Case Study for Big Kitty
8.18.2014
VTA
Kari Anderson
History:
Big Kittly (file #2153) is a 10year old DSH Tabby spayed feline and a new
patient at Sawyer Lake Veterinary Hospital. She was first seen in our office on
06/30/2014. Big Kitty has never been vaccinated, is a barn cat, and eats all kinds of
other animals.
Current Issue:
On Monday, June 30th, Big Kitty’s owner brought her to SLVH saying that Big
Kitty’s weight has been decreasing over the past six (6) months and it has become
very noticeable over the past couple weeks.
S: The owner reported that Big Kitty is about half the size that she was six
(6) months ago and has stopped grooming herself. Stools are mushy and unformed.
Patient will lay in her own urine and feces. O also stated that the Patient seems to
have an increase in appetite over the past couple of weeks.
O: Cannot palpate any masses. Need to do bloodwork to find cause of weight
loss. Purring up a storm. Eats well.
A: Glucose is 129 so Patient is not diabetic. Not grooming but her mouth has
no obvious problems. The diarrhea has been present for years and could be
tritrichomonas or coccidia.
RULE-OUTS
 Bartonellosis
 Neoplasia
 Chronic Renal Failure
 Hyperthyroidism
 Diabetes Mellitus
P: Due to lab tests still pending, this is an open diagnosis.
DIAGNOSTIC PLAN
 Glucose Test-Glucometer
 Senior Feline Screen with CBC
 Bartonella Test
 Specimen Collection, Lab
TREATMENT PLAN
 Ponazuril (toltrazuril sulfone IS), antiprotozoal, 100mg/ml
o – Give 0.6mL SID in the morning for three (3) days
Tuesday, July 1, 2014 - SLVH Diagnosis and Treatment
The lab results came back as follows:

Senior Feline Screen with CBC –
o WBC Count at 24,000 H with Neutrophilia

Chems came back WNL

Bartonella Test
o (Still pending)
Per Dr. Ferguson, the lab results indicate an infection; it would be ideal to
consider a urinalysis or we can just start antibiotics and follow-up in another CBC in
one (1) week to see if Patient is getting better.
After discussing the options with the Owner, she opted to start the antibiotics
now and retest in a week.
Patient was prescribed Clavamox, antibiotic (there is no generic equivalent
available)

Give 1.0mL PO BID for 14 days
Tuesday, July 8, 2014
Owner called in to report that the Patient seems to be doing ok but doesn’t
seem to be gaining weight. Feces had formed a little bit but not much and the smell
was VERY BAD.
The Doctor offered Bene Bac and recommended doing a fecal float and smear
but Owner wants to try offering the Patient yogurt first but will bring in a fecal
sample if things don’t start getting better in a few days.
When adding the Client Communication to the Patient’s Medical Record, I
realized that we didn’t have the results for the Bartonella Test logged in the system.
I brought this to the Doctor’s attention, she asked me to call and have them faxed
over right away.
The results of the Bartonella Test came back as a (+4) – VERY STRONG
POSITIVE.
Discussed the findings with the Doctor and she requested that I call the
Owner with the results and to let her know that we’ll be prescribing Rifampin for
the Patient.
I left message on machine (LMOM) for Owner and told her that we’d have the
script ready for her when she came in.
Patient was prescribed Rifampin and Hill’s A/D Canine/Feline Food
Rifampin, antibiotic (Brand names include Rifadin & Rimactan)

Give 0.6mL PO SID for 21 days.
Tuesday, July 15, 2014
Owner came in to p/u Rifampin & Hill’s A/D food, and dropped off fecal
sample. She was asking me what Bartonella was and how could Big Kitty have
gotten it?
I explained to her that Bartonellosis is an infectious bacterial disease, caused
by the gram-negative bacteria Bartonella henselae. Bartonella are bacteria that live
inside cells; they can infect humans, mammals, and a wide range of wild animals.
It is also commonly known as cat scratch disease (CSD), or "cat scratch fever." This
is a zoonotic disease, meaning that it can be transmitted between animals and
humans and that it is very common in domestic cats. They can get it by being bit by
an infected flea, tick or body lice.
Fecal float results were NEGATIVE
Called O and LMOM letting her know that the results of the fecal float were
negative and to call us if there is no improvement and that I’d check back with her
next week if we haven’t heard anything from her.
Tuesday, July 22, 2014
Called to check-up on Patient, O stated that feces had firmed up and odor is
back to normal.
Tuesday, July 29, 2014
Owner called in to let us know that Big Kitty was doing well on “good”
canned food with pumpkin in it. BM’s aren’t smelling EXTRA BAD anymore. Just
finished the Clavamox and has a little over a week left on the Rifampin. Owner
reports that Patient’s weight is up a little bit.
Advised Owner that as long as everything continues to go well that we will
schedule a Bartonella Titration Test in 6 months but to please contact us if there are
any changes or problem.