No. 18

No. 18 Summer 2004

Feline Immunodeficiency Virus: Alternative Supportive Treatments
By Dr. Ronit Aboutboul

Feline Immunodeficiency Virus (FIV) primarily infects and gradually destroys selected populations of T-lymphocytes.

FIV is shed in saliva and transmitted primarily through direct bite wound inoculation. The first stage is an acute phase of infection, whose effects are transient and usually go unnoticed. Then comes a latent phase of variable duration. It can take years before signs of immunodeficiency occur. The third phase is characterized by chronic, recurrent, opportunistic infections with progressively worsening signs, over a period of months to years.

General manifestations may include progressive weight loss and debilitation, chronic fevers and bacterial infections that represent the most consistent features of FIV. The majority of cats clinically ill with FIV have abnormal findings in the oral cavity (stomatitis, gingivitis, periodontitis) or around the face and ears (naso-ocular discharge, otitis externa, dermatitis), but recurrent urinary tract infections and diarrhea may also be observed, as well as specific opportunistic infections, encephalopathies and neoplasias.

Diagnosis is based on serological detection of anti-FIV antibodies, which indicate prior exposure and infection. Since the infection is lifelong, a positive FIV antibody test means that the virus is present in the cat and will remain so for life.

Even though FIV is incurable, symptomatic cats can often be sustained for a long time with supportive care, using alternative medicine to reduce antibiotic treatments that may weaken the already impaired immune system. Supportive natural treatment of FIV positive cats may be specific or not, system oriented or general. Examples of such treatments follow below.

1. Non-Specific General Treatments: These are based on natural remedies that have immuno-stimulating effects: Plant remedies; Minerals, vitamins and amino-acids; And Aromatherapy, using essential oils, especially with inhalations; Homeopathic remedies, either to enhance immunity or treat symptoms.
2. Non-Specific System-Oriented Treatments: plants, minerals, vitamins and other natural remedies such as probiotics may be used to relieve respiratory, intestinal, urinary and oral symptoms.
3. Specific Treatments exist in homeopathy: dilutions of secretions of sick cats may be used to boost specific reaction to FIV, thus acting as a sort of serum. It is also possible to use secretions of a sick cat to prepare specific and personal remedies for each patient.

FIV patients may achieve, with these treatments, a happy and mostly asymptomatic life, provided they are diagnosed as such! This only stresses the importance of detecting FIV in cats with immunosuppressive related symptoms.

The author is a private practitioner and owns a clinic for cats and dogs in Tel-Aviv, Israel. Dr. Aboutboul specializes in homeopathic veterinary medicine.

“What You Should Know about Feline Toxoplasmosis” - Part 2
By Ephraim Keren, VMD

This ’Part 2’ article addresses the clinical aspects, diagnosis, and prevention & control of Feline Toxoplasmosis. (Part 1 appeared in the ImmunoComb News #17.)

The zoonotic aspects of Toxoplasmosis are a cause of concern among cat owners since a significant number of human infections are acquired by ingestion of oocysts which are shed by cats⁽¹⁾. Veterinarians recognize Toxoplasma gondii infection as a cause of disease in cats and can provide information to the public about its clinical and epidemiological aspects.

Clinical Disease
T. gondii infection in most cats results in a brief period (1 – 2 weeks) of oocyst shedding with no associated signs of illness. Some cats may experience diarrhea or other mild GI signs. Parasites, which localize as cysts in various organs outside the GI tract (such as muscle and brain), remain dormant without causing clinical disease. Illness that we recognize as toxoplasmosis has been described more often in younger cats and also those with compromised immunity. The wide range of signs associated with extra-intestinal toxoplasmosis may be non-specific (fever, lethargy and inappetance) and /or relate to particular organs that are affected.

Breathing difficulty often results when the lungs are affected and uveitis is the hallmark of occular involvement. A strong association between T. gondii infection in cats and uveitis has been described⁽²⁾. Serologic evidence of T. gondii infection was found often in cats with uveitis that were also seropositive for FeLV or FIV. The array of central nervous system signs includes ataxia, hyperesthesia (hypersensitivity to touch), behavioral changes, difficult in chewing or swallowing food and seizures.

Diagnosis
Microscopic examination of feces in identifying oocysts (via floatation) is not considered to be an important diagnostic method for determining T. gondii infection. The period of shedding is brief and may be easily missed since the intra-intestinal phase of infection is usually not associated with clinical signs. T. gondii oocysts are smaller than other common coccidiae that affect cats, such as Isospora spp.

Serology provides valuable information regarding the status of infection (see Table 1). A negative antibody titer indicates that the cat has not been previously exposed and is susceptible to infection followed by oocyst shedding. The presence of a significant level of antibodies in a healthy cat suggests that the cat was infected in the past but is likely to be immune and not excreting oocysts. In cats with compatible clinical signs a high or rising antibody titer to T. gondii supports the diagnosis of toxoplasmosis. The diagnosis may be confirmed by histopathologic changes in tissues and microscopic visualization of active tachyzoites in tissues or tissue impression smears.

