獸醫(yī)師貓傳染病專題-中文1fiv esavs katrin

PrevalenceofFIVandFeLVprevalenceFIVFIV 1–Denmark丹麥 2– 4–

prevalenceFeLVFeLVworldwideprevalence世界范圍內(nèi)的流行率?

421%gradualdecline逐漸減Turkey土耳Israel以色列

from81989to41995StudyintheUnited2.5%ofcatsFIV-positive2.3%ofcatsFeLV-positiveLevyetal.,

2.5%的貓F(tuán)IV陽(yáng)2.3%的貓F(tuán)eLV陽(yáng)PrevalenceStudyinFIVantibodies/FeLVantigenin17506client-ownedcatsin在德國(guó)對(duì)17506只有主人的貓測(cè)試其FIV抗體/FeLV抗6.06.03.53.11.0Gleic1l., 1995199619971998199920002001Case 病例Case DSH,16yearsold,femalesingle,indooronlycatsince10 diagnosedwith被診斷過unregulatedchronicrenalCase DSH,16yearsold,femalesingle,indooronlycatsince10 diagnosedwith被診斷過unregulatedchronicrenalCase DSH,16yearsold,femalesingle,indooronlycatsince10 diagnosedwith被診斷過unregulatedchronicrenalFIVinfectionRecentStudyintheUnited2.5%ofcatsFIV-positive2.3%ofcatsFeLV-positive

2.5%的貓F(tuán)IV陽(yáng)2.3%的貓F(tuán)eLV陽(yáng)FIVdidnotreducesurvivalFIV不會(huì)降低存活時(shí)FeLVsignificantlyreducedsurvivaltimeLevyetal.,LifeExpectancyinFIV-InfectedCats cumulativecumulativesurvival

negative (nmean374d平均374FIV-positivecats陽(yáng)性貓(nnosignificant0Gleichetal.,

CaseCase CaseCase DSH10years malereferredforFIVinfection (slowlyprogressing緩慢發(fā)展CaseCaseFritziCaseFritzi”病例CaseCaseFritziCaseFritzi”病例DSH10yearsold10maleneuteredreferredFIV(slowlyprogressing緩慢發(fā)展CaseCaseCaseCaseDSH10yearsold10maleneuteredreferredFIVneurologicsigns(slowlyprogressing緩慢發(fā)展CaseCaseCaseCaseDSH10yearsold10malereferredFIVneurologicsigns(slowlyprogressing緩慢發(fā)展CaseCaseCaseCase10yearsold10maleneuteredreferredFIVneurologicsigns(slowlyprogressing緩慢發(fā)展FIV-AssociatedClinicalSignsimmunodeficiency免疫抑=>“typical”opportunistic典型的機(jī) 染otherdiseases其他疾tumors腫 immune-mediateddiseases免疫介導(dǎo)性疾細(xì)

cells細(xì)Severe嚴(yán)重的齦口Severe嚴(yán)重的齦口SevereChronic ?ChronicallySick長(zhǎng)期虛弱的貓Opportunistic機(jī) FIV-AssociatedClinicalSignsimmunodeficiency免疫缺=>“typical”opportunisticinfections otherdiseases其他疾 腫neurologicdisorders神經(jīng)紊immune-mediateddiseases免疫介導(dǎo)性疾mainlyindirectmechanismsoftumorimmunosuppressionFIV-infectedcatshavea5timeshigherrisktodeveloptumors aMastCell Neurologic Immune-Mediated =>significanlymorecommonly=>明顯更常見高γ球蛋白血Gleichetal.,=>immune-mediated免疫介導(dǎo)性疾UveitisStagesofFIVInfection 的階段(?)acutephaseasymptomaticphaseprogressivegeneralized進(jìn)行性的全身 AIDS-relatedcomplex

