Hello and welcome to this webinar. Today I'm gonna be talking about cat flu, so acute upper respiratory tract, infection or disease in the cat, and I will touch on the highly pathogenic strains of cholei. They're not common, but when they occur, they are pretty devastating.

And this picture from Aunt Claire is absolutely typical of the sort of thing we're talking about. Mama cat doesn't look too bad, but when you look at the babies, their eyes are just sealed shut. They're absolutely miserable.

And thanks as always, to my university. So what am I talking about? Well, you know, we've all seen it.

We've all seen many, many cases of, of cat flu, but let's just make sure that we're kind of thinking on the same page. We're talking about cats with conjunctivitis. So here we've got acute conjunctivitis.

This is calicivirus at the top. When you see eyes that are this chemotic, swollen, red, this is much more likely to be cholei or mycoplasma. Here, we've got a, a unilateral conjunctivitis, and it's causing a keratiti.

When you see keratiti, the cornea is involved, then if there hasn't been an injury, as in the cat claw or something, then that is gonna be caused by herpes virus. And when you get a mild signs, particularly just affect one eye, this is much more likely to be chlamydia. So that's conjunctivitis.

If we're thinking about ocular nasal discharge and sneezing at the top, we've got acute calicivirus. This little kitten has got very serious discharge, very clear, with the little Devon Rex. It's becoming more pussy, more snotty.

And ultimately little Binky down here has got the really crusty, nose that I want to ask you, how many of you desperately want to pick that off? I know. You know the cat won't like it, but you know it's gonna be so much more comfortable when it's done.

Then what about skin ulceration? Well, we particularly think about tongue ulceration. This is a really calicivirus thing and not surprisingly results in hyper, salivation.

It can be very extensive as we've got in this picture here, on the left, or much more focal, as we've gotten this one on the right. But we can also see ulceration around the nose. Here we've got cholei.

And here we've got herpes to show you both of them do it. And they can cause, a limb ulceration. I've certainly seen herpes cause lesions all over the cat if, if pushed.

And when you see it going to the feet, particularly, I'll show you some pictures of that in a second. That's much more likely to be Calei and particularly virulent Calei, so you need to be worried. When you see a cough, that is more likely to be herpes or borderella.

Not surprisingly you see in appetence and depression and fever. Limping syndrome, this is Calei. This is caused by immune complex deposition in the joints when kittens are first vaccinated.

It can be triggered by, live vaccine that has got onto the kitten's coat or where it's been aerosolized around the room, or it could be exposure to actual wild virus. So it can be either the kittens are sore, the joints really hurt. But they normally get over this in a, in a day or two.

Sometimes they can get significantly dehydrated, and sore, so you might need to give them non-steroidals and fluids. Obviously fluids first. And then vascular systemic disease I'm gonna talk you through later.

So what are the causes? Well, yes, Herpes and Calei, they are the main players. That's 80% of the cases.

But they are party animals. They rarely cause cat flu without another something else to be involved. So other viruses you might be looking at, so coronavirus, so a virus that can cause FIP can certainly when cats are first exposed to it, can cause flu-like signs.

Ria virus, we don't know a great deal about other than we know that it can cause cat flu signs. Avian influenza, quite topical at the moment. If the cats are in an area where there is avian influenza, then yes, it can present as flu-like signs in the cats, and of course, be a risk of zoonotic spread.

And COVID. Yep, it can get into cats too. When we see it in cats, we see it as usually respiratory disease, upper and lower lower.

It can be fatal. And in every case, the cat has come from a household that's recently had somebody with bad, you know, severe flu, and they've been cuddling the cat a lot, so they've infected the cat. So it's an anthropnosis or reverse seinosis.

Other things that might be involved, well, we've got bacteria, so pasturella. Pasurella we tend to think of as a pretty benign bacteria. Find it in just about every respiratory problem we see in cats.

But it is also, a mild zoonos. If you're very, immunosuppressed, it can cause respiratory disease and even be, you know, really make you sick. So always consider that as well.

Chlamydia illus tends to occur mostly in the eyes, doesn't really cause much of a upper respiratory problems, kind of a little bit. And again, this is a, a mild zoonos. It can get into human eyes.

Bordertella bronchoceptica, of course, I'm always going to blame the dog. Certainly can get into cats. There's usually a dog to be, blamed.

And again, it's a mild zoonos, sometimes quite serious zooos. So if you've got any immunosuppression, you need to be thinking about that. And then the mycoplasma.

These are big players. I'll show you some, oh, well I'll show you some data. No, I didn't put it in.

I'll talk you through it now. OK. So, mycoplasma.

So we know that about 20% of cats, you will find mycoplasma. These are not the hemaplasmas. These aren't the ones that get into the blood.

They're respiratory ones, although they can get into joints, particularly in babies. So, Mycoplasma ellius, Mycoplasma gatii, and Mycoplasmafileinum. There are others as well.

