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Demodikoosi Koiralla, Kissalla Ja Muilla Pieneläimillä - Kirjallisuuskatsaus

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Demodikoosi Koiralla, Kissalla Ja Muilla Pieneläimillä - Kirjallisuuskatsaus Demodikoosi koiralla, kissalla ja muilla pieneläimillä - kirjallisuuskatsaus Eläinlääketieteen lisensiaatin tutkielma Pieneläinsisätautien oppiaine Kliinisen hevos- ja pieneläinlääketieteen osasto Eläinlääketieteellinen tiedekunta Helsingin yliopisto Kaisa Valkiala 2013 Tiedekunta - Fakultet – Faculty Osasto - Avdelning – Department Eläinlääketieteellinen tiedekunta Kliinisen hevos- ja pieneläinlääketieteen osasto Tekijä - Författare – Author Kaisa Valkiala Työn nimi - Arbetets titel – Title Demodikoosi koiralla, kissalla ja muilla pieneläimillä - kirjallisuuskatsaus Oppiaine - Läroämne – Subject Pieneläinten sisätaudit Työn laji- Arbetets art – Level Aika- Datum – Month and year Sivumäärä - Sidoantal – Number of pages Lisensiaatin tutkielma Toukokuu 2013 68 Tiivistelmä - Referat – Abstract Kirjallisuuskatsauksen tarkoituksena oli selvittää, mitä nykyään tiedetään koiran, kissan ja muiden pieneläinten demodikoosista. Erityisesti koiran demodikoosiin liittyy vielä epäselvyyksiä. Työn on tarkoitus myös toimia tietolähteenä eläinlääkäreille. Demodikoosi on ihosairaus, jonka aiheuttaa Demodex spp. -punkin liiallinen lisääntyminen. Punkit kuuluvat isäntäeläimensä ihon normaalieliöstöön ja elävät yleensä karvafollikkeleissa. Sikarimaisen muotonsa vuoksi niitä kutsutaan sikaripunkeiksi. Demodikoosi on koiran yleinen ihosairaus. Yleisimmin sen aiheuttaa D. canis, mutta myös D. injai ja D. cornei on tunnistettu. Sairautta esiintyy enemmän nuorilla koirilla. Demodikoosi luokitellaan joko paikalliseksi tai yleistyneeksi. Paikallisen demodikoosin määritelmästä on eriäviä mielipiteitä, mutta demodikoosi luokitellaan yleensä paikalliseksi, mikäli koiralla on 1-4 leesiota, halkaisijaltaan enintään 2,5 cm. Potilaalla nähdään pieniä, punoittavia, hilseileviä ja usein hyperpigmentoituneita, karvattomia ihoalueita. Kutinaa ja sekundääristä pyodermaa esiintyy vaihtelevasti. Paikallista demodikoosia esiintyy erityisesti nuorilla (3-6 kk). Paikallinen demodikoosi paranee yleensä itsestään ilman hoitoa. Joskus tila voi kehittyä yleistyneeksi, jolloin tarvitaan loislääkitystä. Myös yleistyneen demodikoosin määritelmästä on eriäviä mielipiteitä. Demodikoosin voidaan sanoa olevan yleistynyt, jos koiralla on useita iholeesioita, leesioita kahdessa tai useammassa jalassa tai jos vaurioitunut ihoalue kattaa kokonaisen kehonalueen. Oireina nähdään punoitusta, alopesiaa, hilseilyä, follikuliittia ja komedoja. Joskus todetaan sekundäärinen bakteeri-infektio ja kutinaa. Nuoruusiän yleistynyttä demodikoosia tavataan yleensä alle 18 kk ikäisillä koirilla ja sen taustalla on tunnistettu joitakin riskitekijöitä. Aikusiän demodikoosi on usein vakavampi ja sen taustalla on usein jokin altistava tekijä. Demodikoosin patogeneesistä ei tiedetä vielä kaikkea, mutta yleisesti voidaan todeta, että tärkeässä roolissa ovat sekä perintötekijät että immuunijärjestelmän, erityisesti soluvälitteisen immuniteetin toiminta. Kissalla demodikoosi on harvinaisempi ja sitä aiheuttavat D. cati, D. gatoi sekä kolmas, nimeämätön sikaripunkki. Kissan demodikoosi ei yleensä ole yhtä vakava kuin koiran. D. catin aiheuttamat leesiot ovat tyypillisesti karvattomia, hilseileviä, rupisia ja punoittavia. Usein taustalla on jokin altistava tekijä. D. gatoi aiheuttaa usein huomattavaa kutinaa, eikä altistavaa tekijää tarvita. Demodikoosi diagnosoidaan yleensä raapenäytteellä. Muita vaihtoehtoja ovat trikografia, teippinäyte, biopsia ja eksudaattinäyte. Yleistyneen demodikoosn hoito on toisinaan vaikeaa ja kestää useita kuukausia. Yhtä, kaikille tehoava hoitoa ei toistaiseksi ole. Koirilla käytetään amitratsia, ivermektiiniä, milbemysiinioksiimia, moksidektiiniä tai doramektiiniä. Hoidon etenemistä seurataan raapenäyttein. Ennuste on viime vuosikymmeninä parantunut, mutta toisinaan päädytään eutanasiaan. Kissalla käytetään yleensä rikkikalkkia tai amitratsia. Demodikoosia on tavattu myös hamstereilla, freteillä, gerbiileillä, kaneilla ja marsuilla. Avainsanat – Nyckelord – Keywords demodikoosi, koira, kissa, Demodex, diagnostiikka, hoito, patogeneesi, paikallinen, yleistynyt, hamsteri, fretti, marsu, gerbiili, kani Säilytyspaikka – Förvaringställe – Where deposited Viikin kampuskirjasto Työn johtaja (tiedekunnan professori tai dosentti) ja ohjaaja(t) – Instruktör och ledare – Director and Supervisor(s) Dosentti, ELT, pieneläinsairauksien erikoiseläinlääkäri Leena Saijonmaa-Koulumies ja ELL Riitta Seppänen SISÄLLYSLUETTELO 1 JOHDANTO ............................................................................ 1 2 DEMODIKOOSI ....................................................................... 1 2.1 Demodikoosi koiralla .................................................................... 