Good morning to all. It's a pleasure to be here talking with you about one of my favourite, thematics in dermatology, which is bacterial infections of the skin. And I had the opportunity already during, many years of experience as a, a dermatologist to treat, to diagnose and treat, Thousands of cases.
In fact, my, PhD was, in bacterial infection because it's always attract me. What can we do? What can, how can we diagnose on how, how, how can we treat them, in a way that is, the best for the patient.
Now, this first presentation, it will be about diagnosing a bacterial pyoderma. There is a 2nd presentation on the treatment. No, real life.
Let's see. We all see patients in practise, which He, for example, like this English bulldog, has hair loss. Hair loss, which is a very common complaint in practise.
The owner is the, the hair loss. The hair, is all over the house. And sometimes there is situs, associated with this hair loss, mainly circular patches of alopecia and .
We are, the owner brings, the patients to the vet to the veterinarian in order to solve this problem. Now, we will see this in practise, and what we need to know is that bioderma is It's not a primary problem. It is always a secondary problem to an underlying cause.
So, in fact, we should not only think about treating the yidderma, but we also should at the same time, Identify which will be the predisposing factor of this infection because all the dogs are colonised by stuff to intermediates, which is the main pathogen in the bacteria of bioderma, and it is only when the, the skin berry is compromised that we have a bacterial infection. So it is necessary, especially it is very important if we have reidant bioderma, it is very important that we identify the cause and treat it. Now, this presentation will be mainly on the bacterial yoderma.
No, there will be no time to go through all the causes. Which includes allergies, ectopyazites, infections, like fungal infections, leishmaniosis, endocrine diseases, neoplastic or autoimmune diseases, as well as genetically associated conditions like icosis. So, although most of the time, especially in the case of recidivyodermis, we are in fact dealing with atopic dogs.
In atopic dogs, this biosis is observed. And this biosis in, in fact, it is an increase of the population of pseudoyins, pseudotermedius and loss of microbiodiversity. So the atopic dog which has ongoing inflammation of the skin due to his allergic disease.
inflammation of the skin, it leads to this biosis. So it leads to a proliferation of papil intermediate, that potentially can cause an infection and there are lots of the microbial diversity of the skin. No.
What's important is the very first thing. The very first thing is, OK, we need to have a history, a history where we are going to to be sure that we identify with, when did the bioderma started? How did it look like in the beginning, because sometimes it has been a few months before we see the patient.
So, how did it start? How, how I treated during this time, that time, if it applies. And if it is recidivt.
So if there is more than, it's more than one episode, especially in this, in the same year. Now, it is important after the history, a full complete history, a general and dermatological history, it is important to classify the dip of the pyoderma according to the clinical signs. And we have them surface pioderma.
So there are 3 types of bacterial infection. So the surface bioderma. Which might not be in some cases it might be, might not be an infection.
We have two facial yoderma and we have the yoderma. And during this presentation, we will learn to recognise the clinical signs and also look at cytological findings. Which is part, a very important part of our diagnosis.
Surface bioderma. On the first phase bioderma, one of the, one of the most common clinical presentations presentations is intertrial or what we, what we also call dermatitis of the skin folds. That is very common, of course, in bracketallic dogs.
Although some dogs, for example, also have the intertrial in the anal folds or vulva fold. Depends on the breed. Now, in this intertrigo, we have a moist area where normally it's easy to accumulate debris and therefore, it's easy for the bacteria and sometimes malaysia to proliferate and cause inflammation.
Now, most of the time, as I said, we have, sub to intermediate. It's the, it's the common pathogen involved in surface yoderma. But be aware that sometimes you might get infections due to rods, or to proliferation due to rods like pseudomonas.
So, here we are going to see in a minute, all is performed cytology to see which kind of population do you have in your, do you have in this, causing the inflammation. Now, another type of bioderma is the is the hotspot. The hotspot.
As we all seen in practise many times, for example, associated with the, in the lumbar, if it is in the lumbar fa area, is associated with flea allergic dermatitis, and the hot spot has a sudden appearance. Then it says that it wasn't there two days ago and he's itchy and the patient is very itchy. So it is very sudden appearance.
