Clinical/research abstracts accepted for presentation at the ISFM 2021 World Feline Congress

Clinical/research abstracts accepted for presentation at the ISFM 2021 World Feline Congress

The aim of this study was to collect information on signs of travel anxiety in cats and the use of medications and other products to alleviate those signs. Cat owners in the UK and USA were contacted via email and/or social media, and a questionnaire was shared via a public web link. The survey was produced using Webropol 3.0.
In total, 364 owners (UK: 261; USA: 103) completed the survey for 451 cats (UK: 326; USA: 125) with travel anxiety. The most common signs were vocalisation (80%), abnormal activity (40%) and panting (30%). Eighty percent had started showing signs at a young age, and the travel anxiety had either worsened or not changed over time. Many cats also showed similar signs in other situations, such as when placed in a carrier box (36%), visiting a veterinary clinic (35%) or when exposed to any new environment (15%).
Pheromones (14%) and other non-medicinal products (10%) were most frequently used to alleviate signs of anxiety during transportation, but were often assessed to have a poor (55%) or only some (35%) effect. Few owners (2%) had used off-label prescription medicines. However, most (61%) were interested in trying a registered prescription medicine for travel anxiety if there was one available for cats. An oral solution, gel or paste were preferred over a tablet formulation.
This survey increases the knowledge about the signs of travel anxiety in cats, and medications and other products currently used to manage the problem. It shows that there is a clear unmet need to effectively relieve cats' anxiety during transportation.
Medicating cats can be challenging. Attempts to medicate can negatively affect the owner-cat relationship and result in owner injury, failure to complete medication courses and reluctance to seek veterinary care.
An online survey asked owners to consider their experience of medicating their cat and rate the difficulty of administering tablets and liquids using a 1-10 scale (1 being easy and 10 being impossible). Owners were also asked how they gave the medication, what their medication formulation preference was, if medicating their cat had affected their relationship and if their cat had shown negative behavioural responses to being medicated.
This abstract reports the results of 1356 complete survey responses from cat owners without veterinary/cat professional training obtained in the first 4 weeks of the survey. Regarding tablets, 44% of owners gave these in food or a treat (22% crushed and 22% whole) and 55% gave them directly into the mouth (43% by hand and 12% with a pill-giving device). Regarding liquids, 32% of owners gave these in food or a treat (9% liquid treat and 23% in food) and 67% gave them directly into the mouth. The table shows rating of ease of administration of tablets and liquids for those with experience of these formulations.
Given the choice of any medication formulation, 54% would opt for liquid and 29% would choose tablets. Thirty-two percent of owners felt medicating their cat had changed their relationship with their cat and 73% of cats showed negative behavioural responses to medicating (eg, running away from the owner, more wary of the owner). A total of 752 feline histopathology records obtained in 2019, at a nation-wide veterinary laboratory in Portugal, were included. Data regarding breed, sex, age, type of tumour, malignancy and metastasis were recorded. Statistical analysis was conducted to detect associations between variables using an alpha value of 0.05.
Statistical analysis showed that tumour malignancy was associated with older cats (mean age of 10.9 years, P <0.001). Furthermore, sex was associated with tumour type, since all the mammary tumours were diagnosed in female cats.
To the best of our knowledge, this is the first retrospective study of this type conducted in Portugal. Given the high frequency of malignant tumours, early diagnosis and screening for nodules is of paramount importance, both at home and during veterinary consultations. A 13-year-old female cat was admitted to a primary clinic with cholangitis. Despite initial improvement with cefalexin and metronidazole antimicrobial therapy, the cat developed prostration, anorexia and vomiting. An oesophagostomy tube was inserted. Within 7 days, the cat was referred to the Hospital Veterinário Arco do Cego due to fever and prostration. Tumefaction was present at the tube insertion site, from where a swab was collected.

