Stomatitis info Thalidomide

Barbara Baass Fri, 27 May 2005 17:27:35 -0700

I figured out how to send it to the whole group.

Barbara Baass

Feline chronic lymphocytic plasmacytic stomatitis/gingivitis

http://www.gla.ac.uk/companion/stomatitis.htm

Case study

Feb 2000.

Lucky is a MN DSH. He was referred to GUVS by his veterinary surgeon, Mr Gerry Henry, who had extracted most of his teeth (the treatment of choice for this condition). Mr Henry had also treated Lucky with extensive broad spectrum antibiotics and on referral, Lucky had only a sparse culture of Moraxella. Lucky was negative for FeLV and FIV, but feline calicivirus (FCV) was isolated. Treatment was begun with 50 mg thalidomide sid and 200 mg lactoferrin powder (kindly donated by Ko Shiino, Morinaga Foods, Germany) applied directly to the lesions daily.

Sep 2000 Lucky has now improved considerably. He has stopped shedding FCV. He has been changed to Butcher's Classic Cat Food.... could that be significant?

May 2001. Lucky is 100% recovered and is still FCV negative. Dec 2002 - Lucky still has a healthy mouth!

Cause

While the exact aetiology of feline chronic lymphocytic plasmacytic stomatitis is not proven, it is probably caused by combination of feline calicivirus (FCV) infection and the cat's inappropriate immune reaction within the stomatitis lesions (shift from normal Th type 1 response (cellular) to a mixed Th type 1 and 2 (humoral) response. Harley et al, 1999).

Treatment is aimed at restoring normal mouth flora (healthy cat's mouths have predominantly Pasteurella multocida, 50% of cats with stomatitis have spirochaetes), trying to eliminate FCV, and shifting the immune response back to type 1. For the latter, it is not a good idea to use corticosteroids, but a non-steroidal anti-inflammatory safe for the cat.

In addition, it is possible that some irritant in Lucky's food predisposed him to this condition. In humans, chronic stomatitis can be due to intolerance to food additives, especially in chewing gum or Irn Bru. Just before Lucky dramatically improved, his food had been changed to the additive-free Butcher's Classic Cat Food - we cannot tell whether or not the food change aided his recovery.

Diagnosis

Send an oral swab in viral transport medium (vtm) to Companion for FCV isolation (�13.00 plus VAT). You may also wish to send a biopsy of the lesion in 10% formol saline (from �18.00 plus VAT).

To request vtm,

email Companion,

or phone 0141 330 5777.

Treatment

The treatment we currently recommend is as follows: Metacam (continually, or until complete healing), Antirobe for 6 weeks, Classic cat food (continually or until complete healing), 1MU Virbagen Omega per kg every other day subcutaneously for 5 injections, thereafter monitor calicivirus shedding and give injections as required. At this stage we do not know how many injections these cats require .... watch this space! We hope to extend the interval between injections to every 3 days.

Antibiotics

Antirobe 5mg/kg bid for 6 weeks

NOT Metronidazole 4-6 weeks (however, metronidazole has a suppressant effect on cell mediated immunity in mice, and may be less desirable in this condition where CMI is preferable to the humoral response).

Interferon

Feline interferon: Virbac have recently introduced feline recombinant interferon (Virbagen Omega).

Dose: 1 MU/kg, or 0.1 ml/kg of the reconstituted solution, once every other day for 5 treatments. Thereafter

Suppliers: NVS,

Abbeyvet

Human interferons: Intron A (human recombinant interferon) obtained as 3M I.U. from local pharmacist (write a prescription). Dilute in one litre of saline, aliquot into 1ml volumes, freeze for up to a year. Defrost as required, dilute 1:100 to get 30 I.U. per millilitre, keep refrigerated for up to a week.

Treat continually, until FCV shedding ceases.

Dose: 30 I.U. per day orally

Anti-inflammatories

Corticosteroids should be AVOIDED because although the cat may improve initially, ultimately the condition will worsen or become more chronic. For preference, use non-steroidal anti-inflammatories.

Metacam

Metacam is preferable to steroids in the control of this condition. In our study, both controls and the IFN omega group are being put onto Metacam.

Dose:

Day 1: 0.3mg/kg sid with food

Days 2-7: 0.1mg/kg sid with food

Thereafter reduce the dose until you find the minimum that keeps the cat comfortable: most cats will maintain on 1-2 drops per cat per day.

Thalidomide

At present, we are unable to source thalidomide in the UK and are putting all of our cases onto Metacam.

Thalidomide is a good anti-inflammatory to use in this condition but is difficult to obtain. If you do manage to get it, remember to explain to the owner that thalidomide is not licensed for the cat.

Dose: 1-2 x 50 mg capsules per day given in the evening

NOT to be used in pregnant queens

Ketofen

1mg/kg sid per os for 5 days

Aspirin

10-25 mg/kg every 48 hours

Food

Food is a very important feature in this condition. Most affected cats improve on Classic Cat Food (a tinned and pouch food made by Butcher's, available in Safeway, Pets at Home and other supermarkets and pet food shops) and metacam alone. Lucky had just been changed to Classic Cat Food prior to his recovery.

In addition, after dentistry, cats fed on Hills a/d diet gained more weight and had smaller lesions than those fed on a control diet (Theyse et al, 2003).

We currently recommend a change to either of these foods for cats suffering from this condition.

For local suppliers of Classic food or for buying in bulk, phone Butchers on 01788 825209.

Antioxidants

Antioxidants such as vitamins A, C and E and zinc improve mucous membrane health and possibly have anti-viral and/or immune stimulant activities. One has to be careful of using vitamin A in the cat for 2 reasons:

Firstly, the cat can't absorb or convert well the beta-carotene forms (i.e. those found in plant foods), so it must be given in the form of liver or fish oil (halibut or cod).

Secondly, vitamin A shouldn't be used for more than 6 weeks or there is a risk of hypervitaminosis A and bone deposition.

Doses:

vitamin A: 200-400 i.u./kg/day for less than 6 weeks

vitamin C: 125mg/cat bid

vitamin E: 25-75 i.u./cat/bid

zinc: 7-10mg/cat/sid

Slippery elm in honey

UK vet, David Leicester, reports some response to slippery elm in honey applied directly to the lesions. This herb is used widely by humans with inflammatory bowel disease and has been shown to have antioxidant effects on mucosae in vitro. Slippery elm is available from Potter's (Herbal Supplies) Ltd, Wigan, UK.

Virbagen Omega Chronic Feline Gingivostomatitis Trial

This study is currently closed to new cases. Please watch this space for news of new cases required.

We welcome referrals of cats with chronic feline gingivostomatitis to our small animal hospital at the University of Glasgow. Please contact D.Addie

Rory Bell

to make an appointment.

Please note that there will be an initial consultation fee of �90.00 plus VAT (thereafter treatment will be free) but that animals suffering from conditions other than chronic feline gingivostomatitis will be sent back to their own veterinary surgeon.

Stomatitis info Thalidomide

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