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Stefanetti V, Passamonti F, Rampacci E. Antimicrobial Strategies Proposed for the Treatment of S. pseudintermedius and Other Dermato-Pathogenic Staphylococcus spp. in Companion Animals: A Narrative Review. Vet Sci 2024; 11:311. [PMID: 39057995 PMCID: PMC11281426 DOI: 10.3390/vetsci11070311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/03/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
The treatment of dermato-pathogenic Staphylococcus spp., particularly Staphylococcus pseudintermedius, in companion animals presents significant challenges due to rising antimicrobial resistance. This review explores innovative strategies to combat these infections. We examined novel antimicrobials and the repurposing of existing drugs to enhance their efficacy against resistant strains. Additionally, we evaluate the potential of natural products, nanomaterials, and skin antiseptics as alternative treatments. The review also investigates the use of antimicrobial peptides and bacteriophages, highlighting their targeted action against staphylococcal pathogens. Furthermore, the role of adjuvants in antibiotic treatments, such as antimicrobial resistance breakers, is discussed, emphasizing their ability to enhance therapeutic outcomes. Our analysis underscores the importance of a multifaceted approach in developing effective antimicrobial strategies for companion animals, aiming to mitigate resistance and improve clinical management of staphylococcal skin infections.
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Affiliation(s)
- Valentina Stefanetti
- Department of Human Science and Promotion of Quality Life, San Raffaele Telematic University, 00166 Rome, Italy;
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126 Perugia, Italy;
| | - Fabrizio Passamonti
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126 Perugia, Italy;
| | - Elisa Rampacci
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126 Perugia, Italy;
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Eigner F, Keller S, Schmitt S, Corti S, Nolff MC. Efficiency of octenidine dihydrochloride alcohol combination compared to ethanol based skin antiseptics for preoperative skin preparation in dogs. PLoS One 2023; 18:e0293211. [PMID: 37934779 PMCID: PMC10629653 DOI: 10.1371/journal.pone.0293211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/07/2023] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVE To quantify the bacterial burden after skin disinfection using an alcohol octenidine dihydrochloride combination (Octenisept®) compared to an 74.1% ethanol 10% 2-propanol combination (Softasept N®). STUDY DESIGN Prospective randomized clinical trial. MATERIAL & METHODS 61 dogs undergoing clean or clean-contaminated surgeries (excluding surgeries on the gastrointestinal tract) were randomly assigned to group O (skin disinfection with alcohol and octenidine dihydrochloride after washing with octenidine containing soap) or to control group C (skin disinfection using the ethanol-2-propanol combination after washing with a neutral soap without antiseptic ingredients). Samples were then taken from 8 different locations within the surgical field at four different stages: after clipping, after washing, after disinfection and one hour later. At each stage, two different sampling techniques (wet-dry swab technique (WDS) and contact plates (CP)) were used for quantitative analysis of bacterial counts. RESULTS WDS detected about 100-fold more bacteria compared to CP sampling in cases with high bacterial burden, but was not accurate enough to detect small numbers. CP sampling was therefore used for comparison of treatment protocols. 30 dogs were assigned to group O and 31 to group C. A relative reduction of 69% in group O and 77 percent in group C was observed after the soap wash. No significant differences were detected between both groups. Washing and disinfection resulted in a reduction of bacterial counts of 99.99% in group O versus 99.7% in group C (p = 0.018). Bacterial reduction one hour after washing and disinfection was significantly higher in group O (99.9%) than in group C (98.5%, p = 0.001). CONCLUSION Additional octenidine dihydrochloride provided a slightly better decontamination effect after disinfection, particularly one hour after, which means it may only be indicated in longer surgeries. WDS is more sensitive but less specific to detect bacteria on the skin than the CP sampling.
