CNS cryptococosis

[Allyocean]

Hi everyone
My cat was diagnosed with ckd last year and has been doing well. Beginning in early April he began twitching slightly. Just his face. It's started to get worse. Initially I went to my vet and he suggested ear cleaning. Didn't help. Than was told possible seasonal allergies since he plays ( supervised) in my yard. He took Claritin. No help. Went to the internist that said it wasn't significant enough to treat and if they continue to see a neurologist. I'm going tomorrow but after sending the video she believes they are seizures and said we will discuss meds tomorrow.
After doing some research I'm convinced it it CNS cryptococosis. He has most symptoms and spends a cpl hours a day outside where I have bushes and ferns (over 150) on the perimeter. The beds are covered in black cedar mulch. Decaying wood is a principle component for spread.
I am praying she will at least order the test and not refer me out. I'm terrified since outcomes for this type are not great. Does anyone have any experience,hopefully positive with this form not the nasel cryptococcosis.

Looking forward to any information
Thank you

 

[fionasmom]

If you have been doing a lot of research about cryptococcus, which it sounds as if you have, I would insist that the vet do the appropriate test. Once you have a result, you can make a decision about treatment which very often involves antifungals and anti-seizure medication.

Don’t jump to the conclusion that he has cryptococcus until you are sure that he does. While seizures are not a pleasant thing to face, they are not all caused by cryptococcus.

If you were searching through the site, you may come across references to the fact that I had a cat who died from CNS cryptococcus. He was a young adult street rescue who I believe had been infected sometime before he ever came to my house looking for help.

Once I rescued him, he was taken to the vet and neutered and became an indoor only pet cat. He never went outside again, but shortly after adopting him he had an unexpected massive seizure one night. Of course, I sought medical help for him, but a couple of weeks later he went blind. He declined very quickly from there, and I had to let him go.

My guess would be in a very urban area like this one, he may have come into contact with a lot of bird droppings, especially pigeons.

Pangur Ban had much too advanced a case but when it is diagnosed in the early stages, including the CNS form, there’s definitely treatment that can be started. I believe there may even be some new medication if you were able to connect with the right specialist.

This may not be cryptococcus that your cat has, and if it were to be, don’t let the vet talk you out of any treatment that you would like to try to provide for him.

 

[silent meowlook]

Hi. Unfortunately, I have had ample experience with cats being treated for cryptococcus. Sadly, it is never high on regular veterinarian's radar, so often by the time it is diagnosed (usually through a specialist) it is very far advanced. I worked for an internal medicine specialist for about 9 years, and other veterinary specialties as well. I am not a veterinarian.

As far as I know, the treatment for Cryptococcus, once it has passed the blood brain barrier and become neurological. is Amphotericin B. This is used as well as the other oral medications used. The Amphotericin B is tricky stuff because, at least when I did it, NACL 400mls has to be given subcutaneously immediately prior to administration. This is a huge volume of fluids for a cat, even SQ. I believe the treatments were done weekly.

I took on one of the patience at the practice because the owners had a family emergency and had to leave town for 2 weeks. The cat I was caring for was a 3-year-old Siamese, that was basically comatose when I started. I took my vacation at the same time so I could properly take care of a comatose cat at home. I am not going to lie; it was a lot of work. I took him to the hospital once or twice a week for the treatments. I tube fed him, expressed his bladder and basically was a 24/7 nurse for him. He also had antifungal medications but fortunately, I was able to tube feed him. I did work everything out to a routine that was working well. Over the first week, I felt horrible for him, to the point that I phoned the owner to get permission for euthanasia. They agreed. The Specialist did not. By the second week, I started to see some signs of life in him. There was each day more and more cat behind his eyes. He started eating on his own and was able to walk or crawl a little. I would take him outside to sit in the sun and I think that encouraged him a bit. I drove him home the day owners got home. I should have realized that I overwhelmed them. I was so excited that he could walk, which he could by then and he would vocalize. I believe my instructions were too much for them. He was honestly improving so much, and I think he would have made a full recovery.

The owners called me the next day and said they were going to put him to sleep. I talked to them, I offered to care for him until he was fully recovered, I offered to adopt him. They wouldn't do it. They felt he was suffering. Obviously, I couldn't say or do anything. But if he had not been euthanized, I think he would have survived,

Yaki, the cat above, had the most advanced case of cryptococcus I have ever seen or even read about.

I have seen other cases, not as advanced that were well managed and while I don't want to say, made a complete recovery, they lived quality happy lives.

The test for Cryptococcus that most veterinarians test for is a blood test sent to a lab. The blood must be handled a certain way, and the blood is spun down into serum and the serum is lifted off and frozen if I remember correctly. Any veterinarian should have the capability to prepare the sample for the lab. I believe the results take a couple of days.

