Innovative Research in Dog and Cat Nutrition ®

Advances in Puppy & Kitten

Health Care

Presented at
®

Iams Clinical Nutrition Symposium 2005

Seville, Spain
January 29, 2005

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Makers of Eukanuba® and Iams® premium dog and cat foods,
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www.eukanuba-scienceonline.com
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Reprinted in the IVIS Website with the permission of IAMS
Professor Stanley L. Marks
BVSc, PhD, Dip. ACVIM (Internal Medicine, Oncology),
Dip. ACVN
School of Veterinary Medicine,
University of California at Davis, USA
Author’s Profile
Dr. Marks graduated from the University of
Pretoria, South Africa in 1986 and completed an
internship in small animal medicine and surgery
at the University of Missouri, Columbia in 1987.
He completed a small animal internal medicine
residency program at the University of Florida
and an oncology residency program at the
University of California, Davis. Dr. Marks received
his PhD in nutrition from the University of
California, Davis, where he is currently Professor
of Medicine in the Department of Medicine and
Epidemiology. Dr. Marks is a Diplomate of the
American College of Veterinary Internal Medicine
(ACVIM) in the subspecialties of internal medicine
and oncology, and a Diplomate of the American
College of Veterinary Nutrition (ACVN). His
research interests are in the area of small animal
gastroenterology, with an emphasis on dietary
modulation of intestinal mucosal barrier function
and bacterial gastroenteritis.
| 40
Medical approach
to puppies and kittens
with diarrhoea
Introduction
Diarrhoea in puppies and kittens is one of the most common
maladies facing small animal veterinarians today. Despite
the clinical importance of diarrhoea in puppies and kittens,
there is a paucity of veterinary literature providing specific
information on the causes and diagnosis of this problem.
Antibiotics are commonly administered injudiciously to
diarrhoeic puppies and kittens, and subsequent resolution of
clinical signs is often wrongly equated with eradication of a
“putative” infectious pathogen. Indiscriminate antibiotic
therapy may even exacerbate the animal’s diarrhoea or lead
to development of antibiotic resistance. Although diarrhoea
in puppies and kittens can be associated with a number of
different aetiologies, infectious causes are believed to play
an important role in many of these cases. Performing a
comprehensive faecal examination is integral to the diagnostic
work-up of puppies and kittens with diarrhoea, vomiting, and
weight loss.
Maximising the diagnostic yield of a faecal examination
The techniques used most commonly include stained faecal
smear, direct faecal smear (wet preparation), and a faecal
floatation. A Baermann technique is indicated when parasitic
larval stages are being evaluated.
Stained faecal smear
Staining faecal smears with Diff-Quick, New Methylene Blue,
or Wrights stain can be used to evaluate faecal specimens for
the presence of endospores associated with Gram positive
Clostridium perfringens, and spiral-shaped, Gram negative
Iams Clinical Nutrition Symposium | 2005
bacteria consistent with Campylobacter spp., or for the
presence of increased white blood cells. Caution should
be heeded in over interpreting these common findings,
as the diagnostic value of increased faecal endospores
(fig 1) is virtually zero. In addition, healthy dogs and cats
commonly have spiral-shaped bacterial organisms in
their faeces, and many Campylobacter spp. are non-
pathogenic. Stained faecal smears are useful for making
a diagnosis of intestinal lymphoma, intestinal
Histoplasmosis or Prototheca, although these diseases
are extremely rare in puppies and kittens. Faecal smears
can be performed by using a cotton swab introduced into
the rectum, and gently rotating the swab several times.
The cotton swab is rolled onto a glass slide, which is then
stained after air drying.
Figure 1. Stained faecal smear (modified Wright’s stain) from a healthy,
non-diarrhoeic dog showing numerous endospores of Clostridium
perfringens (magnification X 1000)
Faecal flotation
Faecal flotations are indicated to find cysts, oocysts, and
ova in faeces. Fresh faeces should be examined whenever
possible, or a fresh specimen can be refrigerated for up to
72 hours for detection of cysts, oocysts, or eggs via a con-
centration technique. Although standing (gravitational)
flotation methods are easier and quicker to perform than
centrifugation flotation (fig 2), the latter has clearly
superior sensitivity (up to 8 times).1 Animals with low
parasite burdens could have a false negative result if the
gravitational method is utilised.
