Infectious Disease - Herpes Virus or Rhinotracheitis


Infectious Disease - Herpes Virus or Rhinotracheitis

Persistent Rhinotracheitis (feline herpes virus 1) in older cat - continued

Question: Dr Richards--second reply to same e mail--is this rhinotracheitis in any way contagious to my other cats?? I have a household of 11 cats, all but one 14 yr or older. Mitra is somewhat of a loner, tho. When she sneezes, is it likely to be contagious or is she just sneezing in reponse to mechanical irritation?? ( I realize this question probably cant be answered without seeing the cat......) -----

Answer: C- Most cats are infected with rhinotracheitis (feline herpes virus 1). Estimates vary from 70% to 95% of cats being chronically infected but it is likely that it is closer to 90% than to 70%. Cats are usually infected when they are young but because the virus is a herpesvirus it can live in the body long term and surface at times of stress or immune compromise. So the odds are that the other cats have already been infected or have some natural resistance to the infection and won't become infected. There is always a small chance that you would happen to have one of the small number of cats who aren't already infected and that the disease could spread to that cat but with the odds being what they are, this is a fairly minor concern. I don't know with certainty why a small number of cats are hit so hard by the effects of the virus. The best theory is that they have coinfections with other viruses and/or bacteria and/or mycoplasmal organisms that make them sicker and unable to cope with the combination of infections, producing severe damage in the nasal turbinates and respiratory system, which in turn lowers their local immune defenses for life. I hope that this is helpful. Mike Richards, DVM 6/18/2004

Persistent Rhinotracheitis (feline herpes virus 1) - continued

Question: Dr Richards--Mitra is on the zithromax and has improved tremendously. My vet wasnt familiar with it but after I showed him your e mail and because you are a dr he agreed to prescribe it. Since she had a depo shot at the same time I dont know which is working best but my plan is to try to continue with the zithromax until beyond the time at which she would need another depo shot and see if she is still OK. I give it to her twice a week and I do hear some slight sounds of congestion when she sleeps with me and her head is near my ear, but before, it was so bad I could hear her noisy breathing in the next room. She has vomited slightly about once a week or less but maintains her weight. What if any are the side effects I should look for?? My guess is she will be on this indefinitely. Searching on google I noticed that in humans it sometimes causes liver problems?? What are the side effect in cats?? also, in the June vetinfo digest you mentioned a 3/15/04 article re hyperthyroidism and pop top cat food cans. Boy does that sound bizarre. Would you be willing to share the name and address of the authors?? I want to write them for a reprint. The nearest vet school to me is UC Davis which is about 100 miles away. BTW, I have not had any problems with the vetinfo journal, am receiving it timely and only once. I'm in california if that makes any difference. Thanks again for your excellent advice and I'm sure Mitra would thank you if I could make her understand --catwoman.

Answer: Catwoman The longest we have had to use azithromycin, so far, is about 60 days. I think that it has been used longer without much problem with adverse effects in some cats but I can't be sure that long term use might not have some ill effect. I tried to look this up in the pharmacology text I keep at home but it didn't have any advice about long term effects and only listed vomiting as a problem with short term use. I'll try to remember to check on this tomorrow at work in another text. We have treated one cat for 20 days, twice, separated by several months, with no adverse effect and the second time the rhinitis did not return. Unfortunately, we have also had some cats who did not completely clear up with treatment but we never tried going longer than 20 to 30 days with those cats as far as I can remember. I don't have an exact address for the authors of the March 15th article in the Journal of the AVMA but the author's names were Charlotte Edinboro (Exponent Inc. Health Practice in Menlo Park, CA), Larry Glickman (Purdue University), J. Catherine Scott-Moncrieff (no address information) and H. Leon Thacker (no address information). Mike Richards, DVM 6/15/2004

