Herpes Virus in Cats

Question: Dr Richards--second reply to same e mail--is this rhinotracheitis in any way

contagious to my other cats?? I have a household of 11 cats, all but one 14

yr or older. Mitra is somewhat of a loner, tho. When she sneezes, is it

likely to be contagious or is she just sneezing in reponse to mechanical

irritation?? ( I realize this question probably cant be answered without

seeing the cat......)

-----

Answer: C-

Most cats are infected with rhinotracheitis (feline herpes virus 1). Estimates vary from 70% to 95% of cats being chronically infected but it is likely that it is closer to 90% than to 70%. Cats are usually infected when they are young but because the virus is a herpesvirus it can live in the body long term and surface at times of stress or immune compromise. So the odds are that the other cats have already been infected or have some natural resistance to the infection and won't become infected. There is always a small chance that you would happen to have one of the small number of cats who aren't already infected and that the disease could spread to that cat but with the odds being what they are, this is a fairly minor concern.

I don't know with certainty why a small number of cats are hit so hard by the effects of the virus. The best theory is that they have coinfections with other viruses and/or bacteria and/or mycoplasmal organisms that make them sicker and unable to cope with the combination of infections, producing severe damage in the nasal turbinates and respiratory system, which in turn lowers their local immune defenses for life.

I hope that this is helpful.

Mike Richards, DVM

6/18/2004

vet wasnt familiar with it but after I showed him your e mail and because you are a dr he agreed to prescribe it. Since she had a depo shot at the same time I dont know which is working best but my plan is to try to continue with the zithromax until beyond the time at which she would need another depo shot and see if she is still OK. I give it to her twice a week and I do hear some slight sounds of congestion when she sleeps with me

and her head is near my ear, but before, it was so bad I could hear her noisy breathing in the next room. She has vomited slightly about once a week or less but maintains her weight. What if any are the side effects I should look for?? My guess is she will be on this indefinitely. Searching on google I noticed that in humans it sometimes causes liver problems?? What are the side effect in cats?? also, in the June vetinfo digest you mentioned a 3/15/04 article re hyperthyroidism and pop top cat food cans. Boy does that sound bizarre. Would you be willing to share the name and address of the authors?? I want to write them for a reprint. The nearest vet school to me is UC Davis which is about 100 miles away. BTW, I have not had any problems with the vetinfo journal, am receiving it timely and only once. I'm in california if that makes any difference. Thanks again for your excellent advice and I'm sure Mitra would thank you if I could make her understand --catwoman.

1) Is it known how long a cat/kitten is contagious with herpes either while symptoms are still visible are after symptoms are completely gone? I still have several kittens here who are in the process of clearing up the last of symptoms and want to know when it is safe to let them go. Several kittens have already gone into single cat homes and have been vet checked there and are doing just fine. I am concerned about kittens that may go into homes where there is already another cat.

Answer: Cats that are infected with herpes virus are infected for life. They shed the virus intermittently and they may shed the virus with or without clinical signs being present at the time they are shedding it. Since 70% of cats (some studies suggest >90%), at least, are infected with this virus, it is safe to let them go to a new home when they are symptom free. They may have future problems with the virus but that is true of almost all kittens and most do not have recurrences of serious disease from herpes virus.

2) I have two kittens who are now 12 weeks old whose symptoms all have cleared up except each has an eye that is still foggy and watery. I am treating them 4-5x daily with Mycitracin ointment (they had been treated for several weeks with Viroptic drops previously). The ointment is cheaper and seems to be as effective. Any idea how long it will take for this to clear up? Or is there a better medication to use for a persistent eye problem? Viroptic is only supposed to be used for 21 days.

Answer: I think there is a misunderstanding about the use of trifluridine (Viroptic Rx). Trifluridine is supposed to be used for a minimum of three weeks, or at least one week past the resolution of clinical signs, whichever is longer. Some cats require several months of therapy. At some point, the virus is finally handled by the immune system and the clinical signs disappear. Usually this happens about the time
everyone is ready to give up on a cure. Antibiotic ointments don't really help clear up the virus but they can prevent secondary infections. Ointment should be fine for this purpose.

3) Within the last two weeks, I have had three females go into heat and assume they are now pregnant. The first Mom did suffer from symptoms for several days, was treated and has been just fine since. No symptoms now. Must I treat her with antibiotics before delivery and vaccinate the kittens early, isolate, etc. as per your recommendations?

Answer: There is no reason to treat the females with antibiotics prior to delivery. If you want to do the most you can to prevent future occurrences of herpesvirus problems it is best to vaccinate the kittens with an intranasal rhinotracheitis/calicivirus vaccine as soon as their eyes open, then weaning the kittens before the maternal immunity wears off (six weeks is usually OK) and keeping them separate from the adult cats until they can be vaccinated when they are about 12 weeks of age.

This is confusing, but vaccination for herpes virus does not prevent a cat from becoming infected -- it just reduces the clinical signs in infected cats. This is important to do but the most important thing is to try to make sure they get infected when they have been vaccinated and have some immunity so that they do have less severe illness and fewer long term complications.

4) The second Mom never did show symptoms nor does she show any now. Is she definitely a carrier now since the herpes has been in my cattery? Or can cats be exposed to this virus and never get it? (All of my adults have been vaccinated with appropriate vaccines over the years). What precautions, if any, need to be taken for her and her future litters?

Answer: The odds are very high that this cat is infected, too. She just may not show clinical signs as readily or may have a better immune response to the virus. Her kittens should be treated the same as other kittens in the cattery in order to prevent them from having problems to the extent it is possible to do that.

5) The third Mom is the cat who I believe picked up the virus while at an emergency pet treatment place. She never did develop symptoms although it was her litter of kittens that first showed up with it. She is pregnant again and is sometimes sneezing although this is the only thing I am noticing--no congestion or eye problems. Does that mean she could be just contracting the virus now? Or could she be showing some symptoms due to the stress of pregnancy. She is only a week or so into her pregnancy. If she is currently active with the virus, could this affect the kittens in utero (deformities, etc.)?

Answer: She is most likely to being showing signs because of the stress of pregnancy. To the best of my knowledge, there is no in utero transmission of herpes virus. Kittens are infected after they are born, so there should be no risk to the kittens.

6) If a cat or kitten has already had the virus, can they get it again from another cat or kitten who is currently active? In other words, can this thing be passed around again and again within my cattery?

Answer: Cats that get this virus have it for life, in most cases. However, exposure to other infected cats seems to cause recurrence of illness in some cats, probably because they were close to losing immune protection, anyway.

7) Before delivery, how far ahead must I treat a pregnant Mom cat with antibiotics and what kind of antibiotics do you recommend that won't affect the kittens in utero?

Answer: This is not an issue, there is no reason to treat the pregnant cats. However, it may be necessary to use antibiotics for kittens that develop clinical signs of disease, in order to keep secondary bacterial infections under control.

8) You stated that the litters should be vaccinated at 14 days. Should this be done with the Heska vaccine (directly into the eyes and nose). Must they be treated with the whole vaccine or just the part of the vaccine addressing the herpes virus? Is it safe to use the whole vaccine at such a young age?Also, my vet mentioned something about vaccinating them at birth - is this possible or recommended?

Answer: I am not aware of a protocol that calls for vaccinating kittens earlier than 10 to 14 days of age. That doesn't mean there isn't one -- it just means that I don't know about it if it exists.

When vaccinating young kittens (less than three weeks of age) it is really important not to use a vaccine that contains panleukopenia virus (Heska's vaccine does contain panleukopenia, Pfizer's does not --- this is from memory so please be sure to check before using a vaccine). Only use a vaccine that contains herpesvirus (rhinotracheitis) and calicivirus.

9) You stated that the litters must be isolated. For what length of time is this necessary? Is this only until the first vaccine? Also must the Mom cat be isolated too, or can she be free to roam the cattery and just keep the kittens isolated? I always keep my litters isolated for at least the first 3-4 weeks anyway, but do let the Moms out for feedings and to socialize with the other cats/kittens as they hate being separated.

Answer: It is a good idea to keep the litters isolated from the other cats, which does mean that the mother has to be kept isolated, as well because she can bring problems back to the litter. The most critical part of the isolation procedure for keeping herpesvirus problems to a minimum is the period after the kittens are weaned and before their vaccination series is finished (twelve weeks of age).

You might find that early vaccination is sufficient to protect the kittens if you simply can't effectively isolate litters of kittens from weaning at 4 to 6 weeks of age. If that doesn't work, you can adopt the more stringent program.

10) Are there any other precautions other than antibiotics for the Moms, isolation of litters, and vaccines at the appropriate age that you recommend? When handling the new litters, must I take shoes off, wash hands, etc. when going from the main cattery into the areas where the new litters are?
Any other suggestions?

Answer: It is a really good idea to wash your hands very frequently during the day, especially between handling different litters. Disinfecting areas that can be disinfected using dilute chlorine bleach (1:30 dilution) frequently, is a good idea, too. I don't know how effective taking your shoes off is.

