Canine parvovirus enteritis is one of the most deadly and common canine intestinal diseases worldwide. Widespread in the environment, it can be carried by uninfected hosts and eventually spread to dogs. Canine parvovirus vaccination effectively induces protective immunity in most dogs, but early vaccination may make puppies more susceptible to the virus by interfering with maternal antibodies. Current treatments include fluid rehydration, nutritional support, antiemetics, broad-spectrum antibiotics, and empiric deworming. Although inpatient care remains the gold standard, success rates have been recorded for more than 80% of patients treated on an outpatient basis.
Keywords: Virus; Inflammatory bowel disease. Immune; In the hospital
Sex： Male (not-castrated)
Age：8 months old
History： outdoor activities, no vaccination, no deworming,
The owner fed him for about one week and took him to the countryside. No playing with other animals at that time. Days in the past, the dog began to seem lethargic and weak. The owner found it vomited after feeding and then began to present with diarrhea. So decided to take her to the sanatorium. Vaccinate history is not completed.No deworming this year.
The feces before therapy
Body weight 19.0kg， temperature 38.6℃， respiratory rate was 45/min、heart rate：108 beats/min.No prominent murmurs in breathing and cardiophony. Mouth mucosa was pale， capillary refill time（CRT）=2s、body condition score（BCS）was 5/9, which cannot touch the ribs in palpation. The patient presented with depression, a dry coat, and a nose. Abdominal palpation turned into no outstanding atypical locating within the stomach. Dehydration was assessed to 7%, and palpation of arteria cruralis is weak.
Complete Blood Count (CBC) examination for Day 1
Interpretation: No obvious abnormality was observed in the leukocyte line. A mild higher HCT indicates consistency with the performance of dehydration. The loss of body fluid and insufficient water intake may be the reasons.
Idexx Catalyst biochemistry CHEM15
Interpretation: There was a slight increase in globulin and ALP. The rise in the globulin may be due to the immune reaction by the agent, and the growth of the ALP may be due to the young age.No apparent abnormalities in other biochemical indicators.
The result of the CRP testing
Interpretation: The increased CRP significantly indicates the existence of severe acute inflammation or tissue cell damage.
Blood agglutination test
Microscope of the blood gas
The PCR result of infectious examination
Canine parvovirus infection
According to the chief complaint, incomplete immunization, vomiting, diarrhea, and other infectious diseases are the primary direction of consideration. In addition to screening for small dogs, screening for another contagious diseases is also recommended if the patient did not experience recovery after treatment, such as distemper and canine crest. After excluding infectious diseases, consider other disease directions, such as pancreatitis, intestinal foreign body, hepatitis, etc.
1.Antimicrobial therapy： Ampicillin 22 mg/kg IV q 8 hrs
Antimicrobial agents are recommended when peripheral neutropenia increases the risk of sepsis and bacteria may translocate on damaged intestinal epithelium. Broad-spectrum antibiotics provide aerobic and anaerobic coverage.
2.Nutritional therapy： gastrointestinal recuperation diets
Early enteral nutritional support promotes intestinal cell recovery. In one study, patients showed improvement in weight gain after receiving nutrition (through a gastroesophageal feeding tube) 12 hours after admission; with Quick resolution of vomiting and diarrhea; Compared with patients who ate 12 hours after vomiting stopped, appetite and behavior returned to average earlier.
3.Analgesic therapy：lidocaine at 30μg/kg/min IV CRI
Patients with CPV infection often have visceral pain. Consider lidocaine with 30µg/kg/min IV CRI in combination with a partial mu agonist (e.g., Buprenorphine 0.01 mg/kg IV q for 8 hours). Avoid opioids, as they may cause intestinal obstruction in the doses necessary to provide pain relief.
4.Liquid therapy：LRS + 0.9% NaCl solution(1:1) 50mL/kg ivgtt
Fluid therapy is one of the essential components of supportive care. It is usually treated with intravenous fluids. The choice of initial juice is to balance isovadose bodies such as lactate Ringer’s solution. An isotonic fluid is administered at a rate that corrects dehydration; Material maintenance requirements; And makes up for the ongoing losses, which can be high in vomiting and diarrhea. Colloidal solutions can be used for refractory hypovolemia, hypoproteinemia, and intestinal edema
5.Anti-virus therapy：w-interferon 10mg/kg s.c q24hrs
Besides, oseltamivir is a neuraminidase inhibitor used in dogs with CPV infection; However, there is no clear therapeutic benefit. In a randomized clinical trial of 35 affected dogs treated with oseltamivir, there was no significant change in white blood cell counts. Although there was a significant decrease in white blood cell counts in the placebo-treated dogs, no difference was found in clinical outcomes.
The treatment of parvo-viral enteritis is mainly supportive until the clinical symptoms of vomiting and diarrhea are resolved. In general, improvements in clinical symptoms usually correspond to a rebound in white blood cell counts; However, the presence of adverse sequelae, such as aspiration pneumonia, persistent hypoglycemia, and hypoproteinemia with edema or intussusception, can lead to higher morbidity and more extended hospital stays.
