Good evening, everybody, and welcome to tonight's webinar slightly earlier than we used to, but, a big welcome to you all, nevertheless. A big thank you to IEX, our sponsors for tonight. For without them, we wouldn't be able to bring you this webinar.
So my name is Bruce Stevenson and I will be chairing tonight's session. For those of you that haven't been with us before, just a quick bit of housekeeping. If you have a question for our presenter, if you just move your mouse over the screen, you'll see a little control bar.
Normally a black bar pops up at the bottom. There's a Q and A box there. If you just click on that, type in all your questions, we will hold those over to the end and we will get through as many of those as what we possibly can.
So tonight's webinar, is, as I said, proudly sponsored by IDEX and our presenter tonight, is, a very, astounded speaker, Diego. And Diego, graduated from the veterinary programme at the University Autonoma de Barcelona in 1998. And a short period of time practising in small animal practise, after which Diego focused on feline medicine from 1999 to 2016 in TotCA, the first cat-only clinic in Spain.
He then started a new position at Clinica Filia, Barcelona. Diego is a member of the AVEPA and its feline study group, the GEMFE where he is a former president and a member of the scientific community. He is accredited with the AVEPA in feline medicine in 2013, and he re-accredited again in 2018.
Diego is also a member of the ISFM and the ESVE where he was a member of the Alive Committee focused on diabetes mellitus. He was, he has made two externships in private practise, both in the UK and at Ryan Veterinary Hospital in UPenn in the USA. Diego is the author of several papers, a book, and lectures, and a national and international conference speaker.
Diego, welcome to the webinar, vet, and it's over to you. Thank you very much and good evening to everyone. And thanks to IEX to sponsor this webinar and obviously thanks to the webinar vet who they host us during this, this evening.
So the topic is, quite, uncommon, in terms of, scientific, topics because it will join the, the, the climate change and obviously it's evidence-based and, the, the science that we have from the, our feline patients and their diseases. So the, this is me and in, in front of the clinic, so you are very welcome to our clinic and this is my email in the slide if you need to ask some questions or if, even if you are in Barcelona and you want to meet us. The agenda of this webinar will be covering very briefly because I'm not a weather expert, some, evidence-based, climate change, problems or, or not problems, but, and also the experts that are living in Barcelona, I have some data and the impact on the, on the, maybe the pets, the cats that you are going to visit in the near future.
Then we will focus on gastrointestinal infectious agents and some, in one case of a multiple gastrointestinal causes and another case mimicking other diseases, then we will focus on gas cardio pulmonary parasites in the, in the topic of feline asthma or thinking about feline bronchitis in cats. And finally, we will discuss feline leishmaniosis, which I, I, I suppose that you agree that it is an emergent disease and maybe in the near future, you will have those patients in your clinic, but I have to say that obviously feline lemaniosis is much less common than canine leishmaniosis. And the end, we will have some time to do some questions if you, if you wish, and, and I will answer if I know the, the answer, obviously.
And let's start. So, this first slide is about the climate change. I have to say again, I'm not a cli a weather expert, but I, I remember listening to our radio new about this, this paper that was published back in 19 in 2019.
And it, it's like a game playing how different pairs of cities could compare in terms of climate in the future. So in the case of London and Barcelona, because there, there are some other city pairs in the paper, they, they, they, they told us. That in the 2050, in our future, but not too far from now, 25 years from now, London will have Barcelona's climate, so don't, don't be in a rush to move to Barcelona because you will have our weather shortly.
Obviously, I'm not joking. It's a huge problem, but, it's something that the weather experts are just mm expecting to happen in the, in the near future. Then, we need to know how many of your, country's citizens are living at the moment in Barcelona.
And I have found some data from the city hall in, in Barcelona showing that there is an increase over the 5, the last 5 years in numbers of British and Irish citizens. Moving to Barcelona, it's an increase in the UK citizens of 16.7% and 50 45% of more Irish citizens living in Barcelona.
Obviously the Mediterranean climate, good food, which is an, an excellent, . Healthcare because it's public, and public transport is some pros, but there are some cons like high rents, low salaries, and probably hellish bureaucracy. We, we still do have these kind of problems that can trigger.
