Aug. 31, 2023

#100: Feline Upper Respiratory Disease: Fundamentals, Pro Tips and a Review of What's New. With Dr Kath Briscoe and Dr Megan Braunstein.

#100: Feline Upper Respiratory Disease: Fundamentals, Pro Tips and a Review of What's New. With Dr Kath Briscoe and Dr Megan Braunstein.
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Season 1

I don’t know about you, but one of my least favourite things to see on my consult list is a cat with a snotty nose. The idea that my patient’s problem can be anything from a self-limiting mild disease to a serious and frustrating impossible-to-treat condition, and the decision-making around this, fills me with uncertainty and dread. This episode aims to replace that uncertainty with confidence, or at least a solid plan based on sound knowledge!

Dr Kath Briscoe is a Specialist in Feline Medicine who has worked in academic and specialist referral centres and as a referral clinician in a GP setting, and her experience gives her a great insight into the frontline work that we deal with in a non-referral setting. Dr Megan Braunstein is a practice owner and practicing clinician with a Masters in Small Animal Medicine and Surgery and many years of experience. Her practice in Perth, Western Australia, submitted the most feline respiratory PCR panels of any practice on Australia last year, and she helps us unpack what they’re learning about these tests.

Between them, they’ll refresh your foundational knowledge about infectious causes of feline upper respiratory disease and help with decision-making around diagnostics and treatment. We delve into what’s new in the world of diagnostics with a review of feline respiratory disease PCR panels, including learning what it’s great for, when to use it, and how to do it.

This episode is supported by our friends at the SVS Pathology Network, which our Australian listeners will know better as Vetnostics, QML Vetnostics, ASAP Laboratory and Vetpath Laboratory Services. The SVS  Pathology Network provides a wide range of infectious disease PCR tests, including a comprehensive panel for feline respiratory pathogens. Their PCR panels are designed for detecting Australian pathogens, and they have recently introduced additional pathogens on several of their PCR panels. Our guests provide a detailed guide on how to take samples for PCR in this conversation, but your state-based SVS Pathology Network laboratory customer care team are always happy to answer any questions.

 

Topic list:

1. Feline upper respiratory diagnostics: who needs what? [00:00:00-00:05:00]

2. Discussion of different types of feline upper respiratory diseases [00:05:00-00:06:00]

3. Importance of husbandry and stress management in preventing feline upper respiratory diseases [00:16:00-00:31:00]

4. Hygiene practices for cat households and catteries [00:31:00-00:33:00]

5. Overview of infectious causes of feline upper respiratory diseases [00:02:00-00:08:00]

6. Discussion of feline herpesvirus and its symptoms [00:08:00-00:12:00]

7. Discussion of feline calicivirus and its symptoms [00:12:00-00:14:00]

8. Discussion of other infectious causes of feline upper respiratory diseases [00:14:00-00:16:00]

9. Vaccines for preventing feline upper respiratory diseases [00:16:00-00:18:00]

10. Overview of diagnostic tests for feline upper respiratory diseases [00:18:00-00:20:00]

11. Discussion of PCR panels and their usefulness in diagnosing feline upper respiratory diseases [00:20:00-00:22:00]

12. Discussion of treatment options for feline upper respiratory diseases [1, 00:24:00-00:28:00]

 

