5.00, $9.00, 7.

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Melchizedek publications www.catvirus.com

If you print this book out please do so on recycled paper!

Cover photos feline calicivirus ulcer on tongue unilateral conjunctivitis typical of early Chlamydophila felis infection feline chronic lymphocytic plasmacytic gingivostomatitis

Diane D. Addie PhD BVMS MRCVS

Sep 2006

Contents
Page Introduction . Feline calicivirus.. Feline chronic gingivostomatitis .. ... Feline herpesvirus (viral rhinotracheitis).. Chlamydophila felis.. Bordetella bronchiseptica .. Avian influenza virus H5N1 .. Poxvirus Feline coronavirus .. Haemophilus felis Aelurostrongylus abstrusus .. Mycoplasma felis Corynebacterium spp . Cryptococcus spp ... Capillaria aerophila . Cuterebra larval migrans Differential diagnoses acute oral ulceration chronic gingivostomatitis.. chronic rhinitis .. conjunctivitis . coughing fading kittens . bronchopneumonia of kittens . Preventing respiratory infection hygiene . barrier nursing good building design .. cat breeders cat rescuer/shelter boarding cattery . Recommended laboratories .. Useful contact details and websites Index . 4 4 7 10 13 16 17 19 19 19 19 20 20 20 21 21 22 22 22 22 23 23 23 24 25 25 25 25 27 27 27 28 30 31

Introduction
The major feline upper respiratory tract (URT) infections are: Feline calicivirus Feline herpesvirus Chlamydophila felis Bordetella bronchiseptica Mycoplasma felis Less common infectious causes of URT signs in the cat: Poxvirus (cat pox) Haemophilus felis Aelurostrongylus abstrusus Corynebacterium spp (conjunctivitis) Cryptococcus spp Capillaria aerophila Avian bird flu (H5N1)
I am pleased to present the first edition of Feline Infectious Upper Respiratory Disease for veterinary surgeons. The purpose of this book is to present you with everything you might require to know about feline infectious upper respiratory disease in an easily accessible format. Infectious diseases of the lower respiratory tract are outwith the scope of this book at this stage, as are non-infectious causes, though they will be briefly mentioned in the section on differential diagnoses. These may be added later or be the subject of another book, if there is any demand for it. There will soon be a sister book written for non-veterinarians, which you may find useful for your clients and veterinary nurses (technicians) and a book is planned specifically for cat breeders. I am keen for feedback and any suggestions on how the book can be made better will be welcomed. My email address is register@dr-addie.com

Feline calicivirus (FCV)

Feline calicivirus (FCV) is a small, unenveloped, positive strand RNA virus belonging to
the Vesivirus genus. RNA viruses are more prone to mutations than DNA viruses and FCV exists in each cat as a quasispecies (a cloud of viruses with slightly differing genomes and therefore antigenicity). Quasispecies variation is greatest where there are many cats, for example, in boarding and rescue catteries, and in these environments mutants with unusual clinical manifestations are most likely to appear first.

Virus shedding: in oropharyngeal secretions, shedding is continuous. Half life of 75

days.

Transmission: mainly direct, but FCV is slightly more robust than FHV and can survive up
to 7 days in the environment so fomite transmission is possible. It is susceptible to bleach.

Clinical signs of FCV infection

The majority of cats who shed FCV are asymptomatic.

Cat flu: FCV is less severe than feline herpesvirus (FHV) infection, but nevertheless causes cat flu in kittens over 2-3 weeks old and adult cats. FCV commonly causes lingual ulceration, sneezing, anorexia, depression and oculonasal discharge. Fading kittens: if kittens are infected soon after birth they may die, post mortem shows thymic atrophy, congested lungs, the body will probably be underweight for the kittens age. FCV is found in almost 100% of cases of feline chronic gingivostomatitis, though its role in the aetiology of the condition is controversial (see below). Other signs associated with FCV: shifting lameness (especially some vaccines implicated). Acute haemorrhagic diarrhoea, outbreaks in the USA and UK presented with jaundice and oedema, 40% mortality. Dr Kate Hurley, University of California, is an expert in this.

Diagnostic testing: the relative fragility of RNA and the variability of the RNA genome of FCV strains renders polymerase chain reaction (PCR) testing more complex than with other organisms: the RNA may get degraded by ubiquitous RNA-ases before the test can be performed (resulting in false negative results) and there is the possibility that the primers used will miss some isolates which are genetically different from the strain the primers were based upon (again resulting in false negative results). In qPCR this is even more of a problem as both the primers and probe must match the target cDNA (DNA copy of the RNA genome) very closely. Therefore virus isolation is probably still the gold standard test. However, there exist cats who shed very low levels of FCV and these cats can be difficult to detect by virus isolation, so 3 tests at intervals of a week to a month are required to be confident that an infected cat has ceased to shed virus. Treatment of FCV infection
Treatment is essentially symptomatic and supportive. Supportive treatment of cats with flu is vital: the cat should be tempted to eat with small but frequent portions of aromatic foods such as sardines, roast chicken or liver. In order to clear the nasal passages it is beneficial to the cat if he can be confined to a steamy bathroom for an hour each day. Vick Vaporub can be applied to the chin or a few drops of eucalyptus oil put on the cat's bedding. The cat should be cleaned gently with a cloth and warm water (especially if he can no longer groom himself) and kept warm until dry. Cats with ocular discharge should have their eyes bathed three or four times a day with a warm solution of salt and water, using one teaspoonful of ordinary table salt (sodium chloride) in one pint (half a litre) of water.

Feline interferon omega 1 MU/kg s/c for up to 5 days - can be life saving for cats with acute cat flu. Broad spectrum antibiotics should also be given (doxycycline preferably, unless tooth colour is important) to cover secondary bacterial disease.

Treatment of feline chronic gingivostomatitis is given below.

Prevention of FCV infection

FCV vaccination may ameliorate clinical signs, but does not prevent asymptomatic carrier states. Vaccines are given at 8 or 9 and 12 weeks of age, with a booster at 1 year and thereafter every 3 years if you are following AAFP recommendations.

Virus neutralising antibodies to the F9 strain included in many vaccines do not protect against the majority of field strains. Although Fort Dodge claim that their FCV strain (strain 255) covers over 90% of field strains, a published paper placed the figure nearer 55%. A bivalent vaccine was introduced by Merial in 2005 containing two new strains, G1 and 431. It is possible that this vaccine will offer more cross-protection than other vaccines (Poulet et al, 2005).

Table 1 FCV strains in vaccines Vaccine Nobivac Tricat Katavac CHP Katavac Eclipse Fevaxyn Pentofel Felocell CVR Quantum cat CVRP Purevax RC Eurifel RC Feline Ultranasal Manufacturer Intervet Fort Dodge Fort Dodge Fort Dodge Pfizer Schering Plough Merial Merial Heska FCV strain(s) F9 2113 2113 255 F9 F9 G1, 431 255 ? Route admin s/c s/c s/c s/c s/c s/c s/c s/c i/n Comments live live live inactivated live live antigens inactivated live new FCV strains only available in USA (strain info from VMD) (strain info from VMD)

(The only way Ive found of accessing the Veterinary Medicines Directorate files on these products is to do a Google search, put in the product name, and the words Summary Product Characteristics this will often give you information you cant find in the NOAH compendium.) FCV control for cat breeders: test breeding queens by virus isolation or RT-qPCR from an oropharyngeal swab. FCV is shed continuously, so if the test is sensitive enough, a negative result is truly negative. Shedding half-life is 75 days. Separate positive and negative cats and retest after 2-3 months, when half of the cats which were positive should now be negative. Repeat until the whole colony is negative, possibly rehoming any persistent shedders. Preferably breed using only negative queens. If not possible, maternally derived antibody (MDA) lasts up to 2-3 weeks, so kittens can be early weaned and kept in isolation from infected individuals. An intra-nasal vaccine has been introduced by Heska in the USA and may come to the UK if so, it could be used on young kittens to try to prevent infection when MDA wanes. Quarantine: serious cat breeders should try to prevent this virus from entering their household by testing all new cats and prospective mates of their cats before admitting them into their premises. Disinfection: use bleach diluted 1:32 in water with washing up liquid to disinfect.

