Incidences of steroid-induced diabetes mellitus and congestive heart failure in cats given non-immunosuppressive doses of methylprednisolone acetate: 1042 cats.

Objective: Corticosteroids are indicated to treat many feline diseases. However, side effects are a limiting factor in their use. The most concerning side effects are steroid-induced diabetes mellitus (SI-DM) and steroid-induced congestive heart failure (SI-CHF). This study aims to determine the incidences of these diseases in a large population of domestic cats seen at a privately-owned, feline-only practice. Animals: Cats in the study were client-owned patients of Alamo Feline Health Center in San Antonio, Texas. Control cats (controls) were examined as part of their routine health care. Procedures: The records of 732 cats that received methylprednisolone acetate (MPA) for various clinical indications were reviewed to determine how many developed SI-DM and SI-CHF. A similar record review of 310 controls was made to determine the incidence of spontaneous diabetes mellitus (Sp-DM) and spontaneous congestive heart failure (Sp-CHF). Control cats never received any oral or injectable corticosteroids. Results: Of the cats that received MPA, 28 developed SI-DM (3.83%) and 6 developed SI-CHF (0.82%). Of the controls, 22 developed Sp-DM (7.10%) and 6 developed Sp-CHF (1.90%). Conclusion: The incidences of developing SI-DM and SI-CHF were 3.83% and 0.82%, respectively; and the risk was not increased even when repeated doses of MPA were given. Clinical relevance: The authors consider the risk-benefit ratio sufficient to justify the use of MPA when it is indicated, especially if another drug cannot be substituted with the same therapeutic results.

Incidences du diabète sucré et de l'insuffisance cardiaque congestive induits par les stéroïdes chez des chats ayant reçu des doses non immunosuppressives d'acétate de méthylprednisolone : 1042 chats. Objectif: Les corticoïdes sont indiqués pour traiter de nombreuses maladies félines. Cependant, les effets secondaires constituent un facteur limitant leur utilisation. Les effets secondaires les plus préoccupants sont le diabète sucré induit par les stéroïdes (SI-DM) et l'insuffisance cardiaque congestive induite par les stéroïdes (SI-CHF). Cette étude vise à déterminer l'incidence de ces maladies dans une large population de chats domestiques vus dans une pratique privée exclusivement féline. Animaux: Les chats de l'étude étaient des patients appartenant à des clients du Alamo Feline Health Center à San Antonio, au Texas. Les chats témoins (témoins) ont été examinés dans le cadre de leurs soins de santé de routine. Procédures: Les dossiers de 732 chats ayant reçu de l'acétate de méthylprednisolone (MPA) pour diverses indications cliniques ont été examinés afin de déterminer combien d'entre eux ont développé du SI-DM et du SI-CHF. Un examen similaire des dossiers de 310 témoins a été réalisé pour déterminer l'incidence du diabète sucré spontané (Sp-DM) et de l'insuffisance cardiaque congestive spontanée (Sp-CHF). Les chats témoins n'ont jamais reçu de corticostéroïdes oraux ou injectables. Résultats: Parmi les chats ayant reçu du MPA, 28 ont développé du SI-DM (3,83 %) et 6 ont développé du SI-CHF (0,82 %). Parmi les témoins, 22 ont développé du Sp-DM (7,10 %) et 6 ont développé du Sp-CHF (1,90 %). Conclusion: Les incidences de développement de SI-DM et de SI-CHF étaient respectivement de 3,83 % et 0,82 %; et le risque n'a pas augmenté même lorsque des doses répétées de MPA ont été administrées. Pertinence clinique: Les auteurs considèrent le rapport bénéfice/risque suffisant pour justifier l'utilisation du MPA lorsqu'il est indiqué, notamment si un autre médicament ne peut lui être substitué avec les mêmes résultats thérapeutiques.(Traduit par Dr Serge Messier).

Loose-control of diabetes mellitus with protamine zinc insulin in cats: 185 cases (2005-2015).

