Atypical manifestations of feline inflammatory polyps in three cats

Inflammatory polyps of the feline middle ear and nasopharynx are non-neoplastic masses that are presumed to originate from the epithelial lining of the tympanic bulla or Eustachian tube. The exact origin and cause are unknown, however, it is thought that inflammatory polyps arise as a result of a prolonged inflammatory process. It is unclear whether this inflammation initiates or potentiates the development and growth of inflammatory polyps. Cats with inflammatory polyps typically present with either signs of otitis externa and otitis media or with signs consistent with upper airway obstruction. Traditional diagnostics involve imaging of the tympanic bulla either with skull radiographs or computed topography (CT). Treatment consists of traction and avulsion of the polyp with or without ventral bulla osteotomy (VBO) to remove the epithelial lining of the tympanic bulla. The three cases described here are unusual manifestations or presentations of feline inflammatory polyps that address the following issues: (1) concurrent otic and nasopharyngeal polyps, (2) potential association with chronic viral infection, (3) polyp development in the contralateral middle ear, (4) CT appearance of the skull following VBO, and (5) development of secondary pulmonary hypertension.     

Computed tomographic features of feline nasopharyngeal polyps

The computed tomographic (CT) findings of histopathologically confirmed nasopharyngeal polyps are described in 13 cats. Most polyps were mildly hypoattenuating to adjacent muscles and isoattenuating to soft-tissue (n= 13), homogeneous (n = 12) and with ill-defined borders (n = 10) on precontrast images. After contrast medium administration, the polyps were homogeneous (n = 11), with well-defined borders (n = 13), oval (n = 13), and had rim enhancement (n = 13). Nasopharyngeal polyps were pedunculated in 11 cats with a stalk-like structure connecting the polyp through the auditory tube to an affected tympanic bulla. All cats had at least one tympanic bulla severely affected, with CT images identifying: (1) complete (n = 12) or partial (n = 1) obliteration of either the dorsal or ventral compartments with soft-tissue attenuating material; (2) pathologic expansion (n = 13) with wall thickening (n = 10) that was asymmetric in nine cats; and (3) identification of a polyp-associated stalk-like structure (n = 11). Nine cats had unilateral tympanic bulla disease ipsilateral to the polyp, and four cats had bilateral tympanic bulla disease, most severe ipsilateral to the polyp with milder contralateral pathologic changes. Two cats had minimal osteolysis of the tympanic bulla. Enlargement of the medial retropharyngeal lymph node was seen commonly (n = 8), and in all cats it was ipsilateral to the most affected tympanic bulla. One cat had bilateral lymphadenopathy. CT is an excellent imaging tool for the supportive diagnosis of nasopharyngeal polyps in cats. CT findings of a well-defined mass with strong rim enhancement, mass-associated stalk-like structure, and asymmetric tympanic bulla wall thickening with pathologic expansion of the tympanic bullae are highly indicative of an inflammatory polyp.     

Nasopharyngeal polyps arising in the middle ear of the cat

The clinical presentation, diagnosis and surgical treatment of four cats with nasopharyngeal polyps are described. In three cats the microscopic appearance of the polyps together with the finding of radiographic densities in the tympanic bullae point to the middle ear as the origin of these polyps. These are inflammatory lesions and it is suggested that they occur as the result of ascending infection from the nasopharynx. Experience has shown that, in spite of recurrence in some cases, simple traction rather than bulla osteotomy is the preferred method of treatment.     

COMPUTED TOMOGRAPHIC APPEARANCE OF INFLAMMATORY POLYPS IN THREE CATS

This report describes the use of computed tomography (CT) to evaluate the inner ear, tympanic bullae, nasopharyngeal area, and external ear canals of three cats. All cats presented for evaluation of upper respiratory signs or chronic ear infection. Nasopharyngeal masses were present in two cats, and a mass in the external ear canal was present in the third cat. In all three cats, CT was able to define the extent of osseous bulla involvement, which was confirmed at surgery. Computed tomography also defined the extent of the polyp in the nasopharyngeal area in two cats, and in the external ear canal in one cat. Surgical removal of the polyps was accomplished with a combined oral approach and ventral bulla osteotomy in cats 1 and 2. The polyp was removed from cat 3 using a combination of ventral bulla osteotomy and excision of the mass through the external ear canal. Microscopic examination confirmed all masses as nasopharyngeal (inflammatory) polyps.     

