Hello. It's lovely to be here with you all and certainly talking about one of my very favourite topics. I first started seeing cases of TB and cats during my residency, So that's 1992.
So I think that's something like, so nearly like, 35 years of of doing micro back work. And there's very few people that are interested in doing it. So if you pick a small enough pond, it can be your own pond, and this is kind of my little my little puddle, but I have thankfully pulled in my PhD students, particularly Conor O Harra is really taking on my mantle with this, which is great.
Cos otherwise who's gonna do it when I retire? So mycobacteria. I was asked to talk about TB in cats, but I broadened it a little bit because I think you need to see the comparison.
And I'm gonna start by thanking everybody who shares their material with me. And I'll do that at the end as well. And here are two brilliant pictures from Jim Hughes and Rory Lloyd and and these are both cats with TB.
So we've got M bogus mycobacterium Bovis which, of course, you'll all recognise from your, histories that Bovis. Yeah, that's definitely a form of TV. Well, mycobacterium microti is the V bacillus, so this comes from rodents?
To be honest, Bovis in cats, they they don't get intimate with cows, so it's going through badger. But of course, cats don't get intimate with Badger either. So it's environmental contamination, which gets into rodents.
So, really, this is a rodent borne disease, and we're talking about a rodent borne disease that these cats are getting. And we'll come back to that because it is so important. Obviously big.
Thank you to the Edinburgh dick, as always. I'm still part of the furniture. They'll be taking me out feet first in a coffin eventually.
Not just yet, OK, this was actually the first case I ever saw. I know he's not looking so good now, this was lucky. McCulloch I saw him say in 1992 and he just had arthritis in his, left elbow, and, we couldn't find out what it was.
Eventually, I asked the surgeons to go in, and they got some weird grey material out. Which, when it got cultured up, which it was said in positive. So I sent it across to, the Cardiff Lab and they coed up and they said, Well, it's weird.
It it kind of looks halfway between Mycobacteria and Bovis and Mycobacterium tuberculosis. They just hadn't seen it before. Which altered ended in me pulling together.
As you can see down here, 19 cases of this unusual variant which ultimately turned out to be mycobacterium microti when they went back to, stored down material that stored down in the 19 thirties, when it had been worked on, I needed to treat him because his owner was very keen. I treated him and it was only within one elbow. His chest was clear, et cetera, So I tried to treat him with human drugs and a human combo and a damn near killed him because it turns out that the toxic dose is lower than the therapeutic dose nugget.
So that's when I first came up with the the the Modern Protocols. Although we have adapted them, really, it's It's Connor who's been major on pulling together the new protocol. he did really well for five years, but then came back to see me in an absolute mess.
Sadly, Mr. McCulloch had been very elderly, was very elderly, and he hadn't really been able to to look after lucky as well as he wanted to. And Lucky was showing neurological signs.
And when I examined him, he's got this big lump under his, scalp in his, sorry. His shoulder. And he was really unwell.
Great. Big, liver. And, we put him to sleep, and you can see here on his post mortem.
He's got it in his shoulder joint. It was all the way through his brain, through his lungs. We've got horrible in his liver, and you've got it all over the mere.
Now, commit this to memory because you've got the kind of Eris and then this little granulomas all over his Mery This looks exactly like F IP can look, This could be easily be, an F IP. So keep that on your differential. Unlike F IP, it also went into other joints and things which would tell you that it isn't sorry.
It was three years later, not five. So, how do we divide up the mycobacteria Well, different people do it different ways. Old ways did it with Runyon groups, et cetera.
That is not very practical at all. So practically it's now taken into the TB group and the non TB group, the major in the TB group. Thankfully, cats don't get in tuberculosis, but obviously dogs do.
And my tea and Bovis Oh, and we have to add cat prey into there now, which is the one from from goats. I'll try and remember to bring that up later. And then the non TB group you've got, that includes the the ones that grow and we can tell what they are.
So micro avian biggie from birds. But environment as well, F leprosy syndrome used to be a different disease, and it still is considered that way on the other side of the world in Australia. That's why we see a lot of this.
But really, it syndrome is caused by some of the non TV ones. It's just sometimes we can grow them. Sometimes we don't.
So if you do it by PC R diagnostics, this is massive crossover, so it doesn't make any sense. Really to keep them separate. So they're the They're the way we group them now.
And if we look at the the prevalence, this is, a really lovely paper. It's a little bit old now it's over 10 years and they looked at seven years of samples that went through the a PH a. That's the animal.
Plant Health Association was your woman, but obviously I'm having problems with. And so the canines there were no TB and tuberculosis cases during this period. But they do and dogs can act as sentinels for their humans who who got TB and they're coughing it up.
And the the the dogs, all the get up because dogs are a bit revolting like that. But you can see most is Bovis with occasional micro T. Whereas cats you can see it's a 10 fold increase in cases.
As I said, no tuberculosis, thankfully, but lots and lots of microti and lots and lots of Bovis. I'm going to tell you about UK situation because that is what I know most about. But I do also keep kind of the the the Register.
If that makes sense of all the other cases in the world. I usually get to know about them. I usually get to review the papers.
they certainly see a few cases in Italy. This is a non TV. They also see them in France, particularly my croy in France.
This little guy Gorgeous, gorgeous boy. He was a a kitten who came from Ukraine. There's a lot of TB in Ukraine you can imagine.
Now it's much worse. With the war going on, they get a lot of Bovis. the same in all of the Eastern Bloc countries.
They don't have routine testing the way we do here. And this little cat came from Ukraine. He had hurt his elbow before he had had a drain through it.
Practise was very much a large animal practise. They had a lot of students working there at the time who were doing a lot of TB work in the cattle. So you can see it's easy that it got into his Penrose drain open drain, but it seemed to heal up.
And then he moved across to Italy. Sadly, he brought his disease with him. That elbow broke open and he infected the rest of the colony.
I should have put it on here. That's a paper that Petra Cerner and I published, quite a few years ago. And it was a real sleuthing job to try and work out where the infection came from.
