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Evaluierung Eines Scoringsystems Für Canine Demodikose

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Evaluierung Eines Scoringsystems Für Canine Demodikose Inaugural-Dissertation zur Erlangung der Doktorwürde der Tierärztlichen Fakultät der Ludwig-Maximilians-Universität München Evaluierung eines Scoringsystems für canine Demodikose. von Berrett Nicola-Gesa Dengler aus Lüneburg München 2020 Aus dem Zentrum für Klinische Tiermedizin der Tierärztlichen Fakultät der Ludwig-Maximilians-Universität München Lehrstuhl: Dermatologie Arbeit angefertigt unter der Leitung von Univ.-Prof. Dr. Ralf S. Müller Gedruckt mit der Genehmigung der Tierärztlichen Fakultät der Ludwig-Maximilians-Universität München Dekan: Univ.-Prof. Dr. Reinhard K. Straubinger, Ph.D. Berichterstatter: Univ.-Prof. Dr. Ralf S. Müller Korreferent: Univ.-Prof. Dr. Nikolai T. Siegel Tag der Promotion: 25.Juli.2020 Für Schwester Anni und meine Familie Inhaltsverzeichnis IX INHALTSVERZEICHNIS I. EINLEITUNG ............................................................................................ 1 II. LITERATURÜBERSICHT ...................................................................... 3 1. Demodikose ................................................................................................. 3 1.1. Historischer Hintergrund der Demodex-Milbe ............................................ 3 1.2. Taxonomie der Demodex-Milbe .................................................................. 5 1.3. Aufbau der Demodex-Milbe ........................................................................ 5 1.4. Entwicklungszyklus der Demodex-Milbe .................................................... 6 1.5. Lebensweise und Vorkommen der Demodex-Milbe .................................... 7 1.6. Pathogenese der caninen Demodikose ......................................................... 8 1.6.1. Kontrolle der Demodex-Population bei gesunden Hunden .......................... 9 1.6.2. Die Rolle der Genetik bei juveniler generalisierter Demodikose .............. 10 1.6.3. Zusammenhang zwischen Immunsuppression und Demodikose .............. 11 1.6.4. T-Zell-Erschöpfung bei caniner Demodikose ............................................ 14 1.6.5. Oxidativer Stress bei caniner Demodikose ................................................ 16 1.6.6. Pathogene Mechanismen der Demodex-Milbe und deren Einfluss auf die Haut ................................................................................................ 17 1.6.7. Sekundärinfektionen bei caniner Demodikose .......................................... 18 1.7. Übertragungsweg ....................................................................................... 19 1.8. Klinik der caninen Demodikose ................................................................. 19 1.8.1. Lokalisierte Demodikose ........................................................................... 20 1.8.2. Generalisierte Demodikose ........................................................................ 20 1.8.3. Juvenile Demodikose ................................................................................. 21 1.8.4. Adulte Demodikose ................................................................................... 21 1.8.5. Sonderform: Otodemodikose ..................................................................... 22 1.8.6. Sonderform: Pododemodikose ................................................................... 22 1.9. Diagnose der Demodikose ......................................................................... 22 1.9.1. Tiefes Hautgeschabsel ............................................................................... 23 1.9.2. Trichogramm .............................................................................................. 24 1.9.3. Klebeband-Quetschmethode ...................................................................... 24 1.9.4. Hautbiopsie ................................................................................................ 25 1.9.5. Polymerase-Kettenreaktion ........................................................................ 26 1.9.6. Feinnadelaspiration .................................................................................... 26 Inhaltsverzeichnis X 1.9.7. Abklatschpräparat ...................................................................................... 26 1.9.8. Standardized skin surface biopsy ............................................................... 27 1.9.9. Bewertung der einzelnen Methoden in Bezug auf den Hund .................... 27 1.10. Therapie der caninen Demodikose ............................................................. 28 1.10.1. Amitraz ...................................................................................................... 29 1.10.2. Makrozyklische Laktone ............................................................................ 30 1.10.2.1. Ivermectin .................................................................................................. 30 1.10.2.2. Doramectin ................................................................................................. 31 1.10.2.3. Selamectin .................................................................................................. 31 1.10.2.4. Milbemycinoxim ........................................................................................ 32 1.10.2.5. Moxidectin ................................................................................................. 32 1.10.3. Isoxazoline ................................................................................................. 32 1.10.3.1. Fluralaner ................................................................................................... 33 1.10.3.2. Sarolaner .................................................................................................... 34 1.10.3.3. Afoxolaner ................................................................................................. 34 1.10.4. Antimikrobielle Therapie ........................................................................... 35 1.10.5. Immunsuppressive Medikamente .............................................................. 36 1.10.6. Therapiemonitoring .................................................................................... 36 1.10.7. Therapiedauer ............................................................................................ 37 1.10.8. Therapieversagen/Rezidive ........................................................................ 37 1.11. Prognose ..................................................................................................... 37 1.12. Zucht .......................................................................................................... 38 1.13. Demodikose bei anderen Säugetieren ........................................................ 38 1.13.1. Humane Demodikose ................................................................................. 38 1.13.2. Feline Demodikose .................................................................................... 39 1.13.3. Bovine Demodikose ................................................................................... 39 1.13.4. Demodikose der Maus ............................................................................... 39 2. Klinische Scoringsysteme ........................................................................ 40 2.1. Wofür werden klinische Scoringsysteme benötigt? ................................... 40 2.2. Was sollten klinische Scoringsysteme beinhalten? .................................... 41 2.3. Beispiele für Scoringsysteme in der Tiermedizin ...................................... 42 2.3.1. Canine Atopic Dermatitis Extent and Severity Index ................................ 42 2.3.2. Canine Atopic Dermatitis Lesion Index .................................................... 43 Inhaltsverzeichnis XI III. MATERIAL UND METHODEN ........................................................... 45 1. Material ..................................................................................................... 45 1.1. Patienten ..................................................................................................... 45 1.1.1. Beurteiler /Bewerter ................................................................................... 45 1.1.2. Scoring Sheet ............................................................................................. 46 1.1.2.1. Erläuterungen der anatomischen Areale .................................................... 46 1.1.2.2. Erläuterungen der im Bewertungsscore angewandten klinischen Läsionen ................................................................................... 46 1.1.2.2.1. Läsionen zur Bewertung von akutem Geschehen ...................................... 46 1.1.2.2.2. Läsionen zur Bewertung von chronischem Geschehen ............................. 47 1.1.3. Datensammlung ......................................................................................... 47 1.1.4. Statistik ...................................................................................................... 47 IV. ERGEBNISSE .......................................................................................... 49 1. Patienten ................................................................................................... 49 2. Übereinstimmung der Bewerter ............................................................. 49 3. Zusammenhang der Bewertungen mit der Anzahl der Demodex Milben ...................................................................................... 52 4. Sensibilität gegenüber Veränderungen .................................................
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