Feline herpesvirus-1: ocular manifestations, diagnosis and treatment options

PRACTICAL RELEVANCE: Feline herpesvirus-1 (FHV-1) is a major cause of feline morbidity. Following exposure to the virus, virtually all cats become persistently infected and many of these will develop recrudescent disease on one or more occasions during their lifetime. Acute ocular herpetic disease manifests as conjunctivitis, corneal ulceration and keratitis, and can be severe and painful. Repeated bouts of recrudescent ocular disease can lead to progressive corneal pathology that can be ultimately blinding in affected cats. GLOBAL IMPORTANCE: FHV-1 has a worldwide distribution, with reported exposure rates in some cat populations of up to 97%. As such it is a significant cause of clinical disease in the global cat population. PATIENT GROUP: Young and adolescent cats are most at risk of acute primary disease, and the vast majority of these will become persistently infected. Around half of all persistently infected cats will shed virus at some stage in their life and these may develop recrudescent ocular disease. CLINICAL CHALLENGES: Treatment of FHV-1 ocular disease is challenging. Antiviral medications may be expensive, and require good owner and patient compliance. Clinical responses in patients can be variable. Selecting the appropriate therapeutic approach requires good clinical judgement, with assessment of factors such as severity and stage of clinical disease, patient and owner compliance, and financial considerations. EVIDENCE BASE: Although a wide range of antiviral treatments is available, few have been tested in controlled clinical trials. Therapeutic decisions are, therefore, often based on results of in vitro studies, case-based reports and anecdote. Large, masked, controlled clinical trials are required in order to determine the efficacy of the antiviral drugs currently available to treat FHV-1.     

Efficacy of topical aciclovir for the treatment of feline herpetic keratitis: results of a prospective clinical trial and data from in vitro investigations

This study aimed to evaluate the efficacy of topical ophthalmic aciclovir applied five times daily as a treatment for feline herpesvirus type 1 (FHV-1) keratitis in a group of cats in a first-opinion practice setting. Cats with ocular signs indicative of FHV-1 or Chlamydophila species infection, predominantly conjunctivitis and keratitis, were tested for FHV-1 antigen using an immunofluorescent technique on air-dried conjunctival swabs. They were first treated with topical chlortetracycline with efficacy against Chlamydophila species and then, in cases positive for FHV-1, with topical aciclovir. The time to recovery was determined and illustrated using a Kaplan-Meier plot. Three cats were infected with Chlamydophila species and showed a median time to recovery of 14 days (95 per cent confidence interval [CI] 10 to 18 days), while 30 cats infected with FHV-1 showed a median time to recovery of 12 days (95 per cent CI 10 to 14 days). The drug dose at which 50 per cent plaque reduction (ED50) occurred in a standard plaque reduction assay was determined in an in vitro study. This showed a mean (SD) ED50 of aciclovir of 25 (3.5) mg/ml compared with 0.4 (0.05) mg/ml for trifluorothymidine, a drug known to be efficacious against FHV-1. The study shows that even though aciclovir is generally considered to lack efficacy against ocular FHV-1 infection, when used frequently it can have a beneficial effect in FHV-1 conjunctivitis and keratitis.     

Cytologic findings, and feline herpesvirus DNA and Chlamydophila felis antigen detection rates in normal cats and cats with conjunctival and corneal lesions

Samples were collected from 36 cats with feline herpesvirus (FHV-1)-related ocular disease (conjunctivitis, epithelial or stromal keratitis, or corneal sequestration), and 17 cats without ocular changes. Corneoconjunctival swabs, scrapings and biopsies were tested in various combinations for presence of FHV-1 DNA using single round (sr) polymerase chain reaction (PCR) and nested PCR (nPCR). Additional swabs from the inferior conjunctival fornix were tested by enzyme-linked immunosorbent assay for Chlamydophila felis antigen. Cytologic evaluation was carried out on conjunctival (cats with conjunctivitis) and corneal (cats with keratitis) cytobrush preparations. FHV-1 DNA was detected by PCR in 14 (39%) cats with ocular disease and 1 (6%) of the control group. Agreement between srPCR and nPCR results was significant (P < 0.01). FHV-1 DNA was detected in 3/7 cats with conjunctivitis, 5/6 cats with epithelial keratitis, 3/11 cats with stromal keratitis, and 3/12 cats with corneal sequestration. There was a significant association (P = 0.0027) between viral presence and epithelial keratitis. However, no significant association was found between viral presence and conjunctivitis (P = 0.059), stromal keratitis (P = 0.15), or corneal sequestration (P = 0.18). With respect to FHV-1 DNA detection, intersample agreement was significant (P < 0.03). No sampling technique seemed more likely than another to harvest detectable viral DNA, except for cats with corneal sequestrum in which viral DNA was not detected using corneoconjunctival swabs. FHV-1 DNA was detected in 6/9 samples with intranuclear inclusion bodies and in 6/7 cats with eosinophils on cytologic examination. All samples tested negative for C. felis antigen.     

