LITHUANIAN UNIVERSITY OF HEALTH SCIENCES

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VETERINARY ACADEMY Faculty of Veterinary Medicine

Casandra Sarah Gabriella Nors

Diagnostic Procedures Of Pneumonia In Cats And Dogs In 41 Different Countries

MASTER THESIS

of Integrated Studies of Veterinary Medicine

Supervisor: DVM Andrius Kavaliauskas

KAUNAS 2018

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2 THE WORK WAS DONE IN THE DEPARTMENT OF DR. L KRIAUČELIŪNO SMALL

ANIMAL CLINIC DEPARTMENT

CONFIRMATION OF THE INDEPENDENCE OF DONE WORK

I confirm that the presented Master Theses " Diagnostic Procedures Of Pneumonia In Cats And Dogs In 41 Different Countries”

1. Has been done by me;

2. Has not been used in any other Lithuanian or foreign university;

3. I have not used any other sources not indicated in the work and I present the complete list of the used literature.

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LITHUANIAN LANGUAGE IN THE DONE WORK I confirm the correctness of the English language in the done work.

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CONCLUSION OF THE SUPERVISOR REGARDING DEFENCE OF THE MASTER THESES

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THE MASTER THESES HAVE BEEN APPROVED IN DR. L KRIAUČELIŪNO SMALL ANIMAL CLINIC DEPARTMENT

(date of approbation) (name, surname of the

manager of department/clinic) Reviewers of the Master Theses

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1)

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Evaluation of defense commission of the Master Theses:

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SUMMARY

Diagnostic Procedures Of Pneumonia In Cats And Dogs In 41 Different Countries

Casandra Sarah Gabriella Nors

Master Thesis

The goal with this master thesis is to examine the diagnostic and therapeutic approach to pneumonia in dogs and cats.This master’s thesis is accomplished as part of the department of Dr. L. Kriaučeliūno small animal clinic of Lithuanian University of Health Sciences in Kaunas

Data used in this study was collected through two different surveys (annex 1,2) both surveys focused on what the participant does or had been doing to diagnose pneumonia and from what country they were from. In the first survey (annex1) the questions are more detailed, and the participant should think about one specific case not older than two years old. The first survey received 50 answers and the second (annex 2) received 523 answers.

The data was collected and coded using Microsoft Excel 2011. The statistical analysis was made using Statistical Package for the Social Sciences (IBM SPSS) The survives where separated analyzed. Bar charts with concurring frequency tables where done do compare the different responses and to find out percentages, frequency and prevalence. Chi-squared test, Npar test and Kruskal-Wallis Test was used to calculate, maximum, minimum and mean. Kruskal-Wallis Test and Chi-squared test where also used when calculating the p-value and if there was a significant between different variables.

The analyses showed that x-ray and blood test are the most common diagnostic procedure and that bacteria pneumonia with Bordetella bronchiseptica, Streptococcus and Escherichia coli are the

most common pathogen. The studies also showed that Amoxicillin with clavulanic acid is the most frequent treatment and that French bulldogs usually have couching and dyspnea as their first symptoms

The analyze showed significant relation between sex and amount of diagnostic procedures done p=0.027 (p>0.05) and when calculating the mean its shows that castrated animals receives more diagnostic procedure then the non-castrated. However, no significant relation was found when

comparing treatment and sex so even if the castrated received more diagnostic procedures they do not receive more treatment.

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SANTRAUKA

Pneumonijos Diagnostikos Procedūros Katėms Ir Šunims 41 Skirtingose Šalyse

Casandra Sarah Gabriella Nors

Magistrinis baigiamasis darbas

Baigiamuoju darbu buvo norima išanalizuoti, kokios yra taikomos diagnostinės priemonės ir gydymo shcemos šunų ir kačių pneumonijų gydymui. Baigiamasis darbas parašytas Lietuvos sveikatos mokslų universitete, Dr. L. Kriaučeliūno smulkiųjų gyvūnų klinikoje.

Duomenims surinkti, buvo pateiktos dvi anketos (priedas 1,2), jomis buvo siekama išsiaiškinti kokiomis priemonėmis yra diagnozuojamos pneumonijos skirtingose šalyse. Pirmoje anketoje buvo pateikiami platesni klausimai, atsakymia turėjo būti konkrečių atvejų, kurie yra nesenesni nei du metai. Į pirmąją anketą atsakė 50, o į antrąją 523 atsakovų.

Surinkta informacija buvo užkoduota naudojant Mircosoft Excel 2011 metų program. Statistinė analizė buvo atlikta naudojant IBM SPSS program. Abi anketos buvo išanalizuotos individualiai. Atliktos analizės siekant nustatyti ligos pasireiškimo dažnumą bei paplitimą. Nustatyti maksimalias ir minimalias reikšmės buvo panaudota chi – kvadrato, Npar testas, Kruskal – Wallis testai. Nustant p reikšmes ir skirtumus tarp kintamųjų buvo naudota Chi – kvadratas ir Kruskal – Wallis testai.

Išanalizavus duomenis kreiptinas dėmėsys, kad rentgenografinis tyrimas ir kraujo tyrimai – dažniausiai naudojomos diagnostinės priemonės, nustatant bakterinės kilmės pneumonijas, kurių dažniausi sukelėjai - Bordetella bronchiseptica, Streptococcus ir Escherichia coli. Tyrimo rezultatai taip pat parodė, kad dažniausiai gydymui naudojama antibakterinė medžiaga – Amoksicilinas ir klavulano rūgštis. O dažniausia paisreiškianti simptomatika Prancūzų buldogams – kosulys.

Tyrimų rezultatai parodė, kad yra statistiškai patikima koreliacija tarp lyties ir atliktų tyrimų kiekio p=0.027 (p>0.05), taip pat pastebėta, kad kastruotiems gyvūnams yra atliekama daugiau procedūrų nei nekastruotiems. Nors procedūrų skaičius kastruotiems gyvūnams yra didesnis, tačiau skirtumo tarp skirto gydymo kastruotiems ir nekastruotiems gyvūnams nėra.

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LIST OF ABBREVATIONS

PCV- Packed cell volume

RBC- Red blood cell

ALT - Alanine aminotransferase

AST - Aspartate aminotransferase

ALP - Alkaline phosphatase

CPK - Creatine phosphokinase

BUN - Blood urea nitrogen

Nr- Number

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INTRODUCTION

Diseases of the respiratory system in dogs and cats are the most common group of diseases after gastrointestinal system diseases specially if the dogs and cats are housed together in multiple numbers and is indoor outdoor living. Infection agents (viruses, bacteria, parasites, fungus) spread rapidly among dogs and cats and increase the morbidity / mortality rate. Severe respiratory infections can significantly affect the general condition and well-being of animals, resulting in death due to misdiagnosis or inappropriate treatment approaches. In this context, respiratory diseases are an important and up-to-date issue that should be focused on by our veterinarians around the world.

Diagnosis of respiratory system diseases can be done by anamnesis and detailed physical

examination. However, detailed diagnosis methods are required for the correct approach to respiratory diseases as well as anamnesis and physical examination. Hematology, radiography and bronchoscopy are used for this purpose. Apart from these methods, tracheal washing or bronchoalveolar lavage fluid examinations are performed for ease of application in the diagnosis of lung diseases. The diagnostic approach is crucial for a fast and correct diagnosis so that the correct treatment plan can be established. [32]

Aim:

Examine the diagnostic and therapeutic approach to pneumonia in dogs and cats.

