Feline Panleukopenia
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''Carnivore protoparvovirus 1'' is a species of
parvovirus Parvoviruses are a family of animal viruses that constitute the family ''Parvoviridae''. They have linear, single-stranded DNA (ssDNA) genomes that typically contain two genes encoding for a replication initiator protein, called NS1, and the p ...
that infects
carnivorans Carnivora ( ) is an Order (biology), order of Placentalia, placental mammals specialized primarily in eating flesh, whose members are formally referred to as carnivorans. The order Carnivora is the sixth largest order of mammals, comprising at ...
. It causes a highly contagious disease in both dogs and cats separately. The disease is generally divided into two major genogroups: the group of the classical feline panleukopenia virus (FPLV), and the group of the
canine parvovirus Canine parvovirus (also referred to as CPV, CPV2, or parvo) is a contagious virus mainly affecting dogs and wolves. CPV is highly contagious and is spread from dog to dog by direct or indirect contact with their feces. Vaccines can prevent thi ...
type 2 (CPV-2), which appeared in the 1970s. Belonging to the family Parvoviridae, FPLV have linear, single-stranded DNA (ssDNA) genomes. This agent is one of the smallest animal viruses, barely 18 to 20 nm in diameter. Like other parvovirus genomes, it has hairpin structures at both ends of its genome: 3-genome Y-type structure and 5-terminal U-shaped structure, making it challenging to amplify the full-length genome of parvovirus despite its small size. Sequences in the genome show a high degree of nucleotide conservation in the VP2 gene after over 90 years since it has emerged; the VP2 gene codes for the capsid protein VP2, a main structural protein, which determines the major mutations during the evolution of CPV. FPLV is known to infect all wild and domestic members of the
felid Felidae ( ) is the Family (biology), family of mammals in the Order (biology), order Carnivora colloquially referred to as cats. A member of this family is also called a felid ( ). The 41 extant taxon, extant Felidae species exhibit the gre ...
(cat) family worldwide. It is a highly contagious, severe infection that causes gastrointestinal, immune system, and nervous system disease. Its primary effect is to decrease the number of
white blood cells White blood cells (scientific name leukocytes), also called immune cells or immunocytes, are cells of the immune system that are involved in protecting the body against both infectious disease and foreign entities. White blood cells are genera ...
, causing the disease known as feline panleukopenia. Although it was once thought that only FPLV caused panleukopenia in cats, it has been confirmed that a feline panleukopenia illness can be caused by CPV 2a, 2b, and 2c. FPLV is commonly referred to as: * feline infectious enteritis virus (FIE) *feline parvovirus (FPV or FP or "feline parvo") * feline parvoviral enteritis It is sometimes confusingly referred to as "cat plague" and "feline distemper". In addition to members of the felid family, it can also affect other carnivorans (e.g. raccoon, mink).


Transmission

The feline panleukopenia virus is considered ubiquitous, meaning it is in virtually every place that is not regularly disinfected. The infection is highly contagious among unvaccinated cats. Antibodies against FPLV, produced by the
adaptive immune system The adaptive immune system (AIS), also known as the acquired immune system, or specific immune system is a subsystem of the immune system that is composed of specialized cells, organs, and processes that eliminate pathogens specifically. The ac ...
, play an important role in the feline response to the virus. Maternally-derived antibodies (MDA) efficiently protect kittens from fatal infection. This passively acquired immunity is later replaced by an active immune response obtained by vaccination or as a consequence of a natural infection. In kittens, the period of greatest susceptibility to infection is when maternal antibodies are absent, or waning, and vaccine-induced immunity has not yet fully developed. Free-roaming cats are thought to be exposed to the virus during their first year of life. Those that develop a subclinical infection or survive acute illness mount a robust, long-lasting, protective immune response. An infected cat sheds large amounts of virus in all body secretions including feces, vomit, urine, saliva, and mucus during the acute phase of illness. It can continue to shed the virus for as long as six weeks after recovery. Subclinically ill cats can also shed the virus in body secretions. The virus can be carried or transferred on an infected object (such as bedding, food dishes, fur) or by other animals, fleas, and humans (see:
fomite A fomite () or fomes () is any inanimate object that, when contaminated with or exposed to infectious agents (such as pathogenic bacteria, viruses or fungi), can transfer disease to a new host. Transfer of pathogens by fomites A fomite is any ...
s). It persists long after evidence of the original body secretion has faded away, and can be transported long distances. Like all parvoviruses, FPLV is extremely resistant to inactivation and can survive for longer than one year in a suitable environment. Kitten deaths have been reported in households of fully vaccinated cats, possibly because of exposure to large amounts of virus in the environment. In a recent study,
microRNA Micro ribonucleic acid (microRNA, miRNA, μRNA) are small, single-stranded, non-coding RNA molecules containing 21–23 nucleotides. Found in plants, animals, and even some viruses, miRNAs are involved in RNA silencing and post-transcr ...
responses to FPLV infection were identified in feline kidney cells by sequencing, providing a possible link between miRNA expression and pathogenesis of FPV infection. Infection occurs when the virus enters the body through the mouth or nose. Whether illness results or not depends on the immunity in the victim vs. the number of individual virus particles (i.e. the amount of virus) entering the body.


