Feline acne / stud tail

Feline acne is a skin condition of cats. Sometimes it may come to more severe cases that may respond slowly to any treatment.

Please find below further informations about:

Scent marking and sebaceous glands in the skin

The cat’s skin has 2 main types of glands:

Sweat glands

and

Sebaceous glands

Most of the sebaceous glands are associated with hair follicles and produce an important oily secretion, sebum, which waterproofs the hairs and maintains the suppleness of the skin.

A collection of much larger sebaceous glands are found on the chin, the lips, the dorsal (top) surface of the base of the tail and also the eyelids, prepuce and scrotum. The collection of glands under the skin in the chin area is sometimes referred to as the ‘submental organ’ and the glands around the base of the tail are known as the ‘supracaudal organ’.

The special oily secretion of these larger sebaceous glands has an important role in scent marking, and cats will repeatedly rub their chin, lips, temporal area and base of tail over certain objects. In time the secretions build up on favourite marking objects and may be seen as black-brown, greasy patches. You may also notice that they are ‘marked’ by your cat on returning home (by the cat rubbing aginast you). Cats will also often mark certain objects at feeding time.

Stud tail / chin acne

Overactivity of the submental organ (sebaceous gland on the chin) is a relatively common finding and termed ‘chin acne’. This is seen as excessive greasiness of the overlying fur and skin. This is particularly noticeable on the chin of white or pale coloured cats and appears as a yellow, greasy discolouration. There may also be flecks of black, greasy material on the chin which may be mistaken for flea dirt.

Overactivity of the glands at the base of the tail is often known as ‘stud tail’ and can produce a similar appearance in this region. Although stud tail is seen most commonly in entire males (where testosterone presumably influences its development), it can occasionally be seen in neutered males and in females. 
 The overactivity of the sebaceous glands predisposes to development of feline acne. The hair follicles produce excessive sebaceous material and possibly also excessive keratin (the major protein in skin and hair). The associated hair follicles become plugged with black sebaceous material forming comedones (commonly referred to as ‘blackheads’). Secondary bacterial infection may lead to folliculitis (inflammation of the hair follicles) and formation of papules and pustules from which beads of pus may be expressed. In severe cases, many hair follicles are affected and areas of skin infection (pyoderma) develop, with swelling, inflammation, discomfort, and discharge of pus. The point of the chin may become very swollen.

Problems in Persians – idiopathic facial pruritus

A severe form of the condition has been reported in Persians and is known as ‘idiopathic Persian facial dermatitis’. This can be very difficult to manage with the skin showing a black waxy material on the hairs in a symmetrical pattern on the face, but particularly the chin and around the eyes.

Treatment

Treatment of cases of feline acne and stud tail involves removal of excess sebum and hence prevention of comedone formation and secondary infection.

An antibacterial wash, such as chlorhexidine, can be used for this purpose, initially two or three times daily. In mild cases no further treatment is necessary, but in cases showing extensive secondary infection, antibiotic therapy (best selected on the basis of bacterial culture and sensitivity tests) will be required. Occasionally fungal infections (yeasts or dermatophytes/ringworm) may also be involved.

Topical preparations are of very limited value for severe cases, as they are soon licked or cleaned off by cats, and oral antibiotics are usually required for 4-6 weeks. Severe cases may also need short-term treatment with steroids to reduce the inflammation.

Keeping the acne at bay may require clipping of the hair and daily application of topical medications including:

Chlorhexidine washes

Mupirocin

Retinoids

Use of ceramic (or metal) rather than plastic food bowls has been reported to help in some cases.

Keeping the chin clean after feeding may also help to reduce the problem

source/s: international cat care (http://www.icatcare.org/)

Alpha-mannosidosis is a rare autosomal recessively inherited lysosomal storage disease caused by deficiency of the enzyme a-D-mannosidase. This leads to accumulation of oligosaccharides (large sugar molecules) in a number of organs including the brain, kidney and liver.

Age of onset and progression of clinical signs can be variable, which may reflect some degree of hetrerogeneity (variability) in the degree of enzyme deficiency.

Clinical signs include:

Ataxia (uncoordinated walking)

Intention tremors

Stillbirths

Neonatal deaths

Bizarre behaviour/dementia

Liver enlargement

Corneal and lens opacification

Growth retardation

Premature death

Vacuoles may be detected in white cells (lymphocytes and monocytes) from blood samples, and mannose-rich oligosaccharides can be detected in urine samples (supporting the diagnosis).

The disease has been seen in domestic shorthair cats, domestic longhair cats and in Persian cats, and gene defects have been identified.

source/s: international cat care (http://www.icatcare.org/)

Anaemia describes reduced numbers of red blood cells (RBCs or erythrocytes) in the circulation. Red blood cells are a special type of cell that contain haemoglobin - this is a special iron-containing molecule that efficiently binds oxygen. When we breath in and out, oxygen is taken out of the air in the lungs and is absorbed into the blood, being bound to haemoglobin in the red cells. As these red cells circulate around the body, the haemoglobin can then release the oxygen in the tissues of the body where it is vital to maintain life. Haemoglobin in the red blood cells also gives blood its characteristic red colour.

When animals become anaemic, their ability to absorb oxygen from the air and deliver it to tissues in the body becomes very compromised and this can lead to many different problems, but is often manifested as weakness and lathery. In severe cases it will also cause an increased respiratory effort as the animal tries to get more oxygen in the lungs to improve the level of oxygen in the circulation.

Untreated, anaemia can be a debilitating disease, and if severe can be life threatening. Unfortunately, cats are particularly prone to the development of anaemia. This is partly because their red blood cells have a shorter lifespan (around 70 days) than many other animals (around 110-120 days in dogs and humans) - this means they have a higher turnover of RBCs and anaemia can therefore develop quite rapidly if anything interferes with this. Also, cats suffer from a number of different diseases and infections that can cause anaemia.

Different types of anaemia

Anaemia can usually be broadly divided into regenerative and non-regenerative forms. Regenerative anaemias are those in which the bone marrow responds to the anaemia appropriately by trying to produce new RBCs to replace those that have been lost. However, in non-regenerative diseases the anaemia develops because the bone marrow fails to produce new RBCs (or produces too few RBCs) to replace those that are being lost. In cats, sometimes multiple causes of anaemia can be present at the same time, which may complicate the picture.

Signs

Paleness or palor - A common sign of anaemia in cats is paleness of the mucous membranes (these are the membranes - or ‘skin’ - lining the mouth and around the eyes etc.). However, this is not an entirely reliable sign as pale membranes can also be seen for other reasons.

Weakness - severe anaemia can cause weakness, and cats with anaemia will often be lethargic.

Heart and breathing - anaemia, especially when severe, is likely to cause an increased heart rate (known as tachycardia), and an increased respiratory (breathing) rate (known as tachypnoea).

Pica- anaemic cats often develop pica (a craving for unusual foods). Most commonly this is manifested as licking concrete, eating cat litter or eating soil.

Jaundice - occasionally anaemic cats will also become jaundiced (yellow discolouration of the mucous membranes). This is most often a sign of liver disease in cats, but it can be seen with severe and sudden breakdown (haemolysis) of RBCs.

In addition to the signs associated with anaemia, cats may also show signs of an underlying disease (such as chronic kidney disease for example) that may be causing the anaemia. Cats that develop anaemia gradually over a long period are often able to adapt to the anaemia and show fewer signs (until the anaemia is really sever) compared with cats that develop a sudden onset of anaemia.

Diagnostic testing

Anaemia is confirmed by finding reduced RBC numbers (and reduced haemoglobin concentrations) in a blood sample collected from the cat. The reduced RBC numbers can be demonstrated directly using a machine that can count the individual cells, or can be detected more simply by a measurement call the ‘packed cell volume’ or PCV (this measurement can be obtained by spinning a small blood sample in a thin glass tube in a centrifuge, and observing the volume taken up by the RBCs which will sediment [or pack] at the bottom of the tube).

When anaemia is confirmed, the next step is to determine if it is regenerative or not. Features that indicate of regeneration include:

Variations in the size of RBCs (called anisocytosis) due to the presence of some larger and immature RBCs released from the bone marrow

Presence of reticulocytes (immature RBCs) - using special stains these cells can be distinguished from normal (mature) RBCs, and by determining their number it is possible to gauge how regenerative the anaemia is.

Knowing whether the anaemia is regenerative or not will help in narrowing down the likely underlying cause of the anaemia. Regenerative anaemias are usually caused by either an increased breakdown of the RBCs (termed haemolysis), or by blood loss (e.g., from bleeding excessively). Non-regenerative anaemias are usually caused by an underlying problem in the bone marrow preventing or interfering with the normal production of RBCs. Specific causes include:

Blood loss anaemia:

Trauma

Bleeding from an ulcerated mass or tumour

Bleeding due to poor blood clotting

Excessive bleeding may sometimes be very obvious, but can also be within the body or in the intestinal tract, for example, where it may be more difficult to detect.

Haemolytic anaemia:

Feline leukaemia virus (FeLV) infection

Mycoplasma haemofelis infection (feline infectious anaemia, formerly known as Haemobartonella felis infection), or other similar organisms

Immune-mediated haemolytic anaemia (where the cat’s own immune system attacks the RBCs)

Toxins, such as eating onions or onion-containing foods, paracetamol (acetaminophen)

Increased fragility of RBCS, such as with a disease known as pyruvate kinase deficiency, seen particularly in Abyssinian and Somali cats

Low blood phosphate levels

Incompatible blood transfusions Neonatal isoerythrolysis - a condition seen in very young kittens where there is an incompatibility between the blood type of the kitten and the queen.

Non-regenerative anaemia

Feline leukaemia virus (FeLV) infection

Feline immunodeficiency virus (FIV) infection

Bone marrow failure

Red cell aplasia (failure to produce RBCs)

Leukaemia (cancer of the white blood cells that may affect the bone marrow)

Chronic kidney disease

Iron deficiency

Chronic (long-standing) inflammatory diseases

Further investigations

Because of the wide variety of potential underlying causes of the different types of anaemia, further tests are often needed to identify the specific cause. These may include blood tests to identify infectious agents (such as FeLV, FIV and Mycoplasma haemofelis infections), tests to check the clotting ability of the blood, blood tests to check the iron status of the cat and to look for presence of diseases such as chronic kidney disease. X-rays and/or ultrasound investigations may be needed in some cases, and if an underlying bone marrow problem is suspected then collection of bone marrow samples (a bone marrow aspirate or biopsy) may be required - this is a procedure that can be performed by simply placing a needle into a bone under a short general anaesthetic.

Treatment

Treatment of anaemia will be both symptomatic and supportive for the affected cat, and specific (targeted at the underlying disease itself).

Supportive treatment may include the use of blood transfusions when the anaemia is severe as this can be a life-saving procedure. Just as in humans, it is important in cats to know what blood group the donor and recipient are to make sure the blood is compatible. With severe anaemia, a cat may need to be hospitalised and monitored closely.

A variety of treatments may be used depending on the specific underlying cause of the anaemia, and these may include antibiotics for some infectious causes (such as Mycopalsma haemofelis), immunosuppressive drugs (such as corticosteroids) if there is immune-mediated destruction of RBCs, iron supplementation for iron deficiency anaemia etc.

The prognosis in cases of anaemia varies depending on the cause. Many may respond well to treatment, but in some cases (especially severe non-regenerative anaemias caused by bone marrow disease) the long-term prognosis may be very guarded.

source/s: international cat care (http://www.icatcare.org/)

It is well recognised that as humans get older they are likely to suffer from joint pain caused by osteoarthritis. It is also well known that older dogs commonly suffer from arthritis and both owners and vets are familiar with the medication dispensed to relieve their pain. However until relatively recently, arthritis in cats was not commonly diagnosed or treated. This may be due in part to the cats’ survival instinct to hide signs of pain, and the lack of recognition of the condition by owners and veterinary surgeons.

Prevalence of arthritis

Due to the challenges of diagnosing arthritis in cats, it can be difficult to tell how many cats are affected. However, recent studies looking at radiographs of older cats produced startling results. In one study published in 2002, 90% of cats over 12 years of age had evidence of degenerative joint disease. This included cats with so-called ‘spondylosis’ of the spine (a form of degenerative joint disease). However, even when these cases were excluded, around ⅔ of the cats still had radiographic signs of arthritis affecting the limb joints. More recent studies have shown radiographic evidence of arthritis in the limb joints affecting between 60% and more than 90% of cats. All these studies show that arthritis is actually very common in cats, that it is much more common (and more severe) in older cats, and that the shoulders, hips, elbows, knees (stifles) and ankles (tarsi) are the most commonly affected joints.

What causes arthritis:

Osteoarthritis is a complicated type of arthritis in which the normal cartilage that cushions the joint degenerates and is worn away, resulting in inflammation, discomfort, ongoing damage and secondary changes in and around the joint. OA can be primary (without an obvious underlying cause, where the disease may arise at least in part due to mechanical ‘wear and tear’ in the joints) or secondary to a joint injury or abnormality as described below. The other major form of arthritis seen in humans is rheumatoid arthritis, which is (at least in part) an auto-immune disease.

At present it is not entirely clear what causes arthritis in cats. Further studies are needed to determine if this is similar to osteoarthritis in humans, where mechanical damage to the joints may be pivotal in development of the disease, or whether other factors are involved. At present, most cats with arthritis do not appear to have an obvious predisposing cause.

Factores that may increase the risk of arthritis:

Genetics - certain breeds have an increased risk due to various underlying joint problems. This would include:

Hip dysplasia (abnormal development of the hip joints) seen especially in Maine Coon cats (but also Persians, Siamese and other breeds)

Patella luxation (dislocation of the knee cap) which has been reported more commonly in Abyssinian and Devon Rex cats

Scottish Folds are particularly prone to severe arthritis affecting multiple joints due to an abnormality of cartilage that occurs in the breed

Injury or trauma - for examples fractures, dislocations and other joint injuries. These may cause abnormal joint conformation which can result in secondary osteoarthritis

Obesity - there is no evidence that this causes arthritis, but it is likely to make an existing condition worse

Acromegaly - this is an unusual condition of older cats where a tumour in the pituitary gland secretes too much growth hormone. Affected cats usually develop diabetes mellitus, but some also develop secondary arthritis in their joints.

Signs

Cats are masters of hiding discomfort and pain, so often do not demonstrate obvious signs that you might expect. They restrict their own activity to minimise the use of the sore joints and so tend not to show the same signs of arthritis as other animals. In particular, cats uncommonly show overt signs of limping or pain associated with arthritis.

Major signs of arthritis in cats associated with arthritis are:

Reduced mobility

Reluctance, hesitance or refusal to jump up or down

Jumping up to lower surfaces than previously

Jumping up or down less frequently

Difficulty going up or down stairs

Stiffness in the legs, especially after sleeping or resting for a while; occasionally there may be obvious lameness

Difficulty using the litter tray

Difficulty getting in our our of the cat flap

Reduced activity

Increased time spent resting or sleeping

Not hunting or exploring the outdoor environment as frequently

Sleeping in different, easier to access sites

Reduced interaction and playing less with people or other animals

Altered grooming

Reduced frequency or time spent grooming

Matted and scurfy coat

Sometimes overgrooming of painful joints

Overgrown claws due to lack of activity and reduced sharpening of claws

Temperament changes

More irritable or grumpy when handled or stroked

More irritable or grumpy on contact with other animals

Spending more time alone

Avoiding intact with people and/or animals

How is arthritis diagnosed

As arthritis is more common and more severe in older cats, it should be looked for in any mature (7 years plus) or older cat. A diagnosis is often based primarily on the presence of appropriate signs and chances in the home environment (see above). If you see any of these changes, it is important to have your cat checked by your vet as arthritis is an uncomfortable and painful condition.

When your vet examines your cat, they may be able to detect pain, discomfort, swelling or other changes affecting certain joints. If there is any uncertainty, your vet may suggest taking X-rays of the joints, but this is not always needed, and in some cases if the diagnosis is uncertain a simple trail treatment (with anti-inflammatory drugs) may be used.

Although further investigations such as blood and urine tests are note usually needed to investigate arthritis, your vet may suggest these if they think there may be another problem as well (which is not uncommon in older cats), or prior to starting some medications.

Managing arthritis

Many options should be considered when managing a cat with arthritis, and it is not just about finding the right tablet to control the disease!

Environmental enrichment

Modifying the environment in many ways can greatly help to maintain quality of life for an arthritic cat. Things to consider include:

Use of soft, comfortable beds placed in easily accessible, quiet, draft-free locations - use of 'igloo beds’ can make an older cat feel warm and secure

Provision of a series of 'steps’ or a ramp to allow cats to access favoured higher sites (eg, the sofa, a windowsill, the cat flap etc.)

Make sure the cat flap is very easy to open, and if necessary tie it open so the cat doesn’t need to push through

Always have a litter tray inside and one that has at least one low side for easy access

Make sure food and water are easily accessible, at floor level or with steps up to higher levels

Make sure the cat doesn’t have to go up or down stairs to access food, water, or litter trays

Spend time grooming and cleaning an arthritic cat as this may be difficult for them

Overgrown claws need regular cutting

Diet and dietary supplements

Obesity or being overweight will exacerbate arthritis and so should be avoided. Careful weight management is therefore very important for older cats. If your cat is overweight, they will benefit from carefully controlled weight loss, supervised by your vet. Your vet may also recommend a special diet to help achieve this safely and effectively.

Several dietary supplements and diets are available for cats with arthritis. The usually contain combinations of essential fatty acids (EFAs) that are designed to reduce inflammation, and glycosaminoglycans (such as glucosamine and chondroitin) that are the 'building blocks’ of the cartilage in the joint and designed to improve cartilage quality. These diets and dietary supplements are generally very safe to use (but should only be used when recommended by your vet); however, their effectiveness in managing arthritis in cats is uncertain. If they have an effect, it is likely to be relatively mild and so may perhaps help in early cases of arthritis or as part of a management plan using other drugs as well. An additional problem is that the manufacture of dietary supplements (such as glucosamine and chondroitin) is poorly regulated so the quality of different products may vary enormously.

Medical treatment:

Medications can be very effective at controlling the pain and inflammation associated with arthritis, but should only be used under direct supervision by your vet, as any drugs can have side-effects.

The most commonly used class of drugs for managing arthritic pain are non-steroidal anti-inflammatory drugs (NSAIDs). A number of different NSAIDs are licensed for use in cats in different countries, but the safety of these drugs varies, and care is especially needed when choosing a drug for long-term treatment. To minimise the risk of side-effects, the drug should be chosen carefully, and used carefully as well (using the lowest effective dose for the individual cat). For further information see: [Non-steroidal anti-inflammatory drugs (NSAIDs) and your cat].

The first NSAID to have a license for long-term use in cats was meloxicam (Metacam; Boehringer-Ingelheim), and there is now extensive information on the use of this drug showing that it is effective in managing arthritis in cats, and when used appropriately (and at appropriate doses), significant side-effects are rare.

In some cats, alternative or supplemental analgesic (pain-killing) drugs may need to be used in cases where NSAIDs are not appropriate or not sufficient. Drugs that have been suggested (all of which must only be used under supervision by your vet) include:

Buprenorphine

Amantidine

Tramadol

Gabapentin

Additional treatments

Acupuncture has been used in other species to treat the chronic pain of arthritis. The efficacy of acupuncture is still debated and this treatment has not been proven in controlled studies, but anecdotal reports suggest it could be a useful adjunctive therapy for some cats. It should always be performed by a specially trained vet and not used as a substitute for medication in severe cases.

source/s: international cat care (http://www.icatcare.org/)

Cats are often diagnosed as having ‘feline asthma’. While being a common condition the actual cause is somewhat uncertain. The terms ‘feline asthma’ and ‘chronic bronchitis’ are often used interchangeably in cats and used to describe chronic disease of the small airways (bronchioles) within the lungs. Other terms describing the same syndrome are ‘allergic airway disease’ and ‘allergic bronchitis’.

In human medicine, chronic bronchitis and asthma are two separate conditions (although some people have both). Asthma is usually an allergic condition where exposure to a trigger causes inflammation and narrowing of the airways. With chronic bronchitis, there is also inflammation of the airways but this is caused mainly by irritation. Exposure to tobacco smoke and other environmental pollutants is the most common cause of chronic bronchitis.

It is assumed that most cats which develop signs of small airway disease have a condition similar to asthma in humans, but the exact cause in most cases remains uncertain.

What happens in asthma or chronic bronchitis?

Asthma is a condition where the small airways in the lungs over-react to the presence of a stimulus – an irritant or an allergen. This will provoke an inflammatory response and increase mucus production in the airway (making breathing more difficult), but importantly in asthma the reaction causes contraction of the small muscles around the airways causing them to narrow markedly. This too causes difficulty breathing.

In chronic bronchitis, the underlying problem is irritation from small particles being breathed in from the air. Smoking is the major cause in humans, and the breathing in of smoke, fumes or other irritants causes inflammation of the small airways and stimulates increased production of mucus. It is a combination of the inflammation and mucus production that causes narrowing of the airways and difficulty breathing. There may be some constriction of the muscles around the airway, but this is not a major part of the disease.

