A survey on workload and wellbeing
Burnout and poor mental health may be key factors linked to the current shortage of veterinarians; this paper presents the results of a recent survey that attempts to gauge the scale of the problems.
Issue number 26.2 Other Scientific
Published 28/01/2021
Also available in Français , Deutsch , Italiano and Español
Sneezing is a remarkably common presenting complaint in cats, and it is important for the practitioner both to have a good overview about the possible causes when presented with an affected cat or a clowder of cats, and to be aware of the various diagnostic and therapeutic options available.
Imaging, biopsy and possible rhinoscopy are the most likely investigations to result in a diagnosis, whilst PCR testing can be useful for confirmation of a chronic infectious cause.
Older cats that start sneezing may warrant further diagnostics, with the choice of tests based upon assessment of the patient and the owner’s wishes.
In young, healthy cats with an acute onset of sneezing, an infectious etiology is most likely and the signs will normally resolve whatever therapy is chosen.
The sneezing cat is one of the most common presentations in small animal practice. The practitioner should be well acquainted as to the possible causes, as well as the various diagnostic choices and available therapeutic options, when presented with such cases.
Sneezing represents the body’s efforts to clear irritants from the nose, and is generally an involuntary process. Some causes of sneezing are self-limiting, such as exposure to a dusty basement, while others may be more progressive and even life-limiting.
Practically, I feel that it often appears to make sense to divide sneezing cats into categories of “easy” or “complex” when determining the types of investigations that should be pursued when presented with these cats; “easy” cases are typically represented by kittens with mild upper respiratory infections, whilst “complex” cases represent cats with chronic disease that stubbornly refuses to resolve, or cases where the etiology remains elusive despite extensive testing. This paper offers a brief overview for the clinician presented with a sneezing cat.
As with almost all diseases, signalment is very useful in the evaluation of a cat that is sneezing. Other key historical questions I ask include verification of exposure to the outdoors or to other cats, the duration of clinical signs, the animal’s general appetite and activity levels, and the success of any prior therapies. It is important to identify if there has been any nasal discharge, including its characteristics, and whether it is uni or bilateral.
From a physical examination perspective, fever can support the diagnosis of infection; viral infections in particular are commonly accompanied by a high fever. Facial asymmetry or lack of airflow through one or both nostrils may be identified and more directly support the identification of nasal obstruction.
Severe dental disease or the presence of an oronasal fistula may direct therapeutics towards treatment of dental pathology. Enlarged mandibular lymph nodes may support a diagnosis of infection (e.g., with Cryptococcus) or neoplasia. Cats that have recent significant weight loss, or appear otherwise unthrifty, are more likely to have serious underlying disease.
A multitude of potential causes of sneeze exist, and these can be largely divided into the following subcategories:
Kittens and young cats are very prone to upper respiratory infections, particularly when housed in a shelter setting or other small groups. Viral infections are easily spread from cat to cat, and even via fomites on caregivers. Other, far less common, causes of sneezing in young animals include nasopharyngeal polyps (Figure 3), nasopharyngeal stenosis, foreign body, and – rarely – persistent right aortic arch, (resulting in pooling of fluid in the esophagus and subsequent nasal reflux).
Outdoor or primarily outdoor cats are more prone to trauma and foreign bodies. Note that outdoor cats that are not members of a free-roaming colony often do not develop respiratory infection as they are quite solitary and are rarely exposed to other cats.
Middle-aged and older cats are more likely to be affected with neoplastic diseases, and this diagnosis may be suspected in an appropriately aged cat which has no prior history of nasal and airway disease. Many cats with chronic rhinitis have a past history of an apparently favorable response to antibiotics.
I am typically much more enthusiastic to advise a complete work-up in an older cat with new onset of signs. Various diagnostic options are available for investigation of the sneezing cat, and the choice of tests should be based upon the assessment of the patient and the owner’s wishes 3.
General anesthesia is required for almost all diagnostic procedures involving the nose, and any commonly used anesthetic protocol is usually acceptable for a cat that is sneezing. However, the caudal oropharynx is very sensitive in this species, and any examination can result in coughing and gagging. As mentioned above, cats should be intubated if biopsy or flushing is to be performed, and remember that any gauze placed in the oral pharynx should be removed prior to recovery. Cats should always be monitored very closely during recovery.