11) Must the precautions you recommend be done with every litter forever in the future involving these cats? If not, how long or for how many litters must I continue precautions?

Answer: You may find that you can get by just by using an early intranasal vaccination program and keeping up with vaccinations (intranasal or by injection) from 6 or 8 weeks of age to 12 weeks of age. However, if you try this and it doesn't work well enough, you may need to go with the whole program. If you do, it will probably be necessary to keep it up long term (possibly forever).

12) Will future kittens born to females who have either had the virus or who have been exposed to the virus automatically be carriers or if the proper precautions are taken, will they be virus-free and symptom-free?

At some point, most cats become infected with this virus. Once they have, they will usually have the virus for life. So the goal is to control the symptoms. This is done through the vaccination program and by keeping the litters isolated, if necessary, so that they get infected after they have the ability to fight the virus better and to control symptoms better.

Answer: Remember that there is some chance that the symptoms you are seeing could also be due to calicivirus at times. The protocol for vaccination is the same but calcivirus carriers shed the virus persistently, rather than intermittently, so that carriers may infect generation after generation of kittens --- this is just another reason to try to break the cycle of whatever is going on with early vaccination.

Mike Richards, DVM
2/18/2002

Question: Dear Dr.Richards,
One of my 3 cats have recently been diagnosed with feline herpes. She
has an eye that sometimes is a bit redder and smaller than the other one. My
vet say's that she will need some drops to put in. I have been reading
that these drops can be a bit expensive. I am just wondering if there is anything
that I can give her (something that a normal person can get a hold of) to make
the symptons go away. Also how is this going to affect my other 2 cats.
The other 2 are kept in a separate room in the house while the affected cat has
the full reign of the house. But I do let the other 2 out for about half
an hour, at which they sometimes play.
Waiting in Vegas, Pearlie

There are several different eye drops used in cats suspected of having
herpes virus conjunctivitis or keratoconjunctivitis (KCS).

Veterinary ophthalmologists often recommend using tetracycline or
chloramphenicol eye ointment or drops to try to make sure that a
secondary infection with chlamydiosis or mycoplasma is not present. These
infections are sometimes a primary problem, as well.

If the eyes are painful some vets like to use non-steroidal
anti-inflammatory eye drops (these can be expensive) and others use
corticosteroids. The corticosteroid drops seem to be pretty
controversial, though. They can make herpes worse but they also appear to help in some
cases. I try to stay away from them but sometimes it is really tempting
to give them a try.

Oral and/or topical interferon drops may help in some cats, based on
case reports (but no scientific studies that I have seen).

There are anti-viral eye drops that can be used in cats. They are
expensive and are often painful when applied. Trifluridine 1% (Viroptic
Rx) and idoxuridine 0.1 % (currently has to be made by a compounding
pharmacy) are the two most commonly used. We tend to hold off on these drops due
to the cost, irritating properties and the need for frequent
administration of the medications but they probably would help more if
we used them earlier. Many of our clients won't continue the drops in
their cats due to the cat's reaction to the drops, though. So that
discourages us from recommending them quickly.

Oral administration of l-lysine is helpful in some cats. 250 to 500mg
per day per cat is the usual recommendation. Most cats will eat these
tablets if they are crushed and mixed with food. These tablets are available
over the counter.

After reviewing your questions & answers (which we found very helpful)
Your web site is the best one out there. I wanted to ask about our one
cat specifically. Tigsy is 5 years old and has been diagnosed with
herpes virus and chlamydia, as well as arthritis.

His symptoms are:
- he makes a snorting sound which seems to come from his upper nasal
area - we don't notice much discharge from the eye, however, he has what
appears to be an internal drip (which he swallows)
- every few months he gets a cyst (almost resempling a pimple, it's
puss filled) around the outside of his mouth area
- he also has arthritis, as his joints swell and generally are swollen
for a couple days. It is never the same joint, and only one at a time
(one every month or so)

We've seen a specialist for his sores and his arthritis. We were
giving him steriods and antibiotics before seeing the specialist (2 years
ago), her advice was not to give him anything but let his own immune system
fight. As a result of this, we have noticed his symptoms take less
time to heal than when we treated them with medication.

My question to you is, by leaving his symptoms untreated can he live a
full and relatively healthy life? I've tried reading books to educate
myself on the herpes virus, but there isn't much information that I
can find. It is upsetting when you see your little guy in pain and cannot
offer any help. If we know that this is better for him than it may
help us both.

I have been trying to figure out if all the symptoms that you are
seeing could be caused by one condition. So far, if that is the case, I
haven't been able to come up with a disorder that would do this. However, I
have found a couple of case reports of cats with signs of chronic herpes
virus and severe arthritis. The odds are that these are separate conditions,
though. The reason for this is that herpes virus is very common and
many cats are affected by it. So when another condition that is less common
occurs it is tempting to view it as a complication of the herpes virus,
although it is probably more likely that the second condition is only
occurring in a cat with herpes virus because herpes virus is common,
not because it is causing the symptom. It is also tempting to blame almost
all upper respiratory symptoms on herpes virus, just because it does cause
most of the cases of chronic upper respiratory disease. In this case, there
is no really effective treatment except that it does help to keep
secondary bacterial infections down to use antibiotics when the disease seems
worse clinically. There is a small chance that administration of l-lysine,
500mg/day, might be beneficial but usually this doesn't help much in
the chronic upper respiratory infection cases.

With that in mind, it seems very likely that chronic herpes virus is
underlying the post-nasal drip type symptom. However, this may also be
caused by dental disease, oro-nasal polyps, cancers of the nasal
passages or pharyngeal region, fungal infections of the nasal passages,
allergies (probably rarely) and even from eye disease in some cats, due to
excessive tear production draining into the nose through the lacrimal ducts and
then being swallowed. It may be worth making an effort to eliminate one or
more of these problems as a possible cause of the problems seen, depending
on what has been done already and the appearance on a physical exam.

The lameness is probably an entirely different problem. There are
several possible causes of persistent arthritis in cats. If the cat has feline
leukemia virus, there is a disease associated with this, chronic
progressive polyarthritis, that occurs when a second virus, feline
syncytium forming virus, takes advantage of the immunosuppressed cat
and invades the joints. It seems likely that FeLV testing has been done,
though. Cats sometimes get persistent arthritis associated with
mycoplasma or l-form bacteria, both of which usually respond to treatment with
doxycycline, a tetracycline class drug. It can be worth trying the
antibiotic just to see, because both of these organisms are very hard
to culture or identify in joint fluid. In addition, doxycycline is an
effective therapy for chlamydiosis in cats. There are a number of
immune mediated arthritis disorders that occur in cats, including rheumatoid
arthritis, systemic lupus erythematosus and idiopathic (occurs for
unknown reasons) immune mediated polyarthritis. These sometimes respond really
well to corticosteriods but if this hasn't been your experience, it seems
reasonable not to use them.

It is reasonable to try glucosamines, either Adequan (Rx) injectable or
glucosamine/chondroitin tablets orally, for most forms of arthritis.
These medications should not have a detrimental effect and may be helpful. I
also see no reason not to try to control the pain associated with the
arthritis. We sometimes use aspirin, very carefully, in cats with
arthritis and it works reasonably well. We also use narcotic pain relief
medications when pain is severe and it seems necessary to do so. It is hard for me
to believe that pain is beneficial in the healing process so I just don't
see any reason not to try to control it, but it would be best to check this
out with your vet and the specialist, if possible. Pain would be the issue
that would make me wonder about the quality of life, though.

The swelling around his mouth may be due to acne, furunculosis,
eosinophilic granuloma complex, dental disease, localized pyoderma or
even ringworm. With the recurring nature of the problem acne, furunculosis
and eosinophilic granuloma complex seem most likely, though. The first two
sometimes respond to local treatment with things like benzoyl peroxide
shampoo or mupirocin. Eosinophilic granuloma complex often requires
treatment with corticosteroids but can go away without treatment at
times, as well.

I really think it would be worth talking to your vet about trying
doxycycline, if that hasn't been done already, and to ask about
controlling pain and whether glucosamine/chondroitin products might be beneficial.

Good luck with all of this. I hope that this information helps Tigsy at
least a little bit.

I am writing about my 3 year old neutered male cat Oberon. He is by all appearances a healthy, playful cat who is sleek, shiny and a good eater. He is an inside cat
(along with our other cats) and was FIV and FeLV negative at the time of
his adoption. However, he had cat herpes as a small kitten, shortly
before I adopted him. His right eye was so ulcerated that they had to
remove it. His one-eyed status doesn't slow him down at all, and he is
a delight (you get used to the one-eyed visage pretty quickly), but he
does occasionally go through phases when he sneezes out occasional
"boogers" (sorry, can't come up with a better word for dried mucus).
This problem was worse when I first had him, so our vets had him on
clavamox for the first few months after we adopted him. The sneezing
and dried mucus do seem to be worse at times when I notice my hayfever
acting up as well (and I have 2 eyes...still, none of the other animals
sneezes). A couple of vets have told me that it's possible his sinus
doesn't drain as well as it could because of the eye removal and hence
the occasional mucus problems. It doesn't seem to bother him, and it is
intermittent, but I was wondering if you've ever seen anything like
this?

