RINGWORM (DERMATOPHYTOSIS)
What is ringworm?
Ringworm is a fungal infection of the superficial layers of the skin, hairs and nails. The fungi responsible for ringworm belong to a specialised group known as dermatophytes, and these can cause disease in both man and animals. Some species of dermatophytes will only infect man, or only infect certain animals, whereas others can be spread from animals to man.

In cats, one type (species) of dermatophyte called Microsporum canis is responsible for almost all ringworm infections, and this species in addition to being infectious to both cats and dogs, will also readily infect man.

What does ringworm look like?
The most common clinical sign associated with ringworm infection is one or more areas of alopecia (hair loss) which occurs due to the increased fragility of infected hairs. Most typically, infection will produce a discrete irregular or circular patch of hair loss, accompanied by variable scaling, crusting, thickening and reddening of the skin. However, infection may sometimes cause other signs including generalised disease where a much larger area of the body is affected often with patchy hair loss.

How can you diagnose ringworm infection?
Diagnosis of ringworm infection is usually straightforward, although the disease has to be distinguished from a variety of other possible causes of hair loss. When hairs infected by Microsporum canis are examined under ultra-violet light (a Wood’s lamp), they often emit an apple-green fluorescence, and this is a simple and rapid test for the presence of this particular dermatophyte. However, not all dermatophytes cause fluorescence of infected hairs, and contamination of the hairs with other substances can also sometimes result in non-specific fluorescence.

Confirmation of the diagnosis is therefore important, and is made by microscopic examination of infected hairs and/or culture (isolation) of the fungus from hair samples submitted to a laboratory. Results from the latter test may take up to three weeks.

Treatment of ringworm
Although in many cats, ringworm is a self-limiting infection (with resolution typically taking 3-5 months), treatment of the disease is always indicated to minimise the risk of spread of infection to humans (particularly children) and to others cats (and dogs).

Two forms of treatment can be used for cats with ringworm - topical therapy (application of creams, ointments or shampoos) and systemic therapy (administration of anti-fungal drugs by mouth). In addition, attention must also be given to cleaning the environment.

1. Topical therapy
Occasionally, topical therapy is used alone for treatment of ringworm, but more commonly it is used in combination with systemic therapy, or systemic therapy may be used alone. Various creams and ointments are available to apply to localised areas of the skin affected by ringworm, or if there is more generalised disease your veterinary surgeon may advise the use of a shampoo. It is extremely important only to use preparations that have been specifically provided by, or recommended by your veterinary surgeon for topical treatment of cats. For example Sebolyze or Sebolux are safe antifungal shampoos that can be used on cats.

2. Systemic therapy
For most cases of ringworm, effective treatment will require administration of an oral anti-fungal drug. The most widely used drug for this purpose is griseofulvin, although newer alternative drugs are now available. The response of individual cats to treatment varies, and it is important that therapy is not stopped too early to avoid recurrence of the disease. In most cases this means that cats must be treated for a minimum of six weeks, and in some cases much longer therapy is required. If there is more than one cat in the household, it is possible either to try and separate infected from non-infected cats and just treat the infected ones, or in some situations it may be preferable to treat all of the cats - your veterinary surgeon will be able to advise you regarding your own circumstances.

3. Environmental cleaning
Hairs infected with ringworm contain numerous microscopic fungal spores which can be shed into the environment. Infection of other animals and humans can therefore occur either by direct contact with an infected cat, or through the environmental contamination with fungal spores. In addition to minimising direct contact with an infected cat, it is therefore also important to attempt to keep the environment free of spores. Topical treatment of affected skin, and clipping of infected hairs (with careful disposal) may help to reduce environmental contamination, and it is also worthwhile considering restricting the cat to certain rooms of the house that are easy to clean. Thorough vacuum cleaning of rooms where the cat has access to is the best way to minimise environmental contamination, and this should be done as frequently as is possible (e.g. daily or every other day). In addition, the use of diluted bleach is recommended in areas that can be readily disinfected.

Will my cat recover?
The vast majority of cats, if treated appropriately, will recover from ringworm infection within a few weeks. While the appearance of the lesions may not change much during the first week or so of treatment, some response (improvement) should be evident within 2-3 weeks. Occasionally, despite appropriate treatment the infection persists, and in this situation your veterinary surgeon may have to try alternative anti-fungal drugs.

The risk to humans
Ringworm can be transmitted quite readily to humans (particularly children) and it is therefore important to take appropriate steps to minimise exposure to the fungus while the cat is being treated (see ‘Environmental Cleaning’). If any humans in the house develop skin lesions (small patches of skin thickening and reddening, or patches of hair loss) early medical attention should be sought. Ringworm in humans generally responds very well to treatment using topical creams or lotions.

SEIZURES
Seizures and epilepsy are less commonly encountered in cats than dogs. They are, however, the most common sign of disease affecting the front part of the brain in the cat.

Some important terms:-

Seizure (convulsion, ictus, fit)
An involuntary disturbance of normal brain control which is usually seen as uncontrollable muscle activity. Seizures can be single and very occasional, or may occur in clusters followed by long periods (weeks to months) without fitting.

Epilepsy
Recurrent seizures (usually without an identifiable structural cause).

Preictal (aura)
The change in character that occurs prior to a fit e.g. nervousness, attention seeking, head turning.

Postictal
Following a seizures it can take 24-48 hours for a cat to return to normal. This period is called the postictal phase and is characterised by a variety of signs including sleepiness, pacing, depression, excitement, excessive eating and drinking and sometimes blindness.

Generalised seizures (a grand mal seizure)
Jerking movements, rigid limbs, paddling/running movements, loss of faecal and urinary control. The head is often bent backwards along the spine.

