Infectious Disease - Herpes Virus or Rhinotracheitis 2


Herpes treatment Question: Hi Dr. Richards, I have just subscribed to your service it is great to be able to get straight answers. First of all the back ground on Tali, she is (amongst many we have) a two year old neutered female cat, who, literally stumbled into us when she was a very small kitten. Both of her eyes were glued shut with gunge, that looked like red jello. We took her in and bathed them and also took her to the local vet in Israel, where we were living at the time. He prescribed an anti-biotic cream several times a day to be put in both eyes, this we did. This had little noticeable effect, although the gunge went and we could see her eyes. They are both covered with what looks like a gray film and the surface looks uneven.You can just see the yellow eye underneath. We then took her to another vet who prescribed some more cream, needless to say this also had little effect. It was then on to another vet who said that he thought it was caused by her eyelashes turning in on the eye and had scratched the surface, but he also took a swab from her eye and sent it off to be tested. The results came back as "a fungal" infection. More cream was prescribed, again with no improvement. We then returned to Spain where we live and took Tali to our local vet here he said that nothing could be done. We were not convinced as we had received several different answer so off we went again to yet another vet. This one looked at her eyes very carefully through a "microscope type instrument" and told us that the problem was herpes and that it was chronic!! There are little clusters of white dots on her eyes, which he explained were groups of herpes. He prescribed a course of Viromidin ( Trifluridina) drops 3 X day and Colircusi Aureomicina (Clorteraciclina) drops 3 X day, both of these are made by Cusi, Barcelona, Spain. These are to put the herpes into remission. Then it would be possible to operate to clear the eyes of the damages and to give Tali about 80% vision in both eyes. At the moment he estimated she had about 20% vision in both eyes. We went back after 3 weeks and he told us that the Herpes had not retreated enough to allow an operation to take place. He then prescribed only the Viromidin drops 4 X day and Zovirax ( Aciclovir) cream( made by Wellcome) at night for another 3 weeks. This we are in the middle of. Phew, sorry to be so long winded but I thought you should have the full story. Oh, perhaps I should also mention that Tali is otherwise fit and healthy with no other signs of the herpes virus. The questions&&&& 1.Is there anything else we can do to help put the herpes in to an holding state? 2.If nothing is done will Tali eventually go blind? 3.What risks are associated with this type of operation. Thanks, Tony Answer: Tony- Herpes virus is the most common cause of the clinical signs you are seeing in your cat, so it is very likely that your vet is correct in this diagnosis, just based on the odds. In the U.S., acyclovir (Zovirax Rx) cream is not available, but veterinarians sometimes use the oral version of this medication but success is reported to be variable. Oral administration of l-lysine, usually 250 to 500mg per day, is helpful in controlling herpes virus infections over the long run. This interferes with the virus' ability to replicate and helps keep it in check. Interferon, administered orally or mixed with artificial tears is reported to be helpful by some veterinarians but I am not aware of clinical studies supporting this therapy. It is unlikely to be harmful, though. The medications your vet is using are the ones most likely to help. We have had several patients develop really severe corneal damage from herpes virus infection which was eventually possible to control. Most of our patients did not have surgery and most of them were able to see well enough that I could not detect visual defects. Some of these cats had really terrible looking corneas but still seemed as if they could see. There are times when herpes virus leads to corneal sequestrums and surgery is necessary in these cases, most of the time. Sometimes debriding the surface of the cornea seems to help but there seems to be some controversy over doing this, among ophthalmologists. Your vet sounds experienced in treating this problem, so it seems reasonable to me to trust his opinion. There are some cats that won't respond to treatment for this condition, or take a really long time to respond. We have the luxury of having a veterinary ophthalmologist who visits regularly in our area and he is very good. Despite concerted efforts, we had one patient who took over four years of treatment before this condition would resolve. We have had one patient I can remember who had eosinophilic granuloma complex affecting the corneas that looked very much like herpes virus infection, to me. The ophthalmologist was able to distinguish between these conditions, though. Your current veterinarian sounds like a specialist in ophthalmology or at least very competent at it, so again, it is best to trust his judgment. The major risk in ophthalmic surgery of the cornea is corneal ulceration due to secondary infections or complications from the viral infection or due to removing too many layers of the cornea in the effort to clear the corneal surface of scarring or a sequestrum. This is a good reason to be sure that the surgeon is experienced and possesses the instrumentation necessary to work on the cornea, such as adequate magnification (operating microscope is optimum, good head loupes a minimum), ophthalmic surgical instruments and ophthalmic suture. It is unusual to find all of this anywhere but a veterinary ophthalmologist's practice but I do know of a few general practitioners in the U.S. who are skilled at eye surgery and who also possess the instrumentation to do a good job of the surgery. If I didn't answer your questions clearly enough. please feel free to write for clarification. I do think you have found the right veterinarian at this point. Mike Richards, DVM 8/22/2000 Feline herpes Question: Dear Dr. Mike, I have two questions. the first is about feline herpes. My DSH male got this virus when he was about 1yr old. It was a pretty bad case with most of the typical symptoms. Thanks to his opthamologist his ulcerated eye looks as good as new. He does have a blocked tear duct on that side but I keep it wiped and it really