Advice re feline uveitis

[Keit]

We started to research the eye drops, the metacam, and the eye dye he was given again this time. It turns out that in the US, the FDA does not approve the repeated use of metacam in cats. Oral suspension has not been shown to be safe under any circumstances, and the injection is only to ever be given once before operations. The drug has been shown to cause renal failure and death in cats.

Several things come to mind. It's strange what you say about meloxicam, because it would usually cause a different type of side effects. Have you asked the vet about it?

Low doses of meloxicam can be safely used in cats for longer times. But my personal choice is Onsior (robenacoxib). Based on the research, it has the least side effects in cats. But unfortunately there are no NSAIDs with zero side effects, so do your reaearch anyway.

Also perhaps worth asking if they used atropine drops, since atropine causes mydriasis and could be part of uveitis treatment. This would explain the dilated pupils.

And I would also ask if they ever measured your kittie's blood pressure. Because unfortunately chronic high blood pressure can lead to progressing blindness. And one of the symptoms is mydriasis (and/or uveitis).

Also, here's a comprehensive information about uveitis. Unless you already found this page:Managing Uveitis in Dogs and Cats

 

[T.C.]

Several things come to mind. It's strange what you say about meloxicam, because it would usually cause a different type of side effects. Have you asked the vet about it?

It’s a tricky one really, because the only thing we know for sure about his blindness is that it has happened after a meloxicam injection and eye treatments administered by the vets. We don’t know exactly what caused it.

We told the vets what happened and that since they had already mentioned trying oral steroids to treat the pain, inflammation and high temperature the last time we went, that we will switch to that tomorrow, having read about the side-effects of meloxicam, the FDA warning, and the side effects of the eye drops.

We’ll see how he gets on with the oral steroids, and I will ask about the atropine drops. If the steroids don’t agree with him, and we have to try something else, I’ll ask them about Onsior.

Thanks again for your input!

 

[Keit]

It’s a tricky one really, because the only thing we know for sure about his blindness is that it has happened after a meloxicam injection and eye treatments administered by the vets. We don’t know exactly what caused it.

I totally understand how upsetting it can be. To my knowledge, these two drugs are not supposed to lead to such a problem. At the same time uveitis is often the reason for blindness in cats.

Here's an article that provides a good explanation of the possible causes. Perhaps it is something additional to look into:

Sudden Blindness

Suggested Articles Feline Vision Problems: A Host of Possible Causes Corneal Ulcers Cataracts Glaucoma Conjunctivitis White cats and blindness/deafness The Special Needs of the Senior Cat Hypertension

www.vet.cornell.edu

 

[T.C.]

On Sunday afternoon, the day I wrote my last post where Del had regained his vision, he went outside for a few hours, and when he came back, his vision had worsened again and his pupils were dilated. Another confusing thing for us. Now, we questioned just how much the visits to the vets, and what was administered there, had caused the sudden blindness.

We took him back to the vet yesterday morning, having not given him any metacam or pred eye drops since Friday, because we were thinking we would change onto oral steroids instead. The vet said she was a bit surprised that he seemed so pain-free, having not had anything for pain relief. We talked about the blindness, discussed the various risks associated with the different treatments. I shared my concerns about metacam, the FDA warning, and the potential side-effects of the pred eye drops.

The vet said the same thing as you, @Keit. That in her opinion, even though there are risks with any treatment, low doses of metacam in cats is relatively safe, and that she gives it to her own cats. Also, during the consultation, it did occur to me and my wife that the two occasions when he was really sick and we took him to the vets, and he came home blind... well, before we took him in, he basically hadn't moved for two days, and so if he had lost his eyesight, we wouldn't really have been able to tell. When he's at his worse, lethargic and not eating, he's not roaming around the house, and also, he keeps his eyelids half-closed. What we can say for sure in those times is that his eyes are very cloudy.

The vet explained, if I understand this correctly, that the cloudiness is antibodies produced by his immune system. And that the dilation of the pupils may just be his eyes trying to get more light, due to the fact that he can't see anything.

We talked more about toxo itself. The vet said that most of the times where she's diagnosed and treated it, it's actually been in dogs. This is due to the fact that dogs are not the main, end-host the toxo is designed for, and when it gets into them, it causes them a lot more symptomatic issues. She said it usually doesn't cause serious symptomatic issues in cats because biologically speaking, the toxo would want the host to be as well as possible so that it can carry on it's own life cycle. The vet was sharing this with us because the subject of treament plans and what is the long-term prognosis is something that she is inexperienced with and that she is also learning more as we go. I thought it showed strength on her part that rather than try to appear to be all-knowing, or reassure us without foundation, she admitted that she hadn't had much experience with the condition in cats.