Iams Clinical Nutrition Symposium | 2005
Close widow to return to IVIS
Procedure for centrifugal flotation
1. Prepare a faecal emulsion using 2-5 grams of faeces
and 5-10 ml of flotation solution. Zinc sulphate flotation
medium is optimal with a specific gravity of 1.18 to 1.20.
2. Strain the emulsion through a tea strainer or cheese-
cloth, washing it through with an additional 10-15 ml
flotation solution, into 15-20 ml conical centrifuge
tubes.
3. Fill the tubes with flotation medium to create a
positive meniscus.
4. Place a coverslip on top of each tube.
5. Balance the tubes in the centrifuge.
6. Centrifuge the tubes for 10 minutes at 1,500 to 2,000
rpm.
7. Carefully remove the coverslips from each tube by
lifting straight up and place them on a clean slide.
8. Examine the slide within 10 minutes. Examine entire
coverslip at 10X. Use 40X to confirm identification by
visualising internal structures and measuring the
organism.
Modification
If your centrifuge is fixed-angle, and does not have free
swinging buckets, proceed as above but fill the centrifuge
tubes to within 2.5cm or so from the top, and do not add
a coverslip for the final spin.When the final centrifugation
step is complete, carefully set the tubes upright in a test
tube rack. Use a pipette to gently run additional flotation
solution down the side of each tube while disturbing the
contents as little as possible. Create a positive meniscus
and set a coverslip on top. Let this preparation stand for 5
minutes only. Remove the coverslip to a slide and examine
as described in step 8.
Figure 2. Centrifuge with free swinging buckets showing a coverslip in
place before centrifugation.
41 |
Direct wet preparation
Fresh faeces (ideally <2 hours old) should always be used
to preserve the motility of trophozoites such as Giardia
spp. and Tritrichomonas foetus (fig 3). A small amount of
faeces is placed on a warm slide and a drop of 0.9% saline
is mixed with the faeces. It is important that the smear is
not too thick, as trophozoites will be easily missed. A
simple rule of thumb is that you should be able to read
the fine newsprint of a newspaper through the smear.
After application of a coverslip, the smear is evaluated for
motile organisms by examining at 10X magnification,
with confirmation at 40X magnification.
Parasitic causes of diarrhoea
Trichomonosis
Tritrichomonas foetus, the primary causative agent of
bovine trichomoniasis, has recently been recognised as a
protozoal pathogen in cats (fig 3).2,3 Infected cats are
generally young, but have ranged in age from 3 months
to 13 years (median 9 months). The prevalence of T. foetus
infection at an international cat show was found to be
31% (36 out of 117 cats), with 28 out of 89 catteries affec-
ted.3 Co-infection by T. foetus and Giardia was common
and was documented in 12% of cats. Misdiagnosis of
Giardia is common in cats having T. foetus infection, and
may explain why cats diagnosed with apparent Giardia
infection do not respond to appropriate therapy.
Clinical signs
T. foetus infection in cats can be associated with a chronic
or recurrent large intestinal diarrhoea characterised by
increased mucous, tenesmus, occasional haematochezia,
and increased frequency.The anus is frequently red, swollen,
and painful, and faecal incontinence is not uncommon.
Most cats are usually bright, alert, and responsive, and in
diagnosis of T. foetus is relatively low in cats with
spontaneous disease (14%).4 T. foetus can be distin-
guished from Giardia based on morphology and motility.
Giardia trophozoites have a concave ventral disc and
motility mimicking a falling leaf, whereas trichomonads
are spindle-shaped, have an undulating membrane
that courses the entire length of the body, and move
in a more irregular and jerky fashion. T. foetus does
not have a cyst stage, underscoring the limitations of
faecal flotation for diagnosing this organism.
