I have two abyssinians with chronic respiratory issues. One is 7 months old and the other is 13 months old. This past summer, and before I got my current two, I lost my 3 year old abyssinian to what my vet ultimately thought was FIP, but her primary symptoms were related to severe pneumonia. Upon necropsy her lungs were completely full of mucus/fluid. She had had long-term respiratory problems as well with symptoms nearly identical to my two cats now. Her long-term symptoms included loud nasal breathing (wheezy and gurgly sounds in the nasal area), gagging when smelling food, off and on loss of voice, scratching at base of ears/throat and periodically coughing. Her x-rays showed general cloudiness in her lungs for several years and was just diagnosed as asthma, even though she never had any symptoms of having asthma. She had been on pred about 5 months before she became gravely ill. After she passed, I got my current 13 month old approximately 2 months later. Since losing my last one, I have been very proactive in trying to determine what is causing my current cat's respiratory issues. My older one had a PCR run for both bacteria/viruses and one for fungus. The only thing that came up positive on these tests was calicivirus. She was negative for mycoplasma, bordatella, herpes chlamydia and any fungus. She was treated twice over three months with azithromycin. Her primary symptoms were gagging, coughing, sneezing and watery eyes with ulceration. Even though she came up negative for herpes, she has been on lysine since I got her, just in case. When I got my second kitten, she had terrible green eye discharge and after not being able to get her respiratory issues under control with clindamycin drops, she went in for a nasopharyngeal swab as well. We did not run the fungal test this time, but the other test results came back positive for calicivirus and mycoplasma. Both cats were then treated for two weeks on doxycycline. With only three days left to go of this treatment, my younger one started having an increase in symptoms (coughing, gagging). After being off treatment for about 2 weeks, it was time for her spay surgery. Since she was still coughing, my vet recommended doing another swab and I suggested that this time we run a full culture on it. That has recently come back as positive for alpha hemolytic streptococcus and a gram negative bacteria that could not be identified. Both were susceptible to clavamox. The mycoplasma culture came back negative. Both cats have now been on clavamox for a full three days and there has been no improvement thus far in their symptoms. The biggest concern I have with my youngest is that her breathing becomes very labored when she purrs. Her purr is very audible with both a raspy sound and gurgly. She swallows often while purring and mostly keeps her mouth open as well, although most of the time she is still breathing through her nose. When she is not purring, you'd never know anything was wrong, other than the occasional cough and periodic watery eye. When she eats her treats and shakes them in her mouth first, you can hear she has quite a bit of mucus in her nasal passages. Over the last 6 months that I've been dealing with this in both, I've tried numerous things such as a humidifier, homeopathic treatments for URI's, herbal treatments such as echinacea, interferon, etc. and while they seem to be better at times, it's never for very long. They are currently receiving several immune boosting supplements such as Thorne's Immugen, Moducare, Lysine, feline probiotics and Transfer Factor. They also eat a very health diet, grain free and 90% canned. They are both very active cats, but so was my last one up until her death. As you can imagine, I'm just terrified of possibly losing these two to the same thing. The bacteria was never identified in my last cat, even though I had specifically asked for the cause so that I could make sure when I got another cat that this wouldn't happen. And I'm not saying that they have the same thing, but the symptoms are so eerily similar, I can't help but worry. I should also mention that I've had my house tested for mold and other VOC's but have turned up nothing there. The air in my home is about as clean as you can get. At this point I'm at a loss of what to do next. I don't want to just sit around and wait for them to end up with pneumonia, so I would like suggestions on my next steps to take. I should also mention that I also have a labrador that has been in the home for the last 9 years, just in case this could be zoonotic and her being a carrier transferring this from my last cat to the two I have now. I know that's a stretch, but with the similarities between the two I can't help but wonder. I apologize for being so long-winded, but want you to have as much of the background to better assist me. Thank you in advance.
