{"id":1020,"date":"2014-07-01T00:41:53","date_gmt":"2014-07-01T00:41:53","guid":{"rendered":"http:\/\/phosdev.com\/todaysveterinarypractice\/?p=1020"},"modified":"2022-02-16T15:53:55","modified_gmt":"2022-02-16T15:53:55","slug":"diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/infectious-disease\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\/","title":{"rendered":"Diagnostic and Therapeutic Approach: Dogs Infected with Bordetella bronchiseptica and Canine Influenza Virus (H3N8)"},"content":{"rendered":"<p><em>Laura A. Nafe, DVM, MS, Diplomate ACVIM (Small Animal Internal Medicine)<\/em><br \/>\n<em> University of Wisconsin\u2013Madison<\/em><\/p>\n<hr \/>\n<p><span class=\"italic\">Bordetella bronchiseptica<\/span> and canine influenza virus (CIV) are common causes of infectious tracheobronchitis and, occasionally, pneumonia.<\/p>\n<p>Combined, these and other pathogens cause the canine infectious respiratory disease complex (CIRDC), often referred to as <span class=\"italic\">kennel cough or infectious tracheobronchitis<\/span>. The multitude of bacterial and viral organisms associated with CIRDC are listed in <strong><span class=\"bold\">Table 1<\/span><\/strong>.<\/p>\n<p>In general, morbidity for CIRDC is high with mortality being low. Severe cases can result in life-threatening respiratory compromise due to pneumonia.<\/p>\n<table border=\"0\" width=\"80%\" cellspacing=\"0\" cellpadding=\"5\">\n<tbody>\n<tr>\n<td class=\"bluboldheader\" colspan=\"2\" align=\"center\">Table 1. Bacterial &amp; Viral Pathogens Associated with CIRDC<sup>1,2<\/sup><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" bgcolor=\"#e9f4f8\">BACTERIA<\/td>\n<\/tr>\n<tr bgcolor=\"#d3e9f1\">\n<td colspan=\"2\">\n<ul>\n<li><em>Bordetella bronchiseptica<\/em><\/li>\n<li>Mycoplasmas (<em>Mycoplasma cynos<\/em>)<\/li>\n<li><em>Streptococcus equi<\/em> (subspecies <em>zooepidemicus<\/em>)<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" bgcolor=\"#e9f4f8\">CANINE VIRUSES<\/td>\n<\/tr>\n<tr bgcolor=\"#d3e9f1\">\n<td valign=\"top\">\n<ul>\n<li>Adenovirus 2<\/li>\n<li>Bocavirus<\/li>\n<li>Coronavirus (pantropic strain)<\/li>\n<li>Distemper virus<\/li>\n<li>Hepacivirus<\/li>\n<\/ul>\n<\/td>\n<td valign=\"top\">\n<ul>\n<li>Herpesvirus<\/li>\n<li>Influenza virus<\/li>\n<li>Parainfluenza virus<\/li>\n<li>Pneumovirus<\/li>\n<li>Reovirus<\/li>\n<li>Respiratory coronavirus<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3><\/h3>\n<h3><strong><span class=\"bluboldheader\">DISEASE PROFILE<\/span><\/strong><\/h3>\n<p><strong><span class=\"GreenAqua\"><em>Bordetella bronchiseptica<\/em><\/span><\/strong><br \/>\n<span class=\"italic\">B bronchiseptica<\/span>, a primary respiratory pathogen, is a gram-negative, aerobic coccobacillus that is often implicated as a complicating factor in dogs with concurrent viral respiratory infections.<sup>1<\/sup><\/p>\n<p><span class=\"bold\">Virulence Factors<\/span>. After B bronchiseptica colonizes the airways, it can evade the immune system by expressing various virulence factors that lead to:<sup>1,3<\/sup><\/p>\n<ul>\n<li>Direct cellular injury of respiratory epithelium<\/li>\n<li>Impaired immune recognition<\/li>\n<li>Disrupted immune clearance.<\/li>\n<\/ul>\n<p>Perhaps one of the most unique and important effects of these virulence factors is the ability to paralyze the mucociliary apparatus\u2014a key component of the respiratory tract\u2019s local defense mechanisms\u2014and create acquired ciliary dysfunction.<sup>1,3,4<\/sup><\/p>\n<p>The mucociliary apparatus moves inhaled debris and opportunistic pathogens away from the lower respiratory tract, decreasing the risk of colonization by these organisms and the potential for associated pneumonia. By paralyzing the cilia, <span class=\"italic\">B bronchiseptica<\/span> not only improves its own virulence and chance for colonization, but also predisposes the patient to opportunistic infections of the lower respiratory tract.<sup>1<\/sup><\/p>\n<p><span class=\"bold\">Disease Spectrum<\/span>. The spectrum of disease that results from infection with<span class=\"italic\"> B bronchiseptica<\/span> is wide, with some dogs manifesting mild disease characterized by nasal discharge and intermittent cough and others developing severe pneumonia that can be life threatening.<\/p>\n<h3><strong><span class=\"GreenAqua\">Canine Influenza Virus<\/span><\/strong><\/h3>\n<p>CIV (H3N8) is most closely related to equine influenza virus, which suggests that a direct transmission from horses to dogs occurred.<sup>5<\/sup> CIV was first detected in racing greyhounds in Florida, and since has become more prevalent among pet dogs, especially those in kennels, shelters, and multidog households.<sup>6<\/sup><\/p>\n<p><strong><span class=\"bold\">Prevalence<\/span><\/strong>. The prevalence of serum antibodies against CIV in dogs with no clinical signs of respiratory disease has been shown to be 0.5% to 3%, depending on the risk of the population being evaluated (<strong><span class=\"bold\">Figure 1<\/span><\/strong>).<sup>6<\/sup> Note that a positive antibody titer in a population of dogs with no signs of respiratory disease likely indicates prior exposure to the virus, rather than active infection.<\/p>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/07\/F03_Fig1.png\"><img fetchpriority=\"high\" decoding=\"async\" class=\"alignnone size-medium wp-image-6527\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/07\/F03_Fig1-300x190.png\" alt=\"F03_Fig1\" width=\"300\" height=\"190\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/07\/F03_Fig1-300x190.