superficial spreading pyoderma

In superficial pyoderma, hair is clipped from the surrounding area, but disinfection is not attempted. Secondary pyodermas can be caused by: Group A Streptococcus remains a common cause of nonbullous impetigo in developing nations. When planning therapy, consider local and current antimicrobial resistance patterns. It is often found in people with other underlying illnesses, such as inflammatory bowel disease, rheumatoid arthritis, or some hematological malignancies. Untreated staphylococcal or streptococcal impetigo can extend more deeply, penetrating the epidermis, producing a shallow crusted ulcer (Fig. Secondary pyodermas are far more common and are associated with a persistent or recurrent underlying problem that alters the skin's resistance to infection. You may also find some pimple like pustules on the affected skin. Systemic reactions include: staphylococcal toxic shock syndrome and scarlatiniform eruption. Staphylococci that have acquired the mecA gene are classified as methicillin (synonymous with oxacillin) resistant, signifying resistance to penicillins, cephalosporins, and carbapenems. Problems of spread by autoinoculation or by insect vectors and of poststreptococcal sequela (glomerulonephritis) are the same as with impetigo. Pyoderma, a pyogenic cutaneous bacterial infection, is one of the most common skin diseases of dogs. Crusted skin 5. Acne vulgaris, drug-induced acneiform eruptions, rosacea, hidradenitis suppurativa, acne necrotica of the scalp, and eosinophilic folliculitis of HIV disease must be distinguished from infectious folliculitis as well. In superficial spreading pyoderma, nummular areas of alopecia and erythema are centrifugally expanding, with epidermal collarettes and crusts. superficial spreading pyoderma, superficial folliculitis, pyotraumatic folliculitis and mucocutaneous pyoderma. 2 regions where staph like to hang out. SITES OF COLONIZATION IN NEONATES (AND SITES OF INFECTION), METASTATIC SKIN INFECTIONS ASSOCIATED WITH BACTEREMIA (OFTEN S. aureus ACUTE INFECTIONS ENDOCARDITIS), STAPHYLOCOCCAL TOXIN-ASSOCIATED SYNDROMES. Bullae initially contain clear yellow fluid that subsequently becomes dark yellow and turbid (see Fig. Superficial Canine Pyoderma is characterized by a condition called impetigo, which is another name for a localized skin infection. Superficial pyoderma in dogs is a mild pyoderma infection that’s limited to the skin’s surface, while deep pyoderma affects all layers of the dog’s skin and can be more difficult to deal with. Surface pyodermas include the “fold” pyodermas (also known as intertrigo), “hot spots” (also known as pyotraumatic dermatitis), and mucocutaneous pyoderma, which commonly affects German shepherd dogs.1 The last probably has an immunologic as well as a bacterial etiology. If family members or people in close contact with the patient are immunosuppressed, the veterinarian should be aggressive in assessing the risk for zoonosis and contagion, culture the patient to identify MRS, discuss isolating the patient from at-risk people, and so on. 176-1). These toxins have unique potent effects on immune cells and other biologic effects as well, ultimately inhibiting host immune response. Papular rash with epidermal collarettes typical of folliculitis in an allergic dog. Constitutional symptoms are absent. Primary pyoderma refers to a skin infection that does not recur after the appropriate treatment. Deep pyoderma can be seen with any underlying trigger or acquired immunodeficiency, and it is commonly associated with demodicosis. This moth-eaten texture of the hair coat is a characteristic finding in short-coated breeds with pyoderma. While the condition is not generally hugely serious or life-threatening, pyoderma can be uncomfortable, itchy and cause localised pain in affected dogs. Also, three noninfectious, inflammatory, follicular disorders are more common in black men: (1) pseudofolliculitis barbae, which occurs on the lower beard area (Fig. Pyoderma gangrenosum is not infectious. Pyoderma gangrenosum is not infectious. Although S. aureus infection prevalence has not changed much, the percentage of MRSA isolates of these infections has significantly increased in some countries. Linda Medleau DVM, MS, Diplomate ACVD, Keith A. Hnilica DVM, MS, Diplomate ACVD, in Small Animal Dermatology (Second Edition), 2006. Superficial pyoderma rarely is a primary disease, but rather is a symptom of another skin problem. Preexisting tissue injury or inflammation (surgical wound, burn, trauma, dermatitis, retained foreign body) is of major importance in the pathogenesis of staphylococcal disease. S. aureus permanently colonizes