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1.
Blastomycosis in cats: five cases (1979-1986)   总被引:3,自引:0,他引:3  
Medical records of 5 cats with blastomycosis examined at the University of Tennessee Veterinary Teaching Hospital from 1979 to 1986 were reviewed. Clinical signs of blastomycosis varies depending on the organ(s) affected, but respiratory tract disease was most common, followed by CNS signs and ocular problems. A definitive diagnosis was made by identification of characteristic fungal organisms in biopsy or necropsy specimens. Two cats treated with amphotericin B did not respond to treatment and died or were euthanatized. The lungs, brain, eyes, and lymph nodes commonly were affected, but one cat had only cutaneous and regional lymph node involvement. The respiratory tract appeared to be a common primary site of infection, with dissemination to other organ systems. The typical host response was a pyogranulomatous cellular infiltrate with numerous fungal organisms evident.  相似文献   

2.
OBJECTIVE: To determine clinical signs, radiographic and histologic abnormalities, and concurrent diseases in cats with endogenous lipid pneumonia (EnLP) and to determine the pathologic importance of EnLP in cats. DESIGN: Retrospective study. ANIMALS: 24 cats. PROCEDURE: Medical records of cats in which EnLP was confirmed by histologic examination of necropsy specimens were reviewed. Information collected from the medical records included signalment, body weight, clinical signs, and results of clinicopathologic tests. Thoracic radiographs were reviewed by a radiologist; histologic specimens were reviewed by a pathologist. RESULTS: All cats had nonspecific clinical abnormalities, such as lethargy, anorexia, or weight loss; 16 had signs of respiratory tract disease. All cats had concurrent systemic diseases, and clinicopathologic abnormalities were reflective of these conditions. Nonspecific abnormalities were detected on thoracic radiographs from 9 of 11 cats. Most cats had macroscopic, multifocal, subpleural lesions; inflammatory infiltrates, cholesterol clefts, and multinucleated giant cells were common. Ten cats had an underlying obstructive pulmonary disease that was the likely cause of EnLP. Lesions of EnLP were not considered to be severe enough or extensive enough to be the cause of death in any of these cats. CONCLUSIONS AND CLINICAL RELEVANCE: EnLP is an uncommon respiratory tract disorder of cats with no pathognomonic clinical, laboratory, or radiographic findings. Although EnLP was not the cause of death in any of these cats, results of the present study do suggest that EnLP may be a marker for potentially severe underlying obstructive pulmonary disease.  相似文献   

3.
In this retrospective study, we describe 14 cats diagnosed with hepatic abscesses. The objective of the study was to report the clinical signs, physical examination findings, clinicopathologic findings, and outcomes in affected cats. These findings were then compared with those previously reported in dogs and humans. Clinical signs were vague and included anorexia, lethargy, and weight loss. Only 23% of cats had fever, whereas 31% were hypothermic. Increases in serum activities of alanine aminotransferase and alkaline phosphatase were found in 45 and 18%, respectively, of the 11 cats that had laboratory work performed. Abdominal ultrasound examinations were performed in 7 cats, and abnormalities were found in 71% of them. Four cats had solitary abscesses, all of which were located in the right liver lobes. The other 10 cats had multifocal small abscesses or microabscesses, and all of these cats had clinical signs suggestive of sepsis. Cytologic evaluation of samples obtained by abdominocentesis indicated septic inflammation in 67% of cats in which peritoneal fluid was analyzed. Hepatic abscess cultures yielded polymicrobial growth in 66% of the cats: Escherichia coli was the most commonly cultured organism. Overall mortality rate was 79%. All survivors underwent exploratory laparotomy for partial hepatectomy to resect the abscess followed by medical management. Hepatic abscesses should be considered in cats with signs consistent with sepsis. More routine use of ultrasonography may aid in earlier diagnosis of hepatic abscesses, potentially improving prognosis and outcome.  相似文献   

