Stepping Outside Of My Comfort Zone



In my “welcome blog” in October 2009, I promised I would write about “recent professional meetings.”

Well, surprise! I recently attended a dermatology conference, which turned out to be immensely more interesting that I had anticipated. No offense, but who would have thought that a surgeon could find anything exciting at a derm meeting? Brian Palmeiro, a board-certified dermatologist at Lehigh Valley Veterinary Dermatology in Allentown, Pa., shared some practical pearls of knowledge.

Here are a few take home messages.

* If you attempt a diagnostic food trial to rule out food allergy, only prescription diets are recommended because over-the-counter hypoallergenic (OTC) diets are often contaminated with proteins from other meats. In a recent study, 75 percent of OTC venison diets were contaminated with soy, poultry and/or beef, although their labels listed none of these ingredients. 1

* What causes atopic dermatitis? If you think it’s due to inhalation of allergens, well…things have changed. It is now proven that atopic dermatitis is due to percutaneous absorption of allergens (yes, through the skin). 2

* Superficial bacterial pyoderma (bacterial skin infection), if it happens for the first time, should be treated with a good skin antibiotic such as a cephalosporin for a minimum of three weeks.

Deep bacterial pyoderma should be treated for a minimum of six weeks. This is not the time to cut (financial) corners. You may face a recurrence or resistant infections if your treat for less time. Determining the underlying cause for the skin infection is critical in preventing a recurrence.

* Ear cones are often kept soaking in a disinfectant solution or are stored dry on a shelf. A study performed at 50 private vet practices revealed that 30 percent of cones were contaminated, in over half of the cases with pathogenic bacteria such as Pseudomonas and Staph. pseudintermedius. This causes a potential risk, especially for patients with otitis, because the local immunity of their ears may be decreased.

The study concluded that ear cones are often contaminated with various storage or cleaning techniques. The most effective disinfectant storage solution was 3.2 percent glutaraldehyde solution (Cetylcide II). 3
 
Brian Palmeiro also shared some information about MRSA, the dreaded bug.

* If you diagnose a MRSA infection (Methicillin-Resistant Staphylococcus Aureus), it will not just be resistant to methicillin, it will be resistant to all beta-lactams, and often to fluoroquinolones such as enrofloxacin and marbofloxacin.  In fact, the sensitivity may show that fluoroquinolones work in vitro, but it may not work in vivo.

* True MRSA infection in pets is actually very rare.  More commonly, pets are infected with Methicillin-Resistant Staph Pseudintermedius (MRSP) or Methicillin-Resistant Staph Schleiferi (MRSS). When pets do have true MRSA, it often comes from a person. One concern is that pets can transfer MRSA back to people.

* Based on three recent studies, the rate of carriers among specialists was 3.5 percent in dermatologists and their staff, 7 percent in internists and their staff, and…ahem…well…can we skip that information? Seventeen percent of surgeons and their staff. Maybe that’s why surgeons are obsessed with caps, masks and gloves.

* More broadly speaking, 12 percent of vets taking care of MRSA-infected patients (and 8 percent of their owners) were carriers for MRSA, which suggests that there is an occupational risk in our profession.

* Should a worried client ask you to screen their pet for MRSA, it is important to explain that there are no predictive carriage sites for the bacteria in pets. It is therefore recommended that five cultures be performed from the following sites: the top of the head, the nostrils, the mouth, the inguinal area and the anus.

* In people, the two suggested screening sites are the nose and the anus.

* An infected patient should be handled like any pet in your isolation ward: All staff members should wear gloves and gowns, and use equipment dedicated to those pets. In human facilities, implementing common-sense infectious disease programs has decreased the risk of nosocomial infections by 30 percent.

So there you go. Derm can be exciting. I hope that you learned something, or that you will be encouraged to attend a continuing education meeting that is outside of your daily environment.

 

1. Raditic, Remillard and Tater (2010). “ELISA testing for common food antigens in four dry dog foods used in dietary elimination trials.”  NAVDF Conference Proceedings.

 

2. Marsella R. and Samuelson D. (2009). “Unraveling the skin barrier: a new paradigm for atopic dermatitis and house dust mites.”  Veterinary Dermatology, Vol. 20, N. 5-6, p. 533 - 540.

 

3. Kirby A. et al (2010). “Evaluation of otoscope cone disinfection techniques and contamination level in small animal private practice.”  Veterinary Dermatology. Vol. 21, N. 2, p. 175 - 183.

 

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