Evaluation of the association of Bartonella species, feline herpesvirus 1, feline calicivirus, feline leukemia virus and feline immunodeficiency virus with chronic feline gingivostomatitis

Feline chronic gingivostomatitis current concepts in clinical management

PRACTICAL RELEVANCE

Feline chronic gingivostomatitis (FCGS) is a debilitating disease for cats and a challenge for veterinarians and cat caregivers alike. Recent literature indicates that the disease is immune-mediated in nature and likely associated with a chronic viral infection in patients with higher alpha diversity of their subgingival microbiome. The immune-mediated nature of FCGS includes both local as well as systemic effects, and the transcriptomic analysis of affected patients supports these findings.

TREATMENT OPTIONS

Localized therapy in the form of surgical extraction of all, or nearly all, teeth continues to be the mainstay of treatment. For cats that do not respond to surgical management, medical management, in the form of immunosuppressive or immunomodulatory therapy, remains an option. Analgesia is of fundamental importance. Immunomodulation utilizing mesenchymal stromal cell therapy provides an alternative treatment avenue for refractory patients and likely targets the chronic viral infection present in this disease. The potential for treatment stratification and use of novel systemic treatment options may be revealed as the molecular pathways involved in this disease are better described.

AIMS

This review outlines current and emerging concepts linking available science pertaining to FCGS and clinical management of the disease.

EVIDENCE BASE

The article draws on the best evidence base at this juncture and is also driven by the authors' collective experience of working on the disease for over a decade.

Feline calicivirus and natural killer cells: A study of its relationship in chronic gingivostomatitis

Background and Aims

Feline chronic gingivostomatitis (FCGS) is a frequent chronic inflammatory condition in the oral cavity with an etiopathogenesis not completely identified. This study aimed to contribute to the knowledge of FCGS by identifying the presence of feline calicivirus (FCV) antigens and natural killer (NK) cells and comparing them.

Materials and Methods

Forty biopsies from the oral mucosa of cats diagnosed with chronic gingivostomatitis were subjected to immunohistochemical techniques to evaluate cells with FCV antigens and NK cells positive for CD56.

Results

NK cells were identified in all samples, with an average of 725.3 ± 409.1 cells. Regarding FCV, it was identified in 18 out of 30 samples (60%), with a different number of cells with virus in between the analyzed cases. In all cases, the number of cells infected with FCV was lower than the number of NK cells present in the same samples, but there was no statistical association between them.

Conclusion

This preliminary study shows that NK cells are present in gingivostomatitis lesions not exclusively caused by FCV-stimulus, as only 60% of all cases were positive for this virus, but other antigens should be considered in the etiology of FCGS.

Prevalence of feline chronic gingivostomatitis in feral cats and its risk factors

OBJECTIVES

This study investigated the prevalence of feline chronic gingivostomatitis in urban feral cats in South Korea and analysed its risk factors.

METHODS

Three hundred and forty-five feral cats that visited the hospital for neutering using a trap-neuter-return approach were screened for feline chronic gingivostomatitis based on clinical criteria. In addition, we determined if body weight, sex and the presence of tongue lesions are risk factors for feline chronic gingivostomatitis. The difference in severity due to the presence or absence of risk factors, and the relationship between gross findings and histopathological lesions, were analysed by grading lesion severity.

RESULTS

Feline chronic gingivostomatitis was diagnosed in 92 cats. Disease prevalence did not significantly differ with body weight and sex but was significantly related to tongue lesions.

CONCLUSIONS AND RELEVANCE

The prevalence of feline chronic gingivostomatitis in urban feral cats in South Korea was 26.6%. It was significantly more prevalent in cats that had tongue lesions. Severity was also significantly associated with tongue lesions. Feline chronic gingivostomatitis may be associated with an infectious agent that causes tongue lesions.

Clinical, radiographic and histopathologic features of early-onset gingivitis and periodontitis in cats (1997-2022)

OBJECTIVES

This study aimed to characterize the clinical, radiographic and histopathologic features of early-onset gingivitis (EOG) and periodontitis in cats.

METHODS

The medical records database was searched for cats diagnosed with histologically confirmed EOG or periodontitis from 1997 to 2022. Information such as medical history, lifestyle factors, clinical presentation, radiographic and histopathologic features were included for 27 client-owned cats. Response to treatment and long-term follow-up was also recorded.

RESULTS

Moderate-to-severe periodontal disease was radiographically confirmed in 78% (21/27) of cats with moderate-to-severe EOG, compared with the evidence of periodontal disease noted in 30% (8/27) of cases during awake oral examination. Horizontal bone loss, along with missing teeth, were the predominant radiographic features noted in 89% (24/27) of cases. The predominant histopathologic feature was moderate-to-severe, erosive-to-ulcerative, neutrophilic and lymphoplasmacytic inflammation with varying degrees of epithelial and stromal hyperplasia. Two cats developed feline chronic gingivostomatitis (FCGS)-like lesions, and seven cats exhibited worsening of aggressive periodontitis (AP). Lack of improvement in the severity of gingivitis or clinical signs evident at the first follow-up appointment was significantly associated with progression of disease (P = 0.004).

CONCLUSIONS AND RELEVANCE

The results of this study demonstrate the importance of oral evaluations in cats as early as 6 months of age. For cats exhibiting substantial gingivitis, an anesthetized evaluation, periodontal treatment and long-term monitoring are recommended. Given the high frequency of moderate-to-severe periodontitis encountered in these cats, clients should be informed about the potential need for tooth extractions. EOG may progress to AP. Finally, this study suggests that there could be a link between EOG and FCGS; however, further studies are needed to better characterize this condition and establish any potential link between the two entities.

Environmental risk factors for the development of oral squamous cell carcinoma in cats

BACKGROUND

Risk factors for oral squamous cell carcinoma (OSCC) in cats are derived from a single study dated almost 20 years ago. The relationship between inflammation of oral tissues and OSCC is still unclear.

OBJECTIVES

To investigate previously proposed and novel potential risk factors for OSCC development, including oral inflammatory diseases.

ANIMALS

Hundred cats with OSCC, 70 cats with chronic gingivostomatitis (CGS), 63 cats with periodontal disease (PD), and 500 controls.

METHODS

Prospective, observational case-control study. Cats with OSCC were compared with an age-matched control sample of client-owned cats and cats with CGS or PD. Owners of cats completed an anonymous questionnaire including demographic, environmental and lifestyle information.