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You know when you click on that consult list to see what your day is going to hold and you see this consult Bella domestic shorthair reason for visit Snotty nose.I don't know about you, but I get about as excited about that one as I do when I see not herself or acting strangely.
In fact, the only thing that makes me less excited for that consult is if it says under additional notes care owner says she might scratch.That's when you suddenly remember that you had to urgently phone a client and then you tap back into consults when those puppy backs arrive.
I'm just joking, none of us would ever do that, right?So why do I resist the feline upper respiratory consult?Well, because the way I see it, the cause for my patient's problem can be anything from a self limiting nothing much to a really bad cancer diagnosis with many options in between.
And the journey of figuring out which it is and the decision making around that journey can be fraught with frustration and vagueness.It makes me feel a bit lost and quite helpless actually.Also, I'm trying to get better with my antibiotic usage so I'm less and less comfortable with just give it some doxy.
So what we've done in this episode, like we do with all of our clinical episodes, is to get some really smart people who really know this stuff about a topic to help us replace that lust vague, helpless feeling with some certainty or at least a solid plan based on sound knowledge.
Enter Doctor Kath Briscoe and Doctor Megan Braunstein, my smart people for this topic.Doctor Kathy is a specialist in feline medicine who has worked in both academic and specialist referral centers as well as working as a referral clinician in the GP setting, which I think gives her a great insight into the frontline stuff that we deal with in a non referral setting.
Doctor Meg is a practice owner and practicing clinician with many years of experience.Her practice in Perth, WA submitted the most feline respiratory PCR panels of any practice in Australia to the SBS pathology group last year, and she helps us unpack what they're learning from these tests.
Oh, and apparently she's also a slow blinking pro.More on that in this episode.Between them, they'll refresh your foundational knowledge about infectious causes of feline upper respiratory disease, including which agent causes which signs and how much doxy to give it.Just kidding.
They'll help with decision making in that first console around which cases need a full workup, which ones do need doxy, and which ones need nothing much at all.We delve into what's new in the world of diagnostics with a review of the feline respiratory disease PCR panels, which is not something that I had in my tool belt when I left GP practice.
We look at what they grate for, when to use it, and how to do it.This episode is supported by our friends at the SVS Pathology Network, which our Australian listeners will know better as Vadnostics QML Vadnostics ASAP Laboratory and Vet Path Laboratory Services, which is a very relevant sponsor for a discussion around PCR testing.
The SVS Pathology Network provide a wide range of infectious disease PCR tests, including a comprehensive panel for these pesky feline respiratory pathogens.Their PCR panels are designed for detecting specific Australian pathogens and they have recently introduced additional pathogens on several of their PCR panels.
Our guests give us a detailed rundown on how to take samples for PCR in this conversation, with some great tips on PCR sampling in general.But if you have questions, your SVS Pathology Network pathologists are always happy to answer them.I wonder if they get lonely sitting behind a microscope all day, but they love chatting to us.
I think I'm going to start calling them more often just for a chat, OK?Dr. Cath Briscoe, Dr. Megan Bronstein and feline upper Respiratory diseases.Meg, before we start to clarify.
So when we lined up this episode, the people who I asked Who should I speak to about feline respiratory disease and what's new in testing and that put you forward?As somebody who should speak to, Why is that or why are you the person to talk to about feline fixes or spiritual?I think because we had the most upper respiratory check Pcr's done for the for vet path.
And it's been quite a good review process actually because I've gone through and looked at all the ones that all the conditions have taken and there's been about 35 or something.So I've had a look at who they are and what they came up with and why they're using them.Actually asking some of the vets you know why have you run this test and.
So it's actually been quite a good process.I would really like to hear that too, Meg.Should we backtrack?Well, I'd love to dig into the diagnostics and what's new, because I'm not that up to date with what's new in both the diagnostics and the management of this.Should we jump in with the causes?Yeah, look, I was thinking about this.
I think that to lump upper respiratory tract disease into one category is tricky because obviously you've got cats that present with the chronic snuffles or the acute snuffles, so the sneezing acute signs of upper respiratory tract disease and then you've got your cats that are are not snuffly but have.
Up as respiratory tract signs like a stirders respiration and I think that they're different to some extent because the diseases that cause those symptoms can be quite different.So if I'm presented with a snuffly cat, then the sorts of things that I think about.
So obviously snuffles nasal discharge.If we're talking about disease localization, then we're talking about nasal cavity nasopharynx and they may or may not have stirtters, respiration as well.And if obviously if you have a stirtter, then that again is going to localize your disease to caudal nasal cavity, nasopharyngeal locations for the snuffly cats.
What I think of is obviously infectious diseases being high on the list of possibilities depending on the age of the cat and what their previous history is.So your fail and Herpesvirus, Kalesivirus, Chlamydia, fearless or Chlamydophila, whichever particular you know name you want to give it this week and then potentially my plasma border teller I consider to be a normal bacterial component of the upper respiratory tract.
Other infectious diseases which can cause snuffles and nasal discharge would be cryptococcal infections.So your fungal infections as well as Aspigilus.Aspigilus is much less common than and so is Cryptococcus for that matter, as compared to the viral upper respiratory tract diseases and clemidolphyla.
Beyond that, certainly if you're looking at an older cat then a snuffly cat, you'd have to have neoplasia on the list.You could absolutely have inflammatory slash immune mediated disease, so you're allergic rhinitis, lymphoplasmacidic, rhinitis and I think that's a very poorly defined disease process in and of itself.
So it's a diagnosis of exclusion.Again depending on the chronicity of the disease, that again changes what my likely differential diagnosis is.Because obviously if a cats come in with acute initially had snuffles and sneezes and ocular discharge and the typical cat flu type symptoms and yet has then gone on to develop more of a chronic snuffler type syndrome, then even if it's not necessarily a primary viral infection that's caused the snuffles at the moment.
It's likely that played a role because obviously her herpes virus is is a cyclitic virus and you can have significant nasal turbinate damage as a result of herpesvirus infection, and so you can then get your chronic snuffler as a result of previous herpesvirus infection.So it really depends on what the history of the cat is and the chronicity of disease, whether or not they've got a stirter present as to what my list of differential diagnosis would include.
Meg, for you guys in GP practice these days, let's talk about the acute 1.So you've got the console people come in with their cat.It's not a chronic history of respiratory disease.They it comes in and it's got up, it's not your nose runny eyes and you go, yeah, you look like a cat flu type of cat.
