Case #2

Case of the Week

CC: RH foot swollen and infected. Owners first noticed one week ago.
Vaccine history: None

PE:
T: 102.2
HR: 136
RR : 20

  • NWB RH foot, entire paw is swollen and there is a draining abscess present

Diagnostics:

  • Recommended CBC/Chem and Culture/Sensitivity, but owner declined

Treatment:

  • General anesthesia to clean and debride the foot, place drains
  • Ampicillin and Metacam injections, TGH on Clavamox, Meloxidyl, e-collar and Yesterday’s News

Recheck in 3 days

  • The foot is still very swollen and painful
  • Sutures have dehisced
  • Purulent exudate (pus) present

Diagnostics:

  • Bloodwork
    • CBC: Mild lymphopenia, the rest WNL
    • Chem: Elevated BUN (40), Creatinine (2.2), TP (8.4) and globulins (6.4). The rest WNL.
  • Radiographs
    • No evidence of bony changes or air pockets to indicate gangrene
      • Gangrene: type of tissue death caused by lack of blood supply
  • Culture swab taken and sent to the lab

Treatment:

  • Switch antibiotics: started on Enrofloxacin, instructed owners to DC Clavamox
  • Instruct owners to soak the foot twice daily in Chlorhexidine

Recheck in 3 days

  • Case #2’s foot is looking better!!!! (huge sigh of relief)
  • No more purulent discharge
  • Wounds are healing by granulation
  • Case #2 is walking on the foot

Culture/Sensitivity results:

    • Culture and Sensitivity: 2 organisms grown
        • Organism 1: Enterobacter cloacae
          • RESISTANT to amoxicillin (Clavamox)
          • Susceptible to Enrofloxacin
        • Organism 2: Methicillin-resistant Staphylococcus aureus (MRSA)
          • RESISTANT to amoxicillin
          • Also resistant to Enrofloxacin

      Plan to recheck at the end of this week. Need to address vaccine status, FeLV/FIV test, and parasite screening

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Tennessee Avenue Animal Hospital

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