Based on your feedback, Keit, and the discussion we had with the vet, we've decided to keep him on the metacam, and switched the eyedrops from the prednisolone to Acular, an NSAID. We're going to give the metacam once every two days, preventatively, and use the Acular when required. His vision seems pretty good yesterday and today. The cloudiness in his eyes is mostly gone again.

The vet is going to contact the lab to ask about what we need to do when he's finished the clindamycin, whether we should test for the toxo again. She says he may never get it out of his system, and has been forward enough with us in the last two consultations to bring up the subject of "quality of life"; as in, if he has the toxo forever, and his immune system continues to react to it forever, then that's going to be horrible for him. I asked about whether the idea of long-term immunosuppression is a viable treatment option, and she said obviously that would be something we could try with the oral steroids, but that in itself obviously comes with it's own potential problems.

 

[T.C.]

I’m looking for information regarding toxo and iodine. I found a study showing a correlation between prevalence of toxoplasmosis in a small sample of humans, and iodine deficiency. So then I searched for evidence that iodine kills toxo, and found this paper where it’s stated:

A review on inactivation methods of Toxoplasma gondii in foods

Toxoplasmosis is an infection caused by Toxoplasma gondii, a widespread zoonotic protozoan which poses a great threat to human health and economic well-being worldwide. It is usually acquired by ingestion of water contaminated with oocysts from the feces ...

www.ncbi.nlm.nih.gov

“Frenkel et al. found that a strong concentration of ammonia (28%) killed all oocysts of T. gondii within 10 min and a strong tincture of iodine did so within 30 min.”

Iodine eye drops are used to prevent infection before operations, so I’m wondering if we finish the clindamycin and he still tests positive for toxo, whether it would be worth a shot. Apparently povidone iodine 5% is what’s usually used in the eyes. But how long it could be used for would be the main issue. Further research shows that long term use of povidone iodine drops is mainly contraindicated in patients receiving regular intravitreal injections.

I’m struggling to find out exactly where the toxo would be located in the eye, and whether the iodine would actually reach it, since povidone iodine drops mostly run out of the eye and are only used to disinfect the surface.

Well, if it comes to a decision of either putting him to sleep, or trying iodine eye drops first, it’s a no-brainier, anyway.

 

[T.C.]

Del’s now finished his course of antibiotics. For the first four days after my last post, we gave the metacam once every two days preventatively, but he was obviously still in pain, so we just went the whole hog and gave it him every day, and he responded really well.

For about a week, he had good days and bad days, mainly his eyes getting cloudy or bloodshot, and then clearing, but by the second week, his natural personality began to return, and for the last week, he’s really come back to himself - playing, exploring, being affectionate, and having a massively improved appetite. I’d say since the last post, he’s probably gained at least 40 grams in weight, going from 3.6kg, back up to his usual 4kg.

He finished the antibiotic and the metacam last Thursday, and seems fine now. We’d like to know whether the toxo is gone, or just deactivated. So we’ll be contacting the vets this week to see about having him retested.

Thanks again for everyone’s input and kind messages.

 

[karo]

@T.C. I'm so glad I found this thread and I would like to ask how is Del doing 3 years later?

I found myself in exactly the same position right now as you in the past, hence I'm asking.

My cat Hugo had symptoms of conjunctivitis on the 20th of June, and the next day we went to the Vet. He got his eye checked and received some meds, eye drops. Hyphaema formed on his left eye which Vet said is good, but will take some time to get rid off.

Ehh, this story is so long, but on the way he also lost his appetite and also his eyes got cloudy at some point. He seemed to be better and back to his normal self after receiving some anti-inflammatory meds, which he received about every 48h hours in the clinic, because he seemed okay and then symptoms came back so I was driving back and forth trying to solve the mistery with the Vets.
We did huge blood panel (renal, pancreatic, thyroid etc.) and also FiV/FeLV tests, which both came negative. At some point during this month that passed I suspected he had eaten some peace lily leaf, but last week we decided to do a test for toxo and it came positive with high IgM antibodies positive, which stands for early stages of toxo infection.

The worst part about it is that I gave him some raw meat with toxo it appears. He doesn't go outside so he couldn't eat an infected mice. I always pour boiled water on the raw meat before I serve, and did that this time as well, but in order to get rid of toxo, meat has to be cooked. Lesson learned in the worst way possible.

His eyes get BIG sometimes, but not all the time, it happens sometimes and then it subside. But they're slightly clouded. And when his eyes get big, he seems to loose his coordination :(

We are during the first week of Clyndamycine treatment, and from what I've read the eye-Toxo doesn't have a good reputation because it's neurological form of toxo. Most cats when in early infection stages have diarrhea, high temps, loss of appetite and weight. He didn't had diarrhea, quite the contrary, he is doing his second business once in two days.