This study evaluated the outcome of cats with diabetes mellitus treated with a loose-control approach using protamine zinc insulin and identified factors that influence the likelihood of remission and survival in these cats. A total of 185 client-owned domestic cats were followed until death, lost to follow-up, or the end of the 11-year study. These cats were treated primarily basing insulin dose adjustments on clinical response. Patient records were used to examine factors suspected of influencing success of diabetes management. The remission probability was 56.2%. Survival time ranged from 0 to 3808 days with a median of 1488 days. Recent pre-diabetic corticosteroid use, lower mean blood glucose concentration during treatment, and lower mean insulin dose significantly increased the likelihood of remission. A low-carbohydrate diet, occurrence of remission, lack of diabetic ketoacidosis at diagnosis, lower mean blood glucose value during treatment, and lower blood glucose value at diagnosis were significantly associated with increased survival time.

Contrôle relâché du diabète sucré à l'aide de l'insuline au zinc de protamine chez les chats : 185 cas (2005­2015). Cette étude a évalué les résultats chez les chats atteints de diabète sucré traités à l'aide d'une approche de contrôle relâché ayant recours à l'insuline de zinc de protamine et a identifié les facteurs qui influencent la probabilité de rémission et de survie chez ces chats. Un total de 185 chats domestiques appartenant à des clients ont été suivis jusqu'à la mort, la perte de suivi ou à la fin de l'étude de 11 ans. Une approche de contrôle relâché et d'insuline au zinc de protamine a été utilisée, surtout sur la base des ajustements de la dose d'insuline en fonction de la réaction clinique. Les dossiers des patients ont été utilisés pour examiner les facteurs soupçonnés d'influencer le succès de la gestion du diabète. La probabilité de rémission était de 56,2 %. Le temps de survie s'échelonnait de 0 à 3808 jours avec une médiane de 1488 jours. L'usage récent de corticostéroïdes prédiabétiques, un taux de glycémie moyen inférieur durant le traitement et une dose d'insuline moyenne inférieure augmentaient significativement la probabilité de rémission. Une diète faible en glucides, l'occurrence de la rémission, l'absence de kétoacidose diabétique, une valeur moyenne inférieure de glycémie durant le traitement et une valeur inférieure de glycémie étaient significativement associées à des temps de survie accrus.(Traduit par Isabelle Vallières).

Impact of preheparinization and sample volume on routine hematology findings in healthy cats.

OBJECTIVES: It can be challenging to collect sufficient blood from feline patients for both a biochemical profile and a complete blood count (CBC). The ability to generate accurate hematologic and biochemical data from a single, small (<2 ml) sample could reduce patient stress and improve clinical efficiency. The objective of this study was to determine the impact of preheparinization and/or sample size on routine hematology findings in cats. METHODS: Blood was collected from 20 healthy cats; measured aliquots were placed directly into tubes containing either EDTA or lithium-heparin (Hep). Within 2 mins, specific volumes were removed from the Hep tubes and placed in additional EDTA tubes. Four distinct sample sizes/types were created from each cat: (1) 1.3 ml EDTA (criterion standard); (2) 0.5 ml EDTA; (3) 1.3 ml Hep + EDTA; and (4) 0.5 ml Hep + EDTA. Three CBCs were performed on each sample using an automated bench-top hematology analyzer. Drops of blood were contemporaneously used to create three air-dried stained slides from each tube. Triplicate results were averaged for statistical analysis; results were compared across all sample types and against the criterion standard. Significance was set at P <0.05. RESULTS: Preheparinization did not significantly impact determinations of erythrocyte number, hematocrit, hemoglobin concentration, mean cell volume and neutrophil count. Platelet counts for the non-traditional samples correlated poorly with the criterion standard, although numbers could be effectively estimated using stained slides. Cell morphology was well preserved across all sample types. CONCLUSIONS AND RELEVANCE: These results indicate that a 0.5 ml preheparinized EDTA blood sample can generate clinically useful hematologic data (excluding platelet count) in cats, using a bench-top analyzer. Our findings support the collection of a single small (<2 ml) sample that can be used for both biochemical and hematologic analyses. Further studies are needed to verify these findings using other hematology machines and in diseased cats.

Pyometra in a 13-year-old neutered queen.

A 13-year-old female domestic shorthair cat was examined because of weight loss over 4 months. The history included being neutered when a kitten and no signs of estrus recognized by the owner since this surgery. A mid-abdominal mass was palpated. Ultrasonographic abdominal evaluation revealed a tubular fluid-filled mass. The cat underwent surgery to remove the mass, which was one horn of the uterus. The patient made a full recovery.