Objectives:

1. To investigate what diagnostic procedures done most to diagnose pneumonia in dogs and cats around the world.

2. To investigate the most common pathogen that causes pneumonia in cats and dogs. 3. To evaluate if any breed or sex is more predisposed for pneumonia.

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1. LITERATURE REVIEW

1.1 Anatomy and physiology

The respiratory system is made of seven structures the lungs, bronchi, trachea, larynx, nasopharynx, nasal cavity and the external nose. The place of gas exchange in the lungs is alveoli, alveolar sacs, alveolar ducts and the respiratory bronchiole. [10]

Respiratory system is divided into upper respiratory tract and lower respiratory tract.

1.1.1 Upper respiratory tract

Upper respiratory tract contains the nose with associated cartilages, the conchae and meatus of the nasal cavity and the paranasal sinuses.

1.1.1.1 Nose

The apex of the nose differs in shape and size depending on the breed, but they are all hairless around the nostrils [9]

1.1.1.2 Nasal cartilages

The nasal cartilages support the external nares and determinate the shape of the nostrils opening, the external nares surround the nasal vestibule and forms the opening of the nasal cavity. [9] The nasal cavity is divided into left and right by the nasal septum and reaches from the external nares to the porous plate of the ethmoid bone. [10]

1.1.1.3 Conchae

The conchae serve to increase the respiratory surfaces and olfactory senses and are made of ossified scrolls surrounded by mucosa and the conchae is occupying a larger portion of the nasal cavity. [10]

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9 1.1.1.4 Nasal meatus

Nasal meatus is divided into ventral, middle and dorsal meatus and they are all connected and communicating with the common nasal meatus.

The ventral nasal meatus is the main location for airflow to the nasal pharynx and are located between the bottom of the nasal cavity and the ventral part of the conchae.

The middle nasal meatus is the connection between the nasal meatus and the paranasal sinuses it is located in between the ventral and dorsal nasal meatuses.

Dorsal nasal meatus provides air flow to the mucosa of the olfactory and is located between the top of the nasal cavity and the dorsal part of the conchae. [11]

1.1.1.5 Paranasal sinuses

Paranasal sinuses are outpouching, air filled cavities covered with a thin mucosa within the skull, they provide protection to the nasal cavity as well the orbit and cranial cavities [11]

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10 1.1.2 Lower respiratory tract

The lower respiratory tract is constructed by the larynx, trachea, bronchi and lungs. [8]

1.1.2.1 Larynx

The larynx is the connection between the nasal pharynx and the trachea and it is tube shaped, it contains four major cartilaginous bodies the thyroid, arytenoid, cricoid and the epiglottis, the epiglottis prevents foreign bodies to enter the lower respiratory system by cover the entry to the laryngeal

structure during swallowing [12], the other cartilages develops the structure and function of the larynx and vocal box.[13]

The beginning of the larynx cavity contains the leaf shaped epiglottis with a part of the paired arytenoid cartilages, the middle part of the larynx called glottis contains the major part of the paired arytenoid cartilages and the two vocal folds that form the narrow path called glottic cleft, after the narrow path, the stratified squamous epithelium covered, tube shaped lumen becomes wider and form the infraglottic cavity which contains the cricoid cartilages, which in turn is in direct connection with the trachea. [13]

1.1.2.2 Trachea

The trachea is made of several C-shaped hyaline cartilages that is connected with ligaments it is 42-46 in dog and 38-43 in cats. The trachea starts at the cricoid cartilages in the larynx and extends until it divides to the bronchus at the level of the fifth intercostal space dorsally to the base of the heart.

1.1.2.3 Lungs

The lungs of cats and dogs are similar in shape and consist of two pair of lungs connected at the division of the trachea, the lungs are of spongy texture and covers most of the thoracic cavity each lung is surrounded by a pleural sac a thin fluid filled cleft is also present to reduce friction during expansion of the lungs. [14]

Lungs of cats and dogs contains six lobules, two in the left lung (cranial which is divided into cranial and caudal part and then the caudal lobe) and four in the right (cranial, middle, caudal and accessory lobe.)

The trachea, blood vessels, pleura and mediastinum are all connected with the lungs and are keeping the lungs in a fixed position. [15]

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11 1.1.2.4 Bronchial tree

The bronchial tree starts at the division of the trachea and splits up to two tube shaped structures called the principal bronchi reaching left and right side of the thoracic cavity, the principal bronchi then splits into lobular bronchi which is named after the lobes they are associated with, the bronchi inside the lobes splits into a smaller structure called segmental bronchi witch are cone shaped and located close to the surface of the lung.

The segmented bronchi form branches of respiratory bronchi which then divides into secondary and tertiary respiratory bronchioles which later is followed by the alveolar duct that are covered with alveolar sacs. The alveoli ducts with associated sacs, respiratory bronchiole and pulmonary alveoli is responsible for the gas exchange, with their associated capillaries form the blood-air barrier. [15]

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1.2 Pneumonia general

Pneumonia is a chronical or acute inflammation. It disturbs the respiration and causes hypoxemia by affecting the lungs and bronchi, the toxin associated is complicating the pneumonia. The most common cause is viral infection in the lower respiratory tract [1]

1.3 Clinical symptoms of pneumonia

1.3.1 General

Clinical symptoms include coughing, respiratory noise, difficult breathing, tachypnea, and nasal discharge. [2] The animal may be dehydrated and have high fever. Weight loss, anorexia and exercise intolerance may also be present. [3]

1.3.2 Clinical symptoms of bacterial pneumonia

Symptoms of a present bacterial infection in the respiratory system are unilateral or bilateral mucopurulent discharge from the nose, coughing that has a soft, wet sound that increasing with time and exercise intolerance. These symptoms will over time cause respiratory distress in the patient.

The symptoms are not always restricted to the respiratory system, so the symptoms become systemic and causes the patient to become lethargic, anorectic with weight loss and fever occur in half the cases [4]

1.3.3 Clinical symptoms of viral pneumonia

Viral pneumonia is often associated with acute onset of harsh and loud coughing that is continued for more than ten days and worsening with exercise. Increased respiratory rate that develops into

respiratory distress is common. Fever is not always present, and some dogs have symptoms of unilateral or bilateral mucopurulent discharge from nose.

Viral pneumonia is often conjointly with bacterial pathogens. [5]

1.3.4 Clinical symptoms of fungal pneumonia

Fungal pneumonia often starts as asymptomatic and can go undetected for over a year but after onset of symptoms the symptoms rapidly worsen.

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Coughing is not always present, but a dry harsh lung sound can be herd. The patient has exercise intolerance and can even have dyspnea at rest.

