![\"Figure](\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2012\/07\/Figure-2_eyes-300x247.jpg\")
<\/a>Figure 2. Bilateral, serosanguineous ocular discharge, blepharospasm, and nasal discharge in a 4-year-old, neutered male cat with recrudescence of FHV-1 and associated superficial ulceration and keratoconjunctivitis in both eyes.<\/p><\/div>\n
Prevention<\/em><\/p>\n\n- It is important to note that vaccines are not necessarily protective\u2014they are designed to decrease severity of clinical signs (especially with FCV, due to its great antigenic diversity).6<\/sup><\/li>\n
- URT viruses are generally transmitted cat to cat via URT secretions and aerosol transmission over short distances; however, environmental contamination can occur, especially in multicat situations.<\/li>\n<\/ul>\n
\n- FHV is susceptible to common disinfectants, antiseptics, and detergents.<\/li>\n
- FCV, however, can persist in the environment for about a month and is resistant to many common disinfectants; bleach is the preferred agent for killing the virus.<\/li>\n<\/ol>\n
\n- Cats with URT signs should be isolated during their hospital stay in an area with adequate ventilation. Strict hygiene practices should be followed, including bleaching of cages and other items in contact with infected cats.<\/li>\n<\/ul>\n
H1N1 Influenza Virus<\/h3>\n
H1N1 influenza virus (swine flu) has been identified in cats, receiving some interest given its significance in human medicine.<\/p>\n
Naturally occurring H1N1 infection was first documented in cats in 2009 and was associated with the human pandemic.7-9<\/sup>\u00a0Cats most likely acquired the virus from their human household companions.10<\/sup>\u00a0Thus, the virus is essentially absent from surveyed feral cat populations.11<\/sup><\/p>\nH1N1 infection appears to occasionally result in signs of acute upper and lower respiratory tract disease in cats. Mortality is attributable to severe pneumonia.<\/p>\n
Bacterial Infection<\/h3>\n
Other primary URT pathogens include:1,3,12<\/sup><\/p>\n\n- Chlamydia psittaci<\/i><\/li>\n
- Mycoplasma felis<\/i><\/li>\n
- M gatae<\/i><\/li>\n
- Bordetella bronchiseptica<\/i>.<\/li>\n<\/ul>\n
Although these can be primary bacterial pathogens, they are more commonly secondary to and concurrent with viral infection. Notably, viral agents damage the respiratory epithelium, especially in young cats, making the cat more susceptible to opportunistic pathogens, such as staphylococci, streptococci, pasteurellae, and coliforms.<\/p>\n
Fungal Infection<\/h3>\n
Fungal infections (eg, nasal cryptococcosis) can also occur.<\/p>\n
OTHER CAUSES<\/h2>\nNasopharyngeal Polyps<\/h3>\n
Nasopharyngeal polyps can cause chronic URT signs.<\/p>\n
\n- These polyps originate in the Eustachian tube or middle ear and are a source of upper airway obstruction.13<\/sup><\/li>\n
- While nasopharyngeal polyps are inflammatory in nature, their exact etiology is not known.<\/li>\n
- Polyps are generally found in young cats.14<\/sup>They are a rare cause of URT signs in older cats; in this age group, neoplastic processes predominate.15<\/sup><\/li>\n<\/ul>\n
Nasal\/Nasopharyngeal Tumors<\/h3>\n
Nasal tumors are a less common cause of URT signs, although require consideration, especially in older cats. As with laryngeal tumors (see\u00a0Laryngeal Disease<\/b>), lymphoma, squamous cell carcinoma, and adenocarcinoma should be considered. With the exception of lymphoma, these tumors tend to\u00a0be locally invasive without distant metastases.16<\/sup><\/p>\nNasal Foreign Bodies<\/h3>\n
Although less common in cats than dogs, cats may suffer from nasal foreign bodies, the majority of which are plant material lodged above the soft palate.16<\/sup><\/p>\nNasopharyngeal Stenosis<\/h3>\n
Fortunately, this is a rare condition. It can be congenital or acquired secondary to chronic infection or aspiration.<\/p>\n
Laryngeal Disease<\/h3>\n
Laryngeal disease is rarely reported in cats, but all ages can be affected. Laryngeal disease may be inflammatory, neoplastic (benign or malignant), associated with trauma, or idiopathic.<\/p>\n
