histoplasmosis

Hi everyone.  I'm new here but have been searching for anything on histoplasmosis in cats.  Read the thread from back in 2010 so I hope someone will have some info on this.  This is kind of a long story so bare with me.  I live in Oklahoma now.  I moved from Alabama about 9 years ago.  I had 2 house cats that stayed inside most of the time.  Occasionally they went out but never far from the house.  I had to move back to Alabama for a year in 2008 and my cats had to live outside and in our garage.  They never wandered off, just stayed close.  After I moved back to Ok. in 2009 (about 8 months later) I noticed my older cat started breathing rapid and was not eating as well.  I took her to the vet in April of 2010 and they said it was asthma.  Don't remember them doing any x-ray, but they may have.  She continued to be so-so, not doing great but not any worse.  I think she was given medicine that I gave at home.  Anyway, by Oct. she was getting worse again so I took her back to the vet and they did x-ray (chest) and said she had fungal pneumonia or cancer.  It turned out to be the pneumonia (I think it was histoplasmosis.  From what I've read, that is a different fungi than fungal pneu).  We treated her with medicine (again I can't remember if it was itraconazole or not), but she just got worse and I had her put to sleep.  Two years later my other cat got sick with kind of the same thing only her symptoms were different.  She would throw up ever so often, then one day she threw up big time and started staggering around like she had lost her neurologic function.  This was Christmas eve and no vets were open so I took her to an emergency clinic in the next town.  They were puzzled and thought she couldn't see.  They were nice enough to keep her overnight and send her to her regular vet the next day (of course I paid through the _______ for all the treatment).  They kept her several days at my vet and she did get better so then we started the treatment for what I thought was an autoimmune disease.  I never did understand exactly what she had, but she lived for a few months after that. (All this was costing me a fortune and I only have SS).  She went blind and had her ups and downs before she eventually got sick on the weekend(naturally) and no vets open.  I had been gone most all that day and she died early the next morning.  Now I have 2 new cats that were rescue cats from my son.  The reason I'm relaying all this is that now one of these cats has histoplasmosis now.  He just started showing symptoms about 2 weeks ago.  Both of these cats (fixed males) are from Alabama and stayed in all the time at my son's, but one of them came from the Bronx in New York and the other was a rescue that my son took from his vet.  Don't know the history on him before that except that he was run over and had a broken leg that the vet fixed and asked my son if he would take him.  I think he's had him about 2 years.  His symptoms are rapid respirations (like in the 60's to 80's sometimes).  I've been to the vet with him and this is what they diagnosed, but that was on Fri. and I can't get anymore itraconazole until next week.  I had some in my ****. that just expired about 4 days ago and my vet said go ahead and start him on it, but he's getting worse.  He hasn't eaten in a couple of days and I don't think he drank hardly any water yesterday or today so far.  The med. tastes so bad to him that it makes him very agitated and breathe even faster.  I cut the dosage in half and give it at different times and try to disguise it with wet cat food, but neither of these cats will touch canned food.  So I'm in a dilemma worrying about him and if he's even going to make it until tomorrow and then it will take a week probably to get his new medicine.  Anyway, I guess I'm just wanting to talk about it with people who are cat lovers and see what you think.  Thanks for reading this.

I have a lot f experience with the illness. I just finished treatment on my cat. I live in Oklahoma as well. I am on my phone at the moment and will write you a longer reply when I get off work.

oh i am so sorry to read this. What a devastating thing for you to deal with. My son's cat, who was littermate to my two cats had histo and sadly didnt make it. He lived in Texas and the vet found it strange for K.O. to get it there. Well the litter was born and found outside in Ohio... son moved to Texas.... we moved to AZ. I am still fearful it may be dormant in mine and pop up.

Alright. I finally found some time to sit down and get you a reply.

First off, has the cat been given the histo antigen test? If not, you need to get one done to diagnose the disease with certainty. The problem with histo is that it shares similarities with othe illnesses like IBD and lymphoma. To treat those, you have to suppress the immune system which can kill a cat with histo. The test is expensive and it is most effective when the urine is tested. Little Girl had this test done almost every month for seven months until she was declared free.

Histo can manifest in many different ways. Most common is a lung infection. They will cough, pant, be lethargic, not want to eat or play. Little Girl had the infection in her intestines which also resulted in extreme hunger and a wasting disease. She vomited all the time but conitnued eating like a cat dying f starvation, which she was. She also had horrible stools that were smelly and completely liquid. Histo can also effect the muscles, tissues and bones of a cat. It can also attack the central nervous system like the brain and the eyes. If it attacks the nervous system, it is extremely difficult to treat.

Because the infection is in the lungs, an X-ray would be helpful in diagnosing the extent of the illness. Little Girl never had one but her infection was in another location.

