Feline Infectious Peritonitis

What is feline infectious peritonitis? 

Feline infectious peritonitis (FIP) is an important disease of domestic cats. It occurs worldwide in cats of all ages, but the disease is most common in young cats less than two years of age. Although FIP is not a particularly common disease, it is important because once a cat develops the disease, the outcome is almost invariably fatal.

What is the cause of FIP?

FIP is associated with a viral infection called feline coronavirus. There are many different strains of feline coronavirus, which differ in their ability to cause disease. Previously there had been an attempt to classify these strains as either feline infectious peritonitis virus strains (capable of causing the FIP disease) or feline enteric coronavirus strains (essentially harmless strains mainly found in the intestinal tract). It is now recognized that feline enteric coronavirus strains can mutate (change) to the more harmful type of virus and cause FIP disease.

"FIP remains one of the least understood of all cat diseases."

Diagnosing FIP is very challenging for many reasons. Unfortunately there are no laboratory tests available that can distinguish between the enteric coronavirus and the FIP-causing strains. Even when infected with known FIP-causing strains, many cats do not develop FIP disease. The factors determining why one cat becomes diseased while others remain unaffected are unclear. FIP remains one of the least understood of all cat diseases.

 How common is infection with feline coronavirus in comparison with FIP disease?

Many cats (up to 50% in single cat households and as high as 80-90% in multi-cat environments) become infected with one or more strains of feline coronavirus at some time in their lives. The majority of cats with feline enteric coronavirus (about 90% or more) remain healthy. The incidence of feline infectious peritonitis disease is low (only 5 to 10% of infected cats and less than 1% of cats admitted to veterinary hospitals).

Are certain cat breeds more susceptible to FIP?

Certain breeds of cats may be more likely to develop FIP. Those breeds include the Abyssinian, Bengal, Birman, Himalayan, Ragdoll, and Devon Rex. FIP may be more common in cats that live in multi-cat households, shelters, or catteries. Cats that are stressed due to re-homing, have recently had surgery, or have concurrent infections (more than one infection at a time) may also be more susceptible to developing FIP. Genetic factors are also thought to contribute to the development of FIP.

How does a cat become infected with feline coronavirus?

Most cats become infected with feline coronavirus through the fecal-oral route (oral contact with infected feces). It is estimated that about one-third of these cats shed the virus in their feces. Most cats only shed the virus for a few months, but a small percentage will shed the virus continuously for life. Although the virus is quite fragile and does not survive for more than 24-36 hours in the normal environment, it is believed that cold temperatures may preserve the virus for months. Transmission on clothing or other objects is only likely within a few hours of contact.

"Cold temperatures may preserve the virus for months."

As explained above, most infections are with relatively harmless strains of feline coronavirus. Unfortunately, this initial benign infection may later mutate to cause FIP in some cats. Even with the more harmful strains, apparently healthy cats may be carriers of the virus, and may shed the virus without ever showing signs of disease. Many cats that develop FIP have no history of contact with other cats showing clinical signs of FIP. The virus can remain dormant or inactive in the body for months to years before the cat eventually develops disease.

What age is a cat most at risk for developing FIP?

It is believed that most cats are exposed to feline coronavirus at a very young age, perhaps during the first few weeks of life. Most cats that develop FIP are between the age of 3 months and 2 years of age, although any age cat can develop the disease.

What clinical signs does a cat infected with FIP develop?

In cats that develop FIP disease, the first signs of illness may be very vague. Listlessness, lethargy, decreased or absent appetite, weight loss, and a fluctuating fever are commonly reported clinical signs. After a period of several days to a few weeks other symptoms typically begin to occur.

At this stage, most cats will develop the 'wet' or effusive form of FIP, which refers to the accumulation of fluid in body cavities; fluid may accumulate in the abdomen, leading to a swollen abdomen, or in the chest cavity, resulting in difficulty with breathing.

Some cats develop 'dry' or non-effusive FIP where little to no fluid accumulates. The dry form often involves severe inflammation in one or more organs including the eyes, brain, liver, intestine, or other organs of the body, leading to a variety of clinical signs. Many cats with non-effusive FIP will have ocular (eye) symptoms as their only clinical sign.

Once disease develops, most individuals deteriorate rapidly, although some cats remain normal for several weeks. Unfortunately, the disease will eventually result in death in almost every case.

Most cats exposed to feline coronavirus, even to the potentially FIP-inducing strains, are able to develop an immune response that protects them, therefore only a small proportion of infected cats actually develop clinical disease. However, as stated above, those that do develop the disease almost invariably die.

How can FIP be diagnosed?

Many of the clinical signs of FIP are vague and occur with other diseases found in cats, making FIP particularly difficult to diagnose. There may be abnormalities in a routine blood analysis, but none is specific for FIP. X-rays may be helpful to determine the presence of fluid in the abdomen or chest. If fluid is present, some of it can be removed by tapping the chest or the abdomen. Analysis of this fluid at a veterinary laboratory can be particularly valuable, as few other diseases produce the same type of fluid that FIP creates. Nevertheless, fluid analysis does not always provide a definitive diagnosis of the disease. Sometimes FIP is a diagnosis of exclusion, meaning that a variety of similar conditions have been ruled out. The diagnosis may be further complicated because FIP may exist at the same time as some other conditions such as feline leukemia virus diseases. See the handout “Feline Infectious Peritonitis Testing” for further information on diagnosing FIP.

