The article titled Tritrichomonas Foetus discusses the parasite Tritrichomonas Foetus. The article titled Ronidazole describes the recommended drug treatment.

I'd like to share our Tritrichomonas Foetus experience in hopes of providing some insight for those who may be experiencing similar problems within their cattery.

If your cats or kittens have either ongoing or sporadic, smelly, cow pie-like diarrhea, even those that are triggered by certain foods, it may be due to the intestinal parasite Tritrichomonas Foetus (TF).

Realizing each person's experience may vary, we all know that the process of elimination is necessary while searching for a possible cause of chronic or sporadic diarrhea. I know first hand how frustrating it can be when you have reached that dead end road once again! Opening another door… leaves hope for an answer.

It's important to know that Tritrichomonas Foetus isn't always presented in the same way, as some cats appear very healthy and do not exhibit any symptoms of diarrhea whatsoever. One of our cats displayed exactly this, was very healthy and never had any problems with loose stools ever… yet later ended up testing positive for TF!

Our Symptoms

Prior to 2006, we had two adult Abys who arrived at different times with runny, smelly diarrhea. These cats were also picky eaters with poor appetites. Two other cats would have sporadic bouts of diarrhea, sometimes loose and other times totally firm and normal stools. The rest of our Abyssinians always presented with completely normal firm stools.

The cats that had runny stools would be repeatedly in and out of the litter box, straining and leaving very small pools of diarrhea throughout the entire day. It not only drove them nuts, but me too, as I would have to use a child's plastic sand box screen to sift through their litter box several times a day.

NOTE: Poor appetite is not a typical symptom associated with TF.

Pregnancy and Nursing

The female cats with a history of sporadic diarrhea usually started having an episode just before or after delivery of their kittens. Diarrhea would last several weeks then firm up again. Occasionally something would trigger a few days of diarrhea at other times, but it happened mostly when they had kittens. These females maintained good weight.

The mothers with very runny diarrhea had problems keeping weight on, especially when they were nursing kittens. One of our beautiful queens lost so much weight when nursing that we were forced to wean her babies between 3 and 5 weeks of age to protect her health. Reluctantly, we had her spayed for her own good - before we learned about TF.

While initially we noticed it only in our adult cats, the diarrhea started showing up in an occasional litter of kittens, even in kittens from cats that had never showed any signs of loose stools. It wasn't always a problem with every litter, nor with every kitten within a specific litter.

The Weaning Kittens

The kittens often had normal stools until they started eating canned foods. Then "some" of the kitten's stools would change from normal to a very soft cow pies that were lighter in color and had a very distinctive smelly odor. Sometimes we would notice a bit of blood either left on their anus or a drop on the top of their freshly voided stool. We assumed this was a normal reaction caused by the transition from mom's milk to the richer canned foods. We started mixing acidophilus with their moist food to help restore the good bacteria within their digestive tract.

At about 6 to 8 weeks “some” kittens would turn their noses up at food and just pick at it. They appeared normal in every way, played fine and were very active but would rather starve than eat enough for them to maintain their body weight and continue growing. Normal weight gains would level off and they would either stay the same or start to lose weight. We found increasing their feedings to four or five times each day helped maintain their weight gains. We tried every canned food on the market to coax them to eat, including A/D, meat style baby foods and cooked chicken... nothing interested them in eating enough to maintain proper growth.

Observing how canned foods seemed to upset some of the kittens' digestive systems, we started blaming specific brands of food for the problems in the litter box. We switched brands repeatedly, noticing some gave looser stools than others. Reading somewhere that Abyssinians and Bengals seemed to have more sensitive tummies than most breeds, we avoided any food changes and fed the same canned food day after day, being careful not to throw their little systems off.