Also, he has chronically inflamed gums (I've read about this on your
site, I guess it's not uncommon in cats who had viral infections as
kittens...it's possible the poor guy had calici AND cat herpes when he
was abandoned). Our vet recommended cleaning Oberon' teeth recently and
we had the typical pre anesthetic bloodwork done. He came through it
just fine, and his gums and breath are better for now, but the vet
mentioned that his creatinine levels were a bit high. Since the BUNs
were O.K., the vet didn't think there was anything to worry about , but
maybe we should have his blood checked again next time. I know that
high creatinine and BUN levels can indicate kidney problems, but 3 is
pretty young for chronic kidney problems in a cat isn't it? I've heard
that chronic gingivitis can lead to kidney problems. Could the fact that
Oberon had health problems as a kitten predispose him to an early onset
of geriatric type problems? Our vet didn't seem concerned, so I'm not
especially worried, but I wanted to see what you thought.

It is not uncommon for cats who have severe herpes virus infections when
they are young to have intermittent nasal infections or poor ability to
deal with nasal irritation as adults. Severe early viral infections damage
the nasal turbinates and nasal passages and lower the cat's ability to
fight off infections. Sometimes it is helpful to supplement l-lysine, 250
to 500mg/day to these cats but most of the time the damage is just there
and this won't help much as it only suppresses the herpes virus. We have
good luck using azithromycin (Zithromax Rx) in cats with chronic upper
respiratory infections. Sometimes we use it intermittently on an "as
needed" basis and sometimes we use it continuously on a once every 3 to 7
day schedule to suppress infections, depending on how the cat responds.
Things that help with nasal irritation in general, like saline nasal sprays
(not too many cats will let you use these), decongestants like
neosynephrine (same problem) and humidifiers in a room the cat stays in can
be helpful. It is a good idea to try to stay on top of these infections
because they can set up a self perpetuating cycle by causing further
damage. If Clavamox (tm) works for your cat, there is no problem with
continuing its use, or with using any other antibiotic that is helpful. We
just have the best luck with azithromycin right now.

The chronic gum irritation might respond to the use of bovine lactoferrin.
This is applied topically or given mixed with milk. It comes as a 300mg
capsule and we use 1/2 of the capsule's contents once a day. It seems to
help about 20% of cats but that is enough to make it worth a try. Sometimes
using the antibiotic clindamycin (Antirobe Rx) is helpful in chronic gum
disease. We try if for 10 days and if it works well we just give it the
first 7 to 10 days of each month until the problem seems to stay away, if
that happens. Corticosteroids can work well for the gum inflammation but
have drawbacks in cats with chronic nasal infections since they weaken the
immune response --- so I would be hesitant about this treatment. There are
several other treatments that work occasionally and your vet may be aware
of ones that I don't know about. It is a good idea to check for feline
odontoclastic reabsorptive lesions (FORLS) in cats with chronic gum
irritation. These are weaknesses in the enamel caused by a cell, the
odonclast, that is supposed to dissolve the baby teeth and then become
dormant -- but in some cats this doesn't happen for some reason and
permanent tooth enamel gets damaged. If these are present the current
recommendation is to remove affected teeth. We don't always do this,
because the teeth can be really hard to remove and lots of cats have this
problem --- but it is the recommendation of veterinary dentists and others
who study this problem. There is no other good treatment that I know of,
although people are continuing to try to find one so there may be something
new I don't know about.

I would worry about rising creatinine levels but definitely agree that the
thing to do is recheck the blood and see if it is a real problem or if
there was just something wrong with the last test or a minor problem your
cat has resolved. If your cat is Persian, or part Persian, it wouldn't be
so unusual to have kidney failure in this age range, since they are prone
to polycystic renal disease. Once in a while there is damage to the kidneys
from something like kidney stones, kidney hemorrhage or toxins that leads
to early onset kidney failure. If the creatinine is still elevated or
especially if it is rising, it would be a good idea to continue to look for
a cause of the problem, perhaps with X-rays or ultrasound examination.

Good luck with all of this. I'm hoping the creatinine level was just an
aberration.

I am a new subscriber to your web site, which I found extremely useful, and
which has opened my eyes on many things that neither me nor our vet knew!

I have two cats. Both of them (obviously) have herpes virus, but only one
of them (5 months old) is on L-Lysine (great results, I should say: his
awful conjunctivitis has disappeared completely, although I am not sure for
how long - he is still at the end of his treatment!). The other cat (the
elder one - 3 years old) has inflammatory bowl disease and takes
prednisone, that's why our ophthalmologist did not suggest taking L-Lysine
for this elder cat as his immune system is already down.

To add to this "pretty" bouquet of diseases, the elder cat recently was
also diagnosed with Giardia (although both cats are strictly indoor ones)
and is going to be on metronidazole.

Since there's a possibility that the younger cat also has Giardia, our vet
has recommended to give metronidazole to him too. My question is: what do
you think about treating a cat with both medications - L-Lysine and
metronidazole? Is it OK to take both at the same time? Is it really
necessary to treat him with metronidazole (he seems to be very healthy with
a strong immune system, and unlike the other cat, has no diarrhea at all)?

L-lysine is an amino acid, one of the building blocks of protein. It does not have much effect on the cat's body. It works for herpes virus because the virus is an RNA
based virus. Due to this, the virus has to fool the body into making DNA.
L-lysine interferes with this process because it resembles the amino acid
the body really needs for the conversion. This interferes with virus
reproduction and in chronic cases of herpes virus it helps to inhibit the
virus and allow the body to deal with it. So it really doesn't have much
effect on the immune system and it doesn't interfere with other medications
much. It is generally safe to use this amino acid for treatment of herpes
virus while using other medications or while treating other conditions.

Lots of cats with giardia have no clinical signs. Most of them never get
treated for the illness. But they can be carriers and since your older cat
appears to be susceptible to the giardia organism it is probably best to
treat both of them to try to prevent recurrences.

Great site. I love the information.
Our situation:
We had an older male cat, 12 years, who had been an only cat all that time.
Three weeks ago we adopted a six month old kitten from the Humane Society
here in NYC. We wanted a kitten and thought it would keep Fish, the older
cat, company.

Unfortunately we did not take the time to make sure that Fish's shots were
up to date. The kitten, Lucy, came home with a sneeze. Fish caught a cold.
Next thing we know Fish stops eating. He becomes quite lethargic and
retreats to special hiding places in the closet and under the bed.

We take him to the vet who prescribes a course of oral antibiotics,
Amoxycillin (sp?). We administer the medication for a week. Still, Fish
does not eat. He goes to his bowl or the faucet and looks interested but
then fails to ingest. Five days later we bring him back to the vet who
shows us sores on Fish's tongue. She discovers his vocal cords are bleeding
and there are sores down his esophagus. The vet is concerned about hepatic
lipadosis as Fish is a large cat. (We don't think of him as fat.) She
suggests a feeding tube and we agree. For the next five days we inject a/d
food through the tube along with water and medication.

Last Sunday we notice that Fish was having trouble walking. He is very
unsteady on his feet especially the hind legs. And is very lethargic.
Sunday evening he fails to make it to the kitty litter box. We call the vet
who warns us that Fish may die and that she would like to see him Monday
morning.

We bring him in and on the way to the vet he urinates on himself in his
carrier. The vet puts him on intravenous medication, nutrition and fluids.
The 105 fever goes down. Tests for FIV and F leukemia come back negative.
It becomes clear that his joints are swollen and inflamed.

The vet initially suspected a herpes virus which Lucy, the young cat, gave
to Fish. She is still sneezing and there is gunk coming out of her eyes.
Otherwise, she seems fine. The vet said that she is fine. Fish also has
gunk coming out of his eyes. Fish on the other hand, she thinks, has caught
the Calicivirus. Apparently, the sores in his mouth and throat-which
suggested herpes initially--are healing, but he still cannot walk. Our vet
consulted a specialist and the specialist said this pattern of infection is
rare, but not unheard.

We have absorbed a large amount of information in the last few weeks. The
information assimilating and the care giving have been exhausting. Fish is
due to come home from the vet tonight. He is still unable to walk so we
will tube feed and change his absorbent bedding frequently over the weekend.

Our question is what do we do to make Fish comfortable? What do you think
about this series of events? I want to rename Fish Job. From the info
provided can you shed any light on Fish's situation? Our vet thinks a full
recovery is likely. How long might this take?

Sorry to go on at such length, but we want to give Fish every opportunity
for a full life.

It is not uncommon to have both feline herpes virus (rhinotracheitis) and
calcivirus infections at the same time. It sounds like this may be
possible, although it is also possible that calicivirus may be the sole
problem.

