Giardia (Giardia canis, Giardia cati)
by Holly Frisby, DVM
Drs. Foster & Smith
Veterinary Services Department
This article will help you better understand giardia infections in dogs and cats. If your dog or cat is showing any symptoms or signs of disease, please contact your veterinarian. We want you and your pet to be happy and healthy.
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Thank you for reprint permission granted by Drs. Foster & Smith 4/17/2000
Giardia are protozoa (one-celled organisms) that live in the small intestine of dogs and cats. Giardia are found throughout the United States and in many other parts of the world. Infection with Giardia is called giardiasis.
There are many things we don't know about this parasite. Experts don't agree on how many species of Giardia there are and which ones affect which animals. Veterinarians do not even agree on how common Giardia infections are and when they should be treated. Generally it is believed that infection with Giardia is common but disease is rare. There is much about the life cycle we don't know either.
How do Giardia reproduce and how are they transmitted?
Giardia multiply by dividing.
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A dog or cat becomes infected by eating the cyst form of the parasite. In the small intestine, the cyst opens and releases an active form called a trophozoite. These have flagella, hairlike structures that whip back and forth allowing them to move around. They attach to the intestinal wall and reproduce by dividing in two. After an unknown number of divisions, at some stage, in an unknown location, this form develops a wall around itself (encysts) and is passed in the feces. The Giardia in the feces can contaminate the environment and water and infect other animals and people.
What are the signs of a Giardia infection?
Most infections with Giardia are asymptomatic. When disease rarely occurs, it is most common in younger animals, and the usual sign is diarrhea. The diarrhea may be acute, intermittent or chronic. Usually the infected animals will not lose their appetite, but they may lose weight. The feces are often abnormal, being pale, having a bad odor, and appearing greasy. In the intestine, Giardia prevents proper absorption of nutrients, damages the delicate intestinal lining, and interferes with digestion.
Can Giardia of dogs and cats infect people?
This is another unknown. There are many species of Giardia, and experts do not know if these species infect only specific hosts. Sources of some human infections have possibly been linked to beavers, other wild animals and domestic animals. Until we know otherwise, it would be wise to consider infected animals capable of transmitting Giardia to humans.
You may have heard about Giardia outbreaks occurring in humans due to drinking contaminated water. Contamination of urban water supplies with Giardia is usually attributed to (human) sewage effluents. In rural settings, beavers most often get the blame for contaminating lakes and streams. Giardia outbreaks have also occurred in day care centers fueled by the less than optimal hygienic practices of children.
How do we diagnose giardiasis?
Giardiasis is very difficult to diagnose because the protozoa are so small and are not passed with every stool. Tests on serial stool samples (one stool sample every day for three days) are often required to find the organism. Special diagnostic procedures, beyond a routine fecal examination, are necessary to identify Giardia. The procedures we use to identify roundworms and hookworms kill the active form of Giardia and concentrate the cyst form.
To see the active form, a small amount of stool may be mixed with water on a microscope slide and examined under high magnification. Because these forms have flagella, you can see them move around on the slide. The active forms are more commonly found in loose stools. If you ever have the opportunity to see the active form of Giardia under the microscope, take it! It’s an interesting looking creature. It is pear-shaped and its anatomy makes it look like a cartoon face, with eyes (which often look crossed), nose and mouth. Once you see it, you won't forget it.
Cysts are more commonly found in firm stools. Special solutions are used to separate the cysts from the rest of the stool. The portion of the solution that would contain the cysts is then examined microscopically.
Tests which detect antigens of Giardia in the feces are becoming more available. These tests are more difficult to run, are more expensive, and their accuracy may not be better than other methods. In the future, these tests will hopefully be fine-tuned so we can more accurately diagnose infection with Giardia.
We've done the tests, now what?
Now we come to how to interpret the test results. It can be a dilemma for your veterinarian. What you see (or We've see) is not always what you have. A negative test may mean the animal is not infected. It may also mean there were too few Giardia present in the small portion of stool that was examined. Negative test results are common in infected animals. If a negative test occurs, your veterinarian will often suggest repeating the fecal examination at least two more times on different samples taken on different days. Repeat tests are often necessary to finally find the organism.