Chronic feline lymphocytic plasmacytic gingivostomatitis

Feline gingivostomatitis (FGS) is a painful inflammatory condition of the gums and mucosa lateral to the palatoglossal folds of unknown - but likely multifactorial - aetiology that is frequently refractory to treatment. However, it is probably caused by combination of feline calicivirus (FCV) infection and the cat's inappropriate immune reaction within the stomatitis lesions (shift from normal Th type 1 response (cellular) to a mixed Th type 1 and 2 (humoral) response. (Harley et al, 1999). Feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV) have both been linked with the condition, but in my last two small studies,the incidence of these viruses was no more than in the general cat population in the UK. In humans, chronic gingivostomatitis can be due to intolerance to food ingredients (e.g cinammon) or additives, especially those of chewing gum or the fizzy Scottish drink, Irn Bru. Just before Lucky, the cat described in the case report below, dramatically improved, his food had been changed to the additive-free Classic Cat Food. We believe that the food change aided his recovery and have several anecdotal reports from veterinary surgeons of similar responses to this food. The teeth of these cats are often perfectly healthy, without tartar. In my last FGS study, we noticed an abnormal amount of aggression amongst the FGS patients, which we attributed to the pain the cats were in their behaviour and demeanour often improved once treatment began.

Diagnosis of FGS
Definitive diagnosis of feline chronic lymphocytic plasmacytic gingivostomatitis is by biopsy. Diagnosis of feline calicivirus can be performed with an oropharyngeal swab. Virus isolation is still the diagnostic test of choice for this virus because of genetic variability of the virus (so some reverse-transcriptase polymerase chain reaction (RT-PCR) tests will give false negative results). However, virus isolation is not available in all countries. Get three negative tests a month apart before declaring the cat FCV free.

Treatment of FGS
The treatment with the highest reported success rate for this condition remains complete removal of all teeth and especially the roots by a specialised veterinary dentist (see list of veterinary dentists below). A good veterinary dentist can achieve cure rates as high as 7080%. However, this procedure is not without risk: Smith et al (2003) report penetration of the eyeball in 3 cats and 2 dogs following dentistry, with subsequent loss of the eye. And of course general anaesthetics always carry a risk. Not surprisingly, many owners would prefer to try conservative treatment first. Conservative treatment is aimed at using a non-allergenic food, restoring normal mouth flora (healthy cat's mouths have predominantly Pasteurella multocida, 50% of cats with stomatitis have spirochaetes); trying to eliminate FCV; and shifting the immune response back to type 1. For the latter, avoid corticosteroids, but a non-steroidal anti-inflammatory safe for use in the cat (e.g. Metacam or Ketofen). Thalidomide is ideal, since it is safe, anti-inflammatory, and

shifts the immune response from Th1 to Th2, but it is now virtually impossible for veterinary surgeons to source. Corticosteroids are absolutely contraindicated because of the high rate of diabetes mellitus development following long term therapy, the risk of obesity and because whilst they appear to help the cat initially, there is a bounce-back effect - with the cat re-presenting with worse clinical signs than initially and requiring higher and higher doses just to maintain. Corticosteroids cause thinning of the epithelium and suppress both humoral and cellmediated immunity, reducing the cat's chance of clearing the infection. The treatment I currently recommend is as follows: meloxicam (Metacam, Boehringer, continually, or until complete healing), Antirobe for 6 weeks (or on alternative weeks - week on, week off), Classic cat food (continually or until complete healing), 1MU Virbagen Omega per kg every other day subcutaneously for 5 injections, thereafter monitor clinical progress and give injections as required. Individual cats require differing regimes of Virbagen Omega injections - some every other day, others only once a week, others recover completely and no longer require injections. Submucosal injections of Virbagen Omega are reported to give good results. See below for more details.

Food is a very important feature in this condition, prior to the recovery of one case (the cat shown in the photo above), the cat had been changed to Classic Cat Food (Addie et al, 2003). Most affected cats improve on Classic Cat Food (a tinned and pouch food made by Butcher's, available in Safeway, Pets at Home and other supermarkets and pet food shops in the UK) and meloxicam (Metacam, Boehringer) alone. In addition, after dentistry, cats fed on Hills a/d diet gained more weight and had smaller lesions than those fed on a control diet (Theyse et al, 2003). We currently recommend a change to either of these foods for cats suffering from this condition. For local suppliers of Classic food or for buying in bulk, phone Butchers on 01788 823711. I am often asked what can people use in countries which do not have Classic food, or for cats who do not like Classic. Other foods which MAY be all right, but I have no actual experience of using them in these cases, are: 1. Applaws natural cat food this has no additives. Phone Roger Coleman on 08707 508 606 for a sample. Their website is still under construction, but should be www.applaws.co.uk 2. Royal Canin hypoallergenic diet constructed from soy protein. I would be keen to hear from any veterinarians who have experience of using these foods to control feline chronic gingivostomatitis or who would like to work with me on a field based controlled study to establish the most effective food. This study would entail selecting similar cases, matching them according to severity of their mouths, and feeding one group on one diet, and another group on another diet, maintaining both groups on exactly the same regime in terms of dentistry, antibiotics, anti-inflammatories and monitoring feline calicivirus shedding, clinical score (using a questionnaire at each clinical examination) and digital photography. Please contact me by email (register@catvirus.com) if you are interested in taking part. Unfortunately I have no funding for this study. Cats undergoing dental surgery: Antirobe before and after the dental. Submucosal injections of feline interferon omega (Virbagen Omega, Virbac) are reported to give good results. Hills a/d immediately after dental surgery, for about 3 weeks, then Classic cat food. Meloxicam (Metacam) if kidney function and hydration OK. A case study of this technique by Dr Guy Camy is available on the internet: (http://vetinterferon.nexenservices.com/aff_abstract.php?id=99&lang=eng)

Cats not undergoing dental surgery: The treatment we currently recommend is as follows: Metacam (continually, or until complete healing), Antirobe for 6 weeks, Classic cat food (continually or until complete healing). Interferon (Virbagen Omega) by s/c injection.

Drug doses in FGS treatment

Feline interferon omega Subgingival use: A dose of 1 million units (0.2ml of a 5 million unit vial, 0.1ml of a 10 million unit vial) locally into the junction between healthy gum and diseased gum given when the cat is anaesthetised has been reported to have excellent results. However, some cats require more than one treatment and if they are poor anaesthetic risks an alternative may be preferable. Normal use: 1million units Virbagen Omega per kg every other day subcutaneously for 5 injections, thereafter monitor calicivirus shedding and reduce frequency of injections until cat stops shedding FCV or until a comfortable state has been achieved. Reconstituted solution can be kept in the fridge for up to 3 weeks, or can be kept frozen for longer. Antirobe (clindamycin) 5mg/kg bid for 6 weeks Metacam Day 1: 0.3mg/kg sid with food Days 2-7: 0.1mg/kg sid with food

or Ketofen 1mg/kg sid per os for 5 days

Vaccination: never use a live FCV to vaccinate these cats, even after full recovery.

Recommended referral veterinary dentists

If you would like to be added to this list, please contact me by emailing register@draddie.com, giving a brief description of your experience of treating FGS. Pete Southerden Eastcott Veterinary Clinic 6, Clive Parade Cricklade Rd Swindon SN2 1AJ UK

Cecilia Gorrel Tel: personal assistant, Sue, on 02380 891900 www.doctoothfairy.com Runs a dental clinic at Cedar Vet Group 81 Victoria Road Ferndown Dorset BH22 9HU UK Phone: 01202 861622 Fax: 01202 861622 www.cedarvets.com