It has a moist appearance. A very common he I said in the lumbar sacral area, sometimes in the face. If it is in the face, look, for example, for otitis.
Has an underlying cause. So, these are areas, inflamed areas of the skin, which are very pure, and therefore, the patient will lick, traumatise the skin and remove the hair. Now, another type of surface, yoderma is bacterial overgrowth syndrome.
And bacteria overgrowth syndrome, most of the time is associated with proliferation of stuff to intermediate. And most commonly, I see this in atopic patients. So ectopic patients do have the proliferation a proliferation of staff to intermediate which characterises this biosis, that proliferation on the surface of the skin, and all production of toxic products will make an inflammation of the skin.
That inflammation might come with pruritus. Might also be many times and must not be associated with some, some hair loss. Therefore, we can see, for example, this bacterial overgrowth syndrome, for example, in the axilla.
Axilla are common places of where we can see this this syndrome, but as well, for example, on the ventrum. Now, when you see this erythema, all this performed cytology has by a position, by position of a microscopic slide in this area. You need to know which kind of microorganisms are present because, for example, you need to differentiate to differentiate this from a malathhesia dermatitis.
So going back, bacterial growth syndrome, if it is left untreated, most of the time we'll be will be constant, will be there all the time and will lead to chronic changes of the skin. And we can see this in this in the, in this patient, which again have stop to intermediate overgrowth syndrome again in the axilla. It has been there for several months and we can see the hyperplasia of the skin and that hyperplasia leads to skin falls.
And increasing of the, we can see the margin, the, the, the margin of the skin. So the skin, the skin fold, the hair loss, the hyperpigmentation, it's all saying to you that, OK, there is already a chronic problem here. It is not from two days ago.
It is, it is a chronic. Speaking about chronicity, look at this case. Look at the chronicity.
Look at how thick is the skin, and look at the hyperpigmentation. Normally, the skin will have a different, will have a change in the smell. The owner will complain about that.
And will again continue to be pruritic. The patient will be pruritic. How do, how should we collect samples?
Now, surface pioderma, in all the cases that you've seen, doesn't matter if we are talking about intertrigal cell in the fold, collecting the fold, or collecting the hotspot, or we're going to collecting bacteria overgrowth like in this picture. The method choice is by a position of the microscopic slide. And here you can see that it's easy to make the position of the micro microscopic slide in most of the lesions.
Directly on the skin. But the other possibility will be, for example, to use a tape strip or a swab in if it is areas where it's more difficult to access like the fault on the face. Now, Many times you will see this in this cytology, in this cytology, you will see coucca or you might see cocci and molathhesia, or you might see rose or rods and cocci and malathhesia.
So it might be a mixed proliferation. You should always look for the type of, the type of microorganism that is present in your cytology. See the increase in the numbers of, in your cytology.
Sometimes depending on the inflammation of the skin, you might have umdenia strains of the neutrophil, but that's. To take it as that with the inflammation or it might be the absent. So you might not find the neutrophils or the or is it the the clonosome or the DNA streaming.
Anyway, you will see the microorganisms. They will be there. And they will be very helpful for you to differentiate and choose the right topical treatment.
Because the the surface bioderma, as we are going to see in the second presentation is or the treatment is based on topical treatment. Now, to summarise, surface bioderma, we have the dermatitis of the fold, we have the bacterial overgrowth syndrome, and we have the pyotraumatic dermatitis hotspots. So, be able to differentiate these types of bioderma and you'll do, you will characterise and treat your surface bioderma.
Surface bioderma, it's the proliferation of the microorganisms in the surface of the skin. Should be treated with topical antibacterial treatment only. Let's go a bit deeper.
Let's go a bit deeper because of all of our cases are cases of superficial pyoderma. And superficial pyoderma, the most common, the most common, clinical scenario is the, superficial bacterial folliculitis. And then the superficial bacterial like what, for example, we have the hair loss.
Hair loss to circular areas of alopecia. Due to the fact that in this case, we already have the stuff still intermediate inside the hair follicle, and that leads to alopecia. Because there is focal of that intermediate, we have circular areas of alopecia.
And that might be associated with erythema in some cases. In other cases, that is all the erythema, it's not easily seen macroscopically, clinically, and with our eyes. But make sure that you don't confuse these cases with, for example, demodiosis.
