Secondary Species Ferrets




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Secondary Species - Ferrets



Petritiz et al. 2013. Evaluation of portable blood glucose meters for measurement of blood glucose concentration in ferrets (Mustela putorius furo). JAVMA 242(3):350-354
Domain 1; K1 - Diagnostic procedures
SUMMARY: Portable blood glucose meters (PBGMs) are designed for use in humans and have shown to be inaccurate in many veterinary species, but have not been evaluated for use in ferrets. This study compared 3 PBGMs and a laboratory analyzer (gold standard):
ATC = AlphaTrak on canine setting

ATF = AlphaTrak on feline setting

ACA = AccuChek Aviva

OTU = OneTouch Ultra 2


51 ferrets were included in the study; inclusions criteria were that ferrets must have had venipuncture performed for any reason. 9 of 51 were ferrets with a previous diagnosis of insulinoma that was being treated with prednisone and/or diazoxide. Bias (mean differences between PBGM readings and corresponding laboratory analyzer results) was determined for each model. Samples were classified as hypoglycemic (<70 mg/dL), euglycemic (70-200 mg/dL), or hyperglycemic (>200 mg/dL).
Based on the laboratory analyzer, plasma glucose concentrations ranged from 41-160 mg/dL; 10 were hypoglycemic and the remainder were euglycemic with none being hyperglycemic. Greatest agreement was with ATC, which was the only PBGM to overestimate glucose; all other PBGMs significantly underestimated glucose concentrations. When grouping samples as hypoglycemic vs. normoglycemic, overestimation of glucose in hypoglycemic samples by the ATC was significant, and the ATC did not detect hypoglycemia in 4 of 10 samples. The other 3 PBGMs sometimes incorrectly identified animals as hypoglycemic.
The ATC had the least bias and was consistent with previous results in dogs where samples were reported as higher than the reference analyzer. This was also the only meter to misclassify hypoglycemic ferrets as euglycemic. Confirmatory testing should always be done, especially if values are approaching the lower limit of the reference interval and the ferret has clinical signs consistent with hypoglycemia.
QUESTIONS:

1. What are some clinical signs of hypoglycemia in ferrets?

2. The AlphaTrak glucometer has the least bias from a laboratory chemistry analyzer when on which setting?

3. What are possible sources of error for this study (and in general when interpreting blood glucose)?

4. What is an inherent difference in determining glucose via PBGM vs. a lab analyzer?
ANSWERS:

1. Weakness, stargazing, hind limb paresis/ataxia, weight loss, ptyalism or pawing at mouth, seizures. In comparison to dogs, ferrets less commonly have seizures (the most common sign in dogs), and ferrets may have ptyalism whereas dogs do not.

2. Canine

3. Site of venipuncture (especially in capillary vs. venous samples), plasma vs. whole blood, glycolysis, order in which PBGMs were used for each sample. All of these were addressed in the paper.

4. Plasma (lab analyzer) has a higher water content and thus higher glucose concentration when compared to whole blood. Many portable meters are calibrated to compensate for this (assuming normal Hct)

Pfent et al. 2013. Pathology in Practice. JAVMA 242(1):43-45
Domain 1: Management of Spontaneous and Experimentally Induced Diseases and Conditions; Task T3. Diagnose disease or condition as appropriate
SUMMARY: A 14-month-old, castrated male ferret due to failure to respond to treatment, continued progressive lethargy, and continued decline in quality of life, was euthanized and submitted for necropsy. Clinically the ferret was pyrexic and anorexic; reluctant to move and had weak withdrawal reflexes, bruxism, and signs of pain on deep palpation of the abdomen and labored breathing. CBC and chemistry showed a marked leukocytosis with neutrophilia and an appropriate left shift, mild to moderate anemia, mild hyperglycemia, moderate hypokalemia, moderate hypoalbuminemia, and mild hyperglobulinemia. Grossly there was diffuse pulmonary edema, cardiomegaly, bilateral renomegaly, hepatomegaly, small pale areas in the heart and skeletal muscles, and marked generalized skeletal muscle atrophy. The entire esophagus was dilated and flaccid, and the esophageal wall was thickened. The spleen was markedly enlarged, had round edges, and was soft, pale, and mottled pink and tan. Histologic examination of the esophagus revealed severe, transmural, neutrophilic, chronic-active esophagitis, and periesophagitis; smooth muscle fibers were atrophied and infiltrated by large numbers of degenerative and nondegenerative neutrophils with fewer lymphocytes, plasma cells and macrophages. Similar inflammatory infiltrates were detected in striated muscles of the limbs, eyes, diaphragm, tongue, and hear, and within the smooth muscle of the bronchi and bronchioles of the lungs, trachea, great vessels of the heart and intestines. The spleen was pale and swollen because of large numbers of myeloid precursor cells and megakaryocytes. Disseminated idiopathic myofasciitis, also known as disseminated idiopathic myositis, polymyositis, or simply myofasciitis was first identified in ferrets in 2003. It is believed to be immune-mediated disease triggered by vaccine (canine-distemper vaccine) or drug interactions. It affects young animals, < 2 years of age and most affected animals die. The diaphragm from affected ferrets is often so think that you can read print through it.
QUESTION


