Feline Infectious Peritonitis And Your Cat

F.I.P. FIP

Ron Hines DVM PhD 11/26/07

Feline Infectious Peritonitis (FIP) is an insidious disease that has long baffled the veterinary profession. To this day the exact mechanics of the disease are not fully understood. When I practiced in South Texas I encountered four to five times as many cases of FIP as I do in South Florida. I do not know if this is because the incidence of classical FIP is in flux or if the two Communities differ in undefined ways.

Feline Infectious Peritonitis is caused, indirectly, by a coronavirus. It affects only cats, notibly domestic cats and cheetahs. There are many strains of coronavirus, only a few of which cause disease. When a cat is exposed to pathogenic corona virus, these virus strains enter the body’s white blood cells and so spread throughout the body. Infected tissues become targets for the bodies’ own immune response. It is inflammation misdirected at the bodies’ own tissue that constitutes the disease. The virus of FIP is spread through saliva and fecal contamination. Most household cleaning agents destroys the virus. An excellent disinfectant is ordinary generic household bleach diluted one part bleach in twenty parts water. For the bleach to be effective, heavy soiling should be removed first with detergent.

The first signs of Coronavirus infection are quite mild. They are usually confined to a mild upper respiratory tract infection with no more than some sneezing, watery eyes and nasal discharge. Some forms of Coronavirus cause transient diarrhea. In most cats nothing more develops and the infection passes. In a small number of cats, however, the virus persists. Depending on the virulence (strength) of the virus strain, many months or years later the body mounts an inflammatory response aimed at the tissues that harbor these viruses. Problems begin very gradually; the first signs are no more than poor grooming, spotty appetite and weight loss. Recent investigations have found that some strains of the virus can cause rapid disease in a majority of cats that are exposed to it. A veterinarian’s examination often detects a low-grade fever (103-103.5F). At this point the disease can take one of three directions. The more common form is known as the wet or effusive form of FIP. In this form, proteinacious fluids build up in the cat’s abdomen or chest cavity. Abdominal fluid gives the cat a pear-shaped pot bellied appearance while fluid in the chest makes it uncomfortable for the cat to breath. The second, the noneffusive or dry form, often attacks the brain or the eyes. Some cases combine the two forms of the disease. X-rays taken at this time have a characteristic “ground glass” appearance. These cats are usually anemic, depressed and febrile. They are often yellowish due to liver failure. Many of them also drink excessively due to kidney failure. Cats with the dry form of the disease often have neurological problems resulting in lameness, seizures, and tipsy gait. Other dry-form cases show eye inflammation and blindness. The diagnosis of this disease is often missed on initial examination because symptoms are so vague. It is only as the disease progresses that FIP becomes apparent. I remove a small quantity of fluid from the abdomen or thorax of wet-form FIP. I can make the diagnosis based on the specific gravity of this fluid as measured by a refractometer. The high protein content of FIP fluid gives a distinctively high refractometer reading.

Feline Infectious Peritonitis is commonest in younger cats or those recently exposed to large numbers of cats. It seems to be triggered by other diseases as well as stress. There may be genetic factors that influence susceptibility to the disease after exposure to the virus. The vast majoritiy of cats exposed to the virus do not develop disease. Many FIP cats are also positive for feline leukemia or feline immunodeficiency virus. It is also more common in the high stress environment of crowded catteries. It is what we call a sporadic disease striking here and there and rarely twice in the same non-commercial household..

There is a problem with laboratory tests to confirm the diagnosis of FIP. These tests detect past or current exposure to all Coronavirus of cats. Most Coronavirus cause only transient mild disease and the tests cannot differentiate between nonpathogenic Coronavirus and the Coronavirus causing FIP. So a negative antibody test tells us that the cat has not been exposed at all to Coronavirus while a positive test is only an indication of FIP if the cat is ill with FIP-like symptoms. Two new tests, polymerase chain reaction and immunoperoxidase viral protein detection may simplify diagnosis in the future. In its dry form, tissue biopsy can confirm the diagnosis.

I have never had a cat survive long after I confirmed the diagnosis of FIP. Sometimes, oral or injectable corticosteroids perk up the cat for a while but their general health slips down hill rapidly. No disease, not even feline leukemia, is as frustrating for me to deal with, as is FIP. From the time I see them, these cats are dejected and depressed and all my attempts to relieve their suffering seem ineffective. When owners resist my suggestions that these cats be kindly put to sleep I have referred them out for various unusual alternative medicine techniques. I cannot remember a single instance where I felt that the cat benefited. But at least, the owners felt they had exhausted all that both traditional and alternative medicine had to offer.

There is a single vaccine on the market for the prevention of FIP. It is Primucell FIP, marketed by Smith Kline .This vaccine is manufactured from virus engineered to survive in the cat’s nasal passages but not in the body. This vaccine is applied in the nose at nine, sixteen and twenty weeks of age and then yearly. I no longer recommend giving this vaccine since it appears to hold more potential risk than benefit. Dr. Alice Wolf discusses these problems in a 2001 article. Recent studies have found that FIP is actually more likely in vacinated cats. Also, many kittens have already been exposed to Coronavirus by the time they are vaccinated. Primucell is designed to stimulate local immunity within the nasal passages. Cats that have been given this vaccine will test positive in the laboratory for Coronavirus antibody. Several laboratories found that the vaccine actually accelerated the course of the disease in laboratory cats experimentally given FIP through a phenomenon named "antibody-dependent enhancement.

