Giardia elisa positive after treatment
Debra L. Conversely, while adult cats often have different and more chronic causes of diarrhea than kittens, the condition remains a common reason for cats to be presented to veterinarians for care. This review discusses some of the more common causes as well as the best approaches for diagnosis and treatment of diarrhea in kittens and cats. The role of diet in diagnosis and therapy of diarrhea is considered when appropriate. Diarrhea in kittens may range in severity from mild and self-limiting to a severe, hemorrhagic, life-threatening condition.
Knowledge of the giardia elisa positive after treatment frequently encountered causes of diarrhea in kittens is essential in formulating appropriate diagnostic and treatment plans for these young patients. Although adult cats can also have infectious, parasitic, mechanical e. In many adult cats, Giardia species infections are subclinical or transient, but in kittens, infection is classically associated with an acute onset of malodorous, pale, mucoid diarrhea.
The diagnosis is relatively straightforward when the trophozoites or cysts are identified on fresh fecal smears or flotation. Treatment of giardiasis in cats and kittens has not changed drastically for many years, and includes specific antiprotozoal therapy combined with environmental control.
A note of caution here is advised using metronidazole at this dose for longer than days, as metronidazole toxicity is much more likely to result. However, the lack of efficacy may have been due to the combined infection, so, the true effectiveness of fenbendazole against Giardia species is not known.
Finally, experimentally infected cats were effectively treated with a combination product containing febantel Drontal Plus, Bayer Animal Health. In that study, the kittens did not have diarrhea from Giardia infection, gyereknek féreg Giardia antigen test results became negative after therapy, suggesting complete removal of the organism.
One note of caution is that this drug is not approved for use in cats, primarily because neurologic signs were observed during initial testing. Because reinfection is a major cause of persistent or recurrent infection in a household, cattery, or shelter, appropriate environment control measures are essential.
Such measures include environmental decontamination cleaning all floors, cages, litter pans, and surfaces that have been in contact with feces with quaternary ammonium or Clorox-containing disinfectantscoat cleaning bathing or shaving of long-haired catsand isolation of affected animals during the diarrheic phase to prevent infection through grooming and other forms of contact. Vaccination with the commercially available Giardia vaccine GiardiaVax, Fort Dodge Animal Health, Overland Park, KS does not prevent infection or shedding of cysts but may reduce the severity and the duration of shedding.
As a result of studiesperformed by Lappin, et al, evaluating the effectiveness of this vaccine, it is not recommended for routine use in household cats. Because Giardia is zoonotic, appropriate education about handling infected cats and kittens is also important. Trichomoniasis Trichomoniasis, caused by Tritrichomonas foetus, has been giardia elisa positive after treatment recognized as a pathogen in kittens and adult cats. This is the same protozoal organism that infects cattle, causing early embryonic death, abortion, and pyometra.
However, in cats, the organism infects the large intestinal mucosa and causes chronic large bowel diarrhea characterized by increased mucus, tenesmus, giardia elisa positive after treatment, and increased frequency of defecation. Most affected kittens are healthy, alert, and active.
The only outward signs of illness are the presence of anal hyperemia or swelling, and painful defecation. Most infections are diagnosed in young kittens with chronic diarrhea average age 9 monthsbut infection can occur at any age.
Cats that are exposed to the organism will probably become infected, and infection is likely to be persistent. In a recent study, all eight cats that were exposed to Tritrichomonas trophozoites became infected as evidenced by fecal cultures performed throughout the days of the study.
However, infection with T. Diagnosis of this infection can be made by one of four approaches, listed according to relative ease of use and expense: 1 direct examination of the feces for trophozoites, 2 fecal cultures for the organism using the InpouchTF kit, Biomed Diagnostics, White City, OR3 polymerase chain reaction PCR of feces must be submitted to belfergek emberben labs, Dr.
However, it is still the easiest and potentially fastest way to make a definitive diagnosis.
Archive for április, 2007
The InPouchTF kit is more sensitive than the fecal examination but takes up giardia elisa positive after treatment 12 days to grow the organism for diagnosis. The samples giardia elisa positive after treatment be sent to a lab for culture, or the culture kits can be obtained and used in the practice setting. Because other trichomonad species can grow in the pouch, PCR testing of the cultured organisms may be needed. PCR testing is the most sensitive and specific method of diagnosis, but is also more expensive and results take longer to obtain because only a few labs can do this test.
Therapy of cats with trichomoniasis is difficult because there is no readily available, approved drug. Metronidazole and other antibiotics have been used in both experimentally and naturally infected cats but are completely ineffective in clearing the infection. Because members of the nitroimidazole family of antimicrobials would be expected to be effective against trichomonads, other drugs from the family have been tested.
