Cryptococcosis in Cats: My Ragdoll Cat Jax’s Journey

Fungus infections are common with cats, just as they are with humans. One of the most widespread fungal diseases in cats is Cryptococcosis. If left untreated, it can cause health issues for your feline friend. Learn more about this fungal infection and how to recognize and treat Cryptococcosis in cats.

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This post was inspired by a story a reader shared with us.

Submitted and written by Jax’s owner, Kira. Thank you, Kira, for sharing your Jax’s journey on the site!

Cryptococcosis is worldwide the most common systemic fungal disease in cats. It is caused by the C. neoformans-C.gattii  fungus species complex, which exists in the environment and in tissues in a yeast form, which includes eight genotypes and some subtypes (strains) with different geographical distribution, pathogenicity, and antimicrobial susceptibility.

Cryptococcosis in Cats: My Ragdoll Cat Jax's Journey with a savannah cat

Cryptococcosis is a non-contagious, rare, or sporadic disease; cats acquire the infection from a contaminated environment as outside ground, ferrets, and birds guano.

I wanted to write a story to possibly warn all cat parents about the disease that is likely unknown to most: Cryptococcosis.

I will begin my story by telling that like most cat owners I was thinking that it can’t be any harm letting your cats to go outside if you supervise and keep them on the leash.

Ragdoll Jax story Colorpointed Ragdoll cat sitting in the yard on green grass

And for those of you that think like I did and still let their cats go outside I want to share my Ragdoll Jax story with you. Apparently, birds droppings could bring lots of harm that I never knew about and only found out recently when my cat got infected with one of 60 diseases that birds dropping could carry.

I’ll start from the beginning when I decided a few years ago that I’ll train my 2 cats: A Bengal and a Ragdoll to wear harnesses and then let then to be outside on our back yard on the leash and with my supervision.

I thought it wouldn’t bring any harm, and cats seemed to enjoy spending a 30-40 minutes occasional outdoor time. But I turned out to be WRONG thinking that no harm could be done by doing so.

Cryptococcosis in Cats Ragdoll and Savannah cat sitting on green grass with harnesses and leashes on them

At the end of October 2019 I started to notice some changes in my Ragdoll Jax’ breathing. It was minor at first: like he started to snore when sleeping, but I had other cats before that snored, so I didn’t think much of it even though that Jax didn’t have snoring problem before, I thought that it was something that he just developed.

However, just a few days I can actually started to hear him breathing like every breath would come out laboured.

I was a bit puzzled, but he seemed to look and act normal otherwise at that point, so I decided to watch him for a few days and see how his breathing would be thinking to possibly take him to the vet if he didn’t improve.

But it started to look like that every day his breathing was getting louder and louder, and also it seemed that he started having problem swallowing his food. So on Halloween October 31, I’ve decided that it was urgent to take him to the vet.

I was actually in search for a new reliable vet as my old one was not good, and I didn’t want to go there anymore. Luckily I found Valley Brook vet that had pretty good reviews, and they gave me appointment the same day on which Dr. Riskin found 2 huge lumps on Jax’ throat.

Cryptococcosis caused bumps on Jax's throat
Jax’s Throat Bumps

He wasn’t sure at the time what it was, thinking that it possibly could be thyroid problems, so he did ultrasound and extensive tests. Unfortunately nothing we could do to help the cat until the test results would come in.

The blood test came in the next day on Friday and everything was normal, which was good and bad news because we still didn’t know what Jax has. The biopsy of affected tissues from the lumps was taken, but the results for biopsy usually would take a couple of days to come in.

So since it was a weekend coming in, we had to wait till Monday evening till Dr. Riskin finally called me with the results.

It was Cryptococcosis.

A fungal disease that the cat could’ve only picked up outside by sniffing fungal spores from the ground.

Ragdoll cat sitting in the yard next to a short stone wall looking around

This disease is super rare for our area on the East coast.

In fact the vet hadn’t seen any cases of it here since the 1990s, when he had his own cat contract it somehow, so even vet Doctor was super surprised to see the biopsy result, but yet my cat managed to pick it up from just few visits in our back yard.

It’s very difficult to get rid of this fungus and to cure it will take many months and possibly a year. Of course it comes pretty large expenses in vet bills and medication costs.

Cryptococcosis in Cats Jax walking in the snow leaving prints in the yard

Also it was very hard to see Jax getting worse by the hour at that point and not able to help until the diagnosis came in 5 days later.

savannah cat and ragdoll cat playing in the yard next to trees and stepping in snow

I’m also lucky that I found the vet that had personal experience with this disease because it’s so rare here on the East cost that most vets never dealt with this.

Apparently, Ragdolls are predisposed to it more than other breeds.

Maybe that would explain why both of my cats were taking supervised visits in the same back yard but only Jax managed to catch it.

Also lucky that this disease affected only Jax respiratory, and not the whole nervous system as in those cases the outcome could be very bad. It was really no changes in his appearance as this disease also could blow up cats faces and make him deformed.

Aside the very labored breathing, swallowing and lumps on his throat (as I tried to take on the photo best possible) he looked normal.

