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Dr. Adam
Dr. Adam, Veterinarian
Category: Cat Veterinary
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Experience:  Over twelve years of internal medicine, surgery, and preventive care.
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Cat has had nasal discharge (green) (one nostril)/sneezing

Customer Question

Cat has had nasal discharge (green) (one nostril)/sneezing X 2 weeks (approx). The vet tested cultures and did xrays/checked for polyps in throat. Culture came back + for pseudomonas. She said he had some blood in the nose upon exam also. She changed his antibiotic to proper one. She told me also that she thinks that he may have some bone erosion in that nostril. She is newer at reading xrays, so she sent them out to a specialist. She said that this could be from a fungal infection or cancer. His bloodwork was normal, he is eating and drinking, no weight loss, no change in mood. Xrays done of lungs showed no tumor. No facial deformity.
I asked a question before and the vet said that bone erosion could be from chronic inflammation from bacterial or fungal infection. So, my questions are: how long does the inflammation have to go on for the bone to erode? Could have had chronic inflammation without us knowing? Wouldn't there be other changes as far as bloodwork, appetite,ect, if this was a cancer ( I would assume it would take a long time for the bone to erode). Thank you.
Submitted: 2 years ago.
Category: Cat Veterinary
Expert:  Dr. Adam replied 2 years ago.
Bone erosion in the sinuses can actually happen rather quickly. The bone in the sinus and in nose in general is very thin. Any inflammation will stimulate osteoclasts (specialized bone cells) to start to break down bone and at the same time initate osteoblasts (building cells) to start laying down new bone. This is the process by which bone heals itself.

In many cases of spinal disease like herniated disks in dogs for example, there will be inflammation in the disk space and subsequent calcium deposition or basically bone formation in the disk. There will often be spondylosis as well which is a bony bridge that forms between vetebra to stabilize them. This is a natural response. BUT, at the same time, if there is infection in the bone, you will also usually see roughened bone edges that are blurry on xrays. This can be interpreted as either bone erosion, or new bone growth. It is hard to tell on x-rays.

I used the example of the spine because the spine is easier to visualize than the sinuses are. Truthfully, in most cases of xrays of the head and sinuses, MRI would be more appropriate. But, more expensive too. So we are stuck interpreting the xrays.

Chronic inflammation can be present for years without you knowing. A common cause is tooth root inflammation in pets. The teeth are infected. This causes inflammation in and around the root. The root goes very deep into the sinus and bone. The inflammatory cells that come into the area to fight the infection also cause inflammation in the area adjacent to the actual infection. This causes swelling in the sinus, sinus pain, sometimes discharge but not always. This could have been happening for a very long time without you knowing.

Bloodwork doesn't usually show cancer. You might see an increase in certain blood cells if it is a blood born cancer. You might also see toxic neutrophils in the cat that can indicate inflamation in the body, but that aren't very specific. We don't have many biologic indicators that we can test for in small animals like they have in human medicine.

SO, yes, the inflammation may have been there a long time. NO, it doesn't mean you would have seen any changes in the appetite, blood work, etc..

The best way to know what is going on is culture (like has been done), possible biopsy of the tissue (invasive and typically reserved for if medications aren't working), and lastly MRI. Sometimes serial xrays might be taken over the treatment period to see if there is any change in the bone.

Nasal tumors are less common in cats than infection, so that is good news. BUT, the bad news is that when nasal tumors are present they are typically highly aggressive. :(

I hope that answers your question. If not feel free to respond.
Sincerely,
DRRalston
Dr. Adam, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 2095
Experience: Over twelve years of internal medicine, surgery, and preventive care.
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Customer: replied 2 years ago.

Yes, she also did check for tooth problems but, everything was ok.

She said that she is leaning towards the fungal infection.

I am hoping that she is right.

Is there anything else that could cause a chronic inflammation in the cat the we would not be aware of? Or, could just this pseudomonas cause this bone issue?

Expert:  Dr. Adam replied 2 years ago.
Well psedomonas shouldn't be there. So, I do believe it is an abnormal infection. It can be hard to treat, especially in the cat. Culture should show which medication the bacteria is sensitive to. In the cat I have used many different fluroquinolones to treat it. There is danger in the use of these drugs as overdosage is possible at even lower doses, and sudden blindness has been reported (enrofloxacin). I still use it, but I use it with caution and with that in mind.

It could be infection. I hope your vet is right since the tumors are just bad news.

