Background: Gastrointestinal disorders are common in cats, and the differentiation between inflammatory and neoplastic disease is essential to determine therapy. Therefore, ultrasonographic evaluation is an important tool for intestinal diagnosis in cats. The aim of this study is to evaluate the clinical, ultrasonographic and histopathological characteristics of cats with intestinal diseases.Materials, Methods & Results: Forty cats with gastrointestinal clinical signs and abdominal ultrasound findings consistent with inflammatory bowel disease or gastrointestinal neoplasia were studied. Ultrasound evaluated all abdominal organs, with emphasis on the gastrointestinal tract, and parameters included the thickness of gastric and intestinal wall, the variations of its echogenicity, reduced intestinal lumen, mesenteric lymph nodes, involvement of other abdominal organs and presence of abdominal effusion. All cats were referred to exploratory laparotomy, in order to obtain biopsy samples. Mean age was 11.6 years and there were 23 females and 17 males. Clinical signs included weight loss (87.5%), vomiting (82.5%), hyporexia (75%), diarrhea (35%), constipation (10%), polyphagia (5%) and intestinal gases (5%). In abdominal ultrasound, the most common findings were increased thickness of the gastric and/or intestinal wall, decreased echogenicity of the intestinal wall, reduction of the intestinal lumen due to severe wall thickening or presence of obstructive mass, and lymphadenopathy. Histopathology revealed alimentary lymphoma (AL) in 19 cases, inflammatory bowel disease (IBD) in 10 cases, intestinal adenocarcinoma in 7 cases, mast cell tumor in 2 cases and intestinal hemangiosarcoma in 2 cases.Discussion: Weight loss and vomiting were the two main complaints of the owners. However, diarrhea, described by previous authors as one of the main clinical signs in cats with intestinal diseases, was present in only 35% of cats of this study. The intestinal segments that were presented more frequently with increased wall thickness were duodenum and jejunum, and the mean wall thickness was 0.51 cm. Cats diagnosed with AL had mean value of duodenum wall thickness/jejunum of 0.564 cm, while in patients with IBD the mean value was 0.462 cm. Whereas previous authors said that ultrasonographic findings in cats with lymphocytic lymphoma are usually indistinguishable from patients with inflammatory bowel disease and that the wall thickness in both cases may be normal or increased, the analysis presented in this study was considered representative since most cases of AL corresponded to lymphocytic lymphoma. Surgery was performed on 35 cats in the study. The choice for exploratory laparotomy (instead of endoscopy for example) was to collect all layers of the intestinal segment, and it was successful, as all samples were representative and allowed the definitive diagnosis. Histopathology revealed 19 cases of alimentary lymphoma, 10 cases of inflammatory bowel disease, 7 cases of intestinal adenocarcinoma, 2 cases of intestinal mast cell tumor and 2 cases of intestinal hemangiosarcoma. The prevalence of AL over IBD has been previously discussed, but the occurrence of adenocarcinoma and mast cell tumor was higher in the present study. On feline physical examination, attention should be directed to abdominal palpation, since this study showed that 47.5% of the animals had intestinal wall thickening. The ultrasonographic evaluation and histopathological diagnosis is essential for the clinical management of cats with intestinal diseases.