Status epilepticus
Continuous fitting for more than 5-10 minutes. Cats in status require urgent treatment.

Partial seizures
Very rare in cats may involve only certain muscle groups or be characterised by behavioural changes (e.g. tail chasing, biting at imaginary objects, aggression)

Absence seizures(petit mal seizure)
Very rarely recognised in cats.

Seizures often occur at times of changing brain activity e.g. during phases of sleep, excitement or feeding. Affected cats can appear completely normal in between fits. Many different diseases can lead to seizures so it may be important that diagnostic tests are performed to try to discover the cause of the fitting as treatment of the underlying disease is most likely to lead to successful control of the seizures. In cats, idiopathic epilepsy, which occurs commonly in some breeds of dog e.g. German Shepherds, is rare.

How can I help my veterinary surgeon to make a diagnosis?
Carefully observing your cat particularly at the beginning of a fit can provided very valuable information to your veterinary surgeon about the types of disease that may be causing the problem.

1. Age at which fits began; are they getting worse?
2. Chronicity - i.e. are the seizures intermittent or did they develop suddenly?
3. Frequency, multiplicity of seizures
4. Association of seizures i.e. asleep, excitement, feeding
5. Other signs of ill health e.g. poor appetite, excessive drinking, reduced exercise

Information about your cat's lifestyle may also be important
6. Medication use - especially recent worming or use of flea control products.
7. Diet (food rolls?; all fish diet?; pet mince?)
8. Access to poisons (and in particular lead paint)

Both diseases which involve the brain directly (intracranial) and conditions which affect other body systems (extracranial) e.g. the liver or kidney disease can cause fitting. With recent developments in treatment many diseases which have previously been untreatable may now be treated though this can require referral to a specialist centre.

How can a diagnosis of the cause of the seizures made?
A range of tests are often needed before a final diagnosis can be made, initially this is likely to involve blood samples to look for extracranial causes of the fitting. Following this a general anaesthetic may be required to allow x-rays of the skull to be taken and the fluid that surrounds the brain (cerebrospinal fluid) sampled. In order to actually look at the brain, powerful imaging techniques are required e.g. magnetic resonance imaging (MRI) and computer assisted tomography (CT), these tests are only available at a limited number of specialist centres, usually with the co-operation of medical colleagues.

What treatments are available?
It is important that a cat which is having regular seizures (more than one every 6-8 weeks) receives treatment even if the cause is not as yet clear as each fit can lead to further brain damage increasing the likelihood of more fits in the future. Treatment of the underlying causes of fits is without the scope of this leaflet. In some cases where the cause of the fitting is not known or is untreatable then the seizures need to be treated directly. A variety of drugs are available, the treatment chosen will depend on a each individual cases. Several changes of dose rate, timing and drug may be required before the regime that suits your cat best is found. This can be a frustrating time but the benefits of finding the right treatment become self evident. Even with treatment it may not be possible to completely prevent fitting, in many cases the aim is to reduce the seizures so your cat can lead a more or less normal life.

Golden rules of treatment
ALWAYS follow the instructions on the label both the dose rate and timing of the medication is important to maintain adequate drug levels in the bloodstream.

NEVER run out of the medication as sudden withdrawal of treatment can lead to serious fitting.

LET your vet know when your supply is running low so a repeat prescription can be arranged. This is particularly important if the treatment needs to be ordered specially for your cat.

KEEP these drugs safe (away from children etc.) as they can be powerful sedatives.

BE CAREFUL about other drugs including herbal remedies that you also give your cat. If in doubt check with the veterinary practice.

What are the side effects of treatment?
Mild side effects are common particularly at the beginning of treatment or following changes in the regime. The most common side effect is sedation but other signs can also occur, most disappear quite rapidly as the cat becomes used to the medication. If side effects persist or seem severe then the veterinary practice should be informed.

DO NOT BE TEMPTED TO CHANGE THE DOSE OR TIMING OF MEDICATION WITHOUT CONSULTING YOUR VETERINARY SURGEON FIRST

Why has treatment failed?
Sometimes treatment will appear to have failed, in many cases this is because the dosage and timing of the medication is not yet right. Please check that you are following the instructions on the medication label correctly. In some cases your veterinary surgeon may want to take a blood sample to ensure that your cat has adequate circulating blood levels of the medication.

Other causes of treatment failure include:-
1. Specific circumstances e.g. stress - increased medication may be required during such periods.
2. Progression of disease.
3. Some cases are uncontrollable even with medication.
4. Failure to identify the underlying problem, e.g. unidentified food intolerance, brain tumour.

Seizures are generally a sign of fairly severe disease, this does not necessarily mean that nothing can be done for your cat, with the correct treatment, the quality of your cat's life can be dramatically improved.

SOLAR DERMATITIS AND SQUAMOUS CELL CARCINOMA
What is solar dermatitis?
Solar dermatitis (or actinic dermatitis) is a skin disease which is caused by exposure to the sun. It occurs mainly in cats with white non-pigmented areas and the ear flaps, nose and lower eyelids are most commonly affected. In the early stages the skin may look pink and scaly with some degree of hair loss but as the condition progresses the area becomes crusted and eroded. The cat is often irritated by the lesions and if the ears are affected it may shake its head and cause bleeding from the ear tips. If left untreated some cases progress and a malignant tumour (squamous cell carcinoma) can develop at the site.

What can be done to prevent the condition progressing?
Sunlight should be avoided. This is best achieved by keeping the cat indoors between the hours of 9.00 am and 4.00 pm on sunny days. If this is not possible then one can try using sun block cream on the affected areas. Unfortunately cats will rapidly groom or lick this off. Some products may actually be toxic to cats so it is advisable to check with your vet before you start using a cream. There is one sunblock cream available specifically formulated for cats.

