Feline infectious peritonitis (FIP) is a systemic immune-mediated inflammatory perivasculitis that occurs in a minority of cats infected with feline coronavirus (FCoV). Various therapies have been employed to treat this condition, which was previously usually fatal, though no parameters for differentiating FIP recovery from remission have been defined to enable clinicians to decide when it is safe to discontinue treatment. This retrospective observational study shows that a consistent reduction of the acute phase protein alpha-1 acid glycoprotein (AGP) to within normal limits (WNL, i.e., 500 μg/mL or below), as opposed to duration of survival, distinguishes recovery from remission. Forty-two cats were diagnosed with FIP: 75% (12/16) of effusive and 54% (14/26) of non-effusive FIP cases recovered. Presenting with the effusive or non-effusive form did not affect whether or not a cat fully recovered (p = 0.2). AGP consistently reduced to WNL in 26 recovered cats but remained elevated in 16 cats in remission, dipping to normal once in two of the latter. Anaemia was present in 77% (23/30) of the cats and resolved more quickly than AGP in six recovered cats. The presence of anaemia did not affect the cat’s chances of recovery (p = 0.1). Lymphopenia was observed in 43% (16/37) of the cats and reversed in nine recovered cats but did not reverse in seven lymphopenic cats in the remission group. Fewer recovered cats (9/24: 37%) than remission cats (7/13: 54%) were lymphopenic, but the difference was not statistically different (p = 0.5). Hyperglobulinaemia was slower than AGP to return to WNL in the recovered cats. FCoV antibody titre was high in all 42 cats at the outset. It decreased significantly in 7 recovered cats but too slowly to be a useful parameter to determine discontinuation of antiviral treatments. Conclusion: a sustained return to normal levels of AGP was the most rapid and consistent indicator for differentiating recovery from remission following treatment for FIP. This study provides a useful model for differentiating recovery from chronic coronavirus disease using acute phase protein monitoring.
Dunbar, D. et al. (2018) Diagnosis of non-effusive feline infectious peritonitis by reverse transcriptase quantitative PCR from mesenteric lymph node fine-needle aspirates. Abstract 1 Objectives: The aim of this study was to evaluate a feline coronavirus (FCoV) 2 reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) on fine-3 needle aspirates (FNA) from mesenteric lymph nodes (MLN) collected in sterile 4 saline for the purpose of diagnosing non-effusive feline infectious peritonitis (FIP) in 5 cats. 6 Methods: First, the ability of the assay to detect viral RNA in MLN FNA 7 preparations compared to MLN biopsy preparations was assessed in matched samples 8 from eight cats. Secondly, a panel of MLN FNA samples was collected from a series 9 of cats representing non-effusive FIP cases (n = 20), FCoV seropositive individuals 10 (n = 8) and FCoV seronegative individuals (n = 18). Disease status of animals was 11 determined using a combination of gross pathology, histopathology and/or 'FIP 12 profile' consisting of serology, clinical pathology and clinical signs. 13 Results: Viral RNA was detected in 18 of 20 non-effusive FIP cases; it was not 14 detected in two cases that presented with neurological FIP. Samples from 18 15 seronegative non-FIP control cats and seven of eight samples from seropositive non-16 FIP control cats contained no detectable viral RNA. Thus, as a method for diagnosing 17 non-effusive FIP, MLN FNA RT-qPCR had an overall sensitivity of 90.0 % and 18 specificity of 96.1 %. 19 Conclusions and relevance: In cases with a high index of suspicion of disease, RT-20 qPCR targeting FCoV in MLN FNA can provide important information to support the 21 ante-mortem diagnosis of non-effusive FIP. Importantly, viral RNA can be reliably 22 detected in MLN FNA samples in saline submitted via the national mail service. 23 When applied in combination with biochemistry, haematology and serological tests in 24 4 cases with a high index of suspicion of disease, the results of this assay may be used 25 to support a diagnosis of non-effusive FIP. 26 27 11 . However, as a minimally invasive sampling technique has not been described for 47 peritonitis. BMC Vet Res 2017; 13: 228. 426 8. Egberink HF, Herrewegh APM, Schuurman NMP, et al. FIP, easy to 427 diagnose? Vet Quarterly 1995; 17: 24-25. 428 9. Doenges SJ, Weber K, Dorsch R, et al. Comparison of real-time reverse 429 transcriptase polymerase chain reaction of peripheral blood mononuclear cells, serum 430 and cell-free body cavity effusion for the diagnosis of feline infectious peritonitis. J
Case summaryAn 8-year-old female spayed Siamese indoor cat presented with a 3 week history of inspiratory dyspnoea, stridor and open-mouth breathing after exercise. Laryngoscopy, tracheoscopy, bronchoscopy and retroflexed nasopharyngoscopy were performed, and identified a multilobulated intraluminal mass within the trachea. Brush cytology was performed on the mass but was inconclusive in providing a definitive diagnosis. A CT scan of the neck failed to identify an obvious intraluminal mass and was negative to contrast uptake. Surgery was performed and seven rings of the trachea were removed to enable the complete excision of the mass. Histopathology of the excised mass was consistent with B cell lymphoma. After surgery, chemotherapy treatment was started. At the time of writing, 20 months since diagnosis, the cat remained clinically well, with no clinical signs or recurrence of macroscopic disease on endoscopic evaluation.Relevance and novel informationUpper airway endoscopy was considered to be an essential diagnostic tool in this case presenting with signs of upper respiratory dyspnoea. Moreover, combined surgery and chemotherapy were considered effective treatments and positively affected the long-term prognosis of this patient.
Information provided in this article is based on published literature, comprising original studies, case review series and textbook chapters, and the authors' own clinical experience.
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