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/07\/F03_Fig1.png 460w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p>In shelter dogs with signs of respiratory disease, seroprevalence is as high as 50%, depending on length of time since intake to the shelter.<sup>7,8<\/sup> Given the population, these patients are likely co-infected with other common viral and bacterial pathogens that encompass the CIRDC (<strong><span class=\"bold\">Table 1<\/span><\/strong>).<\/p>\n<p>However, veterinarians should recognize that the prevalence of CIV is much lower in client-owned dogs with respiratory signs, especially if they have not been recently exposed in a shelter or boarding kennel.<\/p>\n<p><strong><span class=\"bold\">Geographic Location<\/span><\/strong>. CIV is associated with geographic hot spots, and practitioners should become familiar with the particular areas in which it has been identified. In a recent study, seroprevalence of CIV in dogs with influenza-like illness was highest in the northeast, west, and southwest United States, with the highest representation being in New York, Colorado, and Florida.<sup>7<\/sup><\/p>\n<div class=\"orange-box\">\n<h2><span class=\"aquabold\">Considerations in Hospital<\/span><\/h2>\n<p>Considering modes of transmission and environmental survival of the agent is important when discussing management of patients in hospital. Clinicians should take precautions when handling these patients and make efforts to limit exposure throughout the hospital.<\/p>\n<ul>\n<li>Hospitalize patients in isolation facilities within the clinic to limit exposure to other dogs, especially those that are immunocompromised. As much as possible, manage infected patients as outpatients.<\/li>\n<li>Ensure that staff wear protective clothing, such as gloves and disposable gowns, when working with infectious patients.<\/li>\n<li>Keep the veterinary team from handling other patients of the same species during the same shift in which they have handled infectious patients.<\/li>\n<li>Limit contact between critical patients that require oxygen therapy and close monitoring\u2014who are not candidates for an isolation area\u2014and other patients in the critical care unit.<\/li>\n<li>Implement precautions to limit fomite contamination.<\/li>\n<\/ul>\n<p>An in-depth review of preventing CIV in the hospital setting is presented in the article Is Your Practice Proactive or Reactive? (January\/February 2012), available at tvpjournal.com (Article Library).<\/p>\n<\/div>\n<h2><strong><span class=\"bluboldheader\">RISK FACTORS<\/span><\/strong><\/h2>\n<p>Both CIV and <span class=\"italic\">B bronchiseptica<\/span> infections are highly contagious, and dogs of any age and breed may become infected. Those at most risk for exposure and infection include:<\/p>\n<ul>\n<li>Dogs housed in boarding facilities, shelters, kennels, and pet shops<sup>8,9<\/sup><\/li>\n<li>Puppies, especially those in the above housing situations, due to reduced immunity (both local and systemic), which may result in severe infection and death.<sup>9<\/sup><\/li>\n<\/ul>\n<p>Factors that contribute to risk and severity of infection in puppies include:<\/p>\n<ul>\n<li>Close contact with other dogs and puppies<\/li>\n<li>Immature immune systems<\/li>\n<li>Immune dysfunction due to concurrent infections (viral, bacterial, parasitic).<\/li>\n<\/ul>\n<p>Because puppies housed in shelters and pet shops are often in closed ventilation spaces with other puppies from various environments, they are at highest risk.<\/p>\n<h2><strong><span class=\"bluboldheader\">PREVENTION<\/span><\/strong><\/h2>\n<p>Vaccination can help protect against infection and reduce severity of clinical disease. Read Dr. Richard Ford\u2019s article, <span class=\"bolditalic\">Kennel Cough<\/span><span class=\"bold\"> Revisited<\/span>, for a discussion on current advances in vaccination for canine respiratory disease.<\/p>\n<h2><strong><span class=\"bluboldheader\">TRANSMISSION<\/span><\/strong><\/h2>\n<h3><strong><span class=\"GreenAqua\">Mode of Transmission<\/span><\/strong><\/h3>\n<p>Transmission of <span class=\"italic\">B bronchiseptica<\/span> and CIV occurs via:<sup>1<\/sup><\/p>\n<ul>\n<li>Oronasal contact with other dogs, caregivers, or fomites<\/li>\n<li>Inhalation of aerosolized microdroplets of respiratory secretions.<\/li>\n<\/ul>\n<p>In high-density housing situations, direct contact among dogs is most common. Less commonly, fomites serve as a source of transmission.<\/p>\n<h3><strong><span class=\"GreenAqua\">Shedding &amp; Survival<\/span><\/strong><\/h3>\n<p>Most viruses begin shedding within 2 days post infection, and may continue to shed for 6 to 10 days before viral load decreases.<sup>5<\/sup> <span class=\"italic\">B bronchiseptica<\/span> can survive in the environment for extended periods of time,<sup>1<\/sup> and can be shed from dogs that appear healthy because it has the ability to elude the immune system for weeks to months.<\/p>\n<h2><strong><span class=\"bluboldheader\">INITIAL DIAGNOSIS<\/span><\/strong><\/h2>\n<p>Although definitive diagnosis is pursued in some cases, a suspected clinical diagnosis can often be made based on:<\/p>\n<ul>\n<li>Clinical signs<\/li>\n<li>Assessment of risk\/exposure<\/li>\n<li>Response to appropriate treatment.