What do you guys do in practice these days?Is it a wait and see, Say what's probably that wait and see or do you jump to diagnostics or how do you approach it?And then we'll check it with Cat said as well.The clinical exams still probably the most important thing that we sometimes overlook them.We rush towards tests.
So you know, whether they've got a figure and they're systemically unwell, what's their respiratory pattern, you know, their efforts and how much is the nasal discharge just from the nose?Is it ocular signs just related to conjunctive virus or as their corneal involvement to give you an indication of which of it's bacterial, viral and air flow through the nose and all that sort of thing.
Killer exam and dental disease that's concurrent and ear disease, we're very privileged to have a CT at our practice so we can image heads which helps us in our obviously their diagnosis.So I think that looking at the cat.
And it's clinical exam is probably the most important thing in trying to determine what we think it is.And then I think the other thing is whether they're young or old, whether it's a kitten and it's being vaccinated or whether it's an adult and it hasn't been vaccinated.And there's just so many variables, you know, multi cathodes whether there's been new introductions, stress.
There's just there's a whole gamut of things that comes to mind that you go through in your mind.And then if they're unwell, obviously the PCR test can show different viruses and bacteria.But obviously a lot of them are just hard to interpret the results in terms of false negatives and false positive predictive value and all that sort of thing.
So whether it's.Clinically relevant to the cat.And I think the other thing is whether they're young or old, we have, you know, whether it's a kitten and it's being vaccinated or whether it's an adult and it hasn't been vaccinated.And there's just so many variables, you know, multicat health souls, whether there's been new introductions, stress.
It's just, you know, there's a whole gamut of things that comes to mind that you kind of go through in your mind.And I suppose vets do it so quickly, putting all those puzzle pieces together to make a diagnosis, whether you think treating it is important.And I think that's why this is a challenging topic because if somebody's listening to this and I'm a new grad and I haven't had a lot of clinical experience with the respiratory virus, cat, cats, cats, what's your decision making tree?
How do you make your decisions as to how far do you go?And that's a really tricky one, I think, because it does depend on the cases that you're presented with.And I think it also depends on the motivation of the client to find out exactly what the underlying disease pathology is.
So I guess that my decision making tree is exactly what Meg was saying.So I'm thinking about what is the signalman of my cat first up.So before I've even gone into the consult when I'm calling up the patient sort of information I'm looking at Kay, well, you know who is this fluffy is, you know, four months old versus 14 years old.
That's going to change my possible differential diagnosis list from the outset.So it's the signalman of the cat, It's the history of the cat, as Meg said, whether they've got the.Recent acquisition, whether it's a new introduced animal into the household, whether it's a single cat household versus a multi cat household, whether the cat's recently been in a boarding facility or has been at a cattery or has been to a cat show for our breeding and showing clients.
And then obviously it does depend on your physical examination.But my decision making tree is dependent on how sort of if I'm looking at the patient and I'm thinking OK.How long has the disease process been going on and what do I think is most likely?So I think it's something that is likely to be a viral upper respiratory tract disease, uncomplicated, so not necessarily with secondary bacterial infection or indeed primary bacterial infection being potentially Mycolysmas as well as your Chlamydia fearless.
If it's that sort of patient then and they clinically will, then the reality is that the majority of them are going to get better on their own.So I don't necessarily think that you need to jump to multiple diagnostic investigations that changes if they've got into current disease.
So I don't think that we can talk about upper respiratory tract viral infection without thinking about our ocular disease as well because obviously herpes virus can cause significant ocular disease as well.So if they've got ocular disease, then so I'm talking about initially ulceration, but then obviously down the track you're talking about potential for corneal sequestra to develop.
If they've got those changes, then usually I would be more aggressive in my diagnostic investigation.So I'd want to know whether they do have FHV or Kalesi virus present so that I can know.Whether I need to reach for certain treatments, so for example if they've got ocular disease and you can use the topical antivirals for F HV1, so yesidofovir type formulations.
That's the acute sort of setting and kind of the ones that I think are going to get better, if they're then coming back for more presentations there, they're repeating the cycle later on down the track.Then again, I'm going to be more proactive in trying to find out why that is and what events it might be that's precipitating the sort of the acute presentation.
So for example, if I've got a cat that I thought might have a failing herpes virus infection or Khaleesi, they got better.But then they're coming back sort of three months later or six months later or what have you and they're having a repeat event.I'm going to look at why they're having that repeat event.
You know, was it that again they're in a cattery.So it's the cattery stressful event and we've got to remember FHB One, once infected, the cats will never clear it or will sit late and in the trigeminal nerve ganglia.So those patients.You know, I wanna test them at a time when they're actually clinical for their disease because otherwise I'm potentially not going to find feline herpes virus because it is sitting in the in the trigeminal nerve ganglia.
Then if you've got the cat that's got the more chronic sort of disease process, so your true chronic chronic snuffler.Then again I'm going to be much more aggressive in my investigation because I want to know whether or not it is just a chronic snuffler, meaning a patient that's got either chronic FHV One infection or previous damage from FHV One infection.
That then's resulting in chronic build up of nasal discharge and secondary bacterial infections and so on.And in which case then I would be like Meg, I would be much more aggressive in pursuing further diagnostics like advanced imaging of the nasal cavity, you know, nasal flushing, retroflex evaluation of the nasopharynx with the endoscope and potentially even using a rigid rhinoscope during an antigrade rhinoscopy.
And doing biopsies because I want to make sure that I'm not just assuming that it's a case of chronic snuffler when in fact the cat's got a nasal adenocarcinoma or nasal lymphoma that I need to treat in a much more different way.This vaccination status make much of a difference.I know we vaccinated against some of these, but does it mean that they won't get it?
Like if they come in and they're fully vaccinated, are you more likely to go what's happening yet or not so much?I mean, no vaccine is 100% protective, I think.I think the vaccinations for the herpes virus are.Pretty good.Khaleesi is a little bit different.
It can change quite like a virus itself can change and more for a little bit.So it's perhaps maybe not quite as protective, but they're still pretty good.I don't think that just because a patient is vaccinated means that it's that I can exclude that disease as a cause of the symptoms.
