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Paper text:
a 13-year - old , castrated male , domestic cat that lived indoors in a single - cat household was brought to the iowa state university lloyd veterinary medical center because of depression , inappetance , and respiratory signs of 4 days duration .
the family members noted that the cat was reluctant to lie in lateral recumbency and instead rested in sternal recumbency with neck extended , which was indicative of dyspnea .
the cat s vaccination status was up to date . before the onset of clinical signs in the cat , 2 of the 3 family members had experienced an undiagnosed influenza - like illness 
an upper respiratory tract infection characterized by fever , coughing , and myalgia  that lasted 3 days .
onset of the cat s clinical signs was noted 6 and 4 days after onset of illness for the first and second family members , respectively . at the time of examination , the cat had
bilateral adventitial lung sounds ( wheezes ) , was afebrile , and was clinically dehydrated .
cytologic and microbiologic examination of bronchoalveolar lavage ( bal ) fluid showed foamy macrophages ( 65% ) , nondegenerate neutrophils ( 25% ) , and small lymphocytes ( 10% ) .
standard microbial culture of bal aliquots yielded no substantial growth of aerobic or anaerobic bacteria .
radiographic and cytologic findings were inconsistent with bacterial or parasitic pneumonia and not supportive of allergic airway disease .
a viral cause was considered most likely ; however , the cat was given amoxicillin with clavulanate ( 125 mg orally 2/day ) to reduce the possibility of secondary bacterial pneumonia .
notable findings from laboratory testing ( complete blood count , serum biochemistry , urinalysis , and total thyroxine measurement ) were moderate leukopenia characterized by a moderate lymphopenia , modest hemoconcentration , and a slightly elevated thyroxine level .
radiographs of the thorax of a cat with confirmed influenza a pandemic ( h1n1 ) 2009 virus infection .
an alveolar pattern , composed of air bronchograms with border - effaced ( indistinct ) adjacent pulmonary vessels , is most pronounced in the left caudal lobe .
a small gas lucency in the pleural space appears in the right caudal and dorsal thoracic cavity .
an endotracheal tube is visible at the thoracic inlet on the lateral view in this moderately obese cat .
pcr testing ( feline urd panel ; idexx laboratories , westbrook , me , usa ) of a bal sample showed negative results for chlamydophila felis , feline calicivirus , feline herpesvirus-1 , bordetella bronchiseptica , and mycoplasma felis .
results of feline immunodeficiency virus ( antibody ) and feline leukopenia virus ( antigen ) testing ( idexx snap fiv / felv combo test ; idexx laboratories ) were also negative , ruling out the potential that viral - induced immunosuppression was a concurrent factor . for the following reasons we included pandemic ( h1n1 ) 2009 on our list of differential diagnoses : recent history of respiratory disease in household family members , known widespread community prevalence of pandemic ( h1n1 ) 2009 influenza in humans , paucity of common viral infections causing infectious caudodorsal alveolar pneumonia in adult cats , and documented susceptibility of felids to avian influenza ( h5n1 ) ( 12,13 ) .
we therefore submitted a bal sample to the iowa state university veterinary diagnostic laboratory for molecular screening and typing for influenza a and the pandemic ( h1n1 ) 2009 virus .
rna was obtained from the bal fluid by using the magmax viral rna isolation kit ( applied biosystems , austin , tx , usa ) and a semiautomated magnetic particle processor ( kingfisher 96 ; thermo electron corp . ,
pcr ( rrt - pcr ) influenza a screening assay specific for the nucleoprotein gene .
preliminary differentiation of pandemic ( h1n1 ) 2009 virus from other h1 or h3 types of influenza a was performed by using an in - house rrt - pcr assay that distinguishes between pandemic ( h1n1 ) 2009 [ eurasian matrix ( 10 ) ] and endemic ( to north america ) swine h1n1 influenza viruses ( north american matrix ) .
