Survival estimates and outcome predictors for shelter cats with feline panleukopenia virus infection.

OBJECTIVE To determine survival estimates and outcome predictors for shelter cats with feline panleukopenia virus (FPV) infection. DESIGN Retrospective cohort study. ANIMALS 177 shelter cats with FPV infection. PROCEDURES Medical records of cats treated for FPV infection from 2011 through 2013 were reviewed to collect information pertaining to signalment; history; results of physical examination, CBC, serum biochemical analysis, and blood gas analysis; and treatments (antimicrobials, antiparasitics, antivirals, antiemetics, analgesics, crystalloid or colloid solutions, and blood products). Survival time and outcome predictors were determined by means of Kaplan-Meier estimation, logistic regression, and mixed-model ANOVA. RESULTS Median survival time after hospital admission was 3 days; 20.3% (36/177) of cats survived to discharge from the hospital. Risk of nonsurvival was greater in cats with (vs without) signs of lethargy, rectal temperature < 37.9°C (I00.2°F), or low body weight at hospital admission. Lower (vs higher) leukocyte count on days 3,4, and 7 of hospitalization, but not at admission, was associated with nonsurvival. Amoxicillin-clavulanic acid, antiparasitics, and maropitant but not interferon-ω were associated with survival, whereas glucose infusion was associated with nonsurvival. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that FPV infection carried a poor prognosis for shelter cats. Several variables measured at admission or during hospitalization were associated with outcome. Remarkably and contrary to the existing literature, leukopenia at admission had no association with outcome, possibly owing to early prevention of complications.

Anaplasma, Ehrlichia and Rickettsia species infections in cats: European guidelines from the ABCD on prevention and management

OVERVIEW: Anaplasma species, Ehrlichia species and Rickettsia species are vector-borne pathogens infecting a wide variety of mammals, but causing disease in very few of them. Infection in cats: Anaplasma phagocytophilum is the most important feline pathogen among these rickettsial organisms, and coinfections are possible. Little information is available on the pathogenesis of these agents in cats. Clinical signs are usually reported soon after tick infestation. They are mostly non-specific, consisting of fever, anorexia and lethargy. Joint pain may occur. Infection in humans: Some rickettsial species ( A phagocytophilum, Ehrlichia chaffeensis, Ehrlichia ewingii, Rickettsia conorii, Rickettsia rickettsii, Rickettsia felis, Rickettsia typhi and Candidatus Neoehrlichia mikurensis) are of zoonotic concern. Direct contact with cat saliva should be avoided because of potential contamination by R felis. Infected cats are 'sentinels' of the presence of rickettsial pathogens in ticks and fleas in a given geographical area, and they signal a risk for people exposed to vectors.

Something old, something new: Update of the 2009 and 2013 ABCD guidelines on prevention and management of feline infectious diseases.

OVERVIEW: The ABCD has published 34 guidelines in two Special Issues of the Journal of Feline Medicine and Surgery (JFMS): the first in July 2009 (Volume 11, Issue 7, pages 527-620) and the second in July 2013 (Volume 15, Issue 7, pages 528-652). The present article contains updates and new information on 18 of these (17 disease guidelines and one special article 'Prevention of infectious diseases in cat shelters'). For detailed information, readers are referred to the guidelines published in the above-mentioned JFMS Special Issues.

Matrix vaccination guidelines: 2015 ABCD recommendations for indoor/outdoor cats, rescue shelter cats and breeding catteries.

OVERVIEW: In 2013, the ABCD published 'Matrix vaccination guidelines: ABCD recommendations for indoor/outdoor cats, rescue shelter cats and breeding catteries' in a Special Issue of the Journal of Feline Medicine and Surgery (Volume 15, Issue 7, pages 540-544). The ABCD's vaccination recommendations were presented in tabulated form, taking into account that there is no universal vaccination protocol for all cats. To support the veterinarian's decision making, recommendations for four lifestyles were made: for cats with outdoors access, cats kept solely indoors, rescue shelter cats and cats in breeding catteries. This update article follows the same approach, offering current and, where relevant, expanded recommendations.

Blood transfusion in cats: ABCD guidelines for minimising risks of infectious iatrogenic complications.

