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also see Abscess
also see zoonotic
also see Infectious Disease
Methicillin Resistant Staphylococcus aureus infections of cats
Veterinarians have been lucky over the last decade or so in not having to deal
with methicillin resistant staphylocccus aureus (MRSA) infections very often. It
is likely that this situation will change over the next few years as MRSA
infections are being reported more commonly in pets. In most cases these
infections are thought to be contracted by the pet due to association with an
infected human but it also appears that pets can be a reservoir for the
infection in households and much more rarely a source of infection for
previously uninfected humans.
There are two forms of MRSA that are recognized in people, community acquired
MRSA and hospital acquired MRSA. In general, hospital acquired MRSA is much
worse and can lead to organ failure and death fairly rapidly, despite treatment,
in some patients. So far, the pet cases that have been reported appear to be the
community acquired form of MRSA.
Cats infected with MRSA may have difficult to treat abscesses or lymph node
swelling not explained by other diagnoses. Dogs have more of a tendency to have
inapparent infections affecting the nasal passages but can have severe abscesses
or other signs of an infectious process.
At the present time the main thing to remember about MRSA and pets is that they
are usually infected by a family member who has the disease but that it may be
difficult to clear it from the household without treating pets who are infected.
So if you or someone you have close contact with is diagnosed with MRSA and it
is hard to eliminate, you may want to be sure that a pet is not harboring the
Staph bacteria and keeping the infection going in the household. It is also
important to keep in mind that most Staph infections in dogs and cats are caused
by Staphococcus intermedius, so just the word "staph" should not set off alarm
bells immediately.
Dr Mike Richards, DVM
9/02/2006
Campylobacteria
Campylobacteriosis causes gastrointestinal disease in many species of
animals and is considered to be a zoonotic disease, usually associated
with poor sanitation practices around infected dogs or cats.
The bacteria is a gram negative rod (corkscrew shaped) that is usually
highly motile. It can be cultured using anerobic techniques but is
present in many normal animals so it is hard to determine for sure if
it is the disease agent based on culture results.
It can cause no disease (asymptomatic carriers) to pretty severe
diarrhea that can be hemorrhagic. Vomiting can also occur. The disease
usually lasts about 2 weeks but some chronic cases are reported. It is
unclear how quickly reinfection can occur. It most commonly affects
young kittens and immune compromised cats.
Several antibiotics are effective against campylobacter in most cases.
These include: enrofloxacin at 5mg/kg bid x 5 days, doxycycline 5mg/kg
q12 to 24 hours x 15 to 21 days, erythromycin 10mg/kg every 8 hours x
10 to 14 days.
Most of the commonly used antiseptics will kill campylobacter in the
environment. Keeping the environment as dry as possible is helpful, too
--- so using paper towels and antiseptic spray to clean cages is better
than hosing them out, for instance.
I hope this is helpful.
Mike Richards, DVM
1/24/2003
Meningitis
Question: Dear Dr. Richards:
First, I apologize for probably not spelling "meningitis" correctly!
I wrote to you last January, and the help and advice you gave me regarding
Zithromax RX for cats has saved not only many of my cats, but
by passing it on
to my local vets, saved many, many other cats, and I can't thank you
enough
for that.
Unfortunately a few of the cats died from menengitis. This was
confirmed by a cat I sent to Michigan State Univ. But I don't
really understand
how they contract it or if there is anything I can do to prevent it.
Some of
the cats had recovered (and I thought completely) from inner ear or
upper
respiratory ailments, then would later show neurological symptoms and
die. A
couple of the cats died within 36 hours since I noticed a problem,
3 I had to
have euthanized. Just yesterday, after 6 months of no more deaths,
a cat
who I brought through an inner ear infection a month ago, died.
He had the
same neurological symptoms. Last weekend he was playful and fine,
and then
Tuesday I noticed changes and late last night he died.
I of course, keep asking myself, what have I missed? Got him past
the
inner ear and upper respiratory with Clavamox and Prednisone ( I use
Zithromax as the "big guns").
Any information would be deeply appreciated. When these cats get
sick, I sit with them all through the night and as much of the day
as I can and it
is heartbreaking to see them go through this.
Thank you so much for this wonderful service you are providing.