Clinical signs

The clinical signs of asthma or chronic bronchitis vary in severity between individuals. In addition the signs may be either persistent or episodic. Typical signs include:

Persistent coughing (often bouts of coughing)

Laboured and/or fast breathing

Noisy breathing and wheezing

Difficulty in breathing

These signs are seen in both cases of asthma and chronic bronchitis. In some cats, further signs may develop that are strongly suggestive of asthma – in these cats there is a very sudden onset of severe breathing difficulty and wheezing,, with cats often having great difficulty in catching their breath. This appears to be similar to acute severe asthma in humans (previously termed ‘status asthmaticus’) and will respond rapidly to therapy with drugs that relax the muscles around the small airways and so dilate them (bronchodilators), making breathing easier. The response to bronchodilators in these cats strongly suggests there is reversible constriction of the airways which a characteristic of asthma.

Which cats develop it?

Cats of any age, breed or sex can develop chronic airway disease. Most affected cats are adults, and typically 6-9 years of age, but signs can start in young cats or elderly cats as well. There is also a marked breed predisposition among Siamese and related breeds, strongly suggesting and inherited component to the disease in at least some cats.

How is it diagnosed?

Cats with other diseases such as bacterial infections, pneumonia, foreign bodies, heart disease, airway parasites and lung cancer can present with similar clinical signs to asthma or chronic bronchitis so further investigations are usually needed to confirm a diagnosis. These may include:

Blood tests

X-rays of the chest to look for typical abnormalities in the lungs

Bronchoscopy – passing a small endoscope (camera) down into the lungs to look at the small airways

Airway washes (bronchial or bronchoalveolar lavage) – this is a procedure performed under an anaesthetic that allows cells and fluid from the small airways to be collected and then examined for the presence of inflammatory cells, bacteria, cancer cells and other changes.

Some or all of these investigations may be needed in some cases. These investigations help to rule out other diseases. Some tests such as airway washes, may help to differentiate between asthma and chronic bronchitis but definitive criteria are lacking. Washes are also helpful to look for secondary problems such as lung infections.

Treatment?!

Although in theory, if chronic bronchitis and asthma could be reliably distinguished, this may affect how treatment is targeted, in practice, both are currently treated in the same way.

Generally, any secondary infections (with bacteria or mycoplasmas) should be identified and treated, and any predisposing or exacerbating causes identified and removed if possible. This would include:

Managing any obesity (as this can worsen breathing difficulties)

Identifying any potential irritants or allergens in the house, for example: pollens, use of perfumes or sprays, use of dusty cat litter, smoking in the house etc.

In some cats the disease may be seasonal or may occur only when the cat is in certain rooms. In these situations it may be possible to track down an irritant or allergen that triggers the disease with careful investigations.

Symptomatic treatment

In most cats, specific trigger factors cannot be identified (or cannot be avoided) and so symptomatic treatment will be required. This is mainly based around anti-inflammatory and bronchodilator therapy:

Anti-inflammatory drugs – these are important in most cases to reduce the inflammatory component of the disease. Corticosteroids (glucocorticoids) such as prednisolone are potent anti-inflammatories that are used to achieve this. Treatment can be administered in different ways:

In tablet or liquid form that is given by mouth – usually daily or alternate day therapy is needed, but with long-term therapy often only a low dose will be needed to maintain control of signs

By injection – products given by injection may be short-acting (e.g., 1-3 days), or long-acting (some injections may last up to 3-6 weeks)

By inhalation – metered-dose inhalers (MDIs) used to treat human asthma that contain steroids (such as beclometasone or fluticasone) can also be used in cats. To administer these to cats a ‘spacer’ device is used (just as in human babies and young children) with a face mask. Many cats actually tolerate this extremely well and treatment can be given once or twice a day this way. The big advantage with this is that the steroid can be delivered directly to the lungs, and absorption into the body can be minimised (to reduce the risk of side effects with long term use).

Bronchodilator therapy – this is the use of drugs that relax the small muscles around the airways and help them to dilate. These are usually used along with corticosteroids (see above). They can also be given in three ways:

Tablets or liquid given by mouth – drugs such as terbutaline act as specific bronchodilators in cats and can be valuable. The methylxanthine class of drugs (such as theophylline) are sometimes used in other animals as bronchodilators, but they appear to be less useful and less effective in cats

Injections – short-acting injectable bronchodilators are available (including terbutaline) and as these act quickly (especially if given intravenously) they may be useful in emergency situations

By inhalation – in exactly the same way as human steroid MDIs can be used to treat cats, so too can human bronchodilator MDIs. Inhaled bronchodilators may be rapid in onset but relatively short-lasting (such as salbutamol which may have to be given every few hours), or long-acting such as salmeterol that may need tone given once or twice a day. As with inhaled steroids, the advantage of inhaled bronchodilators is that the drug is delivered directly to the lungs where it is needed.

Other drugs – some other drugs are used on occasions in cats – different types of anti-inflammatory drugs or drugs designed to block an allergic response, but generally their value is uncertain and unproven.

How are inhaled drugs administered?

A special ‘spacer’ has been designed for the delivery of inhalational drugs to cats (see www.aerokat.com). One end of the Aerokat spacer is specially made to allow a human metered-dose inhaler (MDI) to fit and deliver a dose of medication into the chamber (spacer). At the other end a face mask is attached with a valve that allows the cat to breath in the medication from the chamber. One to two puffs (according to our vets instructions) of the MDI are administered into the chamber and then the face mask is held gently over the cat’s face so it can breath in the medication for 10-15 seconds typically. This is usually performed twice daily. Most cats tolerate the procedure very well and with a little practice it is much easier than administering tablets.

What is the prognosis?

The prognosis for these condition depends mainly on the severity of the disease. In most cases, appropriate therapy will dramatically improve clinical signs and quality of life for the cat, but life long therapy may be required and acute severe attacks can prove fatal if treatment is not initiated promptly. In some cases there will be ongoing damage to the lungs and this may result in irreversible fibrotic changes within the lungs in some cases, that can eventually prove fatal.

source/s: international cat care (http://www.icatcare.org/)

Bordetella bronbchiseptica (B bronchispetica) is a bacterium that can cause disease in a number of animals, and also rarely in humans. This bacterium can be a cause of upper respiratory disease in cats, but is mainly a problem where cats are kept together in large groups such as rescue shelters and some breeding households. Bordetella bronchispetica infections can be treated successfully with antibiotics, and for situations where it causes significant ongoing problems, an effective vaccine is available in many countries.

What is it?

Bordetella bronchispetica is a bacterium that causes respiratory disease in a number of animals. It is related to B pertussis and B parapertussis, which are the cause of ‘whooping cough’ in humans. B bronchispetica is a cause of disease in dogs (one of the important causes of ‘kennel cough’), cats, pigs, rabbits and can occasionally cause disease in humans. Bordetella bronchispetica is therefore classified as a rare zoonosis (disease transmissible from animals to humans).

How is B bronchispetica spread

Cats infected with B bronchispetica shed bacteria in saliva and nasal secretions (and in droplets when they sneeze) so direct contact between cats or inhalation of infectious sneeze droplets is an effective means of transmission. Although the bacteria are susceptible to disinfectants, it is likely that they can survive for 1-2 weeks in the environment, so unless kept scrupulously clean, the environment, bedding, feeding bowls, grooming utensils etc. may also be sources of infection.B bronchispetica can also be spread between dogs and cats. Cats can also remain infected with B bronchispetica for many months after clinical signs of infection have subsided, so recovered cats can also be a potential source of infection to others.

What clinical disease does it cause in cats?

Infection with B bronchispetica in cats usually results in mild sneezing, coughing, nasal and ocular discharge and fever. Signs typically last 7-10 days. However, in occasional cases (especially in young kittens, and with severe stress) infection may be more severe and can sometimes result in a life-threatening pneumonia.

The frequency with which B bronchispetica causes disease in cats is not well understood. Studies have shown that exposure to the bacterium is relatively common, especially in colony situations (such as rescues and some breeding establishments). However, sub-clinical and mild infections are likely to be common. Pet cats kept on their own or as part of a small group are much less likely to be infected. Most clinical problems arise in colonies where B bronchispetica may sometimes be an important part of the upper respiratory infection (URI) complex of diseases.

How is the infection diagnosed

A diagnosis of infection is made by detecting the organism in the laboratory from swabs taken from the pharynx (throat). The organism can be detected by bacterial culture (using specific culture medium) or by PCR (polymerase chain reaction – a molecular technique to detect the genetic material of the organism).

How are this infections treated

Treatment with antibacterial drugs is usually very effective in managing B bronchispetica infections. However, the bacteria can be resistant to some antibiotics so in general it is better looks at sensitivity testing in the laboratory (from bacterial culture) to determine which antibiotics are most effective. In general, treatment with doxycycline (or possibly a fluoroquinolone antibiotic) is likely to be most successful.

If infection is severe further supportive care and hospitalisation may be required.

How can B bronchispetica infections be prevented or controlled

In most cases, B bronchispetica is considered a minor infection and no specific precautions are necessary for most pet cats as the risk of infection and serious disease is low. In shelters and breeding colonies it is important to try to minimise the risk by:

Keeping cats individually or in small isolated groups

Maintaining excellent hygiene, with use of appropriate disinfectants

Isolate any cats showing signs of clinical disease

If B bronchispetica is confirmed as a cause of disease and is a persister or widespread problem, a good and effective vaccine is available in many countries (vaccination is achieved via drops placed in the nose), and this can be a helpful part of disease control. However, in most situations this is not required for pet cats.

source/s: international cat care (http://www.icatcare.org/)

Cancer is a term used to describe disease that is caused by a tumour (or neoplasm) – a collection of abnormal cells within the body that continue to grow and divide without control. This usually results in the development of masses (growths or lumps), which are mainly composed of the abnormal dividing cells.

Some tumours do not spread to other parts of the body and tend not to invade other surrounding tissues - these are termed ‘benign’ tumours. 

In contrast to this, the term cancer is generally used to describe ‘malignant’ tumours, which often do invade surrounding normal healthy tissue, and may spread to other sites in the body (or 'metastasise’), typically spreading via the blood stream or lymphatic system. 

Because of their more aggressive and invasive nature, malignant tumours (cancers) are generally more serious than benign tumours, often causing more serious and extensive disease, and are generally more difficult to treat.

Overall, cats suffer with neoplasia (or development of tumour[s]) less frequently than dogs. Neoplasms may perhaps be seen less than half as frequently in cats compared with dogs. However, when cats do develop tumours they are much more likely to be malignant (3-4 times more likely than in dogs) and therefore much more likely to cause serious disease.

The most common sites of cancer in cats include the skin, the white blood cells (leukaemia and lymphoma), the mouth, the stomach and intestines and the mammary glands.

Types of cancer

There are many different types of cancer, and they are often classified according to the origin of the type of abnormal cell they contain. Thus cancers known as 'carcinomas’ and 'sarcomas’ are solid tumours that arise from various different tissues, whereas ‘leukaemias’ are cancers that affect the bone marrow where blood cells are produced and often cause large numbers of abnormal cells to appear in the blood stream. ‘Lymphoma’ is a solid cancer caused by the growth of abnormal lymphocytes – a type of white blood cell that can also be found in tissues and is part of the immune system.

Because of the enormous variety of cancers that can affect cats (as with any other animal), it is impossible to list all the different types and their common manifestations. However, some of the most commonly encountered cancers include the following:

Lymphoma

Squamous cell carcinoma

Basal cell tumour

Mast cell tumour

Mammary carcinoma

Fibrosarcoma

Carcinoma/adenocarcinoma (e.g., affecting lungs, intestine, etc.)

Osteosarcoma (cancer of the bone)

What causes cancer

As is often the case in human medicine, the cause of cancer in any individual cat is often unknown, and indeed many cancers are likely to arise for a number of different reasons.

Inherited (genetic) susceptibility to the development of certain tumours almost certainly occurs in cats, although relatively little is known about this at present. During a cat’s life they may potentially be exposed to a number of different things that can trigger abnormalities within cells that may ultimately lead to development of cancer – this may include exposure to sunlight or to a wide variety of different chemicals (carcinogens) – but still in most individuals, the underlying causes and triggers for the cancer remains unknown.

We do know that some viral infections in cats can cause cancer, and feline leukaemia virus (FeLV) is probably the best

example of this. Fortunately, infection with this virus is now relatively uncommon in most places. However, when cats are exposed to this virus it can infect the blood-producing cells of the bone marrow, and can lead to the development of leukaemia or lymphoma. Infection with feline immunodeficiency virus (FIV, related to human immunodeficiency virus or HIV) also on occasions can lead to the development of cancer. Fortunately it is easy for your vet to test for the presence of both of these viruses.

Studies suggest that compared with an uninfected cat, a cat that is infected with FeLV has an approximately 50-fold increase risk of developing lymphoma, and a cat infected with FIV has an approximately 5-fold increased risk. 

When cancer is diagnosed, a natural and common reaction is ‘What have I done wrong?’ or ‘What could I have done to have prevented this from happening?’ While these are entirely natural responses when we first learn that our pet has cancer, it is important to remember that in the vast majority of cases we don’t know what will have led to the development of the cancer, and therefore it would have been impossible to prevent.

Clinical signs

Because cancers can affect any tissues in the body, the clinical signs that cats develop are extremely diverse and there are no signs that automatically suggest cancer is the cause of disease.

In general, cancers affect older cats more commonly than younger cats. In many cases, cancers will grow over quite a long period of time, and initially there may just be vague signs of disease such as poor appetite, lack of energy and weight loss. In other cases there may be more obvious signs such as persistent lumps in or under the skin, changes in the eyes, vomiting, diarrhoea, unexplained bleeding or wounds that do not heal.

As the disease progresses additional complications will usually develop that often relate to the tissues or organs mainly affected. Although cancer may be one of the potential causes of a variety of different signs (especially in older cats), it is important to remember that many other diseases commonly cause the same signs as cancer and that, even where cancer is diagnosed, there may well be treatment options that will enable control or management of the disease, at least for a period of time. However, as it is important to diagnose cancer early, it is vital to seek veterinary advice as soon as any abnormalities are noticed.

How is cancer diagnosed

You or your vet may suspect cancer to be an underlying cause of the clinical signs your cat is showing. However, the clinical signs and examination by your vet alone are not sufficient to be able to diagnose the condition.

Additional investigations in the form of radiographs (X-rays) or ultrasound examination are often needed to identify

the location and/or the extent of any tumour, but the diagnosis of cancer can only be made by the microscopic examination of tissues by an experienced pathologist. This will usually necessitate a biopsy (surgical removal of a small piece of affected tissue) by your vet, although in some cases it may be possible to make a diagnosis from either a 'fine needle aspirate’ (a small needle is inserted into a mass to remove or ‘suck out’ a few cells that can be smeared on a slide for examination) or a ‘needle biopsy’ (where a larger needle is inserted into a lump to remove a very small 'core’ of tissue). 

Occasionally other techniques are also used to obtain samples of the suspected abnormal cells so that a diagnosis can be made. Blood samples are a routine part of the investigation of any suspected cancer patient – partly to detect any adverse effects of the cancer, and partly to detect the presence of any other disease.

With some cancers, occasionally more sophisticated techniques may be required to either make (or confirm) the diagnosis, or to plan the most appropriate treatment. Computed axial tomography (so-called 'CAT’ or 'CT’ scans) or magnetic resonance imaging (MRI scans) are becoming more widely available for pets and can be very valuable, especially, for example, in the diagnosis of brain tumours, and in assessing the extent of tumour invasion.

Fibrosarcoma / soft tissue sarcoma

These cancers form from the fibroblasts (cells that produce fibrous tissue) and other supporting tissues, most commonly arising beneath the skin.

They commonly present as gradually enlarging firm masses under the skin. The degree of malignancy of these tumours varies – some are highly malignant with extensive local invasion of tissues, and early metastases occurring to lymph nodes and the lungs. Others are less aggressive and will not be so invasive or metastasise so readily.

The most common sign in a cat with a fibrosarcoma is a progressively enlarging firm swelling under the skin, but this can affect almost any site.

Optimum treatment usually involves a combination of surgery with radiation therapy and/or chemotherapy, although the prognosis is variable depending on how aggressive (malignant) the tumour is. For small tumours that have not spread, surgery alone may be curative.

Intestinal adenocarcinoma

The two most common tumours affecting the stomach and intestines in cats are lymphoma and adenocarcinoma.

Adenocarcinomas can affect either the small intestine or the large intestine (rarely the stomach). They are usually quite rapidly growing tumours that often cause disease due to partial blockage of the intestine (loss of appetite, weight loss, vomiting and diarrhoea are the most common signs). Metastasis to local lymph nodes is common, and the tumours often invade the intestine quite extensively.

Surgical removal is the treatment of choice. Additional chemotherapy is used in some cases. Long survival times can be achieved in some cases (with surgery alone) even where the tumour has already spread to local lymph nodes so this can be worth considering, although not all cases will be suitable for surgery.

Lymphoma

Lymphoma (which is also known as malignant lymphoma and lymphosarcoma) is the single most common cancer that affects cats. Lymphoma is a solid tumour of a type of white blood cell (lymphocyte) that is involved in immune responses. In addition to being present in the blood, there are accumulations of lymphocytes present elsewhere in the body – either in discrete sites (lymph nodes or 'lymph glands’), or present within other tissues.

Because of the wide distribution of lymphocytes in the body, and the movement of these cells through the body, lymphoma (a malignant tumour of these cells) can occur at virtually any site, and also commonly occurs at multiple sites. Common sites to be affected include the lymph nodes (distributed throughout the body), the chest cavity, the intestinal tract, the nose, the kidneys and the nervous system.

Lymphoma in cats is often classified according to the site (tissues) that are affected - common terms used include:

Alimentary lymphoma (affecting the stomach and/or intestines)

Mediastinal lymphoma - affecting lymphoid tissue in the chest cavity

Multicentric or nodal lymphoma - affecting multiple lymph nodes and possibly other sites in the body also

Extranodal or miscellaneous lymphoma - these are cases of lymphoma that don’t clearly fall into one of the other categories so things like lymphoma affecting the kidneys, nose, brain etc.

Clinical signs vary widely according to the tissues that are affected. Both infection with feline leukaemia virus (FeLV) and feline immunodeficiency virus (FIV) can be underlying or predisposing causes of lymphoma development.

Various treatment options are available for lymphoma including surgery, drug therapy and radiation therapy. The treatment choice will depend on the site and form of the tumour, and the availability of the treatment options.

In many cats the response to therapy can be very good and long lasting. Although uncommon, some cases of lymphoma will go into complete and permanent remission and thus some cats can effectively be 'cured’.

Surgery and/or chemotherapy are the two most common treatment options used, but it is very difficult to predict which cats will respond well to therapy for lymphoma. It can be helpful, especially with chemotherapy, to use trial therapy as the initial response to chemotherapy (how well the tumour responds in the first few weeks) is often the best predictor of long-term response.

Mammary carcinoma

This is a cancer affecting the mammary glands that is most commonly seen in older entire female cats (although it can also be seen in male cats and neutered female cats).

The tumour commonly affects more than one of the mammary glands, which often develop multiple firm swellings or nodules, and the skin over these nodules and masses often becomes ulcerated over time.

This tumour commonly spreads to the local lymph nodes and can also spread to the lungs.

Early treatment of small tumours is likely to be much more successful than if multiple or larger tumours are present (where local and distant spread of the tumour is much more likely to have occurred).

Treatment is usually by surgical removal of the tumour and associated tissues, and there may also be a role for chemotherapy in some cases.

Mast cell tumours

Mast cells are a type of cell widely distributed in the body and help in the normal immune response.

Mast cell tumours commonly affect the skin, the spleen (in the abdomen) and/or the intestines. The skin is the most common site for mast cell tumours in cats.

Cutaneous (skin) mast cell tumours most commonly affect the head and neck and affected cats develop one or or multiple nodules or plaques in the skin. These may ulcerate. One form of cutaneous mast cell tumour is commonly seen in young cats (most commonly in Siamese cats) and this form spontaneously regresses over 6-24 months. However the other form is more commonly seen in older cats and can vary from being relatively benign to being an aggressive form of tumour with local invasion and spread (metastases).

Intestinal mast cell tumours are relatively uncommon, but are the third most frequent tumour affecting the intestines of cats (lymphoma and adenocarcinomas are much more common). In the intestine, these tumours tend to be highly aggressive and are seen mainly in older cats - spread (metastases) to local lymph nodes and more distant sites is extremely common. Clinical signs are often due to partial obstruction of the intestine.

With splenic mast cell tumours, commonly other sites are affected also (including lymph nodes, liver and sometimes even the skin). Loss of appetite, weight loss and vomiting are common signs.

Mast cell tumours can be removed surgically. This may be curative for many low grade skin mast cell tumours, but the prognosis is much more guarded where there are metastases and with intestinal or splenic mast cell tumours. If there is splenic involvement, removal of the spleen may be helpful and even in the presence of metastases can produce good improvement for around 12 months in many cats.

Oral squamous cell carcinoma

This is a cancer arising from the cells lining the mouth or throat – it often involves the tongue, and the tumour sometimes invades the local bone and can spread to local lymph nodes.

The tumour usually causes progressive difficulty in eating, and there may also be intermittent or continual drooling of saliva. Halitosis (a bad smell from the mouth) often develops.

