Trial and tribulation
By Sibylle Nagel.
(Copyright © Sibylle Nagel, Cattery of GreyGables, Germany.
Reprinted with permission.)
Many breeders know about it but nobody talks about the problem. So, at the time you receive the diagnosis ringworm (Microsporum canis) for any of your cats you will most probably not have heard of it before and in the beginning you will not realise what it is all about. Soon after reading and hearing more about the disease you will certainly be shocked. And, in fact, it is a diagnosis you should not neglect nor treat carelessly. Ringworm is highly contagious and as it is a zoonosis you, your children and friends as well as other animals living in your household can be infected.
We are no vets and we do not claim the following information to be complete but we had to go through a Microsporum Canis infection in our Maine Coon Cattery and we would like to share our experience and knowledge. We shall try to give some information about treatment and some idea about what you will have to do. First of all let us say that the disease is 100 % curable. Take courage! You will manage to get rid of it if you pay attention to some rules which are:
- You should know that the treatment of your animals and the disinfection of the surroundings will take weeks (or months) and that you will need a lot of strength, discipline and staying power and some good friends who will stand by you during hard days (which will come).
- Until you get reliable ringworm negative laboratory results you will have to hold a strict quarantine. You will not be allowed to let in any visitors nor shall you visit friends, especially those with animals or children. You shall not buy or sell cats during this period nor plan any litters or even visit exhibitions.
- You will need a strict treatment plan. A well informed vet should support you for weeks and ideally agree to visit you in your home.
- You will have to treat all of your cats no matter if they show signs of ringworm except there is a chance to separate your cats from each other completely for weeks. But attention: Be aware that all of them might be spore carriers because ringworm often stays asymptomatic and will suddenly break out in single cats within a group. In fact, dermatologists today are talking about 40 % of cats with long hair being carriers and about 20 % of humans being infected.
- If other animals live in your household, they might be infected too (e.g. dogs, guinea pigs) and will have to be treated as well as yourself in case of infection. If there are kittens, you will have to pay special attention to some other things we will be talking about later.
- Please keep in mind that you might need treatment, too. And be careful if children live in your household. Their immune system often is not strong enough and they get severe outbreaks of fungus.
The Disease and its Clinical Symptoms
We will keep this chapter short as you will find information about the disease in world-wide web, in books, and certainly your vet can tell you more.
Several species of fungi occur in cats. Microsporum canis is the most common one - and despite its name (canis = of the dog) more often occurs in cats than in dogs. Sheep, horses and cattle can carry it. The spores of this so called dermatophyte survive on skin, in and on hair shafts and in the surroundings. Circular bare patches on the skin suggest the diagnosis. The spores are very persistent and it is said they can easily survive for 2 years if not treated (and cause outbreaks again and again.
Some pictures of what ringworm can look like:
|Often it starts with the ears ... Microsporum Canis in an adult male.
© Family Roth
|Microsporum around mouth and nose of a young male.
© Sibylle Nagel
How we noticed we have it ... first signs ... first days
We got a call from a friend who had visited us with her children the week before telling us that her daughter had a red circular spot on her body and that one of her two cats had hairless lesions on ears and body. It might be a fungus said her vet. We immediately examined our five adult cats and found very small (around 2 mm) circular bare patches on one ear of our youngest male. We took him to the vet on this very day and he confirmed our suspicion that it might be a fungus. Skin and hair was collected to make a culture test, and the vet told us we would have to wait for around two, maybe four weeks to see results and to get a clear diagnosis. The vet told us it will most likely be a Microsporum canis infection and suggested to take up a treatment plan if the culture should support his suspicion. We heard about Microsporum canis then for the first time, googled it at home and were alarmed. If it was Microsporum, all ouf our cats could be infected. We had three weeks old kittens in the house. A horrible imagination they all could loose their coat or would die from a fungus infection! How could we wait for weeks! In the evening we found a dark spot on the ears of a female. It was round, darker than the normal skin and we could easily scratch off hair and skin. It seemed clear that we had a contagious disease in our cats. We decided not to wait but to react within days and to do everything to get rid of the problem as soon as possible. The next day we went to our doctor talking about treatment for the cats as well as for ourselves. At that time we ourselves had not got any lesions. But we did later although I started to take pills against the fungus from the first day of suspicion.
