WHAT’S YOUR TOP

DIFFERENTIAL FOR
THESE COMMON
SUMMERTIME
VETERINARY
CASES?
Heat Stroke
Snake Bites
Spider Bites
Atopy
Cytauxzoon Felis
Mycoplasma Haemofelis
Lyme Disease
Coccidiosis

AUTHOR

Flavia Vaduva
July. 2019
 ABOUT THE AUTHOR

My journey to my current career started with my very first

words in Romanian, “ham-ham” which translates to “woof-
woof” in English. From that day on, my family was convinced
I would become a Veterinarian. Not wanting to disappoint
them (and because I had a love for pets, science and problem-
solving), I was steadfastly determined to go to veterinary
school. During veterinary school, I discovered I also had a
passion for education and decided to pursue an additional
graduate degree in business management. I joined VetPrep
Flavia Vaduva
because it is an amazing way to combine my interests for
veterinary medicine, education, and the veterinary industry.
I’m beyond excited to be able to share my passion with current
veterinary students that are preparing for one of the most
important exams of their careers!

INTRODUCTION

Summertime can be a lot of fun for pets. However, with

warmer temperatures, more plant, animal and insect life and
more time spent outdoors, it means there can be an increase
in certain types of cases.

In this document, we will cover scenarios about heat stroke,

snake bites, spider bites, atopy, Cytauxzoon felis, Mycoplasma
haemofelis, Lyme disease and Coccidiosis. Can you figure out
which top differential diagnosis best describes each scenario?
Test your knowledge, then check the answers at the end of the
PDF!

01
 SCENARIOS

1
It is July and you are practicing in a rural small animal clinic in north central Florida. A 4-year
male neutered Weimaraner mix presents for swelling and a moderate amount of hemorrhage
on the right side of his muzzle. Upon physical examination, you find that this area is very
painful and you can see two small puncture wounds. His blood cell count (CBC) reveals
thrombocytopenia and on blood smear, you note echinocytosis. On a coagulation profile, both
PT and PTT were very elevated. What is your top differential based on this information?

2
You are practicing in a small animal clinic in the Midwest. It is mid-July and a 3 year-old spayed
female Pug presents to you on emergency for trouble breathing and collapse. Prior to arriving,
she was at the dog park running around with a few other dogs. On exam, she is panting heavily,
has stertorous breathing and a 105.9 F rectal temperature. Based on this signalement and
history, what is your top differential?

3
It is early August and you are practicing in Valdosta, Georgia. Your 2 pm appointment is Sam, a
4-year old West Highland White Terrier, coming in for ear issues. Sam has a long history of otitis
externa infections that occur during the warmer months have been responsive to treatment
for a couple of weeks and then recur. His owner reports he is also very itchy this time of the
year. He reports that Sam rubs his face on the carpet and licks his paws often. What is your top
differential for this presentation?

4
A 1-year old MN DSH presents on emergency. The owner states that he was normal when
they woke up this morning. He ate well and then remained downstairs while the owners went
upstairs for 30 minutes. They then heard him vocalize downstairs and found him restless,
salivating and having muscle rigidity. What’s a likely differential?

02
 SCENARIOS

5
A 5-year old female spayed indoor/outdoor Persian mix cat presents to you for fleas and
lethargy. The cat’s mucous membranes appear pale on physical examination and she has
tachycardia and tachypnea. You perform blood work and find a hematocrit of 7%. The anemia is
regenerative. Given this presentation, what is a likely differential?

6
You are practicing in northern New Jersey and a 4- year old spayed female Labrador Retriever
presents with a history of 3 day history of inappetence. On exam, she has a mildly elevated
temperature of 103.3 F. Her owners report they noticed a small, reddened and inflamed lesion
between her toes on her right front paw. What is a possible differential for this presentation?

7
It is mid-June and you are practicing in a municipal shelter. After a heavy kitten season this past
spring, your shelter managed to get most kittens out on foster. However, now several fosters
are bringing kittens in for consultations for diarrhea. The fosters state that the kittens still have
decent appetites and normal energy levels. You look up the medical records and see that
they were previously dewormed with Pyrantel prior to leaving the shelter and are on monthly
Revolution. What is another possible cause of diarrhea?

8
You practicing in middle Tennessee in June. A 5-year-old indoor/outdoor neutered cat
presents to you for a 3-day history of lethargy and anorexia. At that time, the owner had
removed a tick found on the cat’s right axillary area. On physical exam, the cat is febrile with
a rectal temperature of 104.8F and appears icteric. A blood cell count (CBC) revealed both
thrombocytopenia and normochromic, normocytic, non-regenerative anemia. What is one
likely differential for this presentation?

03
 ANSWERS

1
SnakeBite
This scenario describes a classic case of envenomation, likely by a snake of the Crotalidae family.
In North America, venomous snakes of North America belong to one of two families: either
Elapidae (commonly known as coral snakes) or Crotalidae which includes pit vipers (commonly
referred to as rattlesnakes), cottonmouth moccasins or copperheads. [4] Crotalids have a wider
geographic distribution across the US, while Elapids have a more narrow distribution and can
usually be found on the southern edge of the USA. Consequently, Crotalid bites are much more
common than Elapid bites. It is stated that most snakebites occur between the months of June
and October. [2] Depending on a number of factors related to the type of snake, venom, bite
and characteristics of the victim, snakebite cases can have a variable manifestation, ranging
from mild clinical signs to severe clinical signs and shock. [3] Snakebites should be treated
immediately. If treated early and thoroughly, the majority of snakebite victims can survive. [2]
It is recommended to prevent snakebites by educating clients to keep pets confined and on
leashes.