Pretreatment Histoplasma capsulatum urine enzymatic immunoassay concentrations do not correlate with outcome but may be influenced by renal function in cats with histoplasmosis.

OBJECTIVES: The objective of this study was to determine if urine Histoplasma antigen (HAg) enzyme immunoassay (EIA) concentrations at the time of diagnosis and prior to the administration of antifungal agents are predictive of outcome for cats infected with Histoplasma capsulatum and to determine if compromised renal function affects urine HAg EIA measurements. METHODS: Medical records at four institutions were searched to identify cats diagnosed with histoplasmosis between April 2012 and December 2015. Pretreatment urine Histoplasma EIA values were recorded, along with patient signalment, serum creatinine concentration, urine specific gravity, site(s) of infection and survival data. RESULTS: Pretreatment urine HAg EIA measurements were available for 50 cats, and ranged from 0-19.1 ng/ml (median 6.3 ng/ml). Thirty-five cats were alive at day 180, 12 had died or were euthanized (median survival time 24 days; range 2-124 days) and three were lost to follow-up. The median urine HAg EIA at the time of diagnosis for cats alive at 6 months was 5 ng/ml (range 0-19.1); this was similar to findings for the non-survivors (median 7.29 ng/ml; range 0.78-19.1; P = 0.54). Surviving cats were significantly younger (mean age 6.9 years) than non-survivors (mean age 9.9 years; P = 0.03) but median body weights (3.8 kg vs 3.6 kg) and rates of pulmonary involvement (22/35 vs 9/12) were similar for the two groups. Median urine HAg EIA concentration was lower in cats with evidence of renal compromise than cats with acceptable renal function (0.54 ng/ml vs 7.2 ng/ml; P <0.013). CONCLUSIONS AND RELEVANCE: Urine HAg EIA concentrations at the time of diagnosis are not predictive of outcome in cats with histoplasmosis and should not be used as a prognostic indicator in this species. Renal function may influence urine HAg EIA concentrations in cats; further investigation is needed to see if concurrent kidney disease impacts test sensitivity.

Safety of Benazepril in 400 Azotemic and 110 Non-Azotemic Client-Owned Cats (2001-2012).

This retrospective study examined cats after initiation of benazepril therapy to determine the frequency of systemic hypotension or elevations in serum creatinine and/or potassium. Medical records review identified azotemic and non-azotemic cats prescribed benazepril. Blood pressure was recorded at the first available time after initiation of therapy. No cats experienced documented systolic systemic hypotension (<90 mmHg). Serum creatinine, and potassium when available, were recorded at baseline and in time windows after initiation of treatment: 1-30 days and 31-60 days. Blood chemistry results were screened for hyperkalemia (≥6.0 mEq/L). During the first 2 mo after starting benazepril therapy, there was a low incidence (3.7%) and clinically insignificant magnitude of hyperkalemia. Serum creatinine increases of greater than 30% from baseline were noted. This change was found in 11.0% of cats during the first 30 days of therapy and in 13.7% of cats from days 31-60 after initiation of therapy. The long-term survival of the cats that had >30% increases in creatinine from baseline was not statistically different from the survival of those that did not experience these increases, which suggests this finding may not be a reason to discontinue therapy. Benazepril appeared safe in a heterogeneous population of cats.

Reduced susceptibility to fluconazole in a cat with histoplasmosis.

CASE SUMMARY: An 11-year-old neutered male domestic longhair cat was diagnosed with histoplasmosis from fine-needle aspirates of an abdominal lymph node. Lymph node size initially decreased with fluconazole therapy (11.8 mg/kg PO q12h); however, after 13 months of continuous fluconazole therapy, lymphadenomegaly worsened and samples were collected for culture and antifungal susceptibility. The Histoplasma capsulatum isolate had a very high fluconazole minimum inhibitory concentration (MIC) of 64 µg/ml and an itraconazole MIC of 0.06 µg/ml. The owner declined a change to itraconazole and, ultimately, the cat developed neurologic signs and was euthanized. Owing to the initial response to fluconazole followed by treatment failure and high MIC value, acquired fluconazole resistance was suspected. Clinical breakpoints for fluconazole for the dimorphic fungi are not available to define true antifungal resistance. RELEVANCE AND NOVEL INFORMATION: This is the first published report of reduced susceptibility to fluconazole in a cat being treated for histoplasmosis. Fluconazole failure and increases in MIC between pretreatment and long-term treatment isolates are known to occur in humans with histoplasmosis. Practitioners should be aware of this possibility when treating cats with fluconazole (particularly in cases with long-term [>1 year] fluconazole therapy or in cases with disease recrudescence).

