#the point of this is euthanasia is a viable treatment option in some cases and its carefully chosen

[thehappyvet]

Where do people get this misconception that every single wildlife case at a vet clinic is euthanased so it's better to not take them in even if they're obviously hurt or sick and in need of treatment?!?!

Friendly reminder that a member of the public should not be able to easily pick up or catch a wild animal. We are not in a disney movie. If you can pick it up*, 80% of the time its extremely hurt or sick.

Wildlife, and most animals for that matter, do not show pain as humans do. That does not mean they are not in pain and suffering.

Veterinarians only euthanase wild animals that are suffering from extreme injury or illness, or animals that would stress themselves to death in a hospital setting that cannot be released and survive in the wild with their issue.

We do euthanase some animals, but that's because it's the best welfare decision for that animal and its specific problem.

Maybe trust the professionals trained in providing treatment to animals instead of some Karen on Facebook who demonises vets because she can't understand a bird with multiple wing and shoulder fractures is very unlikely to regain flight and return to the wild and her plan of keeping it means it will live a life of chronic pain and suffering.

*Disclaimer: If you live in a country where diseases such as rabies are endemic, you should not handle wildlife at all if you are not trained or vaccinated. This post is not recommending members of the public handle wildlife in any country.

[iheartvmt]

Feline Infectious Peritonitis

• Other names: FIP

• Cause: Feline coronavirus.

- Most cats are infected with feline coronavirus (up to 50% of cats in single cat households will test positive for coronavirus antibodies; that percentage jumps to 80-90% in multi-cat environments)

- Most feline coronavirus infections cause no or minor symptoms (some people call the virus at this point "feline enteric coronavirus"), and the cat is able to clear the infection. However, cats can be re-infected if exposed again.

- In <5-10% of infected cats, the infection progresses to clinical FIP. This occurs due to a mutation of the virus (at this point some people refer to the virus as "feline infectious peritonitis virus," or FIPV) combined with an aberrant immune response that results in the white blood cells transporting the virus throughout the cat's body, and a subsequent intense inflammatory reaction around vessels in the tissues where these infected cells locate, often in the abdomen, kidney, or brain.

• Species: Domestic cats, and most members of the Felidae family (cheetahs in captivity are especially susceptible)

• Transmission: FIP is not contagious from cat to cat, but when one cat in a household develops FIP, it's likely that all in-contact cats will have already been exposed to the same initial feline coronavirus. However, as a precaution it's not recommended to allow a naïve cat to have contact with a cat that has FIP.

- Transmission of feline coronavirus is via direct contact, fecal-nasal/oral route, and fomites (coronavirus can remain viable in an average household or shelter/cattery environment for days to weeks, or even months if the conditions are cool and dry). Rarely spread can also occur by aerosized droplets from sneezing, or transplacentally.

- Most cats cease shedding the virus after a few months, but about 13% of cats will continue to shed the coronavirus for life.

- In large multi-cat environments, about 40-60% of cats will be shedding the virus in their feces at any given time, and cats will continue to pass the infection back and forth.

- Most cats contract coronavirus either from their infected mothers when they are kittens or through sharing litter boxes with infected cats.

• Signs:

- Any cat that carries coronavirus is potentially at risk for developing FIP. Most cats show no symptoms during the initial infection, but some develop mild signs such as sneezing, watery eyes, nasal discharge, vomiting, or diarrhea.

- Weeks, months, or even years after the initial exposure, a small percentage of cats will develop FIP

- Cats with weak immune systems are most likely to develop FIP (kittens, especially if weaned eay, cats infected with feline leukemia virus or feline immunodeficieny virus, stressed cats, geriatric cats).

- Most cats that develop FIP are under two years of age or over 12 years, but any age cat can be affected.

- FIP is more common in intact cats, especially males

- FIP is relatively uncommon in the general cat population. However, the disease rate is much higher in multiple-cat populations, such as shelters, pet stores, and catteries due to increased viral exposure, likelihood of concurrent diseases, and stress

- Persians, Australian mist, Abyssinian, Bengal, Birman, British shorthair, Himalayan, Ragdoll, Scottish folds, and Rex breeds are more likely to develop FIP

- Littermates of cats with FIP have a higher likelihood of developing FIP than other cats in the same environment

- Once FIP symptoms develop, severity generally increases over the course of several weeks, ending in death. 

- First signs are usually vague and nonspecific: hyporexia/anorexia (however some cats may have normal or increased appetite), weight loss, depression, lethargy, rough hair coat, and fever.