These tumours can be difficult to treat but may potentially respond to surgery or radiation therapy where appropriate. In other cases, only palliative treatment is possible.

Osteosarcoma

Osteosarcoma is a cancer (malignant tumour) affecting the bones.

Bones in the limbs or the spine and skull can be affected, and where the limbs are involved the cancer often leads to weakening of the bone which may result in it becoming fractured (broken), with severe pain and lameness.

Even without a fracture developing, most cases of osteosarcoma will produce progressive marked pain and lameness.

Osteosarcomas can spread (metastasise) to local lymph nodes and to the lungs, but this does not necessarily occur. In the absence of metastases, surgery (where possible) may be curative although this may involve, for example, amputation of an affected limb.

Radiation and drug therapy may also be of value in some cases, usually as an adjunct to surgical management.

Pancreatic and liver (bile duct) adenocarcinoma

Cancers (malignant tumours) affecting the liver and/or pancreas are fortunately not very common in cats.

These tumours can cause jaundice (due to obstruction to the flow of bile), depression, weight loss, vomiting and distension of the abdomen (either due to the tumour or due to accumulation of fluid in the abdomen).

The prognosis for these tumours is very poor with little response being seen to current treatments.

Cats may also be affected with benign tumours of the liver or pancreas which may not necessarily cause any significant clinical signs of illness.

Respiratory (lung or nose) carcinoma

A number of cancers can affect the respiratory tract, but the most common are lymphoma in the nose, or adenocarcinoma affecting the nose or the lungs.

Tumours in the nose often cause progressive obstruction to the flow of air, and may result in progressively worse snorting/snoring noises during breathing. There may be sneezing and discharge from the nose, and as the disease progresses there will be difficulty in breathing.

Adenocarcinoma affecting the lung can cause difficulty in breathing, coughing, or a mixture of the two – the cancer can sometimes spread to the bones in the toes and cause lameness (the so-called 'lung-digit syndrome’).

For lung tumours, surgical removal may be possible if the disease is diagnosed early, and this may be combined with chemotherapy. However, by the time these tumours become apparent there has often been extensive spread within the chest.

For nasal tumours, generally radiation therapy with or without chemotherapy is likely to be the best treatment.

Squamous cell carcinoma

Squamous cell carcinoma is a cancer of the skin. Exposure to sunlight is one trigger-factor for this cancer and it is seen more commonly in white cats, and cats living in hot sunny countries.

The tumour commonly affects the nose or the ears and can initially look like a small scratch or wound that won’t heal. Spread (metastasis) of these tumours is uncommon but local lymph nodes are sometimes affected.

Early treatment of these tumours can be very successful and most commonly involves surgical removal or radiation therapy. For some tumours affecting the superficial layers of the skin local radiation therapy (brachytherapy, applied via a probe touched onto the skin) can be very effective.

The response to drug therapy (chemotherapy) is generally not very good but for some affected cats, an alternative to conventional surgery may be 'cryosurgery’ where the affected tissue is frozen using liquid nitrogen applied via a special probe. However, conventional surgery and/or radiation therapy are usually the preferred options.

Treatment

It is always extremely difficult when you learn that your cat has developed cancer. There are often feelings of bewilderment and even guilt (‘how could I have prevented this?’), and it inevitably takes time to come to terms with the disease. Although for most tumours the underlying cause is simply unknown, for many (although not all), treatment may be available that will significantly improve both the quality and length of life for the cat.

While a diagnosis of cancer is never good news, it is not necessarily a ‘death sentence’ for a cat. Just as in human medicine, many treatment options are available, although not all cancers respond well to therapy and some may be extremely difficult to manage. The cat’s quality of life and potential suffering must always be the overriding concern – it is worthwhile discussing the options available in depth with your vet before arriving at any decision.

The choice of whether or not to treat, and what to treat with, will depend on many factors. Some forms of therapy are only available at specialist centres, and your vet may suggest that he or she refers you to one of these places.

In many cases, appropriate treatment of cancer can result in a significant improvement in quality of life for affected cats. Treatments can carry side effects though, and your vet will be aware of these. The aim is always to improve the quality of life, and not to cause any increased suffering through the treatment. Although good results can be achieved for some cancers, it is not always appropriate or right to treat a cat and you should discuss options carefully with your vet.

Staging the patient

Before any treatment is begun for cancer, your vet will want to 'stage’ your cat. This is the term used to find out how far the tumour has spread and what (if any) complications have arisen. Staging a tumour often involves taking X-rays (or doing an ultrasound) to see if there is evidence of spread (for example to the lungs or liver), perhaps getting samples (biopsies or aspirates) from local lymph nodes, and checking blood samples.

Quality of life for the cat

When treating cancer, it is important that everyone involved has the same goals in mind. Veterinary surgeons aim to provide an improved and good quality of life for the cancer patient without producing any unacceptable side-effects with treatment. Often this will also mean a longer life but unnecessary suffering and pain must be avoided. It helps to have talked in advance with your vet about what guidelines you can use to judge the quality of life by. For many cancers, inevitably there may come a day when you have to consider euthanasia to avoid unnecessary suffering - this can be a difficult and distressing time and having the support and help of your vet, and also friends and family, can be invaluable.

Treatment options

Some treatments are widely available in general practice, while others are only available at specialist centres. Depending on what tumour has been diagnosed, your vet may sometimes suggest referring your cat to a specialist with expert knowledge and a greater range of treatment options. There are three main forms of therapy for cancer:

Surgery

Chemotherapy (drugs)

Radiation therapy

What treatment is used (or offered) for any individual cat will depend on factors such as:

The type of cancer

The site of the cancer (where it is in the body)

The presence of metastases (distant spread of the tumour)

What is appropriate for your cat

What is available/accessible to you

If you have any doubts or questions, ask your vet for more information.

Surgery for cancer patients

Surgery is the single most common form of therapy for cancer and is the treatment most likely to result in a cure. However, complete removal of the tumour by surgery is not always possible (due to the site of the tumour or its spread to other sites). This is one of the reasons why an early diagnosis and early treatment can significantly improve the long-term prognosis.

In addition to 'curative surgery’ (where complete removal of the tumour is attempted), surgery can also be used sometimes to remove some (but not all) of the tumour to help improve quality of life or to help with other treatments (such as chemotherapy or radiotherapy). You can discuss with your vet the risks and benefits anticipated with any surgery to help make a decision in the best interest of your cat. You can also discuss with your vet any pain relief (analgesic therapy) that can be given for the surgery and afterwards, and what sort of post-operative care would be required.

When cancer patients are treated surgically, it is common to remove normal tissue around the tumour as well as the tumour itself (this is referred to as 'surgical margins’). The reason for this is that many tumours spread microscopically so although it may not be possible to see or feel any abnormalities, even normal tissues around a tumour may contain abnormal cells that would cause future problems if not removed.

Radiation therapy (radiotherapy)

Radiation therapy is a frightening concept for many people as it is often assumed there will be numerous side-effects. However, as with any form of cancer therapy for cats, the goal is to improve quality of life and to relieve any discomfort, without causing any unnecessary additional suffering. While radiation therapy is able to achieve this for many cat cancers, unfortunately the availability of this form of therapy is quite limited. Your vet may be able to refer you to a specialist centre for this treatment.

Radiation therapy most commonly involves what is known as 'external beam radiation’ (similar to X-rays). A machine is used to focus a beam of radiation at the tumour, but the radiation is much more intense than X-rays and the radiation produced has the ability to kill off cancer cells. Because normal cells can be damaged too, careful calculation of the dose, frequency and targeting of the radiation is needed. At its best, radiation can kill off cancer cells while causing very little damage to surrounding tissues. Although radiation therapy is used to kill cancer cells, this does not mean that the treated cat becomes 'radioactive’ and there is no risk whatsoever to people in contact with the cat.

External beam radiation therapy is typically delivered by a machine known as a **linear accelerator**. This therapy usually requires a short general anaesthetic (so that the cat does not move during the procedure), and generally several treatments are given (each lasting only a few minutes) over a few weeks.

Radiation therapy can cure some tumours, while with others it may reduce and help control the tumour. In most cases the damage to surrounding normal tissues is minimal and does not cause significant side effects. The specialist undertaking this therapy would discuss with you in detail what was involved before you make any decision. The radiation therapy itself does not hurt, and indeed it can be an effective way of providing pain relief if the cancer is causing pain. Skin irritation and hair loss at the site of radiation therapy is one of the most common side effects.

Another form of radiation therapy called brachytherapy is occasionally used, where sources of radiation are placed within or on the surface of the body (using a probe) to expose a tumour to radiation therapy. This can provide a more localised form of radiation therapy and can be used, for example, to treat some skin tumours such as squamous cell carcinoma.

Radiation therapy is often used in combination with surgery and/or drugs (chemotherapy), and some drugs have the ability to enhance the effectiveness of the radiation therapy.

Chemotherapy (anti-cancer drug therapy)

As with radiation therapy, the thought of chemotherapy often carries many misconceptions. Many people know of friends or relatives who have received chemotherapy for cancer and have experienced significant adverse effects associated with the treatment. Although anti-cancer drugs can, and do on occasions, produce side effects in animals too, most people are surprised and relieved at how well cats tolerate chemotherapy. This is in part because cats do tolerate the treatment better, but also in part because lower doses are often used to avoid side effects that would affect the quality of life.

A wide variety of different drugs are available to treat cancers, the choice depending on

The tumours being treated

What is available

How well the cat may tolerate the treatment

Your vet will be able to discuss these options with you and refer you to a specialist for further advice or treatment if necessary.

For many cancers a combination of different drugs are used to increase effectiveness (attacking the tumour in different ways), and to reduce the risk of side effects (using different drugs usually allows lower doses to be used).

Most chemotherapy drugs work by interfering with the ability of cells to divide (cancer cells have uncontrolled, continual growth and division). Side effects, when they occur, may be due to interference with other cells in the body that also divide rapidly, such as cells in the bone marrow, the intestinal tract and the skin. Side effects include:

Suppression of the bone marrow - this causes a low white blood cell count. The type of white blood cell usually affected first are known as neutrophils. Regular blood samples are usually taken to monitor the white blood cell count (usually seven to 10 days after the drug is given). If the neutrophil count falls too low, the dose and/or frequency of the drug is usually reduced, and antibiotics may be temporarily prescribed. Platelets (cells in the blood associated with clotting) may also sometimes be affected by chemotherapy, and these too are checked when routine blood samples are taken.

Hair loss – although this can be one of the most obvious side effects of chemotherapy in humans, hair loss in cats is unusual. Where it does occur, often just the whiskers on the face are affected. Generalised hair loss is extremely rare.

Gastrointestinal irritation – a number of chemotherapy drugs can cause irritation to the stomach and intestinal tract for a few days after being given. This may result in nausea and vomiting, or sometimes just as lethargy and inappetence. Where this occurs the dose of the drugs can be altered and/or other medications can be used to overcome these effects. It is helpful to keep a diary of your cat’s behaviour while it is receiving chemotherapy, including a note of any vomiting or diarrhoea, and the cat’s appetite. If ever you are concerned about possible side effects associated with treatment, contact your vet immediately.

Other side effects generally depend on the drug being used – some have the potential to damage the kidneys, or the heart and thus monitoring or careful use may be required. However, in general less than 20 per cent (one in five) treated cats will experience any side effects.

Some drugs are given as tablets, but others are given as injections by your vet - these injectable drugs are often given through a catheter that will temporarily be placed into a vein (usually in a leg).

Precautions in cats receiving chemotherapy

Because anti-cancer drugs can affect healthy as well as cancerous cells (in humans as well as cats), unnecessary exposure to these drugs should be avoided wherever possible. This includes unnecessary handling of the drugs, but also exposure to the drugs in urine and faeces that are produced by a cat being treated (and also other body fluids like saliva and vomit). If some simple precautions are taken, this exposure and any consequent risks can be reduced to an absolute minimum:

Giving tablets at home - your vet will warn you if he or she is prescribing tablets for you to give at home that are potentially harmful. If this is the case, these tablets (or capsules) must not be split or crushed – they will have a protective coating designed to prevent you coming into direct contact with the drug itself. Ideally the tablets should be handled and administered while wearing disposable gloves. If your cat spits out a tablet, this can be picked up (wearing gloves), wrapped in kitchen paper and then flushed down the toilet.

Dealing with urine and faeces - most drugs are eliminated from the body in the urine and/or faeces, and in general the concentrations of the drug will be highest in the first few days after treatment. Even early on, the amount of drug excreted is actually very low, but it is safest to wear disposable gloves when cleaning a litter tray and to place soiled litter in a sealed bag in the dustbin. If your cat urinates and defecates outdoors, no special precautions will be necessary.

Dealing with soiled bedding - soiled bedding (with urine or faeces) should be washed separately from any other routine washing, and similarly food and water bowls should be washed separately from your own bowls and utensils.

These simple precautions will help to make sure that any potential exposure to these drugs is kept to an absolute minimum.

General and palliative care

As already noted, it is useful to keep a diary of your cat’s behaviour, appetite, and any abnormalities you observe, as well as a note of when (day and time) you administer any medications. This will help you and your vet determine if any additional treatments or investigations are necessary.

Maintaining good nutritional intake is an important part of the supportive care for your cat with cancer, and offering a variety of foods can help to ensure that a good appetite is maintained. In general good quality commercial foods are the best choice for a cat with cancer, although at times there may be some special dietary requirements to take into consideration. Warming the food may encourage the appetite, but occasionally, depending on the circumstances, temporary use of an appetite stimulant or a feeding tube may be needed to overcome poor food intake. Always talk to your vet if your cats appetite is reduced as this can indicate an underlying problem such as uncontrolled pain or side effects associated with the treatment being received.

Ensuring a good quality of life that is free from pain is the main goal in managing cats with cancer. Supportive therapy can be an important part of this, and such treatments may include use of:

Analgesic drugs - these are 'pain-killers’ and can be important if there is any pain or discomfort associated with the cancer.

Non-steroidal anti-inflammatory drugs (NSAIDs) - these drugs are anti-inflammatory and also help to relieve pain. They can be helpful in the management of some tumours fro both of these reasons, and in addition NSAIDs may have a direct anti-cancer effect in some types of tumours (although this effect is not usually profound).

Anti-emetic drugs - these are drugs that reduce nausea and vomiting and may be needed in some patients.

Antibiotics - if secondary bacterial infections become a problem or if your cat develops a very low white cell count (leaving them vulnerable to infection) antibiotics may sometimes be used.

Never be afraid to ask questions and to find out as much information you can about your cat’s cancer and treatment options, and if there is ever anything you are concerned about regarding the cancer or potential treatment side effects always contact your vet immediately.

Mammary carcinoma

This is a cancer affecting the mammary glands that is most commonly seen in older entire female cats (although it can also be seen in male cats and neutered female cats).

The tumour commonly affects more than one of the mammary glands, which often develop multiple firm swellings or nodules, and the skin over these nodules and masses often becomes ulcerated over time.

This tumour commonly spreads to the local lymph nodes and can also spread to the lungs.

Early treatment of small tumours is likely to be much more successful than if multiple or larger tumours are present (where local and distant spread of the tumour is much more likely to have occurred).

Treatment is usually by surgical removal of the tumour and associated tissues, and there may also be a role for chemotherapy in some cases.

Oral squamous cell carcinoma

This is a cancer arising from the cells lining the mouth or throat – it often involves the tongue, and the tumour sometimes invades the local bone and can spread to local lymph nodes.

The tumour usually causes progressive difficulty in eating, and there may also be intermittent or continual drooling of saliva. Halitosis (a bad smell from the mouth) often develops.

These tumours can be difficult to treat but may potentially respond to surgery or radiation therapy where appropriate. In other cases, only palliative treatment is possible.

Respiratory (lung or nose) carcinoma

A number of cancers can affect the respiratory tract, but the most common are lymphoma in the nose, or adenocarcinoma affecting the nose or the lungs.

Tumours in the nose often cause progressive obstruction to the flow of air, and may result in progressively worse snorting/snoring noises during breathing. There may be sneezing and discharge from the nose, and as the disease progresses there will be difficulty in breathing.

Adenocarcinoma affecting the lung can cause difficulty in breathing, coughing, or a mixture of the two – the cancer can sometimes spread to the bones in the toes and cause lameness (the so-called 'lung-digit syndrome’).

For lung tumours, surgical removal may be possible if the disease is diagnosed early, and this may be combined with chemotherapy. However, by the time these tumours become apparent there has often been extensive spread within the chest.

For nasal tumours, generally radiation therapy with or without chemotherapy is likely to be the best treatment.

Squamous cell carcinoma

Squamous cell carcinoma is a cancer of the skin. Exposure to sunlight is one trigger-factor for this cancer and it is seen more commonly in white cats, and cats living in hot sunny countries.

The tumour commonly affects the nose or the ears and can initially look like a small scratch or wound that won’t heal. Spread (metastasis) of these tumours is uncommon but local lymph nodes are sometimes affected.

Early treatment of these tumours can be very successful and most commonly involves surgical removal or radiation therapy. For some tumours affecting the superficial layers of the skin local radiation therapy (brachytherapy, applied via a probe touched onto the skin) can be very effective.

The response to drug therapy (chemotherapy) is generally not very good but for some affected cats, an alternative to conventional surgery may be 'cryosurgery’ where the affected tissue is frozen using liquid nitrogen applied via a special probe. However, conventional surgery and/or radiation therapy are usually the preferred options.

source/s: international cat care (http://www.icatcare.org/)

Cardiomyopathy is the name given to any disease affecting the heart muscle itself. This is the most common form of heart disease seen in cats, and the most common cause of heart failure.

Disease of the heart valves (causing ‘leaky’ valves which prevent the heart functioning normally) are an important and common cause of heart disease in humans and in dogs, but this is rarely seen in cats.

Cardiomyopathies (disease of the heart muscle) are described according to the effect they have on the structure and function of the cardiac (heart) muscle. The main classification is to divide the disease into:

Hypertrophic cardiomyopathy (HCM) - this is the most common form of heart disease in cats and occurs where there is an increase in the thickness of the muscular wall of the heart. This reduces the volume of blood within the heart and also prevents the heart muscle relaxing properly between contractions.

Dilated cardiomyopathy (DCM) - this is where the muscular wall of the heart generally becomes thinner than usual, the heart enlarges, and the heart muscle cannot contract effectively.

Restrictive cardiomyopathy (RCM) - here primarily there is fibrosis of the wall of the heart, making it stiff and inelastic, so preventing the heart chambers filling normally.

Intermediate cardiomyopathy (ICM) - these cases have changes consistent with more than one type of disease - for example a mixture of both hypertrophy and dilatation present.

Underlying causes

Although in the majority of cases of heart disease in cats, the underlying cause is unknown, there are various potential recognised causes, and your vet may need to investigate some of these. Known potential underlying causes include:

Cardiomyopathy secondary to other diseases

Hyperthyroidism (overactive thyroid glands)

Hypertension (high blood pressure)

Acromegaly (excessive growth hormone production)

Nutritional causes

Taurine deficiency (causing dilated cardiomyopthy)

Infiltrative of the heart muscle

Lymphoma (a type of malignant tumour)

Exposure to toxins

Some drugs may have secondary effects on the heart

Hereditary causes

Genetic defects have been recognised in Maine Coon cats and other breeds that may contribute to development of cardiomyopathy.

What happens in cardiomyopathy

In cardiomyopathy, the underlying abnormality of the cardiac muscle leads to a compromise in cardiac function. The alteration in heart function depends on the type of cardiomyopathy though:

With HCM and RCM - the disease mainly interferes with the ability of the heart muscle to relax properly between contractions. The relaxation phase between each cardiac contraction is called diastole, and if this does not occur properly, the heart cannot fill with blood so effectively. If severe, this will lead to heart failure, and a form known as ‘diastolic heart failure’.

With DM - the disease mainly affects the ability of the heart muscle to contract (called 'systole’). This will compromise the ability of the heart to pump (and eject) blood. In severe cases this too leads to heart failure - a form known as 'systolic heart failure’.

Early signs

In the initial phase of disease, cats may show no signs at all and appear completely normal. In fact a number of cats with cardiomyopathy may never actually develop clinical disease. However, while in some cats, progression of the underlying disease is slow, in others it can be quite rapid.

Some early signs of heart disease may be detectable during a clinical examination by your vet, prior to the onset of any overt signs. This is one of the reasons why every cat should be checked at least one a year by a vet (and ideally more often in older cats). Early warning signs that your vet might detect include:   * Presence of a heart murmur — this is an abnormal noise your vet can detect when listing to your cat’s heart with a stethoscope and develops due to turbulence in the flow of blood through the heart.

Presence of a gallop rhythm — during each cycle of heart contractions, normally you can hear two sounds when you listen to the heart with a stethoscope (these sounds are associated with closure of heart valves during contraction and relaxation of the heart). With significant heart disease, a third audible heart sound is sometimes detected and this is referred to as a 'gallop sound’ or 'gallop rhythm’.

Abnormalities in heart rate - with heart disease, the heart rate can sometimes significantly increase or decrease outside of the normal range for a cat, and sometimes there may be heart beats without any effective flow of blood (a heart beat but no pulse detectable in an artery (known as a 'pulse deficit’)

Presence of cardiac rhythm disturbances — these are also referred to as cardiac dysrrhythmias. Normally, cats have a very regular heart rate, but in heart disease there can be interference in the normal electrical impulses that control heart contractions and this can lead to disturbances to the to the normal rhythm.