"Your veterinarian may advise that a biopsy be taken from your cat, so that FIP can be distinguished from a treatable disease."

Currently the only way to make a positive diagnosis of FIP is by histological examination of affected tissue (or by post-mortem examination) by a pathologist at a laboratory. If there is any doubt about the diagnosis, your veterinarian may advise that a biopsy be taken from your cat, so that FIP can be distinguished from a treatable disease.

 I understand there are specific blood tests. How reliable are these?

Veterinary laboratories provide tests that detect antibodies to feline coronavirus in the blood, but these tests are non-specific and cannot be used alone to diagnose FIP. Some laboratories provide tests such as polymerase-chain reaction (PCR) tests, which can detect very small amounts of the virus but no unique genetic sequence associated with FIP has been identified. Although some of these tests claim to be able to distinguish between the strains, and to detect strains more likely to be associated with FIP, many independent experts disagree with these claims. Therefore, a positive test in a healthy cat is not a strong predictor of subsequent FIP disease.

"If a cat has clinical signs consistent with a diagnosis of FIP, then a positive test is supportive of the diagnosis, but not conclusive."

If a cat has clinical signs consistent with a diagnosis of FIP then a positive test is supportive of the diagnosis, but not conclusive. Likewise, a negative test in the presence of advanced signs does not rule out the diagnosis of FIP.

As you can see, FIP is one of the most challenging diagnoses for your veterinarian to make because of the complexity of the disease and the limitations of current tests.

Is there any treatment for FIP?

FIP is fatal in almost all cases. Supportive treatments may extend longevity and improve quality of life, however, there is no specific cure. Anti-inflammatory drugs such as corticosteroids (e.g., prednisolone) in combination with certain drugs that suppress the immune system (e.g., cyclophosphamide), may temporarily reduce inflammation and improve the cat's quality of life. An experimental drug, polyprenyl immunostimulant (PI), is currently being investigated for use in the dry form of FIP. For the clinically ill cat, once FIP has been diagnosed, euthanasia may be the most humane and appropriate course of action.

Is there a vaccine for FIP?

In recent years, some manufacturers have developed vaccines to help in the prevention of FIP. Because the method of transmission and the sequence of events leading to clinical FIP disease are poorly understood, and because infection may have occurred before vaccination, the success of vaccination is not certain. Currently the vaccines for FIP are not recommended for general use. You and your veterinarian can discuss whether vaccination is appropriate for your cat.

Are other cats in the household at risk?

If your cat has FIP, other cats in your household may be at a greater risk for becoming infected with feline coronavirus. Fortunately, infection will lead to this fatal disease in a minority of cats. As a precaution, many veterinarians recommend that you wait about a month after an infected cat dies before introducing a new cat into the house, to minimize the chance of exposure to the virus. In a multi-cat household in which an infected cat has died, it is recommended to wait at least three months to see if any other cats develop clinical disease. However, these previously exposed cats could be carriers of the disease and could potentially infect any new cats.

"Infection will lead to this fatal disease in only a few cats."

Treating FIP Experimentally - NEW PROTOCOLS BEING TESTED.

FIP is considered incurable, with treatment consisting mainly of providing comfort and supportive care. For cats in respiratory distress from fluid buildup around the lungs or within the abdomen, removing the effusion and providing oxygen support can aid in immediate relief.

Though the experimental antiviral treatment at Kansas State University seems promising, there is concern that the coronavirus that causes FIP could acquire further mutations, rendering it resistant to antiviral treatments such as the one developed at Kansas State University. In addition, this form of treatment was only studied in cats with the effusive form of the disease; its efficacy in cats with the dry form is unknown. It is also unknown whether the antiviral will be successful in treating cats naturally infected with FIP as all of the cats in the study were infected experimentally.

Polyprenyl Immunostimulant (PI) is an investigational biologic used to lessen clinical signs associated with herpes virus infections in cats by promoting immune responses to the virus. PI also has been used to treat FIP. In a small study, three cats with the dry form of FIP were treated with PI. Two cats were alive and still receiving treatment two years following diagnosis. The remaining cat was treated for only 4.5 months and lived a total of 14 months. A larger study was done in 58 cats with the dry form of FIP. Five percent of those cats lived longer than one year and 22 percent lived at least 5.5 months.

Though PI might seem like the magic bullet for treating the dry form of FIP, there are a few caveats to consider. In the smaller study, the amount of disease present in all three cats was minimal; two had no clinical signs at their time of diagnosis. In the larger study, cats who were very ill or died within a week of starting treatment with PI were excluded from the survival analysis, likely skewing results.  

As some cats with no or minimal signs of disease and localized lesions can spontaneously recover from FIP without treatment, the role of PI in aiding the convalescence in these marginally affected cats is unclear. PI is also completely ineffective in treating cats with the effusive form of FIP.

Though these new treatment options seem promising, further research is necessary to determine how successful they will be for cats affected with FIP.