Methods of Diagnosing Microsporum Canis
There are several methods to test if you have a Microsporum outbreak or if your cats under treatment still have it or are Microsporum free again. These are:
- Woods Test and Black Light
Your vet might use the so called Wood lamp. In many but unfortunately not in all cases the fungus' excretions on hair can be seen as fluorescent apple-green spots under ultraviolet light (black light). But note you will not see the green spots on skin. The method is not safe at all. We decided to buy a cheap so-called urine finder lamp (black light) and started to examine our cats and the whole house in the darkness. In the two cats with the visible ringworm infection (lesions) we saw only a very very light green shine on the ears. We walked through the dark house lighting it with black light and found no green spots but a lot of yellowish tracks and marks and laughed about the chartreuse look of our skin. Some weeks later we saw the first fluorescent spots in two of the kittens and then we knew how Microsporum looks like. So be sure: IF you see the spores you will know. They are really fluorescent green.
- Microscopic Test
Sample materials of hairs and skin taken for a culture laboratory test will be viewed under microscope first. Placed in a special solution, spores may be seen in some but not in all cases.
We took samples of all of our cats for several times and we never had one positive microscopic test showing spores, even not in the actually infected cats. One cat got a positive result but in culture this showed to be some not pathological thing she had taken from rolling in the soil of our cat grass and it was not Microsporum or Trichophytum. So, if you get a negative microscopic test this does not mean that your cat is Microsporum free. And if you get a positive microscopic test it can not tell you which species of dermatophyte your cat is wearing.
- Culture Test
This is the only secure method to identify Microsporum canis and to tell you if your cat is Microsporum positive or negative (= free). To get a first clear diagnosis making you ready to start treatment, the infected pet's hair and skin will have to be collected and sent to a lab. Unfortunately, the test will take weeks. If your cat is infected and the fungus culture is growing fast, you may get results after one or two weeks. If not, you will have to wait for a final report which will be ready only four weeks after starting the culture test. Culture tests will be necessary in the beginning and from time to time during the treatment period and again after treatment to make you sure ringworm is gone. We took first samples three and six weeks after having started the treatment, but the time you take them will depend on your treatment plan which we will explain later. You can take collective samples after some time, but better are single samples of each cat to get clear results. Samples should be taken by a so called BRUSH TEST using a clean, newly bought tooth brush. Do not let it get into contact with other materials, your hands or the table. Always keep it clean before brushing your cat's coat in several directions and especially on and behind the ears and around the collar (where infections frequently begin). Then put the brush into a paper bag or paper foldover (to prevent spores from adhering to plastic materials) and then into a plastic bag which you should close carefully. Do not forget to put the name of the respective animal into or onto this bag!
First Steps.... Between Suspicion and Diagnosis
Be prepared that the period of waiting for a culture diagnosis will bring you a deterioration of the symptoms in your animals as well as in your personal see-saw. You will read and hear a lot of information about Microsporum canis. You will doubt and ask yourself if this all really is as hard as people tell you. You will realise how expensive the treatment is and you will ask yourself if it is really necessary and if you could get off cheaply by reducing the common treatment plans and doing it your own way. If you finally realise that this is no option you may be shocked or fall into panic, and you may not sleep for nights.
Once you accept that there is no way to escape from it except by going through with your treatment and disinfection plan you will want to start at once. Of course, your vet will not prescribe any medication before lab test results are ready. But there are some things you could already do. We would like to tell you what we did but of course there are other possibilities and you (and your vet) will have to decide which are suitable for your problem.
- Lufenuron treatment
We learned that good results in Microsporum canis treatment were achieved by Benziony and Arzi using Lufenuron (ingredient of the veterinary flea control medication PROGRAM) against dermatophytes. Their first study (in 2000) with a recommended dosis of 30 mg/kg in cats, turned out to be not effective enough, though, and many relapses occurred. In 2001, they corrected the medication plan and from now on recommended 110 mg/kg for cats living in catteries. A second treatment after two weeks was also recommended and showed good results, as many cats stayed ringworm free for months.
