Prevalence and risk factors for gingivitis in a cohort of UK companion cats aged up to 6 years

OBJECTIVES

Prospectively collected data were used to estimate the prevalence of gingivitis in a cohort of companion cats aged up to 6 years and to investigate factors associated with the risk of gingivitis in cats aged 3 to 4 years.

MATERIALS AND METHODS

Data were obtained from a longitudinal study of domestic cats (the Bristol Cats Study), using owner-completed questionnaires and veterinary surgeon-completed oral health scores. Prevalence estimates of veterinary-reported gingivitis for cats aged up to 6 years old (n = 1534) were calculated for different age groups. Cat signalment, diet and dental care were assessed for association with gingivitis in cats aged 3 to 4 years (n = 317) using univariable and multiple logistic regression.

RESULTS

The prevalence of gingivitis increased with age and ranged from 24.5% (<12 months old) to 56.3% (5 to 6 years old). Odds of gingivitis in cats aged 3 to 4 years were higher in cats fed a wet only or mixed wet/dry diet compared to dry only (odds ratio: 2.7; 95% confidence interval: 1.4 to 5.1), cats not reported to hunt compared to reported hunters (odds ratio: 2.1; 95% confidence interval: 1.0 to 4.2), cats reported to dribble whilst being stroked at age 6 months compared to reported non-dribblers (odds ratio: 3.2; 95% confidence interval: 1.3 to 8.4) and cats with orange variants in their coat colour compared to non-orange cats (odds ratio: 2.3; 95% confidence interval: 1.0 to 5.3).

CLINICAL SIGNIFICANCE

These results will help veterinary surgeons identify cats that may be at a greater risk of gingivitis and provide an evidence base to inform dietary and oral healthcare recommendations aimed at promoting gingival health in cats.

Early-life risk factors identified for owner-reported feline overweight and obesity at around two years of age

Obesity is considered the second most common health problem in pet cats in developed countries. This study used prospective data from a longitudinal study of pet cats ('C.L.A.W.S.', www.bristol.ac.uk/vetscience/claws) to identify early-life risk factors for feline overweight/obesity occurring at around two years of age. Data were collected via five owner-completed questionnaires (for cats aged two-six months, six months, 12 months, 18 months and two years respectively) completed between May 2011 and April 2015. Owner-reported body condition scores (BCS) of cats at age two years, assessed using images from the 9-point BCS system (Laflamme, 1997), were categorised into a dichotomous variable: overweight/obese (BCS 6-9) and not overweight (BCS 1-5) and used as the dependent variable. Of the 375 cats with owner-reported BCS, 25.3% were overweight or obese at two years of age. Multivariable logistic regression models were built using stepwise forward-selection. To account for potential hierarchical clustering due to multi-cat households two-level random intercept models were considered but clustering had no impact on the analysis. Models were compared using Wald tests. Six factors were significantly associated with overweight/obesity at two years of age: being overweight or obese at one year of age (OR=10.6, 95%CI 4.4-25.3); owner belief that BCS 7 was the ideal weight (OR=33.2, 95%CI 8.5-129.4), or that BCS represented overweight cats but they would not be concerned if their cat were classified in this category (OR=2.7, 95%CI 1.2-6.2), at questionnaire five completion; vets advising owners that the cat should lose weight, or making no comment on their weight, between one and two years of age (OR=12.1, 95%CI 3.2-44.9 and OR=3.9, 95%CI 1.5-10.3 respectively); owners giving their cat treats when they "felt happy" with them at 18 months of age (OR=2.7, 95%CI 1.0 - 7.3); feeding ≥250g wet food daily between two and six months of age (OR=2.7, 95%CI 1.2-5.9), and feeding dry food as the only or major part (>50%) of the diet at two years of age (OR=2.1, 95%CI 1.0-4.2). These findings have the potential to reduce the current high prevalence of a widespread problem by informing preventive advice, and as such improving the health and welfare of pet cats.

Risk factors for road traffic accidents in cats up to age 12 months that were registered between 2010 and 2013 with the UK pet cat cohort ('Bristol Cats')

Road traffic accidents (RTAs) are a common cause of death and injury in domestic cats, and a concern to many owners. This study assessed potential risk factors for RTAs in cats up to 12 months of age within a UK cat cohort known as 'The Bristol Cats study'. Data were obtained from three questionnaires, completed by cat owners when their cats were approximately 8-16 weeks old, 6 months old and 12 months old. Information was gathered regarding environmental conditions, cat characteristics and owner management factors. Univariable and multivariable logistic regression models were used to assess associations between these factors and RTAs. Of 1264 eligible study cats, 49 (3.9 per cent) had been involved in an RTA, of which 71.4 per cent (35/49) were known to result in fatal injuries. Rural locations were associated with a higher odds of RTAs than towns, cities or suburban locations. An increased odds of an RTA was also associated with cats that were reported by their owners to hunt at the roadside, as well as cats whose owners classified the road by their house as being a 'long straight section of road'. No significant associations were found between coat colour, breed, sex or neuter status and the odds of an RTA.

Measurement of IL-12 (p40, p35), IL-23p19, and IFN-γ mRNA in duodenal biopsies of cats with inflammatory enteropathy

Background

Dietary hypersensitivity and inflammatory bowel disease (IBD) are important causes of chronic vomiting and diarrhea in cats. IL‐23 has been recently found to be a key factor in the immunopathogenesis of IBD in humans but the involvement in IBD has not been investigated in cats.

Hypothesis/Objectives

Expression of genes encoding Il‐12p35 and p40, IL‐23p19, and IFN‐γ may be up‐regulated in duodenal biopsy specimens taken from cats with histologic evidence of inflammation.

Animals and Methods

Duodenal biopsy specimens were collected from control cats (n = 21) and cats with inflammatory enteropathy (n = 13). Routine histopathology, immunohistochemistry (IHC), and qRT‐PCR were used to assess expression of MHC class II and to measure gene transcripts encoding the p35, p40, and p19 subunits of the IL‐12 family of cytokines and IFN‐γ.

Results

There were significant differences in expression of mRNA encoding IL‐12p35 and IL‐23p19 between healthy cats and cats with inflammatory enteropathy. IL‐12p35 mRNA was lower in the duodenal mucosa of cats with inflammatory enteropathy compared with the mucosa of healthy cats (P = .001). In contrast, IL‐23p19 mRNA expression was higher in duodenal biopsy specimens from cats with inflammatory enteropathy than in those from healthy controls (P = .001). There was no difference in expression of IL‐12p40 and IFN‐γ mRNA (P > .05). The majority of cats with inflammatory enteropathy had histologic evidence of moderate to severe colitis (score 2).

