Viral peritonitis of cats. Diagnosis, symptoms, prevention

Feline infectious peritonitis (FIP) is an extremely dangerous viral disease that can be fatal. Therefore, peritonitis, along with FIV, panleukopenia and leukemia, is considered the most terrible infection. How to recognize peritonitis in a kitten and how to prevent this disease from appearing in your pet - an article from the Murkosha shelter team will help you figure this out.

1) The causative agent and features of the course of the disease

2) Risk factors

3) Routes of infection

4) Symptoms of peritonitis

5) Diagnosis and treatment

6) Prevention

Classification

Based on their origin, there are 3 types:

1. Primary is a rare type, diagnosed in no more than 5% of patients. Infection with pathogenic microflora occurs without perforation of the peritoneum, that is, bacteria enter the hollow organ mainly through lymph or blood from other infected organs. In children, this form of peritonitis occurs in early childhood, up to 5 years. The provoking factor is nephrotic syndrome, lupus erythematosus.
2. Secondary - the cause is acute surgical pathologies. This may be an exacerbation of appendicitis, cholecystitis, pancreatitis, cancer or intestinal obstruction. This form of the disease is also diagnosed as a result of open or closed injuries to the abdominal cavity.
3. Tertiary is a severe infection that occurs 2 days after successful surgical treatment of secondary peritonitis. But due to the reduced immune status of the patient, the body is not able to form an adequate response to surgery. Surgeons say one of the reasons is the presence of a long-term latent intra-abdominal infection in the patient, which cannot be treated surgically. This form of peritonitis has a high risk of death.

Based on the nature of the fluid (exudate) that caused the inflammatory process in the abdominal cavity, there are: purulent, bile, fecal, fibrous and serous peritonitis.

The abdominal cavity is anatomically divided into 9 regions: right precostal, right lateral, right iliac, suprapubic, periumbilical, epigastric, left precostal, left lateral and left iliac. Depending on which areas of the peritoneum the pathological process has spread to, medicine distinguishes:

1. Limited peritonitis or abscess - inflammation has clearly limited boundaries in the form of adhesions or fibrous plaque. The most common are subhepatic, interintestinal or subphrenic.
2. Diffuse diffuse - affects most of the abdominal cavity without a tendency to clear demarcation. The boundaries are difficult to define precisely. Can span multiple adjacent areas.
3. Local - located next to the organ from which the infection occurred. As a rule, it occupies one area.
4. Common - pathological affects several anatomical areas at once.
5. General - the pathological process covers the entire abdominal cavity.

The most common form in surgery is diffuse peritonitis with purulent exudate.

Epstein-Barr virus in children

Epstein-Barr virus in children manifests itself in the form of infectious mononucleosis, ARVI or chronic disease.

For most people, herpes is a “cold on the lips.” However, the Epstein-Barr virus is a type of herpes, but type IV and a “relative” of chickenpox, cytomegalovirus and herpes simplex. The Epstein-Barr virus (like other members of the herpes family) is very widespread, up to 95% of the world's population are its carriers. In 80% of cases, infection occurs in childhood, most often before 3 years. Once an infectious agent enters the body, it remains there for life.

The virus can only reproduce in human cells. Some cells undergo changes under the influence of the disease. The altered cells allow the virus to remain in the human body forever in a “dormant” state. When the host’s immunity decreases, the microorganism is activated, begins to multiply and conquers new cells, which manifests itself as signs of disease

Viruses are transmitted from a sick child to a healthy one; the mode of transmission is airborne droplets from sneezing, coughing and talking; contact when using shared combs, toothbrushes, towels; through kisses. Therefore, the disease caused by the Epstein-Barr virus is called “kissing disease.” Transmission from mother to child during pregnancy is possible. The onset of the disease can be acute or hidden. Often a person does not even suspect that he has become infected.