If it was an unvaccinated cash, then it would make it it would raise the the index of suspicion.But if it's a vaccinated cat, it's not going to eliminate that disease possibility.So I guess it makes a difference, but probably only for the unvaccinated cats, less so the vaccinated ones.
So young cat or maybe an older cat that had been to a cat tree or exposed to other cats or some sort of change and they come in and it's the first round and they not super sick.There's enough reason.Maybe they don't want to eat particularly well because they're snotty and they can't smell their food, but they not orexic and it's just knows those are the ones that you came to say, yeah, just give it a few days and let's see if it if it passes, we're not going to do much about those.
Does that make sense?Again, it depends on the severity of this disease and how sick the cat is.So we'll talk through the nursing care.So warming up the food to make it nice and smelly and and using.Very dodgy nebulisation, as in put them in a steamy shower room and that sort of thing to try and help mobilise the nasal discharge.
If I think that it's likely that they've got secondary infection, then I will reach for antibiotics, but usually they're fairly.You know, I don't go for hard hitting antibiotics like you're sort of the fluoroquinolones or your third generation kefalasporins are all Clindamycin or anything like that.
I go fairly light on with the antimicrobials.But yeah, if that if the cat is coping and it's not too unwell, then I say, you know, let's wait and see what's happening and do nursing care as the at the outset.If you say you think if it's if you thought it was likely to have secondary bacterial infection, what are you using as your measures?
Borexia or cats?More unwell?How do you decide when to reach for an antibiotic?That's a really good question and I'm not sure that I am going to be able to explain it, but it depends a little bit on how much nasal discharge and how snotty and green and yucky they are.
So if they've got a really yucky, horrible green nasal discharge, then I'm going to assume that they've got a secondary bacterial infection.I don't think that you would be wrong to necessarily cover your basis for some of the for climate offer and use something like doxycycline, but it's not usually something that I reach for straight up.
I'm not sure whether Meg has a different opinion.She probably sees more of these cases than I do.So, and I think it's very much on how well the cat is in the console which you could and it sounds very arbitrary but you know there's someones that come in as snuffly and they they might not be pyrexic, but they're not well and I suppose if I've got a 13 year old cat.
I don't really want it to be unwell for 10 days and not eating and drinking and any subclinical disease is suddenly gonna be pushed over the edge.While if it's a 14 week old road bus kitten that's just a bit snotty and sneezing but otherwise playing and fairly well.I'd probably hope that it's a self limiting and that it's going to resolve on its own and it's going to develop some immunity, but and also I suppose you unfortunately you are guided by the owner, some owners that are very concerned.
And there's always that thought that if you don't treat them and they do get unwell, then you've probably not addressed their concerns as well.And owners do, you know, we see these animals I think for 15 minutes or 20 minutes in the consultation.But you know, owners are fairly good judges.
And I think the biggest thing that I see with vets is actually not listening to the owners because they generally know when the animals are unwell.They haven't come to you because they.Are not concerned.There's some people obviously are over anxious, but most of them are quite validated in their concerns for their pet.
Such a great point there, Megan said.It so eloquently is that we that that a lot of times we're not listening to the owners and when I was doing my residency my supervisors said to me that.The vast majority of cases that we see in referral setting can be solved in inverted commas, meaning that we get a likely diagnosis based on a really good thorough history and a physical examination and that really does limit your differential diagnosis list and changes the rank of your differential diagnosis.
And I would add to that, when you're getting your history, that's when you're listening to your clients.So I think that's such an important point to make.So you know, you don't always need to reach for the whiz bang diagnostic.Tests, yes, they're there to help you and to improve your accuracy and to confirm your suspicions.
But your index of suspicion changes dependent on your history.Physical examination.Sometimes that again goes back to what we were saying originally about getting a really good history and physical examination.Because I think sometimes, like you know, your polyps, your adenocarcinomas or lymphomas and sometimes they're not always your Cryptococcal infections.
Those cats will have stirred, as opposed to just having a nasal discharge, sneezing and so on.Like there's usually a little clue in the history or on the physical examination, And I think that stirter can be, we think about it in dogs as that sort of really noisy snoring sound.
But you know, in cats it can be a much more subtle thing.Yeah.One of the biggest things I think we would just see a lot of in the new graduates.It's not that you don't know, it's that you'd haven't looked.You know, facial symmetry is a big one.Just stare at an animal.
People often think, what is she doing looking at my cat like that, what I'm looking at them.So they think I'm nice with that cat blink thing, which I think works fabulously.But often there is subtle changes in facial symmetry or you know, they don't like pressure over their sinuses and I think that you just got to take the time and have a really good look.
Most the time we really do know we'll have a fairly good.Direction in our diagnostic tests or things that we're going to do or treatment if we do a really good clinical exam.I need you just back to quickly being you mentioned that cat blink thing, what the hell is the cat blink thing?
And it's nothing to do with respiratory disease, so.I don't know if you believe in this, the thing where you put your face quite close to them and you blink really slowly, two or three times.And the cats, I don't know what it is they recognize that that's you're a friend or whatever they you know, they say.
But it works.It really works if you've got to open a cat's mouth sequentially to.Have a look because you know it's breathing funny and you want to see where the overall cerations is and you know you can put a tongue depressors and down to its epiglotters and check its tonsils.You know, you know cats get squamous cell carcinomas and things like that.
If you do that sort of make them your friend first.It's amazing what you can get away with.And you know again it helps you push which way you're going to push your diagnostic test but you've actually examined the animal properly.So I yeah.So you just put your face close to the cat.And is that what you do?
Kath and I just blink slowly two or three times.Yeah, I think that ties in with and I'm sure that your listeners are well familiar with Fairline Friendly handling and Freeline friendly nursing care guidelines and cat friendly clinic guidelines and all of those sorts of things.And the resources are all available through the International Society for Fairline Medicine.
It's miraculous how many times you will have a client say to you this is the first time someone's been able to examine them without drugs.Like you know she's so comfortable in your presence.It's like I want to see you because Charlie's so comfortable here you've, you know no one's been able to handle her and mostly that's just about respecting the fact that it's the cat is the cat and the cat can walk around the console room and it doesn't matter or the cat has a limited window in which you can examine it and so but if you give it breaks in between times it and that's where things like the sort of the slow blink the cat blinking and just gentle handling and really just cat friendly approach is so important.