There's our Ginny. They're all players, about 20% of cats normally will have low levels of my mycoplasma, particularly elus, in the back of their noses, low level, and it's not causing them a problem. Once you get to having severe upperspirator tract signs, then you're gonna find 50% are positive, sometimes a little more than that, 60%.

And, it's gonna be a high level. So really, you know, if you do a quantitative RPCR, then you're, you, quantitative PCR, then you'll find them, particularly Felis and Gatti, the others less frequently. If you're actually interested in looking at gingerous dermatitis, again, you're gonna find that in about 40%, which I think is interesting, and 40% of severe conjunctivitis.

So you can see that the mycoplasmas need to be considered. If the cat is from an equine place such equine stables, etc. Then streptococcus, zoomacus, normally called strep zoe, can also be a player, upper or lower, and it can be really bloody.

So please always consider that these cats do demonstrate a potential zoonotic risk, not just a risk to other cats. So it's not just viruses and bacteria. We're also looking at worms.

A strong and stosis is obviously our most common, one, finding that in about up to 5% of cats in Britain. And then capillara aerophilus, also called Euolus aer aerophya. It's less common, that's the smaller worm.

And if the cat has come from abroad, which of course, we're now seeing that a great deal. That is going to be, a, a risk of roglus strongylus revira, particularly if it's come from, Italy, Greece, etc. And lung worms like to travel again, they're party animals, so if you've got one, you may have others.

You think of them causing lung disease. Obviously, that's true. But when they, they go in through the bowel, migrate across to the lungs, but then remember, the small worms are gonna have to come up the, trachea, get into the nasopharynx, and then be swallowed.

Some of those worms get lost and can cause a lot of irritation around the nose. So sneezing, chronic rhinitis, I've seen really bad retropharyngeal lymph node involvement. So please don't forget lung worms.

And almost always comes into play, airway irritants. So just to look at these pictures, another thing Liy can do. This is palatine ulceration, and sometimes ulcers in the hard palate can be going to the palatine artery and you can get severe haemorrhaging.

This is acute pharyngitis, and I hope you can see this cat is in quite a lot of distress. She's, her, her throat is really swollen. She's really toiling to breathe.

And then this is another calllei ulceration on her tongue. Thanks to everybody who provides me pictures. I'm very, very grateful.

So epidemiology? Well, I think we're all pretty good at the epidemiology of respiratory infections right now. Yep, I think so.

So aerosol is your major player, but obviously if a cat is in a cattery, then if you've got a very snotty cat, like poor little Benji here. Then all of the slot that gets left around the, the metal work in a cattery or in our own clinics can be hard to clean off and cause infection. Survival in the environment, if you're talking about herpes, it's not that long, but Khaleesi, it certainly can be.

And what about carrier status? Well, this is where herpes wins the battle. Remember, herpes are always friends for life.

About 80% do become lifelong carriers, and that can then result in intermittent shedding whenever the cats are stressed, for example, by going to a cat show if they're a pedigree, by going into a rescue centre, by going into like, a boarding cattery. See, certainly they, they shed always for at least a month, and you can see that, you know, even after 75 days, half of them are shedding, and up to 25% become lifelong shedders. So it's something you've always got to consider.

And border teller, obviously cats can become chronic, chronically infected, but I'm always gonna look to blame the dog. I know. I'm I'm, I'm speciesist.

Epidemiology, do you need to know what the cause of the infection is? A lot of the time you don't. You're treating a cat as a one-off snotty cat.

But if you've got a cattery problem, then you do need to try to get to the bottom of it. So, here's chlamydia, which from Andrea Harvey. Thank you, Andrea.

Thank you, everybody. Mycoplasma could look just like this as well with this horrible chemosis. He picture from from Francis Harvey.

I don't think that's right. It's Andrea again. My apologies.

I'm sorry, Andrea, I just looked at and I thought no, this is your picture, and you can see his eyes are really inflamed. Sometimes the ulcers are very small, so you need to look at them very carefully. If you see, tongue ulcers with ulceration around the toenails, be worried because that is likely to be virulent systemic leivirus.

So the nature and the duration of the clinical signs might give you a clue. Are the colony problems? So are you also seeing FIP?

Have you got reproductive problems, that's more likely to be herpes or Chlamydia and the age group, it really depended on the vaccination status. So mostly you don't need to know exactly which bug you're treating, you can treat empirically. But when you've got a significant, really sick cat or more than one cat, you're gonna need to try and find out what.

So you can either do PCR and or culture and isolation. If you are doing culture, you need to use specific transport media, preferably using a fine ENT swab. These aren't available at the moment because of COVID.

So we're, adapting to using others. Do not use ones with a big cotton swab because lots of cotton will negate the PCR. It will be a negative PCR.