RESULTS

On multivariable logistic regression, covariates significantly associated with an increased risk of OSCC were rural environment (OR: 1.77; 95% CI: 1.03-3.04; P = .04), outdoor access (OR: 1.68; 95% CI: 1.07-2.63; P = .02), environmental tobacco smoke (OR: 1.77; 95% CI: 1.05-3; P = .03), and petfood containing chemical additives (OR: 1.98; 95% CI: 1.04-3.76; P = .04). Risk factors shared with CGS and PD were outdoor access and petfood containing chemical additives, respectively. A history of oral inflammation was reported in 35% of cats with OSCC but did not emerge as a risk factor.

CONCLUSIONS AND CLINICAL IMPORTANCE

The study proposes novel potential risk factors for OSCC in cats. Although a history of inflammatory oral disease was not significantly more frequent compared with random age-matched controls, OSCC shared several risk factors with CGS and PD.

Management of Severe Oral Inflammatory Conditions in Dogs and Cats

Severe oral inflammatory disease is not uncommon in the mouths of canine and feline patients. An approach to oral diagnosis is offered. This article discusses a brief review of important points in the oral diagnosis and management of main canine (canine chronic ulcerative stomatitis (CCUS), eosinophilic stomatitis, and Wegener's granulomatosis (WG)) and feline diseases (feline gingivostomatitis/caudal stomatitis, oral eosinophilic lesions, pyogenic granuloma, and autoimmune diseases with oral manifestations), and-whereby possible-information about the current understanding of disease pathogenesis and treatment is offered.

A Case Series Analysis of Dental Extractions' Outcome in Cats with Chronic Gingivostomatitis Carrying Retroviral Disease

Simple Summary

Feline chronic gingivostomatitis (FCGS) is a chronic, painful, oral inflammatory disease, which can be associated with retroviral disease comorbidity’s, namely feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV). A total 111 case series of cats affected by this oral disease, treated with dental extractions, were analyzed retrospectively, considering if they carried or not one of these retroviral diseases. Cats with lingual ulcers, independently from their retroviral status, were 2.7 times more prone to have a worse response to dental extractions than cats without lingual ulcers. When compared with cats without retroviral disease, FeLV-positive cats presented less proliferative lesions and tended to have more lingual ulcers. Furthermore, these cats had a significantly worse outcome, with 7.5 times more chances of having no improvement.

Abstract

This study aims to evaluate and compare the clinical outcome after dental extractions of cats with FCGS infected with feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV). A retrospective case series included cats with diagnosis of FCGS, availability of detailed clinical records, full-mouth dental radiographs, and retroviral disease test results. Effectiveness of surgical treatment (EOT) was registered. Three groups were defined: control, FIV and FeLV. In this study, 111 cats were included: 60 controls, 29 FIV- and 22 FeLV-positive cats. When compared with control cases, FeLV-positive cats had significantly less proliferative stomatitis lesions, and they tended to have more lingual ulcers. Concurrently, FeLV-positive cats had significantly less tooth resorptive lesions. No other significant differences in FCGS clinical signs were found between groups. FeLV-positive cats had a significantly worse outcome after dental extractions compared to the other groups. In fact, FeLV-positive cats had 7.5 times more chances of having no improvement after dental extractions. This study concludes that the response to dental extractions in FeLV-positive cats is significantly worse, when comparing to cats that do not carry retroviral disease. Therefore, it is important to acknowledge the effect of FeLV status on the prognosis of these cats.

Use of unbiased metagenomic and transcriptomic analyses to investigate the association between feline calicivirus and feline chronic gingivostomatitis in domestic cats

OBJECTIVE

To identify associations between microbes and host genes in cats with feline chronic gingivostomatitis (FCGS), a debilitating inflammatory oral mucosal disease with no known cause, compared with healthy cats and cats with periodontitis (control cats).

ANIMALS

19 control cats and 23 cats with FCGS.

PROCEDURES

At least 1 caudal oral mucosal swab specimen was obtained from each cat. Each specimen underwent unbiased metatranscriptomic next-generation RNA sequencing (mNGS). Filtered mNGS reads were aligned to all known genetic sequences from all organisms and to the cat transcriptome. The relative abundances of microbial and host gene read alignments were compared between FCGS-affected cats and control cats and between FCGS-affected cats that did and did not clinically respond to primary treatment. Assembled feline calicivirus (FCV) genomes were compared with reverse transcription PCR (RT-PCR) primers commonly used to identify FCV.

RESULTS

The only microbe strongly associated with FCGS was FCV, which was detected in 21 of 23 FCGS-affected cats but no control cats. Problematic base pair mismatches were identified between the assembled FCV genomes and RT-PCR primers. Puma feline foamy virus was detected in 9 of 13 FCGS-affected cats that were refractory to treatment and 5 healthy cats but was not detected in FCGS-affected cats that responded to tooth extractions. The most differentially expressed genes in FCGS-affected cats were those associated with antiviral activity.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that FCGS pathogenesis has a viral component. Many FCV strains may yield false-negative results on RT-PCR-based assays. Coinfection of FCGS-affected cats with FCV and puma feline foamy virus may adversely affect response to treatment.

Bartonella henselae Antibodies in Serum and Oral Fluid Specimens from Cats

Cats are the primary reservoir host for Bartonella henselae(B. henselae), an etiological agent of human bartonellosis, including cat scratch disease. Although Bartonella DNA has been amplified from salivary swabs from cats, dogs and humans, we are not aware of studies investigating Bartonella antibodies in oral fluid (OF). Using inhouse and commercial immunofluorescence antibody assays (IFA), the objective of this study was to detect and compare antibodies against B. henselae in paired OF and serum specimens from cats. Specimens were collected from shelter and client-owned cats. For serum specimens, B. henselae seroreactivity was 78% for both the inhouse and commercial IFA assays and 56.8% for OF specimens. Comparing serum and OF specimens, there was moderate Kappa agreement (Cohen's k = 0.434) for detection of B. henselae antibodies. Oral fluid antibodies were more likely measurable in cats with high B. henselae serum antibody titers when compared with low antibody titers. In conclusion, B. henselae OF IFA antibody measurements were less sensitive compared to serum IFA measurements of ≥1:64. Oral fluid antibodies were detected more often in cats with high B. henselae serum antibody titers. Therefore, OF antibodies, detectable by IFA, is of limited utility for epidemiological or diagnostic testing in cats.