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Affiliation(s)
- Fabian Eigner
- Vetsuisse Faculty Zürich, Clinic for Small Animal Surgery, University of Zürich, Zurich, Switzerland
| | - Stefanie Keller
- Vetsuisse Faculty Zürich, Clinic for Small Animal Reproduction, University of Zürich, Zurich, Switzerland
| | - Sarah Schmitt
- Vetsuisse Faculty Zürich, Section of Veterinary Bacteriology, Institute for Food Safety and Hygiene, University Zürich, Zurich, Switzerland
| | - Sabrina Corti
- Vetsuisse Faculty Zürich, Institute for Food Safety and Hygiene, University Zürich, Zurich, Switzerland
| | - Mirja C. Nolff
- Vetsuisse Faculty Zürich, Clinic for Small Animal Surgery, University of Zürich, Zurich, Switzerland
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Lee T, Hyun J, Kang Y, Baek S, Hwang C. In vitro antifungal activity of cold atmospheric microwave plasma and synergistic activity against
Malassezia pachydermatis
when combined with chlorhexidine gluconate. Vet Med Sci 2022; 8:524-529. [PMID: 35089639 PMCID: PMC8959290 DOI: 10.1002/vms3.719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Tae‐Hyun Lee
- Laboratory of Veterinary Dermatology and the Research Institute for Veterinary Science College of Veterinary Medicine Seoul National University Seoul Republic of Korea
| | - Jae‐Eun Hyun
- Institute of Animal Medicine College of Veterinary Medicine Gyeongsang National University Jinju Republic of Korea
| | - Yeong‐Hun Kang
- Laboratory of Veterinary Dermatology and the Research Institute for Veterinary Science College of Veterinary Medicine Seoul National University Seoul Republic of Korea
| | - Seung‐Joon Baek
- Laboratory of Signal Transduction College of Veterinary Medicine Seoul National University Seoul Republic of Korea
| | - Cheol‐Yong Hwang
- Laboratory of Veterinary Dermatology and the Research Institute for Veterinary Science College of Veterinary Medicine Seoul National University Seoul Republic of Korea
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4
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Santoro D, Kher L, Chala V, Navarro C. Evaluation of the effects of chlorhexidine digluconate with and without cBD103 or cCath against multidrug-resistant clinical isolates of Staphylococcus pseudintermedius. Vet Dermatol 2021; 33:17-e6. [PMID: 34490674 PMCID: PMC9291178 DOI: 10.1111/vde.13018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 05/17/2021] [Accepted: 05/26/2021] [Indexed: 11/28/2022]
Abstract
Background Because of the increased incidence of multidrug‐resistant (MDR) bacteria, the use of disinfectants over antibiotics has been encouraged. However, the interactions between disinfectants and host local immunity are poorly understood. Objective To assess the effects of chlorhexidine digluconate (Chx), with and without selected host defence peptides (HDPs), against MDR Staphylococcus pseudintermedius (MDR‐SP). Methods and materials Ten clinical isolates of MDR‐SP were tested, using a modified microbroth dilution method. Four two‐fold dilutions of 2% Chx and 1 μg/mL the HDPs synthetic canine β‐defensin 103 (cBD103) or cathelicidin (cCath) were tested alone or in combination. Colony counts after 5, 15, 30 and 60 min, and a minimum inhibitory concentration (MIC) after 24 h were recorded. Friedman followed by Dunn’s multiple comparison tests with significance of P < 0.05 were used for statistical analysis. Synergy, additivity/neutrality or antagonism were calculated. Results Growth was not inhibited by either HDP alone. An MIC of 0.312 μg/mL Chx was achieved for nine of the isolates. One isolate had an MIC of 0.078 μg/mL Chx. A MIC90 (in nine of 10 isolates) of 0.312 µg/mL was seen for Chx in combination with either HDP. Synergy was seen in the combination Chx/cCath used at the highest concentrations of Chx (0.624 µg/mL and 0.312 µg/mL) after 30 and 60 min incubation. Additivity/neutrality was seen for most of the other concentrations and times of incubation. Conclusions and clinical importance These results suggest a synergistic/additive effect between Chx and HDPs in dogs. Further studies evaluating the mechanisms behind this effect are needed.