4.
OBJECTIVE: To determine clinical and pathologic findings associated with an outbreak of cryptococcosis in an unusual geographic location (British Columbia, Canada). DESIGN: Retrospective study. ANIMALS: 1 pink-fronted cockatoo, 2 ferrets, 20 cats, and 15 dogs. PROCEDURE: A presumptive diagnosis of cryptococcosis was made on the basis of serologic, histopathologic, or cytologic findings, and a definitive diagnosis was made on the basis of culture or immunohistochemical staining. RESULTS: No breed or sex predilections were detected in affected dogs or cats. Eleven cats had neurologic signs, 7 had skin lesions, and 5 had respiratory tract signs. None of 17 cats tested serologically for FeLV yielded positive results; 1 of 17 cats yielded positive results for FIV (western blot). Nine of 15 dogs had neurologic signs, 2 had periorbital swellings, and only 3 had respiratory tract signs initially. Microbiologic culture in 15 cases yielded 2 isolates of Cryptococcus neoformans var grubii (serotype A) and 13 isolates of C. neoformans var gattii (serotype B); all organisms were susceptible to amphotericin B and ketoconazole. Serologic testing had sensitivity of 92% and specificity of 98%. CONCLUSIONS AND CLINICAL RELEVANCE: Serologic titers were beneficial in identifying infection in animals with nonspecific signs, but routine serum biochemical or hematologic parameters were of little value in diagnosis. Most animals had nonspecific CNS signs and represented a diagnostic challenge. Animals that travel to or live in this region and have nonspecific malaise or unusual neurologic signs should be evaluated for cryptococcosis.  相似文献   

5.
Background: Portal vein thrombosis (PVT) in cats is sparsely reported.
Purpose of Study: To evaluate the clinical signs and diseases associated with PVT in cats.
Animals: 6 client-owned cats.
Methods: Medical records for cats with a portal vein thrombus diagnosed on abdominal ultrasound or at necropsy were reviewed. Signalment, historical data, underlying disorders, clinical findings, clinicopathologic and histopathologic data, diagnostic imaging findings, treatment, and outcome were recorded.
Results: All 6 cats identified with PVT also had hepatic disease. Evidence of a congenital portosystemic shunt was present in 3/6 cats. Two cats had primary or metastatic hepatic neoplasia. One cat had acute cholangitis, acute pancreatitis, and locally extensive acute centrilobular hepatic necrosis. Two cats were suspected to have acute thrombi and 4 cats had chronic thrombi.
Conclusion and Clinical Significance: PVT might be an important concurrent finding in cats with hepatic disease.  相似文献   

6.
OBJECTIVE: To identify the most common causes of pneumoperitoneum in dogs and cats and determine history, clinical features, and outcome of affected animals. DESIGN: Retrospective study. ANIMALS: 31 dogs and 8 cats. PROCEDURES: Medical records were reviewed for signalment; history; abnormal physical, clinicopathologic, and radiographic findings; results of cytologic analysis and bacterial culture of abdominal fluid; gross and histologic findings at surgery or necropsy; and outcome. RESULTS: Pneumoperitoneum was classified as spontaneous in 25 animals and traumatic in 14. Causes of traumatic pneumoperitoneum included vehicular impact, gunshot wounds, abdominal dog bite wounds, and iatrogenic pneumothorax. Spontaneous pneumoperitoneum was caused by gastrointestinal tract perforation in 23 animals; underlying causes included neoplasia, nonsteroidal anti-inflammatory drug administration, and corticosteroid administration. Two animals developed spontaneous pneumoperitoneum after bladder rupture. Animals with spontaneous pneumoperitoneum were significantly older and had clinical signs of longer duration than those with traumatic pneumoperitoneum. Sixteen animals survived, including 15 of 23 animals that underwent surgery. Animals that survived had significantly higher serum albumin concentrations than did animals that died or were euthanatized. CONCLUSIONS AND CLINICAL RELEVANCE: Although pneumoperitoneum is most often attributable to perforation of a hollow viscus, other causes do exist. Early exploration is recommended for diagnosis and treatment of the underlying condition.  相似文献   

7.
Ultrasound-guided fine-needle aspiration (FNA) of the lung was performed on 16 dogs and 3 cats with consolidated pulmonary lesions or masses identified on thoracic radiographs. The cytologic results from the FNA were confirmed by histopathology, response to treatment, or microscopic identification of Blastomyces organisms. Neoplasia was identified correctly by FNA cytology in 10 of 11 animals, and no false positive results occurred, yielding a positive predictive value of 100%. Of 8 animals with infectious disease, 5 of 6 had blastomycosis and 1 had a bacterial infection, based on cytologic evaluation. Eight animals required sedation for the procedure, and none had clinical complications. We conclude that ultrasound-guided FNA of pulmonary mass lesions is an inexpensive, safe, and accurate method for diagnosing blastomycosis or neoplasia, especially carcinomas, in dogs and cats.  相似文献   

