I'm trying to gain some understanding of our 10 month old kitten, which is FELV positive. (Maine Coon mix, adopted from shelter)
Logan was initially FeLV negative, but later after adoption came up with a positive test. He is strictly an indoor kitty. Strong, active, Wellness dry food, no problems until now. Also, he is given a Lycene gel supplement daily.
Here's a bottom line of the past 16 days.
16 days ago:
Logan started acting odd. Not eating, sleeping, hiding under bed.
Blood work at vet showed nothing unusual, but showed a temperature.
Took him back for home care with antibiotics. The ABs caused vomiting. Initial thought was a Fever of unknown origin. Hope fever breaks after a few days.
16 days later here's what we've been seeing:
His temperature has been fluctuating between 102 to and a high of 105.1
8 days ago, new blood test shows high White blood Cells and low red blood cells.
Primary xRay showed all clear in chest.
Initial diagnosis was mycoplasma. Was given ABs for that while we waited for lab to confirm. Still not eating, trying to syringe feed with Hills AD.
Lab results showed negative for mycoplasma.
New diagnosis was IMHA - Immune Mediated Hemolitic Anemia
New blood test shows RBC going down. At start, RBC was 36, then down to 18, then down to 16. Weight loss has been from a start of 9lbs to 8.3 at this point. This is day 15.
He was given prednisone steroid while waiting for confirmation of IHMA.
That actually made him feel a lot better. Weak, but back to his old loveable self.
Next day he went to specialist.
They did Xray, ultrasound, and sent blood to pathology to confirm IMHA and determine if he needed transfusion.
This morning they called with results. Xray and Ultrasound clear - no indication of cancer.
Lab work came back - negative for IMHA.
RBC down to 10, and he needs a transfusion now. Which is being done today.
Diagnosis - his marrow isn't producing RBCs as a result of the FeLV and hopefully all he needs is this one transfusion. But it needs to be monitored.
But that leaves me confused as to why the WBC was elevated, where the fever came from and things like that.
Any ideas, or has anyone been through something similar?
Kitten with mystery illness - definitely anemic...
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LoganPenelope
- Posts: 35
- Joined: Fri Mar 25, 2011 11:48 am
Whenever there is a primary condition going on, there is always susceptibility of secondary problems, like bacterial infections. In FELV+ kitties, it is common to expect secondary infections due to lowered immune response and decreased ability to fight infection. This is why we always advise owners to monitor their FELV+ kitties closely and do not hesitate to get cats seen by your vet at the first hint of illness, no matter how mild or slight.
That said, it also depends on exactly when the testing for mycoplasma was done - timing is everything! It can be problematic sometimes because these organisms can change within hours (i.e., on a blood smear, you might not see anything, yet hours later, you in fact, might see them); likewise, at the time of infection from mycoplasma, you may not see critical symptoms until weeks after the initial infection - PCR testing is crucial to detect and to identify between the species of mycoplasma.
So, was a PCR test done, and was a second one ordered to confirm (with a new blood sample)? If not, I would ask your specialist about this, although at this point, the transfusion is more important. FELV+ kitties are more susceptible to their FELV status potentially causing bone marrow problems or cancer (luckily, cancer has been ruled out, but the bone marrow issue is still a problem)
My guess is your kitten may indeed be infected with mycoplasma, but there is hope that the transfusion will create enough healthy red blood cells to fight the infection - also continuation of the prednisone, and addition of doxycycline (+/- other antibiotics as needed) can help, the doxycycline may need to be given for up to 3-4 weeks.
I would definitely talk to your specialist and ask if he/she is treating this AS IF mycoplasma because it would most likely be the best course of action. (follow up with another PCR if vet feels it's warrranted).
IF infected with mycoplasma, your kitten will remain a carrier, which means if you have other cats, you will need to ensure there is no biting between them. The good news is that once recovered from mycoplasma, there is evidence that these cats will not become infected again. However, since your kitten is FELV+, as cautioned before, he is still susceptible to secondary bacterial infections.
Lastly, although the symptoms don't seem to indicate, ask vet if cytauxzoonosis has been ruled out.
