FCoV-23: Is it driving the Cyprus FIP Outbreak?

This month Nathalie Dowgray is joined by Dr Charalampos Attipa, a researcher at the University of Edinburgh who has been investigating the causes of the FIP outbreak in Cyprus. We also feature our monthly JFMS Clinical Spotlight interview in which Nathalie discussed the diagnostic approach to invasive fungal infections with Professor Vanessa Barrs.

2023 saw a large spike in cases of FIP amongst Cypriot cats. Dr Attipa has been part of an international collaboration investigating the cause of this increase in cases and explains how and why FCOV-23 is different.

We are then joined by Prof. Barrs to discuss how climate change is causing alterations in the distribution of fungal diseases globally. We discuss what we should be aware of and how to diagnose invasive fungal infections.

Stay tuned for part two of our interview with Vanessa, where we discuss treatment, which will be available in the coming months!

For further reading material please visit:

https://www.biorxiv.org/content/10.1101/2023.11.08.566182v2.full.pdf

https://journals.sagepub.com/doi/full/10.1177/1098612X231219696

View The Transcript Here

If you are interested in learning more about the situation with FIP in Cyprus, please follow the link to sign up to the EveryCat webinar:
https://everycat.org/webinar-feline-infectious-peritonitis-from-the-fcov-to-fcov23-the-cyprus-case-or-a-new-perspective-in-the-way-we-see-coronaviruses/

For ISFM members, full recordings of each episode of the podcast is available for you to listen to at portal.icatcare.org. To become an ISFM member, or find out more about our Cat Friendly schemes, visit icatcare.org


Host:
Nathalie Dowgray, BVSc, MANZCVS, PgDip, MRCVS, PhD, Head of ISFM, International Society of Feline Medicine, International Cat Care, Tisbury, Wiltshire, UK

Speakers:
Charalampos Attipa, DVM, MRes, MVetMED, PhD, DipACVP, MRCVS, RVCS & American Recognised Specialist in Veterinary Clinical Pathology

Vanessa Barrs, BVSc (Hons), PhD, MVetClinStud, FANZCVS (Feline Medicine), Registered specialist in Feline Medicine, Dean of Hong Kong Veterinary School and past president of the International Society of Companion Animal Infectious Diseases.

Creators and Guests

Host

Nathalie Dowgray

What is Chattering with iCatCare?

Welcome to Chattering With iCatCare, the official monthly podcast of International Cat Care, hosted by Yaiza Gomez-Mejias (Veterinary Community Co-ordinator). Each month, we chatter about cats and cat-friendly practices with industry experts and contributors to The Journal of Feline Medicine and Surgery. Each episode contains highlights from our longer discussions and interviews, which are accessible to iCatCare members at portal.icatcare.org. If you would like access to our full episodes, would like to become an iCatCare Veterinary Society Member, or find out more about our Cat-Friendly schemes, visit icatcare.org.

Nathalie Dowgray: Hello, welcome to the
January episode of Chattering with ISFM.

I'm Nathalie Dowgray, Head of ISFM
and host of this month's podcast.

First up this month, I'm speaking with Dr.

Charalampos Attipa, who's been involved
in the research work investigating the

feline coronavirus infection that's
led to the outbreak of FIP in Cyprus.

We're also featuring our monthly
JFMS clinical spotlight interview.

This month, the focus is on the diagnosis
of invasive fungal infections.I'm speaking

with Professor Vanessa Barrs on the
first of her two articles on the subject.

We'll be back again in a few months
talking with Vanessa about the treatment

of these infections, but this month we're
going to be focusing on the diagnosis.

How did you first hear about the FIP
outbreak that was occurring in Cyprus?

Charalampos Attipa: Yeah.

I was actually writing my thesis back
then in January, and I was actually

in Cyprus at the time, and we set
up a small laboratory in Cyprus.

The small laboratory was working the past
two years, and this was this January, we

started receiving a lot of fluids, a lot
of CSF,we have a lot of cats with ascites.

So yeah, actually it was there
when everything unfolded in front

of our eyes and we picked it up
via a clinical pathology route.

Nathalie Dowgray: So for those of the
audience, like me, who aren't virologists,

what can you say is different about
this strain of feline coronavirus?

Charalampos Attipa: Obviously, of
course, as we know, when it comes

to feline coronavirus, we have two
biotypes, the enteric version as well

as the feline infection peritonitis.

Now, what happened with feline infection
peritonitis, this random event inside

the cat that is causing a single base
mutation, typically in the spike of

the of the enteric version and the
feline infection peritonitis version

of the virus appears that is getting
functionality and increase virulence.

However, it loses this
ability to transmit.

So nature managed to balance,
to become more pathogenic, but

it's not transmissible anymore.

What happened in this case of
FCOV23 is that not only do we have

a gain of functionality, increased
virulence, however, we also had

an increased transmissibility.

It was not the case with
the previous FIPV viruses.