<\/li>\n<\/ul>\n<h3><strong><span class=\"GreenAqua\">Clinical Presentation<\/span><\/strong><\/h3>\n<p>Clinical presentation varies among individual cases of <span class=\"italic\">B bronchiseptica<\/span> and CIV infections, based on severity and concurrent bacterial and\/or viral pathogens involved. Clinical signs include:<\/p>\n<ul>\n<li>Acute onset of a nonproductive cough (most common clinical sign)<\/li>\n<li>Serous or mucopurulent nasal and\/or ocular discharge<\/li>\n<li>Sneezing<\/li>\n<li>Tachypnea, respiratory distress, systemic illness, and fever (more severe cases).<\/li>\n<\/ul>\n<h3>Thoracic Radiographs<\/h3>\n<p>Thoracic radiographs may support a diagnosis of B bronchiseptica or CIV (<span class=\"bold\">Table 2<\/span>) but, more important, help to rule out other causes of acute cough.<br \/>\nThoracic radiographs are recommended for any patient with:<\/p>\n<ul>\n<li>Persistent (&gt; 1\u20132 weeks) or worsening cough<\/li>\n<li>Respiratory distress<\/li>\n<li>Signs of systemic illness (eg, lethargy, decreased appetite).<\/li>\n<\/ul>\n<p>In more severe cases, radiographs are necessary to evaluate if pneumonia is present.<\/p>\n<p>Thoracic radiographs are <span class=\"bolditalic\">not<\/span> typically indicated in otherwise healthy patients with acute onset of only coughing (no signs of respiratory distress, tachypnea, fever, or systemic illness).<\/p>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/07\/F03_Fig2.png\"><img decoding=\"async\" class=\"alignnone wp-image-6529 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/07\/F03_Fig2.png\" alt=\"F03_Fig2\" width=\"560\" height=\"275\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/07\/F03_Fig2.png 560w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/07\/F03_Fig2-300x147.png 300w\" sizes=\"(max-width: 560px) 100vw, 560px\" \/><\/a><\/p>\n<h3><strong><span class=\"GreenAqua\">Laboratory Analysis<\/span><\/strong><\/h3>\n<p>In complicated cases, a complete blood count and serum biochemical profile should be performed to assess systemic health, but these diagnostics are not generally necessary for diagnosis of <span class=\"italic\">B bronchiseptica<\/span> or CIV.<\/p>\n<h2><strong><span class=\"bluboldheader\">DEFINITIVE DIAGNOSIS<\/span><\/strong><\/h2>\n<h3><span class=\"GreenAqua\">Bordetella bronchiseptica<\/span><\/h3>\n<p>Definitive diagnosis of <span class=\"italic\">B bronchiseptica<\/span> is based on isolation of the pathogen from aerobic culture of respiratory secretions.<\/p>\n<p><span class=\"bold\">Sample Collection<\/span>. For cytology and culture of bacteria, obtain airway samples via:<\/p>\n<ul>\n<li>Transtracheal or endotracheal wash<\/li>\n<li>Bronchoalveolar lavage (blind or bronchoscopy-guided).<\/li>\n<\/ul>\n<p>Patients with unresponsive focal pneumonia may require bronchoscopy-guided bronchoalveolar lavage fluid collection to obtain a sample that accurately represents the causative pathogen.<\/p>\n<p>Nasal, oral, oropharyngeal, and nasopharyngeal bacterial cultures are <span class=\"bolditalic\">not<\/span> recommended, as they yield growth of normal respiratory flora, making it difficult to determine the primary pathogen causing disease. In addition, deep oral swabs are <span class=\"bolditalic\">not<\/span> recommended in puppies with community-acquired pneumonia.<sup>10<\/sup><\/p>\n<p><span class=\"italic\">Mycoplasma<\/span> species cannot be seen on cytology and are difficult to culture; consider submitting a mycoplasma polymerase chain reaction (PCR) or mycoplasma culture, when indicated.<\/p>\n<p><span class=\"bold\">Sample Preparation<\/span>. Following collection of an airway sample, cytology should be performed as quickly as possible (ideally within hours) to reduce disruption of the cells.<sup>11,12<\/sup>Because many samples are fairly low in cellularity, a concentrated population of representative cells can be evaluated by a cytospin or line smear preparation or manual smearing of pelleted cells.<\/p>\n<p>If the clinician is planning to send the sample to a clinical pathologist for evaluation, the sample should be stored at 4\u00b0C and shipped overnight (ideally processed within 24 hours after collection).<sup>12<\/sup><\/p>\n<p><span class=\"bold\">Sample Evaluation<\/span>. Evaluate the sample for the differential cell count and presence of bacteria or other infectious organisms. B bronchiseptica has a characteristic cytologic appearance, with the coccobacilli adhering to respiratory epithelial cells (<strong><span class=\"bold\">Figure 3<\/span><\/strong>).<\/p>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/07\/F03_Fig3.png\"><img decoding=\"async\" class=\"alignnone size-medium wp-image-6528\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/07\/F03_Fig3-295x300.png\" alt=\"F03_Fig3\" width=\"295\" height=\"300\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/07\/F03_Fig3-295x300.png 295w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/07\/F03_Fig3.png 300w\" sizes=\"(max-width: 295px) 100vw, 295px\" \/><\/a><\/p>\n<h3><strong><span class=\"GreenAqua\">Canine Influenza Virus<\/span><\/strong><\/h3>\n<p>Definitive diagnosis of CIV is based on real-time PCR (RT-PCR) identification of CIV from respiratory secretions. RT-PCR (nasal or pharyngeal swabs) has replaced viral isolation via tissue culture or serology due to:<sup>13,14<\/sup><\/p>\n<ul>\n<li>Difficulty in obtaining samples for culture antemortem<\/li>\n<li>Concerns about previous exposure clouding results of serologic testing.<\/li>\n<\/ul>\n<p>Definitive diagnosis is a challenge in some patients because viral shedding declines within approximately 7 to 10 days post exposure, often prior to onset of clinical signs, resulting in a false\u2013negative RT-PCR.