Benjean Dressler

FIP was previously fatal for most cats. However, in the last 3 years, significant developments have occurred in treatment. Studies have shown that antivirals can be effective in curing FIP. This has led to a growth in illegal supplies of these medications, sold to understandably worried caregivers. Since 2021 a legal supply of remdesivir and GS-441524 has been available in the UK and Australia, and via export to other countries. Please click here for more specific information about these drugs and speak to your vet to discuss treatment options if your cat is diagnosed with FIP.

FIP is caused by infection with a virus known as feline coronavirus. Coronaviruses are a common group of viruses that often infect the upper respiratory tract (nose and throat) or gastrointestinal tract (intestines) in different animals. COVID-19 is a coronavirus but the coronavirus causing FIP is not the same and only infects cats. Coronavirus infection is extremely widespread in cats, especially where large numbers of cats are kept together. It is estimated that 25–40% of household pet cats have been infected with FCoV, but the infection rate increases to 80 – 100 per cent for cats kept in multi-cat households or colonies.

Coronaviruses are common and found in the faeces of many cats. In most cats, infection causes no signs or just mild diarrhoea that resolves without treatment. However, occasionally, the virus mutates (changes) inside a cat, and if their immune system reacts in a certain way, they could develop a disease called FIP. This is important, as finding coronavirus in a cat does not mean they have FIP, and it is not possible to consistently tell the difference between a coronavirus causing FIP and one causing no signs at all by just finding the virus itself.

In a cat that develops FIP, the virus spreads throughout the body and can cause a wide range of different signs due to the way it interacts with the cat’s immune system.

FIP can cause many different clinical signs, depending on the parts of the body affected and how the immune system reacts. Early signs of FIP are usually very vague with a fluctuating fever (high temperature), lethargy and reduced appetite being common. After a period of several days or weeks (or sometimes even many months) other signs usually develop. Classically, FIP has been divided into ‘wet (effusive)’ and ‘dry’ forms, but actually cats are likely to have both at different times, or a mixture of both presentations. One of the challenges of diagnosing FIP is that the clinical signs are often vague and not specific for FIP and can be seen with other diseases.

In this form or stage of disease there is accumulation of fluid within the abdominal cavity (resulting in abdominal distension) and/or the chest cavity (resulting in breathing difficulties). The fluid accumulates because infection with FIPV causes damage to and inflammation of blood vessels (called ‘vasculitis’) which results in fluid leaking from the blood into the abdomen or chest. Cases that develop fluid accumulation in the abdomen are responsible for the original name of this disease, ‘peritonitis’ referring to the inflammation that occurs in the lining of the abdominal cavity. The fluid that forms typically is thick and bright yellow in colour and contains a lot of protein. However, other diseases (including some liver diseases and cancers) can also cause a similar fluid accumulation.

FIP can affect any organ of the body and so other forms of FIP (often termed ‘dry’ FIP) involve the formulation of granulomas (masses of virus and inflammatory cells) and the signs will vary according to the organ affected. This inflammation affects the eyes in around 30% of cases and the brain in around 30% of cases, but can also affect almost any tissues in the body including the liver, kidneys, lungs and skin. Thus, a wide range of signs may be observed including neurological disease (e.g., a wobbly and unsteady gait or fits), bleeding in the eyes and other vague signs of disease that may occur with lesions in the liver, kidneys or other internal organs.

Although FIP can occur in cats of any age, it is most often seen in young cats. Around 80% of cases diagnosed are in cats less than 2 years old, and many cases are seen in kittens around 4-12 months old. FIP is also more common in cats kept in groups or colonies (especially breeding households) as this is an environment where FCoV infections are spread easily. A crowded environment may also contribute to stress, which can be a factor in disease development as it compromises the cat’s immune response. There is evidence that genetics can also play a role in susceptibility to disease, although this is complex. Many cats that develop FIP are now in single cat homes, despite coming from multi-cat environments.

FIP is a very difficult disease to deal with because there are no clinical signs that are specific for the diagnosis of FIP, and no simple blood test to confirm a diagnosis. FIP may be considered more likely when:

None of these blood changes are specific for FIP, occurring with other diseases too, but if multiple changes are seen in combination with appropriate signs, a diagnosis of FIP becomes more likely. Many of these abnormalities may also not be present in the early stages of the disease but may become evident as the disease progresses. Thus, some tests that give normal results may have to be repeated later.

If fluid is present in the abdomen or chest cavity, obtaining a sample of the fluid and analysing the cell and protein content can be extremely helpful. With FIP the fluid invariably has a high protein content and further analysis of cell types and types of protein present can be useful. Further tests on fluid can be performed to look for the virus (PCR for example). Looking for fluid is an important part of investigating a cat for FIP so xrays, and particularly ultrasound, can be very helpful and again may need to repeated later as the disease progresses.

Other tests that can also sometimes be helpful include:

Looking for the presence of antibodies against the virus in a blood sample (coronavirus serology) is of very limited value – antibodies against FCoV develop when a cat meets coronavirus – this does not mean they have or will get FIP. A very large number of perfectly healthy cats are therefore positive on this test, and it should not be used for diagnosis.

To confirm a diagnosis is very difficult, but in general finding the typical type of effusion or inflammation and finding the virus in the same areas can be useful. Ways to look for the presence of the virus include immunocytochemistry and immunohistochemistry (staining the virus so it can be detected) and PCR (testing for the viruses genetic material). These tests can be performed on fluids, needle samples, biopsies and other samples. Remember, it is not enough to find just the virus as cats without FIP may have coronavirus, we must put together the puzzle of clinical signs, imaging findings fluid and needle samples and virus detection tests.

There have been significant recent developments in the management of this once fatal condition. Recent research by Professor Niels Pedersen of University of California, Davis, has shown that some newer anti-viral drugs such as GC-376 and GS-441524, used in humans against some emerging viruses, may be effective. Additionally, remdesivir, a prodrug of GS-441524 has become available legally in the UK and Australia. The drug has been used to treat human viral infections including SARS-CoV-2 (COVID-19). Initial experience has been positive with response rates of around 80% and therefore we have reason to be optimistic. The treatment remains expensive and requires a long course of treatment (84 days) so veterinarians should be mindful of commitment and cost involved plus potential for relapse. We look forward to learning more about the treatment of FIP over the next few years. Black market products remain available, but of unknown content and safety so legal drugs should be selected for the treatment of FIP in cats.

A commercial vaccine is available in some countries to help protect against FIP. However, this vaccine (while showing some efficacy) can only be given to kittens over 16 weeks of age. The major indication for using such a vaccine would be in breeding households, especially with a history of FIP, but by the time a kitten can be vaccinated (at 16 weeks) they would almost invariably have already been exposed to FCoV infection and so the vaccine probably has little or no value.

FIP is least common in household pets. The risk can be minimised by obtaining cats from a source with relatively few cats and by keeping cats in small stable groups (less than five cats in a household).

In breeding catteries, eradicating coronavirus infections is extremely difficult, as the virus is so ubiquitous, and it is unsuitable in most situations to attempt this. A more practical approach is to use measures to reduce the risk of FIP occurring, but recognising that on occasions, this may happen even in the best run catteries. Good practice to minimise the risk of FIP would include:

Wherever FIP occurs is a problem in a group of breeding cats:

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