So that's why this outbreak
started, because this mutation

also became transmissible.

Nathalie Dowgray: These sort of changes
really then are indicating it's the

increased transmissibility that's really
leading to the increased FIP cases.

Is that right?

Charalampos Attipa: Absolutely.

Yes.

And here what we have, we
don't have that, just a single

nucleotide single based mutation.

In this case, we have the entire
insertion of the spike protein from

a dog pantropic canine coronaviruses.

So the kind of spike protein
from a canine coronavirus.

In that case, a very nasty canine
coronavirus came and was inserted in the

feline coronavirus that led to this new
FCOV23 virus and somehow we didn't have

just a simple combination of just one pair
base, but the entire spike protein of the

dog got inserted to the feline coronavirus
and that gave them that transmissibility.

And again, this dog pantropic
coronavirus has been circulating

in Greece and presumably Balkan and
all Middle East for a few decades

and caused a very nasty disease.

And pantropic means that it was
in many cells and is causing

much more severe disease in dogs.

So most likely that gave a lot of
properties and transmissibility to

the new virus that emerged in Cyprus.

Nathalie Dowgray: Gosh.

And so potentially this is something that
could happen again in these countries

where the pantropic canine virus is?

Charalampos Attipa: Potentially, yes.

Maybe potentially this is what
happened to that historic outbreak

that was reported in Greece a few
decades ago, was never published.

So potentially there was something to
do with this kind of pantropic virus.

In this case, however,
it's something beyond that.

The virus is very stable.

Pretty much all the cases of FIP has
the same virus from January to today.

Of course, we do see some cases of FIP
with the classic virus, but the vast

majority of them is this new FCOV23.

Nathalie Dowgray: What we've seen is not
necessarily a benefit of the coronavirus

outbreak that we've experienced in the
human side of things, um, it's had a

benefit for our FIP cases in the sense
that we've now got a lot more availability

and use of antivirals for our cats.

Um, but also on the people side of
things, it's led to a massive rise

in the development of vaccines.

Um, do you think we're going to see
the same for, for our feline cases?

Charalampos Attipa: Yeah.

Another positive thing with this
devastating outbreak is that at

the moment there's a huge media
attention to FIP in the cat population

and also the sparked interest.

And obviously because it's
also coronavirus, it's spiking

the interest even more.

So at the moment, there is a lot
of discussion from some of the big

pharmaceutical companies to potentially
manufacture a new vaccine for FIP.

As there's already one that's already
available, but it's not very effective.

And I think also your society does
not suggest to use that vaccine.

So we need a new, much more
effective vaccine for our cats.

So potentially, this is something
that can happen in the future.

This echoes so well what has happened
with the human COVID 19 pandemic.

Initially, there was no vaccine.

Suddenly, there is plethora of vaccines.

And now that accelerate the mRNA vaccines,
we actually have brought a revolution in

all vaccinology, not only for SARS COV 19.

Nathalie Dowgray: In terms of this
sort of event and this change that's

increasing the risk of transmissibility,
is there any indication that we maybe

should be doing something different
to try and prevent cats from becoming

exposed to this strain compared to
our normal preventative measures?

Is it still an oral faecal transmission?

Charalampos Attipa: Usually we are
suspecting, and obviously coronavirus

is that it would transmit naturally,
and this is what we suspect

is happening also with COV 23.

Again, we need to do more experiments,
we need to culture the virus, and

obviously do some more epidemiological
work to answer that question.

But the fact that the same virus is
present throughout the island, every

month, indicates that this is the most
likely cause, way of transmission.

Currently there is a
suspected case in Netherlands.

And the very interesting thing is
that the cat was imported to the

Netherlands in March from Cyprus.

It has only developed clinical signs now.

So this is something very
strange, having such a long

incubation period of six months.

So again, this is
something very interesting.

It's something very new.

We haven't published yet, 1st time
to hear it here in this podcast is

that at the moment, we've seen cycles
of an increased of, it's called dry

forms of FIP we see way more now.

So mostly, the haemological
changes, the new response changes.

Also the, the way that the
case presents is changing.

Nathalie Dowgray: So tthat's really
concerning in the sense that we might

have quite a long tail, especially with
cats that may have been transported out

of Cyprus and to other countries, where
maybe there isn't that awareness yet.

So hopefully we'll raise a
bit more awareness through

doing this podcast as well.

Thank you so much for your time.

Charalampos Attipa: Oh, thank you so much.

Nathalie Dowgray: And now I'm speaking
with Professor Vanessa Barrs on

invasive fungal infections and oomycosis
in cats, the diagnostic approach.

I was wondering what you would advise
we do as a general sort of baseline

workup in cases where we're potentially
suspecting an invasive fungal infection?

Vanessa Barrs: Yeah, look, I think
that's a good case for doing basic

CBC biochem and retrovirus testing,
which I always do for sick cats to

just know if they've got FIV or FELV.

It doesn't mean that you can't treat
them, but it's always good to be

informed because you might need to
treat them for a little bit longer.

