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

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

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

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

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

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

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

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

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

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

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

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Charalampos Attipa: Yeah.

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

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

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

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

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

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

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

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

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

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

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as the feline infection peritonitis.

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

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

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the of the enteric version and the
feline infection peritonitis version

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

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However, it loses this
ability to transmit.

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

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it's not transmissible anymore.

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

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

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an increased transmissibility.

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It was not the case with
the previous FIPV viruses.

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

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also became transmissible.

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

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

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Is that right?

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Charalampos Attipa: Absolutely.

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Yes.

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

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nucleotide single based mutation.

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

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a dog pantropic canine coronaviruses.

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So the kind of spike protein
from a canine coronavirus.

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

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

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

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

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And again, this dog pantropic
coronavirus has been circulating

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

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and caused a very nasty disease.

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

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much more severe disease in dogs.

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

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the new virus that emerged in Cyprus.

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Nathalie Dowgray: Gosh.

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

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where the pantropic canine virus is?

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Charalampos Attipa: Potentially, yes.

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Maybe potentially this is what
happened to that historic outbreak

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

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

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

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The virus is very stable.

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

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

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majority of them is this new FCOV23.

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

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

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

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and use of antivirals for our cats.

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

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in the development of vaccines.

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

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Charalampos Attipa: Yeah.

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Another positive thing with this
devastating outbreak is that at

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

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and also the sparked interest.

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

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the interest even more.

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

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pharmaceutical companies to potentially
manufacture a new vaccine for FIP.

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

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

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

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

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

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Initially, there was no vaccine.

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Suddenly, there is plethora of vaccines.

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

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all vaccinology, not only for SARS COV 19.

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

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

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

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exposed to this strain compared to
our normal preventative measures?

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Is it still an oral faecal transmission?

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Charalampos Attipa: Usually we are
suspecting, and obviously coronavirus

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

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is happening also with COV 23.

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

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obviously do some more epidemiological
work to answer that question.

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

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

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Currently there is a
suspected case in Netherlands.

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

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Netherlands in March from Cyprus.

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It has only developed clinical signs now.

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So this is something very
strange, having such a long

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incubation period of six months.

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So again, this is
something very interesting.

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It's something very new.

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

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

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forms of FIP we see way more now.

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

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

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

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

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

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So hopefully we'll raise a
bit more awareness through

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doing this podcast as well.

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Thank you so much for your time.

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Charalampos Attipa: Oh, thank you so much.

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

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

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

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

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

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

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just know if they've got FIV or FELV.

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

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

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

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sometimes there's little flags.

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

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

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

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

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

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aspergillosis, it's quite common as well.

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So that can be a little flag.

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

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

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

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

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of the vitamin D pathway there.

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

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pseudomycetoma, histoplasmosis,
blastomycosis, things like that.

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

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tests.

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Nathalie Dowgray: Cool.

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

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

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disadvantages of the tests that they have?

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

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

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

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

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

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

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non invasive blood test, which is great.

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

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

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

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

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

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So that's the first things to think about.

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

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

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

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

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they have any data on the efficacy of it?

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

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and specificity has been
investigated by feline researchers.

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

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

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

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kind of monitoring data, isn't it?

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

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

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

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depending on presenting signs.

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

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

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So what is the clinical
presentation, and also, what

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modality you've got available to you.

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When it comes to choice between
between CT and radiography.

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

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

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

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

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So, that's great.

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But, you might not have
the option of that.

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

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

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you and financially for your owner?

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

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whether it can just be done all at once.

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

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

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

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

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some abnormalities on chest x rays.

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

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

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

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

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

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

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

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

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bit more time looking at the sample.

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Nathalie Dowgray: Now that makes sense.

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Brilliant.

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Oh, thank you for that.

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

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

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thinking about to, to diagnose them.

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

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much focusing on the treatment.

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

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

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

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Thank you Nathalie

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Nathalie Dowgray: Thank you for listening.

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If you're an ISFM member, don't forget,
you can access the full version of

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this podcast and all the other ISFM
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recordings, monthly webinars, clinical
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much more at portal.icatcare.org.

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If you're looking for more free CPD from
ISFM in February, do look out for our

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quarterly Cat Friendly Clinic webinar.

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We'll be back again next
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If you don't want to miss out, do make
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