Skin ulceration associated with herpesvirus infection in cats

Quantitative real time polymerase chain reaction (qRT-PCR) and RNAscope in situ hybridization (RNA-ISH) as effective tools to diagnose feline herpesvirus-1-associated dermatitis

BACKGROUND

Felid herpesvirus type 1 (FHV-1)-associated dermatitis is characterized by facial and nasal involvement; clinical and histopathological manifestations may overlap with other dermatitides.

OBJECTIVE

To evaluate the realibility of qRT-PCR-2^{- ΔΔC q} and RNAscope in situ hybridization (RNA-ISH) methods to diagnose FHV-1-associated dermatitis, in formalin-fixed paraffin-embedded (FFPE) tissues.

ANIMALS

Sixteen FFPE samples from cats with facial dermatitis and four controls were studied.

METHODS AND MATERIALS

Based on histopathological features, cases were separated into: Group 1, samples with herpetic dermatitis (four); Group 2, samples with nonherpetic facial dermatitis (six); Group 3, samples with facial dermatitis of ambiguous nature (allergic or viral) (six); and Group 4, samples from healthy cats (four). A relative quantification using the 2^{- ΔΔC q} method was used to estimate the "upregulation" of each FHV-1 target viral gene copies (glycoprotein-B and thymidine-kinase) relative to reference gene. Detection of FHV-1 mRNA was performed using the RNAscope 2.5 detection kit.

RESULTS

By 2^{- ΔΔC q} analysis, upregulation of both FHV-1 genes was observed in all samples from Group 1 and two of six from Group 3. No upregulation was identified in samples from groups 2 and 4. Positive mRNA hybridization signal was observed in all cases from Group 1 and two cases of Group 3. No positivity was observed in samples from groups 2 and 4.

CONCLUSIONS AND CLINICAL IMPORTANCE

QRT-PCR 2^-ΔΔCq analysis and RNA-ISH can identify the FHV-1 genome as causative agent of the associated dermatitis, even where inclusion bodies are not detectable. Both techniques are functional in retrospective studies, have greater specificity than conventional PCR, and may be proposed for research and diagnostic purposes.

Skin as a marker of general feline health: Cutaneous manifestations of infectious disease

Practical relevance: Infectious disease in feline patients often presents a diagnostic challenge. This article reviews the most relevant viral, bacterial and protozoal diseases and their cutaneous manifestations. Many of the diseases discussed have overlapping presentations or may mimic more common noninfectious disease processes. The purpose of the article is to reinforce knowledge of common and uncommon infectious diseases, help practitioners identify possible infectious dermatoses, create a comprehensive and prioritized differential list, and provide guidance for the diagnosis of these diseases. A working knowledge of these clinical syndromes is important if what is thought to be a case of a common disease does not respond to conventional management.

AUDIENCE

This review is aimed at veterinarians who treat cats and especially those with an interest in feline dermatology. Tables are included to allow the reader to formulate a concise list of differential diagnoses for clinically similar presentations. The diagnostic approach to a case of ulcerative facial dermatitis is reviewed in a Case Notes quiz. Evidence base: This article includes up-to-date information regarding dermatologic manifestations of less commonly encountered feline cutaneous infectious diseases. Information has been drawn from the published, peer-reviewed literature and the most recent textbook chapters with a particular aim of describing and differentiating clinical lesions and the diagnostic approach to cutaneous disease, especially in unusual cases.

Chronic Eosinophilic Dermatitis Associated with Persistent Feline Herpes Virus Infection in Cheetahs (Acinonyx jubatus)

A chronic ulcerative and eosinophilic dermatitis occurred in 20 captive cheetahs ( Acinonyx jubatus) with persistent feline herpes virus 1 (FHV1) infection. Affected animals had erythematous, ulcerated plaques primarily on the face and forelegs in sites of contact with lachrymal and salivary secretions. The dermatitis was characterized by dense infiltrates of eosinophils and plasma cells and pseudoepitheliomatous hyperplasia. Rare keratinocytes within the lesions had nuclei with marginated chromatin and small eosinophilic inclusions composed of herpes virus nucleocapsids. Virus isolated from lesions was confirmed to be FHV1. Lesions persisted and progressed unless removed by cryoexcision. The occurrence of this unusual reaction to FHV1 in approximately 5% of captive North American cheetahs suggests a species propensity for a Th2-dominant response to herpes virus infection. This atypical immune reaction may indicate a heritable trait or modulation of the immune response by other factors such as chronic stress.

