What I know about Feline Infectious Peritonitis (FIP)

Feline Coronavirus and FIP Diagnosis & Prevention June 2020

Having been in rescue as long as I have, and focusing my rescue work on kitties, I have come across FIP too many times. Now that I am also networking and providing support to other people who foster kitties, this topic comes up a lot, and it is quite disheartening to hear so many things that I know are patently untrue when it comes to FIP. I wanted to take a moment to write down what I have learned from my own experiences, by reading as many articles as I have, and being a part of the FIP community.

I will admit, it had been a while since I had dug deep into the research and experiences of owners and vets so to do this post I started looking for verification from the experts of what I knew to be true a few years ago as well as any new data that has arisen. Some of the information has changed dramatically since the availability of the new "treatment" for FIP, and that in and of itself is unsettling. Too many people are calling this once 100% fatal disease "curable", which I find to be misleading.

What is FIP?

FIP is a mutation of the Feline CoronaVirus (FCoV). It is rare, occurring in shelter kitties at a rate of 0.06% of the population (*) It presents in two ways, wet and dry. Wet fills the abdomen with fluid, dry does not.

What is Feline CoronaVirus (FCoV)?

CoronaVirus in cats generally is pretty harmless(*); it might cause a bit of diarrhea which might need some supportive care such as fluids, but on the whole, there is not much to be done for it but wait it out. Think of it a very mild common cold. FYI: one fact I stumbled on while getting the reference material for this post is something I have wondered for years. FCoV is a pretty fragile virus. Quote: FCoV is a relatively fragile virus (inactivated at room temperature within 24 to 48 hours), but in dry conditions (eg, in carpet), it has been shown to survive for up to 7 weeks outside the cat. Indirect fomite transmission is thus possible, and the virus can be transmitted through clothes, toys, and grooming tools. In organ homogenates, it is even resistant to repeated freezing at −70°C for many months. The virus is destroyed by most household disinfectants and detergents, however. (*)

Unfortunately, the rates of incidents of FCoV is actually very high in shelter and rescue kitties (*), which leads to all kinds of confusion. If you ever hear of feline coronavirus and you look it up on the internet, all you basically find is information about FIP. At least that is what happened to me when I first tried to figure it out. FCoV is actually pretty contagious and I have been told that we should just assume that any shelter/rescue kitty has it.

FCoV mutates into Feline Infectious Peritonitis (FIP)

Occasionally, rarely, FCoV mutates into Feline Infectious Peritonitis. As far as I can tell, we still do not know why(*). There is a really cool video on YouTube that shows what happens after the mutation if you are interested. 

Once the virus mutates, it is no longer contagious. If you have a kitty with FIP, you do not need to be afraid of it giving it to another kitty. Could the second kitty also mutate the coronavirus and acquire FIP, yes, especially if they have similar genetics and similar stressors in their life, but remember, this is a pretty rare occurrence in the first place.

I have been hearing some people talk about Ocular and Neurologic FIP. I found this quite fascinating as I have only ever heard the experts talk about "wet" and "dry" forms of FIP. Looking for information on this I have found that people are using these terms to discuss the progression of dry FIP.  Back in 2002, my cat Kodi (*)  had dry FIP (although we never did the necessary tests to ultimately confirm that) and he started bleeding in his eyes at the end. It was what caused me to realize that his time was at an end. I always assumed that it was due to the damage of his internal organs and not FIP in his eye, but in the end, that is unimportant. What matters is figuring out if when someone suggests your kitty has FIP if that is accurate or not.

Why am I writing this post?

The reasons are two-fold. One to discuss what FIP is and the second is the serious limitations we still have regarding this disease. We still have no definitive way to diagnosis it. There is no FIP test despite what vets will tell you. Researchers are getting closer to figuring out how to definitively say a cat has it, but right now that is only via some very expensive testing and even that is only 96% accurate. There are biomarkers that can "rule in" or "rule out" FIP, but that does not mean the cat actually has it as those biomarkers can be raised for any number of other reasons.

There are many symptoms to FIP depending on how it presents and sadly all of them are generic and can present because of any number of diseases. Some issues that have been misdiagnosed as FIP have been: toxoplasmosis, brain tumor, required a dental, lymphoma, bacterial pleurisy, thiamine deficiency, cancer, worms, cerebellar hypoplasia among others. Most of these have a pretty safe and easy treatment, so when your health care provider is suggesting your kitty has FIP then you really need to either tell them to forget that diagnosis and look for something else or get yourself to a new vet. The experts in the field have a flowchart to diagnose it. I am going to reiterate how rare it is. Only 18% of the samples for testing that had a diagnosis of FIP actually had FIP.  Quote:

"You can only be really confident of an FIP diagnosis if you have a positive FCoV RT-PCR result on the effusion of a wet FIP case, or a MLN FNA or aqueous humour in a non-effusive FIP case." (*)  

These cases are not just people thinking the kitty had FIP, but vets who suspected it enough to refer the case on to this point. 