So you can get little cellulose swabs, which we've started using. You want deep swab in the conjunctivy and the the pharynx. The lab I use is the veterinary pathology lab because they have extended, used to be CTDS and while all the labs do herpes, lay and chlamydia, and Bella, Most will also do mycoplasma files, but only the vet, group, vet group.

Do mycoplasma gatii and glows strongtosis. So that's important. The, if you're thinking it could be worms, obviously, you could also do, a bain.

Isolation on the faeces. Or you could do a test trial, treating for worms, but remember that you need to get the owner to do that on a morning where they're going to be able to observe the cat, because it could be that you've got a, a lower respiratory infection as well, which you're going to have if you're going to have upper respiratory, but it could be severe in the lungs and show very little sign. And if you then have lots of dead worms, those cats are gonna get into trouble.

You might need some corticosteroids. If you find herpes virus. That's good.

You've got the confirmation. You can know what you're treating, but it's often shared very intermittently. And if you find Calei, you don't know whether it's wild type or it's the pathogenic type.

So that's a bit frustrating. We don't often do bacteriology, but you could do that for Bolla or mycoplasma. We do it for, for lung flushes, but not really for upper respiratory.

I do do cytology, and sometimes, particularly in kittens, that I've been very sick kittens. Particularly if they've had upper respiratory and GI signs, you could have a congenital defect in their, immune systems, and sometimes you'll find a whole load of candid yeast in the pharynxes, which will tell you you've got an immuneo suppressed, cat. So how do we treat?

Usually, empirically, as I said. Most important thing, nursing care. These kittens need to be made to feel they want to live.

Look at these 4 babies. They are miserable, just miserable. They need their faces cleaned, and their eyes lubricated, lubricate around the eyes a little bit so that the, the discharge is easier to clean off the following time.

They need to be groomed so that they feel better about themselves. Cats groom, it makes themselves feel good, so we need to do that for them. They're not gonna be eating or drinking, so you're gonna need fluid support in a lot of these cases.

To be honest, some Q fluids is usually enough in many of them. If not, go for IV. If they're not eating, etc.

You're gonna need to correct the metabolites. If they're not eating, then vitamin B12 is likely to be low, so let's give them some of that. I'll come back to, appetite stimulation, etc.

In a second. Cat-friendly clinics, you've got to really think about being a cat friendly clinic to look after these babies because you need to be looking at them holistically at this little, this is a little Siamese who I treated 25 years ago now. And, her nose, mouth is all ulcerated.

It was really, really horrible. And she just couldn't breathe. So she's open mouth breathing.

It's very unusual to get a cat to do that. And hence, we've got a megaesophagus, and we've got a massive gastric distention. And you can see her intestines are full of gas as well.

And a brilliant, You, vet student was looking after her with me, and his wife had just recently had a baby, and he suggested I tried some infool, which is methicone, and just half a mil, this little girl, she swallowed it. And then I, and she was on his shoulder, and he was patting her on his shoulder, and she let out this huge burp. She looked more stunned than we did, because clearly cats don't normally burp, but after that she was able to start eating.

So if they've got real nasal congestion, you might want to think of some ethicone. It's in for cold if you go for the kitty one or I think it's called the from for large animal. If you're not, a cat friendly clinic, please have a look at the International cat care web page on this.

It gives you all the guidance you need to become one and it's a good thing to be. What sort of things can we do? Reduce stress, reduce fear.

These kit cats, often babies, they're young, they're scared, they're painful. You know, when you've had really bad flu, your joints hurt, all your mu mucosa and your nose hurts. So let's make sure we're trying to reduce the pain, whichever way is sensible if they're not, if they're not dehydrated, then meloxicam would be a good way forward because it's a liquid and easy for them to, to swallow.

You could use buprenorphine. . That would be a good one, but gabapentin works well.

Gabapentin is an appetite stimulant, which can also help. We have catnip in our ward, and we think, that some cats seem to feel better when you put some catnip in with them. They don't get hyper excited.

They just rub against it, and it seems to make them more comfortable. You've got other things to consider, the feely way. Classic sprayed into their beds, and Optimum, which is Philly Wa Classic to reduce anxiety, and Philly Wa friends to help them cope better being surrounded by other cats.

You've got pet remedy, which is also reducing anxiety. Some people find that particularly useful. Whatever else you do, please, please, please weigh the cats daily and calculate the percentage weight change, cause these cats can drop weight really easily.

We're gonna need to stimulate the appetite. Now, we all know how to do this. I just put it on a on a page just to remind everybody, this is where good nurses are absolutely worth worth their weight in gold.

Small tempting meals, actual hand feeding them. What's really important is don't make a smorgasbord of, of bowls, you know, lots of different bowls with lots of different food in it, and then leave them around the cat. That cat is gonna get completely overwhelmed and then not eat anyway.

