Difference between revisions of "Feline Infectious Peritonitis"

Revision as of 11:13, 27 July 2010

Also known as:

FIP

Description

A progressive disease of the cat caused by feline coronavirus. The disease is characterised by a variety of clinical signs, including weight loss, fever and vasculitis. 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 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 for diagnosis:

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

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 and macrophages

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

FECoV may cause mild respiratory symptoms and diarrhoea but is often asymptomatic

Signs of FIP include, chronic weight loss, anorexia, pyrexia and depression. Fluid in the abdomen, thorax or pericardium are symptomatic of wet, or exudative FIP. Granulomatous change in the organs are symptomatic of dry, or nonexudative FIP. FIP has been documented to cause: Uveitis, hydrocephalus, neurological symptoms, such as ataxia or seizures and chronic diarrhoea.

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 the small and large intestine.

Histological

Multifocal pyogranulomas on serosa and throughout gut wall. Infiltration by mononuclear cells, lymphocytes, plasma cells, macrophages and a fewneutrophils. Necrosis and vasculitis will also be seen.

Treatment

Almost invariably fatal. 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. Immunosuppressive drugs such as prednisolone or cyclophosphamide may slow disease progression. Cats should recieve widespread antibiotics and suppotive therapy.

Control

Conventional 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. Antibody tests are available to certify FECoV-free cat houses.

Prognosis

Very poor.

References

Ettinger, S.J, Feldman, E.C. (2005) Textbook of Veterinary Internal Medicine (6th edition, volume 2) Nelson, R.W. and Couto, C.G. (2009) Small Animal Internal Medicine (Fourth Edition) Mosby Elsevier.[[

@@ 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]]. The disease is characterised by a variety of clinical signs, including weight loss, fever and [[Vasculitis|vasculitis]]. 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 form and the dry form.
 ==Signalment==
 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==
@@ Line 23: / Line 17: @@
 Simple serology is impossible as most cats will have antibody to FECoV.
-===Laboratory Tests===
+However, 4 indicators can be used for diagnosis:
-Four indicators can be used for diagnosis:
 *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.
-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.
+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
-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]].
+*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
+==History and Clinical signs==
+FECoV may cause mild respiratory symptoms and diarrhoea but is often asymptomatic
+Signs of FIP include, chronic weight loss, anorexia, pyrexia and depression.
+Fluid in the abdomen, thorax or pericardium are symptomatic of '''wet, or exudative FIP'''.
+Granulomatous change in the organs are symptomatic of '''dry, or nonexudative FIP'''.
+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.
-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==
 ====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 the [[Small Intestine - Anatomy & Physiology|small]] and [[Large Intestine - Anatomy & Physiology|large intestine]].
+====Histological====
-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.
+Multifocal pyogranulomas on serosa and throughout gut wall. Infiltration by mononuclear cells, lymphocytes, plasma cells, macrophages and a few[[Neutrophils|neutrophils]]. Necrosis and vasculitis will also be seen.
-====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==
+Almost invariably fatal.
 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.
+Immunosuppressive drugs such as prednisolone or cyclophosphamide may slow disease progression.
-Immunosuppressive drugs such as [[Steroids| prednisolone]] or cyclophosphamide may slow disease progression.
+Cats should recieve widespread antibiotics and suppotive therapy.
-Cats should recieve widespread [[Antibiotics|antibiotics]] and suppotive therapy.
-The disease is almost invariably fatal.
 ==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 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.
 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''
+Ettinger, S.J, Feldman, E.C. (2005) Textbook of Veterinary Internal Medicine (6th edition, volume 2)
+Nelson, R.W. and Couto, C.G. (2009) Small Animal Internal Medicine (Fourth Edition) Mosby Elsevier.
-Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine''' (Fourth Edition) ''Mosby Elsevier''
+[[Category:Coronaviridae]][[Category:Cat]]
-{{review}}
-{{OpenPages}}
-[[Category:Coronaviridae]][[Category:Cat Viruses]]
 [[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]]