Dr. Asked me to bring Jax the next day to take another blood test, this time special to see actual count of Cryptococcus in his blood, the result was (copied):

“Serology 11/5/19
(Order Received) 11/6/19 2:51 PM
(Last Updated)
TEST RESULT Cryptococcus
Antigen by Latex Agglutination POSITIVE @ GREATER THAN OR EQUAL TO 1:32768
Specimen Type: SERUM”

The actual count most likely was a lot more than the count shown, just 1:32768 is highest that they measure it. Dr. Riskin recommended to bring Jax in for check up and do blood test every 2 months, but as he told me from the beginning that it would be very long road to full recovery.

I actually brought him in for first check up closer to 3 months from the diagnosis, and in spite of almost all the clinical signs of the disease were gone.

His breathing was normal and lumps on his throat were gone, the blood test didn’t even show any difference from the first test and 3 months later it’s still showed the same:

GREATER THAN OR EQUAL TO 1:32768,

as it likely was so much higher above measurable level in the beginning, and until it drops below that level we’ll not see any difference.

So now I’ve decided that I’ll test him every 3 months instead of recommended every 2. In spite of no more clinical signs the treatment can’t be stopped until Cryptococcus blood count would drop to zero. It took about 3 weeks after I started treatment before his breathing got to almost normal.

The only way to treat Cryptococcosis is prolonged twice daily (every 12 hours) anti fungal pill that I have to give Jax.

And since Jax is very picky eater then mixing his meds with food or treat is not an option to ensure that he’ll take full recommended dose.

So the only way to give him pill is to actually force it down his throat, so i was doing it twice a day for almost 5 months already. He was always under weight ever since he was young, but when he got sick he lost even more weight and only weighted 9.7 pounds instead of his normal weight should be around 11.5-12.

So I got the high calorie liquid and was giving it to him with the syringe after each pill given trying to kill 2 birds in one stone: insure that he gets his dose of meds and make him to gain some weight.

So on his second check up visit he gained some weight and was 10.5 pounds. Lucky that he’s very submissive cat and it’s pretty easy to force the pill down making sure that he swallows it.

It would be a different story if you have to do it to cat that fights.

Also, lucky that now the first drug choice for Cryptococcosis is Fluconazole, and it’s a lot milder anti fungal drug with much less side effects. Doctor Riskin told me that when his own cat contracted this disease back in the 1990s, the then drug choice was Itraconazole.

Itraconazole is a much harsher anti-fungal drug that could cause a lot of bad side effects and his cat developed liver failure from the drug, and then he had to switch to Fluconazole that was just new drug on the market and it was super expensive back then with no generic options, but at least he could finish the course of treatment without risking to loose the cat to side effect of the drug.

I will post some updates after next blood test results in a month or more.

In this current situation with all pandemic hype, since it’s not an emergency to check him out and take blood test, I’ll have to wait till hopefully it’s all over before taking cat to the vet since they operate now only on limited emergency bases.

Next time I’m planning to bring him in at the end of April (at around 6 months since the diagnosis) if all normal business operations will be open by then, but if not I may have to wait longer until May sometime. Hoping that maybe then we’ll see any drop in his blood count.

Hopefully my story would help any other cat parents to make a choice if they want to let their cats outside or keep them indoors.

For me it’s hard and expensive lesson learned, and I’m no longer let any of my cats outside even for a short time.

They have great life indoor, as my husband made our house to complete cat house with multiple cat shelves everywhere and even the “Catio”: cat balcony where cats could go outdoor thru special door in the window and enjoy fresh air and bird watching in safe enclosure.

two cats a Ragdoll and a Savannah cat enjoy fresh air and bird watching in safe enclosure

Kira’s Helpful Suggestions:

Jenny here – editor of Floppycats – Kira and I emailed after this article, and she suggested the following:

  • Stella & Chewy’s Freeze Dried Cat Food – “Both of my cats are not big eaters, so i never have to worry of them getting fat, but with Jax is harder because he doesn’t eat enough and i have to come up with food that they like. So far they both like the best Stella & Chewy’s Freeze Dried Cat Food.  They like it the most but Jax still sometimes starts to eat very slow and i found that works for him if I give him occasionally 1/4 pill of mirtazapine as appetite promotion.”
  • Mirtazapine Tablet – “Mirtazapine really helps and boosts his appetite for a few days, I’ve used it on my other 2 cats: the cat that was old with cancer and annorexia, it helped a bit with him and then when Chester fell into depression and anorexia from Jax’ arrival and this pill helped as well.  My vet approves the prescription and here’s the best price on those pills.”
  • Vetoquinol Pill Wrap – Was recommended to help pill Jax, but he only wanted it a few times.
  • Miracle Vet High Calorie Weight Gainer for Cats – “this product is very good for underweight cats. I’ve been given it to Jax since end of december and it helping slowly to game weight”
  • Dr. Bill’s Feline Health Defense – “Given to both of my cats lots of immune stimulating products like Curcumin, L-Lysine”

How to Pill a Cat

“I also made a video of how I give Jax a pill every time. Just push it down his throat and small syringe of this high calorie stuff follows to insure that pill swallowed plus give some calorie that he need to intake, for cats that don’t need extra calorie water can be used instead.

When i found another person to give him his douses when we went away, since offering it to him with pill wrap didn’t work out, I actually put the contains of each capsule into individual syringe and my neighbor just mixed the dry powder with water and give him a syringe. It was easier then asking a stranger stuffing it down his throat.

For me is easier and faster to do it like I do in the video. It takes a lot longer to empty capsule into syringe plus it’s not full insurance that all the 50 mg contains are dissolved and swallowed and not some left in the syringe. It’s ok for occasional dose, much better then skipping the dose, but as every time routine it’s the best like on the video.