Sometimes it can help to roll, raise the bowl up. I think they can breathe a little bit more comfortably. And if they're an elderly elderly cat, it'll help if they've got elbow arthritis.

There are lots of different liquid diets, and these can be easy cause sometimes these cats can lap if they can't actually eat. Some of my favourite are the gourmet, soups, very expensive way of feeding a cat, but they can be really, tempting. We've got, Purina Hydracare.

This is a, a liquid supplement. The cats will, will lap at it. This ends up with the cats being an increase of 20 up to 28% of, water consumption.

So that is great. I've also, the Sheba soup seems to be pretty good, and some people really like, oral aid, and we've always got our, our old favourite of, A Hill's AD, but you can see there are lots of others available and I'm sure in your practise, your nurses will have their preferred ones. What about drugs?

Well, quite often you do end up having to give these drugs to these cats drugs to, entice them to eat better. Mirtazapine is obviously our standard, and yes, you can give it by mouth or percutaneously. And that can be really, really useful.

So, that's the, the, the Decor on. What I would say though is you don't usually need to use the whole tube on a single cat. So I wish they came in a slightly smaller container.

Gabapentin. It's going to be reducing pain, discomfort, anxiety, and it's an appetite stimulant, so that's pretty useful. I gave it to my cat for his, car sickness, over the weekend, and the effect on appetite stimulation was, was amazing.

We've now got aura as well. This is the cat version of Entice. It is a ghrelin antagonist, rein receptor antagonist.

It's carpal rein. It's licenced for the treatment of cats with chronic kidney disease, but it would be very useful on cascade, to use it here as well. It's typically treated at 2 mg per kg.

For us once a day. Sometimes that is too strong, too, too, too much, and one make it can be better. If the cats are dehydrated and things, it can cause low heart rate, low blood pressure, drooling, GI subsets, etc.

Can mess with the blood glucose a bit. So best not to use it for cats with, diabetes. Cupraheptadine is what we used to do.

I don't think most people use it anymore. Now we've got much more readily available things and actually propofol, interestingly, given that sub-hypnotic doses can cause And reduce drug-induced anorexia. Different options.

If the cat hasn't eaten, then vitamin B12 is always gonna be your friend. Make sure that doesn't get too low. Some people swear by anabolic steroids, but there are really no recent studies at all.

I think it is worth considering anti-nausea drugs because these cats are often very sick. Yeah, so, you know, it's when you've got flu, you know, you just feel absolutely miserable. And so anti-nausea can help, as can prokinetics, particularly if they've got aeropasia.

And more often remember is also has an analgesic role. So lots and lots of drugs that can be helpful. But if not, we're gonna need to place a tube.

We need a feeding tube. So, we'll need to pay for tube feeding. They're completely anorexic or just profoundly, hypoorexic, then we're going to need to feed them.

Remember, if they haven't eaten for 3 days, we must do this, or if they've significantly undereen for 5 days. And if they're overweight to start with. So RAR, there are lots of calculations, but actually a standard calculation does actually work pretty well.

Cats don't vary in size that much, and I'm a a they're a simple brain. So I use 50 kilocals per kilo per day, reducing if they haven't eaten, for a long time, particularly if they're fat or they've got liver disease. Which tubes?

Well, look how sore this mouse is. This, this poor little cat is, is not gonna be eating voluntarily. Please don't put tubes up their noses.

They've already got significant pain and damage in their nose. If you feed them with nasal feeding, you are going to get really high risk, but they're going to get chronic, upper respiratory tract disease, after you get them over this flu. So I really love O tubes, and this is a kitty collar, you can see it just makes it so much easier for the cats to to to wear and once they start eating, then they can eat pasta.

Just to remind you, when you first start feeding them, introduce feeding over 3 to 4 days, initially just some lukewarm water, make sure the cat's not horribly nauseous, make sure the tube placement is correct. Then give a third of the RER on day 1 and divide it into many small feeds. As many as you can manage your nurses can manage.

Then go to 2/3 requirement on day 2 and full RAR on day 3. But watch out for nausea, discomfort, particularly look out for gastric distention. If there is gastric distention, then you're gonna need to give some kind of prokinetic.

Say if there is significant risk of hepatic lipidosis, if they haven't eaten for a long time or they're obese or they've got other metabolic problems, diabetes, something like that, then you're gonna need to reduce the Dose amount of food per day, so you're gonna increase the the feeding slowly over instead of 3 days, 4 to 10 days. And O tubs really well tolerated. They do require a short, a short anaesthetic and a functioning oesophagus, which there should be in cats with upper respiratory tract, disease.

Radiograph. Placing to make sure it is in the right place. You don't want the tube to go into the stomach unless you're doing that intentionally.