What about a positive test? That shouldn't be hard to interpret, right? Wrong. Giardia can be found in many dogs and cats with and without diarrhea. If we find Giardia, is it the cause of the diarrhea or is it just coincidence we found it? The animal could actually have diarrhea caused by a bacterial infection, and we just happened to find the Giardia. Test results always need to be interpreted in light of the signs, symptoms and medical history.
If we find Giardia, how do we treat it?
Here we go again; treatment is controversial too. There’s a question about when to treat. If Giardia is found in a dog or cat without symptoms should we treat the animal? Since we shouldn't know if G. canis and G. cati can infect man, we often err on the side of caution and treat an asymptomatic infected animal to prevent possible transmission to people.
If we highly suspect infection with Giardia, but can't find the organism, should we treat anyway? This is often done. Because it is often difficult to detect Giardia in the feces of dogs and cats with diarrhea, if there are no other obvious causes of diarrhea (e.g., the dog didn't get into the garbage several nights ago) we often treat the animal for giardiasis.
There are several treatments for giardiasis; some of them have not been registered to treat giardiasis in dogs or cats. Metronidazole is one of these, but is the old standby. The nice thing about this drug is that it also kills some types of bacteria that could cause diarrhea. So if the diarrhea was caused by bacteria, and not Giardia, we still kill the cause of the diarrhea and eliminate the symptoms. Makes us look pretty sharp! Unfortunately, metronidazole has some drawbacks. It has been found to be only 60-70% effective in eliminating Giardia from infected dogs. In some cats and dogs it can cause vomiting, anorexia and some neurological signs. It also can be toxic to the liver in some animals. It is suspected of being a teratogen so it should not be used in pregnant animals. Finally, it has a very bitter taste and many animals resent taking it – especially cats.
Quinacrine hydrochloride has been used in the past, but is not very effective and can cause side effects such as lethargy, vomiting, anorexia and fever.
Furazolidine has been used effectively in treating giardiasis in cats. It can cause vomiting and diarrhea and should not be used in pregnant cats.
A newer drug, albendazole, has been shown to be 50 times more effective than metronidazole and 10-40 times more effective than quinacrine hydrochloride in killing Giardia in the laboratory. It has not been registered for use in dogs and cats. Some serious side effects of albendazole have been noted, including injury to the bone marrow. Since it may also cause birth defects, it should not be used in pregnant animals.
In a recent small study, fenbendazole, which has been approved for treatment of roundworm, hookworm and whipworm infections in dogs, has been shown to be effective in treating giardiasis in dogs. It is safe to use in puppies but has not been approved for use in cats.
Most recently a combination of praziquantel, pyrantel pamoate and febantel has been shown to decrease cyst excretion in infected dogs.
But now we come to yet another unknown. It is possible these treatments only remove the cysts from the feces but do not kill all the Giardia in the intestine. This means even though the fecal exams after treatment may be negative, the organism is still present in the intestine. This is especially true of the older treatments. So treated animals could still be a source of infection for others.
How can I prevent my pet from becoming infected with Giardia?
The cysts can live several weeks to months outside the host in wet, cold environments. So lawns, parks, kennels and other areas that may be contaminated with animal feces can be a source of infection for your pet. You should keep your pet away from areas contaminated by the feces of other animals. This is not always easy.
As with other parasites of the digestive system, prevention of the spread of Giardia centers on testing and treating infected animals and using sanitary measures to reduce or kill the organisms in the environment. Solutions of Lysol, bleach, and quaternary ammonium compounds are effective against Giardia.
How do I control Giardia in my kennel or cattery?
Infection with Giardia can be a big problem in kennels and catteries. Veterinarians at Cornell University have developed a specific protocol. They recommended a four-pronged approach.
Treat Animals: Treat all nonpregnant animals with fenbendazole or albendazole for 5 days. On the last day of treatment move them to a holding facility while a clean area is established. When the animals are moved back to the clean area, treat them once again with a 5-day course of fenbendazole or albendazole.
Decontaminate the Environment: Establish a clean area. If possible, this can be the whole facility. Otherwise create a few clean runs or cages, separate from the others. Remove all fecal material from the areas since the organic matter in feces can greatly decrease the effectiveness of many disinfectants. Steam clean the area and then clean it with a quaternary ammonium disinfectant according to the manufacturer's directions. These solutions will generally kill the cysts within one minute. Then let the area dry for several days before reintroducing the animals.