Some of these citizens and this expats to go back to their original countries and obviously there are some other problems because the, the law or the rules to move back with a pet, so the pet import legislation has changed, some years ago and in some cases could be less strict and allowing some of these cuts bringing home some parasites. So, why worry about parasites if you attending some cats coming from Barcelona. We do see parasites like in the rest of the world, we will focus on some of them because on, in, in, in, for, for questions of time that we have, we will, need to, to be very concise and maybe not covering all the aspects, but we will tell you.
Just a little bit about gastrointestinal parasites, both run worms, tapeworms, and protozoans. We will discuss then this pulmonary parasites that could be in the differential diagnosis of cat asthma like allotroylus, trastrongylus, and Echoleos, formerly named capillaria. Then, also, very important because, I, I was thinking also when they, they taught me about, this climate change impact about something new, we discovered this year about Diohilari meats in our practise.
Well, it's important as well to think about fleas and ticks and less money at the end. So, if we have a cat with gastrointestinal disease, we need to just do a a problem oriented approach of the clinical signs that the cat will have. And The first thing, to rule out any dietary change and any abrupt dietary change that they could do, just rushing to the pet shop to, to find another brand because the, the, the, the package at home was empty.
Some clients do still do this kind of very rapid or quick change to another brand or another type of food and it's just the, the only reason to, for the cat to have diarrhoea or vomiting. But also, there are some hypersensitivities to food that we need to rule out. And if, the next maybe step could be to rule out infectious agents like the viruses that we all know, Coronavirus, very common, but very weak reason to, to think about, when it, this is a chronic diarrhoea.
Or chronic vomiting case because you know that feline enteric coronavirus can cause just mild clinical signs for a couple of weeks at last, and then it, it's not the case that can have a mutation and cause a feline infectious. Peritonitis, it's something you don't need to worry about. Then the feline leukopenia virus, this arbovirus that it's much more severe, can be fatal.
We will discuss a little bit later, leukaemia and FIV and if it's bacterial, specifically now that some people is starting to feed their cats, raw food, . Salmonella, campylobacter and the protozoal agents like Giardia, cryptosporidium elli and also in some cases sparum and retrichomonas black borne, formerly known as foetus. Obviously, it's still common to find some worms.
And then if we have ruled out properly the infectious diseases and the dietary mm or the food responsive and theopathies, we need to think about the immune-mediated, diseases like the inflammatory bowel disease. Just remember to rule out metabolic diseases like hyperthyroidism in cats, specifically in all cats. Sometimes in young cats or not so old and neoplastic disease and this is maybe a way to think about these kind of cases starting with the single men, the environment of the cat, the dietary history, the antipar parasitic or drug history.
Vaccination response to previous treatments and the physical exam. This should be something to keep in mind when you deal with an a gas intestinal problem in, in, in a fila patient. So, let's start with clinical cases.
I'm a clinician. I'm not a professor of the university, so I work with cats. I work with clinical cases every day.
And I used to find easily more easy to, or easier, sorry, to, to, to show these different aspects showing a clinical sign. Batal is a domestic short haired 44 months old, entire, entire male was rescued by a, a shelter association, but at the moment that I saw Batal was in a foster house and they already knew that it was positive to a snap test to the feline leukaemia virus. It was not, that moment known if it was a progressive infection.
So, second test or a PCR was, should be done to, to assess if it was progressive, progressive or regressive infection. But the cat was presented, presented at the, at the clinic because of diarrhoea. The faecal score was 6/7 and the cat was at the moment, eating a gastrointestinal diet and a probiotic called fortiflora.
The country was not vaccinated, although it, if it was vaccinated, it's nothing that you need to think about when dealing with the result of the Snap test. So think, Mm, every time you do a snap test for leukaemia, that the antigen that the test shows you, if it's a positive result is different from the antigen that is provided for the vaccine of leukaemia. So, no worries if it's vaccinated or not, regarding the leukaemia snap test.
When we did the physical exam, the abdomen was distended with some gas, and he was not hypothermic and the body weight was 900 grammes. On the CBC and the biochemistry, there was an anaemia that anaemia was regenerative and it was something that was concerning us because it was a, a young cat and it's not something you, you normally see in a young cat. And doing some extra work with the faeces, we detected, in a snap, in the GRD snap, a positive result.
And on the microscope, microscope, we detected some X of Toxocara Kati. So, at the moment, we started withendazole to treat both Toxocarin and Giardia for 5 days, 50 milligrammes per kg every day orally and mm, we kept on probiotics and gastrointestinal diet. The problem is that Batal was not doing well.
