Cryptococcosis in Cats: My Ragdoll Cat Jax’s Journey

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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 species complex, which includes eight genotypes and some subtypes (strains) with different geographical distribution, pathogenicity and antimicrobial susceptibility.

Cryptococcosis in Cats IMG_2620

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

I wanted to write a story to possibly warn all cat parents about the disease that 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.

Cryptococcosis in Cats Jax_7_2016

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 IMG_3012

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 in Cats Jax'ThroatBumps2
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: fungal disease that the cat could’ve only picked up outside by sniffing fungal spores from the ground.

Cryptococcosis in Cats Jax&Pond

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 IMG_3399

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.

Cryptococcosis in Cats Snow_Jax&Chester2

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):

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 he 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 indoor.

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.

Cryptococcosis in Cats DSC07856

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.


Comments (4)

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  1. 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.

    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: 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

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