Many cats, especially with early disease, may only have changes in the cardiac muscle that are detected on an ultrasound examination of the heart. These cats are clinically silent (or symptomatic), although many will go n to develop signs later on.

Heart failure

If heart function is significantly impaired by cardiomyopathy, this will lead to heart failure (often called congestive heart failure), where there is compromise to blood flow through the heart and blood output from the heart.

When cats develop clinical signs sometimes occur without prior warning, and some cats can deteriorate very rapidly. Some cats with heart disease show signs of collapse, or 'fainting’. However, this is relatively uncommon and usually associated with marked disturbances to the normal rhythm of the heart (which can lead to episodes where the brain is staved of oxygen through poor blood flow).

Unlike dogs, cats are not exercised in the same way (e.g., taken for walks on a lead) so it is often much more difficult to detect that they have reduced exercise ability - often an early sign of heart disease. Cats are likely just to spend a little more time resting or sleeping and this may not be very obvious. Because detecting early disease (especially without an examination by your vet) is often difficult, and cats are good at hiding signs of disease, there may be no obvious signs until a 'critical point’ is reached due to advance of the disease or perhaps when the cat becomes stressed, that may result in sudden or rapid development of quite marked signs.

In cats, the most common sign of heart failure is the development of difficult breathing (called dyspnoea) and/or more rapid breathing (called tachypnoea). This is generally caused by either a build up of fluid in the chest cavity around the lungs (called a pleural effusion), or due to a build up of fluid within the lungs themselves (called pulmonary oedema).

Along with breathing difficulties, cats may have cold extremities (e.g., ears and paws), and may have pale mucous membranes (gums and eyes) suggesting poor circulation. Occasionally the mucous membranes of the mouth and eyes, and even the skin, may show signs of cyanosis (a bluish colour). Coughing is rarely seen in cats with heart disease, although it is quite common in dogs. In cats, when coughing is seen, this is much more likely to be caused by a disease of the airways (such as bronchitis).

Feline aortic thromboembolism (FATE)

Another sign which can occur in cats, and may sometimes be the first indicator of underlying heart disease, is the development of what is known as 'feline aortic thromboembolism’ or FATE. A thrombus (blood clot) may develop within one of the heart chambers (usually left atrium) in a cat with cardiomyopathy. This occurs mainly because the blood is not flowing normally through the heart. The thrombus, or clot, is initially attached to the wall of the heart, but may become dislodged and be carried into the blood leaving the heart. A thrombus that moves into the blood circulation is called an embolus, hence the term 'thromboembolism’. Once in the circulation, these emboli can lodge in a small artery and obstruct the flow of blood to a region of the body. Although this can happen at a number of different sites, most commonly this happens towards the end of the major artery that leaves the heart (the aorta) as it divides to supply blood to the back legs. This complication is seen most commonly with HCM, and will cause a sudden onset of paralysis to one or both back legs, with severe pain and considerable distress.

Differentiation of forms of cardiomopathy

Various diagnostic tests can be done to assist the diagnosis of heart disease in cats.

Electrocardiogram (ECG) - this is an electrical trace of the heart activity. It can be very useful for the detection of cardiac rhythm disturbances, but has more limited use beyond that.

Radiography (X-rays) - are helpful for showing changes in the overall shape and size of the heart, and for detecting a build up of fluid (pulmonary oedema or pleural effusion). Repeating radiographs may also allow monitoring of the efficacy of any treatment.

Heart ultrasound (echocardiography) - is very helpful as it allows a view of the internal dimensions of the heart, the wall thickness, and the contractility of the heart to be assessed. It can also show where a heart murmur is originating from. This is the only test which can readily distinguish between different types of heart disease in cats. Although a small area of skin usually needs to be shaved to perform ultrasound, the procedure is not uncomfortable or painful and so can be performed in most cats without any sedation or anaesthetic.

Tests for underlying disease - may need to be performed in some cases, including blood tests and blood pressure measurement.

Treatment

The underlying cause of the cardiomyopathy can only rarely be treated, but if it develops secondary to taurine deficiency in the diet (which can be a cause of DCM), or secondary to things like hypertension (high blood pressure) or hyperthyroidism Overactive thyroid gland), then treating the underlying disease may improve cardiac function.

Where heart failure develops, various drug treatments may be available to help improve and manage the condition. These may include drugs such as:

Beta-blockers such as atenolol or propranolol, which slow down the heart rate and reduce the oxygen demand on the heart.

Diltiazem - this drug is known as a 'calcium-channel blocker’, and reduces both heart rate and the strength of heart contractions. It reduces the oxygen demand of the heart and may help the heart muscle to relax between contractions

ACE-inhibitors (angiotensin-converting enzyme inhibitors, e.g., benazepril, ramipril, enalapril) or ARBs (angiotensin receptor blockers, e.g., telmisartan) - help block the activation of the renin-angiotensin-aldosterone system (RAAS) - a hormone system stimulated in cats with heart disease. Their use may help in the management of heart failure and possibly also in earlier stages of heart disease.

Pimobendan - is drug known as a calcium channel sensitiser. It increases the strength of the contraction of the heart and also acts to dilate blood vessels which may help the flow of blood. It has been used in some cats with congestive heart failure.

Diuretics (such as frusemide/furosemide) - these are extremely valuable once signs of congestive heart failure develop, to help remove the fluid build up in or around the lungs. The dose of these drugs can be adjusted over quite a wide range to achieve the desired result.

Unfortunately the true effectiveness of many drugs in treating heart disease in cats is unknown, and more clinical trials are needed. Different drugs also act in different ways, and so may be helpful in different situations. In general, diuretics are the most useful drugs to manage the signs of congestive heart failure, but with early diagnosis of heart disease treatment may help to slow or delay its progression and maintain a good quality of life.

source/s: international cat care (http://www.icatcare.org/)

Feline chlamydophila disease refers to infection with a type of bacterium calledChlamydophila felis. This was formerly known as Chlamydia psitacci var felis.

Many different strains of chlamydia-type bacteria exist, most being highly species specific (each strain or species usually only infecting one or a small number of different animals).

The bacterium that infecting cats is specifically adapted to cats where it primarily causes ocular infections and conjunctivitis. Appropriate treatment can eliminate the organism and resolve all the clinical signs. Where the disease is problematic in colonies of cats, vaccination is also available and can be helpful as part of a control plan.

In keeping with other similar organisms, Chalmydophila felis (or C felis) is a very fragile bacterium and cannot survive for any significant time in the environment. Infection is therefore mainly through direct contact between animals.

What disease does Chlamydophila felis cause

Chlamydoiphila felis is mainly a cause of conjunctivitis (infection and inflammation of the delicate membranes - conjunctiva - that cover the inner surface of the eyelids and the white part of the eye itself).

The bacteria invade and infect the cells of the conjunctiva itself causing inflammation and ocular discharge. Clinical signs usually develop within a few days of infection. Disease starts as a watery eye discharge. At first only one eye may be involved, but within a few days the disease invariably affects both eyes. Pain and discomfort means affected cats may hold their eyelids partially closed (blepharospasm) and as the disease progresses severe swelling and reddening of the conjunctiva may be seen. The discharge changes to a thicker yellowish nature and occasionally the eye infection is accompanied by mild sneezing and nasal discharge. Occasionally there is a mild fever which can result in lethargy and inappetence but cats usually remain bright and eat well.

If left untreated, the conjunctivitis often persists for two months or more, and cats may continue to shed the bacteria in ocular secretions for many months (and thus be a potential source of infection to other cats).

Although C felis mainly causes conjunctivitis, the organism can also be found in the lungs, gastrointestinal tract and reproductive tract of cats. There is some speculation that it may occasionally contribute to infertility in breeding queens.

Which cats are at risk of infection

Chlamydophila infection is relatively common in cats, and it may be a cause of up to 30% of cases of chronic (long-term) conjunctivitis. However, the organism requires direct contact between cats to spread so disease is much more common where larger groups of cats are kept together, such as multi-cat households, breeding households, catteries and shelters.

Although cats of all ages can be infected, disease is seen most commonly in kittens 5-12 weeks of age. Chlamydophila also has to be distinguished from other potential causes of conjunctivitis such as feline herpesvirus, feline calicivirus and mycoplasmas. Conjunctivitis may also occur as a result of trauma, allergies or other non-infectious reasons.

Diagnosis

Diagnosis of feline chalmydophilosis requires detection of the organism in the conjunctiva of a cat showing typical signs. Examination of smears from an eye swab under the microscope may give an indication of the presence of infection by seeing typical changes in the conjunctival cells. However, for definitive diagnosis swabs from the eyes of affected cats should be sent to a veterinary laboratory where the the organism can be identified through culture or through molecular diagnostic techniques such as polymerase chain reaction (PCR).

Treatment

A number of antibiotics can be used to treat C felis infections. A group of antibiotics known as tetracyclines are considered the treatment of choice being most effective. Doxycycline is one of these antibiotics and this only has to be administered once daily to infected cats. Some other antibiotics may also be effective, but these are generally not as good and have to be given for longer to achieve the same results as doxycycline.

Oral treatment with tablets or a suspension is best, as the organism can be present at sites other than the eye, but topical treatment with eye drops or ointment is also helpful - it may enhance recovery and also make the cat feel more comfortable.

Treatment is usually continued for 3-4 weeks to ensure the organism is eliminated (sometimes longer with other antibiotics) and all cats in a house should be treated.

A vaccine is available in many countries to protect cats against chlamydophila conjunctivitis. This does not always prevent infection, but is helpful in preventing severe clinical disease. Although not generally suitable for the majority of pet cats, it can be useful in high risk situations such as catteries with persistent problems with the organism.

Risk to humans

Humans can be infected with Chlamydia psitacci, but the bacterium that infects cats (Chlamydophila felis) is highly adapted to this species. There have been one or two reports of human conjunctivitis following contact with a cat harbouring C felis, but the risk appears to be extremely low. Routine hygiene precautions are recommended when handling and treating infected cats (washing hands after stroking or giving medications, and avoiding close face-to-face contact until the infection has resolved).

source/s: international cat care (http://www.icatcare.org/)

Chronic kidney disease (CKD) is the name now used to refer to cats with kidney failure (or chronic kidney failure). CKD is one of the most common conditions affecting older cats, and in most cases is progressive over time so that there is a gradual decline and worsening of the disease. The rate of decline varies considerably between individual cats.

The kidneys are responsible for helping maintain fluid balance in the body, for producing certain hormones, for regulating many electrolytes in the body and for excreting waste products (via urine). In CKD, all these regulatory processes can be interfered with causing a wide range of different signs.

Although CKD is not a curable or reversible disease, appropriate support and treatment can both increase the quality of life, and also prolong life by slowing down the progression of the disease.

What causes chronic kidney disease

CKD occurs where there is long-standing, irreversible damage to the kidneys that impairs their ability to function and remove waste products from the blood. In most cases, the exact cause of CKD is unknown. Samples (biopsies) from affected kidneys (biopsies) often show a mixture of fibrosis and inflammation termed ‘chronic interstitial nephritis’. These are non-specific ‘end stage’ changes though, and do not tell us anything about the underlying cause. Although most cases of CKD are idiopathic (have an unknown underlying cause), some causes are well recognised. These include:

Polycystic kidney disease (PCKD) - this is an inherited disease seen mainly in Persian and related cats where normal kidney tissue is gradually replaced by multiple fluid filled cysts

Kidney tumours – for example lymphoma (a solid tumour of white blood cells) can affect the kidneys

Infections – bacterial infection of the kidneys (known as 'pyelonephritis’) may lead to sufficient damage to cause CKD

Toxins - certain toxins and drugs can damage the kidneys

Glomerulonephritis - this refers to inflammation of the glomeruli (individual units within the kidneys that filter the blood) - they may become inflamed for various reasons and if prolonged this can lead to CKD

Other conditions such as birth defects affecting the kidneys, trauma, hypokalaemia (low blood potassium), and hypercalcaemia (high blood calcium) may also cause CKD, but work is still going on to discover the underlying cause(s) of most cases of this disease.

If an underlying cause can be identified, in some cases this may be treatable and so progression of the condition may be halted. In most cases though, treatment is aimed at management of the disease and complications that arise from it.

How common is CKD

CKD can be seen in cats of any age, but is most commonly seen in middle- to old-aged cats (those over 7 years), and it becomes increasingly common with age. It has been estimated that around 20-50% of cats over 15 years of age will have some degree of CKD present. CKD is seen about three times more frequently in cats than in dogs.

What is the normal role of the kidneys

Like all mammals, cats have two kidneys located in the abdomen, which perform a wide variety of important roles, including :

Removing toxins from the blood

Maintaining water balance

Maintaining salt balance (and other electrolytes)

Maintaining the acid balance of the body

Maintaining normal blood pressure

Producing hormones

Blood is constantly filtered through the kidneys to remove the toxic waste products of the body’s metabolism. Urine is produced in this process. The kidneys also concentrate the urine by returning water to the body, preventing dehydration.

Fortunately, there is considerable 'reserve capacity’ in the kidneys. It is well recognised that in healthy animals and humans, it is possible to remove one kidney completely without any adverse consequences. In fact it requires around two thirds to three quarters of the total functioning kidney tissue (of both kidneys) to be lost before signs of CKD will develop.

What are the signs of CKD

In most cases CKD is a progressive disease. Initially, clinical signs are often very subtle and mild, but will gradually get worse over a long period of time. More rarely, signs may appear to develop quite suddenly (often as a result of decompensation or sudden worsening of the condition, for example if a cat with CKD is deprived of water).

Many of the signs are vague and non-specific – some arise from the accumulation of toxins in the blood while others may arise as complications from the body trying to adapt to the disease. The most common signs are:

Weight loss

Poor appetite (inappetence)

Lethargy

Increased thirst (polydipsia)

Increased urination (polyuria)

The increased production of urine occurs because cats begin to lose the ability to concentrate their urine with CKD, and they begin to drink more to compensate for this.

Other signs may include:

Poor coat

Hypertension (high blood pressure)

Vomiting

Bad-smelling breath (halitosis)

Weakness

Anaemia

How is CKD diagnosed

A diagnosis of CKD is usually made by collection of blood sample and a urine sample at the same time for analysis. Two substances in the blood – urea and creatinine – are commonly analysed, as these are by-products of metabolism that are normally excreted by the kidneys. In CKD the blood concentration of these two products will increase. However, as some other conditions can also cause elevation of these substances, a urine sample is usually analysed at the same time. With CKD, typically there will increased urea and creatinine concentrations and the blood and at the same time there will be poor concentration of the urine. The urine 'specific gravity’ is measured to assess its concentration, and in most cats with renal failure this is less than 1.030.

Blood tests may also show any important complications that have developed as a result of CKD such as hypokalaemia (low blood potassium), anaemia, and hyperphosphataemia (high blood phosphate). As hypertension (high blood pressure) is a relatively common complication of CKD, your vet will also want to measure your cat’s blood pressure where possible. Sometimes other investigations such as X-rays, ultrasound or even biopsies may be indicated depending on individual circumstances.

Measuring the quantity of protein being lost in urine (usually through a simple urine test called the 'protein to creatinine ratio’) can be important in cats with CKD. Increased loss of protein in the urine (proteinuria) may be a marker of progressive CKD. In humans, using drugs to reduce proteinuria may significantly slow down progression of the CKD - it is not certain if the same is true in cats, but it could be.

Early diagnosis

Because CKD is such a common disease in cats, routine screening of all mature and older cats can help early diagnosis, which in turn may prolong a good quality of life. Yearly or twice yearly routine veterinary check-ups are important, and as your cat begins to get older it is important that urine samples, and body weight, are monitored at each visit. A declining urine concentration or body weight may be early signs that CKD is developing and that further investigations should be done.

source/s: international cat care (http://www.icatcare.org/)

Feline leukaemia virus (FeLV) is very important viral infection of cats occurring throughout the world. FeLV belongs to a group of viruses known as ‘oncornaviruses’ and these viruses have the ability to cause the development of tumours (cancer) in infected individuals. Cats infected with FeLV can develop lymphoma (a solid tumour of lymphocytes - a type of white blood cell), leukaemia (cancer of the bone marrow) and some other tumours. However, other major effects of FeLV infection are severe immunosuppression and development of anaemia, and more cats will die of these complications than of development of tumours.

A cat persistently infected with FeLV is highly likely to develop clinical disease related to the virus and it is an important cause of suffering and death in cats. However, the development of readily accessible tests to identify infected cats, and the development of effective vaccines have together significantly reduced the prevalence (frequency) of infection with this virus, although it remains an important disease.

What is FeLV ? How is it spread?

Feline leukaemia virus (FeLV) belongs to the retrovirus family of viruses in a group known as oncornaviruses. Oncornaviruses are a group of viruses (some infecting humans some infecting animals) that cause development of cancers, among other effects. FeLV only causes disease in cats, and was first discovered in 1964.

FeLV is an important cause of disease and death in cats. In a cat persistently (permanently) infected with the virus is at significant risk of developing many severe illnesses such as anaemia, immunosuppression and cancer. It has been estimated that 80-90% of infected cats die within 3-4 years of their infection being diagnosed.

In a persistently infected cat, large quantities of virus are shed in the saliva, but the virus may also be present in faeces, urine and milk. The virus is fragile and does not survive outside the cat for any length of time. It is thought that infection is perhaps spread most commonly through prolonged social contact (mutual grooming, sharing of food bowls, litter trays etc., where virus may be ingested). However, the virus can also be transmitted through biting and if an entire queen is infected with FeLV, andy kittens she produces will also be infected (although many die and are aborted or resorbed before birth due to the FeLV infection).

In general, less than 1-2% of healthy pet cats are infected with FeLV, but infection is more common in sick cats, in outdoor cats, and slightly more common in male than female cats.

Outcome following infection with FeLV

Cats are most commonly infected orally, by ingestion of the virus. The virus replicates locally in tissues and rapidly spreads to local lymphoid tissue (part of the immune system). The virus will spread through the body in lymphocytes and monocytes (white blood cells involved in immune responses) and within a few weeks will spread to the bone marrow. If the virus establishes a productive infection in cells of the bone marrow, most cats will remain persistently infected with the virus.

An immune response will develop against the virus, but this is not always effective. Several outcomes are possible after infection:

An effective immune response may completely eliminate virus soon after the cat is exposed. These cats have recovered from infection and are immune, but this may be relatively uncommon.

Cats may mount a good immune response and contain infection effectively. These cats have so-called ‘regressive infections’ - the virus may still be present in some cells, but an effective immune response stops widespread replication of the virus. These cats rarely develop any FeLV-related disease and rarely shed the virus.

Cats may be unable to control replication of the virus within the bone marrow. Cells in the bone marrow used to form new blood cells may be infected and the virus will be present in these cells, in circulating blood cells and other sites such as the bladder, intestinal tract, salivary glands etc. These cats are classified as have persistent infections or 'persistent virameia’ (meaning the virus is constantly present in the blood), or as having 'progressive infections’. These cats a re highly likely to develop FeLV-related disease.

On are occasions, cats may develop atypical or localised infections, where a partially effective immune response largely prevents productive infection with the virus, but active replication may take place within certain tissues (such as the bladder or mammary glands).

Effects of FeLV infection

The most common effects of progressive FeLV infections (persistent viraemia) are:

Immunosuppression - suppression of normal immune responses and development of secondary diseases and infections accounts for around 50% of all FeLV-related disease.

Anaemia - FeLV-related anaemia can develop in a number of ways, including viral suppression of the red blood cell precursors in the bone marrow. Anaemia accounts for around 25% of all FeLV-related disease.

Neoplasia - FeLV infection can damage the DNA (genetic material) of infected cells and can lead to development of tumours (most commonly lymphoma or various leukaemias). This accounts for around 15% of FeLV-related disease. Although neoplasia is only a part of the disease spectrum caused by FeLV, an FeLV-infected cat has approximately a 50 times higher risk of developing lymphoma than a non-infected cat.

Other diseases - a variety of other diseases including skin disease and reproductive failure develop in some infected cats.

The type of disease that develops in an individual cat infected with FeLV will depend in part on the strain of virus that infected that cat. At least four different strains (or sub-types) of FeLV are recognised and these are termed A, B, C and T. Some of these sub-types are much more likely to cause immunosuppression, for example, while others are more likely to cause anaemia.

Signs of FeLV infection

Immunosuppression is the single biggest cause of clinical signs in FeLV infected cats. Typically a variety of chronic (persistent) and/or recurrent diseases develop in these cats, with progressive deterioration in their condition over time. These features all suggest a progressive deterioration in the cats immune response and ability to deal with other diseases or infections. Clinical signs are extremely diverse but include fever, lethargy, poor appetite, weight loss, and persistent or recurrent respiratory, skin and intestinal problems.

Anaemia and neoplasia are also seen commonly with FeLV, with a variety of clinical signs arising from these conditions too.

