VN August 2022

Vetnews | Augustus 2022 9 No formal studies have been conducted to demonstrate the relapse rate of treatment with GS-441524, but relapses are estimated to be between 5 and 15%, with most relapses being associated with neurological disease (Jones et al., 2021; Pederson, n.d.). Unfortunately, there is no way to predict which cats will relapse. A recent study has investigated the use of alpha-1- acid-glycoprotein in predicting which cats will relapse (Addie et al., 2022) has shown promise, but this assay is unavailable in South Africa. Deciding if it is safe to stop treatment should be based on clinical progress, withweight gain being a crucial prognosticator and normalising haematological and biochemical parameters (Pederson, n.d.). Debate rages about whether remdesivir and GS-441524 are equally effective or if one is superior to the other. All of our formal studies have been conducted using GS-441524 and the vast majority of our anecdotal evidence. It must be remembered, however, that doses for remdesivir are not the same as for GS-441524 (Pederson, n.d.). COVID has also led to the release of novel anti-virals. Of these, molnupiravir has shownpromise as a second-linemedication in the treatment of resistant FIP, with one of the black-market Chinese companies having performed “clinical trials”and claiming good efficacy. UCDavies(BMurphyandKReagan)iscurrentlyresearchingtheeffectiveness of molnupiravir in cats with FIP. Although viral resistance to GS441-524 is uncommon, it has been noted (Pederson & Jacque, 2021). Case Study: Squirrel A neutered, domestic longhair named Squirrel had been found as a stray at about five months old. Squirrel was rehomed at nine months old. Since rehoming, the newowners hadbeen strugglingwith a capricious appetite – which the foster owners hadnever encountered. Hepresentedat 15months old after the owners noticed an abnormality in his right eye and anorexia. On presentation, Squirrel was lethargic and had an overall unkempt appearance,withapoor coat andthepresentationofweight loss (BCS2.5/9). He was slightly dehydrated, evidenced by sunken eyes and decreased skin turgor. He was pyrexic with a temperature of 40.1 0 C, struggled to walk, had anterior uveitis of the right eye, and had an obvious aqueous flare. On haematology, he showed a moderate, non-regenerative, normocytic anaemia (Ht of 28%, which dropped to 21% in the following days) and a neutrophil count of 11.8 x 10 9 . On biochemistry, his albumin was normal (28g/l), but globulins were elevated (67g/l), giving a ratio of 0.4. ALT was top normal at 108U/l. On abdominal ultrasound, there was a severe hypoechoic subcapsular halo around both kidneys, with an extension of hypo to anechoic fluid or congealed material in the retroperitoneal space. There were oval, hypoechoic renal cortical lesions and mild renal enlargement. A diffuse moderate abdominal lymphadenopathy was evident, and the liver was hypoechoic and heterogeneous. All else was within normal limits. FNAs of the subcapsular kidney material and the retroperitoneal material had cytology consistent with a pyogranulomatous reaction. As amatter of interest, coronavirus titreswere runandwere returnedas 1:86. A likely diagnosis of FIP was made, with ocular and possible neurological involvement. Treatment with a compounded injectable form of GS-441524 441-524 was startedat 10mg/kgdue to suspectedneurological improvement. Additional supportive treatment included B12 due to the anaemia and anti-emetics. Within 48h, Squirrel’s pyrexia had resolved, and within five days, he was eating sufficiently to be discharged. He appeared to have a thrombo- embolic event whilst in hospital, resulting in the tip of his ear and the tip of his tail necrosing and eventually sloughing off. Leading Article Squirrel, at the start of treatment Glucose 5.18mmol/l (4.11-8.84) Creatinine 153umol/l (71-212) Urea 7.2mmol/l (5.7-12.9) TP 95g/l (57-89) Albumin 28g/l (22-40) Globulin 67g/l (28-51) Alb/Glob 0.4 ALT 108U/L (12-130) ALKP <10U/L (14-111) RCC 4.8 x 10 12 /l (5.3-10.60) Ht 28% (29.7-44.5) Retic 32K/ul (3.0-50.0) Neutrophils 11.8 x 10 9 /l (2.5-12.5) Lymphocytes 1.2 x x 10 9 /l (0.40-6.80) Monocytes 0.9 x x 10 9 /l (0.15-1.7) Squirrel: right kidney >>> 10