾体抗炎药(NSAIDs)治疗(卡洛芬、地拉考昔或阿司匹林)。22只犬中，5只接受曲马多治疗，2只接受苯海拉明治疗，1只接受法莫替丁治疗，1只接受硫糖铝治疗。3只犬在全身抗生素的基础上进行了外用抗生素，2只犬用含乳酸乙酯和4%氯己定的药用香波每周洗澡2次，1只犬用1%磺胺嘧啶银乳膏治疗，每日2次。22只犬中的3只接受了抗炎剂量的皮质类固醇(泼尼松)口服治疗(起始剂量，0.5 mg/kg [0.23 mg/lb]， PO，每12到24小时一次)。1只犬仅使用泼尼松治疗，起始剂量为0.5 mg/kg, PO，每24小时1次，在28天内逐渐减少，皮肤病变完全消退。
Discussion
讨论
To our knowledge, the case series presented here included the largest number of dogs with clinical signs and histopathologic findings of a distinct syndrome of acute, dorsally located furunculosis to date. All dogs in the present case series had a history of water immersion or exposure to grooming products prior to onset of skin lesions, contrasting with a prior report by Hillier et a of 7 cases of deep pseudomonal pyoderma in dogs with similar clinical and histopathologic features, but in which a history of bathing or grooming prior to onset could be confirmed for only 2 of 7 dogs. Since the inclusion criteria for the present study required a recent history of water immersion or grooming preceding skin lesion onset, it is possible that a subset of dogs with similar clinical features of this syndrome, but without a history of water or grooming product exposure, were excluded from the patient population. The predilection for skin lesions over the dorsal aspect of the neck and back may be related to typical grooming and bathing behavior by owners or groomers with most vigorous application of shampoo, brushing, or coat-stripping occurring over the dorsum as well as the increased hair follicle density and hair shaft size in this region. Subsequent follicular trauma may then predispose to folliculitis and follicular rupture. By contrast, most humans develop folliculitis following exposure to contaminated water (hot tub folliculitis) in the axillae, groin, perineal region, and other areas where wet bathing suits may lead to prolonged follicular occlusion.
据我们所知，这里的病例系列包括了迄今为止最大数量的具有急性背侧疖病的临床症状和组织病理学检查的患犬。本病例系列中所有的犬在发生皮肤病变前都有浸水或理毛史，对比之前Hillier等报道的7例具有相似临床和组织病理学特征的犬的深部假单胞菌性脓皮病形成了对比，在这些病例中，只有2/7的犬在发病前有洗澡或理毛史。由于本研究的纳入标准要求在皮肤病变发生前有浸水或理毛史，因此有可能从患病动物中排除了一组具有类似临床特征的犬，但没有浸水或理毛史。颈部和背部皮肤病变的好发部位可能与主人或美容师在背部频繁使用香波、刷牙或拔毛的典型理毛和洗澡行为以及该区域毛囊密度和毛干大小增加有关。随后的毛囊损伤可能导致毛囊炎和毛囊破裂。相比之下，大多数人使用受污染的水(热浴盆毛囊炎)后发生毛囊炎部位在腋窝、腹股沟、会阴部和其他部位，这些部位接触湿泳衣可能导致长时间的毛囊阻塞。
A limitation of the present study was the failure to identify a source of bacterial infection for these patients. By isolating the same bacterial species from both grooming products and the skin of affected dogs, Gross and Crowa supported bacterial contamination of grooming products as the likely source of infection for these patients. In the present study, a similar association could not be confirmed. Because of its retrospective design, bacteriologic culture of the shampoo (concentrate or diluted shampoo) was performed for only 2 dogs in the present study, with no bacterial growth in both cases. This could indicate another source of bacterial exposure, such as other grooming products, sinks, tubs, faucets, or showerheads, for these patients. It is also possible antimicrobial agents or detergents from the shampoos may have interfered with bacterial growth on routine aerobic bacteriologic culture. Interestingly, 1 dog in the present case series was not reported to be bathed or groomed, but had physical therapy on an underwater treadmill 24 hours prior to onset of skin lesions. Bacterial contamination of water in small enclosures, like hot tubs, whirlpools, or hydrotherapy tanks, is a common source of infection for humans developing postexposure folliculitis. In this particular case, towel-drying may have contributed to microabrasions of the skin surface, hair follicle trauma, and subsequent furunculosis.