There
is no worse feeling than that of being helpless when you see suffering.
Knowing about the Zithromax did more than words can convey.
Respectfully, Christina
Answer: Christina-
I have tried to research this topic for you to see if there was a
particularly likely cause of the meningitis that was diagnosed at
Michigan State. I think that you best option might be to ask your veterinarian
to check with the pathologist to get his or her opinion of the most
likely
underlying cause and to ask whether the meningitis seemed like the
primary problem or if it might have occurred as another disease progressed
to
the point that it was affecting all of the body's systems. In some
cases it
simply isn't possible to make a diagnosis and this may not be as
helpful, but it is really worth asking, at least.
The most common causes of meningitis in cats are probably feline
infectious peritonitis virus and toxoplasmosis. These are possible
problems
whenever cats live in multi-cat households, so they are probably the
prime
suspects. Cats can develop meningitis as a result of rabies and even
meningitis
as a reaction to rabies vaccination is reported, but I can't remember
seeing
a case of this. I have heard that roundworm migration can lead to
meningitis in some cats and there is evidence that many cats do not
develop the
strong immunity to these worms that dogs develop with age, so that
seems like
a possible problem, as well. Routine deworming (once or twice a year)
is
probably a good idea in a multi-cat household. Cats do get several
forms of bacterial meningitis but these are uncommon. Fungal infection,
especially cryptococcosis, may cause meningitis but is also uncommon.
In your cats there may be a higher chance for bacterial meningitis than
in the average housecat. Bacterial meningitis usually occurs because
of
bite wounds or infections that occur near the spinal cord or in areas
in
which spread into the meninges is possible, such as inner ear infections
or
severe sinus infections. I think that this would be an unusual problem
and not one that would be likely to affect more than a few cats in
your
household over time, though. If you persistently see meningitis over
time it would be a really good idea to look for an underlying cause
that
might be contributing to the cat's susceptibility, such as feline leukemia
virus infection or feline immunodeficiency virus infection. We do seem
to see
really bad upper respiratory infections in some groups of cats that
do
not have these viruses present, though. I am guessing that the cats
in some
multiple cat households pass bacterial infections back and forth and
sometimes these become stronger due to the continued opportunity to
grow.
Feline infectious peritonitis (FIP) can be hard to rule in or rule out
in many cases. There is not yet a reliable blood test for this disease
and
while it can usually be diagnosed during a post mortem examination
this
is not always true. It may be a good idea to consider having the
pathologists at MSU examine another cat, if you see a similar case
in the future.
The last possibility is some sort of toxin. I can't actually think of
one that would lead to these signs but it would be hard to rule that
possibility out with repeated occurrences of problems in one household.
It is something to think about but not something that is likely, at
all.
I guess that I am leaning towards the bacterial meningitis secondary
to
inner ear infection or sinusitis and that these problems are most
likely to be caused as a secondary problem due to the upper respiratory
viruses.
It might help to consider intranasal vaccination for rhinotracheitis
and
calcivirus, since there are some reports of this helping to control
the
infections better in multi-cat households. I haven't actually tried
this approach personally, though -- so I really don't have any idea
how much
more effective it might be.
I wish that I could help you more with this.
Mike Richards, DVM
1/9/2002
L form Bacteria and multiple abscesses
Question: Dear Dr. Richards,
I'm a new subscriber to your VetInfo newsletter. My wife and I came
across the website while researching a puzzling illness one of our
cats
has. The website mentions the "L-form" bacteria as a possible cause
of
multiple abscesses in cats. Let me give you a brief case history and
perhaps you can suggest if the "L-form" is what's causing our cat's
problem:
- "Whitey" is a healthy (at least up until now) 5-yr old male
short-hair (pure white), neutered, all shots
up to date.
- Three weeks ago his left rear foot appeared swollen. Mainly
one of
the toes.
- It formed an abscess, the vet drained it and prescribed Clavamox
and
Antirobe.
- The toe finally healed up.
- Within a week, another abscess formed further up the leg,
the vet
opened it and inserted a drain.
- Now that that's on the mend, other smaller abscesses are forming
up
and down the leg.
Fever was 104 at first, now closer to 103 F. White count around 8000,
high the vet says, but not as high as they expected. Cultures for
aerobic and anaerobic bacteria were negative. Inspection of the puss
under a microscope was also negative.