Please don't give up, talk to your specialist about treating AS IF mycoplasma, and be prepared for a possible second transfusion (to help increase healthy red blood cells). My heart and prayers are with your kitten for a successful recovery, hang in there and keep us posted!
That said, it also depends on exactly when the testing for mycoplasma was done - timing is everything! It can be problematic sometimes because these organisms can change within hours (i.e., on a blood smear, you might not see anything, yet hours later, you in fact, might see them); likewise, at the time of infection from mycoplasma, you may not see critical symptoms until weeks after the initial infection - PCR testing is crucial to detect and to identify between the species of mycoplasma.
So, was a PCR test done, and was a second one ordered to confirm (with a new blood sample)? If not, I would ask your specialist about this, although at this point, the transfusion is more important. FELV+ kitties are more susceptible to their FELV status potentially causing bone marrow problems or cancer (luckily, cancer has been ruled out, but the bone marrow issue is still a problem)
My guess is your kitten may indeed be infected with mycoplasma, but there is hope that the transfusion will create enough healthy red blood cells to fight the infection - also continuation of the prednisone, and addition of doxycycline (+/- other antibiotics as needed) can help, the doxycycline may need to be given for up to 3-4 weeks.
I would definitely talk to your specialist and ask if he/she is treating this AS IF mycoplasma because it would most likely be the best course of action. (follow up with another PCR if vet feels it's warrranted).
IF infected with mycoplasma, your kitten will remain a carrier, which means if you have other cats, you will need to ensure there is no biting between them. The good news is that once recovered from mycoplasma, there is evidence that these cats will not become infected again. However, since your kitten is FELV+, as cautioned before, he is still susceptible to secondary bacterial infections.
Lastly, although the symptoms don't seem to indicate, ask vet if cytauxzoonosis has been ruled out.
Please don't give up, talk to your specialist about treating AS IF mycoplasma, and be prepared for a possible second transfusion (to help increase healthy red blood cells). My heart and prayers are with your kitten for a successful recovery, hang in there and keep us posted!
..........Traci
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LoganPenelope
- Posts: 35
- Joined: Fri Mar 25, 2011 11:48 am
Re: Kitten with mystery illness - definitely anemic...
Traci -
Thanks SO much for the very detailed and great response.
Just to say, we are definitely NOT giving up, and we have complete confidence he will be fine, because he is strong and we are very on top of what's going on.
We just want to make sure there is confidence in what it is, and it gets treated.
Also, we do have another kitten - adopted from the same shelter, but, from a different litter. They look very similar, and she is FeLV positive as well. If she got it from Logan or visa versa or from infections at the shelter is unknown.
That being said, they are best of friends, only 2 months apart, and have never even thought about fighting. The most oral contact they have is licking each other to clean each other.
The transfusion started at 10am and is 4 hours , so it should be ending soon in about 10 or 20 minutes. We checked in on him 1/2 way and they said he was relaxed and doing well.
I'm not sure about the PCR - I will check on that. I'm having out primary vet consulting with the specialist, just so there is a conversation happening and everyone knows we're very interested in knowing what's going on.
What's interesting is the specialist talked as though she would pull him off the prednisone, but the primary care vet mentioned that steroids made him feel better so its good he's on them. I need to check on this.
I will check on everything you mentioned, and update accordingly.
Thanks so much again, and here's Logan riding around in his crunchy tunnel a few months ago haha
http://www.youtube.com/watch?v=W_J2vg7cnYs
Thanks SO much for the very detailed and great response.
Just to say, we are definitely NOT giving up, and we have complete confidence he will be fine, because he is strong and we are very on top of what's going on.
We just want to make sure there is confidence in what it is, and it gets treated. Also, we do have another kitten - adopted from the same shelter, but, from a different litter. They look very similar, and she is FeLV positive as well. If she got it from Logan or visa versa or from infections at the shelter is unknown.
That being said, they are best of friends, only 2 months apart, and have never even thought about fighting. The most oral contact they have is licking each other to clean each other.