\n- Inflammatory laryngeal diseases are a heterogenous group of conditions, including diffuse neutrophilic or lymphoplasmacytic inflammation and inflammatory polyps.17<\/sup>The etiology of laryngeal inflammation in cats is not known.<\/li>\n
- A variety of laryngeal neoplasms have been reported in cats. Feline immunodeficiency virus (FIV) positive cats are overrepresented.<\/li>\n
- Lymphoma and squamous cell carcinoma are most common, but adenocarcinoma and round cell tumor are also found.18,19<\/sup><\/li>\n
- A definitive diagnosis is vital to guide treatment as chemoresponsiveness varies.<\/li>\n
- \u00a0There are a few reports of laryngeal paralysis in cats.20,21<\/sup>\u00a0A significant proportion are idiopathic, but paralysis can be secondary to neoplasia, iatrogenic (neck surgery, traumatic intubation), or laryngeal inflammation.<\/li>\n<\/ul>\n
Tooth Root Disease<\/h3>\n
While dental disease is commonly listed as a cause of URT signs in cats, it is uncommonly reported.22<\/sup>\u00a0Tooth root abscesses should be considered a differential diagnosis for cats with URT signs, particularly unilateral discharge with other evidence of dental disease.<\/p>\nCLINICAL SIGNS<\/h2>\n
Clinical signs are somewhat similar for all feline URT diseases; however, some signs are unique to specific pathogens and\/or anatomic locations of pathology (Table 1<\/b>). As mentioned previously, these diseases may result in acute onset of clinical signs or follow a more chronic course. Physical examination in cats with acute URT infections may be consistent with systemic illness.<\/p>\n\n\n\nTable 1. URT Disease Clinical Signs<\/strong><\/span><\/td>\n<\/tr>\n\n| Type of Sign<\/span><\/td>\n | Clinical Signs<\/span><\/td>\n<\/tr>\n\n| Local Signs<\/span><\/td>\n | \n \u2022\u00a0\u00a0Sneezing and nasal congestion (resulting in open-mouth breathing)<\/span><\/p>\n\u2022\u00a0\u00a0Ocular discharge (with potentially more severe ocular signs)<\/span><\/p>\n\u2022\u00a0\u00a0Nasal discharge (usually bilateral)Often serous discharge initially; secondary bacterial colonization of nasal passages can result in change to mucopurulent dischargeEncrustation of external nares and eyelids due to large discharge volume, dehydration, and poor grooming<\/span><\/p>\n\u2022\u00a0\u00a0Oral ulceration<\/span><\/p>\n\u2022\u00a0\u00a0Stertor or stridor<\/span><\/td>\n<\/tr>\n\n| Systemic Signs<\/span><\/td>\n | \n \u2022\u00a0\u00a0Fever\u2022\u00a0\u00a0Lethargy<\/span><\/p>\n\u2022\u00a0\u00a0Inappetence\/anorexia<\/span><\/td>\n<\/tr>\n\n| URTDisease<\/span><\/td>\n | Clinical Signs<\/span><\/td>\n<\/tr>\n\n| Feline Calicivirus<\/span><\/td>\n | \n \u2022\u00a0\u00a0Commonly associated with oral ulceration, which affects tongue, soft palate, and fauces<\/span><\/p>\n\u2022\u00a0\u00a0Ulcers contribute to ptyalism and oral pain (exacerbating inappetence)<\/span><\/td>\n<\/tr>\n\n| Feline Herpes Virus<\/span><\/td>\n | \n \u2022\u00a0\u00a0More severe URT clinical signs in general<\/span><\/p>\n\u2022\u00a0\u00a0Ocular signs become more marked and chronic, including:BlepharospasmBilateral conjunctivitisKeratitis (persistent or recurrent)<\/span><\/p>\nChemosis<\/span><\/p>\nSuperficial ulceration (dendritic ulcers, direct viral cytolysis of cornea)<\/span><\/td>\n<\/tr>\n\n| FungalRhinitis<\/span><\/td>\n | \n \u2022\u00a0\u00a0May result in facial deformity (eg, Roman nose), skin ulceration, and nasal discharge<\/span><\/p>\n\u2022\u00a0\u00a0Often have submandibular lymphadenopathy<\/span><\/td>\n<\/tr>\n\n| Laryngeal Disease<\/span><\/td>\n | \n \u2022\u00a0\u00a0Increased inspiratory effort (with variable distress) and stridor<\/span><\/p>\n\u2022\u00a0\u00a0May display dysphonia, coughing, gagging, and\/or retching<\/span><\/td>\n<\/tr>\n\n| Nasopharyn-geal Foreign Bodies<\/span><\/td>\n | \n \u2022\u00a0\u00a0Acute onset of sneezing and reverse sneezing<\/span><\/p>\n\u2022\u00a0\u00a0Gagging and swallowing<\/span><\/p>\n\u2022\u00a0\u00a0Both of the above result in distress<\/span><\/td>\n<\/tr>\n\n| Nasopharyn-geal Polyps<\/span><\/td>\n | \n \u2022\u00a0\u00a0Stertorous breathing<\/span><\/p>\n\u2022\u00a0\u00a0Otitis<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nDIAGNOSTICS<\/h2>\nFeline URT infection is usually a clinical diagnosis based on history and physical examination (ocular and nasal discharge, stertor, etc).<\/p>\n FOCUSED DIAGNOSTICS<\/h2>\nFIV\/FeLV Test<\/h3>\n\n- If the cat has not been recently tested and\/or risk factors exist, this test should be performed since URT diseases are associated with immunosuppression.<\/li>\n