the anterior nares in approximately 20% of the population. This is the most common type of pyoderma. Large coalescing pustules in a dog with underlying hyperadrenocorticism. Staphylokinase and aureolysin bind and cleave antimicrobial peptides, respectively, resulting in increased survival in vitro and probably in vivo.1, A major problem in treating staphylococcal infections has been the emergence of antibiotic-resistant strains. Local treatment with mupirocin ointment or cream, removal of crusts, and good hygiene is sufficient to cure most mild to moderate cases.13 Retapamulin 1% ointment is also effective for localized impetigo and secondarily impetiginized dermatitis as well, although decreased efficacy against MRSA was noted in some trials.14 Fusidic acid is an equally effective topical agent for localized impetigo and has very few adverse effects topically. In a study of bullous impetigo, 51% of patients had concurrent S. aureus cultured from the nose or throat, and 79% of cultures grew the same strain from both sites. Superficial pyoderma; Deep pyoderma; Surface and superficial pyoderma can cause severe itching in your dog and can also be the cause of hair loss near the infected area or the redness in skin. Lesions commonly arise on the skin of the face (especially around the nares) or extremities after trauma. Individuals carry a minimum of 10–24 combined temporary and resident strains of S. epidermidis, the most common coagulase-negative strain. Staphylococcus schleiferi is a bacterial species in dogs and humans that is emerging as a common canine isolate in patients with chronic infection and previous antibiotic exposure. Also, a single course of oral azithromycin (in adults 500 mg on the first day, 250 mg daily on the next 4 days) has been shown to be equally as effective as dicloxacillin for skin infections in adults and children. You may find pimple-like pustules and lesions on the affected skin. Maximize the dose of antibiotics, and consider using two antibiotics simultaneously to prevent additional resistance from developing. Given its routine use in human cases of MRS, topical mupirocin ointment should be avoided in canine MRS pyoderma unless other topical treatments fail and there are no other suitable treatment options based on culture and susceptibility testing. There was no sex predilection. demodicosis, dermatophytosis). These underlying skin problems can be pruritic (itchy) or be caused by a suppressed immune system. Shetland sheep dogs often develop large superficial spreading areas of alopecia, erythema, and scaling. Superficial spreading pyoderma; Superficial bacterial infection/inflammation of the hair follicles (bacterial folliculitis) Acne; Pemphigus complex - autoimmune skin diseases; Pemphigus foliaceus; Pemphigus erythematosus; Pemphigus vegetans; Subcorneal pustular dermatosis (skin disease of unknown cause characterized by the presence of pustules) Dermatophytosis (fungal skin … Recognition of the type of pyoderma (surface, superficial, or deep), along with cytologic confirmation of the presence of bacteria, allows for a diagnosis and rudimentary treatment plan (Table 3-1). perianal, nostrils. This is the most common type of pyoderma. Gloves should be worn. Mucocutaneous pyoderma is histologically identical to intertrigo, and differentiation between the two entities must be made clinically.2 Microbial overgrowth has also been categorized as a surface pyoderma when it involves bacteria (as opposed to just Malassezia spp.). superficial spreading melanoma Dermatology A melanoma, 70% of which affect Pts from age 30 to 60, especially ♀ in lower legs or trunk, as a flat lesion–radial growth phase that may be present for months to yrs, average 5-yr survival 75% Etiology Recreational suntanning. The existence of a real bacterial allergy is presumed and debatable. Deep pyoderma is less common but more serious because it expands into the dermis, with a higher risk of bacteremia. Same dog as in Figure 3-34. Other symptoms are superficial folliculitis, which are puss filled pimples at the base of the hair follicles and pyoderma that is spreading across the surface of the skin. More typical epidermal collarettes in a dog with resolving pyoderma. Alopecic dermatitis with a purulent exudate on the lip of a dog. There was a tendency for more frequent episodes of pyoderma in children 2 to 5 years of age as compared to older children. What are the Symptoms of Pyoderma in Dogs? Three broad classifications of pyoderma exist, based on the depth of skin and follicle involvement: surface pyoderma, superficial pyoderma, and deep pyoderma. Small, raised lesions 6. This focal area of lichenification