2) Faecal cultures performed with an InPouch TF kit
A commercially-available system marketed for diagnosis
of T. foetus infection in cattle (InPouch TF, Biomed
Diagnostics, White City, Oregon) is more sensitive
4
than the direct wet preparation. Approximately 0.05
grams (less than a peppercorn) of freshly voided
faeces can be placed in the InPouch for culture, or
alternatively, a saline-moistened cotton-tipped swab
can be placed in the rectum and then gently agitated
in the InPouch for culture. The InPouch should be
incubated at 37°C or room temperature in an upright
position in the dark, and examined q 48 hours for up
to 12 days for motile trophozoites using a 20 or 40X
objective. The media in the InPouch does not support
the growth of Giardia or Pentatrichomonas hominis.
3) Single tube nested PCR of DNA extracted from faeces
A sensitive and specific single-tube nested PCR from
5
feline faeces has been described. The PCR test is
more sensitive than faecal culture and tested positive
in 55% of cultures that were negative for T. foetus,
even when faeces were normal.
Therapy
There is currently no therapy for elimination of T. foetus,
and cats infected with T. foetus have failed treatment with
recommended and higher dosages of numerous antimi-
2
crobial drugs, including metronidazole and fenbendazole.
Greater than 50% of cats diagnosed with T. foetus-
associated diarrhoea were still shedding the organism up
to 5 years following diagnosis based on PCR confirmation,
and diarrhoea persisted for up to 3 years in many cats,
despite aggressive antimicrobial administration.6
Cryptosporidium spp
Infection with the ubiquitous protozoan parasites,
Cryptosporidium parvum and C. felis, in puppies and kittens
causes a spectrum of disease ranging from asymptomatic
carrier state to mild, transient diarrhoea, cholera-like
illness, or prolonged severe life-threatening malabsorption
syndrome. In addition, C. parvum infection has been
diagnosed in association with intestinal cellular infiltrates
indistinguishable from those seen with inflammatory
7
bowel disease in cats.
Diagnosis
The laboratory detection of this ubiquitous protozoan
parasite in diarrhoeic puppies and kittens is difficult, pre-
dominantly because the organism is so small (average
4.6 x 4.0 µm) and difficult to find in faecal specimens via
light microscopy, and because faecal shedding may be
intermittent. Immunofluorescent detection procedures are
more sensitive and specific than acid-fast stains, and are
generally the method of choice for morphological diagnosis
in humans8 (fig 4). The newer enzyme immunoassays
designed to detect Cryptosporidium antigens in faeces,
have proven more sensitive than microscopic techniques.9
A recent study comparing the performance characteristics
of a Ziehl Neelsen stain, direct fluorescent antibody
technique, and 3 ELISA tests (Table 1)10 revealed that the
ProSpecT Microplate ELISA was the most sensitive
diagnostic test for Cryptosporidium on a single day,
whereas the ProSpecT Rapid ELISA was highly insensitive
and should not be utilised by veterinary diagnostic
laboratories.
Treatment
Eradication of this parasite has proven difficult, and
many putatively effective drugs are either toxic or inef-
fective. The aminoglycoside, paramomycin, is potentially
nephrotoxic and ototoxic in cats, and should preferably
not be used. A recent prospective double-blind study
completed by the author failed to show any benefit for
tylosin in naturally infected kittens. Azithromycin is used
in humans for management of Cryptosporidiosis, and
appears safe in dogs and cats when administered at a
dosage of 7-10 mg/kg BID for 7 days; however, its efficacy
is unknown.
Figure 4. Direct immunofluorescent assay (Meifluor
Cryptosporidium/Giardia direct Immunofluorescent kit, Meridian
Diagnostics Inc, Cincinnati, OH) showing fluorescent Giardia cysts
(larger, oval) and Cryptosporidum oocysts (smaller, round).

good body condition with a normal appetite. Tritrichomonas

foetus can also be cultured from the faeces of asymptomatic
Detection Method Day 1 Day 3 Day 4
cats, many of whom will not develop diarrhoea.