2
Heat Stroke
A likely explanation for this case is heat stroke. Heat stroke results from increased ambient
temperatures, conditions that cause heat generation or decreased ability to cool body
temperatures efficiently. In this case, heat stroke could have been caused by a combination
of exercising in hot temperatures and brachycephalic airway syndrome. Heat stroke requires
immediate emergency intervention. The prognosis can be variable. Client education is
paramount - advise owners about the dangers of exercising pets in warm weather or confined in
cars or other hot environments. It is also advisable to educate the owners of brachycephalic pets
about the benefits of early surgical correction of brachycephalic airway syndrome. [2]

3
Atopy
A likely differential for this scenario is atopy. There are several possible underlying causes to
otitis externa which can include allergies (whether environmental atopy or food- related),
hypothyroidism, foreign bodies of water in the ear canal. Atopy is usually non-seasonal, but can
be seasonal depending on what the patient is allergic to. There are many predisposed breeds,
such as the West Highland White Terrier. Diagnosis of atopy requires ruling out other diseases
such as infectious causes, FAD, food allergy and the next step is ideally intradermal testing. [1]

04
 ANSWERS

4
Spider Bite
In the US, the spiders that can cause clinical signs of envenomation include 2 main groups -
widow spiders, the most common of which is Latrodectus mactans (commonly referred to as
the black widow spider or the western black widow spider or Latrodectus hesperus) and brown
spiders (commonly known as the brown recluse spider, Loxosceles reclusa). [6] Black widow
spiders venom contains a neurotoxin that results in severe, painful cramping of muscle groups.
[2] Ascending motor paralysis and destruction of peripheral nerves endings occurs. Emergency
care should be sought immediately.It is advisable to remind owners to check their homes for the
presence of spiders and have these removed immediately as some spider bites can potentially
be life-threatening.

5
Mycoplasma haemofelis
One likely differential is Mycoplasma haemofelis, which was formerly known as
Haemobartonella felis. It is a bacterial infectious agent of feline red blood cells that causes
hemolytic anemia. Blood-sucking arthropods such as fleas are suggested as a mode of
transmission. There is a wide spectrum of clinical signs, ranging from subclinical to severe.
Prognosis is good with treatment and supportive care. Prevention is key to educate clients about
the importance of keeping cats indoor and on flea/tick prevention year round.[1]

6
Lyme disease
A possible differential for this case is Lyme disease, which is bacterial in origin. It is caused by a
gram-negative spirochete called Borrelia burgdorferi that is transmitted via Ixodes ticks. In North
America, only Ixodes scapularis and Ixodes pacificus, the eastern and western black-legged tick,
respectively, have been shown to transmit the infection to dogs. [5] While most seropositive
dogs show no clinical signs, Lyme disease can cause anorexia, fever, arthritis, lymphadenopathy,
lethargy and less commonly, protein-losing nephropathy. According to CAPC, “Infection with
B. burgdorferi is common in the northeastern, upper midwestern, and West Coast states. In
endemic areas, regional seroprevalence in dogs ranges from 1.4% in the West to as high as
13.3% in the Northeast.”[5] Prognosis is good overall. Prevention of Lyme Disease is key. Remind
clients to have their pets on year-round tick prevention and consider the Lyme disease vaccine.
Clients should also check their pets for ticks routinely and have tick testing done at least once a
year for screening.

05
 ANSWERS

7
Coccidiosis
Intestinal coccidiosis is a reasonable differential for a young kitten with diarrhea. However,
it would be important to rule out other possible causes of diarrhea such as panleukopenia.
The causative agent of coccidiosis is a Cystoisospora protozoa. A fecal float usually shows the
characteristic oocysts. Treatment is usually with Sulfadimethoxine, commonly known as Albon,
and disinfection of the environment is recommended.

8
Cytauxzoon felis
Cytauxzoon felis is a protozoan organism. Transmission to cats occurs through Amblyomma
americanum or Dermacentor variabilis tick bites. The organism invades the reticuloendothelial
cells of the lungs, spleen, liver, lymph nodes, and other organs; additionally, the bone marrow
can be affected causing pancytopenias. C. felis infection has been reported in south central and
southeastern U.S and it has been states that most cases occur between April and September.
Historically, almost all reported cases of C. felis in domestic cats were fatal but now cats are
surviving infection with appropriate treatment. [2] It is advisable to educate cat owners about
the importance of keeping cats indoors and on year-round tick prevention. It is also advisable to
encourage owners to check their cats for ticks routinely and seek care immediately.

06
 CONCLUSION

Though not all of these conditions have a seasonal distribution,

it’s important to keep in mind that the warmer temperatures
during the summer season can increase the frequency of
certain types of case presentations. What are some other
common cases seen during summer?

REFERENCES

Bentley, Jennifer. Allergic Skin Disease PowerPage. Retrieved

from VetPrep.com
Cote, Etienne. Clinical Veterinary Advisor. St. Louis, MO: Else-
vier
Emergency and Critical Care notes, University of Florida.
Gwaltney-Brant S.M. Overview of Snakebite. MSD Manual Vet-
erinary Manual. Retrieved from https://www.msdvetmanual.
com/toxicology/snakebite/overview-of-snakebite
Lyme Disease. CAPCVet.org. Retrieved from https://capcvet.
org/guidelines/lyme-disease/
The Merck Veterinary Manual. Whitehouse Station, NJ: Merck &
Co., Inc.

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