The transfusion started at 10am and is 4 hours , so it should be ending soon in about 10 or 20 minutes. We checked in on him 1/2 way and they said he was relaxed and doing well.
I'm not sure about the PCR - I will check on that. I'm having out primary vet consulting with the specialist, just so there is a conversation happening and everyone knows we're very interested in knowing what's going on.
What's interesting is the specialist talked as though she would pull him off the prednisone, but the primary care vet mentioned that steroids made him feel better so its good he's on them. I need to check on this.
I will check on everything you mentioned, and update accordingly.
Thanks so much again, and here's Logan riding around in his crunchy tunnel a few months ago haha
http://www.youtube.com/watch?v=W_J2vg7cnYs
Re: Kitten with mystery illness - definitely anemic...
Oh my, that is so cute, your babies are so adorable!!
Btw, re the prednisone, sometimes it depends - it isn't without it's side effects, but in my opinion, I feel it's worth continuing when you're seeing clear evidence it helps, and that the CBC is showing it's working (or at least mitigating). Since Logan is otherwise a healthy strong young kitten, I think the prednisone is warranted (as long as the CBC indicates it's helping).
Please be prepared to wait, it can take time to determine how successful a transfusion is - the good news is that he seems comfortable.
Just to be certain, is your vet clinic 24/7? Is someone there as well as a doctor on call overnight?
Lastly, I'm not sure whether it is likely he contracted mycoplasma from the shelter - more likely transmission was from a flea, tick or mosquito, which are the usual culprits. And while likely Logan and his sister may never fight so seriously as to cause a puncture wound with teeth, just a tip to watch for for his sister: any signs of fever (warm to the touch), vomiting, anorexia, sitting in sternal position, drooling from mouth (dehydration), reluctance to move, avoidance of food/water, these symptoms are oftentimes rather sudden in development and warrant an ER vet visit right away. Sometimes, the vet can see the organisms on a blood smear right there in the clinic, but usually, one wants to send blood off to an outside lab for confirmation, and the vet wants to ask the lab to expedite the results. If that can't be expedited for some reason, it is generally best to treat AS IF, providing inhouse labs and other blood parameters are indicative for mycoplasma.
Btw, re the prednisone, sometimes it depends - it isn't without it's side effects, but in my opinion, I feel it's worth continuing when you're seeing clear evidence it helps, and that the CBC is showing it's working (or at least mitigating). Since Logan is otherwise a healthy strong young kitten, I think the prednisone is warranted (as long as the CBC indicates it's helping).
Please be prepared to wait, it can take time to determine how successful a transfusion is - the good news is that he seems comfortable.
Just to be certain, is your vet clinic 24/7? Is someone there as well as a doctor on call overnight?
Lastly, I'm not sure whether it is likely he contracted mycoplasma from the shelter - more likely transmission was from a flea, tick or mosquito, which are the usual culprits. And while likely Logan and his sister may never fight so seriously as to cause a puncture wound with teeth, just a tip to watch for for his sister: any signs of fever (warm to the touch), vomiting, anorexia, sitting in sternal position, drooling from mouth (dehydration), reluctance to move, avoidance of food/water, these symptoms are oftentimes rather sudden in development and warrant an ER vet visit right away. Sometimes, the vet can see the organisms on a blood smear right there in the clinic, but usually, one wants to send blood off to an outside lab for confirmation, and the vet wants to ask the lab to expedite the results. If that can't be expedited for some reason, it is generally best to treat AS IF, providing inhouse labs and other blood parameters are indicative for mycoplasma.
..........Traci
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LoganPenelope
- Posts: 35
- Joined: Fri Mar 25, 2011 11:48 am
Re: Kitten with mystery illness - definitely anemic...
haha yes they're quite the pair it's cute overload with these two!
Initially the specialist was very much in favor of Prednisone/steroids - and preferred the oral method. She said orally, it is much easier to regulate, should there be a need to reduce or increase, versus injection which is much more difficult should there be a need to adjust for some reason.
Never the less, I will continue to inquire about steroids, and mycoplasma. Regarding the flea, tick or mosquito - we're here in North Carolina, USA - and ticks don't really show up until around June. That leaves fleas and mosquito. The best bet I would think is flea, but I haven't seen any and don't know how they would get here. Is it possible they can come in through a screen from an open window? Should we treat the house?