Fungal pneumonia is associates with signs of anorexia with sever weight loss, dyspnea, skin lesions, lameness and ocular disease. Lymphadenomegaly is a common symptom and can be present in one or more lymph nodes. [6]

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1.4 Etiology of pneumonia

1.4.1 Etiology

The cause of bacterial, viral and fungal pneumonia depends upon the active infectious agent but what they all have in common is that it affects patients of all ages and breeds but affect young and old more severely. [5]

Bacterial pneumonia is caused by bacteria colonizing in the interstitium, alveoli, or the airways. The transmission route the bacteria use to enters the patient is via the oral cavity to the pharynx the nose or the airways as aerosols or the patient have ingested the bacteria. Other route for bacteria to enter the respiratory tract is by hematogenous origin. Aspiration of gastric content or ingested material is a common cause of pneumonia and is often associated with retardation of the respiratory tract. [4]

Viral pneumonia is caused by viral agents invading the respiratory tract by secretion from an infected patient, the secretion is shed as aerosols and enters the respiratory tract by inspiration or is shed in the environment and infects patients by contaminated objects via indirect contact. After the virus invaded the patient it rapidly multiply within the respiratory tract. [5]

Pneumonia of fungal origin is most common caused when the patient being exposed to a point source of fungus. The transmission is trough spores from the environment that enters the patient via inhalation or by open wounds. After invasion the fungus spreads hematogenous in the patient’s body.

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15 1.4.2 Infectious agents

Table 1: Agents causing pneumonia [7]

Bacteria Viruses Fungus

Mycoplasma Feline rhinotracheitis virus Penicillium

Streptococcus Canine distemper virus Blastomyces

Bordetella Canine parainfluenza virus Aspergillus

Escherichia coli Canine adenovirus-2 Cryptococcus

Mycobacterium Canine herpes virus Coccidioides

Klebsiella Pasteurella

Eugonic fermenter-4 Yersinia pestis Pseudomonas mallei

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1.5 Clinical examination of respiratory system

1.5.1 History

The history of the animal is an excellent start to diagnose respiratory diseases such as history of coughing can suggest asthma in cats and interstitial lung disease, tracheobronchial conditions and edema of the lungs in dogs. If there more than one animal in the household that shows symptoms it can give clues about infectious or environmental factors.

History of trauma can give clues about more acute conditions such as herniation of the diaphragm, fail chest or pneumothorax.

Breed and size of the animal can be a good indicator for what type of pulmonary disease is most likely to occur such as breeds of the brachycephalic type are usually more affected of conditions affecting the upper airways such as obstruction. Smaller breeds and giant breed dogs such as the Cavalier King Charles spaniels and the Great Danes are more predisposed to get cardiac related pulmonary conditions such as pulmonary edema.

Asthma is one of the most common lower respiratory conditions that affects cats more than dogs and specially the Siamese breed. [16]

Parasites as Eucoleus aerophilus (Capillaria aerophile), Filaroides hirthi, Aelurostrongylus

abstrusus and Paragonimus kiettiella is a major cause of lower respiratory system diseases that can

easily be confused with pneumonia due to the similar symptoms, and should not be excluded in the general examination [41]

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17 1.5.2 Examination

1.5.2.1 Observing

The examination of an animal with signs of respiratory distress should always start with observation of the animal from a distance. Observe if there are any signs of trauma, pattern of the breathing, abdominal or chest breathing as well inspiration and expiration phases. Observe the abdomen and chest for distension and listening if there are any abnormal sounds such as coughing, wheezing, gasping or snoring.

Obstruction of the upper respiratory tract correlate with respiratory sounds that is detected without stethoscope and inspiratory dyspnea while obstruction of the lower respiratory tract correlate with sounds usually only detected upon auscultation of the chest with a stethoscope and expiratory dyspnea.

Not possible to diagnose pneumonia only on observation due to that it can have shallow and rapid breathing or even both. Pneumonia can also have both inspiratory and expiratory changes with or without external auditable noise.

1.5.2.2 Temperature

Pneumonia is not often related with increased temperature but may be an indicator of systemic infection. [17]

1.5.2.3Auscultation

Auscultation of the lungs is the second step in the physical examination in the respiratory system, with the help of strategic use of a stethoscope the respiratory diseases can be narrowed down, for example decreased lung sounds is correlated with pleural space disease. Lung sounds that are increased correlate with parenchymal disease of the lungs and lower respiratory tract diseases such as pneumonia.

Pneumonia is often correlated with loud breathing noise with or without wheezing and crackles. [18]

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18 1.5.2.4 Blood sampling

A complete blood count (CBC) sample is used to analyses if the animal is having an infection by checking the amount of white blood cells. The amount of white blood cells is usually increased if pneumonia is present. If its fungal pneumonia it is often the neutrophils and monocytes that are increased.

Bacterial pneumonia will show only increased levels of neutrophils, and decreased levels of lymphocytes decreases.

Viral pneumonia will show increased lymphocytes and decreased neutrophils.

Prior to any treatment a blood serum panel should be done to help with the differential diagnostic and to make sure the planed treatment is safe. [29]

Collection of blood is done in the cephalic, saphenous or jugular vein. The cephalic is the most common, the area of interest is shaved with electrical clippers and then cleaned with 70% alcohol. A hemostat is applied above the elbow when taking samples from the cephalic vein to elevate the vein and to build up pressure for easier withdrawn, in the case when samples are taken from the jugular vein the hemostatic pressure is build up by applying pressure with your hands dorsal to the thoracic inlet. Needle size depending on the size of the animal but smaller then a 21 gauge is not recommended due to poor blood flow. The restriction of blood sampling is that you should not take more than 1% of total blood volume for each sample and not more then 7,5% over the period of 7 days. [19]

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19 1.5.2.5 Complete blood count

Table 2. Complete blood count [20]

Analyze Spectrum Entity

Packed Cell volume 37-55 %

Reticulocytes 0-60.000 #/uL

Lymphocytes 1.0-1.2 X 103/ uL

Red blood cells 5.5-8.5 X 106/uL

Eosinophils 0.1-1.2 X 103/ uL

Platelets 200-500 X 103/ uL

Neutrophils 3.0-11.5 X 103/ uL

Band cells 0-0.3 X 103_{/ uL}

PCV- shows the number of red blood cells in percentage in the hole blood. Low number of red

blood cells (PCV) can be the sign that the patient is anemic or received too much fluids while high number of red blood cells can show that the patient is dehydrated or have defects of the heart.

Reticulocytes- Reticulocytes are immature red blood cells which are produced by the bone

marrow. Low number can be a sign that the bone marrow is not functioning as it should, and anemia is often present. High number of reticulocytes indicate that the bone marrow is in a regenerative state and producing more red blood cells.

Lymphocytes- lymphocytes are withe blood cells responsible for the immune system. Low levels

of lymphocytes indicate stress, viral infection or that steroids have been administrated or released. High levels can indicate bone marrow cancer (Leukemia) or that the animal is simply excited [20]

RBC- this sample shows the amount of red blood cells in one microliter of blood. If red blood

cells are low it indicates blood loss, that the cells get destroyed within the body or that the bone marrow is not producing enough cells. High number can indicate oxygen, kidney and heart deficiency and some rare bone marrow diseases. [21]

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20 Eosinophils- eosinophils are white blood cells acting with the immune system they are often

present in high numbers if there is inflammation and irritation in tissue, but high number can also indicate some cancers, pneumonia, parasitic infestation and allergic reaction. Low number is very common and do not need to raise concern but can be indication of steroid use. [22]

Platelets- Platelets are the cells that gives the blood the ability to clot. Low number can indicate

bleeding disorders. High number can indicate inflammation in the body, trauma, disease of the bone marrow or can be a temporary response to epinephrine release If low platelet numbers occur, the animal may be predisposed to bleeding disorders. [20]

Neutrophils- Neutrophils are the main white blood cells involved in the fight against infections.

