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The Daily Vet by petMD

The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets.

When Is an Infection Not an Infection?

We veterinarians are a simple lot. Rather than take the time to fully explain complicated medical conditions we resort to simplistic explanations. These are often misleading or confusing for owners. Two great examples are recurrent ear "infections" in dogs and recurrent bladder "infections" in cats.


Calling something an infection generally implies a bacterial cause (sometimes fungal). It also implies that with the proper antibiotics (or antifungals) the problem will resolve. No wonder owners are confused when they return to the veterinary office repeatedly with their dogs for treatment of smelly and painful ears and their cats’ inappropriate or frequent urination.


Owners deserve a better explanation that these are chronic medical conditions that are not curable short term but manageable long term.


Ear Problems in Dogs


In humans ear infections are very common in children. Infections take place in the middle ear in back of the eardrum. They are associated with respiratory infections like flu or colds or other bacterial infections from the nose and sinuses. The connection of the nose and throat area to the middle ear, called the Eustachian tube, allows bacterial migration to the middle ear to cause the infection.


Although bacterial middle and inner ear infections do occur in dogs, the most common ear problem in dogs is in the ear canal, which is called otitis externa. These do not occur because of an invasion of bacteria to the ear canal. Rather they result from a breakdown in normal canal cell immunity that allows the overgrowth of bacteria and fungus that are normal inhabitants of the ear canal.


Ear mites and foreign objects (foxtails, grass awns) can cause ear problems but are resolved with proper treatment or removal. Animals with food or environmental allergies, certain skin conditions, or other immune mediated diseases are the most affected. Certain breeds with narrowed or ear canal abnormalities are also chronically troubled. Floppy ears and swimming are often cited as risk factors but are weak explanations. Perky eared dogs and non-swimmers are equally afflicted, while millions of swimming dogs have no ear problems. In fact, the microscopic hairs of the ear canal, called cilia, beat in synchronous waves to expel water or other liquids from the ear.


It is these allergic, immune, or anatomical problems that are the cause. Ear medications that control bacterial and fungal growth resolve the symptoms but don’t address the cause. That is why ear problems recur. If the underlying cause cannot be identified or resolved, veterinarians need to offer treatment programs that manage the condition without creating unreasonable expectations of curing the problem.


Bladder Problems in Cats


Many cat owners are familiar with recurrent bladder problems or cystitis in their cats. These pets exhibit repeated bouts of inappropriate urination or frequent, poor productive trips to the litter box. Occasionally owners will observe blood in the cat’s small urinary deposits.


Some of these cats produce crystals or stones that cause bladder irritation and the resulting symptoms. Most affected cats suffer from a chronic inflammation of the bladder called interstitial cystitis. This condition is believed to be an immune disorder similar to what occurs in women.


With the exception of a small percentage of cats with struvite crystals or stones, cystitis in cats is not associated with bacterial infections. The actual causes for the various types of cystitis are still not known. Although risk factors have been identified with crystal or stone forming cats, interstitial cystitis is still a mystery. Antibiotics will not "cure" these problems. In fact nothing will "cure" most cases of feline cystitis. Even the management of cystitis with dietary intervention, supplements, and various drugs is not universally successful. Owners should be alerted to this reality.

Dr. Ken Tudor



Image: Photographee.eu / Shutterstock

Comments  5

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  • Perhaps, Clueless Vets?
    03/07/2013 01:05pm

    I've found that many vets not only use the term "infections" to diagnose non-infections, but they also prescribe antibiotics to treat these non-infections. I have heard more than once that vets are taught in school that roughly 70% of all pet disorders will cure themselves regardless of what the vet does to treat them. It seems, therefore, that vets indiscriminantly prescribe antibiotics to treat these non-infections just to make the pet owners think that the vet is doing something to help the animal. But when a vet prescribes an antibiotic to treat a non-infection, perhaps it indicates that the vet does not know what he is doing.