Both the primary vet and the specialist luckily are only 2 miles from the house. The specialist is a 24 hour care center, with 2 actual vets on staff at the hospital from 6pm to 7am, then normal staff at 7am. His overnight stay costs include hourly checks to monitor overall health and in this case monitor eating as well. So we're definitely in good hands at the facility.
Thanks, and I'll update more when they call with results.
it's cute overload with these two!Initially the specialist was very much in favor of Prednisone/steroids - and preferred the oral method. She said orally, it is much easier to regulate, should there be a need to reduce or increase, versus injection which is much more difficult should there be a need to adjust for some reason.
Never the less, I will continue to inquire about steroids, and mycoplasma. Regarding the flea, tick or mosquito - we're here in North Carolina, USA - and ticks don't really show up until around June. That leaves fleas and mosquito. The best bet I would think is flea, but I haven't seen any and don't know how they would get here. Is it possible they can come in through a screen from an open window? Should we treat the house?
Both the primary vet and the specialist luckily are only 2 miles from the house. The specialist is a 24 hour care center, with 2 actual vets on staff at the hospital from 6pm to 7am, then normal staff at 7am. His overnight stay costs include hourly checks to monitor overall health and in this case monitor eating as well. So we're definitely in good hands at the facility.
Thanks, and I'll update more when they call with results.
Re: Kitten with mystery illness - definitely anemic...
When did you adopt him from the shelter? (how old was he at the time)
Did you adopt his sister at the same time or?
For example, if he had been at the shelter for some time, there is a slight possibility another kitten or adult cat had fleas and he could have had a flea bite. (or he could have had fleas when originally brought to the shelter).
Another example, regardless of when transmission occurred, he was probably developing his antibodies (indicative of his young age), and they were interrupted by the mycoplasma, and eventually, he stopped producing enough red blood cells to combat them. Don't quote me on this, but I think most cases generally have a period of say a few weeks or more after initial infection to develop symptoms obvious enough that we notice.
If you've had him for over a month or two, it's possible a flea or mosquito came in from a screen, but that possibility seems low. If you've seen no evidence of fleas on the kittens or in the home, I don't think I would treat the environment. It's also possible that his infection was transient and his antibody production protected him until recently. There's no hard and fast rule to determine exactly when transmission occurs, the most important thing is detection and prompt treatment.
Do keep us updated. I also want to mention, try to avoid visiting until later today or near regular office hours at closing, so things will be more quiet, and you have a quieter environment to visit, which also helps Logan when he's in a quiet environment. Of course, your vet may say you can visit anytime so if that's the case, go ahead, just be gentle and as quiet as possible with him.
Did you adopt his sister at the same time or?
For example, if he had been at the shelter for some time, there is a slight possibility another kitten or adult cat had fleas and he could have had a flea bite. (or he could have had fleas when originally brought to the shelter).
Another example, regardless of when transmission occurred, he was probably developing his antibodies (indicative of his young age), and they were interrupted by the mycoplasma, and eventually, he stopped producing enough red blood cells to combat them. Don't quote me on this, but I think most cases generally have a period of say a few weeks or more after initial infection to develop symptoms obvious enough that we notice.
If you've had him for over a month or two, it's possible a flea or mosquito came in from a screen, but that possibility seems low. If you've seen no evidence of fleas on the kittens or in the home, I don't think I would treat the environment. It's also possible that his infection was transient and his antibody production protected him until recently. There's no hard and fast rule to determine exactly when transmission occurs, the most important thing is detection and prompt treatment.
Do keep us updated. I also want to mention, try to avoid visiting until later today or near regular office hours at closing, so things will be more quiet, and you have a quieter environment to visit, which also helps Logan when he's in a quiet environment. Of course, your vet may say you can visit anytime so if that's the case, go ahead, just be gentle and as quiet as possible with him.
..........Traci
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LoganPenelope
- Posts: 35
- Joined: Fri Mar 25, 2011 11:48 am
Re: Kitten with mystery illness - definitely anemic...