Persistent Rhinotracheitis (feline herpes virus 1)in older cat

Question: Hi Drs. Richards-I have 15 yr old cat with dx of rhinotracheitis. It's a very long story, but on 3 29 I gave her a pill using a "pill gun" (which allows me to keep my fingers in one piece as she is extremely difficult to pill.....) . I have used this device hundreds of times but this time I guess I used too much force and she made this squeaking noise and immediately started to breathe noisily. I thought I had forced the pill down her windpipe(tho she did not breathe with her mouth open) and took her to emergency. Chest XR, blood work, oral exam, laryngeal biopsy all negative exc the biopsy showed some inflammation( r/o from chronic pilling). The noisy breathing continued and on 4 29 she was given a shot of depo medrol w improvement for about a week, then gradually the noisy breathing started again. Sounds just like a baby with a cold which cant blow its nose. On 5/12 she had a cat scan, rhinoscopy, more blood work, biopsy of the nasal tissue. There are no polyps or foreign bodies, studies show severe inflammation of both sinuses, rt greater than left. The biopsy was negative for neoplasm. By about 4 29 she had started to have clear discharge from the nose, rt greater than left, which steadily became more "pussy" looking and then bloody. After the cat scan, etc, the bloody discharge greatly increased, and the noisy breathing continues. Every time I clean off her nose (about 20 times a day), she then sneezes 7-8 times, spraying bloody stuff all over. This latest blood test, I dont know the results of. It would seem to me that this much inflammation would mean a rise in white cell count and perhaps globulin. The surgeon and radiologist didnt tell me anything but gave all the info to my regular vet whom we will see 5 /26 for another depo shot, since my vet dr l. says he cant give it to her more than once per month. In meantime she is on clavamox and periactin. The periactin was compounded into a tuna oil but nothing can disguise the bitterness of this antihistamine, and to get 1 ml into her, i usually use up 3 ml out of the bottle. Surgeon doesnt think the traumatic pilling caused this, but I cannot get over the fact that she was totally normal until the pill gun accident. Seems that the more we do to her, the worse she gets. She is eating some and has not lost too much weight, but is much less active than before. I have talked to every cat owner I run into to see if anyone else has had this happen to their cat. I dont know any other diagnoses ( or I havent been told any) other than rhinotracheitis. She is a totally indoor cat who was in good health before 3 /29. The pill I gave her was cosequin which is very helpful to her in terms of ameliorating some leg stiffness. I only vaccinate my cats with 3 in 1 about every 5 years (knowing that there is considerable controversy over how often to vaccinate) and she would have been due in May this year but due to all her problems I have deferred vaccinating her. I do have a total of 11 cats in my house but no one else is ill. It's almost like an allergic reaction to something. I do not use aerosols and no one smokes anywhere near the house or property. One friend said her cat devel. rhinotracheitis because was not vaccinated. She used Zithromax and it relieved the symptoms but cat has to take it daily. I also want to ask dr l. if we can try some other antihistamine. I tasted the tuna preparation myself and it's pretty nasty. No wonder Mitra hates it. It does seem to afford some relief. When she is sleeping the brething is not so noisy. She doesnt breathe with her mouth open except for a couple of breaths after her sneezing fits. Have you any ideas on what I can do for her??? I want to try the zithromax because that's the only thing I have heard of that works. I have asthma and allergies myself and I'm miserable w/o my inhaler and zyrtec, but I have a severe tendency to anthropomorphize..... I'm so sorry this message is so long and rambling. I'm so worried about Mitra, I dont know how to make her better and I still feel I caused this to happen. ---catwoman

Answer: C- We went to a continuing education seminar at which Dr. Leslie (I think) King was the speaker a year or so ago. She discussed an emerging disease being studied at the University of Pennsylvania which was a form of chronic laryngeal inflammation in older cats. She said that it would often respond to the use of long term corticosteroids, with antibiotics used in the beginning of therapy and sometimes longer term. This seems like it might be a possibility for some of the signs you are seeing but probably not all of them. It seems to worsen when other stuff is going on -- we have seen this once after a cat was treated for hyperthyroidism with radioactive iodine and once after we did surgery on a cat and intubated it for the anesthestic. In our experience the most common cause of bloody exudate from the nostrils is cancer. I think this would have to be the main rule out even with the negative biopsy sample since it can be hard to locate nasal cancers. Still, with the extensive work up that has been done it also seems reasonable to hope that cancer isn't present and that this is a chronic bacterial infection due to an underlying cause like rhinotracheitis. This definitely occurs in some older cats who had enough turbinate damage when they were young that they can't fight off infections when they age and their other immune responses begin to weaken. We do have by far the best results from azithromycin (Zithromax Rx) for nasal infections. It is a little irritating that the pediatric solution is only good for ten days after being mixed up, though -- it makes for a lot of waste unless your vet mixes smaller quantities or you have a compounding pharmacy willing to do that for you. I guess you could use fractions of the tablets but even for big cats this is difficult due to the relatively low dose requirements for most cats. We have had really good luck in a couple of cats using piroxicam (Feldene Rx) when nasal inflammation was present. This can be irritating to the cat's stomach (can cause ulcers) but that hasn't been a problem so far for us. This is a non-steroidal anti-inflammatory medication. We have also used neo-synephrine nasal drops as a decongestant in cats with some luck. One drop of the solution is put in one nostril two or three times a day for three days, then in the other nostril for two or three days --- it is necessary to treat only one nostril at a time and to switch back and forth to avoid "rebound" reactions that worsen inflammation. Chlorpheniramine (Chlortrimeton Rx) is another antihistamine that works well in cats if you think that the antihistamine is having a good effect. The dosage is usually 2mg/cat every 12 hours. We have had several cats who had nosebleeds that resolved when we diagnosed and treated high blood pressure. These cats only had nosebleeds, though -- no pus. Still, it might not be a bad idea to make sure that hypertension isn't playing a role in this problem if blood pressure hasn't been checked. It seems likely it has been given the quality of the work up done so far, though. I like to use oral prednisolone (Pediapred Rx is a liquid form if that is easier than pills) instead of Depomedrol (Rx) injections when I think it is necessary to use the injections more than once a month. This allows continuous dosing with more control over the dose. However, I have to admit that I don't think that it works as well in all cats. Some cats just seem to do a lot better with the injections than with oral medications. Good luck with this. Mike Richards, DVM 6/15/2004