However, this drug is not approved for use in cats and is potentially hepatotoxic and neurotoxic. Thus, it should only be used when a definitive diagnosis has been made and the owners understand the risks associated with therapy. It should not be used empirically to treat cats with undiagnosed diarrhea because of numerous anecdotal reports of neurotoxicity, especially at higher-than-recommended doses and for longer than 14 days.
All other antibiotics and parasiticidals, including tylosin, enrofloxacin, azithromycin, and fenbendazole, have not been shown to be effective against T. Clinical remission has been shown to occur in many infected cats, usually by 2 years of age, giardia elisa positive after treatment without treatment.
However, the gyermekek helminthiasis ascariasis feces associated with trichomoniasis reduces the likelihood that infected cats will be acceptable indoor pets.
giardia elisa positive after treatment At this time there is no evidence that this organism is zoonotic, but it is certainly infectious to other cats, and appropriate infection prevention measures should be instituted.
Cryptosporidiosis Cryptosporidium parvum is a coccidian parasite that infects the microvilli of kerek férgek a bőr alatt intestinal epithelium of kittens and immunosuppressed cats. The disease caused by this infection can range from an asymptomatic carrier state; to mild, transient illness; to prolonged, life-threatening malabsorption syndromes.
In some adult cats, the organism can cause intestinal infiltrates similar to those observed with classic IBD, and because the organisms are very small, unless special stains are used, may be not diagnosed.
Because, like many coccidians, the organisms are shed intermittently further complicates the diagnosis because infected cats may have a negative IFA.
Because cryptosporidiosis is zoonotic, appropriate precautions, such as wearing gloves and cleaning any utensils with disinfectants bleachmust be used when infected feces are handled. Treatment of kittens and catsinfected with cryptosporidiosis is very difficult, as the drugs purported to be effective against this organism are either toxic or ineffective in cats e. Tylosin, metronidazole, and other commonly used antimicrobials are ineffective in eradicating the organism. They may improve diarrhea if a bacterial component is active, but are unhelpful in most cases.
Other Infectious Causes of Diarrhea in Kittens Viral causes Other causes of diarrhea that should be considered in kittens include several viral diseases: feline giardia elisa positive after treatment virus, hemorrhagic calicivirus, rotavirus, astrovirus, enteric coronaviruses, and feline infectious peritonitis.
Feline panleukopenia is the most clinically important intestinal virus of this group and affects primarily unvaccinated kittens, causing fever, depression, anorexia, vomiting, and diarrhea. Diagnosis is usually based on szabad élő paraziták clinical signs and history, but the canine giardia elisa positive after treatment antigen test cross-reacts with the feline virus and thus can be used for confirmation.
In adult cats, hemorrhagic calicivirus, FeLV, FIV and feline infectious peritonitis virus are the most important viral causes of enteritis and giardia elisa positive after treatment. Treatment of this and any viral giardia elisa positive after treatment in kittens is symptomatic and supportive.
Because young kittens giardia elisa positive after treatment prone to dehydration and hypoglycemia, fluid therapy and nutritional support are key aspects. The definitive diagnosis of bacterial infections as the cause of diarrhea in kittens or cats is very difficult, primarily because pathogens can be isolated in similar rates from both diarrhea and nondiarrheic feces. Furthermore, many anaerobic bacteria cannot be easily cultured from feces or intraluminal ingesta due to their lability in air, thus, accurate identification of many of these species will likely require very advanced techniques or molecular identification methods.
Fungal causes Other infectious causes of diarrhea include fungal diseases, such as Histoplasma; however, these infections are more likely to occur in adult cats. Parasitic causes Most of the parasitic giardia elisa positive after treatment of diarrhea in kittens are typical e.
However, therapeutic deworming should still be done in kittens that have diarrhea, even if the results of fecal testing is negative. Anatomical and Mechanical Causes The curious, investigative nature of kittens makes them prone to ingesting foreign substances that may cause diarrhea or vomiting. In most cases, obstructions or intussusception cause vomiting, but the more distal the problem in the gastrointestinal tract, the more likely diarrhea may be the primary clinical sign.
Mechanical or anatomic causes of diarrhea to be considered in kittens include developmental abnormalities e. In general, diagnosis of these conditions requires radiographs or other imaging techniques, but ingestion of string can occasionally be diagnosed by finding the string trapped at the base of the tongue or by palpation of the resulting intussusception.
Most of these problems require surgery for resolution, and except in the case of developmental abnormalities, often have a good to excellent prognosis. Nutritional Causes of Diarrhea in Kittens The use of diet to assist in diarrhea management is not a new concept.