    Vets should realize that antibiotics are not harmless water, and that they can do serious harm when given to a dog or cat that does not need them.

  • UTIs
    03/08/2013 01:13am

    Are urinary tract infections often confused with bladder infections?

    It's my understanding that female kitties are sometimes prone to UTIs if there is a lack of grooming simply because it's easier for bacteria to enter the urinary tract. Is that true or a myth?

    My elderly and stress-prone Clara Kathleen (RIP) was prone to UTIs and, luckily, the problem always cleared up with injectable antibiotics. I kept a bottle of Baytril on hand, but from what I've seen lately, Baytril might not be the best choice for a cat.


  • TheOldBroad
    03/09/2013 02:53am

    First, most of these are not infections. That's my point. Vets call them UTI for simplicity, not as fact. Yes. Females are affected more than males. The etiology of this condition is absolutely unknown. Lack of grooming is not a risk factor. Excessive grooming has not proven to be a risk factor because again, there is no bacteria present, oral or otherwise. The condition is generally self limiting so any treatment appears to "cure" the condition. Unless your girl's urine was cultured at each episode and confirmed consistent bacterial infections, the Baytril did not make her better. You could have injected saline and got the same ultimate results.
    Dr. T

  • Good info!
    04/02/2013 09:19pm

    Dr. Tudor, thanks for addressing this issue. I learned about this big myth about feline UTIs mostly from Dr. Pierson's catinfo.org site, and from being involved in other feline health sites with my diabetic boy. I see it all the time where people claim their young cats have UTIs and often chronic UTIs. I see it in forums all the time (catster.com for one). It seems like this is one myth that is going to be difficult to dismantle, mostly in owners, but also within the veterinary community.

    I've read some info from a veterinary urologist who said that pet parents almost won't accept that urinary issues are not infection or bacterial; it's become such a myth that they expect and want an antibiotic for any urinary issue when most times it's inflammation or in some cases stones and crystals (those can be overdiagnosed as well).

    UTIs are not common in young cats, but I also want to say that they do occur in older cats, especially those with CKD and sometimes hyperthyroidism because the urine is so dilute (making a hospitable place for bacteria). And it can become serious. I recently made some mistakes around this issue with my 17-year-old who had CKD. He had been going out of the box and I thought it was just arthritis or something related to aging, but months later we found out he did have a UTI. Since I had learned this info Dr. Pierson etc, I wasn't focusing on him having a UTI, but after a good, clean urine sample (cystocentesis), he was found to have quite a bad UTI and this was months after he started going out of the box. I worry how long that infection had been there, as it can migrate into the kidneys and lead to kidney infection. He also later developed perinephric psuedocysts (pretty rare - do you know about this) and I wonder if this was related to a possible severe urinary infection that may be been there for a while....He passed away about six months ago and I'm still getting over it, and still feeling guilt and anguish over some things.

    So what I'm saying is that, yes, big time YES, UTIs are not common in young cats and are usually cystitis and there's a big myth about this, but they can occur in older cats and people need to be aware of what to look for and because untreated infections can lead to other serious problems.

  • C & S
    04/02/2013 09:54pm

    I also wanted to add that while a culture and sensitivity is ultimately the best way to accurately diagnose urinary issues/bacterial infections, I couldn't justify paying an extra, I think, $200, and waiting for 3 days to culture my 17-year-old cat's urine sample after the urinalysis from a cystocentesis showed infection. I feel that if you get a good, clean sample with a cystocentesis (getting a urine sample with a needle inserted into the bladder) that is sufficient in a lot of cases. But owners bringing in urine samples, or forcing urine out of the cat at the vet and just getting a urinalysis with those type of samples is going to give a lot of incorrect info and false positives - that is a problem. I wonder how often C&Ss are actually performed?

    Also, I thought males were more affected by urinary issues because of their anatomy and perhaps the effect of neutering? I see more young males with urinary issues (claimed to have UTIs, or sometimes it is stones/crystals) than females.

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