  1. Associations between which injections and disseminate idiopathic myofasciitis have been previously document?

    1. Canine distemper vaccine

    2. Canine rabies vaccine

    3. Experimental castration drug

    4. a & b

    5. b & c

    6. a & c

ANSWER


  1. f.



Kleine and Quandt. 2012. Anesthesia Case of the Month. JAVMA 241(12):1577-1582

 

Domain 3: Management of Spontaneous and Experimentally Induced Diseases and Conditions; Task 3: Diagnose disease or condition as appropriate; K2: Surgical techniques associated with diagnostic (e.g., exploratory; biopsy) and therapeutic (e.g., tumor removal) surgeries. 



 

SUMMARY

 

History - Clinical Case: A ferret under surgery for biopsy and potential surgical mass removal. The patient was premedicated with oxymorphone and midazolam, induced with propofol and maintained with isoflurane. A fentanyl and dopamine constant rate infusions were instituted. An abrupt increase in temperature and PEtCO2 was identified and different actions were taken. At this time, hypercarbia and hyperthermia causes secondary to tumor manipulation could not be ruled out.

 

Question: What are likely causes of the hyperthermia and hypercarbia in this ferret?



 

Answer: Initially, the hyperthermia was thought to be due to excessive warming from the forced warm air blanket and circulating hot water blanket. Because the PEtCO2 continued to increase, a hypermetabolic condition, such as malignant hyperthermia was considered, despite the lack of reports of malignant hyperthermia in ferrets.  Additionally, the same clinical signs of hyperthermia and hypercarbia were noted in a 6-wee-old puppy with a vascular ring anomaly anesthetized with the same anesthesia system 3 days later.

 

Outcome: The ferret recovered well from anesthesia with a normal temperature. Two days after surgery, vomiting and bruxism were noted, and ultrasonography revealed free abdominal fluid. Nonseptic purulent exudates were diagnosed and 7 days after surgery, the patient was euthanized. Necropsy revealed septic peritonitis secondary to gastric suture line failure. On further examination of the anesthetic circuit, a faulty inspiratory 1-way valve stuck in the open position was found, and valve malfunction has been reported during severe hypercarbia in dogs and horses.

 

Discussion/Conclusions: Pheochromocytoma has been found to cause acute profound hyperthermia and hypercarbia in people. The clinical findings are similar to those seen with malignant hyperthermia. However, no muscle rigidity is seen with pheochromocytoma. Clinically important complications can arise in anesthetized patients secondary to equipment failure. Thorough inspection of anesthesia equipment prior to use is important for patient safety and a positive outcome.
QUESITONS

1.  True or False. Malignant hyperthermia, a muscular disorder can cause hyperthermia and hypercarbia.

2. What are the likely causes of the hyperthermia and hypercarbia in this ferret?

a. Malignant hyperthermia

b. Decreased heat loss (i.e. heat stroke)

c. Tumor manipulation (i.e. pheochromocytoma)

d. Equipment failure

e. All of them are true

3.  True or False. Malignant hyperthermia is caused by a mutation of the TTR2 gene. This gene is responsible for causing potassium release into the skeletal muscle.

4. Causes of hypercarbia during general anesthesia include:

a. Parenchymal or pleural space disease

b. Thoracic or abdominal restrictive disease

c. Inappropriate ventilator settings

d. Hypermetabolic states

e. Neoplasia

d. All of them are right

5. Dantrolene is unique in malignant hyperthermia treatment and it works directly on:

a. Muscle

b. Centrally

c. Neuromuscular muscle

d. All of them are right

 

ANSWERS



1. True

2. e


3. False. Malignant hyperthermia is caused by a mutation of the RYR1 gene. This gene is responsible for causing calcium release into the skeletal muscle.

