Diagnosis of feline conjunctivitis

Hillström A, Tvedten H, Källberg M, Hanås S, Lindhe A and Holst BS. Evaluation of cytologic findings in feline conjunctivitis. Vet Clin Pathol. 2012; 41: 283-90.

Conjunctivitis is a common problem in cats. The most common causes of conjunctivitis are infections. Feline herpesvirus (FHV-1), Chlamydophila felis (C. felis), and Mycoplasma felis (M. felis) are the most common infectious agents present. PCR analysis has the highest sensitivity along with high specificity and is usually the preferred method for diagnosis. The objectives of this study were to describe the cytological findings in cats with conjunctivitis and compare the findings with the results of PCR analysis for these three main infectious agents. Conjunctival smears from 88 cats with conjunctivitis and 10 healthy control cats were evaluated. 

Infectious agents identified by PCR analysis were FHV-1 in 9 cats, C. felis in 8 cats, and M. felis in 6 cats. All 8 cats that were positive for C. felis by PCR testing had epithelial inclusions interpreted as chlamydial inclusions on conjunctival smears. PCR analysis also detects potential co-infection of C. felis with M. felis and FHV-1. The cytological examination of samples from cats with and without M. felis infections resulted in both false positive and negative diagnoses. Therefore, cytological examination was not a highly specific or sensitive diagnostic test for M. felis infection. Many inflammatory cells were present in conjunctival smears from all cats infected with C. felis. This would support the finding that the absence of inflammation makes the diagnosis of C. felis infection unlikely. When many typical inclusions of C. felis are found, cytological examination can be diagnostic, but not when inclusions are considered “suspicious”. Finding eosinophils in conjunctival smears may be an indication to perform PCR testing for FHV-1. Viral inclusions of FHV-1 were not found in specimens stained with Romanowsky stains. Researchers found the effectiveness of cytologic diagnosis is greatly affected by the quality of the smears. [VT]

See also: Gould D. Feline herpesvirus-1: ocular manifestations, diagnosis and treatment options. J Feline Med Surg. 2011; 13: 333-46.

Related blog articles:
Treatment of feline herpesvirus (Feb 2009)
Pradofloxacin for feline upper respiratory tract disease (March 2008)

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Hillström A, Tvedten H, Källberg M, Hanås S, Lindhe A and Holst BS. Evaluation of cytologic findings in feline conjunctivitis. Vet Clin Pathol. 2012; 41: 283-90.

Conjunctivitis is a common problem in cats. The most common causes of conjunctivitis are infections. Feline herpesvirus (FHV-1), Chlamydophila felis (C. felis), and Mycoplasma felis (M. felis) are the most common infectious agents present. PCR analysis has the highest sensitivity along with high specificity and is usually the preferred method for diagnosis. The objectives of this study were to describe the cytological findings in cats with conjunctivitis and compare the findings with the results of PCR analysis for these three main infectious agents. Conjunctival smears from 88 cats with conjunctivitis and 10 healthy control cats were evaluated. 

Infectious agents identified by PCR analysis were FHV-1 in 9 cats, C. felis in 8 cats, and M. felis in 6 cats. All 8 cats that were positive for C. felis by PCR testing had epithelial inclusions interpreted as chlamydial inclusions on conjunctival smears. PCR analysis also detects potential co-infection of C. felis with M. felis and FHV-1. The cytological examination of samples from cats with and without M. felis infections resulted in both false positive and negative diagnoses. Therefore, cytological examination was not a highly specific or sensitive diagnostic test for M. felis infection. Many inflammatory cells were present in conjunctival smears from all cats infected with C. felis. This would support the finding that the absence of inflammation makes the diagnosis of C. felis infection unlikely. When many typical inclusions of C. felis are found, cytological examination can be diagnostic, but not when inclusions are considered “suspicious”. Finding eosinophils in conjunctival smears may be an indication to perform PCR testing for FHV-1. Viral inclusions of FHV-1 were not found in specimens stained with Romanowsky stains. Researchers found the effectiveness of cytologic diagnosis is greatly affected by the quality of the smears. [VT]

See also: Gould D. Feline herpesvirus-1: ocular manifestations, diagnosis and treatment options. J Feline Med Surg. 2011; 13: 333-46.