So when you see these cases, you should also check for Demodex or don't confuse these cases with dermatophytosis. And again, if you think it's dermatophytosis, you will do the appropriate diagnostic test which will include potentially lumps, wood, back fungal culture, or trichogram. But if you eliminate the possibilities of Demodex.
With the screen scrapings or trichogram and b and dermatophytosis, then most of the time you will end up in the dog with a diagnosis of superficial bacterial folliculitis. And that's our superficial bacterial folliculitis that many times become preciant in the topic dogs. Some genes are especially predisposed, to, because they are predisposed to atopic dermatitis.
They are, they, they do develop superficial bacterial follicitis many times in the dorsal. But also in the, on the ventrum. So, the vial bacterial folliculitis can be localised or more generalised.
It's because of the subsid intermediate in the hair follicle is. It is easy for the epilate the hair. So I check if you can remove the hair of the patient easily.
Because that is giving you a clue that there is a pathogen in the hair follicle. In fact, the other clue is that if you look in the picture, there is some some y. Some scale in the root of their follicle.
And also you can see the same fibrorrhea, the same scale here on the lesion, the circular lesion. Speaking about circular lesion with hair loss, look at this lesion. These lesions have also pupils.
Tiny pupils, very common in superficial, bioderma, a very common clinical signs. Again, these pupils are associated with hair follicles. Pupils, pupils are common, as I said, can be associated all times associated with erythema.
It is much easier, of course, to see when we have skin, when there is no hair. for example, in this case, this patient was admitted for surgery for, for castration, a female, a young female, and at the time that it was admitted, it didn't know that there was a bacterial, folliculitis. And when they, the hair was clipped was when the veterinarian, said, OK.
Many pupils. We have all these pupils in the ventral aspect. I could see this patient, and all these pupils and the erythema are common, are typical of bacterial bacterial, folliculitis.
So, ventral, look at the ventrum, look at the medial ties. Of course, and because there is an infection here, these patients should not be having surgery, but this was a specific case. The, the surgery should always be done after treating the patient.
Oh, no, it's not so, so severe, and, but we can still in this female again see pupils, pupils on the entrum. This female is a a female already with had 5 years, and we also can see here dermatititis, the intertrigal in the polar fold. It was quite chronic because we can see the art pigmentation.
So in case in this patient, we have the yal bacterial folliculitis and the intertrigal. Now again, facial bacterial colitis, on the patient, we have on the clock, we have the my erythema, the cresting, some alopecia. And going back to the bedroom, we can see this is a German shepherd.
This is a German shepherd, one of the last patients, one, that I treated, and this, this, German shepherd has passes. And also have Erythema. Already some hyperpigmentation here, but we can see that this erythema comes in point.
Which are associated with the hair. And again, a pustu, which is one of the best some one of the best reasons to perform a cytology and the bacterial culture. But the the pustule is in the case of bacterial folliculitis, is associated with the hair follicle.
So we can see the hair coming from the pustule. It's a small pustule with an erythema. Like this one here, like this one here again on the centre.
Moustoes associated with the hair follicle. Small alloe of erythema, very typical of bacterial folliculitis. Again, small pustule.
And what we are going to do with, we, if we see the pustules, we can also do this in a pupil, but pustules are by far the best, our best choices for cytology and culture. So we are going to elect this, this lesion, this pustu. To collect, opening a pusil with a needle, very gentle, open the top of the pustule with a needle.
I'm applying a microscopic slide. With the, from the content. The content, we are going to do cytology.
We are going to start our cytology in the clinic using Diu. This quick? It's very easy to use, as we know, 15 seconds in the in the 1st 1515 and 15, and rinse it and it's ready to be seen.
And now, this week allows the identification of agents and cells, as we know. You can, even sometimes if it is from content of you can easily even put 32 or 3 samples in the same microscopic slide which saves you some time and material. So this can be done in the same microscope, 3 samples in this case, but make sure that your your disc quick if it's in good condition.
And the other thing is that we make sure that you have a good microscope, because a good microscope using the magnifying lens. The oil immersion magnification helps you to find the microorganism. It's more viable, it's faster.
