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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 28474
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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Salkin, I contacted you back in September regarding my 2

Customer Question

Hi Dr.Salkin,
I contacted you back in September regarding my 2 cats Leo and Obi. They both came down with vomiting and diarrhea for several days - in fact just over a week. At that time a PCR panel was done and everything came back negative. Now approximately 3 months later the same thing has happened again. They both have come down with diarrhea at the same time and some vomiting. I am wondering is there a virus that can this to recur from time to time that would not show up on the PCR panel?
Submitted: 6 months ago.
Category: Cat Veterinary
Expert:  Dr. Michael Salkin replied 6 months ago.

You're speaking with Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply. Please be patient. This may take a few minutes.

Expert:  Dr. Michael Salkin replied 6 months ago.

I'm sorry to hear of this with Leo and Obi. To answer you directly, that would be unlikely. We're mainly concerned about the feline coronavirus and feline panleukopenia virus. The feline coronavirus can cause a transient, mild diarrhea and vomiting. So many cats carry this virus that I would be surprised if PCR testing were ever negative for it but with any PCR test, it can be negative if the viral particles aren't present in the GI tract at the time of testing. The feline panleukopenia virus (feline distemper) shouldn't be a consideration in cat that have received regular vaccinations.

I would be more concerned with the different bacteria and parasites that are tested for in these PCR panels. Please respond with further questions or concerns if you wish.

Customer: replied 6 months ago.
Well everything turned up negative. I am attaching the results so you can see them. What else is left? I think it's rather strange that they both are getting the same symptoms at the same time and they eat different diets.
Expert:  Dr. Michael Salkin replied 6 months ago.

Thank you! Give me a moment to take a look, please...

Expert:  Dr. Michael Salkin replied 6 months ago.

Something that isn't tested for! This is a situation in which fecal culturing should be considered. There may be a bacterial pathogen other than those tested for by the PCR panel.

Customer: replied 6 months ago.
Before we did the PCR - we did a stool sample that came back negative.
Expert:  Dr. Michael Salkin replied 6 months ago.

No, not a fecal ova and parasite exam; a full fecal bacterial culture and sensitivity.

Customer: replied 6 months ago.
How soon after it is collected does it need to be tested?
Expert:  Dr. Michael Salkin replied 6 months ago.

Idexx needs to be consulted concerning their requirements for this type of culture. I would think the fresher, the better and it should be refrigerated until brought to the vet.

Customer: replied 6 months ago.
Okay - if I look at this from a logical standpoint - what would be the chances that a bacteria that came into there system 3 months ago and caused these symptoms would linger in their system and rear it's head again at precisely the same time in both cats all over again?
Expert:  Dr. Michael Salkin replied 6 months ago.

One cat could have recrudesced (relapsed without cure in between events) and spread the infection to the other or perhaps both were exposed to the same bacteria once again.

Customer: replied 6 months ago.
okay so they could have suffered from a type of bacteria back in september and it then left them and then they were exposed to it again and it affected their system in the same way again?
Expert:  Dr. Michael Salkin replied 6 months ago.

That's one scenario. The other is that it never left them completely and has recrudesced.

Customer: replied 6 months ago.
I want to add that the diarrhea is different this time. Last time was many many times in the day. Now it seems to only be once a day. Sometimes they have a formed bowel movement and then shortly thereafter they have a diarrhea. Not sure if that indicates anything?
Customer: replied 6 months ago.
Also their appetite is normal
Expert:  Dr. Michael Salkin replied 6 months ago.

Perhaps a mutated strain of the same bacteria.

Customer: replied 6 months ago.
I asked my vet about doing a full bacterial and sensitivity and here is how he answered back -"On September 22nd, we ran a comprehensive diarrhoea panel on Leo’s stool sample. This test screened for the presence of several bacteria including Toxoplasma, Titrichomonas, Cryptosporidium, Salmonella, 2 species of Campylobacter and 2 variants of Clostridial toxin.
Bacterial cultures are quite useful diagnostic tools but as we discussed at the time, PCR tests like the one we performed then are inherently more sensitive since they pick up on the DNA or RNA of bacterial organisms (even those present in the stool in extremely scanty numbers) in addition to detecting common, non-bacterial intestinal pathogens like Giardia (a protozoan parasite) and panleucopenia virus."Your thoughts?
Expert:  Dr. Michael Salkin replied 6 months ago.

The response was accurate. Please note, however, that such testing doesn't identify bacteria that aren't tested for in that panel; for example, an overgrowth of a pure culture of E. coli could be present and the previous testing not "see" it.

Customer: replied 6 months ago.
what would you suggest to do at this point?
Customer: replied 6 months ago.
They seem fine - appetite is good, decent energy. But the bowel movements which are regular for them are runny and on the yellowish side have very very strong odour.
Expert:  Dr. Michael Salkin replied 6 months ago.

You'll need to consult further with their vet who if resistant to further testing may consider presumptive therapy with a broad spectrum antibiotic such as enrofloxacin or perhaps the antiinflammatory immunomodulary antibiotic metronidazole. You also have the option of "watchful waiting" because they're otherwise normal.

Customer: replied 6 months ago.
When they had diarrhea in September (it was much more frequent) he was going to treat with metronidazole, but then when the testing came back negative he said there would be no purpose if there is no bacteria present. You mention he may be resistant to further testing - what further testing could we do? I proposed what you suggested and he said we already ran the PCR. Should I ask if there is testing for any other bacteria? If you would like me to put these questions in a new question just let me know.
Expert:  Dr. Michael Salkin replied 6 months ago.

Metronidazole is also antiinflammatory and immunomodulary (suppresses the local gastrointestinal immune system) and so can be of value even when not prescribed as an antibiotic. Further testing would involve culturing for all probable bacteria. Their vet might consult with his reference laboratory to see how that might best be done.

Customer: replied 6 months ago.
Update - Leo's diarrhea last only about 2 days (once a day), but Obi's has been persisting since last Friday (once daily). Does suggest anything?
Expert:  Dr. Michael Salkin replied 6 months ago.

It suggests that my patients can get better in spite of me.