The most aggressive treatment involves intravenous fluids to restore intravascular fluid volume status, replace interstitial fluid loss, and maintain good hydration, which is the gold standard for CPV therapy. Adjuvant therapy, in the form of antiemetics and gastric protectors, minimizes fluid loss, provides analgesia and nutrition, and prevents secondary bacterial infections caused by antibiotics, which are also essential factors in obtaining the best prognosis for diseased animals. Fluid therapy begins with the establishment of vascular access.
In addition to fluid therapy and enteral nutrition, antiemetics are essential in reducing vomiting in CPV-infected animals.
Animals with CPV enteritis are at high risk of bacterial translocation due to the collapse of intestinal villi and lack of protective immune function. Various bacteria (E. coli, Clostridium difficult, Salmonella) have been documented in septic animals with CPV enteritis. Broad-spectrum antibiotics are recommended for all diseased animals affected by CPV.
Enteral nutrition is essential to help prevent intestinal cell atrophy and provide nutrients needed for healing. Early enteral nutrition reduced morbidity and length of hospital stay in puppies with CPV enteritis.
Picture 3.The spirit of the patient after therapy,we can see he can eat and drink without vomit
Picture 4.The feces during therapy,the symptom of the diarrhea get better
The examination during the therapy
The flowing testing by Complete Blood Count (CBC) examination after therapy
The flowing testing by CRP examination after therapy
Reference Range（mg/L ）
One of the main challenges and limiting factors pet owners face in part therapy is the cost of hospitalization and treatment. Cases of parvoviral enteritis have been documented in socioeconomically disadvantaged areas, showing that economic conditions such as lack of education and vaccination may put these puppies at higher risk of contracting the disease. Whether to send a sick animal to a hospital for standard gold treatment, outpatient treatment, or euthanasia depends mainly on the client’s ability and willingness to pay for care.
The incubation period of CPV infection is about 7-14 days. Possible abnormalities with rapidly progressing clinical symptoms include lethargy, depression, anorexia, vomiting, diarrhea (usually profuse and hemorrhagic), fever, dehydration, tachycardia, tachypnea, dyspnea, abdominal pain, weak pulse, prolonged capillary refill time, altered mental status, and seizures. Complications such as hypovolemia, DIC, sepsis, thromboembolic disease, intussusception, congestive heart failure, systemic inflammatory response syndrome, shock, and death may occur.CPV infection is most common in puppies under six months of age; However, unvaccinated dogs of any age can develop clinical diseases. CPV is uncommon in adult dogs. Breeds at increased risk of CPV infection include Rottweilers, Dobermans, Labrador retrievers, American Staffordshire Terriers, and Arctic sled dogs. In one study, purebred dogs had a higher chance than mixed-breed dogs. There’s no record of sexual orientation.
Virus shed in the feces of subclinically infected feral and domestic dogs can be a potential source of infection for other dogs, especially in crowded or unsanitary conditions such as shelters or breeding kennels. Disinfection of environmental surfaces with 0.75% sodium hypochlorite solution can effectively reduce the spread of CPV in crowded canine areas such as animal hospitals and shelters. The only way to prevent infection is to isolate puppies at risk.
It is most important to educate clients to avoid contact between high-risk puppies and other dogs until they have undergone a complete vaccination program, as well-vaccinated adult dogs with normal feces may still expel CPV and be a potential source of exposure. It needs to be emphasized that vaccination is essential to prevent CPV infection. The American Animal Hospital Association considers the canine parvovirus vaccine a core vaccine. Get vaccinated. The modified live vaccine was given as early as six weeks of age and continued every 2-4 weeks until at least 16 weeks. The last vaccine in the series should be given at 16 weeks of age to avoid interference from maternal antibodies with the CPV-2b containing vaccine that produces immunity against CPV-2a and CPV-2c. For further information on canine parvovirus vaccination, see the AAHA’s 2022 Canine Vaccination Guidelines. In shelters and animal hospitals, staff should always wash their hands carefully and wear new gloves for each patient. Clothing, instruments, and the environment, such as thermometers, stethoscopes, infusion pumps, tables, cages, and cushions, should be carefully cleaned and disinfected regularly with cleaners and disinfectants that effectively inactivate CPVS.
For any diarrhoeal and sick animal, even if the feces are ELISA negative, isolation should be carried out while handling the ill animal by wearing special disposable gloves, hats, protective clothing, and boots to prevent cross-contamination and the spread of infection.
The prognosis for survival usually depends on the severity of clinical symptoms at the start of treatment. Clinical manifestations include hypovolemia, hypoperfusion, fever, low C-protein levels, elevated cortisol levels, and low thyroxine levels. Lymphocyte counts less than 1000/mL, hypoalbuminemia, associated with increased mortality, lymphocytic decline on admission, and hypoalbuminemia, associated with a prolonged hospital stay.
Overall, the survival prognosis is between 60 and 90 percent, depending on the study, the type of treatment, and the response of the individual diseased animal to treatment. Comorbidities such as canine coronavirus and gastrointestinal parasites also increase morbidity and mortality among infected animals. Recent outpatient strategies improve outcomes when clients’ financial constraints prevent hospitalization and aggressive care. Without treatment, the prognosis is grim, with mortality occurring in over 90% of infected animals.