Page 9 - Clinical Connections - Spring 2022

 

 

 

 

 

Page 9 - Clinical Connections - Spring 2022
P. 9

Internal Medicine
        FELINE INFECTIOUS PERITONITIS
        TREATMENT WITH REMDESIVIR



               erlin, a 24-week-old male neutered   revealed  mild  hypoalbuminemia  and  Treatment and outcome
               Bengal  cat,  was  referred  to   moderate hyperbilirubinemia.   Merlin  started  treatment  with  15mg/kg
        M the Queen Mother Hospital for       Haematological examination revealed   remdesivir intravenously. 24 hours later, his
        Animals (QMHA) with a one-week history of   moderate monocytosis and a marked   pleural effusion increased in volume and he
        lethargy, hyporexia and a 24-hour history of   neutrophilia  with  left  shift  and  moderate   required repeat thoracocentesis.  After 36
        tachypnoea.                         toxicity.  CT  of  his  thorax  and  abdomen   hours, Merlin remarkably appeared brighter,
          He was the first of more than a dozen cats   demonstrated bilateral pleural effusion, with   he was no longer oxygen-dependent and
        with feline infectious peritonitis (FIP) to be   pleuritis and  multifocal  lymphadenopathy.   began eating. By 48 hours he was bright,
        successfully treated with remdesivir at the   Fine  needle  aspirates  of  abdominal   vocal and active and was transferred out of
        .                                lymph  nodes  were  consistent  with  the ICU. By 72 hours there was significant
          Feline  infectious  peritonitis  is  an  pyogranulomatous  inflammation  and  the   reduction in both pleural and peritoneal
        uncommon disease caused by a mutated   pleural  fluid  was  a  protein-rich  transudate   effusions.
        enteric coronavirus. When diagnosed, the   (59g/L) with an A:G ratio of 0.5 and positive   By  day-five  Merlin’s  pleural  effusion
        disease was thought to be almost always   coronavirus titre.            had  resolved,  and  he  was  transitioned
        fatal due to a lack of efficacious treatment.   Merlin’s  case  was  complicated  by  the   onto 10mg/kg subcutaneous remdesivir
        Over the past few years, a  small number   presence of severe phlebitis of his right   injections.  By  day-seven  his  peritoneal
        of studies showed that an antiviral drug   cephalic vein from previous catheter   effusion  had  resolved,  and  he  underwent
        remdesivir  and  its  parent  nucleoside  GS-  placement,  resulting  in  extensive  necrosis   a general anaesthetic and surgical repair
        441524, could be the key to successfully   of  the  overlying  skin.  He  required  skin   of his extensive right forelimb wound. He
        treating FIP in cats. However, it wasn’t until   debridement under general anaesthesia   recovered well from the procedure and
        the COVID-19 pandemic, when remdesivir   and antibiotic treatment.      two  days  later  Merlin  was  discharged  to
        became  licensed  to  treat  COVID-19   While  hospitalised,  Merlin’s  condition   complete an 84-day course of subcutaneous
        infections in human patients, that the drug   unfortunately  deteriorated.  He developed   remdesivir  injections  at  home.  His  wound
        became widely accessible to treat FIP here   peritoneal effusion and became recumbent,   healed completely with no complications,
        in the UK and Australia.            obtunded, oxygen-dependent and his pleural   and  he  tolerated  his  daily remdesivir
          On presentation Merlin was pyrexic   effusion  required  repeat  thoracocentesis.   injections well.
        (40oC),  with   palpable  abdominal  A diagnosis of FIP was suspected, and   It is now several months after Merlin
        masses  and  a  pleural  effusion  requiring   his owners opted to start treatment with   finished  his  treatment  and  he  has  been
        thoracocentesis.  Serum  biochemistry  remdesivir.                      doing brilliantly at home.
                                                                                 Commenting on Merlin’s case and other
                                                                                cats treated for FIP at  Small Animal
                                                                                Referrals, Jodie Green and Sarah  Tayler,
                                                                                both  of  the  Internal  Medicine  Service,
                                                                                said:  “Thirteen  cats  have  now  followed  in
                                                                                Merlin’s footsteps and the results have been
                                                                                astonishing.  Cats  we  were  worried  were
                                                                                almost  too  severely  affected  have  shown
                                                                                dramatic recoveries within just two to three
                                                                                days of starting treatment. Six months ago,
                                                                                we would have considered this a completely
                                                                                fatal  disease  and  now  we’re  achieving
                                                                                treatment success rates of over eighty
                                                                                percent.
                                                                                 “After  Merlin  finished  his  treatment  a
                                                                                new drug in the form of a tablet became
                                                                                available (GS-441524). This appears to be
                                                                                just as effective as remdesivir and negates
                                                                                the need for daily subcutaneous injections.
                                                                                After initial intravenous remdesivir therapy,
                                                                                we have transitioned cats onto the oral
                                                                                tablet with equal success.”
         Merlin, the first of several cats treated by remdesivir at the 
                                                                                      For small animal referrals, please call:
                                                                                     01707 666399
                                                                                      Email:
                                                                                     qmhreception@rvc.ac.uk



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