So, the diarrhoea was not resolving and the cat was stopping to eat. So, in the 3 days follow-up of Batal, he was 10% dehydrated. Even there was a normal cardiopulmonary auscultation, the rectal temperature.
You, you see that it's not a true hypothermia below 35, but for a kitten, 37.4, it's not very easy to handle. So, I mean, if a cat is dehydrated, the temperature is not 38, close to 39, I start to be Concerned about sick, a very sick cat.
The cat was depressed and there was no pain on the abdominal palpation, but the cat was losing weight when a kitten used to gain some, maybe approximately 100 grammes per week, and sometimes more. Then we did The snapparbo, the, the caninearboviral virus, test, in the, in the faeces of Batal and it was positive. And he was not vaccinated, but again, it was, it's not shown in, in, in all cases that we did snap test that this test could show a positive result because of vaccination.
So commonly than with the PCR that sometimes we, we see. The cat was not showing leukopenia. And remember that this test is used of lab when you use it in cats using the canine test.
But it's known by the ABCD group and other papers or other publications or guidelines that it's, it could be used on an emergency basis to determine if, if the cat has a feline leukopenia virus infection. So, how can we treat fatal? Batal is, has different causes of this diarrhoea.
This is, he is this is vital in the, in the infectious area of the clinic and, and was already diagnosed from leukaemia virus, arbovirus, Giardia, and toxoarakati. So at the moment, he was not doing well. So we started with IV fluids, supplemented with potassium chloride and a multi multivitaminic solution.
If you are interested in the use of this kind of approach, you can read this paper I show you in the, in the right corner, in the low like, right corner of the slide where they show an increase in in In success of this kind of treatment when we use this kind of approach. We, obviously kept on looking at the CBC on a daily basis because you know that the, the, the feline panleukopenia virus and infection can lead the patient to a severe panleukopenia. But it's not, every case that can show it, show it.
Even some cases with a severe panleukopenia in the CBC, sometimes they don't show diarrhoea. So, should be, look for everything in, in these patients and you cannot exclude panleukopenia infection if there is not panleukopenia in the CBC. We also treated fatal with interferron omega, with Birgen Omega for 5 days and Batal did well.
He was discharged after 9 days with a faecal score that was not absolutely normal, was 5/7. And a normal appetite and doing well. So, we just rechecked him 30 days later and on a follow-up visit, diarrhoea was not present, but we found two additional problems because this is the, the, the back of the battle and you see that there are some depiidium arising from them and It, you can, you can think maybe that the previous treatment should go this parasite, but it's not.
Thebendazole is not effective against dibiumaninum and obviously, you can think about this microscopic. An evaluation of the faeces of of fatal, and again, Dyum caninum, is not, easily recognised on faecal samples, on a fresh, sample because they, they don't produce, the same kind of egg like toxoara. They, they, they can act normally, .
Excrete this this gravid proglot it by the, by the, with the faeces like you see in the video. So, We need to add DPDaninium to the list and also to add fleas because they don't have DPluaninum without the ingestion of fleas. So in this case, we can say that this cat with a feline leukaemia virus infection has also different agents that were responsible for the diarrhoea.
And also, I, I want to mention that in the past, there was a so-called Panleukopenia-like syndrome associated with the feline leukaemia virus infection. Now we know that it's not true. It's two infections at the same time.
So cats with low white blood cell, low low white blood cell count and diarrhoea. Even if they have leukaemia virus, normally they are coinfected with the feline panleukopenia virus and and it's two viruses at the same time. Batal did well for several years, but, you know, this is something very sad that cuts with progressive feline leukaemia virus infection like Batal was usually have leukaemia.
So at the end, this is the slide, this is the picture, sorry, of, the, the, the blood smear of Batal 5 years after this episode when he had An acute lymphoblastic leukaemia that was not easy, was not the, the leukaemia didn't respond to the chemotherapy and he was dying because of this disease. OK. So we're changing from a shelter or a, a rescue cat to a purebred cat.
This is Hulk. Hulk is a, an exotic one year old castrated male that is an indoor cat, vaccinated, the worm with a premium dry cat diet. And living very happy at home.
But the main complaint for visiting us was diarrhoea and some vomit over 5 months was referred from some colleagues from another clinic and he was showing some mucus in the faeces, . Having a passing faeces 5 times a day without blood and was already treated with fambendazole because they, they detected some Giardia cysts and also they sent a hulk because of a low CLI and a high B12. And they also treat it with me metronidazole because of, of a suspected these biosis.
