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Feline Cytauxzoonosis

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Feline Cytauxzoonosis Consultant on Call INFECTIOUS DISEASE / PARASITOLOGY Peer Reviewed Joanna K. Fry, DVM, & Derek P. Burney, DVM, PhD, DACVIM Gulf Coast Veterinary Specialists Houston, Texas Feline Cytauxzoonosis First identified in 1948, Cytauxzoon spp are protozoal hemoparasites of wild and domestic cats. PROFILE Q On average, peak exposure and case inci - dence occur in the late spring/early summer Definition (April–June), with a smaller peak in late G Cytauxzoon spp have been isolated and infec - summer/early fall (August–September). 19 tions documented in several animals in the wild, including free-ranging bobcats, Florida Signalment panthers, and Texas cougars. 1-5 G Males and females of all feline breeds and G C felis is associated with a rapid course of dis - ages appear to be equally at risk. Cytauxzoon ease, high morbidity, and high mortality. G Disease transmission requires exposure to and G Recent studies have demonstrated that a small infestation of actively feeding ticks. felis , first percentage of healthy cats are infected and isolated in may represent chronic carriers or a new reser - Risk Factors domestic cats voir. 6-8 G Outdoor, feral, and free-ranging cats are at G Cytauxzoon spp are classified as part of the increased risk for exposure, particularly those in the United family Theileriidae, which includes Babesia with access to wooded environments where States in 1974, and Theileria organisms. 9,10 Dermacentor ticks are prevalent. is associated G No association with FIV and/or FeLV status with a rapid Geographic Distribution has been found. 20 G Cytauxzoonosis has been documented in G Currently, it is believed that C felis is not con - course of south-central, southeastern, and mid-Atlantic tagious between cats. disease, high regions of the United States. 8,11,12 Q Cats within the same household, however, morbidity, and Q Disease has been confirmed in Kansas, likely experience similar exposures and may high mortality. Oklahoma, Missouri, Arkansas, Texas, Indi - be at increased risk for infection. 18 ana, Kentucky, North Carolina, South Car - CONTINUES olina, Mississippi, Louisiana, Georgia, and Virginia. 6,8,9,11-18 G Overall tick activity as well as the activity of ticks at different life stages vary by season and geographic location. Consultant on Call / NAVC Clinician’s Brief / July 2012 ......................................................................................................................................................................... 85 Consultant on Call CONTINUED Pathophysiology Q Tick vectors transmit the sporozoite form G Bobcats are considered reservoir hosts and are to the host. typically asymptomatic. I After the sporozoite has entered endo- Q Erythroparasitemia has been noted. thelial-associated mononuclear cells, it The most Q A transient schizogony does occur in bob - undergoes asexual replication 9; infected common form cats, but this phase is typically self-limiting macrophages can become as large as 75 of C felis is a and clinically insignificant. 18 µm in diameter and can lead to circula - G small round-to- D variabilis and Amblyomma americanum are tory impairment. definitive hosts for C felis . I Asexual reproduction causes merozoites oval signet-ring Q Transmission of the erythrocytic piroplasm to rupture the host cell and infect addi - body with a via direct inoculation from parasitemic bob - tional mononuclear cells or erythrocytes. Q thick round cats will result in a chronic asymptomatic The erythrocyte form or phase is referred to carrier and clinically insignificant para - as a piroplasm and can be identified on nuclear area sitemia. peripheral blood smears ( Figure 1A ). located I Parasitemia does not confer protective I Research has demonstrated that intra- peripherally. immunity. erythrocyte parasites can be visualized as Q Exposure to the schizogonous phase in early as 10 days postexperimental infec - domestic cats can cause clinical disease and tion. death. I Most common form of C felis is a small I Transmission via ingestion or inoculation round-to-oval signet-ring body measuring of blood or tissue from infected bobcats is 1–5 µm ( Figure 1B ), with a thick round possible. nuclear area located peripherally. G There are 2 distinct Cytauxzoon species forms: I The piroplasm can also undergo asexual sporozoite and erythrocyte. reproduction and destroy RBCs, causing (A) Blood film from a cat at 10 × magnification. There is a moderate decrease in red cell mass (anemia) and thrombocytope - 1 nia. The leukocyte count is decreased, and neutrophils exhibit Döhle bodies and increased cytoplasmic basophilia and vacuo - lation consistent with moderate to marked toxic change ( broken arrows ). Small basophilic inclusions are