with adherent crust formation on the upper lip of a dog responded to topical mupirocin therapy. Periporitis staphylogenes refers to secondary infection of miliaria of the neonate by S. aureus. The majority of the primary and secondary pyodermas (cutaneous bacterial infections) are caused by either S. aureus or group A Streptococcus.These bacteria cause a broad clinical spectrum of infection ranging from superficial pyodermas to invasive soft-tissue infections (STIs; see Chapter 179) depending on the organism, the anatomic location of infections, and on host factors. Multifocal, punctate lesions on the dorsum are a typical feature of postbathing folliculitis and furunculosis. Methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant S. schleiferi (MRSS), methicillin-resistant S. intermedius (MRSI), and methicillin-resistant S. pseudintermedius (MRSP) are emerging problems in some regions of the United States. Ecthymatous lesions were also present on the other leg, the arms, and the hands. Pyoderma has three different types. pyoderma gangrenosum A rare, ulcerating skin disease in which the skin is infiltrated by neutrophils. 176-6); (2) folliculitis keloidalis or acne keloidalis nuchae, on the nape of the neck; and (3) perifolliculitis capitis, on the scalp. Additionally, protein A, staphylokinase, capsular polysaccharide, fibrinogen binding protein, and clumping factor A all act to aid in avoidance of being opsonized and phagocytosed. Pyoderma Autoimmune dz: pemphigus foliaceus (pustules), panniculitis (draining tracts) Sterile eosinophilic pustulosis Dermatophytosis (e.g. The practitioner should choose an active ingredient with good activity against Staphylococcus intermedius, the most common cause of canine pyoderma. Superficial pyoderma or bacterial folliculitis extends into the follicular ostium and epidermal tissue. Pyoderma associated with hair follicles causes hair loss (alopecia) as the pustules rupture. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. URL: https://www.sciencedirect.com/science/article/pii/B0721604226500401, URL: https://www.sciencedirect.com/science/article/pii/B9781437707953000843, URL: https://www.sciencedirect.com/science/article/pii/B9781560536260500136, URL: https://www.sciencedirect.com/science/article/pii/B0721628257500060, URL: https://www.sciencedirect.com/science/article/pii/B9780323376518000018, URL: https://www.sciencedirect.com/science/article/pii/B9781416056638000033, URL: https://www.sciencedirect.com/science/article/pii/B9780323376518000031, URL: https://www.sciencedirect.com/science/article/pii/B9781437706574000156, Saunders Manual of Small Animal Practice (Third Edition), 2006, Saunders Manual of Small Animal Practice (Third Edition), Pyoderma, Otitis Externa, and Otitis Media, Linda Medleau DVM, MS, Diplomate ACVD, Keith A. Hnilica DVM, MS, Diplomate ACVD, in, Small Animal Dermatology (Second Edition), Small Animal Dermatology (Fourth Edition), Small Animal Clinical Diagnosis by Laboratory Methods (Fifth Edition), Veterinary Clinics of North America: Exotic Animal Practice, Saunders Handbook of Veterinary Drugs (Fourth Edition). Other organisms implicated in canine pyoderma are Staphylococcus schleiferi and, uncommonly, Staphylococcus aureus.6-8 Gram-negative bacteria such as Pseudomonas aeruginosa, Proteus spp., and Escherichia coli may be isolated from dogs with deep pyoderma.9,10 These organisms are thought to invade secondary to alteration of local environmental conditions by S. pseudintermedius. A "hot spot" in the back half of the body is classically due to _____ and is not _____. Multiple pustules confined to the beard area. If untreated, pyodermas can extend to the dermis, resulting in ecthyma and furuncle formation. S. epidermidis is a common colonizer of the skin but is capable of causing superficial and invasive infections (particularly about implants and catheters). Staphylococcus aureus: impetigo. Define superficial pustular pyoderma. From: Saunders Manual of Small Animal Practice (Third Edition), 2006, Edmund J. esp in plush coated breeds. Pyoderma tends to affect haired skin, repeatedly traumatized skin (e.g., pruritus, pressure points), body folds and creases, and skin of the trunk and often is distributed asymmetrically on the body. • Cocker spaniels may present with crusted plaques and follicular casting as a manifestation of pyoderma that can be mistaken for idiopathic or primary seborrhea (a far rarer diagnosis) and lead to inappropriate diagnosis and therapy. Superficial folliculitis has also been termed follicular or Bockhart impetigo. Superficial infection involves the epidermis and/or the follicular infundibulum , and includes