Difference between revisions of "Feline Infectious Peritonitis"

Revision as of 21:57, 26 July 2010

Also known as:

FIP

Description

A progressive disease of the cat caused by feline coronavirus. Occurs in 5-10% of cats infected with Feline Enteric Coronavirus (FECoV)which is characterised by a variety of clinical signs, including weight loss, fever and vasculitis. Two forms of the disease exist the wet form and the dry form.

Signalment

Domestic and wild cats

Diagnosis

FIP should be suspected in all cases of chronic weight loss or recurrent fever unresponsive to antibiotics, particularly in multiple cat situations. Simple serology is impossible as most cats will have antibody to FECoV

However, 4 indicators can be used to cross reference:

High FECoV Ab titres
Low albumin:globulin ratio in plasma/ascites (globulin levels rise in FIP)
High levels of glycoprotein alpha 1-acid glycoprotein (AGP)
Low white cell counts

FIP antigen detection by immunofluorescence in macrophages gives a definite positive diagnosis

Pathogenesis

FECoV may cause mild respiratory symptoms and diarrhoea but is often asymptomatic
Weeks, months or years may intervene between localized primary FECoV infection and FIP development
FECoV replicates in the gut, but FIP spreads systemically in the circulation
FIP gains ability to replicate in monocytes and macrophages
Almost invariably fatal
Failure of the immune system to clear antibody-antigen complexes leads to immune-mediated disease
- Deposited complexes cause inflammation and exudation
- This leads to characteristic oedema as fibrin-rich serum escapes to intercellular spaces
- Pyogranulomas can develop in major organs as a result of the immune response and the body's failure to clear away excess neutrophils
Cats previously exposed to coronavirus (and therefore with circulating antibody) may be at greater risk as they are more susceptible to taking up virus into mononuclear cells
Cats making a biased Th-1 response are more likely to evade infection, whereas cats making a balanced response are at moderate risk and cats making a biased Th-2 response are at greater risk, as the virus is best tackled by cell mediation and not antibody
Cats compromised by immunosuppression (either iatrogenic or disease-related) are at a greater risk of developing FIP

History and Clinical signs

Chronic weight loss
Anorexia
Pyrexia
Depression
Fluid in the abdomen, thorax or pericardium symptomatic of wet, or exudative FIP
Granulomatous change in the organs symptomatic of dry, or nonexudative FIP

Has been documented to cause: Uveitis, hydrocephalus, neurological symptoms, such as ataxia or seizures and chronic diarrhoea.

Epidemiology

FECoV is endemic worldwide, with the majority of cats showing a subclinical seroconversion
Orofecal, aerosol, and contact transmission
Particular concern for catteries and homes with multiple cats
FIP arises from a mutation of FECoV (in 5-10% of chronically infected cats) and not directly from cat to cat

Granulomatous Enteritis

Caused by feline

Pathology

Gross

Wet form

Widespread miliary, white, pinhead granulomas and fibrin deposition, particularly in the serosa of the intestine. High-protein exudates can be found in peritoneal cavity.

Dry form

- Larger, grey granulomatous masses causing thickening of the wall of small and large intestine.

Histological

Multifocal pyogranulomas on serosa and throughout gut wall.
- Infiltration by mononuclear cells.
  - Lymphocytes, plasma cells, macrophages.
- Fewer neutrophils.
Necrosis.
Vasculitis.