2 2.1.1. Demodikoosin aiheuttajat ................................................... 2 2.1.2. Paikallinen demodikoosi ..................................................... 4 2.1.3. Yleistynyt demodikoosi ...................................................... 5 2.1.3.1. Nuoruusiän yleistynyt demodikoosi ............................................. 6 2.1.3.2. Aikuisiän yleistynyt demodikoosi ................................................ 7 2.1.4. Patogeneesi .......................................................................... 8 2.1.5. Differentiaalidiagnoosit .................................................... 11 2.2. Demodikoosi kissalla ................................................................... 12 2.2.1. Demodikoosin aiheuttajat ................................................. 12 2.2.2. Demodikoosin eri muodot ................................................. 13 2.2.2.1. Demodex cati demodikoosin aiheuttajana .................................. 13 2.2.2.2. Demodex gatoi demodikoosin aiheuttajana ................................ 14 2.2.3. Patogeneesi ........................................................................ 15 2.2.3.1. Patogeneesi. D. cati .................................................................... 15 2.2.3.2. Patogeneesi: D. gatoi .................................................................. 16 2.2.4. Differentiaalidiagnoosit .................................................... 17 3 DIAGNOSTIIKKA .......................................................................... 17 3.1 Demodikoosin diagnostiikka koiralla ........................................ 17 3.1.1. Raapenäyte ........................................................................ 18 3.1.2. Trikografia ........................................................................ 19 3.1.3. Teippinäyte ........................................................................ 20 3.1.4. Eksudaattinäyte ................................................................. 21 3.1.5. Biopsia............................................................................... 22 3.1.6. Muut tutkimukset .............................................................. 23 3.2. Demodikoosin diagnostiikka kissalla........................................... 23 3.2.1. Raape- ja teippinäyte ......................................................... 23 3.2.2. Biopsia............................................................................... 24 3.2.3. Muut tutkimukset .............................................................. 24 4 HOITO ..................................................................................... 25 4.1. Demodikoosin hoito koiralla ........................................................ 25 4.1.1. Paikallisen demodikoosin hoito ........................................ 25 4.1.2. Yleistyneen demodikoosin hoito....................................... 26 4.1.2.1. Amitratsi ..................................................................................... 27 4.1.2.2. Ivermektiini ................................................................................ 29 4.1.2.3. Doramektiini ............................................................................... 32 4.1.2.4. Milbemysiinioksiimi ................................................................... 32 4.1.2.5. Moksidektiini .............................................................................. 33 4.1.2.6. Muut hoidot ................................................................................ 34 4.1.3. Bakteeritulehdusten hoito ................................................. 35 4.1.4. Hoidon kesto ja seuranta ................................................... 36 4.1.5. Ennuste .............................................................................. 37 4.2. Demodikoosin hoito kissalla ........................................................ 39 4.2.1. Rikkikalkki ........................................................................ 39 4.2.2. Amitratsi ............................................................................ 40 4.2.3. Muut hoidot ....................................................................... 40 5 DEMODIKOOSI MUILLA PIENELÄIMILLÄ ................................ 41 5.1. Hamsteri ..................................................................................... 41 5.2. Fretti ..................................................................................... 42 5.3. Gerbiili ..................................................................................... 42 5.4. Marsu ..................................................................................... 42 5.5. Kani ..................................................................................... 43 6 POHDINTA ..................................................................................... 43 7 KIRJALLISUUSLUETTELO .............................................................
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