TOA
PAYOH VETS
"Nothing much can be done when the cat has FIV," Vet 1 told the stray cat care-giver and her domestic worker some 3 months ago when she adopted a skinny malnourished cat with bad breadth and a leg wound and a very bad breath. "This stray cat has FIV. Give him clindamycin one capsule per day for 15 days." Vet 1 treated the cat's leg wound and neutered him.
The cat's bad breath returned after the end of the course of antibiotics.
So she gave clindamycin for 15 days for another 15 days by sprinkling the powder from the capsule into the cat's food. The cat still ate but was not so active.
The cat looked plump and had a rectal temperature of 39.3 C. No runny nose. No bad breath or diarrhoea. No tartar or plaque on the teeth. He was just not eating.
"Unlikely to be FIV as this cat looked so plump at 5 kg and has no upper respiratory tract infections or drooling of saliva," I gave the owner the option as to whether to test for FIV or not since she was fostering at least 5 stray cats. "Of the two, a blood test is more useful." Vet 1 assumed this stray cat has FIV but did not do the test to save the owner costs.
FIV/FeLV TESTS - Negative. The owner was happy to know that.
MOUTH EXAMINATION
It is important that the owner actually see the inside of the mouth. I asked my assistant to shine a white torchlight into the mouth as I pried open the mouth. The cat was quiet but there was pain and objected to it. I opened the sides of the mouth - gum ulcers, tongue ulcers and two large ulcers at the back of the mouth, beside the tongue on both sides.
DIGITAL IMAGES
Best to take pictures to document the oral ulcers at presentation. I took several pictures on April 17. Today, April 19, I took some images. The cat was eating and was less hostile now at day 3. The owner came and was happy that the cat's mouth was not so painful.
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Less oral
pain, no halitosis on Day 4
after treatment. |
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BLOOD COLLECTION
The cat was quite fed up since I had pried opened his mouth a few
times. Dr Daniel collected blood from his veins but there was
insufficient. The cat started clawing in self-defence.
"It is not easy to collect sufficient amount of blood from an angry
cat," I said. "I will tranquilise him. Blood was collected from the
jugular vein by Dr Vanessa.
DIAGNOSIS is best
confirmed by a biopsy or fine needle aspirate of the
eosinophilic plaque but the owner wanted to save money and permitted
FIV and blood tests only as she has other stray cats to pay for
expenses. In this case, the blood test show a higher % of
eosinophils at 6% and the clinical signs of oral ulcers, plaques and
an old leg wound now healed) indicated a likelihood of the EGC.
Blood Test Results - significant findings
1. Glucose elevated 11.0 (normal
3.9 - 6.0) - "stressed induced hyperglycaemia" in the cat.
2. Liver enzymes ALT & AST elevated
--- clindamycin >15-20 days and other antibiotics and powders could
affect the liver.
3. Urea below normal.
4. Platelets low 146 (300-800).
Large platelets present --- toxic products from medications
affecting the platelets?
RBC and WBC are normal.
Differential count - % and absolute numbers are:
N 64% 8.69
L 24% 3.19
M 6% 0.77
E 6% 0.81
B 0.3% 0.04
Could the oral ulcers and plaque be due to eosinophilia? Need to
review my past report at:
http://www.asiahomes.com/singaporepets/0747cat_tonsils
_overwhelmed_Singapore.htm
An extract from the above webpage is as follows:
3. RODENT ULCERS IN CATS (feline eosinophilic granulomatosis).
Salivation and ulcers are signs.
Eosinophilic Granuloma Complex (EGC)
Three distinct but related clinical syndromes comprise the granuloma
complex:
3.1 Eosinophilic (or rodent) Ulcer. This may occur on the skin or in
the mouth but usually affects the upper lips. The lesions are
well-demarcated ulcers.
3.2 Eosinophilic Plaque. These are raised, moist, red eroded or
ulcerated areas with a well demarcated border. Pruritus is usually
severe. Lesions usually occur on the underside of the cat (abdomen,
brisket or inside the thighs).
3.3 Linear Granulomata. These can occur at most sites, especially
behind the hind legs and within the mouth. They are well-demarcated
lesions which are raised and yellow to
yellowish-pink in colour. They are often thin, hence the name
*linear* granuloma.
CONCLUSION
Could this be a case of EGC? The mouth ulcers are well demarcated.
Plaques are seen inside the mouth. Use evidence-based
medicine to diagnose FIV rather than presume the diagnosis based
on oral pain and halitosis. For stray cat owners, it is
understandable that many may not want to spend on testing as is
probably the situation in this case for Vet 1 who treats many stray
cats in the practice.