Computed tomographic evidence of bulla effusion in cats with sinonasal disease: 2001-2004

BACKGROUND: Sinonasal disease is common in cats; chronic inflammatory disease and neoplasia are diagnosed most frequently. Radiographic and computed tomographic (CT) findings in nasal disease have been reported, although involvement of other cranial structures has not been fully described to our knowledge. HYPOTHESIS: We hypothesized that neoplastic or inflammatory obstruction of the auditory tube associated with sinonasal disease could result in CT evidence of effusive bulla disease in affected cats. ANIMALS: 46 cats with sinonasal disease, 18 control cats. METHODS: CT images acquired in cats with (n = 46) and without (n = 18) sinonasal disease were reviewed for evidence of concurrent bulla effusion. CT findings of soft tissue or fluid opacity within the tympanic bulla or thickening of the bone of the bullae were considered evidence of effusive bulla disease. RESULTS: The prevalence of bulla effusion in cats with sinonasal disease was 28% (13/46) and was significantly higher than that observed in cats without sinonasal disease (1/18, P = .043). CT findings that were found in association with effusive bulla disease included imaging features of sinusitis and nasopharyngeal disease. The most common neoplasm associated with bulla effusion was nasopharyngeal lymphoma. Bulla effusion was not observed in any cat with nasal carcinoma. CONCLUSIONS AND CLINICAL IMPORTANCE: Findings of this study suggest that auditory canal dysfunction may play a larger role in feline sinonasal disease than was previously recognized. The implications of these findings for management of cats with chronic inflammatory or neoplastic sinonasal disease require further investigation.     

Detection of virulent feline herpesvirus-1 in the corneas of clinically normal cats

To evaluate the clinically normal feline cornea for the presence of virulent feline herpesvirus-1 (FHV-1), corneas from 31 cats (25 with normal eyes and six with active disease or corneal scarring) euthanased at a shelter were collected. Corneas from two specific pathogen-free cats were included as negative controls. Virus isolation (VI), fluorescent antibody (FA) staining and real-time polymerase chain reaction (rt-PCR) were performed on all samples. The presence or absence of dexamethasone in the media was evaluated for its effect on VI. VI was positive for FHV-1 in six corneas from five cats, all with clinically normal eyes. One cornea was positive for feline calicivirus (FCV) in addition to FHV-1, but only in media that included dexamethasone. Eight corneas were positive on rt-PCR for FHV-1, all from cats with clinically normal eyes. All positive VI samples were confirmed with FA staining. VI and rt-PCR were negative for FHV-1 and FCV in cats with active disease or corneal scarring. Data from this study indicate that virulent FHV-1 and FCV can be present in feline corneas that are clinically normal. Dexamethasone may enhance viral spread through a cell receptor mechanism.     

Analysis of auditory and neurologic effects associated with ventral bulla osteotomy for removal of inflammatory polyps or nasopharyngeal masses in cats

OBJECTIVE: To determine whether cats undergoing ventral bulla osteotomy (VBO) for removal of inflammatory polyps or nasopharyngeal masses have altered ability to hear and whether polyp or mass removal affects auditory function as measured via air-conducted brainstem auditory evoked response (BAER). DESIGN: Prospective case series. ANIMALS: 21 cats. PROCEDURES: Cats were sedated and had otic-oral examinations to confirm presence of nasopharyngeal masses; BAER testing was done immediately prior to and following the completion of a VBO and polyp or mass removal. Recheck examination, including otic examination and BAER in sedated cats, was performed when possible. Results-17 cats met final inclusion criteria, and long-term follow-up was available for 15. Six of 17 had deafness as measured via air-conducted BAER prior to surgery. Mean followup time was 161 days, and there was no change from presurgical status in auditory ability in any cat. Eleven of 17 developed ipsilateral Horner syndrome in the immediate postoperative period, and 1 of 16 had polyp regrowth. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that in cats, VBO for removal of inflammatory polyps or masses is unlikely to affect hearing as measured via air-conducted BAER. Most cats developed short-term Horner syndrome. Cats with deafness prior to surgery did not regain auditory function. Ventral bulla osteotomy to remove nasopharyngeal polyps or masses provided no functional advantage with regard to restoration of hearing, compared with other surgical techniques. Polyp recurrence and long-term adverse effects were uncommon.     