OVERVIEW: The availability of blood components has increased the number of indications for transfusing cats, and fresh whole blood is readily accessible to clinicians because it can be taken from in-house donor cats or 'volunteer' feline blood donors. A certain amount of risk remains to the recipient cat, as immediate or delayed adverse reactions can occur during or after transfusion, related to immunemediated mechanisms. This article, however, focuses on adverse events caused by infectious agents, which may originate either from contamination of blood following incorrect collection, storage or transfusion, or from transfusion of contaminated blood obtained from an infected donor. PREVENTION OF BLOOD CONTAMINATION: In cats, blood cannot be collected through a closed system and, therefore, collection of donor blood requires a multi-step manipulation of syringes and other devices. It is crucial that each step of the procedure is performed under the strictest aseptic conditions and that bacterial contamination of blood bags is prevented, as bacterial endotoxins can cause an immediate febrile reaction or even fatal shock in the recipient cat. PREVENTION OF DISEASE TRANSMISSION: With a view to preventing transmission of blood-borne infectious diseases, the American College of Veterinary Internal Medicine has adopted basic criteria for selecting pathogens to be tested for in donor pets. The worldwide core screening panel for donor cats includes feline leukaemia virus, feline immunodeficiency virus, Bartonella species and feline haemoplasma. The list should be adapted to the local epidemiological situation concerning other vector-borne feline infections. The most practical, rapid and inexpensive measure to reduce transfusion risk is to check the risk profile of donor cats on the basis of a written questionnaire. Blood transfusion can never, however, be considered entirely safe.

Disinfectant choices in veterinary practices, shelters and households: ABCD guidelines on safe and effective disinfection for feline environments.

OVERVIEW: Regardless of whether a pathogen is viral, bacterial, parasitic, fungal or an emerging unknown, the mainstay of infectious disease control is hygiene, and the cornerstone of good hygiene is effective disinfection. CHALLENGES AND CURRENT CHOICES: Certain pathogens present a challenge to kill effectively: parvovirus, protozoal oocysts, mycobacteria, bacterial spores and prions resist most disinfectants but can be eliminated through heat, especially steam, which will kill protozoal oocysts. Heat is the safest and most effective disinfectant, but cannot be universally applied. Temperatures in washing machines and dishwashers should be at least 60 °C to eliminate pathogenic spores and resistant viruses. Enveloped viruses are susceptible to most disinfectants; of the non-enveloped viruses, parvovirus is recognised as being the most difficult to eradicate. Sodium hypochlorite is recommended for many applications: cleaning of floors, laundry, food preparation surfaces and utensils. Skin scrubs and rubs containing alcohols are more effective than those containing chlorhexidine, and less subject to contamination. DISINFECTANTS TO AVOID: Deficiency of the enzyme UDP-glucuronosyl transferase renders the cat susceptible to the toxic effects of phenol-based disinfectants (including many essential oils), so these should be avoided in feline environments. Quaternary ammonium compounds (eg, benzalkonium chloride) are also probably best avoided. THE FUTURE: Veterinary disinfection approaches in the future may include use of ultraviolet radiation and, increasingly, silver.

Borna disease virus infection in cats: ABCD guidelines on prevention and management.

OVERVIEW: Borna disease virus (BDV) has a broad host range, affecting primarily horses and sheep, but also cattle, ostriches, cats and dogs. In cats, BDV may cause a non-suppurative meningoencephalomyelitis ('staggering disease'). INFECTION: The mode of transmission is not completely elucidated. Direct and indirect virus transmission is postulated, but BDV is not readily transmitted between cats. Vectors such as ticks may play a role and shrews have been identified as a potential reservoir host. Access to forested areas has been reported to be an important risk factor for staggering disease. DISEASE SIGNS: It is postulated that BDV may infect nerve endings in the oropharynx and spread via olfactory nerve cells to the central nervous system. A strong T-cell response may contribute to the development of clinical disease. Affected cats develop gait disturbances, ataxia, pain in the lower back and behavioural changes. DIAGNOSIS: For diagnostic purposes, detection of viral RNA by reverse transcription PCR in samples collected from cats with clinical signs of Borna disease can be considered diagnostic. Serology is of little value; cats without signs of Borna disease may be seropositive and yet not every cat with BDV infection has detectable levels of antibodies. HUMAN INFECTION: A hypothesis that BDV infection may be involved in the development of selected neurological disorders in man could not be confirmed. A research group within the German Robert Koch Institute studied the potential health threat of BDV to humans and concluded that BDV was not involved in the aetiology of human psychiatric diseases.

