Tuberculosis due to Mycobacterium bovis in pet cats associated with feeding a commercial raw food diet

Development of an enzyme-linked immunosorbent assay for the diagnosis of feline tuberculosis

Cases of feline tuberculosis (TB) can be challenging to diagnose. Currently, this is achieved through a combination of mycobacterial culture, polymerase chain reaction (PCR), or interferon-gamma release assay (IGRA); however, these each have limitations. There is limited data regarding the use of humoral immunodiagnostics for TB in cats. Therefore, we sought to develop an enzyme-linked immunosorbent assay (ELISA) to further facilitate the diagnosis of feline TB. A comparative PPD (purified protein derivative) antibody ELISA was optimised for use on serum and plasma, and was tested against samples from 14 cats with culture-confirmed TB and 24 uninfected controls. Selection of an appropriate positive cut-off value based on receiver-operator characteristic curve analysis gave test sensitivity of 64.3 % and specificity of 100 %. When tested on further samples from cats with strongly suspected mycobacteriosis, 32.9 % (23/70) were antibody positive. Notably, positive results were recorded in cats that failed to respond to the IGRA, and in one PCR and IGRA negative cat. No positive responses were identified in cats with non-tuberculous mycobacterial infections, or with non-mycobacterial diseases (n = 12). Therefore, antibody-based diagnostics may be useful adjunctive tests for cases of TB missed by the IGRA, helping protect both feline and, in turn, human health.

Disseminated Mycobacterium avium infection in a cat on long-term ciclosporin therapy and potential latent infection of an in-contact cat

Case summary

An 8-year-old domestic shorthair cat receiving long-term ciclosporin treatment was evaluated for a history of weight loss and hyporexia. The main clinical finding was a cluster of enlarged mesenteric lymph nodes. Cytological examination of fine-needle aspirates showed granulomatous inflammation with abundant acid-fast bacilli. A diagnosis of Mycobacterium avium complex (MAC) infection was confirmed by PCR. The cat’s clinical condition deteriorated rapidly despite appropriate antibiotic treatment and it was euthanased 2 weeks after initial presentation due to development of severe paraparesis and ataxia. Post-mortem examination revealed granulomatous inflammation affecting multiple lymph nodes and other organs with intrahistiocytic acid-fast bacilli consistent with mycobacteria when stained using Ziehl–Neelsen stain. Another cat in the same household was screened for infection using the interferon gamma release assay (IGRA), with the result being consistent with infection by non-tuberculous mycobacteria (NTM), which includes MAC; however, it had no grossly detectable disease.

Relevance and novel information

This case report is an unusual presentation of disseminated MAC infection in a cat, which remains a rare diagnosis. Clinicians should be aware of unusual and rare presentations of this infection. The clinical findings, progression of disease and histopathology results add to the current clinical database for feline disseminated MAC infections. Another cat in the same household tested positive for NTM by IGRA without any gross disease. This was suggestive of latent MAC infection which, to our knowledge, has not been previously reported in an in-contact cat.

Ocular mycobacterial lesions in cats

Ocular mycobacterial infections are an under-recognized cause of morbidity in the domestic cat. This study aimed to explore the distribution, histopathological appearance, and severity of feline ocular mycobacterial lesions, and to characterize the immune cell population with immunohistochemistry. Routine histological staining with hematoxylin and eosin, and Masson’s trichrome, was performed to identify ocular lesions and assign an inflammation score based on the number of cells present. Acid-fast bacilli were detected with Ziehl-Neelsen, and immunohistochemistry for ionized calcium-binding adaptor protein-1 (Iba1), calprotectin, cluster of differentiation 3 (CD3), and Pax5 was undertaken on formalin-fixed paraffin-embedded tissue samples from 24 cases of ocular mycobacteriosis. Posterior or panuveitis with concurrent retinitis was identified in 20/24 cases (83%), with retinal detachment in 16/20 (80%) of these cases. Choroidal lesions had the highest median inflammation score. Ziehl-Neelsen-positive organisms were detected in 20/24 cases (83%), with the highest prevalence of acid-fast bacilli detected in choroidal lesions (16/20, 80%). Lesions were typically granulomatous to pyogranulomatous, characterized by abundant numbers of Iba1-positive macrophages, followed by calprotectin-positive granulocytes and monocytes, fewer T cells, and rarer B cells. However, where iritis was identified, inflammation was typically lymphoplasmacytic (11/16 cases, 69%). Where diagnostic testing was performed, tuberculosis (ie, infection with Mycobacterium bovis, Mycobacterium microti, or a nonspeciated Mycobacterium tuberculosis-complex pathogen) was diagnosed in 20/22 cats (91%), with Mycobacterium lepraemurium infection identified in the other 2/22 cats (9%). These results suggest the choroid is the primary site of lesion development in most cases of feline ocular mycobacteriosis, and inflammatory changes are associated with the presence of mycobacteria localized to ocular tissues.