Detection of protective antibody titers against feline panleukopenia virus, feline herpesvirus-1, and feline calicivirus in shelter cats using a point-of-care ELISA

Serum antibody titers are a useful measurement of protection against infection (feline panleukopenia virus [FPV]) or clinical disease (feline herpesvirus-1 [FHV] and feline calicivirus [FCV]), and their determination has been recommended as part of disease outbreak management in animal shelters. The objective of this study was to determine the sensitivity, specificity, and inter-observer and inter-assay agreement of two semi-quantitative point-of-care assays for the detection of protective antibody titers (PAT) against FPV, FHV and FCV in shelter cats. Low sensitivity for FPV antibodies (28%) rendered a canine point-of-care assay inappropriate for use in cats. The feline point-of-care assay also had low sensitivity (49%) and low negative predictive value (74%) for FPV PAT detection, but was highly accurate in the assessment of FHV and FCV PAT. Improvements in accuracy and repeatability of FPV PAT determination could make this tool a valuable component of a disease outbreak response in animal shelters.     

Understanding feline heartworm infection: disease, diagnosis, and treatment

Feline heartworm disease is a very different clinical entity from canine heartworm disease. In cats, the arrival and death of immature heartworms in the pulmonary arteries can cause coughing and dyspnea as early as 3 months postinfection. Adult heartworms suppress the function of pulmonary intravascular macrophages and thus reduce clinical disease in chronic feline heartworm infection. Approximately 80% of asymptomatic cats self-cure. Median survival time for symptomatic cats is 1.5 years, or 4 years if only cats living beyond the day of presentation are considered. Aberrant worm migration is more frequent than it is in dogs, and sudden death can occur with no prior clinical signs. The bacterial endosymbiont Wolbachia likely contributes to the inflammatory pathology of heartworm disease, but its role is not yet fully clear. Unfortunately, the diagnosis, treatment, and management of feline heartworm disease are far from simple. Antemortem diagnosis is hampered by low worm burdens, the frequency of all-male infections, and nonspecific radiographic lesions. It is up to the veterinarian to determine the correct index of suspicion and choose the right combination of diagnostic tests to achieve an answer. Treatment is symptomatic because adulticide therapy is risky and does not increase survival time. Despite the dangers of feline heartworm disease, less than 5% of cats in the United States are on chemoprophylaxis. It is important for veterinarians to take a proactive preventive stance because heartworm infection in cats is a multisystemic disease that has no easy cure.     

Feline panleukopenia virus, feline herpesvirus-1, and feline calicivirus antibody responses in seronegative specific pathogen-free cats after a single administration of two different modified live FVRCP vaccines

Two groups of feline panleukopenia virus (FPV), feline calicivirus (FCV), and feline herpesvirus-1 (FHV-1) seronegative cats (five cats per group) were administered one of two modified live feline viral rhinotracheitis, calicivirus, and panleukopenia virus (FVRCP) vaccines and the serological responses to each agent were followed over 28 days. While all cats developed detectable FPV and FCV antibody titers; only two cats developed detectable FHV-1 antibody titers using the criteria described by the testing laboratory. For FPV and FHV-1, there were no differences in seroconversion rates between the cats that were administered the intranasal (IN) FVRCP vaccine and the cats that were administered the parenteral FVRCP vaccine on any day post-inoculation. For FCV, the cats that were administered the IN FVRCP vaccine were more likely to seroconvert on days 10 and 14 when compared to cats that were administered the parenteral FVRCP vaccine.     

Management of inflammatory polyps in 37 cats

The case records of 37 cats treated for nasopharyngeal or aural inflammatory polyps were reviewed. Thirty of them were managed conservatively with the polyp being removed by traction alone. Long-term follow-up information was available for 22 cats, of which 13 (59 per cent) had no recurrence of clinical signs. The remaining nine cats required recurrent polyps to be removed surgically. Cats with only nasopharyngeal polyps were nearly four times more likely to be cured by traction alone than cats with aural polyps, and none of the cats that was treated with prednisolone after traction suffered a recurrence. Cats with more severe aural signs were more likely to require surgery.     