Clinical signs

The clinical manifestations of FPLV are variable based on the dose of the virus, the age of the cat, potential breed predispositions, and prior immunity from maternal antibodies, previous exposure, or vaccination. Most infections are subclinical, as evidenced by the high seroprevalence of anti-FPV antibodies among some populations of unvaccinated, healthy cats. The cats that become clinically ill are usually less than one year old, but older cats are also at risk. There is high mortality in clinically affected kittens, and sudden death can occur. Clinical signs usually develop in 4–6 days after exposure, but can show in 2–14 days. The virus infects and destroys actively dividing cells in bone marrow, lymphoid tissues, intestinal epithelium, and—in very young animals—in the cerebellum and retina. The virus primarily attacks the lining of the
gastrointestinal tract The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the Digestion, digestive system that leads from the mouth to the anus. The tract is the largest of the body's systems, after the cardiovascula ...
, causing internal
ulceration An ulcer is a discontinuity or break in a bodily membrane that impedes normal function of the affected Organ (biology), organ. According to Robbins's pathology, "ulcer is the breach of the continuity of skin, epithelium or mucous membrane caus ...
and, ultimately, total sloughing of the intestinal
epithelium Epithelium or epithelial tissue is a thin, continuous, protective layer of cells with little extracellular matrix. An example is the epidermis, the outermost layer of the skin. Epithelial ( mesothelial) tissues line the outer surfaces of man ...
. Primary signs include: *anorexia *lethargy *profuse watery to bloody diarrhea (bloody diarrhea is more common in dogs with parvovirus than cats) *vomiting (most common in cats) Clinical laboratory findings include (but are not limited to): * electrolyte and total protein concentrations that reflect dehydration, vomiting, and diarrhea. *
leukopenia Leukopenia () is a decrease in the number of white blood cells (leukocytes). It places individuals at increased risk of infection as white blood cells are the body's primary defense against infections. Signs and symptoms Symptoms may include: * s ...
*
lymphopenia Lymphocytopenia is the condition of having an abnormally low level of lymphocytes in the blood. Lymphocytes are a white blood cell with important functions in the immune system. It is also called lymphopenia. The opposite is lymphocytosis, which r ...
*
neutropenia Neutropenia is an abnormally low concentration of neutrophils (a type of white blood cell) in the blood. Neutrophils make up the majority of circulating white blood cells and serve as the primary defense against infections by destroying bacteria ...
*
thrombocytopenia In hematology, thrombocytopenia is a condition characterized by abnormally low levels of platelets (also known as thrombocytes) in the blood. Low levels of platelets in turn may lead to prolonged or excessive bleeding. It is the most common coag ...
Other signs include: fever, loss of skin elasticity due to dehydration, abdominal pain, sternal recumbency with splayed legs and head droop, nasal discharge and
conjunctivitis Conjunctivitis, also known as pink eye or Madras eye, is inflammation of the conjunctiva, the thin, clear layer that covers the white surface of the eye and the inner eyelid. It makes the eye appear pink or reddish. Pain, burning, scratchiness ...
. Cats may sit at a water bowl, but not drink. Terminal cases are hypothermic and may develop
septic shock Septic shock is a potentially fatal medical condition that occurs when sepsis, which is organ injury or damage in response to infection, leads to dangerously low blood pressure and abnormalities in cellular metabolism. The Third International C ...
and
disseminated intravascular coagulation Disseminated intravascular coagulation (DIC) is a condition in which blood clots form throughout the body, blocking Microvessel, small blood vessels. Symptoms may include chest pain, shortness of breath, leg pain, problems speaking, or problems ...
. Infection in pregnant cats can result in
fetal resorption Fetal resorption (also known as fetus resorption) is the disintegration and assimilation of one or more fetuses in the uterus at any stage after the completion of organogenesis, which, in humans, is after the ninth week of gestation. Before organog ...
, mummification, abortion, or stillbirth of
neonates In common terminology, a baby is the very young offspring of adult human beings, while infant (from the Latin word ''infans'', meaning 'baby' or 'child') is a formal or specialised synonym. The terms may also be used to refer to Juvenile (orga ...
. Fetuses infected in utero that survive and kittens less than a few weeks of age that become infected can have
cerebellar hypoplasia Cerebellar hypoplasia is characterized by reduced cerebellar volume, even though cerebellar shape is (near) normal. It consists of a heterogeneous group of disorders of cerebellum, cerebellar maldevelopment presenting as early-onset Non-progress ...
, retinal dysplasia, and
optic neuropathy Optic neuropathy is damage to the optic nerve from any cause. The optic nerve is a bundle of millions of fibers in the retina that sends visual signals to the brain. Damage and death of these nerve cells, or neurons, leads to characteristic featu ...
.