Conclusions and Clinical Importance

The results of this preliminary study suggest that IL‐23 plays a role in the pathogenesis of feline inflammatory enteropathy.

The neuter status of cats at four and six months of age is strongly associated with the owners' intended age of neutering

The recommended neutering age of client-owned cats reduced recently from six to four months of age. This study assessed the proportion of cats neutered at these ages. Data were obtained from owner-completed questionnaires at recruitment (8-16-week-old kittens) and 6.5-7 months of age. Demographic and lifestyle factors were assessed for potential association with neuter status using univariable and multivariable logistic regression models. Of 751 study cats, 14.1 per cent and 73.5 per cent had been neutered at (or before) four and six months of age, respectively. Multivariable analysis showed that being neutered at four months was significantly more likely for cats whose owners intended to have their cat neutered by this age, cats with a microchip, and from households in deprived regions. The likelihood of being neutered at six months of age was significantly increased for cats that were insured, obtained from an animal welfare organisation, given their second vaccination, from a household with an annual income of ≥£10 000, and owned by people intending to have their cat neutered by this age. This study suggests that while neutering rates were high at six months of age, they were low at four months of age, and that further work is required to disseminate the recommended neutering age of four months.

Phylogenetic analysis of feline coronavirus strains in an epizootic outbreak of feline infectious peritonitis

Background

Feline coronavirus (FCoV) infection is common. In a small percentage of cats, FCoV infection is associated with the fatal disease feline infectious peritonitis (FIP). Genetically distinct virulent and avirulent strains of FCoV might coexist within a cat population.

Objectives

To determine whether the strains of FCoV in FIP‐affected cats are closely related or genetically distinct from the fecally derived strains of FCoV in contemporary‐asymptomatic cats during an epizootic outbreak of FIP.

Animals

Four cats euthanized because of FIP and 16 asymptomatic cats.

Methods

This prospective outbreak investigation was initiated during an outbreak of FIP in cats within or rehomed from a rescue/rehoming center. Postmortem samples were collected from cats with FIP and contemporaneous fecal samples from asymptomatic cats. RNA was purified from tissue and fecal samples, FCoV gene fragments were reverse transcribed, PCR‐amplified using novel primers, and sequenced. Sequences were aligned with ClustalW and compared with published FCoV sequences.

Results

FCoV RNA was detected in all 4 FIP cat postmortem samples and in 9 of the 16 fecal samples from contemporary‐asymptomatic cats. Novel primers successfully amplified fragments from 4 regions of the genome for all FCoV‐positive samples. Phylogenetic analysis showed that the FIP‐associated strains of FCoV from the outbreak were very closely related to the fecally derived strains of FCoV from contemporary‐asymptomatic cats.

Conclusions and Clinical Importance

Sequence analysis provided no evidence that genetically distinct virulent and avirulent strains of FCoV were present during this FIP outbreak.

Survey of the characteristics of cats owned by households in the UK and factors affecting their neutered status

Data were collected on 1260 cats owned by a random sample of UK households in 2007, by means of telephone questionnaires, which were completed by 33 per cent of the households contacted. Cats were owned by 26 per cent of these households, 42 per cent of which owned more than one cat. The owners of 622 female cats reported a total of 110 unplanned litters of kittens. Excluding cats with an unknown neutered status 92 per cent of the cats aged six months or more were neutered, but only 66 per cent of the cats aged six to 12 months were neutered. Multivariable logistic regression, based on data collected for one randomly selected cat aged four months or more in each cat-owning household, was used to identify factors affecting the cats' neutered status. Analysis of 48 sexually entire cats and 501 neutered cats showed that cats aged 10 months or more, with indoor access, that had been vaccinated within the last year or were currently registered with a veterinary practice, were more likely to be neutered than cats aged less than 10 months, without indoor access, that had been vaccinated more than one year ago or were not registered with a veterinary practice.

Is feline foamy virus really apathogenic?

Feline foamy virus (FFV) is a retrovirus commonly found in cats. It is generally thought to be apathogenic, making it a suitable candidate as a gene therapy vector. However, there have been reports of association of FFV with chronic progressive arthritis and a cofactor effect with feline immunodeficiency virus. This study investigated experimental FFV infection and whether this was associated with signs of disease. Eight young specific pathogen free cats were inoculated intramuscularly with FFV. The cats were examined twice weekly and blood and pharyngeal samples were taken. Haematology, biochemistry and FFV quantitative polymerase chain reaction (qPCR) were performed. Tissue samples were also collected throughout the six month period. FFV was initially detected by qPCR in the blood within the first two weeks of infection and viraemia persisted throughout the study. Two peaks of viraemia were observed, at day 20 (80-170FFU/ml blood) and day 155 (332-415FFU/ml blood). FFV was also consistently detected in oropharyngeal samples after day 36. Anti-FFV IgG was detected in all cats by ELISA; antibody levels had an early peak around day 35 and then increased again following the second rise in circulating viral load. All cats remained clinically normal, except for one cat with an unrelated gingivitis. None of the cats developed pyrexia. The biochemical profile and blood cell counts remained within normal limits except for one cat with a persistent eosinophilia. Initial fluctuations in white cell counts settled within three weeks and did not deviate outside of the normal ranges. All tissue samples contained FFV DNA; lymphoreticular tissues, salivary gland and lung had the highest viral loads. Although there were no gross pathological lesions on post mortem examination, histologically a mild glomerulonephritis and a moderate interstitial pneumonia were observed in all cats. We conclude that during the six month period of infection, although cats appeared clinically normal, histopathological changes were observed in the lungs and kidneys. Further investigation of the significance of these changes is warranted before FFV is developed as a vector for gene delivery.