Fungal infections are not as common either, but we do see them. A biopsy is sometimes needed to find the fungal parts and identify them (hyphae). In the cat there are several common fungal infections but that depends on where you live and can vary a lot depending on the pet's exposure to the fungus.

Cryptococcus is, for example, one of those fungal infections that cats can get and often in the nose. This is often spread by birds (pigeons often). They get it from sniffing bird droppings. Here's a link on that (click here). And it is something to consider.

If the antibiotics failed and the biopsy is inconclusive, I would sometimes consider using an antifungal medication as a last resort hoping to get lucky.... but you would want to discuss that with your Veterinarian of course.

In the nose the chronic inflammation is usually going to be fungal, bacteria, virus, tumor, foreign body (usuallky from puncture in the roof of the mouth that winds up in the sinus), or localized inflammation from the teeth. So, kind of a big list. Each of those categories has many examples. That's why culture and biopsy are often needed for the difficult diagnosis that aren't found with the initial tests/treatment. It can really difficult in some cats.

But, yes, pseudomonas could be doing it all by itself. It's a nasty bacteria.

I should also tell you that many cats with Pseudomonas will also respond to azithromycin (Zithromax Rx).
Expert:  Dr. Adam replied 2 years ago.
I apologize for the typos in the last message. It's still early here.

Your questions are very good questions by the way. I hope I am doing them some justice in my answers.
Customer: replied 2 years ago.

So, because she found pseudomonas, this could be the cause of the nasal infection and the bone erosion?

He is an indoor cat, I am not sure where he could have picked it up. Maybe in the drinking water?

She has him on Orbax, 22.7 mg, 1X/day.

I guess though, that since Pseudomonas is hard to treat, we may find it hard to find the proper antibiotic. I am really hoping this is it. The vet and I were hoping to find something in the culture.

Although, she did not think that pseudomonas could be the cause of the bone erosion? He was on Zithromax and it didn't work. Don't worry about the typos...I am just grateful for the help. I have been a basket case since he has been sick.

Expert:  Dr. Adam replied 2 years ago.
Pseudomonas is usually an infection found in the ear, not in the nose. So, no idea what it is doing there Lynette. But sure, it can cause a severe infection. And any severe infection will lead to inflammation, and that inflammation can lead to bone lysis and destruction. So, very likely.

Fluroquinolones often work. Orbax is a good medication for cats.

But, pseudomonas is probably not directly the cause of the erosin, but rather indirectly due to the inflammation. Does that make sense? And it could still be that there is a fungus or a tumor... etc. You just won't know unless fungal cultures are done, and a biopsy. *shrug* And even then...

But, pseudomonas, I can't tell you enough, is HARD to kill. Sometimes a nasal cream will have to be applied. In cats this is hard because it has to be done under sedation. Most cats aren't going to let you put something up their nose. BUT, in some cats you can do this.

Ceftazadime (Fortaz) seems to be a good choice for a systemic, injectible antibiotic as most pseudomonas organisms have never seen that antibiotic. SO, systemic injections might be an option as well. These are usually given IV but can be given in the muscle as well. The drug itself might be expensive and hard to get. It's not one that most vets will have sitting on the shelf, but it is an option to definitely consider and discuss with the Vet.

FOR IV use the pet would probably need to be hospitalized to make it easier. It is usually given IV with fluids. So, keeping a catheter in place is kind of hard in a cat at home. But, central lines into the jugular can be placed, and they last up to 7 days. Most vets do not have the ability to place one of those in private practice. That might have to be done at an ER or speciality hospital. BUT, it is an option.

These treatments might sound a little extreme, but pseudomonas sometimes needs extreme treatments because of it's resistance. Sometimes the oral meds just can't get it. SO then next step would be injections I would think, and lastly things like topical administration of creams into the nose, or flushes. I have never had to go that far thankfully. But, it's not seen every day either. Most of the cases I have seen eventually recovered with medications. Some had to have chronic dosing long term.

I read a report, I wish I knew where it was in the resources, but it was on a case where the cat was given an eye drop medication that was then used for daily administration into the eyes, and this in turn was absorbed through the lacrimal ducts into the sinus. That worked in that cat. I can't find the article though. Perhaps the drops could also be dripped into the nostrils, but many cats again will not tolerate that and might suffer some slight respiratory embarassment or difficultly breathing during that kind of treatment.

So, there are options though. Oral meds, injectables, creams. And if these are inconclusive, consider antifungals a last resort.

