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 FIP 

What is FIP?? FIP (Feline infectious peritonitis), is a disease caused by a "coronavirus" infection; while many different strains of coronavirus are able to infect cats, most do not produce serious disease. The strains of coronavirus that produce FIP are distinguished by their ability to invade and to grow in certain white blood cells. Once infected, the cells transport the virus throughout the cat's body, causing an intense inflammatory reaction in the tissues where these virus-infected cells locate. It is this interaction between the cat's body's own immune system and the virus that is responsible for the disease.

How does a cat get FIP?? Cats infected with the FIP virus shed the coronavirus in their saliva and in their feces. Most cats become infected by inhaling or ingesting the virus, either by direct contact with an infected cat, or by contact with virus-contaminated surfaces such as clothing, bedding, toys or food/water dishes.

How can you keep FIP from spreading?? The FIP virus is rapidly inactivated by most household detergents and disinfectants, although without using these chemicals some authorities believe that the virus can survive for a number of weeks in the environment. A recommended solution for killing the FIP virus on surfaces is one part of household bleach in thirty-two parts of water (which is 4 ounces of bleach per gallon of water.)

What's the difference between FIP and FELV (feline leukemia)?? FIP and FELV are caused by different viruses. It is possible for a cat to be infected with both FIP and FELV, but the diseases are totally separate. It can get confusing with the different illnesses such as FIP, FIV and FELV, and to add to this confusion, some of the symptoms are similar or even the same.

What are the symptoms of FIP?? There is really no way to tell when a cat has been initially exposed to FIP, although some cats do have symptoms of a mild upper respiratory disease such as sneezing, watery eyes, and a watery nasal discharge. Other cats may exhibit a rather unusual bacterial infection such as a very severe ear infection, which is now thought to be a result of the cat's immune system being under stress. Extremely excessive shedding may also be an indication of the very beginning of FIP. Some cats may even experience a mild intestinal disease; most cats that do undergo the primary infection described above recover completely, although some of them may become carriers of the virus. Only a small percentage of cats exposed to the FIP virus will develop the deadly disease, and for those that do, it may be weeks, months, or even years after their primary infection.

In kittens, the onset of clinical signs of FIP may be extremely sudden, or the signs may appear gradually and increase in severity over a period of weeks. Some cats have symptoms that are not clearly associated with FIP by themselves, such as decrease in appetite on occasion, rough hair coat or shedding, depression, fever, and weight loss.

The major forms of FIP are effusive (wet) FIP, noneffusive (dry) FIP, and combinations of both. The sign most characteristic of effusive (wet) FIP is the accumulation of fluid within the abdomen and/or chest of the cat, which can accumulate to the point where it is difficult for the cat to breathe normally.

With noneffusive (dry) FIP, the onset is usually slower, with minimal fluid accumulation, although fever, depression, anemia, and weight loss are almost always present. One of the reasons it is often difficult to diagnose FIP is that symptoms that could also be indicative of kidney failure (increased water consumption and urination), liver failure (jaundice), pancreatic disease (vomiting, diarrhea, diabetes), neurologic disease (loss of balance, behavioral changes, paralysis, seizures), enteritis (vomiting, diarrhea), and eye disease (inflammation, blindness) may be seen in various combinations. FIP is a disease that frustrates veterinarians and owners alike, as both feel so helpless when faced with it.

What is the likelihood of my cat getting FIP in its lifetime?? Young cats (less than two years old), older cats (over ten years old), cats in poor physical condition, and cats undergoing concurrent infections or stress are more susceptible to FIP. Thankfully, it is a relatively uncommon disease in the general cat population, probably affecting fewer than one percent of the cats brought to a veterinarian's office for treatment. In multiple-cat environments, such as some shelters and catteries, the disease rate can be much higher, affecting up to 10 percent of the susceptible population over a period of months. It's important to realize that the presence of FIP is not about someone being a poor animal care-giver, a "bad breeder", etc. The old-fashioned and non-deserved stigma of FIP just gets in the way of what should be our common goal of discovering more about what exactly FIP is; why some kittens and cats come down with it, while others (including their littermates) do not; and most importantly, how to prevent it.

What laboratory tests can detect the FIP virus?? The KELA, ELISA, IFA, and virus-neutralization tests detect the presence of coronavirus antibodies in a cat. A positive test result only means the cat has had a prior exposure to a coronavirus - not necessarily one that causes FIP - and has developed antibodies against that virus. If the test is negative, it means the cat has not been exposed to a coronavirus. Therefore, if a sick cat presents with symptoms of FIP, yet has zero coronavirus titers, this cat can not have FIP. There have, however, been cases reported where the titer count did not represent the true condition of the cat, and a necropsy confirmed FIP yet the cat had a very low titer count.

The number, or titer, that is reported is the highest serum dilution that still produced a positive reaction. Low titers indicate a small amount of coronavirus antibodies in the serum, while high titers indicate greater amounts of antibodies. A healthy cat with a high titer is not necessarily more likely to develop FIP or be a carrier of an FIP-causing coronavirus than a cat with a low titer. It also is not necessarily protected against future FIP virus infection. The titer count testing can be most useful in the case of a very sick cat (one who is isolated from other cats) exhibiting the classic symptoms of FIP, and where FIP is definitely suspected. In a case like this, repeating the titer count bloodwork in about 10 days may be indicated. A substantial rise in the titer count would virtually prove the cat had FIP as there is no other explanation for this change and increase in the animal's titer count.