isn't a problem. What is a problem is that his inner nasal passages (turbinates?) were damaged and he is now a snuffler, to put it mildly. He is 4yrs old and has had either a stuffed up nose or yellowish gunk, which he sneezes all over, ever since the herpes attack. My vet did a culture and found the problem to be strep and pasturella (sp?) which she says is almost impossible to get rid of, especially due to his nasal damage. When he is on Baytril it clears up and is much better. When I take him off, in a week he is back to stuffy and snotty. This has been going on for 3yrs. Other than this he is a normal cat. I know having an infection is really bad for him, and my vet said to put him on the baytril 22.7mg 1 pill a day for the rest of his life. The questions are: Will the infection become immune to the antibiotic? and I worry what a constant dose of antibiotic will do to his liver and kidneys, or is the infection worse on these organs? What do you suggest? Answer: T- Your vet and the ophthalmologist are almost certainly correct about the initiating cause of the recurrent infection. Damage to the nasal turbinates leading to chronic upper respiratory infections is a fairly common problem in cats who have had severe herpes virus infections at an early age. These are very frustrating to treat. I think that a number of vets use enrofloxacin (Baytril Rx) as an initial therapy or as a chronic therapy for this condition. This seems to be safe to do based on anecdotal reports but I am not aware of long term studies of continuous use of this antibiotic. So there may be some unknown risk that will become recognized later. Despite this, if the antibiotic helps I would consider using it because these infections do sometimes get really severe if no attempt is made to control them. Other antibiotics are sometimes recommended and currently the most common one is azithromycin (Zithromax Rx), which can be used daily for several days to a week or more then used on an every three day or a twice weekly schedule, which makes it less work. The usual recommended dosage is 5 to 10mg/kg. Given daily this medication achieves good blood levels after three or four days and then it is OK to switch to an every other day or every third day, or twice weekly schedule (depending on how well the cat does). Other things that sometimes help include humidifiers, nebulized antibiotics, administration of l-lysine 500mg per day (helps fight the recurrence of herpes virus) and sometimes decongestants. Some vets recommend using eyedrops containing antibiotics, on the theory that they are flushed into the nasal passages through the tear ducts (which wouldn't work on the side with the blocked duct, I guess). Good luck with this. Many cats do live nearly normal life spans with this condition, especially if secondary infections can be controlled, even if only intermittently. Mike Richards, DVM 7/21/2000 Sneezing and eye infection/inflammation - Herpes Question: Dear Dr Mike, I have two elderly female spayed cats, one 14 and one 16. The younger is Israeli and the older from Los Angeles (we live in Tel Aviv). They have been very healthy except for starting about a year and a half ago, when they had they're first real illness, an intestinal parasite infection. The older cat also had a run of eye infections (a problem I had at the same time, she is face rubber). Now I'm having a problem with them sneezing. They are indoor cats and almost never have fleas or worms. They received their latest vaccinations in July and this included something for upper respiratory virus (I can't read the name of the vaccine on the form). In late October I treated them with Frontline spray and put them in a boarding facility for a week; they were fine after. In January, I came down with the flu. A few days later the older cat started sneezing. No other symptoms, just small dry sneezes a few times a day and an increased appetite. After a few days I took her to the local vet and he couldn't find anything wrong with her apart from the sneezing, no congestion, fever, nothing. He gave her an antibiotic injection and some liquid antibiotic. No change. A few days later the other cat started sneezing and eating more. I rushed her to the vet, same thing. He gave her an antihistamine injection and told me to stop the antibiotics. The cats continued sneezing and eating and I was very ill. Finally I took them to my previous vet (at the other end of town, who was trained in South Africa and goes to regular course abroad)) who also couldn't find anything wrong with them, suggested it as a mild viral infection, and told me to wait. The sneezing eventually stopped and they started eating less. Mid February I treated them with Frontline drops against fleas and put them in the boarding facility for three weeks (the facility is unheated but the cats are moved into a closed room if the weather gets really bad). The evening I picked them up I found the younger cat was sneezing; loud wet sneezes. Besides that, she was perfectly normal. The facility said they knew nothing about it. This is a very noisy cat and it would be difficult to miss her sneezing, it's almost as loud as human and she is very slow to clean herself up. She quickly got better. Now, about a week later she is no longer sneezing but still seems to be swallowing phlegm. About a week after I picked them up the older cat started sneezing, also wet but not as bad as the younger (this is a very quiet cat). She is still sneezing occasionally but otherwise seems normal. As a note, they hate each other and avoid physical contact with each other though they eat from the same food bowl. They are both very affectionate (to me, only) and enjoy a lot of physical contact (separately). My apartment is unheated during the day and I use electric heat at night. I realize that I should no longer board them during the winter, it's just to cold for them (winter temperature this year ranged from 60 to 35 degrees). Do you have an idea what they are coming down with and what I might be able to do to prevent this? Thank you. Judith Answer: Judith- The most prevalent cause of sneezing and eye infection/inflammation, by far, in cats, is herpes virus infection. This virus has been traditionally referred to as rhinotracheitis virus but is commonly referred to as feline herpes virus 1 at this time. This virus probably accounts for at least 90% chronic or recurrent conjunctivitis in cats and the majority