If you think that the cat might end up with, GI stasis, then put the tube all the way into the stomach. If not, put it to just 2/3 down the oesophagus. What you don't want to be is kind of at the, the esophageal, junction with the stomach, as that's going to, irritate the diaphragm and apparently can make you feel really sick.

These are good because you not only feed through them, you can put medications through them. This is my little cat who's getting fed fast again. And this is one of these, this is a little cat who's got kitty hole on and she's having her medication.

What I will say though, I didn't think I had time enough to talk you through the whole procedure of placing one, but there's great stuff on the internet. When you suture them in, put the suture far away from the hole. Most people put the suture far too close, and that means it's really hard for your nurses, or if you're sending the cats home with the tube in place, the owners to clean around, and that's gonna be important because the cat is gonna be real lot of bugs in the front of this cat's face, and they are going to end up getting into this and causing a biofilm.

And a potential risk of infection. So you can fit one of these fire patches which is chlorine prophen. Yeah, it's funny.

What's the word I'm looking for? You know, the normal stuff, you, the detergent, we clean, like, I'm having a moment. Oh, what annoying.

Look up by patches, you'll see what they're infiltrated with and I'm really sorry I'm having a senior moment, but we really like these, . The same stuff, the pink stuff you put in heavy scrub. I, I can't remember the word at all.

This is a problem I'm having since, since the reaction to the AZ vaccines, actually, that knocked me about badly. But there we go, better than, better than COVID. I actually put the, the suture through the wing of the Atlas.

It's much more secure. And it seems more comfortable for the cats cause it doesn't move and wriggle about. And that's just, and keep the, the tube quite short.

That is easier for the, the, the cats to manage. So chop this, shorten this tube. Do not use all of this tube.

This is going to be, much too complicated for a cat for a cat to wear. And remember, suture, far enough away for a fire patch to place. Then I put a a spacer and then kitty collars.

But we've now got a Miller version, which is, which is cheaper than these kitty collars. He was my beautiful, beautiful old boy, Mortlak, who I lost aged 18, nearly 2 years ago now. He had his spleen taken out because he had a mast cell tumour in it, and he lived another 2 months theory I might have been lucky to get sick, but I didn't.

But I didn't want to be messing him about, with, with food in his, with putting drugs in his food or putting them down in his, his mouth. So we just put, an O tube in him. And you can see he's sat on my husband's knee and he's about to have his drugs.

So there's some really good, advice on how for owners to use these. Just go to the International Cat Care website. It's brilliant.

There's this other one as well, but just what none of them tell you, just having done it with my own cat, is these collars get grubby when you keep using them for feeding. So always place a piece of kitchen roll over it before you start, feeding. What else can we do?

Well, nebulizers are really, really good. So we want to, this is looked at with chronic rhinitis. You just fill the, the nebulizer chamber with saline, and then it puts tiny little saline particles all through the air around the cat.

You could put something expensive together, but we just use a plastic over the front, and you can see he's got his nebulizer there. And that's gonna mean the whole of the inside of his kennel is gonna become lovely and moist. And he's gonna breathe that in, and that's gonna moisten his nasal mucosa.

We use this obviously for lower respiratory tract as well. There is a, a much quieter. Inhaler, nebulizer than the, the, the cheap ones you can get from the chemist.

This one is the Flexeneb. It's beautiful but it is quite expensive, so it can for a short term. I, I wouldn't recommend.

But long term, then yes. Some people are using Mropotent diluted and putting it up their nose. I know it's a crazy concept, but it does seem to help, although it can cause quite a lot of sneezing, so we tend to put it up their nose with lidocaine to try and reduce that.

Ocular antibiotics, that with clophenacol or doxycycline, absolutely, you might need those if those eyes become horribly infected. A way of eucalytics or decongestants, and acetylcysteine is effective. That is, 600 milligrammes peros twice daily.

But the capsules are quite big. You're gonna need to open them up. And if the cat's got the O tube, perfect.

But if not, it's hard to get the cats to take it. And by solving really doesn't seem to work. Ocular anti-inflammatories, I do not have experience of these because we really haven't used them.

But the, Afrin is the, the trade name that tends to be used, but, this is more for a chronic case. I really have never seen a reason to use it, but the books will tell you about it. And if you're in the US you have a vaccine which is a live Caleian herpes vaccine.

So obviously that's gonna be good in the state of emergency, you can give it . The nose, and that's gonna prevent them getting infected. But interestingly, it gives you a more general protection.

It's not just for the the viruses it's got in its vaccine. It also protects against Bla bronchostica. No other infections are being tested, but the fact that it stretches to border teller tells you that this is a much more generic, effect.

I want to talk about antibiotics because clearly this is important. Human flu, no, you wouldn't get antibiotics, but with cats, there's a really good argument for using it, because it, herpes and cholei both cause mucosal ulceration. Herpes, particularly in the nose and the nasal cavities, Calei particularly in the mouth, but there is crossover.