Retrospective study of retroviruses by immunoenzymatic test on cats in Grande Vitória (ES, Brazil) and associated neoplasms

Retroviruses are among the leading causes of death in domestic cats. Retroviruses associate with the host cell in a persistent and permanent way, leading to diverse clinical conditions. The feline leukemia virus (FeLV) is the most pathogenic retrovirus with the potential to cause both degenerative diseases and immunosuppression, as well as proliferative diseases, as its association with the cell may lead to a direct oncogenic effect. The feline immunodeficiency virus (FIV), in turn, can lead to the classic immunodeficiency syndrome, usually has a chronic, less aggressive course and has no direct oncogenic effect. The use of vaccines and control measures has resulted in a decrease in the prevalence of FeLV in the United States of America (USA) and Europe, however, in Brazil, statistics show prevalence rates above 50%. This study aimed to assess the prevalence of feline retroviruses, by immunoenzymatic assay testing, in the region of Grande Vitória, in Espírito Santo and also point out the frequency of neoplasms in these cats. A total of 388 cats were retrospectively evaluated (2014-2016). The prevalence of FIV was 2.3% and FeLV was 33.7%. Neoplasms were identified in the three cats seropositive for FIV and FeLV and in three cats infected only with FIV. Neoplasms were also found in 26.6% of cats that were seropositive only for FeLV, especially mediastinal lymphoma. The high prevalence of FeLV demonstrated in this study highlights the need for establishing effective control measures, with emphasis on vaccination.

Feline leishmaniosis: diagnosis, treatment and outcome in 16 cats

OBJECTIVES

Leishmaniosis is a vector-borne disease and in European countries is caused by Leishmania infantum. Cats are considered secondary reservoirs of the infection in endemic areas. The objective of this retrospective study is to describe the clinical findings, diagnosis, treatment and outcome of feline leishmaniosis (FeL) in 16 cats in Spain.

METHODS

Medical records of cats diagnosed with leishmaniosis were retrospectively reviewed for cases that met the following inclusion criteria: identification of Leishmania organisms and/or DNA on cytological and/or histological specimens and/or a high anti-Leishmania antibody titre, compatible clinical findings and pathological abnormalities.

RESULTS

Sixteen cats met the inclusion criteria, all of which were living in areas endemic for canine leishmaniosis. Systemic signs were present in 11 cases (68.8%). The most common clinical signs on presentation included cutaneous lesions in 12 cats (75%), ocular disease in six cats (37.5%) and anorexia in six cats (37.5%). A polyclonal gammopathy was noted in 12 cats (85.7%). Non-regenerative anaemia and renal abnormalities were present in six (37.5%) and five patients (31.3%), respectively. In nine cats (56.3%), immunosuppressive conditions/comorbidities were identified. The diagnosis was made in eight of the cats (50%) by cytology, but a combination of diagnostic tests was needed for definitive diagnosis in the remaining patients. Twelve cats (75%) were treated specifically for leishmaniosis. Five of the 12 cats (41.7%) did not improve with treatment. The median survival time in the group of patients treated specifically for leishmaniosis was 17 months. Median survival of patients treated with concomitant diseases was 13 months vs 41 months in those without, although this was not statistically significant (P = 0.557).

CONCLUSIONS AND RELEVANCE

Presentation of FeL appears to be similar to canine leishmaniosis but with some specific features: ulcerative and nodular skin lesions are the predominant cutaneous signs; cats with immunosuppressive conditions or coexisting diseases were more commonly present than typically seen in dogs (mainly feline immunodeficiency virus). A combination of diagnostic tests may be needed for definitive diagnosis.

Histological, Immunological, and Genetic Analysis of Feline Chronic Gingivostomatitis

Feline chronic gingivostomatitis (FCGS) is an immune-mediated inflammatory condition affecting the oral mucosa that results in substantial pain and suffering. The goal of this study was to complete an in-depth immunohistochemistry analysis of affected FCGS mucosa, to perform and compare immune cell phenotypes in the blood of FCGS and healthy controls cats, and to determine a transcriptomic profile of the affected and normal oral mucosa of FCGS cats. We hypothesized that cats with FCGS would have circulating activated CD8+ T cells and that tissues would be infiltrated with activated B and T cells with a highly proinflammatory transcriptome. We found that oral mucosal tissues from cats with FCGS have high tissue infiltration of B cells and that T cells include both CD4+ and CD8+ lymphocytes. Cells positive for CD25 (IL2 receptor, indicative of lymphocyte activation) and FOXP3 (indicative of regulatory T cells) were scattered throughout the mucosa. Compared to healthy individuals, cats with FCGS had high circulating CD8+ effector memory cells with a concurrent decrease in central memory cells and evidence of circulating activated CD8+ T cells (CD25+, CD62L−). Gene expression in the affected tissues was enriched for genes associated with T-cell signaling, cell adhesion molecules, leukocyte migration, inflammatory signaling pathways, extracellular matrix-receptor interactions, cytokine-cytokine receptor interactions, and natural killer cell-mediated cytotoxicity, among others. These data are essential to understand disease pathogenesis, to inform mechanism of action studies for future and current therapies, and to help select prognostic biomarkers and potency assays for stem cell treatment of FCGS.

Influence of the FIV Status and Chronic Gingivitis on Feline Oral Microbiota

Feline chronic gingivostomatitis (FCGS) has an unclear pathogenesis with the oral microbiome and viral infections, such as feline immunodeficiency virus (FIV), thought to contribute. Although the relationship between the FIV status and FCGS is not clear, one theory is FIV-induced immune dysregulation could contribute to oral dysbiosis, promoting FCGS development. To further understand the relationship between FCGS, FIV infection, and the oral microbiome, oral cavities of forty cats fitting within 4 groups (FIV- without gingivitis, FIV+ without gingivitis, FIV- with gingivitis, FIV+ with gingivitis) were swabbed. Next generation sequencing targeting the V4 region of the 16s rRNA gene was performed for bacterial community profiling. No differences in diversity were observed, however, analysis of the data in terms of gingivitis revealed differences in the relative abundance of taxa and predicted functional output. Odoribacter spp., a bacteria associated with oral disease, was found in higher relative abundances in cats with the highest gingivitis grade. Cats with gingivitis were also found to harbor communities more involved in production of short-chain fatty acids, which have been connected with oral disease. Significant findings associated with the FIV status were few and of low impact, suggesting any connection between the FIV status and FCGS is likely not related to the oral microbiota.