<sup>5<\/sup><\/p>\n<h2><strong><span class=\"bluboldheader\">ANTIMICROBIAL THERAPY<\/span><\/strong><\/h2>\n<p>Antimicrobial therapy can be important in patients with suspected<span class=\"italic\"> B bronchiseptica<\/span> infections or, if CIV or another viral respiratory pathogen is suspected, to treat secondary bacterial infections.<\/p>\n<h3><strong><span class=\"GreenAqua\">Doxycycline<\/span><\/strong><\/h3>\n<p>Doxycycline (<span class=\"bold\">5 mg\/kg PO Q 12 H<\/span> or <span class=\"bold\">10 mg\/kg PO Q 24 H<\/span>) is my treatment of choice for <span class=\"italic\">B bronchiseptica<\/span> and most infectious respiratory diseases.<\/p>\n<p><span class=\"bold\">Enamel Discoloration<\/span>. Clinicians are often concerned about using doxycycline in young patients due to its potential to discolor enamel of developing teeth; however, it is less likely to cause discoloration compared to other tetracycline antibiotics. Limiting treatment to &lt; 10 days further reduces the risk.<sup>1<\/sup><\/p>\n<p><span class=\"bold\">Doxycycline Resistance<\/span>. Some isolates of <span class=\"italic\">B bronchiseptica<\/span> are doxycycline-resistant, and patients may require treatment with a fluoroquinolone (enrofloxacin or marbofloxacin), azithromycin, or chloramphenicol; however, management of these patients should ideally be based on culture and susceptibility of airway samples.<\/p>\n<h3><strong><span class=\"GreenAqua\">Other Tetracyclines<\/span><\/strong><\/h3>\n<p>The current shortage of doxycycline has dramatically increased its cost; therefore, it is a less desirable option for owners with financial concerns. Most clinicians are using other tetracycline drugs, such as minocycline, in place of doxycycline for treatment of tick-borne disease, but the pharmacokinetics of minocycline for various disease conditions in dogs is currently under investigation.<sup>15<\/sup><\/p>\n<p>Dosing for treatment of bordetellosis is currently unknown; recommended treatment of methicillin-resistant staphylococcal infections is <span class=\"bold\">5 mg\/kg PO Q 12 H<\/span> or <span class=\"bold\">10 mg\/kg PO Q 24 H<\/span>.<\/p>\n<h3><strong><span class=\"GreenAqua\">Other Antibiotics<\/span><\/strong><\/h3>\n<p>Other antibiotics to consider include:<\/p>\n<ul>\n<li>Azithromycin<\/li>\n<li>Fluoroquinolones<\/li>\n<li>Amoxicillin-clavulanate<\/li>\n<li>Cephalosporins.<\/li>\n<\/ul>\n<p>Note that tetracyclines and fluoroquinolones readily cross the blood\u2013bronchus barrier, but penicillins and cephalosporins do not and, therefore, may be associated with treatment failure in some cases. Although fluoroquinolones are less desirable in young animals due to their effects on cartilage development, this risk may be of less concern in patients with life-threatening infections.<sup>16<\/sup><\/p>\n<div class=\"orange-box\">\n<h2><span class=\"bluboldheader\"><b>MANAGING CRITICALLY ILL DOGS<\/b><\/span><\/h2>\n<p>When managing critically ill dogs with B bronchiseptica and\/or CIV, implement the following supportive therapy:<\/p>\n<p><strong><span class=\"aquabold\">1. Provide Increased Oxygen Concentrations<\/span><\/strong><br \/>\nSevere cases of B bronchiseptica and CIV may present in respiratory distress and require oxygen supplementation.Assess oxygenation via pulse oximetry and\/or arterial blood gas analysis. Pulse oximetry is noninvasive and available in most practices, but does not always provide an accurate measurement.Provide oxygen supplementation to patients with an:<\/p>\n<ul>\n<li>SpO2 of &lt; 92% to 94% or PaO2 &lt; 80 mm Hg, especially if signs of respiratory difficulty are present<\/li>\n<li>Increase in respiratory effort, even if the patient is oxygenating appropriately.<\/li>\n<\/ul>\n<p>Common methods of oxygen supplementation in hospital include oxygen cage, tent, nasal cannula(s), and nasal prongs. Nasal cannula or prongs may work best for highly contagious patients that must be isolated, but require supervision to ensure the catheter does not become dislodged (<strong>Figure 4<\/strong>).<\/p>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/07\/f03_fig04.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-6530\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/07\/f03_fig04-300x258.png\" alt=\"f03_fig04\" width=\"300\" height=\"258\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/07\/f03_fig04-300x258.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/07\/f03_fig04.png 360w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p><strong><span class=\"aquabold\">2. Improve Clearance of Respiratory Secretions<\/span><\/strong><br \/>\nCritical patients often lose fluids through the respiratory tract, especially if they are febrile, leading to increased viscosity of secretions and reduced ciliary clearance. Initiate IV fluids to replace fluids lost and improve clearance of respiratory secretions.<\/p>\n<p>Nebulization with sterile saline (6\u201310 mL) results in a liquid particulate suspension that improves clearance of tracheal and bronchial secretions. Nebulization followed by coupage may be performed for 15 to 20 minutes every 4 to 8 hours in hospitalized patients; owners may rent or purchase a handheld jet nebulizer for use at home.<\/p>\n<p><span class=\"aquabold\"><strong>3. Treat Primary or Secondary Bacterial Pathogens<\/strong> <\/span><br \/>\nAntibiotic therapy is essentially the same for all patients (see ANTIMICROBIAL THERAPY); however, injectable antibiotics should be considered for critically ill patients, due to associated gastrointestinal upset and poor bioavailability of oral antibiotics in anorexic patients. Fluoroquinolones (enrofloxacin, ciprofloxacin) may be preferred for injection because, compared to doxycycline, they provide more broad spectrum coverage for gram-negative organisms, are unlikely to result in phlebitis, and are less expensive.