Related blog articles:
Treatment of feline herpesvirus (Feb 2009)
Pradofloxacin for feline upper respiratory tract disease (March 2008)

More on cat health:
Winn Feline Foundation Library
Find us on Facebook
Follow us on Twitter
Join us on Google+

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Back at school and already got the sniffles or other ailment? Here's a pediatrician's advice to battle back-to-school bugs

With school back in session, it probably won't be long before children are coming home with sniffles and sore throats. The average child gets six or more infections each year, reports Dr. Jacqueline Kaari, chair of the Department of Pediatrics at the University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine, who also offers advice.

"Every parent has experienced it — the hectic morning maneuvering of getting the household fed, dressed and out the door is suddenly interrupted by an inconsolable child who has a sore throat, upset stomach, sniffles or something worse," she said. "When that happens, parents need to be able to quickly assess their child and determine if he or she is well enough to go to school or needs to stay home, or if it's time to call the pediatrician. Sometimes, parents will guess wrong, but if there's one rule of thumb, it should be to always err on the side of caution."

Kaari recommends the following guidelines for what do when it comes to:

Colds: Use child-strength, over-the-counter medicines and a cool mist humidifier to treat symptoms. Because they are caused by viruses, do not treat colds with antibiotics. Children can go to school if the symptoms won't impede them from participating in school activities.

Conjunctivitis (pinkeye): Go to the doctor for treatment, which is generally antibiotic eye drops. Children can usually go to school 24 to 48 hours after treatment starts.

Fever: Give acetaminophen (Tylenol) or ibuprofen (Advil) for low-grade fevers. Have the child drink lots of fluids and avoid fatty or fried foods, since fevers decrease stomach activity and make digestion more difficult. Keep children at home if the fever is above 100.4 degrees Fahrenheit. Call the doctor if a high fever lasts more than 24 hours or does not respond to medicine.

Flu: Have the child vaccinated. If he or she has not been vaccinated, keep the child home for several days and make sure he or she gets lots of rest and drinks lots of fluids.

Head lice: Kill with over-the-counter or prescription lotions and shampoos. Keep the child at home until all lice have been killed.

Ringworm: Look for small patches of skin that are scaly and red. They can also blister and ooze. Apply anti-fungal ointments or powders. Call the doctor if the infection is severe or does not go away.

Sore throat: If parents suspect strep throat, they should call the doctor. If drinking water relieves symptoms somewhat, the child likely has a viral infection that should go away in a few days.

Stomach ache: Children who have been vomiting should stay home from school. An hour after the child vomits, parents should start introducing small drinks of water. Clear liquids and bland food should be introduced throughout the day. If vomiting lasts more than 24 hours or if the child vomits blood or green or yellow bile, call the doctor.

Whooping cough (pertussis): Have the child vaccinated. If parents suspect whooping cough, characterized by a "whooping" sound when the child tries to breathe, call the doctor. (Read more)

With school back in session, it probably won't be long before children are coming home with sniffles and sore throats. The average child gets six or more infections each year, reports Dr. Jacqueline Kaari, chair of the Department of Pediatrics at the University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine, who also offers advice.

"Every parent has experienced it — the hectic morning maneuvering of getting the household fed, dressed and out the door is suddenly interrupted by an inconsolable child who has a sore throat, upset stomach, sniffles or something worse," she said. "When that happens, parents need to be able to quickly assess their child and determine if he or she is well enough to go to school or needs to stay home, or if it's time to call the pediatrician. Sometimes, parents will guess wrong, but if there's one rule of thumb, it should be to always err on the side of caution."

Kaari recommends the following guidelines for what do when it comes to:

Colds: Use child-strength, over-the-counter medicines and a cool mist humidifier to treat symptoms. Because they are caused by viruses, do not treat colds with antibiotics. Children can go to school if the symptoms won't impede them from participating in school activities.

