Lapis ISSN 2398-2969

Rhinitis - sinusitis

Contributor(s): Vetstream Ltd, Livia Benato, Susan Brown, Stephen Hernandez-Divers, Maud Lafortune

Introduction

  • CausePasteurellaspp, Moraxella catarrhalisStaphylococcus aureusBordetella bronchisepticaPseudomonasspp, combination of P. multocidaand B. broncisepticaMyxomavirus, Herpes virus, trauma, allergies, chemical exposure, nasal turbinate adenocarcinoma.
  • Signs: nasal discharge, sneezing/audible respiratory noises, matted fur, crusted nose/nasal distortion, conjunctivitis/ocular discharge, torticollis, tachypnea/dyspnea, lethargy, anorexia.
  • Diagnosis: clinical examination, FNA, hematology, biochemistry, urinalysis, endoscopy, radiography, CT, MRI.
  • Treatment: depends on cause. Antimicrobials, mucolytic drugs, probiotics, oxygen therapy, nasal flushing, anti-inflammatory drugs/corticosteroids, antihistamines, opioids, conservative treatment, surgery.
  • Prognosis: depends on extent of disease. Guarded if rhinitis complicated with pneumonia; fair for cases of uncomplicated rhinitis.
  • Respiratory disease is a major cause of both morbidity and mortality in pet rabbits.
  • Pasteurellosis   Pasteurellosis  has historically been quoted as the primary respiratory disease of rabbits and rhinitis is the most common presentation of this infection.
  • A recent study demonstrated that upper respiratory tract infections were mainly due to polybacterial infections and the most common combinations was P. multocidaand B. bronchiseptica.
  • As more pet rabbits make the transition from the garden hutch to the heated home so changes in temperature, ventilation, humidity and environmental pollutants may alter the epidemiology of respiratory diseases.
  • Various predisposing factors can influence pathogenicity of the upper respiratory disease, especially humidity, temperature and ventilation.
  • In cases of stress, irritation of the airways or immunosuppression, the respiratory microbial flora can become pathogenic.
  • There are several other bacterial and viral pathogens and non-infectious causes including allergens, tobacco smoke and aerosol sprays.

Print-off the Owner factsheetSnuffles - the facts  Snuffles - the facts   to give to your clients.

Presentation

  • Nasal discharge (serous to purulent).
  • Sneezing and audible respiratory noises.
  • Matted fur on medial metacarpi (from cleansing of nose with feet).
  • Crusted nose.
  • Open mouth breathing in case of severe upper respiratory tract disease.
  • Nasal distortion, eg abscess   Abscess 04: nose  , tumor.
  • Conjunctivitis   Eye: conjunctivitis  , ocular discharge.
  • Rhinitis can be associated with otitis media and torticollis   Head tilt  .
  • Tachypnea and dyspnea   Dyspnea  .
  • Lethargy and anorexia   Anorexia   if complicated with pneumonia   Pneumonia  .
  •  Pasteurellamay cause a myriad of presentations of which rhinitis may be only one manifestation.

Acute

  • Acute infection of the nares is associated with edema and hyperemia of the mucosa.
  • In chronic cases, mucosal erosion and atrophy of the turbinates can occur.
  • Open mouth breathing can be present in more severe cases.

Incidence

  • The authors are unaware of any studies that have determined the incidence of respiratory disease in pet rabbits.
  •  Pasteurella multocida  Pasteurella multocida  pneumonia is quoted as the most common bacterial infection:
    • Gram-negative rod.
    • Over 20 serotypes.
    • May be a commensal of the upper respiratory tract of rabbits.
    • Differing serotypes from those found in other mammals.
  • Incidence of infection varies:
    • With season, greater in spring and autumn.
    • With temperature, greater with temperature fluctuations.
    • With diet, reduced with addition of fresh vegetables.
  • Rabbits challenged by Pasteurellamay:
    • Resist infection.
    • Spontaneously eliminate infection.
    • Become chronic carriers.
    • Develop acute disease.
    • Develop bacteremia and pneumonia.
  •  Bordetella bronchiseptica  Bordetella bronchiseptica  may be co-pathogen or predisposing factor to Pasteurella.
  •  Bordetellaspp appears to be more common in neonatal/juvenile rabbits while Pasteurellaspp is more common in adults.

Geographic

  • The incidence and prevalence of disease is increased where temperature fluctuations occur as is more likely in temperate regions. Rabbits exposed to excessively high temperatures in tropical environments may also suffer respiratory embarrassment.
  • Temperature variation will be more significant for hutch-housed rabbits than house rabbits. However, house rabbits may be kept too warm in centrally heated houses.
  • Distribution of pathogens:
    • Most bacterial pathogens appear to have a worldwide distribution.
    • Herpesvirus has been reported in Europe and Canada.
    • Coronavirus (pleural effusion disease) worldwide distribution unknown, incidence low, first reported in Scandinavia, appears restricted to labs.
  • Housing and environment may affect disease:
    • Outside hutch and run provide better ventilation but greater temperature fluctuations.
    • House rabbits have a more stable environment but this may be too warm and too dry.

Morbidity

  • It is clear that clinical rhinitis is a common presentation in practice and causes morbidity in many pets.
  • However, the true prevalence of rhinitis, including subclinical disease, is probably much greater in the general rabbit population but no studies have examined the incidence of upper respiratory disease in pet rabbits.

Mortality

  • Mortality is generally low with rhinitis, even in chronic cases the rabbit can survive with severe turbinate atrophy.
  • However, as the disease progresses so the infection can spread to the lower respiratory tract and cause pneumonia, which is more likely to be fatal.

Cost

  • Costs will depend on the level of investigation and the duration of therapy.
  • Standard investigation, ie consultation, nasal culture and sensitivity, and antimicrobial therapy may be modest.
  • Refractory cases may benefit from skull radiography, hematology, and rhinoscopy with tissue biopsy for both microbiology and histology and prolonged medication, which can increase costs substantially.

Special risks

  • Blood collection and deep nasal swabs (now considered of questionable value) can be collected from the conscious animal but radiographs, nasal flushing, rhinoscopy and biopsy will require sedation or general anesthesia.
  • Respiratory disease does add a significant risk to anesthesia, which must be weighed against the benefits of making a diagnosis.
  • However, short anesthetic restraint, incorporating oral endotracheal intubation   Endotracheal intubation  (this can be dramatic in the hands of the novice) greatly facilitates the collection of diagnostic tests and reduces stress of sample collection, thereby ultimately providing a definitive diagnosis and prognosis.

Cause

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Diagnosis

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Treatment

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Prevention

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Prognosis

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Further Reading

Publications

Refereed papers

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