I think that calicivirus is less common than feline herpes virus 1
(FHV1). They both cause upper respiratory disease. Both can cause oral
ulcers, although calicivirus is more likely to cause these and they tend to
be more severe with this virus. Fevers are more common with FHV1, but can
occur with calcivirus. Eye inflammation is worse with FHV1 and if there is
irritation of the cornea (keratitis) it is much more likely that FHV1 is
the culprit. Calicivirus is associated with lameness, swollen joints and
arthritis (limping kitten syndrome) and is more likely to cause
gastrointestinal upset.

It was almost certainly a good idea to go to forced (tube) feeding for
Fish. After three to five days of not eating, cats can develop hepatic
lipidosis. The signs of approaching the bowl as if hungry and then refusing
to eat is typical behavior for that problem. The only treatment that works
is to ensure adequate nutritional intake until the cat is willing to eat on
his own.

The limping syndrome associated with calicivirus is usually self limiting,
resolving all by itself within a few days. It may help to give aspirin
once, at an appropriate dosage for his size. Other than this, nursing care
to keep the patient dry and clean and ensuring that the patient is taking
in adequate quantities of food and water is important, too. This is another
reason to use a feeding tube, so again, that was a good choice.

It really sounds like you and your vet are doing the right things and
working hard to ensure that Fish will be OK. I hope that this good care has
been rewarded and that he is better now, or at least well on his way to
recovery.

I am a new subscriber to Vetinfo, tho I've been
visiting your website for some time now. It is
such a great resource!

I have two kittens, Buddha - 4 months old, and
Lilac - 5 months. Buddha apparently has the
feline herpes virus, since he developed cold-
like symptoms right after I took him home.
Sneezing, eye discharge... It continues to be
a recurring problem in the three months that
he's been with me, and now my other kitty's
eye is gooping up. Buddha has been on (at
various times) Clavamox, Tobramycin for
his eye, then triple-antibiotic ointment for
the eye, then Gentocin (?) for the eye. Now
Lilac is on Tobramycin, Buddha is not on any
medication. So, my questions: What should I
be doing to keep these little squirts as healthy
as I possibly can without taking them to the vet
every two weeks, as I have been doing? When Buddha
gets snuffly and has discharge coming from his eyes,
should I just let it pass or should I take him to
the vet? All the trips to the vet are beginning to
add up, and I just want to know if it is necessary
or even helping him, or if his symptoms will pass on
their own. Not to mention the fact that the symptoms
are supposedly brought on by stress (and what's more
stressful to a kitty than going to the vet?)
Do you recommend wiping their eyes with a kleenex or
am I just irritating them more?
I am going to start putting lysine in
their food, as suggested by you and my vet, do you
recommend 500 mg a day for kittens? My vet says
250 mg.

It is probably fine to use 250mg per day of l-lysine in kittens and small
cats. 500mg of l-lysine per day is better for adult cats of normal or large
size. It takes some time to notice benefits from this (several weeks) so
please give it some time.

I don't see any problem with using a tissue that has been moistened with
warm water to clean the gunk from around the eyes. I usually use Bounty
(tm) paper towels because they are soft but hold together well. A wash
cloth is probably OK, too.

Antibiotic eye drops help sometimes when there is a secondary infection. I
like to use tetracycline ointment or triple antibiotic eye drops or
ointment. We have been having problems getting tetracycline ointment
lately, though. Most of the time antibiotic eye medications don't help
much. The primary problem is usually viral and the virus is not susceptible
to an antibiotic. It is really hard to resist going ahead and using an
antibiotic, though.

It is possible to have anti-viral eye drops compounded at a pharmacy and to
use them (idoxuridine drops). This can be helpful when this problem gets
chronic. They are expensive compared to antibiotic eye drops, though. I
have always been reluctant to try this, but some vets use dilute betadine
solution for herpes eye problems.

If your vet is pretty sure that this is herpes virus it seems reasonable to
me to skip trips to the vet's unless Buddha's eyes seem to hurt more than
usual or if the cornea looks cloudy instead of clear.

Good luck with this. Usually this problem will resolve over time. It is
just frustrating while you wait.

I have just subscribed to your service it is great to be able to get straight answers.

First of all the back ground on Tali, she is (amongst many we have) a two year old neutered female cat, who, literally stumbled into us when she was a very small kitten.

Both of her eyes were glued shut with gunge, that looked like red jello. We took her in and bathed them and also took her to the local vet in Israel, where we were living at the time. He prescribed an anti-biotic cream several times a day to be put in both eyes, this we did.

This had little noticeable effect, although the gunge went and we could see her eyes. They are both covered with what looks like a gray film and the surface looks uneven.You can just see the yellow eye underneath.

We then took her to another vet who prescribed some more cream, needless to say this also had little effect.

It was then on to another vet who said that he thought it was caused by her eyelashes turning in on the eye and had scratched the surface, but he also took a swab from her eye and sent it off to be tested.

The results came back as "a fungal" infection. More cream was prescribed, again with no improvement.

We then returned to Spain where we live and took Tali to our local vet here he said that nothing could be done.

We were not convinced as we had received several different answer so off we went again to yet another vet. This one looked at her eyes very carefully through a "microscope type instrument" and told us that the problem was herpes and that it was chronic!! There are little clusters of white dots on her eyes, which he
explained were groups of herpes.

He prescribed a course of Viromidin ( Trifluridina) drops 3 X day and Colircusi Aureomicina (Clorteraciclina) drops 3 X day, both of these are made by Cusi, Barcelona, Spain. These are to put the herpes into remission.
Then it would be possible to operate to clear the eyes of the damages and to give Tali about 80% vision in both eyes. At the moment he estimated she had about 20% vision in both eyes.

We went back after 3 weeks and he told us that the Herpes had not retreated enough to allow an operation to take place. He then prescribed only the Viromidin drops 4 X day and Zovirax ( Aciclovir) cream( made by Wellcome) at night for another 3 weeks. This we are in the middle of.

Phew, sorry to be so long winded but I thought you should have the full story. Oh, perhaps I should also mention that Tali is otherwise fit and healthy with no other signs of the herpes virus.

1.Is there anything else we can do to help put the herpes in to an holding state?
2.If nothing is done will Tali eventually go blind?
3.What risks are associated with this type of operation.

Herpes virus is the most common cause of the clinical signs you are seeing in your cat, so it is very likely that your vet is correct in this diagnosis, just based on the odds.

In the U.S., acyclovir (Zovirax Rx) cream is not available, but veterinarians sometimes use the oral version of this medication but success is reported to be variable.

Oral administration of l-lysine, usually 250 to 500mg per day, is helpful in controlling herpes virus infections over the long run. This interferes with the virus' ability to replicate and helps keep it in check.

Interferon, administered orally or mixed with artificial tears is reported to be helpful by some veterinarians but I am not aware of clinical studies supporting this therapy. It is unlikely to be harmful, though.

The medications your vet is using are the ones most likely to help. We have had several patients develop really severe corneal damage from herpes virus infection which was eventually possible to control. Most of our patients did not have surgery and most of them were able to see well enough that I could not detect visual defects. Some of these cats had really terrible looking corneas but still seemed as if they could see. There are times when herpes virus leads to corneal sequestrums and surgery is necessary in these cases, most of the time. Sometimes debriding the surface of the cornea
seems to help but there seems to be some controversy over doing this, among ophthalmologists. Your vet sounds experienced in treating this problem, so it seems reasonable to me to trust his opinion.

There are some cats that won't respond to treatment for this condition, or take a really long time to respond. We have the luxury of having a veterinary ophthalmologist who visits regularly in our area and he is very good. Despite concerted efforts, we had one patient who took over four years of treatment before this condition would resolve.

We have had one patient I can remember who had eosinophilic granuloma complex affecting the corneas that looked very much like herpes virus infection, to me. The ophthalmologist was able to distinguish between these conditions, though. Your current veterinarian sounds like a specialist in ophthalmology or at least very competent at it, so again, it is best to trust his judgment.

The major risk in ophthalmic surgery of the cornea is corneal ulceration due to secondary infections or complications from the viral infection or due to removing too many layers of the cornea in the effort to clear the corneal surface of scarring or a sequestrum. This is a good reason to be sure that the surgeon is experienced and possesses the instrumentation necessary to work on the cornea, such as adequate magnification (operating microscope is optimum, good head loupes a minimum), ophthalmic surgical instruments and ophthalmic suture. It is unusual to find all of this anywhere but a veterinary ophthalmologist's practice but I do know of a few general practitioners in the U.S. who
are skilled at eye surgery and who also possess the instrumentation to do a good job of the surgery.

If I didn't answer your questions clearly enough. please feel free to write for clarification. I do think you have found the right veterinarian at this point.