8.
OBJECTIVE: To characterize imaging findings in cats with confirmed inflammatory bowel disease (IBD) of the upper gastrointestinal tract (i.e., stomach and small intestine) and relate these findings to clinical signs and histologic changes. DESIGN: Retrospective study. ANIMALS: 32 cats with clinical and histopathologic diagnoses of IBD. PROCEDURE: Medical records were reviewed for signalment, clinical signs, clinicopathologic findings, radiographic and ultrasonographic findings, and results of endoscopic examination. Histologic findings were reviewed and characterized by severity and type of inflammatory infiltrate. RESULTS: All cats had 1 or more clinical signs (e.g., vomiting, diarrhea, weight loss, and anorexia) consistent with IBD. Lymphocytic and plasmacytic infiltrates were observed in histologic sections of gastrointestinal tissue. Crypt distortion, villous blunting and fusion, and fibrosis were most commonly seen in cats with moderate or severe IBD. Clinicopathologic findings of some cats included anemia, leukocytosis or leukopenia, hypocholesterolemia, and hyper- or hypoproteinemia. Abnormalities were not found on abdominal radiographic views in 9 of 9 cats. However, contrast studies using barium revealed radiographic abnormalities in 1 of 3 cats. In 13 of 17 cats, abdominal ultrasonography revealed several intestinal abnormalities (e.g., poor intestinal wall layer definition, focal thickening) and large mesenteric lymph nodes with hypoechoic changes consistent with IBD. Endoscopic observation revealed findings (e.g., erythema, plaques, mucosal friability) consistent with inflammation in 9 of 18 cats. CONCLUSIONS AND CLINICAL RELEVANCE: Compared with endoscopy of the gastrointestinal tract or abdominal radiography, clinical signs and ultrasonographic findings appear to have the best association with histologic grade of IBD in cats.  相似文献   

9.
OBJECTIVE: To determine whether short-term amitriptyline administration would be efficacious in the treatment of acute, nonobstructive, idiopathic lower urinary tract disease in cats. DESIGN: Randomized controlled trial. ANIMALS: 31 untreated male and female cats with acute, nonobstructive, idiopathic lower urinary tract disease. PROCEDURES: Cats were treated with amitriptyline (5 mg/d; n = 16) or a placebo (15) for 7 days and monitored for pollakiuria, hematuria, and adverse events. Cats were reexamined 1 month after treatment, and owners were interviewed by telephone 6, 12, and 24 months after treatment. RESULTS: 2 amitriptyline-treated cats were excluded from analyses because of acquired urinary tract infection. Clinical signs resolved by day 8 in 8 amitriptyline-treated and 10 control cats. There were no apparent differences in likelihood or rate of recovery from pollakiuria or hematuria between groups. Overall, clinical signs recurred significantly faster and more frequently in amitriptyline-treated than control cats. However, after excluding recurrences within 21 days of treatment, risk of recurrence was similar in both groups. Increasing age was significantly associated with increased likelihood and rate of recovery from hematuria and with decreased risk of recurrence of signs. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that short-term amitriptyline treatment has no benefit in terms of resolution of pollakiuria and hematuria in cats with idiopathic lower urinary tract disease and may be associated with an increased risk of recurrence.  相似文献   