And of course each procedure always follows with some treats so it makes it something that cat remembers as a reward and seems like makes him happy, as he runs in by me every time that hears me taking a capsule out the package. Likely because he knows what he will get rewarded. “

Cryptococcosis Prevention

Free-roaming cats in rural areas are potentially more exposed to Cryptococcus, even though urban cats can be contaminated through pigeon guano.

According to ecology, the presence of avian guanos, particularly pigeon droppings and some decaying vegetation substrates such as Eucalyptus leaves may be considered a risk factor (Fortes et al., 2001).

A knowledge of local fungal habitats that carry the largest risks of exposure and about seasonal variations in the production of infectious propagules would be useful to develop preventive measures for both the human and animal infection.

Cytology 

The study of fungus is known as cytology. The samples for biopsy are collected from lesions to perform:

  • Cytology
  • Culture
  • Histopathology
  • PCR

The organism is cultured from:

  • Exudates
  • CSF
  • Serum,
  • Urine,
  • Joint fluid, and
  • Tissue Samples on Sabouraud Agar for Mycological Assessment

Latex Agglutination test is a commercially available kit, used to diagnose feline Cryptococcosis.  

The samples from the nasal discharge or swab from the nasal cavity and ocular discharge are collected and sent to the laboratory for accurate results. These two secretions have been proven to provide reliable results regarding the disease.

Skin scraping is also helpful in getting reliable results. The granuloma mass helps identify Cryptococcosis in the cat’s body in the least time possible.

Cryptococcus neoformans identification

Vets also use the gram stains method to help identify cryptococcus neoformans in cats. The use of gram stains is easy and trustworthy. The capsule and capsular antigen will turn right red, turning the color crystal violet.

If vets see the variation of colors and budding, the presence of Cryptococcosis is confirmed. 

On the contrary, the wright stain method is more common but gives less reliable results. The organism understudy gets shrink, and the capsule also gets distorted in most cases.

The smear staining requires further testing of more samples from the cat’s body. If a lesion tissue is present on the body, the biopsy will be the most trustworthy option for confirming Cryptococcosis in your cat. 

The tissue from the affected area will reveal the structure under-diagnosis, and you will confirm the issue. The use of blood and urine is also helpful in identifying the immune system strength and the presence of infection in other parts of the body.

With the help of FIV tests and FeLv tests, vets are getting a clear picture of the problem at hand in the least time possible.

Symptoms of Cryptococcosis in Cats

Cryptococcosis infection will affect the upper respiratory system in the very first attack in cats and ferrets. When your cat suffers from the infection, the symptoms start as sneezing and breathing difficulties.

The infection will not be limited to the respiratory system. Instead, it will begin to affect the internal organs of the cat.

The cat may start showing the following symptoms:

  • Sneezing
  • Nasal discharge from the affected nostrils
  • Growths on the upper respiratory tract passage
  • Depression
  • Skin lesions
  • Weight loss
  • Circling without any reason
  • Movements with tilting head 
  • Epilepsy
  • Optic neuritis
  • Lymphosarcoma (lymphatic system cancer)
  • Meningoencephalitis 
  • Metabolic disorders like hepatic insufficiency and hepatic encephalopathy
  • Partial paralysis
  • Blindness
  • Nystagmus 

Symptoms in sheep, goats, and cattle may include:

  • Sneezing
  • Nasal discharge
  • Ocular discharge
  • Eye irritation
  • Oral lesions
  • Behavioral changes
  • Seizures.

Partial paralysis and blindness in the eyes are also the symptoms of Cryptococcal infection. 

Treatment of Cryptococcosis in Cats

Cryptococcosis is an infection that needs quick diagnosis and long-term treatment for a full recovery.

The treatment starts with the infection diagnosis, which usually results from suppressed immunity in cats. All of the domestic felines who live or even just go outdoors for a walk are at risk of Cryptococcosis infection. 

Feline leukemia virus or Feline immunodeficiency virus also affects the cats with suppressed immunity. If your cat is in depression or has recovered from a recent disease restricting them indoors will surely help you save them from various infections. 

Treatment outcome is influenced by FIV and FeLV status, if a feline seropositive for these, then there is a likelihood of treatment failure. It is not influenced by gender, the magnitude of pretreatment antigen titer, and the location of the infection in cats. 

1. Antifungal Medication

The biopsy, blood test, or secretion test will confirm the disease when the feline body is infected from the Cryptococcosis infection.

After the confirmation, you need to take your cat every week to your vet for antifungal medicines of choice i.e. Ketoconazole, Flucytosine, and Fluconazole (2.5 to 10 mg/kg/day). For evaluation of treatment, Fluconazole is administered orally. 

The medication used against Cryptococcosis infection has serious side effects in some cats. It causes immune system depression and leads to the feline immunodeficiency virus.

The vet will give the proper drug dose to your cat according to body weight to prevent immunosuppression. You cannot skip the visit and leave the medication even if your cat shows good health status. 

2. Antibiotics

The use of antibiotics will help care for any antigens in the circulatory and respiratory systems. Antibiotic medicine Amphotericin B proves helpful in Cryptococcosis infections in cats and prevents the spread of the fungal infection.

It has a rapid onset of action and leads to clinical improvement more rapidly. Amphotericin B can be given by the Subcut route at the dose rate of 0.5 to 0.8 mg/kg diluted in 0.46% saline solution. 

