Expert: Jessica - 9/15/2009

Question
QUESTION: How do I know when my kitten is fully recovered from Giardia/Fever?

My 5 month old ragdoll kitten, Casper, used to be very loving and playful. He has a brother, same age. They used to be best friends. About two weeks ago, Casper became ill with a fever. He was withdrawn, had loss of appetite, was lethargic and had sporadic diarrhea. The fever got worse, he became dehydrated and didn't pass a stool for a week. Because the vet didn't know what was causing the fever, she prescribed de-worming medicine and doxycylin and gave him a fluid shot  stating that if he didn't pass a stool within 24 hrs. to take him to the emergency clinic. The day before Labor Day, we took him to the emergency clinic and they prescribed clavamox, a stronger antibiotic for the fever since the fever was getting worse (103.9). The result from several tests (blood, fecal, FIV/Leukemia, X-rays, WBC count) all came back negative. Of two tests to test for parasites, one came back slightly positive for giardia so we continued to treat him with the two de-worming medicaions, the clavamox and doxycylyn. It sounds like a lot of medicine to me, but he did start to get better. Fever went down, he started becoming more playful, eating more, drinking more and using the litter box. The question I have now is how do I know when he is fully recovered? He's been on medication for 10 days and has 3 days to go. We also treated his brother for giardia to make sure they didn't pass it back and forth, but Jordan is extremely healthy and playful while Casper doesn't want to be bothered by his brother and is still a little lethargic. He is more sociable than before since he's now in the same room as us instead of hiding under the bed, but when will he return to his normal playful self? Is it possible there is something else bothering him, medical or otherwise?

ANSWER: Hi Brenda.  It can take some time for a kitty to recover fully from a serious illness.  It’s good that he’s making some progress.  However, I admit that I would be a little concerned myself that he has not seemed to bounce back completely as his treatment draws near to an end.

There is a disease called Feline Infectious Peritonitis (FIP) that could be of concern.  It is uncommon.  The prevalence seems to depend on who you ask.  I have seen that it affects from 0.5% to 5% of the cat population, with my own vets estimating that about 1 or 2 out of every 100 cats comes down with it.  

Symptoms of the disease include fever, often that does not respond well to antibiotics and many times that will wax and wane over the course of many weeks, loss of appetite, lethargy and poor body tone (they tend not to grow as quickly or be as strong as siblings).  In the end stages, which typically come several weeks to a few months after the onset of the illness, the disease causes severe anemia.  There are two forms of FIP – effusive, or “wet”, and non-effusive, or “dry”.  With dry FIP, you also may see neurological symptoms.  With wet FIP you will see a bloated belly as fluid builds up in the abdomen.  Both forms may also cause organ failure.

The most frustrating thing about FIP is that there is no definitive test.  The disease is caused by one strain of a group of viruses called coronaviruses.  There is a test for coronaviruses, but it cannot test for any particular strain, so it can’t say whether your kitty has been infected with the one that may later lead to FIP.  Further, the tests can only detect exposure to the viruses and cannot say whether the cat is currently infected, or if it only has antibodies from a past infection.  In short, a coronavirus test may be a good tool to use as a screening measure when a lot of other signs are pointing to the fact that the kitty may be infected with FIP.  If a coronavirus test is decided upon, a high titer result would usually be a strong indication that the kitten is infected with FIP.  Most vets would agree that tests reading anything over 1:1200 is strongly indicative of FIP, or certainly anything over 1:1400.  When there is an antibody titer detected but it is much lower, it may simply indicate that the kitten was infected with a coronavirus that has now passed.

FIP is uncommon, but if Casper isn’t 100% normal by the end of his antibiotic treatment, I’d get him right back to the vet.  I think it may be something worth opening a dialog over.  And if the vet feels his case does not fit the bill, you can feel relieved!

As far as I can understand, his WBC count came back normal?  So I’m not sure if there would be any merit in trying any further antibiotics.  But if his monocyte count was found to be high, then there are super antibiotics out there that are even stronger than Clavamox if this has been ineffective.  Zithromax is a good one, and there are quinolone antibiotics that might be considered.  These would include Zeniquin and Orbax.  There is also Baytril, although some vets are a little reluctant to use this in kittens.

I hope he’s back to normal soon!

Jessica






---------- FOLLOW-UP ----------

QUESTION: Thank you very much, Jessica for your thorough and thoughtful answer. I am VERY familiar with FIP. Not sure if that makes me lucky or unlucky, but my kitten in Indonesia passed away from FIP at 8 months old. His signs started out with sneezing, then lethargy, weight loss, withdrawal, pale skin, pink eyelids. Casper doesn't appear to have any of these signs except sleepiness. He is gaining weight which is a good sign and did fully recover from an Upper Respiratory Infection in June so his immune system is functional. He also is showing signs of improvement, while with FIP the situation gets progressively worse and it happens faster in kittens.

My last question is, "how do I know if I have a credible vet?" My husband is a little skeptical since she could never give a confident diagnosis after seeing him several times. Would you recommend going back to her if Casper doesn't get better within the next week or would you see a different vet?

Answer
If all the lab tests came back completely normal, I think the vet is probably still credible despite being unable to come up with a diagnosis.  In most cases, aside from the x-ray, the lab analyzes the values and lets the vet know whether the results are within normal parameters or not.  And, in fact, at the end of the report, it even suggests possible diagnoses, so it would be very difficult for her to miss something from those results.  It does sound like she covered all of her bases with treatments despite not knowing exactly what was afflicting the little guy.  I don't think that it's necessarily a question of her credibility, because it does sound as if she has been pretty competent, but you could always go to another vet simply because another vet may look at things from a different angle.  When you have two minds working on one problem, you may come up with more possibilities, more ways to diagnose things, yielding more answers.  However, unless you are able to get a copy of Casper's medical records, or have the vet fax the records over to the new vet, the next vet is very likely going to want to rerun some of the tests you have already paid for.  From a financial standpoint, it could make more sense to stick with this vet.  The next step may be more in-depth blood work if the vet knows which direction to go in next, or an ultrasound.

Sorry you have run into FIP.  I think that definitely makes you unlucky!  I lost four hospice cats to it earlier this year myself, although one did survive for 9 months.  The only "good" thing about that disease is that it is (supposedly) so uncommon.  Hopefully neither of us will run into it again.

Best wishes to you and Casper!