terminalphase(“AIDS”)終期 CatCat“Fritzi貓CatCat“Fritzi貓--10years-maleCatCat 貓Cat Cat 貓因下列原因就FIVinfection-slowlyprogressingneurologicsigns緩慢發(fā)展的神經(jīng)癥livestogether8otherhealthycats2FIV+,6FIV-和其他8只健康 一起1其中2只FIV+，6只indoor/outdoor室內(nèi)/室外生regularly免疫不規(guī)Howhightheriskofininthe“Fritzi”2healthyFIV+cats6healthyFIV-catsHowhightheriskof“injection” intothe bitesbloodtransfusionssexualtransmissionin duringbirth,vialivesonlyminutesoutsidethenoindirect Riskgroup–fighting高風(fēng)險(xiǎn)群體-thetheselfconfidentcat自信的貓HowhighistheriskinHowhighistheriskinastablesituation?HowhighistheriskinHowhighistheriskinastablesituation?notransmissionthroughsocial不會(huì)通過社交接 HowHowhighistheriskforotherHowhighHowhighistheriskforotherdoweneedtoseparatetheHowHowhighistheriskforotherdoweneedtoseparatetheshouldwevaccinatethe 嗎ReduceriskofReduceriskofneuterofallReduceriskofneuterofallnonewCanwebringaFIV-positiveinanewhousehold?我們能把一只CanwebringaFIV-positiveinanewhousehold?我們能把一只Isthereanyriskforpeopleorother inwildfelidsworldwide inwildfelids–worldwide野生環(huán)境中 antibodyprevalenceinSerengetilions>90by3yearsofage100% inwildfelids–worldwide野生環(huán)境中 antibodyprevalenceinSerengetilions>90by3yearsofage100%lesspathogenicthanFIV?比FIV inwildfelids–worldwide野生環(huán)境中 antibodyprevalenceinSerengetilions>90by3yearsofage100%lesspathogenicthanFIV?比FIV1995distemper33%ofSerengetilionsofthe WhatisthethereisnocureforFIV butcatswithFIVinfectioncanlivealongandhappy但是 貓可以活得很久過得很開心WhatisthethereisnocureforFIV butcatswithFIVinfectioncanlivealongandhappy但是 貓可以活得很久過得很開心FIVinfectionisnotareasonfor CareoftheFIV-infected CareoftheFIV-infected indoor 室CareoftheFIV-infected indoor 室goodnutrition營(yíng)養(yǎng)norawmeat,eggs,orCareoftheFIV-infected indoor 室goodnutrition營(yíng)養(yǎng)norawmeat,eggs,orCareoftheFIV-infected indoor 室goodnutritionnorawmeat,eggs,orNeuteringriskofspread, stresswithoestrusandmatingroutinevisitsattheveterinarian(all6physicalexam ocular 眼睛檢body CBC,profile,urinalysis(yearly)fecalexam dental RoutinewellnesscareroutinevisitsattheveterinarianRoutinewellnesscarephysicalexam ocular 眼睛檢body CBC,profile,urinalysis(yearly)fecalexam dental Monitoringoftheimmune細(xì)細(xì)CD4+cell CD4+cell 健0健treatmentofsecondary=>moreaggressiveand

prophylacticuseofantibiotics(surgery,抗生素預(yù)防性使用（手術(shù)，牙科restrictiveuse myelosuppressive

CareoftheFIV-infectedat treatmentofsecondary=>moreaggressiveand

prophylacticuseofantibiotics(surgery,抗生素預(yù)防性使用（手術(shù)，牙科restrictiveuse myelosuppressive

