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Fever of unknown origin: interesting feline cases (Proceedings)
Cats with fevers (103? F-106? F) are a common occurrence in everyday practice. Most cases respond to antibiotic therapy or are self-limiting (abscesses, viral infections, post-surgical fevers). However, the most frustrating case is one in which a routine course of antibiotics does not improve the clinical condition of the cat, routine diagnostics do not identify the cause and the fever is ongoing.
Cats with fevers (103° F-106° F) are a common occurrence in everyday practice. Most cases respond to antibiotic therapy or are self-limiting (abscesses, viral infections, post-surgical fevers). However, the most frustrating case is one in which a routine course of antibiotics does not improve the clinical condition of the cat, routine diagnostics do not identify the cause and the fever is ongoing. This is the fever of unknown origin (FUO) case that requires a methodical approach to discover the exact cause of the fever so that proper therapy can be instituted. Your approach may vary based on the clinical presentation of each cat, as well as the patient's geographic location/travel history. You must also consider the cost/benefit of the diagnostic testing as well as the invasiveness of the tests performed. Tests may need to be repeated as the case progresses.
• Obtain a complete history, including travel, vaccination, drug/supplements.
• Perform a complete physical examination (repeat this step often).
• Collect the minimum data base.
• CBC, Biochemistry profile, Urinalysis, FeLV/FIV test
• Thoracic and abdominal radiographs
Cause of the fever is still not defined, so the hunt continues....
• Urine – aerobic and Mycoplasma, even when urine sediment is inactive. May need to culture urine repeatedly if history, clinical signs or other findings suggest urinary tractconcerns.
• Blood – aerobic, anaerobic, Mycoplasma. Consider volume and timing of blood draws.
• Joint – aerobic, anaerobic, Mycoplasma
• Other (BAL fluid, feces, effusions)
• Also consider culturing for: Mycobacteria, other atypical bacteria, fungi
• PCR tests also available for some organisms (Mycoplasma)
• Ultrasound (Abdominal, Echocardiography, areas of swelling)
• CT/MRI – may reduce the need for exploratory surgery
Follow any leads noted on history, physical examination or localizing signs.
• Lameness – Joint fluid for cytology, cultures (aerobic, anaerobic, Mycoplasma), joint radiographs
• Swellings/ lymph nodes/ effusions/ mass lesions – needle aspirate for cytology/ cultures
• Bone marrow aspirates
• Respiratory signs – Airway wash, lung aspirate
• Infectious disease titers – consider specificity and sensitivity of the tests, disease prevalence, use of acute and convalescent titers
• Immune panels – Antinuclear antibody (ANA), rheumatoid factor (RF), Coombs test
• Tissue biopsies
While performing the hunt, don't forget to treat the patient.
• Therapeutic drug trials – Weigh risks versus benefits.
• Broad spectrum antibiotic therapy: Baytril or other fluoroquinolone, clindamycin
• Unusual bacteria, rickettsial, Mycoplasma: Doxycycline
• Fungal: Fluconazole or other antifungal
• Immune/neoplasia: Corticosteroid therapy (prednisolone)
The fever should break within 3 days if the drug therapy is going to work for that case...
Maintain hydration – fluid therapy as needed.
Encourage appetite. Appetite will typically return once the fever breaks.
Examples of Diseases that Cause Fever in Cats:
Infectious diseases (localized or systemic)
Bacterial: bacteremia, discospondylitis, septic arthritis, osteomyelitis, pyothorax, peritonitis, pancreatitis, pyelonephritis, tooth root or other abscess, septic meningitis, mycobacterial infections, L-form infections, bartonellosis, plague
Viral: FeLV, FIP, FIV, Hemorrhagic calicivirus
Fungal: Histoplasmosis, cryptococcosis, blastomycosis, phycomycosis, coccidioidomycosis, sporotrichosis
Protozoal: Toxoplasmosis, Cytauxzoonosis, Babesia spp
Rickettsial & Myoplasma: Ehrlichiosis, Mycoplasma
Parasitic: Dirofilaria immitis
Inflammatory diseases: pansteatitis, nodular panniculitis, granulomatosis, pancreatitis
Immune-medicated diseases: Immune-mediated polyarthropathy, Pemphigus foliaceus
Neoplastic conditions: Lymphoma, Leukemia, hepatic tumors, gastric tumors, lung tumors, necrotic masses
Miscellaneous conditions: Drug (tetracycline, penicillins, levamisole) or toxin reactions, hyperthyroidism
Points to consider:
Many FUOs are caused by infections.
The fever itself may be beneficial and is rarely harmful to the patient.
Investigation of FUO may be time-consuming and expensive.
Many diagnostic tests may be necessary.
Tests may often be repeated several times.
A diagnosis is ultimately obtained in most cases.
Many cases of FUO prove to be treatable or manageable.
Case studies will be utilized in this presentation.
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