of cases of upper respiratory disease. It is not uncommon for secondary bacterial infections to occur when this virus is present, so sometimes there is a good response to antibiotic therapy even though the primary problem is a virus which is not susceptible to antibiotics. Other possible primary problems include Bordetella and chlamydial bacterial infections and calicivirus infections. Cats with feline leukemia virus or feline immunodeficiency virus sometimes have recurrent upper respiratory disease due to secondary infections, too. Herpes virus infections are lifelong and symptoms tend to recur when cats are stressed. Boarding is stressful at any time and perhaps being cold makes it even more so. Not liking each other is stressful, too but since that is sort of a constant stress it may not be having as much impact. There are antiviral medications but for the most part these haven't been too effective or haven't been very safe for cats. I haven't seen anything new lately on these. Although there is not good scientific evidence to back up these claims, many veterinary practitioners (including me) think that adding l-lysine to the diet, 500mg/cat/day, is helpful in limiting herpes virus flareups. Adding interferon may also be helpful in limiting flareups. Some vets also feel that using topical (intranasal) vaccines for herpes virus is helpful but these vaccines are reported to cause some cats to sneeze or feel a little low for couple of days after vaccination. This is still possibly a good trade-off if they limit the overall incidence of clinical signs. There may be additional problems that are likely in Isreal that I am not aware of since I practice in the United States but I'm sure your vet will cover these with you. In the meantime, you might want to ask him if he thinks that l-lysine or interferon might be helpful. One other thing that I should mention is that your experience is fairly typical in another way. The sneezing tends to go on for awhile and then stop on its own. If there are not severe clinical signs of herpes, such as corneal inflammation or skin disease affecting the face you can just elect to live with this condition and not treat it. Hope this helps some. Mike Richards, DVM 3/15/2000 Feline herpes infection Question: Dear Dr. Mike, Thank you for this wonderful service. I am writing because I adopted a very sick cat ('Nigel') from a local rescue league in July of '98 and he is still quite sick at the present time (February of 2000). I have taken Nigel to a number of veterinary specialists and he is currently seeing a wonderful vet who has really devoted much time and effort trying to help Nigel, but we are still struggling to figure out what's going on with him and how to manage it. Nigel is a white, longhaired, blue-eyed, deaf kitty, possibly a Turkish Angora. I do not know his age because he was not a kitten when I adopted him, but most veterinary estimates put him at younger end of the spectrum, around 3-4 years old. His mouth is quite deformed (one vet thought possibly due to trauma) - he has a severe overbite, crooked teeth, and a slight harelip. His coat is dry and scraggly - he rarely grooms and does not like to be groomed. Despite his scruffy appearance and health problems, he is an absolutely wonderful cat - a real love bug. He is playful and enjoys life very much. When I first got Nigel he had a ravenous appetite, but he was only 4 pounds. He had chronic explosive diarrhea that necessitated 100 cc of subcutaneous fluids daily. A veterinary GI specialist diagnosed inflammatory bowel disease by endoscopy and put Nigel on 40 mg of Flagyl daily, a tapering course of low dose Prednisolone, and Hill's I/D dry food. This therapy resolved his diarrhea after six months and he weighs 10 pounds today. Nigel also had ring worm when I first got him, which went away after a few months of sulfur baths every 10 days. A cardiologist has also diagnosed a mitral valve heart murmur (rate-limited) for which there is no treatment. Although his IBD has been under control for over a year, Nigel continues to look sickly and he has developed some additional problems. For about a year, Nigel has been plagued by crusty, ulcerative sores on his lips, mostly under his nose and sometimes in the corners of his mouth. These sores seem to follow a waxing and waning course and have been so severe at times that the area under his nose seems to be eroding away. Biopsies revealed that the sores were consistent with eosinophilic granuloma complex, although his current vet and a dermatologist both agreed that the sores do not look like typical EGC. He has been on food trials since the EGC diagnosis was made, but the sores continue to flare up. Nigel also has runny eyes (brown thick discharge) and severe gingivitis/stomatitis, which has not improved with dental cleaning or CHX gel. He also rubs his ears a lot as if they are itchy. His blood work is generally normal, but he has been slightly anemic at times and his albumin was slightly elevated on last check. Nigel has tested FeLV negative and FIV negative. I recently found an article, which described a nasal/facial dermatitis associated with feline herpes virus (Hargis, AM and Ginn, PE. Veterinary Clinics of North America:Small Animal Practice. 29:6, pp.1281-90, 1999). The clinical features of this syndrome reminded me of many of Nigel's clinical features - dermatological lesions (dramatically eosinophilic), gingivitis/stomatitis, ocular discharge, and one cat in the study had IBD. The authors of this article stated that the eosinophilic inflammation can lead to a misdiagnosis of eosinophilic granuloma complex. Since hypoallergenic diets have not helped Nigel so far, I decided to look further into feline herpes. A month ago I started giving Nigel 500 mg of lysine per day, based on the information I found on your web site. After only 3 days, his eyes cleared up and he hasn't had any brown eye goop since. His coat is also starting to get oily, whereas it has always been dry. He was just at the vet and she was very impressed, but his lip sores and gingivitis/stomatitis are as bad as ever, so we are going to get another opinion from another dermatologist next week. Since none of the Nigel's vets have really been able to figure out what's going on, I would be very interested to know your opinion about Nigel. Do you think that his lip sores and gingivitis could be due to feline herpes infection? I noticed that