Wednesday, February 29, 2012

Sunday's interesting cases - ringworm or not ringworm in a Sheltie

Sunday 26, 2012. Bright sunshine. Went to NATAS fair at Changi expo at 9.30 am to see what was available in the travel industry and new ideas on marketing. My assistant phoned to say I had an appointment at 11 am.

"Sheltie very itchy below the penis," said the gentleman. I thought it was penile trauma or inflammation of the prepuce. On seeing the dog with Dr Daniel, I saw the red circular spots and the crusted centre. "Ringworm," I said. "Had the dog been to the groomer recently?"

"2 weeks ago," the owner said.
I showed the ringworm hairs to Dr Daniel. He was not convinced saying that those could be damaged hairs, due to the dog licking the ventral area, causing inflammation and rashes.

He didn't buy into my microscopic exam of ringworm hair. Each vet has his own ideas but there are certain presentation that cannot be ignored.

"Circular rings, reddish with crusty scales in the centre," i said. These are typical presentation.

"Needs confirmation with fungal culture," he said. This is what the professors teach.
"Yes," I said. "But the owner cannot wait 2 weeks for the culture to prove it is ringworm. He wants prompt action and successful outcome."

In fact the couple had a bare patch on the dog's left shoulder area diagnosed "ringworm" by Vet 1 from Toa Payoh Vets. Since it did not resolve and the dog was still scratching, he went to Vet 2 who diagnosed demodectic mange.

"How many mites he showed you?" I asked the gentleman banker.
"One mite," he described the cigar shape.
"Well, it is possible that it is demodectic mange on that hot spot," I said. "In any case, demodectic mites are normally present in dogs, as are bacteria in our mouth. Ringworm takes more than 1 week to cure."

I did not want to defend Vet 1's "misdiagnosis" as the gentleman would not believe me. Vet 2 had cured his dog and that was results. "Yellow pimples," he said.

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