Little Girl was on itraconozal in its liquid form for 7 months. She was also on a nausea pill call Cerenia as well as a B12 injection regiment. For the first week of her itraconozal she was also on a steroid to help support Her lungs in case the fungus moved.

Histo is a nasty illness. As the fungal cells are popped they leech into the blood stream and make a cat very, very ill. They will get much worse before they get better. Some never get better. It's a bad illness that effects really good cats.

Little Girl went from 9 lbs to 4lbs. In the first two months she lost even more weight and sh was in her litter box nearly all the time. She was miserable. When she started gaining weight it happened suddenly. She is now at 10lbs and is completely histo free.

Do not stop the itraconozal no matter what. It can be deadly if you do because the illness can come back until he is cleared. If e is not eating this needs to be addressed for other reasons as well. If you are giving a pill, switch to liquid. The medicine also needs to be given in increasing doses over time so not to make them violently ill. B12 will help promote red cell production to fight the infection. Little Girl was given 1cc of itraconozal twice a day until she was finished. It wasnt fun for her or me, but we got through it.

Histo is a long, miserable road. It's expensive but for me it was well worth it. Our vet said that they had never seen a cat so far gone as Little Girl come back the way she did.

Also, here in Oklahoma histo is a serious issue. Little Girl has never been outside in her life and she caught it from an unknown source inside my home. Cats that go outside have an even greater chance of catching it. Even people can catch it from the soil. There are studies going on right now in the state o try and identify some of the risk factors involved.

I really hope that your kitty pulls through with flying colors. I am here if you need any help or any more advice.

Thank you for replying Weemomma.  My Max (cat) had the chest x-ray, blood tests, and urinalysis which the vet said the x-ray showed lots of infiltrates, but the blood work was all normal.  The urinalysis was positive for the histo so he said.  That was the definitive test for showing the histo according to the vet.  Max is worse today as I think I already said.  He's not acting agitated or anything, just breathing extremely fast and no eating or drinking.  I'm calling my vet first thing tomorrow.  Do you think it's possible for cats to pick this up from their litter box?  Before Little Kitty died I had gotten a new litter box, but still used the old one two, but Max didn't arrive here until after she died, but I'm still using that litter pan.  Have you ever heard of that?  You know how dusty they can be and Max digs a "Lot' before he does his business.  Makes as good mess on the floor with litter.  Also, I can't find out anything on the internet about how long they can have this before they show symptoms.  I had fixed a "run" for them to go outside a little while every day where they couldn't get out and it's very grassy, no dust and they don't do their business out there either.  I did notice that Max ate grass quite often, but he only has this in his lungs so far (I hope).  He had only been going out for about 5 days before I noticed his breathing.  I actually think I noticed it a few days before I started letting them out, but I can't be positive.  Besides, I don't think he could pick it up that quick and be this bad off, do you?  I'll keep everybody posted on the prognosis.  Thanks.

The scary thing about Histo is that it's not really understood very well.  Most doctors will say that an animal will get it from scratching around in infected dirt that has the droppings of birds and bats in it.  Actually, it's hard to say how most cats get it.  Little Girl has never been around dirt or potted plants.  The vet and I tend to think that she caught it from the spores being tracked into the house, meaning at some point during one of my days, I walked through some of the histo spores and they were transported into my house on my shoes or pants.  Again, this is a complete guess.  It's possible it might be from the litter box, but not likely.  You may never know how histo ended up in your house.

Little Girl had histo for nearly a year before I saw the signs.  That is really frightening to think about.  I thought the vomiting was normal for a cat.  I thought she looked the same.  I thought she acted the same.  Because cats are so good at hiding their illnesses, I missed the fact that she was wasting and I missed the fact that she wasn't as active as she'd always been.  I almost lost her because of that.  This could have been something that she had for a very long time, but her immune system was really good at combating it until one day it didn't anymore.  Max could have had this for a long time and you just never noticed.

Please call the vet and tell them that your cat is not tolerating the medications.  If the switch can be made to liquid meds, please do so.  Little Girl tolerated them so much better than the pills and the liquid itraconazol is a little bit better absorbed.  If he still can't tolerate it, he will be switched to another anti-fungal medication.  I will tell you (not to scare you) that the other medication is harsher on animals.  To me it sounds like he needs to be on be steroid to help support his lungs if he is having a hard time breathing.  Also ask about B12 injections.  He needs to stop going outside until he is well if he is still allowed to run.  Sometimes cats with histo need to be hospitalized.  They need fluids and support to get them through this.

It's a long, hard battle.  You think that you've got it beat and it just keeps coming at you.  Like I said before, it took us nearly 7 months until we finally got a negative test and even then I was told that she could possibly get it again.  Don't give up.  The outcome is well worth the time and effort.