Clean the Animals: Cysts can remain stuck to the haircoats of infected animals. So before moving the treated animals to the clean area, they should be shampooed and rinsed well. Especially concentrate on the perianal area. The Cornell researchers then recommend washing the animals with a quaternary ammonium compound, using the manufacturer’s recommended dilution. Be sure all shampoo has been rinsed from the animal, as it will neutralize the effect of the quaternary ammonium compounds. Leave the compound on the animal for 3 minutes, then completely rinse the animals. These compounds can be irritating. Do not leave them on for more than 3 minutes. Do not get these compounds on mucous membranes or in the eye. Always use an ophthalmic ointment to protect the eyes.
Prevent Reintroduction of Giardia : Giardia can be brought into the kennel or cattery either by introducing an infected animal or on your shoes or boots. Any new animal should be quarantined from the rest of the animals and be treated and cleaned as described above. You should either use disposable shoe covers or clean shoes/boots and use a footbath containing quaternary ammonium compounds to prevent people from reintroducing Giardia.
Remember, Giardia of dogs and cats may infect people so good personal hygiene should be used by adults when cleaning kennels or picking up the yard, and by children who may play with pets or in potentially contaminated areas.
PARVO
Parvovirus
Veterinary & Aquatic Services Department, Drs. Foster & Smith, Inc.
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Parvovirus
Canine parvovirus disease is currently the most common infectious disorder of dogs in the United States.
'Parvo' is a highly contagious disease characterized by diarrhea that is often bloody and is caused by a pathogen called canine parvovirus, Type 2 (CPV-2). In 1980, the original strain of CPV-2 was replaced by CPV-2A and in 1986, another variation called CPV-2B appeared. Today, CPV-2B has largely replaced the previous strains as the most common isolate. Since all of these strains are similar, we will lump them together and refer to them as CPV-2 (parvo). There is currently some discussion that there may be other strains that are beginning to emerge and have yet to be formally identified. Current vaccinations have helped to control the spread of this disease but despite being vaccinated, some dogs still contract and die from parvo. There is much that we do not know about the virus or the best way to control the disease, but we are learning new information daily. Misinformation about the disease, its spread, and vaccination is widespread in both breeding and veterinary circles. We hope that with a better understanding of the disease, pet owners will be able to make good husbandry decisions that will help prevent and reduce the spread of this disease.
How is parvo spread?
CPV-2 is known to survive on inanimate objects - such as clothing, food pans, and cage floors - for 5 months and longer in the right conditions. Insects and rodents may also serve as vectors playing an important role in the transmission of the disease. All parvoviruses are extremely stable and are resistant to adverse environmental influences such as low pH and high heat. Exposure to ultraviolet light and sodium hypochlorite (a 1:32 dilution of household bleach - ½ cup bleach to 1 gallon of water) can inactivate parvovirus. The bleach solution can be impaired by organic matter and needs to have adequate exposure time and proper concentrations to work effectively. The normal incubation period (time from exposure to the virus to the time when signs of disease appear) is from 7-14 days. Active excretion of the virus in the feces can begin the third day after exposure, often before clinical signs appear, and may last for one to two weeks after the onset of the disease.
Symptoms
There is a broad range in the severity of symptoms shown by dogs that are infected with parvovirus. Many adult dogs exposed to the virus show very few if any symptoms. The majority of cases are seen in dogs less than 6 months of age, with the most severe cases seen in puppies younger than 12 weeks of age. There are also significant differences in response to CPV-2 infections and vaccines among different breeds of dogs, with Rottweilers, Doberman Pinschers, and Labrador Retrievers being more susceptible than other breeds.
The most common form of the disease is the intestinal form known as enteritis. CPV-2 enteritis is characterized by vomiting (often severe), diarrhea, dehydration, dark or bloody feces, and in severe cases, fever and lowered white blood cell counts. Acute CPV-2 enteritis can be seen in dogs of any breed, sex, or age. The disease will progress very rapidly and death can occur as early as two days after the onset of the disease. The presence of gram negative bacteria, parasites, or other viruses can worsen the severity of the disease and slow recovery.
Diagnosis
Not all cases of bloody diarrhea with or without vomiting are caused by Parvovirus and many sick puppies are misdiagnosed as having 'Parvo.' The only way to know if a dog has Parvovirus is through a positive diagnostic test. In addition to the more time consuming and expensive traditional testing of the blood for titers, a newer and simpler test of the fecal matter with an enzyme-linked immunosorbent assay antigen test (ELISA) are also available through most veterinary clinics. Testing of all suspect cases of Parvo is the only way to correctly diagnose and treat this disease.
