Sylvester is a handsome adult cat who lives in a rural, wooded area of West Tisbury. Like many country cats, Sly goes outside and roams around, and, like many country cats, enjoys exhibiting his prowess as a hunter and sharing the bounty with his people. Last week Sly’s owners awoke to find the headless remains of an almost full-grown rabbit on the floor of their house. The following day, they found baby bunny bits strewn about. They carefully cleaned up the blood and body parts (knowing that rabbits can carry tularemia), but were not too concerned about Sly because, well, eating bunnies is just what many outdoor cats do in the springtime, and he seemed fine.
A few days later, however, Sylvester didn’t eat his breakfast. OK, cats can be finicky. It wasn’t unusual for him to be opinionated about the menu, but the next day he refused breakfast yet again. Then he disappeared. Now they were worried. Sly usually came home like clockwork for food and affection. It was not like him to simply vanish. His mom sent me a worried email. Could he have contracted tularemia or some other illness from his rabbit feast? What other misfortune could have befallen him? The reality is that cats who go outside run the risk of using up their nine lives faster than those that stay indoors, but until I could examine him, there was little I could do to help.
The next evening Sylvester was found curled up in the woods, alive but definitely under the weather. On physical exam, he clearly was not well. He was quiet and dull in his affect. I pulled up the skin on the back of his neck. It stayed tented for a minute before slowly going back down, indicating significant dehydration. I paused, then put on a pair of exam gloves. Tularemia is an infection caused by the bacterium Francisella tularensis. The main ways cats get infected are from tick bites, or hunting and eating infected rabbits and rodents. Human cases are rare, and generally occur from contact with rabbits or ticks, but have occasionally been documented as the result of exposure to infected cats, usually via bites or scratches. I wasn’t taking any chances. About 15 years ago, during a late night emergency, before I realized the patient in question had tularemia, I got a drop of blood on my fingers. Being tired, I must have rubbed my eyes without thinking. I ended up with a (thankfully mild) case of ocular tularemia. I wasn’t going to make that mistake again.
Sylvester did not look as sick as other cats I have seen with tularemia, but clinical signs can range from mild to severe, and may include fever, lethargy, swollen lymph nodes, abscesses, dehydration, jaundice, loss of appetite, and ulcers in the mouth. To completely rule it out, I would need to send a large blood sample to a special USDA laboratory. Test results would take at least a few days. When I have a high suspicion of tularemia, I often start appropriate treatment without definitive diagnosis, but that requires either daily injections of the antibiotic gentamicin, which is potentially damaging to the kidneys, or an oral combination of two antibiotics given twice daily. Sylvester is, ahem, let’s say uncooperative when it comes to taking pills, so either course of tularemia treatment would be difficult.
I proceeded cautiously with my exam. Lymph nodes? Normal. Oral exam? No jaundice, no ulcers. Temperature? Normal. This didn’t look like tularemia to me. I started to relax and consider other differentials. In-clinic tests ruled out tick-borne diseases like Lyme or anaplasmosis. Evidence of diarrhea suggested gastrointestinal issues and his general malaise in the absence of fever might be from nausea. Blood chemistry ruled out kidney failure, but showed some liver abnormalities. Putting together the pieces of the puzzle, I began to consider a diagnosis of triaditis.
Triad: meaning a group of three connected things. Itis: a suffix describing inflammatory diseases. Triaditis is a complex condition of cats in which the patient simultaneously experiences inflammation of the pancreas, gallbladder, and intestines. The most common presentation is vomiting, but symptoms may also include lethargy, diarrhea, and poor appetite. Severe cases may exhibit fever, jaundice, and weight loss. We are not sure exactly what causes triaditis, but bacterial infections have been implicated, as have immune system issues. Definitive diagnosis can be complicated, and is not always possible, so we often base our conclusions on history and clinical signs.
Treatment is primarily symptomatic, treating each of the three parts of the triad as needed. Fluids. Antinausea medication.Sometimes antibiotics, anti-inflammatories, and/or analgesics. Nutritional support. We gave Sylvester subcutaneous fluids, injections of an antinausea drug, B vitamins, and long-acting antibiotics so his owners wouldn’t have to give him pills. We prescribed a transdermal appetite stimulant to use at home that also would continue to help with any nausea. This medication is no problem for his owner to administer. Simply wear gloves and apply the cream to the inside of Sly’s ear, where the drug is absorbed through the skin. Easy peasy. Since triaditis sometimes warrants hospitalization and intensive care, and since severe cases can be fatal, we booked Sylvester for a recheck in 24 hours.
The following morning, Sylvester was a different cat. Although not completely back to himself, he was much brighter and more alert. He had eaten a little at home, and was back to enjoying snuggling with his owner. We gave additional fluids and sent him on his way for continued TLC and observation. So far, so good.
It’s baby bunny season, folks. If your cats go outside, don’t panic if they do what cats do and kill a rabbit, but please remember rabbit blood can pose a risk of tularemia to both you and your kitties. In Sly’s case, we are pretty sure he dodged tularemia, but I suspect his overindulgence in bunny bits is what initiated his triaditis, which can be an equally serious illness.