Background: Histoplasmosis is a systemic mycosis whose etiologic agent is the fungus Histoplasma capsulatum. This fungal infection, which is the second most frequent systemic mycotic fungal disease in felines in the United States, has rarely been found in cats in Brazil. This paper reports on a case of acute pulmonary histoplasmosis in a domestic cat treated with oral itraconazole associated with amphotericin B administered subcutaneously. This treatment resulted in clinical remission of the patient’s symptoms, as evidenced by radiographic follow-ups.Case: A domestic cat suffering from acute dyspnea was taken to a veterinary clinic. The animal was subjected to emergency oxygen therapy, and kept at rest through sedation with midazolam. A physical examination revealed normally colored mucosa, 8% dehydration, bristly fur, body condition score 2/9, tachypnea with respiratory rate of 100 breaths per minute and expiratory dyspnea. The radiographic examination showed marked opacification of all the pulmonary fields, with a mixed pattern (interstitial and alveolar) of heterogeneous appearance and diffuse distribution, which are changes consistent with an inflammatory infectious process (pneumonia). A cytological analysis of the pleural fluid revealed round to oval-shaped intracytoplasmic structures, varying in size from 2 to 4 μm, inside foamy macrophages, consistent with Histoplasma capsulatum. Based on the diagnosis of pulmonary histoplasmosis, and in view of the patient’s acute respiratory distress, it was decided to treat the cat using itraconazole associated with amphotericin B. Itraconazole was administered orally at a dose of 100 mg/cat every 24 h, while amphotericin B was administered subcutaneously at a dose of 0.5 mg/kg, combined with 100 mL of sodium chloride 0.9% and 100 mL of 5% glycated serum, with monitoring of serum concentrations of symmetric dimethylarginine (SDMA). Amphotericin B was administered every 48 h up to the 7th dose, followed by three times a week up to the 11th dose, and then twice a week up to the 16th dose. The animal was released from the veterinary hospital 10 days after its admission, showing a considerably improved respiratory condition and a respiratory rate of 40 breaths per minute. Continuation of the antifungal treatment with itraconazole was prescribed, maintaining the same dose and frequency of administration until a new recommendation would be made, as well as frequent return visits for the administration of amphotericin B and reassessment of the animal. The administration of amphotericin B was discontinued when the animal’s respiratory condition stabilized; hence, the feline received a total of 16 doses of the drug. The animal showed remission of clinical respiratory symptoms, confirmed by follow-up chest X-rays, which revealed significantly less radiodense pulmonary parenchyma in response to treatment with itraconazole and amphotericin B. Five months after beginning its treatment, the cat is being treated orally with itraconazole (100 mg/cat, every 24 h), without recrudescence of the clinical symptoms.Discussion: To date, six cases of feline histoplasmosis have been reported in Brazil, only one of which had pulmonary involvement and was treated successfully. The use of oral itraconazole associated with subcutaneous amphotericin B has proved to be effective for the treatment of acute pulmonary histoplasmosis in domestic cats. Note that a rapid diagnosis of pulmonary disease is essential in order to immediately implement a combined drug therapy linked with monitoring to ensure the protocol is safe for the patient
Chronic kidney disease (CKD) is characterized by irreversible morphostructural lesions that can progressively evolve to chronic renal insufficiency and kidney failure. It is known that the heart and kidneys are closely related, and that communication between these organs occurs through a variety of pathways; subtle physiological changes in one of them are compensated by the other. Histopathological cardiac evaluation through routine staining presents a limitation to identify specific or discreet lesions in the cardiomyocytes. This study aimed to evaluate serum troponin levels in cats with CKD, associated with clinical and pathological findings, as well as to correlate the morphostructural cardiac lesions to determine their distribution through macroscopic and histological assessments and anti-cardiac troponin C (cTnC) immunohistochemistry (IHC). To this end, 20 cats (18 diagnosed with CKD and two controls) were selected. Anti-human cTnC IHC was conducted after necropsy and separation in eight regions of each collected heart. Heart fragments from two cats without CKD were used as controls. The anti-human cTnC antibody is useful in detecting cardiac lesions and has shown decreased expression in cardiomyocytes of cats with CKD. Serum troponin was above the reference values in 11/18 (61.11%) animals and decreased expression for the cTnC antibody was observed in individual cardiomyocytes in 9/18 (50%) animals. It was verified that the number of regions with decreased expression for the cTnC antibody in cardiomyocytes is significantly correlated with serum troponin. The anti-human cTnC antibody has been found effective in detecting cardiac lesions and has shown decreased expression in the cardiomyocytes of cats with CKD. Correlation was observed between increased serum cTnI and loss of immunoreactivity at anti-cTnC antibody IHC in cats with CKD, which proves damage to cardiomyocytes secondary to kidney disease.
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