And, even with the CBC, even though
there's not specific changes,

sometimes there's little flags.

And hyperglobulinemia is not just all
about FIP, I know that's probably what

most people commonly think of when
they see a hyperglobulinemia in a cat

but it can be quite common in these
invasive fungal infections as well.

In fact, I think about 60 percent of
cats with sporotrichosis will have

hyperglobulinemia, in some of the
invasive aspergillosis, like sino-orbital

aspergillosis, it's quite common as well.

So that can be a little flag.

And of course, eosinophilia, don't
just think allergy or parasites.

It's not that common, but when it occurs,
I always think about fungi as well.

You know, you think about fungal
inflammation, you get fungal

granulomas and they're full of
monocytes, and you can get activation

of the vitamin D pathway there.

So that can cause hypercalcemia and that's
been seen in things like dermatophytic

pseudomycetoma, histoplasmosis,
blastomycosis, things like that.

I would start there and then I would
move on to the fungal antigen or antibody

tests.

Nathalie Dowgray: Cool.

And how would you recommend we approach
those discussions maybe with our local

laboratory to find out what testing is
available and what the advantages and

disadvantages of the tests that they have?

Vanessa Barrs: I think the first thing is
to think about what's likely to occur in

your area and you're going to be thinking
not only about where you're practising

, but also what kind of clinical signs
your animal is presenting with.

So, anywhere in the world, if you've
got a cat with nasal signs, you

might want to think about ruling out
cryptococcosis and the great thing about

cryptococcosis is that you can make a
definitive diagnosis on a blood test, a

non invasive blood test, which is great.

And then if you're practicing in the
Midwestern, South Central, or Southeast

US and you've got a cat that's got
respiratory distress or or tachypnoea

or dyspnoea, you might be thinking about
doing a histoplasma antigen test on urine.

But then if you're working in Arizona
and you've got a cat with the same

signs, you might think about doing
serology testing for coccidioidomycosis.

So that's the first things to think about.

And then the next thing would be to get on
the phone and ask your lab to provide you

with some data on the prevalence because
they're the ones that are providing the

tests and they should be able to let you
know what they're seeing most commonly,

but it's also good to ask them about,
what is the test that they're using and do

they have any data on the efficacy of it?

A lot of these tests have been
published in terms of sensitivity

and specificity has been
investigated by feline researchers.

So, ask the lab to provide you with
those references and that can really

help you as a vet work out whether
you've been using that test or not.

Nathalie Dowgray: And actually,
that's I guess another source of

kind of monitoring data, isn't it?

Looking at the lab, what's being
submitted, what's coming back positive,

again, is another source for us looking
at changes and spread over time.

In terms of the workup, obviously
advanced imaging then came up again,

depending on presenting signs.

And how, how do you decide
what modality to use?

Vanessa Barrs: IIt depends on which
part of the cat you're going to image.

So what is the clinical
presentation, and also, what

modality you've got available to you.

When it comes to choice between
between CT and radiography.

If it's a cat with nasal signs, if I've
got the option of doing a CT first off,

that would be wonderful because obviously
you can get really good information about

the soft tissues as well as the bony
structures without any problems oof super

imposition of soft tissues and bone that
might obscure the underlying pathology.

So, that's great.

But, you might not have
the option of that.

And in that situation, then, plain
radiography is a good place to start.

Also you want to think about, what
is the best return diagnostically for

you and financially for your owner?

And if it's a case that you know is going
to be referred, then you might think about

whether it can just be done all at once.

If it's a cat that's got neurological
signs and you're thinking about

fungal infections, it might have
upper respiratory signs as well.

Obviously in that situation, the modality
that I really want to use this is an MRI.

But if in doubt, there's quite a lot
of fungal infections that do have

some abnormalities on chest x rays.

So, it would never be a bad
thing to take a chest x ray.

Nathalie Dowgray: So, is there
anything additional we need to

mention to the lab when we're
sending the fluid in for cytology?

Vanessa Barrs: It's always good if you're
suspecting a fungal infection just to

let them know that it's one possibility
because, often for things like BAL, when

they're doing cytology, they're going
to be using dif quick or other modified

Romanowsky type stains, and sometimes the
fungal elements are negatively staining.

So, if it's something you've flagged,
your pathologist might just spend a little

bit more time looking at the sample.

Nathalie Dowgray: Now that makes sense.

Brilliant.

Oh, thank you for that.

I think that's been really helpful to
start to think about these kinds of

infections, how they might be increasing
in prevalence and what we need to be

thinking about to, to diagnose them.

So, part two of our podcast with
you is then going to be very

much focusing on the treatment.

So that will be coming for, for people
in the, in the next few months, but thank

you very much for, for talking about
the diagnosis with us today, Vanessa.

Vanessa Barrs: Oh, that's
my absolute pleasure.

Thank you Nathalie

Nathalie Dowgray: Thank you for listening.

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