Because the same day they got this kitten from Ukraine, they got a little girl kitten from from Russia. So we've got these two groups. Most cases are cutaneous.
We don't get that many that are primary systemic disease. What we do see most of say are are TB cases. So here we've got this is back of a cat's ear.
And obviously this has been clipped so that you can see there's just a a mass there. It's not ulcerated. It's not attached deep.
You really wouldn't look at that, feel it and think that that was TB what it was. And in this case, it's a a granuloma forming inside this cat's eye. I think the top differential for this would have been lymphoma, but it wasn't.
And this is an old picture now, and nobody really knows what it was. But it came from Australia. We think So, we think this is a a non tuberculous one to give you a comparison.
And then this was a study done by one of my, brilliant, SRC undergrad students who did this project, and she went to the a PH a and she got over 300 samples that are cultured up. So these are all ones that have grown. That's important because the culture system in the a PH a is biassed to Bovis because that's what they're looking for.
So we're going to have a bias to Bovis. We didn't manage to grow over 50% or they didn't manage to grow over 50%. And the ones that did grow my T was the biggie, followed by Bovis with some, that gave you 35% were TB.
But when Connor then PC R up lots of samples, he actually found that it's actually 50% by PC R no increase in Bovis. The increase was all in my, which is not surprising because this system isn't designed to grow micro T. So microti is actually our biggest cause of TV and cats, which is a bit of a no brainer because it's from rodents.
Mammal went is, an interesting non, TV one And all the cases came from about there, which is where there's an outbreak in people as well. And what's very interesting is if you look this say, as a very small sample, we've been gathering more samples for a long time, and in Scotland, almost all of them are bright green, which is your microti Scotland and the north of England. And, London and the Southeast are all major major microti areas.
Whereas the Bovis cases are not at all surprising. They are in areas where Bovis is in cattle badger, wild deer, wild boar rodents, et cetera, et cetera. And we shouldn't think of, TB in cattle as a specific thing because it's a whole ecology.
So it affects all these other species as well. And there is, as you can see, a little group here down at Eastbourne. And one of the cats came from one of the farms.
There is a little cluster of my there. We're not quite sure why, but there is. This cat came from Bristol and messed up my picture.
Then another one of my, project students. This was Lottie Gaunt. She phoned or phoned and emailed all of the labs in Britain that accept feline bio biopsy samples.
We got data on over, 18,000 samples. So we figured that's pretty representative. And what was quite striking is what we asked is, how many cases do you get?
And then what percent do you diagnose? Mycobacterium? Yes, my bacterium.
Slightly likely. And then as a comparative, we asked how many lymphoma lymphoma likely? And what was what was fascinating was that, so indicative samples highly suggestive samples was, 1% approximately.
Whereas if you looked at, lymphoma, that was 3%. So we think of lymphoma is very, very common in cats. Well, you know, TB is my back.
Is is only one third of that. So it's very common as well. People think of it as rare.
It's not a rare disease in Britain. When we did ZN staining, which is not very sensitive. Then a third of those cases were confirmed as micro backs.
But say it's not a sensitive test, and then I'm putting in pictures as we go. Please wear gloves from these cases. These are cases where the TV So I'd really like people to have gloves on.
And the good thing is, it's actually really hard to catch TB from from cases like that and certainly where the lumps all internal. Unless you kind of eat the cat without cooking it, the the the zoonotic risk is low. The the risk is much higher.
When there are wet lesions, they're the biggies. Wet skin lesions are the biggest risk. So, in cats, you've really not got any tuberculosis.
We've got Bovis microti. We do see zoo and cases. As I said, when there are wet lesions on the the cats.
And there have been some reverse zoonosis or anthros where, the elderly person has a cat spending their time sitting on their knee, and the human has got the person has got TB. That's recrossed from when they caught it as a child, when they were doing farm work. They're coughing on the cat.
The cat is grooming up there, the spit spit that is on their coat and they can get infected. So we have seen it. What I point out straight away is the The recent cats are a much lower risk than, for example, deer or cattle or, llama and alpaca, which are prone to llama and alpaca.
Get Bovis and my T And a lot of it is pulmonary. And they all do the same with deer. You get these open cavit lesions, which is why they cough.
The infection comes in by aspiration, settles in the the air in the airway where it forms a granuloma, which then ruptures. And then because it's now continuous with the trachea, they can cough and cough it all over whoever it is going to see them. So I really don't like to deal with the I wouldn't want to deal with coughing llama and the packet in a Bovis area, whereas you can see in cats the vast majority of cases when it goes to the lungs and it is common that it does go to the lungs, it gets there from a skin lesion.
So this is a hematogenous spread. So you're going to get a very distributed lesion. Like here, we've got very diffuse interstitial pattern.
It can become more bronchial as they get, more advanced, but they rarely cough. And for that reason, and even if they do, the disease isn't in the the airways. It's It's in the the periphery and in the institution, so that the risk is much lower.
Not that I'm saying there's no risk at all. This was a student who I got on exchange from. That's Alex Alexander Bennett.
I got him on exchange from Colorado. I better not keep introducing my to my people because otherwise I'm going to be here all day. So hopefully I've convinced you that the prevalence is is much higher than you might think.
This is a disease of adult cats. So when we look at my coat, the mean age is, eight. But you can see Sorry.
The median age is eight. Yes, median age. It wasn't normally distributed, but you can see 16 to 6 months.
And Bovis. Then it was three. And again, you can see a very wide distribution.
But Bovis is seen generally in younger cats than my. It is particularly a two thirds boy problem. Not sure why, but, maybe they eat more of prey.
Maybe they fight more with their prey is possibly more likely, no breed breed disposition for TB, although with non TB. Then it's Siamese, particularly plus a, Abyssinians and Somalis, but not with, TB. They are usually hunting kind of background.
FELVFIE is usually negative. People always want to blame Mr Brock the badger. But cats and badger really don't get intimate but badger when they're in terminal stage, they pee everywhere, and it's got TB in it, much like the dogs when they get TB.
