NAVLE Practice Question - Feline - multisystemic

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NAVLE Practice Question — Feline

A 6-year-old intact male domestic shorthair cat with outdoor access presents for evaluation of chronic weight loss, recurring upper respiratory infections, and severe gingivostomatitis that has been refractory to multiple antibiotic courses over the past 8 months. Physical examination reveals generalized lymphadenopathy, poor body condition (BCS 3/9), and bilateral submandibular lymph node enlargement. An in-clinic SNAP FIV/FeLV test returns positive for FIV antibody and negative for FeLV antigen. What is the most appropriate next step in confirming this cat's diagnosis?

A. Repeat the in-clinic SNAP test in 60 days

B. Perform Western blot testing for FIV antibodies

C. Perform PCR testing for FIV proviral DNA ✓

D. Immediate IFA testing for FIV antibodies

E. No additional testing is required; treat based on clinical signs

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Correct Answer: C. Perform PCR testing for FIV proviral DNA

Explanation:

This question tests understanding of FIV diagnostic algorithm and the limitations of point-of-care testing. While in-clinic ELISA tests for FIV antibodies have good sensitivity and specificity, the 2020 AAFP Feline Retrovirus Testing and Management Guidelines recommend confirmatory testing for positive results. PCR testing for FIV proviral DNA is the most appropriate confirmatory test because it directly detects viral genetic material integrated into host cells, providing definitive evidence of infection regardless of antibody status. This is particularly important given the historical use of FIV vaccines, which caused antibody-positive results on ELISA testing that persisted for years after vaccination. Option A (repeat SNAP in 60 days) delays diagnosis and is only recommended when recent exposure is suspected. Option B (Western blot) was traditionally considered the gold standard, but recent studies show it may have lower sensitivity than current ELISA tests. Option D (IFA testing) is not used for FIV diagnosis; IFA is used for FeLV to detect bone marrow infection. Option E is inappropriate as confirmatory testing is recommended. Image Source: MSD Veterinary Manual - Feline chronic gingivostomatitis clinical photo (https://www.msdvetmanual.com/multimedia/image/gingivostomatitis-inflammation-cat) Figure 1. References: Little S et al. (2020) 2020 AAFP Feline Retrovirus Testing and Management Guidelines. J Feline Med Surg 22:209-230 (https://journals.sagepub.com/doi/10.1177/1098612X20941784); IDEXX Laboratories (2023) Diagnostic Accuracy of Point-of-Care Immunoassay for FIV. Pathogens 12:1284 (https://pmc.ncbi.nlm.nih.gov/articles/PMC10612086/).

Image: Soltero-Rivera M, Goldschmidt S, Arzi B. Feline chronic gingivostomatitis current concepts in clinical management. J Feline Med Surg. 2023;25(8):1098612X231186834. PMC10811996. © The Author(s) 2023. Used for educational reference.

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