Nursing the feline patient with upper respiratory tract disease

Vet Times The website for the veterinary profession https://www.vettimes.co.uk Nursing the feline patient with upper respiratory tract disease Author : Sam Frogley Categories : RVNs Date : April 1, 2011 Sam Frogley RVN, discusses the various infectious agents responsible for cat flu, its diagnosis and how excellent nursing care can improve patients outcomes Summary FELINE upper respiratory tract disease (FURT) is also commonly referred to as cat flu. FURT is a common syndrome that involves several primary infectious agents. Signs are similar to a human cold, hence the cat flu tag. All cats are susceptible, but some are more prone to severe infections. There are four main infectious agents that can cause the syndrome. These are feline herpes virus, feline calicivirus, Bordetella bronchiseptica and Chlamydophila felis. Cats may have one or more of these pathogens simultaneously. Kittens and immunosuppressed cats are particularly at risk because their poor immune system makes them more susceptible. Although vaccination can reduce the risk of cat flu, vaccinated cats can still contract or carry it. This article will discuss the four infectious agents, diagnosis of the syndrome, prevention and the importance of nursing care, including assisted feeding and nebulisation. Key words cat flu, FHV, calicivirus, Bordetella bronchiseptica, Chlamydophila felis FELINE upper respiratory tract disease (FURT) is often referred to as cat flu, and there are a number of possible infectious causes, including viruses and bacteria. All cats are susceptible, but some are more prone to severe infections. The four main infectious agents that can cause FURT are feline herpes virus, feline calicivirus, Bordetella bronchiseptica 1 / 6

and Chlamydophila felis. Cats may be infected with one or more of these pathogens (Dawson and Willoughby, 1999). Kittens and immunosuppressed cats are particularly at risk due to a poor immune system. Although vaccination can reduce the risk of FURT, vaccinated cats can still acquire or carry cat flu (Feline Advisory Bureau [FAB], 2008). Cinical signs may vary subtly depending on the infecting agent(s). See Table 1 for a list of common clinical signs associated with the infectious agents. Feline herpes virus Feline herpes virus type-1 (FHV-1) affects both domestic cats and other members of the felidae. Occasionally, more severe signs such as pneumonia can develop, especially in young and debilitated animals. Some animals with FHV-1 can suffer from conjunctivitis and ulcerative keratitis, an ocular disease that leads to eye ulcers (Gaskell et al, 2010). Infection typically lasts 10-14 days, but more than 80 per cent of cats that have had FHV-1 will remain carriers for life (Lane et al, 2007). Carriers intermittently shed virus, especially at times of stress. Feline calicivirus Feline calicivirus (FCV) does not typically cause as severe clinical signs as FHV-1, but many strains exist and there is some variation in presentation. As with FHV-1, cats with FCV can become carriers and shed virus long term; however, most cats are free of infection within six months (Dawson and Willoughby, 1999). Calicivirus infection normally lasts between seven and 14 days (Lane et al, 2007). More virulent strains of FCV have recently been identified in the USA and UK. These strains often cause severe swelling of the face and paws, skin ulcerations on the head and limbs, and jaundice, among other symptoms. They have deleterious effects on the whole body and have a mortality rate of up to 67 per cent (FAB, 2008). Further investigations into these strains are ongoing. Feline herpes virus and FCV account for 80 per cent of all cases of FURT (Lane et al, 2007). However, there are two further infectious agents that deserve mention, these being B bronchiseptica and C felis. Bordetella bronchiseptica This is a bacterium that generally causes mild respiratory infection in cats. Coughing is not as prominent as it is in dogs. Bronchopneumonia is a serious complication of this disease and can be 2 / 6

fatal, especially in kittens. Chlamydophila felis This is a gram-negative bacterium that may be found on the ocular, respiratory, gastrointestinal and genitourinary mucosa of infected cats. Transmission is by direct contact and the organism is very short lived off the host (Lane et al, 2007). The most common signs are acute, chronic and relapsing conjunctivitis. C felis may also cause transient respiratory and nasal infections (Dawson and Willoughby, 1999). The incubation period is two to five days. Signs generally begin in one eye and usually progress to become bilateral. The discharge is initially watery, becoming mucoid or mucopurulent later (ABCD, 2008). Diagnosis The clinician will perform tests to try to identify the underlying cause(s). A swab is usually taken and sent to the lab for analysis. Viral diseases were commonly identified by virus isolation, but polymerase chain reaction tests are now also being used. This technique amplifies the DNA. Swabs can be taken from conscious patients or during sedation or anaesthesia for other procedures. Swabs for FHV-1 and FCV need to be placed in viral transport medium ( Figure 1 ), which may be supplied by the laboratory performing the test. The sample should arrive at the laboratory the day after it is taken. If bacterial infection is suspected for example B bronchiseptica a swab for bacteriology will be taken. This is taken in the same way, but the swab is placed in a charcoal medium. Prevention Vaccination does not cover all infectious agents in cats and, therefore, does not offer complete protection. New strains of FHV-1 and FCV are emerging and being identified and vaccination may not protect against these. Despite this, vaccination of all cats in a household is recommended, especially if they go outdoors or stay in a cattery. Nursing care As there is no specific treatment for cats with a FCV or FHV-1 infection, good nursing care is essential (Dawson and Willoughby, 1999). Ideally, cats are isolated and should be barrier nursed to prevent spread of infection to other hospitalised patients. Equipment, such as food bowls, litter 3 / 6