present within erythrocytes ( solid arrows ). ( B) Same blood film at higher magnification (40 ×). Erythrocytes show several small signet-ring basophilic intracellular organisms consistent with Cytauxzoon organisms ( arrows ). Courtesy of IDEXX Laboratories A B 86 ......................................................................................................................................................................... NAVC Clinician’s Brief / July 2012 / Consultant on Call signs of hemolytic anemia; this mode of replication is significantly less pathogenic WHY PIROPLASM REPLICATION IS (see Why Piroplasm Replication is Less LESS PATHOGENIC Pathogenic ). I Degree of erythroparasitemia varies The erythrocyte form, referred to as a piroplasm , throughout course of disease. often develops late in the course of disease, can vary in severity, and may not develop in some cases. Signs Clinical signs of cytauxzoonosis are often due to the schizogonous G Clinical disease course is acute. 18 phase, and schizont-laden macrophages can be found in any tissue Q Signs occur 5–14 days after exposure, and throughout the body. The infected macrophages become enlarged most cats die within 1 week of onset of and occlude the blood vessels, making this tissue form much more signs. pathogenic. 13 Q Although signs are vague and nonspecific, lethargy, anorexia, dehydration, pallor, and icterus are common. G Temperatures >10 5°F (normal, 101.5°F – Laboratory Findings 102.5°F) are common on presentation; resolu - G Common clinicopathologic abnormalities tion of fever and hypothermia can occur include nonregenerative anemia, leukopenia, before death. and thrombocytopenia. 18 G Generalized pain and reluctance to move can Q Toxic changes to myeloid cell lines are also be common presentations, the cause of which common. is not well understood. G Hyperbilirubinemia, hypoalbuminemia, and G In more severely affected cats, lateral recum - hyperglobulinemia are common late in disease bency, neurologic abnormalities (ataxia, course. 6 nystagmus), and coma are frequently noted. G Disseminated intravascular coagulation (DIC) G Mesenteric lymphadenopathy has been may occur. reported but is not consistent. Imaging G Hepatosplenomegaly may be visible on DIAGNOSIS abdominal radiographs. G Thoracic radiographs may reveal pulmonary Definitive Diagnosis changes consistent with edema, congestion, or G Identification of organism in peripheral blood consolidation. smears is necessary. G Enlarged, tortuous pulmonary vessels may be Q Giemsa or Romanowsky-based stains are present, and generalized cardiomegaly may be ideal for differentiating C felis from other noted in cases of pericardial effusion. erythrocyte parasites (eg, Mycoplasma G Abdominal ultrasonography may disclose par - haemofelis ), erythrocyte inclusions (eg, tial or complete occlusion of vascular beds. Howell-Jolly or Heinz bodies), and stain artifacts. 13 Other Diagnostics Q Differentiation may be difficult early in dis - Cytology ease course when erythroparasitemia is low, G Cytologic examination of spleen, lung, or but marked increase in circulating organ - kidney aspirates may be beneficial. isms is noted as disease progresses. Q The schizont stage is characterized by a Q If C felis is suspected, peripheral blood small, lobulated, ill-defined blue structure smears may be repeated q24h until organ - within the cell cytoplasm. ism is identified. Q Organisms have also been found in lymph Q Piroplasms may be easily missed or nodes, the liver, and bone marrow. misidentified. CONTINUES Consultant on Call / NAVC Clinician’s Brief / July 2012 ......................................................................................................................................................................... 87 Consultant on Call CONTINUED PCR Assay tion are all possible pulmonary pathologies G PCR assay for C felis may be confirmatory in associated with C felis infection. patients with low erythroparasitemia and has G Petechial hemorrhage on the lung serosal been used as a screening test to further define surface and throughout the pulmonary inter - geographic distribution of C felis infection. stitium is common. G Schizont-containing macrophages may be Histopathology identified within the pulmonary venous G Postmortem histopathologic examination system ( Figure 2B ). is often successful at identifying schizont- containing macrophages. G The characteristic histologic lesion of C felis TREATMENT is systemic venous distention with schizont- laden macrophages attached to the vascular Inpatient endothelium 13 (Figure 2 ). G Medical treatment for cytauxzoonosis is Q Numerous small basophilic granules that controversial, as almost all infections are represent the merozoite stage of the parasite inevitably fatal. are found within intracytoplasmic
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