Visiting Vet: Southern charm

Two little kitties are well taken care of, but still have some challenges.

Cats like Tiger and Lily can stay healthy with a proper diet and prompt care. — Eerik and Allison Meisner

Two kittens, Hope and Joy, born down South, somehow found their way to a South Carolina branch of the Humane Society. Arriving as “strays,” no one could say exactly how old they were, or even if they were biological sisters. The shelter took excellent care of them. They were vaccinated for feline distemper and upper respiratory viruses. They were tested for intestinal parasites and treated for roundworms and coccidia. Once they were a bit bigger, they were spayed, rabies vaccinated, screened for Feline Leukemia Virus (FeLV) and Feline Immunodeficiency Virus (FIV) and even given the first of the recommended series of two FeLV vaccines.

With all this pre-adoption care, when they arrived on the Vineyard, their new owner felt confident they were healthy kittens … but Mom quickly noticed Joy was sneezing and Hope was having diarrhea. Both these issues are common in shelter kittens, so I wasn’t overly concerned. Joy’s upper respiratory infection was bad enough that I prescribed antiviral medication. For Hope’s diarrhea, I gave probiotics and an intestinal antibiotic/anti-inflammatory, and suggested increasing the fiber in her diet.

Both kittens were growing, active, and playful, but continued to have intermittent diarrhea and unusually bad flatulence. Diarrhea in young cats is almost always parasite or diet-related. “Bring stool samples,” I advised, even though the girls had been tested and found to be parasite-free prior to their adoption. Although repeated fecal samples here failed to find any kind of parasites, one of the kittens was clearly still having liquidy diarrhea. It was hard to be sure which, but Mom suspected Hope.

If the problem wasn’t intestinal parasites, maybe it was dietary. If we suspect a cat has food intolerance, hypersensitivity, or allergy, a bland diet for “sensitive stomachs” or hypoallergenic diet with limited ingredients may help. Other cats have “fiber-responsive diarrhea” that will resolve if we simply increase dietary fiber. Although Hope did improve a little both with medication and diet changes, the diarrhea and flatulence kept coming back with a vengeance.  What now?

I suggested that, in addition to trials of different diets, we run a Feline Diarrhea PCR panel. This test looks for DNA or RNA genetic material from a whole host of bacterial, viral, and protozoan organisms that can give kitties the runs. When the lab report arrived, I scanned the results. Tritichomonas: negative. Cryptosporidium: negative. Giardia, Salmonella, Toxoplasma: all negative. Out of a long list of organisms, Hope tested positive for just two things. Feline coronavirus and Clostridium perfringens.

Feline coronavirus has nothing to do with COVID-19, so don’t panic. A common viral infection in cats that usually causes a few weeks of mild, self-limiting diarrhea, it was unlikely to be causing Hope’s long-term condition. The bacterium C. perfringens can actually be normal microflora in the gut of cats. If present in large amounts, the toxin it produces can contribute to the diarrhea, but is rarely the underlying cause. The question was WHY Hope had this overgrowth of Clostridium.

I called an internal medicine specialist for advice. ”First of all, get a full database,” she said. “ A complete blood count, chemistry profile, and FeLV/FIV test.” Thinking about my client’s pocketbook, I objected. The kittens had already been screened for Feline Leukemia Virus and Feline Immunodeficiency Virus at the Humane Society. The specialist insisted. It was worth repeating the test. Kittens can sometimes have “false negative” results, especially if they screened very soon after they were exposed to these viruses. The specialist continued. “You can also get false negatives on the Tritrichomonas PCR test,” she said.

Tritrichomonas is a tricky little bug. A highly contagious protozoal parasite, it is easily spread from cat to cat in unsanitary or overcrowded conditions via “fecal-oral” transmission. Although not all infected cats show clinical signs, young cats and kittens are most likely to get visible symptoms which can include liquid or pudding-like diarrhea, bloody or mucousy stools, and flatulence. In severe cases there can be loss of appetite, vomiting, and weight loss. That sounds a lot like Hope. Couldn’t we just treat her and see if she gets better?

Well, no. Not really. There is no treatment for tritrichomonas officially approved for use in cats. The medication we could try, ronidazole, can cause neurological and/or liver damage and  is only partially effective, in any case. It requires special handling as it is a known carcinogen. Not a drug to use without a definitive diagnosis. Hope’s PCR test was negative … but false negatives happen. We could consider doing a different, more sensitive test to try to be sure, but that would require a special procedure, flushing her colon to obtain a specific type of sample. On the other hand, even without treatment, the vast majority of cats with tritrichomonas will self-cure over time. This can take months to years, but probiotics and high fiber diets can help ameliorate the diarrhea in the meantime.

I discussed all this with Hope’s owner. We decided to start with the blood tests. Every test came up perfectly normal. Except one. Hope has Feline Leukemia Virus. That first FeLV test at the shelter was a false negative or was taken too soon after exposure. Or maybe Hope was infected later, some time after that initial test. Although there is currently no cure, with good nutrition and health care, FeLV-positive cats often live much longer nowadays and have a better quality of life  than they used to. Whether FeLV is implicated in her chronic diarrhea, who can tell? As an immunosuppressive virus, FeLV can leave Hope vulnerable to diseases she might otherwise fight off easily. Maybe that coronavirus is lingering. Maybe she does have Tritrichomonas and is having trouble self-curing.

Hope will need to be an indoor kitty, to stay safe and so as not to expose other cats to the virus. Sister Joy will be vaccinated and re-tested annually. With time and supportive care, Hope’s diarrhea may resolve, and we hope she will live as long and happy a life as possible, despite being FeLV-positive.