Page 236 - Problem-Based Feline Medicine

228 PART 4 CAT WITH URINARY TRACT SIGNS

● With incontinence, these signs are not present, Diagnosis
instead cats urinate without being aware that they
Diagnosis of funguria is based on results of urinalysis
are doing so.
and urine cultures.
– Urinalysis is typically normal.
● Microscopic examination of urine sediment reveals
budding yeasts or elongated hyphae, and inflamma-
tion.
FUNGAL URINARY TRACT INFECTION
● Urine culture is necessary to definitively diagnose
fungal urinary tract infections.
Classical signs
– The absolute number of fungal organisms does
● Usually asymptomatic. not correlate with infection; however, fungi are
● Pollakiuria, stranguria, hematuria and not normal inhabitants of the urinary bladder.
inappropriate urination may occur. – A cystocentesis sample should be evaluated.
● Systemic clinical signs may be present. – Use of fungal culture media facilitates isola-
tion and identification of the organism.
Other diagnostic tests should be directed at identify-
Pathogenesis
ing abnormalities in local or systemic host defenses.
Fungal urinary tract infections are often associated ● Serum biochemical analysis may reveal azotemia
with impaired systemic or local host defenses such consistent with renal failure, or hyperglycemia
as glucosuria, indwelling urinary catheters, consistent with diabetes mellitus.
urethrostomy and urolithiasis. ● FeLV and FIV testing should be performed.
● Abdominal radiography, including contrast studies,
Cats with immunosuppressive diseases such as FeLV
and ultrasonography are necessary to determine if
and FIV infection are also at risk for development of
an abnormality of the lower urinary tract is present
fungal urinary tract infections.
such as urolithiasis or neoplasia.
Candida and Torulopsis are normal saprophytic inhab-
itants of the gastrointestinal tract and are the most com- Differential diagnosis
mon fungi observed to occur in urine.
Any disease of the lower urinary tract may present with
similar signs.
Clinical signs
Most common diseases with similar signs are non-
Fungi are not normally found in urine of healthy animals. obstructive idiopathic lower urinary tract disease and
● Cats with funguria may be asymptomatic.
urolithiasis. Differentiation is based on finding yeast
● However, clinical signs of systemic disease may be
or hyphae in the urine. Urolithiasis may occasionally
present. be concurrent with fungal infection.
Symptomatic fungal urinary tract infections are associ-
ated with pollakiuria, hematuria, stranguria and Treatment
inappropriate urination if the infection occurs in the
Some patients have asymptomatic funguria.
lower urinary tract, or fever, inappetence, vomiting
● No treatment may be necessary as some sponta-
and septicemia if it occurs in the upper urinary tract.
neously clear the fungi if predisposing factors can
Rarely, bezoars (fungal balls) may form. be resolved.
● Bezoars are clusters of intertwined fungal ● Urinary catheters should be removed or used
hyphae which may aggregate. intermittently.
● Bezoars may be present in patients with symptomatic ● If possible, antibacterial and immunosuppressive
or asymptomatic fungal urinary tract infections. medication should be discontinued.
● They are sources of persistent funguria. ● Alkalinization of urine may aid in clearing of
● Large bezoars may result in urethral obstruction. the fungal urinary tract infection.