Conjunctivitis (pinkeye): Go to the doctor for treatment, which is generally antibiotic eye drops. Children can usually go to school 24 to 48 hours after treatment starts.

Fever: Give acetaminophen (Tylenol) or ibuprofen (Advil) for low-grade fevers. Have the child drink lots of fluids and avoid fatty or fried foods, since fevers decrease stomach activity and make digestion more difficult. Keep children at home if the fever is above 100.4 degrees Fahrenheit. Call the doctor if a high fever lasts more than 24 hours or does not respond to medicine.

Flu: Have the child vaccinated. If he or she has not been vaccinated, keep the child home for several days and make sure he or she gets lots of rest and drinks lots of fluids.

Head lice: Kill with over-the-counter or prescription lotions and shampoos. Keep the child at home until all lice have been killed.

Ringworm: Look for small patches of skin that are scaly and red. They can also blister and ooze. Apply anti-fungal ointments or powders. Call the doctor if the infection is severe or does not go away.

Sore throat: If parents suspect strep throat, they should call the doctor. If drinking water relieves symptoms somewhat, the child likely has a viral infection that should go away in a few days.

Stomach ache: Children who have been vomiting should stay home from school. An hour after the child vomits, parents should start introducing small drinks of water. Clear liquids and bland food should be introduced throughout the day. If vomiting lasts more than 24 hours or if the child vomits blood or green or yellow bile, call the doctor.

Whooping cough (pertussis): Have the child vaccinated. If parents suspect whooping cough, characterized by a "whooping" sound when the child tries to breathe, call the doctor. (Read more)

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Feline Entropion

Williams, D and J.-Y. Kim. Feline entropion: a case series of 50 affected animals (2003-2008). Veterinary Ophthalmology, 2009. 12(4):221-226.

Entropion is the inward rolling of all or part of an eyelid. The cornea and conjunctiva are irritated by hairs on the eyelid causing problems from mild discomfort and tearing to chronic pain and eye injury. Entropion is more common in dogs than cats, but may be under-recognized in cats. In this study from the U.K., 50 cats with entropion were examined. About 1/3 of the cats had a mean age of 4 years, while the remainder of the cats were relatively older, with a mean age of 11 years. Among the younger cats, entropion was likely to be caused by a pre-existing irritative disorder, such as conjunctivitis or corneal ulceration. In the group of older cats, lid laxity or enophthalmos were more likely causes. Persian cats represented 10% and Maine Coons represented 6% of the study group. Among these cats, involutional entropion was likely caused by anatomic problems. All cats were treated surgically with a Hotz-Celsus procedure, and the results were evaluated from 4 to 22 weeks later. Surgical treatment was curative in the majority of cases. [SL]
>> PubMed Abstract

Related articles:
Read RA, Broun HC. Entropion correction in dogs and cats using a combination Hotz-Celsus and lateral eyelid wedge resection: results in 311 eyes. Vet Ophthalmol. 2007 Jan-Feb;10(1):6-11.
>> PubMed Abstract

More on cat health: Winn Feline Foundation Library
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Williams, D and J.-Y. Kim. Feline entropion: a case series of 50 affected animals (2003-2008). Veterinary Ophthalmology, 2009. 12(4):221-226.

Entropion is the inward rolling of all or part of an eyelid. The cornea and conjunctiva are irritated by hairs on the eyelid causing problems from mild discomfort and tearing to chronic pain and eye injury. Entropion is more common in dogs than cats, but may be under-recognized in cats. In this study from the U.K., 50 cats with entropion were examined. About 1/3 of the cats had a mean age of 4 years, while the remainder of the cats were relatively older, with a mean age of 11 years. Among the younger cats, entropion was likely to be caused by a pre-existing irritative disorder, such as conjunctivitis or corneal ulceration. In the group of older cats, lid laxity or enophthalmos were more likely causes. Persian cats represented 10% and Maine Coons represented 6% of the study group. Among these cats, involutional entropion was likely caused by anatomic problems. All cats were treated surgically with a Hotz-Celsus procedure, and the results were evaluated from 4 to 22 weeks later. Surgical treatment was curative in the majority of cases. [SL]
>> PubMed Abstract