Treatment
The treatment of Parvovirus is fairly straightforward and directed at supportive therapy. Replacing fluids lost through vomiting and diarrhea is probably the single most important treatment. Intravenous administration of a balanced electrolyte solution is preferred, but in less severe cases, subcutaneous or oral fluids may be used. Antibiotic therapy is usually given to help control secondary bacterial infections. In cases of severe vomiting, drugs to slow the vomiting may also be used. After the intestinal symptoms begin to subside, a broad spectrum de-worming agent is often used. Restricting the food during periods of vomiting is also necessary. Undertaking the treatment of affected dogs and puppies without professional veterinary care is very difficult. Even with the best available care, the mortality of severely infected animals is high. Without the correct amount of properly balanced intravenous fluids, the chance of recovery in a severely stricken animal is very small.
Immunity and vaccination
If a puppy recovers from CPV-2 infection, it is immune to reinfection for probably at least twenty months and possibly for life. In addition, after recovery, the virus is not shed in the feces. There are many commercially prepared attenuated (modified) live CPV-2 vaccines available. Although some people have expressed concern about the possibility of attenuated live vaccines reverting to a virulent strain after being given and then causing disease, studies have repeatedly shown that this does not occur. Commercially prepared vaccines are safe and do not cause disease.
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The primary cause of failure of canine parvovirus vaccines is an interfering level of maternal antibody against the parvovirus.
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The primary cause of failure of canine parvovirus vaccines is an interfering level of maternal antibody against the canine parvovirus. Maternal antibodies are the antibodies present in the mother's milk during the first 24 hours after the puppy's birth. The age at which puppies can effectively be immunized is proportional to the titer of the mother and the effectiveness of colostral transfer of maternal antibody within those first 24 hours. High levels of maternal antibodies present in the puppies' bloodstream will block the effectiveness of a vaccine. When the maternal antibodies drop to a low enough level in the puppy, immunization by a commercial vaccine will work. The complicating factor is that there is a period of time from several days to a couple weeks in which the maternal antibodies are too low to provide protection against the disease, but too high to allow the vaccine to work. This period is called the window of susceptibility. This is the time when despite being vaccinated, a puppy can still contract parvovirus. The length and timing of the window of susceptibility is different in every litter.
A study done in 1985 in a cross section of different puppies showed, that the age at which they were able to respond to a vaccine and develop protection covered a wide period of time. At six weeks of age, 25% of the puppies could be immunized. At 9 weeks of age, 40% of the puppies were able to respond to the vaccine. The number increased to 60% by 16 weeks, and by 18 weeks of age, 95% of the puppies could be immunized.
When we examine all of the information about maternal derived antibodies, windows of susceptibility, throw in breed susceptibilities, the possibility of unidentified strains, and the effectiveness of different vaccines, we begin to see why there are so many different vaccination protocols and why some vaccinated animals still develop the disease. Drs. Foster and Smith recommend a protocol that will help protect the widest range of dogs. We realize that with our protocol, we will be vaccinating some dogs that are not capable of responding and we will be revaccinating some dogs that have already responded and developed a high titer. But without doing an individual test on each puppy, it is impossible to determine where the puppy is in its immune status. We also realize due to the window of susceptibility, some litters will contract parvovirus despite being vaccinated. By using quality vaccines and an aggressive vaccination protocol, we can make this window of susceptibility as small as possible.
Conclusion
In summary, parvovirus is a very common problem that is a huge killer of puppies. Due to its ability to be transmitted through hands, clothes, and most likely rodents and insects, it is virtually impossible to have a kennel that will not eventually be exposed to the disease. Modified live vaccines are safe and effective, but despite the best vaccination protocol, all puppies will have a window of susceptibility of at least several days where they will be at risk. Using the newer high titer vaccines may shorten the window of susceptibility on many puppies. Prompt treatment by a veterinarian will increase survivability in infected puppies and working with your veterinarian on a vaccination program that is best for your puppy is important. As new information on this disease and vaccines become available, we will continue to update this article in hopes of keeping you as informed on Parvo as possible.
Coccidia
Coccidia (Coccidiosis): A Cause of Diarrhea
Race Foster, DVM
Marty Smith, DVM
Drs. Foster & Smith, Inc.