10.
OBJECTIVE: To determine clinical signs, physical examination findings, radiographic features, and concurrent diseases in cats with laryngeal paralysis, as well as evaluate the outcome of medical or surgical management. DESIGN: Retrospective study. ANIMALS: 16 cats. PROCEDURE: Medical records from January 1990 to April 1999 were examined for cats with laryngeal paralysis. Signalment, clinical signs, physical examination findings, cervical and thoracic radiographic findings, laryngeal examination results, and clinical outcome were reviewed. RESULTS: No breed or sex predilection was identified in 16 cats with laryngeal paralysis. The most common clinical signs included tachypnea or dyspnea, dysphagia, weight loss, change in vocalization, coughing, and lethargy. Clinical signs were evident for a median of 245 days. Airway obstruction was apparent on cervical and thoracic radiographic views in 9 cats. Examination of the larynx revealed bilateral laryngeal paralysis in 12 cats and unilateral laryngeal paralysis in 4 cats. The 4 cats with unilateral disease were managed with medical treatment, and 3 of these had acceptable long-term outcomes. Seven of 12 cats with bilateral paralysis underwent surgery; procedures performed included left arytenoid tie back, bilateral arytenoid tie back and ventriculo-cordectomy, and partial left arytenoidectomy. One cat was euthanatized as a result of complications from surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Laryngeal paralysis is an uncommon cause of airway obstruction in cats. Cats with less severe clinical signs (often with unilateral paralysis) may be successfully managed with medical treatment, whereas cats with severe airway obstruction (often with bilateral paralysis) may benefit from surgical intervention.  相似文献   

11.
OBJECTIVE: To determine whether a colony environment predisposes healthy cats to high bacterial counts, including counts of obligate anaerobes, in the duodenum and whether increased numbers of bacteria could be found in the duodenum of cats with signs of chronic gastrointestinal tract disease. DESIGN: Prospective study. ANIMALS: 20 healthy control cats (10 from a colony environment and 10 pet cats) and 19 cats with a history of chronic gastrointestinal tract disease. PROCEDURE: Undiluted duodenal fluid was quantitatively and qualitatively assessed by bacteriologic culture under aerobic and anaerobic conditions. Serum concentrations of cobalamin and folate were also measured. RESULTS: Significant differences were not detected in the numbers of bacteria found in the duodenum of cats housed in a colony environment, compared with pet cats fed an identical diet prior to sampling. All healthy cats were, therefore, combined into 1 control group. Compared with healthy cats, cats with clinical signs of gastrointestinal tract disease had significantly lower counts of microaerophilic bacteria, whereas total, anaerobic, and aerobic bacterial counts were not significantly different. None of the cats with disease had total bacterial counts higher than expected from the range established in the control cats. Differences were not detected in regard to serum folate or cobalamin concentrations between diseased and healthy cats. CONCLUSIONS AND CLINICAL RELEVANCE: These findings indicated that healthy colony cats and pet cats have high numbers of bacteria in the duodenum, including high numbers of obligate anaerobes. Our findings also suggest that bacterial overgrowth in the small intestine is not a common clinical syndrome in cats with chronic nonobstructive gastrointestinal tract disease.  相似文献   

12.
OBJECTIVE: To document the clinical, clinicopathologic, and pathologic findings in cats with severe sepsis, identify abnormalities unique to this species, and identify criteria that could be used antemortem to diagnose the systemic inflammatory response syndrome in cats. DESIGN: Retrospective study. ANIMALS: 29 cats confirmed to have severe sepsis at necropsy. PROCEDURE: Pertinent history, physical examination findings, and results of hematologic and biochemical testing were extracted from medical records. RESULTS: Clinical diagnoses included pyothorax, septic peritonitis, bacteremia secondary to gastrointestinal tract disease, pneumonia, endocarditis, pyelonephritis, osteomyelitis, pyometra, and bite wounds. Physical examination findings included lethargy, pale mucous membranes, poor pulse quality, tachypnea, hypo- or hyperthermia, signs of diffuse pain on abdominal palpation, bradycardia, and icterus. Clinicopathologic abnormalities included anemia, thrombocytopenia, band neutrophilia, hypoalbuminemia, low serum alkaline phosphatase activity, and hyperbilirubinemia. Necropsy findings included multi-organ necrosis or inflammation with intralesional bacteria. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that severe sepsis in cats is characterized by lethargy, pale mucous membranes, signs of diffuse abdominal pain, tachypnea, bradycardia, weak pulses, anemia, hypoalbuminemia, hypothermia, and icterus. Recognition of this combination of clinical findings should facilitate the diagnosis of severe sepsis in cats.  相似文献   