4. d


5. a

 
Hess. 2012. Insulin glargine treatment of a ferret with diabetes mellitus. JAVMA 241(11):1490-1494


SUMMARY:  This is a case report of a 7.5 year old spayed female ferret that presented with weight loss in spite of a good appetite.  Previous history included a diagnosis of pancreatic insulinoma and subsequent treatment with methylprednisolone acetate q 30 days for 2 years.  This diagnosis was based on a single incident of low blood glucose.  No insulin level had been determined. 
At the time of presentation, the ferret was thin and serum biochemical analysis revealed a blood glucose level of 855 mg/dl (normal 63 – 134 mg/dl).  Glucocorticoid injections were discontinued and tapering dosages of prednisolone sodium phosphate were initiated.  Subsequent blood glucose curves revealed a persistent hyperglycemia.  Treatment with insulin glargine SQ was given.  Glucose curves continued to be run.  The ferret was sent home with instructions for the owner to monitor the glucose level in the urine twice daily.  The owner was instructed to give 0.5U of insulin glargine whenever the dipstick assessments revealed greater than trace amounts of glucose in the urine.  At 100 days post treatment, the ferret continues to need insulin q 1-3 days to remain under the target high value of 200 mg/dl.
Spontaneous diabetes mellitus is uncommonly diagnosed in ferrets.  A diagnosis is made on the basis of compatible clinical signs (lethargy, weight loss despite a good appetite, polyuria, polydipsia) and documentation of persistent hyperglycemia (> 400 mg/dl).
QUESTIONS

  1. What is the genus and species of the ferret?

  2.  What common treatment in ferrets can result with iatrogenic diabetes mellitus in ferrets?

  3. What type of diet is recommended for diabetic cats?

    1. High protein, high carbohydrate

    2. Low protein, low carbohydrate

    3. High protein, low carbohydrate

    4. Low protein, high carbohydrate

  1. T/F.  Insulin glargine has a longer duration of action and lack of peak effect compared to ultralente insulin or neutral protamine Hagedorn insulin.  

  2. T/F.  Documentation of low blood insulin concurrently with hyperglycemia confirms the diagnosis of pancreatic insulinoma. 

  3. T/F.  Chronic stress may instigate the development of diabetes mellitus.

ANSWERS


        1. Mustela putorius furo)

        2. Glucocorticoid injections such as methylprednisolone acetate which is used to treat pancreatic insulinomas

        3. c

        4. T

        5. F.  This helps confirm diabetes mellitus

        6. T.  Chronic stress can lead to excess endogenous corticosteroid release.  This increases gluconeogenesis and glycogenolysis leading to chronic hyperglycemia and increased blood insulin levels.  This can down-regulate insulin receptors resulting in insulin resistance and the development of diabetes mellitus. 



Malakoff et al. 2012. Echocardiographic and electrocardiographic findings in client-owned ferrets: 95 cases (1994-2009). JAVMA 241(11):1484-1489
Domain 1: Management of Spontaneous and Experimentally Induced Diseases and Conditions

  


SUMMARY: This is a retrospective review of medical records to identify which cardiac diseases are most frequently diagnosed in ferrets and which conditions are most frequently associated with congestive heart failure. Records for all ferrets over a 16-year period that had an echocardiogram were reviewed; ferrets were included if the record included a signalment and an echocardiographic diagnosis. 61% of ferrets were male, 39% were female, mean age was 5.0 +/- 1.8 years. Clinical abnormalities included arrhythmia (n=35), murmur (n=32), cough/dyspnea/tachypnea (n=21), radiographic evidence of cardiomegaly (n=12), pleural or abdominal effusion (n=6).

 

Table 1: Echocardiograms from 95 ferrets




Echo Diagnosis*

No. (%) of Ferrets

No. of Males

No. of Females

Mean Age (yrs)

Clinically normal

20 (21%)

13

7

3.7 ± 1.8

VR

49 (52%)

30

19

5.6 ± 1.6

Ventricular enlarge.

16 (17%)

10

6

4.9 ± 2.0

LVH

14 (15%)

6

8

5.6 ± 1.7

DCM

4 (4%)

3

1

5.7 ± 0.2

Restrictive CM

2 (2%)

2

0

5.7 ± 0.8

*n=10 ferrets with > 1 concurrent diagnosis are represented twice
Table 3: ECGs from 65 ferrets

 


ECG Diagnosis*

No. (%) of Ferrets

No. of Males

No. of Females

Mean Age (yrs)

Sinus rhythm

30 (46%)

16

14

4.4 ± 2.0

1st degree AV block

2 (3%)

0

2

6.5 ± 0.6

2nd degree AV block

19 (29%)

9

10

4.9 ± 1.6

3rd degree AV block

7 (11%)

4

3

6.3 ±1.8

VPCs

12 (18%)

7

5

6.5 ± 1.4

SVPCs

4 (6%)

4

0

3.8 ± 1.4

*Ferrets with >1 ECG abnormality represented in each category in which they were affected

 

For valvular regurgitation (VR), the most commonly affected valve was aortic, followed by mitral. VR was often subclinical, and in the 11 ferrets where both VR and CHF were present, > 1 valve was affected. Ferrets were given diagnoses of both VR and ventricular enlargement when VR was deemed too mild to be a significant contributor to enlargement. DCM, though anecdotally said to be common in ferrets, only occurred in 4% of cases, and was always associated with CHF. This may mean that incidence of DCM is decreasing in ferrets (changes in breeding/genetics or in nutrition), or it may reflect that the current study was done at a referral center where many ferrets did not have clinical signs of heart disease.