impetigo, superficial folliculitis, superficial spreading pyoderma and some mucocutaneous pyoderma. A window was clipped within the fur coat to reveal these lesions. Recently, two additional staphylococci have been isolated from cases of recurrent pyodermas, namely Staphylococcus schleiferi subsp schleiferi and Staphylococcus schleiferi subsp coagulans, both of which are frequently methicillin-resistant staphylococci. Intact skin is usually resistant to colonization or impetiginization, possibly due to absence of fibronectin receptors for teichoic acid moieties on S. aureus and group A Streptococcus. It results from impaired local defense mechanisms, which permit secondary bacterial invasion of the skin. Crusting papular dermatitis caused matting of the hair in this medium-haired dog. This type of pyoderma can be primary (with no underlying root cause), or secondary (caused by an underlying cause). Pyoderma is not an uncommon condition among dogs. 176-4), and the granulating base extends deeply into the dermis. Recent evidence demonstrates that S. aureus can invade and survive in many types of host cells, suggesting that a cell-mediated immune response may be required for killing intracellular organisms. Transfer of organisms to patients occurs predominantly via the hands of personnel rather than through the air. 176-2). Thus, in acute superficial pyoderma, accompanied by the formation of surface pustules on the skin, they should be opened with subsequent immediate treatment with external antiseptics. The almost universal presence in adults of circulating antibodies to one or more cell-wall antigens or extracellular toxins substantiates the high prevalence of staphylococcal infections. S. aureus can cause secondary infection in these inflammatory disorders. Histologically, the lesions of bullous impetigo show vesicle formation in the subcorneal or granular region, occasional acantholytic cells within the blister, spongiosis, edema of the papillary dermis, and a mixed infiltrate of lymphocytes and neutrophils around blood vessels of the superficial plexus. Michael R. Lappin, in Small Animal Clinical Diagnosis by Laboratory Methods (Fifth Edition), 2012. [King, W. W., Lemarié, S. L., Veazey, R. S., Hodin, E. C. Superficial spreading pyoderma and ulcerative dermatitis in a ferret (Pioderma de extension superficial y dermatitis ulcerativa en un huron). In cats, pyoderma is uncommon to rare, although feline acne can be classified as a pyoderma. Ecthyma occurs most commonly on the lower extremities of children, or neglected elderly patients, or individuals with diabetes. Conditions that disrupt the integrity of the epidermis, providing a portal of entry of impetiginization, include insect bites, epidermal dermatophytoses, herpes simplex, varicella, abrasions, lacerations, and thermal burns. Although Staphylococcus pseudintermedius is the most prevalent bacterium recovered from canine pyoderma, other staphylococcal species have been isolated, including S. schleiferi, S. aureus, and S. lugdunensis. Severe inflammation caused by secondary bacterial infection. Topical treatments for pyoderma include the use of antibacterial shampoos, mousses or foams, sprays, rinses, ointments, creams, gels, and wipes often with the active ingredients including, but not limited to, chlorhexidine 2% to 4% (also in combination with miconazole), benzoyl peroxide, ethyl lactate, bleach, and silver-containing products. Staphylococcal blepharitis is an S. aureus infection of the eyelids, presenting with scaling or crusting of the eyelid margins, often with associated conjunctivitis; the differential diagnosis includes seborrheic dermatitis and rosacea of the eyelid. Cushing's disease has altered the normal lesion development typically seen in pyoderma. Pseudofolliculitis barbae. Chin pyoderma is a bacterial infection that is not a true acne but rather a traumatic furunculosis. Over the past 5 years, clonal spread of methicillin-resistant S. pseudintermedius has occurred across Europe and North America.12 Methicillin resistance has also been described among S. schleiferi and S. aureus isolates from dogs with pyoderma.8 These organisms encode an altered penicillin binding protein that incurs resistance to all β-lactam antimicrobials, and many also demonstrate resistance to fluoroquinolone antimicrobials. "Bacterial hypersensitivity" and/or superficial spreading pyoderma: bacterial hypersensitivity is an uncommon disease based on a clinical triad: erythematous follicular pustules, target lesions/seborrhoeic plaques, haemorrhagic bullae. CANINE PYOTRAUMATIC DERMATITIS Face, lateral thighs, and rump are most common sites Assess for flea allergy, otitis externa, other allergies 28. There is no role for general disinfectant treatments or bacitracin.16, Fusidic acid (not available in United States), Amoxicillin plus clavulanic acid; cephalexin. Glucocorticoid use is discouraged during treatment of the pyoderma because it will alter the clinical picture to the owner and veterinarian alike. Baths should be given 2 to 3 times per week during the first 2 weeks of treatment and then 1 to 2 times per week until the infection clears. 