Ziehl Neelsen technique 72% 91% 94%

Direct Immunofluorescence Detection 50% 83% 84%

Diagnosis
Meridian Premier ELISA 80% 93% 93%
1) Multiple direct wet preparations on diarrhoeic faecal
Remel ProSpecT Microplate ELISA 89% 94% 95%
specimens
Remel ProSpecT Rapid ELISA 15% 43% 49%
Direct faecal smears are performed to evaluate for
Figure 3. Giemsa stained faecal smear showing characteristic appearance Table 1: Cumulative sensitivities of 5 methods of detection of Cryptosporidium spp. in faecal specimens collected once daily over 4 consecutive days from 104
the presence of Tritrichomonas foetus trophozoites.
of Tritrichomonas foetus with its 3 anterior flagellae and long undulating naturally exposed kittens10
The sensitivity of direct faecal smear examination for membrane.

| 42 Iams Clinical Nutrition Symposium | 2005 Iams Clinical Nutrition Symposium | 2005 43 |
Giardia spp
Giardia infections in adult cats and dogs are often sub-
clinical or associated with a transient softening of the
stool early in the infection; however, acute diarrhoea tends
to occur in puppies and kittens shortly after infection.
Diagnosis
The diagnosis of Giardia infection traditionally has
depended on microscopic identification of trophozoites
or cysts (fig 5) in faeces from affected animals. However,
microscopic diagnosis of Giardia infection can be difficult,
because cysts may be shed intermittently and because
cysts are so delicate. Many artifacts (grass pollen, yeast,
etc.) mimic to varying degrees the morphology of Giardia
cysts, and care must be exercised in differentiating these
from Giardia. ELISA tests that detect Giardia cyst wall
protein I (GCWP 1) are advantageous because they are
generally easy to perform and results are easy to interpret.11
In addition, the test does not rely upon morphological
identification of cysts or oocysts via microscopy, thus
saving technician time and potentially avoiding false
negative interpretations. The ELISA tests can also detect
11
GCWP 1 in the absence of detectable cysts. A novel
SNAP® Giardia Test Kit (IDEXX Laboratories, Inc.,
Westbrook, Maine) for detection of GCWP 1 in canine and
feline faeces was recently released. This test is a rapid
in-house enzyme immunoassay that can be performed
on fresh faeces, previously frozen faeces, or faeces stored
at 2-7°C for up to 7 days.
Treatment
Metronidazole was shown to be highly effective and safe
when given at 25 mg/kg PO q12h for 7 days to cats with
experimental infections,12 although it is less effective in
dogs with eradication of the organism occurring in 67%
of treated dogs. Albendazole is also relatively effective
when dosed at 25 mg/kg BID for 5 days; however, the
drug has been associated with pancytopenia and is
teratogenic. A recent trial evaluating the efficacy of
fenbendazole in cats co-infected with Cryptosporidium
parvum revealed that the drug was safe; however, it was
relatively ineffective (50%) in cats co-infected with
Cryptosporidium. 13
Fenbendazole is the author’s first
drug of choice for treating infected puppies. Drontal
Plus was shown to be relatively safe and effective in
| 44
experimentally infected kittens when given at twice the
recommended dose. The dose of febantel used was
14
56.5mg/kg.
Figure 5. Zinc sulphate faecal flotation showing Giardia cysts with distinctive
fibrils coursing the length of the cyst (magnification X 400).
Control of Giardia Infection
There are 4 fundamental steps that should be taken to
control Giardia infection, and minimise reinfection of
treated animals:
1) Decontaminate the environment
Simultaneous treatment of animals with the
medications discussed and decontamination of the
environment with a quaternary ammonium-based
(QUAT) disinfectant (Roccal D,Totil, Quatsyl 256, or Aqua
Quat 400) should improve effectiveness of treatment
and maximise the possibility of eliminating Giardia
from the kennel or colony. Cages should be sponged
clean on a daily basis with a dilute disinfectant or mix
15
of Clorox diluted at 1:32 and Quatsyl 256 at 1:256.