A B S T R A C T S / ISFM 2021 World Feline Congress
An extended-spectrum beta-lactamase (ESBL)/carbapenemase-producing Klebsiella pneumoniae ST273 lineage harbouring the bla OXA-181 , bla CTX-M-15 and bla SHV-1 genes was isolated, and was only susceptible to amikacin and gentamicin (minimum inhibitory concentration [MIC] ⩽8 mg/l and ⩽2 mg/l, respectively). Considering the cat's age, the use of aminoglycosides was not ideal. As a therapeutic approach, the oesophagostomy tube was removed, and the wound was surgically cleaned. Antimicrobial treatment included metronizadole (18 mg/kg), enrofloxacin (5 mg/kg) and amoxicillin-clavulanate (25 mg/kg q12h).
The rationale behind the antimicrobial treatment protocol chosen for this case was to aid the cat's immune system by giving it time to respond to infection and avoid additional secondary infections. Furthermore, by removing the source of infection (oesophagostomy tube), and with the consequent removal of biofilm, a reduction in bacterial load was likely. On re-evaluation 12 days later, the cat's appetite had returned and haemogram levels were normal, and it was discharged.
This case highlights the importance of adjuvant measures in treatment of infection associated with medical devices (eg, surgical cleaning) and how first/second-line antibiotics were enough to prevent using antimicrobials reserved for human use. This is particularly important in the treatment of biofilm-producing bacteria that are resistant to critically important antimicrobials such as carbapenems.

Ioana C Tudor
Leal Márquez Veterinary Center, Cáceres, Spain Email: clinicavetmarquez@hotmail.com Pancreatic cysts are generally considered benign incidental findings. Here, we report a case of chronic pancreatitis secondary to true pancreatic cysts.
A 7-year-old castrated male domestic shorthair cat presented with chronic vomiting, which had increased in frequency over the previous month. The patient was an indoor cat, feline leukaemia virus/feline infectious peritonitis negative and up to date on vaccinations. Clinical examination and basic blood tests were normal.
On ultrasound we identified several anechoic structures on both pancreatic lobes, with an increased size of the pancreatic body. Feline pancreatic lipase (fPLI) levels were 6.1 µg/l (reference interval <3.5 µg/l).
Surgical treatment was performed 1 month later, at which point fPLI levels had increased to 9.3 µg/l. The pancreas was exposed via a midline laparotomy and the fluid-filled structures on the pancreas were drained, opened and omentalised. Samples were collected for biochemical and microbiological study of the cystic liquid, as well as histopathological study of the cystic wall and a pancreatic biopsy.
Histopathology revealed benign nodular hyperplasia of the pancreas, with amyloid deposits, and an epithelial lining with secretory cells consistent with the final diagnosis of a true pancreatic cyst. The patient recovered uneventfully from surgery and no further vomiting had been reported at the time of writing. Three months after surgery the fPLI value was 5.9 µg/dl. Long-term treatment involves S-adenosylmethionine and a low carbohydrate diet.
Serial ultrasound examinations have been scheduled to monitor for any relapse of the pancreatic cyst or chronic pancreatitis.

EUGLYCAEMIC EPISODE AFTER TRAMADOL ADMINISTRATION IN A CAT WITH DIABETIC KETOACIDOSIS
Eirini Sarpekidou, Eirini Dimopoulou, George Kazakos Companion Animal Clinic, School of Veterinary Medicine, Aristotle University of Thessaloniki, Greece Email: e.sarpekidou@gmail.com Tramadol is an analgesic agent that has been associated with hypoglycaemia in diabetic human and rat models. This report describes a euglycaemic episode after tramadol administration in a cat with diabetic ketoacidosis.
A 7-year-old intact male domestic shorthair diabetic cat was presented at the emergency department of the Companion Animal Clinic for the management of diabetic ketoacidosis. At presentation, after having been missing for 24 h, the cat was lethargic, hypotensive and had severe hypothermia; blood glucose was 485 mg/dl (reference interval [RI] 60-120) and blood ketones were 1.7 mmol/l (RI 0.86-1.03). A hard palate fracture was also revealed.
Imaging, complete blood count and routine laboratory (blood urea nitrogen, creatinine, alkaline phosphatase, alanine aminotransferase, albumin) and serology testing were unremarkable. The cat initially received two intravenous boluses, 10 mg/kg each, of sodium chloride 0.9% over 15 mins, 1 IU of crystalline insulin intramuscularly (IM) and cefazolin (20 mg/kg) intravenously (IV). The patient responded to resuscitation measures (systolic blood pressure 80 mmHg and improvement of mentation); active rewarming and maintenance fluid therapy were then instigated. Over the next hour, the cat's temperature increased, glucose reached 410 mg/dl and hourly 0.1 IU of crystalline insulin IM was instituted in order to avoid sudden hypoglycemia. In addition, 2 mg/kg tramadol was administered IV for pain relief.
Four hours later, the glucose concentration was 80 mg/dl. Crystalline insulin was thus discontinued and a dextrose 5% infusion was started. Preparation for the transition to feeding and, when feasible, twice daily subcutaneous insulin administration was then initiated.
This abrupt glucose concentration decline was potentially contributed to by tramadol administration. Klebsiella pneumoniae ST348 is an emerging clonal lineage in human infections that is frequently associated with the dissemination of extendedspectrum beta-lactamases (ESBLs)/ carbapenemases. In a previous publication we detected, for the first time, to our knowledge, the ST348 clonal lineage in a cat. The aim of this study was to characterise this ST348 strain K pneumoniae in depth using whole genome sequencing (WGS).

