I have read a plethora of information about feline infectious peritonitis (FIP) in the past few years. I became more familiar with this disease after we had to humanely euthanize three cats at the cat rescue I run who went from jumping 5 feet in the air during play to near death in just two days. We lost three cats in 2019 and four in 2020 to this dreaded disease. It was never easy having to make that decision, but the current cost of treating one cat would wipe us out of existence, which is often the case for small rescues.
FIP was vastly misunderstood for a very long time, even the way that the coronavirus mutates into FIP is still hotly debated between veterinarians and animal rescuers. Researchers often say that this disease is unlike any condition that they have ever seen in the human or feline world, which is why we do not have an effective vaccine or definitive test for FIP. We have made great strides in the past year in understanding the disease through hope and despair. We are not quite where we want to be, but hopefully, we get there one step at a time.
Watching the FIP Warriors Facebook group and listening to Dr. Pedersen (who is the most well-known expert in this field) is the most convenient way for me to remain updated with accurate information. This veterinarian has authored a myriad of articles on the management, detection, and treatment of FIP. My focus is on staying up to date with the gold standard of supportive care as this disease is always fatal and progressive if not treated aggressively. With the gold standard of care, which often includes a whirlwind of medical procedures, there have been some cats that have survived for six months to one year.
Just recently, black market drugs have provided us with the unique opportunity to save a cat that would otherwise be euthanized or pass away at a later date, even if given supportive care. A veterinarian often will deliver the devastating diagnosis after they pull out fluid from the abdomen or analyze bloodwork that is indicative of FIP. There is no definitive test on the market, but fluid and bloodwork can be a very solid indication of an infection. You often see increased total protein and decreased albumin/globulin ratio values in a FIP cat. Hopefully, we can change the conversation from euthanasia to treatment options as we start to understand the disease more and are able to make medical breakthroughs.
Some Information On FIP
Coronavirus-specific antibodies are thought to be present in up to 90% of cats in multiple cat households, and up to 60% of cats in a single-cat home. Catteries that house purebred cats (such as the Ragdoll and Himalayan) are thought to have a higher rate of coronavirus than mixed breed households. The coronavirus will not mutate into FIP for most cats and the strain will remain avirulent, which means that it does not cause disease. Only about 5-10% of cats will experience a mutation of the coronavirus during their lifetime. 40-80% or more of the cats in any environment will shed the coronavirus in their feces at any given point in time, either intermittently or continuously.
Almost every cat will be exposed through a harmless version of coronavirus at some point in life through the fecal-oral route (through infected feces). Most cats only shed the virus for a few months in a household of five cats or less. In a household with more than five total cats, there may be indefinite shedding of the virus. In most cases, infection with a coronavirus will only cause mild symptoms like self-limiting diarrhea or no signs at all which is most likely to be the case.
The virus will usually only live for 24-36 hours at a time and is deactivated by routine disinfection. Unfortunately, an initial infection can later mutate into FIP and harmful strains can even be carried by healthy cats. It may be shocking to hear that many cats who develop FIP have had no contact with cats showing symptoms of FIP. The relationship is extremely complex because some cats remain persistently infected and shed it forever, others can be infected then develop strong immunity against it, and others may be infected and eliminate the virus but is prone to recurrent infections of coronavirus.
Prevention OF FIP:
- House less than 5 cats if possible
- Regular veterinary examinations
- Keep litterboxes away from bowls
- Reduce stress levels
- Routinely clean litter boxes
- Keep the environment clean and sanitary
- Selective breeding for disease resistance
- Minimize exposure to infectious disease
The mutation of coronavirus into FIP is thought to be related to an aberration of the immune response to coronavirus or unfortunate genetics. Kittens, senior cats, and cats who have FELV are most at risk. I always stress that it is always about the individual cat rather than the virus. Most cats will break with the disease after a stressful situation such as being altered since stress often accelerates the activation of a brewing infection like the feline herpes virus. The mutated form of coronavirus is not contagious from cat to cat as the infection confines the mutated virus inside of the cat’s body. The non-mutated virus will still be shed as normal.
The coronavirus will need to mutate for a cat to display clinical symptoms. After the coronavirus mutates, the infection will then slowly start to progress into FIP over a period of weeks or months. The specific mutation will basically allow for the virus to escape the cells that line the small intestine so it can infect white blood cells. The white blood cells that are supposed to protect the cat will then transport the virus throughout the entire body, which results in a widespread inflammatory response. Multiple organs are often infected, such as the kidneys, abdomen, and brain.
The coronavirus has to mutate precisely three times for it to become FIP, with the final mutation of the coronavirus causing significant issues. The last mutation was found to be different in every single cat in recent research. This fact alone has served as convincing evidence that FIP does not spread directly from cat to cat in a multi-cat household environment (horizontally). The third mutation would be the same in every single cat if it was contagious from cat to cat.
Dry FIP (non-effusive) often displays as a small buildup of inflammatory cells or granulomas in a variety of organs. The eyes and neurologic systems are frequently impacted. You can expect to see blood in the eyes, cloudy eyes, inflammation of the eyes, trouble with routine movement, and more. The dry form is found in one-third of the cat population that is diagnosed with FIP. More clinical signs can pop up based on the organs impacted such as increased thirst.
