Claire R. Sharp

•Cause: Viruses of the family Paramyxoviridae; genera Morbillivirus (feline morbillivirus [FeMV], canine distemper virus [CDV], Henipavirus (including Hendra virus [HeV] and Nipah virus), and the newly named Rubulavirus (previously paramyxovirus; mumps virus [MuV]).

•First Described: FeMV was first described in China in 2012. CDV was first described in France in 1905. HeV was first isolated in Queensland, Australia in 1994. Nipah virus was first identified in humans in Malaysia in 1999. MuV was first described in 410 bc (Hippocrates).

•Affected Hosts: Domestic cats (FeMV); large wild Felidae, dogs and other Canidae, Procyonidae (raccoons, pandas), Mustelidae (ferrets, mink, skunks, otters), nonhuman primates (CDV); horses, humans, flying foxes (reservoirs), domestic cats (experimental infection only), guinea pigs (experimental), dogs (HeV); pigs, humans, fruit bats (reservoirs), domestic cats, dogs (Nipah virus); humans, dogs, cats (MuV).

•Geographic Distribution: Asia, Europe, North and South America (FeMV); northeastern Australia (HeV); Malaysia, Singapore, Bangladesh, India (Nipah virus); worldwide (MuV).

•Route of Transmission: Oronasal contact with virus in secretions or excretions, droplet nuclei, and large particle aerosol transmission. Major Clinical Signs: Paramyxoviruses cause infections of the CNS, and respiratory and urinary tracts. FeMV has been implicated in chronic kidney disease in cats, but its clinical significance remains unclear. Natural infections of dogs with HeV have been rare and subclinical. Natural infections of dogs and cats with Nipah virus are also rare, but death and severe respiratory signs have been described. MuV can cause parotitis with salivary gland enlargement.

•Differential Diagnoses: These include other causes of infectious respiratory disease; parasitic respiratory disease; toxins such as lead and ethylene glycol; other causes of infectious meningoencephalitis. Differential diagnosis for mumps include other causes of parotitis such as immune-mediated disease.

•Human Health Significance: FeMV is not known to infect humans. HeV and Nipah virus cause serious infections of humans with high mortality. Mumps is a serious infection of humans but largely controlled by vaccination; periodic outbreaks still occur. Dogs and cats do not appear to be important in transmission of these viruses to humans.

The first section of Clinical Medicine of the Dog and Cat, Fourth Edition elaborates on the medical approach to solving common medical problems in small animals. Chapter 1, authored by Bobbi Connor, explores the all-important topics of client communication and taking a thorough and considered medical history. Chapter 2 then covers common clinical problems, each author taking a short topic and covering history, clinical signs, physical and clinical examination, diagnostic imaging, differential diagnosis, management, and recommended further reading. Short topics such as cough, diarrhea, dyspnea, dysuria, epistaxis, fever of unknown origin, icterus, pallor, polydipsia and polyuria, pigmenturia, syncope, episodic weakness, collapse, and vomiting are updated from the third edition, while additional subchapters are added to cover abdominal distension, peripheral edema, proteinuria, regurgitation, and seizures. The practical application of the information in these sections is presented with text, tables, and algorithms. The objective of this clinical problems section is to emphasize the logical clinical approach to the selected clinical signs.

The systemic inflammatory response syndrome (SIRS) and sepsis are common and associated with high morbidity and mortality in dogs and cats. Identifying the underlying cause of SIRS and, specifically, differentiating infectious from non-infectious causes of SIRS is vital to guide appropriate and timely treatment. Multiple organ dysfunction syndrome (MODS) is a multifactorial phenomenon that occurs secondary to both non-infectious SIRS and sepsis, and refers to the presence of altered organ function in an acutely ill patient such that homeostasis cannot be maintained without intervention. It is generally MODS that causes mortality in dogs and cats with SIRS and sepsis. The diagnostic approach to patients with SIRS and sepsis includes a complete physical examination, laboratory evaluations, diagnostic imaging, and often cytology or culture to identify an underlying infectious agent. Treatment for SIRS and sepsis includes treating shock, supportive care, and managing organ dysfunction(s). Treatment for sepsis should also include early appropriate antimicrobial therapy and source control when possible. Prognosis for dogs and cats with SIRS and sepsis is variable, but the presence of multiple organ dysfunctions is a poor prognostic indicator.