There have been two tests developed that can detect parts of the virus itself. The "immunoperoxidase test" can diagnose FIP more accurately than traditional histopathologic examination because it detects virus-infected cells in the tissue. A biopsy of affected tissue is necessary for evaluation. Another antigen test utilizes "polymerase chain reaction (PCR)" to detect viral genetic material in tissue or body fluid. Although this test shows promise, PCR is only capable of detecting coronaviruses in general at this time, not necessarily those that cause FIP.

Should I or should I not have my cat tested for FIP?? There are two primary situations where it is recommended to test for coronavirus-antibody titers in a cat: 1) As a screening test, to determine the presence or absence of antibodies in a previously untested household and to detect potential virus carriers or shedders when introducing new cats into households or catteries that are currently negative for coronavirus antibodies; 2) as an aid (and nothing more than an aid, as mentioned above) in the clinical diagnosis of a diseased cat that is exhibiting signs strongly suggestive of FIP.

I have heard that you can get different results from different laboratories. This can be true, as each laboratory has their own antigens prepared and interprets the assay differently. The FIP test can be difficult to interpret, since it usually depends on a subjective decision made by the person reading the test.

How can a cat be positively diagnosed with FIP?? This presumptive diagnosis of FIP can usually be made on the basis of clinical signs, routine laboratory tests, and evaluation of abdominal or chest fluid. In all cases, however, a TISSUE BIOPSY IS THE ONLY WAY TO ABSOLUTELY CONFIRM A DIAGNOSIS OF FIP. It's always extremely important to be working with a vet whom you trust and feel very comfortable with ... but with the potential FIP-positive kitty, it's absolutely essential. Owners truly suffer terribly with this disease, right alongside their beloved kitty, and knowing when and how to let go is not something any cat lover should try to go through alone.

Is there a cure for FIP?? Once a 'positive' diagnosis of FIP has been made, it is considered to be a terminal disease, with no cure at this date. The basic aim of therapy is to provide supportive care and to alleviate the self-destroying inflammatory response of the disease. Some treatments may induce short-term remissions in a small percentage of cats, and a combination of corticosteriods, cytotoxic drugs, and antibiotics with maintenance of nutrient and fluid intake may be helpful in some cases. There are numerous studies and research being done now for beneficial medications for the future treatment of FIP. As always, we recommend contacting the teaching veterinary hospitals in your area to speak with the specialists there, as these facilities are most often aware of the most recent test results and cutting edge technologies.

How can I protect my cats from getting FIP?? Keeping cats as healthy as possible, minimizing exposure to infectious agents, preventing overcrowding situations, keeping current on vaccinations, providing good nutrition and adequate sanitation are the most helpful things you can do to reduce the incidence of FIP groups of cats. But even in the best of circumstances, FIP can occur. And if and when it happens to you, you have our heartfelt sympathy and understanding. And you'll no doubt join the ranks of other cat lovers who are dedicated to finding out as much as they can about FIP, and perhaps even contributing to the research efforts and certainly reaching out to others who've been devastated by this elusive yet deadly virus.

What about a vaccination for FIP?? The first FIP vaccination was introduced in 1991, and it is a modified-live, temperature-sensitive vaccine licensed for intranasal vaccination of cats at 16 weeks of age, with boosters in 3 to 4 weeks, then once yearly. The problem is that once a cat is vaccinated with this vaccine, its serum will always have a positive coronavirus antibody titer. Thus, it would affect a cattery-owner's ability to use serologic testing to maintain a coronavirus-free population. Various studies have yielded different estimates of its efficacy. You should discuss with your veterinarian whether or not the Primucell FIP by Pfizer Animal Health vaccine should be given to your cat. There is ongoing work to come up with a much better vaccine.

I've been told my cat has FIP. I am absolutely overwhelmed. What happens now?? First of all, you have our sincere condolences. And you are NOT alone. Once clinical signs appear, cats with effusive (wet) form of FIP will live a few days to a few weeks, although in rare cases, some adult cats may linger for six to eight months. Cats with the dry form of FIP usually die within a few weeks; however, some cats have survived for up to a year or more. There are always so many variables to be considered, such as the age and overall health of your cat, and the quality and timeframe of the medical care that has been provided and that can be provided in the future for the animal. The best you can do is to provide good nursing care, feed a highly nutritious diet, and work with your veterinarian to make your cat as comfortable as possible, which may involve the prescription of medications to reduce some of the symptoms. FIP has not been documented in any species other than those of the cat family, and is not known to be a health risk for humans. The FIP virus for cats is similar to the canine coronavirus, which causes enteritis in dogs.

Where can I go to learn more about this disease, and for support?? There are some WONDERFUL website resources for FIP. Learning as much as you can about this illness, and connecting with other people who understand exactly what you are going through, will be invaluable sources of support for you. Here are our favorite website recommendations:   Dr. Diane D. Addie's FIP and Coronavirus Website;  The Winn Feline Foundation FIP Updates;  FIP Support Group;  Cornell University FIP Brochure;  Yahoo Groups - FIP Support Group.

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Foothill Felines wishes to acknowledge the Cornell Feline Health Center for their valuable contributions to this article.

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