I have two questions. the first is about feline herpes. My DSH male got this virus when he was about 1yr old. It was a pretty bad case with most of the typical symptoms. Thanks to his opthamologist his ulcerated eye looks as good as new. He does have a blocked tear duct on that side but I keep it wiped and it really isn't a problem. What is a problem is that his inner nasal passages (turbinates?) were damaged and he is now a snuffler, to put it mildly. He is 4yrs old and has had either a stuffed up nose or yellowish gunk, which he sneezes all over, ever since the herpes attack. My vet did a culture and found the problem to be strep and pasturella (sp?) which she says is almost impossible to get rid of, especially due to his nasal damage. When he is on Baytril it clears up and is much better. When I take him off, in a week he is back to stuffy and snotty. This has been going on for 3yrs. Other than this he is a normal cat. I know having an
infection is really bad for him, and my vet said to put him on the baytril 22.7mg 1 pill a day for the rest of his life. The questions are: Will the infection become immune to the antibiotic? and I worry what a constant dose of antibiotic will do to his liver and kidneys, or is the infection worse on these organs? What do you suggest?

Your vet and the ophthalmologist are almost certainly correct about the initiating cause of the recurrent infection. Damage to the nasal turbinates leading to chronic upper respiratory infections is a fairly common problem in cats who have had severe herpes virus infections at an early age. These are very frustrating to treat.

I think that a number of vets use enrofloxacin (Baytril Rx) as an initial therapy or as a chronic therapy for this condition. This seems to be safe to do based on anecdotal reports but I am not aware of long term studies of continuous use of this antibiotic. So there may be some unknown risk that will become recognized later. Despite this, if the antibiotic helps I would consider using it because these infections do sometimes get really severe if no attempt is made to control them.

Other antibiotics are sometimes recommended and currently the most common one is
azithromycin (Zithromax Rx), which can be used daily for several days to a week or more then used on an every three day or a twice weekly schedule, which makes it less work. The usual recommended dosage is 5 to 10mg/kg. Given daily this medication achieves good blood levels after three or four days and then it is OK to switch to an every other day or every third day, or twice weekly schedule (depending on how well the cat does).

Other things that sometimes help include humidifiers, nebulized antibiotics, administration of l-lysine 500mg per day (helps fight the recurrence of herpes virus) and sometimes
decongestants. Some vets recommend using eyedrops containing antibiotics, on the theory that they are flushed into the nasal passages through the tear ducts (which wouldn't work on the side with the blocked duct, I guess).

Good luck with this. Many cats do live nearly normal life spans with this condition, especially if secondary infections can be controlled, even if only intermittently.

I have two elderly female spayed cats, one 14 and one 16. The younger
is Israeli and the older from Los Angeles (we live in Tel Aviv). They
have been very healthy except for starting about a year and a half ago,
when they had they're first real illness, an intestinal parasite
infection. The older cat also had a run of eye infections (a problem I
had at the same time, she is face rubber). Now I'm having a problem with
them sneezing.

They are indoor cats and almost never have fleas or worms. They received
their latest vaccinations in July and this included something for upper
respiratory virus (I can't read the name of the vaccine on the form).

In late October I treated them with Frontline spray and put them in a
boarding facility for a week; they were fine after. In January, I came
down with the flu. A few days later the older cat started sneezing. No
other symptoms, just small dry sneezes a few times a day and an
increased appetite. After a few days I took her to the local vet and he
couldn't find anything wrong with her apart from the sneezing, no
congestion, fever, nothing. He gave her an antibiotic injection and some
liquid antibiotic. No change. A few days later the other cat started
sneezing and eating more. I rushed her to the vet, same thing. He gave
her an antihistamine injection and told me to stop the antibiotics. The
cats continued sneezing and eating and I was very ill. Finally I took
them to my previous vet (at the other end of town, who was trained in
South Africa and goes to regular course abroad)) who also couldn't find
anything wrong with them, suggested it as a mild viral infection, and
told me to wait. The sneezing eventually stopped and they started eating
less.

Mid February I treated them with Frontline drops against fleas and put
them in the boarding facility for three weeks (the facility is unheated
but the cats are moved into a closed room if the weather gets really
bad). The evening I picked them up I found the younger cat was sneezing;
loud wet sneezes. Besides that, she was perfectly normal. The facility
said they knew nothing about it. This is a very noisy cat and it would
be difficult to miss her sneezing, it's almost as loud as human and she
is very slow to clean herself up. She quickly got better. Now, about a
week later she is no longer sneezing but still seems to be swallowing
phlegm. About a week after I picked them up the older cat started
sneezing, also wet but not as bad as the younger (this is a very quiet
cat). She is still sneezing occasionally but otherwise seems normal. As
a note, they hate each other and avoid physical contact with each other
though they eat from the same food bowl. They are both very affectionate
(to me, only) and enjoy a lot of physical contact (separately). My
apartment is unheated during the day and I use electric heat at night.

I realize that I should no longer board them during the winter, it's
just to cold for them (winter temperature this year ranged from 60 to 35
degrees). Do you have an idea what they are coming down with and what I
might be able to do to prevent this?

The most prevalent cause of sneezing and eye infection/inflammation, by
far, in cats, is herpes virus infection. This virus has been traditionally
referred to as rhinotracheitis virus but is commonly referred to as feline
herpes virus 1 at this time. This virus probably accounts for at least 90%
chronic or recurrent conjunctivitis in cats and the majority of cases of
upper respiratory disease. It is not uncommon for secondary bacterial
infections to occur when this virus is present, so sometimes there is a
good response to antibiotic therapy even though the primary problem is a
virus which is not susceptible to antibiotics. Other possible primary
problems include Bordetella and chlamydial bacterial infections and
calicivirus infections. Cats with feline leukemia virus or feline
immunodeficiency virus sometimes have recurrent upper respiratory disease
due to secondary infections, too.

Herpes virus infections are lifelong and symptoms tend to recur when cats
are stressed. Boarding is stressful at any time and perhaps being cold
makes it even more so. Not liking each other is stressful, too but since
that is sort of a constant stress it may not be having as much impact.

There are antiviral medications but for the most part these haven't been
too effective or haven't been very safe for cats. I haven't seen anything
new lately on these.

Although there is not good scientific evidence to back up these claims,
many veterinary practitioners (including me) think that adding l-lysine to
the diet, 500mg/cat/day, is helpful in limiting herpes virus
flareups. Adding interferon may also be helpful in limiting
flareups. Some vets also feel that using topical (intranasal) vaccines for
herpes virus is helpful but these vaccines are reported to cause some cats
to sneeze or feel a little low for couple of days after vaccination. This
is still possibly a good trade-off if they limit the overall incidence of
clinical signs.

There may be additional problems that are likely in Isreal that I am not
aware of since I practice in the United States but I'm sure your vet will
cover these with you. In the meantime, you might want to ask him if he
thinks that l-lysine or interferon might be helpful.

One other thing that I should mention is that your experience is fairly
typical in another way. The sneezing tends to go on for awhile and then
stop on its own. If there are not severe clinical signs of herpes, such as
corneal inflammation or skin disease affecting the face you can just elect
to live with this condition and not treat it.

Thank you for this wonderful service. I am writing because I adopted a very sick cat ('Nigel') from a local rescue league in July of '98 and he is still quite sick at the present time (February of 2000). I have taken Nigel to a number of veterinary specialists and he is currently seeing a wonderful vet who has really devoted much time and effort trying to help Nigel, but we are still struggling to figure out what's going on with him and how to manage it.

Nigel is a white, longhaired, blue-eyed, deaf kitty, possibly a Turkish Angora. I do not know his age because he was not a kitten when I adopted him, but most veterinary estimates put him at younger end of the spectrum, around 3-4 years old. His mouth is quite deformed (one vet thought possibly due to trauma) - he has a severe overbite, crooked teeth, and a slight harelip. His coat is dry and scraggly - he rarely grooms and does not like to be groomed. Despite his scruffy appearance and health problems, he is an absolutely wonderful cat - a real love bug. He is playful and enjoys life very much.

When I first got Nigel he had a ravenous appetite, but he was only 4 pounds. He had chronic explosive diarrhea that necessitated 100 cc of subcutaneous fluids daily. A veterinary GI specialist diagnosed inflammatory bowel disease by endoscopy and put Nigel on 40 mg of Flagyl daily, a tapering course of low dose Prednisolone, and Hill's I/D dry food. This therapy resolved his diarrhea after six months and he weighs 10 pounds today. Nigel also had ring worm when I first got him, which went away after a few months of sulfur baths every 10 days. A cardiologist has also diagnosed a mitral valve heart murmur (rate-limited) for which there is
no treatment.

Although his IBD has been under control for over a year, Nigel continues to look sickly and he has developed some additional problems. For about a year, Nigel has been plagued by crusty, ulcerative sores on his lips, mostly under his nose and sometimes in the corners of his mouth. These sores seem to follow a waxing and waning course and have been so severe at times that the area under his nose seems to be eroding away. Biopsies revealed that the sores were consistent with eosinophilic granuloma complex, although his current vet and a dermatologist both agreed that the sores do not look like typical EGC. He has been on food trials since the EGC diagnosis was made, but the sores continue to flare up. Nigel also has runny eyes (brown thick discharge) and severe gingivitis/stomatitis, which has not improved with dental cleaning or CHX gel. He also rubs his ears a lot as if they are itchy. His blood work is generally normal, but he has been slightly anemic at times and his albumin was slightly elevated on last check. Nigel has tested FeLV negative and FIV negative.

