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Chapter 4: Feline Leukemia and Feline Immunodeficiency Virus 2 CE Hours

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Chapter 4: Feline Leukemia and Feline Immunodeficiency Virus 2 CE Hours Chapter 4: Feline Leukemia and Feline Immunodeficiency Virus 2 CE Hours By: Catherine Barnette, DVM Learning objectives Compare and contrast the epidemiology of feline leukemia virus Describe strategies used to manage cats infected with feline and feline immunodeficiency virus. leukemia virus or feline immunodeficiency virus. Develop a rational testing strategy for feline leukemia virus and Educate veterinary clients on vaccination strategies for feline feline immunodeficiency virus. leukemia virus and feline immunodeficiency virus. Introduction Feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) contact between cats, whereas FIV is most frequently spread through are both retroviral infections of cats. These viruses have a number of bite wounds. Additionally, the two viruses differ significantly in key similarities: both viruses have the potential to induce tumor formation aspects of diagnosis because of variations in test methodology and as well as suppressing the immune system. Additionally, both viruses in feline response to the two viruses. Finally, there are significant are unstable in the environment and require transmission through differences in vaccination strategies for FeLV and FIV virus. FeLV bodily fluids, either vertically or horizontally. vaccination is recommended for all at-risk cats; FIV vaccination is far There are also significant differences between the two viruses, more controversial. however. Feline leukemia virus is often spread through close friendly Feline leukemia virus Feline leukemia virus (FeLV) is a single-stranded RNA virus with vary significantly among cats. Therefore, it is impossible to predict the worldwide distribution. Feline leukemia is classified as a retrovirus, likelihood of infection or an infectious dose of FeLV for any particular a term used to describe an RNA virus that inserts a DNA copy of cat. All cats with possible exposure should be considered at risk of its genome into the host cell to allow replication. Other examples contracting the disease (American Association of Feline Practioners, of retroviruses include feline immunodeficiency virus and human 2013). immunodeficiency virus. Feline leukemia is an oncogenic (tumor- Feline leukemia, like other retroviruses, is an enveloped RNA virus. producing) virus capable of replication in a variety of feline The virus contains an enzyme that reverse-transcribes the viral genome tissues, including the bone marrow, salivary glands, and respiratory into a DNA form referred to as the FeLV provirus. This DNA provirus epithelium. is then integrated into the host cat’s genome, allowing it to replicate In the United States, an overall FeLV prevalence of 2.3% was reported within the host cells (Hofmann-Lehmann, 2016). in a 2006 study of healthy cats (Levy, 2006). Prevalence is higher in Feline leukemia virus can be divided into four major subgroups sick cats, as well as in some particular geographic areas. based on the virus envelope and properties that this envelope confers Feline leukemia can be transmitted horizontally, from cat to cat, (Hofmann-Lehmann, 2016): through close contact. Feline leukemia is often described as a disease ● FeLV-A: This subgroup is the form of FeLV that is involved in of “friendly” cats, passed through mutual grooming. Infected cats horizontal transmission between cats. The FeLV-A subgroup is shed feline leukemia virus primarily in the saliva, although urine, found in all infected cats. The pathogenicity of FeLV-A is low, but feces, and milk also contain the virus (Hofmann-Lehmann, 2016). The it is highly infectious. transmission of FeLV is typically associated with close contact because ● FeLV-B: This subgroup is less prevalent than FeLV-A. The the virus is unstable in the environment and dies within minutes; FeLV-B virus forms within the individual cat when FeLV-A virus therefore, FeLV cannot be readily transmitted via fomites. Sharing recombines with endogenous FeLV-related sequences. Lymphoid food bowls and litter boxes may potentially allow transmission, but malignances are often associated with FeLV-B. this is typically regarded as uncommon (Litster, 2015). ● FeLV-C: This subgroup is also less prevalent than FeLV-A. Feline leukemia virus can also be spread vertically, from mother to Like FeLV-B, FeLV-C arises in the individual cat; however, its offspring. Infected pregnant queens frequently suffer reproductive formation is caused by mutations or deletions in the FeLV-A losses and do not carry their kittens to term. Kittens that do survive to surface glycoprotein gene. Aplastic anemia is typically associated term, however, are frequently born viremic. These kittens often fade with