none of your online feline herpes patients seem to have lip ulcers or gingivitis. Do EGC ulcers have a waxing and waning course? Also, do you think Nigel would benefit from interferon therapy? Anything that you can deduce from my lengthy description of Nigel's problems would be greatly appreciated! Kindest regards, Julie Answer: Julie- There was another recent article on this problem in the journal "Veterinary Dermatology", Dec. 1999 by Hargis, et. al. The diagnosis was made in the affected cats using polymerase chain reaction (PCR) testing on biopsy samples of the lesions that were submitted fixed in formalin. I found the summary of this article in the Veterinary Information Network database and it didn't list the lab that was used nor any sort of treatment. It is likely that the dermatologist will have access to this information, though. It does sound very much like the problem Nigel is experiencing, though. There are anti-viral medications, such as acyclovir (Zovirax Rx) but there are also a lot of side effects associated with this medication and variable success reported with its use. Oral interferon might help and at least seems pretty safe, even if it doesn't work out to be helpful. I wish that I could help more with this situation. Mike Richards, DVM 2/25/2000 Herpes virus (rhinotracheitis) Question: This is as much a psychology question as a vet question, but here goes: I took in a third cat two weeks ago, an act that places me squarely into the category of "Weird old maid with too many cats." Zoot is a two-year-old Cornish Rex, joining my existing family of a Cornish male and an Oriental Shorthair female. He is not neutered (yet), and arrived with a kind of sniffly cold which I think must be calcivirus because it also seems as if his mouth hurts. He got Clindamycin drops for a week to prevent infection, and got better, but then got worse again -- he's still sneezing. He eats more or less normally, canned food and dry food moistened with hot water. The other cats are doing fine except that they hate him. HATE him. Zerbi (the Oriental female, and yes, the two "Z" names are purely coincidental) REALLY hates him and hisses whenever she sees him. He and Ranger, the other rex, spar a little but aren't quite as openly hostile. I think relations will get better after he's neutered, but my vet understandably doesn't want to anaesthetize him until he's able to breathe normally. So my questions are: 1. How long are the sniffles likely to last? What if anything can I do to speed his recovery and get him under the knife? 2. What can be done to foster feline amity? Could you suggest any good strategies for promoting inter-cat diplomacy? Thanks. I've tried everything I can think of but there's still a sort of siege mentality going, and I thought the respiratory stuff would be gone by now. Sheesh. gratefully yours, S. Answer: S- The sniffling problem could last a long time if it is herpes virus (rhinotracheitis), which is the most common cause of this type of problem in cats. Some cats have a very hard time suppressing this infection. The intra-nasal rhinotracheitis vaccinations may be better at helping cats suppress the clinical signs of herpes virus than the injectable vaccinations. It is worth using one of these to see if it helps, probably. To be honest, we haven't tried this in our practice yet but it I see the recommendation to do so more and more frequently and we are going to give this a try in our next patient with this problem. Also, giving cats l-lysine, a dietary supplement available at places like pharmacies and health food stores may help to suppress herpes virus. The average cat needs 250 to 500mg/day. We have been using Feliway (tm), an artificial pheromone spray that seems to calm cats down and induce a more relaxed social setting for situations in which new cats are having difficulty fitting into a household. It hasn't been perfect but it seems to help a lot. Your vet should be able to order this product for you. It is actually approved for use in reducing urine spraying but following the same directions seems to help with introducing cats to each other, too. Mike Richards, DVM 12/21/99 Chronic sneezing in cats Q: Dear Dr Mike, First off, I love your website! I spent about 2 hours last night browsing through a bunch of the articles, and by the time I was done, I was really wishing that you were my vet! Ever consider moving to Pittsburgh???? Anyway, here's my question: I've had two, basically indoor, cats for the past 6 years (Bonnie & Clyde). Last spring I adopted a stray who's basically an outdoor kitty (Amstel). In December, a new stray appeared......and of course, I felt compelled to feed the poor starving thing. Needless to say, I'm his new best friend. I called him Grey Kitty. Ever since the first time I met him (3.5 months ago), he's been sneezing quite frequently (in fact, I now have to clean my windows about every two days because he marks them up so bad) and a reddish type liquid has been running out of his left eye. His right eye is almost totally clouded over and looks like it's covered by a cataract (my vet said that it's actually a very old battle scar and that there is a small section of the pupil that is merging into the iris part of the eye). My vet also said that he's approximately 9-10 years old, has been neutered, has battle scars on his right eye, a rip on the top of his one ear, some fur missing for the inside of both front paws (where your thumb would be) and has a pretty severe heart murmur. Poor guy, eh? Just makes me love him that much more. Anyway, he tested negative for Feline Leukemia and Feline Aids and has had all of the necessary shots (including his boosters). I treated him for tapeworm three weeks ago, now it appears that he has I'll be treating him for that starting tomorrow. He actually woke me up one night by the sound of him sneezing and what appeared to be coughing (which went on for a good 5 minutes or so.....I'm not sure what to call it, maybe an asthma attack?). His stool has always been quite loose (the consistency of soft-serve ice cream). He has also been loosing weight, he's been back to the vet twice since I found him and both times his weight has dropped. My vet wants to see him again in 2 months to check his weight. I've also noticed recently that his appetite has not been as good as usual. One more strange thing (not sure if it means anything), he quivers whenever I pet him on his back (if my hand goes any further than his shoulder I basically try to only pet him on his head and neck.) My question is, what do you think might be causing the sneezing and runny nose thing? My vet told me that he probably just has a cold and not to worry too much about it. However, if you think there's something that can be done for him, please let me know! I feel bad enough for the poor thing because if that weren't enough, he's also scared to death of my other cats (unfortunately, he doesn't seem to realize that he has claws, but my other two cats do not). Any advise you could give me would be greatly appreciated!! Sincerely, Lynn A: Lynn- The most common cause of chronic sneezing in cats is chronic herpes virus (rhinotracheitis) infection. Sometimes it helps to give these cats l-lysine, which can be purchased at health food stores. The dose is 250 to 500mg/day. Interferon is supposed to be helpful in some cats, too. Sneezing can also occur with chronic periodontal disease or other tooth related problems. Since these types of problems also sometimes cause weight loss if the cat eats less due to them, it would be a good idea to check his teeth for problems. Coughing in cats is not a common problem but it can occur with bordetella bacterial infection (this is rarely chronic), heartworm disease and asthma. Weight loss in older cats can be associated with hyperthyroidism, cardiomyopathy, kidney failure, liver disease, diabetes and other problems. Cardiomyopathy can be secondary to hyperthyroidism in older cats and it can cause heart murmurs. Without knowing his history it is hard to say how long the murmur may have been present, making it harder to decide how important it is. Lots of cats don't like to be petted on their backs. Cats that over-react to this are sometimes said to have "feline hyperesthesia syndrome". It is a good idea to avoid petting these cats in areas that are sensitive because many of them will bite when stimulated sufficiently by the petting. You have already done a lot for Grey Kitty but you might consider a blood panel and T4 test to rule out hyperthyroidism and the other systemic problems mentioned. Hope this helps some. Mike Richards, DVM 3/18/99 Chronic herpes virus Q: I was searching for some info on interferon and I happened to find this page. Hope you can help me out! "" Any information you could provide, or info on where to look for answers, would be greatly appreciated! A: This is the information that I have on treating chronic herpes virus keratitis and ulcers in cats. Most of it is from a lecture given by Dr. Nasisse who is at the University of Missouri, in case you need to follow up on it. L-lysine, either 500mg sid or 250mg bid is supposed to be helpful in treating herpes virus because it interferes with viral replication. It may work better when combined with interferon at 30 units orally once a day. I can't remember the way that interferon is diluted offhand. If you have problems finding that information let me know. Some people recommend using interferon topically as well using artificial tears to dilute the interferon to 30 units/ml. Anti-viral agents are also reported to be helpful. I have also heard of using dilute Betadine solution as an eye drop but haven't tried it because I just have these worries that it would be really irritating. I have also heard of using the intranasal rhinotracheitis vaccines as an eye drop in an effort to help with this but I can't remember where I heard that. I think it may have been in a continuing education session that Dr. Green from Georgia gave. I seem to remember some discussion about that being irritating (this is strictly from memory but might be worth researching some if you are struggling with this problem). Hope this helps. Mike Richards, DVM Chronic herpes virus (rhinotracheitis virus) infection. Q: Dear Dr. Mike: I have a female cat, about 1 years old who has had a runny eye since I got her. My vet seems to think is was due to a respiratory problem at birth and will never go away. Every day I wipe it and it is a brownish discharge. She also is thin, about 4.5 pounds and very shy...she almost seems not to see well out of this eye. She also constantly wants to drink water and meows for me to run water from the sink.. Can you diagnose any problem that I should be aware of and what can I do for her eye. Thanks...and I enjoy your site.. A: M- Your vet is probably referring to chronic herpes virus (rhinotracheitis virus) infection. It can cause persistent eye problems and upper respiratory signs. Please call your vet and tell him about the excessive water drinking. This can be a sign of kidney disease or diabetes, so it may indicate a serious problem. Mike Richards, DVM Feline Herpes and polymerase chain reaction (PCR) test Q: Dr. Richards, I've read your web page on feline herpes, and found it to be the most helpful of any I've seen. I'd appreciate getting your feedback on the attached history of our new kitten. In addition to the questions below, I'm also curious as to why only one eye is affected so far, and whether the brownish film on Rocky's eye might be a corneal ulcer. It covers his entire eye. It changed from whitish to brownish--what does that mean? Our animal ophthalmologist says the damage is permanent, and that surgery would make it worse. Could this have been avoided by starting aggressive treatment earlier? Should we get a second opinion? We want to do everything possible for this sweet little guy. Also-we have started giving him a small amount of supplement for his coat (it was very dry looking). Does this have enough l-lysine to benifit the herpes situation, or should we go to something stronger? Most importantly-does any of this cause Rocky pain or quality of life issues? The viroptic drops seem to burn when we put them in. Thank you very much for reading this! History My husband and I have just adopted an abandoned kitten, who was diagnosed today by an animal opthamologist as having feline herpes. We are very concerned about the condition and treatment of his right eye, which looks badly damaged. We have now seen three veterinarians, but I feel uncomfortable about whether or not we are doing everything possible for him. None of the three has even done a culture to positively diagnose his problem. Rocky is approximately 6-8 weeks old (was 4-6 weeks old when we found him). When we found him, his left eye was completely crusted closed, and his right eye was