Low numbers can suggest severe acute or chronic infections, damage to the bone marrow and some viral infections, genetics can play a role in low count of neutrophils to. High numbers are often associated with bacterial infections, stress or usage of steroids. [21]

Band Cells- Band cells are immature neutrophils. Low number or even absent is normal in cats

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21 1.5.2.6 Blood serum chemistry

Table 3. Blood serum chemistry [20]

Analyze Spectrum Entity

Alanine Aminotransferase (ALT) 10-120 IU/L Aspartate Aminotransferase (AST) 15-40 IU/L

Alkaline Phosphatase (ALP) 20-150 IU/L

Creatine Phosphokinase (CPK) 50-250 IU/L

Blood Urea Nitrogen (BUN) 7-27 mg/dl

Calcium 9.0-12.0 mg/dl Glucose 65-130 mg/dl Phosphorus 2.8-6.1 mg/dl Creatinine 0.6-1.5 mg/dl Cholesterol 120-350 mg/dl Albumin 2.7-4.5 g/dl Total protein 5.3-7.6 g/dl Sodium 145-159 mEq/L Chloride 106-127 mEq/L Potassium 4.1-5.5 mEq/L

ALT- ALT is a liver enzyme found in the cells of the liver. Increased level can indicate that the

liver is damaged due to diseases such as metabolic disorders, inflammation or indicate lack of oxygen or intoxication. Decreased ALT is uncommon and often not diagnostic significant but can be a sign of end stage liver failure [24]

AST- AST is an enzyme found in various tissues the highest amount is found in the cells of liver

and muscle. Increased levels can indicate metabolic disorders, inflammation, chronic hepatitis, trauma, neoplasia and intoxication. Decreased levels are not clinically important. [24]

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22 ALP- ALP is an enzyme found in bone and liver cells. Increased levels can indicate liver

cholestasis, metabolic disorders, neoplasia, inflammation involving the liver or gallbladder. Increased levels may also indicate increased osteoblastic activity in the bones, or the levels where increased by drugs. decreased levels are not clinically important. [24]

CPK- CPK is an enzyme within the cells of the muscle. Increased levels often indicate

inflammation or trauma to a muscle, decreased levels are not clinically important. [25]

BUN - BUN or Urea is produced by the liver and excreted from the kidneys, it is a byproduct of

metabolized protein. Increased level can indicate high protein diet, dehydration, blood loss, urinary/kidney stones, kidney diseases or ulcers in the gastrointestinal tract. Decreased levels can indicate severe chronic liver disease, severe polyuria, diabetes mellitus or low protein diet. [24]

Calcium- calcium is a mineral that is normally found in the body and is important for the normal

function of the heart and muscle. Increased levels can indicate problems with the kidneys or

parathyroid, bone diseases and some type of cancers. But increased levels can be normal in young fast-growing animals. Decreased levels may indicate dietary insufficiency, ethylene glycol poisoning, intestinal or kidney problems. Decreased levels can also occur in the female during lactation.

Glucose- glucose is a type of sugar found in the blood. Increased levels can indicate diabetes

mellitus, stress, usages of certain drugs or it can be increased if the animal recently eaten. Decreased levels can occur when the animal is suffering from severe bacterial infection, hormonal or liver problems. Decreased levels can also occur if the levels of insulin are too high. [20]

Phosphorus- Phosphorus is a naturally micromineral found in the structure of teeth, bones,

nucleic acid molecules and cell membranes. Increased levels can occur if the animal is suffering from kidney failure or have a large tissue damage or if the animal is dehydrated. [26] Decreased levels can indicate that the animal did not get enough phosphorus in their diet over a long period of time,

suffering from anorexia, chronic vomiting, diabetic ketoacidosis, metabolic acidosis and polyuria. [27]

Creatine-Creatine is a byproduct of the creatine phosphate breakdown process and it is a normal

element in the muscle it is removed from the body mainly through the kidneys. Increased levels can indicate kidney filtration problems, but it can also increase if the animal is heavily muscled or ate a meaty meal prior to testing. Decreased levels can be shown when the animal is suffering from liver, hyperthyroidism diseases, muscle loss due to low protein diet or diseases affecting the muscles. [28]

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23 Cholesterol- cholesterol is an organic molecule found in every cell in the body. Increased levels

can indicate hypothyroidism, diabetes mellitus, pancreatitis, liver and kidney diseases cholesterol can be increased if the animals are feed a high fat diet. Decreased levels can occur if the animal is,

suffering from diseases affecting the absorption and digestion, feed a low fat diet, suffering from liver failure or problems with the pancreas. [20]

Albumin- albumin is a protein in the blood that is transporting other proteins and nutrients

around the body. Increased levels can indicate dehydration, prolonged fever, shock or that the blood was wrongfully drawn or handled. Increased levels are rare and usually not clinically significant. Decreased levels can occur when the animal is suffering from chronic pancreatitis, acute

inflammations, kidney and liver diseases, internal and external parasites and severe blood loss. [29]

Total Protein- Total protein measures all the different proteins in the blood together to get a

better overview. Increased levels can indicate infections, inflammation, dehydration and some types of cancers. Decreased levels can be an indication of malnutrition, blood loss, problems with the intestinal absorption functions or liver and kidney diseases.

Sodium- sodium is a positive charged electrolyte. Increased levels can indicate a high sodium

diet, dehydration, diabetes insipidus, chronic kidney diseases and Cushing’s disease. Decreased levels may occur when the animal is vomiting or diarrheic or suffering from hypothyroidism, kidney diseases, Addison’s, disease or if considerable amount of fluids been administered.

Chloride- chloride is a negative charged electrolyte. Increased levels can indicate dehydration,

acidosis or if considerable amount of fluids been administered. Phenobarbital is also a cause for increased chloride levels. Decreased levels can be caused by administrations of diuretics or vomiting directly after food intake.