Recently had a patient that was referred to me that well actually the client was self referred.She decided she wanted to gain a second opinion and this poor cat had been placed in a cat bag with a cat muzzle on.And in my opinion that is beyond inappropriate.
Like I was furious on this cat's behalf because it wasn't an aggressive cat at all.I could do a complete examination and it wasn't even spicy which is the new word I think that everyone likes to use.But there is no reason why should be placing cats in a cat bag or in a cat muzzle.
Or, you know, there are other Ways and Means to examine that cat.Sorry, we've digressed.On No, I was gonna say I feel like we need to do an episode.We should do a full episode on this at some point, definitely.Absolutely.If you're loving this format where I ask the questions that you've always wondered about, then you should check out our series of clinical podcasts at VVN.
Dot supercast.com That's VVN for Vet Vault network.We cover medicine, emergency and critical care and surgery for weekly updates and recaps and little bits of confidence Builders because work is more fun when you know your stuff.We have a follow up chat on there with Doctor Kath on the Chronic Snuffler.
You know, the one on the appointment list that says still sneezing, still snotty additional notes.Client is getting frustrated.Each episode is backed by Show Notes, which captures all the important bits that you'll need to refer back to later.It's searchable, it's super useful, and it's at least as popular as the podcast themselves.
Check it out now at vvn.supercast.com.Can we get a recap on?From which one?Well, let me ask you this way, Do the pattern of clinical signs, whether it's just nose or nose and eyes or what does that give you a guide as to which is more likely?
So when we're talking about the main ones, we're talking about a Calisi virus and chlamydia and microphones are probably a more commosis, conjunctivitis, red eyes, nasal dish.
Herpes viruses, it just had always got corneal involvement.So you can see the dendritic ulcers often or little dots on the front of their cornea, if you look.And they've got much more as opposed to conjunctivitis, blepharospasm and occure pain I suppose.And then the Calisi viruses, just, you know, we see an outbreak in one of our cateries.
All the kittens have got ulcers on the sides of their tongues and drooling.Drooling would be a big one.Border teller.I think it's just one of those things that just comes secondary.It's not really in my mind as like a.Primary thing Calisivirus, chlamydia.
Obviously Mat.Conjunctivitis herpes viruses, they often get, you know, bad ulcerations, corneal involvement as well as conjunctivitis, Cryptococcus snotty more than anything.The ones that we've diagnosed with CT, they just tend to be almost just nasal discharge and mycoplasmas.
It's just ocular signs often as well, don't tend to see as many.Oral lesions, would that be right, Yeah, yeah.So I tend to think of if you've got oral cavity signs then Cholesis, you go to ocular signs, it would be mycoplasma, chlamydia, herpes, Cholesi.
If there's ulceration then herpes is you go to or for Mycoplasma it's nasal discharge and potentially ocular signs again border teller.I don't think of that as a primary pathogen in the upper respiratory tract.It can be in the lower respiratory tract and whether or not microplasma is a lower respiratory tract pathogen is still it can be found in normal cats as well as in as a pathogen in the upper respiratory tract.
So yeah, they're all mixed.Can I ask a question, the crossover between hemotrophic like a plasma and one that's just in an upper respiratory tract, does that often come together in like do you get?Anemia, so the hematropic mycoplasmas are a different ball game, so you shouldn't unless it's an anemia or inflammatory disease.
But you won't get an immune mediated hemolytic anemia associated with the upper respiratory tract.Mycoplasma pathogens because it's Mycoplasma fearless versus Mycoplasma Hemophealis or Ortura sensis or Hemaminutum.But you never see them together like in.
No, I've never seen it.I'm not aware of any publications that have documented it.Yet.Catherine, you talked earlier about deciding when to do diagnostics.That I understand correctly that you said if you have eye involvement, you're more likely to chase the causative Organism.
Yeah, I'd be more likely to take a a PCR if the owners were keen to diagnose because that is going to change the way that I manage them.Because if they've got feeling herpes virus ulceration and particularly if it's not resolving, then I know that there are medications that I can use that would be specific for FHV 1 infections.
So I can use the topical CISOVA VIA and that's going to help them as I get older.And I don't know that it's necessarily wise.They're all more lazy.I don't know which one it is.But I think about how is this actually going to change what I do in the management of these patients.So is this diagnostic investigation going to change what I'm doing for the for my patient?
So should I perform it?And in that case it is going to change what I do.OK.So just to clarify because you said the others will cause.Conjunctivitis with herpes is more likely to cause corneal signs.So are you limiting sampling if you have corneal involvement or if it?Even if it is just really bad conjunctivitis, will you still go?
Maybe you are herpes.Yeah, because herpes doesn't always cause ulcers.Usually does.But yes, I would try and get for any ocular involvement as well.OK.So anything regarding the eyes, you're going to be more likely to recommend trying to see if you can get a PCR done.Yeah, I would be more proactive in going looking for that disease and it isn't an inexpensive test.
So it does depend on the client quite a bit.I guess I would discuss it with the client as opposed to not necessarily discussing it and saying, you know, we can sell the tests, right?Like we can say we can do this PCR and it's going to be really great because it's going to change the way that we do this season we go, we can do this PCR.
But the cat's probably going to get better if you know of its own accord, and so you can change the way that you sell the investigation.Okay, gotcha.Maybe when do you guys decide to send tests away?This is just treating conservatively.Yeah, I think ocular involvement would probably be the biggest one, all animals which are.
You know, we usually give them a week.That's our basis.I think the biggest thing that I find as a cushion is husbandry or environmental factors are the biggest thing that we're trying to get owners to address.Obviously, all those signs are very obvious in dogs, but in cats, most owners are totally unaware of stress triggers or stress behaviors in cats.
And so they're unaware of what's happened.And so if they change a lot of those environmental things and and do nebulization and, you know, you look at where they're feeding bowls after they've got multicat households and all lots of stuff and most of them will get better.But if they're coming back a week later, all the owners say she's not well, she's really not herself.
Then I'm going to institute therapy because I'm not going to wait for them to get really sick, you know?But we generally try and manage them more conservatively initially.If possible, because you know they are going to develop an immunity, and far as I'm aware, most of those immunities are fairly long standing when they do develop them.
So going through the whole husbandry thing is a whole consult in itself, you know?It's great that you're pointing it out.Is it basically the same sort of chat that you have for the lower urinary tract disease cat basically all the stress triggers that will cause a cat to get the same sort of things, cat that or cat mix that will cause a resurgence or a flare up of upper respiratory disease?