Meds, Cat Food and the Stress Of Going To A New Home

Each time it happened, we put the kittens on Clavamox. Within 36 to 48 hours they were diving into their food like little piggies. The Clavamox seemed to calm their tummies down, making them feel better and renewed their interest in eating. We saw the same affect when giving Flagyl (Metronidazole); the stools improved temporarily. A short time after finishing the course of treatment, however, some but not always all of the kittens would resort back to picking at their food and have loose stools again.

Other kittens would be totally fine after treatment and occasionally start producing loose stools just after going to their new home. Thinking the stress of the move was upsetting their tummies and causing a bacterial overgrowth, we made sure each “new” family kept their kitten on the same diet as to minimize any stress that could cause an upset tummy. We asked that they not change their diet for several weeks. If they wanted to change their food, we asked that they do it by gradually mixing the foods together, slowly increasing the new food and decreasing the older one. I asked each family to let us know if they had any problems with loose stools when their babies arrived home and if need be, suggested they try Acidophilus, Metamucil or pumpkin, to see if this helped restore the normal stools. In some cases it did and others it did not.

There wasn't any real pattern as symptoms seemed very sporadic, depending on how each kitten handled the parasite…which was most frustrating! Weaning was difficult for some kittens, while others were just fine. Some required antibiotics and others did not. Some were upset by certain canned foods where others were not affected. Some continued to eat normally and others went off their food. Some lost weight, others continued to gain slowly. One minute you think everything is just fine and then the next day you are filled with disappointment when it happens once again! We could not figure out why this was happening.

When a kitten starts eating kitten food it will also start using the litter box. Diarrhea can grow the TF, but can't cause an infection. TF passes either from feces brought back into the nest by mom or by contact with feces in the litter box. The canned foods created an environment within the colon where the TF parasites thrived, multiplying and causing the smelly diarrhea. Antibiotics reduced the numbers of TF temporarily but once the meds stopped, they started multiplying again.

The Testing Merry-Go-Round

We spent thousands of dollars over the years going to different vets, looking for a solution to the diarrhea problem. We tested for everything under the sun; Parasitic worms, Giardia, Coccidia, e Coli, Cryptosporidium, Campylobacter.… You name it, we tested for it.

Each time we would be excited in the hope of finding answers as we awaited results and finished medications ... and each time we were disappointed, frustrated and heart broken as we hit another dead end.

Our vet and I tried everything we could think of and nothing seemed to work long term. I was beyond exhausted and frustrated and found myself in tears at times as all I wanted was for the diarrhea to stop happening over and over. I cringed when my babies ran from me as I approached with their meds every day.

Despite all sorts of testing, we didn't have a confirmed diagnosis other than some kittens seemed to have more sensitive tummies than others and to watch what we fed them. Could it really just be sensitive tummies? We couldn't accept that diagnosis was the answer to the problem, so we continued testing and researching, looking for a cause.

Discovering TF

Then, in January of 2006, we first heard about TF and began researching for more information. The symptoms fit. After talking with our vet, Dr. Montgomery, she suggested we go ahead and test all 12 of our cats. Most vets at that time were not even aware TF existed in felines. Dr. Montgomery knew about TF but hadn't had a confirmed case in her practice. I felt a tingle of hope. Could this ultimately be the answer we had been searching for?

The TF Pouch Test

We ordered the TF Pouch Tests from Biomed. Once the tests arrived I started collecting fecal samples from each cat.

After removing litter boxes for several hours and then replacing them, I waited with a container “in hand” for a fresh sample. This proved difficult as several of our cats wouldn't "perform" when I was standing near by.

A trip to the clinic and Dr. Montgomery swabbed the shyer felines.

We inoculated a pouch with a fecal sample for each of our cats. Dr. Montgomery monitored the first set of pouches at her clinic. With my newly purchased microscope, I watched mine at home. We started doing test, after test, after test.

NOTE: At the time, the only TF test pouch available was actually for cows. Occasionally we experienced a pouch balloon up, caused by a “bacteria bloom” when too much fecal matter had been added. These pouches had to be disposed of and those cats retested. In the summer of 2006, new feline-specific pouch tests arrived and it minimized the problems associated with the pouches ballooning up.