TREATMENT OF CHRONIC HERPESVIRAL DERMATITIS IN A CAPTIVE CHEETAH (ACINONYX JUBATUS) IN NAMIBIA

A 9-yr-old male cheetah (Acinonyx jubatus) housed at the Cheetah Conservation Fund in Namibia developed cutaneous lesions consisting of alopecia, erythema, ulceration, and crusting on the left fore and hind limbs. Histopathology of skin biopsies in conjunction with indirect fluorescent antibody and polymerase chain reaction testing confirmed a diagnosis of feline herpesvirus-1 dermatitis; microbial culture indicated secondary bacterial infection. Therapy included targeted systemic antimicrobial and antiviral treatment, topical medications, and repeated cryotherapy. Lesions exhibited varying degrees of clinical improvement but, overall, progressed in extent, size, and severity during the subsequent 2.5 yr of intense treatment. The cheetah was ultimately euthanized due to a guarded prognosis and concerns about poor quality of life. Potential factors initiating or contributing (or both) to the severity and nonhealing nature of the cutaneous lesions include chronic unidentified stress, altered immune system function, and other environmental influences.

Immunohistological evaluation of feline herpesvirus-1 infection in feline eosinophilic dermatoses or stomatitis

This study used immunohistochemistry (IHC) and histopathology to evaluate the presence of feline herpesvirus-1 (FHV-1) in feline cases of 'eosinophilic granuloma complex' (EGC) or other eosinophilic dermatoses or stomatitis, diagnosed at the Veterinary Pathology Diagnostic Service, University of Sydney between January 1996 and June 2008. Two of the 30 cases (6.6%) examined showed positive immunoreactivity to FHV-1 using IHC. Intranuclear inclusion bodies were also detected on histopathological examination of haematoxylin and eosin stained sections of both cases but were very difficult to find. Therefore, FHV-1 is uncommonly associated with EGC or other eosinophilic dermatoses or stomatitis in Sydney. However, misdiagnosis as an EGC lesion or other eosinophilic dermatoses may occur if inclusion bodies are overlooked or absent on histopathology and this may significantly decrease the chance of a favourable treatment outcome. FHV-1 should be considered in cats with severe ulcerative cutaneous or oral lesions, unresponsive to corticosteroid treatment, with or without concurrent or historical signs of upper respiratory tract or ocular disease more typical of FHV-1. IHC may be helpful in differentiating FHV-1 dermatitis or stomatitis from other eosinophilic lesions, which is of vital clinical and therapeutic importance.

Occurrence, morphological characterization and antigen localization of felid herpesvirus-induced pneumonia in cats: a retrospective study (2000-2006)

The pathological findings in nine cases of pneumonia associated with infection by felid herpesvirus-1 (FeHV-1) are presented. The animals affected were five kittens, two subadult cats and two adult cats. The microscopical changes included fibrinonecrotic pneumonia and severe necrosis of the bronchial and bronchiolar epithelium. FeHV-1 antigen was detected immunohistochemically in pneumocytes, alveolar macrophages and necrotic bronchial and bronchiolar epithelial cells. In the youngest kitten viral antigen was also found in the liver. FeHV-1 infection should therefore be considered as a differential diagnosis in cats with fibrinonecrotic pneumonia and demonstration of viral antigen by immunohistochemistry is a useful diagnostic procedure in such cases.

Feline herpesvirus

Feline herpesvirus (FHV-1; felid herpesvirus 1 (FeHV-1)) is an alphaherpesvirus of cats closely related to canine herpesvirus-1 and phocine herpesvirus-1. There is only one serotype of the virus and it is relatively homogenous genetically. FeHV-1 is an important cause of acute upper respiratory tract and ocular disease in cats. In addition, its role in more chronic ocular disease and skin lesions is increasingly being recognised. Epidemiologically, FeHV-1 behaves as a typical alphaherpesvirus whereby clinically recovered cats become latently infected carriers which undergo periodic episodes of virus reactivation, particularly after a stress. The primary site of latency is the trigeminal ganglion. Conventional inactivated and modified-live vaccines are available and protect reasonably well against disease but not infection, although viral shedding may be reduced. Genetically engineered vaccines have also been developed, both for FeHV-1 and as vector vaccines for other pathogens, but none is as yet marketed.