3. Flucytosine and Amphotericin B combination

The antifungal drugs Flucytosine (10mg/kg/day) and Amphotericin B in combination have the best effects for treating Cryptococcosis in cats. 

4. Immunity boosters/ CNS stimulants

Immunity boosters, central nervous system stimulants, probiotics, and supplements are at the discretion of the vets. However, the experts advocate using immunity boosters to aid the healing process.

5. Common Systemic Fungal Infections in Cats

The common fungal infections found in the cat are:

  • Aspergillosis.
  • Candidiasis.
  • Cryptococcosis.
  • Coccidioidomycosis.
  • Histoplasmosis.

Do you need long-term follow-up in Cryptococcosis treatment?

Once the disease has come under control, you cannot think of stopping the medication and vet visits because of the spread and severity. The Cryptococcosis treatment will require you to have patience and go on with the treatment and procedure.

Once you have reached the point where the spread is diminishing, you need to be more careful in this situation. Cryptococcosis in cats requires the owners to take them to vets for regular visits weekly. 

You cannot think of skipping the visit day because of the severity of the infection. Once the vet promises a good prognosis, it is time to start the monthly follow-up and routine checkup to prevent this severe fungal infection.

The therapy and the medication for the Cryptococcosis treatment will span over 6 to 9 months at least.

Regular blood tests will also help understand any change in their body from the side effect of the medicine. Any delay in the tests could hide a chronic illness in the cat’s body that will be painful or, in rare cases, fatal for your beloved feline. 

The veterinary medicine specialist can help you obtain synergy from the combination of different medicines prescribed for your cat’s specific needs. You have discretionary power over the use of medication or therapy to treat this disease.

No matter what approach you have taken with your cat, it would help if you keep up with the pace of:

  • Scheduled visits
  • Tests
  • Examinations.

If you do not work with the vet and specialist, administer the medication, and get the tests done, Cryptococcosis will likely re-appear. You won’t identify it until it shows any central nervous system symptoms. The gum chew fits, blindness, and nausea will be worse than you can imagine.

Recovery of Cryptococcosis in Cats

Recovery of Cryptococcosis is relatively slow even you have diagnosed it in the early stage. Once the situation gets worse, it is difficult to restore normal health conditions. For better recovery, you need to take care of your cat’s diet, along with regular medication. 

Your vet cannot offer the same potency and dosage to cats suffering from different infection levels. Each cat has different needs, and different levels of infections will require vets to prescribe different drug dosages.

It would help if you took your cat regularly to the vet to picture the side effects accurately. 

Your vet will adjust the dosage according to the side effect and recovery of the cat for the infection. The next thing you need is to provide a safe environment for your cat from the occurrence of the disease.

If your cat gets infected with Cryptococcosis from the outside environment, you need to restrict your cat indoors. This way, you are helping both you and your cat from the dangers of this hazardous disease.

If your cat got Cryptococcosis infection from the factors inside the house, you need disinfectants and proper cleaning of your house.

Changing the bedding litter of the cat should be the first move to the safety of your at once tests have diagnosed Cryptococcosis presence in your cat. The contaminated environment needs to be sanitized to protect other pets in your home.

Follow-up treatment is the best method to speed the recovery process. The occasional blood tests will help you identify the effectiveness of the medicine in this case. 

When you keep the cat indoors, you save them from viruses, leukemia, and other hazardous diseases that could worsen the situation and make your cat suffer more.

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Hi, I’m Jenny Dean, creator of Floppycats! Ever since my Aunt got the first Ragdoll cat in our family, I have loved the breed. Inspired by my childhood Ragdoll cat, Rags, I created Floppycats to connect, share and inspire other Ragdoll cat lovers around the world,

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10 Comments

  1. Thank you so much for sharing your experience. I wish more people would blog and share.
    Our black cat is only about 9yo and he suddenly started to have some snoring at night. Then he started to develop a growth in his right nostril and a swollen right lymph node. Unfortunately we had to go to a different vet than our normal one due to no appointments for 3 weeks. He rapidly was getting worse and the vet took a front right canine out thinking it was an abscess tooth along with cutting a biopsy of the nasal growth. Needless to say after almost 2 weeks we finally figured out it was cryptococcosis. The vet tried itraconazole but that didn’t show much results except now swollen gums on the upper right side of his mouth and the vet suggested we put him down. We decided to do a last ditch effort and see if the regular vet could squeeze him in. The new vet ran some blood tests, gave us fluconazole, and said if we were determined we could syringe feed if he’s showing signs of interest in food. It has been almost a month on the fluconazole and syringe feeding (as he still wants to eat but the swollen upper right gum makes it hard for him to even grab pate). He is gaining some weight and finally the growth in the nostril is going down. He is more perky and like his normal self.
    Our vet is still so shocked that our cat got this fungal infection as he is strictly indoors. It is a serious disease that could take so many pets from their loving owners if people are not made aware of its possibility.