And if you've got the nasal mucosa or damaged, then you're gonna get secondary bacterial infection which can cause . Lost another word, infection of the bone. I'm having a bad day, never mind.

So yeah, . I can't, why can't I think of that word as word finding. It's because of the, the damage the vaccine's done, but there you go.

I'm getting better. What I can tell you is that there is really good guidance out there, WSABA, ACIM, the gramme book, ISFM, etc. And the, really clearly stated in the International Society of of Companion Animal Infectious Diseases, this is ISAD, and it says cats and dogs with acute or chronic upper respiratory or lower respiratory tract disease.

First choice of antibiotics should be doxycycline perros. Cats, here are the choices of amoxicillin, dogs, amoxiclav. But there's a problem, isn't there?

Yeah. Doxy, our routine doxycycline hyclate like Reaxan here, is incredibly acidic. It's the most acidic drug we give.

It's got a pH of approximately 2 to 3, whereas the doxycycline monohydrate. Which is available from from Bova Labs as a paste, has a pH of 5 to 6, and in people has been shown to have a significant reduction in esophageal damage with equal bioavailability. And certainly I've been using it for years and I'm very happy with it.

But we do have one other option we could consider, and this is the doxycycline hyclate liquid. Yes, it's acidic. This is Carradox.

It's licenced in chickens and poultry for the treatment of mycoplasma, infection, respirator tract infection, and it's, it's a litre. It comes as 100 mg per mL, so easy dosing. And it's only 40 pounds for a litre, which is pretty good.

So we need to consider. How we might How we might choose to treat. We can certainly justify doxycycline.

It is the one that's recommended. And so therefore, either the liquid, or the late the sorry, the monohydrate paste. Just reminding you about Cascade, you are absolutely OK to use these on Cascade because there are no drugs actually licenced to treat upper respirator tract infections, in cats, not and certainly not that are going to be working, so it's your clinical freedom to prescribe the most appropriate drug.

If there is no medical product available for that, species and that, . A piece of the cat that's infected, then you go to something that's for another species for the same condition. So that takes you back to the carry dogs liquid.

We're not gonna go to human ones, but we've then got the veterinary special. And the reason that the veterinary special, that's the one from Bova, is so good is because of the paste, and we know that it's not, it's not anywhere near so acidic. Most importantly, you make sure the owners understand why you're doing this, and you keep good records, reporting any side effects you see.

So I mentioned antibiotics, you're talking about . Osteomyelitis. I've got the word again.

So you're talking about, osteomyelitis of the turbinates in the, in the cat's nose. So you can need in a severe case, 2 to 3 weeks of antibiotics. Clearly, syrups or liquids are the best way to go.

We used to use azithromycin, but it is now a tier 3 drug. So despite the fact it comes in a nice palatable solution, we really can't justify going there. What about other systemic treatments?

Let's go for antivirals these antivirals against herpes virus. Actually, I'm gonna say I meant to make a slide on, I've completely forgotten. Antivirals against Calei.

You've got you've got interferon at high doses. I will mention that again as we get to there. And we've now got the antivirals that we use for FIP.

Because it looks like they work pretty well for calicivirus as well, so remdezair or GS 44, 1524. My apologies for not including that as a slide. That's kind of very hot off the shelf.

So systemic treatments for herpes, we've got famcyclovir is the one that is by far the most effective. You do need to go high, ideally to 90 mg per kg, twice daily, and that can really get expensive. You've got the human version, or you've got a bova liquid.

The boba liquid is paste rather, is really pretty unpalatable. So it's got to be a cat who's got a good appetite to go for it. You've got Llysine.

Llysine does reduce shedding and clinical signs, but you must, must, must make sure the cat doesn't have all its food for the day laced with the lysine, because if it does, you wanna make the cat worse. Because this works like out competing with, arginine and cats need their arginine too. What about Raregravia?

This is a new one to me. There's a new paper out, well, new to me anyway. That's this paper, 2019.

And it turns out that not only it, it's a drug that's licenced treatment for HIV, it turns out that it also treats FIV. That's not surprising. FELV, OK, and herpes virus, and that's the dose.

I have not managed to cost it up yet. But obviously, we do have one paper, in cats, but obviously Far Cyclo, there are a lot more papers. So farylovi would be your preferred choice.

Systemic, interferon, so this would be, for calicivirus as well as for, herpes virus. We know that if you give this drug by mouth or topically in the eyes, you get production of an MX protein. An MX protein is an indicator of interferon activation in the white blood cells.

So there's some studies show yes, some studies show no. In this paper, which was FIV positive cats, this is a high dose, all right, that's a million international units per kilo. This is actually immunosuppressive dose, getting up there, which is interesting.

So I wonder whether it worked by immunosuppressing the viruses rather than actually immunomodulating. This is the same dose that I would be using for. Verily Collei.