It's something we don't recommend and it's something it's not done in the, in the, in the present, but it was something very common in the past to use, metronidazole in, in these cases. So, on the physical exam, everything was normal. The body weight was not very high.
It was a very small cut, 3.5 kilogrammes for a 1 year old is not a huge cut, but it's an exotic cat. Sometimes they are tiny cats.
And the body condition score was normal, was not hypothermic, and our problem-oriented approach was a chronic large bowel diarrhoea. So, some tests were already done. So if it's something, quite, recent like in this case, we just evaluated the C CBC and biochemistry, the protein electrophoresis, the faecal exam, and also this leukaemia, immune deficiency, folate and cobalamine tests and the TLI.
So everything was already done very recently before the referral. The ratio, the, booming to global in ratio was 0.79, which is something that you must keep in mind because in the, in the FIP world, when we think about FIP and sometimes young cats, you, you need to keep in mind.
These three letters, ratio over 0.8 is something, very, pleasant. You, you feel relieved, maybe it's not the case when you think about confirming or suspecting the disease, is when you have a ratio below 0.4.
So, my apologise, this is real life and I have results in Spanish. So I will speak about all, all these results and you maybe will recognise Some of the words because are similar. So folate in Hulk was 28.5, so a little bit higher than normal and was something compatible with this biosis.
TLI was low, was 1010.6, and the, the reference range was 12 to 80, 82 and cobalamine was 1000. 984, which was higher than the upper reference range from the lab and was 11 of the main complaints of this referral vet in terms of looking for a disease, that you remember that in the past, not now, but in the past, most of the labs just explained this higher.
B12 results because of, or suspecting liver or cancer, liver disease or cancer. So, it was quite common in the past to, to have some cats coming because of these high B12 numbers and this mm, just a couple of, of sentences below the number. So, when we think about TLI, keep in mind this is the paper, this is the paper where Paoinulis and and Steiner obviously just described the exocrine pancreatic ins insufficiency in cats and it's just what I, I told you.
Sometimes, numbers are numbers and even if it's below the reference range in this paper, they, they just showed the commu the veterinary communi community that you need to Pay attention to the cats with less than 8 in TLI even if the reference ranges from 12 to 82, the true affected cats are the ones with less than 8. And in these cases, normally, they have even they, they, showed in this paper that 77% of cats with TLAs, so with exocrine pancreatic insufficiency, have hypocobalainemia. So it's not normal to face a, a clinical case with low TLA and very high B12 because you remember that, that B12 cobalamine is absorbed thanks to the extrinsic.
Factor that is produced by the, by the pancreas in cats. So it's, it's needed this, this, factor from the pancreas. So in the pancreas is not working well in cats that we treat from affected by exocrine pancreatic insufficiency, we also need to, to treat this hypocoallainemia.
So, what we did with Hulk, and needed some other test to confirm a diagnosis. So we just recommended an abdominal ultrasound, a colon flushing, and maybe a faecal, a faecal PCR. I don't have the video of the column flashing of Hulk, but I do use this video from the North Carolina University of the group of Jodiookin showing you how to perform a column flushing.
And, and I did it with Hulk without any sedation or anaesthesia because sometimes we, we have the feeling if the cat is comfortable or, or not with this technique when you insert the, the thermometer or We can test with a small probe if they, they are happy or not with that. So we, we can use some worm saline, sterile saline, and we insert 10 millilitres, maybe in some cases more if it's a Maine Coon. And, and then we, we, we just aspirate the content from the colon and you get a very nice sample.
So, that's what we did with Hulk and also we did the abdominal ultrasound and you see that in the, in the picture, there was an increased or borderline intestinal thickness in the colon and the mucus layer was huge and that was all. So, we, we, we, we were thinking about Tsikomona foetus, and we, we, we, if you want to read a little bit more about this approach to the right diagnosis, the sensitivities of the, of the PCRs, that type of samples you can get from a cat when you suspect this problem. This is the paper.
It's, it was published in 2017 and, and they discussed the different roles of the, the cultural media and column flashing and the faecal loops. And it's something that we, we cannot explain for an hour now and it's something that, that is very interesting and I am sure that most of you are aware of this parasite. And this is the, the real video from Hulk.