- Laryngeal neoplasia is also common in FIV positive cats.<\/li>\n<\/ul>\n
CBC & Serum Biochemical Profile<\/h3>\n\n- These tests are not usually indicated in cats with acute URT signs in the absence of systemic illness.<\/li>\n
- However, they are recommended in cats that are systemically unwell or have chronic clinical signs.<\/li>\n<\/ul>\n
Polymerase Chain Reaction<\/h3>\n\n- Polymerase chain reaction (PCR) is the preferred method for virus detection in cats with URT signs; however, it is not standardized among laboratories (and, thus, sensitivity and specificity vary).<\/li>\n
- IDEXX (idexx.com) has a Feline Upper Respiratory Disease (URD) RealPCR Panel that tests for FHV, FCV,\u00a0Chlamydophila felis<\/i>,\u00a0M felis, B bronchiseptica<\/i>, and H1N1 influenza (requires a deep pharyngeal swab and conjunctival swab).<\/li>\n<\/ul>\n
Other Methods<\/h3>\nOther methods for virus and antigen detection include virus isolation and indirect immunofluorescence antibody assay; however, these are more time consuming and potentially less sensitive than PCR.5<\/sup><\/p>\nFURTHER DIAGNOSTICS<\/h2>\nDiagnostics for cats with chronic URT signs and\/or localizing signs should be more thorough given the broad range of differential diagnoses.1,15<\/sup><\/p>\nOral Examination under Anesthesia<\/h3>\n\n- Fully assesses extent of dental disease and its potential contribution to URT signs and the larynx<\/li>\n
- Indicated in cats that have evidence of dental abnormalities during awake oral examination and those with stridor or other clinical signs attributable to the larynx<\/li>\n<\/ul>\n
Upper Airway Imaging<\/h3>\n\n- Indicated in cats in which a space occupying lesion or bony lytic lesion is suspected<\/li>\n
- Cervical radiographs can be very useful for identifying laryngeal masses in cats with signs attributable to the larynx.<\/li>\n
- Ultrasound (ie, echolaryngography) identifies laryngeal masses and dysfunction.23<\/sup><\/li>\n
- Dental radiographs can identify and assess tooth root abscesses.<\/li>\n
- Computed tomography (CT) and\/or magnetic resonance imaging (MRI) is now used (where available) instead of traditional skull radiographs to assess nasal passages and bullae for potential masses, lytic lesions, or polyps. CT remains the preferred modality given its greater bony detail; MRI is preferable for assessing soft tissue.24<\/sup><\/li>\n<\/ul>\n
Note:\u00a0<\/strong><\/i>Imaging should always be performed prior to sampling procedures.<\/i><\/p>\nRhinoscopy & Nasal Flush<\/h3>\n\n- Used to assess nasopharyngeal masses, foreign bodies, and stenosis<\/li>\n
- Antegrade rhinoscopy is challenging in cats given the small diameter of the nasal passages but can be performed with narrow rigid scopes.<\/li>\n
- Retroflex rhinoscopy is more commonly performed to assess the nasopharynx. If a scope is not available, it can be visualized with a spay hook and dental mirror.<\/li>\n
- Nasal flushes can be used to obtain samples for cytology and bacterial or fungal culture. Tissue samples can be submitted for culture if obtained. While primary bacterial infection is a rare cause of chronic URT signs in cats, identification and treatment of secondary bacterial infection can ameliorate clinical signs, particularly in cats with chronic disease.<\/li>\n
- Biopsy is indicated in cases of space occupying disease in the nasal passages and can be done blind or guided with imaging. Biopsy or, more commonly, fine-needle aspiration is indicated in cats with structural laryngeal disease (notably laryngeal inflammation or mass) identified during laryngeal examination and imaging.<\/li>\n<\/ul>\n