Diagnosis FeLV infection

Fortunately, good diagnostic tests are readily available for FeLV. Simple 'in clinic’ blood tests re used by many vets (generally based on ELISA tests or immunochromatography). These tests detect a protein produced during replication of the FeLV virus which is usually present in the blood of cats persistently infected with the virus. These tests are quick, relatively inexpensive, and generally very reliable. Often the kits simultaneously test for FIV, as many of the clinical signs of FIV infection are similar to FeLV infection.

Occasional false positive and negative results occur, so if an unexpected result is obtained a confirmatory test is usually performed. For a confirmatory test, a blood sample is often submitted to a specialist veterinary laboratory:

Virus isolation - this test detects the virus itself within the blood sample through laboratory culture of the virus

Immunofluorescence - this tests for viral proteins (antigens) present in blood cells

PCR (polymerase chain reaction) - this test detects the genetic material of the virus

Re-testing is sometimes required after 12-16 weeks to confirm the status of a cat - if the cat has only recently been exposed it may test negative for the virus. Conversely, if a cat has only recently been infected it can occasionally test positive, and may then be able to eliminate infection.

Any cat that tests positive for FeLV should be isolated from other cats to prevent transmission.

Treatment

There is no cure for FeLV infection, and management is largely aimed at symptomatic and supportive therapy. This include:

Prompt diagnosis and treatment of secondary infections - more prolonged therapy may be needed as the immunosuppression may mean response to therapy is slower

Maintaining good quality nutritional support and avoidance of raw foods, that may carry a health risk.

Maintaining a good preventive healthcare programme with routine veterinary visits at least twice a year and regular worming, flea treatments and vaccination.

Keeping infected cats indoors to prevent spread of infection to other cats and to reduce the exposure to other infections agents.

In some cases, supportive therapy may include use of blood transfusions and drugs to manage anaemia.

Chemotherapy - may be used to manage FeLV-associated lymphomas. Although the prognosis for cases associated with FeLV infection is always much more guarded, some may still respond to therapy.

Although no treatments can cure FeLV infection, some drugs may help to reduce viral replication and improve the condition of infected cats:

Interferon - recombinant feline interferon omega is available in some countries - studies have suggested it may have some clinical benefit in treating FeLV-infected cats, but the effect (if at all) is likely to be small.

AZT (azidothymidine) - is one of the anti-viral drugs used to treat HIV-infection in humans and may be helpful in some cases of FIV infection. Although it also helps to reduce FeLV replication, there is little evidence that it has any useful clinical effect in cats.

Raltegravir - is a drug used to treat HIV infections in humans and recent experience in cats with FeLV suggests this might be of some help in FeLV-infected cats. Although this drug appears well tolerated and to reduce FeLV replication, its clinical efficacy still needs to be determined.

Control FeLV infection

Efforts should be made to prevent cats being exposed to FeLV. These include:

Where possible, the FeLV and FIV status of any cat should be known.

Any FeLV (or FIV) positive cat should be kept apart from other cats and kept indoors to prevent spread of infection to other cats.

FeLV vaccination has been proven to be successful. Several vaccines are available and these generally appear to provide a valuable level of protection against infection. Kittens tend to be more susceptible to FeLV infection, and as the environment a kitten will end up in is usually uncertain, there is good rationale in routinely vaccinating all kittens against FeLV (ideally with a booster at a year of age). Subsequent vaccinations should be based on risk of exposure (e.g., a single housed indoor cat is at no appreciable risk of exposure to FeLV so vaccination may not be warranted, whereas it may be important in an indoor-outdoor cat.

Prognosis

For a persistently infected cat, the prognosis is very guarded. In one study FeLV infected cats survived on average around 2.5 years after their infection was diagnosed, compared with around 6.5 years for similarly aged uninfected cats.

source/s: international cat care (http://www.icatcare.org/)

Feline calicivirus (FCV) is a highly contagious virus that is one of the major causes of upper respiratory infections (URIs) or cat flu in cats. This virus is ubiquitous and causes disease in cats all over the world. See also [Upper respiratory infections (URIs, Cat flu) in cats]. Together, FCV and feline herpes virus cause the vast majority of URIs in cats.

What is FCV and how is it spread

Feline calicivirus (FCV) is a small virus that mainly causes acute upper respiratory infections (URIs) in cats, although it has been associated with some other diseases also (see below). The virus is readily transmitted between cats through:

Direct contact – through contact with saliva, ocular or nasal secretions

Inhalation of sneeze droplets

Sharing or food bowls and litter trays

A contaminated environment (including bedding and grooming aids) – FCV can potentially survive up to a month in the environment, although probably often does not survive more than 7-14 days.

A characteristic of FCV is that the virus mutates readily during replication and this means that many different strains of the virus exist in nature, some of which are more pathogenic than others (i.e., are a cause of more severe disease).

What are the clinical signs

Acute upper respiratory infection – Acute URI is the most common manifestation of FCV infection. Typical signs include sneezing, nasal discharge, ocular discharge, conjunctivitis, ulceration of the tongue, lethargy, inappetence and fever. Signs may last from a few days to a few weeks and vary in severity. In young kittens the virus may also cause pneumonia.

Gingivitis and stomatitis – chronic gingivitis is a common disease in cats, although the underlying cause(s) are not fully understood. However, FCV can be isolated from virtually all cats with this condition, and it is thought that persistence of FCV infection in these cats is part of the cause of the gingivitis. This is not a simple disease though, as other cats exposed to the virus from a cat with chronic gingivitis will usually only develop upper respiratory signs. Other factors therefore seem to predispose individual cats to developing gingivitis in response to persistent FCV infection.

Limping syndrome – occasionally, in young cats in particular, infection with FCV may also cause joint inflammation (arthritis). This is a transient problem, usually only lasting a few days, but the kitten or cat may be extremely uncomfortable with painful joints during this time. Often, but not always, there will be signs of URI at the same time. See: [Limping syndrome and feline calicivirus].

Virulent systemic FCV infection – vsFCV – on rarely occasions, outbreaks of disease have been reported with very much more pathogenic strains of FCV termed vsFCV. These are associated with mutations of the virus that allow infection to be established within different organs and in the cells that line blood vessels. This can result in severe disease including pneumonia, hepatitis (liver inflammation), pancreatitis, skin swelling and ulceration, and bleeding from the nose and intestine. fortunately these outbreaks are very rare, but up to 50% or more of affected cats may die.

How is FCV infection diagnosed

In most cases, a specific diagnosis of FCV infection will not be required. The presence of typical signs of URI is enough for a presumptive diagnosis of FCV (and/or feline herpesvirus – FHV) infection. If a specific diagnosis is required, ocular or oral swabs can be submitted to a veterinary laboratory where the virus can be grown in culture or, more commonly, detected by PCR (a molecular technique for detecting the genetic material of the virus).

Treatment and management of FCV infections

FCV infections are frequently complicated by secondary bacterial infections, so supportive treatment with antibiotics is usually required. Good nursing care is critical and cats may need to be hospitalised for intravenous fluid therapy and nutritional support in severe cases. Steam inhalation or nebulisation may help in cases of severe nasal congestion and as the cat will not be able to smell food well, using tinned or sachet foods that are gently warmed will help.

In colonies of cats, any cat showing clinical signs should be isolated if at all possible, and strict hygiene should be ensured with disinfection, and use of separate feeding bowls, litter trays, implements etc., careful washing of hands, use of separate (or disposable) apron etc.

Vaccination against FCV

Vaccination for FCV is important for all cats. Two or three injections are recommended in kittens, starting at around 8 weeks of age. Cats should receive a booster at a year of age, and after that should receive further booster vaccines every 1-3 years.

Vaccination does not necessarily prevent infection with FCV but will greatly reduce the severity of clinical disease. Additionally, as there are many different strains of the virus, it is difficult to design a vaccine that will protect against all of them. some newer vaccines incorporate more than one strain of FCV to provide a broader range of protection.

 

source/s: international cat care (http://www.icatcare.org/)

Feline immunodeficiency virus (FIV) is an important viral infection of cats that occurs worldwide. The virus was first discovered during the investigation of a disease outbreak in a previously healthy colony of rescue cats in the USA, that had been showing similar signs to people with the acquired immunodeficiency syndrome (AIDS) caused by human immunodeficiency virus (HIV) infection. Although HIV and FIV are very similar, the viruses are species specific, which means that FIV only infects cats and HIV only infects humans. Thus there is no risk of infection for people in contact with FIV-positive cats. Cats are most commonly infected with FIV through bite wounds. Once infected, a cat will remain infected with the virus for life, and after a period that may last several years, the virus may damage the cat’s immune response and lead to signs of disease.

What is it and how is it spread

Feline immunodeficiency virus belongs to the retrovirus family of viruses in a group called lentiviruses. Lentiviruses typically only cause disease slowly and thus infected cats may remain healthy for many years.

Once a cat has been infected with FIV, the infection is virtually always permanent (cats cannot eliminate the virus), and the virus will be present in the saliva of an infected cat. The most common way for the virus to be transmitted from one cat to another is via a cat bite, where saliva cottoning the virus is inoculated under the skin of another cat. The virus does not survive long in the environment and is readily killed by common disinfectants. Rarely, the virus may also be spread by non-aggressive contact between cats (e.g., mutual grooming), from a pregnant queen to her kittens; and it can also be spread through blood transfusions.

It is not known if blood sucking parasites such as fleas can spread infection so it is wise to maintain a regular flea control programme.

How does FIV cause disease

FIV infects cells of the immune system (white blood cells, mainly lymphocytes). The virus may kill or damage the cells it infects, or compromising their normal function. This may eventually cause a gradual decline in the cat’s immune function.

In the first few weeks after infection the virus replicates and may cause mild signs of disease such as a mild fever and swollen lymph nodes. Usually these signs are so mild they go unnoticed. An immune response will develop which does not eliminate the virus, but keeps viral replication at a relatively low level.

After a period of time, in some infected cats viral replication increases again, and it is typically these cats that go on to develop signs of disease. In most cases this will probably be around 2-5 years after the cat was first infected. Increased replication of the virus leads to progressive damage to the immune system.

How common is this infection

The prevalence (frequency) of FIV infection varies in different cat populations. It tends to be more common where cats live in more crowded conditions (and thus where cat fights are more common) and tends tone much less common where cat populations are low and where cats are kept mainly indoors. In general, among healthy cats around 1-5% will be infected with FIV but in high risk cats (for example in cats with signs of recurrent disease suggesting immunosuppression) the prevalence may be as high as 15-20%. Infection is much more common in outdoor cats, and is about twice as common in male cats compared with female cats. Although cats of all ages can be infected, it is most commonly middle-aged cats (5-10 years of age) where infection is diagnosed.

Clinical signs

FIV usually causes disease through immunosuppression - the normal immune responses of the cat are compromised, leading to an increased susceptibility to other infections and diseases. There are no specific signs associated with FIV, but typically infected cats will develop recurrent bouts of infections or diseases that gradually get worse over time, and infections may not respond to treatment as well as would normally be expected.

Some of the most common signs seen in FIV infected cats are:

Weight loss

Recurrent fever

Lethargy

Enlarged lymph nodes

Gingivitis and stomatitis (inflammation of the gums and mouth)

Chronic or recurrent respiratory, ocular and intestinal disease

Chronic skin disease

Neurological disease (in some cats the virus can affect the brain)

Other disease may also develop such as neoplasia (e.g., lymphoma) and other infectious agents may be more problematic in FIV infected cats (such as toxoplasmosis, haemoplasma infections, feline infectious peritonitis, etc.).

How is it diagnosed

There are several tests available for diagnosing FIV infection, some of which can easily be performed in your own vet’s clinic. Most tests involve collecting a blood sample and detecting the presence of antibodies in the against the virus (usually there is not enough virus in the blood itself to be able to readily detect it).

Antibodies against FIV are produced by the cat’s immune system during infection, and the test works on the principle that cats cannot eliminate the virus so if antibodies are present in the blood then the virus will also be present. These tests are generally highly reliable, but no tat is 100% accurate. If there is any doubt about the validity of the test result, your vet may want to do a follow-up confirmatory test using a different method (such as a different test kit, or sending blood to a laboratory to check for antibodies using a more sophisticated assay such as ‘western blotting’ or to look for virus using a molecular test such as PCR).

It is important to remember that kittens born to FIV-infected queens will receive antibodies from the queen via the milk, and so will test positive early in life though they may not be infected. Kittens with a positive test result should always be retested after that are 5-6 months of age. Additionally, in countries where the FIV vaccine is available (see below), cats that have been vaccinated will also test positive on the routine antibody tests, so alternatives (such as a PCR test) are needed for these cats.

Management options

Many FIV infected cats are able to live happily with the virus for a long period of time, and indeed the virus will not necessarily ever cause clinical disease. Whether disease develops depends on many factors including the strain of FIV a cat is infected with, the cat’s immune response’ and the presence or absence of other infectious agents. In one study, FIV-infected cats were found to survive just under 5 years on average (from the time their disease was diagnosed) compared with about 6 years for a similar group of non-infected cats.

The main aims of managing an FIV-infected are to prevent spread of infection to other cats and to maintain a good quality of life. Some antiviral medications used in human patients with HIV infection have also been shown to help some cats with FIV infection.

General and supportive treatment should include:

Neutering all FIV-infected cats to reduce the risk of fighting and spreading infection

Confining FIV-positive cats indoors where possible, and away from non-infected cats. This helps prevent spread of infection to other cats and reduces exposure of the FIV-infected cat to other infectious agents

Maintaining good quality nutrition - using a good commercial food and avoiding raw meat, eggs and unpasteurized dairy products helps reduce the risk of exposure to parasites and bacteria that might cause disease

Maintaining good routine preventive healthcare (regular flea and worm control, routine vaccinations etc.)

Ideally veterinary health checks twice yearly - your vet may suggest certain blood tests occasionally to monitor your cat’s health

Prompt diagnosis and appropriate treatment of any secondary or concurrent diseases. Longer courses of antibiotics may be needed to treat bacterial infections if they are significantly immunosuppressed.

Two forms of antiviral therapy are sometimes used in FIV-infected cats:

Interferons are a group of naturally-produced compounds that have anti-viral effects and modify immune responses. A recombinant feline interferon (feline interferon omega) is available in some countries and it is possible that using this may have some helpful anti-viral and immune modulating effects. It is unlikely to have a profound effect in FIV-infected cats, but your vet may suggest trying this as a treatment.

Antiviral drugs such as AZT - some of the human antivirus drugs used to treat HIV are also effective against FIV and can be safe to use (although careful monitoring of cats is needed). These drugs cannot ‘cure’ a cat with FIV, but especially if the signs of disease are quite severe, this may be a form of therapy that your vet will offer. Treatment is expensive though, and many cats appear to do just as well with good supportive therapy.

Prevention/Control

A vaccine against FIV has been licensed and is available in a number of countries. The available data suggests that the vaccine gives a useful degree of protection and that it might therefore be useful in cats at appreciable risk of being exposed to FIV. The vaccine cannot be expected to give complete protection though, especially as there are multiple different strains of FIV. Also, a vaccinated cat will subsequently test positive on the routinely used antibody tests for FIV infection (see above).

FIC-infected cats should ideally be separated from other cats, but this can sometimes be difficult in a multicast household. As the risk of transmission by social contact such as sharing food bowls and mutual grooming is low, some owners elect to keep the household as it is. However, it may be helpful to at least feed cats using separate food bowls, as large amounts of virus are present in saliva. Litter trays and food bowls should be disinfected after use to kill the virus.

Advice for breeders

To minimise the risk of introducing FIV into the colony, breeders should prevent their cats having free access outdoors, or having contact with cats allowed outdoors. Annual testing of breeding cats is ideal, but testing any new cats before being introduced to an FIV-free colony is vital. If any cats test positive for FIV they should be removed, the colony isolated, and the remaining cats retested after 3-6 months.

Prognosis for infected cats

The prognosis for FIV-infected is guarded, but depends on the stage of disease. If FIV is diagnosed early, there may be a long period during which the cat is free of clinical signs related to FIV, and not all infected cats go on to develop an immunodeficiency syndrome. Infection is almost invariably permanent, but many infected cats can be maintained with a good quality of life for extended periods.

source/s: international cat care (http://www.icatcare.org/)

Feline infectious enteritis (FIE) is a disease caused by infection with feline parvovirus (FPV), also known as feline panleucopenia virus. It is sometimes referred to as panleucopenia virus because one of the results of infection is the development of a low white blood cell count (which is what panleucopenia means).

Feline parvovirus infection is probably the greatest major disease threat to any rescue facility and infection carries a very high mortality rate, particularly in unvaccinated kittens.

This was the first disease of cats to be shown to be caused by a virus, and parvoviruses are particularly dangerous as they are able to survive for long periods (up to several years) in the environment, and are resistant to many disinfectants.

Source and spread of infection

Feline parvovirus is spread by direct faecal-oral contact, and indirectly following contamination of the environment or objects (eg, on food dishes, grooming equipment, bedding, floors, clothing or hands). Cats infected with FPV can continue to excrete the virus for at least six weeks following infection, and the virus can also be transmitted by dogs.

Clinical disease

In kittens over three or four weeks of age and in adult cats the virus causes a very severe gastroenteritis, following an incubation period of five to nine days. Affected cats develop acute onset haemorrhagic vomiting and diarrhoea and some cats die rapidly. The virus causes severe damage to the lining of the intestine and also travels via the blood to the bone marrow and lymph glands. Viral replication at these sites leads to a marked depletion of white blood cells. Infected cats and kittens usually have a fever, are obviously depressed and will not eat. Some cats may die before even showing signs of gastroenteritis. Pregnant queens infected with parvovirus, the virus can spread to the unborn kittens where it can interfere with the developing brain. Kittens may then be born with a condition known as cerebellar hypoplasia (lack of development of the cerebellum, a part of the brain needed for fine coordination of movement). Kittens may initially seem fine, but as the start to move and walk it become obvious that they are highly uncoordinated. This may also happen in very young kittens (less than 4 weeks of age) infected with FPV as the cerebellum is still developing at that age.

Treatment

No specific treatment is available for FPV infection and it is vital that any suspected cases are nursed in isolation as this is a highly contagious disease. Protective clothing must be worn and hands washed thoroughly after handling any cat or kitten suspected of having the disease. Where possible, one or two people who do not handle any other cats should be assigned as nurses.

Affected cats often die from dehydration and massive secondary infection, so aggressive support with intravenous fluids and broad spectrum antibiotics are crucial, but even with this, a high proportion of affected cats may die. Anti-emetic drugs may be useful to help stop vomiting, and feeding cat small meals as soon as the vomiting has resolved is also important. Good veterinary and nursing care is vital to help cats, especially young kittens, recover from the disease.

Interferons are chemicals made in the body that can exert an antiviral effect. Recombinant feline interferon omega (or human interferon products) might be of some help in the treatment of severe cases. Feline interferon has been shown to be useful in managing dogs with parvovirus infection.

Control

Feline parvovirus is much better prevented than treated. Highly effective vaccines are available and all cats and kittens should be vaccinated (including indoor-only cats). Modified live vaccines should not be used in pregnant queens or cats that are immunosuppressed and, in such cases, inactivated (killed) vaccines are recommended. For further information see Vaccination in cats.

Control of the spread of FPV relies on a combination of vaccination and good management practices, including disinfection (with appropriate disinfectants) and use of isolation procedures. When faced with an outbreak of FPV in a colony of cats, vaccinating all the cats will help, and in some countries anti-FPV serum is available that may be given to susceptible cats and kittens to help protect them by providing antibodies against the virus.

source/s: international cat care (http://www.icatcare.org/)

What is FHV and how is it spread

Feline herpes virus (FHV) is a virus that mainly causes acute upper respiratory infections (URIs) in cats, although it has been associated with some other diseases also (see below). The virus is readily transmitted between cats through:

Direct contact – through contact with saliva, ocular or nasal secretions

Inhalation of sneeze droplets

Sharing or food bowls and litter trays

A contaminated environment (including bedding and grooming aids) – this is less important with FHV than FCV as the virus is fragile can probably only survive for 1-2 days in the environment

With FHV, after infection, virtually all cats will remain latently infected (the virus persists in nerve cells). This means that infected cats effectively become life-long carriers of the virus. In many cats this causes no problems, and in many cats they do not continue to shed virus so are not a risk to others. However, some cats will intermittently shed virus again, and this is more common following episodes of stress or when the cats immune system is suppressed (e.g., following the use of corticosteroids). When virus is shed again, some cats will also develop mild recrudescence of clinical signs. In some cats, persistent FHV infection will cause ocular problems (see below).

Clinical signs of FCV infection

Acute upper respiratory infection – acute URI is the most common manifestation of FHV infection. Typical signs include conjunctivitis, ocular discharge, sneezing, nasal discharge, salivation, pharyngitis, lethargy, inappetence, fever and sometimes coughing. Signs may last from a few days to a few weeks and shedding of virus typically continues for around 3 weeks. Clinical disease with FHV is generally more severe than that seen with FCV.

Keratitis – although relatively uncommon, one manifestation of chronic (long-term) FHV infection that is seen in a number of cats is conjunctivitis and keratitis (infection and inflammation of the cornea – the clear part at the front of the eye). Although keratitis can have a number of different causes, FHV infection causes the development of multiple small branching corneal ulcers (called ‘dendritic keratitis’) and this is considered diagnostic of FHV infection. .