References and further reading on FCV and FGS

Watch my website for up to date developments: www.catvirus.com/stomatitis.html
Addie D.D., Radford A., Yam P., Taylor D.J. 2003 Cessation of feline calicivirus shedding coincided with resolution of clinical signs in a case of chronic lymphocytic plasmacytic gingivostomatitis. Journal of Small Animal Practice. 44 (4) 172-176 Clay S, Maherchandani S, Malik YS, Goyal SM. 2006 Survival on uncommon fomites of feline calicivirus, a surrogate of noroviruses. Am J Infect Control. 34(1):41-3 Gaskell RM, Dawson S, Radford A. Feline respiratory disease. 2006 Infectious Diseases of the Dog and Cat. Third Edition. Editor: Greene, Craig. Saunders Elsevier. 11830 Westline Industrial Drive, St Louis, Missouri 63146. 145-154 Harley R, Helps CR, Harbour DA, Gruffydd-Jones TJ, Day MJ. 1999 Cytokine mRNA expression in lesions in cats with chronic gingivostomatitis. Clinical and Diagnostic Laboratory Immunology. 6 4 471478 Lauritzen A., Jarrett O., Sabara M. 1997. Serological analysis of feline calicivirus isolates from the United States and United Kingdom. Veterinary Microbiology. 56 55-63 Malik YS, Maherchandani S, Goyal SM. 2006 Comparative efficacy of ethanol and isopropanol against feline calicivirus, a norovirus surrogate. Am J Infect Control. ;34(1):31-5. Pesavento PA, MacLachlan NJ, Dillard-Telm L, Grant CK, Hurley KF. 2004 Pathologic, immunohistochemical, and electron microscopic findings in naturally occurring virulent systemic feline calicivirus infection in cats. Vet Pathol. 41(3):257-63. Poulet H, Brunet S, Leroy V, Chappuis G.Immunisation with a combination of two complementary feline calicivirus strains induces a broad cross-protection against heterologous challenges. Vet Microbiol. 2005 Mar 20;106(1-2):17-31 Radford AD, Bennett M, McArdle F, Dawon S, Turner PC, Glenn MA, Gaskell RM. 1997. The use of sequence analysis of a feline calicivirus (FCV) hypervariable region in the epidemiological investigation of FCV related disease and vaccine failures. Vaccine 15 12-13 1451-8 Schorr-Evans EM, Poland A, Johnson WE, Pedersen NC. 2003 An epizootic of highly virulent feline calicivirus disease in a hospital setting in New England. J Feline Med Surg. Aug;5(4):217-26. Smith MM, Smith EM, La Croix N, Mould J. Orbital penetration associated with tooth extraction. J Vet Dent. 2003 Mar;20(1):8-17. Theyse LFH, Logan EI, Picavet P. 2003. Partial extraction in cats with gingivitis-stomatitis-pharyngitis complex beneficial effects of a recovery food. Proceedings Hills European Symposium on Oral Care. Amsterdam 2003 64-65 Veterinary Clinics of North America. 1992 Feline Dentistry 22 www.catvirus.com

Feline herpesvirus
Feline herpesvirus (FHV, sometimes called FHV-1) or feline viral rhinotracheitis virus, is an alpha-herpesvirus with double stranded DNA genome and glycoprotein lipid envelope. Being a DNA virus, there is little variability and essentially only one strain exists (FHV-2 turned out to be a laboratory contaminant!!!). This genetic and antigenic conformity means that there is not much to choose between available vaccines, and that PCR and qPCR are relatively easy (compared with FCV anyway!). The virus is relatively fragile, lasting only up to 18 hours in a damp environment, less in dry conditions.

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Virus shedding: virus is shed in oropharyngeal and ocular secretions within 24 hours of infection and shedding of infectious virus lasts up to 3 weeks, FHV-specific DNA can sometimes be detected up to 80 days post-infection. Over 90% of cats have been exposed to FHV and 80% of exposed cats become persistently infected for life, shedding virus intermittently. The virus becomes latent in the trigeminal ganglia, an immune-privileged site, and the virus does not produce many viral proteins, an additional way of hiding from the immune system. Viral shedding occurs about a week following corticosteroid or cyclosporin A treatment or stress, and usually lasts between hours and 1-2 weeks. Examples of stress in a cat: being rehomed, moving house new additions to house: baby, dog, cat too many cats in one house (over 6) going into cattery surgery or trauma (e.g. RTA) intercurrent illness pregnancy, parturition, lactation In a very nice study by Prof. Niels Pedersen, cats were swabbed at entry to a rescue cattery: 5% were shedding FHV on day of entry. A week later, 50% were shedding FHV and the majority of this viral shedding was attributed to latent viral reactivation due to stress, rather than to becoming infected for the first time.

FHV transmission: mainly direct, FHV can only survive up to 12-18 hours in the environment, fomite transmission is possible only within a household. FHV clinical signs: a more severe infection than FCV. Typical cat flu signs: sneezing, anorexia, depression, oculonasal discharge and pneumonia and death. FHV is the main cause of neonatal ophthalmitis: kittens which survive to 14 days may have very swollen eyes, with corneal ulceration or even ruptured eyeballs (see photograph below) under their still closed eyelids. Surviving affected kittens can be left with lifelong chronic sinusitis.
Fading kittens - post mortem shows thymic atrophy, congested lungs, the body will probably be underweight for the kittens age. Histopathology shows acidophilic intranuclear inclusion bodies. FHV infection should always be suspected in cats with recurrent clinical signs such as conjunctivitis and chronic sinusitis, especially when there is a history of stress a few days prior to onset of clinical signs. Ocular manifestations of FHV: corneal ulceration (see photograph) symblepharon uveitis eosinophilic keratitis stromal keratitis corneal sequestrum keratoconjunctivitis sicca chronic or recurrent conjunctivitis

Dendritic ulcers caused by FHV can be visualised with a vital stain such as Rose Bengal.

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FHV diagnosis
Oral or conjunctival swab, corneal scrape, or lung from dead kitten submitted for virus isolation or PCR. If sending lung from a faded kitten, put some into 10% formol saline for histopathological examination for intranuclear inclusion bodies. Remember that FHV shedding is intermittent, so while a positive result is definitely positive, a negative result may simply mean that you have missed the shedding time. Try to time swabbing to be either at the beginning of the animal being symptomatic, or a few days to a week after stress occurring.

Recommended laboratory for FHV qPCR University of Langford Veterinary Diagnostics School of Clinical Veterinary Science, Langford House, Langford, Bristol, BS40 5DU Tel: 0117 928 9412 Fax: 0117 928 9613 www.bris.ac.uk/acarus

FHV treatment
Human anti-herpesvirus drugs are NOT recommended for use in the cat as they can be toxic and usually dont work. Cat flu supportive treatment is vital, the cat should be tempted to eat with small but frequent portions of aromatic foods such as sardines, roast chicken or liver. In order to clear the nasal passages it is beneficial to the cat if he can be confined to a steamy bathroom for an hour each day. Vick Vaporub can be applied to the chin or a few drops of eucalyptus oil put on the cat's bedding. The cat should be cleaned gently with a cloth and warm water, especially if he can no longer groom himself, and kept warm until dry. Cats with ocular discharge should have their eyes bathed three or four times a day with a warm solution of salt and water, using one teaspoonful of ordinary table salt (sodium chloride) in one pint (half a litre) of water.

Feline interferon omega 1 MU/kg s/c can help to turn these cats around. Broad spectrum antibiotics should also be given (doxycycline preferably, unless tooth colour is important) to cover secondary bacterial disease.

Ocular disease One of the best accounts Ive read of the use of FHV anti-virals was on the website of Zigler Veterinary Professional Corporation (www.eyevet.info/herpes.html), so Ive reproduced it here: Three antiviral medications are available. Idoxuridine (IDU) interferes with viral DNA synthesis by substituting for the essential nucleotide thymidine. IDU is poorly soluble and is virostatic. Prolonged contact with the infected tissue is required. The 0.1% solution must be applied five times daily. IDU is marketed as Stoxil (Smith Kline & French) and Herplex (Allergan Pharmaceuticals). Adenine Arabinoside inhibits viral DNA polymerase and thus decreases viral DNA synthesis. It is sold as Vira A (Parke Davis) and the 3% ointment is applied five times daily. Triflurothymidine is incorporated into the viral DNA and leads to the synthesis of defective proteins. Sold as Viroptic (Burroughs Wellcome) it is considered the most effective, least toxic and most soluble of the antivirals. It is also the most expensive. Available as a 1% solution, Viroptic is applied every two hours while the animal is awake until the cornea has re-epithelialized, then reduced to every four hours while awake, for two weeks more. Acyclovir is the newest antiviral available for human herpesvirus. It is a tablet given orally and is marketed under the trade name Zovirax (Burroughs Wellcome). Research by Nasisse indicates that triflurothymidine is the most effective against Feline Herpesvirus followed by Idoxuridine then Adenine Arabinoside. Although Acyclovir was most effective