Are you starting to understand why I get so incredibly frustrated when people bandy about the idea that a kitty is suffering from FIP?  Yes, FIP is a real and incredibly serious disease. FIP can and does happen to kitties everywhere, but simply because a kitten is failing to thrive doesn't mean it has FIP. 

FIP is also a disease that takes time. Kittens are generally not diagnosable before three months. They are only open to infection to FCoV at 5 to 7 weeks when their maternal antibodies start to wean. It then takes time for the body to interact with the virus enough to mutate and then it takes another couple of weeks for the mutation to do the damage required to start showing symptoms. (*) Most cases of FIP occur in cats between 4 and 18 months (*)

But isn't FIP treatable now?

Yes, there are two drugs that have put cats with FIP into remission. Some people call that a cure, but with so little data on the subject it is hard to know. I looked into what it would take to get the drug, and it is basically a black market drug from China that requires almost no oversight. You don't need a diagnosis of FIP (mostly because it is still extremely hard to prove as there is no test for it) and the people selling this drug simply say if you suspect it to go ahead and try it and see what happens. From what I have learned it is extremely expensive (in the thousands of dollars range) and quite painful (the medication stings) and it involves daily injections for weeks if not months and sadly many cats do not survive. Because we generally do not know if the cats who receive this treatment actually have FIP or not, we can not say that those who survive the treatment are cured of FIP. Maybe they had some other condition that they recovered from because of the constant care of the owner while being given this medication. Lastly, since this medication has only been in use a few years (at the time of this post) we have no long term data about what happens to these cats in five or ten years. Do they continue on with a normal life? Is there organ damage? Are cancer rates higher (or lower?)? We simply do not know.  I do know that, at this time, if I had a kitten with a seriously strong suspicion of FIP, I believe I would not give the medication at this time.

In conclusion:

While FIP is a real and serious threat to kitties and it is not something to be taken lightly. If you suspect your kitty has FIP, you really need to work with a vet who is willing to ignore the suspected FIP infection and look for a different diagnosis or work with you to do the necessary tests (*) to figure out if that is what you are dealing with.  If your vet is not willing to go the extra mile for a kitty who they suspect has FIP, you need a new vet.

I have said that more kittens die of a false FIP diagnosis than will ever die of the disease itself, and the experts are in agreement.

Remember Me Thursday: Shining the light on pet adoption

 I first heard of Remember Me Thursday back in 2013. It is a campaign by the Helen Woodward Animal Center to shine the light on pet adoption (#seethelight)

I will admit I was a little confused by the campaign in the past, as they use candles as part of their logos; to me, that means you are honoring those that have passed on, not those here waiting for homes, but they really want to bring light to animals waiting for their people. 

This year they are having a contest to get people to share their pet's rescue story to show others that rescue pets are wonderful pets. The goal is to get people to go to rescues and shelters and not pet stores or back yard breeders. 

On Thursday I will share the story of Fleurp, of the challenges and joys she has brought to our lives, and the lessons she has taught me. 

I hope you take a moment this Thursday, September 24th, 2020 to take a moment and share your light about adoption. Talk to a friend about the joy of a rescue pet, Share something on social media about the horrors of pet mills. Share what inspires you about pet adoption.  If you are so inspired, enter the contest and tell the world about your rescue story

Meet Virginia

 Meet Virginia

She was surrendered to the rescue for not having a great quality of life. Other pets in the house were intimidating her pretty hard and I heard she spent most of her time hiding.  The owners did the right thing and reached out to find her another home where she can flourish.

She is a bit lacking in self-confidence. She will run and hide every time I go into the kitten room... 

But she very quickly comes out and starts to meep at me if I am not paying her attention. She demands quite a bit of petting and head buts and then will go and lay on the floor and proceed to roll around like a bit of a hussy (yes, she is making biscuits) 

She had not been spayed so that was done right before I picked her up. I am unsure what happened to her chin, but I know it happened a few days before her surgery so I am confident that the vets took a good look at it. I was able to get a pretty good look at her skin and it has healed up nicely.  

She came to me with the name Sketch, but I thought she needed something a little more pizazz. I was calling her Precious for a few hours, but it didn't really work for me. I woke up the morning after bringing her home and I thought about creating this blog post and immediately the song Meet Virginia popped into my head (and it has not left thankyouverymuch) so, Virginia it is.  I am a little surprised I haven't named a kitty Virginia yet.  I know I had a Ginny, but she was Ginny, so this totally works.