FHV-associated dermatitis – a rare manifestation of chronic (long-term) FHV infection is the development of skin inflammation and ulceration. This is most commonly seen around the nose and mouth, but can affect other areas such as the front legs. This is only seen rarely.

How is FHV infection diagnosed

In most cases, a specific diagnosis of FHV infection will not be required. The presence of typical signs of URI is enough for a presumptive diagnosis of FHV (and/or feline calicivirus – FCV) infection. If a specific diagnosis is required, ocular or oral swabs can be submitted to a veterinary laboratory where the virus can be grown in culture or, more commonly, detected by PCR (a molecular technique for detecting the genetic material of the virus). Evidence of the virus may also be present in biopsies and can be useful for the diagnosis of FHV-associated dermatitis (skin infection).

Treatment and management

FHV infections are frequently complicated by secondary bacterial infections, so supportive treatment with antibiotics is usually required. Good nursing care is critical and cats may need to be hospitalised for intravenous fluid therapy and nutritional support in severe cases. Steam inhalation or nebulisation may help in cases of severe nasal congestion and as the cat will not be able to smell food well, using tinned or sachet foods that are gently warmed will help.

Unlike FCV, with FHV infection certain anti-viral drugs are available and can be very helpful in managing the clinical manifestations of disease.

Systemic antiviral therapy: Famciclovir is a human anti-herpes virus drug that has been shown to be safe and effective in cats. It can be given by mouth and can be valuable in managing severe acute infections in particular.

Topical ocular antiviral therapy: idoxuridine, trifluridine and cidofovir are all human anti-herpes virus drugs that can be successfully used as topical ocular (eye drops) therapy for FHV-associated conjunctivitis and keratitis. Some of these drugs have to be given very frequently (several times daily) and they may be combined with topical interferon to enhance efficacy.

In colonies of cats, any cat showing clinical signs should be isolated if at all possible, and strict hygiene should be ensured with disinfection, and use of separate feeding bowls, litter trays, implements etc., careful washing of hands, use of separate (or disposable) apron etc.

source/s: international cat care (http://www.icatcare.org/)

Signs, Causes and investigation

Feline lower urinary tract disease (FLUTD) is not a specific disease, but rather is the term used to describe conditions that can affect the urinary bladder and/or urethra (the lower urinary tract) of cats.

Clinical signs for these disorders are all very similar so it is often difficult or impossible to determine the underlying cause without doing further investigations. Although many different diseases can affect the lower urinary tract, frustratingly, a number of cats develop a disease without any obvious underlying cause - so called ‘feline idiopathic cystitis’ or FIC. This form of disease appears to bear many similarities to a disease in humans called ‘interstitial cystitis’, but in both cats and humans it can be difficult to manage.

Clinical signs

Cats with FLUTD usually present with one or more of a range of signs:

Dysuria - this refers to difficulty or painful urination - a cat may strain to pass urine, and may sometimes cry out if it is painful

Pollakiuria - this is a term simply meaning increased frequency of urination - infection and inflammation of the bladder and urethra will cause irritation and the desire to urinate more frequently

Haematuria - this term simply mean 'blood in the urine’ - this can also occur with infections and inflammation. Blood in the urine may be microscopic (only detectable by your vet using tests) or may be more severe and obvious (you may see red discolouration of the urine)

Periuria - this term means urinating outside the litter-box and in unusual or inappropriate places. This can happen because the pain, irritation and inflammation in the bladder or urethra causes an urgent need to urinate, and so your cat may not have time to get to the litter box or go outside.

Overgrooming - because of the pain and irritation in the bladder and urethra, some cats may start to over groom and lick around their perineum. This can be severe enough to cause loss of hair.

Behavioural changes - some cats may show only behavioural changes such as loss of litter-box training, aggression or irritation

Stranguria - this is the term used to describe a blockage to the urethra - cats will strain to urinate and try to pass urine but will be unable to. This is seen mainly in male cats, as their urethras are longer and narrower than in female cats, and so more likely to become blocked. Although not common, if this occurs it should be treated as an emergency and your cat should be taken to a vet immediately.

What cats are at most risk for FLUTD

FLUTD is thought to affect around 1-3% of cats each year, so is among the more common diseases seen. Because of the diverse nature of the underlying causes, cats of any age, breed and gender can be affected by FLUTD, but in general, the disease is more common in:

Middle-aged cats

Neutered cats

Over-weight cats

Cats which take little exercise

Cats with little or no access outside

Cats that eat a dry diet

Underlying causes of FLUTD

A number of different disease may cause FLUTD, but the relative importance of these disease does vary between different countries and different populations of cats. Some of the more common causes include:

Urolithiasis - this is the term used to describe bladder stones. Just as in humans, cats can develop stones in their bladder. The two most common types of stone (determined by their composition) are 'magnesium ammonium phosphate’ (or 'struvite’) and 'calcium oxalate’. These two types of stone account for 80-90% of cases of urolithiasis, but others may also be seen. Urolithiasis generally accounts for around 10-15% of cases of FLUTD.

Bacterial infections - bacterial cystitis (bacterial infection of the bladder) is the most common cause of lower urinary tract disease in many animal, but is relatively uncommon in cats. It probably accounts for around 5-15% of all cases of FLUTD. Bacterial cystitis tends to be seen in older cats.

Urethral plugs - obstruction of the urethra in male cats may occur as the result of a 'urethral plug’ - this is where there is an accumulation of proteins, cells, crystals and debris in the urine that combines together to form a plug that cannot be passed. Other causes of urethral obstruction include small bladder stones becoming lodged in the urethra or severe muscle spasm of the urethra (which can occur with severe inflammation/irritation).

Anatomical defects - sometimes a defect in the lower urinary tract may cause signs of disease. Most commonly this occurs with a stricture affecting the urethra. If the urethra becomes damaged, during the healing process fibrous tissue may develop which can significantly restrict the diameter of the urethra., When that happens, it may be difficult for cats to pass urine normally.

Neoplasia - although uncommon, particularly in older cats with signs of FLUTD, the possibility of a tumour (cancer) affecting the bladder or urethra needs to be considered. The most common bladder tumour is known as 'transitional cell carcinoma’.

*Idiopathic cystitis - despite the well-recognised causes of FLUTD, in the majority of cats (probably around 60-70%) no specific underlying disease can be identified, and these cats are classified as having 'feline idiopathic cystitis’ or FIC - a term that simply means inflammation of the bladder without a known cause.

Investigation

In cats with signs of FLUTD, especially where signs are persistent, severe or where more than one episode of disease occurs, it is important to try to identify the underlying cause. Common investigations include:

Urinalysis - collecting a urine sample to analyse (examine microscopically and perform bacterial culture to rule out bacterial infections) is an important step. Your vet may obtain a urine sample by placing a very fine needle directly into the bladder (a technique called 'cystocentesis’). This is an good way of obtaining a urine sample because it should not be contaminated with bacteria from elsewhere. This is an easy procedure and most cats do not even notice when it is done!

X-rays - Taking X-rays of the bladder and urethra can be particularly helpful in identifying a number of causes. Some bladder stones are easily identified on X-rays, but in some cases a procedure called 'contrast radiography’ is also needed. Here, a contrast dye is injected into the bladder through a catheter placed in the urethra. This helps outline the urethra and the bladder and can help in the diagnosis of some types of bladder stones, urethral strictures and tumours. This is a straightforward procedure but is done under an anaesthetic to avoid any discomfort for the cat and so that the cat does not move when the X-rays are taken.

Ultrasound - An ultrasound examination of the bladder can also be performed which may also help identify bladder stones, thickening of the bladder etc.

Biopsies - sometimes, obtaining a biopsy (tissue sample) of the bladder wall may be needed, especially if an underlying tumour is suspected. This may be collected during a surgical operation, although if only small biopsies are needed this can sometimes be done through a catheter placed in the bladder through the urethra (so called 'suction catheter biopsy’).

Treatment

The treatment of FLUTD will depend on the underlying cause. In general, increasing water intake, and encouraging more frequent urination are good objectives in all cases of FLUTD. This may be helped by feeding wet (tinned or sachet) foods rather than dry foods, encouraging drinking, correcting obesity, encouraging exercise, and encouraging urination by considering how best to use litter boxes (if the cat is an indoor cat) - for more on this, see [Feline idiopathic cystitis].

Bacterial cystitis

Cases of bacterial cystitis usually respond well to appropriate antibacterial therapy. However, the choice of antibacterial drug should really be made on the basis of bacterial culture and sensitivity testing of the bacteria (this is done in the laboratory and indicates what antibiotics are most appropriate). Because bacterial cystitis is relatively uncommon in cats, antibiotics should only be used where there is a strong suspicion of bacterial infection or where this has been proven by analysis and culture of a urine sample.

Urolithiasis (bladders stones)

With bladder stones, these are most commonly removed from the bladder initially by surgery. With some type of stone (especially struvite stones) it may be possible to dissolve the stones by changing the cat’s diet, and this may be something your vet will suggest to try. Special diets are available from your vet that are designed to carefully alter the composition of the urine in a way that will either dissolve the existing stones and/or help prevent them recurring. Some stones (such as calcium oxalate) cannot be dissolved and so surgery will always be needed to remove them.

Irrespective of whether surgery was performed initially, using a special diet from your vet will be helpful in avoiding recurrence of bladder stones. Also, feeding your cat a wet (tins, sachets) diet rather than a dry diet will help to increase the water intake which can also be helpful in preventing recurrence.

Urethral plugs

Urethral plugs causing obstruction to the urethra are an emergency situation. A blocked urethra in a cat can causes acute kidney failure within just 2-3 days, so rapid relief of the blockage is critical.

Urethral plugs (or urethral stones) are usually removed under an anaesthetic, as the condition is painful for the cat, and attempting to remove the blockage in a conscious cat would risk significant damage to the urethra. After the blockage is relieved, there can be quite severe inflammation of the urethra which may cause swelling and also spasm of the urethral muscles. This can make urination difficult for several days afterwards, and so some cats may need to be hospitalised for a period of time to monitor their progress. Depending on the severity, some cats will also need intravenous fluid therapy, and some may need a urinary catheter placed for a few days. Drugs to relieve pain, swelling and spasm are important.

To help prevent urethral plugs recurring, your vet will probably recommend feeding your cat a wet (tinned, sachet) diet rather than a dry diet (to encourage greater water intake and more frequent urination). Struvite (magnesium ammonium phosphate) crystals are often present in the urethral plug and while these do not cause the obstruction, they may contribute to it. Your vet may therefore recommend using a special diet that will reduce the risk of these crystals forming which may further reduce the risk of recurrence. It is also thought that many cats with urethral blockage may have underlying idiopathic cystitis (FIC) and so treatment recommendations for this disease should also be considered.

Urethral strictures

If a urethral stricture develops, these can be difficult to manage, as surgery is usually needed to correct the problem. The success of surgery will usually depend on the severity of the stricture and its location.

Feline idiopathic cystitis

Management of FIC is more complex, as the underlying causes are not fully understood. Several management options appear to be important though, including increasing the water intake of affected cats and reducing environmental stress - these are explained more fully elsewhere - [see information on FIC]

Bladder tumour, transitional cell carcinoma

Fortunately bladder tumours are rare in cats. Transitional cell carcinoma is the most common tumour seen and occurs mainly in older cats. Often by the time clinical signs develop the disease is quite advanced and surgical removal of the tumour is rarely possible.

Chemotherapy may be helpful in reducing the size of the tumour and improving quality of life for the cat, and in a number of cases using non-steroidal anti-inflammatory drugs (NSAIDs) such as piroxicam or meloxicam appears to be very helpful. These drugs are usually very well tolerated and as well as relieving inflammation can have an anti-cancer effect in some tumours. Transitional cell carcinoma appears to be one of the tumours that often responds to NSAID therapy, and sometimes marked improvement can be seen (although these drugs cannot cure the disease and it will eventually recur).

source/s: international cat care (http://www.icatcare.org/)

Harvest mites, harvest bugs or bracken bugs are the names popularly given to the larvae of the mite Trombicula autumnalis. The adult mite is an eight-legged mite that lives in vegetation, but the six-legged larva is parasitic and lives on mammals (including humans and cats) and birds. The larvae feed on tissue fluid and often cause considerable skin itching and discomfort (in both humans and cats) in the late summer and autumn. The orange/yellow larvae are around 0.2mm long and widely distributed throughout the world, although not present in all climates or regions. Larvae are initially only just visible to the naked eye, but they swell to about three times their original size when they have finished feeding.

Life cycle

The first active stage in the life cycle of Trombicula is the six-legged larva and this is the only stage which attacks animals. These larvae are present on vegetation and are active during the day, especially when it is dry and sunny. When they come into contact with any warm blooded animal they swarm on and congregate in areas where there is little hair and the skin is quite thin. This usually occurs especially towards the end of summer.

The larva feeds by thrusting its small hooked fangs into the surface layers of the skin, and then injects a fluid to break down the cells. The liquid food resulting from this process is sucked back into the digestive system of the larva. It will inject and suck for two to three days at the same site until it has increased in size three to four times. The larva then drops to the ground to complete its life cycle. It descends into the soil and after about six weeks becomes an eight-legged nymph and then an adult which eats plants and small insects. Eggs laid by the adult in the spring and summer hatch into the six-legged larva (known as harvest mites) and the cycle starts again.

Dermatitis (skin inflammation) caused by harvest mites

When larvae inject fluid into the skin, this can cause a severe skin reaction in sensitive individuals. In humans, this can show as small inflamed pimples. In cats the irritation typically causes reddening of the skin, papules and crusted areas. The areas most likely to be affected are the base of the ears (Henry’s pocket – the little pocket of skin on the side of the pinna of the ear), the face (especially the chin and around the mouth), the neck and shoulders, under the front legs, on the abdomen and around the nipples, vulva and scrotum and between the toes – any area where there is only a thin covering of hair.

Scratching, which may dislodge the mites (until more attach), can result in injury to the skin and in severe cases raw areas can develop. These areas can become secondarily infected with bacteria.

Diagnosis

Diagnosis is made by observation and identification of the larvae through the microscope. Your vet will have to take a skin scraping to see the larvae and make a definitive diagnosis. It is best to take your cat to the vet as soon as you see any suspicious signs as the larvae can drop off quite quickly.

Treatment

Some flea treatments available from your vet will be effective in treating Harvest mites, but treatment should always be carried out under the direction of your vet. A cat which appears to be hypersensitive to the mite may also need glucocorticoid therapy for a short period, to relieve the itching, until the mites have reduced in number.

source/s: international cat care (http://www.icatcare.org/)

Hyperadrenocorticism, also known as Cushing’s disease or Cushing’s syndrome, is an uncommon disease in cats that develops when there is a persistent excessive production of the hormone cortisol from the adrenal glands (located close to the kidneys in the abdomen).

This is most often caused by an abnormality of the pituitary gland (located at the base of the brain) which controls production of the adrenal gland hormones, along with many others. In some cases it will be due to an abnormality of the adrenal glands themselves.

This disease is much more common in dogs than it is in cats, and is generally more difficult to control in cats than it is in dogs, although successful treatment is possible. The excessive cortisol concentrations can cause a variety of abnormalities including excessive thrust, weakness and skin changes.

Hyperadrenocorticism can also be induced by using high doses of cortisol-like hormones over a long period of time, as is sometimes necessary to control some diseases.

What causes hyperadrenocorticism

Iatrogenic hyperadrenocorticism

Iatrogenic hyperadrenocorticism is the term used to refer to the disease when it is induced by the long-term administration of high doses of cortisol-like drugs. These drugs can be corticosteroids (often used to manage inflammation or allergies), but in cats progesterone-type drugs (progestagens) that are sometimes used to control reproductive cycling in entire female cats also have potent cortisol-like actions. If high doses of these drugs are used over a long period of time, they will have the same effect as occurs with natrually-occurring hyperadrenocorticism.

Naturally-occurring hyperadrenocorticism

Cortisol is a hormone produced in the body by the adrenal glands; two small glands situated just in front of the kidneys. Excess production of cortisol by the adrenal glands can be caused by an adrenal tumour or, more commonly, by a tumour affecting the pituitary gland (a small gland at the base of the brain). The pituitary gland produces a number of different hormones including adrenocorticotrophic hormone (ACTH), which stimulates the adrenal glands to produce cortisol. If a pituitary gland tumour results in excessive production of ACTH, this in turn will lead to the adrenals becoming enlarged and producing excessive cortisol.

When hyperadrenocorticism is caused by an adrenal tumour it is termed adrenal-dependent disease and when it is caused by a pituitary tumour it is termed pituitary-dependent disease. Adrenal-dependent disease accounts for less than 15% of naturally-occurring hyperadrenocorticism, but when present in around half the cases there is an underlying malignant tumour (adrenal carcinoma). The majority of pituitary tumours causing the disease are benign very tiny (microadenomas).

Clinical signs

Naturally-occurring hyperadrenocorticism is uncommon in cats, and the iatrogenic form of the disease is also relatively uncommon as cats are quite tolerant of high doses of corticosteroids.

Naturally-occurring disease is seen primarily in middle-aged and older cats, and female cats are affected more commonly than males. Cortisol can have many different effects so clinical signs can be quite variable. Initial signs may be mild but they tend to progress over time. The most common signs are:

Excessive drinking (polydipsia) and excessive urination (polyuria)

Increased appetite

Enlargement of the abdomen (a pot-bellied appearance)

Lethargy

Muscle wasting and weakness

Poor coat condition

Hair loss

Curling of the ear tips

Thin and fragile skin

In some affected cats, the skin can become so thin and fragile that it very easily bruises and can also very easily tear. Wounds may also be slow to heal.

Many cats with hyperadrenocorticism also have diabetes mellitus, because the excessive cortisol interferes with the effects of insulin. This may exacerbate the increased thirst and increased urination, and the hyperadrenocorticism may also make the diabetes more difficult to control. In fact, hyperadrenocorticism should always be considered in any diabetic cat that is proving difficult to manage.

Diagnosis

Diagnosis of hyperadrenocorticism is not always straightforward and usually requires multiple blood tests, urine tests and diagnostic imaging (X-rays and/or ultrasound).

Routine blood tests may help to rule out more common causes of the clinical signs, after which more specific tests for hyperadrenocorticism may be done. These may include:

Urine cortisol measurements - this can be used as a screening test to rule out hyperadrenocorticism, but high levels cannot confirm a diagnosis… further tests are needed.

ACTH-stimulation test - with this test, blood samples are taken to measure cortisol levels before and after an injection of synthetic ACTH. If very excessive concentrations of cortisol are found then this usually confirms a diagnosis

Dexamethasone screening test - with this test, blood cortisol levels are measured before and after an injection of dexamethasone (a potent corticosteroid that would normally suppress cortisol production). If cortisol production is not suppressed this may indicate hyperadrenocorticism is present.

Measuring blood concentrations of ACTH - it may be possible to have blood concentrations of your cat’s ACTH measured which may also help to differentiate between adrenal- and pituitary-dependent disease

X-rays and ultrasound - ultrasound especially can be useful as being able to determine the size of the adrenal glands and evaluating whether one or both are enlarged again helps distinguish adrenal- and pituitary-dependent disease

Unfortunately no single test is completely accurate and reliable in diagnosing hyperadrenocorticism, so more than one test is usually needed and sometimes tests have to be repeated.

Treatment

If iatrogenic hyperadrenocorticism is present, this is usually managed by controlled gradual withdrawal of the corticosteroid or progestagen that is being administered. It may be necessary to find an alternative type of drug if it has been used to manage an allergy, for example.

With naturally-occurring hyperadrenocorticism a number of treatment options are available, but most commonly control of the disease will be attempted with drug therapy.

Drug therapy with trilostane - a number of different drugs have been used to suppress cortisol production from the adrenal glands in cases of hyperadrenocorticism, but few of these work well in cats. Trilostane, which inhibits production of cortisol and is widely used in dogs, also appears to be effective in cats, and this is the most commonly used drug. Tablets have to be administered once or twice daily, and the dose adjusted according to response. Clinical signs may improve only gradually even with successful management of the disease

Surgical adrenalectomy - this is the surgical removal of an adrenal gland, and this may be a good treatment option if just one adrenal gland is affected (for example if there is a benign tumour affecting one of the two adrenal glands)

Hypophysectomy - this is the term used to refer to surgical removal of the pituitary gland - although technically possible, this is extremely difficult surgery that carries very high risks and is not generally recommended (and only available at a few specialist centres).

Radiotherapy for pituitary tumours - where available, radiotherapy for an underlying pituitary tumour can help to control hyperadrenocorticism, although availability of this is limited.

What is the prognosis for cats with hyperadrenocorticism

Hyperadrenocorticism is a serious disease and carries a guarded prognosis. The disease can rarely be cured, but with appropriate treatment a number of cats will respond well and may have many months or even years of excellent quality of life. If the underlying cause is a malignant adrenal tumour, inevitably the prognosis is more guarded.

source/s: international cat care (http://www.icatcare.org/)

Hypertension is the medical term for high blood pressure, which is a common problem in people, and also now recognised as a common condition in older cats.

Feline hypertension is commonly found as a complication of other underlying medical conditions (so-called ‘secondary hypertension’), although primary hypertension (hypertension without any underlying disease) may also be seen in cats. In contrast to people, where primary hypertension (also called essential hypertension) is most common, secondary hypertension is more common in cats. The most common cause of secondary hypertension in cats is chronic kidney disease but other disease can also predispose to its development and there is a relationship between hypertension and hyperthyroidism (overactive thyroid gland) in cats too.