Note:<\/strong><\/i>\u00a0Assessment of coagulation status should be done prior to biopsy procedures<\/i>.<\/p>\nOther<\/h3>\nA latex cryptococcal agglutination test can be performed when an index of suspicion for fungal rhinitis (eg, endemic areas, typical lesions) exists; however, the diagnosis is achieved immediately with cytology.<\/p>\n TREATMENT<\/h2>\nTreatment of feline URT disease (Table 2<\/b>) depends on the underlying cause, whether signs or disease is acute or chronic, and extent and severity of systemic illness.<\/p>\n Chronic URT disease can be frustrating to treat since there is commonly no cure unless a diagnosis (eg, tooth root absess) is reached.4<\/sup>\u00a0If no specific diagnosis is reached, chronic viral infection and\/or chronic idiopathic rhinosinusitis is often the default diagnosis.<\/p>\n\n\n\nTable\u00a02.\u00a0URT Disease Treatment<\/b><\/span><\/td>\n<\/tr>\n\n| Disease Type<\/span><\/td>\n | Treatment<\/span><\/td>\n<\/tr>\n\n| Acute Disease<\/span><\/td>\n | \n \u2022\u00a0\u00a0Intravenous fluid therapy for rehydration and maintenance is often indicated.<\/span><\/p>\n\u2022\u00a0\u00a0Provision of nutritional support is indicated since most affected cats are profoundly inappetent or anorexic.\u2022\u00a0\u00a0Antibiotics are warranted in many cases for secondary bacterial infection (Table 3).<\/span><\/p>\n\u2022\u00a0\u00a0The role of systemic antiviral agents is as yet undetermined. One recent report of chronic FHV infection suggested some benefit of oral famciclovir (see Evaluation of Orally Administered Famciclovir in Cats Experimentally Infected with Feline Herpesvirus Type-1, Journal Club, page 86).<\/span><\/p>\n\u2022\u00a0\u00a0Isolation<\/b>\u00a0is a very important part of management in the veterinary hospital, given the contagious nature of these diseases.5,6<\/sup><\/span><\/td>\n<\/tr>\n\n| Chronic Disease<\/span><\/td>\n | \n \u2022\u00a0\u00a0A nasal flush<\/b>, with or without antibiotics, is one method of long-term management.<\/span><\/p>\n\u2022\u00a0\u00a0Long-course, high-dose antibiotics<\/b>\u00a0(eg, clindamycin, 50\u201375 mg\/cat PO Q 12 H for 3\u20134 months) may be used to manage chronic \u201csnufflers.\u201d\u2022\u00a0\u00a0Oral prednisone<\/b>\u00a0may help in cases of lymphocytic\u2013plasmacytic inflammation.<\/span><\/p>\n\u2022\u00a0\u00a0Antihistamines<\/b>\u00a0are rarely effective, but can be tried as they are unlikely to be harmful.4<\/sup><\/span><\/p>\n\u2022\u00a0\u00a0Surgical removal of the turbinates<\/b>\u00a0has been described but is a highly invasive procedure and rarely indicated.<\/span><\/td>\n<\/tr>\n\n| Conditions<\/span><\/td>\n | Treatment<\/span><\/td>\n<\/tr>\n\n| FHV Corneal Lesions<\/span><\/td>\n | \u2022\u00a0\u00a0Topical antiviral agents<\/b>\u00a0(eg, trifluridine, idoxuridine, vidarabine) and parenteral L-lysine (200 mg PO Q 12\u201324 H) have been traditionally recommended; however, recent studies question lysine\u2019s efficacy.25-27<\/sup><\/span><\/td>\n<\/tr>\n\n| Nasopharyngeal Polyps<\/span><\/td>\n | \n \u2022\u00a0\u00a0Simple traction<\/b>\u00a0is considered first-line treatment, with an estimated success of \u2248 50%.<\/span><\/p>\n\u2022\u00a0\u00a0Ventral bulla osteotomy<\/b>\u00a0should be considered if clinical signs recur.14<\/sup><\/span><\/p>\n\u2022\u00a0\u00a0Horner\u2019s syndrome is very commonly seen after removal; it tends to be transient, but may be permanent.14<\/sup><\/span><\/td>\n<\/tr>\n\n| Nasopharyngeal Stenosis<\/span><\/td>\n | \n \u2022\u00a0\u00a0Balloon dilation<\/b>\u00a0and stent placement, although not curative, can be palliative.28-30<\/sup><\/span><\/p>\n\u2022\u00a0\u00a0Anti-inflammatory therapy<\/b>\u00a0has also been advocated to reduce associated inflammation.<\/span><\/td>\n<\/tr>\n\n | | | | | | | | | | | | | | | | | | | |
![\"Figure](\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2012\/07\/Figure-1.jpg\")
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