extremely cloudy, runny, and covered with what appeared to be a thick whitish film. He was also sneezing and had yellow mucus coming from his nose. Amazingly, he was in excellent spirits and very active and feisty. We took him to our local emergency vet clinic, and the doctor on call tested him for feline leukemia and the feline version of HIV, and both were negative. He removed the "scab" on the left eye, and the eye looked very healthy underneath. He gave us oral Amoxicillin drops (.2 ml 2X daily) and a tetracycline eye cream (3X a day), and told us the problem was an upper resp. infection and possibly Herpes or Chlamydia. He recommended that we hold off on other treatment and vaccines until we saw our regular vet, and indicated he thought the kitten might be blind in the right eye. Our family vet saw Rocky the next day and confirmed the emergency clinic's findings. He suggested trying the antibiotics for two weeks, at which point he wanted us to return for vaccinations (he felt Rocky was probably closer to 4 weeks old, and too young and sick for vaccinations), and a follow up on the eye condition. For two weeks we have been diligent with the medication. The left eye cleared up immediately, as did the yellow mucus. The cloudiness of the right eye cleared slightly, and the white-ish film changed to more of a brownish shade. Otherwise no change. The kitten gained weight steadily (very healthy appetite), and continued to be very alert, happy and playful. Then yesterday I noticed the right eye seemed to be getting cloudier and a clear liquid discharge was coming from it. I called our vet who sent us to the eye specialist today. The specialist said the reflexes in the right eye are good, indicating there is at least some fuzzy or cloudy sight. She said the condition appeared to be herpes, and for us to continue using the antibiotics, plus viroptic medication (Trifluridine). She indicated that the damage to the eye was permanent, and that we could expect future herpes outbreaks. However, she did not perform a culture, and the only exam was manual (no computer) witha light and magnifying glass. This all leaves me with many questions: 1) How can we be sure it's herpes? 2) How can we get a better idea of the extent of the damage to Rocky's eyesight, and is there anything we can do to repair it? 3) Is it safe for him to be on antibiotics for such a long period of time? 4) What exactly is feline herpes, how do we spot an outbreak, and what can the virus do to Rocky? 5) How do we avoid future outbreaks? 6)Could we have improved his odds of seeing better, by starting him on the viroptic earlier? 7) Is is safe for him to get his vaccinations now (we're scheduled for two days from now)? 8) Can our two dogs or my husband and I catch the virus? 9) How does such a young kitten get such a full blown outbreak, with such damaging effects? 10) Will future feline herpes outbreaks always be in his eye, and how are feline herpes outbreaks normally treated? Thank you for your patience with my long history and many questions! A: Rocky's folks- 1) There is a relatively new test for herpes virus infection, called a polymerase chain reaction (PCR) test that is supposed to be much more accurate than past testing methods. It is currently the best available way to test for herpes virus infection in cats. I know it is done at the University of Missouri but it is probably done elsewhere, too. I am pretty sure your ophthalmologist is aware of the test. She may feel that the clinical signs are obvious enough that a more definitive diagnosis is not necessary. 2)Time is probably the only thing that will help in getting a definite idea how much sight Rocky will retain and how much discomfort will remain. 3) Antibiotics appear to be safe to use for extended periods when necessary, in most cases. After a while it seems un-necessary to use them in herpes virus infections, though, since they don't do anything for the viral infection. 4) Herpes virus is a virus that has the ability to live in the nervous system, hiding from the body's defenses. Once infected, it is likely that most cats remain infected for life. Dr. Nasisse, one of the researchers studying this disease, estimates that the infection rate in cats is probably greater than 70%. It is also known as rhinotracheitis virus. Most cats with this disease probably exhibit runny eyes and upper respiratory signs without developing corneal lesions. It is the most common cause of persistent eye infections in cats and does frequently cause cornea damage. It is probably reasonable to assume that most kittens with runny eyes and sneezing have rhinotracheitis (feline herpes virus) 5) L-lysine is supposed to inhibit viral reproduction. You should be giving 500mg of the l-lysine per day. It is unlikely that you can achieve this level without using l-lysine tablets. They usually have to be crushed and mixed with an appealing food or broken into pieces and administered bit by bit. Interferon may also be helpful in limiting future outbreaks. Vaccination is thought to be helpful in preventing outbreaks of symptomatic rhinotracheitis in infected cats even though they can not clear the infection. 6) I don't know if starting Viroptic earlier would have helped. Viroptic is irritating to some cats. It is possible to use idoxuridine 0.1% for cats that are sensitive to Viroptic but you have to find a compounding pharmacist to make it for you. 7) I know of no reason not to continue the vaccination series in kittens affected by rhinotracheitis. Some vets think that using the intranasal vaccine is helpful in controlling the disease when it is already present but I don't know if that is true 8) As far as I know there is no risk to dogs or humans from this virus. 9) It is not unusual for young kittens to be affected by this virus. Kittens do not seem to get much effective immune protection from their mothers, who are often stressed by the birth and lactation periods and therefore may be shedding the virus. 10) Most of the chronic problems associated with feline herpes virus appear to be ocular. Some cats appear to develop long-term sinus or upper respiratory infections and gingivitis may also be a long-term sequelae to herpesvirus infection. 