2) Treat the animal with effective drugs
3) Bathe the animal to clean cysts from the coat
4) Prevent reintroduction of infection
Giardia Vaccine
A commercial Giardia vaccine (GiardiaVax™, Fort Dodge
Animal Health, Overland Park, KS) containing chemically
inactivated trophozoites has been prepared and licensed
for use in dogs and cats in the United States. Because
infection is readily diagnosed and treated, and many
infected dogs and cats are asymptomatic, the merit of
vaccination against giardiasis has not been convincingly
demonstrated. The vaccine does not prevent infection
but only reduces shedding of trophozoites or cysts. Thus
Iams Clinical Nutrition Symposium | 2005
routine vaccination for Giardia is not recommended in
household dogs and cats.
Coccidia
Puppies are infected with two species of coccidia, Isospora
canis and I. ohioensis, whereas kittens are infected with
Isospora rivolta and I. felis (fig 6).
Diagnosis
Faecal flotation with zinc sulphate is the recommended
method.
Treatment
Sulfadimethoxine given at 50 mg/kg orally once a day
for 10 to 14 days will eliminate oocyst excretion in most
dogs and cats.16 The combination of ormetoprim (11
mg/kg) and sulfadimethoxine (55 mg/kg) given orally for
up to 23 days has been used effectively in dogs.
Amprolium given orally once a day at 300 to 400 mg/kg
for 5 days or 110 to 220 mg/kg for 7 to 12 days is effective
in treating coccidiosis in dogs. Other agents such as
furazolidone, quinacrine, and metronidazole probably are
of little clinical value.
Figure 6. Zinc sulphate faecal flotation showing Isospora sp. oocysts
recovered from a diarrhoeic kitten (magnification X 400).
Roundworms
Roundworms are common in puppies (Toxocara canis and
Toxascaris leonina) and kittens (Toxocara cati and
Toxascaris leonina) and can cause diarrhoea, failure to
thrive, a poor haircoat, and a “potbellied” appearance.
Vomiting is occasionally observed when the roundworms
gain access to the stomach.
Iams Clinical Nutrition Symposium | 2005
Diagnosis
The large ova (approximately 80 µm) with a characte-
ristic thick wall are easy to recognise on faecal flotation
(fig 7).
Treatment
Pyrantel at 20 mg/kg is safe in puppies and kittens. The
treatment should be repeated at approximately 3 weeks.
Fenbendazole is also an effective anthelmintic, and
can be administered to newborn puppies and kittens at
50mg/kg for 3 days to kill more than 90% of prenatal larvae.
Puppies and kittens should be routinely dewormed every
2 weeks, starting at 2 weeks of age, until 8 weeks.
Figure 7. Faecal flotation showing large, thick-walled ova of Toxocara cati
and Ancylostoma caninum ova (magnification X 400).
Hookworms
Ancylostoma spp. and Uncinaria spp. are voracious blood
suckers, where the worms live in the small intestinal
lumen and attach to the mucosa. Dogs are infected when
ingesting the ova or through transcolostral transmission.
Puppies can occasionally have life-threatening blood loss
or iron-deficiency anaemia, melena, haematochezia, and
failure to thrive.
Diagnosis
Faecal flotation is the procedure of choice for seeing
the characteristic eggs.
Treatment
Fenbendazole, pyrantel, and milbemycin are effective.
45 |
Bacterial causes of diarrhoea
Veterinarians are faced with a quandary when attempting
to diagnose puppies and kittens with suspected bacterial-
associated diarrhoea because the isolation rates for putative
bacterial enteropathogens are often similar in diarrhoeic
and non-diarrhoeic animals, and because the incidence of
bacterial-associated diarrhoea is extremely variable. Faecal
cultures and toxin analyses for specific bacteria should be
reserved for a) puppies and kittens developing diarrhoea
after kenneling once parasitic causes of diarrhoea have
been ruled out, b) in puppies and kittens with an acute
onset of bloody diarrhoea in association with evidence of
sepsis, c) outbreaks of diarrhoea occurring in more than
one household pet, and d) screening for enteropathogens
(C. difficile, Campylobacter spp., or Salmonella spp.) when
zoonotic concerns are present.