West Nile virus infection in cats: ABCD guidelines on prevention and management.

OVERVIEW: West Nile virus (WNV) is a zoonotic mosquito-borne virus with a broad host range that infects mainly birds and mosquitos, but also mammals (including humans), reptiles, amphibians and ticks. It is maintained in a bird-mosquito-bird transmission cycle. The most important vectors are bird-feeding mosquitos of the Culex genus; maintenance and amplification mainly involve passerine birds. WNV can cause disease in humans, horses and several species of birds following infection of the central nervous system. INFECTION IN CATS: Cats can also be infected through mosquito bites, and by eating infected small mammals and probably also birds. Although seroprevalence in cats can be high in endemic areas, clinical disease and mortality are rarely reported. If a cat is suspected of clinical signs due to an acute WNV infection, symptomatic treatment is indicated.

Streptococcal infections in cats: ABCD guidelines on prevention and management.

OVERVIEW: Streptococcus canis is most prevalent in cats, but recently S equi subsp zooepidemicus has been recognised as an emerging feline pathogen. S CANIS INFECTION: S canis is considered part of the commensal mucosal microflora of the oral cavity, upper respiratory tract, genital organs and perianal region in cats. The prevalence of infection is higher in cats housed in groups; and, for example, there may be a high rate of vaginal carriage in young queens in breeding catteries. A wide spectrum of clinical disease is seen, encompassing neonatal septicaemia, upper respiratory tract disease, abscesses, pneumonia, osteomyelitis, polyarthritis, urogenital infections, septicaemia, sinusitis and meningitis. S EQUI SUBSP ZOOEPIDEMICUS INFECTION: S equi subsp zooepidemicus is found in a wide range of species including cats. It was traditionally assumed that this bacterium played no role in disease of cats, but it is now considered a cause of respiratory disease with bronchopneumonia and pneumonia, as well as meningoencephalitis, often with a fatal course. Close confinement of cats, such as in shelters, appears to be a major risk factor. As horses are common carriers of this bacterium, contact with horses is a potential source of infection. Additionally, the possibility of indirect transmission needs to be considered. DIAGNOSIS: Streptococci can be detected by conventional culture techniques from swabs, bronchoalveolar lavage fluid or organ samples. Also real-time PCR can be used, and is more sensitive than culture. TREATMENT: In suspected cases, treatment with broad-spectrum antibiotics should be initiated as soon as possible and, if appropriate, adapted to the results of culture and sensitivity tests.

Feline injection-site sarcoma: ABCD guidelines on prevention and management.

OVERVIEW: In cats, the most serious of adverse effects following vaccination is the occurrence of invasive sarcomas (mostly fibrosarcomas): so-called 'feline injection-site sarcomas' (FISSs). These develop at sites of previous vaccination or injection. They have characteristics that are distinct from those of fibrosarcomas in other areas and behave more aggressively. The rate of metastasis ranges from 10-28%. PATHOGENESIS: The pathogenesis of these sarcomas is not yet definitively explained. However, chronic inflammatory reactions are considered the trigger for subsequent malignant transformation. Injections of long-acting drugs (such as glucocorticoids, and others) have been associated with sarcoma formation. Adjuvanted vaccines induce intense local inflammation and seem therefore to be particularly linked to the development of FISS. The risk is lower for modified-live and recombinant vaccines, but no vaccine is risk-free. TREATMENT AND PREVENTION: Aggressive, radical excision is required to avoid tumour recurrence. The prognosis improves if additional radiotherapy and/or immunotherapy (such as recombinant feline IL-2) are used. For prevention, administration of any irritating substance should be avoided. Vaccination should be performed as often as necessary, but as infrequently as possible. Non-adjuvanted, modified-live or recombinant vaccines should be selected in preference to adjuvanted vaccines. Injections should be given at sites at which surgery would likely lead to a complete cure; the interscapular region should generally be avoided. Post-vaccination monitoring should be performed.

Lungworm disease in cats: ABCD guidelines on prevention and management.

