Diagnosis
To confirm the infection of T. foetus, there are three methods available - direct fecal microscopy, fecal culture, and fecal polymerase chain reaction (PCR) assay.
Direct fecal microscopy involves identifying the motile trophozoites T. foetus in fresh wet smears of diarrheic feces taken directly from the rectum. This method identifies the organisms in about 14% of cases and is less effective with formed or dried feces. In cats who have been treated with antibiotics recently, the detection rate decreases. Trichomonads, which resemble Giardia in size and shape, can be distinguished by their unique undulating membrane and rapid, jerky motility, contrasting with Giardia's "falling leaf" movement.
Fecal culture can be done in-house or at a specialized lab. It helps increase the chances of identifying the organisms. In specific cases, a saline flush might be performed by inserting a catheter through the cat's anus to wash the colon with saline, followed by aspiration of fecal material.
Fecal PCR is the most accurate method for identifying T. foetus. To perform this test, the fecal sample should not contain any litter. This technique detects the organism's DNA traces in the cat's stool.
It's best to conduct testing on cats that have not received antibiotics for at least two weeks for the most accurate test results. Antibiotics can temporarily reduce the number of T. foetus, leading to false negatives.
Treatment
Often, many approaches for treating chronic diarrhea have been tried unsuccessfully before a true diagnosis of T. foetus is confirmed.
Tritrichomonas foetus is resistant to most antibiotics and is extremely difficult to eradicate (Gookin 2001). Numerous antibiotics have been evaluated. Some antibiotics reduce the number of organisms and improve the diarrhea without eliminating the infection, so diarrhea relapses whenever antibiotics are stopped. Diarrhea is typically refractory to corticosteroids.
The most successful treatment for eliminating T. foetus is ronidazole (30 mg/kg PO, once or twice daily for 14 days). The side effects in some cats include lethargy, decreased appetite, and neurotoxicity. Cats with neurotoxic signs usually improve when the drug is stopped, but recovery can take 1 to 4 weeks. Ronidazole should not be used in pregnant and nursing queens or in very young kittens. Ronidazole is not approved for veterinary or human use, but some pharmacies compound chemical grade ronidazole for veterinary use. Because of its bitter taste, ronidazole compounded in gel caps is better tolerated than flavored suspension. When prescribing ronidazole obtain informed consent and instruct owners to wear protective gloves when handling it.
Management of Tritrichomonas foetus Infection
In cases where cats show mild or sporadic symptoms of diarrhea caused by T. foetus, and treatment is not possible due to potential side effects, costs, or the owner's preferences, it is important to know that diarrhea may naturally go away with time, which can take up to two years. However, such cats are likely to remain lifelong carriers of the parasite.
The outlook for cats receiving treatment is generally positive. A majority of treated cats exhibit better stool consistency in just a few days, though diarrhea might linger briefly as related secondary inflammation subsides. Nonetheless, around 25% of cases might experience a continuous infection despite initial treatment.
Fortunately, T. foetus has a short lifespan outside its host and is easily neutralized by common disinfectants. To mitigate infection risks, it's advised to uphold strict litter box cleanliness through daily cleansing, isolate cats under treatment, minimize stress factors, prevent overcrowding, and implement regular screenings in breeding and shelter settings whenever feasible.
Note
Bioguard’s Qmini PCR can detect T. foetus DNA in 90 minutes at your clinics using feces as samples.