A kinetic study of histopathological changes in the subcutis of cats injected with non-adjuvanted and adjuvanted multi-component vaccines

The aim of this study was to investigate the subcutaneous tissue response to administration of a single dose of multi-component vaccine in the cat. Three groups of 15 cats were injected with one of three vaccine products with saline as a negative control. Cats in group A received non-adjuvanted vaccine; cats in group B received vaccine with a lipid-based adjuvant; whilst those in group C were vaccinated with a product adjuvanted with an alum-Quil A mixture. The vaccine and saline injection sites were sampled on days 7, 21 and 62 post-vaccination. Biopsies of these vaccine sites were examined qualitatively and scored semi-quantitatively for a series of parameters related to aspects of the inflammatory and tissue repair responses. These data were analysed statistically, including by principal component analysis. At all three time points of the experiment, there was significantly less inflammation associated with administration of non-adjuvanted vaccine (p=0.000). Although there was evidence of tissue repair by day 62 in all groups, those cats receiving adjuvanted vaccines had evidence of residual adjuvant material accumulated within macrophages at this late time point. The severity of tissue reactions may vary significantly in response to vaccines which include adjuvants or are non-adjuvanted.

Measurement of cytokine mRNA expression in intestinal biopsies of cats with inflammatory enteropathy using quantitative real-time RT-PCR

Inflammatory bowel disease (IBD) is a common condition in cats characterised by infiltration of inflammatory cells into the intestinal mucosa. In this study, real-time reverse transcriptase polymerase chain reaction (RT-PCR) was used to quantify cytokine messenger RNA (mRNA) expression in intestinal biopsies from cats. Biopsies were collected from seven cats with chronic diarrhoea and histologically confirmed IBD, five cats with chronic diarrhoea due to non-IBD gastrointestinal (GI) disease, and nine clinically normal cats with or without subclinical inflammatory changes in small intestine. Real-time RT-PCR was developed for quantification of mRNA encoding interleukin (IL)-2, IL-4, IL-5, IL-6, IL-10, IL-12 (p35 and p40), IL-18, tumour necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma) and transforming growth factor-beta (TGF-beta). Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) was used as a 'housekeeper' gene. All real-time PCR efficiencies were>90% (range 90.4-102%) with correlation coefficients >0.99 (range 0.998-1). The results of the study were analyzed on the basis of either clinical presentation or histopathological evidence of intestinal inflammation. The former analysis showed that mRNA encoding IL-10 and TGF-beta (immunoregulatory cytokines), and IL-6, IL-18, TNF-alpha and IL-12 p40 (Th1 and pro-inflammatory cytokines) was significantly higher in clinically normal cats and cats with IBD when compared to cats with other GI diseases. IL-5 mRNA was significantly higher in cats with IBD compared to clinically normal cats. IL-2 mRNA was significantly lower in cats with non-IBD GI disease than in clinically normal cats. Analysis on the basis of histopathological change revealed that cats with intestinal inflammation had significantly more transcription of genes encoding IL-6, IL-10, IL-12p40, TNF-alpha and TGF-beta than those with normal intestinal morphology. The results suggest that immune dysregulation plays a role in feline IBD and that IBD in cats has a complicated pathogenesis with both pro-inflammatory and immunoregulatory features.

Immunohistochemical Diagnosis of Alimentary Lymphomas and Severe Intestinal Inflammation in Cats

Intestinal tissue samples were examined from 32 cats in which a histopathological diagnosis of alimentary lymphoma or multicentric lymphoma affecting the gastrointestinal tract had been made. These samples were re-evaluated histopathologically and serial sections were examined immunohistochemically with antisera specific for the lymphoid markers CD3, CD79a and BLA-36 and for class II molecules of the major histocompatability complex. The cats ranged in age from 4-16 years (median 10.5 years). The main presenting clinical signs were vomiting, diarrhoea and weight loss. The majority of alimentary lymphomas were of the B-cell type (n=15), whereas cases of T-cell lymphoma were fewer in number (n=8). Four cats had lymphoma of a mixed T-and B-cell phenotype. In five of the cats, immunohistochemistry suggested an inflammatory process, in contradiction to the original histopathological diagnosis of lymphoma. Immunolabelling would appear to be a useful adjunct to histopathology in classifying cases of feline alimentary lymphoma, and may help in distinguishing lymphoma from severe intestinal inflammation.

Preliminary study using an indirect ELISA for the detection of serum antibodies to Alternaria in domestic cats

Alternaria is a saprophytic fungus that is widespread in the environment; it is an opportunistic pathogen and causes disease in human beings and domestic animals. Fungal spores gain entry to the host through skin lesions and cause slow-growing, soft to firm, subcutaneous swellings, either with or without ulcers. An indirect ELISA was developed for the detection of anti-Alternaria immunoglobulin G (IgG) antibodies in serum to determine the prevalence of Alternaria exposure in domestic cats. Fifty-two of 63 cats had detectable levels of anti-Alternaria IgG antibody. There were no correlations between the concentration of antibody and the sex, breed or living environment of the cats, but cats less than two years of age had significantly lower concentrations than older cats. The cats with disease caused by culture-confirmed Alternaria infections did not have significantly higher concentrations of antibody than the healthy cats or cats with other diseases.

A retrospective study of 286 cases of neurological disorders of the cat

Archive central nervous tissue from 286 cats with neurological disorders was reviewed for histological evidence of feline spongiform encephalopathy (FSE), which may have occurred before it was first recognized in 1990. The following six categories of disease were identified: congenital; degenerative; inflammatory; neoplastic; FSE; lesion-free. The largest category (inflammatory) contained 92 cats, of which 47 were considered to be consistent with infection by feline infectious peritonitis (FIP) virus. Six cats showed evidence of more than one disease process; thus, one cat with FIP also had toxocara infection of the lateral ventricles and five cats with FSE also showed perivascular cuffing suggestive of concurrent viral infection. In only two cases did the diagnosis on review differ significantly from the original interpretation. There was no evidence of FSE before the original case was recognized in April 1990.

Diagnosis of feline haemoplasma infection in Australian cats using a real-time PCR assay

A total of 147 cats from the Sydney area of Australia that had blood samples submitted to veterinary laboratories were tested using a real-time polymerase chain reaction (PCR) assay able to detect and distinguish the two feline haemoplasma species. This sample number included two cats diagnosed with feline haemoplasma infection by routine blood smear examination. Statistical analysis was performed to evaluate associations between haemoplasma infection, age, sex, breed, haematocrit (HCT) values and anaemia status. One hundred and six cats (72.1%) were negative. Thirty-four cats (23.1%) were positive for 'Candidatus M. haemominutum', six cats (4.1%) were positive for M. haemofelis and one cat (0.7%) was positive for both species. Older, male, non-pedigree cats, with lower HCT values were more likely to be infected with 'Candidatus M. haemominutum'. Significant inverse correlation was found between the amount of M. haemofelis DNA present in the blood and the HCT value. This report documents the existence of, and prevalence of, both haemoplasma species in a sample of cats in Australia and is the first to use quantitative real-time PCR in a prevalence study for haemoplasma infection.

