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Proceedings of the 34th World Small

Animal Veterinary Congress
WSAVA 2009
So Paulo, Brazil - 2009

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CHLAMYDIAL INFECTIONS OF CATS

Tim Gruffydd-Jones BVetMed PhD DipECVIM-CA MRCVS
The Feline Centre
Department of Clinical Veterinary Science
University of Bristol, UK.

The main chlamydial agent recognised in cats is Chlamydophila felis which was previously known
as Chlamydia psittaci feline strain. There have been suggestions of other chlamydial agents
occurring in cats but there is little evidence that they are clinically relevant. Chlamydial-like
agents such as parachlamydia can frequently be isolated from cats but often from healthy cats.

Prevalence of Chalmydophila felis in cats

Chalmydophila felis is the infectious organism most often isolated from cats with conjunctivitis,
particularly chronic conjunctivitis. It is found in up to 30% of cats with conjunctivitis (Wills et al,
1988). Surveys of feline patients presented to first opinion veterinary practices in the UK and USA
have shown that conjunctivitis is one of the more common reasons for presentation accounting for
up to 3% of cases (Lund et al, 1999). In addition, serological surveys in several countries have
shown that a relatively high proportion (up to 9% or more) unvaccinated domestic cats have
significant titres against chlamydophila, indicating prior infection (Gunn-Moore et al, 1995). These
observations suggest that chlamydophila infection is relatively prevalent in the domestic pet cat
population.

Risk factors for chlamydophila have not been well defined but it appears to be more common in
cats from multicat households, pedigree cats and young cats, often under one year of age.

Biology and pathogenesis

The mode of transmission is uncertain but chlamydophila cannot survive in the environment and
infection is probably dependent on close contact. Social interaction with transfer of ocular
secretions through mutual grooming probably facilitates spread of infection. Clinical disease is
related to ocular infection but the organism can be readily isolated from the gastro-intestinal tract
and the genital tract of females although there is no clear evidence that this is related to any
significant pathology.

Outer membrane proteins are present in chlamydial organisms and there are strong similarities
between these proteins in different Chlamydia species. The most important of these are the PMPs
(polymorphic membrane proteins) which are considered to be key virulence factors and crucial
targets for inducing protective immune responses. Recently the presence of genes coding PMPs
has been confirmed for Chlamydophila felis (Harley et al, 2007). It has also been shown that
some isolates of chlamydial organisms contain plasmids and these may also be key virulence
factors. We have preliminary evidence that the presence of plasmids is variable between
Chlamydophila felis isolates.

Clinical signs
The incubation period for chlamydophila infections is 2-5 days. Initially there may be unilateral
ocular signs but these invariably become bilateral within a day or two. There can be striking
conjunctivitis with involvement of the nictitating membrane. Chemosis is a characteristic feature
of chlamydyosis. Ocular discharges are initially watery but later become mucoid or mucopurulent.
There may be ocular discomfort and blepharospasm. Affected cats usually remain bright and any
pyrexia or other systemic signs are mild. Respiratory signs are generally minimal. There is
circumstantial evidence that chlamydophila infection can cause abortion.

Diagnosis
PCR is now regarded as the preferred diagnostic test. It is extremely sensitive and avoids
problems with poor viability of the organism. Ocular swabs are used and close attention to

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swabbing technique is necessary since the organism is intracellular and some cellular material is
required. Local anaesthetic can be used in the eye prior to swabbing to facilitate the technique.
Other methods for demonstrating the organism are less satisfactory.

Some cross reactivity occurs with other bacteria and titres of up to 1:32 are considered negative.
Established or recent infections are associated with high titres often of 1:512 or greater.