本研究的一个局限性是未能确定这些患病动物的细菌感染来源。通过从美容产品和患犬的皮肤中分离出相同的细菌种类，Gross和Crowa支持美容产品的细菌污染是这些患犬的可能感染源。在本研究中，类似的关联未能得到证实。由于是回顾性设计，在本研究中，仅对2只犬进行了香波(浓缩香波或稀释香波)的细菌培养，两个病例均无细菌生长。这可能表明这些患犬的另一个细菌暴露来源，如其他美容产品、水槽、浴缸、水龙头或淋浴喷头。也有可能是香波中的抗菌剂或洗涤剂在常规的需氧细菌培养中干扰了细菌的生长。有趣的是，本病例系列中的1只犬在发生皮肤病变前24小时没有洗澡或理毛，而是在水下跑步机上进行了物理治疗。热水浴缸、漩涡池或水疗池等小环境中的水受到细菌污染是人类发生暴露后毛囊炎的常见传染源。在该病例中，毛巾擦干可能导致了皮肤表面的微擦伤、毛囊损伤和随后的疖病。
Previous reports of furunculosis arising after grooming have suggested an association with do-it-yourself dog washing facilities or grooming parlors that use bulk shampoo concentrates diluted with tap water. Dilution and redilution of shampoos may lead to bacterial contamination. Frequent handling of the same shampoo bottle over time may increase the opportunity for contamination, whether from tap water or another source. In the present study, nearly 50% of affected dogs were bathed at home. Because of the retrospective nature of the present study, it was not possible to ascertain how many dogs were bathed at commercial self-serve facilities or whether shampoos or conditioners used for bathing at home or at grooming parlors were diluted with tap water prior to use. Similarly, only 1 shampoo used for at-home bathing could be confirmed to be within the manufacturer’s recommended expiration date. Expired shampoos or conditioners may also be more likely to be contaminated by bacteria. An association of furunculosis development with vigorous brushing or coat-stripping (alone or prior to bathing) has also been suggested. Brushing history was unknown for most dogs in the present case series, although 2 dogs were brushed prior to or following bathing with a commercial anti-shedding brush, and 1 had its hair clipped in preparation for surgery. Presumably, aggressive brushing or hair clipping may also cause follicular trauma and increased susceptibility to opportunistic infection following exposure to contaminated grooming products or water sources.
之前关于美容后出现疖病的报告表明，这与使用自来水稀释散装香波浓缩物的自助式犬洗澡设施或美容店有关。香波的稀释和再稀释可能会导致细菌污染。长时间频繁地接触同一瓶香波可能会增加污染的机会，无论是使用自来水还是其他来源。在这项研究中，近50%的患犬在家中洗澡。由于本研究属于回顾性研究，因此无法确定有多少只犬在商业自助洗澡设备，也无法确定用于家中或美容院洗澡的香波或护毛素在使用前是否用自来水稀释。同样，只有一种用于家庭洗澡的香波被确认在效期内使用。过期的香波或护毛素也更有可能被细菌污染。也有人提出疖病的发生与大力刷毛或拔毛(单独或洗澡前)相关。在本病例系列中，大多数犬的刷毛史未知，但有2只犬在洗澡前或洗澡后用商用防脱毛刷进行了刷毛，1只犬在准备手术时剪短了毛发。据推测，在使用受污染的理毛产品或水源后，用力刷毛或剃毛也可能导致毛囊损伤，并增加易感性至条件致病性感染风险。
As has been suggested previously, most dogs included in the present case series were large-breed dogs with thick wiry or short coats. Some smaller dogs with short, bristly coats (Beagles and Jack Russell Terrier) were also represented in the patient population. Short- or wire-haired dogs may be predisposed to follicular perforation by thick or coarse hair shafts following trauma from vigorous bathing or brushing. German Shepherd Dogs and Labrador Retrievers comprised most of the patient population, although major conclusions about breed predisposition are precluded by the fact that several of these patients were working police dogs. Working dogs are frequently evaluated at the authors’ institution through a contractual arrangement.