Prevalence and Genomic Diversity of Feline Leukemia Virus in Privately Owned and Shelter Cats in Aburrá Valley, Colombia

The feline leukemia virus (FeLV) belongs to the family Retroviridae; it is the first feline retrovirus discovered and one of the agents that has a great impact on cats' health and the ecology of the feline population worldwide. It is associated with the occurrence of several syndromes of fatal diseases, including the development of lymphomas. Studies on FeLV have been reported in Colombia, and most of them have been approached from a clinical point of view. However, only a few studies have focused on the prevalence of the infection, while none have clarified which variant or FeLV viral subgroup is presently circulating in our country. Therefore, the present study investigated the prevalence of the infection associated with the molecular characterization of FeLV present in cats in Aburrá Valley, Colombia. The sampling of privately owned and shelter cats was performed in female (n = 54) and male (n = 46) felines; most of them were seemingly healthy according to the owner's report, with nonspecific clinical history. Immunoassay confirmed that 59.44% (95% confidence interval (CI) = 49.81-69.06%) of felines were FeLV seropositive. The molecular testing of felines using reverse transcription-polymerase chain reaction and sequencing showed that 30% (30/100) of felines were positive, and the most prevalent subgroup in the Aburrá Valley was FeLV-A. In conclusion, the frequency of leukemia virus, as revealed by molecular and serological tests, is one of the highest reported frequencies to date, and a high molecular variation is shown in the Colombian population. More studies on the behaviour of the virus in feline populations in Columbia are warranted to determine its prevalence throughout the country.

Feline chronic gingivostomatitis is more prevalent in shared households and its risk correlates with the number of cohabiting cats

OBJECTIVES

The aim of this study was to determine whether feline chronic gingivostomatitis (FCGS) is more prevalent in shared vs single-cat households, whether the number of cohabiting cats or outdoor access represent risk factors for FCGS and whether the number of cohabiting cats is a useful prognostic indicator for standard surgical treatment.

METHODS

Cats diagnosed with FCGS (study group) in the past 5 years at a referral institution were identified. The number of cohabiting cats, outdoor access, number of other cohabiting cats diagnosed with FCGS, ⩾6 month surgical outcome, when applicable, and historical signs of upper respiratory disease among any of the cohabiting cats, as well as patient demographic information, were recorded. Data were collected from medical records and by means of a telephone interview with the owners. The same information was collected from a group of cats of similar demographic characteristics diagnosed with periodontal disease but free of FCGS (control group).

RESULTS

Seventy-six cats were included, of which 36 (47%) had FCGS and 40 (53%) served as controls. Bivariate analysis showed that cats with FCGS were significantly more likely to come from shared households, and had significantly more total cats per household compared with controls. Multivariate analysis also showed that cats in shared households had a significantly increased odds of FCGS compared with those from single-cat households. Historical signs of upper respiratory disease and outdoor access among cats within the same household were not associated with FCGS. The number of cohabiting cats was not associated with surgical outcome.

CONCLUSIONS AND RELEVANCE

Cats with FCGS are more likely to live in shared households. The risk of FCGS correlates with the number of cohabiting cats. The epidemiological features of FCGS may support an infectious etiology. The number of cohabiting cats within a household is not a useful prognostic indicator for standard surgical treatment of FCGS.

Prevalence of microorganisms associated with feline gingivostomatitis

OBJECTIVES

Feline gingivostomatitis (FGS) is a painful chronic inflammatory disease of the oral cavity. The purpose of this study was to examine the frequency of detection of certain common feline bacteria and viruses to determine any potential associations with FGS.

METHODS

A multicentre case-control study design was conducted. In total, 72 control cats and 32 cats with FGS were included in the study. Oral swabs were cultured for bacterial identification and a PCR assay was carried out to examine the infection of feline calicivirus (FCV), feline herpesvirus-1 (FHV-1), Chlamydia felis, Mycoplasma felis and Bordetella bronchiseptica.

RESULTS

There was a significant difference in age distribution between the control and the FGS group. Based on a PCR assay, the positive rate of FCV was significantly higher in FGS cats than control animals. For other infectious pathogens, including FHV-1, C felis and M felis, there was no significant difference. Bacterial culture of oral swabs revealed that Pasteurella multocida was most frequently detected, but the detection rate was significantly lower in FGS cats. In FGS cats, the incidence of Enterococcus faecalis and anaerobic bacteria were more frequently isolated than in control cats.

CONCLUSIONS AND RELEVANCE

This study indicates that the positive rate of FCV was significantly higher in cats with FGS, and the microflora of the oral cavity of cats with FGS might be disrupted, although additional studies are required to compare the oral microbiome in cats of a variety of ages.

Relationship between Feline calicivirus Load, Oral Lesions, and Outcome in Feline Chronic Gingivostomatitis (Caudal Stomatitis): Retrospective Study in 104 Cats

Objective

This study was performed to assess the relationship between oral Feline calicivirus (FCV) load and severity of lesions at the time of presentation of cats suffering from feline chronic gingivostomatitis (FCGS) (part 1) and treatment outcome after dental extractions (part 2). We hypothesized that a higher FCV viral load would be positively correlated with the severity of lesions at presentation and negatively correlated with treatment outcome. In addition, the effect of dental extractions on outcome and the influence of preoperative severity of lesions on the outcome were investigated.

Materials and methods

Cats with FCGS were included in the study if they had been diagnosed with caudal stomatitis, had been tested positive for FCV using a real-time reverse transcriptase-PCR test on oropharyngeal swab, and had dental extractions performed within the authors’ department. General practitioners provided all previous medical treatments. Cats with recheck examinations were included in part 2 of the study. Multivariate statistical analysis was performed to assess the relationship between the different parameters.

Results

One hundred four cats met the requirements for part 1 and 56 cats for part 2 of the study. Data collected from patients’ record included patient history, viral testing results, extent and severity of oral lesions, extent of teeth extraction. Signalment, history, preoperative treatment, and severity of caudal and alveolar stomatitis score were not associated with FCV load (P > 0.05). Presence of lingual ulcers was significantly correlated with FCV load (P = 0.0325). Clinical cure (32.1%) or very significant improvement (19.6%) was achieved in 51.8% of cats within 38 days. Concomitantly, 60.7% of the owners considered their cat cured (41.1%) or significantly improved (19.6%). Extent of teeth extraction was not found to influence the clinical outcome (P > 0.05).