Newest Clinical Studies:
There has been some very interesting work done on FIP by Dr. Diane D. Addie of Glasgow Veterinary School in Scotland. Her work documents extending the lives of FIP cats using corticosteroids to suppress the immune response against the coronavirus responsible for the disease along with administering vitamins and antioxidants. Cats that received immunosupressant medications also received antibiotics to ward off secondary infections. The immunosupressant used was prednisolone administered orally at 1-2mg/pound body weight. Prednisone should be equally effective. Another drug that was utilized was thalidomide, a drug that reduces inflammation and antibody to the feline coronavirus and given at 50-100mg in the evening. The successful use of recombinant feline omega interferon manufactured by Virbac Co. IFN omega (a.k.a Virbigen Omega) has been described. However, I know of no subsequent experiments or cases where this tretment was deemed effective.
Some studies administered 200 iu vitamin A per day. Too much vitamin A is toxic so cats received the compound for a maximum of six weeks. Cats also received 100 ug/day oral vitamin B-1 and B-12 as an appetite stimulant. Although cats are known to produce their own vitamin C (ascorbic acid), these cats received 125mg twice a day orally as well as 25-75 iu of alpha tocopherol acetate. Other cats received aspirin at 5mg/pound given every two to three days in an attempt to decrease inflammation. All cats that received prednisolone or dexamethasone also received the antibiotic, ampicillin to fight infection. Several anabolic steroids were administered to encourage appetite and well-being. The drugs used were Laurabolin, Nandrolin, Nandoral, Retarbolin and Orandrone. The only drug in this group that I know of that is available in the United States is stanazolol (Winsterol). Two cats with the peritoneal effusive form of FIP were said to respond to the thromboxane synthetase inhibitor, ozagrel hydrochloride given at 2.5-5mg/pound twice a day along with 1mg/pound/day prednisolone. Monitoring serum globulin levels and ---blood hematocrit were a good gauge of progress in fighting the disease.

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7/5/06

Several cat owners have written to me expressing their frustration in not being able to locate Virbagen Omega. Although the Virbac Firm initially said it was available in Canada, it apparently isn't. It also sent out press releases that it was teaming with Amarillo Biosciences, Inc. to market it in the United States. The main office of Virbac is located in France. I have found no internet contacts that can tell me of its current availability internationally and references to the product on the net are not current and is not listed among the products currently sold by Virbac in Europe. The Company has not returned my letters of inquiry. I assume a problem of some sort developed but I can not tell you what it is. Should you know the current status of this drug or other information, please inform me. R.S.H. Please see email from the European Manufacturer below

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8/9/06 Dear Vet Ron,
I am a Christian and have come to believe that God has a cure for every disease. When man does not have the answer they say there is no cure but God said that all things are possible to those who believe in Him. I have been caring for a kitten that has all the symptoms of the wet form of FIP. The kitten got to the point of having a rapid heart beat and lost it's ability to eat and was loosing fluid. I would find it soak and wet. It just laid in one spot and looked as though it would only live a short time. Before it got to this point for a few days it walked around with it's tongue hanging out and became very weak but had a good appetite.
After hours of searching I found an article about a women who had nine cats that were diagnosed with FIP. These cats were injected with high doses of Absorbic C and each one recovered. I found more helpful information at www.wholisticanimals.com. I did not have any injectable Vitamin C so I mixed about 1/4 to 1/2 teaspoon in a little water and injected this kitten two times a day and I also used injectable 48 hour Penicillin every other day. After only 2 or 3 days the kitten began to eat again and is now up on it's feet and playful. I find this just so amazing. Also I should add that when the kitten seemed to have a fever I put an ice pack under a blanket and laid him on it. I would like to add that the most important thing was prayer!!! Jesus leads to the answer and all power of healing comes from Him. He gives us the resources but without Him nothing works. I read your article on FIP and about your frustration so I thought that you would find this very helpful. If you decide to try this method for Fip I would love to hear about the results you get. I am very excited at the results I have seen with this kitten. By all appearances it seemed unlikely that this he would survive. But I have seen drastic improvement in only a few days. I believe that He will regain all his strength and live a long life as God intended. God Bless, D N

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8/10/06 Dear DN,
Thank you for telling me your experiences with FIP. I will put the information at the bottom of my article and perhaps others find it inspirational will write back with their experiences. The problem with injecting crushed vitamin C tablets is that vitamin C is quite acidic and might burn. Also, the tablets are held together with binders such as talk that may cause lumps under the skin. Vitamin C is absorbed quite well when given orally. But recovery from FIP is indeed a miracle and I can not argue with miracles. Best wishes, RSH

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10/25/06

Dear Doctor Hines,Please kindly note this modification to our previous mail (copy hereunder) : For any further clinical data on usage of feline interferon in veterinary medicine, please log on the following web site : http://www.vetinterferon.org instead of : http://www.vetcontact.com/interferon as indicated previously.With all our apologizes for the disagreement, Yours sincerely,

Team Virbagenomega.com

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Virbagenomega
26/10/2006 10:58 Pour : ronthepetdoctor@yahoo.com
cc : (ccc : Emmanuel Hess/VIRBAC/FR)
Object : Supplier in the USA Dear Doctor Hines, We have noticed your interest for Virbagen Omega on your internet website, and we thank you for that, as well as your interrogation on the way of supplying with this product in the USA. Actually, Virbagen Omega is currently marketed in the main European Union countries and in Australia as well. Virbagen Omega is not available in the USA yet. From the USA, the feline interferon can be obtained by the veterinary practitioners with a Compassionate Use Dispensation (a form to be filled out from the FDA) and ordered from a wholesaler in a country where it is available. For further information on practical and delivery aspects please visit the following web sites :
http://www.dr-addie.com/stomatitis.html#ifn and http://www.dr-addie.com/stomatitis.html#ifn https://www.abbeyvet-export.co.uk Should you need any further clinical data on usage of feline interferon in veterinary medicine, the following web site may be helpful : http://www.vetinterferon.org Thank you for your interest in Virbagen Omega.
Yours sincerely, Team Virbagenomega.com