Management Of Feline Chronic Gingivostomatitis of Suspected Viral Origin With A Thymic Extract
Richard E. Palmquist, DVM. Centinela Animal Hospital, Inc. 721 Centinela Avenue, Inglewood, CA. 90302. firstname.lastname@example.org
A thymic extract, Kyosenex1, was used in management of a protracted case of feline gingivostomatitis. The patient responded dramatically, especially in the caudal portion of the oral cavity. The condition recurred upon stopping therapy and improved again on reinstituting the agent. This indicates causation, a lack of cure. Since quality of life was greatly improved further research is indicated.
Veterinarians are well acquainted with feline stomatitis, a syndrome of inflammation that can be frustrating to address. (Healey, et al 2007) The condition and its conventional diagnosis and management have been reviewed elsewhere. (Lommer, Verstraete 2003; Belgard, et al 2010; Dowers, et al 2010; Lee, et al 2010; Bhella , Corbee 2011; Goodfellow, et al 2011; Hennet, et al 2011; Krishnan, et al 2011) L-lysine may contribute to inflammation from viral issues in the caudal oral cavity. (Drazenovich, et al. 2009) Thymus extracts can contain many biologically active compounds and may have usefulness in a wide variety of chronic disease states including viral infections and cancer. (Ioannou, et al 2012)
In cases where conventional therapies fail it is appropriate to seek out and try novel therapies and there are many such routes available to those veterinarians with training and interest in complementary and alternative medicine (CAVM) (Goldstein 2008). When these therapies gain research and validation they are integrated into the body of conventional medicine. The purpose of this paper is not to review the condition and its known therapies, but to present a case report involving use of a novel product which provides an interesting option for further research and development.
A thirteen-year old, spayed female, domestic short haired cat presented for a chronic history of hyperthyroidism managed with methimazole. A complete blood count, urinalysis, FeLV, FIV, and T-4 were normal. The cat’s chronically recurring rhinitis and sinusitis had been medically managed using a wide variety of medical therapies including antibiotics (selected empirically and via culture and sensitivity and used for extensive periods of time), antihomotoxic and homeopathic agents, nutritional therapies including L-lysine and medical mushrooms, novel antigen diets, herbal agents, acupuncture, and essential oils.
A few months before the cat had presented with difficulty eating and was diagnosed with chronic stomatitis. At the recommendation of the general practice veterinarian the cat was seen and treated by a boarded veterinary dentist with dental radiographs, dental prophylaxis, multiple extractions and antibiotics. The cat did improve for a short period of time following therapy, but oral cavity pain and inflammation returned shortly after its therapy. The owner’s declined immunosuppressive therapies as their prior cat had died of cancer and they wished to preserve the cat’s immune integrity. Since their other cat had been treated successfully by integrative methods, they sought CAVM to see what assistance could be offered.
A discussion of the condition, its recurring nature and frustrating recurrence rates ensued. The owners were informed that all such therapies were experimental and could not be supported by research. Herpes or other viral infections were strongly suspected as inciting cause in this cat and the owners understood that cure was unlikely. The author had just returned from a holistic conference where he had met with representatives of a company that was seeking research on their novel thymic extract. The owners were interested and agreed to allow its use in their cat. The product was made for oral use but since this cat was so hard to medicate we evaluated sterility and opted to give it by injection subcutaneously. One vial of lyophylized thymic extract was hydrated with 2.0 cc of the recommended diluent. The cat was given a five day cycling dosing pattern that consisted of giving 0.2cc of this mixture by subcutaneous injection daily for three days and skipping two days before repeating the cycle again. During this time the cat received acupuncture weekly for three total treatments. After a month the dose was reduced to 0.1cc daily for three days, off for two days and repeated in five day cycles.
Patient comfort improved rapidly. Nine days after beginning injections the cat was able to open her mouth and began eating. Her owners reported she began playing and purring again. Erythema and pain were both reduced and continued to improve for two months. Her sinusitis would flare but her oral cavity did well until she developed an invasive nasal mass. The owners declined biopsy but CT revealed a mass eroding into the skull from the nasal passage. Carcinoma was suspected by the internist.
The owners continued to manage her condition with multi-modal CAVM therapies and the cat did well until her euthanasia eight months later. Her owners were very happy with her therapy.
The following pictures demonstrate her condition and progress:
This case demonstrates an interesting response to a novel thymic extract. The treatment is not curative but did seem to greatly reduce patient discomfort as evidenced by the cat’s behavior, appetite and activity levels. The owners reported she felt five years younger while on this treatment. She received the injections off and on for a year with no sign of adverse effects. The author has subsequently treated several more cases of chronic gingivostomatitis in cats using this agent and multi-modal integrative therapies with good results.