13.
OBJECTIVE: To determine whether endoscopic examination of the choanae resulted in diagnosis of various diseases in dogs and cats with signs of respiratory tract disease. DESIGN: Retrospective study. ANIMALS: 91 dogs and 27 cats that had endoscopic examination of the choanae. PROCEDURE: Medical records were reviewed for endoscopy findings and results of examination of biopsy or cytologic specimens. RESULTS: 34 animals had neoplasia in the choanal region; in 26 animals, diagnosis was confirmed by evaluation of specimens obtained by endoscopy. Five dogs with neoplasia had an erroneous diagnosis of rhinitis made on the basis of evaluation of specimens obtained by endoscopy. Six dogs and 2 cats had foreign objects in the choanae; 7 foreign objects were removed endoscopically, whereas 1 required nasal flushing. Results of endoscopy and biopsy of the choanae provided diagnosis of cryptococcosis and aspergillosis, but did not aid in the diagnosis of pythiosis or nasal mites. CONCLUSIONS AND CLINICAL RELEVANCE: Endoscopic examination of the choanae may assist in rapid diagnosis of nasal neoplasms, foreign objects, and certain infectious organisms.  相似文献   

14.
Three cats were diagnosed as hyperthyroid based on clinical signs, historical findings, laboratory abnormalities, and basal serum thyroxine (T4) concentrations, and/or nuclear thyroid scans. Additionally, a presumptive diagnosis of thyroid carcinoma with pulmonary metastasis was made in each cat based on radiographic or scintigraphic evaluation. All three cats had solitary pulmonary nodules 1.5 to 2 cm in diameter on survey thoracic radiographs; one cat also had chylous pleural effusion and pulmonary lobar consolidation. Focal pulmonary accumulation of sodium pertechnetate (99mTcO4 -) and/or radioiodine (131I) corresponding to radiographic lesions were seen in all cats. Two cats were treated with single ablative doses (1111 to 1480 MBq) of131I; the remaining cat was euthanatized.
One of the treated cats died 8 days later; the other cat was euthanatized 22 weeks following treatment. Histopathologic examination of tissue obtained at necropsy confirmed metastatic thyroid carcinoma in one cat and bronchogenic adenocarcinoma in two cats. Our findings indicate that increased radionuclide uptake in focal pulmonary lesions and cytologic evaluation of tissue obtained by fine-needle aspiration are not specific for thyroid tissue. (Journal of Veterinary Internal Medicine 1993; 7:303–308. Copyright © 1993 by the American College of Veterinary Internal Medicine.)  相似文献   

15.
16.
Clinical signs, laboratory findings, and treatment results of 40 cats with the histologic diagnosis of plasma cell stomatitis-pharyngitis are discussed. Median age was 7.1 years, with no discernable sex predilection. Anorexia and difficulty prehending food were the most common clinical signs. Hyperproteinemia with associated hyperglobulinemia was the most common laboratory finding. Of various treatments, administration of corticosteroids or injectable gold (aurothioglucose) proved most effective in controlling the clinical signs.  相似文献   

17.
OBJECTIVE: To determine clinical, radiographic, and pathologic features of bronchiectasis in cats. DESIGN: Retrospective study. ANIMALS: 12 cats with histologic evidence of bronchiectasis. PROCEDURE: Information on signalment, body weight, clinical signs of respiratory disease, concurrent diseases, method by which lung tissue specimens were obtained (surgical biopsy or necropsy), and histopathologic findings was obtained by reviewing medical records from January 1987 to June 1999 for cats with confirmation of bronchiectasis by histologic examination. Available thoracic radiographs were reviewed by a board-certified radiologist. RESULTS: Bronchiectasis was most commonly identified in older male cats. Clinical signs referable to the lower portion of the respiratory tract were detected in only 5 cats but, when evident, were usually chronic (duration > 1 year). Radiographic pattern of bronchiectasis was cylindrical in 4 cats, and in 1 of these cats, a saccular pattern was also identified. For most cats, bronchiectasis was detected in a single lung lobe. Radiographic evidence of bronchiectasis was not detected in 2 cats. Concurrent respiratory diseases included chronic bronchitis and bronchiolitis, neoplasia, bronchopneumonia, endogenous lipid pneumonia, and emphysema. CONCLUSIONS AND CLINICAL RELEVANCE: Bronchiectasis appears to be an uncommon respiratory tract disorder that predominantly affects older male cats. Thoracic radiography may not be sensitive for the diagnosis of bronchiectasis in cats. Bronchiectasis in cats appears to be a sequela of chronic inflammatory bronchopulmonary diseases, especially chronic bronchitis, neoplasia, and bronchopneumonia.  相似文献   