Pretty much, yeah.And and I think the other aspect of it is the hygiene aspect, particularly in multiple cat households or cattery showing cats so situations.So I don't necessarily talk about hygiene of sort of food bowls and that sort of thing for your FIC cat, but I absolutely would cover that for an upper respiratory tract presumed viral infection.
As far as I'm with most of these upper respiratory tract diseases, you know they don't live long outside of the cat.They're not.You know everyone thinks they're from snorting on each other or aerosol transmission but that's not really you can isolate affected cats in multi cat households but then you got to look at the stress of isolating cats.
So there's you know you got to weigh it all up in terms of each individual household and what's going on.Yeah, I was I guess talking about the hygiene aspect of things.I was thinking more about adequate cleaning of food bowls and removal of kind of the gross snotty discharge from the food bowls and not sharing and separating out the feed spaces.
Particularly in a multi cat household of the resources meaning food litter, trays, water management of those resources so that the individual cats can have their own space.All to do with stress, really.That's what I was exactly what I was meaning as well.Yeah, exactly.Yeah.Okay.
So you don't want whatever you're doing to cause more stress.So if the cats are in a nice tight little family, don't go and lock the one in the bathroom and it can't get out to separate it from the other cats.So you want to things need to be normal, but just be more astute about how you handle food bowls and contact surfaces.
Yeah, I think that it, I mean again it depends on your on your situation because it's going to vary depending on whether you're talking about A2 cat household or a three cat household versus a cattery situation where the risk to the cattery or the breeding colony for spread of the infectious disease through the colony is high.
So my advice vary depending on what that situation is.There's obviously for a commercial cattery to have an outbreak of upper respiratory tract infection and for all of the cats to go home with upper respiratory tract infection.That's significant.
So they definitely want to be isolating any unwell cat in that situation.And similarly, obviously when we talk about breeders that are not all created equal, some breeders are very astute and vigilant in the way that they're managing their breeding colony.Others are less focused on the individual management of the cats.
So it's having the discussion about which patients should be isolated and numbers of cats within the an individual space.Again, hygiene in terms of the order in which you are maintaining those cats.
So you don't want to go and go in and treat the infectious cats 1st and clean all of those things and then go to the rest of the healthy colony.You want to do them last and then give it as most of the greatest amount of time.So not everyone has inbuilt common sense, particularly when it comes to management of an infectious disease process sort of, you know, some people would think it's common sense to go in and do those sick cats first because they're the sick ones and you want to make sure they're OK in the mornings, whereas it's actually the opposite and.
The other thing I think that with this, you know, nutrition and parasite controls, all those sort of things need to be addressed to make sure they're in optimum health to get over these infections, making sure that they've got proper egg.Quality, I don't think so much transmission of disease, but just actually good quality fresh air that's getting circulated well.
So you know, that sounds silly, but lots of cats spend a lot of time.You know some of them are in the cupboard, You know they need to have fresh Air and Space and be happy.Just practical, just back to again, because it's the most common things that can often be the most frustrating, and especially if they're vague.So again that acute snuffly cat not super sick, we decide, OK, we're not going to chase diagnostics.
Just your management to make them feel better.So we said antibiotics, if they're unwell nebulization, you said that's literally just in the shower after the shower to get some steam in there.Nebulizers, obviously, but I consider that make sure they have a nice hot, steamy shower and keep them.
I mean, there's no, logically speaking, that shouldn't make a difference, but I do think it does.So, you know, there are all sorts of studies to show what the particle size of a nebulized saline should be in order for it to reach the nasal cavity and to actually make a difference.But, you know, the water droplets we're creating in steam in the shower is not the appropriate size, but it's not going to harm.
It gives us some owner something to do that's probably going to help a little bit.But the other things that I, you know, if they're inappetent, then I might want to consider appetite stimulants.So Mirtazapine is an appetite stimulant I like.We're gonna keep a really close eye on those cats to make sure that they're not becoming systemically unwell or dehydrated.
But it's mostly just good nursing care, making sure they've not got nasal discharge around their around their narries that's annoying them and creating problems, making sure that they can breathe adequately.And if they can't, then obviously they now fall into the category of being an unwell cat.It's that fairly simple nursing care and management that I would be talking about.
This might sound really silly, but the reason I'm gonna ask it is.Recently my kid had a pretty nasty sinusitis, which was classified as a viral, so nonbacterial.And they gave him a fairly solid dose of steroids, which I go, yeah, I can understand that it's, it's an inflammatory condition, so I understand why it works.
But I was also thinking, but there's a virus in there, is there a space for steroids in these at all?Because I, my reflex would say no, because we're dealing with the virus and you don't want to suppress the immune system, you know, in my opinion would be absolutely not.And we certainly have an anecdotal evidence that particularly high dose steroids can result in a recrudescence of a viral infection.
I'm sure Meg's seen those cases as well where you you happily put them on, it's impred this loan for another condition.And then lo and behold, they come in two days later and they've got a fabulous herpes virus or recreudescent herpes virus infection and you've just made them sicker than they were to start with.
That always makes you feel good.And the only.Be very happy with that outcome, usually very happy, yes.So I absolutely would not consider steroids in an acute setting.I think that they may have a role in the chronic snuffler as an antiinflammatory, but I certainly wouldn't be using high doses, immunosuppressant doses or an immediate high dose.
I wouldn't a single one off high dose I wouldn't be using.Kathy, you said you're not gonna go for the big gun antibiotics.So if you do think, yeah, you're quite unwell or you've got a really manky perilent looking nasal discharge, which antibiotics are you reaching for, then doxy would be what I would reach for.
So I'd use doxycycline.So it depends on the cases.So if I think that I've got a klamodophilo cat, so that these ones are ones that might repeat with ocular disease as well as nasal cavity disease, then those cats I would potentially be treating in contact cats as well depending on the number of cats.
So if it's a closed household and it's, you know one or two cats and I'd treat all of the cats in the household because of the fact that they can be subclinical carriers of the disease.And I want to try and clear it.If it's just a sort of I'm trying to clear the nasal discharge and it's and I'm not necessarily worried about klamodophila, then I would either use amoxiclav or doxycycline.