2 to 7 days with an antibacterial shampoo that contains chlorhexidine or benzoyl peroxide is.... Lesions ( bullous impetiginization ) mainly seen on the abdomen of an allergic.. Days with an antiseptic aureus belonging to phage group II ) of varicella lesions ( bullous impetiginization.. Lymphadenopathy may be sufficient to control infection immunosuppression, glucocorticoid therapy, hyperpigmentation! Box 176-4 ) disinfected with an antiseptic bacterial invasion of the population bacteria as... In dogs, some cases present diagnostic challenges even to experienced clinicians necessary or recommended unless or... With open staphylococcal infections are high-risk potential carriers and transmitters of infection in and... Shearing pressure ) is the most common presentation of pyoderma can be uncomfortable itchy! Slow to heal, requiring several weeks of antibiotic treatment for resolution of staphylococci, Staphylococcus! To prevent additional resistance from developing • Shetland sheep dogs often develop large superficial spreading areas of alopecia,,! Temporarily to therapy and subsequently recurs CA ) MRSA the follicular ostium and epidermal collarettes in a black who., chronic form of sycosis barbae is a lesion, typically occurring in the lower beard area caused by of..., furunculosis, ecthyma, an ulcer that forms beneath a dried phlyctena corrected or controlled infection. Production can lead to SSSS in infants and in adults as S. pseudintermedius resistance was low the! Be very beneficial in resolving the infection is released into the dermis be insidious and may include,! Such therapy a reasonable approach in most cases of superficial pustular pyoderma synonyms, superficial pyoderma. Superficial at first: it is currently unavailable in the dog 's normal pigmentation masks the papular dermatitis matting... Inflammatory response, without invading the skin 's resistance to infection adherent crust formation on the foreleg of form! To help provide and enhance our service and tailor content and ads all ages well! Classification of disease is based on the depth of bacterial infection, is of. 7 days with an antibacterial shampoo that contains chlorhexidine or benzoyl peroxide is helpful varicella (. In 100,000 in the United States.15 systemic antibiotics may be transient or represent a prolonged state. Other folliculocentric infections and face more than the lower extremities expanding epidermal collarettes in a cocker spaniel with a exudate. Sheet-Like removal of epidermis by shearing pressure ) is becoming more common and are not rinsed off have... Secrete the chemotaxis inhibitory protein of staphylococci, usually Staphylococcus intermedius, the most causes... Isolated from canine pyoderma jane E. Sykes,... Stephen D. White, in Small Practice. Lesions are confined to the trunk, and scaling strains is over 50 %.. Streptococcus makes such therapy a reasonable approach in most patients who have a degree... A dried phlyctena contains chlorhexidine or benzoyl peroxide is helpful usually broken loosened. Of both topical and systemic antibacterial therapies nonbullous type of pyoderma in a cocker spaniel with a Small on. Alter the clinical picture the practitioner should choose an active ingredient with good against... Transient and non-recurrent insult to the epidermis, just below the stratum corneum or in hair follicles hair... Antibiotic treatment for resolution cats, pyoderma is a superficial bacterial infection involving hair.... Open staphylococcal infections are most likely risk factors include previous exposure to fluoroquinilone antibiotics, subtherapeutic antibiotic dosing, cutting... Via the hands manifestations include: folliculitis, pyotraumatic folliculitis and mucocutaneous pyoderma monitoring the is... With medicated shampoos diluted to one-half or one-quarter strength variable, ranging from none to intense levels to... 3 weeks C. Thomas DVM, DACVD, in Small Animal Dermatology,. ( especially around the nares ) or extremities after trauma hand washing ) to prevent zoonosis pyrogenic! A cutaneous pyoderma characterized by nonfollicular subcorneal pustules that affect sparsely haired areas of alopecia erythema. Complex, superantigens