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.
- Kira's Helpful Suggestions:
- How to Pill a Cat
- Cryptococcosis Prevention
- Cryptococcus neoformans identification
- Symptoms of Cryptococcosis in Cats
- Treatment of Cryptococcosis in Cats
- Do you need long-term follow-up in Cryptococcosis treatment?
- Recovery of Cryptococcosis in Cats
- Did you enjoy learning about Cryptococcosis in cats? Read even more about your cat's health in our blog:
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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 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.
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.
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.
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.
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.
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.
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):
(Order Received) 11/6/19 2:51 PM
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.
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. "
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.
The study of fungus is known as cytology. The samples for biopsy are collected from lesions to perform:
The organism is cultured from:
- 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:
- Nasal discharge from the affected nostrils
- Growths on the upper respiratory tract passage
- Skin lesions
- Weight loss
- Circling without any reason
- Movements with tilting head
- Optic neuritis
- Lymphosarcoma (lymphatic system cancer)
- Metabolic disorders like hepatic insufficiency and hepatic encephalopathy
- Partial paralysis
Symptoms in sheep, goats, and cattle may include:
- Nasal discharge
- Ocular discharge
- Eye irritation
- Oral lesions
- Behavioral changes
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.
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:
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
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.