And then rodents go in here to try and steal grain, et cetera. And, that's how they get infected. So yeah, it it's rodents.
And, of course, cats and rodents. Fight. And that's where we see most of the skin infections.
Most of the infections are around the head. Face pores back legs because, of course, the rodents will have to have a go at the cats. As the cats are running away.
We do see occasional cat to cat transfer. That's not common at all. But obviously it can occur.
We have seen those a comal infections. Here's a outbreak I dealt with in Ireland. Aileen was a trainee nurse at the practise, and she pushed this to me and wrote this paper up.
Brilliant, brilliant, brilliant lady. So they these cats, cats a and B brothers and they lived with sea. It was a female who didn't go out.
The boys did. They lived on the bank of a river in Ireland, and, first one presented looked like this. But this is actually C two.
And he looked just like this. They gave him antibiotics, but not the bright ones because they had no idea what they were treating. He was put to sleep.
There was no postmortem. 13 days later, his brother presented. And what this is this is his chimp.
And what we've got is a massive ruptured submandibular lymph node. This is infectious to people. OK, this is droopy pus, which is full of TB.
So I really would like to have seen gloves on. And he didn't make it. 13 days later, he was put to sleep.
He did have a PM. He had acid fast bacteria, so it can consistent with, mycobacteria. And it was cultured.
It was confirmed that it was TB, but sadly, not quickly enough just because these things take time. The day that, I was gonna say that he was put to sleep, and 24 days later, cat C she was put to sleep with respiratory signs. She didn't get a post mortem, so we can't be certain it was the same.
But she groomed her brothers, and so she will have, consumed and inhaled a whole load of this tubercular stuff. So I have little doubt that she almost certainly did. Cat D was castrated on the day that this kitty cat was put to sleep and 42 days later, he presented at the clinic.
And this is his his. It's a prep use. These are the castration wounds which haven't healed.
And on palpation, you could feel lumpy bumps all the way up to his kidneys. I don't know why the owner's brought took so long to bring him back the day he was euthanized. Eileen's, little girl cat was, had spay and, sadly, 14 days later, she felt lumps and bumps around the, the future wound suture was actually removed, but it all started leaking pretty revolting.
She was put to sleep. She she looked, they looked at the fluid, which had acid-fast bacteria, but she didn't have a full, post mortem. But just look at the time frame here from cat A presenting to thankfully, the end of the outbreak.
It was only 13.5 weeks and individual cases. This guy 42 days until it was all the way through him.
And, poor Eileen's cat. It was only two weeks. And if you look at the date oopsie.
Sorry if you look at the data. I thought I got another image there. From the kind of the Bible on this, it's, John Francis's monolith that he did in the 19 thirties.
He infected all sorts of cats and rabbits and and all sorts of animals with and birds with Bovis and tuberculosis and avium by all different routes to see how quickly they died. Yeah, crazy study. But that was what he did.
If if there is a AB and balance in life, then he really should have got infected doing all of these studies. But he found that if cats were given M, Bovis IP. So, interpart merely then the average life expectancy was between 11 and 39 days and effectively, a castration wound or a spay wound is an IP injection, so it actually fits.
If you give it by that route, it will kill the cats very quickly. I thought I should throw in, at the old dog, as we have been pulling together dog data as well. With, Emmy Barker from from Bristol.
So dogs get Bovis more than microti. And now, because people don't get so much TB. And tuberculosis.
So we're not seeing as much tuberculosis in in dogs, which is good. Like, this one is one of Amy's cases, and she scoped this this dog and could see all these granuloma. It's a fabulous image, isn't it?
Thank you. Thank you, Amy. First one I saw was, this little Jack rat.
He lived down in in Devon, and he went down badger sets all the time. He lost weight. He got disseminated disease.
It was on his tongue pulmonary hepatic. But he he he was the little boy's dog. So they've got a little four year old boy and he slept with this dog.
And, of course, the dog licked his face, et cetera, et cetera, and there was a lesion on this dog's tongue. Long story short, the little boy was infected and had to have, he he was infected by the skin test. And you you could see also by the TB blood test.
Thankfully, his lungs were clear, but this poor little four year old had to have three months of rifampicin, and is so these are big drugs that are nasty. They tested the two other dogs, which were also positive to ferrets that couldn't work. An E rough on that, it wasn't going to set out for ferrets.
But the chests were clear. And then this outbreak, happened during Connor Halloran's PhD. Initially, there were about 200 hounds, but some had died.
Before we got there. They had got eight that were definitely all, post mortem with the same acute renal failure. And these were positive on igra, the TB blood test and serology.
Three times, Conner set up three different assays, and, sadly, he confirmed a lot of the dogs were infected. In total 66. Almost 60% were positive on one of the tests or other, so they were put to sleep.
And M Bovis was confirmed in the sick and some of the healthy. but IPOs or serologically positive hands, particularly in dog, seems to go to the kidneys, and they urinated out so that there is going to be a environmental risk from them. These dogs were in the edge area.
If you know your you know, imagine the picture of of and bogus in cattle. And, they were being fed, as was then legal, falling cattle from a TB reactor. Positive herd.
So at that point, if you had positive cattle, so skin test positive cattle, you didn't have to have them euthanized or cold. You could put them into a farm that only had react to positive cattle. And then when they are euthanized Oh, sorry.
Abattoir You slaughtered, different. Different beach for for large animals and small, isn't it? When they're when they're slaughtered at, 30 weeks, if they have no more than two obvious granulomas which can then be cut out the then the so long as they haven't got more than the two that can be cut out.
The meat does go into the human consumption, which is pretty terrifying. but if they if these cats will fall over and die in the field, they farm would obviously have to pay the the Aer Man to come and get the the carcass. But if you've got a got a pack of hounds close by then the soman is very keen to come and pick up the dead cow because he can feed it to his cattle, his his dogs, which is what was happening.
