Expert: Jessica - 8/16/2010

Question
QUESTION: Hi,
I really hope you can help.  I have a 5 month old male tabby kitten who appears to have an illness that the vets are so far unable to diagnose and I am really worried.
Around a month ago he went into boarding for a week.  On bringing him home we noticed he was purring constantly.  The next morning he was off his food (still purring) but listless and sat hunched up and wincing. He felt really hot to the touch. I notices he was shaking, like a shiver all over quite badly.  I took him straight to the vets who gave anti inflammatory and antibiotics and I now understand that constant purring can be a sign of pain or fever, not just a happy cat! No high temp though despite feeling very hot.  Next day the same, but now being sick and had diarrhoea (pale clay colored). Back to the vets, more injections.  A few days passed and he seemed to get better.  A week later, the same thing again, shaking, hunched up not moving %26 off his food and sick, felt very hot again.  Straight to the vets again, core temp 105.7 this time. Hospitalized overnight, fluids more injections and blood tests.  
Basic bloods showed nothing except high white cell count, organ functions normal and more complex bloods looking for FeIV and FIB have come back negative, although vet says that a single test is not classes as conclusive and they don't know where to go from here.  Waiting for results on intestines and pancreas.
Two weeks on and more visits to the vets including emergency vets.
Now I find that at least every day at some point or other he has a period of 'spasm' and shaking.  Its most noticeable when he lays on his side, his hind legs and bottom look like they are scrunching up, like a contraction and his whole body shivers and vibrates although its definitely worse at that end and he doesn't look like its comfortable, doesn't want picking up or stroking at all but is purring.
Its taking around 30 mins to an hour for this to pass now then he seems fine, but sometimes the shaking / spasms seem quite violent and I'm really worried.  Some days hes a little off his food and sometimes hes a bit off his food but is drinking lots.
He stretches is back legs out a lot, almost everytime hes been sat even if its for a few minutes.
The cattery say he was fine whilst there but didn't seem to settle well, other than that nothing.
He's fully inoculated inc leukemia and FeIV (completed a week before going into boarding) and we have another kitten from another litter who shows no symptoms of illness at all.  He was a litter of 1 from rescue Center, the mum had had 30+ litters before him.
in the months before this started he was absolutely fine except some small amounts of blood in his stools on and off for the first few weeks which the rescue Center said was common for kittens settling into a new diet.

He doesnt go out yet (not neutered yet) but had a spell in the garden on a harness just before going into baording.

Please please give any suggestions as to what I can get the vets to check for next.  I'm worried they;re missing something and it'll be too late by the time they identify it.

Sorry this is so long but i thought Id give you all the info I could incase its relevant.

Many thanks

Debbie

ANSWER: Hi Debbie,

Sorry to hear about the little one.  

One question for you.  Vets usually run an FeLV test in combination with an FIV test, but you mention an FIB test.  This isn’t a well-known acronym for any condition.  Did you mean FIV (Feline Immunodeficiency Virus), or perhaps FIP (Feline Infectious Peritonitis)?  I would be strongly suspicious of FIP in your kitten’s case.

FIP is a disease originally introduced to the body by a strain of virus in the group of corona viruses.  The viruses typically cause a mild diarrhea.  Most cats have no lasting ill effects from the virus.  A few cats, suspected to be less than 2% of the cat population, have difficulty fighting off the virus like other cats for a variety of reasons.  There appears to be a genetic factor, and it seems to affect kittens and cats with compromised immune systems almost exclusively.  In these cats, the virus is allowed to mutate and move outside the intestines, into the abdominal lining, called the peritoneum.  Once here, the virus no longer has a way of shedding, and vets generally agree the condition is not contagious at this point.  But upon recognizing the invader, the cat’s immune system causes extreme inflammation trying to rid itself of the germ.  A persistent high fever is a classic sign, usually occurring about 3-6 months after initial infection.  A high white blood cell count may be seen at this stage as the cat mounts an inflammatory response.  The fever can cause muscle cramping, dehydration and even seizures.  In end stages, FIP causes damage to the blood vessels and organs, and in many cases, neurological signs.  In some cases, fluid may begin to collect in the belly area.

There is no good test for FIP, but if your vet has not run a test yet, you may want to talk to them about running a corona virus test.  This test can tell you whether the kitten has been exposed to the group of viruses that can later cause FIP.  The problem is that nearly all kittens have been exposed to at least one of the corona viruses, so most will test positive for exposure, and it doesn’t necessarily mean they have been exposed to the one that causes FIP.  But if the titer count comes back very high, it’s suggestive of the presence of FIP, especially when so many symptoms of the disease are present.  There is a more accurate test that looks for a protein specifically associated with the strain of corona virus associated with FIP, protein 7B  This test is not fool-proof either, however.

If FIP is suspected, I would urge you to talk to your vet about starting your kitty on some palliative treatments.  In my experience, the most important thing is getting that fever down, and the best treatment is Algozone (metamizole).  It’s outlawed for use in human patients but is allowed for use in the veterinary field.  It’s strictly a fever reducer/headache medicine and won’t treat his underlying condition.  I find I have to request it because sometimes the vets feel it’s a bit of “quackery”.  It’s the best bit of quackery I’ve come across.  It won’t save lives, but it helps the cat feel much better while he’s here.  Also, FIP patients do well to take prednisone.  This is a steroid that helps suppress the immune response that’s causing most of their symptoms.  Some vets feel that an antibiotic can also be helpful, because in end stages, FIP can cause a low white blood cell count, leaving them vulnerable to secondary bacterial infections.  Sadly, FIP cannot be cured.

You may also want to see if your vet is running any ehrlichiosis or toxoplasmosis tests.  Ehrlichiosis is a flea and tick-borne disease that can certainly cause a high fever like this.  There may be a small chance he was bitten in the garden or at the boarding facility.   I almost lost a cat to ehrlichiosis a few years ago, and she suffered episodes much like your little one and even went into seizures.  After three days of hospitalization, she recovered.  I would think your baby would respond to antibiotics, but perhaps he needs them intravenously to get a head-start.

Toxoplasmosis is a protozoan illness that can cause symptoms similar to FIP.  I haven’t seen it cause such a high fever, and it usually causes more pronounced neurological symptoms, but with his history of diarrhea, this may still be a possibility.  Toxoplamosis can be cured with an antibiotic called clindamycin.

Best wishes.  I hope the little one has something treatable!

Jessica



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

QUESTION: Hi Jessica,

Thank you so much for your support.  Yes I did mean FIP (not FIB !) and will pursue this with the vets as with your other suggestions.
The diary I am keeping has only shown a couple of things I can associate quite strongly now with the occurrence of the shaking episodes which is 1) although it can start randomly at any time, it almost always starts whilst he is eating too - especially if he hasn't passed a stool in the last few hours.  He tends to pick at his food for a few minutes then walk away when it starts (hence he doesn't seem to be eating much).  The more he eats the worse the shaking afterwards.   2) he's drinking a lot, much more than the other kitty.

Kind regards

Debbie

Answer
Hmmm, I would be suspicious that his increase in water consumption might be linked to his fever.  The fever can cause dehydration and lead to the need to drink a lot more.  I'm not sure why eating would trigger the spasms, unless he's so weak and febrile that any sort of activity causes him to begin to shake.  Also, if he's very dehydrated, electrolytes that are off balance can cause muscle tremors and cramps with any kind of use, and even at rest.  If he seems to be chronically dehydrated, the vet can show you how to give him fluids under the skin at home.  It's actually rather easier than it would seem.  You just lift up the skin between the shoulders and insert a needle into the skin, then allow the fluids to flow in.