Conclusion

The results of this study did not support the hypothesis that FCV oral load is correlated with the severity of oral lesions or with the outcome following dental extractions. In addition, the severity of caudal inflammation was not correlated with healing time or achievement of cure.

Clinical, pathological, immunohistochemical and molecular characterization of feline chronic gingivostomatitis

Objectives This study presents the clinical, pathological, immunohistochemical and molecular characterization of 26 cats with feline chronic gingivostomatitis (FCG). Methods Oral mucosal biopsies, blood and swabs were collected from cats presenting with oral lesions. The tissue sections were submitted for histopathology and immunohistochemical analysis for feline calicivirus (FCV), feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV). The swabs were subjected to PCR analysis for FCV, and blood for FeLV and FIV. Results The main clinical findings were dysphagia (88.2%), halitosis (76.5%), sialorrhea (47.1%), weight loss (41.2%), intense oral discomfort (35.3%), oral hemorrhage (17.6%), and lackluster and fragile coat (11.8%). Gross inspection revealed bilateral lesions across the palatoglossal fold to the lateral tongue base. The lesions were diffuse, proliferative, intensely red and friable, and bled easily upon examination in 80.8% of cases. In 23.1% of cases, the lesions were multifocal to coalescent, at times forming multiple vesicles on a reddened, edematous palatoglossal fold. Microscopic examination showed that 15.4% of lesions had moderate (grade 2) and 84.6% had severe (grade 3) inflammation. Immunohistochemistry revealed the presence of FeLV antigens in the epithelium and the inflammatory infiltrate of 30.8% of the cats with FCG. FCV antigens were not detected in the FCG lesions. Conclusions and relevance The FCG cases analyzed could not be correlated with FCV. It is possible that FeLV plays a role as a causal agent of lesions in cases where the presence of the virus has been confirmed by immunohistochemistry in epithelial samples.

Therapeutic Management of Feline Chronic Gingivostomatitis: A Systematic Review of the Literature

Feline chronic gingivostomatitis (FCGS) is a disease characterized by protracted and potentially debilitating oral inflammation in cats, the etiology of which is currently unknown. The purpose of this review is to apply an evidence-based medicine approach to systematically review and critically evaluate the scientific literature reporting the outcome of medical and surgical management of FCGS. Those articles meeting inclusion criteria were reviewed and assigned an "Experimental Design Grade" (EDG) and an "Evidence Grade" (EG) in order to score relative strength of study design and produced data. Studies were evaluated and compared, especially highlighting the treatments, the outcomes, and the therapeutic success rates. This review found a lack of consistency between articles' data, rendering direct comparison of results unreliable. The field of FCGS research, and ultimately patient care, would benefit from standardizing studies by adopting use of a consistent semi-quantitative scoring system and extending follow-up duration. Future researchers should commit to large prospective studies that compare existing treatments and demonstrate the promise of new treatments.

Prevalence of feline herpesvirus-1, feline calicivirus, Chlamydophila felis and Mycoplasma felis DNA and associated risk factors in cats in Spain with upper respiratory tract disease, conjunctivitis and/or gingivostomatitis

Objectives

Our objective was to perform the first multicentric study in Spain to evaluate the prevalence of feline herpesvirus-1 (FHV-1), feline calicivirus (FCV), Chlamydophila felis and Mycoplasma felis in cats with upper respiratory tract disease (URTD), conjunctivitis and/or gingivostomatitis (GS) compared with control cats; and to evaluate risk factors for these clinical conditions.

Methods

Conjunctival and oropharyngeal swabs were collected and a questionnaire regarding signalment, lifestyle, vaccination history and clinical signs was obtained for each cat. Swabs were tested for each pathogen by real-time PCR.

Results

The study population consisted of 358 cats, including 98 control cats. Among the 260 diseased cats, 127 cats presented with URTD, 149 cats had conjunctivitis, 154 cats were suffering GS; many cats presented more than one clinical condition. The prevalence observed of FHV-1, FCV, C felis and M felis was, respectively, 28.3%, 48.0%, 20.5% and 46.5% in cats with URTD; 24.2%, 43.6%, 19.5% and 38.3% in cats with conjunctivitis; and 15.6%, 58.4%, 9.1% and 37.7% in cats with GS. Prevalences in the control group were 6.1%, 15.3%, 2.0% and 20.4%, respectively. Coinfections were common among all groups of cats. Risk factors were identified for all groups. FHV-1, FCV and C felis were associated with URTD and conjunctivitis. FCV was strongly associated with GS. M felis was present in a high percentage of the population in all groups, but its role in these clinical conditions remains uncertain. Vaccination was protective for URTD and GS but not for conjunctivitis.

Conclusions and relevance

This epidemiological study describes, for the first time, prevalence for FHV-1, FCV, C felis and M felis in Spain. In general, the prevalences found are similar to those reported in other countries. Factors associated with disease expression were also identified, which are relevant for practitioners.

Effect of tooth extraction on stomatitis in cats: 95 cases (2000-2013)

OBJECTIVE

To evaluate long-term response of cats with stomatitis to tooth extraction.

DESIGN

Retrospective case series.

ANIMALS

95 cats with stomatitis.

PROCEDURES

Medical records of cats with stomatitis that was treated with tooth extraction during a 14-year period were reviewed. Demographic information and diagnostic results were recorded as well as surgical procedure, including full-mouth extraction (FME) versus partial-mouth extraction (PME), and specifics of medical management. Patients were categorized according to response to treatment.

RESULTS

Median postoperative follow-up time was 231 days (range, 33 to 2,655 days). Of 95 cats, 6 (6.3%) had no improvement and 25 (26.3%) had little improvement in stomatitis following tooth extraction and extended medical management (EMM). Following tooth extraction, 37 (39.0%) cats had substantial clinical improvement and 27 (28.4%) cats had complete resolution of stomatitis; of these 64 cats, 44 (68.8%) required EMM for a finite period to achieve positive outcomes. Extent of tooth extraction (PME vs FME) was not associated with overall response to treatment. At initial recheck examination, a better long-term response to tooth extraction was observed in patients with resolution of abnormal behavior (OR, 7.2), decrease in oral inflammation (OR, 3.5), and lack of need for follow-up medical management with antimicrobials (OR, 3.7).