And that was completely legal. Yeah, kind of crazy. That's a no shit, Sherlock for infecting the dogs.
And, so it resulted in a change of the law and training of of of Kelman, which was important, should have said at Public Health England, they tested, 11 of the 20 people that were exposed, they can't force you to get tested, and one person was positive by igra, who was the, the the the the the person who was the kennel Master, I think it's called, since then, Connor, Emmy Jane as well. Here was Connor, em and and myself. I did not do the major of the work.
It was very much emy and Connor who did all the work. They started by pulling together cases of canine. TB.
They had 18 new cases and then over 500 that they got from, previous cases. And this was very much looking at, exposures, ET, there were TB cases in this because they're the horizontal Sorry. Historical cases.
And it really fitted into four categories. Most common pulmonary followed by abdominal, and then disseminated and miscellaneous, interestingly, that the hounds were kidneys. Because that wasn't a major major.
Finding what was really interesting is in our heads. TV and dogs was when we saw it. We didn't see it often.
Nowhere as near as often as in cats, but we thought of it as a poor prognosis. But 13 of these 18 cats dogs that were Yeah. I can't talk about dogs of these, 13 of these 18, dogs that were actually given proper treatment.
I'll talk to you through the protocol at the end. They actually had a really good outcome. As good as the cats.
Slightly better, actually. But I think that's not statistical, because obviously, there's not many here. Which, which is really good news.
And then, E emy and and Connor also reviewed, TB more generally. And so 22 nice papers. So, in cats, what are the clinical signs?
Well, I've already mentioned skin is your major. This. I know you wouldn't look at this and think this cat's got TB.
But this cat had a whole load of little lumps and bumps around its face. Little, little granulomas. And this one in cat, lump over the, G claw.
And this cat is lying on its back, on oxygen. And this is submandibular area. He's previously had it biopsied this cat called stripe.
And the previous biopsy proved it got M Bovis. We treated him, sorry, mic. We treated him, and then this came back.
This is a recurrent I. So that's why he's got all these lumps and bumps under his jaw. And certainly subman lymphadenopathy is a very common presentation.
But the lymphadenopathy can also be, popular Teal, because relevance quite nip the heels of people. Primary respiratory is not at all common. I'll point out when we do see it.
But in cats, it that is gonna be usually hematogenous secondary. As I've already mentioned arthritis, we see a lot that is usually but not always, because of bites over joints, you see a lot of ocular, the vast majority, though it's because of bites around their eyes and G I If they've been fed TB food, then this is the the first raw outbreak. We dealt with.
So this started in August 18 and we were started to see cases that were particularly abdominal, which is not a normal presentation for, TB in in in cats because normally from rodent bites. So that was a bit odd, and we were seeing M Bovis cases in parts of Britain that do not have am bogus, like Scotland, which was like, Hm, these were young, indoor only and mostly pedigree cats. So it was like, Hey, hey, hey, this is not right.
So there was no contact with wildlife. They had not had any hunting. They did not have any rodents coming indoors.
The owners did not feed them raw milk. And there was no TB in the the owners. So straight away, it's like, Well, it's got to be the food then, hasn't it?
And we tracked it down to natural instinct there, it's a It's a commercial company. And it was their wild venison version, which, they then, withdrew. Thank you.
And we told all the organisations a PH a public health, England and Scotland et cetera, Food standards authority. And we told the company, And so then we had to try and track down how many cases we'd got. This is AC T slice of one of the cases.
This is a massive granular moment. We did see some in joints. This is a Tigger, and it's in two of his joints.
It was also in one of his eyes, a lot into lungs. Mostly it was the same picture. We would normally see some diffuse, you know, type pattern.
But we did see some of these really nasty cavitation ones. We think this is when the cats really guzzled their food so they inhaled little bits of the infected food, and hence you've then got cavitation lung lesions. Which is why we end up dressing up like this when we're dealing with these dealing with these cases.
So food was recalled, and then we we tracked it down. We tested over 200 cases over 60 had to be euthanized. Because they had active TB plus or minus.
They were TB blood test positive. Which, you know? Does it mean that they've got sub?
You know, subclinical disease. Does it mean they've got inactive disease latent disease thing? There's no way of telling.
And a lot of owners just weren't willing to, to just monitor owners felt it was sticking time bomb. They prefer to have the cats euthanized. We did treat some of them, and they did respond.
They were pretty hard to to get through treatment. Because a lot of them were baby kittens that had been, weaned onto the food. That's not a good scenario.
Breeders were traced. So one group of 10 kittens, all from the same breeder that were weaned, all bar one was found to be positive. The one that wasn't found to be positive.
We don't know what it was. The owner refused to have it tested, cos she just couldn't bear to lose the kitten. Sadly, four owners and one vet were also infected.
The vet had worked with cattle years and years and years ago. But, you know, it's like 30 years ago and had a big positive wheel. So, that's because the these cases we were bad.
It turns out that the rules about deer stalking are pretty lax, to say the least. And it's very easy to, you know, to to just illegally take a deer carcass at night and then you just sell them on and that you can get up to 500 quid from them so you can see why people take them when, when times are hard. What I will say is, we've got new outbreak on the go.
At the moment. It's a completely different food, and the food that it is, it's a poultry version. But when you look at the, it's chicken and and, Turkey.
But there's 30% was 30% cattle offal and that's would be my guess is, is how it's got in. It's a very similar profile as this very similar disease. And you know, it's important to say, as far as we are aware, certainly, in the the new outbreak, the company has done nothing wrong.
They are using food from good sources, and and their sources, Like in this first outbreak, it may have been illegal. Meat was involved. We've no indication of that.
In the the second outbreak, you know, they were complying to all the rules. But if you feed uncooked meat to cats or dogs, there is a serious risk that infections can't go across. And I'm not anti raw food feeding at all.
I would really love to be able to do it, but in order to get the mineral balance, they have to turn it into mince, show you. Here you go. It's always minced, so you get one carcass that goes in that's got infected.