Infectious mononucleosis in children

Infection caused by the Epstein-Barr virus, otherwise called EBV, in 80% of cases in children occurs as an acute respiratory viral infection, and in 20% infectious mononucleosis develops, a disease associated primarily with the Epstein-Barr virus (but do not forget that the culprits may be cytomegalovirus, herpes virus type 6, etc.). Unlike other pathogens that inhibit the development and reproduction of cells, EBV stimulates changes in cells of the immune system, in particular B-lymphocytes. For this reason, typical clinical signs are observed:

• Enlarged tonsils (tonsillitis)
• Difficulty in nasal breathing
• Enlargement of different groups of lymph nodes: more often cervical, less often axillary, inguinal
• Enlarged liver and spleen
• Increased body temperature

Sometimes chronic EBV infection develops. Parents should be alert to the following signs:

• Low-grade fever (up to 37.9 degrees) for a long time (more than a month)
• Weakness, sweating, sleep disturbances, the child has become capricious
• Previously uncharacteristic headaches, dizziness
• Heaviness in the right hypochondrium, the appearance of yellowness of the sclera and skin

Diagnosis of disease caused by EBV

If you see these symptoms in your child, what should you do next? The best decision is to see a doctor, and he will prescribe the following tests:

• Clinical blood test with leukocyte formula
• PCR research
• Antibodies to Epstein-Barr virus
• If necessary, biochemical tests to assess liver and kidney function

Laboratory tests for mononucleosis

Clinical blood test with leukocyte formula (with mandatory microscopy of a blood smear)

The appearance of reactive lymphocytes in a blood test of more than 10% (usually 60-80%) allows the doctor to suspect mononucleosis and continue to search for its cause.

The targets for the Epstein-Barr virus in the human body are lymphocytes, which change under the influence of the pathogen and become similar in structure to other cells - monocytes. Such cells are called reactive lymphocytes, or atypical mononuclear cells (the name of the disease, mononucleosis, comes from the name of the cells).

PCR research

The PCR method is aimed at identifying the DNA of the Epstein-Barr virus, that is, its genetic material. It is relevant specifically in childhood, during the period of primary infection - with mononucleosis. Blood, urine, saliva, or oropharyngeal swab are examined.

In the chronic course of the disease, PCR will not be so informative, because if the pathogen has entered the body, it remains for life, and detecting it in the blood or tissues will only indicate that the body is infected, but when the infection occurred - a week or 2 years ago - the answer we will not get the answer to the question. To do this, we need to study human immunity by examining antibodies.

Antibodies to Epstein-Barr virus

To understand the essence of the study, let’s figure out what happens in the body in response to an infectious agent?

For each type of pathogen, the immune system produces immunoglobulins (Ig) - specific proteins aimed at recognizing and further protecting against the disease upon encounter.

Immunoglobulins M (IgM) appear first; they are markers of the initial encounter with the pathogen and disappear from the blood after about a month. But during EBV infection, IgM immunoglobulins can persist for a long time, since EBV affects immune cells.

Immunoglobulins G (IgG) are persistent, synthesized later than other antibodies, at 3-4 weeks of the disease and retain information about the disease for life. They clearly indicate that this particular type of herpes has entered the body. Usually, the presence of IgG and the absence of IgM indicates that the encounter with the microorganism occurred a long time ago. This does not apply to herpes viruses. Even with a long-term course of the disease, at what points can IgG and IgM be detected simultaneously.

The structure of the Epstein-Barr virus is complex; it contains many proteins - antigens to which the immune system reacts. The main ones are capsid, early and nuclear antigens, and antibodies of the IgM and IgG classes are produced for each of them. It makes sense to discuss each one in order to be able to understand why the doctor prescribes so many tests and whether it is advisable (spoiler alert - it is advisable!)