But I wouldn't do the four weeks, which I'd do if I thought it was chlamydia or klamodophila.And I'm using the terms interchangeably because I don't actually know where we're up to at the moment.They changed the name dependent on the wind.So I think it's chlamodia.You're a fearless at the moment, but it used to be klamodophila and before that was chlamydia.
So it just changes.I would love to ask about the specific treatments for the specific organisms.So you've talked about the herpes drops earlier cat that you can use if you hit a positive herpes or Vamcyclovir.Yeah, so topical Sedovier for ocular disease or Orphancyclovir for the recrudescent or acute herpes virus symptoms.
Sedofa Vere.And Famcyclovir, OK and standard dosing, just label dosing, you don't have any special tricks or higher or lower or how long Famcyclovir you do quite high doses, 40 milligrams per kilogram is usually so twice daily.
And if they're really sick then you would increase to every eight hours, so three times daily.And there's a Doha Vir concentration I can't even remember.But that's just you buy it as an eye drop.It's not a you don't have to make it up or something.Yeah, you buy it as an eye drop.Yep.And I think you can have it compounded as well.
So they would only be a benefit for herpes virus, Kalesi virus.I'm not aware that there are any antiviral therapies as such.So it's really just tincture of time and supportive care managing any secondary infections.Klamodophila and mycoplasma you would usually respond to doxycycline.
If it's klamodophila chlamydia then usually I would go for four weeks and trade all in contacts.Mycoplasma You can usually get away with less.We do.We also have to get it compounded because some of our cats are really big and you can get it compounded as a liquid.We just make sure that they give them some liquid after all they ate, feed them after so that we're not getting any esophage artists or anything.
Even though it's a liquid compound, it's not like a dry pill, but it's just always worry.But yeah, I think otherwise the doxy paste can be quite expensive if you've got a big cat and you're giving it for a long period of time.I use the tablets as well, yeah, yeah, I'm always a bit scared.So we're lucky in Australia that the particular salt that we have of Doxycycline is different to the one that causes esophageal ulceration.
I can't remember which way around it is.I think we've got them on a hydrate and it's the high plate that's the nasty one.But yeah, as it's a different salt that to the one that causes esophageal ulcers, I still give them recommend that you follow it with water or food.I mean, to be honest, I do that with any any oral medication in cats because they're esophages.
I can't even speak anymore.Esophages.I don't know.I feel like it's particularly sensitive and not particularly mobile, so anything that just sits there is likely to cause damage.Very good to know.Thank you.That is good to know.So just for anybody who's listening, who's going, what are you all talking about?So that what I also understood was that if doxycycline sits in the esophagus that it can cause almost like an esophageal burn and then a stricture afterwards.
Anybody who's listening outside of Australia, you should still potentially be concerned about that.So dose your doxy and then some water or something to make sure they swallow it properly.And I suppose the liquid, I mean the pace is really easy, but the liquid, if they're on for long times, is just easy for owners to administer.I mean, a lot of people find Pilling cats difficult.
OK, great.And it's the standard 10 megs per K doxy for these guys.Yeah, 5 to 10 milligrams per kilogram bid.I do bid dosing, it's like a 25 milligram.So it's a half a 50 milligram bid?Dose Unless it's a Maine Coon, in which case, you know, they're big kids.
Catherine, you talked earlier about deciding when to do diagnostics.That I understand correctly that you said if you have eye involvement, you're more likely to chase the causative Organism.Yeah, I'd be more likely to take a a PCR if the owners were keen to diagnose because that is going to change the way that I manage them.
Because if they've got feeling herpes virus ulceration and particularly if it's not resolving, then I know that there are medications that I can use that would be specific for FHV 1 infections.So I can use the topical Cesophervia and that's going to help them.As I get older and I don't know that it's necessarily wise or all more lazy, I don't know which one it is.
But I think about how is this actually going to change what I do in the management of this patient.So is this diagnostic investigation going to change what I'm doing for the for my patient.So should I perform it and in that case, it is going to change what I do.So I do want to know and I mean I think that there are issues with the PCR, the upper respiratory tract PCR panel, so.
Typically that will have you know herpes virus, Kalesi virus, Mycoplasma water, Telechlamydia in that if it's positive and you've got clinical signs then I think you can fairly safely assume that those clinical signs are related to the positive test.
But if you've got clinical signs and it's negative for those pathogens, it doesn't exclude those pathogens as a cause of the of the disease.So I think that it's tricky to interpret them sometimes, but.If I get a positive F HV1 in a cat with ocular disease or even chronic upper respiratory tract disease, then I'm going to be much more inclined to use antiviral therapies.
Have you guys got time to talk about the, the PCR specifically?We've mentioned that a few times then you wish to me they haven't always been a thing.Back in my day it was actually very hard to make a diagnosis on many of these diseases.So we said we're going to do that.OK, cool.
So that's what I want to find out.How are you guys using them and how are you finding it's helping you?Well, I think it's confirmatory if you've got clinical signs.So if I've got herpes virus and I think I've got herpes virus and I take a swell being with those sometimes conjunctive biopsies are probably better than the PCR.
But I've got clinical signs and I've got a positive PCR.And then I can say this, I know this is your cat's got herpes virus, it's going to have herpes viruses whole life.You know, minimizing stress is the way we're going to keep this animal clear and that it can develop sequester and other things to go on with so they know what to expect.
I think people know what to expect there then they're less likely to come back and be upset when there's repeats, visits and things going on.I think for mycoplasma it's really good just if you have an outbreak especially in a multicat household, but I suppose on feline for the teller is really you know there and Calissi virus they can positive for you know that can be carriers forever.
So you know you'd have to have clinical signs to have any warrant to that and most of the cats have vaccinated.So that's another thing Cryptococcus, I suppose it's pretty important that's that's how I would therefore then go and do blood tests to see what's going on.So I think that's pretty much all of them, isn't it?
Does your panel have crypto on it?PC Alpha Crypto.Interesting.I don't think ours does.Calisivirus, Border teller, Chlamydia, Herpes, Cryptococcus, Marker, Plasma.That's such an interesting thing because I mean we know that Cryptococcus can be again just a transient resident of the nasal cavity.
So I find that interesting that they include that because you would absolutely need to follow up with an elcat or a Calis to look for sort of true infection as opposed to transient infection.I think so just going back to is the PCR panel the latest and greatest and best thing that we can use to diagnose Herpes, Khaleesi and another infectious upper respiratory tract disease.
With any PCR testing that you're doing, the testing is only going to be as.As the sample that you can provide them with.So you have to have a good sample to start with, and that means that you have to get a decent collection of potentially infectious diseases laden cells.