It's going to go through everything. It's minced because they've got to get the minerals and vitamins in, and that's the That's the problem with it. So we're still working on the new outbreak.
We've got, 1112 converted confirmed cases so far. But what's fascinating is what we're the the strain we we're confirming and that the a PH a you obviously fabulous and and fully, part of this. In fact, they're doing more of it than we are now.
It's Capra. So somewhere along the line, you know, goat TV has got into here and And when looking at spiga typing, which we haven't published yet, you know, it's it's not from the UK. So where did this come from?
But if you look at the food chains in this company say they are not doing anything wrong. I'm not gonna say their name because they're not doing anything wrong, but the and they've changed the food. But I if you so for a tonne of food and you've got 30% is bovine off 1% would be spleen.
And in one tonne of food, that 1% of spleen came from Ireland, the Netherlands and Germany. Well, none of those places have, TB in the in the in the line. But clearly somewhere it's come in.
So probably the same way as Preta. Andre had all the problems with the the the person who died. It was the premix that it was infected.
And it's just because if it's not being cooked, this is going to happen. And you, a company is really trying the real best, Really, the highest standards to to try and get the best quality food can end up with TB outbreak. And and it's just unfair.
But unfortunately, it is just if it's not cooked, this can be a problem. So we we'll publish that, pretty soon, I think. So how do you get a diagnosis?
First thing is, you've got to suspect it. So I've got lots of pictures of clinical signs. We see quite a bit that are scrotal.
This is a This is the, anus. These are gloves. I think they were my hands.
And then I've got mittens on, and this cat came in with urethral blockage. And this is his his prep use. He's got a granuloma right on the tip of his prep use.
This is a post castrate one picture. Haematology You won't really find very much important unless they've got really severe disease, in which case you can see anaemia to give it in the gut because you can get G I bleeding the serum by chem again depends if it's in the kidneys, etcetera. You're gonna see picture.
You're gonna see the picture of that. Your ears and creatins are gonna go up, but quite a few of these cats, regardless of where it is, if it's big enough infection, they can have high calcium. So just because the cat has got big submandibular lymph nodes and it's got high calcium does not mean it's got lymphoma.
OK, does not mean it's got lympho, but in Britain, big submandibular lymph nodes and high calcium are much more likely to be TB. I'll show you some pictures of of CT and radiology, et cetera. Serology.
We've worked on it. We're still working on it, but it's really not at all sensitive. And the skin test doesn't work in in in cats.
Then the TB blood test. I will talk about at PC R. So just some pictures, lots of no gloves as you, as you'll see because nobody suspects this when it's first coming.
You just think it's a granuloma. So here it's one on the front paw submandibular lymph nodes. Conjunctiva foot.
It's been with a lot of dressings on it, which is why it's soggy. It's not normally like that, again, a wrist you can see like these are a common place to get it. This one is is around a tooth, and you'd never suspect that was TB eyes chin.
It's a great one on chin, Another one on her chin. It's a little rodent nip to them. This one is quite terrifying.
this is a post surgery, but the whole face has slipped off this cat, which is not great. Behind an ear. That could be certainly a zoonotic risk.
Oh, sorry. And of course, that is a zoonotic risk where the face is slipped off, as was that soggy po. Oh, I think if you had that picture so good, we played it twice.
My apologies. Now, one and I, this cat looked like a a weasel because its nose was so long. But that's a granuloma.
in the just the heart in front of the teeth again, Another eye cat lying on his back Huge submandibular lymph nodes. And this is a a soggy one on the skin. We do see quite a lot in eyes, usually around the eyes.
This is one I saw residency a long time ago. And you can see this Siamese has got, this granuloma in the top eyelid, and you can see that it must be warming up the hair follicles, which is why we've lost the the pigment. Remember that?
Cats are, Siamese are acro melanotic. So they only stay dark if they, if they if they're cold, that's a biopsy site. It is a pretty revolting one.
And eyes also see them go blind where it's a systemic spread, and then they do this horrible granuloma, and they all look really similar. You get this granuloma on the optic nerve head and, big vessels coming all over it. We've published quite a lot on ocular disease because it is such a common presentation.
What about radiography, then? Nothing specific. It can be useful for monitoring prog prognosis.
What I would say is it's better for monitoring progress to for when to stop treatment than CT is because CT is too sensitive. And you see the scars really important. It doesn't necessarily.
What you see doesn't reflect the clinical science, which I suppose is radiography all along. Big perihilar lymph nodes that fuse change very similar to the previous ones. Not actually the same image.
It just looks like it. This cat Big, liver, big spleen. And this was read by a, aborted imager as, patho for, so nothing consistent.
Lung changes diffuse and interstitial, can become more. Milly can become more nodular. Occasionally, Very occasionally.
Plural or pericardial. We see that usually TB so be careful when you're draining it. If you're from a TB area, and you can see the changes there.
Sometimes if the that calcium is high, you're gonna get, dystrophic mineralization. Or if the systemic calcium is high, you're gonna get an static mineralization, which is kind of what we're getting here again. Diffuse, diffuse, diffuse.
What is important is well, here you do have the stern lymph node coming up here. Maybe here you don't, so do not always. And you don't have the high low lymph nodes coming up, particularly so, yes, you can see them, but because the lymph nodes aren't up does not rule out TB.
Changes in the abdomen. The big liver. The big spleen.
I've already mentioned big submandibular lymph nodes. They are pretty common. And you can see that That's a big, chunky, chunky, liver as well.
In the skeleton, I particularly see, corpses because, you've seen that the the lesions are often there, and they become progressively more destructive. They are all different cats. This cat, presented, paralysed, and it's actually in the spine.
This cat presented his brother presented with it on his face. This is biffo and buffery. And this one it was around his hock.
But on the X ray, I could see his popularity. Lymph node was, infected. Likely to be infected.
And this just shows you the changes. These are, obviously, reconstructed, but you can see actually within the bone, sometimes very lytic in the bone. But it can also be around the bone, which is what we're seeing here.