Hugo is a stray, I found him in the woods next to my house last year. I tried to found his owners, with no success so I kept him, as I said I only ever take a pet when I found it, I am in no position of taking care of an animal, money wise.
It is said in the articles and papers that most of the cats are positive for toxo, also that symptoms appear in the young cats OR in the cats with compromised immunity. I just wonder, if FIV and FeLV test are negative, then why it happened to him.

I'm happy he is taking Clyndamycine every 12 hours soaked in Fish Oil not too badly, today is 5th day, 23 still before us. I also give him probiotics daily and anti hair ball paste for bowel movement. I'm keeping my fingers crossed for Hugo, and I would love to read how your Del's story went from then on, if you would be so kind to share it. Also, did you try Iodine at any point? I don't have Lugols drops, only Iodine 3% spirit solution, but I'm going to read the articles provided in this thread.
Also if I'm not mistaken, you have more than one cat? If yes, how was the other one, didn't catch the bug from Del?

 

[T.C.]

Hi, karo. I’m really sorry to hear you are going through this at the moment. But try to stay positive and use our example to keep your spirits up, because ever since Del completed his treatment he has had no recurrence of symptoms and is a healthy boy.

Also, don’t be too hard on yourself. From what we learned when Del was sick, it’s possible that Hugo always had toxo since you got him, and it’s just for one reason or another that it migrated inside him, or was dormant and became active. Maybe his immune system was low or he was stressed.

The main advice I can give you at this stage is to have patience now that the treatment has started. It was worrying and frustrating for us that it took a couple of weeks before we saw any improvement in Del because we just didn’t know if it was working or not. So give it time.

We did have another cat at that time, and we have another different cat now also. Since toxo is so perfectly designed to live in cats, it doesn’t normally cause symptoms. It’s only when it ends up somewhere in their body that it wouldn’t normally that they become symptomatic. So we don’t know whether either of our other cats had/have it. We’d have to have got them tested.

Please keep us informed of Hugo’s status. Best wishes to you

 

[karo]

Thank you so much for replying, SURE it is your answer gave me so much hope right now! And also lots of joy knowing that Del is all right after all!

From what I've read about toxo, when symptoms appear and blood tests are done to figure out if it is toxo at all, there are two antibodies to look to - IgG stands for systemic toxo which is dormant but present, and if I remember correctly I saw one case when IgG were very high like 2Ksomething and after the course of antibiotics went down to 200 and some. IgM stands for fresh phase of infection and also at this time cat can expel oocysts with feces (which are 'active' after 24 hours after expelling the poop, so if this is cleaned and throw right away then you good, and not at risk of infection! It is very hard to actually get Toxo from cats, it is WAY easier to get it from unwashed veggies or uncooked meat!!, because one would need to basically eat the poop, and also oocysts are expelled only for some time).

Ai google overwiev of IgG and IgM antibodies in Feline Toxo:

In feline toxoplasmosis, both IgG and IgM antibodies are measured to help diagnose the infection, but they indicate different stages of the disease. High levels of IgG antibodies suggest a past infection and immunity, while high IgM levels indicate a recent or active infection.

IgM Antibodies:

• Appearance: IgM antibodies appear sooner after infection than IgG antibodies.
• Significance: Increased IgM titers are consistent with a recent Toxoplasma infection.
• Persistence: IgM antibodies generally do not persist past 3 months after infection.
• Diagnostic Value: IgM antibodies have a higher positive predictive value than IgG for clinical toxoplasmosis.
• Note: Persistent IgM titers (>4 months) have been documented in cats with FIV coinfection or ocular toxoplasmosis.

_________

For now I'm patient as we are only 5 days into the treatment. Hugo sleeps a lot, but has his appetite back, which is good.
Today I was his bed for almost 2 hours, actually first time since he started living with me
His eyes got big again just like half an hour ago, but he went to sleep again.

This Toxoplasmosis business in cats is difficult to understand even for Vets. I've read plenty about it and can't understand the mechanism of it. It is easier to comprehend what toxo does with mices and rats, as scientist are infecting lab mice and rats with toxo which glows, so they can see where it locates itself in the brain. They can't figure out how toxo does what it does, which is turning on attraction on feline urine, well it is so mysterious. I only understood, it is easy to comprehend, that it is dangerous for young kittens and for cats with compromised immune system. But why it attacks nervous system of its host causing neurological problems?

I hope antibiotics will help us as well, and that Hugo will regain his life and will be playful again.

I'm on my way to check his iron levels and look for anemia, because he started licking concrete on the balcony. Some Reddit posts I've read tell the story of leukemia (Hugo tested negative), anemia and iron deficiency, renal failure (we did renal panel and came OK) and other pointed to cats just being cats, but I want to rule out all the options.

Thank you for reading and answering once again and cuddles to your furry friends, I wish them and you the best keep away from raw meat! Just in case :)

 

[T.C.]

Thanks for the extra info, karo. I didn’t know they could check between recent and long-term infections.

 

[T.C.]

@karo How is Hugo doing?