Effects of hypertension

Hypertension is damaging to the body. The effects are most serious in certain vulnerable organs:

Eyes

Bleeding into the eyes and retinal changes such as swelling and detachment can occur, and this may result in damage to the cat’s vision (and even blindness), which is often permanent. In some cases, bleeding into the front chamber of the eye can be seen without the use of special veterinary equipment (see picture).

Brain and nervous system

Bleeding in this area of the body can cause neurological signs such as odd behaviour, a wobbly or drunken gait, seizures, dementia and coma.

Heart

Over time, the muscle of one of the major heart chambers (the left ventricle) becomes thickened, as the heart has to work harder to pump the blood when there is high blood pressure. In very severe cases, this can lead to the development of congestive heart failure. Affected cats may show signs of breathlessness and lethargy.

Kidneys

Over time, high blood pressure damages the kidneys and may increase the risk of kidney failure developing. In cats with existing kidney disease, the hypertension is likely to make the disease significantly worse over time.

Clinical findings

As hypertension is often seen as an effect of other diseases, cats with hypertension may be showing signs attributable to their underlying problem. For example, in the case of hyperthyroid cats with high blood pressure, weight loss (in spite of a voracious appetite) and hyperactivity may be the major clinical signs.

In many patients, no specific clinical signs of hypertension will be seen until the condition advances to the point where there is spontaneous bleeding into the eye or retinal detachment - these cats are often taken to a vet as they develop sudden onset blindness. Early recognition of hypertension is therefore important in order to minimise the severe and often permanently damaging effects of persistently high blood pressure on the eyes and other organs.

Some cats with hypertension appear depressed, lethargic and withdrawn, and many owners notice an improvement in their cats’ behaviour once hypertension has been successfully managed, even if signs of damage to other organs are not present. Severe headaches can occur in humans with hypertension, and it is likely that cats may suffer something similar.

Diagnosis

To detect hypertension early, and because it is more common in older cats, regular blood pressure checks are recommended in cats from 7 years of age. Initially these may be done once or twice a year, but as the cat gets older these should be done a minimum of twice a year ideally. Blood pressure assessment should be included in the routine clinical examination of all older cats.

Blood pressure should also be carefully assessed in any cat with chronic kidney disease, hyperthyroidism, heart disease, in cats with sudden-onset blindness, or in cats with other ocular or neurological signs that might suggest underlying hypertension.

Various techniques and equipment are available to measure blood pressure in cats, and many veterinary clinics now have these facilities. The equipment used is often similar to that used routinely in people, with an inflatable cuff placed around one of the legs or the tail. Measuring blood pressure only takes a few minutes, is completely pain-free and is extremely well tolerated by most cats.

A detailed eye examination is also essential since ocular disease is common in hypertensive cats. In mildly affected cats, subtle changes to the appearance of the blood vessels at the back of the eye (retina) and to the retina itself may be seen. In more severely affected cats, the changes can be dramatic and include retinal detachment and bleeding into the eye. Abnormalities are usually detected in both eyes although they may be more severe in one.

In the absence of blood pressure measurement devices, a thorough ocular (eye) examination may enable a diagnosis of hypertension to be made and can be used to monitor progress once treatment has been started. However, proper blood pressure measurements are much better both for the diagnosis and monitoring of response to therapy.

Management of hypertensive cats

When hypertension is diagnosed, management has two broad aims:

Firstly, to reduce the blood pressure using anti-hypertensive drugs. A number of drugs are available and those commonly used include amlodipine and benazepril.

Secondly, to search for an underlying disease, such as kidney disease, which has caused the hypertension. In some cases (for example hyperthyroidism), treatment of the underlying disease may also resolve the high blood pressure. These investigations often involve collecting and testing blood and urine samples.

It is also important to assess what complications of hypertension are present in any patient (such as ocular disease) so that these can be appropriately monitored following therapy. There is a great degree of individual variation in response to anti-hypertensive drug therapy, and in some cats it can take some time to stabilise the blood pressure. This may involve trying several drugs, altering the dose and/or frequency of therapy, or using more than one drug simultaneously.

Response to therapy should ideally be monitored by repeat measurements of blood pressure, and also monitoring any ocular abnormalities. In patients with kidney failure, it is also important to monitor kidney function when using anti-hypertensive drugs.

Prognosis

In cats with primary hypertension (where there is no underlying disease that has caused the high blood pressure), it is usually possible to manage the hypertension and prevent future complications such as damage to the eyes.

In cases of secondary hypertension, the long-term outlook is very dependent on the nature and severity of the disease that has caused the high blood pressure. It is important in all cases that the hypertension is monitored as accurately as possible on a regular basis in order to avoid any problems.

source/s: international cat care (http://www.icatcare.org/)

Hyperthyroidism (overactive thyroid glands) is a very common disorder of older cats. It is caused by an increase in production of thyroid hormones from the thyroid glands, which are situated in the neck.

Thyroid hormones are responsible for regulating many body processes and when too much hormone is produced the clinical signs can be quite dramatic, and cats can become seriously ill. Thyroid hormones also help control the body’s metabolic rate and cats with hyperthyroidism tend to burn up energy too rapidly and typically suffer weight loss despite having an increased appetite and increased food intake.

Fortunately, the vast majority of cats that develop hyperthyroidism can be treated very successfully and most cats will make a complete recovery.

What causes hyperthyroidism

In the vast majority of cases hyperthyroidism in cats is caused by a benign (non-cancerous) change. Cats have two thyroid glands, and in most cases (more than 70%) both are involved in the disease, and become enlarged (a change called ‘nodular hyperplasia’, which resembles a very benign tumour). The underlying cause of this change is currently unknown, but is very similar to one of the two main causes of hyperthyroidism in humans called ‘toxic nodular goitre’.

Rarely (in less than 1-2% of cases) a malignant (cancerous) tumour (thyroid adenocarcinoma) can be the underlying cause of the disease.

Clinical signs

Hyperthyroidism is usually seen in middle-aged and older cats, rarely being seen in cats less than 7 years of age. Male and female cats are affected equally.

In affected cats, a wide variety of signs usually develop, but these are usually subtle at first, and become more severe over time as the underlying disease gets worse. Also, as it is mostly older cats that are affected, some cats will have other diseases that can complicate and even mask some of the clinical signs.

The 'classic’ signs of hyperthyroidism are:

Weight loss

Usually a good or increased appetite (polyphagia)

Increased thirst (polydipsia)

Increased activity, restlessness or irritability

An increased heart rate (tachycardia)

A poor and unkempt hair coat

Mild to moderate diarrhoea and/or vomiting develop in some cats, and some will be noticeably intolerant of heat and seek out cooler places to sit. Some (especially advanced cases) may also pant when they are stressed, which is very unusual in cats.

Although most hyperthyroid cats show a good or increased appetite and restlessness, in some cases there may be generalised weakness, lethargy and loss of appetite.

Complications

Uncontrolled hyperthyroidism has important consequences on the heart, causing increased heart rate but also changes in the muscular wall of the heart that will eventually cause heart failure if untreated.

Hypertension (high blood pressure) is another potential complication of hyperthyroidism, although seen less commonly, and this can cause damage to several organs including the eyes, kidneys, heart and brain. If hypertension is diagnosed along with hyperthyroidism, drugs will be needed to control the blood pressure.

Kidney disease (chronic kidney disease) does not generally occur as a direct effect of hyperthyroidism, but the two diseases often occur together because they are both common in older cats. Care is needed where both these conditions are present, as managing hyperthyroidism can sometimes have adverse effects on kidney function.

Reaching a diagnosis

Although the thyroid glands usually enlarge with hyperthyroidism, this is not usually visible. Detection of enlarged glands will usually require careful palpation (examination by touch) by your vet. However, in some cats there is no obvious enlargement, often because the overactive tissue is in an unusual site (such as the chest cavity).

To confirm a diagnosis, a blood test is needed to measure the level of thyroid hormones in the blood. Usually, measuring the thyroxine (T4) concentration is all that is required to confirm a diagnosis, but sometimes additional tests may be needed (such as measurement of 'free T4’ in the blood).

Other laboratory tests may also be abnormal – for example liver enzymes are commonly increased with hyperthyroidism, and both blood and urine tests are usually advised to help rule out concurrent problems (such as kidney disease). Blood pressure should also be checked where possible with hyperthyroid cats, and an electrocardiogram (ECG – electrical tracing of heart activity), and a chest X-ray or ultrasound may be helpful where heart disease is suspected.

Technetium scan

A technetium scan is a technique that is available at some specialist centres, and can be useful in some hyperthyroid cats. This technique can help confirm a diagnosis, but importantly will locate exactly where the abnormal tissue is and so can be very helpful if surgery is being considered but where there is no clearly identifiable enlarged thyroid on examination.

A technetium scan involves injecting a very small dose of a radioactive chemical (technetium) into the cat’s vein. The technetium is selectively taken up by abnormal thyroid tissue, and this can be detected using a special camera (a ‘gamma camera’). This is a simple, safe and easy procedure.

Treatment

Successfully treated cats, irrespective of what treatment is used, will usually have complete reversal of all the signs of hyperthyroidism. Further evaluation will usually be needed to check kidney function and ensure long-term goals of thyroid hormone concentrations are being achieved, but most cats do remarkably well when treatment is administered. There are four main options for treatment, each with advantages and disadvantages:

Medical management (anti-thyroid drug therapy)

The most commonly used and effective anti-thyroid drugs belong to a group known as thioamides. This includes both methimazole and carbimazole that are widely used in the management of both feline and human hyperthyroidism. These drugs are available in tablet form and they reduce both the production and release of thyroid hormones from the thyroid gland. They do not provide a cure for, but they do allow either short-term or long-term control of hyperthyroidism. However, to maintain control of the disease medication has to be given at least on a daily basis (and often twice daily).

The treatment dose is adjusted to effect and these drugs are usually both safe and effective. Side effects are uncommon. Poor appetite, vomiting and lethargy are most commonly seen, and these effects often resolve after the first few weeks of treatment. However, if gastric irritation persists alternative treatment may be necessary. More serious problems (bone marrow suppression, liver disorders, or skin irritation) are rarely seen.

Even if other surgery or radioactive iodine is considered (see below), drug therapy is often used initially to monitor the effect of successful treatment on kidney function.

Surgical thyroidectomy

Surgical removal of the affected tissues (thyroidectomy) can produce a permanent cure and is a common treatment for many hyperthyroid cats. In general this is very successful and can produce a long-term or permanent cure in most cats. However, occasionally signs of hyperthyroidism develop again at a later time if previously unaffected thyroid tissue becomes diseased.

To reduce anaesthetic and surgical complications, where possible cats should initially stabilised with anti-thyroid drug therapy before surgery is performed. Any significant heart disease should also be managed. The major risk associated with the surgery itself is inadvertent damage to the parathyroid glands – these are small glands that lie close to, or within, the thyroid glands themselves, and have a crucial role in maintaining stable blood calcium levels. Because there is a small risk that temporary interference with calcium regulation may occur, it is usually recommended that cats remain hospitalised for a few days after surgery, and blood calcium concentrations are monitored during this time.

After surgery, occasional blood tests are recommended to ensure normal thyroid hormone levels are being maintained.

Radioactive iodine therapy

Radioactive iodine (I-131) is a very safe and effective treatment for hyperthyroidism. It has the advantage of being curative in most cases with no ongoing treatment. The radioactive iodine is administered as a single injection, usually simply given under the skin. The iodine is taken up by the active (abnormal) thyroid tissue, but not by any other tissues, resulting in a selective local accumulation of radioactive material in the abnormal tissues. The radiation destroys the affected abnormal thyroid tissue, but does not damage surrounding tissues or the parathyroid glands.

There are no significant side-effects with this treatment, but because cats are temporarily radioactive they have to be kept hospitalised for a short period after treatment as a precaution. Unfortunately, because this treatment requires handling of radioactive drugs it is also only available at certain centres.

A single injection of radioactive iodine is curative in around 95 per cent of all hyperthyroid cats, but following treatment occasional blood tests are recommended to ensure normal thyroid hormone levels are being maintained.

Dietary treatment

A new option that has more recently become available for managing hyperthyroid cats is to feed them on a special diet that has strictly controlled levels of iodine in the diet. As iodine is used by the thyroid gland to make thyroid hormones, if there i only sufficient iodine in the diet to make normal levels of these hormones, this can help to control the disease.

This is an interesting form of therapy that appears to be quite successful, at least in a number of cats. It does require feeding a special therapeutic diet that is only available from your vet, and cats need to consume this diet exclusively to ensure effective control. Nevertheless, many cats can have their disease controlled in this way and it is an alternative to other forms of therapy for a number of cats.

Treatment of thyroid adenocarcinoma

The rare cases of thyroid adenocarcinoma (malignant tumour of the thyroid) are more difficult to treat, but can sometimes be successfully managed using much higher doses of radioactive iodine.

source/s: international cat care (http://www.icatcare.org/)

Mycobacteria are a specific group of bacteria with special characteristics, and capable of causing disease in both animals and man.

Several species of Mycobacteria can cause disease in animals, being either primary pathogens, or becoming pathogenic (disease causing) under certain circumstances. Mycobacterial infections generally cause one of three different types of disease:

Tuberculosis: the term used to describe disease where there is the formation of granulomas (inflammatory nodules) in the body

Leprosy: the term used to describe disease where infection results in the formation of granulomas in the skin (seen as skin lumps or nodules)

Opportunistic infections: these are infections that usually involving the subcutaneous tissues (tissues just below the skin itself)

Leprosy in cats

Leprosy is the name used to describe skin infections with a number of mycobacterial species that cause single or multiple inflammatory nodules (granulomas) to develop in the skin or just under the skin (subcutaneous tissues).

What causes leprosy

In up to 50% of cases, feline leprosy may be due to infection with Mycobaterium lepraemurium. However, studies have shown that a number of other mycobacterial species may be involved in causing this syndrome in cats (including M malmoense, M avium complex, M mucogenicum and some, as yet, unidentified species).

Disease has been reported from many different countries, but the organisms involved and their relative importance, may vary between different countries. The source of infection for cats is uncertain, but might include rodent bites, insect bites or contamination of wounds from the environment.

Clinical signs (leprosy)

Cats affected with feline leprosy have single or multiple skin nodules often on the head or limbs, and occasionally the body. The nodules often lose their overlying hair, and may become ulcerated. If there are multiple nodes. they usually affect one area of the skin. Local lymph nodes may become enlarged later in the disease, but other signs are of illness are rare.

Disease may occur in cats of varying ages - M lepraemurium may be more common in younger cats, with some other species being more common in older cats. With some (but not all) of the mycobacteria, underlying immunosuppression (e.g., FeLV or FIV infection) may predispose to infection.

Risk to humans (leprosy)

Feline leprosy is not really regarded as a zoonotic disease (i.e., infection is not spread from cats to humans). Leprosy in humans is caused by infection with a different organism, Mycobacterium leprae, and M lepraemurium is not infectious for humans. However, some of the other mycobacterial species that can sometimes cause leprosy in cats could potentially be spread to humans through bites or scratches, although humans are more likely to be infected from the environment.

Diagnosis of leprosy

Obtaining a sample of infected tissue by fine needle aspirate or biopsy is needed to make a diagnosis. Cytology and histology may show large numbers of typical ‘acid fast’ organisms (staining with a special stain known as ‘Ziehl Neelsen’) within macrophages (a type of inflammatory cell) seen within infected tissues.

Culture of samples is often unrewarding, as many of the species of mycobacteria involved are very difficult to culture. Nevertheless, this should be performed where possible. Molecular (PCR) techniques are available to accurately identify some of the bacteria involved.

Treatment (leprosy)

Surgical removal of small nodules may be helpful, but is often not curative, so even if nodules are removed, a minimum of two months follow-up antibacterial therapy is usually recommended.

As with most mycobacterial infections using a combination of more than one antibacterial is recommended - common drugs used include:

Rifampicin

Clarithromycin

Clofazimine

In most cases, the long-term outlook for cats diagnosed with leprosy is good.

 

Opportunistic mycobacterial disease

Opportunistic mycobacterial infections are infections that occur with a diverse group of mycobacteria that are present in the environment, being ubiquitous in soil, decaying vegetation, water, etc. These mycobacteria are often collectively known as 'rapidly growing mycobacteria’ or RGM as they are generally easy to grow (culture) in the laboratory, although slower growing mycobacteria may also sometimes be involved. Infection is usually through to occur from contamination of a wound.

The following organisms have been implicated in causing this syndrome; M. chelonae-abscessus, M fortuitum/peregrinum group,M smegmatis and M phlei, and others. These bacteria are opportunistic, causing disease through contamination of skin wounds, and can be particularly pathogenic if inoculated into adipose (fatty) tissue, particularly that beneath the skin. Adult, outdoor cats with a hunting or fighting lifestyle are more likely to be affected.

Clinical signs (opportunistic mycobacterial infection)

The most common clinical syndrome caused by opportunistic mycobacterial infections is panniculitis (inflammation of the fat under the skin). This usually affects the inguinal tissues (the groin area). Infection causes inflammation which may initially appear as ovules or plaques within or beneath the skin. Infection will spread to surrounding tissues, and usually causes multiple small skin ulcers which can exude fluid - this may resemble a cat bite abscess in some cases. As the infection progresses, more tissue may become infected and further inflammation occurs. Eventually the whole of the ventral abdomen ('belly’) of the cat and more may be affected, and the infected tissues can be extremely painful. Spread to other tissues in the body (internally) is rare.

Risk to humans (opportunistic mycobacterial infection)

Since opportunistic mycobacteria are present in the environment at all times, the risk of transmission from a cat to a human is low. However, it is recommended that normal hygiene measures are followed.

Diagnosis of opportunistic mycobacterial infection

Opportunistic mycobacteria may be seen on impression smears, fine needle aspirates or biopsies from infected tissues. Pyogranulomatous inflammation is seen but organisms may not be easy to identify as they can be quite scarce.

Culture of the organisms from a biopsy (or aspirate) is the test of choice, and the organisms are usually relatively easy to grow . This allows diagnosis, confirmation of the species involved, and also sensitivity testing (determining which antibiotics are best to use). Molecular (PCR) diagnostic tests are also available in some situations.

Treatment (opportunistic mycobacterial infection)

Treatment should be with one or more antibacterial drugs, for example:

A fluoroquinolone, such as pradofloxacin, merbofloxacin, or ciprofloxacin

Doxycycline

Clarithromycin

Clofazimine

Ideally, once antibacterial sensitivity testing has been performed, drugs known to be effective agains the species involved may be used. Therapy should be continued for several months and this may result in complete resolution in some cases.

With severe and widespread disease, usually after an initial course of antibiotics, surgery is needed to remove as much of the infected tissue as possible, followed up with several months (3-12 months typically) further drug treatment.

Prognosis (opportunistic mycobacterial infection)

The prognosis can be good if disease is identified early and treated aggressively. Some cases may be harder to manage than others, and sometimes permanent or intermittent antibiotic treatment may be needed to keep infection under control.

Tuberculosis

In humans, the organism Mycobacterium tuberculosis causes the majority of cases of tuberculosis. This species ofMycobacterium rarely infects other mammals and cats are naturally resistant, so infection is rare. Other mycobacteria that can cause tuberculosis in humans include M bovis, and the M avium complex (MAC) - a group of related mycobacteria that are widespread in animals and in the envrionment.

In cats, tuberculosis has historically often been caused by infection with M bovis. Mycobacterium bovis infects cattle and a wide range of animals including deer, badgers, ferrets, dogs and cats. Cats may be infected through consuming unpasteurized infected cows milk, or from contact with infected other animals or their immediate environment.

Other tuberculosis-causing mycobacteria can also infect cats include M microti - this is a mycobacterial species that mainly infects rodents (e.g., voles) and is an important cause of tuberculosis in cats that hunt actively. Most cat infections have been reported in the UK, but the disease is seen in other countries as well. Infection with M avium complex (MAC) also occurs occasionally in cats and can result in development of dessimentated granulomas (inflammatory masses).

Clinical signs of tuberculosis

If disease is acquired from ingesting infected food (e.g., drinking unpasteurized milk infected with M bovis), then intestinal infection usually results with inflammatory granulomas in the intestine leading to diarrhoea, vomiting, inappetence and weight loss. However, infection via the skin probably occurs more commonly (with organisms acquired from bite wounds during hunting or perhaps from the environment), and initial signs may be non-healing sores and/or nodules (small firm swellings) in the skin, often associated with swollen lymph nodes. The lymph node swelling may be marked, and sometimes this is the only (or most obvious) sign. As the disease progresses, infection may spread elsewhere, including to the cat’s lungs, and so may cause progressive coughing or difficulty breathing. Disease usually progresses slowly, and cats often develop lethargy and weight loss with disseminated infections.

Infection tends to be more common in adult male cats that are active hunters. As infection may often be acquired from fight wounds during hunting, initial skin lesions are often seen around the head and face, or on the extremities. Swollen lymph nodes under the chin often develops after infection to the skin around the head area. In some cases, local infection may spread to tissues under the skin, including muscle and bone that may lead to signs of lameness.