    1. Hi Gina,
      Thanks for reading my Jax’ journey. I shared my experience per Jenny’s (this site owner) request. If you decide to reply to this comment, please let me know how long ago your kitty was diagnosed with Cryptococcosis? It looks like a lot of vets really don’t know how to correctly treat this disease. Incompetent vet can cause pet parent to loose their baby! I got lucky that I just happened to pick the vet that got diagnosis in just a few days and the most important knew how to treat this disease. The only prediction that didn’t really come true that the vet told me it would take up to a year to get negative blood test. it didn’t happen. Our journey of twice a day Fluconazole is already going on for 16 months. Did you cat ever came outside even for a short time? I also consider my cats strictly indoors, except for a few short supervised leashed visits only on the back yard during which he picked up this infections. If you cat accidentally snuck outside even for a short time he could’ve easily pick it up. It could be in any bird droppings, and pigeons are in particular are main carriers of the disease. If your cat NEVER was outside, the other but much lesser chance that could’ve happened that anyone in your household or guests in your house could’ve brought some spores from outside on their shoes. And cat just sniffed it and inhaled the spores.
      Since November 2020, when I took the matter of testing him myself in my hands, it doesn’t cost very much but still a big hassle to draw his blood, pack it carefully and ship it overnight. Plus twice a day pill giving became quite annoying by now. The Titer level of Cryptococcosis keeps dropping exactly in half each of the tests I sent out to the lab. Back in November when i started to use new lab in Texas Titers started with 512, went down to 256 mid December, and i just sent it again for another test last week February 24, and it dropped to 128. So it’s going down but unfortunately not negative yet. The good news that Jax doesn’t have any symptoms and acts his normal self. All his symptoms went away after about 3-4 weeks being on Fluconazole. I just can’t wait till his test comes back negative, so i can stop giving him pills. I just ordered fluconazole from walmartaPetRX. https://www.walmartpetrx.com/p-6954-fluconazole-tablet-100-mg.aspx?sku=50407-2 They have cheapest price of .72c per 100 mg pill with auto ship price. It’s cheapest i could find. It makes a difference when your pet has to be on those pills for this long. I just cut each pill in half daily and give half (50 mg) morning and another half at night.
      Since you have to feed your cat from the syringe you can consider miracle Vet Hight Calorie Liquid. I give it to my Jax every day with the syringe and it works pretty good. I was buying it on Amazon before, but lately they’ve been out of it. I hope they’ll get it back soon. Right now it’s only available from Miracle vet directly: https://miraclevet.com/products/1-2-gallon-of-miracle-vet-weight-gainer-9-600-calories

  2. Hello Kira,
    I also have a cat named Lucy, a Bombay, with Cryptococcus at the age of 3 years old. She was showing symptoms in October of 2018, but we didn’t find a vet that could find her diagnosis until Jan. 2019. By that time, her Titer test was
    1:16, 384. We started her on Abelcet, which is a drug that is in liquid form that the vet must administer by subcutaneous injection on a (ideally) weekly basis. We also give her Turbinafine pills once daily and we were giving her Fluconazole twice daily. She still has the disease, and we have spent over $20,000 on her vet visits and meds for this so far. In the last month we switched one of her meds, Fluconazole to Voriconazole and she seems to be getting worse on that. The last time we tested her titer numbers, she was at only 1:256. Her numbers won’t go below that, and have raised a bit since then but went back down….I am thinking about trying to find a different internist to help erradicate this. I have a question for you. Did you ever give your cat any other medication other than the pills you take at home? I am curious if this vet isn’t trying to take all of our money if perhaps Lucy can live comfortably on this disease if we only give her the pills at home? What are your cat’s titer numbers currently? It seems they are still pretty high yet your cat seems good. I find that interesting, and I am starting my research on this now because I can’t afford any more money now that I have been jobless for almost a year now from Covid-19. My family has been helping with vet bills and I have gotten some assistance from an organization. But I am at a loss here, at what point is your cat’s symtoms obvious to you? I mean, at what titer numbers? Lucy has been starting to sneeze again and her eyes are watery and she has very low numbers.

