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Treatment of a case of feline infectious peritonitis with cyclosporin A

1 Jun, 15 | by Assistant Editor

Feline infectious peritonitis (FIP), which is caused by certain strains of feline coronavirus, is a progressive and usually fatal disease for which there is currently no cure or effective treatment. It is a disease which continues to challenge vets and its diagnosis is a crushing blow to owners who will inevitably lose their cherished cats.

There is an important and unique immunological component to the pathology of the disease and there is evidence that some immunosuppressive drugs may offer hope. However, current treatments may induce short-term remission in a small percentage of cats.

Cyclosporin A (CsA) has recently been shown to exert potent antiviral activities in several in vitro systems, including against coronaviruses. However, whether CsA has clinically relevant activity against coronaviruses remains unknown.

Yoshikazu Tanaka and colleagues report a case of effusive FIP in which treatment with CsA resulted in a sustained reduction in viral copy number and pleural fluid volume and was accompanied by clinical improvement.

A 14-year-old female domestic shorthair cat was presented with persistent fever, anorexia and jaundice for a month. A general clinical examination showed a substantial pleural effusion, and laboratory investigation revealed a significant feline coronavirus antibody titre and a low packed-cell volume, as well as signs indicative of liver damage. Pleural fluid was yellowish, viscous and remarkably dense. Coronavirus antigen was demonstrated within macrophages in the pleural fluid and real-time quantitative reverse transcription PCR (RT-qPCR ) revealed 1.6×10 6 copies/ml in pleural fluid, which is higher than that in other cases of effusive FIP that the authors had encountered. The diagnosis of FIP was based on the clinical presentation and clinicopathological, cytological and RT-qPCR findings.

Type-I interferon treatment for two months did not result in improvement in pleural fluid volume and viral copy number and treatment was stopped. Following discussion with the owner, treatment with a daily dose of modified cyclosporin A (CsA) was started. The volume of pleural fluid decreased and became undetectable within four days of starting CsA therapy. The condition of the cat improved, it became more alert and regained a normal appetite, and therefore CsA administration was stopped. However, the pleural fluid accumulated within four days of stopping CsA treatment. Treatment was recommenced and again the pleural fluid levels disappeared and the viral load decreased substantially. Over a two-month period, during which a low dose of CsA was maintained, no clinical abnormalities were detected, the anaemia resolved and biochemical parameters returned to normal.

Unfortunately, about two months after CsA treatment was stopped, viral load gradually increased but no clinical abnormalities were detected until about seven months after treatment was stopped. The cat’s clinical condition deteriorated and it died shortly after.

The study suggests that the potential therapeutic effects of CsA in combination with other therapeutic agents should be evaluated.

Full details of the investigations carried out, treatment and outcome can be found here.

Researchers investigate what really goes on in small animal consultations

5 Nov, 14 | by Assistant Editor


New open access research published in Veterinary Record indicates that almost half of veterinary consultations last longer than the 10 minutes allocated and that preventive medicine consultations last just as long as consultations for a specific health problem. The results raise issues to do with practice management, as well as the importance of educating veterinary students about comorbidities. 


Consultations are a major part of small animal practice, with small animal vets often meeting a large number of clients and patients each day. Generally speaking, 10 minutes is allocated for each consultation, but the amount of time required to address all of the client’s concerns can often exceed 10 minutes. Furthermore, consultations are often complex interactions in which a wide range of potential health problems are discussed.

In human medicine, large amounts of research has been conducted into the nitty gritty of how consultations work and the types of issues that are discussed. This has shown that more lengthy consultations tend to lead to more issues being discussed and better detection and management of certain conditions. However, until now, veterinary consultations have been less well understood.

A group of researchers at the University of Nottingham recently sought to fill these knowledge gaps by conducting some in-depth research into small animal consultations in the UK. They wanted not only to better understand how long consultations last and what happens during a consultation, but also to develop a tool that would make it easy to analyse veterinary consultations in depth. Their results are reported in two articles recently published in Veterinary Record (found here and here), both of which are open access.

Natalie Robinson, one of the authors of the studies, explains the idea behind them.

‘When the Centre for Evidence-based Veterinary Medicine was first set up at the University of Nottingham, one of our first questions was “What should our research priorities be?”’, she said. ‘We needed to make sure our research was relevant to first-opinion practitioners, so examining the veterinary caseload to determine what practitioners see and do every day was the first logical step. By examining consultations in greater depth, we can start to identify the important decision-making points during the consultation. This will allow us to generate new evidence which can support veterinary decision-making and hopefully lead to improved patient care.’

Eight small animal practices in England and Scotland took part in the study. The team observed a large number of consultations in detail, and recorded what they saw using a specially developed tool.