Strategies to prevent sneezing in cats are dependent on the etiology. Obviously, vaccinations are widely available for protection against herpes and calicivirus; interestingly, a recent study 11 showed that intranasal vaccination against viral agents was also effective in decreasing signs caused by bacterial challenge. Introduction of a new cat or kitten to a household already populated with cats should be undertaken with care 12, and a suitable period of quarantine for any new arrival is certainly advisable.
Elizabeth Rozanski
In most cases of sneezing, no dietary changes are required, although cats that are reluctant to eat due to an upper respiratory infection may benefit from a palatable recovery diet. In cats with nasal tumors, or other conditions that can result in more long-term anorexia, an esophageal feeding tube may be placed (see paper on page 46) and a suitable recovery diet administered. In cats with suspected allergy, it may be prudent to consider a hypoallergenic diet.
Sneezing is a common presenting complaint in cats. In young, otherwise healthy cats with an acute onset, an infectious etiology is most likely and will be expected to resolve regardless of the therapy (or lack of!) that is pursued. Foreign bodies, while less common, are certainly possible, especially in cats with outdoor access where there is a sudden onset of signs, and in particular if no fever is present. For kittens that are systemically ill, careful nursing care and antibiotics are advised.
In older cats, or in cats with an acute onset of sneezing, further diagnostics are warranted, and these should be chosen based upon the assessment of the patient and the owner’s wishes. If possible, a CT scan, biopsy, and rhinoscopy will be the most likely investigations to result in a diagnosis.
PCR can be pursued for confirmation of a chronic infection or if treating a large group of cats. Chronic rhinitis is a long-term medical condition and is unlikely to be curable, but may be palliated with a number of therapies.
Veir JK, Lappin MR, Dow SW. Evaluation of a novel immunotherapy for treatment of chronic rhinitis in cats. J Feline Med Surg 2006;8(6):400-411.
Reed N. Chronic rhinitis in the cat. Vet Clin North Am Small Anim Pract 2014;44(1):33-50.
Egberink H, Addie D, Belák S, et al. Bordetella bronchiseptica infection in cats. ABCD guidelines on prevention and management. J Feline Med Surg 2009;11(7):610-614.
Litster AL, Wu CC, Constable PD. Comparison of the efficacy of amoxicillin- clavulanic acid, cefovecin, and doxycycline in the treatment of upper respiratory tract disease in cats housed in an animal shelter. J Am Vet Med Assoc 2012;15;241(2):218-226.
Haney SM, Beaver L, Turrel J, et al. Survival analysis of 97 cats with nasal lymphoma: a multi-institutional retrospective study (1986-2006). J Vet Intern Med 2009;23(2):287-294.
Bradley A, Kinyon J, Frana T, et al. Efficacy of intranasal administration of a modified live feline herpesvirus 1 and feline calicivirus vaccine against disease caused by Bordetella bronchiseptica after experimental challenge. J Vet Intern Med 2012;26(5):1121-1125.
Litster AL, Lohr BR, Bukowy RA, et al. Clinical and antiviral effect of a single oral dose of famciclovir administered to cats at intake to a shelter. Vet J 2015;203(2):199-204.
Elie M, Sabo M. Basics in canine and feline rhinoscopy. Clin Tech Small Anim Pract 2006;21(2):60-63.
Bellei E, Pisoni L, Joechler M, et al. An unusual case of a nasal foreign body in a cat with chronic nasal discharge. J Am Anim Hosp Assoc 2015;51(4):249-251.
Reed N, Gunn-Moore D. Nasopharyngeal disease in cats: 1. Diagnostic investigation. J Feline Med Surg 2012;14(5):306-315.
Spindel ME, Veir JK, Radecki SV, et al. Evaluation of pradofloxacin for the treatment of feline rhinitis. J Feline Med Surg 2008;10(5):472-479.
Litster AL, Wu CC, Leutenegger CM. Detection of feline upper respiratory tract disease pathogens using a commercially available real-time PCR test. Vet J 2015;206(2):149-153.
Elizabeth Rozanski
After obtaining her DVM from the University of Illinois in 1992, Dr. Rozanski pursued a rotating internship at the University of Minnesota before following a residency at the University of Pennsylvania Read more
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