Herpes and Kittens

Question: Dear Dr Mike: 1) Is it known how long a cat/kitten is contagious with herpes either while symptoms are still visible are after symptoms are completely gone? I still have several kittens here who are in the process of clearing up the last of symptoms and want to know when it is safe to let them go. Several kittens have already gone into single cat homes and have been vet checked there and are doing just fine. I am concerned about kittens that may go into homes where there is already another cat.

Answer: Cats that are infected with herpes virus are infected for life. They shed the virus intermittently and they may shed the virus with or without clinical signs being present at the time they are shedding it. Since 70% of cats (some studies suggest >90%), at least, are infected with this virus, it is safe to let them go to a new home when they are symptom free. They may have future problems with the virus but that is true of almost all kittens and most do not have recurrences of serious disease from herpes virus. 2) I have two kittens who are now 12 weeks old whose symptoms all have cleared up except each has an eye that is still foggy and watery. I am treating them 4-5x daily with Mycitracin ointment (they had been treated for several weeks with Viroptic drops previously). The ointment is cheaper and seems to be as effective. Any idea how long it will take for this to clear up? Or is there a better medication to use for a persistent eye problem? Viroptic is only supposed to be used for 21 days.

Answer: I think there is a misunderstanding about the use of trifluridine (Viroptic Rx). Trifluridine is supposed to be used for a minimum of three weeks, or at least one week past the resolution of clinical signs, whichever is longer. Some cats require several months of therapy. At some point, the virus is finally handled by the immune system and the clinical signs disappear. Usually this happens about the time everyone is ready to give up on a cure. Antibiotic ointments don't really help clear up the virus but they can prevent secondary infections. Ointment should be fine for this purpose. 3) Within the last two weeks, I have had three females go into heat and assume they are now pregnant. The first Mom did suffer from symptoms for several days, was treated and has been just fine since. No symptoms now. Must I treat her with antibiotics before delivery and vaccinate the kittens early, isolate, etc. as per your recommendations?

Answer: There is no reason to treat the females with antibiotics prior to delivery. If you want to do the most you can to prevent future occurrences of herpesvirus problems it is best to vaccinate the kittens with an intranasal rhinotracheitis/calicivirus vaccine as soon as their eyes open, then weaning the kittens before the maternal immunity wears off (six weeks is usually OK) and keeping them separate from the adult cats until they can be vaccinated when they are about 12 weeks of age. This is confusing, but vaccination for herpes virus does not prevent a cat from becoming infected -- it just reduces the clinical signs in infected cats. This is important to do but the most important thing is to try to make sure they get infected when they have been vaccinated and have some immunity so that they do have less severe illness and fewer long term complications. 4) The second Mom never did show symptoms nor does she show any now. Is she definitely a carrier now since the herpes has been in my cattery? Or can cats be exposed to this virus and never get it? (All of my adults have been vaccinated with appropriate vaccines over the years). What precautions, if any, need to be taken for her and her future litters?

Answer: The odds are very high that this cat is infected, too. She just may not show clinical signs as readily or may have a better immune response to the virus. Her kittens should be treated the same as other kittens in the cattery in order to prevent them from having problems to the extent it is possible to do that. 5) The third Mom is the cat who I believe picked up the virus while at an emergency pet treatment place. She never did develop symptoms although it was her litter of kittens that first showed up with it. She is pregnant again and is sometimes sneezing although this is the only thing I am noticing--no congestion or eye problems. Does that mean she could be just contracting the virus now? Or could she be showing some symptoms due to the stress of pregnancy. She is only a week or so into her pregnancy. If she is currently active with the virus, could this affect the kittens in utero (deformities, etc.)?

Answer: She is most likely to being showing signs because of the stress of pregnancy. To the best of my knowledge, there is no in utero transmission of herpes virus. Kittens are infected after they are born, so there should be no risk to the kittens. 6) If a cat or kitten has already had the virus, can they get it again from another cat or kitten who is currently active? In other words, can this thing be passed around again and again within my cattery?

Answer: Cats that get this virus have it for life, in most cases. However, exposure to other infected cats seems to cause recurrence of illness in some cats, probably because they were close to losing immune protection, anyway. 7) Before delivery, how far ahead must I treat a pregnant Mom cat with antibiotics and what kind of antibiotics do you recommend that won't affect the kittens in utero?