Diagnosis

A presumptive clinical diagnosis of FPLV can be made for kittens with appropriate signalment, history, clinical findings and the history of no prior vaccination. The clinical diagnosis is usually supported by documenting parvovirus antigen in feces by ELISA (enzyme-linked immunosorbent assay) and PCR (polymerase chain reaction) assays. The availability of validated assays varies by country but is becoming more common. PCR assays are so sensitive that FPV DNA can be amplified from feces of cats vaccinated with modified live strains of the virus. Attenuated parvoviruses in MLV vaccines replicate in the blood and intestine, and post-vaccinal fecal shedding of FPV has been demonstrated, which can result in recent vaccinations giving false positive results on diagnostic tests. At least one of the ELISA antigen tests for dogs (SNAP®Parvo;
IDEXX Laboratories IDEXX Laboratories, Inc. is an American multinational corporation engaged in the development, manufacture, and distribution of products and services for the companion animal veterinary, livestock and poultry, water testing, and dairy markets. I ...
) detects FPV in feline feces and has a cut point for a positive test result that excludes most vaccinated cats. Thus, this ELISA is superior to PCR for screening cats for FPV infection and can also be performed in the veterinary clinic. (These are only approved and licensed for detecting
canine parvovirus Canine parvovirus (also referred to as CPV, CPV2, or parvo) is a contagious virus mainly affecting dogs and wolves. CPV is highly contagious and is spread from dog to dog by direct or indirect contact with their feces. Vaccines can prevent thi ...
, but it is generally known that they also detect FPL viral antigen in feline feces. These tests are used extra-label because they allow rapid, inexpensive, in-house detection of the virus.) Positive fecal SNAP test results, including weak positives, are highly likely to be true positives in clinically affected animals. Some cats will have completed the shedding period by the time the test is run, leading to false-negative results. Electron microscopy, virus isolation and seroconversion can also be used to document active or recent infection. Leukopenia on a complete blood count (nadir 50–3,000 WBC/μL) supports a diagnosis of FPLV. In an unvaccinated cat, the presence of antibodies against FPV indicates that the cat either has the disease or has had the disease in the past. Elevated IgM titers (1:10 or greater) indicate active infection and if clinical signs are obvious (diarrhea, panleukopenia) the prognosis is poor. Elevated IgG titers (1:100 or greater) in a cat with clinical signs indicates a better prognosis. Differential diagnoses include
salmonellosis Salmonellosis is a symptomatic infection caused by bacteria of the ''Salmonella'' type. It is the most common disease to be known as food poisoning (though the name refers to food-borne illness in general). These are defined as diseases, usuall ...
, enteric toxins,
feline immunodeficiency virus Feline immunodeficiency virus (FIV) is a lentivirus that affects cats worldwide and 2.5% to 4.4% of felines are infected. FIV was first isolated in 1986, by Niels C. Pedersen and Janet K. Yamamoto at the UC Davis School of Veterinary Med ...
(FIV),
feline leukemia virus Feline leukemia virus (FeLV) is a retrovirus that infects cats. FeLV can be transmitted from infected cats when the transfer of saliva or nasal secretions is involved. If not defeated by the animal's immune system, the virus weakens the cat's im ...
(FeLV),