pcrs were conducted by using the agpath - id multiplex one - step rt - pcr kit ( ambion / applied biosystems ) according to manufacturer s recommendations ; 10 units of multiscribe reverse transcriptase ( applied biosystems ) were added per reaction .
thermocycling was performed by using the applied biosystems 7500 fast real - time pcr system according to manufacturer s recommendations . *
primers and mgb probes were obtained from integrated dna technologies ( coralville , ia , usa ) and applied biosystems inc .
pcr testing showed the bal sample to be positive for influenza a virus ( nucleoprotein gene ) , and the virus was determined to contain the matrix ( m ) gene of the pandemic ( h1n1 ) 2009 virus strain .
a bal sample was submitted to the us department of agriculture national veterinary services laboratories ( ames , ia , usa ) for confirmatory testing .
rrt - pcr confirmed that the bal sample was positive for the m gene of influenza a virus and the neuraminidase ( n ) gene of pandemic ( h1n1 ) 2009 virus .
a cytolytic virus was isolated by using mdck cells ( 8) and was designated as a / feline / ia / nvsl026991/2009 .
pcr testing of the isolate for influenza a virus ( m gene ) and n1 gene of pandemic ( h1n1 ) 2009 showed positive results .
sequence analyses for hemagglutinin ( ha ) , n , and m genes confirmed that the virus was pandemic ( h1n1 ) 2009 virus ( genbank accession nos .
gu332630 ( for ha ) , gu332632 ( for na ) , and gu332631 ( for m ) .
nucleotide homologies with the first us human pandemic ( h1n1 ) 2009 isolate ( a / ca/04/2009 ) were 99.4% , 99.4% , and 99.8% for the ha , na , and m genes , respectively . *
primers and probes were obtained from integrated dna technologies ( coralville , ia , usa ) and biosearch technologies , inc .
m , matrix ; ai , avian influenza ; n , neuraminidase . the cat was discharged from the medical center after diagnostic testing and correction of dehydration . a veterinarian ( b.a.s . )
visited the home to monitor the cat s clinical status and administer subcutaneous fluids ( 120160 ml ) until the cat s appetite improved ; adventitial lung sounds resolved within 3 days .
reassessment 1 week later showed marked improvement of clinical signs but only modest improvement of the lymphopenia and radiographic findings .
because the cat was from a single - animal household and remained indoors , he was presumably infected through contact with the family members .
attempts to retrospectively confirm pandemic ( h1n1 ) 2009 infection in the family members have been unsuccessful , but additional testing of archived biologic samples is being conducted .
although more surveillance and studies are needed to determine susceptibility of companion animals to the pandemic ( h1n1 ) 2009 virus , possible reverse zoonotic transmission ( humans to animals ) remains a concern .
indeed , cases in a domestic dog and other felids have been confirmed ( 11 ) ( www.cdc.gov/h1n1flu/qa.htm,www.avma.org/public_health/influenza/new_virus/default.asp , www.usda.gov/wps/portal/?navid=usda_h1n1 ) .
implications of pandemic ( h1n1 ) 2009 virus infection in companion animals are 1 ) apparent human - to - animal transmission ; 2 ) broader host range for the virus ; 3 ) potential endemic establishment of influenza in companion animals ; 4 ) possible transmission of influenza from companion animals to other species , including humans ; and 5 ) the need to reevaluate companion animals as potential reservoirs or intermediate hosts for reassortment of influenza virus .
this case emphasizes the need for close monitoring for interspecies transmission of influenza virus and reinforces the need for collaboration among many disciplines , a cornerstone of the one health initiative ( www.onehealthinitiative.com ) .
influenza a pandemic ( h1n1 ) 2009 virus continues to rapidly spread worldwide . in 2009 , pandemic ( h1n1 ) 2009 infection in a domestic cat from iowa was diagnosed by a novel pcr assay that distinguishes between eurasian and north american pandemic ( h1n1 ) 2009 virus matrix genes . 
 human - to - cat transmission is presumed .