18.
The effect of 3rd-degree atrioventricular block on long-term outcome in cats is unknown. Clinical findings and long-term outcome of 21 cats with 3rd-degree atrioventricular block were studied retrospectively. Median age of cats studied was 14 years (range 7-19 years). Presenting signs included respiratory distress or collapse, but 6 cats had no clinical signs of disease. Eight cats had congestive heart failure (CHF) at the time that 3rd-degree atrioventricular block was detected. Heart rates ranged from 80 to 140 beats per minute (bpm; median 120 bpm) with no difference in heart rate between cats with and those without CHF. Eleven of 18 cats that had echocardiograms had structural cardiac disease, and 6 cats had cardiac changes consistent with concurrent systemic disease. No atrioventricular nodal lesions were detected by echocardiography. One cat had atrioventricular nodal lesions detected on histologic examination. Median survival of 14 cats that died or were euthanized was 386 days (range 1-2,013 days). Survival did not differ between cats with or without CHF or between cats with or without structural cardiac disease. Thirteen cats with 3rd-degree atrioventricular block survived > 1 year after diagnosis, regardless of presenting signs or underlying cardiac disease. Third-degree heart block in cats is often not immediately life threatening. Survival was not affected by the presence of underlying heart disease or congestive heart failure at the time of presentation. Even cats with collapse might survive > 1 year without pacemaker implantation.  相似文献   

19.
OBJECTIVE: To review clinical findings and clinical course for cats exposed to smoke in residential fires and to determine clinical variables that may have prognostic importance. DESIGN: Retrospective study. ANIMALS: 22 cats admitted to our veterinary teaching hospital between 1986 and 1997 with a history of smoke exposure during a residential fire. PROCEDURE: Medical records were reviewed for history, clinical signs, physical examination findings, changes in respiratory tract signs, initial hematologic analysis, treatment, results of thoracic radiography, and outcome. RESULTS: Fifteen of 22 (68%) cats were categorized in the uncomplicated group, 5 (23%) in the complicated group, and 2 (9%) were discharged after a short period because of financial considerations. Twenty (91%) cats survived, but 2 (9%) were euthanatized because of severe respiratory compromise or neurologic changes. Predominant thoracic radiographic changes were diffuse interstitial pattern (6 cats) and focal alveolar pattern (5). The majority (8/13) of cats that were stable or had improved by the day after admission had an uncomplicated clinical course while hospitalized, whereas cats that were worse on the day after admission tended to have a complicated clinical course. CONCLUSIONS AND CLINICAL RELEVANCE: Cats that survive a residential fire and are admitted to a hospital have a good chance to be discharged. Cats that do not have signs of respiratory tract dysfunction at admission probably will not develop severe respiratory complications. For cats with signs of respiratory dysfunction at admission, better prognostic information will be determined by monitoring progression of the respiratory condition on the day after admission.  相似文献   

20.
PRACTICAL RELEVANCE: Lower respiratory tract infections (LRTIs) in cats can be due to bacteria, parasites, fungi and viruses. This review details the practical investigation of these infections and highlights specific therapy where possible. The aim is to avoid the all-too-frequent temptation in practice to treat cats with lower respiratory tract signs empirically for feline bronchial disease (FBD)/asthma. This is potentially hazardous as immunosuppressive therapy for FBD/asthma could exacerbate disease due to a LRTI. Empirical treatment of suspected LRTI is also difficult to recommend given the wide range of potential pathogens. CLINICAL CHALLENGES: Making a clinical ante-mortem diagnosis of LRTI in a cat can be challenging. Consistent historical, clinical, haematological and radiographic abnormalities are often lacking and findings may be non-specific. Astute clinical acumen, thorough investigation and high quality laboratory analysis are usually required for a diagnosis. Bronchoalveolar lavage, if feasible, and tests for lungworm should be routine in cats with lower respiratory tract signs. Lung fine needle aspiration may be useful in cases of diffuse or nodular pulmonary disease. Histopathology is rarely employed in ante-mortem investigations. EVIDENCE BASE: The authors have reviewed a substantial body of literature to provide information on many of the reported bacterial, parasitic, fungal and viral pathogens, including some that occur in Asia. Attention has been given to specific therapy for each pathogen, with evidence-based comments when there is a deviation from routine recommendations.  相似文献   

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