cryptosporidiosis Cryptosporidiosis, sometimes informally called crypto, is a parasitic disease caused by ''Cryptosporidium'', a genus of protozoan parasites in the phylum Apicomplexa. It affects the ileum, distal small intestine and can affect the respiratory tr ...
,
pancreatitis Pancreatitis is a condition characterized by inflammation of the pancreas. The pancreas is a large organ behind the stomach that produces digestive enzymes and a number of hormone A hormone (from the Ancient Greek, Greek participle , "se ...
,
septicaemia Sepsis is a potentially life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage of sepsis is followed by suppression of the immune system. Common signs and s ...
with acute endotoxemia,
toxoplasmosis Toxoplasmosis is a parasitic disease caused by ''Toxoplasma gondii'', an apicomplexan. Infections with toxoplasmosis are associated with a variety of neuropsychiatric and behavioral conditions. Occasionally, people may have a few weeks or month ...
,
peritonitis Peritonitis is inflammation of the localized or generalized peritoneum, the lining of the inner wall of the abdomen and covering of the abdominal organs. Symptoms may include severe pain, swelling of the abdomen, fever, or weight loss. One pa ...
, and
lymphoma Lymphoma is a group of blood and lymph tumors that develop from lymphocytes (a type of white blood cell). The name typically refers to just the cancerous versions rather than all such tumours. Signs and symptoms may include enlarged lymph node ...
.


Treatment

To contain the virus, cats with suspected or diagnosed FPLV should be kept in isolation. It requires immediate, aggressive treatment if the cat is to survive, as it can be fatal in less than 24 hours. Several articles and publications provide guidance for rescuers and veterinarians for optimizing outcomes. Treatment involves: * anti-emetics *IV
antibiotics An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy ...
* intravenous fluids with electrolytes * injections of vitamin B *plasma or whole blood transfusion Feeding should be continued as long as possible. A highly digestible diet is preferred, but the individual animal's preferences may dictate giving whatever it will eat. In anorexic, hypoproteinemic, vomiting and diarrheic cats parenteral nutrition is required. In a disease outbreak, unvaccinated kittens or adults can be given anti-FPV serum containing FPV antibodies injected subcutaneously or
intraperitoneal The peritoneum is the serous membrane forming the lining of the abdominal cavity or coelom in amniotes and some invertebrates, such as annelids. It covers most of the intra-abdominal (or coelomic) organs, and is composed of a layer of mesothe ...
. This may provide protection for 2–4 weeks. Therapeutic efficacy of anti-FPV serum has been demonstrated in dogs, and similar beneficial effects may be expected in cats. Several studies have shown recombinant feline interferon omega is effective in the treatment of parvoviral enteritis in dogs and also inhibits replication of FPV in cell culture. So far no data are available on its efficacy in FPV-infected cats.


Complications

Cats typically die due to complications associated with sepsis, dehydration, and disseminated intravascular coagulopathy (DIC). Leukocytopenia predisposes patients to secondary infections, especially bacterial and fungal, though secondary viral infections also occur. It has been stated that cats with FPLV may be at risk for endocarditis or cardiomyopathy (since CPV-2 is a well-known cause of viral myocarditis in young puppies), but a 2017 retrospective study concluded that "Feline Panleukopenia Virus Is Not Associated With Myocarditis or Endomyocardial Restrictive Cardiomyopathy in Cats".


