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CASE SUMMARY: A 7-year-old neutered male Siamese cat was referred for investigation of weight loss and hypercalcaemia (3.3 mmol/l; reference interval 2-3 mmol/l). Haematology, serum biochemistry, thoracic imaging, bronchoalveolar lavage (BAL), Ziehl-Neelsen staining of the BAL fluid and interferon gamma release assay (IGRA) were compatible with pneumonia caused by the less pathogenic member of the Mycobacterium tuberculosis complex, that is, M microti (the 'vole bacillus'), which is common in cats in the UK. Treatment with azithromycin, rifampicin and marbofloxacin was given for 2 months, followed by 4 months of azithromycin and marbofloxacin. Treatment recommendations for tuberculous pneumonia have since changed. The cat remained asymptomatic for 1 year but went on to develop M microti pneumonia on five other occasions, and was treated for 6-12 months on each occasion. The patient's clinical signs, hypercalcaemia and radiographic/CT pulmonary pathology always resolved completely, and the IGRA became negative, before antimycobacterial treatment was stopped. This suggests cure followed by reinfection owing to avid hunting behaviour. Alternatively, this could represent recrudescence of dormant disease. This case has previously been included in a study that described a series of cases of feline tuberculosis. RELEVANCE AND NOVEL INFORMATION: This case shows that M microti infection in cats can present as recurrent episodes of pneumonia, even after prolonged treatment courses.
RESUMEN
OBJECTIVES: The aims of this study were to evaluate: owners' perceptions and priorities on the treatment and monitoring of feline diabetes mellitus (DM); the perceived effectiveness of the communication between veterinarians and clients regarding disease management; and the impact DM has on the owners' everyday lives and human-pet bonds. METHODS: An initial questionnaire, then an adapted second questionnaire, were available to owners of cats with DM on vetprofessionals.com . RESULTS: A total of 748 questionnaires were completed. At diagnosis, fewer than half of veterinarians discussed how to recognise unstable diabetes (46%) or home blood glucose monitoring (HBGM) (40%). Owners were disappointed that the importance of diet on diabetic remission/stabilisation and HBGM were not discussed. Only 49% of respondents were supervised by a veterinarian/veterinary nurse while first drawing up insulin and injecting their cat. Websites/online forums that owners found themselves were most useful when learning about their cat's diabetes (76% agreed). Over a third of cats (39%) were not fed a 'diabetic' diet but, impressively, 71% of owners used HBGM. Initial concerns about costs, boarding, the effect on their daily life and potential negative impact on the human-pet bond reduced significantly after initiating treatment (P <0.0001). CONCLUSIONS AND RELEVANCE: Caring for a diabetic cat requires significant owner commitment, plus support by the veterinary team for the owner and their cat. It is difficult to discuss all aspects of this complex disease with the owner in a single consultation; hence, it is important to involve the entire veterinary team in owner education and provide owners with informative material (eg, useful websites, printouts). Understanding owners' priorities, fears, and which monitoring methods have helped others, is paramount to achieve owner compliance and satisfaction, and so improve the health and welfare of diabetic cats. This study provides useful information on the management of feline DM, which can be instrumental in educating future owners.