Table 1: Serologic Testing for Toxoplasma in Cats

Interpretation of IgG antibody titers	ImmunoComb^® Value
Negative (no antibody titer) * Susceptible to infection * Potential to shed oocysts in feces	0
Suspicious (low antibody titer) * Inactive or previous infection * Recommend re-test in 3-4 weeks	1 - 2
Positive (a ‘significant’ antibody titer) * Healthy cat is immune (not shedding) * Ill cat: acute or convalescent infection	3 - 4
High Positive * Active infection in clinical cases	5 - 6

Control and Prevention
The two major routes of transmission of Toxoplasma infection to animals and humans are: (1) ingestion of oocysts in the environment, directly or via soil contaminated vegetables, and (2) consumption of cysts in un/undercooked infected meat.

While cat ownership has not been identified as a specific risk for human toxoplasma infection, veterinarians can advise their clients regarding pet health care to address this issue. For example, owners may be recommended to:
1. Provide their pet cats with a cooked or commercially prepared diet to prevent infection.
2. Clean litter boxes daily and wear gloves when doing so.
3. Determine infection status of pet cats via serologic testing.
4. Avoid handling free roaming kittens/cats.

Other preventive health tips (with attention to women of child bearing age and individuals who are immune-compromised) concern good personal hygiene (thorough hand washing) and proper food preparation and handling practices. In particular, meat should be cooked thoroughly (72º C for 15 minutes or longer).

References:
(1) Bowman, Dwight D. "Update on Feline Parasitology", in Ettinger’s Insights in Internal Medicine, Vol. 1(3), 2003, @ Veterinary Learning Systems, Yardley, PA.
(2) Lappin, M., et al. Serologic prevalence of selected infectious disease in cats with uveitis. JAVMA, Vol 201(7), 1992, pp. 1005-9.

From the Editor:Serology to the Rescue
By Ephraim Keren, VDM

Veterinarians are often called upon to examine “healthy” animals and sometimes even provide written testimony that the cat or dog is not exhibiting clinical signs of infectious disease. This issue of the ImmunoComb^® News features several articles that illustrate how serology can broaden the scope of such ‘health examinations’.

Toxoplasma gondii is a widespread parasitic infection of animals and humans. Women of childbearing age are particularly interested in knowing whether the household cat represents a health risk to her and her family. If the cat tests antibody-positive to T. gondii, the owner can be reassured that the cat is immune to the parasite and is not likely to excrete potentially infective oocysts.

Sero-positive test results to Feline Immunodeficiency Virus have quite different implications. This cat is infected for life and will probably develop clinical signs at some later point. Whereas, supportive treatments may soften the expected clinical course of disease, an infected cat is a source of infection to other cats. As such, this cat would be a risk to maintain in a cattery or multiple cat household.

Finally, what about “that doggy in the window?” Confirming a positive antibody titer in this case will tell a potential owner that the frisky pup is likely to be immune to this life threatening canine ‘pediatric’ disease. This information is important for avoiding future disappointment after the pet becomes a member of the family.

In conclusion, serologic testing provides an additional parameter to consider for the veterinary examination of “healthy” animals.

Vet Forum
Early Detection: Canine Parvovirus
By Ephraim Keren, VDM

Dear Dr. Keren,
We recently adopted a puppy from an animal shelter. The pup appeared to be healthy until several days after we brought it home. Then it became sick and after much expense and heart ache, the pup died. According to the veterinarian, the cause of illness and death was parvovirus. Is there a way that puppies could be tested for parvovirus at the shelter prior to the development of clinical symptoms?

Bill Cleveland, Georgia, USA

Dear Bill,
Sorry to hear about your sad experience. It is unfortunate when an apparently healthy puppy is adopted and becomes sick after the new owner brings the pup home. It is not uncommon for unvaccinated pups to be exposed to parvovirus at an animal shelter. To address this problem, we suggest that puppies be tested to determine if they have antibodies to canine parvovirus.

The ImmunoComb^® antibody test kit is a convenient method whereby the pups could actually be evaluated at the shelter. Pups lose their maternal antibodies between 3 and 4 months of age so you can be relatively safe in assessing the pup’s immunity with this test.

A healthy puppy over 3 months old that has a high level of antibodies to parvovirus is likely to be immune. The immunity may have been induced by vaccination or field exposure to the virus. Negative or low antibody levels indicate that the pup is susceptible to infection and may develop clinical disease if exposed to the virus.

Natural exposure in a susceptible pup will not produce high antibody levels until after the onset of clinical signs.

Hope that my comments are helpful.
Dr. Ephraim Keren
Biogal, Galed Labs.