FELINE INFECTIOUS PERITONITIS Navies 2011 Feline Infectious Peritonitis (FIP) is a progressive, almost always fatal, viral disease of domestic cats. It affects some exotic cats, with the cheetah being particularly susceptible. It does not affect non-feline species, such as dogs. Etiology or Cause Field strains of feline coronavirus vary in their ability to induce FIP. Some isolates cause FIP (feline infectious peritonitis virus [FIPV]others cause more localized GI disease) Mutations from feline enteric coronavirus to FIPV occur. FIP is thought to result from a mutation of the virus within the body, combined with the response of the immune system, leading to inflammation in various organ systems. FIPV and canine coronavirus are very closely related antigenically and may have crossed between hosts. Feline coronaviruses are fairly stable in the environment and, once dry, can survive for 4-6 wk. They are enveloped viruses and are destroyed by most household disinfectants, particularly household bleach at a 1:32 dilution. History FIP was first described as early as 1963 and even today it is not fully understood how this disease develops and spreads. History of disease This is the pathogenesis of the Feline Infectious Peritonitis. The video shows how the infection of monocytes by the feline Coronavirus leads to the development of the clinical signs of feline infectious peritonitis. This is still not well undestood Because it was derived from the Coronavirus, history on the disease was vague, as well as any dates on when FIP originated. Signalment FIP primarily affects cats under 1 years of age Low prevalence ~ 5-10% of cats Cats housed in dense populations Cats under stress A genetic predisposition may also exist. (Purebred cats such as Birmans, Abyssinians and Himalayans, among others, may also be at increased risk. Kittens with littermates or mothers definitively diagnosed with FIP are also at higher risk.) Transmission Primarily FECAL –ORAL ROUTE: Ingestion of the virus; aerosol is also possible. Close contact with an infected cat or infected saliva or feces Because Cats shed viral particles in their feces, sharing litter boxes and mutual grooming are important sources of transmission Cats living in multiple cat households are at greater risks of contracting feline coronavirus and developing FIP because of sharing multiple strains of the virus and stress-associated immunosuppression. Contaminated food or water dishes, bedding, and personal clothing may also serve as sources of infection. Clinical signs Wet (more common: 75%) : Ascites “Fluid wave” Pleural effusion Anorexia Depression Weight loss dehydration +/- fever Dry form Fever of unknown origin Anorexia Depression Weight loss Ocular lesion Neurologic signs Enlarged kidneys (uncommon) Diagnostic Tests & Expected Results There is no simple diagnostic test. The ELISA, IFA, and virus-neutralization tests detect the presence of coronavirus antibodies in a cat, but these tests cannot differentiate between the various strains of feline coronavirus. The only way to definitively diagnose FIP is by biopsy, or examination of tissues at autopsy. Evaluation of the cat's history, presenting symptoms, examination of fluid if it is present, and the results of supporting laboratory tests including a positive coronavirus antibody titer. Diagnostic Tests The fluid has been described as :straw-colored / clear – yellow and is usually viscous It usually has a relatively low cellular content : that is pyogranulomatous (macrophages and neutrophils; usually no toxic changes in the latter): < 20,000 nucleated cells/microliter Protein rich > 3.5 microliter Albumin: Globulin < 0.81 Recommended Treatment There is no known treatment that can cure FIP once clinical signs arise. Treatment with anti-inflammatory and immunosuppressive drugs, along with supportive care, can make the cat more comfortable. In some cats, therapy may extend survival time by several months. Treatment is best advised in cats that are in good physical condition, are still eating, have no neurologic signs, and that do not have concurrent FeLV-induced malignancy or bone marrow suppression. Treatment is directed toward controlling the immune-mediated vasculitis and reducing viral load. The most effective treatments are combinations of prednisolone and cyclophosphamide. Supportive therapy for FIP is important and includes broadspectrum antibiotics, adequate nutrition and fluid intake, and high doses of ascorbic acid. The use of low doses of aspirin because they can be useful as an antiinflammatory. The Rivalta test is used in order to differentiate a transudate from an exudate. A test tube is filled with distilled water and acetic acid is added. To this mixture one drop of the effusion to be tested is added. If the drop dissipates, the test is negative, indicating a transudate. If the drop precipitate, the test is positive, indicating an exudate Recommended Treatment There is no cure for FIP. As with all terminal illnesses, the basic course of action is to provide supportive care. A combination of corticosteroids, immunosuppressive drugs, antibiotics, good dietary maintenance and proper fluid intake. It may relieve discomfort. Prognosis The likelihood of survival is very poor for cats who are clinically diagnosed with FIP (~ 1 – 11/2 year) With a 95% mortality rate, euthanasia is normally the most appropriate course of action. Pathologic Lesions of Disease In classic FIP, there is diffuse peritonitis or pleuritis (or both) characterized grossly by variable amounts of viscous abdominal or thoracic fluid, deposition of graywhite exudate, and disseminated necrotic plaques on the visceral and parietal peritoneum or pleura. Fibrinous adhesions (scar tissue), particularly between the liver and diaphragm and between loops of bowel, can develop in protracted cases. Lesions in the CNS affect the brain and spinal cord and can cause several types of masses. Pathological Lesions The lesions are primarily extraserosal. Characterized by granulomatous inflammation in a variety of organs but principally affect the kidneys, visceral lymph nodes, lungs,liver, eyes, and leptomeninges. Prevention & Client Education An intranasal MLV vaccine to prevent FIP is available (but has shown very little effectiveness) Reducing exposure to the disease such as : Disposing of Feces Properly Early Weaning Isolation of Cats that Test Positive for Coronavirus Antibodies Isolation and Testing of Cats after Shows Proper Sanitation/Cleaning with Disinfectants Immunization Against Other Feline Viruses. Prevention and client education Please see text book pg 231 REFERENCES "Client Education - Feline Infectious Peritonitis." Sheepshead Bay Veterinary Group. Web. 10 Mar. 2011. <http://www.sbvet.net/ClientEducation_FIP.html>. "Feline Infectious Peritonitis (FIP) in Cats & Kittens." Pet Health Care | Dog and Cat Behavior Information by Veterinarians. Web. 10 Mar. 2011. <http://www.peteducation.com/article.cfm?c=1 2134&aid=212>. Team, The Petside. "Peritonitis, Infectious (Feline) | Diagnose Dog & Cat Health Problems, Pet Health Information." Petside.com | Pet Health Information, Dog & Cat Breeds, Pet News. Web. 10 Mar. 2011. <http://www.petside.com/health/petvet/peritonitis-infectious-feline.php>. Brown MA, Troyer JL, Pecon-Slattery J, Roelke ME, O'Brien SJ. Genetics and pathogenesis of feline infectious peritonitis virus. Emerg Infect Dis. 2009 Sep. <http://www.cdc.gov/EID/content/15/9/1445.htm>. "Genetics and Pathogenesis of Feline Infectious Peritonitis Virus | CDC EID." Centers for Disease Control and Prevention. Web. 11 Mar. 2011. <http://www.cdc.gov/EID/content/15/9/1445.htm>. "Merck Veterinary Manual." The Merck Veterinary Manual. Web. 11 Mar. 2011. <http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/56900.htm&word=FIP>. "YouTube - Pathogenesis of Feline Infectious Peritonitis (FIP) - the Infection of the Monocyte." YouTube Broadcast Yourself. Web. 11 Mar. 2011. <http://www.youtube.com/watch?v=6RyI2LI9R9Q>.