Feline herpesvirus ocular disease

Infection by FHV-1 is one of the most common ophthalmic diseases of domestic cats worldwide. Although the usual manifestations are conjunctivitis and keratitis, infection with this virus has been linked to a variety of other ophthalmic syndromes of cats, including keratoconjunctivitis sicca and corneal sequestration. Ocular FHV-1 infection of cats provides a significant diagnostic challenge to the practicing veterinarian because, in chronic cases, antigen detection tests often yield negative results. Although therapy for FHV-1 infections of cats is often difficult, the recent development of nontoxic antiviral drugs that demonstrate considerable efficacy against FHV-1 offers hope for improved therapeutic success in the future.     

Outbreak of ocular disease associated with naturally-acquired canine herpesvirus-1 infection in a closed domestic dog colony

Objective  To describe clinical and virological findings of an outbreak of ocular disease attributed to naturally-acquired primary canine herpesvirus-1 (CHV-1) infection in a closed domestic dog colony.
Animals studied  Twenty-seven 10- to 16-week-old laboratory Beagles.
Procedure  Complete ophthalmic examinations were performed and ocular samples collected for CHV-1 polymerase chain reaction and virus isolation.
Results  The prevalence of ocular morbidity was 100% in examined dogs. Lesions were restricted to the ocular surface and included bilateral conjunctivitis (100% of dogs); punctate, dendritic, or geographic ulcerative keratitis (26% of dogs); and non-ulcerative keratitis (19% of dogs). Conjunctival petechiae were detected in 22% of dogs. Punctate and dendritic corneal ulcers were frequently organized into discrete groups or linear arrangements. Non-ulcerative keratitis appeared clinically as a perilimbal ring of superficial corneal vascularization and leukocyte infiltration. CHV-1 was detected in ocular samples by polymerase chain reaction or virus isolation in all dogs sampled.
Conclusions  In susceptible populations of domestic dogs, CHV-1 may be associated with outbreaks of highly contagious ocular infection in the absence of concurrent overt systemic disease. This naturally-acquired outbreak of CHV-1 infection provides an opportunity to report the spectrum and prevalence of ocular lesions associated with primary ocular CHV-1 infection in dogs. Conjunctivitis was the most frequent ocular lesion detected. Ulcerative and non-ulcerative keratitis were less prevalent and of variable clinical appearance. Dendritic ulcerative keratitis, a classic and relatively specific ocular lesion associated with alphaherpesvirus infection, was detected in < 20% of dogs.     

Effect of topical ophthalmic application of cidofovir on experimentally induced primary ocular feline herpesvirus-1 infection in cats

OBJECTIVE: To evaluate the efficacy of twice-daily ophthalmic application of 0.5% cidofovir solution in cats with experimentally induced primary ocular feline herpesvirus-1 (FHV-1) infection. ANIMALS: Twelve 6-month-old sexually intact male cats. PROCEDURES: Cats were randomly assigned to either a treatment or control group. Ocular infection with FHV-1 was induced (day 0) in all cats via inoculation of both eyes with 10(4) plaque-forming units of a plaque-purified FHV-1 field strain. Twice daily for 10 days beginning on day 4 after virus inoculation, the treatment group received 1 drop of 0.5% cidofovir in 1% carboxymethylcellulose in both eyes, and the control group received 1 drop of 1% carboxymethylcellulose in both eyes. A standardized scoring method was used to evaluate clinical signs of FHV-1 infection in each cat once daily for 24 days. The amount of ocular viral shedding was assessed by use of a quantitative real-time PCR procedure every 3 days during the study period. Clinical scores and viral quantification were averaged over the pretreatment (days 0 to 3), treatment (days 4 to 14), and posttreatment (days 15 to 24) periods for each cat. RESULTS: During the treatment period, clinical scores and amount of viral ocular shedding were significantly lower in the treatment group, compared with findings in the control group. CONCLUSIONS AND CLINICAL RELEVANCE: Twice-daily application of 0.5% cidofovir solution in both eyes significantly decreased the amount of viral shedding and the severity of clinical disease in cats with experimentally induced ocular FHV-1 infection.     

