FACT SHEET:

Diagnosis of Feline Infectious Peritonitis (FIP)

Clinical examination and history are essential to the correct diagnosis of FIP. With the exception of histopathology and immunocytochemistry, laboratory tests are only ancillary aids to the diagnosis. Laboratory tests performed should also aim to rule out other differentials since clinical signs of FIP can overlap with many other diseases.

DIAGNOSIS IN A SICK ANIMAL:

The gold standard test for FIP is considered to be histopathology with immunohistochemistry (IHC) analysis to identify viral protein in classical lesions of pyogranulomatous vasculitis. IHC has a specificity of 100% and sensitivity of 95%. Findings suggestive of FIP on haematology may include leukocytosis with neutrophilia and lymphopenia and a non-regenerative anaemia. Serum biochemistry analysis may reveal hyperglobulinaemia and (compensatory) hypoalbuminaemia with increased fibrinogen. Where a blood sample has shown elevated globulins, serum protein electrophoresis (SPE) to assess the distribution of globulins may be useful in differentiating non-specific response to infections and inflammation to the extremely high levels of 2- and -globulins predominantly seen with FIP, and may also help rule out monoclonal gammopathy secondary to lymphoid neoplasia. Alpha-1 acid glycoprotein (AGP) is an acute phase protein. AGP rises in a variety of inflammatory conditions including FIP, however values above 1.5g/l are highly suggestive of FIP. This test may assist in differentiating FIP from other clinical conditions resulting in pleural and peritoneal effusions, such as neoplasia, hepatic and cardiac disease. Cytology of effusions for interpretation of protein content, specific gravity and cell population is useful. This will help to eliminate other causes of effusions but can also be paired with immunocytochemistry. This uses the same antibodies as the IHC test and has 100% specificity. Negative immunocytochemistry does not rule out a diagnosis of FIP since the sensitivity is only 54%. This is because not all samples will contain viral antigen.
Typical effusion fluid

Pyogranulomatous serositis

Pyogranulomatous pleuritis and pneunonia

Coronavirus antibody can be detected using an immunofluorescent antibody (IFA) test. It is not specific for FIP virus, detecting antibodies to all coronaviruses. Although FIP affected cats usually have a very high titre (>1:640), terminal decline in antibody production can give negative or low results and high titres also occur in healthy cats shedding feline coronaviruses (FCoV) in faeces. In a sick cat with other indicators a high titre would be suggestive of FIP.

Diagnostic

Screening

FACT SHEET: Diagnosis of Feline Infectious Peritonitis (FIP)

Screening in a multicat environment:

Coronavirus antibody titre by IFA can be used to indicate the level of shedding of FCoVs in healthy individuals. Cats with no or low titre may be shedding low amounts of virus and those with a high titre are likely to be shedding high levels of virus. In groups where gradual elimination of infection and development of an FCoV negative population is the aim, antibody testing combined with selective euthanasia or separation of cats with high, low and negative titres may be performed. Since most healthy carrier cats will eventually become immune, virus negative and have reducing titres, repeated antibody testing may allow transfer of cats from high to negative groups. This requires extensive owner commitment but may be useful in breeding colonies.

Test
Histopathology Gross post-mortem examination Immunohistochemistry Biochemistry, haematology and urine SG (total body function profile) including interpretation Biochemistry and haematology (health screen and full blood examination) without interpretation Albumin:globulin ratio Serum protein electrophoresis Alpha-1 acid glycoprotein Cytology with fluid analysis Cytology with fluid analysis and immunocytochemistry Immunofluorescent antibody titre

Sample
Formalin fixed tissue Entire carcass (chilled, not frozen) Formalin fixed tissue Blood in EDTA, serum gel or plain and fluoride oxalate tubes, urine in yellow top pot Blood in EDTA, serum gel or plain and fluoride oxalate tubes Blood in plain/lithium heparin tube Blood in serum gel or plain tube Blood in serum gel or plain tube Effusion fluid in EDTA tube (for culture also submit plain tube) Effusion fluid in EDTA tube and plain tube Blood in serum gel or plain tube

Reference: Comparison of different tests to diagnose feline infectious peritonitis. Hartmann et al J. Vet. Intern. Med. 2003;17(6):781-90

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VET FIP 06 2006

Screening

Diagnostic