Prognosis

Mortality in affected felid litters varies between 20 and 100%. Mortality of FPLV is 25–90% in domestic cats with the acute form of the disease and up to 100% in cats with peracute disease. In 2010, a retrospective study of 244 infected cats showed that "leukocyte and thrombocyte counts as well as serum albumin and potassium concentrations at presentation are prognostic indicators in cats with panleukopenia, whereas vaccination status, age, clinical signs, and housing conditions are not." A survival rate of about 50% has been reported with supportive therapies. Cats with FPLV that survive the first five days of treatment usually recover; however, the decrease in the cat's white blood cells compromises its immune system, leaving it vulnerable to secondary infection. Lifelong immunity is thought to follow recovery from disease, and a carrier state of the disease has never been identified.


Preventing transmission from infected cats


Quarantine/isolation

Cats with suspected or diagnosed FPLV should be kept in isolation. This non-enveloped virus is very resistant to environmental conditions and many disinfectants, is highly contagious, and rapidly accumulates in the environment due to high shedding of virus from affected animals. Strict protocols for containment – with isolation, minimal handling, and disinfection of all potential sources of fomites – is warranted. Recovered cats can still shed the virus for up to six weeks and can carry it on their body for prolonged periods.


Vaccination

The practice of recommending and giving
vaccine A vaccine is a biological Dosage form, preparation that provides active acquired immunity to a particular infectious disease, infectious or cancer, malignant disease. The safety and effectiveness of vaccines has been widely studied and verifi ...
s on a fixed schedule with annual boosters has been widely discarded. Current recommendations are based on the philosophy of vaccinating each cat no more frequently than necessary. These recommendations take into account considerations for the efficacy and longevity of each specific vaccine; the exposure, risk, and need of different cat populations; and socioeconomic limitations. Recommendations vary for: * animal shelters *boarding facilities (or animals going into them) * breeders *community cats (free-roaming and/or feral) or TNR (Trap Neuter Return) programs *owned pets (and based on "inside only" or "in and out") The FPLV vaccination is considered a "core" (essential for health) vaccine and is recommended for all domestic cats. Even cats kept indoors can be infected from fomite transmission. Several types and brands of commercial FPLV vaccines are available to induce acquired immunity. These include: * killed virus ("non-infectious")
adjuvant In pharmacology, an adjuvant is a drug or other substance, or a combination of substances, that is used to increase the efficacy or potency of certain drugs. Specifically, the term can refer to: * Adjuvant therapy in cancer management * Anal ...
ed * killed virus non adjuvanted * modified-live virus (MLV or "infectious") adjuvanted *modified-live virus non adjuvanted Combination vaccines that protect against several common viruses, including FPLV, are also available. Selection or use of a specific type/brand of a vaccine may vary depending on the overall risk of viral infection to the specific animal in its environment, along with considerations for the time it takes to confer protection, its overall efficacy, the animal's health, and the potential risks associated with MLV vs killed, adjuvanted vs nonadjuvanted, intranasal/ocular vs injection. Modified-live FPLV vaccines are not recommended in pregnant queens, very young kittens, or cats with FIV or FeLV. Kittens without maternally derived antibodies are especially vulnerable. FPLV vaccination can start as early as 4 weeks of age for kittens at high risk but are usually started at 6 weeks, then given every 3–4 weeks until 16 weeks of age. For cats older than 16 weeks, 2 doses, 3 to 4 weeks apart is generally recommended, followed by a 6-month to 1-year booster. Thereafter, a booster vaccination every 3 years is usually recommended; a blood titer test can be done to determine individual antibody levels for catering the timing of boosters.


References


External links


Feline Distemper (Panleukopenia) from The Pet Health LibraryHow to Limit Parvo in Shelters, Rescues and Transfer Animals
{{DEFAULTSORT:Feline Panleukopenia Cat diseases Animal viral diseases Parvovirinae Vaccine-preventable diseases