How will I know if my cat has squamous cell carcinoma?
If your vet is at all concerned that the condition may be progressing to squamous cell carcinoma he will advise that a biopsy (a small tissue sample) is taken from the affected area. The cat will need to have a general anaesthetic in order to do this. The biopsy will be sent away to a histopathologist who will examine it under a microscope to see if malignant cells are present.

How is squamous cell carcinoma treated?
The treatment of choice is surgical removal of the affected area and a wide surrounding margin. This usually straightforward if the ears are affected. Complete removal of the ear flaps may be necessary; this has no detrimental affect on the cat and the final appearance is usually quite acceptable. Surgery can be more difficult if the nose or eyelids are affected. Where it is not possible to remove all the diseased tissue additional forms of therapy may be needed such as radiotherapy or cryosurgery. Early cases are more amenable to these latter therapies. In advanced cases with nose involvement, removal of the nose is possible as a last resort.

What is the likely outcome following surgery for squamous cell carcinoma?
The prognosis is usually good especially when the ears are involved and particularly if the disease is discovered early. If all the diseased tissue is not adequately removed the tumour will recur at the operation site; this can be a problem if the nose or the eyelids are affected and is the reason why additional therapies are often used in these cases. This type of tumour doesn't spread very rapidly to other parts of the body.

SPRAYING
What is spraying?
Urine spraying is part of the cat's normal scent-marking behavioural repertoire which also includes scratching, rubbing, chinning, bunting (depositing secretions from head glands on twigs etc., and middening (leaving faeces uncovered). Using these scent markers cats can deter others from their range and cats which share a hunting range can avoid one another without coming into direct conflict. Spraying is also designed to help females in oestrus ('in season' or 'on heat') to attract males for breeding. When spraying the cat stands with its tail vertical (often quivering at the tip) while it delivers a squirt of urine backwards onto a vertical surface. This spray probably contains information about sex, age, hormonal state, assertiveness and general health.

Why do cats spray?
Cats may spray when frustrated, upset or subject to competition or challenge and spraying can be interpreted as the cat increasing its own sense of security by surrounding itself with signals of its own occupancy in its territory. The more anxious the individual, the more he or she will need familiar odours for comfort.

Do only tom cats spray?
No, all cats, male or female, neutered or not, may spray, usually outside where we may not see them. Un-neutered toms and queens in oestrus will spray more.

Why do cats spray indoors?
Most neutered pet cats feel sufficiently relaxed in their own home and do not spray. They identify it by rubbing scent from their body and do not need to mark by spraying, scratching or middening. The most common sites for indoor spraying are near entrances to the house or room, curtains and new items brought into the house, e.g., plastic bags, new furniture etc., although individuals may have their own idiosyncratic targets such as washing machines, video players or even certain people! As with most behavioural problems a little detective work may be needed to get to the root of the behaviour problem. While there may be no 'quick fix' solution in some cases, helping to find and understand the motivation for the behaviour will help while you work towards a solution.

There can be many triggers for a cat marking indoors:-
1. The arrival of a new cat, dog or person in the family, or a bereavement.
2. Changes in the home area such as furniture or new carpets. Disruptions such as building work.
3. Installation of a magnetic cat flap which can make the cat feel insecure indoors.
4. In rare cases, spraying can be a learned attention-getting behaviour.

Occasionally urine marking may be carried out from a squatting position usually on the floor, but often on bedcovers or chairs. The cat may still use the litter tray for eliminating larger volumes of urine. This often occurs when owners leave their cat at home but in their neighbour's care when they go on holiday and may be a form of 'associative 'marking - the cat feeling anxious because it is alone, is relieved when it associates its smell with that of the owner - usually in a spot where the owner's smell is concentrated such as on the bed or armchair.

Can the problem be treated?
Cats marking indoors clearly require a clear and extensive approach to diagnosis of cause(s) and careful development of treatment which will not unsettle them even more! It is vital to discover under which situations the problems occur as treatment often depends on defining any specific anxiety-inducing trigger(s) for the behaviour.

It is useful to know the following:-
1. When did the problem first occur?
2. Which people or other animals are normally present in the house. What are the attitudes of all the family towards the cat. What are they doing before, during and after the problem occurs.
3. Are there any other behaviour problems in the cat or its feline housemates and is it receiving any medical treatment?
4. Where is the marking occurring? The layout of the house and even the garden may be important. Are there rival cats outside?
5. What is the cat's daily routine? Does it have free access to outside? Where does it eat and sleep, how much time is spent interacting with the owner and what do they do together.
6. What methods have already been tried to solve the problem? How are the marks cleaned?

The main aim of treatment is to reduce the perceived threat to the cat and make it feel more secure in its home territory, thus reducing its levels of arousal and curtailing the need to scent mark. Identifiable sources of stress should be removed, e.g., by excluding local rival cats from entering the home by blocking the cat flap or replacing it with a selective one.

Carefully introduced friendly routines of handling, feeding and playing will help provide reassurance, providing such contact does not further alarm the cat at any stage. In many cases there may be no single obvious threat and the cat's behaviour may be the result of the cumulative effect of several influences. If such sources of stress cannot be removed or even fully identified the cat should be provided with a safe haven of a small core territory of one room in the house to which it can safely retreat or be placed to relax without fear of disturbance for regular periods and where it should only feel the need to mark normally by rubbing and bunting.

Often people simply become 'over-catted' - they enjoy their feline housemates and because one extra takes up little more physical space and is no more effort to feed, they will continue to collect more. This may be fine until a certain mix of characters just doesn't gel and relations within the group become strained and spraying begins.

Careful introductions can help but sometimes certain individuals simply cannot share a home without stress and it is better to re home one or more. Although this may not be a popular decision, it may be the only option if home hygiene is to be maintained as trying to manage the problems can be very difficult with a number of cats and associated variables.