CONCLUSIONS AND CLINICAL RELEVANCE

Extraction of teeth in areas of oral inflammation provided substantial improvement or complete resolution of stomatitis in more than two-thirds of affected cats. Full-mouth extraction did not appear to provide additional benefit over PME. Most cats with stomatitis may require EMM to achieve substantial clinical improvement or complete resolution.

Association between oral health status and retrovirus test results in cats

OBJECTIVE

To determine associations between oral health status and seropositivity for FIV or FeLV in cats.

DESIGN

Cross-sectional survey.

ANIMALS

5,179 cats.

PROCEDURES

Veterinarians at veterinary clinics and animal shelters completed online training on oral conditions in cats and then scored oral health status of cats with no known history of vaccination against FIV. Age, sex, and results of an ELISA for retroviruses were recorded. Results were analyzed by means of standard logistic regression with binary outcome.

RESULTS

Of 5,179 cats, 237 (4.6%) and 186 (3.6%) were seropositive for FIV and FeLV, respectively, and of these, 12 (0.2%) were seropositive for FIV and FeLV. Of all 5,179 cats, 1,073 (20.7%) had gingivitis, 576 (11.1%) had periodontitis, 203 (3.9%) had stomatitis, and 252 (4.9%) had other oral conditions (overall oral disease prevalence, 2,104/5,179 [40.6%]). Across all age categories, inflammatory oral disease was associated with a significantly higher risk of a positive test result for FIV, compared with the seropositivity risk associated with other oral diseases or no oral disease. Stomatitis was most highly associated with risk of FIV seropositivity. Cats with any oral inflammatory disease were more likely than orally healthy cats to have a positive test result for FeLV. Increasing age was associated with a higher prevalence of oral disease in retrovirus-seronegative cats.

CONCLUSIONS AND CLINICAL RELEVANCE

Inflammatory oral disease was associated with an increased risk of seropositivity for retroviruses in naturally infected cats. Therefore, retroviral status of cats with oral inflammatory disease should be determined and appropriate management initiated.

Contrasting clinical outcomes in two cohorts of cats naturally infected with feline immunodeficiency virus (FIV)

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Multi-cat household animals displayed 63% mortality rate.

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Lymphoma was the most common cause of death.

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The CD4:CD8 ratio failed to distinguish cats classified as healthy and not healthy.

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FIV load failed to distinguish cats classified as healthy and not healthy.

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Management and housing conditions impact on the progression of FIV infection.

Despite over 25 years of feline immunodeficiency virus (FIV) research, relatively little is known about the longitudinal course of FIV infection following natural infection. In contrast to published reports of experimental infections using lethal strains of the virus, clinical signs of naturally acquired FIV infection can be mild or inapparent, rather than life-threatening. In this prospective, longitudinal controlled study, based in Chicago, IL (n = 17) and Memphis, TN (n = 27), we investigated two cohorts of privately owned, naturally infected cats kept under different housing conditions. Cats in the Chicago cohort (Group 1) were kept in households of ≤2 cats, while the Memphis cohort (Group 2) comprised part of a large multi-cat household of over 60 cats kept indoors only, with unrestricted access to one another.

The majority of cats from Group 1 did not display clinical signs consistent with immunodeficiency during the 22-month observation period. In contrast, the outcome of infection in Group 2 was dramatically different; 17/27 (63%) of cats lost a median of 51.3% of their bodyweight (P < 0.0005) and died during the study period, with lymphoma being the most common cause of mortality.

Although the decrease in CD4+ T cell count between enrolment and terminal disease was significant (P = 0.0017), the CD4:CD8 ratio at the time of enrolment did not reliably distinguish FIV-positive cats classified as ‘healthy’ and ‘not healthy’ at either cohort. FIV load at enrolment was significantly lower in Group 1 than in Group 2 (P < 0.0001), but there were no significant differences at enrolment between healthy and not healthy cats at either group.

In conclusion, the results of this study suggest that management and housing conditions impact on disease progression and survival times of FIV-positive cats.

Sequence variation of the feline immunodeficiency virus genome and its clinical relevance

The ongoing evolution of feline immunodeficiency virus (FIV) has resulted in the existence of a diverse continuum of viruses. FIV isolates differ with regards to their mutation and replication rates, plasma viral loads, cell tropism and the ability to induce apoptosis. Clinical disease in FIV-infected cats is also inconsistent. Genomic sequence variation of FIV is likely to be responsible for some of the variation in viral behaviour. The specific genetic sequences that influence these key viral properties remain to be determined. With knowledge of the specific key determinants of pathogenicity, there is the potential for veterinarians in the future to apply this information for prognostic purposes. Genomic sequence variation of FIV also presents an obstacle to effective vaccine development. Most challenge studies demonstrate acceptable efficacy of a dual-subtype FIV vaccine (Fel-O-Vax FIV) against FIV infection under experimental settings; however, vaccine efficacy in the field still remains to be proven. It is important that we discover the key determinants of immunity induced by this vaccine; such data would compliment vaccine field efficacy studies and provide the basis to make informed recommendations on its use.

Bartonella Species Infection in Cats

Overview:

Over 22 Bartonella species have been described in mammals, and Bartonella henselae is most common worldwide. Cats are the main reservoir for this bacterium. B henselae is the causative agent of cat scratch disease in man, a self-limiting regional lymphadenopathy, but also of other potentially fatal disorders in immunocompromised people.

Infection:

B henselae is naturally transmitted among cats by the flea Ctenocephalides felis felis, or by flea faeces. A cat scratch is the common mode of transmission of the organism to other animals, including humans. Blood transfusion also represents a risk.

Disease signs:

Most cats naturally infected by B henselae do not show clinical signs but cardiac (endocarditis, myocarditis) or ocular (uveitis) signs may be found in sporadic cases. B vinsonii subspecies berkhoffii infection has reportedly caused lameness in a cat affected by recurrent osteomyelitis and polyarthritis.

Diagnosis:

Isolation of the bacterium is the gold standard, but because of the high prevalence of infection in healthy cats in endemic areas, a positive culture (or polymerase chain reaction) is not confirmatory. Other compatible diagnoses must be ruled out and response to therapy gives a definitive diagnosis. Serology (IFAT or ELISA) is more useful for exclusion of the infection because of the low positive predictive value (39–46%) compared with the good negative predictive value (87–97%). Laboratory testing is required for blood donors.