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Affiliation(s)
- Domenico Santoro
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Lopamudra Kher
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Vanessa Chala
- Virbac SA Laboratories, 13ème Rue LID, Carros, 06511, France
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Bond R, Morris DO, Guillot J, Bensignor EJ, Robson D, Mason KV, Kano R, Hill PB. Biology, diagnosis and treatment of Malassezia dermatitis in dogs and cats Clinical Consensus Guidelines of the World Association for Veterinary Dermatology. Vet Dermatol 2020; 31:28-74. [PMID: 31957204 DOI: 10.1111/vde.12809] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND The genus Malassezia is comprised of a group of lipophilic yeasts that have evolved as skin commensals and opportunistic cutaneous pathogens of a variety of mammals and birds. OBJECTIVES The objective of this document is to provide the veterinary community and other interested parties with current information on the ecology, pathophysiology, diagnosis, treatment and prevention of skin diseases associated with Malassezia yeasts in dogs and cats. METHODS AND MATERIAL The authors served as a Guideline Panel (GP) and reviewed the literature available prior to October 2018. The GP prepared a detailed literature review and made recommendations on selected topics. The World Association of Veterinary Dermatology (WAVD) Clinical Consensus Guideline committee provided guidance and oversight for this process. The document was presented at two international meetings of veterinary dermatology societies and one international mycology workshop; it was made available for comment on the WAVD website for a period of six months. Comments were shared with the GP electronically and responses incorporated into the final document. CONCLUSIONS AND CLINICAL IMPORTANCE There has been a remarkable expansion of knowledge on Malassezia yeasts and their role in animal disease, particularly since the early 1990's. Malassezia dermatitis in dogs and cats has evolved from a disease of obscurity and controversy on its existence, to now being a routine diagnosis in general veterinary practice. Clinical signs are well recognised and diagnostic approaches are well developed. A range of topical and systemic therapies is known to be effective, especially when predisposing factors are identified and corrected.
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Affiliation(s)
- Ross Bond
- Department of Clinical Sciences and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, AL9 7TA, UK
| | - Daniel O Morris
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancy Street, Philadelphia, PA, 19104, USA
| | - Jacques Guillot
- École nationale vétérinaire d'Alfort, BioPôle Alfort, EA 7380 Dynamyc, UPEC, EnvA, Maisons Alfort, Ile-de-France, France
| | | | - David Robson
- Animal Skin and Ear Specialists, Melbourne Veterinary Specialist Centre, 70 Blackburn Road, Glen Waverley, Victoria, 3150, Australia
| | - Kenneth V Mason
- Dermcare-vet PTY LTD, 7 Centenary Road, Slacks Creek, Queensland, 4127, Australia
| | - Rui Kano
- Department of Veterinary Pathobiology, Nihon University College of Bioresource Sciences, 1866 Kameino, Fujisawa, Kanagawa, 252-0880, Japan
| | - Peter B Hill
- Department of Veterinary Science, University of Adelaide, Adelaide, South Australia, 5005, Australia
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Fregeneda-Grandes JM, Nicolás-González JJ, Rejas-López J, Carvajal-Urueña A. Preliminary evaluation of two commercial ear solutions in the treatment of canine otitis externa. J Small Anim Pract 2020; 61:547-553. [PMID: 32716068 DOI: 10.1111/jsap.13177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 04/13/2020] [Accepted: 05/09/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Preliminary evaluation of the efficacy of two commercial ear solutions composed of (1) chlorhexidine-Tris-ethylenediaminetetraacetic acid (EDTA) or (2) medical grade honey, for the treatment of otitis externa in dogs. MATERIALS AND METHODS Dogs affected with otitis externa housed in an animal shelter were eligible for inclusion. Treatment was applied daily for 10 days and effect was measured by otitis clinical scores and microbiological counts. One of the treatments was applied to affected left ears, while the other was applied to affected right ears. RESULTS A total of 24 ears from 13 dogs were included in the study. During the treatment period, with both treatments it was observed an improvement in clinical scores and a decrease in microbiological counts. At the end of the study 22 of 24 ears were deemed to have mild (4 ears), or no (18 ears) pain, with only two ears still showing pruritus. CLINICAL SIGNIFICANCE The application of ear solutions composed of chlorhexidine-Tris-EDTA or medical grade honey, in the absence of antimicrobial treatment, might be effective for the control of clinical signs and microbial colonisation in dogs with otitis externa. Additional randomised studies on clinical patients are required to validate these findings.