Risk to humans (tuberculosis)

All mycobacteria that cause tuberculosis pose a potential threat to humans (and other animals too), although the risk of spread of infection from cats to humans or other animals appears very low. Nevertheless, as M tuberculosis and M bovis are important causes of tuberculosis in humans, if cats are infected with these bacteria, treatment is not recommended.

Diagnosis of tuberculosis

Infection may be suspected on the basis of clinical signs, but these are not diagnostic for mycobacterial infections. Investigations will often include X-rays to identify spread of infection to lungs, bone, abdominal organs, etc. Routine blood tests may sometimes show anaemia and/or hypercalcaemia (high blood calcium concentrations, that can occur secondary to the inflammatory granulomas).

In some animals, a skin test can be used to diagnose tuberculosis but this is unreliable in cats and so not used. To confirm mycobacterial infection, aspirates and/or biopsy samples of affected tissue should be obtained. These sample can be:

Stained (using a stain called Ziehl Neelsen - ZN) - which specifically stains mycobacteria to identify their presence - careful examination is require though as sometime the number of organisms present is small

Submitted for routine histology to look for typical inflammation, and also for the presence of organisms using ZN stains

Submitted to a laboratory for culture of the organism to determine the exact species involved. Since these are very slow-growing bacteria, culture typically takes several months and unfortunately, many samples that are seen to have ZN positive organisms may fail to culture anything

Submitted to a laboratory for PCR analysis (genetic testing for the presence of mycobacteria and the species involved). However, these tests are only available for some of the organisms causing mycobacterial infections in cats.

If the species of mycobacteria is identified, the zoonotic risk, potential source of infection, and treatment options can be evaluated.

Treatment of tuberculosis

It is not generally recommended that cats with M tuberculosis or M bovis are treated, as although the risk to humans is low, these are important causes of tuberculosis in humans. Also, in some countries, these infections have to be notified to the appropriate health authorities.

Other tuberculous mycobacteria may also carry a very low risk of transmission to humans so careful consideration of treatment is needed, especially if there is contact with very young, very old, or immunocompromised people. If treatment is undertaken, this needs to be long-term (for many months) and it is important that cats are monitored during treatment as side effects can occur. In some cases the drugs may suppress the disease, at best, and indefinite treatment may be required. Surgical removal of small skin lesions may sometimes help, but does not remove the need for follow-up drug therapy.

Because antibacterial drug resistance is a problem with mycobacteria, treatment usually involves the use of a combination of two or three antibiotics. Those most commonly used include:

A fluoroquinolone, such as marbofloxacin, pradofloxacin, or orbifloxacin

A macrolide, such as clarithromycin or azithromycin

Rifampicin

Isoniazid

Clofazimine

Prognosis (tuberculosis)

The prognosis for infected cats depends on the type of mycobacteria, and the extent and severity of the infection. While many cases, especially those caused by M. microti, may respond favourably to treatment, the prognosis should always be viewed as guarded.

 

source/s: international cat care (http://www.icatcare.org/)

Ringworm - what a nightmare

One of the most dreaded skin diseases that cats could get… 

This skin disease is caused by a fungus (plural: fungi).

The disease has it’s name because once was thought that

ringworm would be cause by a worm curling up in the tissue

but it has really nothing to do with any type of worm. Also

known dermatophytosis.

4 species of fungi can cause dermatophytosis in cats; but most

likely it is caused by the organism called microsporum canis.

Microsporum canis is so well adapted to cats that up

to 20% of cats are thought to be asymptomatic carriers,

meaning they have the organism but show no outward signs.

Actually an Ringworm infection starts in the dead layer

of the skin, hair, and nails. The fungus is able to

utilize this dead keratin in the skin as a source of

nutrition.

It is in no way life threatening and exactly the

same fungus that people might get on their feet.

Almost every breeder made at least once his

experience with this fungus. Having several cats in a

house doesn’t make it easier. You can isolate the

infected cat but it’s almost impossible to keep this

disease away from the rest of the cats and even family

members. And if you have it once it seems that it is a

neverending story… Just keep in mind that ringworm is

NOT life threatening. For sure, it is a nuisance BUT it

is treatable.

Really nobody can say that he will never get

ringworm, especially not a breeder who is buying new cats

for breeding, who is showing the cats, etc. not even if

the cats are regularly checked by the vet. Sure you can

keep it under control with preventative treatment if you

keep new cats isolated or if you come back from shows, etc.

but saying your cattery is completely ringworm free seems

a lie to me, as you have ringworm spores everywhere in the

air. Sure nobody should sell a cat or a kitten with an

active ringworm infection but even if you don’t see any

ringworm infection it doesn’t mean that there are no

spores in the coat.

Prevention could be:

If you bring a new cat to your home, keep it isolate

for at lease 4 weeks and give a fungal culture upon

arrival, means after 3 days because some breeder give

topical or oral treatment so you might get a false

negative result.

After the culture has been taken, start giving topical

treatment once a week for 4 weeks (please

contact your vet) to get the best treatment for your

cat. Sure you could wait for the result of the culture

but prevention is cheaper before all your cats and family

members are infected.

Kittens are most susceptible and preferable they

should'nt have ringworm at all. Preventative they could

get topical treatments from 3 weeks of age and if

necessary treat the entire litter with oral Sporanox

(low dose 5mg/kg) until they go to their new home.

Sporanox is the most expensive, but the safest and

most effective oral treatment out there and lime

sulphur dips (although smelly) work the best topically.

However, please keep in mind that the majority of

breeders you come across will probably have, at some

time, dealt with ringworm as well even if they would

never talk about that officially.

Autosomal Polycystic Kidney

Disease (PKD) is a progressive, inherited condition which

causes multiple fluid filled cysts on the kidneys of

Persian Cats/Exotic Shorthair cats. Also other breeds with Persian

Cats/Exotic Shorthair in their lines (e.g. British Shorthair) carry

that risk.

In fact the Cysts are present from birth, but are

tiny at the beginning and will slowly increase the size.

They can range from very small up to several centimetres

in diameter. When the Cysts start increasing their size

they damage the normal kidney tissue, which causes

eventually kidney failure.

The number of cysts, the speed & the size in which

they grow varies from cat to cat. The average age of

kidney failure due to PKD is around 7 years. It might be that cats

will die when they are young but they can get very old, even with

PKD and die at the end because of something completely

different. 

How is PKD inherited?

Genetic studies approved that PKD is autosomal

dominant. So if only one parent has this gene he/she

will pass it on to the offspring with a chance of 50% of

inheriting PKD. Cats that are genetically free of PKD

have no possibility to pass it to the kittens.

What are the signs of PKD?

Weight loss

Depression

Vomiting

Polyuria (excessive urination)

Polydipsia (excessive thirst)

Lethargy

Enlarged kidneys

How is PKD diagnosed? 

Ultrasound: When the cat has reached approx.

10 month of age the Ultrasound diagnosis is 98% accurate.

The Ultrasound should be performed by a vet. that is

skilled to use the ultrasound.

Genetic Test: A buccal swab (from inside the cheeks)

will be send to a specialized laboratory for testing.

The result of this test is 100% accurate.

Treatment?

Unfortunately there is nothing that you can do

to slow down the growth of the cysts and they can’t be

removed. When kidneys begin not to work properly, they

lose their ability to filter out toxins. To understand

the treatment please find below a brief summary of how

the kidney’s work:

Kidneys are releasing an enzyme called

Renin to help control the blood pressure. When blood

pressure drops and kidneys donÕt receive enough blood,

Renin is released and will be causing blood vessels to

contract. When blood vessels contract, the blood pressure

goes up again. The main function of Kidneys is to filter

waste products and excess water from the blood. Wast

products leave the body in urine and the cleaned blood

remains in the body. The Stimulation of red blood cell

production.

They help maintain the proper balance of acid and minerals,

including sodium, calcium, potassium and magnesium, in the

blood.

So it is very important helping to reduce the level

of toxins in the cat. This Treatment is based on a cat

with chronic renal failure & may include:

Administration of fluids subcutaneously to treat dehydration.

Prescription diet: This food contains a lower

percentage of protein and less phosphorus than normal cat

food. For the growth, building muscles and repairing tissue

cats need protein every day. After the body uses the

protein in the food, a waste product called urea is made.

If a cat has a kidney failure it is not able to get rid

of this urea on a normal way. Damaged kidneys may not be

able to remove phosphorus from the blood so the level of

phosphorus in the blood will become too high. With a high

blood phosphorus level the cat might lose calcium from

their bones.

Phosphorus binders can be given (available in tablet or

capsule form).

High blood pressure (hypertension): If the blood

pressure is too high Medication may be prescribed.

Antacids & anti nausea medication.

Erythropoietin: The kidneys produce a hormone,

erythropoietin, which instructs the bone marrow to produce

red blood cells. The red blood cell count is often low

by cats with kidney failure. Since only the human form

is available there is a possibility that some cats may

eventually recognize this substance as foreign and build

antibodies against it.

What is the outcome for a cat with PKD?

It is so different from cat to cat. It’s depending

on how many cysts are present, how large they grow and

how quickly they grow. A cat with only a few small & slow

growing cysts may live very long and will die eventually

from something unrelated to PKD. Other cats may die very

young if they have numerous cysts that are growing and

become large very fast.

Is there a cure?

Unfortunately there isn’t a cure for PKD. Breeders

should test their cats and if one of the cats should be

PKD positive tested, it should be desexed.

Note: Some breeders are using PKD positive cats in

their breeding programs because some lines are too

precious to lose. Especially if somebody is breeding rare

colors like chocolate and lilac, he has to go sometimes

the more difficult and longer way to be successful.

Of course they will go on breeding with the kittens that

are PKD negative out of this combination and the rest will

be neutered/spayed.

If you are interested in a kitten from a breeder that

is breeding with NOT PKD negative cats please ask the

breeder directly why he/she is working with PKD positive

cats.

Remember that PKD positive doesn’t mean that the

cat will die of PKD.

Feline infectious peritonitis (FIP) is a viral disease of cats that occurs throughout the world and is almost invariably a fatal disease. The disease is caused by infection with a virus known as feline coronavirus. Infection with coronavirus is actually very common in cats but most of the time it does not cause any problems, other than perhaps mild self-limiting diarrhoea.

Uncommonly, the virus mutates (changes) and a strain of coronavirus emerges that has dramatically altered disease-cashing potential, and it is one of these mutated forms of the virus that is the underlying causes the disease of FIP.

In an affected cat, the virus spreads throughout the body and can cause a wide range of different signs (including peritonitis with the accumulation of fluid in the abdomen, but in other cats fluid may accumulate in the chest cavity; in others the virus may cause inflammation affecting the brain, eyes, liver, kidneys or elsewhere).

What are coronavirus infections

Coronaviruses are a common group of viruses that often infect the upper respiratory tract or gastrointestinal tract in different animals. Different species of coronavirus are adapted to cause disease in different animals. In humans, coronaviruses are one of the frequent causes of the common cold.

Coronaviruses that infect cats are called ‘feline coronaviruses’ or FCoV. In cats, FCoV most frequently causes gastrointestinal infections, but in unusual cases (with a mutated form of the virus) it can spread through the body and cause FIP.

How do cats get infected

Coronavirus infection is extremely widespread in cats, especially where large numbers of cats are kept together. It is estimated that 25 to 40 per cent of household pet cats have been infected with FCoV, but the infection rate increases to 80 to 100 per cent of cats kept in multi-cat households or colonies.

The virus mainly infects the intestinal tract, where it replicates. Virus is shed in the faeces and may survive in the environment for a short while (several days or a few weeks), but is readily destroyed by commonly used disinfectants. Infection is caused when a cat ingests the virus (e.g., through licking). The relationship between the virus and the cat is complex - some cats may remain persistently infected with FCoV and shed virus in their faeces the whole time, others may be infected, develop a strong immunity and be protected from future infections, and others may be infected and manage to eliminate the virus, but then get recurrent infections.

In most cases, infection with FCoV will cause mild sings of enteritis (mild, sled-limiting diarrhoea), or sometimes no signs at all. Diarrhoea is more likely to be seen in young cats, but because it is mild and self-limiting a specific diagnosis of FCoV infection is almost never made.

How does FcoV cause FIP

Infections with FCoV are usually limited to the intestinal tract, with very limited viral replication elsewhere. Strains of FCoV causing these infections are referred to as feline enteric coronavirus (or FECV). During infection, and while the virus replicates in the intestine, it undergoes spontaneous mutations. This leads to the development of different strains of the virus, and occasionally a strain may develop that has dramatically altered disease-causing potential - these viral strains are referred to as feline infectious peritonitis virus (FIPV). FIPV strains of FCoV differ from FECV in that they no longer replicate well in the intestine, but rather preferentially infect macrophages - one of the important cells of the immune system. The virus spreads throughout the body, and if replication is not contained by a good immune response, a cat will develop clinical signs of FIP.

In most cases, it appears that an FIP-producing strain of FCoV probably arises within a cat already infected with FCoV. In many (or even most) cases of FIP, the FIP-producing strains of the virus are not shed in the faeces of a cat with FIP.

When an FIP-producing strain of FCoV emerges, whether a cat will develop FIP or will remain healthy depends on the quality of its immune response. A strong immune response (especially the type of immunity termed ‘cell mediated immunity’) may enable the cat to control the infection and prevent signs developing.

Clinical signs of FIP

FIP can cause a very wide range of clinical signs, and unfortunately none of the signs are unique for FIP - a diagnosis cannot therefore be based on clinical signs alone.

Early signs of FIP are usually very vague with a fluctuating fever, lethargy and inappetence being common. After a period of several days or weeks (or sometimes even many months) other signs usually develop. Two main forms of the disease are recognised known as 'wet’ or 'effusive’ disease, and 'dry’ or 'non-effusive’ disease. Many cats may in fact have a mix of these two types:

„Wet“ (effusive) FIP

In this form of disease there is accumulation of fluid within the abdominal cavity (resulting in abdominal distension) and/or in the chest cavity (resulting in breathing difficulties). The fluid accumulates because infection with FIPV causes damage to and inflammation of blood vessels (called 'vasculitis’) which causes fluid to leak from the blood into the abdomen or chest. Cases that develop fluid accumulation in the abdomen are responsible for the original name of this disease, 'peritonitis’ referring to the inflammation that occurs in the lining of the abdominal cavity.

In effusive FIP, the fluid that accumulates typically has a very high protein content, and is often a clear-yellowish colour. However, other diseases (including some liver diseases and neoplasia) can also cause a similar fluid accumulation.

„Dry“ (non-effusive) FIP

With non-effusive disease, infection with FIPV predominantly causes chronic (long-standing) inflammatory lesions to develop around blood vessels in many different organs and sites in the body. The type of changes present is usually what is known as 'pyogranulomatous’ inflammation.

This inflammation affects the eyes in around 30% of cases, the brain in around 30% of cases, but can affect almost any tissues in the body including the liver, kidneys, lungs and skin, and can thus cause a wide range of signs from neurological disease (e.g., a wobbly and unsteady gait), to bleeding in the eyes, to more vague signs of disease that may occur with lesions in the liver or other internal organs.

In most cases of FIP, once clinical signs have started, they tend to get progressively worse over time, and in most cases (though not all) the time course for disease is rapid with cats deteriorating to the point that euthanasia is usually required within a matter of days or weeks. It is thought that non-effusive cases of FIP are where the cat has developed a partially effective immune response that helps to limit viral replication - this may prevent development of effusions, but is not sufficient to stop disease development.

In a number of cats, signs may develop that are a combination of both effusive and non-effusive disease.

Which cats are most affected

Although FIP can occur in cats of any age, it is most often seen in young cats. Around 80% of cases diagnosed are in cats less than 2 years of age, and many cases are seen in kittens around 4-12 months old. FIP is also more common in cats kept in groups or colonies (especially breeding households) as this is an environment where FCoV infections are spread easily. A crowded environment may also contribute to stress, which can be a factor in disease development as it compromises the cat’s immune response. There is evidence that genetics can also play a role in susceptibility to disease, although this is complex.

How can it be diagnosed

FIP is a very difficult disease to deal with because there are no clinical signs that are specific for the diagnosis of FIP, and no simple blood test to confirm a diagnosis. FIP may be considered more likely when:

Cats are showing clinical signs compatible with FIP

Cats are in a higher risk category (e.g., younger cats, colony cats, etc.)

Typical changes are seen on routine blood tests - these may include

Lymphopenia (low numbers of lymphocytes, a type of white blood cell)

Neutrophilia (increased numbers of neutrophils, a type of white blood cell)

Anaemia

Elevated globulin concentrations (one of the major groups of proteins in the blood)

Elevated liver enzymes (eg, ALT, ALP)

Elevated bilirubin (and jaundice or yellowing of the gums and eyes)

None of these blood changes are specific for FIP, occurring with other diseases too, but if multiple changes are seen in combination with appropriate signs, a diagnosis of FIP becomes more likely. Many of these abnormalities may also not be present in the early stages of the disease, but may become evident as the disease progresses. Thus some tests that give normal results may have to be repeated later.

If an effusion is present in the abdomen or chest cavity, obtaining a sample of the fluid and analysing the cell and protein content can be extremely helpful. With FIP the fluid invariably has a high protein content (greater than 35 g/l) and at least 50% of the proteins are globulins. Because this test is very helpful, and because few other diseases cause this type of fluid accumulation, when FIP is suspected a vet will often take X-rays or do an ultrasound examination to see if fluid is present so that a sample can be collected for analysis.

Other tests that can also sometimes be helpful include:

Further analysis of proteins in the blood (e.g., looking at globulin sub-types or measuring the protein acid-1-alpha glycoprotein [AGP])

Evaluation of a cerebrospinal fluid sample (the fluid that surround the brain and spinal cord) in cases where there are neurological signs

Looking for the presence of antibodies against the virus in a blood sample (coronavirus serology) is of very limited value - antibodies against FCoV develop irrespective of the type of virus infecting a cat and the antibody test cannot differentiate between different strains of the virus. A very large number of perfectly healthy cats are therefore positive on this test.

Confirming a diagnosis of FIP

The best test to confirm a diagnosis of FIP is to collect a biopsy (usually done through a surgical operation) from affected tissues. Typical FIP-type inflammation is usually seen, which is highly suggestive, but the diagnosis can be confirmed using a technique called 'immunohistochemistry’ which will demonstrate the presence of the virus itself within the damaged tissues.

With FIP, unfortunately a cat may be too sick for surgery to be performed, and so in many cases a definitive diagnosis may only made on post-mortem examination (using immunohistochemistry, as above).

The virus itself can also be detected by the use of PCR (polymerase chain reaction, a molecular technique to show the presence of the virus). This can be useful - for example if fluid is present in the chest or abdomen which has typical characteristics of FIP (see above), and if the fluid is also PCR positive for coronavirus, this is highly suggestive that FIP is the underlying cause. However, because PCR cannot distinguish different types of coronavirus (FIP-producing strains from enteritis-producing strains), this test is not definitive.

Treatment

Once clinical signs of FIP develop, it is generally an incurable and fatal disease. Supportive treatment (e.g., anti-inflammatory drugs) may help relieve some signs and improve quality of life temporarily but in most cases euthanasia is the most humane course of action to avoid suffering. There are some reports of cats responding to therapy with injectable interferon (recombinant feline interferon omega), but there is currently no evidence for this being genuinely effective.

Prevention

A commercial vaccine is available in some countries to help protect against FIP. However, this vaccine (while showing some efficacy) can only be given to kittens over 16 weeks of age. The major indication for using such a vaccine would be in breeding households, especially with a history of FIP, but by the time a kitten can be vaccinated (at 16 weeks) they would almost invariably have already been exposed to FCoV infection and so the vaccine probably has little or no value.

Reducing the risk in breeding households

FIP is least common in household pets. The risk can be minimised by obtaining cats from a source with relatively few cats and by keeping cats in small stable groups (less than five cats in a household).

In breeding catteries, eradicating coronavirus infections is extremely difficult, as the virus is so ubiquitous, and it is unsuitable in most situations to attempt this. A more practical approach is to use measures to reduce the risk of FIP occurring, but recognising that on occasions, this may happen even in the best run catteries. Good practice to minimise the risk of FIP would include:

Avoid keeping large groups of cats and having multiple litters of kittens at any one time

Keep cats in small isolated groups (ideally no more than four cats in each group - this reduces the risk of endemic FCoV infection)

Have at least one litter box for every two cats, located in easy to clean and disinfect areas

Keep litterboxes away from food and water bowls, and clean/disinfectant them regularly (at least daily)

Avoid stress and maintain good hygiene and preventive healthcare for all cats

Wherever FIP occurs as a problem in a group breeding of cats:

Consider preferentially breeding from older cats, as these will less likely be shedding FCoV

Consider isolating queens just before they give birth and keeping the queen and kittens isolated from all other cats until the kittens are homed, as a means of reducing the risk of FCoV spread to kittens

Stop breeding from any queens or tom cats that repeatedly produce litters of kittens that develop FIP as they may be passing on FCoV infection or may be passing on genetic susceptibility to disease

Carefully review management and hygiene policies

If faced with an outbreak of FIP, stop all breeding for several months.

source/s: international cat care (http://www.icatcare.org/)