Related articles:
Read RA, Broun HC. Entropion correction in dogs and cats using a combination Hotz-Celsus and lateral eyelid wedge resection: results in 311 eyes. Vet Ophthalmol. 2007 Jan-Feb;10(1):6-11.
>> PubMed Abstract

More on cat health: Winn Feline Foundation Library
Join us on Facebook

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Pradofloxacin For Feline Upper Respiratory Tract Disease

Hartmann, A. D., C. R. Helps, et al. (2008). "Efficacy of pradofloxacin in cats with feline upper respiratory tract disease due to Chlamydophila felis or Mycoplasma infections." J Vet Intern Med 22(1): 44-52.

Two of the pathogens implicated in feline upper respiratory tract disease (URTD) are Chlamydophila felis and Mycoplasma. Typical treatment for these pathogens has been doxycycline or enrofloxacin. Both drugs are associated with adverse effects. This study investigated the efficacy of a novel fluoroquinolone, pradofloxacin, for treatment of these pathogens. In this placebo-controlled, double-blind clinical trial, 39 cats with clinical signs of URTD were divided into 2 treatment groups. One group was treated with pradofloxacin and the other group was treated with doxycycline; both groups were treated for 42 days. Clinical scores were evaluated as response to treatment. The presence of C. felis and Mycoplasma was determined by PCR analysis of conjunctival swabs. Before treatment, C. felis was detected in 23 cats, and Mycoplasma was detected in 20 cats. Both groups of cats responded to treatment with a marked improvement in clinical signs within 1 week. Complete elimination of Mycoplasma was achieved in both groups of cats. However, while all cats receiving doxycycline eliminated C. felis, 4 cats treated with pradofloxacin remained PCR-positive.
>> PubMed abstract

Related articles:
Hartmann, A., R. Krebber, et al. (2008). "Pharmacokinetics of pradofloxacin and doxycycline in serum, saliva, and tear fluid of cats after oral administration." J Vet Pharmacol Ther 31(2): 87-94.
>> PubMed abstract

Litster, A., S. Moss, et al. (2007). "Clinical efficacy and palatability of pradofloxacin 2.5% oral suspension for the treatment of bacterial lower urinary tract infections in cats." J Vet Intern Med 21(5): 990-5.
>> PubMed abstract

More on cat health: Winn Feline Foundation Library

Hartmann, A. D., C. R. Helps, et al. (2008). "Efficacy of pradofloxacin in cats with feline upper respiratory tract disease due to Chlamydophila felis or Mycoplasma infections." J Vet Intern Med 22(1): 44-52.

Two of the pathogens implicated in feline upper respiratory tract disease (URTD) are Chlamydophila felis and Mycoplasma. Typical treatment for these pathogens has been doxycycline or enrofloxacin. Both drugs are associated with adverse effects. This study investigated the efficacy of a novel fluoroquinolone, pradofloxacin, for treatment of these pathogens. In this placebo-controlled, double-blind clinical trial, 39 cats with clinical signs of URTD were divided into 2 treatment groups. One group was treated with pradofloxacin and the other group was treated with doxycycline; both groups were treated for 42 days. Clinical scores were evaluated as response to treatment. The presence of C. felis and Mycoplasma was determined by PCR analysis of conjunctival swabs. Before treatment, C. felis was detected in 23 cats, and Mycoplasma was detected in 20 cats. Both groups of cats responded to treatment with a marked improvement in clinical signs within 1 week. Complete elimination of Mycoplasma was achieved in both groups of cats. However, while all cats receiving doxycycline eliminated C. felis, 4 cats treated with pradofloxacin remained PCR-positive.
>> PubMed abstract