Hepatitis

coronavirus
causes pyogranulomatous lesions on the surface of many organs including the liver

Treatment

Control

Conventional vaccination is counterproductive as antibody worsens infection
A non-systemic vaccine (Primucell) is available outside the UK
- Temperature-sensitive mutant
- Replication confined to nasal mucosa, providing local immunity and cell-mediated immunity
- Cannot protect cats already infected with FECoV
- Kittens must be isolated until old enough to vaccinate at 16 weeks
Antibody tests are available to certify "FECoV-free" cat houses

Prognosis

References

[[

@@ Line 1: / Line 1: @@
-{{OpenPagesTop}}
+{{unfinished}}
-Also known as: '''''FIP'''
-==Introduction==
+{| cellpadding="10" cellspacing="0" border="1"
-A progressive disease of the cat caused by feline [[Coronaviridae|coronavirus]]. FIP arises from a mutation of '''Feline Enteric Coronavirus (FECoV)''' in 5-10% of chronically infected cats and not directly from cat to cat. Two forms of the disease exist the '''wet''' or '''exudative form''' and the '''dry''' or '''non exudative form'''.
+| Also known as:
+| '''FIP'''
+|-
+|}
+==Description==
+A progressive disease of the cat caused by feline [[Coronaviridae|coronavirus]]. Occurs in 5-10% of cats infected with Feline Enteric Coronavirus (FECoV)which is characterised by a variety of clinical signs, including weight loss, fever and vasculitis. Two forms of the disease exist the wet form and the dry form.
 ==Signalment==
-Domestic and wild cats.
+Domestic and wild cats
-Cats compromised by immunosuppression (either iatrogenic or disease-related) are at a greater risk of developing FIP.
-==History and Clinical signs==
-FECoV may cause mild respiratory signs and diarrhoea but is often asymptomatic.
-Signs of FIP include, chronic weight loss, anorexia, pyrexia, depression, fever and [[Vasculitis|vasculitis]].
-Fluid in the abdomen, thorax or pericardium are symptomatic of wet FIP.
-Granulomatous change in the organs are symptomatic of dry FIP.
-FIP has also been documented to cause:
-Uveitis, [[Congenital and Neonatal Disease - Pathology #Hydrocephalus| hydrocephalus]], neurological symptoms, such as ataxia or [[Seizures|seizures]] and chronic [[Diarrhoea|diarrhoea]].
 ==Diagnosis==
 FIP should be suspected in all cases of chronic weight loss or recurrent fever unresponsive to antibiotics, particularly in multiple cat situations.
-Simple serology is impossible as most cats will have antibody to FECoV.
+Simple serology is impossible as most cats will have antibody to FECoV
-===Laboratory Tests===
+However, 4 indicators can be used to cross reference:
-Four indicators can be used for diagnosis:
+*High FECoV Ab titres
-*High FECoV Antibody titres
 *Low albumin:globulin ratio in plasma/ascites (globulin levels rise in FIP)
 *High levels of glycoprotein alpha 1-acid glycoprotein (AGP)
 *Low white cell counts
-FIP antigen detection by immunofluorescence in macrophages gives a definite positive diagnosis
+FIP antigen detection by '''immunofluorescence''' in macrophages gives a definite positive diagnosis
 ==Pathogenesis==
-Weeks, months or years may intervene between localized primary FECoV infection and FIP development. FECoV replicates in the gut, but FIP spreads systemically in the circulation. FIP then gains the ability to replicate in [[Monocytes|monocytes]] and macrophages.
+*FECoV may cause mild respiratory symptoms and diarrhoea but is often asymptomatic
+*Weeks, months or years may intervene between localized primary FECoV infection and FIP development
+*FECoV replicates in the gut, but FIP spreads systemically in the circulation
+*FIP gains ability to replicate in [[Monocytes|monocytes]] and macrophages
+*Almost invariably '''fatal'''
+*Failure of the immune system to clear antibody-antigen complexes leads to '''immune-mediated disease'''
+**Deposited complexes cause '''inflammation''' and '''exudation'''