Disease management:

Treatment is recommended in the rare cases where Bartonella actually causes disease.

Efficacy of Cyclosporine for Chronic, Refractory Stomatitis in Cats: A Randomized, Placebo-Controlled, Double-Blinded Clinical Study

Sixteen cats with chronic stomatitis, that had previously undergone premolar-molar or full-mouth extractions, were randomly assigned a group to receive 2.5 mg/kg cyclosporine or placebo orally twice daily. Neither the clinician nor the clients were aware of the group assignments. Cats were evaluated prior to treatment and every 2 weeks for 6 weeks using a 30 point Stomatitis Disease Activity Index (SDAI) score. Mean improvement in SDAI scores among cats in the treatment group after 6 weeks was 52.7 %. This was significantly different from the mean improvement (12.2 %) of cats in the placebo group. During the 6 week study period, 7 of the 9 cats in the treatment group (77.8 %) showed a > 40 % improvement in SDAI score, while 1 of 7 cats in placebo group (14.3 %) showed a > 40 % improvement in SDAI score. This difference was statistically significant. Individual variability in the absorption of orally-administered cyclosporine was high. Trough whole-blood cyclosporine levels ranged from 32.1 ng/ml to 1,576.2 ng/ml. At the end of the 6 week observation period, there was a statistically significant difference among cats with trough whole-blood cyclosporine levels > 300 ng/ml (72.3 % improvement) compared with cats with cyclosporine levels < 300 ng/ml (28.2 % improvement). Whole-blood cyclosporine levels > 300 ng/ml were associated with significant improvement in oral inflammation in cats with chronic stomatitis that had previously undergone premolar-molar or full-mouth extraction.

Chronic Bartonellosis in cats: what are the potential implications?

PRACTICAL RELEVANCE

Bartonellae are small, vector-transmitted Gram-negative intracellular bacteria that are well adapted to one or more mammalian reservoir hosts. Cats are the natural reservoir for Bartonella henselae, which is a (re-)emerging bacterial pathogen. It can cause cat scratch disease in humans and, in immunocompromised people, may lead to severe systemic diseases, such as bacillary angiomatosis. Cats bacteraemic with B henselae constitute the main reservoir from which humans become infected. Most cats naturally infected with B henselae show no clinical signs themselves, but other Bartonella species for which cats are accidental hosts appear to have more pathogenicity.

GLOBAL IMPORTANCE

Several studies have reported a prevalence of previous or current Bartonella species infection in cats of up to 36%. B henselae is common in cats worldwide, and bacteraemia can be documented by blood culture in about a quarter of healthy cats. The distribution of B henselae to various parts of the world has largely occurred through humans migrating with their pet cats. The pathogen is mainly transmitted from cat to cat by fleas, and the majority of infected cats derive from areas with high flea exposure. No significant difference in B henselae prevalence has been determined between male and female cats. In studies on both naturally and experimentally infected cats, chronic bacteraemia has mainly been found in cats under the age of 2 years, while those over 2 years of age are rarely chronically bacteraemic.

EVIDENCE BASE

This article reviews published studies and case reports on bartonellosis to explore the clinical significance of the infection in cats and its impact on humans. The article also discusses possible treatment options for cats and means of minimising the zoonotic potential.

Clinical aspects of feline retroviruses: a review

Feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) are retroviruses with global impact on the health of domestic cats. The two viruses differ in their potential to cause disease. FeLV is more pathogenic, and was long considered to be responsible for more clinical syndromes than any other agent in cats. FeLV can cause tumors (mainly lymphoma), bone marrow suppression syndromes (mainly anemia), and lead to secondary infectious diseases caused by suppressive effects of the virus on bone marrow and the immune system. Today, FeLV is less commonly diagnosed than in the previous 20 years; prevalence has been decreasing in most countries. However, FeLV importance may be underestimated as it has been shown that regressively infected cats (that are negative in routinely used FeLV tests) also can develop clinical signs. FIV can cause an acquired immunodeficiency syndrome that increases the risk of opportunistic infections, neurological diseases, and tumors. In most naturally infected cats, however, FIV itself does not cause severe clinical signs, and FIV-infected cats may live many years without any health problems. This article provides a review of clinical syndromes in progressively and regressively FeLV-infected cats as well as in FIV-infected cats.

Prevalence of Bartonella species, hemoplasmas, and Rickettsia felis DNA in blood and fleas of cats in Bangkok, Thailand

Flea infestations are common in Thailand, but little is known about the flea-borne infections. Fifty flea pools and 153 blood samples were collected from client-owned cats between June and August 2009 from veterinary hospitals in Bangkok, Thailand. Total DNA was extracted from all samples, and then assessed by conventional PCR assays. The prevalence rates of Bartonella spp. in blood and flea samples were 17% and 32%, respectively, with DNA of Bartonella henselae and Bartonella clarridgeiae being amplified most commonly. Bartonella koehlerae DNA was amplified for the first time in Thailand. Hemoplasma DNA was amplified from 23% and 34% of blood samples and flea pools, respectively, with 'Candidatus Mycoplasma haemominutum' and Mycoplasma haemofelis being detected most frequently. All samples were negative for Rickettsia felis. Prevalence rate of B. henselae DNA was increased 6.9 times in cats with flea infestation. Cats administered flea control products were 4.2 times less likely to be Bartonella-infected.

Feline immunodeficiency virus: disease association versus causation in domestic and nondomestic felids

Feline immunodeficiency virus (FIV) is an important infection in both domestic and nondomestic cats. Although many studies have provided insight into FIV pathophysiology and immunologic responses to infection in cats, questions remain regarding the association of FIV with specific disease syndromes. For many diseases, both association and causation of disease with FIV remain to be confirmed and clarified. The use of experimental infection models is unlikely to yield answers about naturally infected domestic cats and is not feasible in nondomestic felids, many of which are endangered species. Researches might consider further study of naturally occurring disease with an emphasis on confirming which diseases have a likely association with FIV.