Which hopefully I'll get to because I've been waffling on rather a lot. If you give 5 injections, sub Q, starting on day 0, day 14, and day, if they need it, 2 months. And in this study, reduced clinical signs, you see, 4 of the 4 cats with Calei resolved, 4 of the 5 cats with, herpes were very much better.

And you've got other suggested doses which are significantly lower, these are much more immunomodulation doses. And we have polypure immunostimulant, also known as vetimmune. This is licenced in the US, for the treatment of they call it rhinotracheitis virus, which, of course, is a herpes virus, double blinded study and a significant reduction in the clinical signs.

It's very, very safe, but you will need to order it in from the, the, the states. And it can be used topically. I'm gonna get to topical in a second for the treatment of ophthalmic hepatic ulcers.

So there you go. And it is the dose. What about topicals then?

I'm not gonna say so much about these because I really don't think many of us are using them very much. They are only virostatic. You do need to give them for at least 7 days post re resolution.

They're often limited by cost, availability, or just because they're really irritant. So trifluthyidine is incredibly irritant, and you've got to give every 1 to 2 hours. Well, that's not gonna happen.

Through to Sudofair, which isn't irritant, which is great, and it's only twice a day, perfect, but you need a compounding pharmacy, expensive. Zavarrax is one that people are using, which is acyclovir, where's gagcyclovir? Oh gangcyclovir, there you go.

That one is also being used, the vegan, that's the one that people can get hold of at the moment. That's, that's what our ophthalmology, team are using. Yeah, but it's still, you know, it's still frequent applications.

We can also use our interferon topically. Again, you see that, as I mentioned, the MX protein coming up, but there are studies which have compared the human interferon with the veterinary interferon and with saline, and they all recovered at the same time. So probably if you're going to be using interferon much more effective if you're gonna give it topically, if you're gonna give it systemically and only ever as an adjunct to other things.

What I would say is you definitely want to get some form of hyaluronate drops. So high back, remand, or the human Vismed. This is important because, herpes virus trashes the, hyaluronic acid in tears.

And that is why the eyes get so bad. That is why these cats get, corneal damage. And you, you can put it, or you can add interferon in any of these solutions.

So certainly in remand or high back, and that means you're giving topical interferon as well, plus oral fanvia. That is the perfect combination if you've got a very precious cat with bad flu. Just mentioning virulent Calei in the last 5 to 10 minutes.

It is not common. I've probably had to deal with, I think 3. I should know, yeah, 33 outbreaks.

These are horrible, absolutely horrible. They're, they've been seen anywhere and the biggie is their mortality rate. 50%.

And adults more than kittens. Kittens typically just show flow, whereas adults, even though they're vaccinated. Can get really, really sick.

These pictures from Kate Hurley show some of the early cases. It was first called applehead disease because the cat's got these swollen heads, very edematous. You see the ears are edematous, and the vasculitis in the skin makes them, you can imagine you could just touch them and they're gonna bleed.

Same with the feet. You can see these feet are very swollen. The skin is, oozing.

It's one of the Scottish cases, it's one of our cases. You can see the edoema of the eyelids and swollen face. So clinical signs, fever in almost all of them.

The peripheral vasculitis, certainly in more than 50%, the subcutaneous edoema, ulceration, nose, lips, ears, around the eyes and the feet. That is the thing that tends to tell you that's what you're dealing with. You've then got the standard signs of flu, so mouth ulcers, nasal discharge.

The respiratory distress can be from edoema and pleural and or pleural fluid, as well as the upper respiratory signs. And yet, oh, look, 10% get, ocular discharge. Jaundice in about 10%, and that really tells you the cat something's horribly wrong.

And that's because you've got a systemic vasculitis, which results in coagulopathy. They're gonna be bruising and ultimately in DIC and death. I love the fact that the papers say pleural effusion and jaundice are an indication of poor prognosis.

I'd say sudden death was as well. I know. So what about the pathology?

Well, clean past, the blood, it does what you expect it to do. Proteins, as an acute phase protein loss, increased bilirubin with the jaundice, creatine kinase, the muscles are damaged, non-regenerative anaemia and severe coagulopathy, necropsy, as per the clinical signs, severe pancreatic. Bronch pneumonia and necrosis, the liver, spleen, etc.

So this is a peripheral and systemic vasculitis, and this little cat's leg, you're clipping up to put an IV line in and you can see we've got all this ulceration, just horrid. Diagnosis, it's usually the epidemiology of it. You get more than one cat looking like this, and you just go, I'm really not happy.

This little cat, Archie, typical background, his, well, remember him, and I'll talk about his background, in the next slide. Or in a couple of slides, . Yes, you can isolate or get PCR for Calei, but that doesn't tell you, whether it is a vaccine strain, pathogenic strain, or one of these really pathogenic strains.