Feline herpes dermatitis treated with interferon omega

This case report describes the diagnosis, demonstration and treatment of feline herpes virus-induced facial dermatitis in a cat. The cat was successfully treated with interferon omega (IFN-omega).

Detection of feline herpesvirus 1 DNA in skin biopsy specimens from cats with or without dermatitis

OBJECTIVE

To compare detection rates of feline herpesvirus 1 (FHV-1) DNA in skin biopsy specimens from cats with herpetic dermatitis, cats with nonherpetic dermatitis, and cats without dermatitis.

DESIGN

Prevalence survey. Animals-5 cats (9 biopsy specimens) with herpetic ulcerative dermatitis, 14 cats (17 biopsy specimens) with nonherpetic ulcerative dermatitis, and 8 cats (21 biopsy specimens) without clinically apparent skin lesions.

PROCEDURES

A single-phase PCR assay was used to detect FHV-1 DNA in biopsy specimens. Assay results were compared with results of histologic examination.

RESULTS

FHV-1 DNA was detected in all 9 biopsy specimens from the 5 cats with herpetic dermatitis and in 1 of 17 biopsy specimens from the 14 cats with nonherpetic dermatitis, but was not detected in any of the 21 biopsy specimens from the 8 cats without dermatitis. When results of histologic examination were used as the gold standard, sensitivity and specificity of the PCR assay were 100% and 95%, respectively.

CONCLUSIONS AND CLINICAL RELEVANCE

Results confirmed that FHV-1 DNA can be detected in the skin of cats with herpetic dermatitis and suggest that the virus may play a causative role in the disease. In addition, the PCR assay may be useful in confirming a diagnosis of herpetic dermatitis.

Feline herpesvirus 1-associated facial and nasal dermatitis and stomatitis in domestic cats

Feline herpesvirus-associated dermatitis has rarely been reported. Recently we documented a unique ulcerative and often persistent facial dermatitis or stomatitis syndrome associated with feline herpesvirus 1. We believe this syndrome is relatively common, with the 10 cases in our series diagnosed between 1996 and 1997. The syndrome is associated with epithelial cell necrosis, eosinophilic inflammation, and intraepithelial herpesvirus inclusion bodies. The prevalence of eosinophilic inflammation and low number of inclusion bodies may lead to the misdiagnosis of allergic dermatitis or a lesion within the eosinophilic granuloma complex group of disorders. Feline herpesvirus 1 can be identified in lesional tissue by PCR methodology. Most of our cases developed under circumstances suggesting reactivation of latent herpesvirus infection, and previous glucocorticoid therapy or stress from overcrowding may have played a role in lesion development. Cats with ulcerative dermatitis, especially of the face and nose, and cats with stomatitis should be evaluated for the presence of feline herpesvirus. Treatment options include surgical excision, topical or systemic antibiotic therapy to treat secondary bacterial infection, and oral alpha interferon.

Herpesviruses of carnivores

This review focuses on felid herpesvirus 1 (FHV-1), the most studied of the carnivore herpesviruses. Canid herpesvirus (CHV-1) and phocid (seal) herpesvirus 1 (PhHV-1) are also included where information is available. FHV-1 is a member of the Varicellovirus genus of the Alphaherpesvirinae, which appears to be closely related phylogenetically to both CHV-1 and PhHV-1. FHV-1 infects both domestic and some wild Felidae, such as cheetahs, and is predominantly a respiratory pathogen of cats. As in other herpesviruses, infection with FHV-1 is characterised by a latent carrier state, during which intermittent shedding of infectious virus may occur. Typical of an alphaherpesvirus, the primary site of FHV-1 latency is neurological tissue (trigeminal ganglion), though recent studies using the polymerase chain reaction have suggested that some latency may occur in non-neurological sites. Latently infected carriers are epidemiologically important as sources of infection for susceptible animals. Though conventional modified live and inactivated vaccines have been available for a number of years, they do not protect against infection nor the development of latency. Recently, work has focused on molecular characterisation of FHV-1, detecting genes such as glycoproteins or regulatory genes. Such work will enable better understanding of the interaction of FHV-1 with the natural host. Deletion mutants of some of these genes may also have potential as vaccine strains.