Our vet was sceptical but as no toxic effects are known we decided to try Lufenuron and treated all of our cats (except the lactating queen and the kittens) three days after the Microsporum canis suspicion had come up and again after two weeks. We cannot say if Lufenuron did have any effect on the badly infected male as he had already lost most of his neck coat after some days and as we treated his spots locally (see next chapter). But the other adults (again except the lactating queen) did not get lesions although two of them got mild positive results in culture tests later. And in the female with the dark spot on her ear it seemed to work. After one week this female seemed to show a good reaction, and the hair on her ear started growing which corresponds to the study of Benziony/Arzi saying that around 5 days after giving Program this occurred in most of the cats. The female's dark skin on this one small scabby spot vanished after some weeks. Nevertheless, she got her systemic treatment later on, as all the other cats.
It could be an alternative if you have only one or two cats, if you are not breeding and if you have time enough to test treatment methods. Also, it could be a suggestion for preventing outbreaks of ringworm. But we are not sure if Lufenuron/Program will help to eliminate spores in carrier cats. We do not think it will. Using Lufenuron only, you should certainly make some brush tests.
- Local treatment of ringworm spots
Many vets will recommend IMAVEROL for the local topical treatment of ringworm spots even before the diagnosis is clear. We applied Imaverol on the spots for about two weeks but it did not seem to stop the expansion of the ringworm in our young male. When we found out it is not admitted for cats (dogs and horses only) in Germany, we decided not to apply it any more and only used it in a sprayer for the disinfection of sleeping places and climbing trees. Instead, after two weeks of Imaverol application (we were still waiting for a diagnosis via culture as microscopic investigation had turned out negative) we started applying Lamisil cream (not Lamisil Once!) on the spots which contains Terbinafinhydrochlorid and which we think was most effective. You will have to apply it directly onto the spot and especially onto the area around the bare patches. Ringworm is spreading around the patches, spores sitting on hair shafts. Treat the coat around the lesions, too! You will have to do this daily for weeks until there is no more sign of red scabby ringworm skin. We applied the cream in the morning and in the evening. But you could also use other antifungal treatments containing either Miconazole or Terbinafine or Clotrimazole or Ketoconazole, for example Canesten cream (which worked well in the cat of our friend). If you will have to treat the eyes or eye surrounding skin you could use Pima Biciron N which covers fungi.
For each disease there are always several hemopathic drugs you could consider - depending on the individual constitution. As we do not always have the chance or time to find out the ONE drug for the one special animal there are combined products covering certain fields. We are talking about skin diseases and we found SAPONARIA COMP most helpful giving it into the water bowls daily in turn with ECHINACEA, the latter to improve the immune system. We could not get the recommended PSORINUM anywhere and we had to order Saponaria comp. in Sweden with the help of our friends. We think that giving Saponaria to our cats and kittens helped to prevent a severe outbreak.
After two weeks we finally got the result for our young male. He turned out to have a mild Microsporum canis infection. Mild? He did not have any fur left around his neck at that time and looked like a vulture more than a Maine Coon male. We had already given a first dermatophyte vaccination to him, now we started a cattery treatment plan comprising systemic and hemopathic treatment of animals and humans, a vaccination against dermatophytes, the disinfection of the household and all clothes. Fortunately, I had the opportunity to stay at home during the coming weeks. And let me say, it was necessary. Getting rid of Microsporum canis in a three-floor-house is a job of 12 hours a day for weeks and it will not be easier in a flat! It took us around 6 weeks of treatment and disinfection until - after 9 weeks - we had Microsporum negative results for all of our cats in single culture tests. We will never forget those days!
- Disinfection of the house
This is a very important point! Microsporum spores can survive for 12 to 24 months if not removed and will cause new infections again and again. Therefore, put the utmost care on cleaning and disinfection your house! You will certainly manage to get rid of the spores on floors by using bleach. Also, ozone kills the spores but you cannot stay in a room where an ozonisator is working! Neither your animals! Which makes it a logistic undertaking to ozonise room after room in your apartment or house. But you will not manage it without ozone!
- We washed the floor of every room with bleach every day. Acetic acid in water also kills spores but be careful! It has to be watered down!
- We washed tables and other pieces of furniture with bleach or disinfectant.
- We sprayed disinfectant onto the cats' climbing trees, litter trays and their special places (cat sofas and cushions) daily.
- We put all carpets, curtains and all kind of drapery we could go without into plastic bags and threw them away.
- We removed sofas, matresses and climbing trees especially from the room where the male group had been sleeping and threw them away.