Hi Weemomma.  Been meaning to reply to your last post and just haven't done it.  I wanted to give you an update on Max since last week.  We know he has histo from his urine test.  Started him on  Itraconazole about 11 days ago, but didn't get the new medicine until last Tues. so that's 6 days for the new stuff.  He didn't eat for about 4 or 5 days and don't know if he drank any water, but he was still urinating a little.  Took him back to the vet on Mon. and he got some subQ fluids and an appetite simulant.  He had lost about a pound  in 10 days.  My vet was concerned about his not eating as much as his labored/fast respirations.  I checked back with him on Wed. and Max still had not been eating. We talked about putting a PEG tube in, but wanted to wait another day or two.  The next day he ate a few bites of kibbles and later that night he ate some more (about 7 or 8 kibbles, I counted them).  On Fri. he didn't eat anything that morning that I could tell, but later that afternoon he ate again and that night he ate more and even had a small BM.  I've started keeping him in a separate bedroom at night  so I can monitor his food and litter box.  He has been eating a little every day since then and today I actually saw him drink some water.  He still gets around and jumps up in the window or on the chair so he's not so debilitated that he can't get around, but his breathing is so fast.  It's up in the 80's if he exerts himself at all and if he's dead still and asleep it can go down to the 50' or 60's.  Sometimes I look at him and think I should put him to sleep, but then when he gets up and moves around I think maybe he might get better.  He's not grooming much at all so I know he feels bad because he used to groom constantly when he was well. We're going  back to the vet today and get a checkup.  His O2 sats were pretty low also last week so that is a concern.  I've also been reading about liver problems from his not eating.  Do you remember how long it took your Little Kitty to start improving after the itraconazole was started?  I know it hasn't been that long since I started Max on it, but it seems like a long time and his breathing is not improving; it's not worse, but it's not much better either.  I'll try to keep you updated after our visit to the vet today. 

Jane

It is a long, slow process.  The entire treatment took a little over 7 months.  She had stopped grooming simply because she didn't have the energy.  The fast breathing is from the illness itself.  The fact that he's eating and drinking and using the litter box is encouraging.  It took her about two months before she started gaining weight and grooming again.

Just take a deep breath and keep doing what you're doing.  Things will get better.

Hi, here's my update from Mon. visit to the vet.  Max is still eating a little along, especially at night when he is by himself.  He's even had a couple of BM's.  His breathing is still rapid, but not as bad as it was when this first started.  His O2 sats were a little better at the vet's office.  He's lost about 2 lb. since this started so now he's at 9 lb instead of 11.  The vet said if we can level him out on losing weight and not get down too low, that will be a big help.  He doesn't think it's affected his liver any.  We talked about putting a PEG tube in, but we decided to give him another few days and give him another appetite stimulant.  He has days where he seems to feel a little better and he hangs around more with me and Larry, but then he has days where he just stays in another room by himself and doesn't come out much.  It's been almost 2 weeks on the itraconazole so maybe I'm expecting too much improvement for a short period of time.  I just wish his breathing would improve more than what it has.  I'll probably go back to the vet again next week  unless he's a lot better. 

Jane

sending positive thoughts and prayers that Max has a major breakthrough!! C'mon Max..you can do this!!!

I know this is an older thread, but if the OP or weemomma are still around, I would like to revive it.  I have a kitty that is likely going to be diagnosed with histo and we are just waiting on the blood/urine results to confirm it.  Her x-ray shows a pattern consistent with histo though, so we are starting her up on the itraconazole.  There is a lot more to her story, but I'll save that for when I know others that have gone through this are still around to discuss.  Thank you!

I have just receive a slap of diagnosis of histoplamosis for my 2 year old cat and the vet had tried 2 months medications of antifungal and antibiotics. Today I just sent him for a checkup and the doctor says the medication doesnt responding to the infection and was asked to put him to sleep. I am devastated for choosing the procedure. or should I continue the medication where the vet had alrd given up. I am also financially not in a good state. The series of vet visitation is cost almost my pay. Is there any option to keep the cat alive, while I come out something to cover up the expenses. I heard  itraconozal but the medicine i have never tried. T^T

Hi, sorry I'm just now replying but haven't been on here lately.  Is you kitty still with you? I hope so.  My cat is on itraconazole and has been since he got sick. He is doing great.  Did you say you have tried that med. or haven't.  I think it has saved my cat, but if the disease is too far advanced the med. might not help.  Is your cat eating and drinking?  Is his breathing fast or regular?  Histo can affect different parts of the body and my cat had it in his lungs just like my first cat.  They thought it was asthma at first but there is a urine test they do to be sure that it is histo.  It's some kind of titer test from the urine.  Sorry I don't have much info and no treatments to offer other than the itraconazole since that is all I have ever dealt with.  Let me know how things turn out.  Good luck!