All forms of punishment should be discontinued (even if the cat is 'caught in the act') as this is only likely to raise the cat's level of arousal and anxiety. You may feel often angry and want to react if you catch the cat 'in the act', however, stopping all punishment and threatening behaviour is an essential first step towards improvement.

Placing food (dry food is best) or a bed at the base of spraying sites is often helpful at protecting those particular areas as cats are extremely reluctant to spray their own key resources, although they may simply move to other areas and mark there instead. Food and beds are also reassuring and may reduce anxiety.

Spraying can be triggered by the smell of previous marks so marked areas should be thoroughly cleaned (not with ammonia-based products as ammonia is a constituent of cat urine). A damp cloth should be used to remove any fresh urine marks and while some commercially available 'urine digester' products remove the smell (to the sensitivity of the human nose at least), no data has been published on relative efficacies.

An enzymatic or biological washing powder or liquid may be just as effective at removing residues. Follow with agitation using a light brush with a low grade alcohol (test the colour fastness of material/carpets first).

It is unlikely that spraying will be effectively resolved with drugs without trying to ascertain the cause of the problem and without employing management changes and behaviour modifications.

Some drugs are available but their use should be based on sound understanding of the problem cat and the effects of the drug on the feline physiology. Drugs should alter a cat's mood to enable it to learn new forms of behaviour and the drugs should then be withdrawn.

TOILETING PROBLEMS
Marking or toileting?
Indoor marking behaviour can be confused with a breakdown in toileting behaviour. Territorial marking by urine spraying which usually occurs against vertical objects such as chairs or walls and can be distinguished from urinating where a greater volume of liquid is deposited from a squatting position by both male and female cats. However, sometimes a small volume of concentrated urine is also deposited from a squatting position as a mark, and faeces can also be used to mark territory.

Why do cats toilet indoors?
One of the reasons cats make good pets is that they usually learn very early and with little effort from us that our homes are not toilets. Kittens almost instinctively head for the litter tray at even a few weeks of age and usually make the transfer fully to the garden once allowed out. Some individuals take longer to learn than others and some longhair breeds can be notoriously difficult to establish as house trained. Yet others develop clean indoor behaviour normally and then suffer a breakdown, perhaps as a result of illness and then fail to re-establish their previous clean behaviour.

Treatment
Several aspects of the cat's environment can be altered to try and treat the problem.

The litter tray
(a) Number of litter trays
One tray per cat is a good rough guide, as many cats do not like to share trays. Having tray in geographically separate areas, e.g. kitchen and laundry also helps.
(b) Type of litter
Several types of cat litter can be offered, such as Fuller's Earth granule types, wood chip pellet, re-usable waxed granule varieties or finer grained litters. Cats often prefer finely grained substrates such as sand or a proprietary brand with sand-like texture. If the cat is to be allowed outdoors the litter can be mixed with soil from the garden to help transfer toileting behaviour completely to the outdoors later.
(c) Cleaning
The litter tray should neither be allowed to get too dirty as this will discourage most cats, nor should it be cleaned too often as the presence of the cat's own smell on the litter will help to develop the idea of a latrine. Solids can be removed regularly but the more cats use a tray, the more often it will need to be cleaned, but one per day per cats is recommended. (Cats don’t like litter that reaks of ammonia!)
(d) Security and position
An open litter tray in a busy part of the room may make some cats feel very vulnerable and they may prefer to eliminate (urine or faeces) behind the furniture or in a quite corner. Place the tray in a secure quiet place and either cover with an inverted cardboard box with a hole cut in it for entry and exit or buy a proprietary litter covered litter box. for those that seem anxious, although many prefer an open tray. Cats may usually be most unwilling to use a litter tray placed too close to a feeding area.

Encouraging use/preventing accidents
Confine the cat in a kittening pen in a small room with only enough space for a bed and a litter tray. The desire to avoid soiling the bed is established early in life and he or she should move as far away from the bed as possible to eliminate and this will mean using the litter tray. Hopefully within a few days the cat should again being to associate toileting with the litter tray. The cat should be kept in the cage indoors at all times when the owner is unable to supervise. After a couple of days of 'good aim' the cat can be allowed out of the cage only into the room where it is kept and the litter tray moved progressively further away from the bed. Access to the rest of the house should be allowed one room at a time and only under supervision for the initial introduction to each room.

Cleaning up
Before allowing access to any room, all previous unwanted toileting areas should be thoroughly dried then sprayed with a proprietary 'urine digester'. Do not wet the area with large volumes of cleaning solution, as this just spreads the smell, and never use ammonia based products. The area should be left to dry thoroughly before supervised access is allowed.

Making your cat more relaxed
1. If neighbourhood cats entering your home is a problem, magnetic cat flaps may be a solution, and allow your cat to feel more secure in their own space.

2. Never punish cats. If caught in the act they can be picked up and placed on the litter tray, stroked and calmed. Never 'rub the cat's nose in it' as this will make a nervous cat even more likely to toilet indoors.

3. ‘Feliway’ is a pheromone spray available from our clinic, which can be used in the cats environment to relax them and reduce stress levels.

4. The speed and success of treatment may be assisted by the use of certain drugs, particularly with nervous or agoraphobic cats. This option should be discussed with one of our vets, and will be used in conjunction with the above suggestions.

UPPER RESPIRATORY TRACT INFECTIONS - 'CAT FLU'
'Cat flu' is a common disease in unvaccinated cats of all ages, but tends to be particularly severe in young and especially purebred cats. A number of infectious agents have been found to cause 'cat flu' but the vast majority of cases will be caused by one of two viruses, feline herpes virus type 1 (FHV-1) and feline calicivirus (FCV). FHV-1 is also known as feline rhinotracheitis virus.

