Page 17 - Problem-Based Feline Medicine

2 – THE CAT WITH ACUTE SNEEZING OR NASAL DISCHARGE 9

● Nasal decongestants (intranasal or oral) are gener- front of cat, or oxazepam (Serax; 2–2.5 mg/cat, PO
ally not well tolerated by cats, but can be tried. q 12 h) or cyproheptadiene (Periactin, 1–2 mg/cat
– Intranasal decongestants (e.g. pedi- PO q 12 h) just before feeding.
atric preparations of phenylephrine, neo- ● Multivitamins (A, B and C) but especially thiamine
synephrine or oxymethazoline, 1 drop in one and vitamin A.
nostril) may be useful, but do not use longer than ● Tempt to eat with strong smelling foods, e.g. fried
a couple of days. chicken or sardines. Warming food to body temper-
– Oral decongestants, e.g. ephedrine or pseu- ature increases palatability.
doephedrine (e.g. Sudafed) can be tried, but are ● Handfeed or force feed initially.
unpalatable to cats, and may induce severe sali- ● Tube feed via a naso-osophageal, esphageal or gas-
vation. trostomy tube if the cat is still depressed and
anorexic after 3 days.
Treat eyes with topical therapy. For more treatment
details see page1214 (The Cat With Ocular Discharge or Warmth enhances recovery because the virus is tem-
Changed Conjunctival Appearance) and page 1239 (The perature sensitive (e.g. use incubator or heating pad).
Cat With Abnormalities Confined to the Cornea).
● Clean discharges from eyes three times daily.
Prognosis
● Antibiotic eye ointment (without steroids), e.g.
tetracycline or tobramycin. Avoid use of baci- Mortality is usually low, although may be higher (up
tracin-neomycin-polymyxin ointment because of to 30%) in young kittens.
reports of acute death associated with its use.
Persistent or recurrent chronic bacterial rhinitis and
● Antiviral eye drops or ointment should be used if
sinusitis occurs in some cats as a result of nasal epithe-
herpetic keratitis is present; they may also help
lium damage and osteolysis.
conjunctivitis.
● Chronic rhinitis is evident as recurrent sneezing,
– Idoxuridine q 4–5 h (Dendrid, Herplex, IDU,
and mucopurulent nasal discharge, which responds
Stoxil), vidarabine q 5 h (Vira-A), trifluo-
temporarily to antibiotics.
rothymidine q 2–4 h for 3 weeks (Viroptic).
Viroptic was the most effective of the viricidal Scarring and occlusion of the lacrimal ducts may
agents in vitro, but it is expensive, and may be produce chronic wetting of the face from tears.
very irritating to the eye.
Rarely, chronic keratitis, poorly healing corneal ulcers,
Acyclovir (100–200 mg/cat q 8–12 h, per os; conjunctival adhesions (symblephron), and keratocon-
Zovirax) may be useful in resistant ulcers. If using junctivitis sicca occur.
this drug monitor white and red cell counts for evi-
Herpesvirus ulcerative facial dermatitis or stomatitis
dence of bone marrow suppression. The efficacy is
syndrome appears to occur in some cats in situations
controversial in FHV-1 infection because the enzyme
associated with reactivation of latent infection.
involved in conversion to the active form has low
activity in cats compared to humans, and the drug is Carrier state is common (up to 80% of recovered
100 times less active. cats), and may last years.
● Virus is shed intermittently, often following stress;
L-lysine (500 mg/cat q 24 h, per os) is recommended,
shedding may or may not be associated with mild
and may help to reduce signs and viral shedding. It
clinical signs.
competes with arginine which is essential for viral
● Glucocorticoid administration or environmental
replication.
stress such as from overcrowding or relocation may
Interferon (30 IU α-interferon) orally and topically predispose to reactivation of infection.
(30 u/ml in artificial tears q 6 h) daily until lesions have
resolved and then taper. Transmission
Support nutrition Herpesvirus is highly contagious with rapid spread
● Appetite stimulants. Use diazepam (Valium; in catteries, veterinary hospitals and multicat house-
0.1–0.2 mg/kg, IV) and immediately place food in holds.