I recently found an article, which described a nasal/facial dermatitis associated with feline
herpes virus (Hargis, AM and Ginn, PE. Veterinary Clinics of North America:Small Animal Practice. 29:6, pp.1281-90, 1999). The clinical features of this syndrome reminded me of many of Nigel's clinical features - dermatological lesions (dramatically eosinophilic), gingivitis/stomatitis, ocular discharge, and one cat in the study had IBD. The authors of this article stated that the eosinophilic inflammation can lead to a misdiagnosis of eosinophilic granuloma complex. Since hypoallergenic diets have not helped Nigel so far, I decided to look further into feline herpes.

A month ago I started giving Nigel 500 mg of lysine per day, based on the information I found on your web site. After only 3 days, his eyes cleared up and he hasn't had any brown eye goop since. His coat is also starting to get oily, whereas it has always been dry. He was just at the vet and she was very impressed, but his lip sores and gingivitis/stomatitis are as bad as ever, so we are going to get another opinion from another dermatologist next week.

Since none of the Nigel's vets have really been able to figure out what's going on, I would be very interested to know your opinion about Nigel. Do you think that his lip sores and gingivitis could be due to feline herpes infection? I noticed that none of your online feline herpes patients seem to have lip ulcers or gingivitis. Do EGC ulcers have a waxing and waning course? Also, do you think Nigel would benefit from interferon therapy? Anything that you can deduce from my lengthy description of Nigel's problems would be greatly appreciated!

There was another recent article on this problem in the journal "Veterinary Dermatology", Dec. 1999 by Hargis, et. al. The diagnosis was made in the affected cats using polymerase chain reaction (PCR) testing on biopsy samples of the lesions that were submitted fixed in formalin. I found the summary of this article in the Veterinary Information Network database and it didn't list the lab that was used nor any sort of treatment. It is likely that the dermatologist will have access to this information, though. It does sound very much like the problem Nigel is
experiencing, though.

There are anti-viral medications, such as acyclovir (Zovirax Rx) but there are also a lot of side effects associated with this medication and variable success reported with its use. Oral interferon might help and at least seems pretty safe, even if it doesn't work out to be helpful.

Question: This is as much a psychology question as a vet question, but here goes:

I took in a third cat two weeks ago, an act that places me squarely into
the category of "Weird old maid with too many cats." Zoot is a
two-year-old Cornish Rex, joining my existing family of a Cornish male and
an Oriental Shorthair female. He is not neutered (yet), and arrived with a
kind of sniffly cold which I think must be calcivirus because it also
seems as if his mouth hurts. He got Clindamycin drops for a week to
prevent infection, and got better, but then got worse again -- he's still
sneezing. He eats more or less normally, canned food and dry food
moistened with hot water. The other cats are doing fine except that they
hate him. HATE him. Zerbi (the Oriental female, and yes, the two "Z"
names are purely coincidental) REALLY hates him and hisses whenever she
sees him. He and Ranger, the other rex, spar a little but aren't quite as
openly hostile. I think relations will get better after he's neutered,
but my vet understandably doesn't want to anaesthetize him until he's able
to breathe normally.

1. How long are the sniffles likely to last? What if anything can I do
to speed his recovery and get him under the knife?

2. What can be done to foster feline amity? Could you suggest any good
strategies for promoting inter-cat diplomacy?

Thanks. I've tried everything I can think of but there's still a sort of
siege mentality going, and I thought the respiratory stuff would be gone
by now. Sheesh.

The sniffling problem could last a long time if it is herpes virus
(rhinotracheitis), which is the most common cause of this type of problem
in cats. Some cats have a very hard time suppressing this infection. The
intra-nasal rhinotracheitis vaccinations may be better at helping cats
suppress the clinical signs of herpes virus than the injectable
vaccinations. It is worth using one of these to see if it helps, probably.
To be honest, we haven't tried this in our practice yet but it I see the
recommendation to do so more and more frequently and we are going to give
this a try in our next patient with this problem. Also, giving cats
l-lysine, a dietary supplement available at places like pharmacies and
health food stores may help to suppress herpes virus. The average cat needs
250 to 500mg/day.

We have been using Feliway (tm), an artificial pheromone spray that seems
to calm cats down and induce a more relaxed social setting for situations
in which new cats are having difficulty fitting into a household. It hasn't
been perfect but it seems to help a lot. Your vet should be able to order
this product for you. It is actually approved for use in reducing urine
spraying but following the same directions seems to help with introducing
cats to each other, too.

First off, I love your website! I spent about 2 hours last night
browsing through a bunch of the articles, and by the time I was done, I
was really wishing that you were my vet! Ever consider moving to
Pittsburgh????

I've had two, basically indoor, cats for the past 6 years (Bonnie &
Clyde). Last spring I adopted a stray who's basically an outdoor kitty
(Amstel).

In December, a new stray appeared......and of course, I felt compelled
to feed the poor starving thing. Needless to say, I'm his new best
friend. I called him Grey Kitty. Ever since the first time I met him
(3.5 months ago), he's been sneezing quite frequently (in fact, I now
have to clean my windows about every two days because he marks them up
so bad) and a reddish type liquid has been running out of his left eye.
His right eye is almost totally clouded over and looks like it's covered
by a cataract (my vet said that it's actually a very old battle scar and
that there is a small section of the pupil that is merging into the iris
part of the eye). My vet also said that he's approximately 9-10 years
old, has been neutered, has battle scars on his right eye, a rip on the
top of his one ear, some fur missing for the inside of both front paws
(where your thumb would be) and has a pretty severe heart murmur. Poor
guy, eh? Just makes me love him that much more.

Anyway, he tested negative for Feline Leukemia and Feline Aids and has
had all of the necessary shots (including his boosters). I treated him
for tapeworm three weeks ago, now it appears that he has roundworm....so
I'll be treating him for that starting tomorrow. He actually woke me up
one night by the sound of him sneezing and what appeared to be coughing
(which went on for a good 5 minutes or so.....I'm not sure what to call
it, maybe an asthma attack?). His stool has always been quite loose
(the consistency of soft-serve ice cream). He has also been loosing
weight, he's been back to the vet twice since I found him and both times
his weight has dropped. My vet wants to see him again in 2 months to
check his weight. I've also noticed recently that his appetite has not
been as good as usual. One more strange thing (not sure if it means
anything), he quivers whenever I pet him on his back (if my hand goes
any further than his shoulder blades....so I basically try to only pet
him on his head and neck.)

My question is, what do you think might be causing the sneezing and
runny nose thing? My vet told me that he probably just has a cold and
not to worry too much about it. However, if you think there's something
that can be done for him, please let me know! I feel bad enough for
the poor thing because if that weren't enough, he's also scared to death
of my other cats (unfortunately, he doesn't seem to realize that he has
claws, but my other two cats do not).

The most common cause of chronic sneezing in cats is chronic herpes virus
(rhinotracheitis) infection. Sometimes it helps to give these cats
l-lysine, which can be purchased at health food stores. The dose is 250 to
500mg/day. Interferon is supposed to be helpful in some cats, too. Sneezing
can also occur with chronic periodontal disease or other tooth related
problems. Since these types of problems also sometimes cause weight loss if
the cat eats less due to them, it would be a good idea to check his teeth
for problems.

Coughing in cats is not a common problem but it can occur with bordetella
bacterial infection (this is rarely chronic), heartworm disease and asthma.

Weight loss in older cats can be associated with hyperthyroidism,
cardiomyopathy, kidney failure, liver disease, diabetes and other problems.
Cardiomyopathy can be secondary to hyperthyroidism in older cats and it can
cause heart murmurs. Without knowing his history it is hard to say how long
the murmur may have been present, making it harder to decide how important
it is.

Lots of cats don't like to be petted on their backs. Cats that over-react
to this are sometimes said to have "feline hyperesthesia syndrome". It is a
good idea to avoid petting these cats in areas that are sensitive because
many of them will bite when stimulated sufficiently by the petting.

You have already done a lot for Grey Kitty but you might consider a blood
panel and T4 test to rule out hyperthyroidism and the other systemic
problems mentioned.

Q: I was searching for some info on interferon and I happened to find
this page. Hope you can help me out! "" Any information you could
provide, or info on where to look for answers, would be greatly appreciated!

A: This is the information that I have on treating chronic herpes virus
keratitis and ulcers in cats. Most of it is from a lecture given by Dr.
Nasisse who is at the University of Missouri, in case you need to follow up
on it.

