ABSTRACT OF THE WEEK

Journal of feline medicine and surgery
Volume 19 | Issue 11 (November 2017)

Pyrexia in cats: Retrospective analysis of signalment, clinical investigations, diagnosis and influence of prior treatment in 106 referred cases.

J Feline Med Surg. November 2017;19(11):1123-1130.

Sarah E Spencer¹, Toby Knowles², Ian K Ramsey³, Séverine Tasker⁴

¹ 1 School of Veterinary Sciences, University of Bristol, Langford, Bristol, UK.; ² 1 School of Veterinary Sciences, University of Bristol, Langford, Bristol, UK.; ³ 2 School of Veterinary Medicine, University of Glasgow, Bearsden Road, Glasgow, UK.; ⁴ 1 School of Veterinary Sciences, University of Bristol, Langford, Bristol, UK.

Abstract

OBJECTIVES:The main aim of the study was to describe the features and diagnoses of a population of cats referred with pyrexia. Other aims were to report and evaluate the utility of clinical investigations performed, and describe any effect of treatment before referral on temperature at presentation and ability to make a diagnosis.

METHODS:Clinical records of cats with pyrexia (⩾39.2°C) documented at least twice were retrospectively reviewed. Cases were assigned to disease categories (infectious, inflammatory, immune-mediated, neoplastic, miscellaneous and no diagnosis [pyrexia of unknown origin, PUO]) based on diagnosis. The overall value of clinical investigations was assessed by classifying them as 'enabling', 'assisting' or 'no assistance' in achieving each diagnosis. The effect of treatment before referral was assessed for any association with temperature at presentation and ability to make a diagnosis (PUO vs other disease categories).

RESULTS:One hundred and six cases were identified. The most common cause of pyrexia was feline infectious peritonitis (22 cats, 20.8%) and the largest disease category was infectious (41/106, 38.7%). Inflammatory conditions were found in 19 (17.9%) cats, neoplasia in 13 (12.3%), miscellaneous causes in 11 (10.4%) and immune-mediated disease in six (5.7%). No diagnosis was reached in 16 (15.0%) cats, often despite extensive diagnostic investigations. Cytology and histopathology most often 'enabled' or 'assisted' in obtaining a diagnosis. Most cats (91, 85.8%) received treatment before referral, with antimicrobial treatment given to 87 (82.1%). Prior treatment before referral was not associated with temperature at presentation nor with success in establishing a diagnosis.

CONCLUSIONS AND RELEVANCE:This is the first study investigating causes of pyrexia in cats. Infectious diseases were most common and immune-mediated diseases were comparatively rare.

Companion Notes

Retrospective report on the signalment, testing, diagnosis and influence of prior treatment in 106 referred cats with fever

Study design

- study population: cats seen at the Universities of Bristol and Glasgow

- 106 referred cats with fever (rectal temperature >39.2°C (102.56°F))

- cats had documented fever at least twice

- to help rule out cats with stress hyperthermia

- procedure: records retrospectively reviewed for fever etc from 01/11-06/15

- cases were assigned to 6 disease categories

- overall diagnostic utility of clinical investigations assessed

- they were classified as 'enabling', `assisting' or ‘no assistance'

(in obtaining each diagnosis)

- treatment before referral assessed for any association with the following:

- temperature at presentation

- ability to make a diagnosis (FUO vs other disease categories)

Results

- causes of fever included the following:

- infectious, 41 (38.7%) (median age: 2.5 years of age)

- feline infectious peritonitis, 20.8% (22 cats)

- cellulitis/otitis (media), 4

- pyothorax, 3

- pyelonephritis/UTI, 3

- lower airway inflammation with Mycoplasma felis, 2

- neutrophilic cholangiohepatitis, 2

- campylobacter enteritis, 2

- bronchopneumonia, 1

- brain empyema, 1

- hepatic abscess, 1

- inflammatory, 19 (17.9%) (median age: 5.0 years of age)

- pancreatitis, 5

- sterile peritonitis, 3

- sterile lymphadenitis/panniculitis/cellulitis, 3

- inflammatory lower airway disease, 3

- lymphocytic cholangiohepatitis, 2

- inflammatory CNS disease, 2

- myocarditis, 1

- neoplasia, 13 (12.3%) (median age: 8.0 years of age)

- lymphoma, 6

- pulmonary carcinoma, 3

- leukemia (not characterized), 2

- pulmonary metastases (primary neoplasm unidentified), 1

- gastrointestinal adenocarcinoma, 1

- immune-mediated, 6 (5.7%) (median age: 8.5 years of age)

- immune-mediated hemolytic anemia, 3

- immune-mediated polyarthritis, 3

- miscellaneous, 11 (10.4%) (median age: 3.0 years of age)

- intestinal obstruction (foreign body), 3

- bone marrow disorder (uncharacterized), 2

- ureterolithiasis/urolithiasis, 2

- intussusception, 1

- perirenal pseudocysts, 1

- trauma, 1

- hippocampal necrosis, 1

- fever of unknown origin, 16 (15.1%) (median age: 3.0 years of age)

- utility of investigations

- tests that enabled a diagnosis in over 14.0% of cases in which it was performed

- histopathology, 50% (enabled diagnosis in ½ the cases where it was done)

- assisted diagnosis in 26.9%

- cytology, 37.2%

- assisted diagnosis in 27.9%

- non-urine bacterial culture, 16.1%

- assisted diagnosis in 16.1%

- abdominal ultrasonography, 14.9%

- assisted diagnosis in 37.8%

- MRI, 14.3%

- assisted diagnosis in 85.7%

- CT/survey radiography of head, joints, 14.3%

- assisted diagnosis in 85.7%

- body cavity fluid analysis assisted diagnosis in 63.3% of cases

- treatment before referral, given to 85.8% of cats

- antimicrobial treatment, 82.1% (87 cats)

- amoxicillin-clavulanic acid, 35 cases

- not significantly associated with the following:

- temperature at presentation

- success in establishing a diagnosis

- history & signalment

- median age: 4 years of age with a range of 10 weeks to 15 years

- breeds representing 5.7% or more of the population

- ragdoll cat, 6.6%

- Bengal, 5.7%

- British shorthair, 5.7%

- clinical signs

- fever reported present for a median of 4 days before presentation

- with a range of 1-168 days

- 76.4% were pyrexic at referral

- CBC and biochemistry

- abnormal neutrophil parameters, 50 cases

- neutrophilia graded as follows

- mild when count was 12 to <20 x 10⁹/l, 13 cases

- moderate at 20 to <30 x 10⁹/l, 14 cases

- severe at ≥ 30 x 10⁹/l, 9 cases

- neutropenia = <4 x 10⁹/l, 7 cases

- anemia, 39 cases

- anemia graded as follows

- mild when PCV was 20 to ≤ 24%, 18 cases

- moderate at 15 to <20%, 17 cases

- severe at <15%, 4 cases

- increased alanine transaminase, 49 cases

- mild at <2 times upper inference interval (RI), 37 cases

- moderate at ≥ 2 to 3 times upper RI, 9

- severe at >3 times upper RI, 2

- hypoalbuminemia, 32 cases

- mild at 20 to <24 g/l, 14 cases

- moderate at 16 to <20 g/l, 14

- severe at <16 g/l, 4

- outcome

- survival to discharge, 67.0%

- owner elected euthanasia, 29.2%

- death during hospitalization, 3.8%

“The poor overall diagnostic value of routine serological and immunological tests is well recognised in human medicine and there is debate over the minimal serological tests indicated in PUO [pyrexia of unknown origin] patients, due to the low prevalence of implicated disease.”

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