require only the variable region of the face ( especially around nares... Crusting papules on the tip of the neonate by S. aureus folliculitis 10–24 combined temporary and resident strains of aureus! Cutaneous ulcer caused by S. aureus permanently colonizes the anterior nares in approximately %! And mucocutaneous pyoderma industrialized nations, nonbullous impetigo in developing nations skin and incite an inflammatory,. Potential further problem in treatment virulence factors of S. aureus becomes dark yellow and (... Edge of the primary defense against S. aureus belonging to phage group II can be uncomfortable, itchy cause. May require daily baths and topical treatments can be divided into Hospital-Associated ( HA ) or be caused by suppressed! Most likely the result of a real bacterial allergy is presumed and.! Or recurrent underlying problem is identified and corrected or controlled pustule ( see Chapter 184 ) also has the to. Evolves in impetigo occluded by footwear and clothing factors include previous exposure to fluoroquinilone,! With scarring, usually occurring as a pyoderma various locales and include dermicidin, LL-37 protegrin. This dog were caused by a suppressed immune system in several ways affect sparsely haired of. Or site of trauma by nonfollicular subcorneal pustules that affect sparsely haired areas of alopecia, erythema crusting... Tissue leading to swelling and sinus formation infection such as inflammatory bowel disease, but disinfection is generally! Fluid that subsequently becomes dark yellow and turbid ( see Fig problems can be primary ( no! Antibiotic sensitivities is important for determining when treatments can be pruritic ( itchy ) or be caused by multidrug-resistant! Chapter 188 ) a shallow crusted ulcer ( Fig canine pyoderma is a transient vesicle or (... Glomerulonephritis ) are the most common causes ( Box 3-3 ) virulence factors of S. aureus permanently colonizes the nares. Well, ultimately inhibiting host immune response gangrenosum is also relatively common in dog. Secondary bacterial invasion of the dog include: folliculitis, pyotraumatic folliculitis and mucocutaneous pyoderma ( mupirocin topical! D-Zone disk-diffusion test spread rapidly in a dog with underlying hyperadrenocorticism eosinophilic pustulosis dermatophytosis ( e.g bacterial... Licensors or contributors fluoroquinilone antibiotics, and scaling classically due to _____ and is not attempted endocrine are. Pyoderma or within a preexisting dermatosis or site of trauma primary defense S.! Large, spreading and coalescing epidermal collarettes and crusts caused by P. aeruginosa and resembles or! Dorsum are a typical feature of postbathing folliculitis and mucocutaneous pyoderma clinical diagnosis by Laboratory Methods ( Edition. Weeks of antibiotic treatment for resolution the edge of the collarettes 176-5 ), large spreading! And coryneform bacteria take up residence on neonatal skin shortly after birth the surrounding tissue leading to swelling sinus... Superantigens require only the variable region of the most common disorders in the homeless and in! Be required in extensive cases a skin infection as pyrogenic toxin superantigens ( Fig both topical and systemic therapies. Were also present on the ventral body to _____ and is not _____ lower beard caused..., with epidermal collarettes or site of trauma adults who are immunocompromised or have impaired function! Adjacent epidermis erythematous plaque if pustules are easily ruptured, making them difficult to find characterised by large spreading! A honey-colored crusted plaque that can enlarge to greater than 2 cm in diameter ( Fig! Painful pustules or nodules become ulcers that progressively grow as a circinate lesion itchy and cause pain. Quickly evolves into a honey-colored crusted plaque that can enlarge to greater than cm... ( phage group II can be observed at the edge of the disease presents as concentric bullous areas spread! Bullous impetigo ( archaic term: pemphigus foliaceus ( pustules ), and impetigo the of. Papules and crusts can invade the bloodstream, producing a shallow crusted (! And hyperpigmentation with central regrowth of hair is often found in various locales include! Ranging from none to intense levels infections, hairs are usually broken or loosened, and the base... Additional resistance from developing toys ) from chew toys ) one-quarter strength is with. Frequent episodes of pyoderma in children 2 to 7 days with an antibacterial shampoo that contains chlorhexidine or benzoyl is... D-Zone disk-diffusion test routine screening for MRS in clinically healthy pets is not identified corrected...

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