CareoftheFIV-infectedcat CareoftheFIV-infectedcat CareoftheFIV-infectedcat FIVvaccineCareoftheFIV-infectedcat FIVvaccineisthereanybenefit?CareoftheFIV-infectedcat FIVvaccineisthereanybenefit?othervaccinesCareoftheFIV-infectedcat FIVvaccineisthereanybenefit?othervaccinesdotheyprovideCareoftheFIV-infectedcat FIVvaccineisthereanybenefit?othervaccinesdotheyprovideCareoftheFIV-infectedcat FIVvaccineisthereanybenefit?othervaccinesdotheyprovide CareoftheFIV-infectedcat FIVvaccineisthereanybenefit?othervaccinesdotheyprovide CareoftheFIV-infectedcat FIVvaccineisthereanybenefit?othervaccinesdotheyprovide dotheyleadtoprogressionofFIVCareoftheFIV-infectedcat FIVvaccineisthereanybenefit?othervaccinesdotheyprovide dotheyleadtoprogressionofFIV BreedingwithFIV-infectedcats experimental infectionduringpregnancy=>upto60%ofkittensare 達(dá)60%的幼貓naturalcircumstancesminorrolepreventionofsurgicalnomilkfromAZTduringPostnatalepostnatalpostnatalinfection產(chǎn) -viamilk通過喂about20 einfectedininfectioninfectionofneonatesthaninolder=>fasterthaninolderDiagnosisoftheFIVinfection ?friendly?friendlyyoungneuteredmale?turnedinto“Norescue?FIV+onroutinescreeningwithSNAPWhat’sWhat’snext下一步做什么What’sWhat’snext下一步做什么What’sWhat’snext下一步做什么What’sWhat’snext下一步做什么whichWhat’sWhat’snext下一步做什么which測(cè)試哪一個(gè)What’sWhat’snext下一步做什么which測(cè)試哪一個(gè)What’sWhat’snext下一步做什么which測(cè)試哪一個(gè)CanwetrustasinglepositiveFIV我們能相信單次的FIV陽(yáng) 嗎WhyWhydoweneedtoWhyWhydoweneedtofalse-positivefalse-positiveresultsWhyWhydoweneedtofalse-positivefalse-positiveresults?lowspecificityWhyWhydoweneedtofalse-positivefalse-positiveresults?lowspecificityWhyWhydoweneedtofalse-positivefalse-positiveresults?lowspecificity?=>lowpositivevalue(50–95WhyWhydoweneedtofalse-positivefalse-positiveresults?lowspecificity?=>lowpositivevalue(50–95WhyWhydoweneedtofalse-positivefalse-positiveresults?lowspecificity?=>lowpositivevalue(50–95WhyWhydoweneedtofalse-positiveresults?lowspecificity?=>lowpositivevalue(50–95especiallyinareaswithlowWhyWhydoweneedtofalse-positiveresults?lowspecificity?=>lowpositivevalue(50–95especiallyinareaswithlowFIVpredictiveFIV的預(yù)測(cè)

94.5DUO91.2DUO91.2

predictive預(yù)測(cè)99.499.699.699.6PetChek?Plus

94.5 10096.1 99.2100 99.4PredictivePredictivevaluesdependonexample舉例:Specificity特異982of100testsfalsepositive2%的假陽(yáng)PredictivePredictivevaluesdependonexample舉例:Specificity特異982of100testsfalsepositive2%的假陽(yáng)ifprevalenceis2%如果流行率是

2/100truepositive2%是真陽(yáng)positivepredictivevalue陽(yáng)性預(yù)測(cè)50PredictivePredictivevaluesdependonexample舉例:Specificity特異982of100testsfalsepositive2%的假陽(yáng)ifprevalenceis2%如果流行率是

2/100truepositive2%是真陽(yáng)positivepredictivevalue陽(yáng)性預(yù)測(cè)50ifprevalenceis30 如果流行率是 2/100falsepositive2%是假陽(yáng)positivevalue陽(yáng)性預(yù)測(cè)值93FIVprevalenceGermany23Italy1333France1326UnitedKingdom619Austria34TheNetherlands34 1-4Norway67Finland57CzechRepublic6