You will see some parasites, some Trichiomonas here, here, and here, and some of another one coming from the, from the, from the bottom of the video. And then you need to pay attention to the movement of this Kind of parasite because it's different movement comparing to Giardia phosoides. Remember that the 3 trichomonas moves in a straightforward motion, but Giardia is like a leaf falling, and this is something you need to be familiar with.
Another interesting paper, also from the same author, Jodyookin and other colleagues, is the, this paper published 6 years ago now, regarding the type of samples and the effect of some drugs on the PC PCR sensitivity. So it's a huge number of cats, so 1,717 cats and they compare the, the number. Of positive PCR test results when they obtained the sample from a normal voided faecal sample or it was used a faecal loop, the, the one that you see in the left upper corner, or when it was obtained by a colon flushing.
So, if it's possible, so the, the summary or maybe the, the, the, the, the take home message. Use the column flashing or the faecal loop to increase the sensitivity of, of, of your PCR. And keep in mind also what it's in the, in the chart here at the bottom.
There are some drugs that can decrease. A lot, the, the sensitivity of the test. And if it's something that you don't know, you can wait 15 days normally and you can do it, after, just, a period of time without any drug that can interfere with the test.
So Hulk was diagnosed an infection of treaty common as Black Burney. It was not something related with the pancreas. It was not something related.
With alteration of the B12 and maybe it was a coinfection because in the lab, they saw Giardia cysts and it's quite common to find Giardia associated with Gritiomonas, and obviously, if it's responding to the treatment for Giardia, we don't treat retriomonas, but in this case, since the, the referral bed treated Giardia and the cat was still on there. Yeah, we decided to go on ronnidazole, and tronidazole is a non-resistor drug. You need signed in consent from the owner and advise or warn maybe better that could be causing neurotoxicity in cats.
Although, the, the, the, the dose and the frequency because the dose is the same, but the frequencies, Just once a day and in the past, we treated these cats, these cuts with twice a day administration of the same dose. We don't see routinely neurotoxicity and but we still request an, an informed consent signed by the owner. This can resolved the diarrhoea in 7 days.
It was a 14 days treatment and there has been no relapse. And my experience with this parasite were presented in an ICBIam Congress some years ago, because, at the beginning, all the veterinary community was very active looking for differences of the feline trichiomonas with the cattle tritiomonas foetus. It was not known that it's a different, there is a small genetic variation, but it's a different parasite.
And also there were some, well, interesting, aspects of the way we obtain the samples, if we're, if the samples of the faecal samples were cultured before the PCR or not, and this, this is what something I presented from The, the 15 maybe first cases I saw back some, some years ago, 2007 to 2010 in the Toulouse, 2010 EB Congress. OK. Moving on to a different topic, but still talking about parasites, then I want to present a different area, but again, maybe something you will see more in the near future if, if, if people from your country living in Barcelona move back to London or maybe another country from the north of Europe and Obviously, cardio respiratory disease is something we do see on a, on a, on a day, on a daily basis in our clinics.
Again, think about this, approach, the signalment so a a proper, history of the, of the patient. Antiparasitic drug history response to previous treatments in this case. Also, besides the physical exam, we will need some imaging and also some tests to be done in the lab like B man test, her heartworm antigen test or antibody test, and PCR for another agents.
Normally, we, we deal with these cases, with this dilemma, so we, we don't know if it's cardiac or respiratory disease when they present in our clinic, breathing with difficulties. Sometimes we keep in mind that cough is not the typical clinical sign in a cardiac disease in cats, but it could be something, especially when there is pleural effusion. And when there is effusion, It's something that can help a lot because we can do total protein and assessment, we can do a cell count, and also we can do a snap, a pro BMP snap to determine if it's something cardiac or respiratory.
And if we just focus on bronchial disease, as I told you that we will discuss a little bit more about parasites and And, and this, asthma, a scenario that we, we see so, so commonly. We, we, Typically think about two different scenarios so we can deal with an allergic patient, so as asthma, or we can deal with chronic bronchitis related with other infectious agents, sometimes not easy to, to diagnose. If it's asthma, it's an allergy.
So eosinophilic presence in the tracheal was or in, in the bron bronchiolar lavage is typical. There won't be parasites because if we see Aosinophis, sometimes it's, they are related to, to parasites. And if it's a chronic bronchitis, could be related with some bacteria, we know, we know that chlamydia, mycoplasma, more mycoplasma than chlamydia.