    1. Kira Dessau says:

      Hello Jenna,
      Thanks for sharing your Lucy’s story. I’m actually surprised knowing that as rare as this disease is that you’re already second person that commented here and going thru the same thing that Jax and myself going thru. It’s interesting to read how different vets approaching the treatment. I’m sure you probably read previous comment from Stephen and my reply to him. Meant to post the update of Jax progress, but the last test that vet performed threw me off balance and all my expectations.
      I took Jax for what I hoped for his final testing at the end of September but my hopes for his to finally be negative not only got shattered but the vet surprised me when called me and let me know that his levels went all the way up again to highest measurable level: POSITIVE @ GREATER THAN OR EQUAL TO 1:32768. It surprised and shocked me so i asked him how could it be? He never missed a dose of meds. The Dr. was a bit puzzled himself and told me that he spoke to the lab doctor and he gave several reasons for it: maybe cat just got immune to meds and it’s stopped working, or maybe cat has FeLv and it could interfere with recovery or it’s possible that one of tests was wrong. The only reason that made sense to me that the test was wrong, as I knew that Jax had nowhere to get infected with FeLv or other reasons didn’t make sense either also because Jax feels fine and no symptoms returned. I was quite disappointed with the wrong result as all those tests are expensive: very time i take Jax to get tested it cost $200 for Crypto test plus another $160 for general bloodwork, so each time it’s closed to $400 and when you pay this money the least you can expect is accurate result. I was expecting for the lab and vet at least to offer to retest Jax, but the Doc said lets wait couple of months and test him again. This didn’t make me feel any better because i’d have to pay another $400 then, and also didn’t have any trust in the lab anymore, as 2 months later where would be guaranty that they won’t screw up the results again! So i’ve decided to take matters in my own hands and first took Jax to Vetco (at Petco store) to test and make sure that he doesn’t have FeLv, they do this test very cheap: for $35 for all 3 FeLv , FIV and Heartworm and all 3 were Negative. My next step was to research online to find a lab that performs Cryptococcosis test. I found a few and contacted them. One of them nobody answers the phone and never replied on the email, the other 2 both said that they will accept samples from private person not a vet. They test serum not whole blood and one of them said that i’d have to separate it and send them a serum, but of course i don’t have a centrifuge to do it, but the other lab in Texas said that i can send them about 1 ml of blood and they’ll prepare it and separate serum for the test themselves. It was great for me and my last step was to figure out how to draw some blood from Jax. Fortunately it’s lots of videos on youtube of how to do it and was very helpful. the best way is to use Cephalic Vein (front paw) or Medial Saphenous Vein (inner back paw)
      I was inspecting Jax veins and first tried to use Medial Saphenous Vein then Cephalic Vein and found for myself that easiest way is to use Cephalic Vein So finally on November 4th i took some blood and shipped it overnight to Texas lab https://tvmdl.tamu.edu
      https://tvmdl.tamu.edu/tests/cryptococcus-neoformans-antigen-latex-agglutination/ and 2 days finally got a result that made sense: Specimen: Serum Collection Date: 11/04/2020
      Test: Cryptococcus neoformans Antigen (Latex Agglutination) Result: Positive Titer: 512
      It’s just proved what i already suspected that the lab my vet was using simply messed up the result. Plus it saved me lots of money: instead of paying $200 for that test that my vet was charging I only paid $27 to the lab in Texas plus the cost of overnight shipping. I submitted the results of the test to my vet and Dr agreed with the first lab results were wrong. And also said that I have to continue Fluconazole until blood levels will be negative. I’m quite surprised that your vet bills were so extensive! $20.000!!! I know that you’ve been treating your cat a year extra than I treated mine, but it’s still sounds way too hight! Mine were around $2000 so far. Also quite surprised about all those extra treatments that your vet was doing to your Lucy. From what I’ve learned about this disease that Fluconazole given twice daily of 50 mg dose is the best treatment. And no other additional treatments needed. It’s the most mild drug with minimal side effects and the most effective. That’s what my vet told me and that’s what I’ve learned online as well: https://www.drugs.com/condition/cryptococcosis.html? sort=popularity&order=desc&page_number=1&page_size=25&category_id=0&include_rx=1&include_otc=1&show_off_label=1&only_generics=0&submitted=0&hide_off_label=0
      I also retested Jax last week: 1.5 months later from the 1st test on December 16 and it tested as follows: Specimen: Serum Collection Date: 12/16/2020 Test: Cryptococcus neoformans Antigen (Latex Agglutination) Result: Positive Titer: 256. So in 1.5 months it dropped exactly in half.
      I’m still lucky to found this vet as they diagnosed Jax very quickly, plus of course their prices are not super cheap but at least Dr doesn’t mind for me to save money wherever possible, like buying fluconazole pills online for less then half price instead of buying them from them. Also Recommended to get 100 Mg pill and cut it in half daily as it’s much cheaper this way. They just approve the prescription whenever i need a new badge. In my first comment i posted the link for Fluconazole on Alivet, and now I found even a little cheaper with auto ship signed up https://www.walmartpetrx.com/p-6954-fluconazole-tablet.aspx
      You didn’t write what initial symptoms your Lucy had when she got sick in 2018? My Jax had only respiratory problems, labored breathing and very enlarged lymph nodes. all his symptoms were almost gone after a month of consistent treatment on fluconazole. And in-spite hight crypto blood levels, he didn’t look or act sick after a month. He still looks fine. Just i’m looking forward for him to be negative and hopefully stop this already almost 14 months daily pill routine. Based on how his levels were dropping for past 2 tests I did, I’m thinking that i’ll test him at the end of January and maybe he’d be negative by them hopefully. If you interested to try testing Lucy yourself, i can give a site where i ordered all the necessary supplies for it: syringes, needles, blood tubes for shipping etc. If you have any more questions, please don’t hesitate to post in comments.

      1. Hi Kira. I was wondering what dosage of flucanozole your vet prescribed? My cat Merlin has been diagnosed with cryptococcus since May 2021. His titer levels have been 1:32768 since diagnosis and have not once gone down. Both the vet and specialist were perplexed that it hasnt gone down at all since he physically seemed to be getting better. He has it in his nose and the nose went down significantly with albacet treatments. He was first put in Itraconazole but I was having trouble giving the to him as it is a liquid medicine. So the switched me to 50mg of flucanozole once a day and he was also going in twice a week for albacet treatments (which were about $600 per visit thank goodness for pet insurance). After 3 months, he went down to albacet treatments once a week along with his daily 50 mg of flucanozole. At 6 months, he seemed to physically be improving, so we lessened the albacet treatments to once every 10 days along with his daily 50 mg of flucanozole once a day. The specialist than added terbinafine once a day as well as I was concerned that his titer levels weren’t going down, they were still at 1:32768. I went to see a new specialist about 4 months ago to get a 2nd opinion and they wanted me to stop albacet treatments and terbinafine and do flucanozole 50mg but twice a day! He said his standard to treat cryptococcus is 50 mg twice a day so I’m wondering what other vets standards are. My first specialist had recommended 50 mg once a day but that might have been because of his weight. He had lost 4 lbs and was down to 6lbs when we finally got him correctly diagnosed with cryptococcus. Now that he’s been on flucanozole twice a day, I feel like his nose is getting bigger. I’m so exhausted with this disease. I’ve probably spent about $20,000 out of my own pocket in vet bills with insurance paying about $40,000.

