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Feline Infectious Peritonitis (view source)
Revision as of 09:46, 19 January 2016
, 09:46, 19 January 2016→Prognosis
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Also known as: '''''FIP'''
==Introduction==
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'''.
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''' or '''exudative form''' and the '''dry''' or '''non exudative form'''.
==Signalment==
==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==
==Diagnosis==
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===
Four indicators can be used for diagnosis:
*High FECoV Antibody titres
*High FECoV Antibody titres
*Low albumin:globulin ratio in plasma/ascites (globulin levels rise in FIP)
*Low albumin:globulin ratio in plasma/ascites (globulin levels rise in FIP)
==Pathogenesis==
==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.
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 [[Adaptive Immune System - WikiBlood|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 - Pathology| oedema]] as fibrin-rich serum escapes to intercellular spaces.
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]].
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]].
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 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 - WikiBlood #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 - WikiBlood #Cellular response: Proliferation and Differentiation| Th-2]] response are at greater risk, as the virus is best tackled by cell mediation and not antibody.
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==
==Pathology==
====Gross====
====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]]
High-protein exudates can be found in [[Peritoneal Cavity - Anatomy & Physiology|peritoneal cavity]].
'''Dry form'''
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.
Larger, grey granulomatous masses causing thickening of the wall of the [[Small Intestine - Anatomy & Physiology|small]] and [[Large Intestine - Anatomy & Physiology|large intestine]].
====Histological====
====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.
Multifocal pyogranulomas on serosa and throughout gut wall. Infiltration by mononuclear cells, [[Lymphocytes|lymphocytes]], plasma cells, [[Macrophages| macrophages]] and a few[[Neutrophils|neutrophils]]. [[Necrosis - Pathology|Necrosis]] and vasculitis will also be seen.
==Treatment==
==Treatment==
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.
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 [[Steroids| prednisolone]] or cyclophosphamide may slow disease progression.
Immunosuppressive drugs such as [[Steroids| prednisolone]] or cyclophosphamide may slow disease progression.
Cats should recieve widespread [[Antibiotics|antibiotics]] and suppotive therapy.
Cats should recieve widespread [[Antibiotics|antibiotics]] and suppotive therapy.
The disease is almost invariably fatal.
==Control==
==Control==
Conventional [[Vaccines - WikiBlood| 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 [[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.
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==
==Prognosis==
Very poor.
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==
==References==
Ettinger, S.J, Feldman, E.C. (2005) Textbook of Veterinary Internal Medicine (6th edition, volume 2)
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''
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[[Category:Coronaviridae]][[Category:Cat Viruses]]
[[Category:Coronaviridae]][[Category:Cat]]
[[Category:Enteritis, Granulomatous]]
[[Category:Enteritis, Granulomatous]]
[[Category:Enteritis,_Viral]]
[[Category:Enteritis,_Viral]]
[[Category:Hepatitis,_Viral]]
[[Category:Hepatitis,_Viral]]
[[Category:To_Do_-_Viruses]][[
[[Category:Peritoneal Cavity Diseases - Cat]]
[[Category:To_Do_-_Caz]]
[[Category:Expert_Review - Small Animal]]
[[Category:To_Do_-_Review]]
[[Category:Lymphoreticular and Haemopoietic Diseases]]