Pretreatment with feline interferon omega and the course of subsequent infection with feline herpesvirus in cats

OBJECTIVE: Recombinant feline interferon omega (rFeIFN-omega), a type I IFN, may have the potential to limit virus replication and associated clinical signs when administered early on in the course of feline herpesvirus type 1 (FHV-1) infection and reactivation, respectively. The effect of rFeIFN-omega pretreatment on the course of subsequent FHV-1 infection in cats was investigated. ANIMALS STUDIED: Nine SPF cats were divided into an IFN group (n = 5) and a control-group (n = 4). PROCEDURES: The IFN group was pretreated for 2 days with 10 000 units rFeIFN-omega twice a day topically into both eyes and 20 000 units rFeIFN-omega once a day orally, whereas the control group was mock-treated. Subsequently all cats were infected with FHV-1. Samples for FHV-1 DNA detection and quantitation, virus isolation, and titration of FHV-1 antibodies were collected. Clinical and ocular signs were recorded and scored. RESULTS: Courses of median individual clinical and ocular scores and virus load did not differ significantly between both groups using anova for repeated measurements. Analysis (anova) of each individual ocular parameter revealed significantly high scores for epithelial keratitis (P = 0.016) in the IFN group compared to the control group. Periods of virus shedding did not differ significantly between both groups using the Wilcoxon rank sum test. CONCLUSIONS: Results indicated a lack of beneficial effects of rFeIFN-omega pretreatment in the course of primary FHV-1 infection in cats.     

Isolation of Feline Herpesvirus 1 from the Trigeminal Ganglia of Acutely and Chronically Infected Cats

Feline herpesvirus 1 (FHV-1) is one of the most common viral infections of domestic cats worldwide, estimated to cause 50% of all respiratory infections in this species. Feline herpesvirus 1 is also an important ocular pathogen of cats, causing conjunctivitis, epithelial and stromal keratitis, symblepharon formation, keratocon-junctivitis sicca, and corneal sequestration. Despite the importance of this viral disease, major questions remain unanswered concerning the pathogenesis of its most important manifestation, the recrudescent infection. Although the taxonomic classification of FHV-1 as an alpha herpesvirus implies the ability of FHV-1 to establish neural latency, attempts at recovering the virus from the trigeminal ganglia of latently infected cats have typically yielded negative results. This failure has stimulated speculation that neural tissue is not an important site for latent FHV-1. However, in the most successful of such studies, FHV-1 was isolated from the trigeminal ganglia of 3 of 17 cats using an explant technique. In the present study, we describe the successful isolation of FHV-1 from the trigeminal ganglia of cats using a similar tissue culture method.     

Schirmer tear test values and tear film break-up times in cats with conjunctivitis