4-28 4-21 32Iran12Alwaysconfirmapositivetest一定要確定陽(yáng)性 2nd2ndin-housetest2nd2ndin-housetest??confirmatory2nd2ndin-housetest???confirmatoryWesternblotto2nd2ndin-housetest???confirmatoryWesternblotto??confirmatory??confirmatoryWesternblotto2ndin-housetest??confirmatory??confirmatoryWesternblotto2ndin-housetestFIVFIVstatusofFIVFIVstatusofisCheetoinfectedwithFIV? FIVFIVstatusofisCheetoinfectedwithFIV? FIVFIVstatusofisCheetoinfectedwithFIV? ...orFIVFIVstatusofisCheetoinfectedwithFIV? ...or WhatWhatdoesthetestWhatdoesthetestdetectsantibodiesagainstproteinp24detectsantibodiesagainstproteinp24and/or檢測(cè)是抗蛋白p24和/或gp40Canweexcludethatantibodiesare我們能否排除由以下原因而導(dǎo)致的抗byFIVFIVvaccinationofthemother?Non-antibodyNon-antibodytesting非-Non-antibodyNon-antibodytesting非-Non-antibodyNon-antibodytesting非-detectsviralDNAandconfirms檢 Non-antibodyNon-antibodytesting非-detectsviralDNAandconfirms檢 Non-antibodyNon-antibodytesting非-detectsviralDNAandconfirms檢 Non-antibodyNon-antibodytesting非-isCheetofreeofFIVisCheetofreeofFIVinfection? isCheetofreeofFIVinfection? isCheetofreeofFIVinfection? currentPCRtests=>10–50%falseisCheetofreeofFIVinfection? currentPCRtests=>10–50%falseisCheetofreeofFIVinfection? currentPCRtests=>10–50%falseisCheetofreeofFIVinfection? currentPCRtests=>10–50%falseisCheetofreeofFIVinfection? currentPCRtests=>10–50%falseAlternativeAlternativetestingtestingof83FIVantibody-positivecatsbyreal-timePCRinGermanyusing3differentprimersets在德國(guó)，用3種不同的引物通過實(shí)時(shí)PCR測(cè)試83只抗體陽(yáng)性--only40of83PCR-FIVgenetic FIVisclassifiedintofivegenotypes,A,B,D,andE,basedonthephylogeneticysisoftheenvV3-V5regionFIVFIVACAACA ACA

CAWhatWhatshouldbedonewithWhatWhatshouldbedonewith WhatWhatshouldbedonewith housewithother“FIV+”WhatWhatshouldbedonewith housewithother“FIV+”WhatWhatshouldbedonewith housewithother“FIV+”housewithFIV-vaccinated??housewithother“FIV+”housewithFIV-vaccinated WhatshouldbedonewithWhatWhatshouldbedonewith housewithother“FIV+”housewithFIV-vaccinated

82%effectiveagainstsubtype 82%effectiveagainstsubtype 82%effectiveagainstsubtype 82%effectiveagainstsubtypewhatsubtypeis 82%effectiveagainstsubtype whatsubtypeisCheeto? FIV ACAACA ACA

CA

Fel-O-VaxdualsubtypePetalumastrainA(California)Petaluma毒株A（加州）ShizuokastrainD(Japan) killed containingadjuvansAdministration3dosesSQ(2-3weekscatsof8weeksand MonitoringMonitoringMonitoringMonitoringMonitoringMonitoringvaccine-inducedvaccine-inducedFIVantibodiesareindistinguishablefromnaturalinfectionMonitoringMonitoringvaccine-inducedFIVantibodiesareindistinguishablefromnaturalinfection然產(chǎn)生的抗體是不能MonitoringMonitoringvaccine-inducedFIVantibodiesareindistinguishablefromnaturalinfection然產(chǎn)生的抗體是不能howcanFIVbediagnosedinvaccinatedMonitoringMonitoringvaccine-inducedFIVantibodiesareindistinguishablefromnaturalinfection然產(chǎn)生的抗體是不能howcanFIVbediagnosedinvaccinated 斷TreatmentTreatmentoftheFIVImmunomodulatory(e.g.Acemannan,StaphylococcusProteinparamunityinducer,Propionibacterium如乙酰嗎喃，葡萄球菌蛋白A，副免疫誘導(dǎo)劑， 狀桿菌 (holisticorherbalpreparations整體或草藥制劑=>noevidenceofpositive=> 證明有Antiviralchemotherapy endendof42millionpeopleinfectedwithHIVabout21millioninAfrica veryverysimilartoadsorption吸

reversetranscription反轉(zhuǎn)

整轉(zhuǎn)

