Cat flu

RE: Cat flu

Nicola Cole — Wed, 15 Mar 2017 23:21:11 GMT

Based on cost (£330 for 10day course) the owner is not going to go for famcyclovir, is considering further work up. Will re-post with findings if/when further tests are done.

Many thanks for all your help.

RE: Cat flu

Kate Richardson — Wed, 01 Mar 2017 23:07:08 GMT

Treat until symptoms resolve + 2-3 days. Restart when symptoms recur

RE: Cat flu

Nicola Cole — Wed, 01 Mar 2017 18:16:19 GMT

[quote user="Kate Richardson"]

What dose of famcyclovir and for how long-try 250-500mg tid for a week and assess response?

[/quote]

Hiw long a course would you do of famcyclovir if you're seeing an improvement on it?

RE: Cat flu

Thomas Johnson — Wed, 01 Mar 2017 14:39:48 GMT

[quote user="Kate Richardson"] Lysine variable effectiveness, I believe it is more effective if given on empty stomach rather than with food though. [/quote]

This is the conclusion from the paper I linked to earlier:

Based on the complete lack of scientific evidence for the efficacy of lysine supplementation, we recommend an immediate stop of lysine supplementation for cats. Lysine supplementation is not effective to prevent cats from becoming infected with FHV-1, it does not decrease the chance of developing clinical signs related to active FHV-1 infection, and it does not have a positive effect on the clinical course of its disease manifestations. In fact, results from two clinical trials with cats even suggest that excess dietary lysine may have an enhancing effect on FHV-1 replication. Positive findings, either for HHV-1 or FHV-1, were the result of poor study design and could not be replicated in well-controlled, larger studies. Furthermore, the proposed mechanism of action of lysine-arginine antagonism does not work in cats and its result, lowering arginine levels, would be highly undesirable.

RE: Cat flu

Nicola Cole — Wed, 01 Mar 2017 09:54:22 GMT

Many thanks for all the replies. I'll have a chat with them today and update the thread with either a response to drugs or hopefully investigation results.

RE: Cat flu

Nicola Cole — Tue, 28 Feb 2017 22:46:49 GMT

Apparently is in the BSAVA Infectious Disease manual: 0.05% xylometazoline topical nasal drops are Otrivine paediatric drops-Ovitrine acts like a adrenaline drop to open the airways. Apparently can use for 3 days consecutively 1 drop each nostril once daily the needs a break to prevent rebound of discharge during which can use saline drops (but don't know how long a break needs to be). Never heard of it before!

RE: Cat flu

Kate Richardson — Tue, 28 Feb 2017 08:17:54 GMT

Would have expected some response to those doses, but you could try a higher dose of Famvir, 5-7 days and see if any improvement? It sounds then like it is chronic rhinitis, which is difficult to manage as you know, as its the damage caused by the initial (prob viral) infection and secondary infection causing the clinical signs now. I think given the cough, I would push to do chest xrays/BAL and while under the GA have a good look at the pharynx/nasal cavity for polyps etc. , nasal cavity xray as well if you can.If you've not done any blood work, then haematology and biochem to check for any concurrent problems, haematology can be useful, but they may all be normal. That's the frustration with these cases, you spend lots of money looking for a cause and often yield very little Worth it if you find something!

[quote user="Nicola M"]Trial led xylometazoline topical nasal drops daily for 3 days then break with saline drops in interim-owner reported reasonable control for 6 months with drops.[/quote]

Tell me more, not familiar with this

RE: Cat flu

Nicola Cole — Mon, 27 Feb 2017 22:00:13 GMT

Doxycycline was 10mg/kg bid, appears like for 10days with view to extending to 4 weeks if making some improvement but course was not extended so am presuming (!) didn't start to see an improvement.

famcyclovir looks like was a much lower dose: 30mg/kg sid. Would that be an ineffective dosage? Doesnt say how long given for-was a written prescription with repeats, then an entry 8 months later with 'owner reports it made no difference so stopped tx'. How long would you advise as a minimum and how long before normally start seeing an improvement?

Looks like was PCRs for resp pathogens (the lab code seems to be PCRs but was 4 years ago so I guess lab code may have changed).

How reliable is PCR for herpes etc?

My gut feeling is that if owner wants to work up again then I should virtually start from scratch as investigations a long time ago and could now be missing something (including Fiv/Felv!)...?