So:

• Antibodies to the capsid antigen IgM are produced from the first days of the disease, persist for up to 3 months in the acute form, and can be periodically detected in the blood in the chronic course.
• Antibodies to capsid antigen IgG (IgG to VCA) – are synthesized 1-2 months after the onset of the disease and persist for life
• Antibodies to the early antigen IgM (IgM to EA) - appear in the first week of contact with the pathogen, disappear after 3 months upon recovery. Retention in high titers for a long time (more than 3-4 months) is alarming in terms of the formation of a chronic form of infection. Their appearance in the chronic form serves as an indicator of reactivation. They can often be detected during primary infection in EBV carriers.
• Antibodies to nuclear antigen IgG (IgG to EBNA) - appear later than others, 1-3 months from the onset, remain at high levels for up to 12 months, and remain at low levels for life.

Thus:

• The detection of IgG antibodies to capsid and nuclear antigens indicates a previous disease.
• The detection of IgM antibodies to capsid and early antigens in the absence of IgG to capsid and nuclear antigens is regarded as a period of acute primary infection, which often happens with mononucleosis in children.

And in order for the doctor to understand this, it is necessary to pass all the tests.

• Detection of antibodies to all antigens except nuclear - requires further examination and consultation with a doctor

How to assess the duration of a herpes infection (including EBV)?

For this purpose, the avidity of IgG to the Epstein-Barr virus is determined. Avidity is the degree of strength of binding of antibodies to viral proteins. The longer the virus stays in the body, the stronger and more stable the connection becomes. IgG avidity is expressed as a percentage: high avidity indicates a long-standing disease, even in the presence of IgM; low avidity indicates a recent encounter with the virus.

Treatment of infection caused by the Epstein-Barr virus.

It is known that there is no specific treatment! There are no antiviral drugs that have proven their effectiveness. Therefore, be sure to consult a doctor and do not self-medicate.

Treatment of acute infection is symptomatic and includes the main points:

• Bed rest or rest
• Drinking plenty of fluids is mandatory (to reduce intoxication)
• Taking antipyretic drugs when the temperature rises above 38.5 C
• And most importantly - no antibiotics! Antibiotics do not cure the virus, but they can damage the body and reduce immunity, which will only worsen the course of the disease. Antibiotics are prescribed only by a doctor in case of bacterial complications.

Important: timely diagnosis of mononucleosis and other manifestations of acute primary infection caused by the Epstein-Barr virus facilitates timely treatment and prevents the development of complications.

Clinical manifestations of pathology

Symptoms vary and depend on the stage of the pathological process, as well as the cause of inflammation. The most common manifestations:

• pain in the abdominal area, which increases with movement;
• nausea;
• vomit;
• fever, chills.

During the reactive stage (the first day of development of inflammation), the main symptom is sharp pain of a constant nature. Usually a person lies on his side, bent over, and tries not to move. If the source of peritonitis is in the upper region of the peritoneum, then the pain may radiate to the back or shoulder area. When inflammation is localized in the lower part, false urge to go to the toilet, pain in the pelvis and perineum are possible.

Vomiting does not bring relief. There is a rapid pulse, more than 100 beats per minute. Blood pressure may be slightly lower. When certain intestinal diseases are complicated, there may be blood in the stool.

With increasing intoxication of the body, the toxic stage of peritonitis occurs. Symptoms are smoothed out as protective muscle tension is weakened. The pain may decrease. The so-called symptom of deathly silence is observed when peristaltic noises are not heard in the intestines. The abdomen is tense, gas and stool retention occurs.

Body temperature rises to 38-39° degrees. Consciousness becomes confused. The terminal stage begins, which is characterized by severe loss of strength, shallow breathing, and severe profuse vomiting of intestinal contents. At this stage, the risk of death without immediate medical attention increases.

Peritonitis often leads to the development of septic shock, sepsis or hepatic renal failure.

Symptoms of non-infectious peritonitis

Aseptic necrosis of the peritoneal layers develops quite slowly as the immune reaction in the tissues intensifies. Most often, such types of inflammation are observed during the disintegration of a malignant tumor or after blunt trauma to the abdomen.

Symptoms of non-infectious peritonitis include:

1. Noticeable changes in the pet's behavior.
2. Refusal to eat, and sometimes even water.
3. No elevated body temperature.
4. Sharp pain in the abdomen that does not have time to disappear (necrosis of the peritoneum develops very slowly).