Isolation of feline herpesvirus-1 and feline calicivirus from healthy cats in Swedish breeding catteries

Feline calicivirus (FCV) could be isolated from four cats (2.6%) and feline herpesvirus-1 (FHV) from none of 152 clinically healthy cats from 22 Swedish breeding catteries. These cats had all previously shown signs of respiratory tract disease or conjunctivitis, although several years ago. The results suggest that carriers of FCV and FHV were uncommon in Swedish breeding catteries studied. Prevalence rates in other European countries and North America are usually higher, especially of FCV. The lower prevalence rates in our study might be explained by test group selection, differences in factors such as management, environment, or genetic constitution of the cats, or by sample handling. It was concluded that the presence of an FCV shedder in the cattery does not mean that all cats in the group are infected, but special measures are recommended to avoid infection of susceptible cats.     

Results of molecular diagnostic assays targeting feline herpesvirus-1 and feline calicivirus in adult cats administered modified live vaccines

In this pilot study, 12 adult, gang-housed cats that were known to be previously exposed (n=12) to feline herpesvirus-1 (FHV-1) and/or vaccinated against (n=2) feline calicivirus (FCV) and FHV-1 were randomly assigned to one of two groups of six cats each. Nasal and pharyngeal samples were collected from each cat on days -7, -3, and 0 prior to vaccination and on days 3, 7, 10, 14, 17, 21, and 28 after vaccination with an FHV-1, FCV, and panleukopenia (FVRCP) vaccine developed for intranasal (six cats) or parenteral (six cats) use. FHV-1 DNA was amplified from 1/12 cats (1/69 samples; 1.4%) prior to vaccination and 2/12 cats after vaccination (2/154 samples; 1.3%). FCV RNA was amplified from 2/12 cats (2/69 samples; 2.9%) prior to vaccination and 7/12 cats (12/154 samples; 7.8%) after vaccination. Positive molecular diagnostic assay results for FHV-1 and FCV were uncommon prior to or after vaccination in these cats.     

Comparison of ultrasonography, radiography and a single computed tomography slice for fluid identification within the feline tympanic bulla

Evaluation of the tympanic bulla (TB) in cases of acute feline otitis media can be a diagnostic challenge, although a feature often associated with this condition is the accumulation of fluid or material within the middle ear cavity. A technique is reported allowing optimum imaging of the feline TB using ultrasound (US) and recording of the appearance of gas and fluid-filled TB. A random number of bullae in 42 feline cadavers were filled with lubricant and rostroventral-caudodorsal oblique radiographs, single slice computed tomography (CT) images and US images were created and interpreted by blinded operators. The content (fluid or gas) of each TB was determined using each technique and the cadavers were then frozen and sectioned for confirmation. CT remained the most accurate diagnostic method, but US produced better results than radiology. Given the advantages of US over other imaging techniques, these results suggest that further work is warranted to determine applications of this modality in the evaluation of clinical cases of feline otitis media.     

A study of feline upper respiratory tract disease with reference to prevalence and risk factors for infection with feline calicivirus and feline herpesvirus.

A cross-sectional survey of a convenience sample of cats was carried out to determine the prevalence of and risk factors for respiratory tract disease, feline calicivirus (FCV) infection and feline herpesvirus (FHV) infection. Seven hundred and forty cats were studied; samples for isolation of FCV and FHV were obtained from 622 (84%). Data on individual cat and household variables were obtained by questionnaire for each cat and analysed using univariable and logistic regression analysis. Thirty-eight percent (282/740) of cats surveyed had respiratory tract disease. Eighteen of 24 predictor variables were found to be significantly (P<0.05) associated with the presence of respiratory tract disease in a cat on univariable analysis. Following logistic regression, several factors retained significance including isolation of FCV and FHV, younger cats (4-11 months of age) and multiple cat households. A negative association was found with breeding catteries and other types of household in comparison with rescue catteries. Overall, feline calicivirus was isolated from 162/622 (26%) of cats sampled; 33% of the cats with respiratory tract disease were FCV positive compared to 21% of healthy cats. Variables significantly associated with FCV isolation on logistic regression were the presence of respiratory tract disease and contact with dogs with and without respiratory tract disease. Feline herpesvirus was isolated from 30/622 (5%) of all cats sampled; 11% of cats with respiratory tract disease were FHV positive compared to 1% of healthy cats. Variables significantly associated with FHV isolation on univariable analysis included age, gender, and the presence of respiratory tract disease. Vaccination showed a negative association. Logistic regression analysis of the data for FHV was limited by the sample size and the low prevalence of FHV.     