Honestly though, most of the infections I have seen were related to teeth somehow. Remember just because the teeth look ok from the gums out, doesn't mean they are ok below the gums. AN xray will sometimes show a completely different story.
Expert:  Dr. Adam replied 2 years ago.
Just another suggestion too, again, discuss with your Vet.

You might need to treat for up to 8 weeks! Most infections we just treat for 2 weeks, but sometimes with this guy here we need to go much longer.

And hopefully you have ruled out other subinfections like FeLV/FIV. Make sure you have a negative there as that can reduce the immune system and lead to infections like this that are hard to treat.

Also, a subclinical infection of feline herpes can also make it hard to treat the bacteria. Herpes is viral, not a lot of good medications are available for that. But L-lysine has been used, and famvir is also an antiviral availble for use in cats. It might have to be compounded at a compounding pharmacy. But, that is yet one more option.
Customer: replied 2 years ago.

I am hopeful because the nose discharge is not really there anymore (slightly). Some sneezing still though. I did see some clear discharge from the other side, only once and that was yesterday (it was only confined to the R side before)

I just got drops for the eyes for reddish/brown discharge. I am hoping really hoping that this clears up. He is only 9 and such a good cat.

Yes, when she first look at his teeth the L front incisor had blood on it so, she thought this may have been the culprit but, I don't know if she cultured it.

Will these antibiotics help that too? She did an Xray of the skull and only mentioned the nose. But, she said that she is still learning to read radiographs and we are awaiting a specialist to read them. I wish the cat could talk!

Like I said, he is eating, ect. I am praying.

Expert:  Dr. Adam replied 2 years ago.
Hey, that's good news! But still talk to your vet about extending treatment up to 8 weeks. Another problem with some sinus infection is that there is a LARGE amount of networks, and spaces and tunnels in the sinus. SO, there are a lot of places for the bacteria to hide. So, I think that is one reason it takes so long to treat.

GOOD that you have the eye drops, it might leak into the sinus like mentioned. And, I don't know, maybe drops into the nose might help?

Most infections can be treated by Orbax. I can't say for sure it will help the teeth in your cat, but probably it would. And, if that tooth was bleeding, that can definitely be the cause of the sinus inflammation. BUT, the tooth also might be bleeding secondary to the inflammation as well.. so.. correlation doesn't always imply causation.

Yeah, I wish cats could speak as well. Two questions I really wish I could ask them:
1. What did you eat?
2. Where does it hurt?

And I guess the third would be :
3. Why aren't you using the litter box???????????

Again, sinus xrays in most cats are almost useless. They are just so darn hard to read. EVEN for experienced Vets. So, your Vet is probably doing the best she can. Specialists often will look at the xrays and they aren't even sure. Sometimes they request a repeat, sometimes... they go to the 2000$ MRI. BUT, I still think that all medical possibilities should be chosen first before going that route unless money is not a problem. MRI is helpful, but it is only diagnostic, not curative. I'd rather spend the money in cures personally.

AND you know, in the ear sometime we will use povodine iodine or Tris EDTA. I have NEVER used these in a flush of the sinuses, but I wonder if this could be attempted in the cat. This is PURE conjecture on my part though. I am not recommending this treatment, just reaching for possibilities to see if I can help.

Just keep in mind, even if you can't remove the infection entirely, you might still be able to control the symptoms and give your pet a normal life, assuming it isn't something worse like cancer. BUT, at least you have found a bacteria that is present. And that at least gives you a direction to pursue the treatment.
Customer: replied 2 years ago.

I did not see your 2 nd response right away. We did not do the testing for the other 2 you mentioned. I think b/c he was an indoor cat. We have two other cats who are showing no symptoms. I will ask her about testing him. I should have said to test him when we talked but, I guess it didn't feel it was necessary.

Do we need to sedate him again for the nose culture?

If the antibiotics work, I guess there is still a chance of a tumor?

Customer: replied 2 years ago.

Yes, I feel a little better.

The CT scan started at $2000 up to $3500. Before I could do that I would have to meet with the vet for another $200. I panicked at first and wanted the CT scan but, when I heard the amount of cried about that. I am hoping we don't have to go that route.

I am just hoping the big cat has an infection. It took him a couple of weeks to get rid of bronchitis back in 2006 (and he wasn't that big back then).

Thank you for all your help. Wish I could let you know what happens.

Expert:  Dr. Adam replied 2 years ago.
Oh ok.. did you see my latest response? Let me just repost it here and then I will answer your last questions:

Previous- Hey, that's good news! But still talk to your vet about extending treatment up to 8 weeks. Another problem with some sinus infection is that there is a LARGE amount of networks, and spaces and tunnels in the sinus. SO, there are a lot of places for the bacteria to hide. So, I think that is one reason it takes so long to treat.