- May be icteric

- Two major forms: effusive ("wet") and noneffusive ("dry")

- Noneffusive form: usually progresses slower than effusive; chronic weight loss, depression, anemia, and a persistent fever that does not respond to antibiotic therapy. Often involves severe inflammation and granulomatous changes in one or more organs, such as the eyes, brain, liver, intestine; signs will vary based on which organ(s) affected. If the lungs are involved, thoracic radiographs may show patchy densities in the lungs. Enlarged mesenteric lymph nodes, irregular kidneys, or nodular irregularities in other viscera can sometimes be palpated. CNS signs may be present (ataxia, nystagmus, seizures, intention tremors, hyperesthesia, behavioral changes, visual deficits, loss of menace reflex, lameness, progressive ataxia). Finding hydrocephalus on a CT scan is suggestive of neurologic FIP (75% of cats with neurological FIP have hydrocephalus on necropsy). Ocular lesions include retinal lesions, (granulomatous changes on the retina, retinal hemorrhage or detachment), uveitis, change in color of the iris, hemorrhage into the anterior chamber of the eye, buildup of inflammatory cells in the anterior chamber of the eye, leading to keratic precipitates. Intestinal lesions or pyogranulomas may occur, leading to omental/visceral adhesions, lymphadenopathy, diarrhea, vomiting, and/or obstruction.

- Effusive form: Most common, and usually progresses rapidly. Symptoms similar to dry form early on, then patient also develops ascites, resulting in a pot-bellied appearance. A fluid wave may be present in severe cases. Fluid may also accumulate in the chest (less common; causes muffled heart sounds, EKG changes, and increased respiratory signs). Eventually the fluid accumulation makes it difficult for the cat to breathe normally, and if pericardial effusion is present, cardiac tamponade can occur.

• Diagnosis: Difficult due to wide variance in clinical signs, which often overlap with many other diseases

- Generally presumptive based on history, clinical signs, cytology of effusion fluid (if present), and ruling out other diseases

- CBC and blood chemistry changes: WBC may be decreased or increased (Lymphopenia + neutrophilia common), nonregenerative anemia, increase in total serum protein, increased globulins, low albumin, low albumin:globulin ratio, hyperbilirubinemia (in absence of hemolysis), icterus, increased liver enzymes, increased serum AGP, increased serum amyloid A (SAA), other laboratory parameters can be variably increased depending on the degree and localization of organ damage 

- Ultrasound may be normal or may show lymphadenopathy, peritoneal or retroperitoneal effusion, renomegaly, irregular renal contour, hypoechoic subcapsular echogenicity, and diffuse changes within the intestines.

- Abdomenocentesis -- fluid typically clear, straw yellow with a sticky consistency; protein content is very high, cellular content is low (cytology often consists predominantly of macrophages and nondegenerate neutrophils in much lower numbers than with bacterial infection). If the albumin to globulin ratio of the fluid is >0.81, FIP can be ruled out.

- Rivalta's test: "To perform the test, a transparent reagent tube (10 mL) is filled with ~8 mL distilled water, to which 1 drop of acetic acid (highly concentrated vinegar, 98%) is added and mixed thoroughly. On the surface of this solution, 1 drop of the effusion fluid is carefully layered. If the drop disappears and the solution remains clear, the Rivalta’s test is defined as negative.If the drop retains its shape, stays attached to the surface, or slowly floats down to the bottom of the tube (drop- or jelly-fish-like), the test is defined as positive. Rivalta’s test has a high PPV (86%) and a very high NPV (96%) for FIP. Positive results can sometimes be seen in cats with bacterial peritonitis or lymphoma." (Merck Veterinary Manual) If the test is negative, it's likely safe to rule-out FIP

- Cerebrospinal fluid (CSF) from cats with neurologic signs may be normal or may have increased protein and pleocytosis (neutrophils, lymphocytes, and macrophages)

- ELISA, IFA, and virus-neutralization tests detect the presence of coronavirus antibodies, but cannot differentiate between the various strains of feline coronavirus. A positive result means only that the cat has had a prior exposure to coronavirus, not that the coronavirus has mutated into FIPV.

- In advanced disease, there is also the risk of false negative results due to antibodies being bound into complexes that aren't detectable by laboratory tests.

- PCR to detect viral genetic material in tissue or body fluid (presently only capable of detecting coronaviruses in general, not necessarily those that cause FIP)

- Only way to definitively diagnose FIP is by biopsy or examination of tissues at necropsy: "H&E-stained samples typically contain localized perivascular mixed inflammation with macrophages, neutrophils, lymphocytes, and plasma cells. FCoV can be identified by immunohistochemistry in the macrophages within the lesions. Pyogranulomas may be large and consolidated, sometimes with focal tissue necrosis, or numerous and small. Lymphoid tissues in cats with FIP often show lymphoid depletion caused by apoptosis." (Merck Veterinary Manual)

• Treatment: Once a cat develops clinical FIP, the disease is progressive and always fatal. Some treatments may induce short-term remissions in a small percentage of cats, but eventually the disease will result in death.