JFMS CLINICAL PRACTICE 855
The K pneumoniae ST348 strain was obtained from a cat with a urinary tract infection. WGS was conducted on an Illumina HiSeq 4K (2x151bp). De novo assembly was carried out from raw sequence reads and the genome assemblies characterised for its resistomic and virulence gene content.
Cats are increasingly popular pets. Thus, the characterisation of emergent K pneumoniae clonal lineages harbouring antimicrobial-resistant mechanisms to CIA is crucial to understand the cat's role in antimicrobial resistance dissemination from a One Health perspective.

Bacterial cystitis is one of the most important reasons for the use of antimicrobials in veterinary medicine. Prevalences and resistances show great geographical variation, and are not reported for the UK. A retrospective analysis of feline urine samples collected by cystocentesis over a period of 2 years (2018-2019) was performed. A total of 2712 samples was obtained, of which 425 (from different cats) documented a positive culture (15.7%), with a total of 444 bacterial isolates. Escherichia coli (43.7%), miscellaneous Enterobacteriaceae (26.4%),
Enterococcus species (14.9%) and Staphylococcus species (9.2%) were the most commonly isolated bacteria.
This study documented bacteria with significant resistance to frequently used antibiotics. Compared with other studies, Enterococcus species were much less susceptible to trimethoprim/sulfamethoxazole. Well-defined indications for antimicrobial use and well-justified choices of antimicrobials based on susceptibility testing are therefore mandatory to avoid the development of further resistant bacteria.

The International Society of Feline Medicine Cat Friendly Clinic accreditation scheme grants veterinary practices Cat Friendly Clinic status based on the implementation of a number of measures aimed to reduce stress in cats while visiting the clinic. The objective of this study was to assess if there was a difference in reported frequency of cat-related injuries to staff in clinics accredited under this scheme compared with non-accredited practices.
The rate of cat-related injuries was retrospectively analysed in practices from the UK CVS Group. A report of all cat-related injuries per site over a 16-month period from 16 April 2019 to 13 August 2020 was generated from the online health and safety accident reporting system, and then the injury rate expressed per 1000 cat visits per year for each practice. During this period, 221/384 practices using the system recorded cat-related injuries, of which 82 practices were accredited with ISFM Cat Friendly Clinic status. Clinics with no reports were omitted from analysis, as we were unable to decipher whether this was due to no reporting or no actual injuries.
The difference in injury rates between clinics that were ISFM Cat Friendly Clinic accredited and those that were not was investigated using a Wilcoxon rank sum test (see table).
ISFM-accredited Cat Friendly Clinics had a significantly lower (P = 0.023) rate of cat-related injury, suggesting that there is a potential benefit to staff safety in accrediting via this scheme.

< This abstract won both the Scientific Committee
Best Abstract Award and the Delegates' Choice Best Poster Award.

Treatments for feline diabetes mellitus (DM) have evolved over the past two decades and diabetic remission is nowadays considered a realistic treatment goal.
A questionnaire was sent to owners of cats treated for DM (n = 405). The questions concerned factors associated with the cat (eg, age and indoor/outdoor status), the owner and household (eg, age and place of residence), treatment and disease monitoring (eg, insulin and type of diet) and the impact of DM on the quality of life (QoL) of the cat. Data were analysed with multiple regression with diabetic remission as outcome, and odds ratios (ORs) were calculated with a 95% confidence interval (CI).
Nearly a third (n = 118, 29%) of the cats achieved remission, of which 38% experienced relapse. Cats fed predominantly a commercially available wet food (low carbohydrate diet) after diagnosis had an increased chance of achieving both remission (OR 2.5, CI 1.3-5.2, P = 0.008) and permanent remission (OR 9.2, CI 1.9-4.6, P = 0.02). In cats with a negative effect of DM on QoL, there was a negative association with remission (OR 0.15, CI 0.1-0.4, P = 0.00005) compared with cats with a QoL that had been improved since a DM diagnosis. Similarly, a deterioration in the cat's QoL was associated with relapse from remission (OR 0.02, CI 0-0.14, P = 0.0012).

