FIP, Part 2: Hope for future

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Part one above....here's part two. :)
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FIP, Part 2: Hope for future


Last week, "Part 1: The Many Faces of FIP" described the disease, symptoms and testing challenges, as well as the story of Christie Meyer's kitten Johnnie that died of FIP. This article continues to recap information presented IN February by experts at the 2005 Western Veterinary Conference FIP Symposium.

Feline Infectious Peritonitis (FIP) arises from infection with a normally harmless coronavirus (good twin) that mutates inside a cat's body into the deadly form (evil twin). This Jekyll and Hyde disease has so many vague symptoms that mimic other illnesses it could be called the "great pretender." For instance, a swollen abdomen filled with straw-colored fluid typical of wet FIP may instead be a treatable liver disease.

Dr. Susan Little, a feline specialist in Ottawa, Canada and vice president of the WINN Feline Foundation, says in addition to liver disease, lymphoma, FIV, and toxoplasmosis often are mis-diagnosed as FIP.

Many cats develop wet signs that go away as the body resists the infection, and progress into dry FIP that takes even longer to resolve. But ultimately, "FIP takes apart the immunity," says Niels Pedersen, DVM, Ph.D of the University of California-Davis and cats may later have wet signs return. The vague symptoms in combination with nonspecific tests make diagnosis almost impossible.

"This is a disease with a dismal prognosis," says Little.

No effective treatment has been identified, but treatment won't hurt and could actually help the cat feel better for as long as possible.

Offering treatment depends on the individual cat, your expectations and resources, and your veterinarian's experience and expertise. Decide with your veterinarian at what point treatment should stop. Monitor results so that your cat continues to enjoy a good quality of life.

Keep kitty comfortable

Cats with wet FIP rapidly get very sick and die or are humanely euthanized. Fluid buildup makes breathing difficult, so draining the effusion keeps your cat more comfortable until further decisions can be made about his care. " You've got nothing to loose," says Danielle A. Gunn-Moore, BSc, PHD, a specialist in feline medicine and head of the feline clinic at the University of Edinburgh, in England. "Once you've drained them, they may feel quite well for a time."

Palliative treatment also gives you the time to make life-and-death decisions for your cat. Such choices aren't as hurried in dry FIP, since these cats may linger for several months. Treatment helps keep kitties comfortable until they can no longer be helped.

Standard FIP therapy suppresses the immune response usually with prednisolone, says Little. Steroids also stimulate the appetite to keep sick cats eating. Little also cites chlorambucil, a cancer drug that helps suppress the immune system. While some practitioners include an oral low dose of human interferon in the treatment plan, Little says it won't hurt but probably doesn't help much, either.

A calorie-dense diet helps the cats that don't want to eat very much. Helpful vitamin and antioxidant supplements include vitamin A, thiamine, vitamin B complex, vitamin C and E.

"I think lots of cuddles really give them the best quality of life," says Gunn-Moore.

Protecting other cats

Because Christie Meyer didn't know that her kitten Johnny had FIP until after his death, she hadn't kept him separated from her other cat.

"I tested my other cat Commit, and found out he was positive," Meyer says.

Meyer called the test company and, according to their guidelines, Commit's results indicated he would show symptoms and die within six months. Meyer was devastated. She'd lost one loving kitten and now learned Johnny had also signed Commit's death warrant.

"So I had a nervous breakdown," says Meyer.

Had she followed the recommended protocol, Commit would have been euthanized. But Meyer couldn't bear to lose another cat friend and instead opted to wait and see. She watched for symptoms, and worried . . .

When other cats live in the same house with an FIP cat, they've already been exposed to the "good twin." You can't control or predict which cats are resistant or susceptible. Isolation of the sick cat only increases his stress level, which can speed the progress of the disease. Today, the experts agree it's not necessary to separate your sick cat from his kitty buddies.

Experimental hope?

This frustrating disease has prompted some researchers to push the treatment envelope by using "off-label" (non-approved) therapies alone or in combination. For instance, Dr. Diane Addie theorizes that the drug thalidomide reduces both the inflammatory and immune response of the disease while leaving the beneficial cell mediated (anti-viral) response intact. So far, only a small number of FIP cats have been treated with this drug and while it appeared to prompt a remission in one, all the kitties subsequently died anyway.

Boasts of FIP cures are found on the Internet, but take these with a large grain of salt. The experts believe these cats likely recovered from one of the many look-alike conditions and never had FIP.