Wet FIP (effusive) is characterized as a rapid accrual of fluid in the abdomen or the chest cavity. It would not be uncommon to draw out 3 to 5 ounces of yellow fluid from these cavities in an infected cat. Rapid breathing or labored breathing are the two most commonly observed signs. The wet form is discovered in two-thirds of the cat population diagnosed with FIP.
In both versions of FIP, you will often observe a fever of 104 degrees Fahrenheit or higher. Anemia, loss of appetite, dehydration, loss of weight, and jaundice will be observed in the intermediate and advanced stages of FIP. Small indications of FIP are unkempt hair coats, a prominent third eyelid, diarrhea, and lethargy. The cat that we found breathing rapidly at the rescue just two months ago registered with a fever of 106 degrees Fahrenheit and a prominent third eyelid. These symptoms can easily be confused with upper respiratory infection or asthma, which can lead to a misdiagnosis.
Black Market Drugs
Black market drugs have been used to treat FIP with a high success rate according to the FIP Warriors Facebook group, which often utilizes GS-441524 or GC376 analogs. GS-441524 is patented by Gilead Sciences, and GC376 is patented by Kansas State University. Both drugs were shown to reverse the progression of FIP in clinical trials involving several dozen cats. The two agents directly interfere with the virus’s ability to infiltrate and hijack the immune system.
The before and after pictures of cats stricken down in their prime with FIP is shocking. Seeing a cat who is 5 pounds underweight in the before picture with sunken-in eyes and dehydration then again in the after photo, where the cat is of ideal weight, is almost breathtaking. In one video, you see the cat gasping for air, and in the next video, you see the cat running around and playing. There are hundreds of before and after testimonials available on the FIP Warriors Facebook page.
The problem right now is that the black market drugs cannot be endorsed by veterinarians because of the red tape surrounding the use of black market drugs that have not been approved for veterinary use in the United States. Veterinarians that support the treatment are often facing the ethics of discussing this treatment without losing their veterinary license that took years to obtain. The drugs have not been proven beyond a shadow of a doubt that they are effective for FIP treatment since the patent holders have not pursued this any further, despite the hundreds if not thousands of positive testimonials by pet owners.
Coronavirus in China And Drug Development
Many of the drugs used to treat FIP are manufactured and shipped from China to cut costs, and because they have the technology to manufacture them at an accelerated pace. It is a tough feat even to find these drugs because no veterinarian will tell you where to find them due to the legal trouble that they could face for doing so. Even members of the FIP Warriors group will not show you the specific websites to search for the drugs but will give you the list of drugs. It took me about 2 hours of googling the drug names to find some of the lesser-known brands that are sold in China.
The treatment of FIP can range from $2000 to $10000 depending on the severity of the disease and the duration of treatment. The drugs are available in both injectable form and capsule form for individuals who prefer one method over the other. Dry and neuro versions of the disease are more difficult to treat since a higher dose of medication is required for effective treatment.
The most well-known supplier of FIP drugs is Mutian, who is one of the only suppliers based in the United States. Mutian guarantees successful treatment in 84 days, or they will supply an additional 180 of treatment at no cost. Most of the drug therapies are given for 84 days for a complete cure. They boast 24/7 assistance and offer a Facebook group ran by experts who provide their expertise in helping you implement your FIP treatment plan. Mutian is the only brand you can find right away by typing their name into Google.
Individuals are often forced to use an alternative from China, which usually works but can come with heightened risk due to the potential of more side effects. Recently, Shire just had a bad batch of vials, which caused problems amongst several cats. Some of the individuals that used the last batch did not see any positive impact and wasted quite a bit of money. As you might suspect, you cannot guarantee that every drug coming from China is going to be pure. The quality control for drugs released from China is not always the best, unfortunately.
Common Drug Names
Just recently, we have seen an infection of coronavirus in humans, which originated in China. As of today, more than 11,000 humans have been diagnosed with coronavirus around the world, according to the Johns Hopkins virus dashboard. Starting on February 2nd, all United States citizens who have visited China will undergo a required two-week quarantine. The coronavirus between humans and animals is not communicable or zoonotic, but it does make us wonder if this situation will accelerate the official approval of these drugs for use in veterinary medicine.
Gilead Sciences just offered an experimental drug for coronavirus treatment for humans in response to the state of emergency that was declared. Various individuals across several FIP support groups are hoping that this unfortunate event will also speed up the approval of FIP drug use for cats. The GS-441524 and GC376 analogs that are being used for the treatment of FIP in cats is a derivative of the parent drug that is going to be used for treatment in humans who are impacted by a coronavirus. At the same time, people think that the veterinary world could be put on the backburner since Gilead Sciences is also wanting to use the same drug to treat ebola for humans.
Many owners cannot afford FIP treatment because of the substantial amount of money that you have to invest in medication, diagnostics, and treatment for 84 days or beyond. The cost can even cost above the estimated $10,000 if you need to schedule multiple veterinary visits. I read about people investing money from their college funds, retirement savings, and emergency savings. It is both endearing that they do this but sad that they have to. Every person who is going through treating and FIP cat is praying that the cost will come down at some point and that the drugs are easier to obtain.
The more roadblocks that there are to successful treatment of FIP, the more cats that will have to be euthanized at the time of diagnosis. Treating clinical signs of FIP is no longer a myth or an impossible dream, but it does very little good if we cannot afford to treat FIP without going completely broke in the process. The world of veterinary medicine is a far cry away from a commercially available cure that veterinarians can recommend to clients, but hopefully, it isn’t years away.