A B S T R A C T S / ISFM 2021 World Feline Congress
We show that feeding a commercial wet diet may be preferred to achieve and maintain remission in cats with DM. Further, the association between QoL and remission emphasises the significance of remission as a goal of treatment, and the importance of assessing QoL when evaluating treatment success. This abstract describes the clinical presentation and necropsy findings of a 4-year-old male mixedbreed cat that received topical administration of a 5% minoxidil spray solution, and which also had oral exposure to the solution via grooming. The solution had been applied on the thoracolumbar region. The first application was 48 h, and the second application 4 h, prior to presentation. Topical use of minoxidil had been prescribed due to severe alopecia.

MINOXIDIL INTOXICATION IN A CAT
Clinical examination revealed hypothermia (34.3ºC), acute sialorrhea, dyspnea, tachypnea (70 breaths per min), tachycardia (220 beats per min), hypertension (160 mmHg), pulmonary edema, pleural effusion, cyanotic mucous membranes and 5% dehydration. Oxygen therapy, fluid therapy with lactated Ringer's solution and furosemide were instituted as supportive treatment. In addition, 100 ml of yellowish liquid was drained by thoracocentesis and residues of the substance were washed out from the oral mucosa. A blood test revealed hyperglycemia and high levels of alanine aminotransferase. The cat experienced cardiopulmonary arrest 8 h after admission, with no response to cardiopulmonary resuscitation.
Necropsy revealed pulmonary congestion, with severe pulmonary edema, hepatomegaly, nephromegaly, hydropericardium and hemorrhagic areas in the heart. Histopathology revealed hepatocellular edema, as well as interstitial edema in cardiac myofibrils, fibrinoid necrosis of blood vessels, necrotic cardiomyocytes and mild lymphoplasmacytic myocarditis, suggestive of minoxidil intoxication. Moreover, severe acute tubular degeneration was observed in the kidneys.
Minoxidil is an antihypertensive drug that acts as a systemic vasodilator; its side effect of hypertrichosis in humans results in it also being prescribed for the treatment of hair loss. A few studies have reported oral toxicity in dogs and one study suggested toxicity in cats after topical exposure. Minoxidil toxicosis has an unfavorable clinical outcome and therefore minoxidil must not be applied directly to cats. In addition, cats should be prevented from having contact with the hair (or pillows) of owners who are being treated with minoxidil.  Cat allergy is a very common condition that can affect cat welfare owing to it causing the owner to decrease their interaction with their cat. Also, one of the top five reasons for cats being relinquished is their owners being allergic to them. The aim of this study was to determine the effect of cat allergy on owner-cat interaction. An online survey of cat owners was carried out independently of whether they were allergic or not. In total, 710 people answered the survey. From the results, it was found that >98% of owners talk, pet and enjoy watching their cats, >94% hug and relax with their cats and ~84% kiss and play with their cats more than once a day. Of those surveyed, 25.1% were allergic to cats, 58% were not allergic and 16.9% were not sure. Of the owners with allergy, 55.6% were diagnosed by a doctor, and 34% were advised to give their cat(s) up for adoption, but 94.4% of those advised to give up their cats dismissed this suggestion. In order to avoid allergen exposure, 17.1% of allergic owners interacted less frequently with their cats. If there was an effective treatment for their condition, 55% of allergic owners believe that the relationship with their cat(s) would improve, because they could interact with them more often. When asked how their personal life would change, 42.1% answered that their social life would improve.

EFFECT OF CAT ALLERGY ON PET OWNER-CAT INTERACTION
The majority of owners have a high interaction level with their cats irrespective of whether they are allergic or not to them, but in an important proportion (17.5%), the relationship was affected. An effective treatment for cat allergy would improve not only owner-cat interaction but, based on the results of this study, also the owner's personal/social life. A stray male domestic shorthair cat that was positive for feline immunodeficiency virus was presented after being rescued in Collado Villalba, Madrid. The cat was in very poor body condition (body condition score 3/9). There was a fleshy mass on the medial canthus of the left eye's corneal surface and also an ulcerated sublingual nodule. On cytology, negatively staining bacilli could be seen inside macrophages and scattered in the background. Histopathological examination of biopsy samples reported ulcerative pyogranulomatous keratitis and ulcerative pyogranulomatous necrotic glossitis. Ziehl-Neelsen staining was negative. Six weeks after presentation a subcutaneous nodule had appeared on the lateral side of the left tarsus. Cytological evaluation detected negatively staining bacilli. Histopathology of the nodule reported fibrotic pyogranulomatous dermatitis. Ziehl-Neelsen staining was negative. Mycobacterium avium complex and Mycobacterium tuberculosis PCR were negative. Specific mycobacterial culture was negative. M lepraemurium infection was suspected.