11) If the pain in an eye can not be controlled it is possible that conjunctival flap surgery to fix a small portion of the pink conjunctiva to the damaged portion of the cornea may be helpful (I saw this information in an exchange on the Veterinary Information Network but do not have any other reference to support it at this time). If you are seeing a board certified ophthalmologist it is very likely that she knows a great deal more than I do about the effects of herpes virus and the treatment of herpes virus as it relates to the eye. Veterinary ophthalmologists seem to be among the busier specialists and many of my clients seem to leave their offices with their questions unanswered. I think you are entitled to her opinion on your questions if you pay for a visit, so I'd take the list back to her on the next visit. Mike Richards, DVM Herpes Q: My cat was recently diagnosed with this virus and was treated with Valtrex, Depo-Medrol and an antibiotic injection. Within a week his systems improved, but after 4 weeks (Depo-medrol wore off) the herpes was back stronger than ever. I have found information on the internet about high quality diet and supplements in treating this virus and that the Depo-medrol slows the healing and actually strengthens the virus. How can I find information on treating my cat with supplements for this virus since there doesn't seem to be any medication to directly treat it. I have had herpes simplex I for 30 years and know all about the medications and remedies available for humans. I don't want to hurt my cat by giving him supplements. Please - any information would be helpful. Thank you. Lou A: Lou- I think that the treatment for herpes (rhinotracheitis) is still controversial enough that you will have a hard time finding a definitive answer. The location of the lesions associated with herpesvirus has some bearing on the recommended treatments as well. If your cat is being treated for herpes keratitis (lesions on the cornea of the eye) there are proponents of corticosteroid use. For a long time steroids have been used in persistant keratitis problems in cats due to the presence of eosinophilic granuloma complex lesions on the corneas of some cats. It is recognized that some or perhaps many of these cats actually have herpes virus keratitis. Even though it seems logical that using corticosteroids in a viral infection would cause problems that doesn't seem to be the case based on clinical response. Due to this, there is a higher tolerance for the use of corticosteroids when herpes may be present than you might expect. I am not familiar with Valtrex and am not able to comment on its use. Interferon seems to be recommended fairly frequently for use in herpesvirus infections, mostly in combination with anti-viral agents or with l-lysine. The use of l-lysine at 250 to 500mg per cat per day reported to be helpful, at least according to Dr. Nasisse of the University of Missouri. Mike Richards, DVM Chronic Herpes Virus Infection Q: Dear Doctor, let me begin by saying I told my vet I was doing research on my cat's problem not because of him, because I understand that caring for a sick animal would be like caring for an infant, and frankly he's as frustrated as I am. About 6 months ago we let in a stray cat that the vet estimated to be 2 yrs. old. "Kitty" had a horrible cold, and it was cold and raining, I wasn't thrilled about letting him in because we have an old cat Micky who is 16 and a dalmation-lab pup who was a stray also, & I was afraid to infect them with anything. But we ended up keeping this poor creature mostly because it walked into the house rubbing up against the dog, as if it was its mother. It loved everybody, and everything. We took it to the vet, got it antibiotics Amoxyl, fattened it up, got its shots, had it fixed & declawed, emergency declaw because of our old cat & neutered because it seemed to have a urinary tract problem the vet thought would clear up with neutering. In between all of this the cat was on about 4 prescriptions of Amoxyl, which helped its upper respiratory but as soon as the amoxyl was done the cat would start wheezing, and sneezing, mucous would get thick, and he would get a fever. The vet put him on cephalexin and that worked also but as soon as treatment stopped all symptoms returned. He was tested for Feline leukemia, and FIV, also tested for Feline AIDS all negative. Over christmas in aproximately 2 days the cat got so sick I thought it would die. My vet wasn't in so the vet who was taking over for him and I credit for saving his life actually thought this cat had raibies. He didn't eat for 2 days, he sat with a blank look, mouth half open with saliva running out of his mouth, his neck was stiff, and he seemed to think there was neurolical damage. He gave him an antibiotic shot, a steroid shot, a shot for migratory worms just in case and an anti-inflamatory, fever reducer, and sent me home with antibiotics. This cats temp was 106. It broke late that evening and took a couple drinks of water for the first time in 2 days. He survived, and when I went to my vet this time he prescribed Batril. All is well until the medicine is gone. I questioned whether this could be a fungal infection because of the chronic upper respiratory, but also he has scabs all over his back, I don't know if they could be considered ulcers, and I'm not sure if they look like ring worm they look to be the size of a quarter look like a brush burn that scabbed over, the hair comes out and it seems to grow back and the area heals but moves right beside it & starts all over again. It doesn't seem to heal in the center and spread in a ring. Also since we've had him he leaks urine, just drops at a time. It's so little it's not a problem to me, but I wonder if it's not related. The most important symptem is that respiratory problem. My other animals do not seem to be affected by this. This baffles me. Especially with my old cat. Anyway now he's on Nizarol 1/4 tablet once a day, and were going to keep him on it for about 3 months to see if we have any success. With the antibiotics the cat would quit sneezing and his breathing would clear up, with this Nizarol it doesn't seem to be doing anything. Also he has a spot on one of his eyes he had when we took him in, it's cloudy, the pupil seems to be half the size of the other one, but I red about something that corneal ulcers were one of the symptoms. Anyway we are so frustrated Do you have any ideas at all? I'm just afraid after christmas I never saw an animal that sick. Would it be worthwhile to have it retested for aids? Everything seems to point to some sort of immune deficiency. Thanks so much