如前所述，本病例系列中纳入的大多数犬是大型犬，粗硬或短的被毛。一些有短毛、钢毛的小型犬也是易感犬种(比格犬和杰克罗素梗)。短毛或钢毛的犬在剧烈洗澡或刷毛创伤后，可能容易因粗大或粗糙的毛干而发生毛囊刺破。德国牧羊犬和拉布拉多寻回犬占患犬的大多数，但由于这些患犬中有几只是工作警犬，因此无法得出关于品种易感性的主要结论。工作犬通常通过合同安排在作者所在机构接受诊疗。
Most dogs in the present case series had other constitutional signs, particularly signs of back or neck pain, fever, and lethargy. In several dogs, evaluation of signs of back or neck pain and fever preceded discovery of skin lesions. It should be mentioned that alopecia was not a typical clinical feature in these dogs. Skin lesions are often masked by the thick dorsal coat until the hair is clipped; clipping of the coat or collection of skin biopsy specimens may necessitate sedation or anesthesia to minimize discomfort. Without knowledge of skin lesions, initial differential diagnoses in patients with fever and signs of back or neck pain included diskospondylitis and meningitis. Results of the present study suggested that dorsal furunculosis should be considered as a differential diagnosis for any dog with fever of unknown origin or signs of back or neck pain. Owners should be asked specific historical questions concerning recent swimming, bathing, or grooming, and the skin overlying the neck and back should be examined closely for maculopapular, pustular, or crusted lesions prior to performing diagnostic tests such as radiography. Although all of the dogs included in the present study had a history of water immersion or grooming prior to onset of clinical signs, deep pyoderma associated with P aeruginosa has been previously described as a cause of dorsally located furunculosis and signs of back pain, even in dogs without a reported history of bathing or grooming within the 48 hours preceding the onset of skin lesions. Signs of systemic illness, such as headache, gastrointestinal upset, sore throat, and lymphadenomegaly, may also be seen in humans with pseudomonal folliculitis secondary to contaminated water-source exposure.
本病例系列中的大多数犬有其他症状，特别是背部或颈部疼痛、发热和嗜睡的症状。在一些犬中，在发现皮肤病变之前，对背部或颈部疼痛和发热的症状进行评估。值得一提的是，脱毛不是这些犬的典型临床特征。皮肤病变常被厚厚的背部毛发掩盖，直到剃毛才被发现。为了减少不适感，剃毛或皮肤活检采样时可能需要镇静或麻醉。在不知道皮肤病变的情况下，发热和有背部或颈部疼痛症状的患犬最初的鉴别诊断包括脊柱炎和脑膜炎。本研究结果提示，对于任何有不明原因发热或背部或颈部疼痛症状的犬，应考虑将背部疖病作为一种鉴别诊断。应询问主人有关近期游泳、洗澡或理毛的具体病史，在进行诊断性检查(如影像学检查)之前，并应仔细检查颈部和背部皮肤是否有斑丘疹、脓疱或结痂性病变。虽然本研究纳入的所有犬在出现临床症状前都有浸水或理毛的病史，但与铜绿假单胞菌相关的深部脓皮病曾被描述为背部疖病和背部疼痛的病因，即使在皮肤病变发生前48小时内没有洗澡或理毛史的犬中也是如此。在人类中，头痛、胃肠道不适、咽喉痛和淋巴结肿大等全身性疾病的症状也可见于继发于受污染水源导致的假单胞菌性毛囊炎患者。
In addition to constitutional signs, several affected dogs also had clinical laboratory abnormalities. The most common hematologic abnormalities were leukocytosis, characterized by neutrophilia with or without a left shift and monocytosis; lymphopenia; and mild thrombocytopenia. Taken together, these hematologic abnormalities, along with fever in several affected dogs, are potentially consistent with early systemic inflammatory response syndrome. Lipopolysaccharide, a component of the cell membrane of gram-negative bacteria, may play a major role in inciting the proinflammatory cascade in patients with gram-negative bacterial