What you are going to do then with the cytology. You're going to look for coucci inside the neutrophils. And that's the, that you can easily see in most of the pustules coca inside the neutrophils.
Sometimes you don't, you don't see inside. You see outside the neutrophils because they will degenerate, and you see here lots of neutrophils that are degenerated. So there is coci many times inside and out, and, outside the neutrophils.
But the intracellular cocci shows you that there is an active in an active inflammatory response, an active immune response against the pathogen, which I, as I already mentioned. Most of the time in surface, in superficial pyoderma, especially in bacterial folliculitis, we are looking for most of the times actually, sometimes over 90% of the cases. So, Another clinic, another clinical sign that you see in the superficial bacterial folliculitis are the epidermal cholera.
The epidermal colours are due to the toxin of intermediate, but are lesions that are round. You can see this, the round lesion of of disclamation. Associated with erythema, many times with hyperpigmentation, but they are, they tend to be circular.
Again, look at the circular pattern. They are circle they have the circular pattern, mainly spreading the, of the stuff to me from the centre to the periphery, and you can see here that the information is more is an information that is more evident in the periphery. And we have the staff tomediate heating in this lesion.
Here exactly on the rim of scaling. So if you pull this rim of scaling with a needle, and do a cytology here by, by a physician. You can, you can even use the, the, the, the, the slide to pull this this this rim of scaling.
And you can do this position and you will see the cocky. So you going back just again in the picture, sorry, we'll have here again, this is a big circle, a big, much larger. They can become very large, very very large colouring with erythema, with hyperpigmentation.
And again, in this case, we'll see, look at the tiny pustule there. You, you'll do the cytology and by looking at the cytology, you'll see many times cockey, they will be there. And stream of DNA from the neutrophil because there is an inflammatory response.
So you see the DNA streaming of the neutrophil that that means that neutrophils are generated and because it's a superficial lesion, you see the keratinocytes. Now, there is a, a 2nd time, a second type of superficial pyoderma, which is not so common, which is the expositive superficial or also called spreading pyoderma. It's tough to do to me again, it is causing, that is causing the problem.
And it is characterised by large lacking of the skin, as we can see associated with alopecia, as we can see here in this patient. So hair loss, liking. Flaking, and this flaking might not be associated many times we don't see the pupils are the pus like we'll see in the superficial bacterial poderma.
Now, we see here flaking, this large flaking, due to the toxins of stuff stillinus. Ha what we can see here. So, large, this is, that is why it is called exfoliated superficial, because there is exfoliation.
It's the main clinic I'll find here, it's the exfoliation. Caused by the infection. The last one is empatigo, which is large, characterised like in mainly in young patients, characterised by large pustules.
And these large pustules go through several hair follicles, but that is very uncommon. OK. Finally, types of superficial pyoderma.
So we have most of the time in front of us, we have a superficial bacterial folliculitis. We might have an exfoliated superficial spreading pyoderma. Sometimes in very young patients, we have empatigo, the large pato on the bedroom.
Or in some cases, very rarely, we have the mucocutaneous junction yoderma. And this is an an entity that there is some, some con controversy in some cases. And it is associated with controversy because there is, in this case, the possibility of being in fact an autoimmune disease.
So if you're not sure, it's potentially you need to do a biopsy in this patient. No, Superficial pyoderma. Why it is important again that we characterise and we know for sure the superficial yoderma.
Because most of the time, we just need a topical treatment and topical treatment. Depend will depend the choice of the topical treatment will depend, for example, it's several factors like localization of the bioderma, look at how spread, how severe, on the personality of the, on the behaviour of the patient. But most of the times we will treat with topical antibacterial treatment.
But in the case that It might be in some cases necessarily systemic antibiotics, and this is the systemic antibiotics we can consider if the tropical treatment fails. After 2 or 3 weeks of treatment, or it is not feasible. In the, in the for that owner or for that patient.
And if, if it, we are considering to use a systemic antibiotics, then before prescribing the antibiotics, it is always advised, and we are going to go through this in more detail in the second presentation, it is advised to perform bacterial culture and antibiotic sensitivity. Now, if we look for the bacterial culture and sensitivity, again, look at the your lesions and the best lesion for doing a bacterial culture, it is a a pustule. In case of the, we are talking about the bacterial folliculitis.