And there's just one doing really something funky with the scapula. What about CT changes the vast majority are pulmonary. And it's a structured interstitial pattern is what we call it when it's affecting.
The lungs of I do most of this work with, Tobias. Schwarz suza. Professor of, diagnostic imaging.
You've had a bad diagnostic imaging. So we've seen loads of these cases, so you can see different extents of granulomas and lumps and bumps. Occasionally we see cavitation lesions.
Now, this one did not look cavit on the radiograph because it just looked like a nodule. Whereas that is a nodule. This one.
You could just see a little bit of air. This is one of the the cats that from the original food outbreak. Can't remember where I'm coming from now.
But you can also see other changes here. We've got a big lymph nodes, higher lymph nodes. Here it's actually affecting the the the ear, which is a bit interesting.
And this one it's, on his face. Very, very destructive. You would presume that was carcinoma.
But it isn't here. We've got a pathological fracture. Be careful.
This one. You've got all of these. It's all around the joint.
So we've got these bony changes, Whereas this one's really fascinating. We've got this palisading changes, which are rather cute. We do use the mousetrap for monitoring these, some of the time.
So that, I think, brings me to saying I gotta tell you something about non traacs might go back, and then I'm gonna come back to diagnosis and treatment, if that's OK, Not when I say too much. The major one is, avium or Avium Cellular complex to his friends. So we just call him Mac.
But it's all of these, I. I could list these. I could list 20 rodents and, environmental.
Most where these guys come from. This is the classic presentation. It gets into the fat on the apron.
This one's obviously been being shaved. I should replace those for more clearer pictures. My apologies.
And you just get this salt and pepper. Look, it looks like it's got these little draining bits said like a salt and pepper shaker. A and dots.
This is the classic presentation. This you don't see with TV S. You're not gonna mistake those.
Sadly, you see lots of all sorts of other things. So here, that nose could easily be TV. That's actually one from Italy.
This is an an avium. And that's it is poor. We couldn't, culture that one up, so it's a in a view.
In Australia. You'd say that that was a, what's it called? What's the word?
Palsy. But we don't call it froy. We call it non Traber Micro back because that could easily be a VM.
I've already mentioned the breeds at risk. They don't appear to be FELV or FIV most of the time. And you see them, all over the world in different degrees.
There's a lot in, Canada. Zoo are not at risk. Always used to be said as none, which is obviously a big fat fib because people can get mycobacterium avium.
Not easy to get from a a an animal, But you can, so, yeah, you have to presume that there are some zoonotic risks. It's just not at all studied. So this is what you Oh, yeah, that's better.
Better pictures. These are a couple of mine. So this is obviously the apron.
And, you know, the the the fatty bit is a little cat called Maisie. It was all the way around her vulva down her back legs as well. So I've shaved this bit a bit.
No. Referring a vet. Shave this bit a bit, but we've got other lesions all the way down her back legs.
It's Beanie. It's all the way around Beanie's bottom and you can see it's leaking. You've got one shoulder.
This is an old picture. I can't find out who owns it. Richard Halliwell gave it to me, but he said it wasn't his.
And you can see this salt and pepper approach and you got these or picture and they kind of leak this fatty serum. And then this guy had a biopsy, which is then broken down, which is what will happen when you biopsy this stuff. So that presentation you won't mistake.
But here all these changes could absolutely easily be a Yeah. See that one? There's a picture from, Rita, which is very, very similar.
It's actually a completely different animal, So, lots of different pictures, but it looks just the same. That was it. That's what I really am showing you here.
There's one in the to the tongue eyes edge of the the the the Penis, et cetera. If you've got these big, solid things, you can do ultrasound and you get these little fatty pockets and you aspirate those. They're the best bits for cult chewing.
So how do we diagnose what is causing these lumps and bumps? First bit. Let's get some cytology.
FNAs are really good for PC R. So take this and send it for PC. R.
Obviously not with a needle on it. You need to put that into a little plastic sterile plastic tub. But that's a really good thing for for doing PC, R and PC R is your diagnosis of choice.
Now, that's the Leeds Reference Hospital Reference Lab. I think the Leeds Infirmary we are still developing our PC R. It is not there yet.
If you send to IDX, all they're going to do is send it to Leeds and charge another 60 quid and it's already expensive, So don't do that. Send it yourself and you go on to our website. Ah, I forgot to put our website link.
If you email me, you will get my you will get the the website link. I must add that in because we've now got the website up and running. And there's all the forms.
Are there everything you need? Because sadly, we are now having to charge for our advice because it's only Connor and myself doing this, and it's a heavy load. All the advice calls, so you still can have an advice call, but it's going to be I think it's 40 pounds for a simple one and 70 pounds for a more complicated one.
But all the all the information you need and the forms and everything is all on our website. So, biopsy and hist pa Absolutely. Here.
We've got one here, and you can see ZN stain is showing. ZN positive if you've got a lot of micro back and you can sometimes see this more typically with avium this is a fine needle aspirate that I've just D quick and you see these macrophages. So this is high a high, high power.
This is a macrophage that is full up with these ghost bodies. When you then stain with ZN, you can stain all the ghost bodies. So this is a typical for mycobacterial.
OK, so when you take a biopsy, chop it in half. That way you can send one for HIST to drop the other in the freezer, and you've then got it because that's better to do. PC R from.
But to be honest, believes PC R is now so good that they can get it from formula fixed, which is great. And as I said, ZN staining not that great. We set up the TB blood test in law 15 years ago.
Something like that. This was my poster child. This was gorgeous, at Brian Dunlop and I biopsied that nose three times and I couldn't find out what it was.
It was granulomatous, but I couldn't find out what it was. I think culture, PC, R, everything I could do then and then this is the day before he was going to be put to sleep because they said he's now it's you know, this thing is getting in the way of him eating and I said, Look, I've just set up this blood test. Let me just have him in.
Let me look at him because thankfully, they phoned me before putting him to sleep. And let me just do the blood test, and this is his result. So it's a live blood test.