Answer: This is not an issue, there is no reason to treat the pregnant cats. However, it may be necessary to use antibiotics for kittens that develop clinical signs of disease, in order to keep secondary bacterial infections under control. 8) You stated that the litters should be vaccinated at 14 days. Should this be done with the Heska vaccine (directly into the eyes and nose). Must they be treated with the whole vaccine or just the part of the vaccine addressing the herpes virus? Is it safe to use the whole vaccine at such a young age?Also, my vet mentioned something about vaccinating them at birth - is this possible or recommended?

Answer: I am not aware of a protocol that calls for vaccinating kittens earlier than 10 to 14 days of age. That doesn't mean there isn't one -- it just means that I don't know about it if it exists. When vaccinating young kittens (less than three weeks of age) it is really important not to use a vaccine that contains panleukopenia virus (Heska's vaccine does contain panleukopenia, Pfizer's does not --- this is from memory so please be sure to check before using a vaccine). Only use a vaccine that contains herpesvirus (rhinotracheitis) and calicivirus. 9) You stated that the litters must be isolated. For what length of time is this necessary? Is this only until the first vaccine? Also must the Mom cat be isolated too, or can she be free to roam the cattery and just keep the kittens isolated? I always keep my litters isolated for at least the first 3-4 weeks anyway, but do let the Moms out for feedings and to socialize with the other cats/kittens as they hate being separated.

Answer: It is a good idea to keep the litters isolated from the other cats, which does mean that the mother has to be kept isolated, as well because she can bring problems back to the litter. The most critical part of the isolation procedure for keeping herpesvirus problems to a minimum is the period after the kittens are weaned and before their vaccination series is finished (twelve weeks of age). You might find that early vaccination is sufficient to protect the kittens if you simply can't effectively isolate litters of kittens from weaning at 4 to 6 weeks of age. If that doesn't work, you can adopt the more stringent program. 10) Are there any other precautions other than antibiotics for the Moms, isolation of litters, and vaccines at the appropriate age that you recommend? When handling the new litters, must I take shoes off, wash hands, etc. when going from the main cattery into the areas where the new litters are? Any other suggestions?

Answer: It is a really good idea to wash your hands very frequently during the day, especially between handling different litters. Disinfecting areas that can be disinfected using dilute chlorine bleach (1:30 dilution) frequently, is a good idea, too. I don't know how effective taking your shoes off is. 11) Must the precautions you recommend be done with every litter forever in the future involving these cats? If not, how long or for how many litters must I continue precautions?

Answer: You may find that you can get by just by using an early intranasal vaccination program and keeping up with vaccinations (intranasal or by injection) from 6 or 8 weeks of age to 12 weeks of age. However, if you try this and it doesn't work well enough, you may need to go with the whole program. If you do, it will probably be necessary to keep it up long term (possibly forever). 12) Will future kittens born to females who have either had the virus or who have been exposed to the virus automatically be carriers or if the proper precautions are taken, will they be virus-free and symptom-free? At some point, most cats become infected with this virus. Once they have, they will usually have the virus for life. So the goal is to control the symptoms. This is done through the vaccination program and by keeping the litters isolated, if necessary, so that they get infected after they have the ability to fight the virus better and to control symptoms better.

Answer: Remember that there is some chance that the symptoms you are seeing could also be due to calicivirus at times. The protocol for vaccination is the same but calcivirus carriers shed the virus persistently, rather than intermittently, so that carriers may infect generation after generation of kittens --- this is just another reason to try to break the cycle of whatever is going on with early vaccination. Mike Richards, DVM 2/18/2002 Herpes and eye drops and medication

Question: Dear Dr.Richards, One of my 3 cats have recently been diagnosed with feline herpes. She has an eye that sometimes is a bit redder and smaller than the other one. My vet say's that she will need some drops to put in. I have been reading that these drops can be a bit expensive. I am just wondering if there is anything that I can give her (something that a normal person can get a hold of) to make the symptons go away. Also how is this going to affect my other 2 cats. The other 2 are kept in a separate room in the house while the affected cat has the full reign of the house. But I do let the other 2 out for about half an hour, at which they sometimes play. Waiting in Vegas, Pearlie

Answer: Pam- There are several different eye drops used in cats suspected of having herpes virus conjunctivitis or keratoconjunctivitis (KCS). Veterinary ophthalmologists often recommend using tetracycline or chloramphenicol eye ointment or drops to try to make sure that a secondary infection with chlamydiosis or mycoplasma is not present. These infections are sometimes a primary problem, as well. If the eyes are painful some vets like to use non-steroidal anti-inflammatory eye drops (these can be expensive) and others use corticosteroids. The corticosteroid drops seem to be pretty controversial, though. They can make herpes worse but they also appear to help in some cases. I try to stay away from them but sometimes it is really tempting to give them a try. Oral and/or topical interferon drops may help in some cats, based on case reports (but no scientific studies that I have seen). There are anti-viral eye drops that can be used in cats. They are expensive and are often painful when applied. Trifluridine 1% (Viroptic Rx) and idoxuridine 0.1 % (currently has to be made by a compounding pharmacy) are the two most commonly used. We tend to hold off on these drops due to the cost, irritating properties and the need for frequent administration of the medications but they probably would help more if we used them earlier. Many of our clients won't continue the drops in their cats due to the cat's reaction to the drops, though. So that discourages us from recommending them quickly. Oral administration of l-lysine is helpful in some cats. 250 to 500mg per day per cat is the usual recommendation. Most cats will eat these tablets if they are crushed and mixed with food. These tablets are available over the counter. I hope that this helps some. Mike Richards DVM 10/20/2001