Nevertheless, the type of diet used to help manage the problem has become an increasingly complex issue. In many if not most simple cases of diarrhea especially in kittensthe best approach is to feed a highly digestible diet moderate to low fat, moderate protein, moderate carbohydrate that has fewer food colors, preservatives, flavorings, or other substances than may be associated with food intolerance e.
Some of these highly digestible diets may contain additives designed to improve intestinal health such as soluble fibers, omega-3 fatty acids, prebiotics, and increased antioxidants.
Thus, when one diet from this category not accepted by the kitten, is ineffective or seems to make the diarrhea worse, you cannot assume that all diets in this category will be ineffective.
If a highly digestible diet has been fed for at least 2 weeks with minimal response, then is it reasonable to try another diet or an entirely different dietary strategy e. Another consideration in kittens is that the diarrhea may be due to carbohydrate intolerance or bacterial changes resulting from dietary changes i. Thus, in kittens with carbohydrate intolerance, feeding a canned food diet, which contains fewer carbohydrates, may resolve the diarrhea.
Alternatively, adding probiotics to the diet may help increase the normal microflora, and is also a reasonable therapeutic option. Inflammatory or Immune-Mediated Causes Inflammatory Bowel Disease Inflammatory bowel disease IBD is a commonly diagnosed chronic intestinal disorder of adult cats, but it is a condition that frequently represents multiple diseases. IBD is characterized by persistent clinical signs vomiting, diarrhea, or weight loss consistent with gastrointestinal disease that occurs concurrently with histologic evidence of mucosal inflammation.
These differentials should be investigated thoroughly and appropriate empirical therapy should be instituted before a diagnosis of idiopathic IBD can be made.
Food sensitivity can be particularly difficult to distinguish from IBD or other intestinal disorders. Thus, appropriate food trials are very important in both diagnosis and therapy of cats with gastrointestinal disease or suspected IBD.
Serum cobalamin levels in cats commonly decrease with severe small bowel disease, and in cats with hypocobalaminemia, the diarrhea will not resolve until replacement therapy is instituted.
Cobalamin therapy µg IM weekly for 4 weeks, then monthly prn in some cats may be lifelong, while in others, supplementation can be discontinued once the clinical disease resolves.
Radiographs and ultrasonography are important to evaluate for the presence of such infiltrative diseases as FIP granulomas, histoplasmosis, or lymphosarcoma.
Ultimately, intestinal biopsies, either obtained endoscopically or during laparotomy—are essential both for the diagnosis of IBD and for ruling out other specific causes of the clinical signs. In humans, recent studies indicate a strong association between IBD and a breakdown of normal tolerance mechanisms, host susceptibility, and enteric microflora.
It is quite likely that these same giardia elisa positive after treatment are important in feline IBD, and in studies using experimental models of IBD, the resident microflora are essential cofactors in driving the inflammatory response. Further, modulation of the enteric microenvironment using probiotic therapy and targeted antimicrobial therapy in humans with IBD has been shown to reduce pathogenic bacteria and reduce proinflammatory cytokines, thereby decreasing the inflammation and resulting in better disease control.
Unfortunately, accurate, readily accessible methods of assessing bacterial numbers and the species populating the small intestine are not yet available in clinical cases. In addition, studies in cats with IBD assessing modulation of the enteric flora using probiotics, prebiotics, or other specific therapy for cytokines are only in the early stages of study.
At this time, therapy of Giardia elisa positive after treatment in cats continues to include inflammatory suppression and antibiotic therapy. In cats that are intolerant of steroids e. The two drugs that most commonly recommended in this setting are cyclosporine and chlorambucil, with chlorambucil having the fewest reported side effects or monitoring requirements.
Traditional nonsteroidal antiinflammatory therapy is not beneficial in intestinal IBD; however, in colonic IBD, sulfasalazine or mesalamine may be considered, as microflora locally act on these drugs, releasing their antiinflammatory effects.
These drugs have not been studied for efficacy or safety in cats. There is also a widely held belief that both metronidazole and tylosin are effective, not only because of their antibacterial properties, but also because of concurrent immune modulation properties.
There are some data to support this theory with metronidazole; however, the specific role of both metronidazole and tylosin in therapy of IBD is still not completely known. A note of caution is needed here, as current evidence giardia elisa positive after treatment a study that is not yet published, suggests that chronic or high dose metronidazole therapy in cats may be potentially deleterious to the GI mucosa, due to the DNA damaging effects of this nitroimidazole drug.
