Page 1517 - Small Animal Internal Medicine, 6th Edition

CHAPTER 96 Polysystemic Viral Diseases 1489

BOX 96.1 link feline coronavirus with reproductive failure or neonatal
kitten death.
VetBooks.ir Clinical Findings Suggestive of FIP in Cats Diagnosis

Signalment and History
Cats < 5 years or >10 years of age Multiple hematologic, serum biochemical, urinalysis, diag-
nostic imaging, and CSF abnormalities develop in cats with
Purebred cat FIP. There have been multiple review articles and case series
Purchased from a cattery or housed in a multiple-cat evaluating diagnostic procedures (Pedersen 2014b; Stranieri
household et al., 2018; Tasker et al., 2018). Other than histopathology,
Previous history of a mild, self-limiting gastrointestinal or the positive predictive values of tests used to aid in the diag-
respiratory disease
Serologic evidence of infection by FeLV nosis of FIP are less than 100%. A presumptive diagnosis of
Nonspecific signs of anorexia, weight loss, or depression FIP is usually based on the combination of clinical and clini-
Seizures, nystagmus, or ataxia copathologic findings.
Acute, fulminant course in cats with effusive disease Normocytic, normochromic, nonregenerative anemia;
Chronic, intermittent course in cats with noneffusive neutrophilic leukocytosis; and lymphopenia are common.
disease Disseminated intravascular coagulation resulting in throm-
bocytopenia and, rarely, hemolytic anemia occurs in cats
Physical Examination with FIP. Hyperglobulinemia is one of the most common
Fever abnormalities and occurs in up to 89% of cases. Hyperglobu-
Weight loss linemia can be detected with or without hypoalbuminemia
Pale mucous membranes with or without petechiae (Riemer et al., 2016). In some studies, the ratio of albumin to
Dyspnea with a restrictive breathing pattern
Muffled heart or lung sounds globulins of <0.4 was supportive of a diagnosis of FIP, and a
Abdominal distension with a fluid wave with or without ratio >0.8 excluded the diagnosis. Polyclonal gammopathies
scrotal swelling from increases in α 2 -globulin and γ-globulin concentrations
Abdominal mass from focal intestinal granuloma or are most commonly detected; monoclonal gammopathies
lymphadenopathy are rare. A number of acute phase proteins like α 1 -acid gly-
Icterus with or without hepatomegaly coprotein have been evaluated in the blood of cats with and
Chorioretinitis or iridocyclitis without FIP. In one small study of 12 cats with FIP, serum
Multifocal neurologic abnormalities concentrations of α 1 -acid glycoprotein had high sensitivity
Irregularly marginated kidneys with or without (100%) and specificity for the diagnosis of FIP (Giori et al.,
renomegaly 2011). Most of these findings are consistent with chronic
Splenomegaly inflammation and do not prove FIP.

Clinicopathologic Abnormalities Hyperbilirubinemia with variable increases in alanine
Nonregenerative anemia aminotransferase and alkaline phosphatase activities occurs
Neutrophilic leukocytosis with or without a left shift in some cats with hepatic disease. Prerenal azotemia, renal
Lymphopenia azotemia, and proteinuria are the most common renal
Hyperglobulinemia characterized as a polyclonal abnormalities. Radiographs can reveal pleural, pericardial,
gammopathy; rare monoclonal gammopathies or peritoneal effusions; hepatomegaly; or renomegaly. Mes-
Nonseptic, pyogranulomatous exudate in pleural space, enteric lymphadenopathy may result in mass lesions in some
peritoneal cavity, or pericardial space cats. Ultrasonography can be used to confirm the presence
Increased protein concentrations and neutrophilic of abdominal fluid in cats with minimal fluid volumes and
pleocytosis in CSF to evaluate the pancreas, liver, lymph nodes, and kidneys
Positive coronavirus antibody titer in the majority (Lewis and O’Brien, 2010). Protein concentrations and
(especially noneffusive)
Pyogranulomatous or granulomatous inflammation in nucleated cell counts (neutrophils predominate in most
perivascular location on histologic examination of cases) are commonly increased in CSF from cats with CNS
tissues involvement. Although high coronavirus antibody titers are
Positive results of immunofluorescence or RT-PCR common in the CSF of cats with neurologic FIP, the antibod-
performed on pleural or peritoneal exudate ies appear to be derived from blood and, as the authors of one
study concluded, were of equivocal value (Boettcher et al.,
CSF, Cerebrospinal fluid; FeLV, feline leukemia virus; FIP, feline 2007).
infectious peritonitis; RT-PCR, reverse transcriptase polymerase chain Feline coronavirus antibody tests that were available
reaction.
at the time were evaluated and how to use the results of
the assays in feline practice were reviewed (Addie et al.,
2015). There are multiple potential reasons to use corona-
virus antibody tests, particularly in breeding catteries. In
the diagnosis of clinical FIP, the greatest clinical value of
coronavirus antibody tests is the detection of a negative