Herpes, arthritis and possibly other health problems

Question: Dear Dr. Mike, After reviewing your questions & answers (which we found very helpful) Your web site is the best one out there. I wanted to ask about our one cat specifically. Tigsy is 5 years old and has been diagnosed with herpes virus and chlamydia, as well as arthritis. His symptoms are: - he makes a snorting sound which seems to come from his upper nasal area - we don't notice much discharge from the eye, however, he has what appears to be an internal drip (which he swallows) - every few months he gets a cyst (almost resempling a pimple, it's puss filled) around the outside of his mouth area - he also has arthritis, as his joints swell and generally are swollen for a couple days. It is never the same joint, and only one at a time (one every month or so) We've seen a specialist for his sores and his arthritis. We were giving him steriods and antibiotics before seeing the specialist (2 years ago), her advice was not to give him anything but let his own immune system fight. As a result of this, we have noticed his symptoms take less time to heal than when we treated them with medication. My question to you is, by leaving his symptoms untreated can he live a full and relatively healthy life? I've tried reading books to educate myself on the herpes virus, but there isn't much information that I can find. It is upsetting when you see your little guy in pain and cannot offer any help. If we know that this is better for him than it may help us both. Thank you Dr. Mike, Sheri & Tony

Answer: Sheri- I have been trying to figure out if all the symptoms that you are seeing could be caused by one condition. So far, if that is the case, I haven't been able to come up with a disorder that would do this. However, I have found a couple of case reports of cats with signs of chronic herpes virus and severe arthritis. The odds are that these are separate conditions, though. The reason for this is that herpes virus is very common and many cats are affected by it. So when another condition that is less common occurs it is tempting to view it as a complication of the herpes virus, although it is probably more likely that the second condition is only occurring in a cat with herpes virus because herpes virus is common, not because it is causing the symptom. It is also tempting to blame almost all upper respiratory symptoms on herpes virus, just because it does cause most of the cases of chronic upper respiratory disease. In this case, there is no really effective treatment except that it does help to keep secondary bacterial infections down to use antibiotics when the disease seems worse clinically. There is a small chance that administration of l-lysine, 500mg/day, might be beneficial but usually this doesn't help much in the chronic upper respiratory infection cases. With that in mind, it seems very likely that chronic herpes virus is underlying the post-nasal drip type symptom. However, this may also be caused by dental disease, oro-nasal polyps, cancers of the nasal passages or pharyngeal region, fungal infections of the nasal passages, allergies (probably rarely) and even from eye disease in some cats, due to excessive tear production draining into the nose through the lacrimal ducts and then being swallowed. It may be worth making an effort to eliminate one or more of these problems as a possible cause of the problems seen, depending on what has been done already and the appearance on a physical exam. The lameness is probably an entirely different problem. There are several possible causes of persistent arthritis in cats. If the cat has feline leukemia virus, there is a disease associated with this, chronic progressive polyarthritis, that occurs when a second virus, feline syncytium forming virus, takes advantage of the immunosuppressed cat and invades the joints. It seems likely that FeLV testing has been done, though. Cats sometimes get persistent arthritis associated with mycoplasma or l-form bacteria, both of which usually respond to treatment with doxycycline, a tetracycline class drug. It can be worth trying the antibiotic just to see, because both of these organisms are very hard to culture or identify in joint fluid. In addition, doxycycline is an effective therapy for chlamydiosis in cats. There are a number of immune mediated arthritis disorders that occur in cats, including rheumatoid arthritis, systemic lupus erythematosus and idiopathic (occurs for unknown reasons) immune mediated polyarthritis. These sometimes respond really well to corticosteriods but if this hasn't been your experience, it seems reasonable not to use them. It is reasonable to try glucosamines, either Adequan (Rx) injectable or glucosamine/chondroitin tablets orally, for most forms of arthritis. These medications should not have a detrimental effect and may be helpful. I also see no reason not to try to control the pain associated with the arthritis. We sometimes use aspirin, very carefully, in cats with arthritis and it works reasonably well. We also use narcotic pain relief medications when pain is severe and it seems necessary to do so. It is hard for me to believe that pain is beneficial in the healing process so I just don't see any reason not to try to control it, but it would be best to check this out with your vet and the specialist, if possible. Pain would be the issue that would make me wonder about the quality of life, though. The swelling around his mouth may be due to acne, furunculosis, eosinophilic granuloma complex, dental disease, localized pyoderma or even ringworm. With the recurring nature of the problem acne, furunculosis and eosinophilic granuloma complex seem most likely, though. The first two sometimes respond to local treatment with things like benzoyl peroxide shampoo or mupirocin. Eosinophilic granuloma complex often requires treatment with corticosteroids but can go away without treatment at times, as well. I really think it would be worth talking to your vet about trying doxycycline, if that hasn't been done already, and to ask about controlling pain and whether glucosamine/chondroitin products might be beneficial. Good luck with all of this. I hope that this information helps Tigsy at least a little bit. Mike Richards, DVM 8/20/2001