Detection of Bartonella henselae IgM in serum of experimentally infected and naturally exposed cats

BACKGROUND

Results of Bartonella henselae blood culture, polymerase chain reaction (PCR) assay on blood, or IgG antibody assays do not always correlate with the presence or absence of clinical disease in cats, and B. henselae IgG antibodies in serum do not always correlate with bacteremia. However, little is known concerning Bartonella spp. IgM antibodies in naturally exposed cats.

HYPOTHESIS

Bartonella spp. IgM antibodies in serum are associated with fever, stomatitis, and bacteremia based on PCR assay results in experimentally infected or client-owned cats.

ANIMALS

Stored sera from cats experimentally infected with B. henselae by exposure to Ctenocephalides felis, client-owned cats with and without fever, and client-owned cats with and without stomatitis were studied.

METHODS

A Bartonella spp. IgM ELISA was titrated with samples from experimentally infected cats and then test sera from client-owned cats were assayed. Associations among IgM ELISA results, clinical findings, and bacteremia as defined by Bartonella spp. PCR assay were assessed.

RESULTS

All experimentally infected cats developed Bartonella spp. IgM antibodies. Bartonella spp. IgM antibody assay results were not always in agreement with PCR assay results in client-owned cats (60%). Bartonella spp. DNA in blood, IgM antibodies, and IgG antibodies were not associated with the presence of fever or stomatitis.

CONCLUSIONS AND CLINICAL IMPORTANCE

Because Bartonella spp. IgM antibodies as measured by this assay were not associated with fever or stomatitis and were not always in agreement with PCR assay results, there appears to be little need for assessing individual client-owned cats for this antibody class alone.

Clinical aspects of feline immunodeficiency and feline leukemia virus infection

Feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) are retroviruses with a global impact on the health of domestic cats. The two viruses differ in their potential to cause disease. FIV can cause an acquired immunodeficiency syndrome that increases the risk of developing opportunistic infections, neurological diseases, and tumors. In most naturally infected cats, however, FIV itself does not cause severe clinical signs, and FIV-infected cats may live many years without any health problems. FeLV is more pathogenic, and was long considered to be responsible for more clinical syndromes than any other agent in cats. FeLV can cause tumors (mainly lymphoma), bone marrow suppression syndromes (mainly anemia) and lead to secondary infectious diseases caused by suppressive effects of the virus on bone marrow and the immune system. Today, FeLV is less important as a deadly infectious agent as in the last 20 years prevalence has been decreasing in most countries.

Feline bartonellosis

Bartonella infection is common among domestic cats, but the role of Bartonella species as feline pathogens requires further study. Most Bartonella species that infect cats are zoonotic. Cats are the mammalian reservoir and vector for Bartonella henselae, an important zoonotic agent. Cat fleas transmit Bartonella among cats, and cats with fleas are an important source of human B henselae infections. New information about Bartonella as feline pathogens has recently been published, and this article summarizes much of that information. Issues surrounding diagnosis and treatment of feline Bartonella infections are described, and prevention of zoonotic transmission of Bartonella is discussed.

Association between Bartonella species infection and disease in pet cats as determined using serology and culture

This study's objective was to determine whether a relationship exists between infection or seropositivity to Bartonella species and clinical illness in cats. Blood samples were obtained for Bartonella species isolation and immunofluorescent antibody serology from 298 cats presenting to a tertiary referral hospital. Medical records were searched and the history, physical examination findings and the results of diagnostic testing relating to the visit at which Bartonella species testing was performed were recorded. Fifty-two (17%) samples were seropositive for Bartonella henselae, four (1%) for Bartonella clarridgeiae, and 57 (19%) for both organisms. Nineteen (6.4%) samples were culture positive, 17 for B henselae and two for B clarridgeiae. Gingivostomatitis was associated with Bartonella species isolation ( P=0.001), but not seropositivity. There was no association with uveitis, neurologic signs, or chronic kidney disease, and a weak association between seropositivity and idiopathic lower urinary tract disease (feline interstitial cystitis) ( P=0.05).

Oral shedding of Bartonella in cats: correlation with bacteremia and seropositivity

Cats are the main reservoirs of zoonotic Bartonella henselae, B. clarridgeiae and B. koehlerae, transmitted among cats by cat fleas. No study has investigated the presence of Bartonella in the saliva of bacteremic and non-bacteremic cats to correlate it to the level of bacteremia and the presence or absence of oral lesions. Shelter cats from northern California (n=130) and Michigan (n=50) were tested for Bartonella bacteremia by blood culture, presence of Bartonella antibodies and Bartonella DNA in oral swabs. Bacteremia was detected in 45 (25%) cats, mainly from northern California (n=40), which were highly flea infested and were 4 times more likely to be bacteremic than the non-flea-infested cats from Michigan. Overall, 69 (38.3%) cats had Bartonella PCR positive oral swabs. Bacteremic cats were almost 3 times (P=0.003) more likely to have PCR positive oral swabs (59%, 26/44) than non-bacteremic cats (32.5%, 44/135). However, there was no correlation between cats being bacteremic and having oral lesions. Antibody prevalences for B. henselae and B. clarridgeiae were 30% and 42.8%. B. henselae and B. clarridgeiae seropositive cats were almost 4 times (P=0.0001) and 3 times (P=0.003) more likely to have oral lesions than seronegative cats. Despite a higher prevalence (odds ratio=1.73; 95% confidence interval=0.88-3.38) of oral lesions in cats with oral swabs testing PCR positive, no statistical association could be demonstrated in this cat population.

Association of Bartonella species, feline calicivirus, and feline herpesvirus 1 infection with gingivostomatitis in cats

Feline gingivostomatitis (FGS) is a common syndrome in cats; feline calicivirus (FCV), feline herpesvirus 1 (FHV-1), and Bartonella species are common differential diagnoses. In this study, blood from 70 cats with FGS and 61 healthy control cats was tested for Bartonella species antibodies in serum by enzyme-linked immunosorbent assay and Western blot immunoassay and DNA in blood using a conventional polymerase chain reaction assay. Additionally, fresh oral biopsies from cats with FGS ( n=42) and 19 healthy controls were tested for FCV RNA, FHV-1 DNA and Bartonella species DNA. The prevalence rates for Bartonella species antibodies and DNA in the blood and the tissues did not differ between the two groups. FHV-1 DNA was also not significantly different between groups. Only FCV RNA was present in significantly more cats with FGS (40.5%) than control cats (0%). The results suggest that FCV was associated with FGS in some of the cats.