Type of Animal: Abyssinian Cat
Hi there,Yes, I can understand your fears. These upper respiratory and ocular conditions of cats are very difficult to treat. Extremely frustrating for all concerned. The PCR testing for what is or is not present is fraoujght with false negatives and so it is hard to know for sure what you are dealing with. I would say that nearly every cat has Herpes so the ulcerating eye and the conjunctivitis is most likely due to that and to Chlamydia. Treating with Terramycin or Erythromycin ophthalmic ointment for 3 times a day for 4 weeks is helpful. I would treat with the Doxycycline for three or 4 weeks and use the Clavamox at the same time. Consider Famcyclovir when out breaks are bad. I know you will never cure the Herpes. There is more luck with the Chlamydia and the Mycoplasma.Usually these conditions do not go further than URI. I think you are doing all you can with the ummune support and oather supportive care. Don't use any steroids and just keep on keeping on with treating when symptoms reappear!
Thank you for your quick response. I'm also against the use of steroids, at least for these types of UR symptoms given my last cat's history with them. I think my biggest hindrance at this point is the treatment portion. Although I see a feline-only vet that I really love, she doesn't seem to have the same thought regarding longer-term antibiotic treatment. It's always 2 weeks or less. Even the clavamox I was given will only last them a week and for something this chronic, I was expecting at least two weeks worth of treatment. She is always very open to my suggestions, but other than physically taking the cats back in, I'm usually dealing with staff that act more as a block to my cat's treatment than helping. I think I will plan to take them back in on Saturday and let her recheck them. The clavamox I have should get me by until then and I can make your suggestions to her then. One more question if you don't mind. What about my dog? Is it possible she is carrying the mycoplasma so they just keep getting reinfected? They are all very close and the dog often eats their left overs if I'm not keeping a close eye out. She was treated last fall with a round of doxy, back when we thought this might be bordetella, but the UR issues in the cats have been ongoing even since then.Thanks again!
No, I do not think that the Mycoplasma is coming from the dog. That sounds like a good plan to take them back in on Sat. I do think that office staff can get overzealous in protecting the vet and I would mention it to your vet. The vet doesn't know what these people are saying and sometimes you can have just the wrong people in the front and really they are so important to set the whole tone to be favorable and helpful. Here is a article that might help your vet and you will find it interesting too. Although it is primarily discussing conjuctivitis it is usually a package deal with the ither URI symptoms.
Feline conjunctivitis is a common and often frustrating clinical problem. It is most frequently caused by feline herpesvirus-1 (FHV-1) or Chlamydophila felis, primary feline pathogens capable of infecting the healthy ocular surface. Non-infectious feline conjunctival disorders include eosinophilic conjunctivitis, keratoconjunctivitis sicca and lipogranulomatous conjunctivitis.
Owing to the frequently infectious nature of feline conjunctivitis, symptomatic therapy with topical and/or systemic corticosteroids is contraindicated until an infectious aetiology is disproved. Clinical inflammation may initially decrease with steroid therapy, but the immunosuppressive effects increase the risk of herpes-related corneal ulceration, lengthen the period of ocular virus shedding and encourage deeper corneal infection.
FHV-1 and Chlamydophila felis infections tend to occur more frequently in catteries, shelters and multicat households. Natural (pregnancy, lactation, oestrus and systemic illness) and exogenous (relocation, new pets, exhibitions and corticosteroids) stress factors have a proven role in reactivating latent ocular infections.
The typical patient with viral conjunctivitis is a neonatal or adolescent cat with an acute conjunctival-respiratory infection. The conjunctivitis is bilateral and characterised by pronounced hyperaemia and serous discharge that becomes mucopurulent as the disease follows its 10-14-day course. Conjunctival adhesions known as symblepharon frequently occur in very young kittens, resulting in epiphora due to occlusion of the nasolacrimal puncta, reduced eyelid mobility and permanent corneal opacity.
An estimated 80% of cats become latently infected; 45% of these will either shed the virus asymptomatically or develop recurrent clinical disease. Cats may have intermittent ocular disease, after which they appear clinically normal, or may have chronic clinical signs that persist or fail to respond to therapy. Recurrent herpetic conjunctivitis is often unilateral, characterised by intermittent blepharospasm, mild conjunctival hyperaemia and serous discharge, without signs of respiratory infection.