Potassium- potassium is a positive charged electrolyte. Increased levels may indicate acidosis,

kidney diseases, Addison’s disease and tears of the urinary bladder. Decreased levels can indicate kidney, liver, Cushing’s disease but also found in animals with chronic vomiting with or without diarrhea. [20]

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24 1.5.2.7 Thoracic radiography

Thoracic radiography is a very important step in diagnosing lower respiratory diseases. 3

projections should be taken, right lateral, left lateral and dorsoventral or ventrodorsally. Depending on the cause of the pulmonary problems different pattern will be visualized in the thoracic radiography. [31]

Table 4. Pattern on lungs depending on pathogen [31] Lobar alveolar

merging

Focal alveolar merging

Diffuse alveolar pattern Diffuse or focal interstitial pattern

• Aspiration pneumonia

• Foreign body • Acute respiratory distress syndrome

• Early bacterial pneumonia • Lung lobe torsion • Primary

pulmonary neoplasia • Congestive heart failure • Imminent congestive heart failure • Atelectasis secondary to mucus plugging • Noncardiogenic pulmonary edema

• Fluid overload • Pneumocystis

carinii infection

• Fungal Pneumonia • Eosinophilic Broncho pneumopathy

• Inhalant toxicity

• Coagulopathy • Viral pneumonia

• Metastatic neoplasia

1.5.2.8 Bronchoalveolar Lavage

Bronchiolar lavage (BAL) is a great tool for diagnose of pulmonary conditions but it is not recommended for animals in respiratory distress due to that it is performed under general anesthesia, BAL is performed by inserting an endoscopic tube in to the lungs via the mouth and trachea and flushing with 0.9% NaCl, then with suction remove the fluid. (same amount of fluid that was put in should also be removed) The fluid collected can then be used for cytological, microbiological, biochemical and immunological testing. [30,31]

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25 1.5.2.9 Bronchoscopy

Bronchoscopy is done with a flexible fiber-optic tube that has a light source and a camera in the edge. Bronchoscopy is done under general anesthesia and is not recommended for animals in

respiratory distress. The bronchoscopy is entered through the mouth and then gently pushed through the trachea to enter the lungs to visualize the tracheal- bronchial branches, bronchoscopy is used to visualize all respiratory tract but most used to visualize the lower respiratory tract.

Bronchoscopy can be useful in removal of foreign bodies, secretion collection for cytology, biopsy of the respiratory tract. Bronchoscopy is usually done together with bronchial lavage and it aids in the diagnostic of unknown pneumonia. [33,34]

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2. RESERCH METHODS AND MATERIAL

The surveys that is seen in Annex 1 (Pneumonia in dogs and cats) and Annex 2 (Pneumonia (only two questions)), was conducted July- August 2018. Both surveys were done with Google Formulär. The survey Pneumonia in dogs and cats contains 12 detailed questions and the survey Pneumonia (only two questions) contained two questions. Both surveys were posted and shared on various veterinary medicine groups on Facebook to reach a broader audience. I decided two make 2 surveys due to a low respond to the survey with 12 questions. 50 people answered the Pneumonia in dogs and cats survey and 523 people answered the Pneumonia (only two questions) survey. People were allowed to skip questions, chose multiple answers and to write different answers then the once suggested by me.

2.1 Cases

To ensure the data quality 49 of the answers in survey 1 (Pneumonia in dogs and cats) was used and in survey 2 (Pneumonia (only two questions)) all the 523 answers where used.

2.2 Analysis of static data

The data was collected and coded using Microsoft Excel 2011. The statistical analysis was made using Statistical Package for the Social Sciences (IBM SPSS) The survives where separated analyzed. Bar charts with concurring frequency tables where done do compare the different responses and to find out percentages, frequency and prevalence. Chi-squared test and Kruskal-Wallis Test was used to calculate, maximum, minimum and mean. Kruskal-Wallis Test and Chi-squared test where also used when calculating the p-value and if there was a significant between different variables.

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REASERCH RESULTS

Table 5. Frequency of species

In table nr 5, it can be seen that (95.9%, n=47) of the responses are dogs and (4.1%, n=2) of the responses are cats. It shows that dogs are very higher in number than the cats.

Table 6. Frequency of sex

In table nr 6, it can be seen that (20.4%, n=10) of the responses are female, (36.7%, n=18) of the responses are male, (22.4%, n=11) of the responses are castrated female, and (20.4%, n=10) of the responses are castrated male. It shows that most of the responses are males.

Kruskal-Wallis Test 1 and means displays the independent variable sex and its four categorical, independent groups (Female, male, Castrated female and Castrated male).

4.1% 95.9%, 0 5 10 15 20 25 30 35 40 45 50 Cat Dog FRE QUE N CY OF AN IMALS SPECIES 20.4% 22.4% 20.4% 36.7% _{Castrated female} Castrated male Female Male

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The Kruskal Wallis Test 1 results indicate that there is statistically significant difference in procedures done to diagnose among the four sex groups (chi-square =9.191, p-value =0.027). p>0.05

Looking at the median scores, it can be concluded that the Castrated male and Castrated female are statistically significantly higher procedures done to diagnose than the female and male not castrated.

The Kruskal Wallis Test 2 results indicate that there is no statistically significant difference in treatment used among the four sex groups (chi-square =1.331, p-value =0.722). p>0.05

Table 7. Frequency of breed

In table nr 7 it shows that mix and French bulldog (12.2%, n= 6) are the most common breeds and are very higher in number than other breeds.

2% 2% 2% 4% 2% 10.2% 2% 12.2% 8.1% 2% 4% 4% 2% 8.1% 2% 2% 12.2% 2% 2% 4%2 2% 2% 2% 2% 2% 0 1 2 3 4 5 6 7 A u str al ian c attl e d o g Ber n es se mo u n tai n d o g Co lli e Do go ar ge n ti n e Do me sti c s h o rt h air En gl is h Bu lld o g Fl atc o ate d re tr ie ve r Fr en ch b u lld o g G e rman s h ep h erd G o ld en re tr ie ve r G re at d an e Jac k r u ss el l Ke lp ie La b rad o re r etr ie ve r Ih as o ap so Min iatu re fo x te rr ie r Mi x O ld e n gl is h s h e ep d o g Po me ran ian R o tt w ei le r Th ai s e al b ro w n To y p o me ran ian V iz sl a W ei m aran er W ire h air ed d ac h sh u n d FR EQU EN SY OF AN IMA LS BREED

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29 Table 8. Frequency of first symptoms

In table nr 8 it shows that Coughing (26.5%, 13) is the most common First symptoms and are very higher in number than other First symptoms.

2% 2% 26.5% 8.1% 2% 8.1% 2% 8.1% 2% 4% 2% 10.2% 2% 6.1% 4% 2% 2% 6.1% 0 2 4 6 8 10 12 14 A n o re xi a A n o re xi a, mu sc le tr e mo rs Co u gh in g Co u gh in g, an o re xi a Co u gh in g, d ys p n ea, vo mit in g Co u gh in g, L eth arg ic Co u gh in g, L eth arg ic , A n o re xi a Dys p n e a Dys p n e a, A n o re xi a, V o mi ti n g In cre as ed re sp irat o ry s o u n d s Le th ar gi c, D ys p n ea Le th ar gi c N as al d is ch arg e N as al d is ch arg e , Dys p n e a Py re xi a Py re xi a, L et h arg ic R eg u rg it at io n V o mit in g FRE Q UE N CY O F A N IM AL S FIRST SYMPTOMS

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30 Table 9. Frequency of diagnostic procedures

In table nr 9 , it can be seen that (2.0%, n=1) of the procedures done are X-ray, Blood test; X-ray, Clinical signs; X-ray, Blood test, Clinical signs; X-ray, Blood test, Auscultation, Nasal swabs, Clinical signs; X-ray, Blood test, Auscultation, Bronchoalveolar lavage; X-ray, Blood test, Auscultation; X-ray, Auscultation, Clinical signs, Bronchoalveolar lavage; and Blood test,

(6.1%, n=3) of the procedures done are X-ray, Blood test, Bronchoalveolar lavage,

(38.8%, n=19) of the procedures done are X-ray, Blood test, and X-ray. It shows that the majority of the procedures done are X-ray, Blood test, and X-ray.