- We bought an ozonisator and have been running it daily (room after room) until all tests were negative (and since then weekly).
- We put our clothes in one special room which the cats were not allowed to enter and ozonised it regularly. Nevertheless, we both got one Microsporum spot (one on the arm, the other on the leg) and had to be treated.
- We washed all clothes with hygienic rinser.
- The cats were allowed to roam around the house during the day but we did not let any cat sleep in our bed.
- We built three smaller groups (males, females, queen with kittens) and let them sleep in three different rooms which were washed and ozonised before putting them in in the evening (after cream treatment or coat disinfection).
- For the queen and kittens we prepared two rooms, ozonising one when they were in the other one and vice versa. So we managed them to stay spore free and did not have an outbreak in them although their mother who had been in contact with the infected male before got ringworm lesions.
- We removed all cat hair daily and ozonised the vacuum cleaner as well as pet boxes, litter trays, mop brushes and all you can think about.
- Strict quarantine
To hold strict quarantine is very important to avoid infection and reinfection of animals and humans.
- We informed our family and friends that they will not see us for a while.
- We did not let visitors in for weeks (except the vet).
- We did not visit anybody for weeks. During the first weeks I did not go out and my husband went to work only after taking a Ketoconazole shower and after dressing in clothes that had been disinfected by ozone.
- Cattery business
You shall not bring in any new cat during the treatment period nor shall you sell kittens before tests show that all cats of your cattery are Microsporum free. You will have to inform your club. You are not allowed to visit exhibitions. You should wait with matings for at least 6 months.
- We informed our club about the outbreak and when it was gone.
- We informed our breeder friends but did not talk about our problem to everybody during the treatment period. We decided to be open in the future in order to help others but the treatment period should not be burdened with gossip which unfortunately happens.
- We knew we could not bring in breeding cats we had already "ordered" and informed the breeders, cancelled flights, postponed dates etc.
- We knew we could not let the people in who had already shown interest in buying one of our kittens and informed them that they will not be allowed to visit their favourite kitten as planned.
- We also informed buyers that the kittens might have to stay with us longer than 13/14 weeks and that we will not sell them before the test for all of our cats are negative. We told them we understand if they will withdraw.
- Human Treatment
I had a little itching red and round spot on my arm soon after we had discovered the problem in our cats. Because I would have to stay with the cats for weeks and I would have to treat them I decided for a systemic treatment and took Terbinafin drug once a day (for 8 weeks). Also, I applied Lamisil cream onto the spot. After two weeks it was gone and I did not get any further problems. My husband got a spot 20 days after we had started the adult cats' treatment. It was treated with Lamisil cream and vanished after some time. But you could see a dark spot for a while and they say that in some cats you can also see darker skin after ringworm is gone.
To protect yourself be very careful! Use disinfectant for hands and wear gloves! Shower yourself and wash your hair daily with Ketoconazol shampoo. Change your clothes often and wash clothes with a hygienic rinser. Ozonise clothes which were in contact with your cats.
- Local Treatment and Bathing of Cats
We did not cut the coat but we heard this might be necessary in some cases. We never gave our cats an Imaverol bath although all of the vets involved recommended it. We applied Imaverol locally but we did not have the impression that it stopped the ringworm. We were successful with other things like applying Lamisil cream (as mentioned before) or using Canesten spray. Lamisil cream was our favourite local treatment for the ringworm lesions, we applied it twice a day. Between, we applied Liverwort Balsam. We had heard that it was successfully used in horses with Microsporum and we think it also works in cats. Don't use tea tree oil which is poisonous for cats!
We started bathing the cats with a Ketoconazol shampoo (Ketoconazol destroys the spores). It is recommended to bath the cats twice a week during the treatment period. Bathing the kittens was quite easy but it was no fun with the adults. Especially our 9 kg neuter did not agree at all. We looked for better methods to get rid of the spores and read about disinfecting with a spray. We think this is a good idea! Once a day, we sprayed it onto the cats' coat and rubbed it into the coat before placing the cat in an ozonised room. Of course, they do not like it very much, and you will have to be very careful not to spray it onto the head and into the eyes. Hold your cat's neck and only spray onto the back!!! Do talk to your vet about this before. We practised this for around two weeks in order to get rid of the spores in the coat.
