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Detection of Encephalitozoon Cuniculi-Infection (Strain II) by PCR in a Cat with Anterior Uveitis

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Detection of Encephalitozoon Cuniculi-Infection (Strain II) by PCR in a Cat with Anterior Uveitis Wien. Tierärztl. Mschr. - Vet. Med. Austria 97 (2010), 210 - 215 From the Institute of Parasitology1 and the Institute of Pathology and Forensic Veterinary Medicine2, Department of Patho- biology, University of Veterinary Medicine, Vienna, and the Veterinary Practice Dr. Maaß3 Detection of Encephalitozoon cuniculi-infection (strain II) by PCR in a cat with anterior uveitis J. CSOKAI1, A. FUCHS-BAUMGARTINGER2, G. MAASS3 and A. JOACHIM1 received December 17, 2009 accepted for publication May 1, 2010 Keywords: cat, Encephalitozoon cuniculi, mouse strain, Schlüsselwörter: Katze, Encephalitozoon cuniculi, uveitis, cataract, PCR. Mäusestamm, Uveitis, Katarakt, PCR. Summary Zusammenfassung A 4 and a half year old female neutered European Nachweis einer Encephalitozoon cuniculi-Infektion shorthair cat showed recurring bilateral anterior uveitis (Stamm II) mittels PCR bei einer Katze mit Uveitis with a cataract for 2 and a half years. Despite therapy with anterior local 1 % atropine, dexamethasone-oxytetracycline oint- Eine 4 ½ Jahre alte weibliche, kastrierte Katze der Ras- ment and systemic carprofen there was no clear improve- se Europäisch Kurzhaar zeigte seit 2 ½ Jahren beidseitige ment of the inflammation and new uveitis exacerbations rezidivierende Uveitis anterior und Katarakt. Trotz Therapie followed. Serological tests for antibodies against Toxoplas- mit einer 1 %igen Atropin-Augensalbe, einer Dexametha- ma gondii, FIP-feline corona virus, Feline leukemia virus son-Oxytetracyclin-Augensalbe und oraler Gabe von Car- and Feline immunodeficiency virus were negative. The profen gab es keine deutliche Verbesserung der Entzün- determination of antibodies against Encephalitozoon cuni- dung, und neuerliche Uveitisschübe traten immer wieder culi revealed a titre of 1:320 in the Indirect Immunofluores- auf. Serologische Tests auf Antikörper gegen Toxoplasma cence Test. Therapy with fenbendazole was initiated but gondii, FIP-Felines Coronavirus, Felines Leukämievirus finally an enucleation of the right eye had to be performed und Felines Immundefizienz-Virus verliefen negativ. Eine due to glaucoma and perforation of the cornea. In the lens, Bestimmung des Antikörpertiters gegen Encephalitozoon DNA of Encephalitozoon cuniculi (strain II) was detected by cuniculi mit einem Indirekten Immunfluoreszenz Test ergab PCR and DNA sequencing. The anatomical lens structure einen Titer von 1:320. Eine orale Therapie mit Fenbenda- was destroyed for the PCR and therefore no spores could be zol wurde gestartet. Aufgrund eines Glaukoms und einer found in pathohistological examination with special staining Hornhautperforation des rechten Auges wurde schließlich (acid-fast trichrome). Sporadic spores could be detected by eine Enukleation durchgeführt. In der Linse wurde mittels transmission electron microscopy. The presented case PCR und DNA-Sequenzierung der Mäusestamm (II) von report shows that E. cuniculi should be considered in cats Encephalitozoon cuniculi nachgewiesen. In der an- with suspected infectious uveitis and cataract. schließenden pathohistologischen Untersuchung konnten in der für die PCR aufbereiteten und damit in ihrer anato- Abbreviations: AFT = acid-fast trichrome; DNA = deoxyribonucle- mischen Struktur zerstörten Linse keine Sporen mittels ic acid; FIP = Feline infectious peritonitis; E. cuniculi = Encephali- Spezialfärbung (Acid Fast Trichrom) gefunden werden. Im tozoon cuniculi; EM = electron microscopy; FeLV = Feline Elektronenmikroskop waren vereinzelt Sporen nachweis- leukemia virus; HE = haematoxylin and eosin; ITS region = inter- bar. Der vorgestellte Fall zeigt, dass E. cuniculi bei Katzen nal transcribed spacer region; PCR = polymerase chain reaction; mit Verdacht einer infektiösen Uveitis und Katarakt in MU = million units; RNA = ribonucleic acid Betracht gezogen werden sollte. Introduction described. Immunosuppressed animals as well as new- born carnivores and new-world monkeys have a higher risk Feline uveitis is a common disorder, represented in var- of an outbreak of infection. Clinical onsets of dogs occurred ious ocular signs. Uveitis in cats often has a subtle course, in South Africa and the United States of America (SHAD- leading to delayed diagnosis when alterations are already DUCK et al., 1978; BOTHA et al., 1979; SNOWDEN et al., advanced. It can have infectious, immune-mediated, trau- 2009). In Norway and Finland blue foxes also showed matic, neoplastic or idiopathic causes. Frequently no defin- symptoms (MATHIS et al., 1996; ÅKERSTEDT et al., itive cause can be found (MAGGS, 2009). 