Please Help. Fungus disease and eye infection. Anyone have any suggestions or experience to share?

[3kittykatsmom]

My 5 year old gentle giant male kitty began having nasal symptoms in September. After months of taking him to my vet who has served me well and helped save my other 5 year old from crystal disease, he has been diagnosed with nasal fungal disease cryptococcus, which has spread to his eye. I guess fungal disease is tricky to diagnose because it gets better, then worse, then repeat. Very uncommon in an indoor cat. He has no other known immune deficiencies as we have tested for all of them.

First med (fluconazole-typical med used in fungal eye infection- dose 50mg twice daily) didn't work. Now on second med (itraconazole- dose 100 mg once daily) which is working systemically but not so much in the eye. Has anyone had any experience with fungal infections and if so any advice on how to save the eye? His left eye retina may be also involved. Just praying to save his vision. Please if you have any advice please share. Thank you so kindly.

 

[MissClouseau]

Is he on a multivitamin or another supplement to support the immune system? When the street cats in my condo got fungal infection I found multivitamins to make a big difference. I would discuss multivitamins with the vet.

 

[FeebysOwner]

Hi. Have you talked to the vet about his eye not improving? Perhaps, he has a secondary infection (bacterial in nature) in addition to the fungal problem? I don't think the meds you are giving would help with a bacterial infection. It's worth asking the vet about this anyway.

 

[3kittykatsmom]

Yes, he has been on antibiotics for a while, even different kinds. Vet even checked for bartonella, which is a bacteria that infects the eye. That is why this is delayed because for many months the differential diagnosis was bacterial versus just herpes viral infection. It is uncommon for indoor cat to have fungal infections. The mass in eye is definitely fungal. Thank you.

 

[FeebysOwner]

So, you are saying he tested negative for herpes? That is the other thing that comes to mind - and if it would be a flare up from herpes, I believe anti-virals would be needed, in addition to the fungal infection that has been identified. A lot of times, unless the herpes PCR test is used, herpes testing results will come out negative when the herpes is in a latent (inactive) mode.

Other than that, ask the vet about duration of treatment. I have heard the specific fungus your vet thinks he has can take 6-18 months to get rid of. I have also read the cause of this fungus is not always known and something such as even dust spores has been known to trigger it.

Lastly, has your vet considered consulting with a specialist in internal medicine for cats? Might be another idea.

 

[3kittykatsmom]

I don't think they actually tested for herpes. I think they just said likely since herpes is so common in the cat. I will look into that. Thank you for being so kind and helpful

 

[FeebysOwner]

I just edited my post above, just in case you didn't see the changes.

 

[white shadow]

.
Hi 3kittykatsmom and welcome to the forum !

I would insist on an immediate referral to a veterinary ophthalmologist.....and, then have him seen there as quickly as possible.
.

 

[3kittykatsmom]

yes, he has been going to vet opthalmologist for a few weeks now. Took 10 days to get in to see her but he is going. That is hard part about this is the waiting for improvement in the eye. Eye doc changed med after two and half weeks as she thought it wasn't working in the eye. thank you.

 

[3kittykatsmom]

So, you are saying he tested negative for herpes? That is the other thing that comes to mind - and if it would be a flare up from herpes, I believe anti-virals would be needed, in addition to the fungal infection that has been identified. A lot of times, unless the herpes PCR test is used, herpes testing results will come out negative when the herpes is in a latent (inactive) mode.

Other than that, ask the vet about duration of treatment. I have heard the specific fungus your vet thinks he has can take 6-18 months to get rid of. I have also read the cause of this fungus is not always known and something such as even dust spores has been known to trigger it.

Lastly, has your vet considered consulting with a specialist in internal medicine for cats? Might be another idea.

Yes he is also seeing internal medicine vet. Told us it would be 10-18 months of treatment. Internal med vet won't talk eye problems and eye doctor won't talk internal medicine problems. It is just like in the human world i suppose. We don't know the cause of the fungus. I am with a heavy heart as I fear it may have been the grass boxes I planted for my cats on my catio over the past two summers. Of course there is no way to know for sure. My other two cats are fine. Needless to say, I threw out my grass boxes on the catio. I feel such guilt in possibly causing this infection. I had no idea.

 

[FeebysOwner]

Yes he is also seeing internal medicine vet. Told us it would be 10-18 months of treatment. Internal med vet won't talk eye problems and eye doctor won't talk internal medicine problems. It is just like in the human world i suppose. We don't know the cause of the fungus. I am with a heavy heart as I fear it may have been the grass boxes I planted for my cats on my catio over the past two summers. Of course there is no way to know for sure. My other two cats are fine. Needless to say, I threw out my grass boxes on the catio. I feel such guilt in possibly causing this infection. I had no idea.

The good thing is that he is being seen by both - as long as each of them doesn't 'palm him off' on the other. I think both angles need to be pursued. I hope they are at least exchanging information among themselves - or, at a minimum with your regular vet.

There is no way anyone would be able to know if the grass boxes you had caused the issue. It is not common for such a thing to occur. And, that is why I think there is an underlying condition, that you had no idea existed, which may have enabled such a thing like the grass to create a problem - hence my curiosity about herpes.

 

[3kittykatsmom]

The good thing is that he is being seen by both - as long as each of them doesn't 'palm him off' on the other. I think both angles need to be pursued. I hope they are at least exchanging information among themselves - or, at a minimum with your regular vet.

There is no way anyone would be able to know if the grass boxes you had caused the issue. It is not common for such a thing to occur. And, that is why I think there is an underlying condition, that you had no idea existed, which may have enabled such a thing like the grass to create a problem - hence my curiosity about herpes.