Investigation of nasal disease in the cat--a retrospective study of 77 cases

A retrospective study was undertaken to determine the prevalence of different diseases in cats referred for investigation of chronic nasal disease, to identify historical, clinical and diagnostic features which may assist in making a diagnosis, and to provide information pertaining to outcome in these cats. Diagnoses included neoplasia (30 cases), chronic rhinitis (27), foreign body (8), nasopharyngeal stenosis (5), Actinomyces infection (2), nasal polyps (2), stenotic nares (2), and rhinitis subsequent to trauma (1). The most common neoplasia was lymphosarcoma (21 cases), with a median survival of 98 days for cats treated with multiagent chemotherapy. Cats with neoplasia were older on average than the other cats, and were more likely to be dyspnoeic and have a haemorrhagic and/or unilateral nasal discharge than cats with chronic rhinitis. Cats with neoplasia were more likely to have radiographic evidence of nasal turbinate destruction, septal changes, or severe increases in soft tissue density than cats with chronic rhinitis. It was unusual for cats with diseases other than neoplasia to be euthanased as a result of their nasal disease.

Efficacy of azithromycin for the treatment of feline chlamydophilosis

The current recommended treatment for feline chlamydophilosis involves daily oral administration of antimicrobials to all cats within an affected group for a prolonged period of time (4-6 weeks). Not surprisingly, owner compliance can be poor resulting in apparent treatment failure. Recent anecdotal evidence, supported by its efficacy in the treatment of Chlamydia trachomatis infection in humans, has suggested that azithromycin may offer an alternative by allowing less frequent dosing for a shorter duration. A clinical trial was designed to evaluate the efficacy of azithromycin for the treatment of chlamydia (Chlamydophila felis) infection in cats. Whilst azithromycin, given at 10-15 mg/kg daily for 3 days and then twice weekly, provided a similar, rapid resolution of clinical signs and negative isolation scores as doxycycline, C felis was re-isolated in four out of the five cats treated. Furthermore, even daily administration of azithromycin to chronically infected cats was ineffective in clearing infection. The azithromycin protocols used here were therefore found to be unsuccessful in eliminating the carriage of this strain of C felis.

Phylogenetic analysis of hemoplasma species: an international study

Nearly complete 16S rRNA gene sequences for feline and canine hemoplasma isolates from Europe, Australia, Africa, and Asia showed almost 100% identity to those previously reported for United States isolates. Partial sequences of the RNA subunit of the RNase P gene were also determined, and RNase P-based phylogenetic analysis showed that the hemoplasmas are most closely related to the members of the Mycoplasma pneumoniae group.

Feline idiopathic cardiomyopathy: a retrospective study of 106 cats (1994-2001)

The case records of 106 cats with idiopathic cardiomyopathy that presented to the Feline Centre of the University of Bristol between September 1994 and September 2001 were reviewed retrospectively. Hypertrophic cardiomyopathy (HCM) was the most common form seen (57.5%), followed by restrictive cardiomyopathy (RCM) (20.7%), dilated cardiomyopathy (DCM) (10.4%) and unclassified cardiomyopathy (UCM) (10.4%). One cat showed echocardiographic changes compatible with a moderator band cardiomyopathy (MBCM). Most affected cats were domestic short hairs (DSH) (57.5%). The mean (+/-SD, range) age of cats with cardiomyopathy at presentation was 6.8 (4.3, 0.5-16) years, with an equal distribution of males and females. Clinical findings, electrocardiographic changes and radiographic abnormalities were also reviewed. The median survival time for 73 cats for which follow-up data was available was 300 days. A greater survival time was observed for cats with UCM (925 days) when compared with those with HCM (492 days), RCM (132 days) or DCM (11 days).

Use of a PCR assay to assess the prevalence and risk factors for Mycoplasma haemofelis and 'Candidatus Mycoplasma haemominutum' in cats in the United Kingdom

Blood samples from 426 healthy and sick cats in the UK were tested in a PCR assay for 'Candidatus Mycoplasma haemominutum' and Mycoplasma haemofelis (basonym Haemobartonella felis). Seventy-two of the cats (16.9 per cent) were positive for 'Candidatus M. haemominutum' alone, six (1.4 per cent) were positive for M. haemofelis alone and one (0.2 per cent) was positive for both. Logistic regression analysis indicated that older male cats were significantly more likely to be infected with 'Candidatus M. haemominutum', but there was no significant association between it and any of the haematological variables measured. M. haemofelis infection was uncommon in the anaemic cats sampled, and there were too few positive cases for multivariable analysis to be performed for M. haemofelis-positive status.

Characterization of immune cell populations in oral mucosal tissue of healthy adult cats

The aim of this study was to characterize the leucocyte subsets present in the oral mucosa of healthy cats. Immunohistochemical labelling and computer-assisted morphometric analysis was used to identify expression of MHC class II, CD3, CD79a, IgG, IgM, IgA, and leucocyte antigen L1 (L1) by cells in sections from 19 cats, and expression of CD4 and CD8 by cells in sections from 17 cats. Mast cells were detected by toluidine blue staining. In the epithelial compartment, CD3(+) intraepithelial lymphocytes were detected, and CD8(+) cells were more common than CD4(+) cells. MHC class II labelling revealed intraepithelial and subepithelial cells with a characteristic dendritic morphology. In some sections these dendritic cells were closely associated with subepithelial clusters of CD3(+) T cells containing both CD4(+) and CD8(+) cells. In the lamina propria and submucosal compartments, the cells most commonly identified were mast cells. CD3(+) T-lymphocytes were also observed, and CD4(+) and CD8(+) cells were detected in similar numbers. L1(+) and CD79(+) cells were detected least frequently. The few plasma cells present were generally found to be either IgG(+) or IgA(+). Within the stroma surrounding the salivary glands, CD79a(+) and IgA(+) cells predominated. Slight epithelial labelling for L1 was seen in some sections. The normal feline oral mucosa clearly contains a range of immune cell populations.