Related articles:
Hartmann, A., R. Krebber, et al. (2008). "Pharmacokinetics of pradofloxacin and doxycycline in serum, saliva, and tear fluid of cats after oral administration." J Vet Pharmacol Ther 31(2): 87-94.
>> PubMed abstract

Litster, A., S. Moss, et al. (2007). "Clinical efficacy and palatability of pradofloxacin 2.5% oral suspension for the treatment of bacterial lower urinary tract infections in cats." J Vet Intern Med 21(5): 990-5.
>> PubMed abstract

More on cat health: Winn Feline Foundation Library

Read More

Treatment of Feline Herpesvirus with Cidofovir

Fontenelle, J. P., C. C. Powell, et al. (2008). "Effect of topical ophthalmic application of cidofovir on experimentally induced primary ocular feline herpesvirus-1 infection in cats." Am J Vet Res 69(2): 289-93.

The efficacy of twice-daily topical application of 0.5% cidofovir in cats with experimentally induced ocular feline herpesvirus-1 (FHV-1) infection was evaluated in this project. Twelve cats were infected with an FHV-1 field strain and divided into treatment and control groups. The treatment group received 1 drop of cidofovir solution in both eyes twice daily for 2 weeks, starting on day 4. The control group received 1 drop of the same solution but without cidofovir. The cats were evaluated with a standard scoring system for 24 days. Ocular viral shedding was assessed with PCR every 3 days. During the treatment period, the clinical scores and amount of viral shedding were significantly lower in the treatment group compared to the control group. No systemic or local adverse effects were seen in the cats treated with cidofovir, and all cats were monitored for at least 1 year following the end of the project. Cidofovir may represent an effective new treatment for FHV-1 with the added benefits of causing less local irritation than currently available topical treatments, and requiring less frequent administration.
>> PubMed abstract

For further reading:
van der Meulen, K., B. Garre, et al. (2006). "In vitro comparison of antiviral drugs against feline herpesvirus 1." BMC Vet Res 2: 13.
>> Free full text article

Sandmeyer, L. S., C. B. Keller, et al. (2005). "Effects of cidofovir on cell death and replication of feline herpesvirus-1 in cultured feline corneal epithelial cells." Am J Vet Res 66(2): 217-22.
>> PubMed abstract

More on cat health: Winn Feline Foundation Library

Fontenelle, J. P., C. C. Powell, et al. (2008). "Effect of topical ophthalmic application of cidofovir on experimentally induced primary ocular feline herpesvirus-1 infection in cats." Am J Vet Res 69(2): 289-93.

The efficacy of twice-daily topical application of 0.5% cidofovir in cats with experimentally induced ocular feline herpesvirus-1 (FHV-1) infection was evaluated in this project. Twelve cats were infected with an FHV-1 field strain and divided into treatment and control groups. The treatment group received 1 drop of cidofovir solution in both eyes twice daily for 2 weeks, starting on day 4. The control group received 1 drop of the same solution but without cidofovir. The cats were evaluated with a standard scoring system for 24 days. Ocular viral shedding was assessed with PCR every 3 days. During the treatment period, the clinical scores and amount of viral shedding were significantly lower in the treatment group compared to the control group. No systemic or local adverse effects were seen in the cats treated with cidofovir, and all cats were monitored for at least 1 year following the end of the project. Cidofovir may represent an effective new treatment for FHV-1 with the added benefits of causing less local irritation than currently available topical treatments, and requiring less frequent administration.
>> PubMed abstract

For further reading:
van der Meulen, K., B. Garre, et al. (2006). "In vitro comparison of antiviral drugs against feline herpesvirus 1." BMC Vet Res 2: 13.
>> Free full text article

Sandmeyer, L. S., C. B. Keller, et al. (2005). "Effects of cidofovir on cell death and replication of feline herpesvirus-1 in cultured feline corneal epithelial cells." Am J Vet Res 66(2): 217-22.
>> PubMed abstract

More on cat health: Winn Feline Foundation Library

Read More