And each outbreak is a completely new pathogenic strain. So there isn't a, a specific test for this. Ultimately, it tends to be postmortem immunohistochemistry, so basically taking piece of the body after death like Archie's ears and doing immunohistochemistry for calicivirus.

And the epidemiology, well, I'm gonna keep Archie in mind here. Almost always there is a background there there is a cat that has met this cat that's come from a rescue centre. So anyone dealing with rescue is at some point likely to meet this problem, particularly if you've got a lot of, you know, big rescue centres.

And it rapidly spreads really rapidly. So you've got crowded, stressed environments. So multiple different strains of cholei, different cats getting reinfected, persistently infected, even multiply infected.

And so you're gonna get a lot of viral recombination. And you get an immunity developing, but it just selects. It pushes down all the the the wimpy Calei strains and selects for these highly contagious virulent ones.

And while the cat stays in that population, then it's kind of matched. You get little disease beyond a bit of flu. But it's when you take this cat and put it near another cat, then you get virulent systemic cholei, and that is because you've got to change to the viral pathogenicity.

This is just exactly what we see with COVID, of course, increased pathogenicity, or self tropism, and instead of wanting to replicate in the cat's nose, and the nasal epithelium, it's gone from the endothelium of the blood vessels. So this is what happened to beautiful Archie, not his fault at all. The owner had just bought in a cat which she'd rescued, he'd been.

Had a little bit of flu, but was over it now and within 2 days, Archie was with us with virulent systemic lay and we were not able to save him. That's. So, management.

I I love this advice because it is absolutely true. Just don't let them into your practise. If you're a referral practise, then you're in luck, because of course, we're a referral practise, but we've also got general practise, and that is how the cases have come to us every time.

You do need to trace contacts, and they can be shedding for a long time. Treatment, thankfully do have treatment. Oh, I have put something on the bottom here, but not in a useful manner.

I apologise that my slide is a scruffy. So treatment, high dose, interferon. This is a really good dose, monster-sized dose.

This is immunosuppressive, but it's antiviral. So you need to think about the fact that you're putting immunosuppression, so you're gonna need to cover them with antibiotics. Some people put corticsteroids as well to reduce the, .

The autoimmune effect, but actually the just the interferon at this dose will do that for you. If all your veins were on fire, I think you would want analgesia, and I really think that you must. Getting decent IV access is the hard thing because of the vasculitis.

And I can say, I will say to the owners, give me 3 days. Either they're dead or they're getting better. Other options now where you've got Tamiflu, which has been used, but Remdezir and GS 44 are 1524 and looks like mefloquine as well.

These are all drugs that we use for the treatment of FIP, and it turns out that, you know what, they treat calicivirus as well. Routine vaccination is not gonna help these cats because if you look at the routine vaccinations, so this would be F9 which you'd find in into that, that's the standard vaccine. This would be the Fort Dodge Boringeringelheim vaccine, and it only protects about 11% of the US strains.

In the UK we have got, pure vax, and pure vax is a bivalent protection, and it does reduce, it does give you protection against at least some of the European, virulent forms, reducing clinical signs. If you're in the US, then it's the boringa, Calei acts group that does it. So, Why this is important to point out is your blood donors, because at the moment, obviously, we can't get the blood from Portugal, so we've all resorted back to using our blood donors, which are usually, staff cats, and you want them protected as best possibly.

So make sure that they are protected with pure vaxx before they start coming into the clinic to, to give blood. And then lastly, whether it is cholei or routine flow, you need to address the infectious and the non-infectious causes of disease. Reducing stress is the most important thing, and that is almost always going to be reducing the number of cats you've got in the groups and reducing group size.

It's getting down to groups of 3, it tends to stabilise things. Increased air flow. Sneeze barriers which go up at least 2 ft higher than where a cat could sit.

I've seen catteries that have got sneeze barriers to half the distance, but then at the top of the sneeze barrier, there's a shelf for the cat to sit on, and they're just gonna sneeze into the kennel beside. Disinfection, routine bleach, is good, ercon, trigine, etc. Getting sunlight onto the areas can also work.

Quarantining any new cats coming into breeding centres are really, really important. And then if you really want to have breed cats that are Free of calicivirus, herpes virus, coronavirus, you need to do isolation, breeding and early weaning, which I'm not gonna go through because it's a very, very draconian thing to do. If anyone wants to know more about it, you can contact me.

But really importantly, if it's a rescue, if it's a breeding centre, then stop breeding, for at least 6 months to get everything to come back to normal. And then you need to be up to date with your vaccination. I haven't got time to go into that in this talk, but look at the WSAVA guidelines for that.

So I hope there was some useful stuff in there for you. there, there have been some things that have moved on, so hopefully some of those ideas are going to be useful and thank you as always for Webinar vet for organising this webinar. Thank you.