FeLV-C. quickly, experiencing death early in life, although as many as 20% ● FeLV-T: Like FeLV-C, FeLV-T also arises in the individual cat of kittens born with FeLV may survive to adulthood with persistent caused by mutations or deletions in FeLV-A surface glycoproteins. infection (American Association of Feline Practioners, 2013). If the Immunodeficiency is typically associated with FeLV-T because it kittens of an infected queen are not infected in utero, they may also is a T-cell tropic cytopathic virus and causes lymphoid depletion. be infected through the queen’s milk while nursing or saliva during At this time, FeLV is not regarded as a zoonotic disease. Some studies grooming (American Association of Feline Practioners, 2013). have suggested that human infection with FeLV could be a possibility; The highest susceptibility to FeLV virus is observed in kittens up to however, there are no reports of transmission and no documented cases 4 months of age. Adult cats typically demonstrate some degree of of FeLV-associated human leukemia (Litster, 2015). resistance to infection. It is important to note, however, that biological behavior differs between FeLV strains, and immune responses can Page 35 veterinarians.elitecme.com Pathophysiology destruction or secondary Mycoplasma hemofelis infection. In other In exposed cats, FeLV infection typically begins in the oropharynx. cases, liver disease may be the cause of icterus. This liver disease may Viral replication occurs in the tonsils and adjacent lymphoid tissues, be attributed to lymphoma, Toxoplasma gondii infection, or hepatic and the virus is then spread throughout the body in the lymphatic lipidosis (Fenimore, 2014). system. At this time, any one of four possible courses of disease may Many cats with feline leukemia will experience reproductive be observed (Hofmann-Lehmann, 2016; Litster, 2015): difficulties, with kittens dying before, or shortly after, birth. ● Abortive infection: These cats are able to mount an effective Additionally, evidence of neurologic disease may also be observed immune response. Abortive infections are often associated with (Lutz, 2012). Neurologic signs associated with FeLV include ataxia, exposure to low doses of FeLV. These cats will not test positive weakness, anisocoria, para- or tetraparesis, behavioral changes, and for FeLV at any time. In the past, these cats were referred to as urinary incontinence. These signs may be attributed to polyneuropathy regressor cats. or lymphoma (Fenimore, 2014). ● Regressive infection: Most adult cats exposed to FeLV fall into this category. After infection, the FeLV virus does reach the bone Additionally, there have been reports of immune-complex deposition marrow in these cats and triggers a transient infection. These leading to polyarthritis and glomerulonephritis in FeLV-positive cats will temporarily test FeLV-positive, and they may shed virus cats (Litster, 2015). When a cat with FeLV develops kidney disease, during this time. Within 3 to 16 weeks of infection, these cats will however, it is also important to consider the possibility that renal mount an immune response that suppresses the virus. At this time, failure may also be caused by renal lymphoma (Fenimore, 2014). ELISA testing will be negative though PCR tests may remain Diagnosis positive. The risk of clinical infection in these cats is low though Because of the varying manifestations of FeLV infection, it is viral replication may be reactivated in the future. These cats important that all sick cats be tested for FeLV. Especially strong were previously described as transient viremic followed by latent indicators for FeLV testing include complete blood cell count infection. abnormalities (anemia, leukopenia, leukocytosis, thrombocytopenia, ● Progressive infection: Persistent viremia, with positive tests thrombocytosis, pancytopenia, leukemia), chronic oral infections repeated weeks or months apart. These cats shed high numbers of (gingivitis, stomatitis), uveitis, immune-complex deposition virus and are most capable of infecting other cats. Progressively (evidence of polyarthritis or glomerulonephritis), other signs of infected cats are at a high risk of death within the next several immunodeficiency, reproductive problems, or neurologic disease. months to years, although some may go on to live long lives. In studies of unvaccinated, exposed cats, approximately 30% to 40% Additionally, cats that have been exposed, or potentially exposed, developed progressive infection (Lutz, 2012). to FeLV should be tested. This includes newly adopted cats and cats ● Focal or atypical infection: Although rare in naturally infected who have been in contact with a known FeLV-positive cat. It can take cats, viral replication can be confined to one anatomical region 6 weeks or longer for FeLV to be detected in peripheral blood on an of the body.
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