Now, our last, we are last, now we're going to talk about deepyderma. So, in the case of the yerma, we have different kinds of lesions and we have a patient that is in pain. So, in this case, we have, for example, exudative area.
Ulcerated area. And we have here a problem because most of the patients with hipyderma, they have ruptured of the hair follicle, so they have what we call phuncholosis. So, the phylosis, there is also the ulcerated area.
It's areas where we can find this oozing, this blood. This is telling you when there is blood. OK, there is here a deep problem.
Because of this blood, we tend many times to have a brownish crest crest. We still are kept for days that needs to be removed. So this brownish crust means blood.
Many of, of these patients has has already said many of these patients might have also pain associated or pruritus. Depends, but many times it is areas that can be painful. And here we can find, again, on this is on the doorstone of, of the, of the patient.
We can find the oozing areas. These areas, sometimes we can find intact bulla that are that are purple, have a purple colour, and this intact bulla will open and decharge aeros andimulant liquid. Again, why?
Because we are deep. We are deep. We are, we have rupture of the follicle.
The dermis, we are at the level of the dermis, and many times the infection goes for the subcut for the subcut tissue. So we have not only an infection in the dermis but also in the, in the subcut with that what we call a cellulitis. So These patients can become really very severely affected with a large, with pus.
We can see the pus in the surface of this patient. It was a a large patient, a big dog, . And these areas, we can only see the severity after clipping, clipping in this case after sedation cause the patient was very unwell with with the pain.
So we have this. This, we have the pus, we have the deep ulcerated, the deep ulcerated areas. All the hair was matted with pus, with blood, with crust.
And we can see all this in inflammation around this lesion, very severe inflammation. Now, with time, sometimes with some patients, we have, that might be associated with, with the ulcers, but we also have the development of hyperkeratosis. So the, the, the areas of the skin tend to become thicker with chronicity.
And again with hair loss and inflammation and pain ass associated. No, we can have widespread like this one here, widespread or widespread broncholosis and sit that. But we have also in the case of fungoloiditis.
We have specific entities, clinical entities. Like we have acrylic dermatitis, very common again on the carpet. This mainly, we know in, in our days that it's mostly associated with atopic dogs.
So make sure that you cover well all the differential diagnosis for an acrylic dermatitis. At atopic dermatitis or some pain in the underlying structure and leaves the possibility of being behaviour after including all the, all the, all the other differential diagnosis causes. So, a chronic dermatitis, it is an area, where we can find many, the patient will lick, click, lick, click during mm sometimes months, a year.
We can find the hyperkeratosis, we might find the, the alteration. Sometimes common, in big dogs like the, like the Labrador, and it is a deep infection. It is a deep, it is a deep deep deep infection which needs to be treated and at the same time, in order to avoid the recurrence needs to be to be also controlled the underlying cause.
No, another one that also comes with the big dogs, is the interdigital in infected nodule. And this interdigital infected nodules, most of the times are red. And we can see them.
The owner will say, they always show up between, for example, in this case, between the the same two digits. Always between these two digits, we developed a boa. This bulla will burst and will make the the patient to lick and will discharge a purulent or sometimes tinolent material.
And donor say it always come back to the same place. And they pay attention to this interregation how not to because yes, it is possible that this can be caused by the penetration of a grass on a foreign body, but most of many times, especially in cities, it is not a vegetable foreign body. It is implantation of the hair follicle.
Why? Look at these patients. Look at The poor poor confirmation.
Between the two digits. The two front digits. Look at this for this thicker.
This thicker, this thicker bridge between the two digits. This is not normal, as we know. This is supposed to be normal, not here.
And the thicker, area with hair follicle. Sometimes with hairs protruding, makes them and the big dog makes that the patient is walking in with hairs in the footpath. So the patient is walking.
With her that will go. Will, will take with the pressure, will be reversed. So it takes the reverse way and will cause the interdigital bula that will be recidiv.
And it shows up as a boa, a nodule. With again, a possibility of bursting, which you will many times and with angina land discharge. So look at the the confirmation of the foot ped.
