Page 2011 - Cote clinical veterinary advisor dogs and cats 4th

Upper Respiratory Infection (Cat) 1007

Identification of a causative agent is often not Acute General Treatment • Placement of a feeding tube may be necessary
necessary because the disease is self-limited in Supportive care is the recommended treatment in chronic cases with prolonged hyporexia
VetBooks.ir and recurrent cases. Ruling out nonviral causes respiratory tract disease. Most cats with URIs PROGNOSIS & OUTCOME Diseases and Disorders
for cats presented with moderate to severe upper
or severe oral ulceration (p. 1106).
most cats, but it is recommended in chronic
can and should be managed at home by the
is important for treatment considerations.
Differential Diagnosis owner to decrease pathogen dissemination in the Except for very young or severely compromised
hospital. Animals that are febrile, dehydrated,
• Nasal signs (p. 1255) depressed, or compromised should be treated in cats or in cases of virulent calicivirus, prognosis
• Cough (p. 1209) isolation within the hospital until they are stable is usually good for recovery from acute URI.
• Respiratory distress (p. 1219) and can be sent home. Acute treatment includes Some animals develop chronic rhinitis, stoma-
• Ocular signs: corneal and/or conjunctival • IV or subcutaneous crystalloid fluid therapy titis, and/or KCS or have frequent recurrence
trauma, corneal foreign body, neoplasia, • Antibiotic therapy if a secondary bacterial of disease that requires lifelong management.
KCS, uveitis, glaucoma infection is suspected (one of the following)
○ Amoxicillin-clavulanate 12.5 mg/kg PO PEARLS & CONSIDERATIONS
Initial Database q 12h
• CBC: often normal, but stress or inflamma- ○ Azithromycin 5-10 mg/kg PO q 24-48h Comments
tory leukogram can occur ○ Pradofloxacin 7.5 mg/kg PO q 24h Indirect transmission may occur through
• Serum biochemistry profile and uri- ○ Marbofloxacin 2.75-5 mg/kg PO q 24h cages, bowls, instruments, or personnel con-
nalysis: typically unremarkable; may reflect ○ Doxycycline 10 mg/kg PO q 24h (effective taminated with secretions from infected cats.
dehydration against B. bronchiseptica, Mycoplasma spp) It is important to limit personnel exposure and
• Thoracic radiographs: if lower respiratory • Topical ophthalmic preparations the movement of cats suspected to have a URI.
signs are present ○ Artificial tears q 6h
○ I-Drop Vet (lubricant with 0.3% sodium Prevention
Advanced or Confirmatory Testing hyaluronate): apply 1 drop q 8h • Improve husbandry, decrease overcrowding
• Serologic testing for herpesvirus and calici- ○ Antibiotic therapy: apply q 6-8h and exposure to free-roaming or feral cats, and
virus is unrewarding because of widespread ■ Tetracycline ophthalmic preparations ensure appropriate cleaning and disinfection.
vaccination and exposure. are the treatment of choice for C. felis • Accelerated hydrogen peroxide disinfectants
○ Serologic testing may be helpful in and Mycoplasma spp conjunctivitis or dilute bleach (1 part bleach to 30 parts
unvaccinated cats because affected animals and in FHV-1–positive cats to prevent water) can be used to prevent FHV-1 and
typically have high titers. secondary bacterial infections. Topical FCV spread in the hospital environment.
• Virus isolation from nasal, conjunctival, or tetracyclines can be irritating. Chloram- FCV has shown resistance to common
oropharyngeal swabs is the best diagnostic phenicol, erythromycin, or ciprofloxacin disinfectants such as quaternary ammonium
assay for FHV-1 and FCV; however, FCV is topicals are alternative options. compounds and chlorhexidine.
commonly isolated from the oral/respiratory ■ Topical or systemic glucocorticoids should • Several modified live or inactivated virus
mucosa of healthy cats, and positive viral not be used in suspected FHV-1 keratitis. vaccines are available and induce reasonable
culture should be supported by appropriate ■ Most triple-antibiotic ophthalmic protection against clinical disease associated
clinical presentation. Requires special swabs preparations (neomycin, polymyxin, with FHV-1 and FCV infection. The vaccines
or media for transport. and bacitracin/gramicidin) are typically are relatively successful in controlling disease
○ Feline upper respiratory disease panel ineffective against C. felis, Mycoplasma and decreasing virus shedding, but they do
(www.idexx.com or www.antechdiagnostics spp, and FHV-1. not completely protect against infection or
.com); requires swab samples, depending • Topical and systemic antiviral drugs for development of the carrier state.
on location of predominant clinical signs FHV-1 (p. 464) ○ Modified live vaccines (MLVs) may induce
• Conjunctival scrapes may demonstrate baso- • Treatment duration with antibiotics and anti- a mild form of respiratory disease.
philic intracytoplasmic inclusions indicating virals should be determined on an individual • An intranasal MLV is available for B.
C. felis infection. case basis, but 2-4 weeks is often required bronchiseptica but is indicated only for cats
• Polymerase chain reaction (PCR) assay of while the viral disease runs its course. at high risk for infection. Mild respiratory
conjunctival swabs can also be used for ruling signs can occur after vaccination.
out C. felis. Special transport medium is Chronic Treatment • MLV and killed vaccines are available for C.
required for culture. • Room humidification or inhalation of steam felis, but use is reserved for cats in multi-cat
• Transtracheal wash or bronchoalveolar lavage (putting the cat on a dry surface in a steamy environments in which confirmed infections
(p. 1073) with cytologic exam and culture bathroom) may aid in the removal of thick have been associated with clinical disease.
and sensitivity are helpful in isolating B. and viscous secretions and help ease nasal
bronchiseptica or other bacteria as causative or airway congestion. Technician Tips
agents of lower respiratory tract disease. • FHV-1 carriers that have bouts of recru- Personnel should wear gloves, wash hands, and
• Cryptococcal antigen titer to rule out descence can be treated on as-needed basis thoroughly clean and disinfect the room and
cryptococcosis (p. 223) when chronic nasal with oral antiviral therapy and/or L-lysine any instruments, bowls, and/or cages that have
signs present (250-500 mg PO/CAT q 24h) to decrease been in contact with the cat.
• Nasal CT with rhinoscopy and nasal biopsy/ severity of outbreaks.
culture can help to rule out neoplasia, fungal Client Education
infection, dental disease, nasopharyngeal Nutrition/Diet Owners should be instructed to minimize
polyps, and deformities as causes of chronic • Feed fresh, warm, highly palatable, and accumulation of mucus and saliva by cleaning
respiratory signs (p. 678). aromatic foods to overcome a decreased sense the cat’s face, mouth, and nares regularly.
of smell from nasal congestion and reluctance
TREATMENT to eat due to oral discomfort (p. 1199). SUGGESTED READING
• Appetite stimulants may be necessary. Sykes JE: Feline respiratory viral infections. In Sykes
Treatment Overview ○ Mirtazapine 3.75 mg/CAT PO q 24-72h, JE, editor: Canine and feline infectious diseases,
Treatment is typically supportive, with the goal or St. Louis, 2014, Elsevier, pp 239-251.
of controlling secondary bacterial infections and ○ Capromorelin 1-3 mg/kg PO q 24h for AUTHOR: Jon M. Fletcher, DVM, DACVIM
maintaining comfort and appetite. up to 21 days EDITOR: Joseph Taboada, DVM, DACVIM
www.ExpertConsult.com