+**This leads to characteristic '''oedema''' as fibrin-rich serum escapes to intercellular spaces
+** '''Pyogranulomas''' can develop in major organs as a result of the immune response and the body's failure to clear away excess [[Neutrophils|neutrophils]]
+*Cats previously exposed to coronavirus (and therefore with circulating antibody) may be at greater risk as they are more susceptible to taking up virus into mononuclear cells
+*Cats making a biased Th-1 response are more likely to evade infection, whereas cats making a balanced response are at moderate risk and cats making a biased Th-2 response are at greater risk, as the virus is best tackled by cell mediation and not antibody
+*Cats compromised by '''immunosuppression''' (either iatrogenic or disease-related) are at a greater risk of developing FIP
-Failure of the [[:Category:Adaptive Immune System|immune system]] to clear antibody-antigen complexes leads to immune-mediated disease and deposited complexes cause [[Inflammation - Pathology|inflammation]] and exudation. This leads to characteristic [[Oedema| oedema]] as fibrin-rich serum escapes to intercellular spaces.
-Pyogranulomas reactions can develop in major organs as a result of the immune response and the body's failure to clear away excess [[Neutrophils|neutrophils]].
+==History and Clinical signs==
+*Chronic weight loss
+*Anorexia
+*Pyrexia
+*Depression
+*Fluid in the abdomen, thorax or pericardium symptomatic of '''wet, or exudative FIP'''
+*Granulomatous change in the organs symptomatic of '''dry, or nonexudative FIP'''
+Has been documented to cause:
+Uveitis, hydrocephalus, neurological symptoms, such as ataxia or seizures and chronic diarrhoea.
-Cats previously exposed to coronavirus (and therefore with circulating antibody) may be at greater risk as they are more susceptible to taking up virus into mononuclear cells.
+====Epidemiology====
+*FECoV is '''endemic worldwide''', with the majority of cats showing a subclinical seroconversion
+*'''Orofecal, aerosol, and contact''' transmission
+*Particular concern for '''catteries''' and homes with '''multiple cats'''
+*FIP arises from a '''mutation of FECoV''' (in 5-10% of chronically infected cats) and not directly from cat to cat
-Cats making a biased [[Adaptive Immune System - Overview#Cellular response: Proliferation and Differentiation|Th-1]] response are more likely to evade infection, whereas cats making a balanced response are at moderate risk and cats making a biased [[Adaptive Immune System - Overview#Cellular response: Proliferation and Differentiation| Th-2]] response are at greater risk, as the virus is best tackled by cell mediation and not antibody.
-==Pathology==
+==Granulomatous Enteritis==
+*Caused by feline
+===Pathology===
 ====Gross====
-'''Wet form'''
-Widespread miliary, white, pinhead granulomas and fibrin deposition, particularly in the serosa of  the [[Small Intestine Overview - Anatomy & Physiology|small]] and [[Large Intestine - Anatomy & Physiology |large intestine]]
+==='''Wet form'''===
-High-protein exudates can be found in [[Peritoneal Cavity - Anatomy & Physiology|peritoneal cavity]].
+Widespread miliary, white, pinhead granulomas and fibrin deposition, particularly in the serosa of  the intestine.
+High-protein exudates can be found in [[Peritoneal cavity - Anatomy & Physiology|peritoneal cavity]].
-'''Dry form'''
+==='''Dry form'''===
+** Larger, grey granulomatous masses causing thickening of the  wall of [[Small Intestine - Anatomy & Physiology|small]] and [[Large Intestine - Anatomy & Physiology|large intestine]].
-Larger, grey granulomatous masses are found in abdominal organs, including the [[Small Intestine Overview - Anatomy & Physiology|small]] and [[Large Intestine - Anatomy & Physiology|large intestine]], kidneys, liver and mesenteric lymph nodes. CNS and ocular involvement occurs in up to 60% of cases, with granulomas causing the clinical signs.