Decreased tear production (Schirmer tear test <5 mm/min) can occur, attributed to occlusion of lacrimal ductules or lacrimal adenitis secondary to FHV-1. Response to ciclosporin is limited. Because Schirmer tear test values can decrease substantially in anxious cats, a single low reading in the absence of other clinical signs may be insignificant.
In contrast to herpes-infected cats, patients with acute Chlamydophila rarely demonstrate signs of upper respiratory disease beyond a mild rhinitis. Conjunctivitis is initially unilateral, with marked conjunctival oedema (chemosis) and serous to mucopurulent discharge. Second eye involvement occurs 5-7 days later. Conjunctival follicles are described but can occur in any chronic conjunctivitis. Chronic chlamydial conjunctivitis may be unilateral or bilateral, with mild blepharospasm, serous discharge and mild hyperaemia.
Other Infectious Agents
Although Mycoplasma spp. have been isolated from the cul-de-sacs of cats with chronic conjunctivitis, the organisms are also prevalent in the conjunctival sacs of normal animals. This ubiquitous nature, coupled with the difficulty of experimentally establishing mycoplasmal conjunctivitis in the absence of other organisms, suggests that Mycoplasma is significant only as a secondary pathogen. Calicivirus and reovirus are insignificant ocular pathogens. Histoplasma capsulatum has been identified in conjunctival nodules on rare occasion. Recent reports have implicated Bartonella spp. in feline conjunctivitis.
Since the initial herpetic conjunctivitis has a short clinical course and acute Chlamydophila conjunctivitis responds readily to antibacterial therapy, diagnostic tests are not often performed in the acute presentation. Instead diagnosis is based on clinical signs and response to therapy. Basophilic intracytoplasmic inclusions are only seen in conjunctival scrapings taken during the first few days of an acute chlamydial infection. Herpesvirus intranuclear inclusions are not identifiable in routinely prepared conjunctival scrapings.
Determination of the aetiological agent in chronic or recurrent conjunctivitis in the adult cat is especially difficult. Multiple studies have concluded that an aetiological diagnosis cannot be made in the majority of chronically infected cats using aerobic bacterial and chlamydial cultures, cytology, virus isolation, serum neutralisation, immunofluorescent antibody (IFA), or enzyme-linked immunosorbent assay (ELISA). Although polymerase chain reaction (PCR) technology is vastly superior at detecting virus compared to other methods, the test's sensitivity actually complicates interpretation. A positive PCR result may reflect viral DNA of vaccine origin rather than wild type virus, as well as low levels of latent or persistent FHV-1 DNA that are not contributing to disease.
A clinical feature that clearly distinguishes herpesvirus from Chlamydophila is the presence of corneal ulceration. Linear, branching epithelial erosions termed dendrites are pathognomonic for herpetic keratitis, but these early indicators of viral replication are usually subtle and may be overlooked without use of Rose Bengal stain. Patients should be routinely screened for feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV) which occur in a higher percentage of cats with chronic conjunctivitis compared to the general population.
Therapy: Acute Conjunctivitis
The usual approach to acute feline conjunctivitis of suspected infectious aetiology is to 'treat the treatable'. Symptomatic ocular therapy is directed against Chlamydophila, coupled with supportive systemic care. Since the primary viral infection is self-limiting in 10-14 days, antiviral therapy is rarely used during the initial infection except in patients with corneal ulceration. There is no known way to prevent viral latency, but dietary supplementation with L-lysine (in kittens, 250 mg twice daily in food) may limit frequency and severity of recurrences. Chlamydophila is resistant to many common topical antibiotics including bacitracin, neomycin and gentamicin. The treatment of choice is topical tetracycline applied four times daily for 3 weeks, but because the ointment is often quite irritating, suitable alternatives include erythromycin, chloramphenicol and the fluoroquinolones such as ofloxacin. Systemic therapy may also be considered. Although tetracycline would be an excellent choice with respect to sensitivity of the organism, the risk of dental staining precludes its use in young animals. Doxycycline is not as likely to discolour enamel in the short term, but the possibility still exists in the 3-week regimen recommended to discourage the carrier state (5 mg/kg q12h for 21 days). Azithromycin has the advantage of a longer half-life and less frequent administration but is more expensive. The usual dosage is 5 mg/kg for 5 days, then 5 mg/kg every 72 hours for five to seven additional doses. The recommended dosage of azithromycin for Bartonella-associated conjunctivitis is 10 mg/kg daily for 6 weeks.