- Combined Systemic Treatment and Vaccination of Cats
A vaccination against Microsporum canis was developped by Boehringer Ingelheim. It is named INSOL DERMATOPHYTON. Two (sometimes three) shots are necessary to give protection for around 10 months and the vaccination will also heal acute infections in most cases. Two weeks after the second shot ringworm spots are likely to vanish. Kittens can get their first shot at earliest 10 weeks of age and must weigh 1 kg, lactating queens and pregnant cats shall not be vaccinated. We do not know if it reduces spores or just prohibits the outbreak of the disease. Most probably the latter.
- Systemic Treatment
There are several products and we decided to take ITRAFUNGOL as the side effects on liver and kidneys are not like those with other drugs. Cats with kidney or liver problems shall not be treated with Itrafungol, also not lactating queens and pregnant cats. Itrafungol is given once a day in a dose of 0,5 ml/kg. You give it in three intervals of 7 days with a treatment interruption of 7 days each between.
- Queen and Kitten Treatment
It was a hard decision to take: Although not recommended, we had to treat the lactating queen because she showed ringworm signs after some weeks and we could not take the risk of a severe infection for her nine kittens whose treatment also had to be started earlier as planned. We waited until the kittens were eating food and gave the queen the first vaccination not before the kittens were 9 weeks old. She also got a reduced dose of Itrafungol to avoid overdosage in the kittens (who got Itrafungol too), also Itrafungol intervals were different from those of the babies and held much shorter than recommended. We gave the kittens Itrafungol starting in the 8th week (weight at least 1 kg), later they got their dermatophyte vaccination like the adults. We had problems in combining ringworm prevention/treatment and RCP vaccinations - which we thought should not be left aside - in a way that would not be too much for the organism. With the help of our vet we managed to decide the best possible, and luckily this litter were the strongest and healthiest kittens we ever had so they went through it without any problem.
Our treatment plan for the adult cats:
Our treatment plan for the nine kittens and the queen:
- Day 1: First Insol shot
- Day 6-12: First 7-day-interval Itrafungol
- Day 14: Second Insol shot
- Day 20-26: Second 7-day-interval Itrafungol
- Day 28: Sample 1
- Day 38: Result sample 1: Two adults Microsporum free, one cat with light spore amount, one cat with moderate spore amount
- Day 34-40: Third 7-day-interval Itrafungol
- Day 46: Sample 2
- Day 66: Result sample 2: All adults Microsporum free
- Day 1-5: First 5-day-interval Itrafungol kittens (age 7 weeks, day 10 of adult treatment plan)
- Day 6: First RCP shot kittens (age 8 weeks)
- Day 8-9: First 2-day-interval Itrafungol queen
- Day 10-14: Second 5-day-interval Itrafungol kittens
- Day 12: First Insol shot queen
- Day 20: First Insol shot kittens (age 10 weeks)
- Day 22-27: Third 6-day-interval Itrafungol kittens
- Day 27: Second Insol shot for the queen
- Day 27-30: Second 4-day-interval Itrafungol queen
- Day 34: Second Insol shot kittens (age 12 weeks)
- Day 37: Sample 1
- Day 38: Second RCP shot for the kittens (age 13 weeks)
- Day 39-43: Fourth 5-day-interval Itrafungol kittens and queen
- Day 57: Result sample 1: Queen and kittens Microsporum free
We were so lucky we have not had bad reactions neither from breeder friends we informed nor from buyers (except one who got the information by her vet that we will never get rid of this problem again). Our breeder friends were so helpful during that time and we were in mail contact with them almost every day. The "kitten people" were also very nice and understanding and trusted in us.
The "Microsporum period" was the hardest thing we ever had to stand. There were days when I thought I can't bear it any longer. It was not only extremely physically exhausting but I was always very sad about what I had to do with my cats every day. I am so glad that all of my cats are still normal and social and still love me. And you cannot imagine how happy we were when the infection was beaten and when we got good lab results. All of our kittens found good homes and left us "ringworm free".
I would like to thank my breeder friends from the catteries Yovimba, Merryborn, S*Manitou, S*Ramsekatten and S*Silveronyx for reading and answering to my long and daily mails during quarantine. Giving me strength to go through! Special thanks go to Misha Peersmans, The Dorsai, who helped with words and deeds giving information about treatment methods and hemopathics and a lot of other things and keeping me alive.