infections. In dogs in the present study that underwent bacteriologic culture of skin samples, gram-negative bacteria, particularly P aeruginosa, were isolated most commonly. In healthy dogs receiving infusions of lipopolysaccharide to model endotoxemia, release of proinflammatory and fever-inducing cytokines, such as tumor necrosis factor-α, interleukin-1, and interleukin-6, occurs within the first 3 to 6 hours. Progressive thrombocytopenia is a common change; with time, coagulation abnormalities may occur. One of the earliest markers of coagulation abnormalities in systemic inflammatory response syndrome is elevation of D-dimers concentrations. D-dimers are cross-linked products of fibrin breakdown; increased production of D-dimers may be found in a variety of diseases that result in fibrin formation and degradation (including inflammatory disease and hemorrhage). Concentration of D-dimers was assessed in only 1 dog in the present case series (a 6-year-old spayed female Labrador Retriever bathed at a commercial grooming facility 1 day prior to initial evaluation at the veterinary hospital) and found to be mildly high. This dog also had other evidence of a serious systemic inflammatory response, including fever (41.17°C [106.1°F]), neutrophilia with a left shift, and mild thrombocytopenia. Pseudomonas aeruginosa was isolated from this dog’s skin lesions, lending support to lipopolysaccharide-associated systemic inflammatory response syndrome.
除临床症状外，一些患犬还有临床实验室异常。最常见的血液学异常是白细胞增多症，表现为中性粒细胞增多症伴或不伴核左移和单核细胞增多症;淋巴细胞减少症;轻度血小板减少症。综上所述，这些血液学异常，以及一些患犬的发热，可能符合早期全身炎症反应综合征。脂多糖是革兰阴性菌细胞膜的一种成分，可能在革兰阴性菌感染患病动物的促炎级联反应中发挥主要作用。在本研究犬的皮肤样本中，革兰阴性菌，特别是铜绿假单胞菌，是最常见的分离菌。在通过给健康犬输入脂多糖建立内毒素血症模型中，促炎和诱导发热的细胞因子(如肿瘤坏死因子-α、白细胞介素-1和白细胞介素-6)在最初3-6小时内释放。进行性血小板减少症是常见异常变化。随着时间的推移，可能出现凝血功能异常。D-二聚体浓度升高是全身炎症反应综合征中凝血功能异常的早期标志之一。D-二聚体是纤维蛋白分解的交联产物;在多种导致纤维蛋白形成和降解的疾病(包括炎性疾病和出血)中可能发现D-二聚体的产生增加。在本病例系列中，仅评估了1只犬的D-二聚体浓度(在兽医医院进行初步评估前1日，在一家商业美容机构洗澡的一只6岁雌性拉布拉多猎犬)，结果发现D-二聚体浓度轻度偏高。这只犬还有其他严重全身炎症反应的证据，包括发热(41.17℃[106.1°F])、中性粒细胞核左移和轻度血小板减少症。从这只犬的皮肤病变中分离出铜绿假单胞菌，为脂多糖相关的全身炎症反应综合征提供了支持。
Pseudomonas aeruginosa was the most common bacterial isolate from skin lesions of affected dogs in the present study, either alone or in combination with Staphylococcus spp or other gram-negative bacteria. Pseudomonas aeruginosa is ubiquitous in the environment and is found most commonly in soil and water. Opportunistic infection of the skin can occur following colonization with exposure to contaminated water sources and abrasions of the skin or through hair follicle ostia. Contamination of water sources, such as swimming pools and hot tubs, may be more likely to occur with increased water temperature, high pH, low chlorine concentration, or poor disinfection. However, P aeruginosa has been commonly isolated from swimming pools and hot tubs even when chlorination is considered adequate. Piping or fixtures that are small or difficult to disinfect, such as sinks or showerheads, may also predispose to P aeruginosa contamination by facilitating biofilm formation.