Ah interesting. ok -
So Logan and Penelope we both adopted about last June. Logan was 2 months and Penelope was 4 months. They're not related. They're from different litters and were in different cages...
Thanks for the tip on visiting hours. They have visiting hours from 9am to 9pm, maximum of two visits per day maximum 30 minutes. We'll go after 7pm and just for a bit.
Thanks!
So Logan and Penelope we both adopted about last June. Logan was 2 months and Penelope was 4 months. They're not related. They're from different litters and were in different cages...
Thanks for the tip on visiting hours. They have visiting hours from 9am to 9pm, maximum of two visits per day maximum 30 minutes. We'll go after 7pm and just for a bit.
Thanks!
Re: Kitten with mystery illness - definitely anemic...
Based on your information and their adoption dates, it's possible you had a stray flea or mosquito in your environment. Do you often have flea problems in your area? Do you have the kittens on a flea preventative (Frontline or Advantage)?
Are the kittens kept strictly indoors only?
Are the kittens kept strictly indoors only?
..........Traci
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LoganPenelope
- Posts: 35
- Joined: Fri Mar 25, 2011 11:48 am
Re: Kitten with mystery illness - definitely anemic...
They are strictly indoor kitties and we don't have any bad flea problems in our neighborhood. Also, don't have any fleas in here that I can tell. They get brushed several times a week at least, and no fleas on the brush teeth either.
I did get an update from the vet.
Logan's transfusion went well and he's resting now. His temperature is around 101-102. They're going to keep him overnight to monitor and slowly try to reduce the steroids. If he doesn't eat by monday they're going to consider feeding tube.
She might send him home tomorrow for the weekend to see if he eats at home versus the hospital.
What's a new mystery - checking with our primary care vet, he said his blood work about 6 days ago showed his RBC reproduction very good and high - around 16,000, i believe he said.
He thought it curious that the new lab which did the test 2 days ago showed his RBC reproduction very low -causing the specialist to say he is not producing RBCs.
What do you think of that?
I did get an update from the vet.
Logan's transfusion went well and he's resting now. His temperature is around 101-102. They're going to keep him overnight to monitor and slowly try to reduce the steroids. If he doesn't eat by monday they're going to consider feeding tube.
She might send him home tomorrow for the weekend to see if he eats at home versus the hospital.
What's a new mystery - checking with our primary care vet, he said his blood work about 6 days ago showed his RBC reproduction very good and high - around 16,000, i believe he said.
He thought it curious that the new lab which did the test 2 days ago showed his RBC reproduction very low -causing the specialist to say he is not producing RBCs.
What do you think of that?
Re: Kitten with mystery illness - definitely anemic...
It's really hard to say, but I'm a bit confused about the 6 days ago result, since your first post indicated all the bloodwork recently indicated evidence the RBC's were dropping to a critical low (did you mean to say 16 days ago or do you mean that he's had several blood draws just in over a week?)
Either way, when there is RBC destruction, it can be extremely rapid, and the FELV-immunocompromised status didn't help. In mycoplasma for example, there is no membrane on the cells, which means it is easier for them to proliferate and the good cells (new RBC's) can't attack them as vigilantly or fast enough.
I couldn't be happier to hear Logan seems to be doing well and resting, hopefully by morning, he will be interested in trying food and water on his own. Do ask the vet however, if they think doxycycline might be a good choice in treatment right now, and if you bring him home over the weekend, please ensure that any stress is reduced to the barest minimum.
Either way, when there is RBC destruction, it can be extremely rapid, and the FELV-immunocompromised status didn't help. In mycoplasma for example, there is no membrane on the cells, which means it is easier for them to proliferate and the good cells (new RBC's) can't attack them as vigilantly or fast enough.
I couldn't be happier to hear Logan seems to be doing well and resting, hopefully by morning, he will be interested in trying food and water on his own. Do ask the vet however, if they think doxycycline might be a good choice in treatment right now, and if you bring him home over the weekend, please ensure that any stress is reduced to the barest minimum.
..........Traci