OBJECTIVES: (1) To document tear film break-up time (TFBUT) in a group of cats with conjunctivitis; (2) to determine if TFBUTs from cats with conjunctivitis vary significantly from previously established normal values for TFBUT in young cats without ocular disease; (3) to determine if a correlation exists between Schirmer tear test (STT) values and TFBUTs in cats with conjunctivitis; (4) to determine if the TFBUTs in cats with conjunctivitis are influenced by the detection of DNA from feline herpes virus-type 1 (FHV-1), Chlamydophila felis, Mycoplasma spp., and feline calicivirus. ANIMALS STUDIED: Fourteen cats between the ages of 0.8 years to 12 years with active, untreated conjunctivitis and without active keratitis or other ocular or systemic abnormalities were included in this study. Procedures Complete ophthalmic examinations, including TFBUT, were performed on all cats. Polymerase chain reaction (PCR) screening for FHV-1, Chlamydophila felis, Mycoplasma spp., and feline calicivirus was performed on conjunctival swabs from affected eyes and blood samples from all cats. RESULTS: Mean TFBUT for cats in this study was 8.9 (+/- 4.8) s in the right eye (OD) and 8.1 (+/- 4.6) s in the left eye (OS). No correlation existed between mean TFBUTs and mean STT values OD or OS. Conjunctival swabs from seven cats (n = 9 eyes) tested positive via PCR for one of the above infectious agents. Blood samples from nine cats tested positive for FHV-1. Mean TFBUTs for cats from which the DNA from FHV-1 was isolated from the blood were significantly lower than mean TFBUTs for cats from which no such DNA was isolated from the blood. CONCLUSIONS: In this study, the mean TFBUT in cats with conjunctivitis was significantly lower than previously established values for clinically healthy cats. This supports the theory that qualitative tear film deficiency, and thus tear film instability, may play a role in the pathogenesis of feline conjunctivitis. Qualitative tear film deficiency may predispose to the development of conjunctivitis or may occur secondarily to this condition.     

Mineralized corneal sequestrum in a cat.

An 8-month-old 3-kg (6.6-lb) sexually intact male cat was evaluated for chronic refractory keratitis and a corneal plaque that developed after treatment with a corticosteroid-containing ophthalmic preparation. Pertinent ophthalmic findings included blepharospasm, conjunctivitis, corneal vascularization, and a tan raised corneal plaque with a dense and gritty composition. Lamellar keratectomy was performed to excise the plaque. The cornea healed with mild scarring. Histologic examination revealed extensive coagulation necrosis and mineralization of the corneal stroma with increased inflammatory cells, blood vessels, and fibrosis, which is compatible with a diagnosis of mineralized corneal sequestrum. The history suggested chronic feline herpesvirus-1 (FHV-1)-induced keratoconjunctivitis as the underlying cause. Topical corticosteroid administration may have potentiated the preexisting corneal necrosis and initiated mineralization. To our knowledge, mineralization of a corneal sequestrum in a cat has not been reported in a clinical case but has been reported in cats experimentally infected with FHV-1.     

Evaluation of serologic and viral detection methods for diagnosing feline herpesvirus-1 infection in cats with acute respiratory tract or chronic ocular disease

OBJECTIVE: To determine the value of virus isolation (VI), immunofluorescent antibody (IFA) assay, serum neutralization (SN), and ELISA for the diagnosis of clinical feline herpesvirus-1 (FHV-1) infection in cats. ANIMALS: 46 clinically normal cats, 17 cats with signs of acute respiratory tract disease, and 38 cats with signs of chronic ocular disease. PROCEDURE: Conjunctival swabs for VI, conjunctival scrapings for IFA testing, and venous blood samples for SN or ELISA testing were obtained from all cats. RESULTS: FHV-1 was detected in 10.9 and 28.3% of clinically normal cats and in 18.2 and 33.3% of cats with FHV-1-associated disease by VI and the IFA assay, respectively. There were no significant differences in the viral detection rate between cats with acute respiratory tract disease and cats with chronic ocular disease or between diseased cats and clinically normal cats; however, FHV-1 was never detected by both methods in clinically normal cats. Overall FHV-1 seroprevalence was 97% when tested by ELISA and 66% when tested by SN. Seroprevalence did not vary significantly among the 3 groups for either serologic test. Magnitude of SN and ELISA titers varied greatly but independently of presence or absence of clinical signs of FHV-1-associated disease. Sensitivity, specificity, and positive and negative predictive values were assessed for VI and the IFA assay--jointly and individually--and for each SN and ELISA titer magnitude. Values never all exceeded 50%. CLINICAL IMPLICATIONS: Because FHV-1 can be detected commonly in clinically normal cats by the IFA assay or VI, neither test appears to aid in the clinical diagnosis of FHV-1 infection. Seroprevalence does not appear to vary between affected and clinically normal cats. SN, ELISA, VI, and the IFA assay appear to be of limited value in the diagnosis of FHV-1-associated disease in cats. Concurrent assessment of the IFA assay and VI results may permit exclusion of FHV-1 as an etiologic agent if results of both tests are negative.     