What are the clinical signs of 'cat flu'?
Signs of 'cat flu' are similar to colds and flu in people. FHV-1 tends to cause more severe disease, the major signs are inflammation of the lining around the eye (conjunctivitis) and nose (rhinitis). This causes a clear discharge from the nose and eyes which becomes thickened and purulent as the disease progresses due to secondary bacterial infection. Cats tend to be dull and depressed with a raised temperature, sneezing and are reluctant to eat. Coughing is also a feature in some cases. Rarely the virus will cause skin lesions and invade the lungs causing pneumonia. Without treatment signs usually resolve in 2-3 weeks but some cats are left with a chronic, intermittent nasal discharge or eye disease. Treatment can significantly aid recovery.

FCV tends to cause less serious disease, but clinical signs are dependent on the strain of virus that is involved. Mouth ulceration can be a prominent feature of the disease causing severe lack of appetite. Ulcers may also sometimes occur on the tongue, nose and hard palate. Some strains of FCV cause a lameness and fever syndrome in young kittens. FCV is commonly isolated from cats with long-standing (chronic) inflammation of the gums (gingivitis) and from cats with ‘faucitis’ (inflammation of the recesses at the back of the throat).

Deaths following respiratory virus infections are rare, usually occurring in young kittens that have advanced disease before being presented for treatment.

How is 'cat flu' diagnosed?
In most cases the diagnosis is made on clinical signs but in cases where there is recurrent disease or in vaccinated cats a specific diagnosis may be required. This can be achieved by swabbing the cat's mouth and sending the swab in viral transport medium to a laboratory where the virus can be grown in culture and identified. (This service is not generally commercially available).

What treatments are available?
As for colds and flu, specific anti-viral treatments are not generally available. Treatment is aimed at controlling secondary bacterial infection (with antibiotics) and stimulating eating and drinking as, particularly dehydration, is a major cause of worsening disease. Anti-viral ointment (e.g. acyclovir) used to treat herpes virus infections in people (cold sores) has been used in cats, but generally the response is not as good and the drug needs to be used early in the course of infection.

What can be done to help treatment?
Your cat can be encouraged to eat and drink using drugs such as multivitamins and mucolytics (which help dissolve secretions) but good nursing plays a crucial role. The eyes and nose can be kept clear of secretions by gently bathing the area with cotton wool and by steaming. Steaming needs to be undertaken carefully, the cat is placed in a wire basket and a bowl of steaming water is placed outside the basket, the two are then covered by a towel and the cat left for up to 5 minutes. The steam acts to loosen secretions making the cat feel better, oils such as eucalyptus should be avoided as they can cause ulceration of the nose in cats. Your cat can be encouraged to eating by providing highly flavoured foods e.g. sardines warmed to body temperature. Hand feeding can also help.

Severely ill cats may need nursing in hospital, this allows rehydration with intravenous fluids and feeding by naso-oesophageal tube.

How can 'cat flu' be prevented and controlled?
For most households, with a few cats, vaccination is sufficient. Vaccination may not prevent your cat becoming infected but will drastically reduce the severity of the disease, often to the point that all that is noticed is mild transient lethargy and inappetance for a few days. A variety of vaccines are available depending on the circumstances (see vaccination leaflet). Neither virus is very hardy, FHV-1 will survive for a maximum of 48 hours in the environment, FCV lasting 7-10 days.

In multi-cat households, particularly where new cats are continually arriving (rescue, boarding or breeding), vaccination alone may not be sufficient to control the problem. In these households isolation and quarantine is also required. Disinfection, whilst an important part of disease control generally, is of limited value in respiratory virus control as most cats become infected by aerosol droplets sneezed or coughed out by infected cats. Clinically ill cats or those suspected of being carriers should be isolated and handled last, their food bowls and litter trays disinfected and your hands, face and boots washed before handling other cats. Where possible separate clothing or overalls should be worn. New arrivals to the group should be quarantined for 7-10 days in case they are incubating 'cat flu'. Unfortunately, quarantine will not identify carrier cats. In households where 'cat flu' is endemic, queens should be kittened in isolation from other cats and, where possible, the kittens remain in isolation until vaccinated.

What are carrier cats?
Carriers are animals that are infected with 'cat flu' but are not showing any clinical signs. Carriers are only infectious to other animals when shedding the virus. Viral shedding can be continual or intermittent. Around 80% of cats that have been infected with FHV-1 become carriers, they shed the virus intermittently usually during periods of stress e.g. re-homing, lactation trauma, early weaning, cold and remain carriers for life. About 50% of cats infected with FCV are still excreting virus 3 months after they were originally unwell, some of these cats continue to excrete for up to 18 months. FCV carriers excrete continually so are always potentially infectious to unvaccinated cats.

Can I check to see if my cat is a carrier?
In some special circumstances it may be helpful to identify carriers but this is not usually important for pet cats. A swab can be taken from your cat's mouth which will show if it is a FCV carrier. FHV-1 carriers are only diagnosed if they are excreting the virus at the time the swab is taken which is unlikely. Unfortunately virus isolation from swabs is not generally commercially available.

What should I do if my cat is a carrier?
Nothing can be done to change the carrier status of your cat. Therefore it is important that your cat does not come into contact with unvaccinated cats or kittens. All cats that have had ‘cat flu’ and specifically FHV-1 infection should be assumed to be carriers.

My cat has had 'cat flu' should I bother to vaccinate it?
YES! Your cat is likely to have been infected with only one of the viruses so will still be susceptible to infection with the other, or with other strains of calicivirus.