Prevalence and underlying causes of histologic abnormalities in cats suspected to have chronic small bowel disease: 300 cases (2008-2013).

OBJECTIVE: To determine prevalence of histologic abnormalities in cats suspected, on the basis of compatible clinical signs and ultrasonographic findings, to have chronic small bowel disease; identify the most common underlying causes in affected cats; and compare methods for differentiating among the various causes of chronic small bowel disease. DESIGN: Retrospective case series. ANIMALS: 300 client-owned domestic cats suspected to have chronic small bowel disease. PROCEDURES: Medical records were reviewed to identify cats evaluated because of chronic vomiting, chronic small bowel diarrhea, or weight loss that also had ultrasonographic evidence of thickening of the small intestine. Cats were included in the study if full-thickness biopsy specimens had been obtained from ≥ 3 locations of the small intestine by means of laparotomy and biopsy specimens had been examined by means of histologic evaluation and, when necessary to obtain a diagnosis, immunohistochemical analysis and a PCR assay for antigen receptor rearrangement. RESULTS: Chronic small bowel disease was diagnosed in 288 of the 300 (96%) cats. The most common diagnoses were chronic enteritis (n = 150) and intestinal lymphoma (124). CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that a high percentage of cats with clinical signs of chronic small bowel disease and ultrasonographic evidence of thickening of the small intestine had histologic abnormalities. Furthermore, full-thickness biopsy specimens were useful in differentiating between intestinal lymphoma and chronic enteritis, but such differentiation was not possible with ultrasonography or clinicopathologic testing alone.

Diagnosis of chronic small bowel disease in cats: 100 cases (2008-2012).

OBJECTIVE: To determine whether a diagnosis of chronic small bowel disease could be established in a subset of cats that had clinical signs of chronic vomiting, chronic small bowel diarrhea, weight loss, or a combination of these, combined with ultrasonographically determined thickening of the small bowel. DESIGN: Retrospective case series. ANIMALS: 100 client-owned domestic cats. PROCEDURES: Medical records of cats with clinical signs of chronic vomiting, chronic small bowel diarrhea, weight loss, or a combination of these, combined with ultrasonographically determined small bowel thickening, that underwent laparotomy and multiple small bowel biopsies between 2008 and 2012 were examined. Biopsy specimens were submitted for histologic evaluation, immunohistochemical evaluation, and, when findings were ambiguous, PCR assay for antigen receptor rearrangement. RESULTS: Chronic small bowel disease was diagnosed in 99 of the 100 cats. The most common diagnoses were chronic enteritis and intestinal lymphoma. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that cats with clinical signs of chronic small bowel disease should undergo detailed diagnostic testing because they are likely to have clinically important, diagnosable, treatable disease. Clinical signs of small bowel disease, especially weight loss and chronic or recurrent vomiting, are extremely common in cats. These signs should not be considered a normal condition and should not be ignored, regardless of common explanations given by owners, and cats with these signs should undergo appropriate diagnostic testing.

Retrobulbar thrombus in a cat with systemic hypertension.

This report describes a 14-year-old neutered male Norwegian Forest cat that was evaluated for a complaint of inappetence, lethargy, and ocular protrusion with third eyelid prolapse. The systemic blood pressure was elevated at 205/129 mmHg. Fundic examination revealed severe retinal hemorrhage in both eyes. Based on an ultrasound study of the retrobulbar area, a thrombus caudal to the right globe was suspected. Over 18 days, the cat exhibited significant clinical improvement as well as good blood pressure control. To our knowledge this is the first report of a retrobulbar thrombus in a cat with systemic hypertension.