Complicated URI diagnosis

[webmann]

Have an 8 year old cat. Has had sneezing spells on and off for several years.
Now has ONE nostril swollen -other is normal, and raw/red with some pus and small 1mm sore which opens periodically-this is more recent, over last few months.
Continual nasal discharge serous, sneeze is serous
Shaking his head peridodically.
Appetite is suppressed.
When stressed a few months ago, he developed mild conjunctivitis which cleared up on saline irrigation.
He has a broken molar and most of his teeth are gone, gums are reddened, but no obvious abcess/swelling.

Have tried these so far:

Tetracycline for about a month. Intialing sneezing disappeared completely, but came back towards
end of treatment. No effect on sore nose or swelling.
Lysine 500mg bid
Topical terramycin ointment on nose, -no effect
Has broken tooth, and very few teeth left, reddened gums, stinky breath which clears on antibiotic treatment.

Started on cephalexin. Nose swelling has diminished, but not disappeared. Sneezing stopped for first day or two, then returned at lesser rate
Nose is bothering him, he ocassionally paws at it aggressively.
Redness has diminished so far on the cephalexin.

Last vet thought it was herpesvirus and secondary infection but was guessing, since no tests were done to confirm this.



Questions:

What is causing the one nostril swelling, redness and sore? Why won't it heal?
If the sneezing is due to secondary infection, why does it dissappear then reappear on antbiotics?
What is needed to DEFINITIVELY determine what is causing this cats upper respiratory congestion, nose swelling/sore?

Thanks for any GOOD answers.

[Aleda M Cheng, D.V.M., C.V.A]

The vitamin E is to be given orally.  The biopsy would be definitive (usually) for one of the auto-immune diseases I have already discussed.  

I would have the teeth done since they can be harboring infection and some of the roots of the teeth in the maxilla lead into the sinus cavity which in-turn leads to the nasal cavity.  

Prednisolone is an anti-inflammatory steroid.  Cats are very resistant to side-effects from steroids, unless they are obese.  Obese cats can develop diabetes with repeated use of INJECTABLE steroids.    The dosing schedule for auto-immune disease in cats is very safe.  It begins with a high dose at first, the dose is halved every 2 or 3 days until the lowest effective dose is achieved.

[webmann]

Thanks for taking time to answer my question in detail.

I will research the auto-immune diseases you suggested-these are things I had not considered before.

By biopsy do you mean biopsy of the outer nose sore or from where?
Will this tell me anything about the cause of the sneezing, or just for the nose? I have read that culturing the nasal secretions does little good cuz what is found is often a normal part of respiratory tract organisms, not necessarily what is causing his symptoms.
Will a biopsy be a definitive test for the auto immune diseases you mentioned? If not, are there other tests for those?

I am probably going to have the dental cleaning done and bad tooth(eeth) extracted, so they could possibly do the biopsy when he is under for the cleaning. I have been previously reluctant to have his teeth cleaned cuz his breathing is somewhat obstructed by the nasal congestion.

Whatever is causing the sneezing was senstive to the tetracycline, so I am thinking maybe the bad teeth are harboring the infection, so it returns as soon as the drugs are withdrawn. What do you think is the probability that his few bad teeth and gum inflammation are either contributing or causing the sneezing and nose infection?

You suggestion is for vitamin E orally? I already tried vitamin e applied to the sore on his nose, but he is pawing it off. Both the nose and his broken tooth are causing him pain, especially the tooth after eating.  I have also tried echinacea which seemed to help the sneezing, but can only be used short term. Also buffered vit c, a and d as well as several herbs have been suggested to me. Also what effect does the prednisolone have; any serious side effects?

Thanks again for you valued input.

[Aleda M Cheng, D.V.M., C.V.A]

Your cat may have an auto-immune disease such as Pemphigus F,  Lupus E,  or an Indolent ulcer or others, with a secondary bacterial or viral infection, or he may have Bartonella H.  If the problem was just restricted to the nose I would also suspect a nasal foreign body.

I think your vet was on the right path.  It could have been Herpes, or other viral disease with secondary bacterial infection.  The secondary bacterial infection may simply not gone away because it was not strong enough and the primary disease is too strong.

Biopsy of the affected tissue would give you a definitive answer, but,  would require anesthesia.  A culture and sensitivity should also be performed to find the perfect anti-biotic for the secondary bacterial infection, but culture and sensitivities take a few days.  

If you do not choose to biopsy, and while waiting for the culture and sensitivity results,  your vet could try treating your cat with prednisolone, vitamin E, and with the antibiotic Zithromax.  The prednisolone and vitamin E would be for the auto-immune part of the disease and the Zithromax should cover the secondary bacterial infection.  Zithromax is excellent for upper respiratory infections and it also is effective against Bartonella.  

I would continue with the Lysine for a possible Herpes infection just in case.  It is just an amino acid so there is absolutely no contraindications.