I originally thought she was going to need a lot of time to decompress and to be won over, but really all that needs to be done is for the hormones to leave her body and a little self-confidence building (which has started and she is willing to participate in) so I am guessing she will not be here for long.  She is a VERY good girl.. 

Kreb has been adopted

Well, that took a bit longer than I thought it would, but not nearly long enough in some respects. You know how it is, you get a kitty in your arms and they purr and you fall in love.. Neither my husband or I wanted to let him go, but we both knew that this was most likely not the right household for Kreb, so we both agreed, most reluctantly, to go ahead with adopting him out. 

The rescue that found a home for Suri found him a home as well. It is always a risk when you take in a cat with unwanted urination behaviors because you never know if someone is willing to give a kitty a second chance. I knew if no one else would, we would find a way to make it work here, but we were blessed to find a lovely young woman who appears to be the absolute perfect fit for him. And considering the initial reports of his sleeping under the covers with her the very first night, I would say Kreb totally approves.

It is such a fine line when you let a kitty go, wanting updates, information, knowing how he is doing, getting reassurances that all is going well vs respecting the new owner's privacy and her relationship with her kitty. I have opened the door (maybe a bit too wide, because I am just a wee bit obsessed with Kreb) and if I get updates I will be thrilled. 

I am so glad I got to know Kreb as an adult. He is such a magnificent kitty, full of spunk and charm and that boy next door qualities that are so hard to resist.. 

Good luck Kreb, best wishes, and you will always have a place in my heart.. 

The Nintendo Kittens have gone back to the shelter

Last I checked in with you, Princess Peach was spending her days in "jail". I was having the worst time figuring out why she was simply failing to thrive. She was generally okay, but she wasn't gaining weight. She was dehydrated for a while, had many days of good stool, a few bad days of good stool, some days she ate really well, others not so much. As time went on she became more and more lethargic after eating, and I was getting very concerned.  I brought her to the local vet on Friday and we tested her for Felv/Fiv and tested her stool. Both were negative. I was pretty much at the end of what I thought I could do and the shelter recommended that she go back to them for further diagnostics. There was talk about a liver shunt or FIP, and in the end, it really was in her best interest to be closer to the decision-makers so she and her siblings went back today.

Mario is doing extremely well. She has energy to spare. I swear if I could harness kitten energy I could power the world. She loves running at full speed and pouncing on anything that she can. She and Luigi would often run at each other and jump at the same time and crash in the middle of the air. I wish I could have caught it on camera as I probably would have won AFV.  She does like attention, but she is quite a busy kitty. She was the first of the group to figure out she could climb the cage Peach was in to investigate things I left up there.  She would often join in Princess Peach and Luigi's cuddle time with me and having all three of these kittens up on my chest was pretty awesome.

Luigi is a love.  He loves Peach, he likes attention, he is quick to purr and quick to snuggle up to me. he too has a lot of energy but wasn't as aggressive in burning it off. Right up to the end he still wanted to nurse on Peach. I hate that I couldn't recommend those two be adopted together because I think he would really like being with her, but it is in Princess Peach's best interest to not be with him.

On Friday, after the vet appointment, I was desperate. I hated seeing Princess Peach scream to eat and then eat and have to sleep for an hour or more after eating. She originally shunned eating raw food, but I decided to push it again, and I force-fed her a serving of it. She wasn't pleased, but she wasn't as exhausted as she had been. After the vet exam, she had a major .. um.. evacuation of her intestines.. and I guessed that it was the food that wasn't agreeing with her. I left her with some raw and some canned food and in the morning she had eaten it all, so I put her exclusively on raw all day Saturday and Sunday.  Come Monday morning she had regained the weight she had lost from the explosion and she didn't feel nearly as boney and she had so much energy that I was highly tempted to call off returning them.  I asked and the shelter still thought it best to bring her into the fold since I am more than an hour away from them.  I was sad about this, but I totally understand.   I just hope this wasn't one more false lead on the road to her health. I originally thought her only issue was being nursed on, then I thought it was this and that.. and I didn't even consider it could be a food issue because he stool was generally pretty good.  Time will tell.  I am hopeful she will get her happy ending, but if it is a liver shunt or some digestive issue I am sure they will do what is in her best interest. 


And now a few other adorable photos from the photoshoot this morning.  They really are super adorable. I do kinda wish they could be adopted as a trio, but I am sure they will be very happy wherever they land as long as they have toy mice, ping pong balls, and a warm lap to snuggle up into.