Nasenausfluss beim Hund – Wie sinnvoll sind bakteriologische und histopathologische Untersuchungen?

Zusammenfassung

Gegenstand und Ziel Es sollte untersucht werden, inwieweit die bakteriologische Untersuchung von Nasenschleimhautabstrichen (BU) und die histopathologische Untersuchung (HP) von Nasenschleimhautbioptaten bei Hunden mit Nasenausfluss (NAF) für das Stellen einer Diagnose von Bedeutung sind.

Material und Methoden Retrospektiv wurden Patientenakten von Hunden ausgewertet, die mit dem Hauptsymptom NAF von Januar 2015 bis Dezember 2016 in der HNO-Abteilung der Klinik für Kleintiere vorgestellt wurden.

Ergebnisse Die Auswertung umfasste die Daten von 85 Hunden. Auf der Basis der Ergebnisse einer Computertomografie (CT) des Kopfes, einer Rhinoskopie, der BU und der HP wurden 6 Gruppen nach den Primärursachen klassifiziert: nasale Neoplasie (24/85, 28 %), oronasale Defekte (22/85, 26 %), idiopathische chronische Rhinitis (17/85, 20 %), Fremdkörper (8/85, 10 %), sinonasale Aspergillose (7/85, 8 %) und pathologische Veränderungen des Nasenspiegels (NSP; 7/85, 8 %). Bei brachyzephalen Hunden (14/85, 17 %) stellten oronasale Defekte (8/14, 57 %) mit Abstand die häufigste Ursache für NAF dar. Eine bakterielle Infektion der Nasenschleimhaut war bei keinem Tier die Primärursache für NAF und daher nicht allein mit einem Antibiotikum zu therapieren. Dennoch waren 72 % der Tiere antibiotisch vorbehandelt. Die BU zeigte Sekundärerreger, die für keine Primärursache charakteristisch waren. Die HP erwies sich nur für die endoskopisch kontrollierte Probenentnahme von Tumorgewebe als diagnostisch. Nicht diagnostisch waren dagegen die Biopsie von Nasenschleimhaut und die Bestimmung des Entzündungstyps.

Schlussfolgerungen NAF ist beim Hund häufig Folge einer gravierenden Grunderkrankung, die zu bleibenden Schäden bis hin zum Tod führen kann. Daher bedarf es einer frühzeitigen weiterführenden Diagnostik in Narkose. Die Rhinoskopie als zentrales Diagnostikum wird durch CT und Biopsie ergänzt. Eine bakteriologische Untersuchung des Nasenausflusses ermöglicht keine Diagnose der zugrunde liegenden Primärerkrankung.

Klinische Relevanz Ohne Diagnose ist die Anwendung von Antibiotika bei Hunden mit NAF nicht indiziert, bei Tumorerkrankungen oder einer Pilzinfektion sogar schädlich. Bei Tumorverdacht sollten Bioptate unter endoskopischer Sicht gewonnen werden, da Blindbiopsien häufig benachbartes Gewebe erfassen und zu einer falschen Diagnose führen.

Abstract

Objective Retrospective evaluation of the diagnostic value of bacterial culture of nasal mucosal swabs and histopathologic assessment of nasal mucosal biopsies in dogs with nasal discharge.

Material and methods Medical records of dogs with the predominant clinical sign of nasal discharge that were referred to the ENT Unit of the Small Animal Department between January 2015 and December 2016 were reviewed.

Results Data of 85 dogs were evaluated. On the basis of the results of computed tomography (CT), rhinoscopy, bacterial culture of a nasal mucosal swab and histopathologic examination of nasal mucosal biopsies, dogs were assigned to one of six groups of primary nasal diseases: nasal neoplasia (24/85, 28 %), oronasal defect (22/85, 26 %), idiopathic chronic rhinitis (17/85, 20 %), foreign body (8/85, 10 %), sinonasal aspergillosis (7/85, 8 %) and diseases of the planum nasale (7/85, 8 %). In brachycephalic dogs (14/85, 17 %), oronasal defects (8/14, 57 %) were the most frequent cause of nasal discharge. No cases of a primary bacterial infection of the nasal cavity were observed and, therefore, antibiotic treatment had not been successful. Nevertheless, 72 % of the dogs in this study had received prior antibiotic treatment. Secondary bacterial infec tions diagnosed via nasal mucosal swabs were not diagnostic for the underlying primary nasal diseases. Targeted biopsies of tumors obtained under endoscopic visualization may lead to a definitive diagnosis, whereas biopsies of the nasal mucosa and the type of the inflammatory infiltrate were not diagnostic.

Conclusions Nasal discharge in dogs is frequently an indicator of an underlying severe primary nasal disease possibly leading to mortality of the affected dogs. Further diagnostics under anesthesia should be performed early in the diagnostic evaluation. Rhinoscopy as the central diagnostic is supported by CT and biopsy. Bacterial culture of the nasal discharge does not provide a diagnosis for the primary nasal disease process.

Clinical relevance Without further diagnostics, antibiotic treatment of dogs presenting with nasal discharge is considered as not appropriate and can be harmful in dogs with nasal tumors or sinonasal aspergillosis. When an intranasal malignant neoplasia is suspected, endoscopic-guided biopsies of the nasal mass should be obtained, because blind nasal biopsies are associated with a high rate of false-negative results.

Schlüsselwörter

Rhinorrhö - Rhinitis - Nasentumor - sinonasale Aspergillose - Nasenbiopsie - Rhinoskopie

Key words

Rhinorrhea - rhinitis - nasal tumor - sinonasal aspergillosis - nasal biopsy - rhinoscopy

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