铜绿假单胞菌是本研究中从患犬皮肤病变中分离出的最常见细菌，或单独分离，或与葡萄球菌属或其他革兰阴性菌合并分离。铜绿假单胞菌在环境中普遍存在，最常见于土壤和水中。接触受污染的水源和皮肤擦伤或通过毛囊口定殖后可发生皮肤条件致病性感染。游泳池和热水浴缸等水源在水温升高、pH值高、氯浓度低或消毒不佳的情况下更容易受到污染。然而，即使在氯化处理足够的情况下，铜绿假单胞菌也经常从游泳池和热水浴缸中分离出来。较小或难以消毒的管道或固定装置，如水槽或淋浴喷头，也可能通过促进生物膜形成而容易受到铜绿假单胞菌污染。
In addition to P aeruginosa, S marcescens was isolated from the skin lesions of 1 dog, which developed skin lesions following hair clipping and scrubbing for a hemilaminectomy. Serratia marcescens is a gram-negative facultative anaerobe that can also be found commonly in water and soil and has been isolated from skin lesions and shampoo of a dog with acute, dorsally located furunculosis following bathing. In humans, opportunistic nosocomial infections have been reported, particularly in immunocompromised patients. In dogs and cats, S marcescens has been implicated as a contaminant of indwelling IV catheters. In a study of widespread bacterial contamination of IV catheters and other sites throughout a veterinary hospital, contamination was traced to a common source of aqueous benzalkonium chloride solution stored with cotton sponges.In the infection described in that study, the chlorhexidine-based surgical scrub used following clipping of hair at the surgical site may have been the source of P aeruginosa and Serratia marcescens contamination, considering that both organisms may survive at room temperature in areas of high humidity. Pseudomonas aeruginosa has been documented as a contaminant of antimicrobial hand soaps and soap dispensers in human hospitals. Isolates obtained from soap dispensers containing chlorhexidinebased products may be multidrug resistant and resistant to chlorhexidine; biocide resistance is intrinsic in Pseudomonas spp and other gram-negative organisms.
除铜绿假单胞菌外，从1只犬的皮肤病变中分离出粘质沙雷菌，该犬在剃毛和擦洗半椎板术后出现皮肤病变。粘质沙雷菌是一种革兰氏阴性兼性厌氧菌，也常见于水和土壤中，已从一只患洗澡后背部急性疖病的犬的皮肤病变和香波中分离出。在人类中，有条件致病性医院感染的报道，特别是在免疫功能低下的患者中。在犬和猫中，粘质沙雷菌被认为是留置的静脉导管的污染物。在对整个兽医医院静脉导管和其他部位的广泛细菌污染进行的一项研究中，污染追溯到与棉球一起储存的苯扎氯铵水溶液的一个常见来源。在该研究中描述的感染中，考虑到铜绿假单胞菌和粘质沙雷菌在室温下可在高湿地区存活，手术部位剃毛后使用的含氯己定的手术刷可能是铜绿假单胞菌和粘质沙雷菌污染的来源。铜绿假单胞菌已被证明是人类医院中抗菌洗手液和肥皂分配器的污染物。从含氯己定产品的皂液中分离的菌株可能具有多重耐药和对氯己定耐药;假单胞菌属和其他革兰阴性菌具有固有的抗菌剂耐药性。
Like Pseudomonas spp, Burkholderia spp are also commonly found in water and soil. Although infection is poorly documented in veterinary patients, B cepacia is an important cause of opportunistic infections in humans, particularly severe respiratory infections in cystic fibrosis patients. To the authors’ knowledge, this is the first report of B cepacia as a cause of furunculosis in a dog. Contamination of commercial ear cleansing solutions used for home treatment of dogs with B cepacia has been documented, supporting the organism’s ability to survive in liquids. In another dog described in the present study, only K oxytoca was isolated from skin lesions. To the authors’ knowledge, this organism has not been previously described as a cause of furunculosis following water immersion but has been rarely associated with necrotizing fasciitis in humans.