 ====Histological====
-Multifocal pyogranulomas on serosa and throughout gut wall. Infiltration by mononuclear cells, [[Lymphocytes - Introduction|lymphocytes]], plasma cells, [[Macrophages|  macrophages]] and a few [[Neutrophils|neutrophils]]. [[Necrosis - Pathology|Necrosis]] and vasculitis will also be seen.
-==Treatment==
+* Multifocal pyogranulomas on serosa and throughout gut wall.
-Immunomodulators including interferon have been used to control the virus and Dr. Diane Addie at Glasgow vet school has found that cats do respond to this form of treatment.
+** Infiltration by mononuclear cells.
+*** Lymphocytes, plasma cells, macrophages.
+** Fewer [[Neutrophils|neutrophils]].
+* Necrosis.
+* Vasculitis.
-Immunosuppressive drugs such as [[Steroids| prednisolone]] or cyclophosphamide may slow disease progression.
+==Hepatitis==
-Cats should recieve widespread [[Antibiotics|antibiotics]] and suppotive therapy.
+*coronavirus
+*causes pyogranulomatous lesions on the surface of many organs including the [[Liver - Anatomy & Physiology|liver]]
-The disease is almost invariably fatal.
+==Treatment==
 ==Control==
-Conventional [[Vaccines| vaccination]] is counterproductive as antibody worsens infection however a non-systemic vaccine (Primucell) is available outside the UK. Replication confined to nasal mucosa, providing local immunity and cell-mediated immunity and it cannot protect cats already infected with FECoV.
+*Conventional vaccination is counterproductive as antibody worsens infection
+*A non-systemic vaccine (Primucell) is available outside the UK
+**Temperature-sensitive mutant
+**Replication confined to nasal mucosa, providing local immunity and cell-mediated immunity
+**Cannot protect cats already infected with FECoV
+**Kittens must be isolated until old enough to vaccinate at 16 weeks
+*Antibody tests are available to certify "FECoV-free" cat houses
-Antibody tests are available to certify FECoV-free cat houses.
-Recommendations for control and prevention include:
-:keeping cats in small stable groups
-:good litter tray hygiene to prevent faeco-oral transmission
-:reducing stress and minimising concurrent diseases
-:avoid breeding from cats that previously produced kittens that succumbed to FIP.
-Eliminating FIP from a cattery that has had a case is difficult, but involves closing the cattery to new arrivals and restricting movement within the buildlings. Attempts to produce FCoV-free kittens from an FCoV positive queen can be made through isolation of the queen and kittens combined with early weaning of the kittens at 5-6 weeks of age. But there is a high risk that poorly socialised kittens are produced.
-Even once the cattery is free from FCoV, the long-term maintenance of this is any multicat household is extremely difficult.
 ==Prognosis==
-Very poor.
-{{Learning
-|flashcards = [[Small Animal Abdominal and Metabolic Disorders Q&A 13]]<br>[[Feline Medicine Q&A 16]]<br>[[Feline Medicine Q&A 22]]
-|literature search =[http://www.cabdirect.org/search.html?q=title%3A%28%22Feline+Infectious+Peritonitis%22%29+OR+title%3A%28FIP%29+AND+od%3A%28cats%29 Feline Infectious Peritonitis publications]
-|Vetstream = [https://www.vetstream.com/felis/Content/Disease/dis60142 Feline infectious peritonitis]
-}}
 ==References==
-Ettinger, S.J, Feldman, E.C. (2005) '''Textbook of Veterinary Internal Medicine''' (6th edition, volume 2) ''W.B. Saunders Company''
-Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine''' (Fourth Edition) ''Mosby Elsevier''
-{{review}}
-{{OpenPages}}
-[[Category:Coronaviridae]][[Category:Cat Viruses]]
+[[Category:Coronaviridae]][[Category:Cat]]
 [[Category:Enteritis, Granulomatous]]
 [[Category:Enteritis,_Viral]]
 [[Category:Hepatitis,_Viral]]
-[[Category:Peritoneal Cavity Diseases - Cat]]
+[[Category:To_Do_-_Viruses]][[
-[[Category:Expert_Review - Small Animal]]
+[[Category:To_Do_-_Caz]]
-[[Category:Lymphoreticular and Haemopoietic Diseases]]