Page 353 - Problem-Based Feline Medicine

18 – THE THIN, INAPPETENT CAT 345

Fever may be sustained or fluctuating. Other differentials to be considered depend on the site,
location and nature of the disease causing fever.
Other clinical signs will vary with the nature of the dis-
ease causing the fever.
Treatment

Effective treatment is based on accurate assessment of
Diagnosis
the cause of the fever, followed by appropriate man-
A thorough history and clinical examination is vital to agement.
identify any localizing signs that would narrow the dif-
Use of antibiotics, corticosteroids and NSAIDs prior to
ferential diagnosis list.
diagnosis should be avoided where possible, as it will
Monitoring the cat’s temperature three or four mask the clinical signs and interfere with diagnostic
times daily over a period of 48–72 hours confirms testing.
the presence and nature of the fever.
If a septic focus is identified, treatment involves
Routine hematology often reveals a neutrophilia with drainage where appropriate (e.g. placement of tho-
or without a regenerative left shift. racic drains in pyothorax) and use of antibiotic ther-
● Occasionally a degenerative left shift occurs when apy based on the results of culture and sensitivity
the bone marrow is unable to make an adequate testing.
response, and neutropenia develops in the face of a
Mild fever is unlikely to be fatal and may be beneficial
left shift. This has a poor prognosis.
in inhibiting viral and bacterial replication and increas-
In the absence of localizing signs a series of initial ing leukocyte function.
screening tests are carried out to identify the septic focus:
Fever in excess of 41.0˚C often results in significant
● Routine hematology and biochemistry.
organ damage and may initiate disseminated
● Routine urinalysis including bacterial culture and
intravascular coagulation.
sensitivity.
● Thoracic and abdominal radiographs. Symptomatic therapy for fever includes:
● Fecal analysis and culture for enteric pathogens. ● Oxygen.
● Crystalloid fluid therapy.
Further diagnostic investigation may be required
● Antipyretic drugs (NSAIDs) – these act directly
depending on the cause of the fever, this may include:
on the thermoregulatory center and should be tried
● Blood culture.
before surface cooling, unless the fever is life-
● Synovial fluid aspirates.
threatening, when they may be instituted together.
● Echocardiography.
● Surface cooling. Core temperature will continue to
● Bone marrow aspirates.
decrease after surface cooling has ceased, so to
● Immunological tests such as Coomb’s, antiplatelet
avoid large oscillations in temperature, aggressive
antibody and antinuclear antibody tests.
cooling should stop just prior to reaching the
● Serum protein electrophoresis.
desired temperature.
● Serology.
– With cool, not cold, water (avoid inducing shiv-
If a bacterial cause is suspected, strenuous attempts ering).
should be made to obtain a sample of infected mate- – Fans.
rial for bacterial culture and sensitivity testing – Ice packs over large blood vessels.
prior to administering antibiotics.
Prognosis
Differential diagnosis
The prognosis for each individual case will be depend-
Differential diagnoses include most causes of inappe- ent on the etiology of the fever and the response to
tence and weight loss. therapy.