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Sneezing and nasal discharge

image of Sneezing and nasal discharge
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Abstract

Sneezing and nasal discharge are common presenting clinical signs in cats, indicating disease within the nasal cavity or nasopharynx. Unlike many other presenting clinical signs, the differential diagnoses for these signs are relatively limited, and diagnostics are also limited to a number of key procedures. This chapter will look at differential diagnoses and diagnostic approach. : Evaluating the nasopharynx; Nasal flushing and biopsy.

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Figures

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5.34.1 A 7-year-old male neutered Burmese cat from a multi-cat household, where another cat had also been sneezing. He was presented with severe bilateral purulent nasal discharge with no other clinical signs. Disease was thought most likely to be due to FHV infection and the cat was treated empirically with doxycycline and famciclovir. The nasal discharge resolved fully within a week. (Courtesy of Samantha Taylor)
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5.34.2 This kitten was presented with nasal discharge and concurrent conjunctivitis and keratitis, the latter strongly suggesting nasal disease was referable to FHV infection. Concurrent chlamydophilosis would also be a possible cause for the ocular signs but is not usually associated with corneal ulceration and was not identified by PCR on plain conjunctival swabs. Treatment with amoxicillin/clavulanate and famciclovir were successful in resolving clinical signs within several days.
Image of This 6-year-old male neutered DSH cat was presented with an acute history of sneezing and pawing at his face after having been outside in the owner’s garden. The cat had no nasal discharge or stertor. These signs, with their acute onset, are the typical presentation for a nasopharyngeal foreign body. Retraction of the soft palate using Allis tissue forceps and the use of a laryngoscope allowed a blade of grass to be seen in the nasopharynx. Grass blades appear to get lodged while a cat is chewing on long grass, or if grass is ingested and then vomited up. This grass blade was removed intact using a pair of forceps; retrograde rhinoscopy was not required.
This 6-year-old male neutered DSH cat was presented with an acute history of sneezing and pawing at his face after having been outside in the owner’s garden. The cat had no nasal discharge or stertor. These signs, with their acute onset, are the typical presentation for a nasopharyngeal foreign body. Retraction of the soft palate using Allis tissue forceps and the use of a laryngoscope allowed a blade of grass to be seen in the nasopharynx. Grass blades appear to get lodged while a cat is chewing on long grass, or if grass is ingested and then vomited up. This grass blade was removed intact using a pair of forceps; retrograde rhinoscopy was not required. This 6-year-old male neutered DSH cat was presented with an acute history of sneezing and pawing at his face after having been outside in the owner’s garden. The cat had no nasal discharge or stertor. These signs, with their acute onset, are the typical presentation for a nasopharyngeal foreign body. Retraction of the soft palate using Allis tissue forceps and the use of a laryngoscope allowed a blade of grass to be seen in the nasopharynx. Grass blades appear to get lodged while a cat is chewing on long grass, or if grass is ingested and then vomited up. This grass blade was removed intact using a pair of forceps; retrograde rhinoscopy was not required.
Image of This 1-year-old female neutered DSH cat was presented with a history of several weeks of progressively worsening stertor. There was no nasal discharge or sneezing. Under anaesthesia, a firm ‘bulging’ of the soft palate was palpable. With the cat in dorsal recumbency the soft palate was retracted rostrally using a spay hook, and a nasopharyngeal polyp (the red lesion just caudal to the tip of the spay hook) was seen. This was successfully removed by traction using grasping forceps.
This 1-year-old female neutered DSH cat was presented with a history of several weeks of progressively worsening stertor. There was no nasal discharge or sneezing. Under anaesthesia, a firm ‘bulging’ of the soft palate was palpable. With the cat in dorsal recumbency the soft palate was retracted rostrally using a spay hook, and a nasopharyngeal polyp (the red lesion just caudal to the tip of the spay hook) was seen. This was successfully removed by traction using grasping forceps. This 1-year-old female neutered DSH cat was presented with a history of several weeks of progressively worsening stertor. There was no nasal discharge or sneezing. Under anaesthesia, a firm ‘bulging’ of the soft palate was palpable. With the cat in dorsal recumbency the soft palate was retracted rostrally using a spay hook, and a nasopharyngeal polyp (the red lesion just caudal to the tip of the spay hook) was seen. This was successfully removed by traction using grasping forceps.
Image of View of the nasopharynx obtained by retrograde rhinoscopy. This 5-year-old male neutered DSH cat was presented with a chronic mucopurulent nasal discharge and progressively worsening stertor. A fungal (cryptococcal) granuloma can be seen (arrow) occluding the posterior nares. Orientation of the image can be determined by pushing a finger against the soft palate; the resultant indentation can be seen at the bottom of the image here.
View of the nasopharynx obtained by retrograde rhinoscopy. This 5-year-old male neutered DSH cat was presented with a chronic mucopurulent nasal discharge and progressively worsening stertor. A fungal (cryptococcal) granuloma can be seen (arrow) occluding the posterior nares. Orientation of the image can be determined by pushing a finger against the soft palate; the resultant indentation can be seen at the bottom of the image here. View of the nasopharynx obtained by retrograde rhinoscopy. This 5-year-old male neutered DSH cat was presented with a chronic mucopurulent nasal discharge and progressively worsening stertor. A fungal (cryptococcal) granuloma can be seen (arrow) occluding the posterior nares. Orientation of the image can be determined by pushing a finger against the soft palate; the resultant indentation can be seen at the bottom of the image here.
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Throat pack Throat pack
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Alligator forceps Alligator forceps
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Image of Pre-measuring the forceps. This cat has a mouth gag in place because retrograde rhinoscopy had just been performed; a gag is not necessary for nasal biopsy
Pre-measuring the forceps. This cat has a mouth gag in place because retrograde rhinoscopy had just been performed; a gag is not necessary for nasal biopsy Pre-measuring the forceps. This cat has a mouth gag in place because retrograde rhinoscopy had just been performed; a gag is not necessary for nasal biopsy
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Image of Typical samples collected from nasal investigations. From left to right: nasal flush fluid in EDTA tube for cytology; secretions from nasal flush on a gauze swab for bacterial and fungal culture; tissue samples from the left and right sides of the nose in formalin for histopathology
Typical samples collected from nasal investigations. From left to right: nasal flush fluid in EDTA tube for cytology; secretions from nasal flush on a gauze swab for bacterial and fungal culture; tissue samples from the left and right sides of the nose in formalin for histopathology Typical samples collected from nasal investigations. From left to right: nasal flush fluid in EDTA tube for cytology; secretions from nasal flush on a gauze swab for bacterial and fungal culture; tissue samples from the left and right sides of the nose in formalin for histopathology

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