In the author’s experience this condition should be addressed in a systematic and thorough manner with the aid of a qualified, preferably board-certified veterinary dentist. In the event of poor outcome, it seems appropriate to seek out further ways to relieve suffering and assist these patients and their owners. Integrative medicine may well have many new options for such cats and the entire profession will benefit as we gain more research and understanding of these therapies.
1. Kyosenex. ULR Laboratories LLC, 5333 Likini Street 1510, Honolulu, HI 96818.
Belgard S, Truyen U, Thibault JC, Sauter-Louis C, Hartmann K. Relevance of feline calicivirus, feline immunodeficiency virus, feline leukemia virus, feline herpesvirus and Bartonella henselae in cats with chronic gingivostomatitis. Berl Munch Tierarztl Wochenschr. 2010 Sep-Oct;123(9-10):369-76.
Bhella D, Goodfellow IG. The cryo-electron microscopy structure of feline calicivirus bound to junctional adhesion molecule A at 9-angstrom resolution reveals receptor-induced flexibility and two distinct conformational changes in the capsid protein VP1. J Virol. 2011 Nov;85(21):11381-90.
Corbee RJ, Booij-Vrieling HE, van de Lest CH, Penning LC, Tryfonidou MA, Riemers FM, Hazewinkel HA. Inflammation and wound healing in cats with chronic gingivitis/stomatitis after extraction of all premolars and molars were not affected by feeding of two diets with different omega-6/omega-3 polyunsaturated fatty acid ratios. J Anim Physiol Anim Nutr (Berl). 2011 Jul 18. doi: 10.1111/j.1439-0396.2011.01195.x
Dolieslager SM, Riggio MP, Lennon A, Lappin DF, Johnston N, Taylor D, Bennett D. Identification of bacteria associated with feline chronic gingivostomatitis using culture-dependent and culture-independent methods. Vet Microbiol. 2011 Feb 24;148(1):93-8.
Dowers KL, Hawley JR, Brewer MM, Morris AK, Radecki SV, Lappin MR. Association of Bartonella species, feline calicivirus, and feline herpesvirus 1 infection with gingivostomatitis in cats. J Feline Med Surg. 2010 Apr;12(4):314-21.
Drazenovich TL, Fascetti AJ, Westermeyer HD, Sykes JE, Bannasch MJ, Kass PH, Hurley KF, Maggs DJ. Effects of dietary lysine supplementation on upper respiratory and ocular disease and detection of infectious organisms in cats within an animal shelter. Am J Vet Res. 2009 Nov;70(11):1391-400.
Goldstein R, editor. 2008. Integrating Complementary Medicine into Veterinary Practice, Wiley-Blackwell Publishing. pp 277-91, 669.
Hargis AM, Ginn PE. Feline herpesvirus 1-associated facial and nasal dermatitis and stomatitis in domestic cats. Vet Clin North Am Small Anim Pract. 1999 Nov;29(6):1281-90.
Healey KA, Dawson S, Burrow R, Cripps P, Gaskell CJ, Hart CA, Pinchbeck GL, Radford AD, Gaskell RM. Prevalence of feline chronic gingivo-stomatitis in first opinion veterinary practice. J Feline Med Surg. 2007 Oct;9(5):373-81.
Hennet PR, Camy GA, McGahie DM, Albouy MV. Comparative efficacy of a recombinant feline interferon omega in refractory cases of calicivirus-positive cats with caudal stomatitis: a randomised, multi-centre, controlled, double-blind study in 39 cats. J Feline Med Surg. 2011 Aug;13(8):577-87.
Ioannou K, Samara P, Livaniou E, Derhovanessian E, Tsitsilonis OE. Prothymosin alpha: a ubiquitous polypeptide with potential use in cancer diagnosis and therapy. Cancer Immunol Immunother. 2012 May;61(5):599-614.
Krishnan SK, Ganguly S, Veerasamy R, Jan B. Synthesis, antiviral and cytotoxic investigation of 2-phenyl-3-substituted quinazolin-4(3H)-ones. Eur Rev Med Pharmacol Sci. 2011 Jun;15(6):673-81.
Lee M, Bosward KL, Norris JM. Immunohistological evaluation of feline herpesvirus-1 infection in feline eosinophilic dermatoses or stomatitis. J Feline Med Surg. 2010 Feb;12(2):72-9.
Lommer MJ, Verstraete FJ. Concurrent oral shedding of feline calicivirus and feline herpesvirus 1 in cats with chronic gingivostomatitis. Oral Microbiol Immunol. 2003 Apr;18(2):131-4.