Mycobacterium tuberculosis infection in a free-ranging urban dog from Argentina

Mycobacterium bovis and Mycobacterium avium are the most important Mycobacteria isolated from diseased dogs, but Mycobacterium tuberculosis can be isolated as well, especially when close contact with humans exists. Free ranging street dogs may carry zoonotic diseases, being a potential health risk to new owners after adoption. In this study, the clinical case of a dog affected by Mycobacterium tuberculosis is described. A six-year-old bitch that had been living with a homeless man was rescued and put for adoption in dog shelter. After being adopted, her health declined, and abdominal ultrasound and exploratory laparoscopy were performed. A tuberculosis-like lesion in the liver was biopsied and histopathological, bacteriological, and molecular analyses were carried out. Then, the animal was euthanized and necropsied, and disseminated macroscopic tuberculosis-like lesions were observed in abdominal organs. Mycobacterium presence was confirmed by histopathological and bacteriological methods. Genotyping identified a SIT-1228 Mycobacterium tuberculosis strain. Notification to the sanitary authorities was performed and the couple that had contact with the dog were alerted and sent to the hospital for assessment, as Mycobacterium tuberculosis is a primary pathogenic agent for humans. The epidemiology in this clinical case is unclear, but the most likely source of infection might have been consumption of sputum contaminated food during the years that this bitch lived with the homeless man, because this person had died with chronic respiratory symptoms. Veterinarians must consider this disease and perform a complete diagnosis when dogs that used to live on the streets show nonspecific clinical signs.

Diagnostic accuracy of the interferon-gamma release assay (IGRA) for cases of feline mycobacteriosis

The aim of this study was to evaluate the sensitivity and specificity of the interferon-gamma release assay (IGRA) for diagnosing infections with members of the Mycobacterium (M.) tuberculosis-complex (MTBC) and non-tuberculous mycobacteria (NTM) in domestic cats, and to generate defined feline-specific cut-off values using receiver operating characteristic (ROC) curve analysis to improve test performance. Records of 594 cats that had been tested by IGRA were explored to identify individuals that had a culture and/or polymerase chain reaction (PCR)-confirmed case of mycobacterial disease, and those that had a final diagnosis of non-mycobacterial disease. A total of 117 cats - 80 with mycobacterial disease and 37 diagnosed with a condition other than mycobacteriosis - were identified for further detailed analysis. This population was used to estimate test sensitivity and specificity, as well as likelihood ratios for the IGRA to correctly identify a cat with or without mycobacterial disease. Agreement between IGRA results and culture/PCR using current and proposed new cut-off values was also determined. ROC analysis of defined confirmed infected and non-mycobacterial disease control cats allowed an adjustment of current test cut-offs that increased the overall test sensitivity for MTBC infections from 83.1 % (95 % confidence interval [CI]: 71.5-90.5 %) to 90.2 % (95 % CI: 80.2-95.4%), and M. bovis infection from 43 % (95 % CI: 28.2-60.7%) to 68 % (95 % CI: 51.4-82.1%) while maintaining high test specificity (100 % in both cases). Overall agreement between IGRA results and culture/PCR, while recognising that neither culture nor PCR tests have perfect sensitivity, improved from weak (κ = 0.57) to moderate (κ = 0.71) using new proposed IGRA test cut-off values. Application of these results, based upon the statistical analysis of accumulated test data, can improve the diagnostic performance of the feline IGRA, particularly for identifying infections with M. bovis, without compromising specificity.

Isolation of Nontuberculous Mycobacteria from Bovine Raw Lungs Bought in Butchers' Shops

Nontuberculous Mycobacteria (NTM) can cause opportunistic disease in animals and humans, causing mycobacteriosis. In this study, bovine lungs were collected from butchers' shops and slaughterhouses after food official's inspection from the metropolitan area of Buenos Aires. All samples were cultured and then identified by molecular methods. Twelve isolates of NTM were identified being the most prevalent Mycolicibacterium insubricum. This demonstrates that viable Mycobacteria can pass food inspection and contaminate surfaces and food, making manipulation of raw organs and feeding of animals with raw lungs a potential source of infection for pets and owners.