It happens, for example, in English bulldogs. It happens in Labradors. And many times it's associated with depending on the severity, but sometimes the one is fitted, for example, with a long walk or going to the beach because it is, they have the patient, it requires more traction from the, from the feet of the patient.
Now, another type of localised cholosis cellulitis is callusspioderma. Calopioderma, again, first thing associated with the pressure. Pressure that makes implantation of the hair follicle, implantation of the hair, and secondary, a rupture of the hair follicle.
And because normally we know with their big patients, they, they might be in the areas where they a bit rough. So again, pressure, continuous pressure, continuous implantation of the hair will make a bioderma, will make an infection. Sometimes it's just the calls, but the call can be infected due to this ongoing hair implantation.
And again, you need to treat the infection. That's also manage the environment of this patient in order to be successful in in treating the infection and avoid relapses. And finally, the last type of of deep deep pyoderma.
It's a pyoderma that we we call post grooming losis and post grooming holosis. Appeared normally 24, the day after or 48 hours after going to a groomer, a groomer or might be just to have a bath or sometimes for bathing or bathing and and hair clip. But what happened is that if the, the bathing is than in, using lots of pressure in the hair follicles, lots of pressure or it leads, the pressure leads to implantation of the hair.
Inside the dermi. So, if it is too rough. With the hand, if the, the, the technician that is bathing the patient, for example, is a bit too rough for the patient, or, or do when it's washing the patient, the hair flow in the the hair goes further than it.
In this, in that specific moment, nothing happened, but the patient. Will show up and the typical history is a patient that shows up 24 to 48 hours. With lots of pain that is still here, if the patient hasn't been clipped.
This one hasn't been clipped. This was clipped after. When it was, when it came to the practise, but there is lots of pain in the dorsal area.
It looks like that it even has spinal pain, which it isn't. So comes with pain and It takes again a few 24 or 48 hours before the cholosis, the lesions start to appear. So on the lesions will be inflammation of the skin, bulla, and then ulceration.
And this is a very severe case of grooming for that was split in the practise so we could see what was happening and treat and this patient, when it was hospitalised, it was due to pain and the very first thing that was not at that point by the referring veterin. Was, OK, there is a spinal pain, but no, it's a post grooming funcolosis. Again, this psychology always in this in all the cases because sometimes the post grooming fungulosis can be associated with infection by rods.
Now, to summarise the type of the yedema, so we have the widespread funcholosis slash flulitis, or we might have the localised funcolosis, so we have the aqualic dermatitis. The interdigital infected infected nodules, the colour of yderma, sometimes the yerma might show up in the chin, called sometimes chin acne, but it's in fact, again, another type of yema with implantation of the hair. And finally, post-grooming funlosis.
No. Why is it important to know if we are in the presence of a deep learning? Because many times the required systemic amphibia therapy because of the deepness of the of the infection.
So we have, as I said, infection present in the dermis and many times in the subcutaneous tissue. So, In these cases, it is advised to again do cultural insensitivity. OK, first thing that you do is psychology.
But make sure that you always think if you're going to do a systemic antibiotic. If you want to identify, which is the microorganism and you want to identify the sensitivity, the mic the sensitivity to the antibiotics. Now, of course, deep pyodermy can be, we should always associate topical therapy, wherever possible, might be, not for, for example, if the patient is very painful in the first few days, but then you can associate it two or three days later.
So topical therapy always according to, to the patient. And I, and most, most of the time we need antibiotics, as I said. In fact, I already, I treated sometimes cases of the derma just topically.
I can choose the, do ytology to to to choose the right topical antibacterial therapy. And again, we'll talk about this on the second presentation. And how we are going to do cytology.
So in the interdigital nodule, for example, here, this is the, the oxidate, the, the, the oxidate you clean outside and you squeeze in order to have The, the material, the oozing, material, in the digital, so, and we apply it, directly a microscopic slide or collect with the, with the, with the swab, it's also fine. Now, this can be again used here also for culture, because if you are thinking about it, I said, using antibiotics, if you need. You do want to do a culture?
And that the previous lesion was already open. So if you have cases where you see lesion, the nodules, the bulla. If they are still intact.
Go for those intact lesions. So, clean the surface, open the lesion with a needle. And pick the material for bacterial culture and do here a cytology from the same lesion using a microscopic slide.