<\/p>\n<\/div>\n<h2><strong><span class=\"bluboldheader\">ADDITIONAL THERAPIES<\/span><\/strong><\/h2>\n<h3><span class=\"GreenAqua\">Glucocorticoids &amp; Cough Suppressants<\/span><\/h3>\n<p>Anti-inflammatory glucocorticoids and\/or cough suppressants may be indicated for patients with infectious tracheobronchitis or suspected tracheitis secondary to frequent coughing. Ensure the patient has no evidence of pneumonia and is otherwise systemically healthy before intervening with these therapies.<\/p>\n<p>Most patients with CIRDC do <span class=\"bolditalic\">not<\/span> require these therapies, and I do <span class=\"bolditalic\">not<\/span> recommend using oral\/inhaled corticosteroids or cough suppressants in patients with moderate to severe <span class=\"italic\">B bronchiseptica<\/span> infection or CIV, especially if pneumonia has developed.<\/p>\n<p>Cough suppressants, in particular, are contraindicated in patients with bronchopneumonia, as suppression of cough can prevent clearance of bacteria, worsen disease, and\/or delay recovery.<\/p>\n<h3><strong><span class=\"GreenAqua\">Bronchodilators<\/span><\/strong><\/h3>\n<p>Methylxanthines (eg, theophylline, aminophylline) and beta-2 agonists are bronchodilators that prevent bronchospasm. There is evidence that methylxanthines improve ventilation and diaphragmatic contractility in dogs, which may result in improved PaCO<sub>2<\/sub> levels in severely affected puppies; however, there is no evidence of benefit in patients with uncomplicated CIRDC.<sup>17<\/sup><\/p>\n<p>If considering use of a bronchodilator in a patient with CIRDC, I prefer methlyxanthines due to their other potentially beneficial effects, including anti-inflammatory properties, improved mucociliary clearance, and improved diaphragmatic contractility.<sup>17<\/sup> Unlike cats and humans, dogs do not develop true smooth muscle bronchoconstriction, and therefore, beta-2-agonists are not useful in the management of canine respiratory disease.<\/p>\n<p>In my opinion, bronchodilator therapy, while extremely important in management of feline lower airway disease, has limited value in canine respiratory disease and may have undesirable adverse effects (cardiac, gastrointestinal). Therefore, I do <span class=\"bolditalic\">not<\/span> recommend bronchodilators for treatment of infectious tracheobronchitis or pneumonia caused by <span class=\"italic\">B bronchiseptica<\/span> or CIV.<\/p>\n<h3><strong><span class=\"GreenAqua\">Expectorants<\/span><\/strong><\/h3>\n<p>Aerosolized or oral expectorant or mucolytic therapy is often instituted in cases of canine respiratory diseases that result in excessive tracheal and\/or bronchial secretions.<\/p>\n<p>However, I do <span class=\"bolditalic\">not<\/span> recommend therapy with expectorants because:<\/p>\n<ul>\n<li>Nebulized N-acetylcysteine can be irritating and result in bronchospasm, further worsening tracheobronchitis and coughing.<\/li>\n<li>Guaifenesin, an expectorant often paired with a cough suppressant, has no scientific or anecdotal (that I have observed) evidence supporting its use in patients with <span class=\"italic\">B bronchiseptica<\/span> or CIV.<\/li>\n<\/ul>\n<h3><strong><span class=\"GreenAqua\">Antiviral Agents<\/span><\/strong><\/h3>\n<p>The safety and efficacy of specific antiviral agents, such as neuroaminidase inhibitors (eg, oseltamivir phosphate, zanaminir) has not been evaluated in dogs.<sup>1<\/sup> Therefore, these agents<span class=\"bolditalic\">cannot<\/span> be recommended for dogs with CIV or other respiratory viral diseases.<\/p>\n<h3><strong><span class=\"GreenAqua\">Intranasal Vaccines<\/span><\/strong><\/h3>\n<p>There are anecdotal reports promoting administration of the intranasal <span class=\"italic\">B bronchiseptica<\/span> vaccine in dogs with CIRDC. However, to date, there are no controlled studies that support its use as a \u201ctherapeutic\u201d intervention in dogs with <span class=\"italic\">B bronchiseptica<\/span> infection or CIV and, in critical patients with this infection or virus, intranasal vaccine administration may worsen the course of disease because the immune system is already compromised, and an immune response places additional stress on the system.<\/p>\n<p>CIRDC = canine infectious respiratory disease complex; CIV = canine influenza virus; PaCO2 = arterial partial pressure of carbon dioxide; PaO2 = arterial partial pressure of oxygen; PCR = polymerase chain reaction; RT-PCR = real-time PCR; SpO2 = hemoglobin oxygenation saturation measured by pulse oximetry<\/p>\n<h3 class=\"references\">References<\/h3>\n<ol>\n<li class=\"references\">Ford RB. Canine infectious tracheobronchitis. In Greene CE (ed): <em><span class=\"italic\">Infectious Diseases of the Dog and Cat<\/span>,<\/em> 4th ed. St. Louis: Saunders, 2012, pp. 55-65.<\/li>\n<li class=\"references\">Priestnall SL, Mitchell JA, Walker CA, et al. New and emerging pathogens in canine infectious respiratory disease. <em><span class=\"italic\">Vet Pathol<\/span> <\/em>2013 [Epub ahead of print].<\/li>\n<li class=\"references\">Mattoo S, Cherry JD. Molecular pathogenesis, epidemiology, and clinical manifestation of respiratory infections due to Bordetella pertussis and other Bordetella subspecies. <em><span class=\"italic\">Clin Microbiol Rev<\/span><\/em> 2005; 18:326-382.