 

The most common ECG abnormality, 2nd degree AV block, was usually not associated with clinical abnormalities, but there was no follow up to determine whether this was a risk factor for development of 3rd degree AV block. 3rd degree AV block was strongly associated with CHF, weakness, or syncope (6 of 7 ferrets). VPCs were often associated with CHF, although many ferrets had concurrent abnormalities with VPCs; authors recommend ferrets with VPCs should have an echo and radiographs.

 

Many of these ferrets were evaluated prior to publication of reference intervals for ferrets, thus cases may not have been uniformly evaluated.



 

QUESTIONS

1.   What is the most common echocardiographic abnormality in ferrets?

2. What valve is most often affected by VR in ferrets?

3. What is the most common arrhythmia diagnosed in ferrets?

4. Which echocardiographic finding, though uncommon, was always associated with CHF?

5. Which ECG abnormalities were most often associated with CHF or clinical signs of heart disease?
ANSWERS

1. Ventricular regurgitation

2. Aortic

3.   2nd degree AV block

4. DCM

5. VPCs and 3rd degree AV block



 
Geyer and Reichle. 2012. What Is Your Diagnosis? JAVMA 241(1):45-50
SUMMARY: An evaluation of a 1 year old castrated male ferret was performed due to its acute onset of vomiting mucus and respiratory distress. Upon presentation, a physical exam revealed lethargy, increased respiratory effort, hypothermia (98.7F), and mild dehydration. Other significant findings included a painful abdomen and splenomegaly. Analytical serum chemistry results revealed that the ferret was hyponatremic, hypokalemic, and hyperglycemic. Right Lateral and ventrodorsal abdominal radiographs indicated a stomach severely distend with gas and ingesta with rotation of the gastric axis. The pylorus was located in the dorsal cranial position. There was loss of intra-abdominal contrast and the spleen was enlarged and malpositioned to the right abdominal wall. Initial management of the ferret included intravenous fluids, buprenorphine and famotidine. The ferret was refractory to the therapy and remained depressed. Ten hours post-presentation repeat abdominal radiographs were performed and the characteristic double- bubble or Popeye’s arm was detected indicating Gastric dilatation-volvulus (GDV). An immediate laparotomy revealed torsion of the stomach and spleen, and large amounts of blood tinged peritoneal fluid. Due to tissue necrosis, vascular compromise, intraoperative complications and a poor prognosis the owners elected to have the ferret euthanized.
GDV is described as the rotation of the stomach along its axis leading to distension of the stomach with gas or fluid. The stomach commonly rotates clockwise between 90 and 360 degrees.  GDV occurs more commonly in large or giant breed dogs, especially those that are deep chested, however it has been reported in guinea pigs and cats. The etiology of GDV is truly unknown but it is believed to be related to the following predisposing factors: stress, family history, increased thoracic depth, exercise, diet and concurrent disease.  Diagnostics typically include radiographic evaluation (right lateral and ventrodorsal) of an abnormally positioned, gas filled, pylorus that is dorsocranial in location and left of midline. The right lateral abdominal radiographic is highly preferred because it serves as a tool to differentiate between simple gastric dilatation and gastric dilatation-volvulus, a surgical emergency. Splenic torsion commonly occurs with GDV and can be detected by evaluation of blood flow using Doppler ultrasonographic examination. Prognosis of GDV is variable depending on tissue compromise, and the patient’s response to therapy.
QUESTIONS

1.   What abdominal radiographic projection is most preferred when attempting to diagnose gastric-dilatation-volvulus?

a.  Right lateral

b.   Left lateral

c.  Dorsoventral

d.   None of the above because Doppler ultrasonographic examination is preferred

2.   What direction does the stomach more commonly rotate when initiating torsion? 

a.  Clockwise    

b.   Counter clockwise

3.   What organ commonly undergoes torsion and compromise due to its close proximity to the stomach when GDV occurs?

a.   Liver

b.  Left kidney

c.   Diaphragm

d.   Spleen


ANSWERS

1.   a. The right lateral abdominal projection: It is an important diagnostic tool to detect the Popeye’s arm and differentiate between simple gastric dilation and GDV.