TOXOPLASMOSIS
What is toxoplasmosis?
Toxoplasmosis is a disease caused by infection with the protozoan organism called Toxoplasma gondii (T. gondii), a microscopic single-cell organism which is one of the most common parasites of animals. Although virtually all warm-blooded animals, including man, can be infected with this organism, it is an extremely well adapted parasite and rarely causes significant disease to the individuals which it infects.

How is Toxoplasma transmitted?
Cats are usually infected by eating the organism present in the tissues (meat) of another infected animal (an ‘intermediate host’), which is usually a rodent. The organism replicates locally in the intestinal tract of the cat, and also replicates within the body. The replication in the intestinal tract results in shedding of oocysts (eggs) in the faeces, but an immune response rapidly develops which halts both shedding of eggs and replication of the organism in the body. Despite the immune response, infection still persists in the form of microscopic cysts present in some tissues of the body, although this does not usually result in any disease.

The oocysts (eggs) shed in the faeces are very resistant, and can contaminate the environment for several years. Other animals become infected by eating these eggs and then, as with cats, the organism replicates in the body and cysts develop within certain tissues. Cats are particularly important, as they are the only animal in which T. gondii replicates in the intestinal tract resulting in shedding of eggs in the faeces, and therefore cats are essential to the life-cycle of the organism.

While cats are usually infected by preying on infected rodents (or more rarely by ingestion of oocysts from the environment), humans are most commonly infected through the food chain. Sheep, pigs and other animals grazing on contaminated pastures, or fed oocyst-contaminated food, can also develop the encysted form of the organism in body tissues and if infected meat is not cooked adequately enough, or poor hygiene precautions are adopted during handling of uncooked meat, humans can become infected. Ingestion of oocysts, for example during gardening in contaminated soil, is a less common source of human infection.

How common is Toxoplasma in cats?
The proportion of cats infected with Toxoplasma varies according to their life-style. Because of the way in which the organism is transmitted, infection is much more common in stray, feral, farm cats, and others which engage in a lot of hunting or are fed a lot of raw meat. As many as 60% of these cats may be infected with Toxoplasma. In contrast, infection is uncommon in pet cats which do little or no hunting, and which are fed primarily or exclusively commercial cat foods.

What disease does Toxoplasma cause in cats?
Although Toxoplasma is a relatively common infection, it usually causes no disease in infected cats. Rarely, cats fail to develop an adequate immune response to the organism which may allow it to continue to replicate and cause damage to tissues. When this happens a variety of different clinical signs can develop including ocular (eye) disease, respiratory disease, diarrhoea, hepatitis and nervous signs. It is important to remember that Toxoplasma is a rare cause of disease though. It can become a problem, however, if cats become severely immunosupressed, as a latent infection can be re-activated.

How can you diagnose and treat toxoplasmosis?
Toxoplasmosis is difficult to diagnose in cats. Blood tests are available which will show whether a cat has been exposed to the organism, but these tests do not necessarily mean that Toxoplasma is the cause of any disease (as most exposed cats do not develop disease). When toxoplasmosis is suspected in a cat, this can be treated with a course of an appropriate antibiotic.

How important is Toxoplasma in man?
Around 20 - 40% of the adult population have been exposed to Toxoplasma. As with infection in cats, the vast majority of people infected with this organism experience no clinical disease at all, or possibly just mild and transient ‘flu’-like signs. However, as with cats there are also some individuals where significant disease does occur and one situation is particularly important.

If a pregnant woman acquires Toxoplasma infection during her pregnancy, the infection may be transmitted to the foetus, and sometimes causes severe damage. This is only a risk though, if the woman acquires the infection during her pregnancy. A woman who has previously been exposed to the organism carries no risk of transmission to a foetus if she subsequently becomes pregnant - blood tests can confirm that she has already been infected.

How can human infection be avoided?
Although cats are essential to complete the life-cycle of T. gondii, numerous surveys have shown that people who own cats are not themselves at a higher risk of acquiring infection. There are several reasons for this:-

• Many pet cats will never be exposed to Toxoplasma and therefore cannot pass infection on to humans.
• Even if a cat does become infected with Toxoplasma, it will only shed the oocysts (eggs) in its faeces for a short period (approximately 10 days) after initial exposure. Following this there is no further significant oocyst shedding and therefore again no further risk to humans. It is usually young cats which shed oocysts.
• Although humans can be infected through exposure to, and ingestion of oocysts in the environment, a more common source of infection appears to be infected meat.

Following a few sensible environmental and meat hygiene measures can greatly reduce the risk of human infection:

• Cook all meat thoroughly to at least 70°C throughout.
• Wash hands, utensils and surfaces carefully after handling raw meat.
• Wash all vegetables carefully.
• Wear gloves when gardening in soil potentially contaminated by cat faeces.
• Empty cat litter trays daily, dispose of litter carefully, and disinfect with boiling water. If this is done every day, even if a cat is excreting oocysts, they will not have become infectious (which takes more than 24 hours from when they are passed in the faeces) by the time the litter is changed.
• Discourage pet cats from hunting.
• Cover any children's sand pits/boxes to prevent cats using them as a litter tray.

VACCINATIONS
Recent advances in veterinary science have resulted in an increase in the number and type of vaccines that are available for use in cats. Currently cats can be vaccinated against six different diseases:-

Feline panleukopenia (= feline infectious enteritis; feline parvovirus)
Feline herpes virus type 1 (= FHV-1; feline rhinotracheitis virus)
Feline calicivirus (= FCV)
Feline leukaemia virus (= FeLV)
Rabies*
Feline chlamydia

* For animals who are exported to the United Kingdom

How do vaccines work?
Vaccines work by exposing the body's immune system to a particular modified infectious agent. This causes the white blood cells to react to fight the infection by producing proteins (antibodies) which are able to bind to and neutralise the infectious agent (antigen). Antibodies work together with other white blood cells (lymphocytes) which are able to identify and kill cells within the body which have become infected by the agent (cell mediated response).