2% 38.8% 2% 38.8% 2% 2% 2% 6.1% 2% 2% 2% 2% 0 2 4 6 8 10 12 14 16 18 20 Blo o d t es t X-ray X-ray, A u sc u ltati o n , Cli n ic al s ig n s, Bro n ch alve o lar l ava ge X-ray, B lo o d te st X-ray, B lo o d te st, A u sc u ltati o n X-ray, B lo o d te st, A u sc u ltati o n , B ro n ch alve o lar lava ge X-ray, B lo o d te st, A u sc u ltati o n , N as al s w ab s, Cl in ic al s ig n s X-ray, B lo o d te st, B ro n ch alve o lar l ava ge X-ray, B lo o d te st, Cli n ic al s ig n s X-ray, Cli n ic al s ig n s X-ray. Blo o d te st N as al s w ab s FRE QUE N CY OF AN IMALS DIAGNOSTIC PROCEDURES

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31 Table 10. Type of pneumonia

In table nr 10 it shows that Bacteria (73.5%, 36) are the most common type of pneumonia and are very higher in number than other types of pneumonia.

2% 73.5% 8.1% 2% 4% Aspiration Bacteria Mix Pulmonary fibrosis virus

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32 Table 11. Pathogen type

In table nr 11 in shows that Bordetella bronchiseptica and Streptococcus (8.2%, 4) are the most common kind of bacteria, virus or fungus and are very higher in number than other kinds of bacteria, virus or fungus 8.2% 4% 2% 2% 2% 8.2% Bordetella bronchiseptica Escherichia Coli Herpesviridae Mix Pasteurella Streptococcus

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33 Table 12. Frequency of treatment performed

In table 12 , it can be seen that (2.0%, n=1) of the treatments done are I.V Fluids, Oxygen; I.V Fluids, Acetaminophen, Buprenorphine, Nebulization; Humane euthanasia; Antibiotics, Oxygen, Mechanical ventilation; Antibiotics, Oxygen, Butorphanol; Antibiotics, Omeprazole, Coupage, Nebulization; Antibiotics, NSAIDs, Cerenia, Ulsanic; Antibiotics and Pseudoephedrine; Antibiotics I.V Fluids, Oxygen, NSAIDs; Antibiotics, Albuterol, Nebulization; Antibiotics, Coupage; Antibiotics, I.V Fluid, Butorphanol, Mirtazapine; Antibiotics, I.V fluids; Antibiotics, I.V fluids, Cortisone; Antibiotics, I.V Fluids, Coupage; Antibiotics, I.V Fluids, Nebulization; Antibiotics, I.V fluids, Nebulization, Bronchodilators, Oxygen;

Antibiotics, I.V Fluids, NSAIDs; Antibiotics, I.V Fluids, NSAIDs, Bronchodilator; Antibiotics, I.V Fluids, Paracetamol, Meloxicam; Antibiotics, Nebulization with acetylcysteine, (4.1%, n=2) of the treatments done are Antibiotics, Nebulization; Antibiotics, Nebulization, Coupage; Antibiotics, Nebulization, (44.9%, n=22) of the treatments done are Antibiotics. It shows that most of the treatments done with Antibiotics.

44.9% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 8.1% 4% 2% 2% 2% 2% 2% 2% 2% 0 5 10 15 20 25 A n ti b io ti cs A n ti b io ti cs an d P se u d o e p h e d ri n e A n ti b io ti cs I.V F lu id s, O xyg en , N SA IDs A n ti b io ti cs , A lb u te ro l, N e b u liz at io n A n ti b io ti cs , Co u p ag e A n ti b io ti cs , I. V F lu id , B u to rp h an o l,… A n ti b io ti cs , I. V flu id s A n ti b io ti cs , I. V flu id s, Co rti so n e A n ti b io ti cs , I. V F lu id s, Co u p ag e A n ti b io ti cs , I.V F lu id s, N eb u liz ati o n A n ti b io ti cs , I. V flu id s, N e b u liz at io n ,… A n ti b io ti cs , I. V F lu id s, N SA IDs A n ti b io ti cs , I. V F lu id s, N SA IDs ,… A n ti b io ti cs , I. V F lu id s, P arac etamo l,… A n ti b io ti cs , N eb u lis ati o n w ith … A n ti b io ti cs , N eb u liz ati o n A n ti b io ti cs , N eb u liz ati o n , Co u p ag e A n ti b io ti cs , N SA IDs , Ce re n ia, Ul san ic A n ti b io ti cs , O me p raz o le , Co u p ag e, … A n ti b io ti cs , O xyg en , B u to rp h an o l A n ti b io ti cs , O xyg en , Me ch an ic al… H u man e e u th an as ia I.V F lu id s, A ce tam in o p h e n ,… I.V F lu id s, O xyg e n FR EQ UE N CY O F A N IMA LS TREATMENT CHOİCE

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34 Table 13. Frequency of antibiotic type

In table nr 13 it shows that Amoxicillin + Clavulanic acid (16.3%, n= 8) is the most common antibiotics used and are very higher in number than other antibiotics used.

8.1% 16.3% 6.1% 2% 4% 2% 4% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 8.1% 12.2% 2% 2% 2% 4% 2% 2% 0 1 2 3 4 5 6 7 8 9 A mo xi ci lli n A mo xi ci lli n + Clau vu lan ic ac id A m o xi ci lli n + Clau vu lan ic ac id , E n ro flo xac in A mo xi ci lli n + Clau vu lan ic ac id , E n ro flo xac in ,… A mo xi ci lli n + Clavu lan ic ac id A mo xi ci lli n , Do xyc yc lin e A mo xi ci lli n , E n ro flo xac in A mo xi ci lli n , F lu ro q u in o lo n e A mp ic ill in + Clo xac ill in , E n ro flo xac in A mp ic ill in + S u lb ac tam A mp ic ill in + S u lb ac tam, E n ro flo xac in A zi th ro m yc in Ce faz o lin , E n ro fl o xac in Ce fo ve ci n , A zyth ro myc in Ce ftr iax o n e Ce fu ro xi me , Marb o flo xac in Ce p h alo th in , E n ro fl o xa ci n Do xyc yc lin e En ro fl o xacin En ro flo xac in , A mp ic ill in En ro flo xac in , Cli n d amyc in , A mp ic ill in + S u lb ac tam En ro flo xac in , Do xyc yc lin e En ro flo xac in , G en tami ci n Me ro p en e m, A mik ac in O xyte tr ac yc lin e FRE QUE N CY OF AN IMALS DRUGS

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35 Table 14. Frequency of origin of participant in survey 1

In table nr 14 it can be seen that (2.0%, n=1) of the responses are from Pakistan, New Zealand, Ireland, Thailand, Germany, Finland, Denmark, and Austria,

(4.1%, n=2) of the responses are from South Africa and Canada, (6.1%, n=3) of the responses are from Australia,

(14.3%, n=7) of the responses are from Sweden, (22.4%, n=11) of the responses are from UK, and (32.7%, n=16) of the responses are from USA.

It shows that most of the responses are from USA.