OVERVIEW: Cardiopulmonary nematodes are emerging parasites of cats in Europe. A number of helminth parasites may be involved. The most prevalent lungworm in domestic cats is Aelurostrongylus abstrusus. Oslerus rostratus and Troglostrongylus species are found mainly in wild cats. The trichurid Capillaria aerophila has a low host specificity and is not uncommon in cats. Additionally the lung flukes Paragonimus species are reported in many species outside of Europe, including cats. CLINICAL SIGNS: Lungworm infections may be asymptomatic, or cause mild to severe respiratory signs, dependent on the worm species and burden; mixed infections are observed. Kittens can be vertically infected and may develop a more severe disease. Affected cats show a productive cough, mucopurulent nasal discharge, tachypnoea, dyspnoea and, in severe cases, respiratory failure and death. MANAGEMENT: Early diagnosis and treatment greatly improves the prognosis. First-stage larvae can be easily detected in fresh faecal samples; the Baermann migration method is the enrichment technique of choice, but takes 24 h. Lungworm larvae can be found in tracheal swabs and bronchoalveolar lavage fluid, but with less sensitivity than in faeces. Molecular methods have been developed that exhibit high specificity and sensitivity, and allow diagnosis in the prepatent phase. Treatment options include fenbendazole paste, milbemycin oxime/praziquantel and various spot-on formulations. Severe cases should receive prompt medical care in an intensive care unit. PREVENTION: Avoiding predation is at present the only preventive measure for pulmonary worms with indirect life cycles. ZOONOTIC RISK: C aerophila has zoonotic potential, causing severe pulmonary disease in humans. Some Paragonimus species are also of zoonotic concern.

Cytauxzoonosis in cats: ABCD guidelines on prevention and management.

OVERVIEW: Cytauxzoon species are apicomplexan haemoparasites, which may cause severe disease in domestic cats, as well as lions and tigers. For many years, cytauxzoonosis in domestic cats was only reported in North and South America, but in recent years the infection has also been seen in Europe (Spain, France and Italy). INFECTION: Cytauxzoon felis is the main species; it occurs as numerous different strains or genotypes and is transmitted via ticks. Therefore, the disease shows a seasonal incidence from spring to early autumn and affects primarily cats with outdoor access in areas where tick vectors are prevalent. Domestic cats may experience subclinical infection and may also act as reservoirs. CLINICAL SIGNS: Cytauxzoonosis caused by C felis in the USA is an acute or peracute severe febrile disease with non-specific signs. Haemolytic anaemia occurs frequently; in some cats neurological signs may occur in late stages. The Cytauxzoon species identified in Europe differ from C felis that causes disease in the USA and are probably less virulent. The majority of infected cats have been healthy; in some cases anaemia was found, but disease as it occurs in the USA has not been reported to date. DIAGNOSIS: Diagnosis is usually obtained by Cytauxzoon detection in blood smears and/or fine-needle aspirates from the liver, spleen and lymph nodes. PCR assays are able to detect low levels of parasitaemia and may be used for confirmation. TREATMENT: Currently a combination of the antiprotozoal drugs atovaquone and azithromycin is the treatment of choice. Concurrent supportive and critical care treatment is extremely important to improve the prognosis. Cats that survive the infection may become chronic carriers for life. PREVENTION: Cats with outdoor access in endemic areas should receive effective tick treatment.

Hepatozoonosis in cats: ABCD guidelines on prevention and management.

OVERVIEW: Hepatozoonosis of domestic cats has been reported in several countries, mainly as a subclinical infection. DISEASE AGENT: Infection has been described mostly in areas where canine infection is present and, in recent years, Hepatozoon felis has been identified as a distinct species by molecular techniques. The vector for feline hepatozoonosis remains unknown and the pathogenesis has not been elucidated. INFECTION IN CATS: Feline hepatozoonosis is mainly a subclinical infection and few cases have been reported with clinical signs. The diagnosis of hepatozoonosis in cats can be made by observation of parasite gamonts in blood smears, parasite meronts in muscles by histopathology, and detection of parasite DNA in blood and tissue by PCR. DISEASE MANAGEMENT: The treatment of choice is not known, but single cases have been treated with doxycycline or oxytetracycline and primaquine. Although the mode of transmission and the type of vector is not known, preventive treatment against blood-sucking vectors (fleas and ticks) is advised.

ABCD: Update of the 2009 guidelines on prevention and management of feline infectious diseases.

OVERVIEW: In this article, the ABCD guidelines published in the JFMS Special Issue of July 2009 (Volume 11, Issue 7, pages 527-620) are updated by including previously unavailable and novel information. For a better picture, the reader is advised to consult that issue before focusing on the novel features.