The Results

After testing for several weeks, we narrowed it down to three positive cases out of 12 cats tested:

• One female cat with runny diarrhea
• One female cat with sporadic bouts of diarrhea
• One female cat with completely normal stools all the time

The last one surprised us the most. Our nine other Abyssinians all tested negative. We immediately separated the positive cats from the negative cats.

More Questions

My head was spinning and ready to explode. There were still so many questions we needed to answer before moving further ... including the best course of treatment now that we finally had a diagnosis:

• How did they get TF?
• Where does it come from?
• What does it do to my cats?
• How is it spread?
• What is the best way to disinfect?
• Are we able to cure this?
• What is the treatment?
• What risks are associated with treatment?
• What risks are associated without treatment?
• What do we do next?
• How much will this cost?
• What are the steps?
• How long will it take?
• Will it ever come back?
• What precautions do we need to take?

A Friend Indeed

In my search for answers I stumbled upon a very dedicated breeder, Dave Dybas of Highgait Paws Abyssinians, who had also recently tested cats that were positive for TF. He kindly shared his knowledge and experiences with Tritrichomonas Foetus and generously offered his support. As time went on we continued to keep in touch and share anything we noticed or discovered about our experiences with TF.

Evaluating all the information we had gathered with our vet, and weighing all our options, we decided to go ahead with a new treatment using a drug called Ronidazole.

Unavailable in Canada, we had to wait weeks for our Canadian pharmacy to submit paperwork to have Ronidazole imported into the country. During this time I kept the positive and negative cats separated.

I waited impatiently, hoping after treatment I would be able to close the door on the years of frustration, heartache and sleepless nights - and never to have to worry about loose stools again! Only time would tell…

The TF Treatment

Once the Ronidazole arrived, each cat's dosage was made up in a capsule based on their body weight. Labeling the bottles helped ensure they all received the correct dosages. Over dosing can be toxic. Under dosing may be ineffective.

We completed our 14 days of treatment without side effects. We also dumped, cleaned and disinfected all the litter boxes several times during the course of treatment, minimizing the chances of any cleared cat becoming reinfected.

In early 2006, we paid approximately $110 in Canadian dollars to treat a 7lb cat. Today it would cost much less. The treatment recommendations in the spring of 2006 were much different than they are today. We are fortunate that ongoing research continues to provide us with more information. Changes made since we treated our cats include: The recommended method of fecal collection has changed. Significantly reduced dosage recommendations. Treatment dosing has changed from twice a day (BID) to only once a day (SID). The “Feline specific pouch test” emerged the summer of 2006. Ronidazole prices have dropped considerably, especially within the US.

Our Observations

Here is what we noticed during and after treatment:

• The female cat with runny diarrhea: The frequency of her bowel movements noticeably decreased, as did the smell. Her diarrhea continued through the third week after treatment until I added Acidophilus to her moist food. She then had normal stool within days. This was the very first time in years that she had completely normal bowel movements.
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• The female cat with sporadic boats of diarrhea: She loosened up at the start of treatment and then part way through, firmed right up voiding normal stools.
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• The cat with completely normal stools all the time: She loosened up somewhat during treatment, completely firming back up part way through.

All stools returned to normal and the weights and appetites of the two cats affected, increased. I continued testing these three cats for weeks after treatment and before re-integrating them to the rest of the cattery. What a WONDERFUL and LONG AWAITED IMPROVEMENT… we were elated!

TF Relapse

To our surprise, several months later several 12 week old kittens started showing signs of TF again, even though all our adults were still producing completely firm stools. We retested the kittens and they were positive for TF. What went wrong? Did one of our cat's treatments fail? Or did we have false negative results on our first batch of testing?