Effect of oral administration of L-lysine on conjunctivitis caused by feline herpesvirus in cats

OBJECTIVE: To determine whether oral administration of L-lysine to cats would lessen the severity of conjunctivitis caused by feline herpesvirus (FHV-1). ANIMALS: 8 healthy young adult cats. PROCEDURE: Cats received oral administration of lysine monohydrochloride (500 mg, q 12 h) or placebo (lactose) beginning 6 hours prior to inoculation of virus. The left conjunctival sac received a 50-microl suspension of FHV-1 grown in cell culture (1.8 X 10(8) tissue culture infective dose50) on day 1. Cats were evaluated and scores given for clinical signs each day for 21 days. Samples for virus isolation were collected from the eye and throat every third day. Plasma lysine and arginine concentrations were measured prior to the study and on days 3, 14, and 22. RESULTS: Cats that received lysine had less severe conjunctivitis than cats that received placebo. Virus isolation results did not differ between the groups. Plasma lysine concentration was significantly higher in cats that received lysine, compared with control cats, whereas plasma arginine concentrations did not differ between groups. CONCLUSIONS AND CLINICAL RELEVANCE: Oral administration of 500 mg of lysine to cats was well tolerated and resulted in less severe manifestations of conjunctivitis caused by FHV-1, compared with cats that received placebo. Oral administration of lysine may be helpful in early treatment for FHV-1 infection by lessening the severity of disease.     

Bilateral proliferative keratitis in a Domestic Long-haired cat

A 9-year-old, female spayed, Domestic Long-haired cat was presented with bilateral, progressive, pink-white corneal opacities. The referring veterinarian had diagnosed feline herpesvirus-1 (FHV-1) keratitis though diagnostics for FHV-1 had not been performed and treatment with antibiotics and antivirals did not improve the condition. Histopathology showed neutrophils, plasma cells and lymphocytes, but no eosinophils or mast cells. Routine diagnostics did not find an underlying cause, but Southern blot analysis for FHV-1 was positive. The cat responded to topical corticosteroids and cyclosporine when used consistently.     

Efficacy of oral supplementation with L-lysine in cats latently infected with feline herpesvirus

OBJECTIVE: To examine the effects of orally administered L-lysine on clinical signs of feline herpesvirus type 1 (FHV-1) infection and ocular shedding of FHV-1 in latently infected cats. ANIMALS: 14 young adult, FHV-1-naive cats. PROCEDURE: Five months after primary conjunctival inoculation with FHV-1, cats were rehoused and assigned to receive 400 mg of L-lysine in food once daily for 30 days or food only. On day 15, all cats received methylprednisolone to induce viral reactivation. Clinical signs of infection were graded, and viral shedding was assessed by a polymerase chain reaction assay throughout our study. Peak and trough plasma amino acid concentrations were assessed on day 30. RESULTS: Fewer cats and eyes were affected by conjunctivitis, and onset of clinical signs of infection was delayed on average by 7 days in cats receiving L-lysine, compared with cats in the control group; however, significant differences between groups were not demonstrated. Significantly fewer viral shedding episodes were identified in the treatment group cats, compared with the control group cats, after rehousing but not following corticosteroid-induced viral reactivation. Mean plasma L-lysine concentration was significantly increased at 3 hours but not at 24 hours after L-lysine administration. Plasma arginine concentration was not significantly altered. CONCLUSIONS AND CLINICAL RELEVANCE: Once daily oral administration of 400 mg of L-lysine to cats latently infected with FHV-1 was associated with reduced viral shedding following changes in housing and husbandry but not following corticosteroid administration. This dose caused a significant but short-term increase in plasma L-lysine concentration without altering plasma arginine concentration or inducing adverse clinical effects.     