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against Human herpes simplex virus, it was not effective against Feline Herpesvirus. This may be due to the inability of FHV-1 to induce deoxycytidine kinase. Trifluorothymidine ointment requires a special import licence in the UK and can sometimes be obtained from veterinary ophthalmologists. Feline interferon omega has also been used topically for FHV-associated ocular disease (Jongh, 2004): a 5MU vial is diluted in 9ml of 0.9% NaCl and used as eye drops. 2 drops are instilled in each eye 5 times a day for 10 days. Chronic sinusitis: antibiotics for long periods often helps, feline interferon omega at 50,000 i.u. per day orally l-lysine (see below) L-lysine: 250mg orally sid helps prevent successful FHV viral particle assembly. L-lysine competes with arginine which is essential for the capsid protein of the herpesvirus. A palatable paste form called Enisyl-F is made by Vetoquinol. In the UK, if you have difficulty sourcing Enisyl-F, contact Barry Dallas at Vetoquinol, on 01280-814500 or email: BarryDallas@vetoquinol.co.uk

FHV prevention
Vaccination ameliorates clinical signs but doesnt prevent infection or development of latency. Cats entering a disease-free colony should be quarantined for 3 weeks and virus detection attempted at least twice a week before being allowed to mix with the other cats. Vaccination does not prevent induction of a carrier state, so a carrier cat may never have shown clinical signs. Clean contaminated food bowls, etc. using bleach diluted 1:32 in water with washing up liquid to disinfect. FHV is likely responsible for many outbreaks of cat flu in fully vaccinated cats in boarding and rescue catteries, when stress reduction, rather than vaccination regime or hygiene, may be indicated. Test breeding queens by virus isolation or PCR from an oropharyngeal swab but bear in mind that FHV shedding is intermittent and occurs post-stress. Use the feature of virus reactivation by stress to advantage: stress carrier queen 2-3 weeks prior to kittening by moving her into her kittening room. This will cause viral recrudescence before the kittens are born, so shedding will be stopped when they are born. It will also boost her antibodies, giving the kittens increased MDA and a longer period of protection. Disinfection - susceptible to most disinfectants.

Risk to other species

FHV is completely different from human and canine herpesvirus infections and there is absolutely no risk from a FHV infected cat. As a DNA virus, the risk of mutation leading to species jump, whilst not impossible, is unlikely.

References and further reading:

D.J. Maggs 2001 Update on the diagnosis and management of feline herpesvirus-1 infection. Consultations in Feline Internal Medicine 4. Editor John August Johnson LR, Foley JE, De Cock HE, Clarke HE, Maggs DJ. 2005 Assessment of infectious organisms associated with chronic rhinosinusitis in cats. J Am Vet Med Assoc. 227(4):579-85. Johnson LR, De Cock HE, Sykes JE, Kass PH, Maggs DJ, Leutenegger CM. 2005 Cytokine gene transcription in feline nasal tissue with histologic evidence of inflammation. Am J Vet Res. 66(6):9961001.
H

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Johnson LR, Maggs DJ. 2005 Feline herpesvirus type-1 transcription is associated with increased nasal cytokine gene transcription in cats. Vet Microbiol. 108(3-4):225-33. Jongh O. 2004 A cat with herpetic keratitis (primary stage of infection) treated with a feline omega interferon. Veterinary Interferon Handbook. Editor Karine de Mari. Published by Virbac. 138-147 S.E.Andrew Ocular manifestations of feline herpesvirus. JFMS 2001 3 9-16 www.eyevet.info/herpes.html

Further information for cat owners

Questions frequently asked by cat guardians are available on the respiratory page of www.catvirus.com. An e-book for cat breeders will shortly be available from www.catvirus.com Cat flu leaflets for owners can be obtained from Cats Protection or downloaded from their website (www.cats.org.uk).

Chlamydophila felis
Chlamydophila felis is an obligate intracellular parasite and is the major cause of conjunctivitis in the cat. The incubation period from infection to clinical signs, is up to 14 days. Most infected cats are under 2 years old. Originally the organism was called Chlamydia psittaci var felis, and the condition called feline pneumonitis, but pneumonia is a relatively rare event in the cat.

Chlamydophila felis shedding and transmission

Chlamydophila felis is shed in the ocular secretions (and possibly faeces) for at least 35 days and has been recorded for up to 18 months in experimental infection, although clinical signs last only days to weeks. Doxycycline treatment stops shedding 9-25 days after the start of treatment. Chlortetracycline ointment stops shedding 14-25 days after treatment begins. Transmission is direct, through contact with ocular secretions, and indirect, via fomites. Chlamydophila felis have both intracellular and extracellular forms, infection is via the extracellular elementary bodies which are small (0.3m) resistant particles with rigid cell walls.

Clinical signs
chemosis (swelling of the conjunctiva) serous to mucopurulent ocular discharge unilateral becoming bilateral

Although sometimes shed from the reproductive tract, there is currently no evidence that Chlamydophila felis causes reproductive disorders in the cat. (unlike human Chlamydiosis). I have examined various stillborn and aborted kittens and have never been able to detect C. felis (though a negative is more difficult to prove than a positive!).

Diagnosis of Chlamydophila felis

Advantages
PCR* sensitive

Disadvantages
possibility of false

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First choice Chlamydophila isolation Conjunctival scraping

not dependent on organism viability specific

positive results organism can die rapidly in transit

rapid

NOT RECOMMENDED (scraping stained by immunofluorescence or Giemsa to search for inclusion bodies difficult to interpret) Serology useful to rule out exposure does not correlate with Chlamydophila shedding * send a conjunctival swab to the laboratory.

Treatment of Chlamydophila felis

The treatment of choice is doxycycline (Ronaxan, Merial Animal Health) at 10mg/kg (i.e. 2 x 20mg tablets for a 4kg cat) s.i.d. for 4 weeks or until 2 weeks after the end of clinical signs. Doxycycline is contraindicated in pregnant cats as it may affect the unborn kitten, and should not be used in kittens under 6 months because it can cause discolouring of the teeth. An alternative treatment is 1% chlortetracycline ointment (Aureomycin opthalmic ointment, Fort Dodge Animal Health) q.i.d. for 4 weeks or until 2 weeks after the end of clinical signs. Fucithalmic ointment does not work, neither does Synulox, other penicillins or sulphonamides. Azithromycin (Zithromax) resolves clinical signs but fails to clear infection, to quote Owen et al, (2003): A clinical trial was designed to evaluate the efficacy of azithromycin for the treatment of chlamydia (Chlamydophila felis) infection in cats. Whilst azithromycin, given at 10-15 mg/kg daily for 3 days and then twice weekly, provided a similar, rapid resolution of clinical signs and negative isolation scores as doxycycline, C felis was re-isolated in four out of the five cats treated. Furthermore, even daily administration of azithromycin to chronically infected cats was ineffective in clearing infection. The azithromycin protocols used here were therefore found to be unsuccessful in eliminating the carriage of this strain of C felis. Treat all the cats in the household, whether symptomatic or not.

Vaccination
Chlamydophila vaccines are not designated as core vaccines by the American Association of Feline Practitioners. Fel O Vax 4, Pentofel, Katavac Eclipse (Fort Dodge Animal Health), are inactivated vaccines. From 8 weeks of age, two doses 3-4 weeks apart, s/c. Annual boosters. Does not prevent Chlamydophila shedding, indeed may predispose to carrier state, but does ameliorate clinical signs.

Prevention
Since vaccination does not prevent infection, prevention of infection consists mainly of avoiding exposure of susceptible cats to infection: cat breeders should test their existing cats to establish whether or not they have endemic Chlamydophila and new cats to prevent introducing infection where none previously existed. Obviously, hygiene precautions should be taken when treating infected cats and preventative treatment of asymptomatic cats hands should be washed between cats and, where eye ointment is used, each cat should have its own tube labelled with its name (put your label directly onto the tube, not the box). Warn cat owners to wash their hands carefully after handling an infected cat and to avoid touching their own eyes after handling the cat.

MDA protects kittens until 7-9 weeks of age, after which kittens should be isolated from infected cats.

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Can C. felis infect other species?