Long term effects of serious Herpes infection

Question: Dear Dr. Richards, I am writing about my 3 year old neutered male cat Oberon. He is by all appearances a healthy, playful cat who is sleek, shiny and a good eater. He is an inside cat (along with our other cats) and was FIV and FeLV negative at the time of his adoption. However, he had cat herpes as a small kitten, shortly before I adopted him. His right eye was so ulcerated that they had to remove it. His one-eyed status doesn't slow him down at all, and he is a delight (you get used to the one-eyed visage pretty quickly), but he does occasionally go through phases when he sneezes out occasional "boogers" (sorry, can't come up with a better word for dried mucus). This problem was worse when I first had him, so our vets had him on clavamox for the first few months after we adopted him. The sneezing and dried mucus do seem to be worse at times when I notice my hayfever acting up as well (and I have 2 eyes...still, none of the other animals sneezes). A couple of vets have told me that it's possible his sinus doesn't drain as well as it could because of the eye removal and hence the occasional mucus problems. It doesn't seem to bother him, and it is intermittent, but I was wondering if you've ever seen anything like this? Also, he has chronically inflamed gums (I've read about this on your site, I guess it's not uncommon in cats who had viral infections as's possible the poor guy had calici AND cat herpes when he was abandoned). Our vet recommended cleaning Oberon' teeth recently and we had the typical pre anesthetic bloodwork done. He came through it just fine, and his gums and breath are better for now, but the vet mentioned that his creatinine levels were a bit high. Since the BUNs were O.K., the vet didn't think there was anything to worry about , but maybe we should have his blood checked again next time. I know that high creatinine and BUN levels can indicate kidney problems, but 3 is pretty young for chronic kidney problems in a cat isn't it? I've heard that chronic gingivitis can lead to kidney problems. Could the fact that Oberon had health problems as a kitten predispose him to an early onset of geriatric type problems? Our vet didn't seem concerned, so I'm not especially worried, but I wanted to see what you thought. Thanks,Erica-

Answer: Erica- It is not uncommon for cats who have severe herpes virus infections when they are young to have intermittent nasal infections or poor ability to deal with nasal irritation as adults. Severe early viral infections damage the nasal turbinates and nasal passages and lower the cat's ability to fight off infections. Sometimes it is helpful to supplement l-lysine, 250 to 500mg/day to these cats but most of the time the damage is just there and this won't help much as it only suppresses the herpes virus. We have good luck using azithromycin (Zithromax Rx) in cats with chronic upper respiratory infections. Sometimes we use it intermittently on an "as needed" basis and sometimes we use it continuously on a once every 3 to 7 day schedule to suppress infections, depending on how the cat responds. Things that help with nasal irritation in general, like saline nasal sprays (not too many cats will let you use these), decongestants like neosynephrine (same problem) and humidifiers in a room the cat stays in can be helpful. It is a good idea to try to stay on top of these infections because they can set up a self perpetuating cycle by causing further damage. If Clavamox (tm) works for your cat, there is no problem with continuing its use, or with using any other antibiotic that is helpful. We just have the best luck with azithromycin right now. The chronic gum irritation might respond to the use of bovine lactoferrin. This is applied topically or given mixed with milk. It comes as a 300mg capsule and we use 1/2 of the capsule's contents once a day. It seems to help about 20% of cats but that is enough to make it worth a try. Sometimes using the antibiotic clindamycin (Antirobe Rx) is helpful in chronic gum disease. We try if for 10 days and if it works well we just give it the first 7 to 10 days of each month until the problem seems to stay away, if that happens. Corticosteroids can work well for the gum inflammation but have drawbacks in cats with chronic nasal infections since they weaken the immune response --- so I would be hesitant about this treatment. There are several other treatments that work occasionally and your vet may be aware of ones that I don't know about. It is a good idea to check for feline odontoclastic reabsorptive lesions (FORLS) in cats with chronic gum irritation. These are weaknesses in the enamel caused by a cell, the odonclast, that is supposed to dissolve the baby teeth and then become dormant -- but in some cats this doesn't happen for some reason and permanent tooth enamel gets damaged. If these are present the current recommendation is to remove affected teeth. We don't always do this, because the teeth can be really hard to remove and lots of cats have this problem --- but it is the recommendation of veterinary dentists and others who study this problem. There is no other good treatment that I know of, although people are continuing to try to find one so there may be something new I don't know about. I would worry about rising creatinine levels but definitely agree that the thing to do is recheck the blood and see if it is a real problem or if there was just something wrong with the last test or a minor problem your cat has resolved. If your cat is Persian, or part Persian, it wouldn't be so unusual to have kidney failure in this age range, since they are prone to polycystic renal disease. Once in a while there is damage to the kidneys from something like kidney stones, kidney hemorrhage or toxins that leads to early onset kidney failure. If the creatinine is still elevated or especially if it is rising, it would be a good idea to continue to look for a cause of the problem, perhaps with X-rays or ultrasound examination. Good luck with all of this. I'm hoping the creatinine level was just an aberration. Mike Richards, DVM 7/16/2001