        1. Hi Suzie, Thanks for reading Jax’ Cryptococcosis story. I just logged in after a long time to see this post and saw you question. Unfortunately I don’t get any emails notifying me that it was any comment on any of my posts. In any case from reading your comment it looks to me that the vet was treating your Merlin was trying to squeeze more money from you. I got super lucky that I found the doctor that actually had personal experience with this rare disease and identified it quickly and also prescribed a treatment that worked well and despite the cost that I incurred still wasn’t outrageous. I didn’t have to bring my Jax to any treatment to the vet, but only for recurrent 2-3 months check ups and blood tests. The only treatment he prescribed was the Fluconazole 50 mg pill twice a day. Even to make it more cost effective he said to buy as cheaper option the 10 mg pills and cut it in half to give half of the same pill 2 times a day. He said that even if I didn’t cut it exactly in perfect half it wouldn’t matter as long as Jax gets 100 mg total a day split in 2 doses of around half (closed to 50 mg each) His initial blood test started from highest measurable level: 1:32768 and in 3 months didn’t go down at all despite the fact that he felt good by then. It did go down to 1:8192 3rd time I tested him in 7.5 months. However in another 3 months when I tested him the doctor notified me that it went all the way up again to 1:32768. It absolutely didn’t make any sense and I suspected that the lab screwed up the result somehow. That’s why I took the matter in my own hands and found my own lab to test him. So i’ve learned to draw blood from the cat and shipped the sample myself to the lab in Texas overnight, and the result came tis titer was at 512. So the lab in NY that my vet was using definitely messed up the test results. So I was testing him myself every 2 months and it was going down to 256, and then 128 on 02/25/2021. However I’ve tested him 4/21/21and titer was still stuck on 128. After 18 months on the pill and the last 2 tests were the same with no improvements, so the doctor advised to stop the pill. and try to retest him in 3-6 months. I actually send his sample 4 months later but Fed Ex overnight messed up the delivery and deliver the package at the end of next day instead of by 10 am the next morning while it was super hot weather outside, so the ice in the package didn’t last the extra time and his blood sample got all clotted and not suitable for a test. So I didn’t get to test it after that. It’s been 1.5 years since I last tested him and stop giving him pills, he’s been fine thank God so I didn’t get ti test him again. I’m thinking to possibly send the sample and try to test him maybe within next 2-3 weeks just to see what it would be. I’ll update if I do it. I’m so sorry you have to go thru such a heartache with your Merlin. My Jax also lost weight when he got sick and was down to around 9 pounds but my doc still gave prescription of twice a day fluconazole. It seemed to work well on getting his symptoms clearing, but it took 18 months for hir titer to go down to 128, but never to zero. The doc was also puzzled a bit but after some research called me and said that some study said that it’s possible it would never go to zero. Seems ok so far since stop giving him a pill. I guess I was quite lucky that I found more competent vet that prescribed correct treatment without sucking up all the funds. It’s still cost me around $2500-3000, but not as much as your treatments. Of course i saved lots of money when started to test his blood on my own without the vet. (my tests cost me then around $27 per test plus overnight shipping was somewhere $40) still cheaper then the vet charged you around $400 for 2 blood tests plus the visit cost. The cost of testing and shipping went up now but still would be a lot cheaper then go to the vet. The trickiest thing is to draw the blood from Jax but, luckily he’s such a calm cat that makes it a bit easier. I don’t have insurance so it ads up. I wish you best of luck and quick recovery to your fur baby Merlin. Please write the update of his progress!

  3. Stephen Elliott says:

    CRANBERRY JUICE
    It seems that I am losing the 7 year battle against Cryptococcosis with Scamp ! With Scamp, the fungus was nasal, affecting his nostrils, behind the nose and sinuses ! It also grew across his face but we managed to get that under control — it is an extremely nasty and ugly thing to see ! All this time, he has been on Fluconazole which has not cured it but we believe it has slowed down the advancement of the fungus which was not in his throat !
    I am considering using a couple of drops of Cranberry Juice down his throat ! This is based on the belief that when ladies use it for cystitis, I have read that it works by making the walls of the bladder and urinary tract slippery, thus preventing the cystitis from getting a grip ! Thus, I’m hoping the same effect might happen with the cat’s throat !
    Secondly, I’m presuming that Itraconazole is more potent but I do know it can cause liver failure ! Thus, I’m wondering if a short course might be safe, say a week ? There’s also another ” vicious ” drug from yesteryear called ” Amphotericin b ” ! Again, I’m wondering whether we could get away with just a short course !
    You’ll probably see that I’m getting more and more desperate to save my lovely, loyal and gentle little mate’s life at the tender age of 11 !
    I would point out that he does not appear to be in pain ! Although he eats like a horse, twice as much, quite literally as the other two cats and I give him mainly proper chicken, cut into very small pieces ! He even gets an extra meal at 3 o’clock in the morning and yet he is still a bit underweight and, perhaps, he needs the ” mitrazipine ” as mentioned by this article above !
    I am shortly going to take him to see a different vet at another practice ! This practice cannot get Fluconazole from their suppliers so I am very interested to see if they come up with an alternative ! If not, I’m sure they could give me the prescription which I could get fulfilled at a pharmacy for the Fluconazole !
    I am also awaiting the delivery of a homeopathic remedy ! Although previous experience of Homeopathic remedies as been negative, I’m willing to give a different form of it, especially to treat Cryptocossis, a try, even if it only has a 1% chance of working !
    Please wish me luck, say a little prayer for Scamp if you are so inclined, and I would be grateful for any and all advice / suggestions !
    Love to you all and your puddycat friends,
    Steve XXX