Chlamydophila felis is different from Chlamydophila trachomatis, which is the human form causing conjunctivitis, salpingitis and infertility. Nevertheless, there are documented cases of humans becoming infected by infected cats, so some caution needs to be taken when handling potentially infected cats. Humans are more likely to get psittacosis (fever, lymphadenopathy, pneumonia) from birds than from cats. Cats may also become infected by birds, but the likelihood of infection from a human source is unknown. Serologic surveys of dogs show evidence of exposure to Chlamydophila, and they have been implicated in chronic superficial keratitis of the dog. The cat is unlikely to become infected by human, ovine or porcine Chlamydophila.

Further reading
Greene C.E. Chlamydial infections. 2006 Infectious Diseases of the Dog and Cat. Third Edition. Editor: Greene, Craig. Saunders Elsevier. 11830 Westline Industrial Drive, St Louis, Missouri 63146. 245-252

M. McDonald, B.J. Willett, O. Jarrett, D.D. Addie. 1998 A comparison of DNA amplification, isolation and serology for the detection of Chlamydia psittaci infection in cats. Veterinary Record. 143 97-101 Owen WMA, Sturgess CP, Harbour DA, Egan K, Gruffydd-Jones TJ. 2003 Efficacy of azithromycin for the treatment of feline chlamydophilosis. JFMS 5 305-311 Sparkes AH, Caney SM, Sturgess CP, Gruffydd-Jones TJ. 1999 The clinical efficacy of topical and systemic therapy for the treatment of feline ocular chlamydiosis. J Feline Med Surg. 1(1):31-5.

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Bordetella bronchiseptica
B. bronchiseptica is a pleomorphic, aerobic, gram negative coccobacillus which causes respiratory infection in cats, and death of kittens up to 8 weeks old. B. bronchiseptica has been isolated from 11 percent of 740 cats sampled in the UK. The prevalence was 19.5% in rescue catteries, 9% in breeding catteries and 0% in household pets. Transmission is usually from infected dogs or cats. Infected cats frequently have a history of having been in a rescue or boarding cattery or contact with a dog suffering from kennel cough.

Clinical signs of B. bronchiseptica infection

Harsh, productive or non-productive cough in an otherwise well cat. White froth produced, as in dogs. Signs generally resolve in 10 days. URT disease: sneezing, ocular discharge, dyspnoea, pyrexia Tonsillitis, submandibular lymph nodes raised Fatal broncho-pneumonia in kittens up to 8 wks old

Diagnosis and shedding of B. bronchiseptica

Oropharyngeal swab, swab of nasal discharge, tracheal wash or sample of pneumonic lung into charcoal Amies bacterial transport medium to a reliable veterinary laboratory. B. bronchiseptica may be difficult to isolate from carrier cats because low numbers of organisms are shed and are easily overgrown by other flora, so selective media such as charcoalcephalexin agar (Oxoid, Unipath, UK) or Bordet-Gengou agar may be used to suppress undesirable bacterial overgrowth. Characterization of isolates can be performed by ribotype analysis. Blood samples can be taken for antibody detection. Post-partum shedding of B. bronchiseptica has been demonstrated in seropositive queens from which no Bordetella could be isolated prior to kittening, suggesting a carrier state. Bacterial shedding has been known to occur for as long as 19 weeks and is not always controlled by antibiotic therapy.

Treatment of B. bronchiseptica
First choice: Doxycycline 20-40mg/kg sid (Ronaxan, Merial) for 5 days. Second choice: Trimethoprim-sulfadiazine for 5-7d (i.e. one Tribrissen 20 (Schering-Plough) per day or one Trimacare 20 (Animalcare Ltd) per day). Never divide these tablets as the cats froth at the mouth after dosing and dont use in cats under 1kg. Note that B. bronchiseptica is NOT susceptible to penicillins.

Prevention of B. bronchiseptica
Vaccinate all cats going into rescue and boarding catteries (and some breeding catteries) with Nobivac Bb (Intervet). Vaccinate in-contact dogs with Intrac (Schering-Plough) or Nobivac KC (Intervet). Intrac is not licensed for use in the cat. The primary route of infection is via oro-pharyngeal and nasal secretions and excretions from infected hosts, so isolate infected animals from uninfected animals and disinfect hands, food bowls, etc. Minimize overcrowding, stress, intercurrent diseases. Ensure adequate ventilation.

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Impact on other species B. bronchiseptica is primarily an infection of dogs, causing kennel cough. B. bronchiseptica has caused fatal pneumonia in humans with AIDS, however, no contact with either cats or dogs was demonstrated in a series of 9 patients, suggesting that the humans were not infected by pets. B. bronchiseptica also causes fatal pneumonia of guinea pigs and can cause "snuffles" in rabbits (more commonly caused by Pasteurella), and it would probably be wise to keep infected cats, dogs or humans away from guinea pigs, rabbits and rats. Current area of expertise: University of Liverpool Veterinary School, England, UK. Further reading
Gaskell RM, Dawson S, Radford A. Feline respiratory disease. 2006 Infectious Diseases of the Dog and Cat. Third Edition. Editor: Greene, Craig. Saunders Elsevier. 11830 Westline Industrial Drive, St Louis, Missouri 63146. 145-154

Avian Influenza H5N1 Virus

Avian influenza virus, subgroup H5N1 is a member of the Orthomyxovirus family. It has recently caused deaths in domestic cats in Germany and in large cats (tigers and leopards) in Thailand. Very little is known about this virus in cats at present, and so these notes are simply a summary of present knowledge at time of printing. Virus transmission: the tigers were infected by feeding raw chickens. Most people who have been infected have worked in the poultry industry. Orthomyxoviruses are enveloped viruses and therefore do not survive well in the environment hours rather than days therefore indirect transmission can only occur shortly after the virus is shed, but is unlikely to be a problem after several days. Virus is shed in oropharyngeal secretions and faeces of infected cats. Clinical signs of avian flu in cats: pyrexia, lethargy, conjunctivitis, protrusion of nictitating membrane, laboured breathing, pneumonia, rapid death. Clearly there are many other, far more common, causes of similar clinical signs in cats. Clinical signs in humans: conjunctivitis has been a big feature of this infection in humans, other than that, signs are typically those of flu. Confirmation of diagnosis: a list of recommended laboratories is given at the end of this book. Treatment of avian flu: there is no evidence that neuraminidase inhibitors such as oseltamivir (Tamiflu) would work in cats, it didnt work in the tiger outbreak and there are many reports of resistant strains of H5N1 having developed in humans. Whether it causes side effects in cats is unknown. Probably Virbagen Omega (Virbac) injections (1MU/kg s/c daily or e.o.d) and broad spectrum antibiotic cover are as good as anything at this stage. Prevention and vaccination: a fowlpox vaccine expressing the H5 haemagglutinin gene (Trovac AIV-H5, Merial) has shown immunogenicity in cats (Karaca et al, 2005). General advice to cat owners would be:

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avoid feeding cats uncooked poultry meat if there are many deaths amongst local wild birds, keep your cat in until further information is available

Cat to human transmission: there is currently no evidence that this occurs. Human cases have mainly been in people in the poultry industry. However, if a suspect case occurred, one would take stringent hygiene precautions and isolate the cat. WHO states on 28th February 2006 that: There is no present evidence that domestic cats play a role in the transmission cycle of H5N1 viruses. To date, no human case has been linked to exposure to a diseased cat. No outbreaks in domestic cats have been reported. Unlike the case in domestic and wild birds, there is no evidence that domestic cats are a reservoir of the virus. All available evidence indicates that cat infections occur in association with H5N1 outbreaks in domestic or wild birds.

Further information and references For updates, watch these websites: World Health Organisation www.who.int/en World Organisation for Animal Health www.oie.int/eng/AVIAN_INFLUENZA/home.htm www.catvirus.com

Karaca K, Swayne DE, Grosenbaugh D, Bublot M, Robles A, Spackman E, Nordgren R. 2005. Immunogenicity of fowlpox virus expressing the avian influenza virus H5 gene (TROVAC AIV-H5) in cats. Clin Diagn Lab Immunol. 12(11):1340-2.