The head vet at the local animal hospital is now suspecting a fungus.
I
have printed our the VetInfo article on L-Form. Does that sound like
what's going on? The vet says cancerous lesions don't move around.
We'd appreciate any ideas you can suggest. Vet bills are probably
approaching $800 and the poor cat is soooo tired of being sick! Our
local vet is top notch, but we need all the help we can get.
Thanks so much. Charles
Answer: Charles-
L-form bacteria are not a common problem, but they are one of the things
to
think about when there are abscesses that do not respond to the typical
antibiotics used for bite wounds and sterile cultures from these wounds.
These bacteria do not grow in normal cultures so they are not found,
even
though they are present. I am not sure that I completely understand
L-form
bacteria, but I think they are considered to be a sort of mutant bacteria
that may be produced after treatment with an antibiotic, such as
penicillin, that damages cell walls. Since these can't be easily cultured,
the usual tactic is to put cats on doxycycline or some other tetracycline,
which usually will kill this bacteria.
There are a several other odd bacterial infections that do not grow
well on
normal cultures and have to be considered. We see Mycobacterium marinum
here in the tidewater area of Virginia and other mycobacterium species,
such as M. fortuitum and M chelonei can also cause abscesses resistant
to
antibiotic treatment. These are organisms related to Mycobacterium
tuberculosis, which you might recognize as the cause of tuberculosis,
so
sometimes looking for a lung infection through X-rays can be helpful
in
determining if these bacteria are present. Sometimes the organism can
be
seen on smears of the exudate using special stains (so a degree of
suspicion for the organism is necessary). These do sometimes respond
to
treatment with enrofloxacin or other fluorquinolone antibiotics and
sometimes to sulfa-trimethoprim combinations (hard to use in cats because
they cause excessive salivation when administered) and gentamicin,
an
injectable antibiotic. I am not sure if isoniazid or rifampin, used
for
tuberculosis, would be helpful, or not. So far, we have not had to
resort
to these as we see these infections most commonly in dogs and have
been
able to get results using one or the other of the previously mentioned
antibiotics.
Actinomyces and nocardiosis may be hard to find with normal culture
techniques, too. Nocardiosis can usually be identified by looking for
the
organism in smears from the abscessed area, though. At least that is
what
the books say. I can't recall ever finding it but it is more common
farther
south and in the Southwest. It is supposed to respond best to
sulfa/trimethoprim combination antibiotics. Actinomyces also shows
up in
smears from the abscessed site. We have seen this organism. We do not
routinely do anaerobic cultures on our initial cultures of abscesses
and it
is necessary to do this in order to grow Actinomyces. These bacteria
sometimes respond to doxycycline but are usually treated with penicillins
or penicillin derivatives.
In our area, I think that these less common bacterial infections are
more
likely than fungal infections, but I have heard that fungal infections
are
more common just a little south of us, which would be closer to you,
so
your vet may be thinking a fungus is more likely where you are.
Since there isn't a reliable test for L-form bacteria they are usually
eliminated as a possibility by treating for the possibility they are
there,
using doxycycline or tetracyclines, which are not among the first choice
antibiotics for bite wounds in cats.
We have seen moving draining tracts from foreign bodies in several
patients, as well. The most frustrating one was a dog that lived in
a boat
construction facility and who got a small piece of fiberglass in it's
paw.
We treated an abscess there, including surgical exploration and found
nothing. We treated several more abscesses before finally finding the
piece
of fiberglass just behind the dog's shoulder blade. I am certain it
was the
same foreign body that just moved from the toe to the shoulder as there
was
a clear path of abscessation along the way. If your cat hangs around
a
workbench or other place problems like this might occur, it would be
worth
considering, too.
Good luck with this. Abscesses that recur or that don't respond to
treatment can be very frustrating but usually it is possible to find
a
solution, eventually. It doesn't hurt to take X-rays to rule
out an
underlying osteomyelitis (bone infection), if that hasn't been done,
or if
it was done early in the diagnostic process.
Mike Richards, DVM
9/23/2000
also see Pruritis or Itchy Skin
also see Ear Disorders of Cats
also see Flea Life Cycle
also see Ticks