- Euthanasia [most humane option in my professional opinion]

- Palliative options if owner is unwilling to euthanize: supportive care (nursing care, nutritional support, fluid therapy, blood transfusions, draining accumulated fluids), corticosteroids, cytotoxic drugs, antibiotics

- Currently further research is being done to explore new, effective treatment options, but unlikely that anything will be available to clinical practitioners any time soon.

• Prevention:

- Keeping cats as healthy as possible and minimizing exposure to infectious diseases can help decrease the risk of FIP in multiple-cat environments: locate litter boxes away from food and water dishes, remove feces from litter boxes daily, thoroughly clean and disinfect litter boxes regularly; quarantine new cats and any cats suspected of infectious disease; prevent overcrowding; ensure cats are well-vaccinated, and provide proper nutrition, environmental enrichment, and treatment for any illnesses that occur.

- Some sources recommend avoiding bringing kittens (who have greatest risk of developing FIP) into an environment with a recent history of FIP if possible

- Some sources recommend waiting at least 2-3 months after the death of an FIP cat before bringing new, naive cats into the environment if possible

- In shelters and in multicat environments with >10 cats, feline coronavirus is endemic and FIP is almost inevitable. "Households of <5 cats may spontaneously and naturally become FCoV-free, but in households of >10 cats per group, this is almost impossible because the virus passes from one cat to another, maintaining the infection. In these FCoV-endemic environments, such as breeding catteries, shelters, foster homes, and other multicat homes, there is virtually nothing to prevent FIP." (Merck Veterinary Manual)

- To decrease the risk of FIP, some breeding catteries practice an early (<5-6 weeks old) weaning protocol. To be successful, this depends on strict isolation procedures including separate caretakers and air space, low numbers of cats, and intense socialization of kittens to prevent subsequent behavioral problems from being removed from their mother at such a young age [Also deliberately taking kittens away from their mothers that young may be legally considered animal cruelty depending on local animal welfare laws!]

- Some breeding catteries focus on increasing genetic resistance to FIP in their lines by removing cats from their breeding program if 2 or more litters they sired or birthed contain kittens that developed FIP.

- Some breeding catteries test for feline coronavirus and remove all positive cats; others remove only cats that prove through sequential testing to be chronic viral shedders. Once the cattery is free of feline coronavirus, care must be taken to test and quarantine all incoming cats to ensure the virus is not reintroduced to the cattery.

- FIP vaccine available but ineffective. Efficacy is questionable to start with, plus most cats have already been infected by the time the vaccine can be administered (16 weeks). Additionally, the vaccine causes a positive antibody titer, further complicating diagnosis or testing to maintain a coronavirus-free environment.

Sources:

• Feline Infectious Peritonitis

https://www.vet.cornell.edu/departments-centers-and-institutes/cornell-feline-health-center/health-information/feline-health-topics/feline-infectious-peritonitis

• Feline Infectious Peritonitis

https://vcahospitals.com/know-your-pet/feline-infectious-peritonitis

• Overview of Feline Infectious Peritonitis

https://www.merckvetmanual.com/generalized-conditions/feline-infectious-peritonitis/overview-of-feline-infectious-peritonitis

• FIP kitten https://commons.m.wikimedia.org/wiki/File:FIP_kitten.jpg#mw-jump-to-license (image source)

• Feline Infectious Peritonitis https://veterinarypartner.vin.com/default.aspx?pid=19239&id=4951549

• Feline infectious peritonitis: Strategies for diagnosing and treating this deadly disease in young cats http://veterinarymedicine.dvm360.com/feline-infectious-peritonitis-strategies-diagnosing-and-treating-deadly-disease-young-cats

•Feline Infectious Peritonitis/Feline Coronavirus (FIP/FCoV) https://www.sheltermedicine.com/library/resources/?utf8=%E2%9C%93&site=sheltermedicine&search%5Bslug%5D=feline-infectious-peritonitis-feline-coronavirus-fip-fcov

• Feline Infectious Peritonitis (FIP)

http://muncity.blogspot.com/2013/08/feline-infectious-peritonitis-fip.html?m=1 (image source only)

[This disease is especially heartwrenching for me every time we see a case in my clinic... When I was about 7 or 8 years old, my family lost our kitten, Cuddles, to effusive FIP. While she wasn't the first pet I had who passed away, she was the first one we had to euthanize, and I still remember that appointment every time we put an FIP kitty to sleep. I definitely hugged my guys a bit tighter while doing this write-up 😢 Doc and I hope that by the time we retire, the new research into FIP will have yielded a clinical treatment affordable for our clients!]