3 2% 4% 2% 2% 2% 2% 2% 2% 4% 14.2% 2% 22.4% 32.6% Australia Austria Canada Denmark Finland Germany Ireland New Zealand Pakistan South Africa Sweden Thailand UK USA

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36 Table 15. Frequency of first symptoms in different species

The results showing in table nr 15, from the case processing summary and cross-tabulation and Chi-square tests indicates that there is no statistically significant relationship between the Species and First symptoms (chi-square with17 degree of freedom = 8.394, p =0.957). p >0,05

2%2% 24.5 2% 8.1% 2% 8.1% 2% 8.1% 2% 4% 2% 10.2% 2% 4% 2% 4% 2%2% 6.1% 0 2 4 6 8 10 12 14 Do g Cat FRE QUE N CY OF AN IMALS SPECIES

Anorexia Anorexia, muscle tremors Coughing

Coughing, Anorexia Coughing, Dyspnea, Vomiting Coughing, Lethargic

Coughing, Lethargic, Anorexia Dyspnea Dyspnea, Anorexia, Vomiting

Increased respiratory sounds Lethargic, Dyspnea Lethargic

Nasal discharge Nasal discharge, Dyspnea Pyrexia

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37 Table 16. Frequency of first symptoms in different sex groups

The results showing in table 16, from the case processing summary, cross-tabulation and Chi-square test indicates that there is no statistically significant relationship between the Sex and First symptoms (chi-square with 51 degree of freedom = 63.680, p = 0.110). p >0,05

2% 2% 6.1% 4% 14.3% 2% 2% 6.1% 2% 6.1% 2% 2% 4% 2%2% 2% 4% 2% 2% 6.1% 4% 2% 2% 4% 2%2%2% 2% 2% 2% 4% F E M A L E M A L E C A S T R A T E D F E M A L E C A S T R A T E D M A L E FR EQ UE N CY O F A N IMA LS SEX

Anorexia Anorexia, muscle tremors Coughing

Coughing, Anorexia Coughing, Dyspnea, Vomiting Coughing, Lethargic

Coughing, Lethargic, Anorexia Dyspnea Dyspnea, Anorexia, Vomiting

Increased respiratory sounds Lethargic, Dyspnea Lethargic

Nasal discharge Nasal discharge, Dyspnea Pyrexia

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38 Table 17. Frequency of first symptoms in different breeds

The results showing in table 17, from the case processing summary, cross-tabulation and Chi-square test indicates that there is statistically significant relationship between the breeds and First symptoms (chi-square with 425 degree of freedom = 509.885, p = 0.003). p >0,05

0 1 2 3 4 5 6 7 A u str al ian c attl e d o g Ber n es se m o u n tai n d o g Co lli e Do go ar ge n ti n e Do me sti c s h o rt h air En gl is h b u lld o g Fl atc o ate d re tr ie ve r Fr en ch b u lld o g G e rman s h ep h erd G o ld en re tr ie ve r G re at d an e Jac k r u ss el l Jac k r u ss el l te rr ie r Ke lp ie La b rad o re r etr ie ve r Ih as o ap so Mi n iatu re fo x te rr ie r Mix O ld e n gl is h s h e ep d o g Po me ran ian Ro tt w ei le r Th ai s e al b ro w n To y p o me ran ian V iz sl a W ei maran er W ire h air ed d ac h sh u n d FR EQ UE N CY O F A N IMA LS BREED

Anorexia Anorexia, muscle tremors

Coughing Coughing, Anorexia

Coughing, Dyspnea, Vomiting Coughing, Lethargic

Coughing, Lethargic, Anorexia Dyspnea

Dyspnea, Anorexia, Vomiting Increased respiratory sounds

Lethargic, Dyspnea Lethargic

Nasal discharge Nasal discharge, Dyspnea

Pyrexia Pyrexia, Lethargic

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39 Table 18. Most common diagnostic procedures in different countries

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DISCUSSION OF RESULTS

There was a large difference between the number of cats and dogs participating in this study 95,9% n=47 where dog and 4,1% n =2 where cats, this corresponding with research showing that dogs are more susceptible to get pneumonia then cats. [35]

There were more males 57.1% then females 42.9 % in this study. This can indicate that males are more likely to get pneumonia, this has also been reported in previous studies [36,37] but the difference in male female ratio in this study (14,2 %) and in the former studies are moderately trivial which make the clinical importance uncertain.

There is more uncastrated 57.1 % then castrated 42.9% cats and dogs in this study. 20.4% where uncastrated females and 36.7% where uncastrated males. This can indicate that uncastrated especially uncastrated males are more predisposed to pneumonia, but this is not stated in any other studies know to the author and the small number of participants in this study can be the reason of these results.

The most common breed in this study is French bulldog and Mix breeds with 12.2 % and the third most common is English bulldog with 10.2%.

77,6 % are of non-brachycephalic group and 22,4% of the breeds are in the brachycephalic group this can indicate that non-brachycephalic groups are more likely to get pneumonia, but other studies indicate that brachycephalic breeds have 50% higher risk of pneumonia. [38]

The most common symptoms that appeared first was couching without any other symptoms present second most common first symptom was lethargic without couching, third most common were couching with anorexia or lethargy, dyspnea was also the third most common first symptom. All these symptoms are the standard symptoms for bacterial and viral pneumonia with bacterial pneumonia has a softer couching that gets progressive worse and viral pneumonia has a more acute onset of harsh crackling couching and usually don’t progress. Fungal pneumonia is more associated with lethargy and anorexia due to that the cat or dog can asymptomatic for a long period. [4,5,6]

To use only x-ray to diagnose or x-ray together with blood test were the most common (38.8%) tool for diagnosing pneumonia in this study. X-ray of the thorax is one of the most important and most helpful tools in diagnose pneumonia the alveolar pattern will appear different depending on the

pathogen causing the pneumonia, the severity of the pneumonia will also affect the alveolar pattern. [31] Blood test are the most universal test for all kind of diseases and is a good indicator for overall health status the complete blood count is a great tool to diagnose pneumonia. If bacterial pneumonia is

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present an increased level of lymphocytes, neutrophils, and or increased levels of eosinophils may be present, in viral pneumonia is present decreased levels of neutrophils and lymphocytes may be present. Fungal pneumonia may show increased neutrophils, eosinophils and or band cells. [20,21,31]

Bacteria was the most common type of pneumonia in this study (73.5%) with Bordetella

bronchiseptica and Streptococcus both 8.2% as the most common pathogen. Escherichia coli were the

third most common pathogen with 4%. The result in this study corresponds with the previous research done stating that bacterial pneumonia is the most common and that these three bacteria is the most common pathogen affecting cats and dog’s lower respiratory system with Bordetella bronchiseptica being highly contagious [39] it’s not strange that it’s the top most common pathogen in this study. Due to the low number of cats in this study clinical importance for the cats is uncertain [39]

Antibiotics where used as a treatment in 93% and amoxicillin with clavulanic acid was the most commonly used (16.3%). Amoxicillin with clavulanic acid is recommended to use as a first choice in non-acute patients where bacterial infection is suspected, due to affecting both gram -negative and gram-positive bacteria and can easily be administrated trough injections or pills. [40]

The most participants where from USA and UK this can be because the survey was written in English and shared in groups on Facebook were the communication language is English