The cause of aseptic peritonitis is the impregnation of peritoneal tissue with blood cells (lymphocytes, eosinophils) and the formation of a nonspecific granuloma.

Diagnostics

The main diagnostic method is palpation of the peritoneum. This allows you to determine the degree of muscle tension and the localization of the inflammatory process.

To confirm the diagnosis, laboratory tests are prescribed: general blood test, urine test; blood for liver function tests. An abdominal ultrasound is also recommended. But due to severe bloating and severe pain, such an examination is not always possible, especially if the person is at a terminal stage.

If sepsis of unknown origin is suspected, diagnostic laparoscopy is performed. This is a minimally invasive surgical intervention through small punctures.

Reference! Laparoscopy is a modern and gentle method for determining the exact cause of acute abdominal pain. Its advantage is that, simultaneously with a diagnostic examination of the peritoneum, the doctor has the opportunity to carry out surgical treatment, if necessary. The accuracy of this method reaches 90%.

One of the first available instrumental studies in the serious condition of the patient is a survey radiography of the abdominal cavity. It can be done in a lateral position or lying on your back.

Prevention

Unfortunately, a vaccine has not yet been developed in Russia that could protect an animal from the disease, but in world practice there is experience in vaccinating against peritonitis. In US clinics, animals are given a live vaccine in the upper respiratory tract, after which the cat develops immunity. The vaccine is not licensed in the Russian Federation and the European Union.

Available methods of prevention are as follows:

• Create comfortable living conditions for the cat. The less the animal is exposed to stress, the better its immunity will cope with pathogenic microflora.
• Do not allow the cat to come into contact with other animals. For example, taking your pet to a cat show not for the sake of participation, but for the sake of a walk, or releasing the animal into places where there are large concentrations of other cats (for example, a cat “hotel”) is not a good idea.
• Do not allow simultaneous implementation of several activities associated with a decrease in immunity. You cannot give medications against helminthic infestations and immediately treat the animal for fleas or sterilize it. The combination of procedures is a great stress that can cause coronavirus mutations.
• Promptly remove animal feces.
• Keep eating and resting areas clean.

If the animal is infected but has immune defenses, peritonitis will not develop. In the external environment, the virus will live a little more than a day, but only if hygiene rules are observed. If you do not clean the tray, the coronavirus in feces will remain viable for about 7 days.

If the cat is infected, all objects with which it has come into contact must be washed with a sodium hydrochloride solution.

Pregnant cats need special protection. 3 weeks before birth they must be isolated from other animals. Newborn kittens are kept with a cat until they reach 5 weeks, completely eliminating contact with other pets. After kittens reach 16 weeks, PCR diagnostics can be performed.

If there are several cats living in a house, and one of them has been diagnosed with IPC, it is highly likely that the other cats are already infected. The only thing that can be done is to improve the pet’s diet, supplementing it with products to strengthen the immune system, and eliminate any irritating factors. You should also check your cats' blood for antibodies. Perhaps the entry of the pathogen was asymptomatic, and the animal acquired immune protection against peritonitis.

Surgery

The main stages of surgical intervention for any form of pathology:

1. Radical complete elimination of exudate by washing with a special solution.
2. Performing intestinal decompression. This is necessary due to the fact that with peritonitis of any form, the intestine is compressed and is in a state of paresis.
3. Drainage of the peritoneum with drainage into the subcutaneous fatty tissue.
4. Suturing with drainage in place for subsequent treatment of residual infection. If the operation was performed at the initial reactive stage, then it is possible to complete the operation without drainage. In this case, surgeons must be sure that the body will cope with the residual infection on its own.

In most cases, a midline laparotomy is used. It allows optimal access to all areas of the abdominal cavity.

Postoperative period and prognosis

After surgery, it is important to prevent complications. For this purpose, intravenous antibacterial drugs and immune therapy are prescribed. Painkillers are used to relieve pain.