I will definitely have to follow and look into the herpes angle. The internal medicine vet said that he felt there is some underlying issue. He said that to treat with meds to eradicate fungus. Then see what residual signs would be present in the nose before doing something to the nose/relieving obstruction or removing any fungus plaques that may be causing problem breathing and to also possibly biopsy nose to see what underlying cause could be. My cat has inspirational dyspnea, trouble getting air in, which is obvious now in hindsight now that I have read everything under the sun regarding this. It pains me how long it took to diagnose this. Internal medicine vet said it was common to go months where he gets better/worse/better, etc. Over this Christmas I would have swore my cat was fine too. This is just mind boggling and sad.

 

[3kittykatsmom]

I will definitely have to follow and look into the herpes angle. The internal medicine vet said that he felt there is some underlying issue. He said that to treat with meds to eradicate fungus. Then see what residual signs would be present in the nose before doing something to the nose/relieving obstruction or removing any fungus plaques that may be causing problem breathing and to also possibly biopsy nose to see what underlying cause could be. My cat has inspirational dyspnea, trouble getting air in, which is obvious now in hindsight now that I have read everything under the sun regarding this. It pains me how long it took to diagnose this. Internal medicine vet said it was common to go months where he gets better/worse/better, etc. Over this Christmas I would have swore my cat was fine too. This is just mind boggling and sad.

You are so kind to reply and talk to me about this. I have struggled with myself over this whole thing.

 

[FeebysOwner]

It just seems to me that you have taken all the right steps in trying to get to the bottom of this. It is hard, I am sure, but you have made great strides in helping your little guy get through this to this point!!

 

[3kittykatsmom]

I am trying my best right now. I really trusted my vet was doing the right things. I should have taken him to an internist or something but I didn't even think of that as an option. This all came to a head at a very difficult point in my life, my best friend and office manager of 16 years died suddenly. It was all I could do at the time to make it through the day. I took what my vet told me to do and I did it. I wish she had referred me to specialty vet sooner or I had questioned her judgement sooner. Time will tell now how he does. Thank you.

 

[FeebysOwner]

 

[BlackCatOp]

My 5 year old gentle giant male kitty began having nasal symptoms in September. After months of taking him to my vet who has served me well and helped save my other 5 year old from crystal disease, he has been diagnosed with nasal fungal disease cryptococcus, which has spread to his eye. I guess fungal disease is tricky to diagnose because it gets better, then worse, then repeat. Very uncommon in an indoor cat. He has no other known immune deficiencies as we have tested for all of them.

First med (fluconazole-typical med used in fungal eye infection- dose 50mg twice daily) didn't work. Now on second med (itraconazole- dose 100 mg once daily) which is working systemically but not so much in the eye. Has anyone had any experience with fungal infections and if so any advice on how to save the eye? His left eye retina may be also involved. Just praying to save his vision. Please if you have any advice please share. Thank you so kindly.

I’m sorry to hear about your kitty. Unfortunately, you are correct that fungal diseases are difficult to diagnose as the symptoms commonly mimic viral or bacterial diseases which are much more prevalent. There are additional drugs that could be added but they also come with increased side effects and risks. Unfortunately, fungal disease is also not easy to treat.

I have a few questions if you don’t mind.
How was he initially diagnosed? Was a blood test performed? Cytology, etc?
Was he given steroids (prednisone/etc) prior to his fungal diagnosis?
Do you know if he is still visual in his affected eye? Are there any CNS signs?
Could his dyspnea be caused by fungal spread to lungs? Have chest radiographs be taken?

Other drug options:
Amphotericin-B is an effective agent to treat severe cases of cryptococcosis in cats that fail to respond to “azole” therapy. The drug can cause kidney damage, and must be administered by IV or SQ.
5-flucytosine in combination with an “azole” can be used to treat cryptococcosis that has entered the CNS. 5-flucytosine also has good eye penetration but can cause GI upset, liver toxicity and bone marrow suppression.

I would discuss with the ophthalmologist about his eye not improving and what the next step should be.

FWIW, I do not hold much weight in the herpes PCR test even though I know it gets mentioned on this site here a lot as a valuable test. IMHO, since ~97% of cats are infected with herpes most likely the test will come back positive. Thus there is no way to know if the signs the cat is displaying at this moment is due to a herpes flare or some other pathogen. Herpes is a retrovirus, and the PCR test detects the viral DNA that has been integrated within the cat’s own DNA. The viral DNA is present whether the cat is experiencing herpes symptoms or not.

Again sorry your cat is not getting better and wishing both of you the best of luck!

 

[3kittykatsmom]

He was diagnosed by blood and urine test (by me saying to my vet, "what about a fungus").Was given steroids prior to fungal diagnosis when his eye got infected. The eye infection diagnosis and treatment was again delayed (like this whole story)

 

[3kittykatsmom]

...sorry sent too early.....was given steroids prior to eye going bad, in effort to help breathing I suppose. Then also steroids after eye went bad while waiting for a new batch of tests to come back (retested all the feline viral stuff and also bartonella bacteria). Yes he is still visual in his affected eye right now. The opthalmologist recently told me the good eye's retina was detached or partially detached. idk.....crazy. He seems to see fine. Can follow a laser pointer just fine and watches birds out window. He is CNS fine. No CNS involvement, just the eye, which I a part of CNS if you look at it that way. All the dyspnea is nasal/sinus. Lung films were taken yes and vet said normal, which I have read is common for crypto, to settle in the upper airway. You sure seem knowledgeable about this. Yes, I have read some of those additional drugs too. I will talk to eye doctor about what she thinks is next step. My dilemma I suppose is balancing out bad eye/good eye in hope that he will have one good eye at least, with no kidney or liver damage. I didn't know much about the herpes info so thank you much that is very helpful.