Relative sensitivity of polymerase chain reaction assays used for detection of feline herpesvirus type 1 DNA in clinical samples and commercial vaccines

OBJECTIVE: To determine relative detection rates and detection limits for 6 published polymerase chain reaction (PCR) assays used for detection of feline herpesvirus type 1 (FHV-1) DNA. SAMPLE POPULATION: 5 vaccines licensed for use in preventing FHV-1-associated disease; 15 conjunctival biopsy specimens collected from cats with keratitis, conjunctivitis, or both; and a plaque-purified field isolate of FHV-1 cultured in vitro. PROCEDURE: Vaccines and clinical samples were assessed for FHV-1 DNA by use of all 6 assays. Detection rates were calculated by assuming that any sample in which FHV-1 DNA was detected was a true-positive result. Detection limits were estimated by use of serial dilutions of DNA extracted from cultured FHV-1 and 1 clinical sample. RESULTS: Testing by use of all 6 assays resulted in detection of FHV-1 DNA in all 5 vaccines. Testing by use of all 6 assays yielded concordant results for 9 of 15 conjunctival biopsy specimens (8 with negative results and 1 with a positive result). Calculated detection rates for clinical samples ranged from 29% to 86%. Assay sensitivity was ranked similarly by use of detection rate or detection limit. CONCLUSIONS AND CLINICAL RELEVANCE: Testing by use of all assays was equally likely to detect vaccine virus. Therefore, a positive PCR result in a cat may reflect vaccine virus rather than wild-type virus. Test sensitivity as assessed by detection limits and detection rates varied greatly. Because FHV-1 can be shed in clinically normal animals, high detection rate will not necessarily correlate with high diagnostic sensitivity.     

Experimental infection of recent field isolates of feline herpesvirus type 1

Two field isolates of feline herpesvirus type 1 (FHV-1) designated as 00-015 and 00-035, were obtained from cats diagnosed as feline viral rhinotracheitis (FVR) in Japan. To analyze the character of recent FHV-1, these two isolates and our laboratory strain C7301 were inoculated experimentally to specific-pathogen-free cats. Although all cats showed typical FVR symptoms, more severe clinical symptoms were observed on cats infected with the isolates 00-015 and 00-035 compared with those of C7301-infected cats. Severe ocular lesions including conjunctivitis were found in the cats infected with the isolates, indicating that the recent FHV-1 has a potential to induce severe FVR symptoms including ocular lesions.     

An etiological investigation of domestic cats with conjunctivitis and upper respiratory tract disease in Japan

Chlamydophila felis (C. felis), feline herpesvirus-1 (FHV-1) and feline calicivirus (FCV) were detected in 39 (59.1%), 11 (16.7%) and 14 (21.2%) cats respectively, from 66 domestic cats presented with conjunctivitis and upper respiratory tract disease (URTD) in 9 prefectures of Japan. Dual and multiple infections were found in 7 (10.6%) cats with both C. felis and FHV-1, 10 (15.2%) cats with both C. felis and FCV, and 1 (1.5%) cat with all three agents. C. felis was isolated from 11 (28.2%) of 39 PCR positive cats. Antigenic difference was found in a 96 kDa protein of our isolates and Fe/145 strain isolated in USA. In conclusion, C. felis is the most common agent of feline conjunctivitis and URTD, and the coinfection with C. felis, FHV-1 and FCV are also common in cats in Japan.     

Prevalence of Chlamydophila felis and feline herpesvirus 1 in cats with conjunctivitis in northern Italy

The prevalence of Chlamydophila felis and feline herpesvirus 1 (FHV-1) infection in cats with conjunctivitis in northern Italy was investigated by conventional polymerase chain reaction (PCR) testing. In cats with conjunctivitis, C felis and FHV-1 were detected in 14 of 70 (20%) and in 23 of 70 (33%) animals, respectively. None of the 35 control cats were positive for C felis, whereas 7 (20%) of these cats were positive for FHV-1. Mixed infections were present in 5 of 70 cats (7%). Cats positive for C felis were significantly younger than control animals (P = .02), whereas no significant age differences were observed between FHV-1-positive cats and control cats (P = .41) or between FHV-1-positive animals and C felis-positive animals (P = .16). Cats sampled during acute-phase conjunctivitis were also investigated for the presence of C felis by conjunctival scrapings. In this acute phase, substantial agreement was found when comparing the results of the 2 methods (K = .80). The association between PCR results and conjunctivitis was evaluated for the 2 pathogens. The presence of C felis was significantly associated with conjunctivitis (P = .004), whereas the detection of FHV-1 did not significantly correlate with the clinical sign (P = .25), suggesting that, by itself. PCR is not suitable for the diagnosis of FHV-1-related conjunctivitis.