与假单胞菌属一样，伯克霍尔德菌属也常见于水和土壤中。虽然关于兽医患病动物感染的记录很少，但洋葱伯克霍尔德菌是人类条件致病性感染的一个重要病因，尤其是囊性纤维化患者的严重呼吸道感染病因。据作者所知，这是首次报道犬洋葱伯克霍尔德菌引起疖病。有证据表明，家中使用的犬治疗用商业化洗耳液，被洋葱伯克霍尔德菌污染，这支持了细菌在液体中生存的能力。在本研究中描述的另一只犬中，仅从皮肤病变中分离出产酸克雷伯菌。据作者所知，这种微生物以前没有被描述为浸水后疖病的病因，但是人类坏死性筋膜炎的罕见病因。
Histopathologic features of furunculosis were similar in skin biopsy specimens from affected dogs, including superficially oriented acute outer root sheath rupture with suppurative inflammation, superficial dermal hemorrhage, and epidermal and follicular outer root sheath necrosis. Although other differential diagnoses for folliculitis and furunculosis, including dermatophytosis, should be considered, the acute and superficial nature of the furunculosis, dermal hemorrhage, and characteristic lesion distribution (dorsal aspect of trunk and midline) should increase the suspicion for furunculosis following water immersion or grooming product exposure among clinicians and pathologists. Results of Gram staining of skin biopsy specimens were negative in most cases, illustrating the limitations in identifying bacteria, particularly gram-negative bacteria, within heavily inflammatory skin lesions by histologic evaluation. Bacteriologic culture and antimicrobial susceptibility testing of lesional skin is recommended in all cases of furunculosis following water immersion or grooming, even in cases with negative findings on Gram staining of histologic sections.
在患犬的皮肤活检样本中，组织病理学特征与疖病相似，包括浅表为主的急性外根鞘破裂伴化脓性炎症、真皮浅表出血以及表皮和毛囊外根鞘坏死。虽然应考虑毛囊炎和疖病的其他鉴别诊断，包括皮肤癣菌病，但疖病的急性和浅表性质、皮肤出血和特征性病变分布(躯干背侧和中线)应增加临床医师和病理学家在浸水或使用美容产品后对疖病的怀疑。皮肤活检样本的革兰染色结果大多数为阴性，说明组织学评估在鉴别重度炎症皮肤病变内的细菌，尤其是革兰阴性菌方面存在局限性。建议所有在浸水或理毛后的疖病病例进行皮肤病变的细菌培养和药敏试验，即使组织学切片革兰染色结果为阴性的病例也是如此。
Most dogs in the present study were treated systemically with antimicrobials, with excellent clinical response. In several dogs, improvement in attitude, appetite, and fever was observed within 24 to 48 hours after initiating antimicrobial treatment. As has been reported for dogs with pseudomonal pyoderma, fluoroquinolones administered orally for approximately 4 weeks had excellent clinical results in the present study. Bacteriologic culture and antimicrobial susceptibility testing is recommended to base antimicrobial treatment in cases of suspected pseudomonal pyoderma. Although all P aeruginosa isolates from dogs in the present study were susceptible to fluoroquinolones, Pseudomonas spp isolates frequently have resistance to multiple antimicrobials as the result of altered cell membrane permeability, drug efflux pumps, and production of β-lactamases and cephalosporinases. A recent study demonstrated isolation of multidrug-resistant P aeruginosa from privately owned hot tubs and swimming pools. In addition to the unpredictable antimicrobial susceptibility of gram-negative organisms, bacteriologic culture and antimicrobial susceptibility testing is also indicated, given that bacterial furunculosis is a form of deep pyoderma. Although most dogs in the present study were clinically normal within 4 weeks of antimicrobial treatment, antimicrobial treatment should be extended 1 to 2 weeks beyond clinical resolution of deep pyoderma and may be required for 6 to 8 weeks or more.