The prognosis depends on how early the inflammatory process was diagnosed and eliminated. The likelihood of death depends on the general condition of the patient, age, the presence of concomitant diseases and the severity of peritonitis. At stages 1 and 2, the prognosis with adequate therapy is favorable. At the terminal stage, severe damage to the abdominal organs occurs, which leads to their dysfunction. In this case, the mortality rate reaches 70‒80%.

To avoid this pathology, it is necessary to promptly treat chronic gastrointestinal diseases, and in acute conditions, immediately seek medical help.

Routes of infection

Coronavirus in cats is transmitted mainly through infected individuals who have not been isolated, and also under the following circumstances:

— contact with the feces of an infected animal;

- use of common trays, bowls and toys;

— through the owner’s shoes;

— transmission of the virus from a sick mother to kittens is possible.

We also note that there is one factor that sharply increases the risk of spreading the infection. We are talking about crowded keeping of animals in one apartment, where they are not isolated, but communicate freely with each other. If there are 5-10 cats (or even more) in an apartment and one of them gets sick, then most likely everyone will get sick. By the way, this is why at the Murkosha shelter pets are kept in separate enclosures - for the shelter this is the only possible way to prevent animals (some of which may be sick) from contacting each other and reducing the risk of virus transmission to zero.

Read more about this: Why we keep cats in cages

Establishing diagnosis

Having shown the animal to the veterinarian, many are shocked to hear that only an autopsy can give an absolutely correct diagnosis. This is not the black humor of the Aesculapians, but a fact that once again proves the extreme danger of the disease.

But not everything is so gloomy - more familiar methods can also clarify the picture:

• Serological analysis of blood and serum obtained from it.
• PCR (polymerase chain reaction) - laboratory technicians examine a blood or saliva collection by “breaking down” the material into individual strands of DNA and RNA. The same can be done with swabs or feces.
• Abdominal puncture followed by analysis of the collected fluid is also practiced.

Learn about the following cat diseases: mycoplasmosis, piroplasmosis, calcivirosis, pyometra, toxocariasis, aspergillosis, epiphora, distemper (panleukopenia) and urolithiasis.

Deciphering samples makes it possible to exclude the presence of a number of diseases: bacterial peritonitis, toxoplasmosis, tuberculosis and cardiac or pulmonary failure.

After making sure that no such ailments are found (as well as tumors or consequences of previous injuries), doctors make a diagnosis and decide how to proceed with treatment.

Can a vaccine protect an animal?

At the moment, vaccination against peritonitis is the only hope for ensuring the safety of your pet. However, the drug Primucel is considered a single prophylactic drug, and it does not provide a 100% guarantee of protection.

The cat is injected with a weakened virus that spreads only in the upper respiratory tract, as a result of which it should develop strong mucosal immunity.

Vaccination can be carried out only when it reaches 16 weeks, and if a cat lives with a sick animal, then it is only 75% protected.

To protect your cat from getting sick, you need to keep the room clean, and it is advisable to disinfect it from time to time. Strengthening the immune system will prevent the occurrence of infectious and viral diseases.

Pathological changes

A standard complication is the accumulation of viscous clear fluid in the abdomen or chest area, sometimes with visible flakes and fibrin thread.

This same fibrin forms a film covering the tissues and membranes of internal organs. At the same time, they become dim, and mini-spikes are observed in different areas.

Moreover, whitish foci of rotting are often found there, surrounded by compacted exudate (taking the form of small nodes or plaques with a diameter of up to 10 mm). This affects the liver, pancreas, intestinal wall and other membranes through which necrosis penetrates.

In the lungs there are fewer such formations, and the pathways themselves acquire a rich scarlet color, often becoming denser.

The clinical picture also includes enlargement of the kidneys against the background of the appearance of single white nodes, absorbed into the cortical composition.

Did you know? When frightened, a cat can jump to a height 5 times its height.

With proliferative dynamics, foci of inflammation arise, covering the eyes and nerve endings, cardiovascular lines and the lower abdominal region.