Therapy: Chronic Conjunctivitis
Therapy for the adult cat with recurring bouts of conjunctivitis is first directed against Chlamydophila, as described for the acute episode. Failure to respond to a 3-week course of therapy implicates herpesvirus as the inciting cause and subsequent treatment is based on the severity, duration and frequency of the outbreaks.
In mild cases of presumed herpetic conjunctivitis, oral L-lysine supplementation limits viral replication by suppressing arginine incorporation into viral proteins. The recommended lifelong dose in adult patients is 500 mg twice daily. The product is available as a powder, paste or over-the-counter capsule that can be opened and mixed with moist food. Topical interferon alpha-2b (3000 units/ml) applied three times daily may limit spread of the virus to adjacent cells and potentially shorten the course of the disease. A topical antibiotic ointment such as erythromycin or a viscous artificial tear supplement may provide subjective relief of discomfort. Topically applied 0.5-1% povidone- iodine solution has been used three to four times daily for its antiviral effect, but its extracellular site of action may limit efficacy.
Antivirals should be considered when clinical signs are severe, persistent or recurrent, or when there is notable corneal involvement. The in vitro potency of specific antiviral drugs against FHV-1 is: trifluridine > ganciclovir = idoxuridine = cidofovir = penciclovir = vidarabine > acyclovir >> foscarnet. Idoxuridine is a less irritating, more economical antiviral than trifluridine and can be compounded as a 0.1% solution or 0.5% ointment. Topical antivirals are virostatic, requiring frequent application to be effective (every 2 hours the first day, then five to six times daily.) The exception is 0.5% cidofovir applied twice daily. Topical antivirals should not be applied for more than 3 weeks at a time due to epithelial cell toxicity. Rather than topical antivirals, the author prefers to use oral famciclovir, dosed at 32 mg (1/4of a 125 mg tablet) q12h for 10-14 days.
Eosinophilic conjunctivitis is a presumably immune-mediated disorder characterised by unilateral or bilateral conjunctival hyperaemia, thickening and discharge. A nodular variation occurs in the third eyelid. Both herpesvirus-1 and Chlamydophila have been implicated as a cause or secondary opportunist. Diagnosis is based on conjunctival scrapings containing eosinophils, with occasional mast cells, lymphocytes and plasma cells. Treatment consists of a topical corticosteroid such as 1% prednisolone acetate two to four times daily, tapering the frequency of therapy as clinical signs resolve. Signs may recur if treatment is discontinued.
Keratoconjunctivitis sicca (KCS) is rare in cats. Decreased tear production occurs occasionally in patients with chronic infectious conjunctivitis or keratitis. Schirmer tear test values are consistently less than 5 mm/min. FHV-1 is usually implicated in the pathogenesis of the problem owing to secondary ductal occlusion or lacrimal adenitis. Because the Schirmer tear test can decrease substantially in anxious cats, a single low reading may be insignificant. Topical ciclosporin is rarely effective. Symptomatic therapy with topical artificial tear supplements is recommended.
Older cats (mean age 11 years) demonstrate an inflammatory reaction to lipids, presumably of meibomian gland origin, causing multifocal palpebral conjunctival nodules adjacent to the eyelid margins. Biopsy specimens demonstrate accumulations of lipid surrounded by macrophages, giant cells, lymphocytes and plasma cells. Surgical excision of the abnormal tissue is reportedly curative.
XXXXX XXXXXe Glaze, DVM, MS, DACVO Gulf Coast Animal Eye ClinicHouston, TX, USA
Internship and residency at UCD. 47 years experience.