New Breakthroughs in Feline Infectious Peritonitis: Essential ABCD Guidelines for Vets

Feline Infectious Peritonitis: European Advisory Board on Cat Diseases Guidelines

Séverine Tasker et al.

Background:
Feline coronavirus (FCoV) is a widespread enteric virus in cats, typically causing no or mild clinical signs. However, a small percentage of infected cats develop feline infectious peritonitis (FIP), a severe and often fatal systemic disease characterized by vasculitis. FIP is most common in young and pedigree cats. The disease's pathogenesis is linked to mutations in FCoV that shift tropism from enterocytes to monocytes/macrophages, leading to systemic infection. The article, authored by the European Advisory Board on Cat Diseases (ABCD), offers a comprehensive update and revision of the 2009 guidelines.

Methods:
This is a comprehensive review and guideline article developed by the ABCD, synthesizing and evaluating a wide range of peer-reviewed studies, expert opinions, and clinical findings related to FCoV and FIP. The guidelines aim to inform clinical diagnosis, treatment, and prevention strategies and are structured for use in sections for ease of application in veterinary settings.

Results:
The review outlines the virology, pathogenesis, epidemiology, diagnostic approaches, and treatment options for FIP. Key findings include:

-FCoV is classified into types I and II, with type I being more prevalent but harder to culture.
-FIP development involves a switch to systemic infection within monocytes, facilitated by viral mutations (particularly in the spike and accessory genes).
-Diagnostic approaches prioritize sampling effusions for cytology and RT-PCR or antigen detection, with histopathology required for definitive diagnosis.
-Antiviral treatments, notably GS-441524, have significantly improved the prognosis of FIP, although availability remains inconsistent across regions.

Limitations:
The review acknowledges several limitations:

-Despite extensive research, the specific mutations responsible for virulence in FCoV remain unidentified.
-Diagnostic tools vary in sensitivity and specificity, especially concerning RT-PCR on blood samples.
-Legal and regulatory barriers limit access to effective antiviral therapies in some countries.
-There is variability in clinical manifestations and responses to treatment among cats, reflecting underlying gaps in understanding of host-virus interactions.

Conclusions:
The updated guidelines represent a substantial advancement in the understanding and clinical management of FIP. They emphasize the importance of rapid and accurate diagnosis, the utility of nucleoside analogues for treatment, and the necessity for broader availability of these therapeutics. Continued research is critical to fully elucidate the mechanisms behind FCoV mutation and FIP pathogenesis, improve diagnostic accuracy, and expand treatment access.

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