So we have to have two mils of heparin which mustn't be put in the fridge mustn't be separated, and we set it up against negative control. That's important, because you need to know that the cat isn't spontaneously making interfere on, gamma, which a few baby cats will do. You need to have a positive control, because if the sample got cold on the way to there, it will give you a a false negative, and you don't want that.
So let's make sure that the macrophages could sorry the memories the memory lymphocytes could give you interfere on, Gamma. Because if they couldn't, you do not want the cat being told. No, no, he's fine.
He's negative, but actually, he could never have tested positive because the sample was dead. Then we look at, the protein from M Bovis, and it's crossover between avium. That's why we do both.
That's why If you've done skin testing in cattle, you put the A at the top. That's PPD a and then B at the bottom. PP DB.
That's because if the cat or the cow is infected with avium, they will test positive. So you need to know that it's a false positive because they're infected with Avian. And we also have a a marker for pathogenicity.
And this is particularly this is gonna be positive for if, for example, we've got a dog with tuberculosis and with some cattle, Bovis is sadly not all of them. So this is a classic picture. So it's got we do this with Biest.
That's where the lab is. That's where the forms go to, et cetera. But again, the forms are on the website.
100% specificity, but not so good for telling Bovis and the Cro part. Sadly, Bovis can sneak a peek at about only 40% actually make the, the pathogenic marker. And it's really pretty rubbish for Avians.
Yes. If it's positive, you can say they've got an environmental, but you can't say which for those who need PC R so for those Why do we need to find it? Is What's the source?
Was it, rodent born? Was it? I love this picture.
Cattle rarely come into this picture, but it's great, or is it bird born? So it's pictures showing you all the sources, but we need to know because it tells us zoonotic risk treatment options and prognosis quick through, potential DDXS. That's important.
So if you're looking at lymph nodes, then certainly FELVFIV Toxoplasma lymphoma. I've already mentioned all of those young Maine coon cats. Do it anyway, and then you can get this weird proliferative disease of short haired kittens.
So if they're babies, very unlikely to be Myco. If it's just skin is granuloma, it will catch you out a lot. And, of course, they could have concurrent asthma, which could make lungs look rubbish.
Cutaneous lymphoma. These are this one is Mets from a mammary carcinoma, which can certainly look very much like TB sterile pan granuloma. There have been occasions not common in the cats, as far as I'm concerned.
If it's a granuloma, it's usually infectious and cryptococcus. We do see occasional cases of crypto lungs. Primary carcinoma would be my biggie particularly if there's mineralization, but pulmonary lymphoma occasionally.
Hemio are not not not common at all. So severe asthma. Absolutely.
Barum aspiration Lipid granny. All sorts of those. But then all the infectious causes Lung worm is a biggie, OK?
And people aren't good at looking for lung worm. There is a, path group Do a, PC R An extended PC R which gives you your standards. Calica, herpes, chlamydia, border teller, mycoplasma fuss.
But they also do mycoplasma GTI and the lyras Strongylus abstrusive. OK, so always go for the extended one and get it from the vet path group the map that in a few years ago. So all of these, can look just like it.
We've got pulmonary cases of F IP now that look just the same and all of these other infections. OK, so, you would be treating them very differently, So you need to keep those on your differentials. And if it's affecting lung and skin, which is obviously our most common, then it would be me.
Carcinoma ox or ox tends to be faster, more acute disease. But we see herpes and Calica. They can both do skin disease.
Rhoda Coccus Absolutely toxo can cause skin disease and lungs so all of these guys can do it. And if anywhere you are in the world, then Cox Mycosis so always be thinking what the differentials could be. And then we come to the treatment.
How are we doing time, O? Ok, I think I've just got to do it. Recommendations?
When we're talking about TB, if you have a case of tuberculosis, I'm sorry, but the cat should be euthanized. The risk of people is too high. We have to prioritise human health.
M tuberculosis is so rare in cats. Thankfully, I've never seen it in my 35 years. But if you had it, you would need to euthanize then.
Bovis. It's very dependent. The public Health England say the the the risk is very low.
And if there are no cutaneous lesions that are dripping, then the likelihood that you're gonna get infected you or your staff or the owner, it is vanishing below. As I said, you'd need to eat the cat without cooking it, which clearly no one's gonna do. So the risk with those guys is really, really low.
If you've got cavitation lung disease, yeah, I'm gonna be worried. And there's never been a case. Oh, sorry, I should say, in the last 150 years there's been about 200 known cases of cats infecting people with, Bovis.
That's globally. So 20 cases in 100 and 50 years. Obviously, it's not very accurate when you go back about 20 years, but it shows it's not common.
And there's no cases of microti going from cats to people. There's only a couple of dozen cases in microti globally, and most of them are in Scotland. So you you do need to think about zoonotic risk, particularly if you've got humans who are at risk and you have to prioritise the humans, and then it's severity of the disease.
If you've got those horrible drippy lung, drippy skin lesions, you've got cavit lung lesions, et cetera. The cat needs to be euthanased. If the cat is skinny and looking rubbish, then you know what euthanasia euthanasia might be the most sensible thing, so you've got to balance all of that.
It also depends on the ease of treatment because it is rarely a surgical removal. If you have that one lump behind the ear that we saw right at the beginning of the talk Yeah, you could take that off. Otherwise, you seriously risk wound dis about 10 years ago or so I suggested that up until 10 years ago that we did, an interim treatment and then, only added in rifampicin, which is such a big drug once we had TB confirmed.
But this was when we were waiting for culture results, which took at least two months, sometimes six months. But now, no, don't do this. Do If you are using a protocol which is got interim treatment that is ancient, go straight in as if you've got any suggestion that it's TB start high.
You can then deescalated if you get confirmation that it's something different that we've got to I know we're using big drugs. But we need to prioritise human health and the treatment. Sorry, we've never seen rampin resistant strains, which is good.