The research showed that small animal consultations often ran over the allocated 10 minutes



One of the studies assessed how long consultations tended to last. The researchers timed 182 consultations involving 203 animals in two of the participating practices in England.

They found that there was a huge range in the length of consultations. The shortest consultation observed lasted for just 51 seconds, while the longest lasted for 36 minutes and 45 seconds. Almost half (48 per cent) of consultations exceeded the 10 minutes allocated. Perhaps unsurprisingly, consultations in which more problems were discussed, or which involved more patients, tended to last longer.

‘One of the things that surprised us is that preventive medicine consultations lasted just as long as consultations for a specific health problem’, said Dr Robinson. ‘Preventive medicine consultations are often seen as “quick and easy” but the results would suggest that this is not necessarily the case. In fact it would appear that preventive medicine consultations may be even more complex than other types of consultations, with even more problems discussed, and so are an important part of the healthcare of our pets.’


Looking at consultations in more detail

In another part of the study, a total of 1720 consultations (involving 1901 patients) were recorded and analysed. The results make interesting reading.

The first key finding was that a total of 4486 problems were discussed for the 1901 patients, an average of 2.4 problems per patient. In almost two-thirds of consultations, more than one problem was discussed. The highest number of problems discussed in one session was eight.

‘Interestingly, fewer problems were discussed for rabbits than for cats or dogs,’ said Dr Robinson. ‘While there could be a range of reasons for this finding, it could be that vets and owners are less familiar with identifying health problems in this species. Previous work within our group has suggested that vets feel there is less information available for rabbits than for dogs or cats, so it could be that rabbit medicine is an important area for the generation of new evidence.’ The previous study she refers to was published in Veterinary Record earlier this year.



In almost two-thirds of consultations, more than one problem was discussed. The highest number of problems discussed in one session was eight.


More health problems were also discussed in consultations involving older animals, while when younger animals were presented, preventive medicine was more likely to be discussed.

While the results answer some questions, they also raise others. For example, if consultation length varies so widely, should vets begin to offer different types of appointments? The authors suggest that practices could set up geriatric clinics specifically aimed at older animals in which appointments are longer, ensuring enough time for all problems to be discussed.

They also note that the findings could have implications for veterinary education, as they show that comorbidities are common and consultations can be complex.

‘We need to make sure that training in consultation skills adequately prepares veterinary undergraduates for the realities of first-opinion practice,’ said Dr Robinson. ‘The findings suggest that first-opinion consultations often involve dealing with multiple problems and comorbidities within a single consultation, meaning the decision-making process is often complex.’

‘Ultimately, we need more evidence to support decision-making in patients with comorbidities, which will benefit not only undergraduate education, but also the wider veterinary profession and the patients they treat.’


Cat’s eyes shed light on vascular anomalies

20 Oct, 14 | by Assistant Editor


An article recently published in Veterinary Record Case Reports describes an unusual case of sudden blindness in a pet cat…

When an eight-year-old female cat presented with an acute onset of blindness, lethargy and poor appetite, the first-opinion vet could be forgiven for not expecting the final diagnosis. The cat was referred to a neurologist, to whom the owners mentioned that she had had several previous episodes of lethargy since she was a kitten, usually lasting less than 24 hours.

On examination, the cat was stunted, had copper-coloured irises and a protruding tongue. The neurological examination revealed several cognitive, cranial nerve and generalised motor abnormalities. Neuroanatomical localisation was consistent with a diffuse forebrain disease.

MRI and routine cerebrospinal fluid analysis revealed no significant findings. However, an abdominal ultrasound scan demonstrated that the splanchnic venous flow was diverted away from the liver (that is hepatofugal flow), via an anomalous tortuous vessel. The liver parenchyma appeared normal and the rest of the abdominal ultrasound was unremarkable. A blood ammonia level measured immediately after sample collection, supported the diagnosis of hepatic encephalopathy secondary to a splenosystemic shunt.

Portosystemic shunts (PSS) are vascular anomalies redirecting the blood from the portal circulation to the systemic circulation. Congenital PSSs, the most common type identified in cats, are the result of an abnormal embryonic vasculature development, and are usually diagnosed in young animals. Acquired PSSs are usually secondary to portal hypertension leading to the opening of pre-existing fetal blood vessels. Signs of hepatic encephalopathy often wax and wane, but neurological signs, including seizures are common.


Simplified representation of the vascular anomaly observed in the cat

CVC, caudal vena cava; GI, gastrointestinal; SV, splenic vein; PV, portal vein


The patient quickly responded to medical treatment and the owners reported in a follow-up consultation five months later that the cat has been completely normal without any episode of abnormal behaviour or visual deficits.