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Affiliation(s)
- J M Fregeneda-Grandes
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad de León, 24071, León, Spain
| | - J J Nicolás-González
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad de León, 24071, León, Spain
| | - J Rejas-López
- Departamento de Medicina, Cirugía y Anatomía Veterinaria, Facultad de Veterinaria, Universidad de León, 24071, León, Spain
| | - A Carvajal-Urueña
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad de León, 24071, León, Spain
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Rafferty R, Robinson VH, Harris J, Argyle SA, Nuttall TJ. A pilot study of the in vitro antimicrobial activity and in vivo residual activity of chlorhexidine and acetic acid/boric acid impregnated cleansing wipes. BMC Vet Res 2019; 15:382. [PMID: 31666075 PMCID: PMC6820967 DOI: 10.1186/s12917-019-2098-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Topical antimicrobials are recommended for first line treatment of surface and superficial infections in dogs. This is especially important given the increasing prevalence of antimicrobial resistant infections. Antimicrobial wipes have become popular, but there are a lack of controlled studies assessing their in vitro antimicrobial and in vivo residual activity. We aimed to assess the antimicrobial efficacy of two commercial antimicrobial wipes against frequently isolated pathogens. Ten clinical and one reference isolate each of meticillin-susceptible Staphylococcus pseudintermedius (MSSP), meticillin-resistant S. pseudintermedius (MRSP), Escherichia coli (EC), extended spectrum beta-lactamase (ESBL) producing E. coli (ESBL-EC), Pseudomonas aeruginosa (PA) and Malassezia pachydermatis (MP) were tested using a modified Kirby-Bauer technique. Each isolate was tested against 6 mm discs of chlorhexidine (CHX) and acetic acid/boric acid (AABA) wipes, and positive and negative controls either overnight (bacteria) or for 3 days (Malassezia). Healthy dogs were treated with the wipes and distilled water on a randomised flank (n = 5 each). Hair samples (1 cm; 0.1 g) taken at days 0, 1 and 3 were inoculated with an isolate of each organism. Zones of inhibition (ZI) were measured. RESULTS All isolates produced confluent growth with AABA and control wipes, except for the cleansing wipes and MP (median ZI 12 mm; 95% CI 8.2-15.8). The median (95% CI) CHX wipe ZIs (mm) were: MP 48.0 (47.0-49.0), MSSP 15.6 (14.2-17.0), MRSP 14.0 (13.6-14.4), EC 13.6 (12.0-15.2) and ESBL-EC 10.0 (9.4-10.6). PA showed confluent growth. The differences between the bacterial isolates was significant (Kruskal-Wallis p < 0.0001; post-tests MSSP = MRSP = EC > EBSL-EC > PA). Confluent growth was visible with all the hair samples. CONCLUSION CHX but not AABA showed in vitro efficacy against MSSP, MRSP, EC and MP. ESBL-EC were less susceptible and there was no activity against PA. There was no residual activity on hair. Additional studies are required to determine efficacy of these products in clinically affected patients.
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Affiliation(s)
- Rebecca Rafferty
- University of Edinburgh, Royal (Dick) School of Veterinary Studies, Easter Bush Campus, Roslin, EH25 9RG, UK
| | - Victoria H Robinson
- The Dermatology Referral Service, 528 Paisley Road West, Glasgow, G51 1RN, UK.
| | - Jennifer Harris
- University of Edinburgh, Royal (Dick) School of Veterinary Studies, Easter Bush Campus, Roslin, EH25 9RG, UK
| | - Sally A Argyle
- University of Edinburgh, Royal (Dick) School of Veterinary Studies, Easter Bush Campus, Roslin, EH25 9RG, UK
| | - Tim J Nuttall
- University of Edinburgh, Royal (Dick) School of Veterinary Studies, Easter Bush Campus, Roslin, EH25 9RG, UK
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Fadok VA, Irwin K. Sodium Hypochlorite/Salicylic Acid Shampoo for Treatment of Canine Staphylococcal Pyoderma. J Am Anim Hosp Assoc 2019; 55:117-123. [PMID: 30870602 DOI: 10.5326/jaaha-ms-6628] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The emergence of methicillin-resistant Staphylococcus pseudintermedius has increased the interest in topical therapy for treating canine pyoderma. Shampooing with chlorhexidine followed by dilute bleach rinses are often recommended, but household bleach can dry the skin and is unpleasant to use. A shampoo formulated with sodium hypochlorite and salicylic acid was evaluated as sole therapy for dogs with superficial pyoderma associated with S. pseudintermedius, including methicillin-resistant strains. Client-owned dogs were recruited based on positive culture for methicillin-resistant staphylococci or prior failure of pyoderma to respond to antibiotics. This prospective, open-label pilot study assessed the efficacy of the shampoo when used three times weekly for 4 wk. Dogs were evaluated at baseline and at 2 and 4 wk by cytology, clinical examination, and owner assessment. Digital images were also obtained. Baseline bacterial counts, clinical assessments and owner scores were significantly improved at 2 and 4 wk. Clients completing the study reported excellent lathering and dispersion, reduction in odor, and brightening of white and light coats. No owners reported skin dryness or other adverse events during the study. We conclude that this shampoo containing sodium hypochlorite in a vehicle that avoids skin drying is an effective treatment for canine pyoderma.