Thus, it is been recently suggested by those investigating these adverse effects of metronidazole that therapy should not continue giardia féreg weeks at a time. Gastroenterologists generally agree that elimination diets or novel protein, highly digestible diets are beneficial in cats with IBD.
Nevertheless, they also agree that dietary management alone is seldom successful, making control of the aberrant inflammatory process and bacterial components still necessary.
Further, at this point in our understanding, we still do not know which components of the diet e. Current data in human IBD patients show the use of probiotics and antioxidant, prebiotic nutraceuticals may be important components of therapy as they allow significant reductions in the anti-inflammatory and immunosuppressive drugs used in disease management.
Further evaluation of probiotic therapy in cats is needed before these products can be universally recommended for therapy of the disease in cats; however, giardia elisa positive after treatment is certainly an area of intense interest. Food Reactions Sensitivity and intolerance are the most common adverse reactions to food in cats. Food sensitivity or allergy is an adverse reaction to a food or food additive with a proven immunologic basis.
Food intolerance is a nonimmunologic, abnormal physiologic response to a food or food additive. Both can cause diarrhea or vomiting, but vomiting is reportedly a more common presenting sign. Food poisoning, food idiosyncrasy, and pharmacologic reactions to foods also come under this category of adverse reactions to food. Különféle férgek szalagféreg specific food allergens that cause problems in cats are poorly documented—only 10 studies describe the clinical lesions associated with adverse food giardia elisa positive after treatment.
The incidence of food allergy versus food intolerance in cats is unknown. However, intolerance to carbohydrates, specifically disaccharides, is a recognized cause of diarrhea in cats due to their low-levels of intestinal disaccharidase activity or loss of activity in enteritis.
Both food sensitivity and intolerance are diagnosed on the basis of a dietary elimination trial. The major difference between these two types of adverse food reactions is the length of time on the diet that is required to achieve férgek nyulak kezelésében response cats with food sensitivity require 6 to 12 weeks on the elimination diet before an improvement will zallatorvos fereg seen.
Alternatively, in cats with food intolerance, resolution of signs usually occurs within days of the dietary change unless there is concurrent bacterial floral disruption or other factors influencing the response. There are a variety of commercially available and homemade elimination giardia elisa positive after treatment, as well as diets formulated with hydrolyzed proteins, that may be used in cats with suspected food sensitivity or intolerance. The key is to select a diet that has a novel or hydrolyzed protein source based on a careful giardia elisa positive after treatment history and is balanced and nutritionally complete giardia elisa positive after treatment diets are best for this.
However, homemade elimination diets may be needed to find a truly novel protein for an appropriate test diet. If a homemade diet must be used for long-term therapy, a complete and balanced diet containing the necessary protein sources should be formulated by a nutritionist. In most cats with food sensitivity, avoiding the offending food is the most effective therapy and will result in complete resolution of signs.
However, short-term steroid therapy can be used to decrease concurrent intestinal inflammation until the appropriate protein source can be identified. Finally, some kittens and cats with diarrhea will respond to a high-protein, low-carbohydrate diet canned growth or diabetic formula foods. Why kittens or cats respond to such diets is not completely known but may be related to the reduction in carbohydrate or due to the highly digestible, protein based nature of these foods.
While the incidence of carbohydrate intolerance remains to be determined in cats and kittens, there is increasing giardia elisa positive after treatment evidence that in kittens and adult cats with idiopathic diarrhea, feeding a canned diet with high-protein, and low-carbohydrate content is frequently beneficial. Obviously, many cases of diarrhea in kittens or cats will not resolve by use of dietary manipulation alone, but it is clear that dietary therapy is important and should be carefully considered, implemented, and adjusted to meet the needs of the pet and its situation.
Neoplasia The most common intestinal neoplasia in cats is lymphosarcoma, followed by adenocarcinoma and then intestinal mastocytosis. Adenocarcinoma and mast cell tumors tend to occur in the distal small intestine or colon, but lymphoma can occur in any region of the gastrointestinal tract.
Intestinal neoplasia can be associated with a variety of clinical presentations, the most common of which are anorexia and weight loss. With lymphoma, diarrhea is more common with intestinal disease, while gastric lymphoma or lymphoma causing masses more often are associated with anorexia or vomiting.
Alimentary lymphoma is a complex disease in cats, and although most lymphomas are believed to be caused by clonal expansion of B cells, this disorder has a variety of presentations that make diagnosis and treatment difficult. There are several types of lymphoma described in cats including small-cell lymphoma, lymphoblastic lymphoma, T-cell lymphoma, and mixed-cell tumors. The most common variant, small-cell lymphoma, is the most difficult to diagnose because it cannot be reliably distinguished from IBD using histopathologic analysis alone.