<\/li>\n<li class=\"references\">Anderton TI, Maskell DJ, Preston A. Ciliostasis is a key early event during colonization of canine tracheal tissue by Bordetella bronchiseptica. <em><span class=\"italic\">Microbiol<\/span> <\/em>2004; 150:2843-2855.<\/li>\n<li class=\"references\">Crawford PC, Dubovi EJ, Castleman WL, et al. Transmission of equine influenza virus to dogs.<em> <span class=\"italic\">Science<\/span> <\/em>2005; 310:482-485.<\/li>\n<li class=\"references\">Serra VF, Stanzani G, Smith G, et al. Point seroprevelence of canine influenza virus H3N8 in dogs participating in a flyball tournament in Pennsylvania. <em><span class=\"italic\">JAVMA<\/span><\/em> 2011; 238:726-730.<\/li>\n<li class=\"references\">Anderson TC, Crawford PC, Dubovi EJ, et al. Prevalence of and exposure factors for seropositivity to H3N8 canine influenza virus in dogs with influenza-like illness in the United States. <em><span class=\"italic\">JAVMA <\/span><\/em>2013; 242:209-216.<\/li>\n<li class=\"references\">Holt DE, Mover MR, Brown DC. Serologic prevalence of antibodies against canine influenza virus (H3N8) in dogs in a metropolitan animal shelter. <em><span class=\"italic\">JAVMA<\/span><\/em> 2010; 237:71-73.<\/li>\n<li class=\"references\">Radhakrishnan A, Drobatz KJ, Culp WT, et al. Community-acquired infectious pneumonia in puppies: 65 cases (1993-2002). <em><span class=\"italic\">JAVMA<\/span><\/em> 2007; 230:1493-1497.<\/li>\n<li class=\"references\">Sumner CM, Rozanski EA, Sharp CR, et al. The use of deep oral swabs as a surrogate for transoral tracheal wash to obtain bacterial cultures in dogs with pneumonia. <span class=\"italic\">J <em>Vet Emerg Crit Care<\/em><\/span> 2011; 21:515-520.<\/li>\n<li class=\"references\">Dehard S, Bernaerts F, Peeters D, et al. Comparison of bronchoalveolar lavage cytospins and smears in dogs and cats. <em><span class=\"italic\">JAAHA<\/span><\/em> 2008; 44:285-294.<\/li>\n<li class=\"references\">Nafe LA, DeClue AE, Reinero CR. Storage alters feline bronchoalveolar lavage fluid cytological analysis. <em><span class=\"italic\">J Feline Med Surg<\/span><\/em> 2011; 13:94-100.<\/li>\n<li class=\"references\">Anderson TC, Crawford PC, Katz JM, et al. Diagnostic performance of the canine influenza A virus subtype H3N8 hemagglutination inhibition assay. <em><span class=\"italic\">J Vet Diagn Invest<\/span> <\/em>2012; 24:499-508.<\/li>\n<li class=\"references\">Pecoraro HL, Spindel ME, Bennett S, et al. Evaluation of virus isolation, one-step real-time reverse transcription polymerase chain reaction assay, and two rapid influenza diagnostic tests for detecting canine Influenza A virus H3N8 shedding in dogs. <span class=\"italic\">J Vet Diagn Invest<\/span> 2013; 25:402-406.<\/li>\n<li class=\"references\">Maaland MG, Guardabassi L, Papich MG. Minocycline pharmacokinetics and pharmacodynamics in dogs: Dosage recommendations for treatment of methicillin-resistant Staphylococcus pseudintermedius infections. <em><span class=\"italic\">Vet Dermatol<\/span> <\/em>2014; 25:182-190.<\/li>\n<li class=\"references\">Lim S, Hossain MA, Park J, et al. The effects of enrofloxacin on canine tendon cells and chondrocytes proliferation in vitro.<em><span class=\"italic\"> Vet Res Commun<\/span> <\/em>2008; 32:243-253.<\/li>\n<li class=\"references\">Jagers JV, Hawes HG, Easton PA. Aminophylline increases ventilation and diaphragm contractility in awake canines. <em><span class=\"italic\">Respir Physiol Neurobiol<\/span><\/em> 2009; 167:273-280.<\/li>\n<\/ol>\n<div class=\"references\"><span class=\"author-bio\" style=\"color: #000000\"><strong><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/07\/F03_B.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-6531\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/07\/F03_B.png\" alt=\"F03_B\" width=\"100\" height=\"115\" \/><\/a>Laura A. Nafe<\/strong><span class=\"italic\">, DVM, MS, Diplomate ACVIM (Small Animal Internal Medicine), is a clinical instructor in small animal internal medicine at University of Wisconsin SVM\u2013Madison. She received her DVM from University of Missouri then completed an internship in small animal medicine and surgery at North Carolina State University, before completing a residency in small animal internal medicine at University of Missouri.<\/span><\/span><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Severe cases of kennel cough are highly contagious and can result in life-threatening respiratory compromise.<\/p>\n","protected":false},"author":1,"featured_media":3047,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"iawp_total_views":4139,"footnotes":""},"categories":[367],"tags":[13],"class_list":["post-1020","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-july-august-2014","tag-peer-reviewed","column-features","clinical_topics-infectious-disease"],"acf":{"hide_sidebar":false,"hide_sidebar_ad":false,"hide_all_ads":false},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.7 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Diagnostic and Therapeutic Approach: Dogs Infected with Bordetella bronchiseptica and Canine Influenza Virus (H3N8) | Today&#039;s Veterinary Practice<\/title>\n<meta name=\"description\" content=\"Severe cases of kennel cough are highly contagious and can result in life-threatening respiratory compromise. Here&#039;s how to manage critically ill dogs.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Diagnostic and Therapeutic Approach: Dogs Infected with Bordetella bronchiseptica and Canine Influenza Virus (H3N8)\" \/>\n<meta property=\"og:description\" content=\"Severe cases of kennel cough are highly contagious and can result in life-threatening respiratory compromise. Here&#039;s how to manage critically ill dogs.