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Affiliation(s)
- Valerie A Fadok
- From Zoetis, Inc., Bellaire, Texas (V.A.F.); and ACVD Dermatology for Animals, Omaha, Nebraska (K.I.)
| | - Katherine Irwin
- From Zoetis, Inc., Bellaire, Texas (V.A.F.); and ACVD Dermatology for Animals, Omaha, Nebraska (K.I.)
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Yabes JM, White BK, Murray CK, Sanchez CJ, Mende K, Beckius ML, Zera WC, Wenke JC, Akers KS. In Vitro activity of Manuka Honey and polyhexamethylene biguanide on filamentous fungi and toxicity to human cell lines. Med Mycol 2017; 55:334-343. [PMID: 27601610 PMCID: PMC5339061 DOI: 10.1093/mmy/myw070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 07/02/2016] [Accepted: 07/29/2016] [Indexed: 12/11/2022] Open
Abstract
Soft-tissue invasive fungal infections are increasingly recognized as significant entities directly contributing to morbidity and mortality. They complicate clinical care, requiring aggressive surgical debridement and systemic antifungal therapy. To evaluate new topical approaches to therapy, we examined the antifungal activity and cytotoxicity of Manuka Honey (MH) and polyhexamethylene biguanide (PHMB). The activities of multiple concentrations of MH (40%, 60%, 80%) and PHMB (0.01%, 0.04%, 0.1%) against 13 clinical mould isolates were evaluated using a time-kill assay between 5 min and 24 h. Concentrations were selected to represent current clinical use. Cell viability was examined in parallel for human epidermal keratinocytes, dermal fibroblasts and osteoblasts, allowing determination of the 50% viability (LD50) concentration. Antifungal activity of both agents correlated more closely with exposure time than concentration. Exophiala and Fusarium growth was completely suppressed at 5 min for all PHMB concentrations, and at 12 and 6 h, respectively, for all MH concentrations. Only Lichtheimia had persistent growth to both agents at 24 h. Viability assays displayed concentration-and time-dependent toxicity for PHMB. For MH, exposure time predicted cytotoxicity only when all cell types were analyzed in aggregate. This study demonstrates that MH and PHMB possess primarily time-dependent antifungal activity, but also exert in vitro toxicity on human cells which may limit clinical use. Further research is needed to determine ideal treatment strategies to optimize antifungal activity against moulds while limiting cytotoxicity against host tissues in vivo.
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Affiliation(s)
- Joseph M. Yabes
- San Antonio Military Medical Center, Fort Sam Houston, TX, USA
| | - Brian K. White
- San Antonio Military Medical Center, Fort Sam Houston, TX, USA
| | | | - Carlos J. Sanchez
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA
| | - Katrin Mende
- San Antonio Military Medical Center, Fort Sam Houston, TX, USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | | | - Wendy C. Zera
- San Antonio Military Medical Center, Fort Sam Houston, TX, USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Joseph C. Wenke
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA
| | - Kevin S. Akers
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA
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10
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Banovic F, Lemo N. In vitro
evaluation of the use of diluted sodium hypochlorite (bleach) against Staphylococcus pseudintermedius
,Pseudomonas aeruginosa
and Malassezia pachydermatis. Vet Dermatol 2014; 25:233-234. [DOI: 10.1111/vde.12121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Frane Banovic
- Department of Clinical Sciences; North Carolina State University College of Veterinary Medicine; 1052 Wiliam Moore Drive Raleigh NC 27607 USA
| | - Niksa Lemo
- Clinic of Internal Diseases; Faculty of Veterinary Medicine; University of Zagreb; Heinzelova 55 Zagreb 10000 Croatia
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