It's a long treatment. It's a minimum of three months, and in most cases, if they've got lung involvement, it's gonna be six. So they've gotta be cats that are compliant, or it's a case of putting an O tube in.
Or Maisie kept pulling her O tubes out. She, went out and I'd had no problem with these cats going outside. The cats that are used to being going in and out, then it to keep them locked up.
They're gonna be pretty mean. That's gonna be mean to them. And we don't need to to, you know, the cats got infected outside.
So once there's no wet lesions, et cetera. I have no problem that they can go outside. But Maisie was a tree climber.
Despite being a chunky girl, she kept hanging her O tubes up in the tree. So she ended up with a low profile peg tube in instead, drug toxicity. Certainly a high dose of Prada fluoxetin.
You will see neutropenia, but cats are on three big antibiotics, so we don't need to worry too much. Rifampicin is the biggie. About 30% of the cats on this do, show some degree of toxicity.
Usually it's nausea, occasionally vomiting. Itchy skin is common. The the nausea, then certainly encounter that with, anti-nausea meds.
More potent, et cetera. If it's just itchy skin, then, ermine, you know, So Perin, that can work very well. But if you've got really swollen skin, et cetera, or you've got a hepatopathy, then you need to stop the drug and reconsider and contact us, then, financial considerations it is probably going to cost the treatment is probably gonna cost around 1000 pounds if you've got a six month treatment.
Which compared to all the you know, like, compared to TF IP or can I treating, orthopaedic procedures, et cetera. That is not that much. But obviously, for some people, it's way too much.
And if the cats are shooting fishing kind of cat and you can't catch it up and it's not going to get medicated every day there, and the owner can't really give tablets at all, and they're really not gonna do an O tube, then euthanasia is the appropriate thing to for the cat. Because, of course, on top of here is the monitoring costs, I should say, by way of monitoring, we usually monitor by way of, checking chest radiographs and then body weight. Body weight is most important.
And then when we think we're coming to two months from the end, so normally about if it's chest lesions, we would suggest radiographs at two months to make sure everything's going well, and we don't need to change the treatment. And if the chest is clear at that point, then they need to do another two months more. So treat for two months beyond full clinical and radiographic resolution, we are trying to look at the acute phase proteins, particularly a GP and possibly haptoglobin to see whether they are gonna help us, because these are the big drugs.
And we would like to get the cats off them sooner than we're currently doing. So triple therapy up to six months. No initial, phase.
Just go straight in three drugs for three months and certainly two months beyond full clinical resolution. If there is not a significant improvement in the first month, contact me. We need to change the drugs standard protocol.
Rifampicin. That's a, level three drug proto floxacin. That would be, two.
What is it? Stage level. I can't remember what it's called.
Level called it level. And azithromycin that's another three. So you got two threes and two.
These are big drugs. Thankfully, in Britain, we are allowed to treat, in Europe. They often somewhere have no access to rifampicin or azithromycin.
Bova, thankfully, have combined this. I asked them to do this. So this is azithromycin and rifampicin combined so that you then only have to give Prada foxes Is two tablets each day.
Makes it much, much easier if they show signs of hepatopathy. Then an cyst, Sammy or neck is the way to go. But remember, your anti-nausea drugs as well?
We don't vitamin supplement. Although the, the vitamin, beat Vitamin D is low, but we're not sure too much about it. And the prognosis until we switched from the So when I first looked at the, outcome 10.
Whatever it was years ago, this one, the outcome was about 40% remission. But once we switch to not everything goes on to three drugs for a minimum of three, months, and we only step down if it shows that that's not appropriate. We're now getting 70.
80% over 80% is what we're getting now with TB, which is pretty good. Much better than avium. Avium is much harder to treat.
So here's a micro T. It's K Peter as his Hi. His leg gets hot, gets better.
This is Kal Blue. You see its lymph node? PLO lymph node lung.
Beautifully. What about non tuberculous mia back much harder to treat. You need to know what it is.
And the problem is that a lot of these don't grow, so you need to have access to the PC R? In the US, it's more likely to be for cheatum, or tilonia aps apsos. So, a combination three drugs again, at least two drugs anyway.
But the combination needs to contain, chloro Romycin. Whereas in Australia it's much more likely to be magma and Fortuin. So quinone fluoroquinolone and a doxycycline would be better.
And I want a doxy safee one. So either the doxycycline monohydrate paste or the doxycycline high plate liquid that you can get. That one's from Su.
The important thing is the clinical science, you can get really strange culture patterns. So it is not not ideal for prediction, but culture and sensitivity is the best way you've got to try and do it pending culture results or pending PC R results and treat. As for TB and then deescalated, if you can If it's a small module, then, surgical removal.
But you've already met Maisie a few times. There's no way this is gonna be surgical. She was actually she did respond to treatment, but that was a year of treatment.
So these are not for the faint hearted. If it's Mac, that's your combination. Usually I use a zit, zit fin and product, so I treat the same way as TB.
But I've got other options. And if this doesn't respond to treatment, then try and get hold of it's any of these, but it's not. It's not a good option, so they're much harder to treat.
Is it pictures from Richard Malek? You see a lot of this in Australia and they really treat as a cancer protocol. So they do really heavy antibiotic treatment, and then they surgically removal.
Everything that they can once they've shrunk it as much as they can reconstruct and do more antibiotics, and that has impro improved the prognosis. But you can imagine that's a lot for the cats. And that is expensive.
So I hope my whistle stop tour through, M, the MS the mycobacteria. So particularly, we're focused on TB in cats. But we did do a bit of TB in dogs, and we had to do a comparator to non vous mycobacteria.
And I know some people like to listen back to these things at, like, 1.5 speed. I wouldn't do that because I'm already speaking at that speed.
So, maybe slow me down when you're listening to this. There's a lot to get through. So But thank you so much for, being interested in this and obviously thank you to everybody who has ever supplied any material to me, et cetera, et cetera, et cetera.
To the funding bodies that have funded my research. My collaborators, and of course, my fabulous, students. So thank you very much.