在本研究中，大多数犬接受了系统性抗生素，临床效果良好。几只犬在开始抗生素后24-48小时内观察到姿势、食欲和发热改善。正如关于假单胞菌性脓皮病的犬的报道，在目前的研究中，口服氟喹诺酮类药物约4周有很好的临床效果。建议在疑似假单胞菌性脓皮病病例中，以细菌培养和药敏试验为基础进行抗菌治疗。虽然本研究中从犬分离的铜绿假单胞菌对氟喹诺酮类药物敏感，但由于细胞膜通透性、药物外排泵以及β-内酰胺酶和头孢菌素酶的产生，假单胞菌分离株经常对多种抗生素耐药。最近的一项研究表明，从家用热水浴缸和游泳池中分离出了多重耐药铜绿假单胞菌。鉴于细菌性疖病是深部脓皮病的一种形式，除了革兰阴性菌对抗生素的敏感性不可预测之外，还需要进行细菌培养和药敏试验。虽然本研究中的大多数犬在抗菌治疗4周内达到临床正常，但在深部脓皮病临床消退后，抗菌治疗应延长1-2周，可能需要6-8周或更长时间。
Interestingly, several dogs, particularly those that did not have bacteriologic culture and antimicrobial susceptibility testing performed on samples from skin lesions, were reported to be treated successfully with cephalosporins (cephalexin or cefpodoxime) that typically have poor antipseudomonal activity. None of the P aeruginosa isolates from dogs in the present case series were susceptible to cephalexin or cefpodoxime. In humans, pseudomonal folliculitis is also frequently self-limiting and may resolve without treatment. The skin lesions of these dogs may have self-resolved regardless of the antimicrobial administered. In 1 dog, cephalexin and a tapering course of prednisone at an anti-inflammatory dose were started pending bacteriologic culture and antimicrobial susceptibility testing results. Bacteriologic culture and antimicrobial susceptibility testing from skin lesions isolated P aeruginosa resistant to cephalexin and methicillin-susceptible S pseudintermedius. In this dog, skin lesions were so improved with initial treatment that cephalexin was continued for 4 weeks while prednisone was tapered. In this dog, the dramatic clinical response may have occurred with antimicrobial treatment targeting S pseudintermedius or may be related to prednisone administration. Another patient was treated with only a tapering course of prednisone at an anti-inflammatory dose, despite clinical and histopathologic features typical of bacterial furunculosis following physical therapy on an underwater treadmill. In these dogs, systemic treatment with corticosteroids may have reduced inflammation associated with hair follicle rupture and the foreign body response to keratin, facilitating spontaneous resolution of bacterial infection and skin lesions. Because deep pyoderma typically requires extended systemic treatment with antimicrobials and bacteriologic culture and antimicrobial susceptibility testing was not performed in the latter dog, sterile furunculosis secondary to manipulation of the skin and coat cannot be ruled out for this dog or, possibly, other dogs included in the present case series. Cytologic assessment of impression smears and bacteriologic culture and antimicrobial susceptibility testing from skin lesions should be performed in all dogs with acuteonset furunculosis both to establish a definitive diagnosis of deep bacterial infection as well as to provide targeted antimicrobial treatment.