This case raises the importance of considering a PSS as a possible cause of acute onset of neurological signs in adult cats. Additionally, it suggests a potential good response to medical treatment for splenosystemic shunts.

Read about this case in more detail here, including videos (found under supplementary data).

Nine lives required: the hazards encountered by free-roaming cats

27 Sep, 13 | by Assistant Editor


Should cats be kept indoors or allowed to roam freely? In the UK, the large majority of the estimated 8 million cats are ‘indoor-outdoor’ cats that spend some proportion of their time exploring outside the house. Often, these cats are free to come and go as they please, undertaking behaviours such as prowling, marking territory and hunting away from home.

However, over recent years, some UK cat owners have considered the decision to keep their cats indoors. The RSPCA notes that there is still uncertainty about whether indoor-only cats are healthier than outdoor cats, but suggests that if cats are kept indoors from an early age and provided with plenty of stimulation and entertainment, they can adapt well to being confined to the home.

One of the main arguments for keeping cats indoors is that outdoor cats encounter a large range of hazards and tend to have reduced lifespans compared to indoor cats. This may affect the health and welfare of the cat and also means that outdoor cats are likely to present to a vet with very different problems (including infectious disease and injury) compared to indoor cats.

Up until now, there has been little scientific research into the lives of outdoor cats, but modern digital technology has created new opportunities, and a recent study by a team from the University of Georgia and National Geographic published in Veterinary Record set out to see first-hand what free-roaming cats in a US town experience.

The researchers sought cat owners to volunteer in the city of Athens, Georgia, USA, and asked them to fit their cats with a video camera designed to give a cats-eye-view without disturbing the cat’s behaviour.

‘While it is commonly stated that roaming cats live shorter lives due to injury, disease, and vehicular accidents, there was very little information available on how often our pets may encounter dangerous situations in the suburban outdoors,’ explains author Kerrie Anne Loyd. ‘The use of animal-borne cameras allowed us to objectively examine and quantify all of the activities pet cats experienced while roaming.’


A cat wearing a KittyCam

Fifty-five cats were included in the study and more than 2000 hours of footage was collected and analysed. The results were compelling.

The video footage revealed that the Athens cats encountered a large number of hazards in their daily lives, including exploring storm drains, having contact with unknown cats and crawling into small spaces in buildings where they could become trapped.

The most common risk encountered was, perhaps unsurprisingly, moving vehicles, with a total of 178 incidents of cats crossing roads recorded.

But some of the hazardous activities were ones that owners may be unlikely to be aware of. For example, one-fifth of the cats consumed liquids and solids away from the home, which the authors state may pose a risk of poisoning. Cats were witnessed drinking from old children’s paddling pools filled with rainwater, puddles in parking lots and the storm drain system. They were also witnessed eating a wide range of things including roadkill, rubbish and compost.

‘Parking lot puddles and runoff from roads and parking lots may be contaminated with anti-freeze or other dangerous chemicals. Food left out for stray cats may become mouldy or infested with ants.’ Notes Loyd, ‘Pet owners can reduce this risk by making sure that roaming cats have access to fresh food and water outside their home. Contact with other roaming cats poses a health risk to pets – feline immunodeficiency virus is just one of the many infectious diseases that may be acquired from contact with other outdoor or stray cats.’


A cat meets a canine neighbour

The authors were also found that four of the 55 cats visited other homes during the period and were petted and fed by other people. In several cases, cats repeatedly returned to other houses and interacted with the people living there.

Although no encounters with larger predators were recorded, one cat did meet and ward off an opossum and the video footage of the event can be viewed here.


Encounter with a possum

Another major risk behaviour was cats visiting places where they could become lost or trapped, with 20 per cent of the cats either spending time in storm drains (posing a risk of drowning in a flood event) or entering the crawl spaces underneath buildings or houses.

When the results were analysed statistically, the authors found that some cats were more likely than others to show risky behaviours. Males were significantly more likely than females to undertake risks (including crossing roads), and cats seemed to become more cautious as they got older, with the number of hazardous incidents decreasing in line with age.

While the results cannot be extrapolated to every outdoor cat, with cats that roam in the inner-city or very rural country probably experiencing different risks, the paper shows that free-roaming pet cats experience a wide variety of hazards.

Kerrie Anne Loyd states, ‘In addition to documented risks, we are aware that many pet cats become lost while roaming, and three of our initial volunteers had to withdraw because their pets became lost or critically injured before we could get the video cameras on their cats.’ She suggests that owners could reduce these risks by considering an indoor life for their cat.

Video footage from the study can be viewed on the KittyCam Project page here.

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