for even reading this. A: My first impression is that you have adopted a cat with a chronic herpes virus infection (rhinotracheitis in cats is a herpes virus). That would explain the chronic respiratory infection and possibly the eye damage you are seeing. Some cats with herpes virus infection simply can not be cured of the persistent upper respiratory signs. They do often respond temporarily to antibiotics but they just never get better. I have done exactly what your vet is doing -- treated cats with this condition over and over again with antibiotics, become convinced it must be fungal (ketaconazole - Nizoral Rx, is an antifungal medication) and then decided it must be cancer -- and still not ever found a "cure". It has always been hard to prove that herpes was the problem. It is hard not to do that because herpes is common in cats but only occasionally does it get this bad. That doesn't explain the bout of high temperature, etc. but the emergency vet gave you the most likely causes of that. I might also include feline infectious peritonitis but cats severely affected with FIP don't usually recover for very long, even with treatment. Dr. Nasisse (sp?) at the University of Missouri does research on feline herpes virus infections. He might be a good person for your vet to talk to, if possible. Mike Richards, DVM Herpes and repeated corneal ulcers Question: We have an Exotic Long Hair, five years old who now has had 3 episodes of corneal ulcers. No history of trauma has been noted. Each time the vet has treated him with Chloramphenicol eye drops, for secondary Infection. The ulcers are singular and sheet-like across the cornea and always unilateral. What could their origin be and is there anything we can do to prevent them? Thank you very much Answer: By far the most common cause of recurrent or difficult to cure corneal ulcers in cats is chronic herpes virus infection. It can be helpful to use l-lysine at 250 to 500mg/day to help control this problem. It can be purchased at health food type stores, usually. If your vet knows a source of anti-viral eye drops (I think they are hard to get right now but haven't had to treat for this recently so I am not sure), they can be helpful, too. It is possible to do punctate keratotomy surgery for stubborn ulcers in cats. This is a fairly simple procedure but if your vet hasn't done this before he or she may want to send you to a veterinary ophthalmologist for the procedure. That may be a good idea, anyway, given the difficulty in clearing up this ulcer. These are frustrating and the ophthalmologist may not be able to help much more than your local vet but at least you'd get a second opinion. Rhinotracheitis is a herpes virus. Just like herpes in people, it keeps coming back. It is almost certainly the most common cause of chronic, non-responsive conjunctivitis in cats. It doesn't respond to any anti-bacterial agent because it isn't a bacteria. Anti-viral eye drops are available but may not be very effective, either. There is some evidence that administration of L-lysine is helpful in control of this condition. I am not sure how helpful. It can still be useful to use an anti-bacterial ophthalmic drop but the best recommendation is to use one that will work well against gram positive bacteria, which is gentamycin's weak area. A triple antibiotic drop with polymyxin and bacitracin may work better than gentamycin in this case. This is especially likely in a cat that had pneumonia because of the high probability of rhinotracheitis being involved in that, too. Unfortunately, if this is the problem, chronic non-responsive disease until the body can finally develop immunity for a while is not uncommon. Sometimes, nothing seems to aid this process. Michael Richards, DVM Herpes Virus Q: I have written to you before about my cat with the herpesvirus. Your reply was about the herpes that affects the eyes. My cat has the herpes blisters around his back teeth and in his throat. A throat culture revealed positive for herpes but my vet said she didn't know which one. He was treated with Valtrex for 16 days with no improvement. My vet has never seen a case of the herpes that affects the throat. He cat also has herpes but he also gets a bladder infection at the same time and the Valtrex helps in this situation because her cat doesn't respond to antibiotics. I can't seen to find any information on the herpes that affects the mouth and throat. All the information I can turn up is about the eyes. You mentioned before about the l-lysine. Would that be helpful in my cat's case or is there something else available? He seems fine otherwise but scratches his neck after eating. I have him on a natural diet of Pet Guard food which is fed twice day and he drinks distilled water. The Pet Guard food contains NO meat-by products or any artificial colors or flavors. It is completely balanced. I also give him 1/4 teaspoon of skin and coat supplement for his mild case of dandruff. His fur is very thick and shiny and the dandruff is starting to clear up. He has had 5 Depo-Medrol shots back to back so I think it will take a little time for the dandruff to go away. The shots relieved the symptoms for about 2-3 weeks and then the blisters came back worse than ever. I don't like the side affects of these shots. He was a zombie most of the time and produced very large amount of urine. So that is why I'm looking for an alternative to the depo-medrol shots. I have occasional outbreaks of herpes myself on my lip and around my eyes so I know the pain and itch that they can cause. Any information you can provide will be most appreciated. Thanks. Lou. A: Lou - As far as I know, rhinotracheitis is the only herpes virus that affects cats but that doesn't mean it is. The l-lysine interferes with the reproduction of herpes virus and should work for lesions anywhere and also should work for any strain of herpes virus. Oral interferon may be worth trying in conjunction with the l-lysine. If your vet can find acyclovir it may be useful, too. Herpes is one of the causes of chronic stomatitis/gingivitis problems in cats but it is also possible that it could be present when there is another underlying cause. If therapy for herpes doesn't seem to help it may be necessary to consider a biopsy of the affected area or some other diagnostic testing. Good luck with this. Mike Richards, DVM Last edited 07/08/05


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...