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Poxvirus
Cowpox or cat pox is a condition of the late summer, early autumn, and only of free-ranging and usually hunting cats, usually from rural areas. Transmission is from rodents. This is quite a resistant virus and the virus will survive in the scabs to infect humans, if their integument is abrased. Diagnosis: virus isolation from scab sent in clean receptacle to reference laboratory (Companion Animal Diagnostics, University of Glasgow, UK) or PCR. Clinical signs: scabs on the face and paws, can present as oral ulceration. Self-limiting, in about 6 weeks. Treatment: supportive. NEVER use corticosteroids, which lead to fatal systemic dissemination of the virus. Possible zoonosis. Expert: Dr Malcolm Bennett, University of Liverpool Veterinary School, UK.

Feline coronavirus
It has been reported that feline coronavirus infection newly introduced into a household can manifest as upper respiratory signs amongst the cats. Kittens which have been infected with FCoV are more likely to have a history of upper respiratory disease (and diarrhoea, and stunting) than kittens which were seronegative. See www.catvirus.com for more information

Haemophilus felis
Causes mild URT signs. Easily killed by most antibiotics. Diagnosis very difficult, because sample (oropharnygeal swab in bacterial transport medium) needs to be gotten to lab within 20 minutes, since very fragile organism.

Aelurostrongylus abstrusus
Transmission: from infected intermediate host (slug, snail) or transport host (mouse) Clinical signs: coughing, possibly dyspnoea, pleural effusion Treatment: fenbendazole (Panacur) 50 mg/kg daily for 3 days Prevention: keep cat indoors.

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Corynebacterium spp
Non toxigenic strains have been found in some cats, dogs and humans with chronic conjunctivitis or chronic nasal discharge. Send swab in bacterial transport medium to a reference laboratory, such as Companion Animal Diagnostics, University of Glasgow. Expert: Prof. David Taylor, University of Glasgow, G61 1QH, UK.

Mycoplasma felis
This is a different organism from Mycoplasma haemofelis (a cause of feline infectious anaemia). Mycoplasma felis is found in 25% of cats with conjunctivitis. Clinical signs: serous discharge, becoming mucoid. Treatment: Doxycycline 20-40mg/kg sid (Ronaxan, Merial) for 5 days.

Cryptococcus spp
Cryptococcus neoformans and C. gatti are encapsulated yeasts. It can affect many organ systems, but the upper respiratory system is most commonly involved. It is usually associated with exposure to avian, especially pigeon, guano. Distribution is worldwide, but infection is very rare in the UK. Clinical signs: uni- or bilateral chronic rhinitis, mucopurulent or sanguineous nasal discharge facial deformity, especially around bridge of nose (major differential squamous cell carcinoma) sneezing snoring polyp-like mass protruding from nares small, fleshy and granulomatous in appearance Diagnosis: cytology (stain smear with DiffQuik) look for peanut-like yeast organisms Treatment: surgical debridement and:flucytosine 30-75mg/kg orally qid for 1-9 months and amphotericin B 0.5- 0.8 mg/kg i/v 3 times a week or fluconazole 30-50 mg/cat orally bid for 6 18 months or ketoconazole 5-10 mg/kg orally bid for 6 18 months or itraconazole 50-100 mg/cat orally sid for 6 18 months If toxicity develops with any of these, change drugs, or go on to eod dosages. Further reading Holzsworth J. 1987 Mycotic Diseases in Diseases of the Cat. Ed: Holzsworth J. WB Saunders Company, The Curtis Center, Independence Square West, Philadelphia, Pennsylvania 19106. 320-358 Malik R, Krockenberger M, OBrien CR, Martin P, Wigney D, Medleau L. 2006 Cryptococcosis. Infectious Diseases of the Dog and Cat. Third Edition. Editor: Greene, Craig.
Saunders Elsevier. 11830 Westline Industrial Drive, St Louis, Missouri 63146. 584-598

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Capillaria aerophila
Nematode of the cat, dog and fox. They are 25-30mm in length and live in the trachea and bronchi. Direct life cycle bipolar eggs containing unsegmented ovum are coughed up and swallowed and pass in the faeces. Most likely to be found in outdoor cat where there are foxes, but is still a rare parasite.

Cuterebra
The adult fly resembles a bumblebee. It lays its eggs near the burrows of its natural hosts lagomorphs and rodents. Cats may become by first stage larva, these can live in the skin but sometimes enter the nares and migrate through the cribriform plate into the brain. Clinical signs: the URT signs can be epistaxis and sneezing. However, more importantly, this is the likely cause of feline ischaemic encephalopathy, which will present with neurological signs which are usually focal and asymmetric (circling, seizures, contralateral hemiparesis, behavioural changes, blindness in contralateral visual field, with normal papillary light reflexes). Incidence: late summer, only in countries in which the fly lives (USA) Reference Thomas WB. 2001 Vascular disorders. Consultations in Feline Medicine Volume 4. Ed: August JR. WB Saunders Company, The Curtis Center, Independence Square West, Philadelphia, Pennsylvania 19106. 405-412

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Differential diagnoses
Differential diagnoses of acute oral ulceration:
acute feline calicivirus - discrete ulcers on tongue, soft and hard palates feline herpesvirus - discrete ulcers, often concentrated around laryngeal region poxvirus discrete ulcers similar to those of FCV infection caustic substance usually the tip of the tongue is ulcerated uraemia ulceration plus necrotic smell, cat dehydrated, other signs of kidney disease trauma foreign body cats often get elastic bands or thread caught round root of tongue

Differential diagnoses of chronic feline gingivostomatitis:

tartar, bad dentition responsive to dental treatment alone squamous cell carcinoma commonest tumour of cats mouth, biopsy to diagnose eosinophilic granuloma fibrosarcoma melanoma (uncommon in the cat)

Differential diagnoses of chronic rhinitis:

chronic herpesvirus infection foreign body (e.g. grass blade, bone of prey, see photo below) cleft palate (this can be very fine and only detectable by probing under GA, can follow a fall or be congenital) nasopharyngeal polyp neoplasia (squamous cell carcinoma is commonest tumour of cat skin, may also get lymphoma, fibrosarcoma, or rarely melanoma) Cryptococcus neoformans (cats rarely get Aspergillosis)

Cytology and culture of the nasal exudate should help differentiate these conditions and a nasal flush under general anaesthetic may be required. The commonest foreign body above the soft palate of the human in the UK is the chip (French fry). Drunken Brits get peckish, scoff a bag of chips, or a kebab, and when they vomit, the chip becomes lodged at the back of the nasal cavity. It is similar with cats, giving rise to foreign bodies of grass blades or small bones from prey animals. However, usually the cat is sober. I am grateful to Richard Irvine for this photograph.

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Differential diagnoses of conjunctivitis:

acute feline herpesvirus Chlamydophila felis Mycoplasma felis feline calicivirus foreign body (e.g. grass seed) avian flu H5N1 chronic feline herpesvirus Chlamydophila felis Mycoplasma felis

blocked nasolacrimal duct conformational (Persian) allergy (Corynebacterium spp infection) (Cryptococcus neoformans) (tumour) (pemphigous)

Differential diagnoses of the coughing cat:

Bordetella bronchiseptica infection feline asthma fur ball Aelurostrongylus abstrusus (feline lungworm)infection intratracheal or intra-bronchial foreign body (may require endoscopy since often not radioopaque, e.g. plant material) tumour (e.g. bronchial carcinoma often get lesions on toes) Capillaria aerophila Cryptococcus neoformans (Cat flu cats with flu dont usually cough)

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Differential diagnoses and time scale of fading kittens

Feline infectious peritonitis

Feline panleukopenia

Bacterial infections / accidents / endo- ectoparasites / Mycoplasma haemofelis

Feline herpesvirus

Feline calicivirus Neonatal isoerythrolysis

10

11

12

13

Weeks of age

Differential diagnoses kittens with bronchopneumonia:

Bordetella bronchiseptica Feline herpesvirus Inhalation pneumonia Bacterial pneumonia Feline calicivirus

Differential diagnoses of cats with URT signs:

Common Cat flu (feline herpesvirus, feline calicivirus) Chlamydophila felis Bordetella bronchiseptica infection Mycoplasma felis Haemophilus felis Uncommon Feline asthma Tumour Foreign body Poxvirus (cat pox) Aelurostrongylus abstrusus Corynebacterium spp Cryptococcus neoformans Capillaria aerophila Avian bird flu (H5N1)

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Preventing respiratory infection

Good hygiene
Hygiene is the single most important aspect of infection control, since there are more respiratory pathogens than there are vaccines. Outbreaks of virulent FCV in veterinary surgeries resulted in the closure of those surgeries for days to weeks, this might have been averted if stringent barrier nursing had been observed at all times.