Salivary and serum immunoglobulin levels in cats with chronic gingivostomatitis

The salivary and serum concentrations of immunoglobulins G, M and A (IgG, IgM and IgA), and the salivary concentrations of albumin were measured by ELISA in 30 cats with chronic gingivostomatitis and 32 healthy cats. The cats with chronic gingivostomatitis had significantly higher salivary concentrations of IgG, IgM and albumin, and higher serum concentrations of IgG, IgM and IgA, but significantly lower salivary concentrations of IgA than the healthy cats. The cats with chronic gingivostomatitis were treated with either methylprednisolone, sodium aurothiomalate, metronidazole and spiramycin, or oral hygiene products. After three months of treatment, the cats receiving methylprednisolone had a significant reduction in serum IgG levels compared to the cats treated with sodium aurothiomalate or metronidazole and spiramycin, but after six months of treatment there were no significant differences between the groups. Before the treatments, the levels of oral inflammation were not correlated significantly with any of the serum or salivary immunoglobulin levels. However, the changes in oral inflammation were correlated significantly with the changes in the salivary IgM concentration after three and six months of treatment, and with the change in the salivary IgA concentration after six months of treatment.

Non-specific labelling of mast cells in feline oral mucosa--a potential problem in immunohistochemical studies

Non-specific labelling of mast cells was found to occur in formalin-fixed sections of feline oral mucosa during immunohistochemical procedures. The phenomenon occurred when normal goat, rabbit or mouse serum was applied as a negative control in place of primary antibodies. In addition, with murine isotype-specific negative control reagents, non-specific labelling of mast cells was intense when IgG2b was applied as the primary reagent, but absent or mild when IgGl or IgG2a isotypes were utilized. The non-specific labelling could be eliminated or diminished by reducing the pH of the washing and dilution buffers from 7.4 to 6.0, or by preincubating sections with heparin. The non-specific binding could also be abolished by preincubating sections with heparinase-I. The results suggest that the non-specific binding was mediated by heparin present within feline oral mucosal mast cells. These findings illustrate the importance of the inclusion of adequate control sections in immunohistochemical studies.

Protection against oronasal challenge with virulent feline leukaemia virus lasts for at least 12 months following a primary course of immunisation with Leukocell 2 vaccine

The duration of immunity provided by a feline leukemia virus (FeLV) vaccine, Leukocell 2, was determined. Kittens were vaccinated when 9 and 12 weeks of age and were challenged 12 months later with FeLV-A/Glasgow-1. An oronasal challenge protocol without corticosteroid enhancement was developed in order to induce a persistent viraemia in a high proportion of adult cats. Fourteen of 18 (80%) of the vaccinated cats challenged in this way remained non-viraemic while 9/15 (60%) of age-matched controls became persistently infected, a preventable fraction of 63%. This difference was statistically significant (P=0.038). For comparison, 10 of 12 (83%) 15-17-week-old kittens challenged in the same way became persistently infected, confirming the relative resistance of adult animals to FeLV. Tests for virus neutralising and anti-feline oncornavirus-associated cell membrane antigen (FOCMA) antibodies suggested that the former were more important than the latter in protection. Thus, Leukocell 2 protected a significant proportion of cats from FeLV challenge 1 year after primary vaccination as kittens.

Expression of chemokine receptors in the feline reproductive tract and large intestine

Feline immunodeficiency virus (FIV) is a lentivirus that causes feline acquired immunodeficiency syndrome. Infection can be transmitted experimentally via the vagina and rectum, making the cat a useful model for human immunodeficiency virus (HIV) infection. Some strains of FIV use the CXCR4 chemokine receptor in vitro to gain entry to feline cell lines, thymocytes and peripheral blood leucocytes (PBLs). In this study, the tissue expression of messenger ribonucleic acid (mRNA) encoding the CCR3, CXCR4 and CCR5 receptors was examined by reverse transcriptase polymerase chain reaction (RT-PCR). mRNA encoding each receptor was expressed by two feline T-cell lines (Mya-1 and FeTJ), a feline kidney fibroblast cell line (FKCU) and PBLs. Mesenteric lymph node, colon, rectum, uterus, cervix and vagina all expressed mRNA for CXCR4 and CCR5 whilst only lymph node expressed CCR3 mRNA. In order to locate this receptor mRNA expression, in-situ hybridization studies were performed with DNA probes specific for the chemokine receptor mRNAs. CCR5 and CXCR4 receptor mRNA was expressed by epithelial cells and some lamina propria cells of the colon and rectum. Epithelial cell expression of chemokine receptor mRNA was reduced in intensity towards the base of the crypts. Expression of CXCR4 receptor was also demonstrated immunohistochemically on some lamina propria and intraepithelial cells. The expression of these receptor molecules may be important in mucosal infection with FIV.

Targeted lymph node immunization can protect cats from a mucosal challenge with feline immunodeficiency virus

With the rapid spread of human immunodeficiency virus (HIV) infection worldwide it is clear that effective strategies for mucosal vaccination against lentiviruses are urgently required. The aim of the present study is to determine whether protective immune responses against a mucosal challenge by feline immunodeficiency virus (FIV) can be elicited by targeting the immunization to the medial iliac lymph nodes--the principal site of migration of cells from the genital and rectal mucosa. Cats were challenged with homologous FIV via the rectal route. Targeted lymph node immunization was found to be an effective route of immunization eliciting both humoral and proliferative responses to peptide-based and fixed cell vaccines. Vaccination with fixed virus infected cells elicited protection against a cell-free mucosal FIV challenge. In addition, some cats vaccinated with fixed uninfected cells also remained uninfected following a cell-associated FIV challenge.

Prevalence of polycystic kidney disease in Persian cats in the United Kingdom

The prevalence of polycystic kidney disease was assessed in 132 Persian cats, 46 of them referred for the investigation and treatment of medical or surgical conditions, and 86 apparently healthy cats referred specifically to be screened for the disease. Cats referred for the investigation of renomegaly or renal failure were excluded, and cats under 10 months old were only included if they had been examined postmortem. One hundred and twenty-six of the cats were examined ultrasonographically with a 7.5 MHz sector scanner, and the other six cats were examined postmortem. Forty-nine of the 86 cats referred specifically for screening (57.0 per cent) and 16 of the 46 cats referred for other clinical reasons (34.8 per cent) were affected by the disease, giving an overall prevalence of 49.2 per cent.