MYCOBACTERIUM LEPRAEMURIUM INFECTION IN A CAT FROM MADRID, SPAIN
DNA was extracted from an ocular granuloma sample and submitted for PCR testing of the mycobacterial ITS region. The amplified product was sequenced using the same forward and reverse primers. The sequence obtained displayed 100% identity with that of M lepraemurium (strain Hawaii) in basic local alignment search tool (BLAST) analysis.
Pending the above results, the tarsal nodule became ulcerated. Empirical treatment with clarithromycin 62.5 mg q12h, rifampicin 75 mg q24h and marbofloxacin 10 mg q24h was administered PO. The cat responded very well. Fourteen months after initiating therapy all lesions had regressed completely. Treatment was discontinued. At the time of writing, 14 months after discontinuation of therapy, the cat remained free of disease. The level of resistance to third/fourth generation cephalosporins in Enterobacterales is a wellestablished problem in human medicine. The aim of this retrospective study (performed between January 2017 and December 2020) was to assess prevalence and trends of extended-spectrum betalactamase (ESBL)-producing Enterobacterales (ESBL-E) causing infections in cats.

RISING TRENDS ON EXTENDED-SPECTRUM BETA-LACTAMASE-PRODUCING ENTEROBACTERALES CLINICAL STRAINS FROM CATS
In total, 5606 samples were submitted for culture. Each sample was plated on standard media and ESBL-selective plates.
Of the submitted samples, 2058 were positive, of which 193 were positive for at least one ESBL-E (9.4%). In 2017, 12.4% samples were positive for ESBL-E. In 2019, this decreased to 7.6%, but in 2020 rose to 8.6% (Figure 1). Escherichia coli was the most prevalent species found (Figure 2), but only 17% of isolates were ESBL-producers. In contrast, 53% of Klebsiella species isolates were ESBL-producers.
The rising number of ESBL-E in cats poses daily therapeutic dilemmas concerning the use of highest priority critically important antimicrobials for humans, and emphasises the need to consider cats in close contact with other cats/humans as a potential microbiological hazard for feline and human health.
This study was financed through CIISA and FCT project UIDB/00276/2020; JMS holds an FCT PhD grant 2020.06540.BD and JM holds an FCT PhD Grant 2020.07562.BD. The interferon-gamma release assay (IGRA) is used to diagnose cases of feline mycobacteriosis, but the use of serial IGRA testing to monitor the response to treatment has not been evaluated in this species.

SERIAL INTERFERON-GAMMA RELEASE ASSAY TESTING TO MONITOR TREATMENT RESPONSES IN CASES OF FELINE MYCOBACTERIOSIS
Cats with mycobacterial disease were identified if they had a pretreatment and end of treatment IGRA performed. The number of cats that reverted to negative was assessed using a McNemar test. Antigen-specific optical density (OD) values for paired data were assessed using a Wilcoxon signed-rank test, and a Mann-Whitney test was performed to determine if cats that reverted to IGRA negativity had a lower pretreatment antigen-specific OD value. Factors to explain reversion to negativity and recurrence of disease post-treatment were explored using logistic regression.
Eighteen cats met the inclusion criteria for this study. All cats were positive on the pretreatment IGRA, with results suggestive of tuberculosis. Having achieved clinical resolution, only four cats (22%) reverted to IGRA negativity (P = 0.13). No statistically significant differences were identified between paired antigen-specific OD values (P >0.12), and cats that reverted to IGRA negativity did not have a lower pretreatment antigen-specific OD value (P = 0.68). Logistic regression identified no statistically significant factors predicting reversion to IGRA negativity (P >0.08), and remained positive at the end of treatment. IGRA was not associated with recurrence of mycobacterial disease post-treatment (P = 0.34).
Overall, these data suggest that IGRA testing at the point of apparent clinical resolution is of limited value. This is in line with human studies.

< Since being accepted for the ISFM 2021 World
Feline Congress, this abstract has been published as a full paper in the journal Pathogens, in May 2021, under a CC BY 4.0 license.