RE: Cat flu

Kate Richardson — Mon, 27 Feb 2017 21:09:46 GMT

What dose of doxy and for how long? What dose of famcyclovir and for how long-try 250-500mg tid for a week and assess response? Did you do PCRs for the respiratory pathogens?

Don't assume the upper and lower respiratory signs are connected, it might be worth BALs and PCRs on the fluid though.

Gut feeling Herpes. Marbofloxacin may be worth a trial if Os don't want to spend much. Lysine variable effectiveness, I believe it is more effective if given on empty stomach rather than with food though.

RE: Cat flu

Martin Atkinson — Mon, 27 Feb 2017 19:22:47 GMT

I would still be wanting to eliminate FIV.

RE: Cat flu

Anthony Dennison — Mon, 27 Feb 2017 15:48:26 GMT

Will the owners stretch for CT to find the polyp? I see you've mentioned the cat has had doxycycline in the past, how long were the courses?

RE: Cat flu

Thomas Johnson — Mon, 27 Feb 2017 15:39:25 GMT

[quote user="Nicola M"](and already on lysine)[/quote]

I wouldn't bother with the lysine, no evidence that it's effective and some concerns that it might be harmful:

https://www.ncbi.nlm.nih.gov/pubmed/26573523

RE: Cat flu

Clare Tapsfield-Wright — Sun, 26 Feb 2017 22:54:51 GMT

polyps can be such sneaky little suckers and hard to find when they are small. Do let us know , interesting , good luck

RE: Cat flu

Nicola Cole — Sun, 26 Feb 2017 22:49:27 GMT

Yep-was checked for that with endoscopy near start but I do think it would be worth repeating this (as we are 6 years later!) plus adding in chest rads (especially with cough becoming more predominant) incase missed/additional condition.

RE: Cat flu

Clare Tapsfield-Wright — Sun, 26 Feb 2017 22:44:05 GMT

Polyp ?? Long shot I know

RE: Cat flu

Nicola Cole — Sun, 26 Feb 2017 22:29:07 GMT

Ok. More info:

-presented with sneezing and 'snuffliness' 6 years ago at about 6 months old. Was rehomed from a charity with a history of ocular trauma or possible herpes virus leading to corneal scarring and some vision loss. Chest clear, nasal discharge. also had bloody diarrhoea. treated with synulox improved then relapsed once abs course finished. Improved on further synulox. Owner aware high chance viral so recurrence likely.

-intermittent upper respiratory signs for following year-supportive tx, occas synulox and doxycycline.

-then had GA to examine throat and endoscopy, followed by nasal flush as large amount discharge and inflammation. Discharge returned 2 weeks later and interferon discussed and viral testing. Was declined at that stage. Then further intermittent upper resp problems, predis given as skin also issue (on understanding could make anything viral worse)-seemed to temporarily help resp signs as well but then no response on subsequent tx (nor with ronaxan nor flumax).

-owner agreed to viral swabs-neg for herpes, calici and neg result for chlamydophyla. But lab reports often get false neg FHV. Trialled famciclovir (and already on lysine)-o reported no response.

-seemed stable over next year (presume further episodes but not bad enough to require tx).

-2015 stated coughing more (had previously offered X-rays)- thought to be swallowing/coughing with nasal discharge draining into pharynx as previously very thick. Owner declined repeat flush/further investigations. Abs given(enrofloxacin and clindamycin)-no change. Trial led xylometazoline topical nasal drops daily for 3 days then break with saline drops in interim-owner reported reasonable control for 6 months with drops.

-tried steaming and bisolvon.

-then to current: ongoing intermittent cough and nasal discharge, increasing in severity and frequency over past 9 months.....

please help!

RE: Cat flu

Beats — Fri, 24 Feb 2017 08:48:53 GMT

[quote user="Kate Richardson"]Or join the ISFM forum and ask yourself [/quote]

I'm still holding out for practice membership - I've made my case again

[quote user="Kate Richardson"]not used pencyclovir [/quote]

It's the active metabolite of famcyclovir (which, as a prodrug, has no in vitro antiviral activity against FHV-1 itself)

I happened to have read a review paper by Maggs on Antiviral drugs for FHV-1 earlier this week (Veterinary Ophthalmology 19, 119-130), hence being fresh in my mind.