There was no significant relation between species and first symptoms p=0.957 (P=0.05) coughing was the most common first symptoms in both cats and dog. There were no significant between sex and first symptoms p=0.110 (p>0.05) coughing was the most common first clinical sign in all sexes no changes if they were castrated or not. This corresponding with coughing being one of the most common clinical signs in pneumonia. [4]

There is a significant relation between breed and first symptoms p=0.003 (p>0.05). French bulldogs are more predisposed to dypnea and mix breeds are more predisposed to have couching as there first symptom, then other breeds this can be due to the low number of participants or because French bulldogs are in the brachycephalic type dog and they are susceptible to respiratory problems in general [38]

The Kruskal Wallis Test results indicate that there is statistically significant difference in procedures done to diagnose among the four sex groups, p=0.027. (p>0.05) and looking at the median scores, it can be concluded that the castrated male and castrated female are statistically significantly higher procedures done to diagnose than the female and male not castrated. This can indicate that owners

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of castrated animals allowed more procedures to be done but this is not stated in any other studies know to the author and the small number of participants in this study can be the reason of these results. However, there is no significant relation between the sex groups and treatment p=0.722 (p>0.05)

In my second survey (found in annex 2) there were more participant n= 532 but 65% n= 345 where from United states of America and from some counties (Peru, Poland, Hungary, Iceland, Italy, Macedonia, Malta, Mexico, New Zealand, Denmark, Brazil, Fiji, Nigeria, Serbia, Taiwan, Thailand, Turkey, United Arab Emirates) only 1 participant so making any valuable concussion from this statistical data would not give a justifiably picture of diagnostic procedures done to diagnose pneumonia in different counties due to the uneven distribution and small amount of participants.

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CONCLUSIONS

1. X-ray and blood tests are the most common diagnostic tools around the world for diagnosing pneumonia.

2. Bacterial pneumonia is the most common with Bordetella bronchiseptica, Streptococcus and Escherichia coli as the most common bacteria.

3. Animals of non-brachycephalic type are more predisposed to pneumonia, but French bulldog is the most common breed, and this study indicate that males and especially uncastrated males are more predisposed to get pneumonia.

4. Castrated animals in this study received more diagnostic procedures then the non-castrated. 5. Levels of treatment do not differ between the sex.

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44

REFERENCES

1. The Merck Veterinary Manual eleventh edition; 12th August 2016. p.1486

2. Lynelle R Johnson, DVM, MS, PHD, Diplomate ACVIM Clinical canine and feline respiratory medicine 23 Apr 2010;3

3. Cheryl Yuill DVM, MSc, CVH Bacterial Pneumonia and Bronchopneumonia in Dogs [internet] Available from https://vcahospitals.com/know-your-pet/bacterial-pneumonia-and-bronchopneumonia-in-dogs; 1

4. Small Animal Internal Medicine fifth edition; 2008. P.318

5. Small Animal Internal Medicine fifth edition; 2008. P.316

6. Infectious diseases of the dog and cat third edition; 2006. p.571

7. Infectious diseases of the dog and cat third edition; 2006. p. 870

8. Veterinary Anatomy of Domestic Mammals sixth edition; 2014. p 377

11. Veterinary Anatomy of Domestic Mammals sixth edition ;2014. p384

13. Veterinary Anatomy of Domestic Mammals sixth edition; 2014. p 388-389

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17. Kogan DA, Johnson LR, Jandrey KE, et al. Clinical, clinicopathologic, and radiographic findings in dogs with aspiration pneumonia: 88 cases (2004-2006). JAVMA 2008; 233,1742-1747

18. Goutal CM, Keir I, Kenney S, et al. Evaluation of acute congestive heart failure in dogs and cats: 145 cases (2007-2008). J Vet Emerg Crit Care 2010;20, 330-337

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20. Cody W Faerber Animal health publication 6th edition 2006;80,120

21. Dr. Dawn Ruben Understanding Blood Work: The Complete Blood Count (CBC) for Dogs, 23 Sep, 2015 [internet] Available from

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23. Small Animal Clinical Diagnosis by Laboratory Methods Fifth Edition; 2012. p 63-91

24. Willard MD, Tvedten H, eds, St. Louis, MO: Saunders Small Animal Clinical Diagnosis by Laboratory Methods, 4th ed.; 2004 p 117-134

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28 Dr. Mike Paul, DVM Dog and Cat Creatinine Levels 101 Dog Checkups & Preventive Care [internet] Available from https://www.pethealthnetwork.com/dog-health/dog-checkups-preventive-care/dog-and-cat-creatinine-levels-101 ;1

29. Ron Hines DVM PhD Your Pet's Blood Albumin Level, ALB [internet] Available from

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30. Ettinger & Feldman – Textbook of Veterinary Internal Medicine Client Information Sheet Pneumonia Lynelle R. Johnson p.2

31. Dear, JD Publication Date 2014 DOI 10.1016/j.cvsm.2013.09.003 Peer reviewed p. 148-150 [internet] Available from Permalink https://escholarship.org/uc/item/32h6b976

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33. Padrid P. Diagostic tests for respiratory disease. Proceeding of the North American Veterinary Conference 2006 Jan 7-11, Orlando, Florida.;18,1314

34. Johnson LR. Bronchoscopy. Proceedings of the Europan Veterinary Conference 2009 Apr. 23-25, Amsterdam, Netherlands.;2-18,

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36. Sanna J. Viitanen Canine Bacterial Pneumonia Role Of Acutephase Proteins And Viral Coinfection 2017. [internet] Available from https://helda.helsinki.fi/handle/10138/172953

37. by Thayer and Robinson, 1984 and in AP (Kogan et al., 2008b; Tart et al., Bacteria Pneumonia 2010;1

38.Tao Feng, Ph.D., Carol McConnell, DVM, MBA, Kerry O’Hara, Ph.D., Jing Chai, MS, and Gina Spadafori The Nationwide® Brachycephalic Breed Disease Prevalence. [internet] Available from http://nationwidedvm.com/wp-content/uploads/2017/03/NWBrachycelphalicStudy0317.pdf ;6

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41 Stephen C. Barr, BVSc, M Parasites of the lower respiratory tract of dogs and cats Nov 01, 2010: p 1-2

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46 Annex 1

Pneumonia in dogs and cats

The data from this survey will be used in my final thesis, you can answer about your own pet or a case in your clinic. you can answer as many times as you like. the case should not be older than 2 years.

Species o Dog o Cat Sex o Male o Female o Castrated male o Castrated female Breed First symptoms

What where done to diagnose? (blood samples, x-ray etc.) What type of pneumonia was it?

o Bacteria o Virus o Fungus o Mix o Other:

What kind of bacteria, virus or fungus (ex, streptococcus, Hemophilus) What kind of treatment where used?

If antibiotics where used, what kind where used? What country are you from?

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Annex 2

Pneumonia (only two questions) The answers will be used in my final thesis

What are you doing? /what is your clinic doing to diagnose pneumonia (more than one can be marked) o Auscultation

o Blood tests

o X-ray

o Bronchoscopy

o Bronchoscopy with lavage

o Clinical signs

o Treatment therapy

o Cytology of nasal discharge

o Other:

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