    1. Hi Stephen, i didn’t log into the site for awhile and just look at my article and saw new comments. I’m very sorry to hear about your cat suffering with this nasty disease! From the info you gave looks like maybe your vet is not approaching the treatment correctly. You didn’t specify how long you had your cat on fluconazol? Did your vet take cat’s blood for a tests to determine Cryptococcus count? Test called Cryptococcus Antigen by Latex Agglutination. I got lucky that I found a vet that had personal experience with this disease so he knew how to approach it. My vet recommended to test it every 2 months. However he warned me that unfortunately it’ll not be quick road to full recovery and in most cases it’ll be between 9 to 12 months. that’s why i’ve decided to test him every 3 months instead just to get cost of total tests a bit less. So far i had 3 tests plus original diagnosis visit and already out a bit over $2000, plus another test will be done, so it’s not the end yet. Fluconazol is primarily choice to use. My vet doctor was against itraconazole because he had bad experience with it when he was treating his own cat many years ago back in 90s, and his cat developed liver failure from this meds after only couple of months of using it, and he had to urgently switch him to fluconazol that at that time was just new drug and very expensive with no generic forms available, but he was able to finish treatment on fluconazol and luckily the liver failure was reversible as soon as itraconazole was stopped and replaced with fluconazole. So that helped to fully cure his cat. It took him a year to fully get rid of it and get finally negative result in his blood test. Unfortunately is no such a thing as short term treatment against Cryptococcus. And you have to keep your cat on the pill long after clinical signs of disease are gone. For Jax all his respiratory symptoms were gone after 5-6 weeks on the pill, but doctor told me to continue treatment until blood level would get to zero. Otherwise if fungus not fully killed it’ll start growing again and you’d have to start all over. I took him for blood test 3 months later and inspite that he felt good and had no signs of the disease his cryptococcosis blood level didn’t even drop below measurable level of 1:32768. So I continued giving him fluconazol and because the pandemic the vet said since it’s not an emergency to continue giving him a pill and bring him back for test in June. So I finally got him tested at the end of June (4 months since last test in January) and finally we saw the drop to POSITIVE @ 1:8192. It’s pretty good improvement as it stated somewhere way above measurable level of 1:32768. But it’s all after almost 8 months of treatment. However in his general bloodwork they find that his kidney levels were slightly off and needed to test his urine. It turned out that he was a bit dehydrated and doc tell me that I should increase his water intake. So every time now when I give him a pill I give about 5 ml syringe of water mixed with high calorie supplement. Planning to take him for next test in mid or end September and hopping that his levels would be finally to zero and I could stop giving him pills. As for Fluconazole it’s pretty easy to get it. My vet is selling it but it’s more expensive then i can get in online. I asked the doc if he doesn’t mind if i’ll be buying pills not from them but cheaper where i can find them and it was fine with him so I was buying it here:
      https://www.allivet.com/p-6954-fluconazole-tablet.aspx?SearchTerm=Fluc+Auto they just have to call your vet to get authorization to fill prescription each time you’d buy them and you’ll get them shipped to your house. My Doc also recommended as the 50 mg pills are a lot more expensive to save money to buy 100 mg pills and divide it in half each day and give him half morning and evening. Even if you cut it not exact half, as long as he gets both parts of the same pill in the same day it wouldn’t matter. I would definitely try to get second opinion from some other vet that hopefully would have some better experience treating it. It should not keep going on for 7 years, and if you treat it correctly it should’ve been goon within first year. It seemed that the treatment may have been stopped too early without killing all the fungus and some of it was left and it would definitely start regrowing and affecting the cat. That’s why special blood test for cryptococcosis is so important. Generally if treatment done correctly the prognosis for full recovery with longer term full course treatment are pretty good assuming that disease didn’t affect cat’s full nervous system. Also doc recommends general blood tests along with cryptococcosis test while cat is on medication to make sure the liver enzymes are normal.
      Good luck and I hope you’ll find an answer for your baby Scamp. And please keep me posted with any updates. I’ll post an update in 5-6 weeks after i’ll have the next (hopefully it’ll be final) blood test

  4. Anonymous says:

    Thank you for this article. My cats only go out in a catio, but I recently put a pie pan of bird seed on top of the catio, to protect it from the rain. Now I realize that location for the bird seed is inviting problems from bird droppings into the cage.

    1. I’m glad to write about this fairly rare disease. I’ would be happy if more people will learn about it and that my unfortunate experience would help other pet parents to protect they fur babies from harm that could be picked up outside. And definitely you should keep anything that would invite birds near your catio. My catio protected with roof in most parts except for one small part, and there it’ll be not likely that birds would make any droppings. And of course i prevent both of them from going outside on the ground for obvious reason.

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