Could be involved in, in these patients. And, and in this case, depending on your lab, it's preferred to do a PCR than a culture because they don't grow easily. And then also, this chronic bronchitis could be related with parasite.
So that's, that's, that's when, This, part of the, of the webinar is, is, interesting when we think about cats moving from Barcelona to your country or maybe in the future if the climate change changes so, so much. And in terms of imaging, we routinely use radiology. Also, ultrasound very commonly used at the beginning to know if there are bee lines or not, a fusion or not, and sometimes to guide our fine needle aspirates.
And in some patients, we need a CT and more commonly than CT bronchoscopy. So this is the typical scenario. So, a patient comes to you and the owner brings you this nice videos to show you what's the problem.
Sometimes they think they are trying to, to just throw. A hairball or something like that, and they don't think about cough when they see these episodes. But this is another presentation.
So this is a cat that I will present you in just in a second, in some seconds that was affected by lung worms and they can present it to you for the same reason for being coughing and also breathing with some difficulties. So, let's move on this kind of a scenario. Obviously, think about if it's indoor or outdoor, if there are some parasites, if there is only cough or also dyne, and look at the cat if there is an abnormal respiratory pattern, especially this restricive pattern that is something that you need to, to, to evaluate more carefully.
And use your radiology, not immediately if the cat is not breathing properly, just after oxygen and after some drugs that you can use to just do the radiology more safely and ultrasound, if you are wishing to rule out heart disease because sometimes they can present at the same time. So, Some cats with chronic bronchitis also have some problems in the heart and can be decompensated because of the, the breathing effort. And in some cases, it's not something we do see routinely in Barcelona, but in some areas, they do see also heart, heartworm, heartworm in the, in the mm pulmonary, our artery and it's something can be seen by ultrasound.
If you need to do some lab work in terms of cardiopulmonary disease, parasitic cardiopulmonary disease, you need to think about Berman test, faecal Berman test, and an antigen and an antibody test for heartworm. And if you do a, a microscopic examination of, of the mucus, you can use Jay was blindly or maybe better broncho bron bronchoscopy and a bronchoalvear lavage. And in, in some cases, even for some lung worms, the diagnosis could be achieved by fine needle aspirate.
So, this is Gattita. Gatti is not a cat from Barcelona. And then, and I present this cat very often because it's a very severe affected cat from the Canarian Islands, from a colleague, that I, I, I was helping her to obtain an accreditation in feline medicine.
So this, this, this video and the images are, provided and with permission from the Doctor Jessica Gonzalez. And I thank her for, for that because this is something, I used to teach, some vets in, in, in Spain about this disease that some cats can present with lung worm, not mimicking the typical asthma case. Some cats are heavily para parasitic and And in this case, she is 10 months old and entire female that was not vaccinated, not the worm, and was an outdoor cat, was coughing and with Taybnea and was in a very poor body condition score and muscular condition score without tachy tachy hypothermia but with tachypnea breathing 50 times per, per minute.
So we did some tests and, and obviously, this is something you can expect in these cases, the huge parasite numbers will appear in your, in your sample from the bronchiolar, alveolar lavage. And even if you are not seeing them on the fresh sample, you can stain the cytology and in the cytology, obviously, there are plenty of eosinophis and also you can, you can see some larvae, just in the, in the staining. If you are interested, there are some papers and, and obviously, parasitology journals will help you as, as well, distinguishing the, the two species, the two common species of lung worms, Aurostraylus and relostraylus.
In some cases it's, it's, it's interesting to, to, to know that there are some differences in terms of, the parasite cycle and also, can be affecting more kittens than other cats can be causing a very high number of parasites, can, can be associated with a higher number of parasites in the cat. But this is something, too technical to, to, to move on now. And these are the X-rays from Gitaita on the day zero was showing This broncho interstitial pattern with the right middle lobe consolidation and obviously with some air trapping.
It's a very not clear in picture of, of, of the lungs. So we, we were concerned and my colleague was concerned about, this problem, a lot. So, she, she did some recheck with radiology, but I can show you that on day 21 after combined treatment with Abendazole and oxidectin, it's not essential to do this combination, but in this case, as the cat was very affected by the disease.