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What are coccidia?
Coccidia are small protozoans (one-celled organisms) that multiply in the intestinal tracts of dogs and cats, most commonly in puppies and kittens less than six months of age, in adult animals whose immune system is suppressed, or in animals who are stressed in other ways (e.g.; change in ownership, other disease present).
In dogs and cats, most coccidia are of the genus called Isospora. Isospora canis and I. ohioensis are the species most often encountered in dogs. Regardless of which species is present, we generally refer to the disease as coccidiosis. As a puppy ages, he tends to develop a natural immunity to the effects of coccidia. As an adult, he may carry coccidia in his intestines, and shed the cyst in the feces, but experience no ill effects.
How are coccidia transmitted?
A puppy is not born with the coccidia organisms in his intestine. However, once born, the puppy is frequently exposed to his mother's feces, and if the mother is shedding the infective cysts in her feces, then the young animals will likely ingest them and coccidia will develop within their intestines. Since young puppies, usually those less than six months of age, have no immunity to coccidia, the organisms reproduce in great numbers and parasitize the young animal's intestines. Oftentimes, this has severe effects.
From exposure to the coccidia in feces to the onset of the illness is about 13 days. Most puppies who are ill from coccidia are, therefore, two weeks of age and older. Although most infections are the result of spread from the mother, this is not always the case. Any infected puppy or kitten is contagious to other puppies or kittens. In breeding facilities, shelters, animal hospitals, etc., it is wise to isolate those infected from those that are not.
What are the symptoms of coccidiosis?
The primary sign of an animal suffering with coccidiosis is diarrhea. The diarrhea may be mild to severe depending on the level of infection. Blood and mucous may be present, especially in advanced cases. Severely affected animals may also vomit, lose their appetite, become dehydrated, and in some instances, die from the disease.
Most infected puppies encountered by the authors are in the four to twelve week age group. The possibility of coccidiosis should always be considered when a loose stool or diarrhea is encountered in this age group. A microscopic fecal exam by a veterinarian will detect the cysts confirming a diagnosis.
What are the risks?
Although many cases are mild, it is not uncommon to see severe, bloody diarrhea result in dehydration and even death. This is most common in animals who are ill or infected with other parasites, bacteria, or viruses. Coccidiosis is very contagious, especially among young puppies. Entire kennels may become contaminated, with puppies of many age groups simultaneously affected.
What is the treatment of coccidiosis?
It should be mentioned that stress plays a role in the development of coccidiosis. It is not uncommon for a seemingly healthy puppy to arrive at his new home and develop diarrhea several days later leading to a diagnosis of coccidia. If the puppy has been at the new home for less than thirteen days, then he had coccidia before he arrived. Remember, the incubation period (from exposure to illness) is about thirteen days. If the puppy has been with his new owner several weeks, then the exposure to coccidia most likely occurred after the animal arrived at the new home.
Fortunately, coccidiosis is treatable. Drugs such as sulfadimethoxine (Albon®) and trimethoprim-sulfadiazine (Tribrissen®) have been effective in the treatment and prevention of coccidia. Because these drugs do not kill the organisms, but rather inhibit their reproduction capabilities, elimination of coccidia from the intestine is not rapid. By stopping the ability of the protozoa to reproduce, time is allowed for the puppy's own immunity to develop and remove the organisms.
How is coccidiosis prevented or controlled?
Because coccidia is spread by the feces of carrier animals, it is very important to practice strict sanitation. All fecal material should be removed. Housing needs to be such that food and water cannot become contaminated with feces. Clean water should be provided at all times. Most disinfectants do not work well against coccidia; incineration of the feces, and steam cleaning, immersion in boiling water, or a 10% ammonia solution are the best methods to kill coccidia. Coccidia can withstand freezing.
Cockroaches and flies can mechanically carry coccidia from one place to another. Mice and other animals can ingest the coccidia and when killed and eaten by a dog, for instance, can infect the dog. Therefore, insect and rodent control is very important in preventing coccidiosis.
The coccidia species of dogs and cats do not infect humans.
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Kennel Cough
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(INFECTIOUS TRACHEOBRONCHITIS)
WHAT IS IT?
Kennel cough is a bronchitis characterized by a harsh, hacking cough which most people describe as sounding like “something stuck in my dog’s throat.” It is analogous to a chest cold for humans and is only a serious condition in special circumstances (see below); in general, it resolves on its own..