2002). Studies in Norway and Switzerland revealed no Encephalitozoon cuniculi is a microsporidian pathogen antibodies against E. cuniculi in dogs, and only one Swiss of worldwide distribution affecting primarily rabbits as cat was seropositive (DEPLAZES et al., 1996; ÅKERST- hosts. Other animals like rodents can become infected, but EDT, 2003). By contrast, in Slovakia the seroprevalence in normally do not show symptoms (CHALUPSKÝ et al., dogs were high (37.8 and 23.6 %, respectively) 1979). Clinical outbreaks in other animals are rarely (HALÁNOVÁ et al., 2003). However, the authors did not 210 Wien. Tierärztl. Mschr. - Vet. Med. Austria 97 (2010) describe the isolation of the parasite to confirm the results; per os once daily for 3 weeks, a knife point of L-Lysin pow- therefore these results should be interpreted with care. So der (L-Lysin®, Hecht-Pharma GmbH, Stinstedt, German) far, only 2 studies of naturally infected cats are published twice a day into the food, 9 mg/kg famciclovir (Famvir®, (RENSBURG and DU PLESSIS, 1971; BUYUKMIHCI et Novartis Pharma GmbH, Vienna, Austria) once a day per al., 1977), and pathogen determination in those cases was os and topical recombinant interferon omega (Virbagen carried out only to the genus level (Encephalitozoon spp.). Omega 10 MU®, Virbac S.A., Carros, France) 3 times a day Our case report describes a clinical manifestation of E. because of the corneal erosion which could be caused by cuniculi (strain II) in a cat. felines herpesvirus. Despite intensive therapy no significant improvement of Case report the uveitis was noticed and medication was finally discon- tinued after 5 months. Approximately 1 and a half years lat- er a bilateral exacerbation of the anterior uveitis re- History and clinical appearance occurred, which was again treated with atropine ointment, A 4 and a half year old female neutered European dexamthasone-oxytetracycline ointment, carprofen and shorthair cat showed recurring bilateral anterior uveitis doxycycline. A little improvement was notable. with a cataract, which had been present for 2 and a half After 9 months the cat was presented to a veterinarian years. The cat was born on a farm and housed indoors since the age of 2 months. It was kept with a litter mate and in a private practice with bilateral total mature cataract an older cat. In the past there were 2 rabbits in the house- beside the anterior uveitis. In addition, vascularisation hold as well, which had no contact with the cats. One of between the iris and the anterior lens capsule was present these rabbits developed a head tilt. A determination of anti- in the region of the posterior synechiae in both eyes (Fig. bodies against E. cuniculi was not performed despite a 1a,b). The suspicion of an infection with E. cuniculi arose suspicion of encephalitozoonosis. The rabbit was finally because of the negative results in serological tests for oth- euthanized. er infectious diseases as well as the similarity with anoth- At the age of 2 years the cat was presented the first time er case where a cat, seropositive for E. cuniculi, showed an with eye problems at the Veterinary University in Vienna. anterior uveitis with keratitic precipitates. In both cats a The left eye showed a mildly swollen conjunctiva. The pupil vascularisation between the iris and the lens was remark- was miotic and the pupillary light reflex was complete. A able, where the lens was adhered with the iris. This vascu- swollen and reddened iris was presented. Keratitic precip- larisation was reminiscent of the beginning of a phaco- itates were visible on the ventral half of the corneal clastic uveitis like those found in rabbits due to E. cuniculi. endothelium and a fibrin clot was located in the anterior The cataract of the first cat appeared conspicuous and chamber. A total mature cataract was present. Therefore a unusual, a filiform opacity, which terminated in an enlarge- fundus examination was not possible. The intraocular pres- ment in the area of the lens capsule (Fig. 1c,d). In the pre- sure was 3 mmHg. The ophthalmic examination of the right sented cat the determination of antibodies against E. cuni- eye offered a mildly dilated pupil and a normal pupillary culi was also positive with a titer of 1:320. The litter mate light reflex. The menace response and the dazzle reflex showed seroconversion as well, while the older cat in the were normal. The lens showed an immature cortical and household was seronegative. The cat was treated with 20 ® nuclear cataract. At the retina areas of chorioretinitis were mg/kg fenbendazole (Panacur , Intervet, Vienna, Austria) found. The intraocular pressure measured 11 mmHg. For once daily per os in intervals of 2x10 days application, clarification of the cause serological test for Toxoplasma interrupted by a 10 day break, topical gentamicin ointment gondii, FIP-feline corona virus, Feline leukemia virus (Gentax®, Agepha, Vienna, Austria) twice daily, topical vita- (FeLV) and Feline immunodeficiency
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