After vaccinal exposure the body 'remembers' the particular antigens so that when they are encountered again it can mount a very rapid and strong immune response preventing the cat from showing clinical signs of disease. It is important to realise that most vaccines work by preventing your cat from becoming ill and may not prevent it from becoming infected. This means that if a vaccinated cat becomes infected with ‘cat flu’ it may still shed the disease producing organism which can infect unvaccinated animals which will then become ill. This is not a major consideration in the pet cat but may be important in the breeding colony.

What is the difference between the various types of vaccine?
Four major types of vaccine are produced for use in cats.
1. Modified live vaccines - these vaccines contain live organisms that are weakened (attenuated) so that they do not produce disease but will multiply in the cat's body. It is not advisable to use modified live vaccines in pregnant queens or cats whose immune system is not working properly e.g. cats infected by feline immunodeficiency virus (FIV).
2. Modified live intranasal vaccines - for protection against cat flu. Intranasal vaccines are given as drops up the cat's nose rather than by injection under the skin. They have the advantage of causing a very rapid immune response to a single dose and can, in emergencies, be used to protect very young kittens, but can cause signs of cat flu in some cats.
3. Killed (inactivated) vaccines - these vaccines are prepared using fully virulent organisms that have been killed by chemicals, UV light or radiation. Because, on their own, they do not give such a high level of protection, a chemical (adjuvant) is added to the vaccine to stimulate a better immune response.
4. Subunit vaccines - these are dead vaccines in which the infectious organism has been broken apart and only certain parts are included in the vaccine. In some cases this is achieved by using genetic engineering techniques.

When should my kitten be vaccinated?
Generally kittens are vaccinated for the first time at between 6 and 10 weeks, second dose given at 12 to 14 weeks and third dose at 16-18 weeks of age. A kitten will not be fully protected until 7-10 days after the second vaccination. Under specific circumstances your veterinary surgeon may advise an alternative regime.

How often should booster vaccinations be given?
Booster vaccination is generally carried out yearly. Panleukopenia vaccines provide long lasting protection, some up to 2 years. All cats should be boosted regularly, adult cats are also susceptible to these infections particularly as they grow old and their immune system becomes less efficient.

Will vaccination always protect my cat?
Vaccination will protect the vast majority of cats but under some circumstance vaccine breakdowns will occur. There are many reasons for this including:-

1. Variations between different strains of viruses - this is particularly true of FCV where many different strains exist, not all of which are covered by the vaccines available.

2. Maternally derived antibodies - when a kitten is born it is protected in its early life by antibodies passed from the queen in the first milk (colostrum). These antibodies can also prevent vaccination from working properly. The amount of colostral antibodies that each kitten receives is variable and so the age at which a kitten can respond to vaccination successfully will also vary. This is part of the reason why two or three injections are given in the primary course.

3. The cat was not healthy at the time of vaccination - 'stress' can prevent a good response to vaccination. For this reason your vet will give your cat a physical examination before a vaccination is given.

4. The cat may also be pre-infected with the ‘cat flu’ virus and incubating the disease.

If you feel your cat has contracted an infection for which it is vaccinated then let your veterinary surgeon know. Investigation to establish why vaccination has possibly failed can be undertaken.

What are the risks of vaccination?
Generally the risks of vaccination are extremely low. Severe reactions being very rare. Many cats experience mild reactions at the site of vaccination where a lump may occur that can be painful. Generalised reactions are sometimes seen, the cat being quiet, lame and often off its food for 24 hours after vaccination. Occasionally more severe signs occur including vomiting, diarrhoea and profound depression. Under these circumstances your veterinary practice should be informed. Vaccine reactions appear to occur more commonly in kittens and some purebred cats.

Which are the most important vaccinations to have?
Your veterinary surgeon will be able to advise you of the most appropriate vaccinations to give your cat.

Feline panleukopenia infection
This is now an uncommon disease that causes a severe and often fatal gastro-enteritis. Vaccination provides a high level of long lasting protection.

Feline respiratory virus infection
Disease is caused by FHV-1 or FCV and is commonly termed 'cat flu'. It is a common disease in unvaccinated cats and can cause long-term problems, including chronic and severe gum problems. Vaccination is required regularly as immunity is not long lived. Cats at high risk may need to be vaccinated twice yearly to provide better protection.

Feline Chlamydial infection
This tends to be a particular problem in colony cats. Chlamydiosis is a bacterial infection causing a painful inflammation and swelling of the conjunctiva (the membrane around the eye) and has been associated with infertility in queens. Infection in colonies of cats can last for long periods as protection against reinfection is relatively short lived. Vaccination can help to prevent infection becoming established in a colony and can be used in conjunction with treatment where infection is already present.

Feline leukaemia virus infection
Whilst the majority of cats are able to combat this infection a significant proportion (about 30%) will become persistently infected by the virus. The vast majority of persistently infected cats will die from tumours or indirectly due to the immunosuppression caused by the virus. Current vaccines provide a good level of protection and do not interfere with routine testing for the virus in breeding colonies. Because the virus tends to take many months before it causes disease infected cats can appear completely normal. For this reason your veterinary surgeon may suggest that your cat should have a blood test to make sure it is not infected before vaccination. Despite vaccination a few cats will still become infected with the virus.

REGULAR VACCINATION IS AN IMPORTANT PART OF ROUTINE HEALTH CARE FOR YOUR CAT AND HELPS TO ENSURE YOUR CAT REMAINS FIT AND WELL.

VOMITING
Vomiting describes the return of food from the stomach. It may be related to disorders of the stomach but is a sign that can occur with many other different diseases and problems. It is not a specific disease or diagnosis itself. Cats vomit quite readily and occasional vomiting in an otherwise healthy cat may not indicate anything abnormal.