The points I took away were that antiviral agents generally require metabolism by both host and virus to active compounds and therefore a different host and different virus doesn't allow much extrapolation from studies on human herpesviridae; that therapeutic indices were often narrow; and that efficacy was generally questionable and virostatic at best. There was some mention (i think) of resistance from underdosing with respect to FHV-1, but no mention of any human health implications - I can't imagine a likely mechanism of transfer of resistance between such viruses, so I'd be interested to know if it's a consideration or not - if not then that can be scratched from objections and it's just cost/efficacy/toxicity to balance.

On the topic, are any of the following available in the UK:

idoxuridine 0.1% solution or 0.5% ointment (ocular topical)

vidarabine 3% ophthalmic ointment

trifluridine 1% ophthalmic solution

What hyaluroante product in UK is most commonly used ocularly as adjunctive treatment?

Evidence for lysine benefit in vivo sounded dubious but at least pretty harmless, but for those choosing to use it, do you use optixcare one (http://optixcare.ca/product-lysinechews.htm) and if so do you rate it as actually palatable?

Finally, last charity clinic I locumed in (with a vet with eye cert) added a little iodine to bottle of tear drops and used that as non-specific antimicrobial for presumed viral and secondary bacterial eye infections in kittens - sounded a rationale approach, but does anyone know if this is actually considered effective or not?

CHeers,

Dave

PS - cat you assisted with advice before Christmas went for PM yesterday to check not Mycobacterium bovis - I'll let you know if hear anything back.

RE: Cat flu

Kate Richardson — Fri, 24 Feb 2017 07:37:12 GMT

Beats

Good question- not something that i have ever had any discussion about or heard discussed in cps (and FHV is quite a common topic)

not used pencyclovir myself but that question applies to any antiviral I guess. I will ask! (Or join the ISFM forum and ask yourself

RE: Cat flu

Beats — Thu, 23 Feb 2017 23:01:58 GMT

[quote user="Kate Richardson"]Famcyclovir is very effective against feline herpes virus[/quote]

What are thoughts on whether development of resistance to pencyclovir in FHV through dosing clinical cases can or cannot have any human healthcare implications re resistant herpesviruses. i.e. is resistance transmission between feline and human herpesviridae even a theoretical talking point or considered not possible?

Genuine question I've always wondered about if anyone knows the answer.

RE: Cat flu

Kate Richardson — Thu, 23 Feb 2017 22:16:22 GMT

Famcyclovir is very effective against feline herpes virus, and high dose rates are advocated by some (David Maggs for eg) but he also quotes 40mg/kg as effective and I know many other that use much lower doses (125mg bid or tid) to good effect as the high doses are prohibitively expensive in most cases. Talk of topical cidofovir in conjunction as very effective too for ocular disease although have no personal experience of this or of its availability in the UK.

RE: Cat flu

Martin Atkinson — Thu, 23 Feb 2017 09:33:17 GMT

[quote user="Nicola M"]-how well does interferon work?[/quote]I have used a lot of Virbagen Omega in the past but although it may relieve symptoms for a while it won't effect a cure unless you give it to kittens when they show the very first symptoms and we don't often get the chance to catch them that young. The dose I've used is 2.5mU/kg sid q 3days. I've used it for chronic herpetic conjunctivitis in the form of eye drops with success but again there is no cure, you may alleviate the symptoms for as long as you use it.

Famciclovir is useful and the best choice apparently is Famvir but at high doses 90mg/kg bid for a week as cats can't convert it well to the active form. I say apparently as I've not used it, that is just from the lecture notes I have from BSAVA last year.

I would test for FHV if not already done so as they are going to be spending a lot of money whichever way and at the same time I would have a look to make sure this cat hasn't also got an immunosuppressive disease like FeLV or FIV, especially with the skin involvement, but then the interferon may help those too!

RE: Cat flu

Kate Richardson — Wed, 22 Feb 2017 22:19:14 GMT

RE: Cat flu

Nicola Cole — Wed, 22 Feb 2017 22:16:44 GMT

Yep thought that may be the case (but felt bad as I hadn't posted the question yet when I told the owners I would!). Back to work on Saturday so I can check the details of the case then!I definitely remember it was a cat....

(edited: they came in for the skin when I saw them but mentioned relapsing resp signs when leaving and asked if anything else they could try-about 25 pages of history so said I would go through history and see if there's anything else they can try-hence my slightly hazy recollection!)

RE: Cat flu

Kate Richardson — Wed, 22 Feb 2017 22:11:34 GMT

I think you're going to have to provide more specifics

to start with upper or lower respiratory signs? Are we talking chronic rhinitis?