If it is cryptococcus I am not sure, but I think that the Amphotericin B is nephrotoxic, which is why they have to do the massive fluids prior to giving. I know you mentioned your cat has some kidney issues; I think. There may have been more advances in treatment than when I was working,

But no need to worry about all that now, since you don't know if he has it or not. If the symptoms are neurological, there are many other things that could be causing that.

Of course, I am sure you have carefully checked your house and yard for anything toxic.

Anyway, hope this helps,

 

[Allyocean]

Thank you both!

I am praying the neurologist will do the test and they have experience in handling and preparing the sample. I'm glad you gave me some idea of what would be involved. I already do subq 2 or 3xs a week and I only give 100 ml at a time so yes 400 sounds daunting but I will do anything for this cat.

You are both right about jumping to conclusions. I just cannot find anything indicating focal seizures increase in frequency and are continual day and night. No difference in awake or sleeping. Still twitching 3-10 times every 3 minutes.

I think the yard is free of toxins. I've checked everything, I think. Of course there may be something I'm missing. A few years back a pesticide was used on a small section of the grass for sedge grass. That was 2 or 3 years ago and once I realized what that stuff does to the environment and all creatures I will never use any chemicals again. That being said it has crossed my mind that it may be causing issues. The thing that makes me doubt that, is the time. Why now? Why 2 or 3 years passed and now it's effecting him.....I'm going crazy trying to figure it out!

I had the heska allergy test done 4 years ago and he's allergic to so many things that I've kept from him but giving him the famotadine I put it in a pill pocket and that has corn or wheat, I forget. Only 2 a day so can't imagine this would be the cause but maybe?

3:30 today I'll have more info but at this point I just want the test to rule in/out.
I'll post when I know more.

Thank you! This really helped me not feel so alone

Allyson

 

[Meowmee]

Hi. Unfortunately, I have had ample experience with cats being treated for cryptococcus. Sadly, it is never high on regular veterinarian's radar, so often by the time it is diagnosed (usually through a specialist) it is very far advanced. I worked for an internal medicine specialist for about 9 years, and other veterinary specialties as well. I am not a veterinarian.

As far as I know, the treatment for Cryptococcus, once it has passed the blood brain barrier and become neurological. is Amphotericin B. This is used as well as the other oral medications used. The Amphotericin B is tricky stuff because, at least when I did it, NACL 400mls has to be given subcutaneously immediately prior to administration. This is a huge volume of fluids for a cat, even SQ. I believe the treatments were done weekly.

I took on one of the patience at the practice because the owners had a family emergency and had to leave town for 2 weeks. The cat I was caring for was a 3-year-old Siamese, that was basically comatose when I started. I took my vacation at the same time so I could properly take care of a comatose cat at home. I am not going to lie; it was a lot of work. I took him to the hospital once or twice a week for the treatments. I tube fed him, expressed his bladder and basically was a 24/7 nurse for him. He also had antifungal medications but fortunately, I was able to tube feed him. I did work everything out to a routine that was working well. Over the first week, I felt horrible for him, to the point that I phoned the owner to get permission for euthanasia. They agreed. The Specialist did not. By the second week, I started to see some signs of life in him. There was each day more and more cat behind his eyes. He started eating on his own and was able to walk or crawl a little. I would take him outside to sit in the sun and I think that encouraged him a bit. I drove him home the day owners got home. I should have realized that I overwhelmed them. I was so excited that he could walk, which he could by then and he would vocalize. I believe my instructions were too much for them. He was honestly improving so much, and I think he would have made a full recovery.

The owners called me the next day and said they were going to put him to sleep. I talked to them, I offered to care for him until he was fully recovered, I offered to adopt him. They wouldn't do it. They felt he was suffering. Obviously, I couldn't say or do anything. But if he had not been euthanized, I think he would have survived,

Yaki, the cat above, had the most advanced case of cryptococcus I have ever seen or even read about.

I have seen other cases, not as advanced that were well managed and while I don't want to say, made a complete recovery, they lived quality happy lives.

The test for Cryptococcus that most veterinarians test for is a blood test sent to a lab. The blood must be handled a certain way, and the blood is spun down into serum and the serum is lifted off and frozen if I remember correctly. Any veterinarian should have the capability to prepare the sample for the lab. I believe the results take a couple of days.

If it is cryptococcus I am not sure, but I think that the Amphotericin B is nephrotoxic, which is why they have to do the massive fluids prior to giving. I know you mentioned your cat has some kidney issues; I think. There may have been more advances in treatment than when I was working,

But no need to worry about all that now, since you don't know if he has it or not. If the symptoms are neurological, there are many other things that could be causing that.

Of course, I am sure you have carefully checked your house and yard for anything toxic.

Anyway, hope this helps,

Omg horrible the owners did that, but it’s their call ultimately.

 

[silent meowlook]

Any updates?