Herpes and IBD and Giardia

Question: Dear Dr. Richards, I am a new subscriber to your web site, which I found extremely useful, and which has opened my eyes on many things that neither me nor our vet knew! I have two cats. Both of them (obviously) have herpes virus, but only one of them (5 months old) is on L-Lysine (great results, I should say: his awful conjunctivitis has disappeared completely, although I am not sure for how long - he is still at the end of his treatment!). The other cat (the elder one - 3 years old) has inflammatory bowl disease and takes prednisone, that's why our ophthalmologist did not suggest taking L-Lysine for this elder cat as his immune system is already down. To add to this "pretty" bouquet of diseases, the elder cat recently was also diagnosed with Giardia (although both cats are strictly indoor ones) and is going to be on metronidazole. Since there's a possibility that the younger cat also has Giardia, our vet has recommended to give metronidazole to him too. My question is: what do you think about treating a cat with both medications - L-Lysine and metronidazole? Is it OK to take both at the same time? Is it really necessary to treat him with metronidazole (he seems to be very healthy with a strong immune system, and unlike the other cat, has no diarrhea at all)? Thank you very much for your time, Corinne

Answer: Corinne- L-lysine is an amino acid, one of the building blocks of protein. It does not have much effect on the cat's body. It works for herpes virus because the virus is an RNA based virus. Due to this, the virus has to fool the body into making DNA. L-lysine interferes with this process because it resembles the amino acid the body really needs for the conversion. This interferes with virus reproduction and in chronic cases of herpes virus it helps to inhibit the virus and allow the body to deal with it. So it really doesn't have much effect on the immune system and it doesn't interfere with other medications much. It is generally safe to use this amino acid for treatment of herpes virus while using other medications or while treating other conditions. Lots of cats with giardia have no clinical signs. Most of them never get treated for the illness. But they can be carriers and since your older cat appears to be susceptible to the giardia organism it is probably best to treat both of them to try to prevent recurrences. Hope this helps. Mike Richards, DVM 1/13/2001

Herpes virus (rhinotracheitis) and calcivirus infections

Question: Dr. Mike, Great site. I love the information. Our situation: We had an older male cat, 12 years, who had been an only cat all that time. Three weeks ago we adopted a six month old kitten from the Humane Society here in NYC. We wanted a kitten and thought it would keep Fish, the older cat, company. Unfortunately we did not take the time to make sure that Fish's shots were up to date. The kitten, Lucy, came home with a sneeze. Fish caught a cold. Next thing we know Fish stops eating. He becomes quite lethargic and retreats to special hiding places in the closet and under the bed. We take him to the vet who prescribes a course of oral antibiotics, Amoxycillin (sp?). We administer the medication for a week. Still, Fish does not eat. He goes to his bowl or the faucet and looks interested but then fails to ingest. Five days later we bring him back to the vet who shows us sores on Fish's tongue. She discovers his vocal cords are bleeding and there are sores down his esophagus. The vet is concerned about hepatic lipadosis as Fish is a large cat. (We don't think of him as fat.) She suggests a feeding tube and we agree. For the next five days we inject a/d food through the tube along with water and medication. Last Sunday we notice that Fish was having trouble walking. He is very unsteady on his feet especially the hind legs. And is very lethargic. Sunday evening he fails to make it to the kitty litter box. We call the vet who warns us that Fish may die and that she would like to see him Monday morning. We bring him in and on the way to the vet he urinates on himself in his carrier. The vet puts him on intravenous medication, nutrition and fluids. The 105 fever goes down. Tests for FIV and F leukemia come back negative. It becomes clear that his joints are swollen and inflamed. The vet initially suspected a herpes virus which Lucy, the young cat, gave to Fish. She is still sneezing and there is gunk coming out of her eyes. Otherwise, she seems fine. The vet said that she is fine. Fish also has gunk coming out of his eyes. Fish on the other hand, she thinks, has caught the Calicivirus. Apparently, the sores in his mouth and throat-which suggested herpes initially--are healing, but he still cannot walk. Our vet consulted a specialist and the specialist said this pattern of infection is rare, but not unheard. We have absorbed a large amount of information in the last few weeks. The information assimilating and the care giving have been exhausting. Fish is due to come home from the vet tonight. He is still unable to walk so we will tube feed and change his absorbent bedding frequently over the weekend. Our question is what do we do to make Fish comfortable? What do you think about this series of events? I want to rename Fish Job. From the info provided can you shed any light on Fish's situation? Our vet thinks a full recovery is likely. How long might this take? Sorry to go on at such length, but we want to give Fish every opportunity for a full life. Any light you may shed will be appreciated. John