Some experimental treatments seem to offer more hope than others. Treatment with the Aventis drug Trental (pentoxifylline), an immune modulating drug, needs to go through clinical trials but is used to treat FIP cats, usually as early as possible in conjunction with prednisone. Anecdotal reports so far note no side effects.

Virbagen Omega (made by Virbac) is recombinant feline interferon omega (IFN omega) first used in the treatment of FIP by Japanese veterinarian and scientist Takuo Ishida (www.felinecoronavirus.com/ishida).

Other researchers haven't been able to reproduce Ishida's success rate, although some results prove promising. While feline interferon should be investigated further, it's not currently available in either the U.S. or Canada and remains prohibitively expensive.

Using shida's protocol, Addie and Gunn-Moore achieved 12 to 18-month remissions in some FIP cats.

"Success is very much anecdotal because until the cats die we haven't necessarily got a diagnosis," says Dr. Gunn-Moore. "We do need scientific trials, but we need to build up anecdotal evidence to know what questions to ask."

She says the feline interferon is given as injections by the owner at home similarly to administering insulin to a diabetic cat. That reduces the cat's stress of running back and forth to the clinic.

Is prevention possible?

Vaccines work by stimulating the body's natural immunity.

"No vaccine can induce better immunity than a natural infection," says Dr. Pedersen, but there is no significant natural immunity to FIP. In fact, a strong antibody response makes FIP worse.

"I can't imagine any vaccine able to provide protection given what we know," says Pedersen.

What about the commercial FIP vaccine? According to Pedersen and other experts, no concrete independent studies have shown this vaccine induces any significant protection against FIP. The vaccine can't be given until kittens reach 16 weeks of age - and that's much too late to help. By that time, susceptible kittens have already been exposed, infected, and their bodies may already have transformed coronavirus into the deadly evil twin version. Mutations happen more readily in quickly multiplying cells, so growing kittens are the most common victims.

So why not get rid of the "good twin" by eliminating coronavirus altogether? Pedersen says researchers in Holland and Japan are working on that very problem, and trying to develop a vaccine that protects against enteric coronavirus.

Managing risks

"You can't be coy," says Gunn-Moore. "You have to think about poop to control this virus. Kitten poop is more important than cat poop."

Eliminating coronavirus from the environment isn't easy because infected cats constantly shed coronavirus into the litter box and re-infect each other. Different strains of the virus are worse than others, though, and dose of the virus - how much is there and ongoing exposure - has a great impact.

Hygiene is key. The virus stays viable for up to two months if not killed, but it can be easily destroyed with plain soap and water. Use a non-tracking litter to help control the spread of the virus, scoop daily and clean boxes weekly. Stress increases viral shedding, so reduce stress and improve hygiene by providing enough litter boxes for all the cats - one box per cat, plus one. Locate them away from food sources to reduce the chance of oral contamination.

Eighty to ninety percent of cats in the multicat households are coronavirus positive. Living with other cats also increases feline stress levels. Gunn-Moore says to reduce the dose of the virus and risk factors by decreasing the number of cats to 10 or fewer. That doesn't mean getting rid of the cats you love. Instead, you can reduce risk by dividing up your cats into stable groups of two to four cats each. Use protective clothing including shoe covers to keep from transmitting the virus from group to group, especially in households where FIP has occurred or when dealing with kittens.

Ideally, shelters should house cats singly, and not co-mingle cats, says Gunn-Moore. Most closed households with less than 10 cats eventually spontaneously eliminate coronavirus from the environment.

Even the most fastidious and caring cat owners, shelters, and breeders lose cherished cats to this disease. If you do lose a cat to the heartbreak of FIP, you can still safely adopt another furry wonder after you've thoroughly cleaned the house. Waiting about three months ensures the coronavirus is dead in the environment.

Surviving cat buddies don't necessarily become ill, either. Today at age nine, Meyer's cat Commit still tests positive for coronavirus (not FIP, she now understands!) and remains a healthy, active cat. While poor little Johnny was susceptible, Commit is resistant to FIP.

Meyer no longer fosters kittens from the shelter, though. She doesn't want to risk further exposing her cats or other susceptible felines to the potential for disease.

"Nobody knows how each cat will react," she says. "That's what's scary."

Read more about FIP at www.felinecoronavirus.com, as well as reputable links to more information and support for owners at www.orionfoundation.com/. Those interested in donating to FIP research should contact the WINN Feline Foundation, www.winnfelinehealth.org. © 2005 Amy D. Shojai