Prevention of infectious diseases in cat shelters: ABCD guidelines.

OVERVIEW: Recommendations are given in relation to infectious diseases in rescue shelters. The ABCD recognises that there is a wide variation in the design and management of shelters, and that these largely reflect local pressures. These guidelines are written with this diverse audience in mind; they point to the ideal, and also provide for some level of compromise where this ideal cannot immediately be attained. In addition consideration should be given to general requirements in order to optimise overall health and wellbeing of cats within the shelter. HOUSING: Compartmentalisation of the shelter into at least three individual sections (quarantine area for incoming cats, isolation facilities for sick or potentially infectious cats, and accommodation for clinically healthy, retrovirus-negative cats) can facilitate containment of a disease outbreak, should it occur. STANDARD OF CARE: Incoming cats should receive a full health check by a veterinary surgeon, should be dewormed and tested for retrovirus infections (feline leukaemia virus [FeLV] and/or feline immunodeficiency virus [FIV]) in regions with high prevalence and in shelters that allow contact between cats. Cats which are not rehomed should receive a regular veterinary check-up at intervals recommended by their veterinarian. VACCINATION: Each cat should be vaccinated as soon as possible against feline panleukopenia virus (FPV), feline herpesvirus (FHV-1) and feline calicivirus (FCV) infections. HYGIENE: Adequate hygiene conditions should ensure that contact between shedders of infectious agents and susceptible animals is reduced as efficiently as possible by movement control, hygiene procedures of care workers, barrier nursing, cleaning and disinfection. STRESS REDUCTION: Stress reduction is important for overall health and for minimising the risk of recrudescence and exacerbation of infectious diseases. In general, a special effort should be made to rehome cats as soon as possible.

Matrix vaccination guidelines: ABCD recommendations for indoor/ outdoor cats, rescue shelter cats and breeding catteries.

OVERVIEW: This article presents, in a user-friendly, tabluated form, the ABCD's current vaccination recommendations for four broad categories of cats: outdoor cats (ie, those with access outdoors that come into contact with other cats outdoors); indoor cats (ie, those with no contact with other cats from outdoors); rescue shelter cats; and cats in breeding catteries. Note that it is not always possible to make a clear distinction between these various categories and the definition in any individual case is left up to the veterinary surgeon conducting the vaccination interview.

Aujeszky's disease/pseudorabies in cats: ABCD guidelines on prevention and management.

OVERVIEW: Although pseudorabies in swine - Aujeszky's disease - has been eradicated from many pork-producing countries, the virus may still lurk in other vertebrate species and cause feline cases. Infection occurs through the ingestion of uncooked meat and organ material and presents as an acute encephalitis with a short incubation period and a rapidly fatal outcome. The ABCD considers this reason enough to include a review of this, now very rare, condition in this Special Issue.

Cowpox virus infection in cats: ABCD guidelines on prevention and management.

OVERVIEW: The misnomer 'cowpox' has historical roots: cats rather acquire the virus from small rodents. It has a wide host spectrum (including man) and causes skin lesions, predominantly on the head and paws. Progressive proliferative ulcerations in kittens and immunosuppressed cats may take a fatal course. Cat owners should be informed about the zoonotic risk.

Feline viral papillomatosis: ABCD guidelines on prevention and management.

OVERVIEW: Papillomaviruses are epitheliotropic and cause cutaneous lesions in man and several animal species, including cats. INFECTION: Cats most likely become infected through lesions or abrasions of the skin. Species-specific viruses have been detected but human and bovine related sequences have also been found, suggesting cross-species transmission. CLINICAL SIGNS: In cats, papillomaviruses are associated with four different skin lesions: hyperkeratotic plaques, which can progress into Bowenoid in situ carcinomas (BISCs) and further to invasive squamous cell carcinomas (ISCCs); cutaneous fibropapillomas or feline sarcoids; and cutaneous papillomas. However, papillomaviruses have also been found in normal skin. DIAGNOSIS: Papillomavirus-induced skin lesions can be diagnosed by demonstration of papillomavirus antigen in biopsies of skin lesions, or detection of papillomavirus-like particles by electron microscopy and papillomavirus DNA by polymerase chain reaction (PCR). TREATMENT: Spontaneous regression might be expected. In cases of ISCC, complete excision should be considered if possible.