Answer: John- It is not uncommon to have both feline herpes virus (rhinotracheitis) and calcivirus infections at the same time. It sounds like this may be possible, although it is also possible that calicivirus may be the sole problem. I think that calicivirus is less common than feline herpes virus 1 (FHV1). They both cause upper respiratory disease. Both can cause oral ulcers, although calicivirus is more likely to cause these and they tend to be more severe with this virus. Fevers are more common with FHV1, but can occur with calcivirus. Eye inflammation is worse with FHV1 and if there is irritation of the cornea (keratitis) it is much more likely that FHV1 is the culprit. Calicivirus is associated with lameness, swollen joints and arthritis (limping kitten syndrome) and is more likely to cause gastrointestinal upset. It was almost certainly a good idea to go to forced (tube) feeding for Fish. After three to five days of not eating, cats can develop hepatic lipidosis. The signs of approaching the bowl as if hungry and then refusing to eat is typical behavior for that problem. The only treatment that works is to ensure adequate nutritional intake until the cat is willing to eat on his own. The limping syndrome associated with calicivirus is usually self limiting, resolving all by itself within a few days. It may help to give aspirin once, at an appropriate dosage for his size. Other than this, nursing care to keep the patient dry and clean and ensuring that the patient is taking in adequate quantities of food and water is important, too. This is another reason to use a feeding tube, so again, that was a good choice. It really sounds like you and your vet are doing the right things and working hard to ensure that Fish will be OK. I hope that this good care has been rewarded and that he is better now, or at least well on his way to recovery. Mike Richards, DVM 10/5/2000

Feline herpes

Question: Dr. Mike - I am a new subscriber to Vetinfo, tho I've been visiting your website for some time now. It is such a great resource! My problem: I have two kittens, Buddha - 4 months old, and Lilac - 5 months. Buddha apparently has the feline herpes virus, since he developed cold- like symptoms right after I took him home. Sneezing, eye discharge... It continues to be a recurring problem in the three months that he's been with me, and now my other kitty's eye is gooping up. Buddha has been on (at various times) Clavamox, Tobramycin for his eye, then triple-antibiotic ointment for the eye, then Gentocin (?) for the eye. Now Lilac is on Tobramycin, Buddha is not on any medication. So, my questions: What should I be doing to keep these little squirts as healthy as I possibly can without taking them to the vet every two weeks, as I have been doing? When Buddha gets snuffly and has discharge coming from his eyes, should I just let it pass or should I take him to the vet? All the trips to the vet are beginning to add up, and I just want to know if it is necessary or even helping him, or if his symptoms will pass on their own. Not to mention the fact that the symptoms are supposedly brought on by stress (and what's more stressful to a kitty than going to the vet?) Do you recommend wiping their eyes with a kleenex or am I just irritating them more? I am going to start putting lysine in their food, as suggested by you and my vet, do you recommend 500 mg a day for kittens? My vet says 250 mg. Thanks so much for your help! -Jennifer

Answer: Jennifer- It is probably fine to use 250mg per day of l-lysine in kittens and small cats. 500mg of l-lysine per day is better for adult cats of normal or large size. It takes some time to notice benefits from this (several weeks) so please give it some time. I don't see any problem with using a tissue that has been moistened with warm water to clean the gunk from around the eyes. I usually use Bounty (tm) paper towels because they are soft but hold together well. A wash cloth is probably OK, too. Antibiotic eye drops help sometimes when there is a secondary infection. I like to use tetracycline ointment or triple antibiotic eye drops or ointment. We have been having problems getting tetracycline ointment lately, though. Most of the time antibiotic eye medications don't help much. The primary problem is usually viral and the virus is not susceptible to an antibiotic. It is really hard to resist going ahead and using an antibiotic, though. It is possible to have anti-viral eye drops compounded at a pharmacy and to use them (idoxuridine drops). This can be helpful when this problem gets chronic. They are expensive compared to antibiotic eye drops, though. I have always been reluctant to try this, but some vets use dilute betadine solution for herpes eye problems. If your vet is pretty sure that this is herpes virus it seems reasonable to me to skip trips to the vet's unless Buddha's eyes seem to hurt more than usual or if the cornea looks cloudy instead of clear. Good luck with this. Usually this problem will resolve over time. It is just frustrating while you wait. Mike Richards, DVM 9/4/2000


Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater Virginia. Dr. Richards graduated from Iowa State University's College of Veterinary Medicine in 1979, and has been in private practice ever since. Dr. Richards has been the director of the PetCare Forum...