She used this, this combination and it's, it's, shown in the guidelines that you can find, elsewhere, but, she resolved this middle, right lobe, consolidation and there were still, some, bronchial pattern in the radiology which resolved afterwards. But the most, well, easy to see in, in terms of the follow-up of Kaita is that two months after the, the, the initial presentation, she was showing a better conditions, body condition score and was breathing normally. OK.
So, thinking about asthma, we need to think about other parasite, theophylaittis, because there is this, well-known, heart syndrome or heartworm associated respiratory disease that is something you need to worry if especially if you see a cat coming from the south of Spain, or Even the south of Europe. It's not, as, as you will see as uncommon in other parts of Spain or even Europe. In this paper that it, it was shown in another part of the world because it was, this area, this headworm endemic area is in Taiwan.
In 2017, they compared to different populations at the same time. The ones that were affected by lower airway disease and the ones that were not affected. And also they included a group of cats that were stray cats, without clinical signs.
And they found a higher proportion of seropositivity in the Cats with lower airway disease in comparison with the, the, the cats without these clinical signs. Even though that there was not a, a statistical significance, below 0.505, .
As you know, but there was a, an association with this, seropositivity and always keep in mind that to be positive in antibody test, mm does not necessarily mean that, the cat was affected but was exposed at least to this parasite. Remember also that heartworm disease in cats is different than in dogs. Like in people, cats are more easy.
They, they, they handle easier with the, with the parasite and obviously, they get infection as we do, but they clear the infection, mice nicely than, than dogs, and they typically don't show larvae in the, in the blood. That's why. We don't use and not a technique, and they, can have maybe a couple of, maybe one or two, adult, worms in the, in the heart, maybe in the pulmonary, artery.
Living for a couple or 3 years. So, in these cats, we sometimes are lucky because they have a, a female worm and it's positive in the antigen test. And my colleagues in the clinic, all female vets say that males are useless.
In this case, it's a Nemo technique or something to remember, male worms are Not, something will give you a positive antigen test in the heartworm, heartworm, antigen test. So, sometimes it's, a negative test even with an adult worm in the, in the patient because it's a male worm. And, we typically use a combination of tests.
I will show you the algorithm. But it's a difference that you need to be aware between canine and feline heartworm disease. In Barcelona, we find a scenario 10 years ago, different from now.
So, 10 years ago, 11, to be honest, in 2014, we were asked to bring some serum samples for a study. This is the study that was published, from Alberto Montoya, and it is the first epidemiological report on this disease in Barcelona. And it was an 11.7% set of positivity from a number of 2039 cuts.
It was positive in 28. But two years ago, we started because it was available to, to look for Diophylaria antibodies in our patients, both with respiratory signs or without respiratory signs. And we found that it's not still published because we are still collecting all the data.
At, at 32% seropositivity. So it's something that is increasing in our area and it's related with some information I will show you just in a second. We for sure know that we can do antigen test in those cuts, both in the first paper or in the near future, if we publish this paper of the new data, we know that it's related, as I told you, with the presence of female adults in the car, and it could be increased the sensitivity if you do a heat treatment to increase the expression of the antigen.
And we also know that, that the, the prevalence, the estimation, the estimation of the prevalence in the, in the, so in, in cats is 10% of the prevalence in dogs. In the last 10 years, we know that it's been changing these, these problems. So it's been changing the, the, the scenario, the number of countries that are now endemic, as you see in the, in the maps, have changed a little bit.
So, this is a movement upwards in the map and most of the countries that were free of the disease now are considered endemic. And this is the last paper that it's still not published. It's in, in press and it's it's a, it's a it's a paper showing different ways to, to detect the, the Diofilaria infection, both with antibodies, antigen tests, and, and PCR.
This, I, I show you just if you want to review with the, with the recording webinar, the algorithm of diagnosis of theofiraiosis using the antigen test and then using antibody testing. And Just to end this, this webinar, I will present you Messi. Messi is a 4 year old male cat, castrated male cat outdoor.
That the main complaint, as you can probably see in the picture, was an ocular disease, was referred by, by some colleagues, just 20 kilometres south from Barcelona, and this cat was involved in some cat fights, even though the cat was negative to retroviral infections. And sometimes he was vomiting. On the physical exam, nothing exciting.
