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STREPTOCOCCAL INFECTIONS in CATS ABCD Guidelines on Prevention and Management

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STREPTOCOCCAL INFECTIONS in CATS ABCD Guidelines on Prevention and Management 620_625_Streptococcal infection.qxp_FAB 27/05/2015 15:50 Page 620 Journal of Feline Medicine and Surgery (2015) 17, 620–625 CLINICAL REVIEW STREPTOCOCCAL INFECTIONS IN CATS ABCD guidelines on prevention and management Tadeusz Frymus, Diane D Addie, Corine Boucraut-Baralon, Herman Egberink, Tim Gruffydd-Jones, Katrin Hartmann, Marian C Horzinek, Margaret J Hosie, Albert Lloret, Hans Lutz, Fulvio Marsilio, Maria Grazia Pennisi, Alan D Radford, Etienne Thiry, Uwe Truyen and Karin Möstl Overview: Streptococcus canis is most prevalent Introduction in cats, but recently S equi subsp zooepidemicus has been recognised as an emerging feline Although different streptococci have been isolated occasionally from pathogen. cats, including Streptococcus agalactiae, S pneumoniae and S suis, the most S canis infection: S canis is considered part prevalent species is S canis.1 S equi subspecies zooepidemicus has been of the commensal mucosal microflora of the oral recognised as an emerging pathogen in dogs, and also recently in cats.2,3 cavity, upper respiratory tract, genital organs and perianal region in cats. The prevalence of infection Streptococcus canis is higher in cats housed in groups; and, for example, there may be a high rate of vaginal S canis is a beta-haemolytic Lancefield group G gram-positive bacteri- carriage in young queens in breeding catteries. um that is considered part of the commensal mucosal microflora of the A wide spectrum of clinical disease is seen, oral cavity, upper respiratory tract, genital organs and perianal region encompassing neonatal septicaemia, upper in cats. S canis infection seems to be sporadic in single-cat households, respiratory tract disease, abscesses, pneumonia, especially in older cats.1 Young queens (up to 2 years of age) may carry osteomyelitis, polyarthritis, urogenital infections, S canis in the vagina, and the prevalence of infection is generally higher septicaemia, sinusitis and meningitis. in cats housed in groups. Up to 70–100% of young queens in breeding S equi subsp zooepidemicus infection: S equi catteries may carry this bac- subsp zooepidemicus is found in a wide range of terium in the vagina, result- species including cats. It was traditionally assumed ing in infection of the kittens, that this bacterium played no role in disease of cats, but also in the transfer of pas- but it is now considered a cause of respiratory sive immunity against S canis disease with bronchopneumonia and pneumonia, via colostrum. Various fac- as well as meningoencephalitis, often with a fatal tors, including the level of course. Close confinement of cats, such as in maternally derived antibod- shelters, appears to be a major risk factor. As ies, immune response, age, horses are common carriers of this bacterium, infection pressure, stress and contact with horses is a potential source of probably also the strain viru- infection. Additionally, the possibility of indirect lence, determine whether or transmission needs to be considered. not the bacteria cause disease. Diagnosis: Streptococci can be detected by Contamination of the conventional culture techniques from swabs, Figure 1 In adult cats, S canis infection is usually umbilical vein may lead to a bronchoalveolar lavage fluid or organ samples. opportunistic as a result of wounds, surgery, generalised infection result- immunosuppression or viral infection. In this 1 Also real-time PCR can be used, and is more shelter cat, viral infection was severely ing in neonatal septicaemia. sensitive than culture. complicated by secondary bacterial infection In 3- to 7-month-old kittens, due to poor hygienic conditions. Courtesy of Treatment: In suspected cases, treatment with Tadeusz Frymus, Faculty of Veterinary Medicine, a subclinical infection of the broad-spectrum antibiotics should be initiated as Warsaw University of Life Sciences, Poland pharynx and tonsils may soon as possible and, if appropriate, adapted to the results of culture and sensitivity tests. European Advisory Board on Cat Diseases www.abcdcatsvets.org www.abcd-vets.org Corresponding author: Tadeusz Frymus Email: [email protected] 620 JFMS CLINICAL PRACTICE Downloaded from jfm.sagepub.com at Universite de Liege on November 8, 2015 doI: 10.1177/1098612X15588454 © Published by SAGE on behalf of ISFM and AAFP 2015 620_625_Streptococcal infection.qxp_FAB 27/05/2015 15:50 Page 621 REVIEW / ABCD guidelines on streptococcal infections Figure 2 In some cats portation or other stressful situations.6 suffering from upper Believed to be part of the normal microflora of respiratory tract disease, S canis can be isolated from the upper respiratory airways and lower the nasal cavity. Courtesy