trays, etc, should only be used for the infected cat. Steel bowls are useful as these can autoclaved once the animal has left the hospital. Barrier nursing protocols include wearing gloves, apron, mask, over-boots and a change of clothes or overall ( Figure 2 ). Good hand hygiene is always essential, but extra care should be taken when dealing with cats with upper respiratory tract disease. Once the cat has left the hospital, all surfaces should be washed with an appropriate disinfectant and any bedding used should be soaked. Diluted hypochlorite/detergent mixture should be effective for the viral causes of feline upper respiratory tract disease. Feeding The main nursing concern in hospitalised cats with upper respiratory tract disease is often anorexia. This could be due to pyrexia, anosmia or oral ulceration. Good nutrition is helpful in disease recovery. Warm, smelly food (in my experience fish is good) should be offered. The food should be removed if not eaten after approximately one hour and fresh food offered later. Tempting a cat to eat may unfortunately not be as simple as offering a bowl of warm food. Spending time with the patients is vital and some cats will eat when groomed. Assisted feeding, in the form of syringe feeding, may be an inexpensive way of encouraging cats to eat, but care must be taken to ensure the cat does not aspirate and develop aspiration pneumonia. Appetite stimulants may be beneficial in some cases. It is essential to provide adequate calories, with whichever feeding method is selected. A cat s resting energy requirement (RER) should be calculated to enable appropriate feeding. The RER is calculated as follows: 30 bodyweight (Kg) + 70 [for cats more than 2kg] = kcal to feed per day. 70 (bodyweight) 0.75 [for cats less than 2kg] = kcal to feed per day. Some cats may be dehydrated and intravenous fluid therapy may be required. If anorexia persists, the vet may decide to place a feeding tube. Given the intranasal involvement in flu cases, an oesophagostomy tube may be preferred. Oesophagostomy tubes offer an inexpensive, long-term feeding solution and allow a greater variety of foods to be delivered. They are normally well tolerated in cats and are becoming more commonplace. An anaesthetic is required to place these tubes, but, once in situ, they can be left in for longer than nasogastric tubes (Watson and Chan, 2010). Oesophagostomy tube feeding 4 / 6

Key points to remember are that feeding should be nonstressful, the food warmed, and each feed should take 10-15 minutes (giving it too fast may induce vomiting). The tube should be flushed with water before and after each feed. A concentrated calorie liquid diet is often the vet s diet of choice. Flush the tube with 5ml of warm water and observe the patient for any abnormal behaviour or indications the tube is not in place. Signs include coughing, retching or gagging. A dislodged tube may lead to pneumonia. Give the calculated amount of diet slowly. The amount is based on the RER and the diet selected. Again, monitor the patient for any signs of tube dislodgement. Flush the tube again with a further 5ml of water. Each feed needs to be recorded, and document how well the cat received the feed. Feeds are normally started at onethird to a half of the required daily amount and the quantity is gradually increased. Feeding is normally carried out over the day at intervals of four to six hours (Watson and Chan, 2010). The cat s general well-being should be considered and care should be taken to keep its eyes and nose clean and free of discharge. Many cats will tolerate a groom even when congested with mucus, and many will rub their faces on a damp piece of cotton wool. Keeping cats clean and groomed helps their well-being and aids in maintaining their cleanliness. A key part of a nursing care plan is to maintain the activities of living as detailed in Roper, Logan and Tierney s Activities of Living (Lane et al, 2007) and this includes cleanliness. Nebulisation Nebulisation or steaming is sometimes effective when nursing cats with upper respiratory tract infection. It helps to break down mucus within the upper respiratory tract (King et al, 2004). The nebuliser should be held by the cat s face for five to 10 minutes some patients tolerate this better than others. Some prefer to be in their kennel without it being too close, while others enjoy it and may even try to rub their face on the nebuliser. If a nebuliser is not available, steam therapy can be used, especially if the cat is at home. This involves placing the cat within a steamy room (usually the bathroom) with a hot tap or shower running. Conclusions Many infectious agents can cause feline upper respiratory tract disease. Vaccination will help reduce the risk of a cat acquiring the disease, but will not affect the carrier status of an already infected animal. Complete protection cannot be offered as there are different strains of the infectious agents developing all the time. Good nursing care is vital to aid these patients to a speedy recovery, which involves spending time with them, keeping them clean and encouraging 5 / 6

Powered by TCPDF (www.tcpdf.org) them to eat. Nursing a FURT patient can be extremely rewarding and uses all of our skills as nurses. References Chan and Watson (2010). Principles of clinical nutrition. In Lindley S and Watson P (eds), The BSAVA Manual of Canine and Feline Rehabilitation, Supportive and Palliative care. BSAVA, Gloucester. Dawson S and Willoughby K (1999). Feline infectious upper respiratory disease an update. In Practice: Companion Animal Practice 21: 232-237. doi: 10.1136/inpract.21.5.232 European Advisory Board on Cat Diseases (ABCD), 2008. www.abcd-vets.org/guidelines Feline Advisory Bureau (2008). Feline upper respiratory disease cat flu, information sheet. www.fabcats.org/owners. Gaskell R, Dawson S and Radford A (2010). Other feline viral diseases. In Ettinger J and Feldman E, Textbook of Veterinary Internal Medicine (7th edn). Saunders-Elsevier, Missouri. King L (2004). Feline viral upper respiratory disease. In Textbook of respiratory disease in dog and cats. Saunders-Elsevier, Missouri. Lane D, Cooper B and Turner L (2007). BSAVA Textbook of Veterinary nursing (4th edn). BSAVA, Gloucester. Spencer C (2009). Feeding hospitalised patients for a speedy recovery. Veterinary Nursing Journal 24(7): 26. 6 / 6