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/infectious-disease\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\/\" \/>\n<meta property=\"og:site_name\" content=\"Today&#039;s Veterinary Practice\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/todaysveterinarypractice\" \/>\n<meta property=\"article:published_time\" content=\"2014-07-01T00:41:53+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2022-02-16T15:53:55+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/03\/Figure-3_header.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"800\" \/>\n\t<meta property=\"og:image:height\" content=\"540\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"16 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/infectious-disease\\\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/infectious-disease\\\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\\\/\"},\"author\":{\"name\":\"\",\"@id\":\"\"},\"headline\":\"Diagnostic and Therapeutic Approach: Dogs Infected with Bordetella bronchiseptica and Canine Influenza Virus (H3N8)\",\"datePublished\":\"2014-07-01T00:41:53+00:00\",\"dateModified\":\"2022-02-16T15:53:55+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/infectious-disease\\\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\\\/\"},\"wordCount\":3131,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/infectious-disease\\\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/wp-content\\\/uploads\\\/sites\\\/4\\\/2014\\\/03\\\/Figure-3_header.jpg\",\"keywords\":[\"Peer Reviewed\"],\"articleSection\":[\"July\\\/August 2014\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/infectious-disease\\\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\\\/#respond\"]}]},{\"@type\":[\"WebPage\",\"MedicalWebPage\"],\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/infectious-disease\\\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\\\/\",\"url\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/infectious-disease\\\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\\\/\",\"name\":\"Diagnostic and Therapeutic Approach: Dogs Infected with Bordetella bronchiseptica and Canine Influenza Virus (H3N8) | Today&#039;s Veterinary Practice\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/infectious-disease\\\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/infectious-disease\\\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/wp-content\\\/uploads\\\/sites\\\/4\\\/2014\\\/03\\\/Figure-3_header.jpg\",\"datePublished\":\"2014-07-01T00:41:53+00:00\",\"dateModified\":\"2022-02-16T15:53:55+00:00\",\"description\":\"Severe cases of kennel cough are highly contagious and can result in life-threatening respiratory compromise. Here's how to manage critically ill dogs.\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/infectious-disease\\\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/infectious-disease\\\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/infectious-disease\\\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\\\/#primaryimage\",\"url\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/wp-content\\\/uploads\\\/sites\\\/4\\\/2014\\\/03\\\/Figure-3_header.jpg\",\"contentUrl\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/wp-content\\\/uploads\\\/sites\\\/4\\\/2014\\\/03\\\/Figure-3_header.jpg\",\"width\":800,\"height\":540},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/infectious-disease\\\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Diagnostic and Therapeutic Approach: Dogs Infected with Bordetella bronchiseptica and Canine Influenza Virus (H3N8)\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#website\",\"url\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/\",\"name\":\"Today's Veterinary Practice\",\"description\":\"Peer-Reviewed Veterinary Journal\",\"publisher\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#organization\",\"name\":\"Today's Veterinary Practice\",\"url\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/todaysveterinarypractice.com\\\/wp-content\\\/uploads\\\/sites\\\/4\\\/2022\\\/01\\\/tvp-logo.png\",\"contentUrl\":\"https:\\\/\\\/todaysveterinarypractice.com\\\/wp-content\\\/uploads\\\/sites\\\/4\\\/2022\\\/01\\\/tvp-logo.png\",\"width\":179,\"height\":89,\"caption\":\"Today's Veterinary Practice\"},\"image\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/todaysveterinarypractice\",\"https:\\\/\\\/www.youtube.com\\\/thenavc\"],\"email\":\"info@navc.com\"},{\"@type\":\"Person\",\"@id\":\"\",\"url\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/author\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"Diagnostic and Therapeutic Approach: Dogs Infected with Bordetella bronchiseptica and Canine Influenza Virus (H3N8) | Today&#039;s Veterinary Practice","description":"Severe cases of kennel cough are highly contagious and can result in life-threatening respiratory compromise. Here's how to manage critically ill dogs.","robots":{"index":"noindex","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"og_locale":"en_US","og_type":"article","og_title":"Diagnostic and Therapeutic Approach: Dogs Infected with Bordetella bronchiseptica and Canine Influenza Virus (H3N8)","og_description":"Severe cases of kennel cough are highly contagious and can result in life-threatening respiratory compromise. Here's how to manage critically ill