There are many reasons why a test may produce a false negative:

• Tested while the cat is still or medication or before being off for a minimum or 2-3 weeks.
• The sample is collected incorrectly
• The TF dies before being placed in Biomed pouch
• The test is stored inappropriately
• Not enough time is taken to examine the pouch thoroughly
• The correct magnification on the microscope is not used

Not following all the steps correctly leaves quite a large window for error. Especially with the pouch test since the TF must be living, where as the PCR test can detect both living and dead TF.

In our case, the answer may have been in our method of acquiring a stool sample for testing. By the time we realized we had it again, the research and protocol had changed suggesting that “looping,” having a vet use a tool to scrap samples from the walls deep within the colon where the number of TF are higher, proved to be a more accurate way of collecting a sample for testing. We took most of our samples directly from a freshly voided stool which may not have had the highest numbers of TF resulting in a false negative.

Today Dr. Gookin's preferred method of collecting a sample is having a veterinarian perform a “Colon Flush” also called a “Saline Flush” where a catheter tube is inserted into the rectum and deep within the colon. Saline is injected through the catheter into the colon and then re-aspirated back into the syringe.

After discussing our findings with Dr. Montgomery and considering we may have had a false negative result initially, we felt the best chance to eradicate TF from our cattery was to re-treat all our cats, including the small litter of 12 week old kittens that had tested positive.

We treated everyone. None of our cats or kittens experienced any negative side affects from the Ronidazole treatment, even though the recommended dosage was higher than currently suggested. Never was I so excited to see those "Tootsie Roll" poops in their litter boxes!

Continued Improvements

It was a long road, but we were very fortunate to have banished TF from our cattery. It's been just over two years and we are overjoyed to report the improvements have been huge:

• Not a single loose stool in cats or kittens since treatment… I happily threw out my sand box screener!!
• We always feed a large variety of canned foods, changing them from one day to the next and never had a single reaction… NO MORE SENSITIVE TUMMIES! WOW!!
• Never any more problems with introducing first foods, weaning kittens or with any kittens going off their foods and just picking.
• Our kittens are much larger and we don't have any more problems with kittens loosing weight.
• Our Queens all have normal stools even through labor, delivery and raising their kittens.
• Not a single case of Diarrhea within our home.
• Our cats that seemed to be finicky eaters are happily eating foods they wouldn't even touch before.
• No more tiny blood spots on their anus or on the tops of their stools.
• Never again have any stresses related to travel or transition within their new home caused even the slightest bit of loose stools. Nor have any of the kittens been affected by any sudden food change.
• We quit adding acidophilus to their food.
• NO MORE HORRID SMELLING STOOLS!

Contacting Past Owners

We care deeply about all our fur babies and have always believed honestly is the best policy. A happy owner makes for a happy breeder. With a wealth of information from our TF experience, we decided to get in touch with kitten owners who had contacted us regarding loose stools in the past. We asked if they were still having any issues.

One of the owners we contacted had an appointment booked for his baby the following week to have a biopsy to test for IBD.

Another owner's cat had been prescribed a daily dose of Metronidazole for months and yet another owner's cat had been taking it for over a year!

I explained our situation and all that we had been through, then forwarded them the most updated information and made them aware of any associated risks with treatment. With the information in hand, they were asked to consult their local veterinarian and take the time they needed to decide what they felt was best for their individual cat.

All but one decided to proceed with testing for TF.

The two cats that had been on extended periods of Metronidazole produced several negative test results, both within a couple of weeks of stopping treatment. We had to convince the owners and their vets to wait till they were sure the Metronidazole had cleared completely from their systems before retesting. Sure enough, after just over three weeks of being completely off meds, the cats tested positive and all were subsequently treated successfully.

Helpful Litter Box Tip

To minimize the transmission of parasites or other contagious diseases that are spread through fecal contamination, we made litter box platforms that have 2 x 4 legs (or 2 x 2 legs) about 6.5 to 9 inches high.