The main bacterial enteropathogen that should be
considered in diarrhoeic puppies or kittens <4 months old
is Campylobacter spp. Other bacterial enteropathogens
that are considered in older dogs and cats include
Clostridium perfringens, Clostridium difficile, Salmonella
spp., and Escherichia coli.
Campylobacter spp
Campylobacter spp. are small (0.2 - 0.5 µm X 0.5 - 5 µm),
microaerophilic, gram-negative, curved rod-shaped
bacteria. Campylobacter jejuni, C. coli, C. helveticus, and
C. upsaliensis have been associated with diarrhoea in
puppies and kittens, although recent studies have shown
more sensitive species such as C. upsaliensis or other
catalase-negative or weakly-positive species can be
missed with routine culture techniques. Faecal shedding
of C. jejuni is significantly greater in dogs < 6 months old
and during the summer and autumn periods. The higher
prevalence of infection in pups versus adult dogs may
reflect increased exposure of young animals to faecal
excrement and confinement to a limited space. In
addition, the unexposed immune system of the pups
may increase the susceptibility to intestinal colonisation
by C. jejuni. The isolation of Campylobacter spp. from
a diarrhoeic animal does not necessarily implicate
Campylobacter as a cause of the diarrhoea.
Diagnosis
Campylobacter-like organisms (CLO’s) can be identified
| 46
by examining stained smears (Gram stain or Romanovsky-
type stain) of fresh faeces from the patient.The organism’s
characteristic morphology (slender, curved rods with an
“S” shape or sea gull-shaped appearance) allows it to be
identified relatively easily. Unfortunately, microscopic
evaluation of the spiral-shaped bacteria does not allow
you to differentiate between Campylobacter spp. or
related organisms such as Helicobacter spp. For optimal
isolation (culture) of Campylobacter spp., faeces or faecal
swabs should be fresh or placed immediately into
anaerobic transport medium before refrigeration at 4° C.
The specimen should be mailed as soon as possible to a
reputable veterinary microbiology laboratory that has
the formulated selective media containing antimicrobial
agents and microaerophilic incubation conditions to
isolate the organism.
Treatment
Although diarrhoea produced by Campylobacter orga-
nisms is usually self-limiting, the zoonotic potential of
the organism often necessitates medical therapy. It is
now recognised that Campylobacter are a leading cause
of enteric disease in people and that diarrhoeic and non-
diarrhoeic dogs can serve as sources of infection for humans.
The drugs of choice are the macrolides (erythromycin at
10 to 15 mg/kg TID) or quinolones (enrofloxacin at 5
mg/kg BID). Erythromycin is the preferred drug due to
the increased rate of antibiotic resistance with the
17
quinolones. The duration of excretion in infected dogs
and cats can be as long as 4 months and infected animals
should be quarantined away from children during this
period.
Viral causes of diarrhoea
Canine and feline viral enteritis is usually diagnosed in
younger unvaccinated animals. The animal’s signalment,
history, clinical signs, and haematological findings are
important in ranking a viral aetiology as a likely cause of
the animal’s diarrhoea.
Canine Parvoviral Enteritis
Dogs are susceptible to infection by two types of parvovirus.
Canine parvovirus-1 (CPV-1) is a relatively nonpathogenic
virus that is occasionally associated with myocarditis,
pneumonitis, and gastroenteritis in very young puppies.
Iams Clinical Nutrition Symposium | 2005
Canine parvovirus-2 (CPV-2) causes classic parvovirus
enteritis 5-12 days after infection via the faecal-oral route.
Canine parvovirus-2b is a more recently recognised
mutated form of CPV-2, which may be more pathogenic
in some dogs. Doberman Pinschers, Rottweilers, Pit Bulls,
and Labrador Retrievers appear more susceptible than
other breeds. Dogs are predisposed to sepsis secondary
to neutropaenia associated with viral damage to bone
marrow progenitors, and bacterial translocation due to
intestinal damage.
Clinical Signs
Anorexia, lethargy, fever, vomiting, and dehydration are
common. Diarrhoea can be absent in the early stages
of infection, and usually occurs 24 to 48 hours after onset
of vomiting. The diarrhoea can often be profuse and
haemorrhagic. Hypothermia, icterus, and disseminated
intravascular coagulation are typically seen in severe
cases with bacterial sepsis or endotoxaemia. Clinical
signs can be exacerbated with concurrent infection with
distemper virus, coronavirus, Giardia, Salmonella,
Campylobacter, or intestinal parasites.