 

[Allyocean]

Yes! Great news. But id like your opinions. The neurologist said if he has cns cryptococosis it would not be this subtle. If first signs were early April with only a few days of watery eyes and sneezing (likely allergies)., he would be dead by now. She said we could start zonisamide since he l tolerated it 6 years ago or we could do imaging which would be a bazillion dollars( her words lol) or I could let him be since the IBD and CKD would explain his intermittent GI issues and inappetence. She said if he is still doing normal cat things and the twitching doesn't escalate, she would not add medication yet. She said at any time I feel his quality of life is suffering and the side effects and stress of medication seem appropriate , she will write a prescription.

Please weigh in with opinions and experiences.

Thanks so much for caring

 

[silent meowlook]

Hi. Cryptococcus, from what I have seen, can manifest in many different ways and progress very differently. For example; When I worked specialty, there was a cat with a mass in his chest. A Cryptococcus titer was sent to the lab and it came back negative. The cat underwent surgery to have the mass removed, and it was. The mass was sent to the same lab for histopathology, and the results came back as it being Cryptococcus.

So, I don’t think anyone can actually predict how it progresses, but I will say that I have not seen it manifest as just tremors in my experience.

I had a cat with chronic rhinitis. I was going to get a CT scan done. Back then in 2009 it was around $1,000.00. I opted not to do it because I didn’t want to have my cat anesthetized. I am sure the price has gone up since then, but I doubt it is a bazillion dollars. But it is probably expensive. What it will show is if there is a mass, if there is destruction of some of the nasal structures. I am sure it is helpful in many cases, I just didn’t like the anesthesia part for my cat.

Many regular veterinarian don’t refer to specialists when they should and I have seen the clients money spent going down the wrong avenues to try to get a diagnosis when if they had gone to a specialist, it would have been less money and stress in the long run.

My cat now has many different illnesses. Lymphoma, hyperthyroidism, kidney disease, asthma and now elevated liver enzymes. She has the small focal facial tremors. Sometimes more than others. With her, I believe it is in part due to some electrolyte abnormalities. Her potassium was low and once supplemented, I found them to be less. So always keep that in mind.

I think it is important to keep up with routine bloodwork. I am not sure the cost of a Cryptococcus titer would be the best use of your money, as it isn’t a cheap test.

It sounds like the plan you have now is a reasonable one.

 

[Allyocean]

I am so sorry you have so much going on with your baby. I can't imagine the emotionaltoll but with all your knowledge at least you understand and can advocate without spinning your wheels.. I'm really glad you responded since you have experience dealing with all of my boys' issues.

The neurologist is just wonderful and was joking as the cost is 3000 -3600 around here. She also expressed concern about anesthesia. 6 years ago we did a CT because of his focal seizures and after 2 years on zonisamide he became so drugged out we stopped the meds and he has not had a staring focal seizures since. She said she thought it may be a GI related neurological issue and sent me a PubMed study showing a preliminary correlation. But so far as she knows it's the only study involving cats.

His bloodwork has been so encouraging every three months. In fact the only thing still showing kidney issue is his creatinine and it's down to 2, so I really panicked with the twitching. I went right to electrolyte or phosphorus too. That's what led me to neurology.

Do you think I should do the imaging?
-Allyson

 

[fionasmom]

I am certainly not a crytococcus expert, and I hope that I never see another case. Pangur Ban's first manifestation was huge, as I said. He was a sweet, manageable stray whom I immediately made an indoor cat and I interacted with him daily and never saw preliminary twitching or anything that looked like a mild seizure or tremor. The time frame that the neurologist gave you of

If first signs were early April with only a few days of watery eyes and sneezing (likely allergies)., he would be dead by now.

definitely matched the time frame that I experienced. So that is all rather good news.

I will say that I have not seen it manifest as just tremors in my experience.

This also fits my experience with cryptococcus...again, only one experience.

If you are already seeing a neurologist, I would probably follow their suggestion as it stands. The fact that there were previous seizures might be a piece in this.

The CT scan might be of value, but you have to weigh the use of anesthesia and the cost. With a cat who may need other care, I think that anyone has to be careful about spending money on something that may or may not help.

 

[silent meowlook]

Hi. I wouldn’t do the CT scan because I wouldn’t want to have my cat anesthetized . Also, you have to understand what exactly the CT scan will show and how the information gained from it will alter what you are doing.

 

[Meowmee]

I don’t know very much about this condition, but I found some links for you, one of which shows an MRI I think. I think most cats have nodules/ ulcers on their face before they get CNS but I don’t know really. But they could get it in their nose too, and then it goes to the brain.

Cryptococcus infection | Cat Specialist Services

Cryptococcus infection is a fungus found frequently in the environment, particularly in pigeon droppings, nesting places and soil, especially if it is contamina

www.catspecialists.com.au

.

https://www.vet.cornell.edu/departments/cornell-feline-health-center/health-information/feline-health-topics/cryptococcosis#:~:text=Central%20nervous%20system%20(CNS)%20cryptococcosis,cavity%20into%20a%20cat's%20brain.