16S rDNA comparison demonstrates near identity between an United Kingdom Haemobartonella felis strain and the American California strain

A handful of North American (USA) strains of the uncultured erythrocytotrophic pathogen of cats, Haemobartonella felis, have been differentiated by comparison of the 16S rRNA gene sequences. Using this approach, an UK strain was characterised, providing an identity for a non-USA H. felis for the first time. This strain shared close phylogenetic homology with the USA Californian strain.

Controlled study of the efficacy of clavulanic acid-potentiated amoxycillin in the treatment of Chlamydia psittaci in cats

Twenty-four specific pathogen-free cats were inoculated with 3 x 10(3) infectious units of a field isolate of Chlamydia psittaci on to the corneal surface. Seven days later they were assigned randomly to three groups of eight and treated orally for 19 days with either clavulanic acid-potentiated amoxycillin, doxycycline or a placebo. Both treated groups responded rapidly, with a marked reduction in isolation rates and clinical scores which were significantly lower than in the placebo group within two and four days, respectively. After two days the group treated with potentiated amoxycillin had a significantly lower isolation score than the group treated with doxycycline. Forty days after they were infected the clinical signs recurred in five of the eight cats treated with potentiated amoxycillin, but a four-week course of potentiated amoxycillin resulted in a complete clinical recovery with no evidence of a recurrence for six months.

A gross and microscopical morphometric evaluation of feline large intestinal anatomy

The objective of this study was to examine measurable parameters that could be used to describe the gross and microscopical anatomy of the feline colon, which has not been previously characterized. Post-mortem data were collected from 35 specific pathogen-free cats. Gross morphometric data (total colonic length, wet weight, number of lymphoid aggregates) were collected together with microscopical measurement of crypt depth and numbers, intra-epithelial lymphocyte numbers and the number of proliferating cell nuclear antigen (PCNA)-positive cells and their relative position within the crypt. Colonic length as a percentage of intestinal length was remarkably constant (20.9+/-2.0%). Crypt depth, however, showed considerable inter-cat variation (149-688 microm); the crypts became deeper with distance from the anus. Cellular proliferation was predominantly in the lower part of the crypt, and the numbers of PCNA-positive cells increased with distance from the anus. The number of lymphoid aggregates varied with distance from the anorectum and appeared to reflect the bacterial load. Intra-epithelial lymphocytes were relatively sparse (3.9+/-2.7/100 epithelial cells); they showed considerable inter-cat variation but did not vary with distance from the anus. These data suggest that to improve the interpretation of morphometric parameters by reducing inter-cat variation, samples should be taken at a consistent distance from the anus, broad reference ranges having now been established.

The distribution of leucocyte subsets in the small intestine of healthy cats

The aim of this study was to investigate the distribution of leucocyte subsets in the small intestine of healthy adult cats (n=16). Immunohistochemical methods were used to identify leucocyte subsets within the mucosa of the duodenum, jejunum and ileum. Computer-aided morphometry was used to enumerate cells within the epithelial compartment, villous lamina propria and lamina propria adjacent to upper and lower crypt. Throughout the small intestine, IgA+ and IgM+ plasma cells were more prominent in the lamina propria adjacent to the lower crypt than in the villus, whereas IgG+ plasma cells were present in equal numbers in the crypt and villous regions. Overall, IgA+ plasma cells predominated and IgM+ plasma cells were higher in number than IgG+ plasma cells at each of the three anatomical locations. By contrast, T cells (CD3+) and T-cell subsets (CD4+ and CD8+) were present in greater numbers in the villous lamina propria than in the lamina adjacent to the crypts. Intraepithelial lymphocytes (IELs) were also characterized phenotypically, the majority being CD8+ T lymphocytes. Lamina propria macrophages and dendritic cells were characterized by expression of L1 and major histocompatibility complex (MHC) class II, and MHC class II expression by enterocytes overlying Peyer's patches, although rare, was also shown. The qualitative and quantitative data from this study provide a basis for comparison with cats with inflammatory enteropathies.

Molecular cloning and phylogenetic analysis of a cDNA encoding the cat (Felis domesticus) Ig epsilon constant region

A feline splenic cDNA library was screened with a (32)P-labelled cDNA probe encoding the canine IgE epsilon heavy chain subunit. A cDNA sequence of 1614 nucleotides encoding the complete feline IgE heavy chain, as well as a portion of a variable region, was identified. A search of the GenBank database revealed an identity of 82% at the nucleotide level and 76% at the amino acid level between the feline epsilon heavy chain sequence and the canine homologue. In a separate study, feline genomic DNA, isolated from whole feline embryo cells, was subjected to PCR amplification using primers based on known partial genomic DNA sequences for the feline C epsilon gene. Following removal of an intron from the 683 bp PCR product, the coding sequence yielded an ORF of 506 bp. The DNA sequence of this PCR clone differed by a single nucleotide from the cDNA clone. This difference is silent, and therefore the proteins encoded by the two sequences are identical over the regions cloned and sequenced. Phylogenetic analysis of the constant regions of nine immunoglobulin epsilon genes revealed that the feline cDNA is most similar to the canine homologue.

Mucosal immunization with experimental feline immunodeficiency virus (FIV) vaccines induces both antibody and T cell responses but does not protect against rectal FIV challenge

Feline immunodeficiency virus (FIV) is a natural lentiviral pathogen of cats which can be experimentally transmitted via rectal and vaginal routes--the major routes of human immunodeficiency virus type 1 transmission in man. An important objective for lentiviral research is the development of vaccine strategies which generate good mucosal immune responses capable of giving protection from a mucosal virus challenge. The experimental vaccines employed in this study were based on (a) a peptide from the third variable region of the FIV envelope glycoprotein and (b) fixed whole FIV, Glasgow-8 strain. Adjuvants used were Quil A and cholera toxin for mucosal administration and incomplete Freund's adjuvant and immune stimulating complexes for subcutaneous injection. Mucosal immunization was given by rectal and intranasal routes. Both antibody and proliferative responses were elicited by mucosal immunization and cholera toxin was found to be a good mucosal adjuvant. The addition of a lipo thioester to the FIV peptide improved IgG and IgA responses upon parenteral administration. However, no protection from a rectal FIV challenge was achieved.

Determination of solid- and liquid-phase gastric emptying half times in cats by use of nuclear scintigraphy

OBJECTIVE

To use nuclear scintigraphy to establish a range of gastric emptying half times (t1/2) following a liquid or solid meal in nonsedated cats.

ANIMALS

12 clinically normal 3-year-old domestic shorthair cats.