Diagnosis
The diagnosis is often made tentatively on the basis of
clinical details, history, and physical examination findings.
A history of sudden onset of vomiting and diarrhoea in a
young dog, particularly if the puppy is unvaccinated or
only partially vaccinated, warrants consideration. The
presence of neutropaenia on the haemogram in associa-
tion with signs of enteritis is suggestive of CPV; however,
salmonellosis or severe infections can also be associated
with neutropaenia. There are no pathognomonic findings
on a serum biochemistry profile, although hypoglycaemia,
hypokalemia, prerenal azotaemia, and increased bilirubin
or liver enzymes are commonly found. Abdominal radio-
graphs are indicated to help rule out an intestinal foreign
body, and may reveal intestinal gas, intestinal fluid, and
ileus. A faecal ELISA test for CPV-2 should always be done
on faeces, even if diarrhoea is not present. The test is
considered sensitive and specific; however, the ELISA test
may be negative if the assay is performed early in the
clinical course of the disease, or after 10-14 days following
infection. Other tests that can be done to confirm the
diagnosis of CPV include electron microscopic evaluation
Iams Clinical Nutrition Symposium | 2005
of the faeces for the presence of the virus (CPV-1 is indis-
tinguishable from CPV-2), haemagglutination inhibition
for serum IgM, histopathology of intestinal lesions, and
immunohistochemistry of intestinal biopsies.
Treatment
Treatment is supportive and similar to other severe,
acute infectious enteropathies. Intravenous fluid and
electrolyte therapy is indicated, with particular attention
given to potassium repletion. The intramedullary route
can be utilised in very small puppies; the subcutaneous
route is likely to be inadequate. Dextrose solution (2.5-
5%) is added to the IV fluids if the dog is hypoglycaemic.
Plasma or colloids (dextran 70 or hetastarch) are indicated
if the serum albumin concentration drops below 20 g/l.
Antibiotics are administered to febrile or severely neutro-
paenic dogs. If the animal is neutropaenic, but afebrile,
the administration of a first-generation cephalosporin is
reasonable. Dogs in septic shock should be treated with a
broad-spectrum aerobic and anaerobic antibiotic (e.g.,
ampicillin plus amikacin). Human granulocyte colony-
stimulating factor (G-CSF) at 5 µg/kg q 24 h subcutaneously
or intravenously has been used to increase neutrophil
numbers, but may not influence patient outcome,
whereas some benefit has been shown for ω-interferon.
Antiemetics such as prochlorperazine, metoclopramide,
or ondansetron, are indicated if the vomiting is intractable.
Metoclopramide is most effective when administered as
a constant rate infusion at a dose of 1mg/kg/24hours.
Gastric protectants including H2-receptor antagonists and
sucralfate are indicated if there is evidence of secondary
oesophagitis. Broad spectrum anthelmintics to treat con-
current intestinal parasites should be administered
when the dog is no longer vomiting. Most dogs can be
gradually weaned onto a bland diet of cottage cheese
and rice, or a commercially available highly digestible
intestinal diet; however, the presence of intractable
vomiting might warrant the administration of partial or
total parenteral nutrition.
Feline Panleucopaenia (FP)
Feline Panleucopaenia is a viral disease characterised by
fever, depression, anorexia, vomiting, and diarrhoea.
Historically, feline panleucopaenia was caused exclusive-
ly by feline panleucopaenia virus (FPV); however, it has
47 |
now been confirmed that FP can be caused by CPV-2a
and CPV-2b.18 Feline panleucopaenia has become an
uncommon disease because of routine vaccination; howe-
ver, outbreaks are occasionally seen in unvaccinated ani-
mals, particularly feral populations and catteries. The clini-
cal signs are similar to those described for dogs with par-
voviral enteritis.