L-lysine, either 500mg sid or 250mg bid is supposed to be helpful in
treating herpes virus because it interferes with viral replication. It may
work better when combined with interferon at 30 units orally once a day. I
can't remember the way that interferon is diluted offhand. If you have
problems finding that information let me know. Some people recommend using
interferon topically as well using artificial tears to dilute the
interferon to 30 units/ml. Anti-viral agents are also reported to be
helpful. I have also heard of using dilute Betadine solution as an eye drop
but haven't tried it because I just have these worries that it would be
really irritating. I have also heard of using the intranasal
rhinotracheitis vaccines as an eye drop in an effort to help with this but
I can't remember where I heard that. I think it may have been in a
continuing education session that Dr. Green from Georgia gave. I seem to
remember some discussion about that being irritating (this is strictly from
memory but might be worth researching some if you are struggling with this
problem).

I have a female cat, about 1 years old who has had a runny eye since I got her. My vet seems to think is was due to a respiratory problem at birth and will never go away. Every day I wipe it and it is a brownish discharge. She also is thin, about 4.5 pounds and very shy...she almost seems not to see well out of this eye. She also constantly wants to drink water and meows for me to run water from the sink..

Can you diagnose any problem that I should be aware of and what can I do for her eye.

Your vet is probably referring to chronic herpes virus (rhinotracheitis virus) infection. It can cause persistent eye problems and upper respiratory signs.

Please call your vet and tell him about the excessive water drinking. This can be a sign of kidney disease or diabetes, so it may indicate a serious problem.

Q: Dr. Richards, I've read your web page on feline herpes, and found it to be the most helpful of any I've seen. I'd appreciate getting your feedback on the attached history of our new kitten. In addition to the questions below, I'm also curious as to why only one eye is affected so far, and whether the brownish film on Rocky's eye might be a corneal ulcer. It covers his entire eye. It changed from whitish to brownish--what does that mean? Our animal ophthalmologist says the damage is permanent, and that surgery would make it worse. Could this have been avoided by starting aggressive treatment earlier? Should we get a second opinion? We want to do everything possible for this sweet little guy.

Also-we have started giving him a small amount of supplement for his coat (it was very dry looking). Does this have enough l-lysine to benifit the herpes situation, or should we go to something stronger?

Most importantly-does any of this cause Rocky pain or quality of life issues? The viroptic drops seem to burn when we put them in.

My husband and I have just adopted an abandoned kitten, who was diagnosed today by an animal opthamologist as having feline herpes. We are very concerned about the condition and treatment of his right eye, which looks badly damaged. We have now seen three veterinarians, but I feel uncomfortable about whether or not we are doing everything possible for him. None of the three has even done a culture to positively diagnose his problem.

Rocky is approximately 6-8 weeks old (was 4-6 weeks old when we found him). When we found him, his left eye was completely crusted closed, and his right eye was extremely cloudy, runny, and covered with what appeared to be a thick whitish film. He was also sneezing and had yellow mucus coming from his nose. Amazingly, he was in excellent spirits and very active and feisty.

We took him to our local emergency vet clinic, and the doctor on call tested him for feline leukemia and the feline version of HIV, and both were negative. He removed the "scab" on the left eye, and the eye looked very healthy underneath. He gave us oral Amoxicillin drops (.2 ml 2X daily) and a tetracycline eye cream (3X a day), and told us the problem was an upper resp. infection and possibly Herpes or Chlamydia. He recommended that we hold off on other treatment and vaccines until we saw our regular vet, and indicated he thought the kitten might be blind in the right eye.

Our family vet saw Rocky the next day and confirmed the emergency clinic's findings. He suggested trying the antibiotics for two weeks, at which point he wanted us to return for vaccinations (he felt Rocky was probably closer to 4 weeks old, and too young and sick for vaccinations), and a follow up on the eye condition.

For two weeks we have been diligent with the medication. The left eye cleared up immediately, as did the yellow mucus. The cloudiness of the right eye cleared slightly, and the white-ish film changed to more of a brownish shade. Otherwise no change. The kitten gained weight steadily (very healthy appetite), and continued to be very alert, happy and playful.

Then yesterday I noticed the right eye seemed to be getting cloudier and a clear liquid discharge was coming from it. I called our vet who sent us to the eye specialist today.
The specialist said the reflexes in the right eye are good, indicating there is at least some fuzzy or cloudy sight. She said the condition appeared to be herpes, and for us to continue using the antibiotics, plus viroptic medication (Trifluridine). She indicated that the damage to the eye was permanent, and that we could expect future herpes outbreaks. However, she did not perform a culture, and the only exam was manual (no computer) witha light and magnifying glass. This all leaves me with many questions:

1) How can we be sure it's herpes?
2) How can we get a better idea of the extent of the damage to Rocky's
eyesight, and is there anything we can do to repair it?
3) Is it safe for him to be on antibiotics for such a long period of time?
4) What exactly is feline herpes, how do we spot an outbreak, and what can
the virus do to Rocky?
5) How do we avoid future outbreaks?
6)Could we have improved his odds of seeing better, by starting him on the
viroptic earlier?
7) Is is safe for him to get his vaccinations now (we're scheduled for two
days from now)?
8) Can our two dogs or my husband and I catch the virus?
9) How does such a young kitten get such a full blown outbreak, with such
damaging effects?
10) Will future feline herpes outbreaks always be in his eye, and how are
feline herpes outbreaks normally treated?

1) There is a relatively new test for herpes virus infection, called a
polymerase chain reaction (PCR) test that is supposed to be much more
accurate than past testing methods. It is currently the best available way
to test for herpes virus infection in cats. I know it is done at the
University of Missouri but it is probably done elsewhere, too. I am pretty
sure your ophthalmologist is aware of the test. She may feel that the
clinical signs are obvious enough that a more definitive diagnosis is not
necessary.

2)Time is probably the only thing that will help in getting a definite idea
how much sight Rocky will retain and how much discomfort will remain.

3) Antibiotics appear to be safe to use for extended periods when
necessary, in most cases. After a while it seems un-necessary to use them
in herpes virus infections, though, since they don't do anything for the
viral infection.

4) Herpes virus is a virus that has the ability to live in the nervous
system, hiding from the body's defenses. Once infected, it is likely that
most cats remain infected for life. Dr. Nasisse, one of the researchers
studying this disease, estimates that the infection rate in cats is
probably greater than 70%. It is also known as rhinotracheitis virus. Most
cats with this disease probably exhibit runny eyes and upper respiratory
signs without developing corneal lesions. It is the most common cause of
persistent eye infections in cats and does frequently cause cornea damage.
It is probably reasonable to assume that most kittens with runny eyes and
sneezing have rhinotracheitis (feline herpes virus)

5) L-lysine is supposed to inhibit viral reproduction. You should be giving
500mg of the l-lysine per day. It is unlikely that you can achieve this
level without using l-lysine tablets. They usually have to be crushed and
mixed with an appealing food or broken into pieces and administered bit by
bit. Interferon may also be helpful in limiting future outbreaks.
Vaccination is thought to be helpful in preventing outbreaks of symptomatic
rhinotracheitis in infected cats even though they can not clear the infection.

6) I don't know if starting Viroptic earlier would have helped. Viroptic is
irritating to some cats. It is possible to use idoxuridine 0.1% for cats
that are sensitive to Viroptic but you have to find a compounding
pharmacist to make it for you.

7) I know of no reason not to continue the vaccination series in kittens
affected by rhinotracheitis. Some vets think that using the intranasal
vaccine is helpful in controlling the disease when it is already present
but I don't know if that is true

9) It is not unusual for young kittens to be affected by this virus.
Kittens do not seem to get much effective immune protection from their
mothers, who are often stressed by the birth and lactation periods and
therefore may be shedding the virus.

10) Most of the chronic problems associated with feline herpes virus appear
to be ocular. Some cats appear to develop long-term sinus or upper
respiratory infections and gingivitis may also be a long-term sequelae to
herpesvirus infection.

11) If the pain in an eye can not be controlled it is possible that
conjunctival flap surgery to fix a small portion of the pink conjunctiva to
the damaged portion of the cornea may be helpful (I saw this information in
an exchange on the Veterinary Information Network but do not have any other
reference to support it at this time).

If you are seeing a board certified ophthalmologist it is very likely that
she knows a great deal more than I do about the effects of herpes virus and
the treatment of herpes virus as it relates to the eye. Veterinary
ophthalmologists seem to be among the busier specialists and many of my
clients seem to leave their offices with their questions unanswered. I
think you are entitled to her opinion on your questions if you pay for a
visit, so I'd take the list back to her on the next visit.

Q: My cat was recently diagnosed with this virus and was treated with Valtrex, Depo-Medrol and an antibiotic injection. Within a week his systems improved, but after 4 weeks (Depo-medrol wore off) the herpes was back stronger than ever. I have found information on the internet about high quality diet and supplements in treating this virus and that the Depo-medrol slows the healing and actually strengthens the virus. How can I find information on treating my cat with supplements for this virus since there doesn't seem to be any medication to directly treat it. I have had herpes simplex I for 30 years and know all about the medications and remedies available for humans. I don't want to hurt my cat by giving him supplements. Please - any information would be helpful. Thank you. Lou

I think that the treatment for herpes (rhinotracheitis) is still controversial enough that you will have a hard time finding a definitive answer. The location of the lesions associated with herpesvirus has some bearing on the recommended treatments as well.