GOOD that you have the eye drops, it might leak into the sinus like mentioned. And, I don't know, maybe drops into the nose might help?

Most infections can be treated by Orbax. I can't say for sure it will help the teeth in your cat, but probably it would. And, if that tooth was bleeding, that can definitely be the cause of the sinus inflammation. BUT, the tooth also might be bleeding secondary to the inflammation as well.. so.. correlation doesn't always imply causation.

Yeah, I wish cats could speak as well. Two questions I really wish I could ask them:
1. What did you eat?
2. Where does it hurt?

And I guess the third would be :
3. Why aren't you using the litter box???????????

Again, sinus xrays in most cats are almost useless. They are just so darn hard to read. EVEN for experienced Vets. So, your Vet is probably doing the best she can. Specialists often will look at the xrays and they aren't even sure. Sometimes they request a repeat, sometimes... they go to the 2000$ MRI. BUT, I still think that all medical possibilities should be chosen first before going that route unless money is not a problem. MRI is helpful, but it is only diagnostic, not curative. I'd rather spend the money in cures personally.

AND you know, in the ear sometime we will use povodine iodine or Tris EDTA. I have NEVER used these in a flush of the sinuses, but I wonder if this could be attempted in the cat. This is PURE conjecture on my part though. I am not recommending this treatment, just reaching for possibilities to see if I can help.

Just keep in mind, even if you can't remove the infection entirely, you might still be able to control the symptoms and give your pet a normal life, assuming it isn't something worse like cancer. BUT, at least you have found a bacteria that is present. And that at least gives you a direction to pursue the treatment.


OK. back to the present: The American Association of Feline Practioners recommends testing all cats for FeLV/FIV once a year regardless of indoor or outdoor status.
A cat can be a carrier for years with no signs. Important to remember. Also, eventhough your cat is an indoor only cat, he is exposed to the other two cats. Have they been tested??? Could be that one is a chronic carrier.

They wouldn't always show signs of FeLV or FIV just that their immune systems don't fight off infection very well. So, it's worth testing to be sure in a cat that isn't getting better. Just to let you know it often is negative. BUT, in cats that are frustrating and not getting better I always run that FeLV/FIV to be sure I am not just trying to put out a fire with water gun. Again, likely it will be negative and probably in most situations not necessary, but in the chronic cases or cases that don't respond to treatment it's nice to know what you are up against.

Culture/biopsy would probably be done with an endoscope. It is invasive. It is probably painful. Yes, the pet would have to be anesthetized.

There is still a chance for a tumor even if antibiotics do work, yes. That is true. Tumors are hard to treat once infected as well because the tumor is a source of inflamation and also reduced immunity in the area. BUT, again, most nasal tumors are very fast growing tumors to the point of disfigurement within just a period of weeks. So, during the 8 weeks of trial medications the tumor would usually grow no matter what you do. So, you will likely know after a certain length of time if a tumor is present with or without biopsy just based on the clincal signs.

These are often untreatable. The most common is probably squamous cell carcinoma. These are just terrible tumors that grow very fast and invade everything around them. In my experience radiation has been mildly effective and chemotherapy almost not at all. But, that's just my experience. I am not sure what the published reports say about long term survival with different medications. But, it's a bad prognosis. We don't have a cure, let's put it that way.

Fungal infections, also very hard to treat. Hopefully it isn't that AND pseudomonas.

You can follow up on this question even if you accept the answer. This is the link .. bookmark it. http://www.justanswer.com/expert/qa.aspx?T=11190798

I will also send a follow up question in about 2 weeks Lynette. You will likely receive an update at that time in your e-mail. I would like to know how it turns out, so please feel free.

Customer: replied 2 years ago.

Dr. Adam,

We spoke a few weeks ago. I just wanted to give you an update on my cat, elmo.

Expert:  Dr. Adam replied 2 years ago.
Hey yes, I remember.

How is the nasal problem? Any change? It's only been a few weeks, so maybe not.
Customer: replied 2 years ago.

Hi Dr. Adam,

Unfortunately Elmo has lymphoma. I am going to an oncologist next week.

I am very sad :(

Lynette

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Dr. Adam
Dr. Adam
Cat Veterinarian
2095 Satisfied Customers
Over twelve years of internal medicine, surgery, and preventive care.