Which means that you have to do good deep pharyngeal swabs, you need to do good conjunctival swabs with your sampling or when you're sampling in order to get then enough cells to be able to provide a reasonable chance of detecting those viruses or bacterial agent.
The other thing that I think that is important is a PCR positive as we said before if in a cat that's got clinical signs is going to be useful.And a negative result does not exclude that disease as a possibility because for all those reasons I just discussed, as in you may not have enough cells, that may not be that the PCR has been as sensitive in that it depends again on whether you're doing quantitative or qualitative PCR.
Most of them are just going to be qualitative rather than quantitative.If it's quantitative, then we want to know how many CT cycles they've done and so on.Okay.So to achieve those decent swabs, do you knock them out?Do you do a GA to get dried back in the pharynx in the eye or kind of sedation megs?
How do you guys do them when you do decide to do them?I'm surprised actually.Most of them will let you do a pharyngeal swab if you're very nice and you've blink at them first.And I think the main thing is swab broken off in their mouth or anything.That would be the biggest thing.So I've never had one come back that we haven't had enough samples, so we're obviously getting it right.
I think though that I mean because we don't get or at least our lab doesn't report it as you know, the sample is adequate because there's no like they'll have positive and negative controls within their PCR run, but they're not going to look at the individual cell count of that swab that you're getting through.
So I don't know that you would know whether or not your samples are good enough.I don't think we, and I'm not saying you don't know.I'm just saying that we don't know how good our samples are, which is why I think you have to be, you know, just provide them with the best that you possibly can.And I agree with Meg.I think that you can get good deep pharyngeal swabs, in most cases in an unsedated or underneath a tised patient.
When I'm doing conjunctival swabbing, sometimes I'll just use some topical anesthetic in the eye to allow me to do it without causing discomfort to the cat.Particularly for the cats that are quite sore already and if they are a bit anxious that it will often give them some gabapentin so they just and then you can do anything you like really.
Yeah, absolutely.So there there's this specific PCR swabs and you just go in there either conjunctival or Pharyx and just a good solid.Tweeling the swab.And just giving it both sides, giving it a good sort of good swish around.Yep, absolutely.You can just use your regular sort of dry swabs, and obviously not in a transport medium, but it can't be one that's on a wooden stick.
It has to be either a plastic or a metal stick.We had the most upper respiratory check Pcr's done for the for vet path and it's been quite a good review process actually because I've gone through and looked at all the ones that all the conditions have taken and there's been about 35 or something.
So I've had a look at who they are and what they came up with and why they're using them, actually asking some of the vets, you know, why have you run this test.And so it's actually been quite a good process.I would really like to hear that too Meg.Yeah so most of the of our thirty that I've got on my list, I've got print out from the clinic. 13 of them were for one of our breeders who is a very large Maine Coon breeder.
She probably has 100 cats, so she's huge and we see a lot of their cats and we had some microplasma infections, so that was why it was used, which was good.Does she screen all of her cats?So is this was a particular outbreak that she was you had an outbreak?
Yeah.Bummer.And it was one of the vets swapped them all to she had an import coming and a lot of them all got sick.So that's what.And then actually looking through the rest of the results, a large amount of them came up negative, which I found quite interesting that, that obviously being swabbed because on clinical review, most of them had conjunctivitis, upper respiratory tract snuffles and things like that.
A lot of them were negative.There was 9 negatives and then a few here like implicit virus and marker plasma and one border teller.So whether they're significant or not, it's up for review.But that was my findings.And one of the things that you know, and it's it's only because privileged enough to have a CT in the practice.
But the number of cases that we put through with our perspiratory tracts, which have other changes, polyps that have been there for a long time, nasal adenocarcinomas, destructive rhinitis that has come back on negative on a PCR for Cryptococcus.
It's quite amazing, the level of detail.You know, it doesn't always tell you a definitive diagnosis, but it definitely tells you how bad it is.The ones that have got a little bit of fluid in their sinuses and otherwise everything looks fine.It's a Peace of Mind thing that some of these cats are going to have this on and off I suppose for intermittently for the rest of their life depending on what they're going to do.
Not saying that's not going to change and you don't need to repeat imaging.But for a lot of cases, you know this cat's been an older mid age cat and it's actually got a polyp or something else going on.And therefore whether or not they go ahead with referral to oncology or decide to even doing biopsies or treating it, they know what to expect.
And I think if everyone knows what to expect, there's a lot of Peace of Mind in that because when things get bad, you know what your options are.I agree and I think that the other thing about doing something like a sort of nasal cavity nasopharyngeal CT scan is that if you do have those changes, like a destructive rhinitis in a chronic snuffler type situation, you can actually activate then a treatment which is probably going to give the cat some reprieve for some time.
So you can get in and do vigorous nasal flushing and get rid of all of that.So there's thick inspisated nasal cavity discharge and that can give them a pray for a reasonable duration.We'd recently had an older cat which had been snuffly for years, and we did a CT that had an adenocarcinoma, which the specialist came in and operated on.
That cat went on for another 18 months.He could breathe because he couldn't breathe.You know, probably I was thinking, oh, that's the end in a very elderly cat.But the owners persisted and kudos.He had a great time before it came back.So yeah.OK, we should probably wrap this up, Cath.
I mean, that was simply spectacular.I'm always astounded when I tackle one of these kind of everyday, seemingly simple, straightforward conditions and we start talking to somebody who knows about it and you realize the depth that there is to it and how much there is to understand.
I think this will give a lot of clarity.I want to make some really, really nice show notes because there's so much to cover here.And I think for myself, including to be able to go back to these things and say, OK, well, this is what you're presenting at, this is what I should be thinking.Here is my decision making around it.So thank you.
Thank you so much for your time, your input and your wisdom.And Kath, we'll get back to you and we will talk about The Chronic Snuffler, because I feel like that's a whole different ball game.And we'll speak to you another time.Thank you so, so much.Before you disappear, I wanted to tell you about our new weekly newsletter.
I speak to so many interesting people and learn so many new things while making the podcasts.So I thought I'd create a little summary each week of the stuff that stood out for me.We call it the Vet Vault 3 to one and it consists of firstly 3 clinical pearls.These are three things that I've taken away from.
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Dr Kath Briscoe

Dr Megan Braunstein