If your cat is being treated for herpes keratitis (lesions on the cornea of the eye) there are proponents of corticosteroid use. For a long time steroids have been used in persistant keratitis problems in cats due to the presence of eosinophilic granuloma complex lesions on the corneas of some cats. It is recognized that some or perhaps many of these cats actually have herpes virus keratitis. Even though it seems logical that using corticosteroids in a viral infection would cause problems that doesn't seem to be the case based on clinical response. Due to this, there is a higher tolerance for the use of corticosteroids when herpes may be present than you might expect.

Interferon seems to be recommended fairly frequently for use in herpesvirus infections, mostly in combination with anti-viral agents or with l-lysine. The use of l-lysine at 250 to 500mg per cat per day reported to be helpful, at least according to Dr. Nasisse of the University of Missouri.

Q: Dear Doctor, let me begin by saying I told my vet I was doing research on my cat's problem not because of him, because I understand that caring for a sick animal would be like caring for an infant, and frankly he's as frustrated as I am. About 6 months ago we let in a stray cat that the vet estimated to be 2 yrs. old. "Kitty" had a horrible cold, and it was cold and raining, I wasn't thrilled about letting him in because we have an old cat Micky who is 16 and a dalmation-lab pup who was a stray also, & I was afraid to infect them with anything. But we ended up keeping this poor creature mostly because it walked into the house rubbing up against the dog, as if it was its mother. It loved everybody, and everything. We took it to the vet, got it antibiotics Amoxyl, fattened it up, got its shots, had it fixed & declawed, emergency declaw because of our old cat & neutered because it seemed to have a urinary tract problem the vet thought would clear up with neutering. In between all of this the cat was on about 4 prescriptions of Amoxyl, which helped its upper respiratory but as soon as the amoxyl was done the cat would start wheezing, and sneezing, mucous would get thick, and he would get a fever. The vet put him on cephalexin and that worked also but as soon as treatment stopped all symptoms returned. He was tested for Feline leukemia, and FIV, also tested for Feline AIDS all negative. Over christmas in aproximately 2 days the cat got so sick I thought it would die. My vet wasn't in so the vet who was taking over for him and I credit for saving his life actually thought this cat had raibies. He didn't eat for 2 days, he sat with a blank look, mouth half open with saliva running out of his mouth, his neck was stiff, and he seemed to think there was neurolical damage. He gave him an antibiotic shot, a steroid shot, a shot for migratory worms just in case and an anti-inflamatory, fever reducer, and sent me home with antibiotics. This cats temp was 106. It broke late that evening and took a couple drinks of water for the first time in 2 days. He survived, and when I went to my vet this time he prescribed Batril. All is well until the medicine is gone. I questioned whether this could be a fungal infection because of the chronic upper respiratory, but also he has scabs all over his back, I don't know if they could be considered ulcers, and I'm not sure if they look like ring worm they look to be the size of a quarter look like a brush burn that scabbed over, the hair comes out and it seems to grow back and the area heals but moves right beside it & starts all over again. It doesn't seem to heal in the center and spread in a ring. Also since we've had him he leaks urine, just drops at a time. It's so little it's not a problem to me, but I wonder if it's not related. The most important symptem is that respiratory problem. My other animals do not seem to be affected by this. This baffles me. Especially with my old cat. Anyway now he's on Nizarol 1/4 tablet once a day, and were going to keep him on it for about 3 months to see if we have any success. With the antibiotics the cat would quit sneezing and his breathing would clear up, with this Nizarol it doesn't seem to be doing anything. Also he has a spot on one of his eyes he had when we took him in, it's cloudy, the pupil seems to be half the size of the other one, but I red about something that corneal ulcers were one of the symptoms. Anyway we are so frustrated Do you have any ideas at all? I'm just afraid after christmas I never saw an animal that sick. Would it be worthwhile to have it retested for aids? Everything seems to point to some sort of immune deficiency. Thanks so much for even reading this.

A: My first impression is that you have adopted a cat with a chronic herpes virus infection (rhinotracheitis in cats is a herpes virus). That would explain the chronic respiratory infection and possibly the eye damage you are seeing. Some cats with herpes virus infection simply can not be cured of the persistent upper respiratory signs. They do often respond temporarily to antibiotics but they just never get better. I have done exactly what your vet is doing -- treated cats with this condition over and over again with antibiotics, become convinced it must be fungal (ketaconazole - Nizoral Rx, is an antifungal medication) and then decided it must be cancer -- and still not ever found a "cure". It has always been hard to prove that herpes was the problem. It is hard not to do that because herpes is common in cats but only occasionally does it get this bad. That doesn't explain the bout of high temperature, etc. but the emergency vet gave you the most likely causes of that. I might also include feline infectious peritonitis but cats severely affected with FIP don't usually recover for very long, even with treatment. Dr. Nasisse (sp?) at the University of Missouri does research on feline herpes virus infections. He might be a good person for your vet to talk to, if possible.

Question: We have an Exotic Long Hair, five years old who now has had 3 episodes of corneal ulcers. No history of trauma has been noted. Each time the vet has treated him with Chloramphenicol eye drops, for secondary Infection. The ulcers are singular and sheet-like across the cornea and always unilateral. What could their origin be and is there anything we can do to prevent them? Thank you very much

Answer: By far the most common cause of recurrent or difficult to cure corneal ulcers in cats is chronic herpes virus infection.

It can be helpful to use l-lysine at 250 to 500mg/day to help control this problem. It can be purchased at health food type stores, usually.

If your vet knows a source of anti-viral eye drops (I think they are hard to get right now but haven't had to treat for this recently so I am not sure), they can be helpful, too.

It is possible to do punctate keratotomy surgery for stubborn ulcers in cats. This is a fairly simple procedure but if your vet hasn't done this before he or she may want to send you to a veterinary ophthalmologist for the procedure.

That may be a good idea, anyway, given the difficulty in clearing up this ulcer. These are frustrating and the ophthalmologist may not be able to help much more than your local vet but at least you'd get a second opinion.

Rhinotracheitis is a herpes virus. Just like herpes in people, it keeps coming back. It is almost certainly the most common cause of chronic, non-responsive conjunctivitis in cats. It doesn't respond to any anti-bacterial agent because it isn't a bacteria. Anti-viral eye drops are available but may not be very effective, either. There is some evidence that administration of L-lysine is helpful in control of this condition. I am not sure how helpful. It can still be useful to use an anti-bacterial ophthalmic drop but the best recommendation is to use one that will work well against gram positive bacteria, which is gentamycin's weak area. A triple antibiotic drop with polymyxin and bacitracin may work better than gentamycin in this case. This is especially likely in a cat that had pneumonia because of the high probability of rhinotracheitis being involved in that, too. Unfortunately, if this is the problem, chronic non-responsive disease until the body can finally develop immunity for a while is not uncommon. Sometimes, nothing seems to aid this process.

Q: I have written to you before about my cat with the herpesvirus. Your reply was about the herpes that affects the eyes. My cat has the herpes blisters around his back teeth and in his throat. A throat culture revealed positive for herpes but my vet said she didn't know which one. He was treated with Valtrex for 16 days with no improvement. My vet has never seen a case of the herpes that affects the throat. He cat also has herpes but he also gets a bladder infection at the same time and the Valtrex helps in this situation because her cat doesn't respond to antibiotics. I can't seen to find any information on the herpes that affects the mouth and throat. All the information I can turn up is about the eyes. You mentioned before about the l-lysine. Would that be helpful in my cat's case or is there something else available? He seems fine otherwise but scratches his neck after eating. I have him on a natural diet of Pet Guard food which is fed twice day and he drinks distilled water. The Pet Guard food contains NO meat-by products or any artificial colors or flavors. It is completely balanced. I also give him 1/4 teaspoon of skin and coat supplement for his mild case of dandruff. His fur is very thick and shiny and the dandruff is starting to clear up. He has had 5 Depo-Medrol shots back to back so I think it will take a little time for the dandruff to go away. The shots relieved the symptoms for about 2-3 weeks and then the blisters came back worse than ever. I don't like the side affects of these shots. He was a zombie most of the time and produced very large amount of urine. So that is why I'm looking for an alternative to the depo-medrol shots. I have occasional outbreaks of herpes myself on my lip and around my eyes so I know the pain and itch that they can cause. Any information you can provide will be most appreciated. Thanks. Lou.

A: Lou - As far as I know, rhinotracheitis is the only herpes virus that affects cats but that doesn't mean it is. The l-lysine interferes with the reproduction of herpes virus and should work for lesions anywhere and also should work for any strain of herpes virus. Oral interferon may be worth trying in conjunction with the l-lysine. If your vet can find acyclovir it may be useful, too.

Herpes is one of the causes of chronic stomatitis/gingivitis problems in cats but it is also possible that it could be present when there is another underlying cause. If therapy for herpes doesn't seem to help it may be necessary to consider a biopsy of the affected area or some other diagnostic testing.