We place the mom's covered litter box on top of the platform and the kitten's shorter sided litter box under it.

We use clay litter for our moms and World Best litter for our kittens. Our moms never want to use the corn litter and aren't able to get underneath the platform to use the kitten's box.

I place the mom's litter box opening so it is slightly over hanging the edge of the platform. The kittens can't go onto the platform and get into the litter box as they would have to jump from the floor up and into, in one sweep.

By the time they are old enough to jump like that, I'd move mom's box much higher so they still can't gain access.

Final Words of Advice

This has been "our own personal experience" with TF in our cattery. I share it in the hope of helping others who may be having a similar problem in their cattery. I believe the more we share about our personal experience with Tritrichomonas Foetus, the more we are able to learn.

Every situation is different; every situation is individual. Only you and your veterinarian will be able to determine if treating your cat(s) is the best option. Many things have to be considered before developing a treatment plan.

• Find a veterinarian who is familiar with TF or is willing to learn. If you find it difficult to find one familiar with TF, educate yourself with the most updated information from the links below. Send a copy of the “ An Owners Guide to Diagnosis and Treatment of Cats Affected with Tritrichomonas Foetus ” to your vet so they have a chance to look at it. If you find a veterinarian who is familiar with TF, make sure they are aware of the most updated information available with regards to testing and treatment as dosages have changed considerably .
• Veterinarians are slowly realizing that TF is much more wide spread than originally suspected.
• Chronic or sporadic, smelly diarrhea that responds temporarily to medication but returns when the meds are finished is suggestive of TF.
• Some cats with TF appear healthy and do not exhibit any symptoms of diarrhea whatsoever.
• Carriers are usually adults, rarely a kitten.
• Carriers may or may not be shedding the parasite at any time, so it can make them difficult to confirm their positive status.
• As with many tests for parasites, a positive test result can confirm TF, but a negative test result does not always rule it out, therefore retesting is often necessary to establish an accurate result. Make sure all meds are stopped for a minimum of two to three weeks prior to testing to avoid any false negative results. The Meds decrease the TF numbers making them harder to locate.
• For the most accurate results, have your vet obtain a fecal sample from within the colon to mazimize the number of the TF collected.  Inoculating the pouch right away will minimize the number of TF dying in the sample.
• The most accurate, but also expensive, means of testing for TF is a PCR test (Polymerase Chain Reaction). From a pet owner/breeder/vet perspective the PCR test (Polymerase Chain Reaction) test seems to be most sensitive since it can detect dead TF so it is unlikely that the submitter can make an error, especially if the sample was collected accurately.
• The Feline Pouch Test is cost efficient for a multiple cat household, although retesting any negative results is necessary to confirm the accuracy of the results. Collecting samples correctly also helps improve the accuracy of the test results as the Pouch test only detects live TF.
• Undoubtedly, cats with TF are being misdiagnosed with things such as IBD, prescribed with ineffective and costly medications or prescription diets. Before discovering TF and later the drug Ronidazole, an untold number of cats were euthanized for incurable chronic diarrhea. If you have a cat with diarrhea that has not responded to typical medication, please consider testing for TF.
  

Testing for TF and treating for TF are two separate issues. For more information about TF, visit the website of Dr. Jody Gookin at www.jodygookin.com Dr. Gookin is the leading researcher of Tritrichomonas Foetus and thanks to her dedication and hard work, progress continues to be made. Her website has several informative “live video” links identifying TF and Giardia (distinguishing the difference) under the microscope, showing how fecal collection is done as well as how to inoculate the TF Pouch test. You will also find a very well written, easy to read guide called “An Owners Guide to Diagnosis and Treatment of Cats Affected with Tritrichomonas Foetus” that will answer many questions and help those interested in learning more about Tritrichomonas Foetus. The “ TF Owners Guide ” is revised each time new information becomes available… so it is always current!