Histological and immunohistochemical features suggesting aetiological differences in lymph node and (muco)cutaneous feline tuberculosis lesions

OBJECTIVES

To identify and describe histological and immunohistochemical criteria that may differentiate between skin and lymph node lesions associated with Mycobacterium (M.) bovis and M. microti in a diagnostic pathology setting.

MATERIALS AND METHODS

Archived skin and lymph node biopsies of tuberculous lesions were stained with haematoxylin and eosin, Ziehl-Neelsen and Masson's Trichrome. Immunohistochemistry was performed to detect the expression of calprotectin, CD3 and Pax5. Samples were scored for histological parameters (i.e. granulomas with central necrosis versus small granulomas without central necrosis, percentage necrosis and/or multinucleated giant cells), number of acid-fast bacilli (bacterial index) and lesion percentage of fibrosis and positive immunohistochemical staining.

RESULTS

Twenty-two samples were examined (M. bovis n=11, M. microti n=11). When controlling for age, gender and tissue, feline M. bovis-associated lesions more often featured large multi-layered granulomas with central necrosis. Conversely, this presentation was infrequent in feline M. microti-associated lesions, where small granulomas without central necrosis predominated. The presence of an outer fibrous capsule was variable in both groups, as was the bacterial index. There were no differences in intralesional expression of immunohistochemical markers.

CLINICAL SIGNIFICANCE

Differences in the histological appearance of skin and lymph node lesions may help to infer feline infection with either M. bovis or M. microti at an earlier stage when investigating these cases, informing clinicians of the potential zoonotic risk. Importantly, cases of tuberculosis can present with numerous acid-fast bacilli. This implies that a high bacterial index does not infer infection with non-zoonotic non-tuberculous mycobacteria.

Canine and Feline Obesity Management

Obesity and overweight have an impact on more than half of pet cats and dogs. Effective and team-based communication is essential for creating an effective weight loss plan. The diet should meet all essential nutrient requirements during energy/calorie restriction. There are several ways to initiate a weight loss plan, and regular monitoring is essential for determining if a plan is working or needs to be adjusted.

Repeated bouts of pulmonary tuberculosis in a hunting cat: reinfection or recrudescence?

CASE SUMMARY

A 7-year-old neutered male Siamese cat was referred for investigation of weight loss and hypercalcaemia (3.3 mmol/l; reference interval 2-3 mmol/l). Haematology, serum biochemistry, thoracic imaging, bronchoalveolar lavage (BAL), Ziehl-Neelsen staining of the BAL fluid and interferon gamma release assay (IGRA) were compatible with pneumonia caused by the less pathogenic member of the Mycobacterium tuberculosis complex, that is, M microti (the 'vole bacillus'), which is common in cats in the UK. Treatment with azithromycin, rifampicin and marbofloxacin was given for 2 months, followed by 4 months of azithromycin and marbofloxacin. Treatment recommendations for tuberculous pneumonia have since changed. The cat remained asymptomatic for 1 year but went on to develop M microti pneumonia on five other occasions, and was treated for 6-12 months on each occasion. The patient's clinical signs, hypercalcaemia and radiographic/CT pulmonary pathology always resolved completely, and the IGRA became negative, before antimycobacterial treatment was stopped. This suggests cure followed by reinfection owing to avid hunting behaviour. Alternatively, this could represent recrudescence of dormant disease. This case has previously been included in a study that described a series of cases of feline tuberculosis.

RELEVANCE AND NOVEL INFORMATION

This case shows that M microti infection in cats can present as recurrent episodes of pneumonia, even after prolonged treatment courses.

Insights into dog owner perspectives on risks, benefits, and nutritional value of raw diets compared to commercial cooked diets

Background

The practice of feeding a raw meat-based diet (RMBD) to dogs is a topic of increasing interest to owners and veterinary professionals alike. Despite the research around the practice, particularly about the risk of nutritional imbalances and microbial contamination, an increasing number of dog owners are adopting a raw diet for their dogs. This study expands the research into owner motivations for feeding RMBDs and cooked diets and asks them their opinions about risk and nutritional value.