Everything was normal except from the left eye that was positive tindal and also has elevated intraocular pressure. So we were, we were working on a On, an anterior UVIis and a glaucoma, and we already had some work done by the referral bed as the CBC and biochemistry, the protein electrophoresis, Leishmania, serology, and a bartonella PCR. And you just look at this protein electrophoresis.
There is a huge increase in the gamma globulin part and it was something that, again, looking into the albumin globulin ratio was very close to the 0.4 that was suggesting FIP because in this card, the result for was 0.48.
The Leishmaniasterology, so the antibodies to Leishmania was negative and the PCR for Bartonella was negative. So we were working with UVITs and, and just focusing on the infectious causes of UVITs, this is the, the, the, the, just the box that you need to look at and there are several causes of infectious UVITs in cats that you, obviously, you cannot rule out everything at the same time. So we proposed the serology.
For FIV, leukaemia virus, coronavirus, and toxoplasma, knowing that the serology for coronavirus is not typically recommended even if we are thinking as we were FIP. Obviously, we can obtain a sample from the eye, so we recommended accuynthesis to perform a cytology and a PCR. The results came with a borderline IgG title for toxoplasma, also coronavirus, not very exciting, not, diagnostic and negative to, again, to leukaemia and FIV.
And we performed, this is messy and we perform the aqueousyesis under general anaesthesia using a 27G. Insulin needle aspirating 0.2 millilitres of the, of the aqueous humour.
We expected this scenario. So, in this cut with FIP confirmed, the cytology of the, of the eye, normally show this piogralomatose, . Exudate, so macrophages and neutrophils, but instead of that, we saw this picture.
So it was performed by the IDEX lab in Spain and they showed very nice pictures of macrophages with a masticodes inside. So was diagnostic for Leishmannia and the PCR confirmed that Leishmannia was the reason to have these UVITs. This is the first clinical case report of Leishmaniosis in Barcelona, affecting the eye.
In this case, from the colleagues from the, the vet school in Barcelona. This is one paper where I was involved in describing 16 cats with feline leishmaniosis in our area. In my case, the, it, it's not messy.
In this paper, it was involved a cat with a splenic, with a spleen, sorry, involvement of the disease and the neurological form, so it was a different case. But I have not seen a lot of cases of lemaniosis. I have to say maybe less than 10.
And this is the actual scenario of Leishmannia in Europe. There's, this is a, a very recent paper, 2024, and it's known that it's increasing and in some areas, the seropositivity is close to 20% and the risk increases with the HIV infection also depending on the country and if the, the cat is outdoor cat. So for Messy, the diagnosis was Leishmania.
The treatment was with allopurinol and meglumine antimonate and some eye drops at the beginning. The UVA is was resolved afterwards and the cat relapsed 6 months after and was treated again with meglumine antimonate and was free, and is free of disease, 5 years later. So this was a, a very nice case that was happily treated like that.
So, for my part, this is the end of the webinar. So I hope that you enjoyed the cases I, I, I showed you and, and I'm happy to answer if I know that, the answer, obviously, any question you will have. Diego, thank you very much.
Those certainly were very interesting cases and makes you have to think, especially with all the movement of people around the country and, changes and everything else that are happening. But, I think for me, the big thing is to always consider the multifactorial aetiology rather than getting narrow tunnel vision on just one thing that you're suspecting. So, thank you for that.
Thank you. Also, a big thank you to our sponsors, IEX. Without their generous sponsorship, we would not have been able to listen to Diego this evening and, to enjoy the cases that he has brought us.
Speaking of enjoyment, Diego, we don't have any questions, but we have had quite a few comments coming in. People thanking you and saying that, the information is really good. So thank you for that.
We do appreciate it. Thank you. For those of you that are asking to see slides again, please just remember that our webinars are all recorded and they will be up on the webinar vet website in the next 24 to 36 hours.
So, those wonderful tables that Diego was showing us, if you want to see those, go back onto the website, in the next day or two and you'll be able to rewind, fast forward, stop it, do screenshots as you wanted to get those information as well as to get the information of those fantastic articles which he presented to us tonight. Diego, once again, thank you for your time. We really do appreciate it.
And with all the comments that are coming through, thanks, our audience also really enjoyed it. So thank you for your time. Thank you very much to you and, and thanks again to A and And hope to see you soon.
Thank you, Diego, and I agree. Thank you very much to IDEX, and least, last but not least to my controller Beck in the background. Thank you for making everything run smoothly.
From myself, Bruce Stevenson, it's good night.
