Table 2.
Serial clinical procedures and treatments
| Day | Clinical procedures | Laboratory procedures | Farmacological treatments |
|---|---|---|---|
| 0a | Orthopaedic examination, radiographic study, first arthroscopy to collect synovial fluid and synovia (membrane and villi) and to explore stifle joint | Blood and synovial analysis, bacterial culture and sensitivity testing | Perioperative analgesic treatment: carprofen 4 mg/kg IV SID and buprenorphine 0.015 mg/kg IM TID |
| 1 | Cytological examination of synovial revealed yeasts. Serological test positive for Leishmania infantum | Analgesic treatment: carprofen 2 mg/kg SC SID and buprenorphine 0.015 mg/kg IM TID | |
| 2 | Positive culture for Candida spp. (post enrichment) | Analgesic treatment: carprofen 2 mg/kg SC SID | |
| 3 | Second arthroscopy to obtain new samples and carry out joint lavage | New bacterial culture and sensitivity testing of synovial fluid and synovia (membrane and villi) | Perioperative analgesic treatment: carprofen 2 mg/kg IV SID and buprenorphine 0.015 mg/kg IM TID |
| 4 | Analgesic treatment: carprofen 2 mg/kg SC SID and buprenorphine 0.015 mg/kg IM TID | ||
| 5 | Starting antifungal treatment: joint lavage + intra-articular fluconazole (0.7 mg/kg) | Confirmation of positivity for Candida guilliermondii | Antifungal and analgesic treatment: fluconazole 5 mg/kg PO SID, carprofen 2 mg/kg SC SID, respectively |
| 7 | Joint lavage + intra-articular fluconazole (0.7 mg/kg) | Antifungal and analgesic treatment: fluconazole 5 mg/kg PO SID, carprofen 2 mg/kg SC SID, respectively | |
| 9 | Joint lavage + intra-articular fluconazole (0.7 mg/kg) | Bacteriological culture of synovial fluid | Antifungal and analgesic treatment: fluconazole 5 mg/kg PO SID, carprofen 2 mg/kg SC SID, respectively |
| 10 | Antifungal and analgesic treatment: fluconazole 5 mg/kg PO SID, carprofen 2 mg/kg SC SID, respectively | ||
| 11 | Returned to the care of the primary practitioner | Negative to Candida spp. | |
| 19 | Follow up: improvement of lameness (1/5) | Starting Leishmania treatment (by the practitioner) | |
| 49 | TTA surgery (by the practitioner). | New sample of synovial fluid for bacteriological culture during TTA surgery | |
| 51 | Confirm negativity to Candida spp. |
aLameness had been apparent for approximately 3 months prior to the day of referral (denoted day 0)