of reproductive tract, this bacterium is frequent- Tadeusz Frymus, Faculty of Veterinary Medicine, Warsaw ly isolated from suppurative discharge in University of Life Sciences, horses including cases of mixed bacterial/ Poland viral infection of the upper airways.5,6 However, in contrast to S equi, S zooepidemicus strains are highly diverse and are not restrict- ed to causing disease in horses. These strains have been found in a wide range of other S zooepidemicus species including pigs, cattle, sheep, goats, was thought to poultry, dogs, cats, guinea pigs, seals, dol- phins, monkeys, llama and farmed red play no role deer.2,7–17 occasionally, glomerulonephritis, induce cervical lymphadenitis. In older cats, rheumatic fever, meningitis or purulent the infection is usually opportunistic, as a in diseases of arthritis caused by S zooepidemicus have been result of wounds, surgery, immunosuppres- cats until an reported in humans.18–20 Many of these sion or viral infection (Figure 1). In up to 10% zoonotic infections have resulted from contact of cats suffering from chronic upper respirato- outbreak was with horses or from the consumption of ry tract disease, S canis can be isolated from unpasteurised milk of cows or goats. the nasal cavity (Figure 2).4 Conditions associ- described in a There is increasing evidence that the veteri- ated with this pathogen include abscesses, shelter in Israel nary importance of S zooepidemicus may be pneumonia, discospondylitis, osteomyelitis, underestimated, and concern has been polyarthritis, urogenital infections, necrotis- in 2010. Cases expressed that this bacterium may be ‘poten- 21 ing fasciitis (toxic shock syndrome), sinusitis have since tially more than just an opportunist’. Several and meningitis. outbreaks of fatal disease in outbreaks in species other than horses have cats have been reported in shelters and breed- been described been described. In Asia, pandemics have ing colonies,4 as all of these conditions may occurred in pigs.14,22 Also in companion ani- result in septicaemia and embolic lesions, in the USA mals, the incidence of infections by this agent especially of the lung and heart.1 and Canada. has apparently increased. Since 2003, several Microscopic examination of exudates or outbreaks of an acute S zooepidemicus-related tissue reveals gram-positive cocci (usually in severe haemorrhagic canine pneumonia have chains), and culture can confirm the diagno- been described in many countries.23–27 This sis. S canis is generally sensitive to penicillins, disease is highly contagious and often fatal. and early antibiotic administration is the basis The most prominent signs reported were a of therapy. sudden-onset fever, dyspnoea, and haemor- More information can be found in a review rhagic nasal discharge. Haemorrhagic pneu- by Greene and Prescott.1 monia and pleural effusion were recognised post mortem. Most outbreaks occurred in shel- Streptococcus equi subsp ters, where S zooepidemicus infection caused zooepidemicus many deaths. Kennels and research facilities were also involved;28 in addition, individually Agent and host susceptibility housed dogs were occasionally affected.20,27 S equi subsp equi (commonly referred to as S Figure 3 Purulent nasal discharge and cough may be equi) and S equi subsp zooepidemicus (S zooepi- early signs of S equi subsp Feline S zooepidemicus-related disease demicus) are beta-haemolytic gram-positive zooepidemicus-related It was thought that S zooepidemicus played no disease in cats. Courtesy of Lancefield group C bacteria, and the most Tadeusz Frymus, Faculty of role in diseases of cats until an outbreak was important equine streptococci worldwide.5 Veterinary Medicine, Warsaw described in 2010 in a shelter in Israel.2 Early University of Life Sciences, S equi is an obligate agent causing strangles, Poland clinical signs included an effusive purulent the most frequently diagnosed nasal discharge and cough infectious disease of horses, and (Figure 3), progressing to sinusi- one which is both devastating tis, dyspnoea, pneumonia and and highly contagious. S equi is death. The vaccination status of host-restricted, infecting equids the shelter cats was unknown. almost exclusively. Between June 2006 and January S zooepidemicus is regarded as 2008, 78 dead cats from the shel- a mucosal commensal, most ter, which housed approximately notably in equids, with a poten- 700 animals, had been submitted tial to cause serious opportunis- for post-mortem examination. In tic disease secondary to viral 39 of these, the major necropsy infections, heat exposure, trans- findings were severe, acute and Downloaded from jfm.sagepub.com at Universite de Liege on November 8, 2015 JFMS CLINICAL PRACTICE 621 620_625_Streptococcal infection.qxp_FAB 27/05/2015 15:50 Page 622 REVIEW / ABCD guidelines on streptococcal infections Figure 4 In cats shelter was infected
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