So you want to do again, what you're going to see on that cytology, you are going to, to look for rods, you are going to look for staphylococci. You are going to see the neutrophils and sometimes the microphages. Now, sometimes it can be a bit harder in some cases, for example, to do a representative culture.
And because in, in some cases, you not going to squeeze here, you're not going to do the sample might not be what might not be the organ microorganism might not be on the surface. So in this case, which in acrylic dermatitis. It is advised, especially long-standing, which you have been treated several times.
It is advised or you can consider to do a culture based on a skin biopsy. So you collect the skin biopsy, you remove the epidermis, and you're going to ask the lab to do an aerobic culture. And the aerobic culture and fungal culture, so.
Make sure that you ask for bacteria, aerobic, and aerobic, and fungal culture if you're going to do, if you do biopsies. At the same time, don't only do also another sample, that will be the second sample for histopathology. And the histopathology, you want to confirm that you have here an infection.
#1. #2, you want to do a special staining, special staining, which should include special staining for fungal and potentially fastigious bacteria. Now, why is this, why we should be careful, especially in cases of the yoderma, because in case of deep pyoderma.
We might have negative bacteria involved such as Echoly pseudomonas. Sometimes a neurobes can be found. So, in this pandemic because we cannot predict the sensitivity of those micro microorganisms.
We need to identify them, we need to ask for a bacterial sensitivity. Now, as I said before, in the in the This is not the case. Normally, in the superficial bacterial folliculitis, so when there is a superficial paraderma.
To intermediate is the one that is involved. Typically, 90%. Other species might be involved will be Staph aure, Sta schleprae, and Sta coagulants, which was formerly called Stylococcal, leery subspecies quaagulants, and sometimes streptococcus.
So, this is the staff to intermediate to resume. It's the number one when it comes to official bioderma. Other stuff might be found, but in case of the bioderma, be aware that other kinds of other species of microorganisms might be involved.
So, in order to make sure that we have the right diagnosis. We will need. Number one, history of the patient.
And make sure that you ascertain if it is the first time or with a different bioderma. Make sure that in your physical examination, you characterise the type of pyoderma. Are we talking about surface?
The proficial or the bioderma because based on the type of pyoderma, your treatment approach might bed will be different. And only do pathology. Depending on the case, it might be necessary culture and sensitivity, especially we are considering antibiotics.
The cytology is the number one. The number one, the all the test that goes up in front. He did your very first test.
And it, the, the findings that are supportive of bioderma will be intracellular bacteria coca. That's the number one. Sometimes depending on the, and also needs this finding needs all this to be associated with the clinical signs.
Sometimes you might also have a pyoderma with extracellular bacteria with nuclear streaking, also called nuclear streaming. So we are talking about the degenerated neutrophil. Or in case of bacteria overgrowth, and we are talking in this case about surface pioderma, we have a large number of bacteria from regional stream in the absence of inflammatory cells.
So finally, they take, this, there are lots of advantage of pathology in canine bioderma. So this can be canine cytology can be done in the clinic very easy with immediate results. It's simple, it's economic, it's very easy to do, in most patients.
It will can confirm your clinical suspicion that all of bioderma with the presence of intracellular microorganisms. Or But you, make you pay attention. For example, if you, you really need to, you need to do a bacterial culture, for example, if there is bacili in the deep infection, bacili or rod is the same thing.
The other thing is that cytology. Will help you to interpret bacterial culture. Because if in the bacterial culture, for example, you have the, the bacterial culture was identified up to intermediate and equally, which sometimes happens.
And if in your cytology, you only have coca. Inside the neutrophil, then you should, you only need to be concerned about the the sensitivity of the stuff to the intermediate. Don't worry about, in that case about the E.
Coli, because it will be a contamination. Now, the pathology will also help to differentiate from other pathologies like be exfoliation. And many times, and I'll do this all the time.
When I monitor my patient, I will use psychology to always in the rechecked appointment to see the bacterial number decreasing or and disappearing along with the clinical signs. So it's very useful to monitor treatment and to check the patient. Finally, thank you very much for your attention.
I hope you enjoyed this presentation and I will be back with our second presentation about the treatment.