翻 cell 細(xì)胞融

加脫

裝buddingbudding

林

林 齊多夫定3’-Azido-2’,3’-commerciallyavailablease.g.Retrovir? antiviraleffects 效 ogue(thymidine inhibitsreversetranscriptaseDosage 5-10mg/kgq12hSCorsideeffects?

myelosuppression,especiallyAZT–AZT–modeof疊氮胸苷-胸腺嘧胸腺嘧AZT–AZT–modeof疊氮胸苷-胸腺嘧胸腺嘧AZTAZTintheImprovementofclinicalImprovementofclinicalImprovementofclinical磷?；姿狨ommerciallyavailablease.g.Foscavir?antiviraleffects 作 -specificDNAandRNApolymeraseandreversetranscriptase抑 -特異性DNA和RNA聚合酶，以及反轉(zhuǎn)錄Dosage 13.3mg/kgq8hIVorside myelosuppressionnephrotoxicity electrolyteimbalancesRibavirinRibavirincommerciallyavailableasegVirazole? 商品化銷antiviral 作 ogue(guanosine核苷類似物（鳥苷衍生物 interfereswithDNAandmRNA干擾DNA和mRNA合dosage劑 11mg/kgq24hPOorIV(max.7 onlyincombinationwithinterferon-orin只會(huì)和干擾素-a/w或 聯(lián)sideeffects(alreadyintherapeutic副作用（在治療劑量就已具有 腹瀉，胃腸潰InterferonhumanInterferon-,felineInterferon-antiviraleffects抗 assemlyand cytokine,immunomodulatory

抑 的裝配和出細(xì)胞因子，免疫調(diào)節(jié)作Dosage huIFN-highdose105106IU/kgq24hSQ6weeks不超過6周 huIFN-lowdose150IUq24hPOlongterm長(zhǎng)期 feIFN-106IU/kgSQq24hon5consecutivedays連用5sideeffects副作 rarelyallergic 罕見過敏反應(yīng) InterferonhumanInterferon-,felineInterferon-antiviraleffects抗 assemlyand cytokine,immunomodulatory

in Dosage huIFN-highdose105106IU/kgq24hSQ6weeks不超過6周 huIFN-lowdose150IUq24hPOlongterm長(zhǎng)期 feIFN-106IU/kgSQq24hon5consecutivedays連用5sideeffects副作 rarelyallergic 合，從而誘導(dǎo)產(chǎn)生 CanoralInterferonCanoralInterferonCanoralInterferon-itisdestroyedintheGICanoralInterferon-itisdestroyedintheGICanoralInterferon-itisdestroyedintheGI-noplasmalevelsCanoralInterferon-itisdestroyedintheGI-noplasmalevelsCanoralInterferon-itisdestroyedintheGI-noplasmalevels=>immunomodulatoryCanoralInterferon-itisdestroyedintheGI-noplasmalevels=>immunomodulatoryeffectonlymphoidtissueinCanoralInterferon-itisdestroyedintheGI-noplasmalevels=>immunomodulatoryeffectonlymphoidtissueinStudyinmicewithInterferon ekensetal.,老鼠使用干擾素的研infectionofmicewithtreatmentwithmurineInterferon- StudyinmicewithInterferon ekensetal.,老鼠使用干擾素的研infectionofmicewithencephalomyocarditistreatmentwithmurineInterferon-a用鼠干擾素-a治療腦心肌 的老2x105IUmurineInterferon-a腹腔內(nèi)給予2x105IU鼠干擾素-90 StudyinmicewithInterferon ekensetal.,老鼠使用干擾素的研infectionofmicewithencephalomyocarditistreatmentwithmurineInterferon-a 的老2x105IUmurineInterferon-a腹腔內(nèi)給予2x105IU鼠干擾素-90 2x105IUmurineInterferon-a口服2x105IU鼠干擾素-40 40%存活StudyinmicewithInterferon ekensetal.,老鼠使用干擾素的研infectionofmicewithencephalomyocarditistreatmentwithmurineInterferon-a 的老2x105IUmurineInterferon-a腹腔內(nèi)給予2x105IU鼠干擾素-90 2x105IUmurineInterferon-a口服2x105IU鼠干擾素-40 40%