Diagnosis
Diagnosis is based on the history, physical examination
findings, results of a haemogram (neutropaenia), and fae-
cal ELISA. The ELISA test used to detect canine parvovirus
has been reported to cross-react with feline parvovirus.
Treatment
Treatment is supportive and virtually identical to that
described for the dog with parvovirus enteritis.
Empiric therapy for puppies and kittens with diarrhoea
of unknown cause
Unlike acute diarrhoea, which is often self-limiting and
may be managed with symptomatic or supportive therapy,
chronic diarrhoea usually requires specific diagnosis and
therapy. Finding intestinal parasites in the faeces of a
puppy or kitten with diarrhoea does not establish
parasitism as the cause of the intestinal disease, although
many puppies and kittens will show a partial or complete
resolution of clinical signs following administration of a
broad-spectrum anthelmintic. Diarrhoeic puppies and
kittens should be empirically dewormed even in the face
of a negative faecal flotation. Serologic screening for FeLV
is recommended for kittens with chronic diarrhoea that
have not responded to antiparasitic and dietary therapy.
Metronidazole administration is often associated with some
amelioration of diarrhoea, possibly due to alteration of the
intestinal microflora, dampening cell-mediated immunity,
or killing a specific pathogen such as Clostridium difficile.
Dietary modification should be considered in puppies and
kittens failing to respond to empiric antiparasitic therapy
and metronidazole administration.
The author frequently utilises commercial intestinal
diets, and has had success utilising a diet for puppies that
is highly digestible and contains fermentable fibres
(Eukanuba Veterinary Diet Intestinal Formula for Puppies).
Kittens failing to improve on a standard commercial diet
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can be fed a diet containing a select protein source
(Eukanuba Veterinary Diet Dermatosis LB Formula for
Cats). Alternatively, a home-cooked turkey or chicken diet
(without carbohydrates) can be fed for 5-10 days before
balancing this diet or switching to a commercial diet
containing a similar protein source. Dietary fat restriction
does not appear to be as important in cats with intestinal
disease as it is in dogs. Home-cooked diets are not com-
plete and balanced, and should not be fed to puppies and
kittens for more than 10 days.
Inflammatory bowel disease is primarily a disease of
middle-aged to older dogs and cats, and puppies and kittens
are more likely to have diarrhoea due to an infectious
cause. The author discourages the administration of
prednisone to diarrhoeic puppies and kittens unless a
comprehensive work-up, including intestinal biopsies,
warrants this therapy. Puppies and kittens with chronic
ileitis could have secondary deficiencies of vitamin B12
(cobalamin), an important micronutrient for DNA
replication in the intestinal crypts. Vitamin B12 can be
administered empirically to puppies and kittens at
100 - 200 µg per kitten or puppy, respectively, given sub-
cutaneously once weekly for 4-6 weeks. Repeat injections
should be based on determination of serum cobalamin
concentrations. Cobalamin is safe, easy to administer,
and cheap. Use of pre- and probiotics for diarrhoeic
animals has recently received tremendous attention;
however, most studies completed to date have not been
performed in animals with clinical disease. Furthermore,
caution should be heeded when purchasing over-the-
counter commercial probiotics because there is little federal
regulation and quality control over many products, and
label descriptions do not always match the ingredients.
When facing a diarrhoeic puppy or kitten that is not
responding to therapy and for which a diagnosis has not
been made, it is often more helpful to repeat previously
negative diagnostic tests as opposed to performing
endoscopy and biopsy.
Summary
The presentation at the clinic of a new puppy or kitten
with diarrhoea must be managed promptly to ensure
appropriate health care is implemented before potential
life-threatening developments can take place. Infectious
causes of diarrhoea are believed to play an important
Iams Clinical Nutrition Symposium | 2005
role in many of these cases, and implementation of simple
bench-top techniques such as faecal flotation, faecal wet
preparation, and judicious use of faecal ELISA’s for
bacteria or viruses should give a diagnosis in the majority
of cases. Appropriate anthelmintic administration, fluid
and electrolyte administration, dietary modification, and
avoidance of indiscriminate antibiotic administration
should ensure a successful outcome in most cases.
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