2.   a. Clockwise

3.   d. The spleen :Due to its attachment to the stomach via the gastrosplenic ligament, it is often undergoes torsion in conjunction with the stomach



Gupta et al. 2012. Pathology in Practice. JAVMA 240(12):1427-1431
Domain 1: Management of Spontaneous and Experimentally Induced Diseases and Conditions; Task T3: Diagnose disease or condition as appropriate
SUMMARY: A 3-year-old spayed female ferret was evaluated for a 3-week history of weight loss, lethargy, decreased appetite, non-productive hacking cough and abnormal faeces. The ferret was in poor body condition, bright, alert and responsive but tachypnoiec with possible presence of splenomegaly and an abdominal mass. Radiography revealed a severe diffuse alveolar pulmonary pattern with multiple air bronchograms and complete consolidation of the left cranial lung lobe and diffuse splenic enlargement. Ultrasonography revealed diffuse consolidation of the left lateral and dorsal lung lobes, diffusely enlarged intra-abdominal lymph nodes and a loss of wall layering in several intestinal segments. The ferret died after discharge from the hospital.
Gross necropsy revealed multifocal to coalescing, raised, pale tan nodules in all lung lobes, the intestines contained nodular intramural thickenings, the spleen was enlarged and the tracheobronchial and mesenteric lymph nodes were also enlarged. Differential diagnoses for the gross lesion in the ferret included neoplasia, bacterial and fungal infection.
The cytologic interpretation was marked granulomatous inflammation with intracellular organisms (consistent with Mycobacterium sp.). This was based on microscopic examination of fine needle samples from lung lesions which showed large numbers of epithelioid macrophages and multinucleated giant cells, few degenerate neutrophils and some small mature lymphocytes. The macrophages contained large numbers of phagocytosed clear, rod-shaped bacteria.
The morphologic diagnosis was severe pyogranulomatous pneumonia, enteritis and lymphadenitis with numerous acid-fast bacteria (M. xenopi). This was based on histological findings which consisted of: the lung parenchyma being obliterated by a granulomatous infiltrate of primarily epithelioid macrophages mixed with fewer multinucleated giant cells, multiple aggressive lymphocytes and scattered neutrophils and plasma cells with large numbers of macrophages and multinucleated giant cells containing numerous clear rod shaped bacteria that were positive to acid fast stain; the lamina propria and submucosa of jejunum and tracheobronchial and mesenteric lymph nodes containing multifocal areas of granulomatous infiltrates of acid fast bacilli similar to those detected in the lung sections;  a hypercellular spleen with marked extramedullary haematopoiesis.
PCR assay on lung and spleen tissue samples yielded a product with similarity to Mycobacterium spp. (M xenopi and M celatum).
Mycobacterial pathogens can be divided into three classes: slow-growing with and without production of tubercles; leproid granuloma-production organisms and rapidly growing organisms. Ferrets are susceptible to various mycobacterial infections including M. avium, M. bovis, M. genavense, M. microti, M. abscessus, M triplex and M celatum. M xenopi (a slow growing, nontuberculous, acid-fast bacteria) infection in ferrets has not been previously reported though it has been reported in humans and cats. Murine macrophages efficiently kill or inhibit the growth of some intracellular mycobacteria, however ferret macrophages activated with T cell derived supernatant, lipopolysaccharide or both fail to have increased ability to control M bovis infection and survival of the intracellular bacteria within activated ferret macrophages is enhanced.
A diagnosis of mycobacteriosis can be made on the basis of the cytologic and histology findings – evaluation of acid fast stained organisms and PCR procedures. Single-antimicrobial treatment of any mycobacterial infection is not advised but combination antimicrobial therapy in a cat with disseminated M xenopi infection prolonged survival of the animal by about 7 years.
QUESTIONS

  1. How can mycobacterial infections be treated?

    1. No treatment advised

    2. Single antimicrobial therapy

    3. Combination antimicrobial therapy

    4. None of the above

  2. Why might ferrets be more susceptible to mycobacterial infection?

  3. What are the differential diagnoses for multifocal pale nodules in lung, enlarged spleen, enlarged mesenteric and tracheobronchial lymph nodes and nodular intramural thickenings of the intestine

    1. Neoplasia

    2. Fungal infection

    3. Bacterial infection

    4. All of the above

ANSWERS


  1. c

  2. Activated ferret macrophages fail to control intracellular mycobacterial infections and may in fact may enhance the survival of the intracellular bacteria

  3. d


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