有趣的是，据报道，有几只犬，特别是那些没有对皮肤病变样本进行细菌培养和药敏试验的犬，使用了通常抗假单胞菌活性较差的头孢菌素(头孢氨苄或头孢泊肟)得到成功治疗。在本病例系列中，从犬分离的铜绿假单胞菌均对头孢氨苄或头孢泊肟不敏感。在人类，假单胞菌性毛囊炎通常也是自限性的，可能不经治疗而自行消退。这些犬的皮肤病变可能自行缓解，无论用不用抗生素。1只犬初期等待细菌培养和药敏试验结果时，接受头孢氨苄和抗炎剂量的泼尼松递减治疗。对皮肤病变中细菌培养和药敏试验分离出的铜绿假单胞菌对头孢氨苄耐药，假中间型葡萄球菌对甲氧西林敏感。在这只犬中，皮肤病变在初始治疗后得到改善，头孢氨苄持续用药4周，而泼尼松逐渐减量。在这只犬中，显著的临床效果可能发生于针对假中间葡萄球菌的抗菌治疗，或可能与泼尼松的使用有关。另1只患犬在水下跑步机物理治疗后出现了典型的细菌性疖病的临床和组织病理学特征，但仅接受了抗炎剂量的泼尼松减量治疗。在这些犬中，皮质类固醇的全身性治疗可能减轻了与毛囊破裂和角蛋白引起的异物反应相关的炎症，促进了细菌感染和皮肤病变的自然消退。由于深部脓皮病通常需要长时间的全身性抗生素治疗和细菌培养，并且未对后者进行抗生素敏感性测试，因此不能排除这只犬以及本病例系列中的其他犬继发于皮肤和被毛操作的无菌性疖病。应对所有急性发病的疖病犬进行皮肤病变压片细胞学评估、细菌培养和药敏试验，以明确深部细菌感染的诊断，并提供针对性的抗生素治疗。
 Figure 1—Photographs of a 6-year-old castrated male Golden Retriever (A and C) and a 1-year-old castrated male Cardigan Welsh Corgi (B and D) that had skin lesions consistent with furunculosis and a history of water immersion or grooming prior to onset. Intense macular erythema surrounded skin lesions found along the dorsum of these 2 dogs. A and C—Hemorrhagic papules, pustules, and crusts surrounded by a zone of intense erythema are evident. These lesions were photographed 3 days after bathing with a prescription cleansing nonmedicated shampoo. Bathing was followed by brushing with an antishedding brush. B and D—Erythematous plaques, pinpoint ulcers draining hemorrhagic and purulent exudate, and crusts are evident. These lesions were photographed 2 days after bathing with an unknown shampoo. Hair has been clipped from the coat to reveal skin lesions.
图1 1只6岁的已去势雄性金毛猎犬(A和C)和1岁的已去势雄性威尔士柯基犬(B和D)的照片，它们的皮肤病变符合疖病，并且在发病前有浸水或理毛史。2只犬背部皮肤病变周围可见强烈的发红斑点。A和C明显可见出血性丘疹、脓疱和结痂，周围有明显发红区域。这些病变在使用处方清洁非药物香波洗澡后3天拍摄。洗澡之后，使用防脱毛刷进行刷毛。B和D:发红斑块、有针尖状溃疡的出血性瘘道和脓性渗出物和结痂。这些病变是在使用未知香波洗澡后2天拍摄的。剃毛后，露出皮肤病变。
Figure 2—Representative photomicrographs of sections of skin lesions from a dog with furunculosis and a history of water immersion or grooming prior to onset. Typical histopathologic findings included acute follicular rupture with suppurative to pyogranulomatous furunculosis, most pronounced within the superficial dermis. A—Suppurative inflammation and hemorrhage associated with acute follicular wall necrosis and perforation (arrows). H&E stain; bar = 400 µm. B—Higher magnification image showing hemorrhagic and suppurative inflammation in the superficial dermis adjacent to the follicular rupture. H&E stain; bar = 200 µm.
图2患疖病且发病前有浸水或理毛史患犬的皮肤病变切片的代表性显微照片。
典型的组织病理学表现包括急性毛囊破裂伴化脓性至化脓性肉芽肿性疖病，最明显位于真皮浅层。A-化脓性炎症和出血伴急性毛囊壁坏死和刺破(箭头)。HE染色;标尺 = 400µm。B-高倍镜图像显示真皮浅层靠近毛囊破裂处的出血和化脓性炎症。HE染色;标尺= 200µm。
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发表于 2023-10-20 16:06:24
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