PROCEDURE

A test meal of 75 g of scrambled eggs labeled with technetium Tc 99m tin colloid was fed to 10 of the cats, and solid-phase gastric emptying t1/2 were determined by use of nuclear scintigraphy. In a separate experiment, 8 of these cats plus an additional 2 cats were fed 18 ml (n = 5) or 36 ml (n = 5) of a nutrient liquid meal labeled with technetium Tc 99m pentetate. Liquid-phase gastric emptying t1/2 then were determined by use of scintigraphy.

RESULTS

Solid-phase gastric emptying t1/2 were between 210 and 769 minutes (median, 330 minutes). Median liquid-phase gastric emptying t1/2 after ingestion of 18 or 36 ml of the test meal were 67 minutes (range, 60 to 96 minutes) and 117 minutes (range, 101 to 170 minutes), respectively. The median t1/2 determined for cats receiving 18 ml of the radiolabeled liquid was significantly less than that determined for cats receiving 36 ml of the test meal.

CONCLUSIONS AND CLINICAL RELEVANCE

The protocol was tolerated by nonsedated cats. Solid-phase gastric emptying t1/2 were prolonged, compared with liquid-phase t1/2, and a major factor governing the emptying rate of liquids was the volume consumed. Nuclear scintigraphy may prove useful in assessing gastric motility disorders in cats.

Mucosal infection and vaccination against feline immunodeficiency virus

Feline immunodeficiency virus (FIV) infection is a naturally occurring lentiviral infection of cats which progresses to immunodeficiency in a manner strikingly similar to that observed in HIV infection in man. The rectal and cervico-vaginal mucosae are common routes of transmission of HIV and it has been shown that the gastrointestinal tract is an important site of HIV infection and primary pathology. Although biting is the principle mode of transmission for FIV, we have shown that it is possible to reliably infect cats via both the rectal and vaginal routes. Using a biotin-streptavidin linked immunoperoxidase technique we have detected FIV core and envelope proteins in the colonic follicle associated epithelial cells, cells within the lymphoid follice and occasional cells in the lamina propria. Further, in the intestine we have detected FIV RNA and proviral DNA in epithelial cells, colonic lymphoid aggregates and isolated lamina propria cells. We have studied a group of asymptotic cats which have been rectally infected with FIV for 1 year or longer and shown an increase in the number of lamina propria CD8+ cells and greater levels of IL-2, IL-6, IL-10 and gamma-IFN mRNA. Since these cats remained clinically healthy these results might suggest that both local antibody and class I restricted cytotoxic lymphocytes (CTLs) may play a role in control of viral replication. We have investigated a range of vaccination regimes for their ability to generate responses which would protect from rectal challenge with virulent virus. Cats have been immunized with whole virus (FIV-pet, FIV-GLA-8), V3, V3MAP or C2 with cholera toxin (CT), or Quil A based adjuvants via rectal, intra-nasal, parenteral or targeted lymph node routes, and challenged rectally with ten mucosal cat infectious doses (MCID) of FIV-GLA-8. We have shown that the adjuvant effects of cholera toxin and Quil A are not influenced by the route of delivery (intraperitoneal (i.p.) versus rectal) with CT more effective in stimulating humoral and Quil A more effective in stimulating cellular responses to FIV antigens. However we have shown that, quantitatively, CT is more effective when used as an adjuvant via the intra-nasal than the rectal route. Recently, we have begun to investigate if the promising results obtained with targeted lymph node (TLN) vaccination in monkeys could be reproduced in the cat. We have shown that TLN was more effective than rectal immunisation in stimulating both humoral and proliferative responses. In a preliminary study we have also been able to detect FIV specific CTLs and have observed protection from rectal challenge in four out of four cats.

Inter- and intraindividual variation in Doppler ultrasonic indirect blood pressure measurements in healthy cats

This study was undertaken to evaluate reference ranges for systolic blood pressure (SBP) in cats under conditions mimicking a clinical setting. SBP was measured in 50 healthy adult cats of various ages (range, 1.5-16 years) and body weights (range, 2.2-6.1 kg) by Doppler ultrasonic sphygmomanometry. A cuff width of 2.5 cm was used, placed on the left antebrachium, and this represented a mean cuff width of 35% limb circumference (range, 31-42%). The mean (+/-SD) SBP in the 50 cats was 162 +/- 19 mm Hg (range 124-210), with only 1 cat having a SBP > or = 200 mm Hg. No significant difference (P > .05) in SBP was found between male and female cats, and no significant correlation was found between SBP and age (r(s) = 0.075) or body weight (r(s) = 0.007). Further studies in some of these cats indicated that allowing a period of 10 minutes for acclimatization to the environment where SBP was recorded resulted in a significant decrease in SBP from 176 +/- 17 to 157 +/- 21 mm Hg (n = 7) and that use of a 3.3-cm-width cuff resulted in a significant decrease in measured SBP from 168 +/- 13 to 164 +/- 13 mm Hg (n = 10). Reproducibility of SBP measurements was evaluated in 7 cats by assessing SBP 7 times at intervals of > or = 24 hours over a 10-day period. These 7 cats had a low intraindividual coefficient of variation of SBP measurements (CV < or = 7.9%) although 2 of the 7 cats had SBP values > 200 mm Hg on at least 1 occasion.

Cytokine mRNA expression in lesions in cats with chronic gingivostomatitis

Semiquantitative reverse transcription-PCR assays were developed to measure feline interleukin-2 (IL-2), IL-4, IL-5, IL-6, IL-10, and IL-12 (p35 & p40); gamma interferon (IFN-gamma); and glyceraldehyde-3-phosphate dehydrogenase mRNA concentrations in biopsies of feline oral mucosa. Biopsies were collected from 30 cats with chronic gingivostomatitis (diseased) prior to each cat receiving one of four treatments. In 23 cases replicate biopsies were collected 3 months after treatment commenced. Biopsies were also analyzed from 11 cats without clinical disease (nondiseased). Expression of IL-2, IL-10, IL-12 (p35 and p40), and IFN-gamma was detected in most nondiseased biopsies, while IL-6 was detected in a minority, and IL-4 and IL-5 were both undetectable. Compared to nondiseased cats, the diseased population showed a significant increase in the relative mRNA expression of IL-2, IL-4, IL-6, IL-10, IL-12 (p35 and p40), and IFN-gamma. In contrast, IL-5 mRNA expression was unchanged and was only detected in one case. No significant relationship was demonstrable between the change in relative expression of specific cytokine mRNA and the change in clinical severity of the local mucosal lesions over the treatment period. The results demonstrate that the normal feline oral mucosa is biased towards a predominantly (Th) type 1 profile of cytokine expression and that during the development of lesions seen in feline chronic gingivostomatitis there is a shift in the cytokine profile from a type 1 to a mixed type 1 and type 2 response.