Methods

An anonymized, online, internationally accessible questionnaire was developed to ascertain owner perspectives on the risks, benefits, and nutritional value of commercially prepared and homemade RMBDs as compared with commercially prepared cooked diets (CCDs).

Results

The questionnaire was completed by 419 dog owners of diverse backgrounds across the world. Of the participants, 25.3% fed RMBDs. Just over 70.0% of all participants had spoken to their veterinarian about their dog’s nutrition. Owners who fed RMBDs ranked their veterinarian’s knowledge lower and their own knowledge of canine nutrition higher than owners who fed CCDs. They rated commercial and homemade RMBDs as highly nutritious 83.5% and 73.6% of the time, respectively, while only 12.5% rated CCDs as highly nutritious. Owners who fed CCDs ranked RMBDs as highly nutritious less often, but also only ranked CCDs as highly nutritious 52.7% of the time. All participants agreed that CCDs were low risk to human health. Owners who fed RMBDs ranked raw diets as highly risky to human or dog health under 20.0% of the time but deemed CCDs risky to animal health over 65.0% of the time. When asked about benefits of raw diets, the most repeated words offered by owners were “health”, “better”, “coat” and “teeth”. The most repeated risks presented were “bacteria”, “nutrition”, “risk” and “Salmonella”. Owners who fed RMBDs tended to use vague terminology like “health” and “better” when asked why they fed a raw diet. Owners who did not feed RMBDs used more specific terminology like “expensive”, “time” and “risk” when asked why they did not feed a raw diet. Overall, the two groups differed in their perceptions around RMBD and CCD feeding, which highlights the need for a better line of communication and education between veterinarians and owners.

Systemic Mycobacterium kansasii Infection in Two Related Cats

Mycobacterial infections are a major concern in veterinary medicine because of the difficulty achieving an etiological diagnosis, the challenges and concerns of treatment, and the potential zoonotic risk. Mycobacterium kansasii, a slow-growing non-tuberculous mycobacteria, causes disease in both humans and animals. While infections have been well described in humans, where it may be misdiagnosed as tuberculosis, there are fewer reports in animals. Only four cases have been reported in the domestic cat. This case report describes systemic M. kansasii infection in two sibling indoor-only cats that presented two and half years apart with cutaneous disease that was found to be associated with osteolytic and pulmonary pathology. Infection with M. kansasii was confirmed in both cats by polymerase chain reaction on fine-needle aspirate of a lumbosacral soft tissue mass in one cat and on a tissue punch biopsy of a skin lesion in the other; interferon-gamma release assay inferred M. avium-complex and M. tuberculosis-complex infection in the two cats, respectively. Both patients made a full recovery following antimicrobial therapy with rifampicin, azithromycin, and pradofloxacin (plus N-acetyl cysteine in cat 2). This report highlights successful treatment of systemic M. kansasii mycobacteriosis in the cat and the challenge of accurately diagnosing this infection.

Feline tuberculosis caused by Mycobacterium bovis infection of domestic UK cats associated with feeding a commercial raw food diet

Mycobacterium (M.) bovis can infect cats and is a demonstrated zoonosis. We describe an outbreak of M. bovis in pet cats across England and Scotland associated with feeding a commercial raw food diet. Forty-seven cats presented with (pyo)granulomatous lesions, lymphadenopathy, pulmonary and/or alimentary disease over a one-year period where M. bovis infection was suspected or definitively diagnosed, and the cats all consumed the same specific brand of commercial raw venison pet food. Infection with M. bovis genotype 10:a was confirmed by culture and DNA typing of isolates in a small number of cases (n = 5); PCR was used in combination with or as an alternative to culture (n = 12) and/or infection with a Mycobacterium tuberculosis complex group organism was strongly suggested by positive responses to an interferon-gamma release assay (IGRA; n = 34). Asymptomatic at-risk cats were screened by IGRA, identifying a further 83 infected cats. The five culture-positive cases were distributed across areas of England and Scotland at low risk of endemic bovine tuberculosis. Investigations revealed affected cats were mainly indoor-only, and had been fed the same commercial raw food as at least part of their diet. This diet was recalled by the manufacturer due to failure of statutory meat inspection of the component venison. As far as possible, other sources of infection were explored and excluded, including wildlife contact, access to raw milk and living with people with active M. bovis infection. Four owners and one veterinary surgeon were found to have high likelihood of latent tuberculosis infection. One owner required treatment. Although it was not possible to conclusively demonstrate a zoonotic origin for these infections, neither was it possible to eliminate the possibility. Our results provide compelling evidence that the commercial raw diet of these cats was the likely route of M. bovis infection in this outbreak of cases.