This is particularly true if the vomited material consists largely of hair. It is a normal process for cats to retain hair and vomit this back as a fur ball periodically. Vomiting grass soon after it is eaten is also considered a normal phenomenon in the cat.

How serious is vomiting
Most cases of acute vomiting (i.e. the vomiting has been present for less than 2-3 days) resolve readily with simple treatment without the underlying caused being diagnosed. Severe or chronic vomiting is more serious. It can lead to secondary problems, particularly dehydration and disturbances in the levels of electrolytes (salt etc.) in the blood. It is important to investigate such cases to identify the underlying cause if effective treatment is to achieve a cure.

Recognising vomiting
Vomiting may begin with a stage of nausea, the cat appearing restless, and possibly apprehensive. The cat may lick its lips, salivate and swallow repeatedly. Vomiting itself involves contractions of the abdominal muscles which may be repeated, leading to return of fluid, froth or food. The severe effort associated with vomiting may be distressing to the cat.

It is important to differentiate this from the abdominal contractions associated with coughing. Cats may cough up some froth which they subsequently swallow creating more confusion with vomiting. Cats usually crouch down on all four legs when coughing with the neck stretched out.

It is also helpful to differentiate vomiting from regurgitation which is usually associated with problems affecting the oesophagus or gullet. Features which help to differentiate vomiting from regurgitation are:-

• whether return of food involves abdominal contractions and effort
• whether the returned food is in the shape of a sausage
• whether the returned food is re-eaten
• the relation to feeding

Acute vomiting
Acute vomiting is vomiting which has been present for no more than 2-3 days. Most cases will respond quickly to simple treatment. The cause of such cases is often never established and may often be due to relatively trivial factors such as eating spoiled food etc. In a minority of acute cases of vomiting, usually because the vomiting is severe leading to complications such as dehydration or because a more serious underlying cause is suspected, further investigations, specific treatment and more supportive care will be required. Features that you may be able to identify which will help the veterinary surgeon decide whether simple treatment or further investigations are appropriate would be:-

• if the cat appears otherwise well or ill - depressed, lethargic or any other specific signs
• if the cat is eating
• if there has been weight loss
• if there has been any blood in the vomit ( a few specks of fresh blood may not be abnormal but more copious or persistent bleeding is significant)
• any pain or distress, particularly affecting the abdomen
• whether faeces are being passed
• the frequency of vomiting
• the relationship of vomiting to feeding - particularly if there is a long delay
• any offensive odour to the vomitus
• what the cat has been fed
• any recent change of diet
• any possible access to other foods or other substances
• any treatment given recently
• whether other cats in the household are affected

Symptomatic treatment for vomiting
Symptomatic treatment is usually tried initially in mild cases of vomiting. It may involve a number of measures:-

1. Withholding of food for up to 24 hours. This may help to allow the stomach to recover.
2. Provision of a simple diet
A simple, easily digestible diet will normally be offered initially in small quantities. A diet based on boiled chicken or sometimes fish with rice is often used. It is important that the cat does not receive any other foods during this period. This includes milk. Water should be freely available and is important to combat dehydration. If the cat is progressing well, the quantity of food offered can be gradually increased back to normal over several days and then the cat's normal diet reintroduced gradually over several days.
3. Drugs. Certain drugs are available to control vomiting and the veterinary surgeon may advise the use of these.

Further investigation of vomiting
If the vomiting is severe or the veterinary surgeon suspects a serious underlying problem, other treatment and investigations may be required. It may be necessary to hospitalise your cat so that intravenous fluids can be given to combat dehydration as well as correcting any imbalances in the levels of electrolytes (salt etc.) in the blood. It will also be possible to administer drugs by injection as required to control the vomiting. In some less severe cases you may be asked to administer fluids and special solutions at home. You may be provided with a syringe to help you do this. You must be patient, giving only small quantities at frequent intervals, and if your cat becomes unduly distressed, report back to your veterinary surgeon.

Further investigations may also be required in cases of chronic vomiting in which the cat has been vomiting for more than 2-3 weeks, even though the vomiting may be intermittent and the cat may appear otherwise well. Such cases can often not be treated successfully until the underlying cause has been determined. Some of the more commonly used tests are:-

Blood tests - to check for serious viral infections, kidney and liver problems and provide other clues to the diagnosis.

X-rays - these may show up abnormalities of the oesophagus or stomach. It may be necessary to give a barium meal or something similar to help show up any blockages, tumours, ulcers, foreign bodies etc. Ultrasound scans may also prove useful.

Endoscopy - in some cases a diagnosis can be made by viewing the inside of the stomach directly through an endoscope, a flexible viewing tube, which is passed through the mouth under a general anaesthetic.

Laparotomy - in some cases an exploratory operation is necessary, particularly if some obstruction or blockage is suspected. This may also allow surgical treatment of the problem.

Finally, there are several ‘innocent’ reasons for vomiting. Examples include:

• ingestion of cockroaches and some lizards; check the vomitus for these
• eating too much, too fast
• eating cold canned food, too fast
• eating high starch content dry cat foods too fast.

WORMS (INTESTINAL PARASITES)
What are tapeworms and roundworms?
Tapeworms and roundworms are two of the most common intestinal parasites of cats. Tapeworms are long flat worms composed of many individual segments whereas round worms are much shorter and have rounded bodies. Roundworms produce microscopic eggs which are shed in the faeces of infected cats, whereas tapeworms release mature segments (which again contain eggs) from the end of the worm into the faeces. These segments sometimes look like grains of rice and are mobile. They can occasionally be seen on the hair around the anus of the cat or in the faeces.

How do cats get roundworms?
Roundw