The clinical efficacy of topical and systemic therapy for the treatment of feline ocular chlamydiosis

Twenty-four specific-pathogen-free-derived cats aged four to 11 months were challenged by ocular application of a field isolate of Chlamydia psittaci to evaluate the effect of topical and systemic therapy on the course of disease. The cats were monitored for 35 days post-challenge, with severity of clinical signs being measured using a scoring system, and ocular shedding of the organism monitored by culture of conjunctival swabs. All cats developed active C psittaci infection, and after 7 days the cats were randomly assigned to one of four treatment groups: Group P (placebo) was given twice-daily ophthalmic tear-replacement ointment; group F was given twice-daily topical 1% fusidic acid ophthalmic viscous drops; group C was given twice-daily topical 1% chlortetracycline ophthalmic ointment; and group D was given doxycycline at 10 mg/kg daily per os in addition to twice-daily topical 1% fusidic acid ophthalmic ointment. Within 24 h of commencement of therapy, group D had significantly lower median clinical scores than group P, and with the exception of day 16, this trend was maintained throughout the observation period. Median clinical scores of cats in group F were not appreciably different to those in group P, whereas the median scores of cats in group C generally fell between those of groups P and D. The median duration of C psittaci shedding was 10 and 15 days for groups D and C respectively, but four of the six cats in groups F and P were still shedding organisms at the end of the study (day 35). In this study, systemic therapy with doxycycline proved superior to topical therapy in the treatment of feline chlamydiosis.

Determination of salivary and serum immunoglobulin concentrations in the cat

The concentrations of immunoglobulin(Ig)G, IgM, and IgA were determined in unstimulated saliva (n=14), stimulated saliva (n=6), and serum (n=14) from healthy adult cats. Analysis by single radial immunodiffusion (SRID) was compared with class-specific enzyme linked immunoassays (ELISA), and good correlation was demonstrated between the two techniques. Mean (s.d.) serum concentrations of 19.08 (5.38) mg/ml IgG, 2.04 (0.83) mg/ml IgM and 2.6 (2.16) mg/ml IgA were obtained by SRID. The immunoglobulin concentrations of the saliva samples frequently fell below the quantification limits for SRID, however, all samples could be quantified by ELISA making this the method of choice for the determination of salivary immunoglobulin concentrations. IgA was the predominant class of immunoglobulin secreted by the major feline salivary glands, and the concentration of each immunoglobulin class was greater in unstimulated versus stimulated saliva. Analysis of sequential unstimulated saliva samples collected each morning and evening over a 4-day period from four cats revealed the salivary immunoglobulin concentrations to be relatively constant.

Antibody and cytokine responses in kittens during the development of feline infectious peritonitis (FIP)

Two recombinant FIPV spike proteins were assessed for their immunogenic properties in 8-week-old kittens, which were then challenged intranasally with FIPV 79-1146. Humoral responses were assessed by ELISA and serum neutralisation test. Changes in PBMC cytokine mRNA levels were detected by a reverse transcription, semiquantitative polymerase chain reaction assay (RT-sqPCR), assessing IL-2, IL-4, IL-6, IL-10, IL-12 and IFNgamma. All of the kittens developed clinical signs typical of FIP, which were confirmed on gross post mortem examination. The recombinant proteins induced little or no specific antibody response prior to challenge, and failed to alter the course of disease compared to controls. One week after virus challenge, the stimulated PBMCs showed small increases in the expression of IL-6 and IFNgamma mRNA, which correlated with a transient pyrexia. After this time expression of IL-6 mRNA remained unaltered but, as FIP developed, mRNA levels of IL-2, IL-4, IL-10, IL-12 and IFNgamma became markedly depressed.

Use of the breath hydrogen test to assess the effect of age on orocecal transit time and carbohydrate assimilation in cats

OBJECTIVE

To evaluate the effect of age on orocecal transit time (OCTT) in cats, using the breath hydrogen test, and to assess potential differences in nutrient absorption.

ANIMALS

27 healthy cats.

PROCEDURE

Cats were allocated to the following 3 groups on the basis of age: group A (9 kittens, 5 to 7 months old), group B (9 young adults, 3 to 5 years old), and group C (9 older cats, 12 to 15 years old). Cats were fed a standard canned diet for 2 weeks prior to measurement of OCTT. Exhaled hydrogen concentration (parts per minute [ppm x min]) was monitored for 8 hours after feeding 60 g of the canned diet.

RESULTS

Mean OCTT in group-A cats was 203 minutes (range, 90 to 345 minutes), which was significantly different from that in group-B (317 minutes; range, 180 to 435 minutes) and group-C (309 minutes; range, 225 to 375 minutes) cats. Median area under the breath hydrogen excretion time curve (ppm x min) for the 8-hour monitoring period, first 45 minutes, and 105 minutes after OCTT for the 3 groups was not significantly different among groups.

CONCLUSIONS

Kittens had significantly faster OCTT than did adult cats.

Detection of feline coronaviruses by culture and reverse transcriptase-polymerase chain reaction of blood samples from healthy cats and cats with clinical feline infectious peritonitis

A reverse transcriptase-polymerase chain reaction (RT-PCR) assay for the detection of the feline coronavirus (FCoV) genome and a co-cultivation method for the isolation of field strains of FCoV are described. Using the RT-PCR assay to assess blood samples from cats with feline infectious peritonitis (FIP) (n = 47) and healthy cats from households with endemic FCoV (n = 69) it was shown that approximately 80% of the cats were viraemic, irrespective of their health status. It was also shown that, over a 12-month period, a similar percentage of healthy cats remained viraemic, and that the presence of viraemia did not appear to predispose the cats to the development of FIP. The co-cultivation system proved to be a suitable method for the culture of field strains of FCoV from blood samples, so long as the cultures were maintained for at least 4 weeks. Using this system, followed by the RT-PCR, viraemia was detected as frequently as by RT-PCR on RNA extracted directly from peripheral blood mononuclear cells.