Contamination factors associated with surviving bacteria in Thai commercial raw pet foods

Aim:

This study aimed to identify the surviving bacteria in commercial raw pet food and to analyze the factors associated with their contamination.

Materials and Methods:

A total of 17 samples from 12 brands available in Thailand were randomly selected for analysis. Fifteen samples were frozen products and two were freeze-dried. The total bacterial counts (TBCs) of Clostridiumperfringens, Campylobacter spp., Staphylococcus aureus, Escherichia coli, Salmonella spp., Listeria spp., and Listeriamonocytogenes were measured. Association between the bacterial profile and feed ingredients, as well as with product types, was analyzed by Chi-squared and Fisher’s exact tests.

Results:

Campylobacter was not found in any product, whereas Salmonella spp. and Listeria spp. showed the highest prevalence with respect to the standard’s limits. The TBC was significantly related to the type of the products (frozen or freeze-dried), and S. aureus and L. monocytogenes were significantly related to a chicken-based diet.

Conclusion:

Pet food contamination can occur during the manufacturing process, storage, or even preparation. The freezing and drying processes may reduce, but not eradicate, the bacterial contamination in raw pet food. These results emphasize the need for quality control in the manufacturing process and show the importance of personal hygiene for the pet owner to reduce health risks.

Current Standards and Practices Within the Therapy Dog Industry: Results of a Representative Survey of United States Therapy Dog Organizations

Organizations that deliver animal-assisted interventions (AAIs), as well as those that train, evaluate, and register therapy dogs, have proliferated in recent decades in the United States (U.S.). Each of these organizations has its own policies and procedures for screening, evaluating, and instructing dogs and their owners/handlers, but little is currently known about the range of different practices that exist nationwide. The aim of this project was to survey a representative, national sample of U.S. therapy dog organizations to investigate commonalities and differences in the types of practices in current use and to compare these to recommendations in existing published guidelines. The findings suggest the need for further research, and highlight a number of areas relating to dog welfare, human safety, and infection control in which many organizations were inconsistent in their adherence to existing guidelines. Of particular concern with regard to animal welfare was the finding that approximately half of the organizations surveyed imposed no time limit on the length of visits. Also, given the potential for zoonotic disease transmission, the finding that only a small minority of organizations prohibit the feeding of raw meat diets and treats to visiting dogs is concerning. This information will help to raise awareness among facilities with therapy animal programs and assist in the development of future best practices within the therapy dog industry.

Seroprevalence and Risk Factors for Toxoplasma gondii Infection in Owned Domestic Cats in Australia

Ongoing surveillance of Toxoplasma gondii seroprevalence and exposure risks in owned cats is important to identify effective mechanisms to decrease the prevalence of this global zoonotic parasite. We aimed to determine the seroprevalence of T. gondii and risk factors for seropositivity in owned domestic cats in Australia. Sera, signalment data, postcode, and completed owner-questionnaires surveying diet composition and lifestyle factors were collected for cats presenting to 18 veterinary clinics across Australia. T. gondii-specific IgG was measured by enzyme-linked immunosorbent assay. Data were analyzed using univariable and multivariable logistic regression to evaluate risk factors associated with positive T. gondii IgG serology. Among 417 cats, T. gondii seroprevalence was 39%. More than two-thirds of cats tested (69%) had outdoor access and 59% were fed a diet containing raw meat. Univariable analyses identified, age (>1 year, p < 0.001), a diet containing any raw meat (p = 0.001), raw kangaroo (p = 0.008), raw chicken (p = 0.012), or raw beef (p = 0.017), and hunting (p = 0.049) as risk factors for T. gondii infection. Age (>1 year, odds ratio [OR]: 7.15) and feeding of raw meat (OR: 2.23) remained significant risk factors (p < 0.001) in multivariable analyses. T. gondii seroprevalence did not differ between cats domiciled in urban and semiurban or rural areas. Pet cats in Australia are commonly infected with T. gondii. Feeding raw meat to cats, a common practice in Australia, is associated with T. gondii infection, highlighting the need for education about the health implications for cats from feeding a diet containing raw meat.