Measurement of aldosterone in feline, canine and human urine

BACKGROUND: Systemic hypertension is an important problem in older cats associated with kidney disease and hypokalaemia, suggesting that excessive activity of the renin-angiotensin-aldosterone system might contribute to the hypertensive state. Fluctuations in plasma renin activity and plasma aldosterone concentrations complicate the interpretation of these assays. OBJECTIVES: The aim of this study was to determine whether measurement of urinary aldosterone excretion in cats aided the investigation of hypertension. METHODS: Urine concentrations of free (ethyl acetate extract) and 18-glucuronidated aldosterone (acid hydrolysis before extraction) were measured by radioimmunoassay in normal, normotensive and hypertensive azotaemic cats (n=11 per group). Urine samples from 11 healthy human volunteers and eight normal dogs were also analysed for comparison. Urinary aldosterone concentration was corrected for the urinary creatinine concentration. RESULTS: Cats excreted 7.3 times less free aldosterone than human beings, and no free aldosterone was detected in dog urine. Acid hydrolysis led to large increases in aldosterone recovery from both human beings and dog but not feline urine. No significant effect of hypertension or azotaemia on feline urinary aldosterone concentration was found. CLINICAL SIGNIFICANCE: Measurement of aldosterone in feline urine using the available methodology has limited or no utility in investigating feline hypertension.     

Three cases of feline ocular coccidioidomycosis: presentation,clinical features,diagnosis, and treatment

Objective To describe clinical and diagnostic features of ocular coccidioidomycosis in cats and the response to fluconazole and anti‐inflammatory therapy. Animals studied Three cats with naturally acquired coccidioidomycosis. Procedure Cats were treated with topical or systemic corticosteroids and systemic fluconazole, an antifungal of unproven efficacy against feline ocular coccidioidomycosis. Results Two cats presented for periocular swellings, either subpalpebral or periorbital, with systemic signs including weight loss, unkempt hair coat, and lethargy. One cat presented for apparent blindness with no systemic signs. Clinical ophthalmologic abnormalities were bilateral in each cat and included hyperemic, conjunctival masses, fluid‐filled periorbital swellings, granulomatous chorioretinitis, nonrhegmatogenous retinal detachments, and anterior uveitis. Cats were diagnosed with coccidioidomycosis using a combination of clinical findings, serology and, in two cases, visualization of Coccidioides spherules by either aspiration cytology or biopsy. Active anterior uveitis and periocular swelling were resolved in all cats during treatment. Chorioretinal granulomas, although persistent, significantly decreased in size. Conclusions Coccidioidomycosis should be considered as a differential diagnosis for cats with a travel history to the southwestern United States that demonstrate periocular swelling, anterior uveitis, or granulomatous chorioretinitis, with or without evidence of systemic disease. Aspiration cytology or biopsy of suspicious conjunctival or skin lesions, if present, may aid in diagnosis. A combination of corticosteroids and fluconazole may be effective in treating ocular coccidioidomycosis, although chorioretinal granulomas may persist and long‐term fluconazole therapy may be necessary.     

Three-year duration of immunity in cats following vaccination against feline rhinotracheitis virus, feline calicivirus, and feline panleukopenia virus

Forty-two seronegative cats received an initial vaccination at 8 weeks of age and a booster vaccination at 12 weeks. All cats were kept in strict isolation for 3 years after the second vaccination and then were challenged with feline calicivirus (FCV) or sequentially challenged with feline rhinotracheitis virus (FRV) followed by feline panleukopenia virus (FPV). For each viral challenge, a separate group of 10 age-matched, nonvaccinated control cats was also challenged. Vaccinated cats showed a statistically significant reduction in virulent FRV-associated clinical signs (P = .015), 100% protection against oral ulcerations associated with FCV infection (P < .001), and 100% protection against disease associated with virulent FPV challenge (P < .005). These results demonstrated that the vaccine provided protection against virulent FRV, FCV, and FPV challenge in cats 8 weeks of age or older for a minimum of 3 years following second vaccination.