HOW INFECTION OCCURS?
The normal respiratory tract has substantial safeguards against invading infectious agents. The most important of these is probably what is called the “mucociliary escalator.” This safeguard consists of tiny hairlike structures called cilia, which protrude from the cells lining the respiratory tract, and a coat of mucus over them. The cilia beat in a coordinated fashion. Debris, including infectious agents, get trapped in the sticky mucus and the cilia move the mucus upward towards the throat where the collection of debris and mucus may be coughed up and/or swallowed.
The mucociliary escalator is damaged by the following:
 shipping stress crowding stress
heavy dust exposure
cigarette smoke exposure
infectious agents (viruses such as reovirus, adenovirus, parainfluenza virus, and even the distemper virus can be initiating infections)
Cold temperature
Poor ventilation
Without this protective mechanism, invading bacteria, especially Bordetella bronchiseptica may simply march down the airways unimpeded.
Bordetella bronchiseptica has some tricks of its own as well:
 It is able to bind directly to cilia, rendering them unable to move within 3 hours of contact. It secretes substances that disable the immune cells normally responsible for consuming & destroying bacteria
Because it is common for Bordetella to be accompanied by at least one other infections agent (such as one of the viruses listed above), “Kennel Cough” is actually a complex of infections, rather than infection by one agent.
Classically, dogs get infected when they are kept in a crowded situation with poor air circulation but lots of warm air (i.e. a boarding kennel, vaccination clinic, obedience class, local park, animal shelter, animal hospital waiting room, or grooming parlor). In reality, most causes of coughing that begin acutely in the dog are due to infectious causes and usually represent some form of Kennel Cough.
THE INCUBATION PERIOD IS 2 - 14 DAYS
HOW CONTAGIOUS IS IT?
Bordetella infection can be picked up by rabbits, guinea pigs, pigs, cats (if they are very young and housed in groups), and other dogs. It is not contagious to humans though it is closely related to Bordetella pertussis, the agent of Whooping Cough. Among dogs it is fairly contagious depending on stress level, vaccination status, and exposure to minor viruses.
Our hospital recommends keeping all dogs current on their Bordetella vaccinations as you never know when they be in an unexpected situation
HOW IS IT TREATED?
Although most cases will go away on their own, we like to think we can hasten recovery with antibiotics to directly kill the Bordetella organism. Alternatively, Kennel Cough may be treated with cough suppressants to provide comfort during natural recovery. Or antibiotics and cough suppressants can be combined.
WHEN IS IT A SERIOUS CONDITION?
In very young puppies, especially those with a recent shipping history (i.e. pet store puppies) are especially prone to severe cases of infectious tracheobronchitis (frequently progressing to pneumonia).
In dogs where the distemper virus is involved (usually shelter or pet store puppies), there is tremendous potential for serious consequences. (For more information on distemper, click here)
VACCINATION OPTIONS:
There are basically two options for Kennel cough vaccination: injectable and intranasal.
Injectable is a good choice for aggressive dogs, who may bite if their muzzle is approached. It provides good systemic immunity as long as two doses are given after age 4 months (with an annual booster). Injectable vaccination may only lead to less severe infection and not complete prevention.
Intranasal vaccination may be given as early as 2 weeks of age and immunity generally lasts 10-12 months. (Usually this vaccine is boosted annually.) The advantage here is that the local immunity is stimulated, right at the site where the natural infection would be trying to take hold.
It takes 4 days to generate a solid immune response after intranasal vaccination so it is best if vaccination is given at least 4 days prior to the exposure. Some dogs will have some sneezing or nasal discharge in the week following intranasal vaccination. As a general rule, nasal vaccination provides faster immunity than injectable vaccination.
Parainfluenza, Adenovirus type 2, and canine distemper, all members of the Kennel Cough complex, are all covered by the standard DHLPP vaccine, the basic vaccine for dogs. Adenovirus Type 2 serum also immunizes against Adenovirus Type 1, the agent of infectious canine hepatitis.
VACCINATION IS NOT USEFUL IN A DOG
ALREADY INCUBATING KENNEL COUGH
WHAT IF IT DOESN’T IMPROVE?
As previously noted, this infection is generally self-limiting. It should be at least improved partially after one week of treatment. If no improvement has been observed in this time, a re-check exam (possibly including radiographs of the chest) would be a good idea.
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