Hi thanks for the reply. 

My kitty is still with me. The vet told me to discuss with my family members to decide for putting him to sleep. I have been giving him anti fungal medications - known as sporonax vit b complex for 2 months and antibiotics, broncial dilators and vit b complex for a month. first 2 months the anti fungal meds seems to reduced the rashes he has completely and the swollen small region on his nose but the third month they stop giving him the antifungal med and straight go to antibiotics. yesterday, i brought him for x rays but rejected coz they say from physical appearances that the infection is coming back; rashes and swollen of the other side of the nose. His is eating and drinking but lesser. but the first 2 months was like normal. I am thinking is it alright for me to be more selfish and asks for another round of sporonax. As the vets says he is not responsive to the med. 

and in addition to that my cat is as if having common cold like symptoms. Although his appetite seems to drop last week but he is eating alot of wet food instead. breathing as if like having flu since the nose had been blocked one side (coz there are swelling) - not panting.

I am curious because all of the tests that I have read from all the thread above my vet did not do. All he did is lab Smear  microscopy test. When i brought my cat for x-ray as scheduled he is refused as he "seen" the condition of the swab tests that my cat isnt responding to the sporonax. Plus, all of the drastic symptoms as read in this thread isnt observed in my cat. The only thing my cat currently having is rashes in the underarm, breathing as if having flu with mucous discharges (abit), slightly lethargic (appeared now) and loss of appetite on dry pellet food - wet food still ok.

My question is we tried 2 months of sporonax and vit b complex and after that it has been stop and switched to antibiotics instead. my cat was showing physical improvement after 2 months of sporanax. for example, rash and pus is completely healed, and sneezing decreases.  Is microscopy smear can tell how is my cat infections doing? and What are the duration of treatment for histoplasmosis? Because in only 3 months, from the very first visit to the vet he told me to put him to sleep (he was very much vy healthy at that point) and after 3 months of medication (no injections or tests - just microscopy tests) again the same advice. I am considering of putting him on sporanax again. but is there any adverse effect from taking these drugs for longer period? I read from the internet about the duration of the treatment was supposed to be about 4-6 months and the post treatment in alert for relapse. But i think he still got a chance right? 

I'm sorry for the late reply.  Sporonox (itraconazole) should be used at least 4-6 months, but the internal medicine specialist I saw said the few he's seen with histo actually had to be on it for life.  That wouldn't surprise me as fungus is a pain to completely eliminate. 

I wanted to post again because my girl had to go to the ophthalmologist yesterday and I thought he had some good insight that might help others.  I'm hopeful it well help my girl as well.  She has never tested positive for histo and we've tested twice, but he said he's had a few patients that they knew had histo and they came back negative as well.  In addition, he warned me about itraconazole not always being readily absorbed and that the compound pharmacy absolutely has to use the name brand version, Sporonox.  The internal medicine specialist had warned me about this as well, but the ophthalmologist recommended we test her to see what her itraconazole levels are actually at, so we're now waiting on that result. 

She's been fighting this for a while (over a year and a half) and now has infiltrates in her eyes, which is why he's positive this is fungal.  He said if she had cancer (i.e. leukemia/lymphoma), she wouldn't be here at this point.  We've been fighting it for over a year and a half, but she's been on itraconazole twice and is on it currently.  He suggested if the serum levels come back low that we switch her to fluconazole.  From at least one report I read (link below), it seems to be just as successful as itraconazole, plus you only have to give it once daily.  I think that is what we're going to be trying next. 

http://www.okvma.org/docs/Histoplasmosis_OVMA_5-19-15.pdf

The biggest problem my girl has had is breathing difficulty and a high white cell count.  Has anyone else had the high white cell count issue?  That is why she keeps going on antibiotics as well.  We eventually get it down, but then it goes back up once off the antibiotics.  I'm really frustrated at this point because she's been through so much and now it just seems to be spreading to other parts (eyes, skin).  Also, does anyone else have another cat?  Did you have to treat that one as well?  I worry that maybe my other girl is carrying this and that is why she keeps going back and forth.

Well, I just got the report back and the lab results showed no trace of itraconazole in her system, despite her being on it twice a day for months.  They're switching her to fluconazole, 50 mg twice daily, so we'll see how that goes.  I did call the compound pharmacy to find out if they were using the name brand Sporonox, and they confirmed they were not.  They stated they are using 100% pure itraconazole though, but clearly that's doing diddly squat.  I'm praying that the new meds are finally the solution we've been looking for.  I will report back anything noteworthy after she's been on it for a while.  I just wanted to mention this in case anyone else feels like itraconazole isn't doing anything for their cat.  It's definitely worth having the blood test done to check the levels!