Barrier nursing applicable in the veterinary surgery, the cat breeder household,
the rescue shelter, the boarding cattery A routine should be established whereby susceptible 'clean' animals should be fed and their litter changed first. Older, vaccinated animals should be attended to next and the sick cats last of all. The person tending the cats should not go back to the susceptible cats after dealing with those who are sick. Each cat should be equipped with two sets of litter trays and bowls, so that while one is being cleaned and disinfected, the cat is using the other. Larger catteries and veterinary practices will have separate attendants for healthy kittens, adult cats and sick cats. The most hygienic catteries will provide an overall, overshoes, boots or a foot bath and rubber gloves to wear when attending each individual pen. Pens should be thoroughly disinfected between cats inhabiting them, using either sodium hypochlorite (bleach Domestos), Virkon, Parvocide. Pens should be left empty for as long as possible between occupants.

Good building design in veterinary surgeries, rescue shelters, breeding and

boarding catteries can minimise infectious upper respiratory disease See the photo of Cardyke Farm Cats Protection shelter on the next page: natural ventilation was used instead of air conditioning and the cats did not share any air space. There was no shared air space between cats the doors looking onto communal corridors were of clear perspex. There were heated pads in the high-walled beds to keep the cats warm, and shutters to close at night. There were shaded areas for the heat of the summer and plenty of cool, fresh water. Potential guardians were not allowed to handle the cats, but could interact with them using toys specific to each cat. There high-sided baskets also allowed timid cats to cower from view, and sometimes disposable cardboard boxes were introduced for cats to hide in stress reduction minimised FHV shedding. The wards were colour coded, so that food bowls, litter trays and even mops were immediately identifiable as belonging to the kitten corridor, the adult corridor or the quarantine area. Dusty, Fullers earth based cat litters were not used, to minimise feline asthma. Regrettably, Cardyke cattery is no longer managed in this way. People thinking of building a cattery should consult the Feline Advisory Bureau for advice on sneeze barriers, pen construction and dimensions to minimise disease spread. : The Feline Advisory Bureau Boarding Cattery Officer, 1 Church Close, Orcheston, Salisbury, Wiltshire. SP3 4RP Tel/Fax. 01981 621201 www.fabcats.org/boarding_catteries.html

Recommended reading: Feline Advisory Bureau Boarding Cattery Manual.

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There are many good features about this Cats Protection rescue shelter in the UK which minimised respiratory disease in this cattery.

There is an open meshwork to outside air, ensuring that the cats always have clean, fresh air.

Note the wire mesh to the outside ensuring the cat has plenty of clean, fresh air.

Note that potential cat guardians can only interact with the cats using a toy and that each cat has his or her own toy. This minimises indirect transmission of pathogens on their clothing or hands.

Cats have a high-sided bed, so they can hide if they feel stressed this reduces FHV shedding. The bed contains a heated cat blanket.

There is a perspex front to each cage, ensuring that sneezed pathogens do not circulate in the communal corridor, which prevents infection of other cats.

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Control of URT infection for cat breeders

Everything said above about hygiene and cattery design should be applied assiduously. If the breeder simply keeps cats in their house, then they need to bear in mind that cat behaviourists estimate that up to 6 cats can be maintained comfortably in an ordinary house when there are more than 6 cats, signs of stress, such as inappropriate elimination, start to manifest in the cats. Stressed cats will shed FHV more often. Vaccinate cats against feline panleukopenia, FCV, and FHV twice as kittens, boosting at a year old, and thereafter every 3 years. The breeder should strive to become FCV free by testing all their cats, separating positive and negative cats, and retesting every 2-3 months until all the cats have stopped shedding virus. In a household of 8 cats, this should be achieved within approximately a year. Once the household is FCV free, killed FCV vaccines are preferred to reduce the risk of iatrogenic re-introduction of virus. New cats and kittens and queens visiting studs should all be tested FCV negative within the previous 2 weeks prior to introduction (unless from a similar FCV free cattery, where annual testing would be acceptable). Cats being taken out to stud or show should be quarantined on return, then tested 1-2 weeks later before being reintroduced to the other cats. FHV control is by reactivating latent infection deliberately by stressing the queen 2-3 weeks prior to kittening by moving her into her kittening room. This will cause viral recrudescence before the kittens are born, so shedding will be stopped when they are born. It will also boost her antibodies, giving the kittens increased MDA and a longer period of protection. The queen may also be dosed with l-lysine at 250mg per day from shortly before kittening till after the kittens are gone, to attempt to prevent viral shedding. The efficacy of this is currently under investigation by Dr David Maggs, at the University of California, Davis, USA. Chlamydophila felis will also be controlled by elimination from the household by testing all the cats initially, separating positive and negative cats, treating positive cats with doxycycline and retesting 2 weeks post-treatment. Vaccination is contraindicated for breeders as it may lead to carrier status should the cat be subsequently exposed to Chlamydophila.

Rescue cattery infectious URT disease prevention

Rescue shelters should house cats individually, unless they have come from the same home. Rescue catteries should ideally home every cat in a section of the cattery and disinfect and rest the pens before introducing a new batch of cats. See notes on hygiene and cattery design above. Where funds permit, vaccinate against panleukopenia, FCV, FHV and Bordetella bronchiseptica. It might be wise to use Purevax RC (Merial) to give increased coverage against the many field strains of FCV which will be present one cat in every 4 passing through the doors will be shedding FCV. Alternatively, in the USA, you may choose to use Heskas intranasal vaccine, to give more rapid onset of protection against flu viruses. It would also be my recommendation, in the USA, to use Primucell (Pfizer) to protect against feline infectious peritonitis.

Boarding Cattery URT infection prevention

All cats entering boarding catteries should be vaccinated against feline panleukopenia, FCV, FHV and Bordetella bronchiseptica. It may be that the Purevax RC (Merial) would be a good choice to give maximal coverage against the various FCV strains that will be present about a quarter of all cats in the cattery will be shedding FCV at any one time. Vaccination against

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FeLV, FIV or Chlamydophila should be superfluous, if good management practices are observed (i.e. no mixing of cats and barrier nursing between cats). However, I strongly recommend use of Primucell (Pfizer, not available in UK) to protect against feline infectious peritonitis. If there is also a kennel - house dogs away from cats to minimise stress (reduce FHV shedding) and to reduce transmission of Bordetella.

Recommended laboratories
Based on country For avian flu virus

Based on country
This list is a purely personal one, the choice of the author, based on personal experience of either the laboratory, or those who operate it, or on the publications emanating from it. This list is unfortunately nowhere near complete and I apologise if your country is missed. Scandinavian countries usually send their samples to Companion Animal Diagnostics in Scotland, UK.

France
Scanelis laboratory, which is attached to the Ecole Nationale Veterinaire Toulouse - for quantitative RT-polymerase chain reaction to detect FCV, FHV, Chlamydophila felis and Bordetella bronchiseptica. www.scanelis.com

Switzerland
The laboratory of Prof. Hans Lutz at Zurich Veterinary School is one of the finest veterinary laboratories in the world. It pioneered many veterinary quantitative PCR tests to detect virus. www.vetlabor.unizh.ch

UK
Virus isolation Companion Animal Diagnostics, University of Glasgow Veterinary School - who perform virus isolation, this is especially useful for feline calicivirus infection and will detect the occasional pox which can present as oral ulceration clinically indistinguishable from FCV infection. Telephone or email them to order viral transport medium, swabs and sample submission forms. Their charge is 13.00 plus VAT for virus isolation. If you wish to send a biopsy of the lesion in 10% formol saline (from 18.00 plus VAT). For Chlamydophila felis PCR, their charge is 25.00 plus VAT. Companion Animal Diagnostics University of Glasgow Veterinary School Bearsden Glasgow G61 1QH UK Tel: 0141 330 5777 Fax: 0141 330 3748

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Email: Companion@vet.gla.ac.uk www.gla.ac.uk/companion

For FHV PCR in the UK: Langford Veterinary Diagnostics School of Clinical Veterinary Science, Langford House, Langford, Bristol, BS40 5DU Tel: 0117 928 9412 Fax: 0117 928 9613 www.bris.ac.uk/acarus For suspected Avian Influenza virus infection, use the Veterinary Laboratories Agency.