dogs.","og_url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/infectious-disease\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\/","og_site_name":"Today&#039;s Veterinary Practice","article_publisher":"https:\/\/www.facebook.com\/todaysveterinarypractice","article_published_time":"2014-07-01T00:41:53+00:00","article_modified_time":"2022-02-16T15:53:55+00:00","og_image":[{"width":800,"height":540,"url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/03\/Figure-3_header.jpg","type":"image\/jpeg"}],"twitter_card":"summary_large_image","twitter_misc":{"Written by":"","Est. reading time":"16 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/infectious-disease\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\/#article","isPartOf":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/infectious-disease\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\/"},"author":{"name":"","@id":""},"headline":"Diagnostic and Therapeutic Approach: Dogs Infected with Bordetella bronchiseptica and Canine Influenza Virus (H3N8)","datePublished":"2014-07-01T00:41:53+00:00","dateModified":"2022-02-16T15:53:55+00:00","mainEntityOfPage":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/infectious-disease\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\/"},"wordCount":3131,"commentCount":0,"publisher":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#organization"},"image":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/infectious-disease\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\/#primaryimage"},"thumbnailUrl":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/03\/Figure-3_header.jpg","keywords":["Peer Reviewed"],"articleSection":["July\/August 2014"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/infectious-disease\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\/#respond"]}]},{"@type":["WebPage","MedicalWebPage"],"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/infectious-disease\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\/","url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/infectious-disease\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\/","name":"Diagnostic and Therapeutic Approach: Dogs Infected with Bordetella bronchiseptica and Canine Influenza Virus (H3N8) | Today&#039;s Veterinary Practice","isPartOf":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#website"},"primaryImageOfPage":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/infectious-disease\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\/#primaryimage"},"image":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/infectious-disease\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\/#primaryimage"},"thumbnailUrl":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/03\/Figure-3_header.jpg","datePublished":"2014-07-01T00:41:53+00:00","dateModified":"2022-02-16T15:53:55+00:00","description":"Severe cases of kennel cough are highly contagious and can result in life-threatening respiratory compromise. Here's how to manage critically ill dogs.","breadcrumb":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/infectious-disease\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/infectious-disease\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/infectious-disease\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\/#primaryimage","url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/03\/Figure-3_header.jpg","contentUrl":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/03\/Figure-3_header.jpg","width":800,"height":540},{"@type":"BreadcrumbList","@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/infectious-disease\/diagnostic-therapeutic-approach-dogs-infected-with-bordetella-bronchiseptica-canine-influenza-virus-h3n8\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/"},{"@type":"ListItem","position":2,"name":"Diagnostic and Therapeutic Approach: Dogs Infected with Bordetella bronchiseptica and Canine Influenza Virus (H3N8)"}]},{"@type":"WebSite","@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#website","url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/","name":"Today's Veterinary Practice","description":"Peer-Reviewed Veterinary Journal","publisher":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#organization","name":"Today's Veterinary Practice","url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#\/schema\/logo\/image\/","url":"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2022\/01\/tvp-logo.png","contentUrl":"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2022\/01\/tvp-logo.png","width":179,"height":89,"caption":"Today's Veterinary Practice"},"image":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/todaysveterinarypractice","https:\/\/www.youtube.com\/thenavc"],"email":"info@navc.com"},{"@type":"Person","@id":"","url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/author\/"}]}},"_links":{"self":[{"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/posts\/1020","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/comments?post=1020"}],"version-history":[{"count":1,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/posts\/1020\/revisions"}],"predecessor-version":[{"id":28068,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/posts\/1020\/revisions\/28068"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/media\/3047"}],"wp:attachment":[{"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/media?parent=1020"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/categories?post=1020"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/tags?post=1020"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}