Treatment
Chlamydophila felis is a bacterium and is sensitive to antibiotics. Tetracyclines are regarded as the
treatment of choice and doxycycline is usually used since this can be administered orally just once
a day at a dosage of 10 mg/kg. Treatment for one or two weeks will not usually eliminate
infection, and it is recommended that treatment is continued for a minimum of 3-4 weeks (Dean et
al, 2005). This is more important in cats from multicat environments particularly from breeding
catteries as the goal of treatment is to eliminate infection. It may be less important for pet cats
but inadequate duration may lead to recurrence of signs and chronic conjunctivitis. Systemic
treatment has been shown to be more effective than topical ocular treatment (Sparkes et al, 1999)
but ocular preparations may help to alleviate ocular discomfort. As with most antibiotics, there are
some potential side effects with doxycycline although the risk is low. Oesophagitis and
oesophageal strictures have been reported as a potential complication with the more acidic forms
of doxycycline which represent the lincensed veterinary product in most countries. There are also
concerns over tooth discolouration in young kittens although this appears to be a rare problem.
Alternative antibiotics can be considered but may prove less effective at eliminating infection.
Fluoroquinolones and potentiated amoxicillin are two options. Azithromycin has been suggested
and has the advantage of requiring relatively infrequent administration but is has been shown to
have poor efficacy at eliminating infection and is not licensed for use in cats.

Prevention and control

Both inactivated and modified live vaccines are available usually as one component of a
multivalent vaccine. They are effective at protecting against disease but do not prevent infection.
Routine vaccination of pet cats is sometimes questioned usually on the basis that the disease
caused by Chlamydophila felis is treatable and not life threatening. However infection is common
(see above) and it can cause significant distress to affected cats which justifies consideration of
inclusion of chlamydophila in routine vaccination protocols. It has been suggested that
chlamydophila vaccination is sometimes associated with side effects but this is unsubstantiated.
Pedigree cats from breeding colonies are at higher risk and routine vaccination will help to provide
protection against disease.

The most common manifestation of infection in the breeding cattery is infection of litters of young
kittens at around 5-8 weeks of age. If the queen is infected her kittens are likely to be protected
initially by maternally derived immunity obtained from the colostrum, but they will become
vulnerable to infection as this decays. Vaccination will not prevent this problem since the queen
may become infected even though she is protected from disease and so clinical signs have
occurred to alert the owner to infection. If chlamydophial infection is endemic in a colony and
causing disease, the best solution is to treat all the cats in the cattery with doxycycline. It is
crucial to maintain treatment for at least four weeks in this situation to ensure that infection is
eliminated.

References
Dean R, Harley R, Helps C, Caney S and Gruffydd-Jones TJ (2005)Use of quantitative real-time PCR to monitor
the response of Chlamydophila felis infection to doxycycline treatment. J. Clin. Microbiol 43, 1858-1864
Gunn-Moore DA, Werrett G, Harbour DA, Fielden H, Gruffydd-Jones TJ. Prevalence of Chalmydia psittaci
antibodies in healthy pet cats in Britain. Vet Rec 1995; 136: 366-7.
Harley R, Herring A, Egan K, Howard P, Gruffydd-Jones TJ, Azuma Y, Shirai M and Helps C (2007) Detection of
Clamydophila felis polymorphic membrane protein (pmp) family genes and mRNA expression.Veterinary
Microbiology 124, 230-238

34th World Small Animal Veterinary Congress 2009 - So Paulo, Brazil

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Lund EM, Armstrong PJ, Kirk CA, Kolar LM and Klausner JS (1999) Health status and population characteristics
of dogs and cats examined at private veterinary practise in the United States. J. Amer. Vet. Med. Assoc 214,
1336-1341
Owen MA, Sturgess CP, Harbour DA, Egan K, & Gruffydd-Jones TJ (2003) Efficacy of azithromycin for the
treatment of feline chalmydophilosis. J. Fel. Med. Surgery 5, 305-311
Sparkes AH, Caney SMA, Sturgess CP, Gruffydd-Jones TJ (1999) The clinical efficacy of topical and systemic
therapy for the treatment of of feline ocular chlamydiosis. J Fel. Med. Surg, 1: 31-5.
Sturgess CP, Gruffydd-Jones TJ, Harbour DA & Jones, RL (2000)
Controlled study of the efficacy of clavulanic acid- potentiated amoxicillin in the treatment of Chlamydia psittaci
in cats. Vet. Rec. 149, 73-76
Wills, J.M., Howard, P.E., Gruffydd-Jones, T.J. & Wathes, C.M. (1988) Prevalence of Chlamydia psittaci in
different cat populations in Britain. J.small Anim Pract 29, 327.

34th World Small Animal Veterinary Congress 2009 - So Paulo, Brazil