USA
In America, the quantitative PCR tests which I would recommend you use is available from Dr Christian Leutenneger's laboratory, the Lucy Whittier Molecular and Diagnostic Core Facility, at the University of California, Davis. You can download a sample submission form from his website. www.vetmed.ucdavis.edu/vme/taqmanservice/

For avian flu virus H5N1

LIST OF THE OIE REFERENCE LABORATORIES AND OTHER EXPERTS FOR HIGHLY PATHOGENIC AVIAN INFLUENZA
OIE REFERENCE LABORATORIES / LABORATOIRES DE RFRENCE DE LOIE / LABORATORIOS DE REFERENCIA DE LA OIE Dr Ortrud Werner National Reference Laboratory for Highly pathogenic avian influenza and Newcastle disease, Institute of Diagnostic Virology, Federal Research Centre for Virus Diseases of Animals (BFAV) Insel Riems, Boddenblick 5a, 17493 Greifswald - Insel Riems GERMANY/ALLEMAGNE/ALEMANA Tel: (41) 383.517.152 Fax: (41) 383.517.151 Email: ortrud.werner@rie.bfav.de Dr Ian Brown VLA Weybridge New Haw, Addlestone, Surrey KT15 3NB UNITED KINGDOM/ROYAUME UNI/REINO UNIDO Tel: (44.1932) 34.11.11 Fax: (44.1932) 34.70.46 Email: i.h.brown@vla.defra.gsi.gov.uk Dr Paul W. Selleck CSIRO, Australian Animal Health Laboratory (AAHL) 5 Portarlington Road, Private Bag 24, Geelong 3220, Victoria AUSTRALIA/AUSTRALIE Tel: (61.3) 52.27.50.00 Fax: (61.3) 52.27.55.55 Email: paul.selleck@csiro.au Dr B. Panigrahy National Veterinary Services Laboratories P.O. Box 844, Ames, IA 50010 USA/EE.UU Tel: (1.515) 663.75.51 Fax: (1.515) 663.73.48 Email: brundaban.panigrahy@aphis.usda.gov

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Dr Ilaria Capua Istituto Zooprofilattico Sperimentale delle Venezie, Laboratorio Virologia Via Romea 14/A, 35020 Legnaro, Padova ITALY/ITALIE/ITALIA Tel: (39.049) 808.43.69 Fax: (39.049) 808.43.60 Email: icapua@izsvenezie.it Dr H. Kida Graduate School of Veterinary Medicine, Hokkaido University, Department of Disease Control Kita-18, Nishi-9, Kita-ku, Sapporo 060-0818 JAPAN/JAPON/JAPN Tel: (81.11) 706.52.07 Fax: (81.11) 706.52.73 Email: kida@vetmed.hokudai.ac.jp OTHER EXPERTS / AUTRES EXPERTS / OTROS EXPERTOS Dr David Swayne Southeast Poultry Research Laboratory USDA/ARS 934 College Station Road Athens, Georgia USA Tel: 001-706-546-3433 Fax: 001-706-546-3161 Email: dswayne@seprl.usda.gov Dr Vronique Jestin Unit de pathologie aviaire Zoople Beaucemaine-Les Croix BP 53, 22440 Ploufragan FRANCE Tel: (33 (0)2) 96.01.62.81 Fax: (33 (0)2) 96 01 62 73 Email: v.jestin@ploufragan.afssa.fr

Useful contact details and websites

www.catvirus.com

Cats Protection www.cats.org.uk

Feline Advisory Bureau Boarding Cattery Officer, 1 Church Close, Orcheston, Salisbury, Wiltshire. SP3 4RP Tel/Fax. 01981 621201 www.fabcats.org/boarding_catteries.html

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Index
Acyclovir . 12 Adenine Arabinoside 12 Aggression 7 Aleurostrongylus abstrusus . 19 Allergy .... 24 Amino acid (in FHV infection) ... 12, 27 Asthma .. 24, 25, 26 Avian bird flu ..... 4, 18, 19, 21, 24, 25, 29, 30 Azithromycin 15, 16 Behaviour change ... 7 Bird flu ... 4, 18, 19, 21, 24, 25, 29, 30 Bordetella bronchiseptica .. 4, 17, 28, 29 Breeder, breeding ... 4, 6, 13, 14, 16, 17, 26, 28 Bronchopneumonia .... 17, 25 Calicivirus . 4, 5, 6, 7, 9, 11, 23, 26, 28, 29 Capillaria aerophila .... 4, 22, 24, 25 Cat pox .. 4, 20, 23, 25, 29 Cat show .... 28 Chlamydia psittaci . 4, 14, 16 Chlamydophila felis .... 4, 14, 16, 24, 25, 28, 29 Chronic rhinitis .. .11, 12, 21, 23 Chronic sinusitis .... 11, 12, 21, 23 Cleft palate .... 23 Corneal ulcer . 11 Conjunctivitis .... 4, 11, 14, 16, 18, 21, 24 Corynebacterium diptherans 4, 21 Cowpox .. 4, 20, 23, 25, 29 Cuterebra ................................ 22 Enisyl-F 12, 28 Epistaxis .... 22 F9 (strain of feline calicivirus) 5 Fading kittens . 5, 11, 25 FCV .... 4, 5, 6, 7, 9, 11, 23, 26, 28, 29 Feline asthma .. 24, 25, 26 Feline calicivirus 4, 5, 6, 7, 9, 11, 23, 26, 28, 29 Feline herpesvirus ...4, 10, 11, 12, 13, 14, 25, 26, 28, 29 Feline interferon omega 5, 8, 9, 12, 13 FHV .. 4, 10, 11, 12, 13, 14, 25, 26, 28, 29 Foreign body ... 23, 24, 25 431 (strain of feline calicivirus) .... 5, 6 G1 (strain of feline calicivirus) . 5, 6 Haemophilus felis .. 4, 19, 24 Herpesvirus .... 4, 10, 11, 12, 13, 14, 25, 26, 28, 29 Heska Ultranasal vaccine 5, 6, 28 H5N1 (subtype of avian influenza virus) .. 4, 18, 19, 21, 24, 25, 29, 30 Idoxuridine . 12 Influenza virus (avian) .. 4, 17, 18, 20, 23, 24, 28, 29 Inhalation pneumonia ... 25 Interferon .... 5, 8, 9, 12, 13 Interferon omega 5, 8, 9, 12, 13 Keratitis ..... 11, 14, 16 Laboratories recommended .. 11, 29 L-lysine . 14, 28

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Maternally derived antibody (MDA) .. 6, 14, 16, 28 MDA (maternally derived antibody) .. 6, 14, 16, 28 Mycoplasma felis 4, 21, 24, 25 Neonatal ophthalmitis ... 11 Nobivac Tricat .. 5 Ocular signs .... 11, 12 Oral ulceration .... 4, 20, 23, 29 Orthomyxovirus 4, 18, 19, 21, 24, 25, 29, 30 Pneumonia .. 11, 14, 16, 17, 18, 25 Poxvirus ... 4, 20, 23, 25, 29 Purevax RC ... 5, 6, 28 Quasispecies .. 4 Queen .. 6, 13, 17, 28 Recommended laboratories ..11, 29 Rose Bengal .. 11 Sneezing . 4, 11, 17, 21, 22, 26 Snoring ... 21 Squamous cell carcinoma ... 23 Stoxil 12 Stress ... 11, 12, 17, 28, 29 Stud . 28 255 (strain of feline calicivirus) 5 Trifluorothymidine . 12 Ulceration corneal .. 11 Ulceration oral .. 4, 19, 22, 28 Uveitis ..... 11 Vaccination . 5, 6, 9, 10, 13, 15, 16, 17, 18, 26, 28 Virbagen Omega ... 8, 9, 13, 14 Zithromax . 15, 16 Zovirax .... 12

This e-book will be kept updated as and when new information becomes available.
Dr Diane D. Addie Sep 2006.

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